Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

In Training Exam TL > ITE block 5 > Flashcards

ITE block 5 Flashcards

1
Q

Interval data

A

data has order, difference b/w values is meaningful
NO true zero exists
ex: temperature, pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

nominal data

A

categories w/ no order
gender, race, blood type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ordinal data

A

order exists, but the difference between values is not meaningful
ex: mallampati, numerical pain score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ratio data

A

order exists, difference between values is meaningful
TRUE zero does exist
ex: kelvin, weight, length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which types of data are categorical?

A

nominal, ordinal
they both kinda ordinary sounding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what types of data are numerical?

A

ratio, interval
ratio has a O -> so it has a true zero, interval does not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

primary method of heat production in neonates

A

nonshivering thermogeneies
-metabolism of brown fat (uncouples oxidate phosphorylation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pt found down after drowning, what do you to?

A

always give PPV FIRST, no compressions
-b/c hypoxic so if you do compressions just moving hypoxic blood -> often oxygen from 2 breaths a start to ROSC
-also helps tx any larnygospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pt found down after drowning, what do you to?

A

always give PPV FIRST, no compressions
-b/c hypoxic so if you do compressions just moving hypoxic blood -> often oxygen from 2 breaths a start to ROSC
-also helps tx any laryngospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where does majority of cholesterol biosynthesis occur

A

Cytosol of hepatic cells from precursor acetyl CoA (enzyme is HMG-CoA reductase)
-why statins (HMG-CoA reductase inhibitors) prescribed to people w/ poorly controlled lipid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Insulin actions

A

-inc glucose transport into skeletal muscle and adipose tissues
inc glycogen sytnhesis and storage
inc TG synthesis
inc protein synthesis
dec glucagon release
dec lipolysis in adipose tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Stress resp to surgery

A

GH inc lipolysis and inhibits cellular glucose uptake
-surgical stress -> insulin def 2/2 opposing hormones and stress-induced insulin resistance to inc glucose available for body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

neuraxial blockade and stress response

A

-red conc of catabolic mediators: cortisol, catecholamines
-NOT been shown to prevent secretion of cytokines pro-inflammatory: IL-2, TNF alpha, and IL 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Implants contraindicated in MRI

A

cerebral aneurysm clips
ICDs
pain pumps
cochlear implants
peripheral n stimulators
any ferromagnetic-containing metal objects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Okay for MRI

A

spinal herrington rods
heart valve prothesis
annuloplasty rings
newer pacemakers
-okay if metal is non-ferromagnetic: Aluminum, titanium, nitinol, or stainless steel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Quenching of magnet in mRI results in for pt

A

massive high pressure -> if door stuck, break glass
rupture of tympanic membranes
evaluate for asphyxia and hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Therapeutic levels of Mg for preeclampsia

A

5-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SE based on Mg level

A

> 5: deep tendon reflexes reduced
7: muscle weakness and resp depression
7-12: hypoTN
12: DTR lost, cardiac conduction abnormalities may be seen
15-20: respiratory arrest
25: asystole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Non-reassuring airway signs

A

-relatively long incisors
-prominent “overbite”
-pt can’t bring mandibular incisors anterior to maxillary incisors
-less than 3 cm interincisor distance
-uvula not visible when tongue protruded
-highly arched or very narrow palate
-mandibular space stiff, indurated, or has a mass
-less than 3 finger breadth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mechanism for bradycardia that occurs w/ neonatal apnea

A

hypoxic stimulation of carotid chemoreceptors -> leads to inc in ventilation followed by brief apnea (hypoxic ventilatory depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Most important RF for apnea postop in neonates

A

premature birth! post-conceptual age
-highest risk: < 40 weeks PCA
-decreases b/w 40-50 weeks
-gradually declines b/w 60 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ways to dec incidence of postop apnea in neonates if risk is high

A

-bolus of caffeine (shown to dec incidence)
-using neuraxial techniques
-limiting opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Resuscitation after drowning

A

no pulse -> give 2 rescue breaths -> if nothing then compressions
-give it 1 min to find pulse if hypothermia b/c can have arrythmias assoc w/ it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

RF that would make an invasive cardiac procedure better as opposed to medical management

A

-recurrent angina or ischemia at rest or w/ low level activities despite medical therapy (unstable angina)
-elevated cardiac biomarkers
-New ST depression
-signs of symp of HR or new/worsening MR
-hemodynamic instability
-sustained V tach
-PCI w/i 6 months
-prior CABG
-high risk TIMI score ( >2 points)
-red EF < 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

TIMI score

A

risk stratification for rdeath and ischemic events
RF:
age > 65
> 3 CAD RF (HTN, HLD, DM, fam hx, smoker)
known CAD (stenosis > 50%)
ASA use in 7 days
severe angina (>2 episodes in 24 hours)
ECG ST changes > 0.5 mm
positive cardiac marker
0 or 1: low risk compared to higher scoroe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What type of shock is vasopressin most useful

