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In Training Exam TL > ITE block 10 > Flashcards

ITE block 10 Flashcards

1
Q

Normal FHR

A

110-160 bpm

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2
Q

Sinusoidal pattern on FHR

A

Sign of placental abruption, ominous

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3
Q

Early decelerations FHR

A

assoc w/ contractions
vagal activation from fetal head compression

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4
Q

Late decelerations

A

end of contraction
uteroplacental insuf or fetal hypoxia

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5
Q

What decreases hepatic blood flow?

A

Hypoxia
Hypercarbia
Catecholamine release
hypoTN

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6
Q

Which tests best determinate of synthetic fxn of liver?

A

PT or INR
b/c measures extrinsic pathway which has factor VII which is the shortest life span

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7
Q

Strong ion difference

A

(Na + Mg + K + Ca) - (Cl + lactate)

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8
Q

Inc in SID does what to pH

A

increase it -> alkalosis

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9
Q

Dec in SID does what to PH?

A

decrease it -> acidosis

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10
Q

How does inc in phosphate change pH?

A

Decrease -> metabolic acidosis
b/c inc in total acids

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11
Q

Dec in albumin change in pH

A

increases pH -> metabolic alkalosis
-b/c albumin mild acid -> dec = alk

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12
Q

CI to closed circuit anesthesia

A

Sevo (can’t run at high enough flows)
DKA (rebreath ketones)
Actively drunk/alcoholism (rebreath acetone)
Malnutrition
Cirrhosis
Heavy smokers (rebreath carbon monoxide)

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13
Q

Which meds will vasodilate and also decrease CBF?

A

Precedex
Propofol
gases at < 0.5 MAC
**labetalol doesn’t inc CBF!

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14
Q

Total O2 content equation

A

O2 content = )1.34 x Hg x O2 saturation in decimal) + .0003 * PaO2

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15
Q

Hypocalcemia EKG

A

Short PR interval
Prolonged QT
occasional inversion of T waves

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16
Q

Hypercalcemia EKG

A

Prolonged PR interval
Short QT
Peaked T waves
hyPeR Ca, PRolonged PR

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17
Q

alpha stat monitoring during CBG

A

pts temp is not corrected for in ABG
-does not add CO2 -> preserving cerebral autoregulation

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18
Q

pH stat monitoring during CBG

A

corrects pts temp for in ABG
-req adding CO2 -> inc CBF
-counteracts L shift of Hg curve

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19
Q

RF for severe bradycardia after spinal

A

young male
HR <60 prior to spinal

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20
Q

How to screen for cerebral vasospasm?

A

transcranial doppler

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21
Q

What is considered to be a positive transcranial doppler for cerebral vasospasm?

A

Compares fow velocity of middle cerebral artery to ICA
FVMCA > 120 cm/s
or if FVMCA: FVICA is > 3

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22
Q

When is rebleeding after SAH most likely to happen?

A

w/i 48 hours

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23
Q

When is vasospasm post SAH most likely to happen?

A

3-15 days

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24
Q

When to restart ppx heparin after epidural placement?

A

Immediately

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25
Q

UFH ppx <15k, when can put in catheter after last dose?

A

4-6 hours

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26
Q

UFH ppx <15k, when after injxn can you pull catheter?

A

4-6 hours

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27
Q

UFH ppx < 15k, when after catheter removal can you start heparin?

A

immediately

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28
Q

high dose UFH ppx >15k, when after last dose can you put catheter in?

A

12 hours

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29
Q

high dose UFH ppx >15k, when after catheter placement can you start again?

A

1 hour

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30
Q

high dose UFH ppx >15k, when after injxn can you remove catheter?

A

12 hours

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31
Q

high dose UFH ppx >15k, when after catheter removal can you restart?

A

1 hour

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32
Q

LMHW ppx, when can you do catheter after last dose?

A

12 hours

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33
Q

LMHW ppx, when can you restart after placing catheter?

