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In Training Exam TL > ITE block 7 > Flashcards

ITE block 7 Flashcards

1
Q

Why do infants tolerate dehydration better than adults?

A

Greater total body water to body weight ratio
infants 70% and adults 60%
-10% fluid deficit would be severe dehydration in adults, mod in infants

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2
Q

Best way to assess dehydration in infants

A

weight!
the tachycardia, skin turgor, cap refill can change due to other factors

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3
Q

Signs of mild dehydration

A

Weight loss 5%
fluid deficit 50 cc/kg
normal skin turgor
flat anterior fontanelle
normal eyes
Urine <2 cc/kg/hr
urine specific gravity < 1.02

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4
Q

infant moderate dehydration

A

weight loss 10%
fluid deficit 100 cc/kg
decreased skin turgor
sunken anterior fontanelle
sunken eyes
dry mucous membranes
<1 cc/kg/hr urine
urine specific gravy 1.02-1.03

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5
Q

infant severe dehydratio

A

weight loss 15%
fluid deficit 150 cc/kg
greatly decreased skin turgor
markedly sunken anterior fontanelle
very dry mucous membranes
UOP <0.5 cc/kg/hr
urine specific gravy >1.030

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6
Q

Burn resuscitation

A

4 cc x %TBSA x kg
1st half given in first 8 hours
2nd half given in next 16 hours

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7
Q

Fluid rehydratio in severe dehydration in infants

A

emergency phase: 20-30 cc/kg isotonic fluid bolus
phase I: first 6-8 hrs: 25-50 cc/kg
phase 2: next 24 hours: remainder of deficit

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8
Q

ABA physical requirements to practice

A

no age or physical requirements
-if disability and safe workaround it’s okay
-on a case by case basis determined by practitioner and their employer if can be done safely

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9
Q

When to use blood cyanide levels

A

only as a confirmatory diagnostic
-not helpful acutely due to time it takes to process -> use co-oximetry, ABG/VBG, lactic acidosis, hx of Na nitroprusside use to dx and treat

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10
Q

Tx for cyanide toxicity

A

hydroxocobalamin
sodium thiosulfate
-b/c it causes inhibition of oxidative phosphorylation

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11
Q

Symp of cyanide toxicity

A

HA, confusion, dizziness, sz -> coma
HTN and tachycardia -> hypoTN, arrhythmia, AV block
flushing, cherry red appearence
abd pain, N/V
tachypnea -> bradypnea
pulm edema
cyanosis
renal failure
hepatic necrosis
rhabdo

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12
Q

Decelerations in Fetal heart tracing

A

HR decrease >15 bpm for max of 3 minutes

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13
Q

Variable decelerations when cat II v III?

A

if >15 bpm for < 3 minutes, for <50% of the contractions category II
if >50% of contractions -> category III -> intrauterine resuscitation -> L lateral position, IVF, maternal O2, or poss intra-amniotic infusion

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14
Q

Types of deceleration

A

VEAL CHOP
Variable: Cord compression
Early: Head compression
Accelerations: Okay
Late: Placental insuff

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15
Q

Prolonged decelerations

A

decelerations lasting 2-10 minutes -> severe uteroplacental insuff or umbilical cord compression

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16
Q

Achondroplasia considerations

A

-short stature
-foramen magnum stenosis -> likely to get brainstem compression dep on position
-avoid inc ICP (likely to have hydrocephalus + foramen magnum stenosis)
-choanal stenosis
-central apnea and OSA -> can lead to pulm HTN
-macroglossia, high arched palate
-spinal stenosis
-macrocephaly

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17
Q

Post ROSC what is the next step

A

12 lead EKG
-need baseline if doing hypothermia
-need baseline if going to do PCI

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18
Q

Gold standard for dx of MH

A

halothane and caffeine muscle contracture test

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19
Q

hypothermia causes intraop

A

Decreased wound healing
Increased myocardial O2 consumption (shivering)
clotting issues
inc infectio
risk of arrhythmia or ischemia