A

vasodilatory (sepsis, hypothermic rewarming)
-b/c it will cause peripheral vasoconstriction, but it also dec Cardiac output (b/c inc in SVR and afterload) but raise MAP
-vasodilation at cerebral perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

vasopressin SE

A

mild dec in plt concentration and inc in plt aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Allodynia

A

pain due to a stimulus that does not normally provoke pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

1st line for post herpetic neuralgia

A

gabapentin and lyrica!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

albumin solutions Na conc

A

145 mEq/L +/- 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Dantrolene dose for MH

A

2.5 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

HyperK (K > 5.9) tx

A

Ca chloride 10 mg/kg or Ca gluconate 10-50 mg/kg if life-threatening
-Sodium bicarb 1-2 mEq/kg
-10 units insulin
-50 cc of 50% dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how do charcoal filters for MH work?

A

activated charcoal filter is highly porous w/ large surface area of carbon atoms that bind to volatile anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

most sensitive evoked potentials to inhaled anesthetics

A

visual and motor evoked potentials
-visual #1
somatosensory and brainstem less sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Anesthesia concern long QT syndrome

A

volatiles esp sevo worsen -> consider TIVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Plateau pressure versus peak insp pressure

A

plateau: seen by alveoli and small airways during PPV -> static measured w/ no flow
-peak: pressure needed to deliver a breath -> result of resistance that occurs in large and medium conducting airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When is it more reliable to weigh a cylinder to tell how much is left as opposed to using pressure?

A

liquified gases -> ones that exist in a pressurized cylinder at partial liquid and partial gas -> gas re-equilibrates and so pressure is full even when gas is used -> weight more accurate
-ex: nitrous oxide, propane, CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what gases are the pressure reliable to tell how much gas is left in a cylinder?

A

nonliquified gases -> so they exist entirely in gaseous form in a cylinder -> so pressure reliable indicator of how much gas left
ex: oxygen, helium, air, nitrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Full O2 cylinder L and psig

A

660L
1900 psig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Full nitrous oxide cylinder L and psig

A

1590L
745psig
=> pressure gauge reads full until 75% of cylinder used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Air full cylinder L and psig

A

625L
1900psig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Helium full cylinder L and psig

A

500L
1600psig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When doing biphasic shock w/ paddles directly on heart how many J?

A

Start at 5 -> 10 -> 20 -> 30 -> 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Clark electrode ABG

A

cathode, anode, and membrane
-measures O2 on ABG, calibrated by 100% and 0% sample
-O2 passes through membrane, reduced by cathode -> creates current -> current relative to O2 sat
-C is mostly O compared to sanz and severinghaus -> so it’s the oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

When is an enzymatic electrode used in ABG?

A

Glucose concentration!
-glucose oxidase is attached to electrode -> hydrogen peroxidase that is generated by enzyme degradation creates a current that is proportional to BG concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Sanz electrode

A

measures serum pH
-sanz is shorter than severinghaus, pH is shorter than Co2
-H+ permeable membrane -> as H ions cross membrane -> generates current proportional to pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Severinghaus electrode

A

measures serum CO2
-CO2 sensitive glass membrane surrounded by bicarb -> as CO2 crosses membrane ->equilibration w/ bicarb -> H ions in solution detected by electrode
-sanz is shorter than severinghaus, pH is shorter than Co2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Vaporizer output

A

Output = (carrier gas flow * SVP) / (barometric pressure - SVP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Vaporizer compensation for temperature changes

A

10-40 C by using bimetallic strip
-it has 2 diff metals against each other that bends w/ temp changes
-when cold -> strip moves to increase the flow in, and when warm moves to decrease the flow into the vaporizer
-when you’re cold you want more heat!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Treatment of LAST

A

lipid emulsion 20%
1.5 cc/kg inital dose -> if doesn’t work, give it again
-then infusion .25 cc/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Nerve gas sarin MOA

A

AChE inhibitor -> atropine is the treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Difference b/w mature and immature ACh receptors

A

mature: at NMJ two α, and one each of β, δ, and ε subunits
immature: extrajunctinal and consists of α, β, δ, and γ subunits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Neostigmine immediately after succ

A

inhibits AChE, but also inhibits pseudocholinesterase -> prolong succ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What’s included in the low pressure system of an anesthesia machine w/ circle system

A

Flowmeters
unidirectional valves
vaporizers
pressure relief devices
hypoxia prevention safety devices
common gas outlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