A

12 hours

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34
Q

LMHW ppx dose given, when can you remove the catheter?

A

12 hours

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35
Q

LMHW ppx, catheter removed, when can you restart?

A

4 hours

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36
Q

LMHW therapeutic, when after last dose can you place catheter?

A

24 hours

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37
Q

LMHW therapeutic, when can you restart after catheter placement?

A

24 hours

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38
Q

LMHW therapeutic, when can you restart after catheter removal?

A

4 hours

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39
Q

Dx of carbon monoxide poisoning

A

Made on hx
Elevated carboxyHg levels

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40
Q

Amniotic fluid embolism dx progression

A

1st: pulm vasospasm and R heart failure
2nd: L heart failure pulm edema
DIC
-if pt still pregnant 911 c/s

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41
Q

When 2 NMB from same class are both given, whats the effect?

A

Additive ->no inc of duration of action

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42
Q

When small roc given before succ what’s the effect?

A

Antagonism
-req more succ to get paralysis -> shorter duration of action

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43
Q

What happens when you give 2 NMB from diff classes?

A

Synergistic
-inc duration of action

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44
Q

Which cardiac defects MC assoc w/ omphalocele?

A

ASD and VSD

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45
Q

older pt w/ no comorbidities change in DBP?

A

no change or decrease

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46
Q

Isovolumic hemodilution causes what hemodynamic changes?

A

Inc in cardiac output
Dec in SVR -> dec blood viscosity
Inc O2 extraction

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47
Q

How to tx vasogenic cerebral edema caused by brain tumor?

A

Steroids! Dexamethasone
-tumor disrupts BBB -> edema

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48
Q

What does a brain lesion w/ surrounding T2-weighted hyperintensity and a lack of diffusion restriction in white matter mean?

A

Vasogenic cerebral edema like 2/2 tumor
-more common in WHITE matter

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49
Q

Cytotoxic edema

A

Usually occurs 2/2 cell injury or death 2/2 ischemia, hypoxia, trauma, toxins
-occurs in GRAY matter
-steroids don’t help

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50
Q

Advantages of pH stat

A

Improved O2 delivery to tissues (counteracts L shift of Hg curve)
Inc speed of cerebral cooling due to cerebral vasodilation (from CO2 that is added)
-used in congenital heart surgery

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51
Q

Disadvantage of pH stat

A

Inc embolic load to brain
cerebral vasodilation -> loss of cerebral autoregulation

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52
Q

Dexmedetomidine and Cardiac output

A

Decreases it

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53
Q

What should be used in a Bair block?

A

Lidocaine .5% or 1% NO EPI

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54
Q

Lid lag hyper or hypothyroid?

A

Hyperthyroidism
-adrenergic hyperactivity -> spasming of muscle

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55
Q

How to estimate an anatomical shunt fraction

A

pulm phys shunt/Cardiac output= (1-Art O2 sat)/ (1-ven O2 sat)
-normal: 0.05

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56
Q

Normal shunt fraction

A

0.05

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57
Q

Calculation of stroke volume variation

A

SVV= (SVmax -SVmin) / [(SVmax +SVmin) / 2 ]
ex: 80 and 60
80-60/ [ (80+60) /2 ]

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58
Q

Endometritis

A

POSTPartum uterine infxn

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59
Q

Above what Reynolds number is considered turbulent flow?

A

4000

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60
Q

What factors determine flow rate Poiseuille’s law?

A

Assume laminar flow
pressure exerted on fluid
length of tubing
viscosity of liquid
radius of tubing *** biggest impact

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61
Q

When determining flow rate of fluid by Poiseuille’s law, what impact will doubling the radius have?

A

increase flow 16x
r ^ 4

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62
Q

Diabetic autonomic neuropathy symptoms

A

GI: GERD (dec LES tone), gastroparesis, chronic diarrhea
CV: loss of heart rate variability, resting tachy, orthostatic hypoTN *MI can have NO PAIN
peripheral: no sweating in hands and feet, periperhal edema
hypoglycemia unawareness (no symp)
erectile dysfxn
bladder dysfxn

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63
Q

Dose of PO midaz

A

0.5 mg/kg

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64
Q

Cardiac anomaly with carcinoid tumor

A

Tricuspid regurge

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65
Q

What has a large uptake in lungs?

