Final B Flashcards
(241 cards)
1
Q
Induction plan for hiatal hernia surgery
A
RSI
2
Q
Common side effect after gallbladder removal
A
Diarrhea
3
Q
GI organs in right upper quadrant
A
- Liver
- Gallbladder
- Duodenum
- Right kidney
4
Q
GI organs in left upper quadrant
A
- Spleen
- Pancreas
5
Q
GI organ in right lower quadrant
A
Appendix
6
Q
The “upper GU tract” consists of which organ
A
Kidneys
7
Q
What anatomical features make up the “lower GU tract”
A
- Ureters
- Urethra
- Bladder
8
Q
Important history in patients with kidney disease
A
- History of kidney dysfunction
- History of dialysis
- Location/function of AV fistula
- Current medications
- Daily urine production
9
Q
What does CHLORIDE stand for when trying to characterize a symptom
A
- CHaracter of pain
- Location
- Onset
- Radiation
- Intensity of pain
- Duration
- Exacerbating/alleviating factors
10
Q
What is dysphagia
A
Difficulty swallowing
11
Q
What is odynophagia
A
Pain with swallowing
12
Q
What electrolyte abnormalities can be caused by excessive diarrhea? (4)
A
1) Hyponatremia (can’t excrete water due to ADH release)
2) Hypernatremia (if free water loss is not replaced)
3) Hypokalemia (loss of K+)
4) Metabolic acidosis (loss of bicarb)
13
Q
What is melena? What does it signify?
A
Black tarry stool that signifies upper GI bleed
14
Q
What is hematochezia? What does it signify?
A
Bright red blood that signifies lower GI bleed
15
Q
What is jaundice?
A
Yellowish discoloration of skin from increased levels of bilirubin
16
Q
What is dysuria
A
Pain with urination/difficulty voiding
17
Q
What is polyuria
A
Increase in 24 hour urine volume
18
Q
What is nocturia
A
Urinary frequency at night
19
Q
What are the 4 main types of incontinence
A
1) Urge (overactive bladder)
2) Stress (poor closure of bladder)
3) Overflow (poor contraction/blockage)
4) Functional (medications or health problems)
20
Q
What is borborygmi
A
Stomach growling
21
Q
Where should bruits be auscultated for a basic abdominal exam
A
- Aorta
- Renal artery
- Iliac artery
- Femoral artery
22
Q
When are bruits normal?
A
When they are confined to systole
23
Q
How do we assess for peritoneal inflammation
A
Ask patient to cough and determine where the cough produces pain
24
Q
Pain associated with costovertebral angle tenderness (CVA tenderness) is associated with what
A
Pyelonephritis (kidney infection)
25
A normal aorta is not more than __ cm wide
3
26
Risk factors for AAA
- Over 65 y/o
- Smoker
- Male
- Family history
27
What do we assume about a patient coming in for a bowel obstruction who has a history of N/V and feculent emesis
Full stomach
28
Normal albumin levels
3.5-5.5g/dL
29
Albumin levels are a measure of...
Hepatic function and nutritional status
30
Normal AST and ALT levels
7-40 U/L
31
Which aminotransferase is found predominately in the liver
ALT
32
Normal alkaline phosphatase levels
25-85 IU/L
33
When are alkaline phosphatase levels increased?
- Obstructive biliary disease
| - Cirrhosis
34
What test is useful in confirming that elevated ALP is due to liver pathology?
5'-Nucleotidase
35
When is 5'NT test not useful?
Later in pregnancy
36
What are amylase and lipase labs used for?
To detect and monitor pancreatic disease
37
Normal bilirubin levels
Less than 1.5mg/dL
38
What is the most sensitive liver enzyme for detecting biliary obstruction, cholangitis, and cholecystitis?
GGTP (gamma-glutamyl transpeptidase)
39
Normal PT value
11-14 seconds
40
What does PT tests assess for
Extrinsic pathway of clot formation
41
Normal PTT
25-38 seconds
42
What does PTT assess for
Intrinsic pathway of clot formation
43
Coagulation test used in coumadin therapy
PT
44
Coagulation test used in heparin therapy
PTT
45
How does hepatocellular disease affect PT
Prolongs PT because the production of coagulation factors by the liver is altered
46
Why does hepatocellular disease prolong PTT
Decreased factor VII
47
Normal BUN levels
10-20mg/dL
48
BUN levels are an indication of...