To figure out how much des is needed at higher altitude

A
  1. calculate partial pressure of des = % x barometic pressure at sea level -> 5% x 760 = 38
  2. calculate w/ the new barometric pressure = partial pressure agent / barometric pressure -> 38 / 500 = 7.6%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Urgent warfarin reversal emergency

A

prothrombin complex concentrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Fat/Blood coefficient order of inh anesthetics

A

Sevo (48) > iso (45) > des (27)
-needs to be considered at the end of the case to determine how long it will take to pull the gas from the fat into the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

vessel rich group/blood solubility coefficient for inh anesthetics

A

iso = sevo = des = 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

CNS/blood solubility coefficient

A

sevo (1.7) > iso (1.5) > des (1.3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Oil:gas solubility coefficient inh anesthestics

A

iso (90) > sevo (50) > DES (19)
-potency! -> b/c more hydrophobic, so needs less in CNS (b/c hydrophobic there)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

thermodilution cardiac output measurement effect if injectate solution is colder than programmed injectate temp

A

underestimate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

thermodilution cardiac output measurement effect if injectate volume is larger than programmed

A

understimate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Underestimation of thermodilution cardiac output

A
  1. larger volume of injectate than programmed
  2. colder temp of injectate volume than programmed
  3. large volume of fluid is administred during a reading
  4. self-measuring Ti probe is warmer than actual injectate temp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Overestimation of thermodilution cardiac output

A
  1. injectate bolus is smaller than programmed
    2.injectate temp is warmer than programed
  2. self measuring Ti probe is colder than actual injectate temp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

OR fire triad

A
  1. Ignition source: bovie, lasers
  2. oxidizing agent: O2, N2O
  3. fuel: prep, drapes, gowns, gauze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

To minimize the risk of airway fire, what changes can you make with your ETT?

A

Change it -> laser safe (non-PVC based) ETT
-fill ETT cuff w/ solution containing saline and methylene blue -> prevents ignition and allows easy identification of inadvertent damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What ultrasound-guided central venous cath is a compressible, and relatively low risk of infection, thrombosis, and PTX?

A

Axillary
-but higher risk of brachial plexus injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what part of the brachial plexus surrounds axillary artery

A

lateral, medial and posterior cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How does heliox work?

A

70-30 or 80-20 helium-oxygen
-helium has a lower density than nitrogen -> converts turbulant flow to laminar flow to increase the O2 that is being delivered to alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Reynolds number

A

Re = (density x velocity x diameter)/ viscosity
>4,000 -> flow is turbulent
< 2,300 -> flow is laminar
-so if you replace density of N w/ helium -> changes turbulent flow to laminar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Critical temperature

A

temperature above which a gas can no longer be converted to a liquid w/ increasing pressure alone
-ex: nitrous oxide exists in a gaseous state at standard temp and pressure -> when inc pressure and placed in E cylinder -> converted into liquid form as long as temp is less than 36.5 C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Relationship b/w resistance in airway and airway radius

A

R = 1/r ^ 4
-dec in airway radiance lead to exponential inc in airway resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Max dose of lido w and w/o epi

A

w/o: 4.5 mg/kg
w/ epi: 7 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

max dose of bupivacaine w and w/o epi

A

both: 2.5 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What determines local anesthetic potency

A

lipid solubility -> more solubility crosses membrane faster -> enhanced diffusion through n sheaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What determines local anesthetic time to onset

A

pKa -> determines ionized v unionzed form -> can only cross when unionized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What determines local anesthetic duration of action

A

protein binding
-highly protein bound will remain bound for longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What determines local anesthetic level of absorption

A

Location of injection
BICEPSS
IV (blood) > intercostal > caudal > epidural > brachial Plexus > Sciatic > subcutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Alveolar gas equation

A

used to calculated the partial pressure of oxygen in alveoli in lungs
PAO2 = FiO2 x (Patm - PH2O) - (PaCO2/RQ)
-used to determine PAO2 for A-a gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Normal A-a gradient

A

< 10
-higher indicates ventilation/perfusion issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Anesthesia dolorosa

A

pain is invoked a region that is denervated and should not have sensation at all
-pain referral phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

2 hrs after 2U of pRBCs, acutely febrile, hypoxic, chills, pink frothy airway secretions, CXR pulm infiltates

A

TRALI
-supportive care -> give O2, intubate if needed
-symp usually w/i 6 hrs of transfusion
**separates from acute hemolytic which would happen in MINUTES*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Cause of TRALI

A

Donor antibodies attack recipient neutrophils -> attack pulm vasculature -> pulm edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

blood transfusion after: HTN, dyspnea, tachycardia, CXR b/l infiltrates

A

TACO
-give diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Tx for organophosphate poisoning

A

atropine and pralidoxime (also does nicotinic receptors! w/i first 48 hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Dimercaprol

A

used for toxicity involving arsenic, mercury or gold
-tx for Wilson dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What hypersensitivity type of allergy is latex allergy?