A

Serotonin
NE
PG
bradykinin

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66
Q

When NMB administered which muscles respond first?

A

diaphragm and laryngeal muscles
b/c greater BF

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67
Q

Which muscle recovers from NMB first?

A

Diaphragm

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68
Q

Corrugator supercilii correlates w/ recovery of?

A

Diaphgram and laryngeal muscles
(no o’s)

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69
Q

Orbicularis oculi correlates w/ recovery of?

A

adductor pollicis
2 o’s: Orbicularis Oculi

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70
Q

When NMB blockers given, muscle group recovery order

A
  1. Diaphragm
  2. laryngeal m
  3. corrugator supercilii
  4. abd muscles
  5. orbicularis oculi
  6. geniohyoid
  7. adductor pollicis
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71
Q

Begins at epiglottis and ends at cricoid

A

hypophyarnx

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72
Q

Innvervation of nasopharynx

A

V2 (maxillary trigeminal n)

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73
Q

begins at the epiglottis and ends at cricoid cartilage

A

larynx

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74
Q

begins at nasal cavity ends at soft palate

A

nasopharynx

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75
Q

begins at soft palate and ends at hyoid bone

A

oropharynx

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76
Q

Larynx vertical location in infants v adults?

A

C3-5 in infants
C4-6 in adults

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77
Q

Larynx of invants v adults

A

epiglottis longer and omega-shaped
aryepiglottic folds closer to midline
pliable laryngeal cartilage
larynx proportionally smaller
vertical location C3-5 (C4-6 in adults)

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78
Q

Where in lung is atelectasis most likely to occur

A

lower segments of lung near diaphragm

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79
Q

Atelectasis inhal v TIVA

A

it the same

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80
Q

tramadol MOA

A

mu opiod agonism and inh of serotonin and NE reuptake

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81
Q

Buprenorphine MOA

A

mixed agonist/antagonist at mu-opioid receptor

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82
Q

Type of blood rxn: IgM antigen-Ab complex activating complement

A

acute hemolytic transfusion rxn

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83
Q

For screening tests: highly specific or sensitive?

A

highly sensitive

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84
Q

For confirmatory tests: highly specific or sensitive?

A

highly specific

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85
Q

Bronchiectasis tx

A

prevention w/ aggressive antimicrobials
chest PT

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86
Q

classic triad of congenital diaphragmatic hernia

A

cyanosis
dyspnea
dextrocardia

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87
Q

w/ congenital diaphragm repair, where should IVs go?

A

ONLY UPPER extremity
-no lower b/c risk of compression of IVC w/ reduction of hernia

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88
Q

Anesthesia considerations for congenital diaphragm hernia

A
  1. permissive hypercapnia: lower TV to prevent PTX, keep peak p below 25
  2. no lower extremity IV (IVC comp w/ reductino of hernia)
  3. avoid hypothermia (inc PVR), and nitrous oxide
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89
Q

Changes in resp volumes in pregnancy

A

DEC: FRC, ERV, RV
INCREASE: MV, TV, RR

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90
Q

Interscalene block: what is posterolateral to the roots?