Renal health
49
Main causes of an increase in BUN
- High protein diet
- Decreased GFR
- Hypovolemia
- CHF
- GI hemorrhage
- Fever
50
Main causes of a decrease in BUN
- Liver disease
| - Inappropriate ADH
51
Normal creatinine levels in men
0.8-1.3mg/dL
52
normal creatinine levels in women
0.6-1mg/dL
53
A doubling of creatinine levels suggests a __% reduction in GFR
50
54
What does creatinine clearance measure?
Glomerular filtration rate
55
Na+ levels are considered critically low if they are under
131mEq/L
56
Na+ levels are considered critically high if they are over
150mEq/L
57
K+ levels are considered critically low if they are under
2.5
58
K+ levels are considered critically high if they are over
5.9
59
A patient's stress response to surgery is proportional to what factors? (4)
1) Magnitude of injury
2) Total operating time
3) Amount of intraop blood loss
4) Degree of postop pain
60
What is the most important component of the pre-op evaluation?
The patient's history
61
How soon before surgery should monoamine oxidase inhibitors be discontinued?
2-3 weeks
62
How soon before surgery should oral contraceptive pills be discontinued? Why?
6 weeks due to increased risk of venous thrombosis
63
How soon before surgery should herbal supplements be discontinued
2 weeks
64
How soon before surgery should aspirin be discontinued
7-10 days
65
How soon before surgery should Thienopyridines (such as clopidogrel) be discontinued
2 weeks
66
How soon before surgery should oral anticoagulants be discontinued
4-5 days
67
Oral anticoagulants are discontinued before surgery to allow INR to reach what level
1.5
68
Major patient risk factors for periop cardiac complications
- MI within 30 days
- Unstable/severe angina
- CHF
- Significant arrhythmias
- Severe valvular disease
69
Procedures that are high risk factors for periop cardiac complications
- Emergency surgeries
- Aortic/major vascular surgeries
- Prolonged surgeries with large fluid shifts or blood loss
- Unstable hemodynamic situations
70
What are METs
Metabolic Equivalents of oxygen consumption
71
Procedure related risk factors of post-op pulmonary complications
- How close the surgery is to the diaphragm
- Length of surgery (more than 3 hours)
- General anesthesia
- Emergency surgery
72
Patient risk factors for post-op pulmonary complications
- COPD
- Smoker
- Over 60 y/o
- Obese
- OSA
- Poor exercise tolerance
73
Intra-op blood glucose should be kept under
180mg/dL
74
Complications of periop hyperglycemia
- Dehydration
- Impaired wound healing
- Inhibition of WBC function
75
In which procedures do patients not need to alter their anticoagulant regimen
- Dental extractions
- Arthrocentesis
- Biopsies
- Ophthalmic operations
- Diagnostic endoscopies
76
Invasive surgery is generally safe from major hemorrhagic complication when the INR is...
Below 1.5
77
How long does it take for the INR to reach 1.5 once oral anticoagulants are discontinued
4 days
78
How long does it take for the INR to reach 2.0 once the oral anticoagulant is re-started postoperatively
3 days
79
How soon before a spinal procedure should Warfarin be discontinued
4-5 days
80
How soon before a neuraxial procedure should a thromboprophylaxis dose of LMWH be stopped
12 hours
81
How soon before a neuraxial procedure should a treatment dose of LMWH be stopped
24 hours
82
SubQ heparin is not a contraindication to a neuraxial procedure if the dose is under...
10,000 units
83
How long should neuraxial needle/catheter insertion be delayed after a dose of IV heparin
2-4 hours
84
What lab test is used to monitor heparin effects
PTT
85
EKG changes associated with hyperkalemia
- Peaked T waves
- Loss of P wave
- Sine wave
86
3 EKG changes associated with hypokalemia
- ST depression
- Flattened T wave
- U wave
87
What part of the EKG is affected with alterations in serum calcium
QT interval
88
How does hypocalcemia affect EKG
Prolongs QT interval
89
How does hypercalcemia affect EKG
Shortens QT interval
90
Arrhythmia associated with prolonged QT
Torsades de Pointes
91
When are Osborn waves seen
Hypothermia
92
How does Digitalis affect the EKG
Downsloping ST segment depression
93
Stages of EKG changes in pericarditis
1) ST elevation
2) ST back to baseline
3) T wave inversion
94
What is hypertrophic obstructive cardiomyopathy?
Primary disease of the myocardium where a portion of the myocardium gets thick without any obvious cause
95
Common EKG changes seen in patients with hypertrophic obstructive cardiomyopathy
- Left axis deviation (due to LVH)
| - Q waves in lateral leads
96
Most common conduction blocks associated with myocarditis
- Bundle branch blocks
| - Hemiblocks
97
EKG changes in a patient with long standing COPD
- Low voltage
- Right axis deviation
- Poor R wave progression
98
The S1Q3T3 pattern on an EKG is associated with what?