A

Type I
IgE -> urticaria, bronchospasm, anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

difference b/w skin reactions in Type I and type IV hypersensitivty reactions

A

type I: hives, immediately occurs after exposure
type IV: delayed T-cell mediated, appears 1-4 days after contact -> appears like eczema w/ vesciles -> lichenified, dry, crusted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Type II hypersensitivity reaction

A

IgG or IgM antibodies formed against previously exposed anitgens
ex: Graves and myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Type III hypersentivity

A

Antigen IgG complexes -> deposited in tissues -> activation of complement cascade and inflammation
-ex: serum sickness, lupus nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What food allergies are assoc w/ latex allergy?

A

avocados, apple, bananas, buckwheat, carrot, celery, chestnut, kiwis, melon, papaya, peach, pineapple, tomatoes, and white potatoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Normal central venous pressure waveform

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

affect of a fib on CVP waveform

A

loss of a wave

94
Q

affect of AV dissociation on CVP waveform

A

cannon a waves

95
Q

effect of tricuspid regurge on CVP waveform

A

tall, fused c and v waves, loss of x descent

96
Q

effect of tricuspid stenosis on CVP waveform

A

tall a and v waves, minimal y descent

97
Q

RV ischemia on CVP waveform

A

tall a and v waves
steep x and y descents
“M or W” configuration

98
Q

pericardial constriction on CVP waveform

A

tall a and v waves
steep x an y descents
M or W configuration

99
Q

cardiac tamponade on CVP waveform

A

dominant x descent, minimal y

100
Q

Sacubitril

A

anti-HTN that acts by inh enzyme neprilysin (enzyme that breaks down ANP and BNP)

101
Q

Main receptors on plts

A

adenosine diphosphate (ADP)
thrombin
thromboxane A2 (TXA2)
glycoprotein IIb receptor (binds vWF)

102
Q

plt process after bound to damaged epithelial cell

A

once bound to damaged epithelial a change in shape happens ->alters receptors on surface so can be activated -> glycoprotein IIb/IIIa receptor is more prominent allowing binding of fibrinogen -> formation of bridge where other plts bind
-plts become negatively charged -> allowing factor V to bind (cofactor for thrombin)

103
Q

ASA MOA and duration

A

COX enzyme inhibitor
-COX allows conversion of arachidonic acid to PG -> TXA2 (vital for plt aggregation and vasoconstriction)
-irreversible, so plt lifespan 5-10 days

104
Q

Clopidogrel and prasugrel

A

thienopyridines -> plt receptor inhibitors
-selectively inhibit ADP-induced plt aggregation
-form a covalent bond to P2Y12 receptor -> unresponsive to ADP -> irreversible
*prodrug -> large amount of interpt variability

105
Q

Ticagrelor

A

cyclopentyl-triazolo-pryimidines
ADP analog -> P2Y12 receptor antagonist -> reversible block
-not a prodrug -> less inter-pt variability

106
Q

Cangrelor

A

Purinoreceptor anatogonist -> IV P2Y12 rec antagonist
-short 1/2 life and plasma clearance -> 70% plts normal after 1 hr stopping infusion

107
Q

Abciximab, Eptifibtaide, tirofiban

A

Glycoprotein IIb/IIIa antagonists
-used in acute MI where cath or PCI is planned
-monitored by plt aggregometry, no change in PT/PTT

108
Q

DAPT in drug eluding stent and elective surgery

A

6-12 months elective
3 months minimum if delaying would result in significant morbidity

109
Q

surgery after balloon angioplasty

A

surgery can occur 2 weeks after procedure
-do not need DAPT after, may benefit from antiplt for stroke or MI prevention

110
Q

Surgery post CABG

A

can have additional surgery as soon as they are healed, do not a specific amount of time, can proceed w/i 1 week if needed
-if can wait, allow time for a full recovery

111
Q

DAPT bare metal stents

A

at least 1 month

112
Q

late decelerations on OB

A

uteroplacental blood flow problem

113
Q

Intrauterine resuscitative efforts before c/s in nonemergent situations

A

L lateral decubitus positioning
Supplemental O2
turn off oxytocin
fluids/vasopressors if hypoTN

114
Q

Decrease the risk of hypoglycemia after TPN d/c

A

use lower glucose-to-lipid ratio TPN -> makes less insulin
start IV glucose after d/c w/ freq glucose checks
turn off IV insulin

115
Q

Refeeding syndrome

A

fluids and electrolyte issues (hypoPhos) after starting TPN w/ poor or no nutritional intake for > 72-96 hrs
*higher risk if low prealbumin <10)