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20
Q

Why hypothermia post neuraxial

A

Impaired detection of cold
Vasodilation
Decreased threshold for shivering and vasoconstriction (lower temp required to initiate)
worse w/ higher dermatome

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21
Q

GA v GA and neuraxial hypothermia

A

GA + neuraxial -> worse hypothermia than GA alone
-Get redistribution from both, and lowering vasoconstriction
-Worse central recognition of hypothermia w/ both

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22
Q

Cirrhosis hemodynamic changes

A

portal HTN -> inc endogenous vasodilators (nitric oxide) -> sensed as volume depleted by kidneys -> inc renin and sodium retention
-vasodilation -> dec SVR -> dec afterload -> inc cardiac output -> inc mixed venous
-inc collaterals produced to avoid portal HTN -> AV collaterals bypass capillary beds -> inc mixed venous
-hyperdynamic cardiac (inc CO and dec SVR)
-inc blood shunted to intestinal system -> inc vasoactive intestinal peptide

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23
Q

Platypnea

A

hypoxia and dyspnea while sitting up, improved while laying flat
-due to inc shunting of blood through lungs
-assoc w/ hepatopulm syndrome

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24
Q

thromboangiitis obliterans

A

small blood vessels become inflamed and swollen -> blood vessels narrow and get blocked
-fingers/toes pale, red, blue, and cold w/ sudden severe pain

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25
Q

When to use a sympathetic block

A

Neuropathic pain (CRPS, DM, herpes zoster)
Visceral pain (cancer pain -> celiac block)
Vaso-occlusive dx -> helps relieve pain and improves circulation (CP from chronic angina, Raynauds, vasospasm, thromboangiitis obliterans)

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26
Q

Where are sympathetic NS cell bodies located?

A

T1-L2 in lateral horn

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27
Q

Stellate ganglion

A

C6-7
block used for pain in upper extremity/thorax
complications: Horner syndrome, tracheo/esophageal injury, PTX, RCLN injury

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28
Q

Celiac plexus

A

located by aorta and IVC at L1
used to block for abd cancers, usually posterior approach below 12th rib
complications: retroperitoneal hematoma, bleeding, chylothorax, PTX

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29
Q

Lumbar sympathetic chain

A

Anterior to L1-5
posterior approach
tx: neuropathic pain in lower limbs, phantom pain, visceral pain involving intestinal/urinary
compl: genitofemoral n injury, bleeding

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30
Q

ABG for pregnant woman

A

Ventilation changes occur w/i 1st 12 weeks -> 40% inc MV by 12 weeks
resp alk -> incompletely compensated w/ metabolic acidosis
pH 7.44/ PaCO2 30/ PaO2 105/ HCO3 21
O2 initially inc during 1st and 2nd trimester, by 3rd inc O2 counteracted by the inc O2 demand from fetus

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31
Q

Respiratory quotient

A

Amount of CO2 per unit O2 consumed to a specific energy substrate
0.8: mix of carbs and proteins
0.7: lipids
0.8: protein
1: Carbs
if pt having trouble weaning off vent -> give more lipids, lower CO2 production

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32
Q

Rapid shallow breathing index

A

RSBI = RR/ TV
<105: successful weaning predicted
>105: failure predicted

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33
Q

In ICU RSBI > 105, TPN due to ileus
how to improve chances of vent weaning?

A

Inc lipid concentration in TPN -> less CO2 produced than if more carbs or protein -> easier to wean b/c less inc in RR encouraged

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34
Q

Rf for metformin lactic acidosis

A

contrast dye
renal impairment
hepatic impairment
65 or older
hypoxic or volume-depleted
excessive alcohol**

tx: supportive, HD

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35
Q

What side ETT fits in a size 4 Unique LMA?

A

6.0

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36
Q

What size ETT fits in a size 4 Ambu LMA?