Pulmonary embolus
99
What is the S1Q3T3 pattern?
1) Large S wave in lead I
3) Deep Q wave in lead III
3) Inverted T waves in lead III
100
Major EKG change seen in patients with CNS bleed
Deeply inverted, wide T waves
101
How does smoking affect the cardiovascular system?
- Increases amount of carbon monoxide attached to hemoglobin, decreasing O2 supply
- Increases O2 demand
102
Effects of OSA
- HTN
- Diabetes
- CV disease
- Stroke
- Depression
- Obesity
103
How soon before surgery is it safe for patients to consume clear liquids
2 hours
104
How soon before surgery is it safe for patients to consume breast milk
4 hours
105
How soon before surgery is it safe for patients to consume infant formula
6 hours
106
How soon before surgery is it safe for patients to consume nonhuman milk
6 hours
107
How soon before surgery is it safe for patients to consume a light meal
6 hours
108
How soon before surgery is it safe for patients to consume a fatty meal
8 hours
109
Effects of muscle relaxants on patients with myasthenia gravis
- Need more succinylcholine
| - Very sensitive to non-depolarizers
110
Signs/symptoms of MH
- Muscle rigidity
- Increased ETCO2
- Tachycardia
- Fever
- Myoglobinemia
- Increase creatinine
111
Patients with pseudocholinesterase deficiency may be sensitive to what drug
Succinylcholine
112
What is TSH
Hormone that stimulates the thyroid gland to secrete T4 and T3
113
What hormone stimulates the production of TSH
TRH
114
What hormone inhibits the production of TSH
Somatostatin
115
Signs of hyperthyroidism
- Goiter
- Exophthalmos
- Anxiety
- Tachycardia
- Increased sweating
- Hyperkinesia
- Fatigue
116
Grave's disease is associated with what endocrine abnormality
Hyperthyroidism
117
How are labs changed with hyperthyroidism
- Increased T3/T4
- Decreased TSH
- Increased Ca2+
118
S/s of hypothyroidism
- Weight gain
- Bradycardia
- Cold intolerance
- Anorexia
- Cardiac rub
- Etc.
119
How are labs changed with hypothyroidism
- Low T4
- Increased TSH
- Hyponatremia
- Hypoglycemia
120
Most common complications seen with hypothyroidism
Cardiac complications such as CAD and CHF
121
What is a complication of SEVERE hypothyroidism that is most often seen in elderly women?
Myxedema coma - hypothermia, hypoventilation, hyponatremia, hypoxia, hypotension
122
Treatment for hypothyroidism
Synthetic levothyroxine (Synthroid)
123
Parathyroid hormone raises serum levels of which electrolyte?
Ca2+
124
Most common cause of hyperparathyroidism
Parathyroid adenoma
125
2 signs of hypocalcemia that can be tested in pre-op
- Trousseau's sign
| - Chvostek's sign
126
What Chvostek's sign
Abnormal contraction to stimulation of the facial nerve
127
What is Trousseau's sign
Spasm in hand muscles when the brachial artery is occluded
128
Most common endocrine disease
Diabetes mellitus
129
Type I DM
Autoimmune disorder in which the body produces no insulin
130
Type II DM
Deficiency or resistance to insulin
131
What is Addison's disease
Adrenal insufficiency disorder that occurs when adrenal glands don't produce enough cortisol or aldosterone
132
Symptoms of Addison's disease
- Fatigue
- Weakness
- Appetite loss
- Hypotension
- Darkening of skin
133
How is Addison's disease diagnosed
ACTH stimulation test - patient's with Addison's disease do not respond to ACTH
134
What is Cushing's disease
Adrenal disease caused by exposure to excessive cortisol levels usually due to ACTH secreting pituitary adenoma
135
Symptoms of Cushing's disease
- Weight gain in face and on back
- Excess hair growth (hirsutism)
- Hypertension
- Weakness/fatigue
136
Diagnosis of Cushing's disease
- Dexamethasone suppression test
| - 24 hour urine for cortisol
137
What are pheochromocytomas
Rare catecholamine secreting adrenal tumor
138
Diagnosis for pheochromocytomas
- Plasma metanephrine
| - 24 hour urine for catecholamines
139
Preop drug regimen before pheochromocytoma removal
Alpha blockage with phenoxybenzamine 7-10 days preop following by beta blocker
140
What preop test should be given to any female of childbearing age (12-50)
Pregnancy test
141
What hormone is detected by pregnancy tests
hCG
142
Most common indications for pregnant women undergoing non-obstetric surgery
- Acute appendicitis
| - Cholecystitis
143
Anesthetic risks of a pregnant patient
- Hypoxia (decreased FRC)
- Difficult intubation (swelling)
- Hypotension (aortocaval compression)
- Aspiration
144
A fetus is considered viable at...