A

Middle scalene muscle

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91
Q

PPV inspiration on RV preload and LV afterload

A

both DECREASE (+ pressure compressed LV reducing force req to eject blood)

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92
Q

PPV inspiration on RV afterload and LV preload

A

both INCREASE
-b/c compression causes inc in PVR and compression forces blood into LA

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93
Q

Acute altitude change hypoxia CV changes

A

Inc HR
Inc Cardiac output
Dec SVR -> however compensation w/ sympathetic activation could lead to an in in MAP
(in in symp tone)
inc PVR (hypoxic pulm vasoconstriction)

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94
Q

Compensation for prolonged hypoxia

A
  1. EPO -> Inc Hg
  2. hyperventilation
  3. Renal bicarb elimination (counteract resp alk)
  4. inc 23DPG prod -> shift Hg curve to R
  5. Inc mitochondria (inc aerobic efficiency)
95
Q

What effect of dexmedetomidine occurs b/c of alpha 2 rec w/i spinal cord

A

Analgesia
-alpha 2 receptors in dorsal horn suppress pain transmission

96
Q

Dexmedetomidine suppresses shivering by agonism of alpha 2 where?

A

hypothalamus

97
Q

Dexmedetomidine produces sedation and anxiolysis by binding to alpha 2 receptors where?

A

locus coeruleus of brainstem

98
Q

Dexmedetomidine produces bradycardia by binding to alpha 2 receptors where?

A

brainstem vasomotor center -> centrally mediated inhibition of sympathetic NS

99
Q

What muscles does the SLN external branch innervate?

A

cricothyroid

100
Q

anechoic space b/w parietal and visceral pleura is?

A

pleural effusion

101
Q

Cutaneous landmark for LFCN block

A

ASIS

102
Q

landmark for blocking sural n

A

lateral malleolus

103
Q

landmark for blocking posterior tibial n

A

medial malleolus

104
Q

Chassaignac tubercle is landmark for what n block?

A

C6
deep cervical plexus

105
Q

Dabigatran MOA

A

direct oral thrombin inhibitor

106
Q

Dabigatran coag lab change

A

Increase in thrombin time (TT) -> not used for monitoring b/c levels predictable
-possible inc in PTT

107
Q

If no posttetanic twitches present, sugammadex dose?

A

16 mg/kg

108
Q

if posttenic twitches are present for TOF twitches <1, sugammadex dose?

A

4 mg/kg

109
Q

If TOF ct of 1 sugammadex dose?

A

4 mg/kg

110
Q

If TOF ct of 2, sugammadex dose?

A

2 mg/kg

111
Q

alpha-methyl-para-tyrosinee MOA

A

inhibits tyrosine hydroxylase, rate limiting step in catecholamine synthesis

112
Q

when to use alpha-methyl-para-tyrosine

A

adjust in malignant or inoperable tumors (pheo)
-to limit catecholamine synthesis

113
Q

What causes early mortality (1-2 days) in pts after inhalational burn injury

A

carbon monoxide poisoning

114
Q

What medications inc likelihood of LAST w/tumescent anesthesia?

A

SSRI/SNRI b/c they CYP450 inh -> lidocaine metabolized by CYP1A2 and 3A4

115
Q

CYP450 inhibitors

A

SICKFACES.COM
Sodium Valproate/SSRI/SNRI
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Acute alcohol cute
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

116
Q

CYP Inducers

A

CRAP GPS
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas

117
Q

How frequently should tubing for blood products and TPN be changed?

A

24 hours

118
Q

In emergencies where aseptic technique not guaranteed for central line, when should catheter be replaced?

A

w/i 48 hours

119
Q

How frequently should dressing be changed on CVC?

A

every 7 days or sooner if damp, loose or soiled

120
Q

Why hypoTN w/ hypoplastic L heart during induction w/ sevo 100% FiO2

A

tachypnea + high O2 -> dec pulm vascular resistant
-pt dependent on BF from pulm vasc to PDA to body -> if dec PVR blunt shunts to lungs instead of body

121
Q

Why does phenylephrine worsen situation w/ hypoTN in hypoplastic L heart?