116
Q

Static compliance

A

statis compl = TV/(plateau P - PEEP)
change in volume/change in pressure
elastic resistance

117
Q

Dynamic compliacen

A

continous measure of compliance as pt breaths
-elastic and airway resistance

118
Q

Massive Transfusion

A

Given at least 10 units of blood products w/i a 24 hour period

119
Q

When to give plts in MTP

A

if plts < 75,000
could be dilutional or DIC

120
Q

Cryoprecipitate contents

A

factor VIII, fibrinogen, vWF, and fibronectin

121
Q

Indications for cryo

A
  1. microvascular w/ fibrnogen < 80-100
  2. hemorrhage or massive transfusion w/ fibrniogen < 100-150
  3. ppx in hemophilia A and vWD
122
Q

The difference in success and injury b/w video-assisted laryngoscope compared to DL

A

VL has more seriously peri0intubation complications than DL
-no improvment in 1st pass success w/ DL
-higher rate of life-threatening complications w/ DL
-NO change in risk of pharyngeal injury

123
Q

Possible complications of mask ventilation

A

direct pressure trauma from improperly fitting mask
lifting pressure to mandible -> subluxation of TMJ

124
Q

Acid/base status of large amount of blood transfusions

A

Metabolic alkalosis -> citrate metabolized to bicarb

125
Q

what is citrate metabolized by

A

the liver

126
Q

no prior hx of HTN at 24 wks gestation, 145/95 then 1 week later 150/100, 24 hr urine shows 25 mg of protein, asymp, labs normal dx?

A

gestational HTN
-to meet preeclampsia dx proteinuria: >300 mg/24 hrs, protein-cr ratio > 0.3 or 1+ on urine dipstick

127
Q

Diff b/w preeclampsia w/ and w/o severe features

A

w/o: HTN + proteinuria
w/: HTN, proteinuria plus epigastric or RUQ pain, fetal growth restriction, BP > 160 or diastolic > 110, plts < 100, in Cr, inc LFTs, pulm edema, visual changes, neuro changes

128
Q

Anesthesia considerations for AVM repair

A

-hypoTN during actual embolization -> slow flow through AVM and prevent embolization of occlusive material
-can be done under MA or GA
-AC for 1st 24 hrs to prevent occlusion near embolization

129
Q

Normal perfusion pressure breakthrough

A

After AVM occlusion -> prev brain was max dilated b/c used to high flow low P system of AVM
-after closure -> normal perfusion pressure results in excessive CBF and hyperemia -> brain edema and hemorrhage

130
Q

Succ and neonate dosing

A

higher doses needed for inc volume of distribtuion -> but avoid succ when you can due to possibility of undx dystrophies

131
Q

mature v immature ACh receptors, how much longer is the immature open

A

10x inc in ion channel opening times

132
Q

How long does it take to start upregulation of immature fetal nicotinic ACh receptors in pts who are immobile?

A

w/i 72 hours

133
Q

The fastest way to reverse a suspected high spinal

A

CSF lavage: removal 20cc of CSF and replace w/ sterile normal saline or plasmalyte
**lipid emulsion doesn’t help, because it’s not LAST

134
Q

Hemophilia A

A

X-linked def factor VIII
-aPTT prolonged and PT is normal
-1st line tx: Desmopressin if minor, if active bleeding: Cryo

135
Q

Pt w/ hx of hemophilia A hx of prior MTP, what to give pt if large intraop blood loss refractory to cryoprecipitate

A

Recombinant factor VIIa and IIa
-pts who have a large amount of blood transfuionsn may get antibodies to exogenous human factor VIIIa
-tx: porcine factor VIII, recombinant factor VIIa, or recombinant factor IIa -> since VIIa is extrinsic pathway, and IIa is further down on both pathways

136
Q

Neonatal myasthenia gravis

A

20% of infants if moms have it
-if mom has 1st child w/ it, likelihoood of 2nd child having it are 75%
-Neostigmine can help w/ weakness prior to feeding
-symp should be gone by 4 weeks

137
Q

SVT in pregnant women tx?

A

Adenosine 1st line after attempting vagal maneuvers

138
Q

Best method of preoxygenation to prolong apnea time

A

breathing 100% O2 until EtO2 >90%
-usually 3-5 min of TV breathing 100% O2 at 10-12 L/min FGF

139
Q

Normal murmur v abnormal in preg

A

normal: systolic murmur grade 1 or 2 flow murmur
abnormal: diastolic murmur, or grade 3/4 systolic murmur

140
Q

Normal aortic valve area

A

3-4 cm^2
-symptoms usually start when valve area <1 and pressure gradient > 40

141
Q

aortic valve area and gradient in pregnant pts w/ high risk for CV complications

A

area < 1-1.5
gradient 25-50

142
Q

Which pts most likely to get arrhythmias while pregnant

A

congenital heart dx pts s/p fontan procedure

143
Q

P50 Hg curve

A

the O2 tension when SaO2 is 50%
normal: 27
L shift -> lower P50 valuve
R shift -> higher P50 value