24 weeks
145
Potential concerns assc. with aloe
Hypokalemia due to diarrhea
146
Potential concerns assc. with Echinacea
Immunostimulant that inhibits CYP3A4 so causes a risk of toxicity for drugs metabolized by CYP3A4 (alprazolam, CCBs, protease inhibitors)
147
What is caused from toxicity of Echinacea
Hepatic inflammation
148
Potential concerns assc. with garlic
- Inhibits platelet aggregation
| - Induces CYP450 (decreases effectiveness of drugs metabolized by it)
149
Symptoms of garlic toxicity
- GI discomfort
| - Hemorrhage
150
Drug interactions with garlic
Increases INR with warfarin
151
How long before surgery should garlic supplement be stopped
7 days
152
Potential concerns assc. with ginkgo biloba
Inhibits platelet-activating factor
153
Drug interactions with ginkgo biloba
- Warfarin
| - MAOIs
154
Symptoms of ginkgo biloba toxicity
- GI discomfort
- Dizziness
- Seizures
- Bleeding
155
Potential concerns assc. with ginseng
- HTN
- Tachycardia
- Bleeding
- CNS stimulation
- Hypoglycemia
156
Symptoms of ginseng toxicity
- HTN
| - Tachycardia
157
Drug interactions with ginseng
- Decreased INR with warfarin
- Increases hypoglycemic effects of insulin
- Increases manic like episodes with MAOIs
158
Potential concerns assc. with saw palmetto
- Intraop bleeding
- N/V
- Diarrhea
159
Drug interactions with saw palmetto
Anticoagulants
160
Potential concerns assc. with St. John's wort
- Works as a possible weak MAOI or SSRI
| - Risk of serotonin syndrome
161
Drug interactions with St. John's wort that we use in the OR
- Opioids
- Sympathomimetics (exaggerated response)
- Benzos
162
Drug interactions with St. John's wort that patients take at home
- CCBs
- Warfarin
- Digoxin (won't work)
- Oral contraceptives
163
Potential concerns assc. with Coenzyme Q10
- Decreased effectiveness of warfarin (decreased INR)
- Hypoglycemia
- Decreased statins
164
Potential concerns assc. with dong quai
Inhibition of platelet aggregation
165
Drug interactions with dong quai
- Increased INR
| - Estrogen-like effects with hormone meds
166
Potential concerns assc. with vitamin E
Bleeding possible with higher doses
167
When should most dietary supplements be stopped prior to surgery
2-3 weks
168
When should ginkgo be stopped prior to surgery
36 hrs
169
When should ginseng be stopped prior to surgery
7 days
170
When should St. Johns wort be stopped prior to surgery
5 days
171
Herbal supplement with laxative properties and a risk of hypokalemia
Aloe
172
Herbal supplement that can increase manic like episodes with MAOIs
Ginseng
173
OR drugs that interact with St. Johns wort
- Opioids
- Sympathomimetics
- Benzos
174
Dietary supplements that do not influence bleeding
- Aloe
- Echinacea
- St Johns wort
175
Uses for Echinacea
- URIs
| - Flu
176
Uses for garlic
- HTN
- HLD
- Infection
- Cancer
- Atherosclerosis
177
Uses for ginkgo biloba
- Circulatory disorders like Raynaud's
- Increased mental acuity
- Tinnitus
- Vertigo
- Sexual dysfunction
178
Uses for Ginseng
- Immunostimulation
- Diabetes mellitus
- Menopause
179
Uses for Saw palmetto
- BPH
- Pelvic pain
- Bladder disorders
180
Uses for St Johns wort
- Depression
- Anxiety
- Sleep
181
Uses for Coenzyme Q10
- CHF
- CAD
- HTN
- HLD
- DM
182
Uses for dong quai
- Menopausal symptoms
| - GYN issues
183
Uses for vitamin E
- Antioxidant
- Antiaging
- Heart health
- Cancer
- Fibrocystic breast syndrome
184
Intrinsic rate of SA node
60-100bpm
185
Intrinsic rate of atrial foci
60-75bpm
186
Intrinsic rate of AV node
40-60bpm
187
Intrinsic rate of ventricular foci (HIS bundle, bundle brances, purkinje fibers)
20-40bpm
188
Voltage of 1 small square on EKG paper
0.1mV
189
Anterior EKG leads
V2-V4
190
Lateral EKG leads
I, aVL, V5, V6
191
Inferior EKG leads
II, III, aVF
192
What does a wide QRS complex tell you
Beat most likely originates in ventricles
193
2 leads that we use to determine normal axis
I and aVF
194
Portion of the EKG that we use to look for atrial enlargement
P wave
195
What on an EKG indicates ventricular hypertrophy
Increased voltage of QRS complexes
196
Normal PR interval
Less than 0.2 seconds
197
Normal QRS interval
0.08-0.1 seconds
198
What factors is the length of the QT interval based on
Sex and heart rate
199
What is sinus arrhythmia
When the SA node fires faster with inspiration
200
What is the origin of ectopic beats
Groups of pacemaker cells throughout the conduction system of the heart that are capable of spontaneous depolarization
201
What atrial dysrhythmia is characterized by a "warm up period"
Paroxysmal atrial tachycardia
202
What dysrhythmia is characterized by at least 3 different P wave morphologies
Multifocal atrial tachycardia (if over 100bpm) or Wandering Atrial Pacemaker
203
When is Accelerated Idioventricular Rhythm seenon the EKG?