A

Inc afterload -> will shunt blood trying to go through PDA to pulm circulation instead -> worsening BF to pulm vasculature instead of going systemically

122
Q

Determinants of pulm vascular resistance

A

PAO2 (hypoxic pulm vasoconstriction_
PaCO2
temp
intrathoracic pressure
FRC
vasodilators( Nitric, NG, nitroprusside)

123
Q

How to inc PVR

A

Dec FiO2
Dec MV
Inc intrathoracic pressure
Inc PaCO2 (acid -> inc extraceullar Ca -> contriction)
Acidemia

124
Q

Acromegaly and VC changes

A

VC paresis 2/2 stretching of RCLN by cartilaginous expansion i neck

125
Q

Treacher Collins airway cahnges

A

mandibular hypoplasia
microstomia (small sized mouth)

126
Q

Neurofibromatosis anesthesia concerns

A

-Neurofibromas in airway
-Neurofibrama in SC or assoc w/ scoliosis issues -> problem w/ spine and DL
-neurofibromas bleed profusely when dirupted
-screen for HTN: renal artery stenosis, catecholamine-secreting neurofibroma, pheo
-intracranial tumors
-endocine anomalies

127
Q

Post ECT

A

parasympathetic initial resp -> symp
inc in CBF
Inc ICP
Inc CMRO2
Inc Intraocular pressure
Inc Intragastric pressure

128
Q

Gold standard for ECT meds

A

Methohexital

129
Q

How fast should sugar be fixed in DKA?

A

No faster than 100 mg/dL an hour -> brain needs time to compensate
-> if too fast -> cerebral edema

130
Q

Risk of transmission after contaminated needle stick in HIV is

A

0.3%

131
Q

Risk of transmission after contaminated needle stick in Hep C

A

2%

132
Q

Risk of transmission after contaminated needle stick in of Hep B

A

23-62% -> why HCW get vaccinated against Hep B

133
Q

When should postexposure ppx against HIV be given?

A

as soon as possible when necessary and continued for 4 weeks
-ideally w/i hours of exposure, but can extend up to 2-4 weeks postexposure

134
Q

In OLV, what volumes allow max pulm BF?

A

Maintaining the lung at FRC and PEEP

135
Q

In One lung ventilation, once settled and time passes, how much is shunt fraction?

A

20-30% in healthy pt

136
Q

Hypoxic pulm vasoconstriction response timing

A

biphasic temporal resp
-initial rapid phase plateau after 20-30 minutes
-delayed phase max 2-3 hours

137
Q

Effect on cardiac output changes w/ one lung ventilation

A

if you inc cardiac output -> worsens hypoxia b/c inc BF to nonventilated lung
-if cardiac output dec -> tissue extraction inc before HPV and shutning can occur -> drop in PaO2 and dec in mixed venous O2

138
Q

Predictors of hypoxemia during one lung ventilation

A

Normal preop spirometry
Normal FEV1/FVC
R side thoracotomy
Supine position
low partial P of O2 during 2 lung
high % of V/Q on operative lung on V/Q scan

139
Q

Dest w/ One lung ventilation what to do?

A
  1. Inc FiO2
  2. Confirm tube placement w/ fiberoptic
  3. Dec volatile and optimize cardiac output
  4. Recruitment to ventilated lung
  5. apneic oxygenation insufflation of nonvent lung
  6. recruitement maneuver w/ CPAP to nonvent lung
  7. pharm, VV ECMO
140
Q

At the NMJ, ACh release during action potential binds where

A

postjunctional nAChR -> m contraction
prejunctional nAChR to mobilize ACh to the n termal to be available for release during next action potential

141
Q

What receptors do NDNMB lock?

A

BOTH postjunctional and prejunctional nAChRs
-inhibits m contraction
-prevents replenishment of ACh at n termianl for repeat or sustained contractions

142
Q

Why does TOF fade occur?

A

Decreased release of ACh molecules w/ repetitive or sustained stimulation
-due to continued inhibition of prejunctional nicotinic ACh receptors

143
Q

Why do we have no fade w/ phase I succ

A

b/c it doesn’t bind to the prejunctional nicotinic ACh receptors

144
Q

Klippel-Feil syndrome

A

fusion and dec neck mobility
-scoliosis assoc

145
Q

What peds syndrome has hypoglycemia assoc?