144
Q

What causes an inc in 23DPG -> R shift of Hg curve

A

Thyroxine
Hyperphos
Anemia
Altitude sickness
CHF
liver cirrhosis
sleep apnea syndrome

145
Q

Stored RBCs and Hg curve

A

Decreased 2,3DPG, L shift

146
Q

Absolute CI to trach placement

A

operator inexperience
infants (esp w/ congenital anatomy issues tracheomalacia, tracheal stenosis)
insertion site infection
severe/uncontrolled coagulpathy
unstable cervical spine

147
Q

percutaneous tracheostomy

A

put a guidewire through small opening into trachea -> serial dilation -> tracheostomy tube over wire

148
Q

Most likely to attenuate some of the effects of radiation exposure

A

potassium iodide -> saturate the thyroid with this iodide so it doesn’t uptake the radioactive I
w/i 24 hrs of exposure

149
Q

How to decide who gets a TAVR

A

-if they have a high-risk medicial condition that they would not do well w/ surgical fix
-but must have a life expectancy of > 1 year where benefits of TAVR > risks
-must have symptomatic AS
-if low risk -> get surgical replacement

150
Q

How to handle symp epiglottitis in peds

A

Take to OR -> inhalation induction, no muscle relaxants -> perform intubation under GA

151
Q

Stage II in inhalational induction in adults

A

usually avoided w/ high conc of sevo that are being used to induce adult pts

152
Q

Plasma osmolarity

A

Osmolarity = (2xNa) + (glucose/18) + (BUN/2.8)

153
Q

What fluid will dec serum osmolality

A

Plasmalyte

154
Q

Why avoid lactated ringers in liver failure?

A

Lactate normally broken down to bicarb -> won’t happen in liver failure

155
Q

Retained epidural catheter tip pt asymp next step?

A

observation

156
Q

pt spontaneous muscle hematoma, no family hx of coag issues, PTT high, stays high after mixing study, plts and fibrinogen normal, dx?

A

Antibody inhibitor to a coagulation factor (MC acquired hemophilia A, inhibitor to factor VIII)
-assoc w/ Autoimmune d/o (type 1 DM, SLE, rheumatoid arthritis), malignancy, or recent birth
-the mixing study tells all the difference b/w if it was hemophilia A, she would have a family hx (less likely in women b/c X linked), and would be fixed by mixing study

157
Q

Prolonged bleeding time w/ epistaxis, menorrhagia, prolonged bleeding after dental extractions

A

vWD

158
Q

What causes more problems: aspirated roasted or unraosted peanuts?

A

Unroasted: the oils cause more pnuemonitis
-both bad b/c likely to crumble and cause more obstructions further down in tree

159
Q

End of diagnostic lap, inc EtCO2, pulse ox stable, airway pressure stable, dx?

A

Subcutaneous emphysema

160
Q

Abd compartment syndrome sacle

A

grade 1: P 10-15
2: 16-25
3: 26-35
4: > 35

161
Q

Dec PaCO2 by 1, what happens to CBF

A

Dec by 1-2 cc/100g/min

162
Q

A patient who has the capacity to understand the consequences to reject or accept medical tx is…

A

Autonomy
*informed consent is part of this

163
Q

Obligation of physicians to do good for their pts

A

Beneficence

164
Q

Physician Obligation to do no harm

A

Nonmaleficence

165
Q

A new treatment should be given equally across all societal groups, which doctor obligation?

A

Justice

166
Q

Inc Pulm Vascular Reistance

A

pain
hypothermia
acidosis
hypercarbia
nitrous oxide

167
Q

Anesthesia induction concerns w/ tetralogy of Fallot

A

prevent R -> L shunt
use katmine as an inducer to prevent dec of SVR -> if SVR < PVR => R to L shunt
-if you get hypoxia and hypoTN, put pressure on abd of raise legs to inc preoad and dec afterload

168
Q

When can you use neostigmine to reverse succinylcholine apnea

A

in a phase II block (in pt w/ abnormal pseudocholinesterase 60-120 min after dose)
TOF < 0.3 w/ fade
-use 0.3 mg/kg -> any larger will cause inhibition of pseudocholinesterase as well and succ won’t break down
**however, safest to confinut emechanical ventilation until muscle tone returns

169
Q

Dibucaine number

A

Determine if pseudocholinesterase def
-if low the natural enzyme is not inhibited by dibucaine -> abnormal
Normal: 70-80
Heterozygous: 50-60
Homozygous: 20-30

170
Q

Pulm Pathophysiology of Drowning

A

Hold breath voluntarily -> larygnospasm -> hypoxia to point of unable to hold laryngospasm -> aspiration
-pulm issues due to washout of surfactant -> V?W mismatch -> hypoxemia
*if you survive do not aspiration enough water to make a change in blood volume!