- During acute infarction
| - After reperfusion of a blocked coronary artery
204
What electrolyte disturbances can cause Torsades de Pointes?
- Hypocalcemia
- Hypomagnesemia
- Hypokalemia
205
EKG change seen in V2 that is indicative of right bundle branch block
r/R' wave
206
EKG change seen in Lead I that is indicative of RBBB
Slurred S wave
207
EKG change seen in V1 that is indicative of left bundle branch blood
Widened, abnormal QRS complex
208
EKG change seen in V6 that is indicative of LBBB
r/R' wave with absent Q wave
209
EKG changes assc. with left anterior fascicular block
1) Positive qR wave in lead I
| 2) Negative rS in leads II and III
210
EKG changes assc. with left posterior fascicular block
1) Negative rS wave in lead I
| 2) Positive qR in leads II and III
211
Normal cardiac QRS axis
-30 to 90 degrees
212
Directions of Leads I and aVF in a normal cardiac axis
Both positive
213
Directions of Lead I and aVF in left axis deviation
Lead I positive, aVF negative
214
Directions of Lead I and aVF in right axis deviation
Lead 1 negative, Lead aVF positive
215
2 leads used to determine atrial enlargement
- Lead II
| - V1
216
Peaked P waves in inferior leads is indicative of...
P pulmonale
217
Cause of P pulmonale
Pulmonary HTN
218
Notched P waves in Lead II and V1 is indicative of...
P mitrale
219
Causes of P mitrale
- HTN
- A fib
- Mitral stenosis
220
How do you diagnose LVH on an EKG?
The sum of the S wave in V1 or V2 and the R wave in V5 or V6 is greater than 35mm
221
How do you diagnose RVH on an EKG?
RAD with QRS axis exceeding 100 degrees. R wave is larger than the S wave in V1 and S wave is larger than R wave in V6
222
ST changes assc. with myocardial INJURY
ST elevation
223
ST changes assc. with myocardial ISCHEMIA
ST depression
224
Stages of an acute MI
1) Peaked T waves
2) ST elevation
3) Q waves
4) T wave inversion
225
What EKG change IS diagnostic of an MI?
Appearance of pathological Q waves
226
What coronary artery supplies the anterior portion of the heart and the septum?
Left anterior descending
227
What coronary artery supplies the lateral wall of the left ventricle?
Left circumflex
228
What coronary artery supplies the inferior portion of the heart?
Right coronary
229
What EKG change can be seen with hypokalemia
U waves
230
"Digitalis effect" on an EKG
Downsloping of ST segment
231
S1Q3T3 is associated with
Pulmonary embolus
232
EKG change assc. with pericarditis
Diffuse ST elevation
233
EKG change assc. with intracranial hemorrhage
Deep T wave inversion
234
EKG change assc. with hypercalcemia
Shortened QT segment
235
Definition of ASA 4 classification
A patient with severe systemic disease that is a constant threat to life
236
Lab values for hyperthyroidism
- Elevated T3/T4
- Decreased TSH
- Hypercalcemia
237
Posterior pituitary hormones
- ADH
| - Oxytocin
238
Incidence of unrecognized pregnancy
0.3%
239
Major risk factors assc. with diabetes mellitus
- Heart disease
- Stroke
- Kidney disease
- Blindness
- Nontraumatic amputations
240
What is listed as #1 under the problem list on the anesthesia consult
Reason for surgery
241
What is the most serious effect of untreated OSA
Heart problems
