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In Training Exam TL > ITE block 6 > Flashcards

ITE block 6 Flashcards

1
Q

Post MTP and QT shortening what eletrolyte issue?

A

HyperK

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2
Q

EKG changes in hypoCa

A

prolonged QT due to prolonged ST segment
reduced PR interval
T wave flattening and inversion

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3
Q
A

J waves
Caused by hypercalcemia and hypothermia

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4
Q

One of the highest risk of leading to malpractice claims in anesthesia

A

residual anesthetic agents in PACU -> significant hypoxia
*resp events are one of the main causes
-so is cardiovasc d/o in relation to anesthetic medication

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5
Q

Effects of acute normovolemic hemodilution

A

Take some of pts own blood and replace with saline
-Inc in HR -> inc in CO to compensate
-Dec in blood viscosity -> Peripheral vasodilation -> inc in regional blood flow
no increase in O2 delivery, just the same with less Hg

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6
Q

O2 content equation

A

CaO2 = (SaO2 x Hg x 1.34) + (PaO2 x 0.003)

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7
Q

Maximum dose of lidocaine w/ Epi 1:200,000

A

7 mg/kg
-dose used for regional anesthesia

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8
Q

Maximum dose of lidocaine w/ epi 1:1,000,000

A

This is the dose used in tumescent anesthesia
-for liposuction
-dose is 35-55 mg/kg !!
-max: 5L of fat removal

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9
Q

Dermatome for medial knee

A

L3

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10
Q

Dermatome for medial malleolus

A

L4

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11
Q

Dermatome for lateral malleolus

A

S1

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12
Q

Lumbar n root that causes flexion of the lower extremity at the hip

A

L1-L2

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13
Q

Lumbar n root that causes extension of the knee

A

L3 and L4

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14
Q

Lumbar n root that causes flexion of the knee

A

L5 (S1-2)

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15
Q

Early decelerations in OB caused by?

A

Head compression w/ contraction -> activation of vagal resp

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16
Q

Late decels in OB caused by

A

Uteroplacental insuff -> fetal hypoxia and acidosis

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17
Q

Variable decels in OB caused by

A

umbilical cord compression -> baroreceptor or chemoreceptor med vagal activation -> dec blood supply and transient hypoxemia

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18
Q

Relative contraindications to MAC

A

unable to lie still
unable to follow instructions
unable to communicate w/ care team

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19
Q

What stimulates carotid body chemoreceptors

A

arterial partial pressure of O2

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20
Q

what innervates the carotid body chemoreceptor

A

glossopharyngeal nerve
-activated when partial pressure of O2 < 60-65 -> augment ventilation

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21
Q

Causes an increase in SvO2

A

Cyanide tox, Met-Hg (dec O2 extraction)
Increased cardiac output
blood transfusion
Inc oxyHg saturation

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22
Q

Dec SvO2

A

Decreased cardiac output
Inc catabolic state -> sepsis, shivering, fever, pain
Anemia
Dec arterial O2 saturation (PNA, pulm edema)

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23
Q

Pt w/ concern for possible aspiration PNA, but hemodynamically stable what now?

A

If pt is reliable and able to follow instructions, can send home w/ outpt f/u
if not reliable -> keep admitted to monitor for fevers, labs, f/u CXRs

-can get initial decompensation at time of event or 4-6 hrs later
*it pt hasn’t developed PNA by 12-24 hrs unlikely, and only give abx if actually has PNA

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24
Q

Mitral regurge hemodynamic goals

A

Normal to inc HR
Dec PVR
Dec afterload
Normovolemia

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25
Q

aortic stenosis hemodynamic goals

A

inc preload
inc afterload
dec HR
**maintain diastolic pressure

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26
Q

Mitral stenosis hemodynamic goals

A

Dec HR
Inc preload
Normal afterload

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27
Q

HOCM hemodynamic goals

A

Inc preload -> lots of volume
inc afterload
HR down
contractility down

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28
Q

Most rapid form of cooling for post cardiac arrest hypothermia

A

endovascular cooling (put in a central line and cold things)

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29
Q

Post cardiac arrest hypothermia

A

Goal temp: 32-36 for 12-24 hrs
cooling: endovascular fastest
-ppl most likely to die if you rewarm too fast
-use meperidine to dec shivering and dec O2 demand

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30
Q

Leading cause of malpractice claims in the 2000s?

A

Death (29%)
Then n injruy, permanent brain damage and airway injuries

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31
Q

DKA lytes

A

HypoNa (dilutional, water pulled into extracellular space due to hyperglycemia)
hyperphos (insulin def, P shifted out of cells by acidosis) -> total body phos be decreased
hyperK (but total body deficit)
Hyperglcyemia
hyperosmolality
elevated ketones
Anionn gap acidosis

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32
Q

on arrival to ED pt w/ depression is hyperthermic, tachycardia, HTN, cleaning jaw, disinhibited what drug?

A

3,4-Methylenedioxymethamphetamine (MDMA) -> ecstasy
-jaw clenching possible serotonin syndrome

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33
Q

Flunitrazepam

A

Rohypnol aka the date rape drug
-benzo -> amnesia and muscle relaxation

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34
Q

When will retrograde cardioplegia be ineffective

A

persistent L SVC b/c solution will be lost to the upper extremity and head instead of coronary vasculature

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35
Q

Cuffed cricothryoidotomy

A

-larger possibility for trauma b/c scalpel and placement
-compression on airway while placing -> inc risk of damage or perforation of the posterior trachea wall
-but cuffed so no risk of aspiration
-attaches to anesthesia vent and can be used w/ low pressures

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36
Q

Needle cricothyroidotomy cannula

A

involves needle placement, wire, and dilation
-only allows inspiration through cannula, expiration done passively requiring open upper airway
-less likelihood of tracheal trauma, but inc risk of complications like PTX, malposition
-requires large pressure to get TV through small cannula

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37
Q

Why does nitrous oxide cause air space expansion

A

because it is more soluble than nitrogen -> enters the space faster than N can leave

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38
Q

Insulin response

A

glycogenesis
fatty acid synthesis
TG synthesis
glucose uptake
protein synthesis

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39
Q

PDA murmur

A

in the first few weeks of life is systolic ->becomes continuous later on

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40
Q

premature neonate w/ apnea, bradycardia, diff weaning from vent, systolic murmur, dx? tx?

A

Patent PDA -> systolic in first few weeks
if symp (diff vent weaning) -> get echo and then possibly indomethacin

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41
Q

Where does aerobic glycolysis produce the majority of its ATP

A

mitochondria!
-NOT cytoplasm :* -> anearobic in cytosol

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42
Q

Starting substrate for aerobic and anaerobic glycolysis

A

Glucose!

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43
Q

End products of aerobic metabolism

A

CO2 and H2O

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44
Q

end products of anaerobic metabolism

A

lactate

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45
Q

What is a univent tube

A

ETT with smaller lumen for bronchial blocker to pass through -> ETT have smaller internal diameters
-smallest have internal diameters of 3.5-4 designed for peds 6 or older -> w/ internal diameter of 3.5-4, external diamter is 7.5

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46
Q

Smallest double lumen tube

A

designed for kids 8+
26 Fr

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47
Q

insulin and glucagon mediated in hepatocytes by which secondary messenger?

A

cAMP
-glucagon inc cAMP
-insulin dec

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48
Q

cGMP

A

secondary messenger for NG, nitroprusside, nitric oxide, sildenafil

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49
Q

IP-3

A

secondary messenger in cardiac myocytes -> inc in cytoplasmic Ca ions -> inc in Ca activates ryanodine receptors on SR -> promotes Ca release

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50
Q

ICAM-1

A

intracellular adhesion molecule
-promotes adhesion of neutrophils, monocytes, T cells and B cells

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51
Q

Tx for Met-Hg in pts w/ G6PD def

A

Ascorbic acid
Vit C
-acts as electron donor to aid in reduction of Fe 3+ to Fe 2+
-slower than methylene blue, but can be used safely in G6PD

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52
Q

Amyl nitrite

A

used to tx cyanide toxicty by oxidizing Fe 2+ to 3+
-cyanide binds more readily to Met-Hg -> this induces it and hopefully binds up all the cyanide

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53
Q

Why does indigo carmine dye dec pulse ox?

A

b/c absorption closer to 600nm range -> falsely lowering saturation

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54
Q

sinusoidal patterns on FHR

A

assoc w/ placental abruption -> very ominous sign

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55
Q

When does a fetal heart rate tracing -> change in baseline FHR?

A

When you have an acceleration or deceleration that lasts longer than 10 minutes

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56
Q

Normal baseline fetal HR

A

110-160

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57
Q

Propofol elimination kinetics order and graphic representation

A

1st order
so on logarithmic graph, straight incline down
on linear graph, curve down

58
Q

HIPAA and email

A

compliant email: providers and pts include authentication, encryption, time-stamping and INFORMED CONSENT!

59
Q

What triggers nonshivering thermogenesis in neonates

A

norepinephrine, glucocorticoids, thyroxine

60
Q

What inhibits nonshivering thermogenesis in neonates

A

inhaled anesthetics and beta blockers

61
Q

Terminology related to drowning: distress

A

precursor to drowning: resp impaired from being in/under liquid

62
Q

Terminology related to drowning: active drowning

A

non-swimmer, unable to maintain airway above water

63
Q

Terminology related to drowning: passive drowning

A

loss of consciousness

64
Q

Terminology related to drowning: w/ or w/o ungoing health problems

A

what you’re seeing is related entirely to drowning or other ongoing health issues

65
Q

BISreadings and anesthesia

A

100: awake
80: light/mod sedation
60:GA, low probability of recall
40: deep hypnotic state
20: burst suppression
0: isoelectric EEG
target for GA: 40-60

66
Q

Anrep effect

A

inc in ventricular contractility following acute in afterload (Frank-sterling(

67
Q

Bainbridge reflex

A

R atrial stretch receptors
-Inc R sided filling pressure -> parasymp inhibition -> inc in HR
-so if lots of water flowing under the bridge overloaded, it’s going to inc how fast it lifts up the bridge -> inc in HR

68
Q

Bezold-Jarisch reflex

A

hypoTN, bradycardia, coronary artery dilatation in resp to noxious stimuli w/i LV wall sensed by chemo and mechanoreceptors

69
Q

Dec in Hr reflex w/ laryngospasm

A

Baroreceptor reflex
-transient inc in LV output 2/2 compression of thoracic aorta

70
Q

neuraxial v IV opioids

A

neuraxial may increase duration of 2nd stage of labor, but no inc in morbidity or mortality and no effect on c/s rates

71
Q

How does the body compensate quickly for inc ICP?

A

redistribution of blood in intracranial v to extracranial v
redistribution of CSF from brain to spinal column.

72
Q

Normal serum osmolality

A

275-295

73
Q

post neurosurg polyuria, plasma osmolality over 290

A

Diabetes insipidus
-def of ADH
-tx: DDAVP, isotonic fluids to maintain euvolemia

74
Q

post neurosurg, polyuria, dehydration, osmolality 250

A

cerebral salt wasting

75
Q

RF for postop cognitive delerium

A

lower education
older age
previous hx of CVA w/ no residual deficits

76
Q

Antecubital anatomy med -> lateral

A

median n ->ulnar v -> brachial artery

77
Q

Spica casting

A

lower chest to the calves -> if inadequate space b/w cast and lower chest or abd -> restrictive resp defect
-airway will be disconnected due to placement on board
-hips cast in flexed, externally rotated and abducted

78
Q

According to ASA physical exam MUST include

A

airway exam
lung auscultation
cardiovascular exam (no req auscultation)
vital signs

79
Q

RF for emergence delirium

A

ages 2-6
use of volatile anesthetic

80
Q

SE of methylergonovine

A

HTN
vasoconstriction
coronary vasospasm

81
Q

Misoprostol

A

used to ripen cervix and induce labor usually in low-resources areas (b/c doesn’t need to be refrigerated)
-not as effective as oxytocin

82
Q

What do you not have to disclose as part of a COI

A

personal relationships
paid expert testimony
travel grants
relationships w/ outside oragnizations

83
Q

Uteroplacental circulation

A

-Ovarian arteries supply up to 15% of uterine BF, rest uterine arteries
-uterus receives 20% of cardiac output at term
-terminal villi on FETAL side of placenta exchange gas, nutrients, and waste products
0primary villi form during 1st trimester
-umbilical arteries originate off fetal internal iliac arteries -> carry deoxygenated blood from fetus to placenta (paired arteries)
-single umbilical v carries oxygenated blood back to fetus

84
Q

Coagulation changes in pregnancy

A

Decreased fibrinolysis
Dec anticoagulations -> dec protein C and S
Dec plts (dilutional)
Inc D-dimer
inc thrombin-antithrombin complexes

85
Q

Goldenhar Syndrome

A

micrognathia, hypoplastici zygomatic arch, facial asymmetry, fascial hypoplasia
mod to severe congenital cardiac defects
resp problems
at risk for C1-2 subluxation
usually intellectually intact (15% not)
**possibility for pseudocholinesterase def*

86
Q

Limb-girdle muscular dystrophy

A

weakness in shoulders, hips, proximal muscles
-some ppl can have normal life, others severe dx
-likely to have cardiac issues -> arrhythmias, cardiomyopathies
-avoid succ and volatiles anesthetics

87
Q

Effect of dilute epi in bupi for epidural analgesia

A

causes a more profound motor block -> why is not used frequently
-possible reduction in uterine activity by beta agonism
-dec uterine and SC BF