171
Q

MOA of NG on uterine smooth muscle

A

converted to nitric oxide -> diffuses to activate guanylyl cyclase -> inc cGMP -> sequestration of Calcium -> smooth m relaxation

172
Q

MOA of phosphodiesterase 5 inhibitors

A

potentiate the actions of nitrates -> prolongation of cGMP

173
Q

Which factors decrease during storage of FFP?

A

VIII and V -> why not helpful in treating hemophilia A

174
Q

Why cryo over FFP to tx hemophilia A

A

higher conc of factor VIII

175
Q

Why does FFP help w/ heparin resistance?

A

FFP containsf ATIII

176
Q

Stage II excitation in adult inhalation induction

A

Generally avoided b/c of the high conc of sevo used for induction of adults

177
Q

MEPs v SSEPs which better for detecting spinal cord ischemia?

A

MEPs -> SSEPs are slower response and have a higher false positive and false negative rate

178
Q

MEP changes that correlate to spinal cord ischemia

A

MEP ratio of adductor pollicis to anterior tibial reduction > 50% or latency dec > 10%

179
Q

Which do volatiles affect more MEPs or SSEPs

A

volatiles supress MEPs to a signifacntly greater degree

180
Q

During spine surgery, which nerve is most commonly monitored of ischemia?

A

tibial nerve

181
Q

Nociceptive afferent neurons

A

made of A delta and C fibers
-high threshold
-A delta: thinly myelinated, C: slow-conducting unmyelinated

182
Q

Metabolism of inhaled anesthetics

A

Des, iso, and sevo metab by cytochrome P450 2E1 into inorganic fluoride in kidneys and liver
Sevo&raquo_space; iso > des

183
Q

What is soda lime?

A

CO2 absorber
80% calcium hydroxide
15% water
4% sodium hydroxide
-> greater CO2 absorption than Ca hydroxide or barium hydroxide alone b/c of inc water content

184
Q

Desiccated CO2 absorbents w/ sevo and des

A

sevo produces most heat
des produces most CO

185
Q

Calcium hydroxide absorbents

A

lack strong bases -> offer less CO2 absorption
-but less risk of fire or compound A production

186
Q

Barium hydroxide absorbents

A

most likely to produce compound A and be assoc w/ fire production
-when combines w/ CO2 creates more heat than soda lime
why its removed from US market

187
Q

Ethyl violet

A

pH indicator used in CO2 absorbents which becomes purple when pH < 10.3 -> absorbent exhaustion

188
Q

2 hours after 2U pRBCs, desat to 88%, chills, pink forthy airway secretions, pulm infiltrates on CXR, dx? tx?

A

TRALI
supportive -> give O2, intubate if needed, ARDS protocol for vent

189
Q

MOA of nitrous oxide

A

noncompetitive inhibition of NMDA receptors 2
-analgesic: release of endogenous opioids or weak direct agonism

190
Q

Nitrous oxide hemodynamic changes

A

-may cause myocardial depression, but stimulations symp NS to inc systemic vascular resistsance and inc cardiac output
-dec TV, inc RR, no change on MV
-inc CBF and ICP

191
Q

What is the highest risk of inc the risk of postop A fib?

A

Hypovolemia -> b/c dec volume, dec O2 delivery, inc catecholamines -> inc risk
Hypervolemia -> inc atrial stretch, inc in atrial cell triggering

192
Q

Inc risk of postop A fib

A

male sex
hypo/hypervolemia
surgery type: inc risk in cardiac and major thoracic
hx of a fib
obesity
asthma/COPD
atrial injury
ischemia, inflammation
electrolyte disturbances
adv age
HTN
valvular dx

193
Q

fetus: what age is pulm system mature for adequate gas exchange?

A

24-26 weeks

194
Q

neonate: how long does it take for the fluid-filled alveoli to expand and become air filled?

A

5-10 minutes of life

195
Q

neonate: what initial negative intrathoracic pressure is required to expand alveoli?

A

40-60 cm H2O

196
Q

neonate: how long does it take to reach a normal RBC?

A

10-20 minutes of life
-inc in PaO2 and dec in PaCO2

197
Q

Morquio syndrome

A

Auto Rec lysosomal storage d/o
-short-trunk dwarfism, corneal deposits, normal intelligence, odontoid hypoplasisa w/ atlantoaxial instability
**risk of SC damage w/ DL

198
Q

What factor is protective against preeclampsia?