A

Beckwith-Wiedemann
hypoglycemia, macroglossia, and organomegaly (why get hypoglycemia)

146
Q

RF that inc the potential of n injury

A

male sex
extremes of body habitus
prolonged hospitalization
malnutrition

147
Q

With spinal stenosis, which are affected first sensory n or motor n?

A

Sensory

148
Q

Post-Anesthetic D/c Scoring System

A

vital signs
activity level
N/V
Pain
Surgical site bleeding

149
Q

Aging and sensitivity to muscle relaxants at NMJ

A

DOES NOT CHANGE

150
Q

When do hearing and vision begin to decline for physicians

A

as early as 40

151
Q

Labs for hyperosmolar hyperglycemic syndrome

A

pH > 7.3
bicarb > 18
serum osmolality > 320
**no acidosis b/c no ketone formation

152
Q

Intial symptoms of pt w/ hyperglycemic hyperosmolar syndrome

A

Neurologic!
AMS, possibly seizures

153
Q

Transcutaneous electrical nerve stimulator, how to reverse analgesic effects?

A

Naloxone

154
Q

Type I v Type II CRPS

A

type II has n injury assoc w/ it
type I has no n injury

155
Q

SE of paracervical n block during labor

A

fetal bradycardia -> dec fetal O2 and acidosis

156
Q

What part of the circuit is dead space?

A

Anything on the pt side of the Y piece

157
Q

Dec in V dead space/ V TV and CO2

A

higher end tital CO2 due to less dilutional effect from dead space ventilation

158
Q

pt w/ new heachaches and CN symp -> first test?

A

MRI

159
Q

Gold standard for ICP measurement

A

ventriculostomy catheter

160
Q

Hemifacial microsomia, what syndrome?

A

Goldenhar syndrome
oculo-auriculo-vertebral synderome OAVS
-hemifacial microsomia, mandibular hypoplasia, epibulbar dermoid, vertebral anomalies

161
Q

How does BIS work?

A

microprocessor w/ proprietary algorithm to process EEG signal into a numerical representation

162
Q

Which dec protein S or C?

A

S!
C the same

163
Q

PPx for hypoxic pulm vasoconstriction causing high altitude pulm edem

A

Nifedipine
PDE 5 inh (sildenafil)

164
Q

Peds sedation guidelines, minimum freq of vital signs and monitoring data?

A

10 minutes

165
Q

MOA of hashimoto thyroiditis

A

Autoantibodies targeting thyroid peroxidase

166
Q

Quadriplegia injury where?

A

Above 1st thoracic vertebrae w/i C1-8

167
Q

Paraplegis injury where?

A

T1-L5

168
Q

1st line for postherpetic neuralgia

A

TCAs: Nortriptyline
opioids
gabapentin

169
Q

Graves antibodys

A

Target thyrotropic receptor

170
Q

Airway fire 1st 2 things to do

A

Turn off gas flows
extubate

171
Q

Propofol and RR

A

increases RR when used as an infusion w/ spontaneous ventilation intact but dec TV

172
Q

Propfol and baroreceptor HR response

A

Blunts! why we don’t get tachycardia despite hypoTN

173
Q

Propofol and bronchioles

A

potent bronchodilator -> inc diameter in bronchi

174
Q

What pt population should you be careful w/ LR?

A

liver failure
-lactate converted to bicarb -> can build up in liver failure

175
Q

Which hormones cross cellularl membranes and exert effect in nuclei of target cells?

A

Steroid hormones!
Aldosterone
-but b/c lipophilic need carrier protein in serum

176
Q

How do benzos act as a muscle relaxant?

A

Centrally acting GABA potentiation

177
Q

Aprepitant MOA

A

neurokinin-1 antagonist -> more effective at preventing late PONV (24-48 hrs postop)

178
Q

Who would benefit most from early invasive strategies?