A

7.5

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37
Q

What size ETT fits in a size 4 ProSeal LMA?

A

5

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38
Q

What size ETT fits in a size 4 iGel LMA?

A

7

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39
Q

Pulmonary compliance equation

A

inverse of elastance
complication = Change in volume/ change in pleural pressure

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40
Q

2 most common causes for delay in ambulatory surgery center

A

pain
PONV

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41
Q

Best way to wean pt off vent if failed initial SBT

A

Daily SBTs w/ pressure support assistance (pressure support augmentation w/ pt initiation)
-progressive dec in pressure support

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42
Q

10 month old for uro procedure long face, high prominent forehead, wide nose, low-set ears, high arched clef palate, micrognathia, deep palmar creases, developmentl delay, systolic murmur? chromosomal abnormality?

A

Trisomy 8 w/ mosaicism
-may have renal issues, assoc w/ AML and MDS,
prenatal corpus callosum agenesis and ventriculomegaly are suggestive
-if you survive beyond first few weeks of life, likely have mosaicism

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43
Q

A few day old baby, microcephay, microphthalmia (small eyes), cleft lip, cardiac def, hypoplastic or absent riibs, polydactyly

A

Patau syndrome (mean surival 7 days)
Trisomy 13
**holoprosencephaly, cleft lip, absent ribs, polydactylyl)
-if you survive beyond first few weeks of life, likely have mosaicism

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44
Q

One week old baby, microcephaly, micrognathia, VSD/ASD, inguinal hernia, renal malformation, rocker bottom feet, clenched hand w/ overlapping fingers, intellectual disability

A

Edwards Syndrome
Trisomy 18 (mean surival 14 days)
VSD, rocker bottom feed, clenched hand w/ overlapping digits
-if you survive beyond first few weeks of life, likely have mosaicism

45
Q

peds single palmar crease, upslanting palpebral fissures, endocardial cushion defects, atlantoaxial instability and sleep apnea, dx?

A

Trisomy 21

46
Q

How much of a hospital pharmacy budget is anesthesia medication

A

10-13%

47
Q

What’s cheaper TIVA or inhaled anesthesia?

A

TIVA 10-100x more expensive
-meds, pumps, tumbing
-does not result in signicant PACU savings

48
Q

Cost of iso v sevo

A

sevo 10x more expensive
des 25x more

49
Q

MC cause of death in preeclampsia

A

Stroke
-93% hemorrhagic
-why we give meds to get BP <160 but by non more than 15-25%

50
Q

MC cause of maternal death in US

A

cardiac dx

51
Q

MC cause of maternal death worldwide

A

PPH

52
Q

Lab tests that indicate preeclampsia with severe features

A

-plts < 100
-Cr > 1.1
-doubling of Cr
-doubling of LFTs
-pulm edema
-cerebral/visual symp

53
Q

How is serotonin involved w/ nausea and vomiting

A

When toxic substances come into constant w/ enterochromaffin cells in gut walls -> release serotonin

54
Q

Chemoreceptor trigger zone, how nausea?

A

Outside of BBB -> direct action of drugs and toxins on CRTZ **doesn’t come in contact w/ bloodstream materials

55
Q

Carcinoid tumor symptoms

A

flushing, diarrhea, wheezing, abd cramping
**NO N/V

56
Q

What inhibits serotonin nausea?

A

GABA, vasoactive intestinal peptide, somatostatin

57
Q

Pacemaker nomenclature

A

I: Paced
II: Sensed
III: Resp to sensing
IV: rate modulation (O or R)
V: multisite pacing
PCR -> PaCeR

58
Q

What is pacemaker syndrome?

A

VVI
Ventricles are pacing w/o atrial coordiation -> loss of cardiac output

59
Q

Central line placement, what do after after manometry use?

A

Confirmed -> no further steps necessary, can dilate and place line

60
Q

Why RIJ over LIJ?

A

Direct route to heart
Higher apex of lung on L
Thoracic duct on L

61
Q

Difference b/w V-V and V-A ECMO

A

V-V is respiratory support -> native and artificial lung in series
V-A is cardiopulm support -> native and artifical lung in parallel
both drained through venous system, just about where it goes back
**in both native lungs can be completely or partially bypassed

62
Q

Flows for V-A ECMO

A

peds; 100 cc/kg/min
adults: 60 cc/kg/min

63
Q

Flows for V-V ECMO

A

peds: 120 cc/kg/min
adults: 60-80 cc/kg/min

64
Q

Advantage of centrifugal pumps over roller pumps

A

smaller priming volume
lack of gravity drainage
prolonged operation

65
Q

Disadvantage of centrifugal pumps

A

blood stagnation and heating (inc risk of thrombi)
cavitation (air bubbles)
hemolysis
- dec w/ modern changes

66
Q

Sympathetic innervation of heart

A

T1-T4
alpha 1: positive inotropy
beta 1: positive chronotropy, dromotropy (n conduction), lusitropy (relaxation), inotropy
beta 2: positive chronotropy > inotropy

67
Q

Dromotropy

A

Conduction of a nerve

68
Q

Sympathetic innervation T1-T4 of heart

A

n travel through b/l stellate ganglions
R stellate ganglion: effect on HR
L stellate ganglion: MAP and contractility -> block can be done to red risk of arrhythmias w/ long QT

69
Q

What matters w/ turbulent flow

A

Density -> why helium moves more

70
Q

What matters w/ laminar flow?

A

Viscosity

71
Q

Which medication increases sz duration

A

Etomidate

72
Q

Which meds have no effect on sz duration

A

Methohexital
Ketamine

73
Q

Dec sz duration in ECT

A

Propofol
Midazolam
Lidocaine
Volatiles

74
Q

What is given to prevent post sz myalgias from ECT?

A

peds: ketorolac
elderly: acetaminophen

75
Q

Contraindications to acute normovolemic hemodilution

A

Preop anemia
Active infxn
Cardiac hx (MI, uncontrolled HTN, aortic stenosis)
recent CVA
clinically significant kidney or liver dx

76
Q

Tx for cardiac embolism in pt after CABG

A

support hemodynamics
re-heparinize and go back on bypass

77
Q

Tx for protamine induced pulm HTN

A

milrinone
epi
NG

78
Q

How to tx vasoplegia coming off bypass

A

Vasopressin and methylene blue

79
Q

Which coronary artery is most susceptible to embolism post bypass

A

RCA

80
Q

Osmolality gap

A

Used to figure out if non-measured solutes impacting
OG = measured serum osmolality - calculated osmolality

**MC ethanol, ketones, lactate -> DM2 does NOT cause a gap, DKA does!

81
Q

Osmolality calculation

A

osmolality = (2 x Na) + (Glucose/18) + (BUN/2.8)

82
Q

Which is more liver specific AST or ALT?

A

ALT
AST is present in cardiac, skeletal m, brain, kidney, pancreas

83
Q

RF for postop hepatic dysfxn

A

1 type of surgery: more likely in cardiac

2nd: presence of acute or chronic hepatitis/cirrhosis
**asymp inc in < 2x AST is NOT

84
Q

Pulm pathophysiology of drowning

A

Surfactant washed out -> dec compliance and V/Q mismatch -> hypoxia

85
Q

How long after drowning process started irreversible brain damage?

A

LOC: 2 min
damage irreversible: 4-6 minutes

86
Q

Cardiac changes w/ drowning

A

Initially tachycardia to compensate for hypoxia -> more acidosis -> bradycardia -> PEA -> asystole

87
Q

O2 content

A

CaO2 = (hg x 1.34 x SaO2) + (.003 x PaO2)
SaO2: O2 saturation
PaO2: partial pressure of O2 mmHg (O2 dissolved in blood)

88
Q

What affects myocardial blood supply

A
  1. HR: supplies during diastole
  2. CPP = Aortic DP - LVEDP
  3. Coronary vascular resistance (inc w/ vasospasm or atherosclerosis)
  4. Hg: affects O2 content
89
Q

RF for infant postop apnea

A

<60 weeks post conception
hx of apnea or bradycardia
GA
regional w/ sedation
anemia

90
Q

protective factor against infantile postop apnea

A

small for gestational age

91
Q

RF for multi-drug resistant pathogens causing VAP

A

5 or more days in hospital
IV abx in 90 days
septic shock
ARDS or acute renal replacement therapy

92
Q

If concern for multi-drug resistant MAP what abx?

A

MRSA coverage + 2 anti-pseudomonal
(Vanc or Linezolid) + (Pip-tazo or penem or cephalosporins or aztrenoam) + (floxacin or gent or colistin)

93
Q

American Spinal Injury Association scoring system, what impairment is A

A

A: Complete cord injury w/ complete motor and sensory deficits in S4/5
B: Incomplete cord injury w/ sensation preserved below level of injury, intact S4 and S5
C: Incomplete cord injury w/ motor function preserved below level of injury, < 3 out of 5 motor strength in 1/2 major muscle groups
D: Incomplete cord injury w/ motor function preserved below level of injury, > 3 out of 5 motor strength in 1/2 major muscle groups
E: No evidence of cord injury w/ intact motor and sensory innervation

94
Q

Which lead alone has the highest sensitivity for myocardial ischemia?

A

V5

95
Q

Preferred intraop lead monitoring

A

II: biggest p wave
V4: sens for ischemia

96
Q

Carbamazepine MOA

A

Blocks sodium channels -> inhibit generation and propagation of action potentials

97
Q

Carbamazepine tx

A

tx: sz, trigeminal neuralgia, bipolar d/o, neuropathic pain

98
Q

Carbamazepine P450

A

P450 inducer -> inc metabolism of other antiepileptic drugs

99
Q

Carbamazepine toxicity

A

Cardiac: wide QRS, prolonged QT, vent arrhythmias, tachycardia, hypoTN
Neurologic: nystagmus, AMS, delirium
Anticholinergic: mydriasis, hyperthermia, flushing, dry mouth, urinary retention

100
Q

Superior way to dx brain death

A

Clinical exam is considered superior to all imaging when dx brain death
-ancillary studies can be used to support when prereqs for clinical exam can’t be met or when apnea test invalid due to chronic CO2 retainers (cerebral angio gold)

101
Q

When in a disaster planning, what is the first staff that is short-handed?

A

Nursing due to direct pt contact

102
Q

In a disaster which pts arrive at the hospital first?

A

Those that can bring themselves: minimally injured
2nd wave of very sick pts that require help w/ transportation

103
Q

Prep for mass casuality

A
  1. staffing: nurses run out 1st, getting ppl mentored for ICU coverage
  2. space: being able to make non ICU places have resources to cover ICU pts
  3. stuff: resources, must get enough stuff to have 72 hrs w/o help
  4. strategy:
104
Q

Palpable taut band w/ radiating pain

A

myofascial pain syndrome
-localized pain in single m or region w/ trigger pts
-can do dry needling or local anesthesia injxn

105
Q

Lean body weight

A

weight - adipose tissue
usually 80% of obese male, 70% of obese female

106
Q

What meds doses by lean body weight?

A

Induction Thiopental and prop, fent, remi, vec, roc, cistatracurium

107
Q

What meds dosed by total body weight?

A

Maintenance thiopental, prop, succ

108
Q

What molecules inactivated w/ pass through lungs?

A

Serotonin (98%)
Norepi (30%)
Bradykinin

109
Q

What intranasal meds are vasoconstrictors to prevent epistasxis with fiberoptic

A

oxymetazoline and phenylephrine

In Training Exam TL (11 decks)

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