88
Q

minimum local anesthetic concentration of epidural

A

measure of the potency of local anesthetics and is the median effective neuraxial conc of local anesthetic solution

89
Q

minimum local anesthetic concentration of epidural effect of adding epi to bupi

A

lowers it, because epi has some direct agonism in dorsal horn as well

90
Q

MOA of renin

A

converts angiotensinogen to ATI

91
Q

What triggers renin secretion

A

Dec in serum NaCl sensed by kidneys
Dec in BF sensed by kidney baroreceptors
activation of beta 1 receptors by NE

92
Q

AT II

A

acts directly on BV to cause vasoconstriction
acgts on kidneys to stimulate reabsorptin of water and NaCl
stimulates release of aldo from adrenal glands

93
Q

effect of lorazepam on pt satisfaction

A

NO EFFECT and prolongs extubation time -> why it’s not used

94
Q

Fentanyl premedication and postop pain control

A

-only use if pt has pain porior to surgery
-admin w/o pain -> sensitize pts ot pain -> postop hyperalgesia

95
Q

Concerns for down syndrome and ear tubes

A

Pt ha sa more narrow external auditory meatus -> procedures will take longer
tilt table instead o neck due to possible atlantoaxial instability
-worth it to put an LMA in b/c lots of issues, want to have hands free
-put the IV in

96
Q

Hepatic extraction ratio

A

extraction ratio = (mixed hepatic arterial-portal drug conc - hepatic v drug conc)/mixe dhepatic arterial-portal drug conversation

97
Q

How to tell if a drug clearance is dpt on BF or not

A

If a drug has high intrinsic clearance -> dept on blood flow (b/c more BF, can clear more drug) -> flow dependent

If drug has low intrinsic clearance -> not dpt on blood flow (b/c increased BF wouldn’t change anything) -> flow independent

98
Q

Commonly used drugs with high hepatic extraction ratio

A

FLOW DEPENDENT
Fentanyl
Ketamine
Meperidine
Bupivacaine
Diltiazem
Metoprolol
Morphone
Nifedipine
Propofol

99
Q

Commonly used drugs w/ low hepatic extraction ratio

A

FLOW INDEPENDENT
Diazepam
Methadone
Rocuronium
Alfentanil
Thiopental

100
Q

Ex of a laser-resistant ETT

A

dual cuffed tracheal tube
-nonflammable and laser resistance -> stainless steel shaft and 2 indpt cuffs in series

101
Q

How does methylene blue treat Met-Hg

A

Acts as an electron receptor for NADPH-methemoglobin reductase -> enhances enzyme -> reduction nof MetHg to Hg

102
Q

Oxygen delivery

A

cardiac output x CaO2

CaO2= (1.34 x Hg x SaO2) + (.0031 x PaO2)

103
Q

Thrombotic thrombocytopenic purpursa

A

Plt destruction d/o
-Def in vWF-cleaving protease activity (ADAMSTS13 def)
-FFP repeltes enzyme

**plasmapheresis may used to tx the acquired type, to remove antibodies that damages the enzyme

104
Q

Emergent reversal of warfarin

A

prothrombin compledx concentrate

(FFP if it isn’t available, but PCC is better!)

105
Q

Indications for FFP

A

-Coag d/o once whole body blood volume has been replaced
-Factor def when there isn’t isolated factor concentrate
-microvascular bleeding when PT, PTT, and INR elevated (2x normal)
-When giving heparin, but pt has dec ATIII (heparin resistasnce)
-Thrombotic thrombocytopenic purpura
-Urgent reversal of warfarin if PCC isn’t available

106
Q

What J do you shock a pt w/ in SVT for synchronixed cardiovesrion

A

50-100 J

107
Q

Tx of unstable SVT in a pt post heart transplant

A

synchronized cardioversion
-vagal carotid massage won’t work
-phenylephrine won’t dec it
-esmolol won’t really help in transplanted heart

108
Q

Ion movement during depol at NM

A

Na in
Ca in
K out

109
Q

Hydrostatic pressure

A

pressure exerted by blood plasma and interstitial fluid on capillary walls
(force that pushes fluid out of blood)
-hydrostatic P > oncotic pressure-> fluid leaks out into periphery

110
Q

Oncotic pressure

A

pressure exerted by proteins in blood plasma
(force that pushes fluid into blood)
-oncotic P > hydrostatic pressure -> fluid stakes in bllod

111
Q

Clinical findings of cardiogenic shock

A

Low cardiac output with JVD
vascular and pulm vascular congestion
peripheral vasoconstriction
cold extremities
poor urine output
AMS
hypoTN

112
Q

Which factor decreased in pregnancy?

A

Factor XI

113
Q

Factors for inc neuroblastoma survival

A

Dx < 18 months
extraabd tumors
low INHRG (international neuroblastoma risk group) score
good tumor resectability
primary tumor
no mets
small tumor
favorable tumor biology

114
Q

Dx of neuroblastsoma what lab test?

A

elevated urinary catecholamines

115
Q

Anesthetic concerns for neuroblastoma removal

A

-If catecholamine secreting -> alpha and beta blockade prior to surgery
-A line and central line
-euvolemia (pt is dehydrated from chronic symp activation)
-blood available and rapid transfuser
-good BP control esp during tumor manipulation

116
Q

Vaporizer output

A

1/4 for sevo
1/2 for iso
-If 100 mL/min of O2 inflow through sevo vaporizer -> 1/4 will be sevo -> 25 mL

117
Q

CVP tracing in relation to EKG

A
118
Q

Guillain-Barre and Na

A

often accompanied w/ SIADH in 50% of pts -> hypoNa

119
Q

GBS LP

A

inc protein, normal glucose and cell count

120
Q

Earliest indication of respiratory failure in GBS

A

spirometry! should be followed throughout hospitalization
-1/3 of pts have respiratory failure

121
Q

Autonomic symp and GBS

A

autonomic dysfunction
hypoTN, HTN, cardiac dysrhythmias, ileus

122
Q

Cushing syndrome

A

excess cortisol
-hirsuitism (minimics androgen hormones)
-elevated blood glucose
-inc protein breakdown -> moon facies, buffalo hump, abd weight gain
-mood changes
-thinning of extremities
-HTN
-hypoK

123
Q

signs of extrathoracic airway object

A

inspiratory stridor, drooling

124
Q

object has migrated to trachea/lower airways signs

A

asthmatoid wheeze
expiratory wheeze
audible slap w/ expiration
palpable thud over suprasternal notch

125
Q

What fluid at large doses can cause a coagulopathy

A

Hydroxyethyl startch

126
Q

What type of conversations b/w attorney and physician are privileged

A

oral, print, or electronic
as long as only intended for them to be the only parties

127
Q

13 YOM fever, sore throat, trismus, diff swallowing, normal voice dx? cause?

A

peritonsillar abscess
Group A beta-hemolytic Strep
abscess more common in older children and adults

128
Q

Anesthesia considerations for peritonsillar abscesses

A

if trismus:
inhalational induction -> keep breathing
-reassess airway after inhalational induction -> adequate mask vent and can open mouth okay -> give NMB and prop to intubate
if no trismus: RSI to avoid oral airway placement and risk rupture

129
Q

RF for failed neuraxial in OB

A

fast decision to incision interval
late labor epidural placement
maternal obesity

130
Q

terbutaline lyte changes

A

hypoK
hyperglycemia

131
Q

If ETT is unable to pass off fiberoptic, most likely cause?

A

tip impinged on R arytenoid cartilage

132
Q

Assist-control ventilation

A

has a set TV and RR
if pt not spontaneously breathing -> looks like VCV
if pt initiates -> delivers positive pressure w/ set TV
**be careful in pts w/ rapid resp rate -> auto PEEP and breath stacking

133
Q

Elevated DLCO

A

DLCO is a function of: diffusion rate and binding capacity

Asthma
Obesity
Cardiac Output
Polycythemia
Pulm vasodilation
L to R shunting

134
Q

Propofol v sevo for airway reflexes

A

propfol more likely to mitigate laryngospasm
sevo more likely to mitigate cough, spasmodic panting reflex

135
Q

MOCA questions per year

A

120 -> 30 max per quarter

136
Q

Allodynia

A

mild sensory stimulations elicit severe pain
-ordinarily non-noxious stimulus perceived as painful

137
Q

anesthesia dolorosa

A

pain in an area that lacks sensation (usually the face)
feared complication of radiofreq ablation for treatment of trigeminal neuralgia

138
Q

Pacemaker indications

A

sick sinus syndrome
congenital long QT syndrome
supraventricular tachycardias responsive to pacing and nothing else working
Heart block: Mobitz type II or type III
HF as part of resynchronization therapy
Dilated cardiomyopathy
HOCM
sinus node dysfxn w/ symp bradycardia

139
Q

anxious pt starts getting extremity numbness, cramping, why?

A

Hyperventilation -> hypocarbia -> resp alk -> functional hypoCa

140
Q

pt w/ placenta previa, what inc risk of PPH?

A

Prior hx of c/s -> inc risk of placenta accreta

In Training Exam TL (11 decks)

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