A

Ischemia at rest
Elevated biomarkers
New ST seg depression
worsening FG or MR
EF < 40%
V tach
Hemodynamic instability
recent PCI
Prior CABG

179
Q

TIMI risk score: risk of death and ischemic events RF:

A

Age > 65
> 3 CAD RF (HTN, HLD, DM, fam hx)
known CAD ( > 50%)
ASA use in 7 days
severe angina (> 2 episodes in 24 hrs)
ECG ST changes > 0.5 mm
Positive cardiac marker

180
Q

Def of proteinuria for preeclamspia

A

> 300 mg/ 24 hrs
protein-cr ratio > 0.3
1+ or higher on urine dipstick

181
Q

Lithium and anesthesia interference

A

Reduces the release of ACh -> prolonoging blockade
-Dec anesthetic requirements (b/c reduces release of neurotransmitters)

182
Q

SE of lithium

A

-T wave changes
-Leukocytosis
-hypothyroid
-DI
-Heart block
-hypoTN
-Sz

183
Q

Lithium and taking during surgery

A

-D/c 24 hours prior to surgery b/c hypoNa (from diuretics) or NSAID use inc levels and potential for toxicity

184
Q

Glucagon MOA

A

activates adenylyl cyclase -> inc cAMP -> positive inotropic and chronotropic cardiac response

185
Q

After donor hepatectomy, when will INR returnt o normal

A

5-7 days

186
Q

After donor hepatectomy, when will INR be it’s highest?

A

2-3 days
no greater than 2

187
Q

After donor hepatectomy, when can an epidural catheter be removed?

A

3-5 days after normalization of INR

188
Q

After donor hepatectomy, what does TEG look like?

A

hypercoagulable state

189
Q

Hemodynamic changes during a forced expiration against a closed glottis

A

Valsalva
-initial: Inc in LV output b/c compression of thoracic aorta -> baroreceptor dec in HR
-2nd: straining: dec in venous return, RV and LV output, SV, MAP -> baroreceptor inc in HR
-3rd: release: arterial pressure dec b/c rlease of thoracic aorta compression -> brief reflex tachycardia by baroreceptor
-last: rapid inc in cardiac filling -> inc in stroke volume and pressure -> baroreceptor of HR dec

190
Q

Anrep effect

A

Frank-Starling Curve
-inc in ventricular contractility following acute inc in afterload

191
Q

Periop concern of Methotrexate

A

Pulmonary toxicity: review all chest imaging beforehand -> if signs will need lung protective ventilation (restrictive lung dx)
symp: fever, chills, dyspnea, nonprod cough

192
Q

Treacher Collins syndrome

A

cheekbone and mandibular hypoplasia
microstomia (small mouth)

193
Q

Acromegaly Cardiovascular changes

A

LVH
Diastolic dysfxn
HTN
cardiomyopathy
arrhythmias
-more likely to get HF and valve issues

194
Q

Why would a pt have AMS after GI bleed w/ hx of cirrhosis?

A

b/c breakdown of Hg -> breakdown and absorption of amino acids -> inc nitrogen -> inc ammonia
-liver responsible for metabolism of N/ammonia
-if compromised it builds up -> hepatic encephalopathy

195
Q

Tx of hepatic encephalopathy

A

Lactulose
Rifaximin (kills ammonia prod GI organisms

196
Q

Critical temp of nitrous oxide

A

36.5 C
-under pressurized conditions at room temp => nitrous oxide will be a mixed liquid and gas form
-at temps greater than 36.5 -> nitrous oxide will only be a gas

197
Q

When Peak pressure elevated alone why?

A

Change in airway resistance

198
Q

When peak and plateau pressure elevated why?

A

Decrease in lung compliance

199
Q

UOF for infants in mild, mod sevre dehydration

A

mild: < 2 cc/kg/hr
mod: < 1
severe < 0.5

200
Q

urine specific gravity of mild, mod, severe dehydration

A

mild: < 1.02
mod: 1.02-1.03
severe: > 1.03

201
Q

Repletion for mod to sevre dehyration in infants

A

Bolus: 20-30 cc/kg
phase 1: 25-50 cc/kg over 6-8 hrs
2: remainder of deficit over 24 hours

202
Q

Elderly body mass changes

A

-Dec in lean body mass
-inc in body fat
-decrease in total body water
-> smaller central compartment w/ inc concentration of medications
-> inc fat inc volume of distribution and can prolong medication effects

203
Q

If doctor has a license restrictions what next

A

MUST notify ABA themselves w/i 60 days

204
Q

If a pt has thalassemia besides Hg what else workup should you have?

A

possibly an echo?
Iron overload related cardiomyopathy

205
Q

Contraindications to shock waave lithotripsy

A

Pregnancy
Active UTI
Untreated bleeding d/o

206
Q

What is persistent L SVC?

A

L brachiocephalic v doesn’t form properly -> L arm, head, neck drain into coronary sinus and RA
**retrograde cardioplegia is useless

207
Q

Equation for pressure across the aortic valve?

A

4 * (Peak volocity) ^2

208
Q

Early post HD labs

A

hypoK (most intracellular and hasn’t equilibrated yet)
Inc PTT (from heparin in HD machine)
Anemia

209
Q

Clear safety goggles used for which laser?

A

CO2

210
Q

green safety goggles used for which laser?

A

neodymium: yttrium aluminum garnet laser

211
Q

orange safety goggles used for which laser?

A

Argon

212
Q

orange-red safety goggles used for which laser?

A

potassium-titanyl-phosphate Nd:YAG lser

213
Q

How does NG reduce mycoardial O2 demand

A

NG dilates veins > arteries –> dec preload -> dec stretching of LV -> dec demand

214
Q

Physiologic changes after brain death

A

Catecholamine storm:
-pulm edema (OL from heart)
-polyuria (death of posterior pit -> DI)
-myocardial dysfunction
-hyperglycemia
-hyperNa (fluid loss)
-hypovolemia

215
Q

Meds commonly given during organ procurement

A

Thyroid hormone
Steroids
Vasopressin

216
Q

Peds adjsutment of dosing for succ compared to adults

A

infants 3 mg/kg
peds 2 mg/kg
adults 1 mg/kg

**because infants have inc ECF and high cardiac output -> redistributed quickly

217
Q

NMB to avoid in hyperthyroid or pheo

A

Pancuronium
**causes sympathetic stimultion!

218
Q

Which gases in a cylinder, is the weight of the clyinder the best way to see how much is left in the cylinder? (as opposed to pressure)

A

Nitrous oxide
CO2
-exist as liquid and gas -> why WEIGHT needs to be used not psi

219
Q

Which cylinders contain ONLY gases, no liquid

A

O2
air
helium
nitrogen
**why can use pressure to see what’s left!

220
Q

What color is a helium cylinder?

A

brown

221
Q

Which IV anesthetic assoc w/ inc in hepatic BF?

A

Propofol -> the rest decrease

222
Q

Most abudant CYP enzyme in liver

A

CYP3A4

223
Q

Foe 5 year MOCA -> minmum number of quality impromvent points required

A

25
-25 in years 1-5, and ADDITIONAl 25 in 6-10

224
Q

CME req for MOCA

A

125 category 1 in each 5 years -> 250 total

225
Q

Optimal pump flow during CPB

A

1.6 -3 L/min/m^2

226
Q

Optimal MAP during CPB

A

50-90

227
Q

ptimal venous O2 sat during CPB

A

> 65%

228
Q

Strong Ion Difference

A

(Na + K + Mg + Ca) - (Cl + lactate)

229
Q

Anion Gap

A

(Na + K ) - ( Cl + bicarb)

230
Q

Normal strong ion difference

A

40!

231
Q

Normal serum osmolality

A

275-290

232
Q

DES elective surgery time

A

6 months

233
Q

DES time sensitive surgery

A

3 months

In Training Exam TL (11 decks)

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