A

smoking

199
Q

ppx therapy for preeclampsia

A

low dose aspirin

200
Q

RF for preeclampsia

A

Antiphospholipid syndrome
prior preeclampsia
chronic HTN
DM
obesity
assisted reproductive techniques

201
Q

To maintain professional standing MOCA w/ ABA:

A

-maintain an active license to practice medicine in Canada or US
-Any restrictions on the license must be reported to ABA w/i 60 days

202
Q

Original purpose of developing ASA physical status classification system

A

comparison of anesthetic data

203
Q

Protective traits for peds preop anxiety

A

Enrollment in daycare
calm temperament
high number of siblings
-age >5 and not anxious parents help

204
Q

Inc risk of peds preop anxiety

A

parental divorce
age 1-5
hx of poor medical encounters
children of anxious parents
lower educational background of parents

205
Q

Primary adrenal insuff labs

A

hyperK, hypoNa, hypoglycemia, hyperCa

206
Q

What happens if you put iso in a sevo vaporizer?

A

iso has a higher saturated vapor pressure -> larger amt of it in gas form, so when FGF comes in, picks up more iso -> higher % than on dial

207
Q

RF for getting a vascular or cardiac perforation w/ removal of an ICD/PM lead

A

> 5 years since placement of ICD
female
BMI < 25 (lower BMI, female have smaller blood vessels)
ICD leads > PM leads (ICD leads larger so more scar tissue)

208
Q

Reasons an ICD/PM would be removed

A

recall
lead fracture causing malfunction or arrhythmias
infxn
thrombotic complication

209
Q

What passes easily across BBB?

A

lipophilic small molecules (O2, CO2)

210
Q

Timing of amniotic fluid embolism

A

during or w/i 30 minute sof labor, c/s, D&C or postpartum

211
Q

Symp of Amniotic fluid embolism

A

1st phase: severe pulm vasospasm -> R heart failure
2nd phase: LV failure, consumptive coagulopathy, pulm edema, R heart relaxes, uterine hypertonus -> fetal bradycardia and distress
-if pt non postpartum -> 911 c/s

212
Q

Renal changes w/ hypothermia

A

renal tubules dysfxn -> inc UOP -> cold diuresis

213
Q

Glucose and hypothermia

A

hyperglycemia -> dec insulin

214
Q

ABG in hypothermia

A

PaCO2 and PaO2 dec, pH inc

215
Q

CV hypothermia

A

low cardiac output and bradycardia
-inc risk for arrythmias
-defib ineffective if temp < 30
-SVR inc

216
Q

Best mapleson for spontaneous vent

A

most efficient FGF: A
AS expected: A for spontaneous

217
Q

Best mapleson for controlled vent

A

D
CD in alphabet: Controlled D

218
Q

worse pain w/ lumbar spine extension and axial rotation

A

facet arthropathy

219
Q

low back pain, worse on one side, can radiate to posterior buttock and thigh of affected side

A

Sacroiliac joint dysfxn
-hip flexion/abduction/external rotation, pelvis compression brings it out

220
Q

worsening pain and possible lower extremity weakness that is worse when walking down the hill

A

spinal stenosis
“shopping cart sign”

221
Q

What back issue is relieved w/ extension and worse w/ flexion

A

radiculopathy (herniated disc compressing nerve)

222
Q

painful, reproducible spasticity on palpation

A

muscle strain

223
Q

treatment of autoimmune thrombocytopenic purpura in pregnancy

A

caused by Ab to plts -> spleen eats them
-give steroids if plts < 50k in labor, <30k in pregnancy
-if no luck, IVIG

224
Q

Limit of plts for neuraxial/ catheter removal

A

80k

225
Q

toxicity of tacrolimus

A

nephrotoxicity

226
Q

toxicity of methotrexate

A

pulm, hepatic, thyroid, myelosuppression

227
Q

Lyte changes in acute small bowel obstruction w/ severe N/V

A

due to large amt of gastric fluid loss -> hypoNa, hypoK, hypovolemia
-met acidosis more common b/c of loss of luids -> lactic acidosis from tissue ischemia, dehydration, starvation, ketosis

228
Q

hemodynamic change sw/ severe abd obstruction

A

hypovolemic from severe N/V
dec FRC (abd distention) -> limiting downward movement -> inc if PaCO2 and dec PaO2
-impaired venous return (can’t get as neg intrathoracic pressure and direct vena cava compression)

229
Q

Cohort study

A

When exposure and outcomes occur before study begins
-if you look at PONV pts and see if they had exposure to multivitamins or not
-see if exposure plays a role in outcome of interest

230
Q

case-control study

A

pt selected w/ outcome as case gropu, w/o outcome as control group -> see what % has been exposed and not exposed
-usually used in rare dx or dx w/ long latent periods

In Training Exam TL (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions