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in training exam tl > ITE block 8 > Flashcards

ITE block 8 Flashcards

1
Q

RF for diff mask ventilation

A

BMI > 30
male gender
age over 55
no teeth
mallampati III or IV
beard
OSA/ hx of snoring

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2
Q

most significant source of radiation exposure for clinicians

A

Scatter radiation
(radiant energy scattered after contact w/ pt

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3
Q

most significant source of radiation exposure for patients

A

primary radiation
(direct beam)

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4
Q

Dosimeter

A

Quantification of radiation exposure at a specific site
(usually attached to lead aprons)

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5
Q

Recommendations from CDC to minimize radiation exposure

A

-use dosimeter (quantification of radiation exposure)
-wear lead
-inc distance from source (1/distance^2)
-dec exposure time

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6
Q

Hemodynamic changes in neg pressure pulm edema

A

Neg intrathrocic pressure -> inc v return to R heart -> inc pulm BF
-symp activation from hypoxia -> inc afterload
-inc pulm vascular resistance b/c of hypoxic pulm vasoconstriction

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7
Q

Statistical analysis

A
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8
Q

End-systolic pressure volume relationship

A

slope of the line indicates inotropy -> shift to L inotropy inc (inc contractility)
-as becomes flatter and to the R, contractility dec

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9
Q

Change in PV loop w/ diastolic dysfxn

A

PV loop compliance curve shifts up in initial diastolic dysfxn -> b/c heart can compensate to maintain volumes but requires inc pressure
-eventual dec in LVEDV and dec in SV

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10
Q

P-V loop stroke work

A

area under the curve

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11
Q

What does burst suppression look like on EEG?

A

alternating episodes of isoelectricity and active oscillations

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12
Q

EEG freq of 8 to 12 Hz

A

alpha waves -> relaxed and alert pt

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13
Q

EEG freq of 13 to 25

A

beta waves, arousable state of sedation

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14
Q

EEG freq of 13 to 25

A

beta waves, arousable state of sedation

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15
Q

Dantrolene dose for MH

A

2.5 mg/kg IV boluss

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16
Q

Intralipid dose for LAST

A

1.5 cc/kg IV bolus repeat 1-2 times, infusion .25 cc/kg/min

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17
Q

Get room MH ready

A

Remove vaporizers, flush machine w/o filters 1 hour of high flows, w/ filters 1.5 min before filters -> filters last 12 hours w/ FGF of at least 3

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18
Q

claims made malpractice insurance policies

A

Covers the provider if claim made during the year the insurance policy is active
ex: policy active in 2017, get sued in 2017 -> still covers if paid in 2018
-NEED tail coverage

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19
Q

Claims paid malpractice insurance policies

A

Cover claims that are paid during the year the policy is active

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20
Q

Occurrence malpractice insurance policies

A

Cover claims for the year the policy is active
ex: in 2018 you get sued for a case in 2015, but policy active in 2015, will cover

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21
Q

What’s in cryoprecipitate

A

fibrinogen (factor I)
factors VIII, XIII, vWF, fibronectin

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22
Q

Thrombotic thrombocytopenic purpura

A

microangiopathic hemolyic anemia, thrombocytopenia, and consumption of coag factors
-tx: plasmapheresis w/ donor FFP

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23
Q

When to use FFP

A

-TTP or hemolytic uremic syndrome
-mult coag factor def w/ microvascular bleeding, and -PT/PTT >1.5-2x normal
-urgent warfarin reversal
-correction of microvascular bledding during MTP
-tx of heparin resistance in pt req heparin
-single coag factor def when specific conc not available
-trauma-related or massive blood loss

**ideally not for hemophilia A -> too much volume, and cyro has more conc factor VIII

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24
Q

Goals for sickle cell anemia surgey

A

avoid hypoxia, manage pain, avoid hypothermia, avoid acidosis -> inc sickling
**can use a tourniquet!!

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25
Q

tourniquet and SCD

A

can use!

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26
Q

beta thalassemia

A

-dec beta, inc alpha -> inc in unbount globin changes -> accumulates in cell -> destruction -> inc risk of cardiomyopathy

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27
Q

Why induction of inh anesthetics faster in infants

A

greater fraction of cardiac output to vessel rich groups
-lower blood gas solubility in infants

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28
Q

co-oximeter

A

blood gas analyzer that measures conc of carboxyHg, oxyHg, deoxyHg, and metHg

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29
Q

Treatment of cyanide toxicity

A

hydroxocobalamin (B12)
-or amyl and Na nitrite to induce Met-Hg -> CI in carbon monoxide poisoning

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30
Q

Labs for pyloric stenosis

A

hypoCl, hypoK, hypoNa, met alkalosis

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31
Q

v-wave on CVP correlates w/ what on EKG?

A

end of T wave

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32
Q

Normal PaCO2 and EtCO2 difference

A

PaCO2 2-5 higher due to dead sapce

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33
Q

When would EtCO2 be higher than PaCO2

A

inspiring CO2 (rebreathing, incompetent expiratory valve)
exogenous admin (laparoscopic insuff)

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34
Q

When would the PaCO2 EtCO2 be larger than 2-5?

A

V/Q mismatch (airway/lung dx, dec cardiac ouput, PE)
-diff b/w alveolar CO2 and CO2 delivered to sampling line -> very high RR, may not reach upper airway (peds)
-Y pieces inc circuit dead space -> widens the gap

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35
Q

mechanism of carbon monoxide poisoning?

A

Disrupting oxidative phosphorylation

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36
Q

Induction of GA for preeclampsia emergent c/s

A

succ, prop, fast acting anit-HTN (nitroglycerin, esmolol, remifent)

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37
Q

Why do pts get preeclampsia

A

abnormal placentation regarding spiral arteries -> needs inc in BP to overcome inc peripheral vascular resistance

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38
Q

what teratogenic effect does ACEinh have on a fetus?

A

oligohydramnios

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39
Q

Treatment for polyhydramnios

A

Indomethacin

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40
Q

Antenatal Bartter Syndrome

A

defect in Na/K cotransporter in fetal kidney -> fetal polyuria and polyhydramnios

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41
Q

Twin-to-twin transfusion syndrome

A

BF from placenta is disproportionate b/c monochorionic twins
-1 twin gets more blood: polyhydramnios
-1 gets less: oligo

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42
Q

Donor Management Goals for donation after brain death:

A

-MAP 60-120
-CVP 4-12
-Na < 155
-pressors <1 or low dose
-PaO2/FiO2 > 300
-pH on ABG: 7.25-7.5
-Glucose < 150
-UOP .5-3 cc/kg/hr
-LV EF > 50%
-Hg > 10

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43
Q

Echothiophate

A

cholinesterase inhibitor used by optho to induce miosis
-if absorbed systemically can impair cholinesterase and inc duration of succ

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44
Q

oculocardiac reflex

A

afferent: ophthalmic branch of trigeminal n
efferent: vagus n

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45
Q

non-hemolytic febrile transfusion rxn

A

antibodies in recipient to donor leukocytes

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46
Q

MC transfusion related fatality

A

TRALI

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47
Q

Concern for acute hemolytic transfusion rxn, which labs?

A

Direct Coombs test
repeat crossmatching
serum haptoglobin, bilirubin
urine Hg levels

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48
Q

Timeframe for delayed hemolytic transfusion reaction

A

2-21 days
-suspect w/ acute drop in Hg

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49
Q

main RF for emergence delirium

A

age 2-6 yrs old
inh anesthetics: sevo and des

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50
Q

pain worse w/ spine flexion, coughs, sneezes

A

discogenic pain
-inc in intraabd pressure puts more pressure on disc

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51
Q

which inh gas most significantly augments NMB

A

DES!!
Des delays reversal of NMB
-more likely to occur w/ aminosteroids than benzylisoquinoline NMBDs

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52
Q

Max lose of tumescent lidocaine for liposuction

A

0.1% lidocaine 35-55 cc/kg
Epi 0.07 mg/kg or 1:1,000,000

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53
Q

Obturator n provides innervation where

A

medial aspect of the thigh
-motor innervation for adductor of lower limb

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54
Q

Alloimmunization

A

when you’ve had multiple blood transfusions and you’ve developed antibodies to prior antigens from prev blood transfusions
-inc risk of delayed hemolytic rxn

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55
Q

Intrapulmonary percussive ventilation

A

high freq (100-300 cycles/min) of high-flow jets of air to pts respiratory system
-helps loosen mucus and facilitates mobilization w/i airway

56
Q

Acapella device

A

exhalation through a handheld device that results in oscillations that aid in mucus clearance

57
Q

Mechanical insufflator-exsufflator

A

alternates positive and negative pressure to pts airway to stimulate a natural cough

58
Q

Symp of autonomic hyperreflexia

A

severe HTN and tachycardia
below lesion: vasoconstriction, piloerection, spastic m contraction, inc m tone
above lesion: vasodilation, mydriasis, face/neck flushing, diaphoresis
HA, dyspnea, blurred vision, N, CP

59
Q

Enzyme for rate-determining step in cholesterol synthesis

A

hydroxy-methylglutaryl-CoA reductase
statins inhibit enzyme

60
Q

management of acute MR after MI w/ pulm congestion and edema

A

-give vasodilator 1st: nitroprusside b/c vasodilation dec regurge flow and lowers afterload
-if contractility impaired and need inotrope -> use milrinone since it also causes vasodilation

61
Q

3 day hx of elevated troponins, TTE secure acute MR w/ anteriorly directed regurge jet, which vessel?

A

RCA
-posteriomedial papillary m rupture

62
Q

Difficult intubation predictors

A

overbite
can’t protrude manibular incisors anterior to maxillary incisors
inter-incisor distasnce < 3 cm
high arches or narrow palate
long upper incisors
thyromental distance < 3 finger breadth

63
Q

what is the subglycocalyceal layer

A

700-1000 cc b/w the vascular endothelial cells and the interstitial fluid space (separates intravasc from interstitial)
-fenestrations, protein poor, only water and lytes pass through
-lytes same as plasma

64
Q

What determines transcapillary flow?

A

plasma to subglycocalyceal layer colloid oncotic pressure gradient not plasma to interstitial fluid colloid pressure
***when expanding volume intraprocedure, crystalloid is 1.5:1 w/ colloids

65
Q

Hydralazine and ICP

A

inc ICP

66
Q

Hydralazine MOA

A

-direct alpha rec antagonist
direct arteriolar smooth m relaxant -> inc CGMP
-metab in liver
-duration of action 2-6 hours
**reflexive tachycardia

67
Q

metabolism of clevidipine

A

plasma esterases

68
Q

metabolism of esmolol

A

erythrocyte esterases

69
Q

Factors that decrease DLCO

A

sarcoid
asbestosis
berylliosis
O2 toxicity
COPD
anemia
pulm edema
fibrosis

70
Q

Inc risk w/ pulm resection assoc w/

A

DLCO < 40%
VC < 2L
FVC < 50% of predicted
FEV1 <30%
Maximal voluntary ventilation <50%
RV/TLC >50%
VC < 2L
VO2 Max < 10 mL/kg/min
ABG: PCO2 > 46, PO2 < 60

71
Q

Cardiac output equation if given O2 consumption, hg, and art O2 sat

A

CO = O2 consumption/arteriovenous difference
AV difference = 1.34 x 10 x Hg x (art O2 sat - mixed venous O2 sat)

72
Q

What causes pain in pancreatic cancer

A

-neuronal secretion of substasnce P and CGRP
-pressure on n from tumor growth

73
Q

Distal site to block saphenous n

A

around great saphneous vein
-superior and medial to medial malleolus and toward achilles tendon

74
Q

Where is posterior tibial n

A

behind medial malleolus

75
Q

Where is sural n

A

behind lateral malleolus

76
Q

Med to tx opioid-induced pruritis w/o affecting analgesia

A

Nalbuphine
-mixed opioid agonist/antagonist

77
Q

lipophilic more: fent or hydromorphone/morphine

A

fentanyl

78
Q

What is urinary 5-HIAA used to dx?

A

Carcinoid syndrome
5-hydroxy-indole-acetic-acid

79
Q

What valve issue is most likely to be assoc w/ carcinoid syndrome?

A

Tricuspid regurge

80
Q

What is urinary vanillylmandelic acid used to dx?

A

pheo and neuroblastoma

81
Q

What is urinary normetanephine used to dx?

A

pheo

82
Q

fever, neck stiffness, AMS

A

bacterial meningitis

83
Q

LP from bacterial meniingitis

A

inc WBC, inc protein, dec glucose

84
Q

Proper ppx for PONV

A

1-2 RF: 2 agents
3-4 RF: 3-4 agents

85
Q

MOA of carbonic anhydrase inh

A

blocks reabsorption of bicarb in PCT -> inc excretion in urine
-metabolic acidosis

86
Q

Goldenhar syndrome

A

oculo-auriculo-vertebral spectrum
-hemifacial microsomia, mandibular hypoplasia, epibulbar dermoid, vertebral anomalies

87
Q

Which opioid has the least amount of first=pass uptake and retention by lungs?

A

Morphone
**hydrophilic, lipophobic -> does not cross barrier easily

88
Q

Which opioid has the largest percentage of first pass uptake and retention by lungs?

A

Fentanyl -> highly lipophililc

89
Q

Critically ill pt extubsed w/ HFNC tarnsitioned to NC O2 sat 100%, day 4 she gets gait instability and a sz, w/ pulm edema and gets reintubated, why?

A

Hyperoxia
-ROS -> tracheobronchitis, pulm edema, ARDS, when PaO2 > 100
-ROS central tox: retinal damage, neuropathies, paralysis, sz

90
Q

Vasopressin and plts

A

mild dec in plt conc and inc in plt aggregation

91
Q

Vasopressin and pulm vasculature

A

no V1 receptors in lungs -> no change or causes pulm vasoconstriction

92
Q

Limb-girdle muscular dystrophy

A

-proximal weakness in shoulder and pelvic girdle
-cardiomyopathy and AV donuction defects -> short lie span
-large range of weakness and morbitidy, mortalities
-avoid succ and volatiles

93
Q

Why inc in SVR and MAP w/ abd insufflation

A

Vasopressin release
sympathetic d/c -> activation of renin-angiotensin-aldo

94
Q

WHich opioids have greater migration in CSF?

A

Most hydophilic opioids -> take longer to get taken up by blood -> spread further in CSF
-sufent and fent more lipophilic -> gets taken up by blood faster, so spreads less

95
Q

RF for transient neuro symptoms (pain in legs or butt after spinal anesthesia)

A

use of lidocaine
-lithotomy position w/ knee flexion
-adding phenyleprhine to .5% tetracaine
-outpt procedures

96
Q

Crouzon syndrome

A

premature closure of cranial sutures
-small uper mandible, airway narrowing
-prominent underbite
-developmental delay and intracranial HTN from premature closure

97
Q

Klippel-Feil Syndrome

A

lack of segmentation of cervical spine -> presents w/ fused cervical spine

98
Q

Pierre Robin

A

micgrognathia, glossoptosis (tongue falls into back of throat), cleft palate
-airway imrpves as child ages, intubating easier w/ age

99
Q

Treacher Collins

A

Auto Dom w/ variable penetrance
-zygoma and mandibular hypoplasia
-ear deforminty, deafness, mental retardation
-harder to intubate w/ older age

100
Q

Doubling of H+ ions, dec pH by what?

A

0.3

101
Q

Z test

A

determines whether or not the difference b/w the 2 proportions is significant
-ex: diff b/w man and women
-if calculated is higher than critical z score -> difference b/w groups

102
Q

Eisenmenger Syndrome

A

L to R cardiac shunt causes pulm HTN and eventaul reversal to R to L shunt

103
Q

Anesthetic goal of Eisenmenger syndrome

A

avoid a fall in arterial BP by maintaing cardiac output and SVR

104
Q

Pregnancy in Eisenmenger syndrome

A

Morbidity and mortality is 30-50%

105
Q

Bronchopulm dysplasia

A

if needing suppl O2 at > 28 days after birth
-assoc w/ subglottic stenosis
-obstructive lung dx!

106
Q

Tx of bronchopulm dysplasia

A

supplemental O2 and ventilation
diuretics
steroids
bronchodilators

107
Q

Vit K dpt factors

A

X, IX, VII, II
1972

108
Q

Which electrodes measure pH, PCO2, and PO2?

A

pH: Sanz
pCO2: Severinghaus
PO2: Clark
**longer names correspond w/ more letters*

109
Q

Acquired hemophilias

A

antibodies against clotting factors
more common in pts w/ AI condition, malignancy, or recent birth

110
Q

Why bradycardia w/ neonatal apnea?

A

hypoxic stimulation of the carotid body chemoreceptors

111
Q

Recently had TMP-S and now experiencing severe abd pain, numbness, paresthesias, weakness in extremities, N/V/ psychosis

A

acute intermittent porphyria

112
Q

Anesthetic triggers for acute intermittent porphyria

A

Ketamine
Etomidate
Barbiturates
Ketorolac
metabolic surgical stress

113
Q

Accumulation of delta-aminolevulinic acid in urine

A

Mutation in prophobilinogen deaminase
-Acute intermittent porphyria

114
Q

Porphobilinogen in urine

A

Acute intermittent porphyria

115
Q

Treatment for acute intermittent prophyria

A

Hemin and glucose -> dec activity of delta-aminolevulinate
-IVF, lyte repletion, pain management

116
Q

Predictors of hypoxia during one lung ventilation

A

normal or inc FEV1
High % of V/Q on operative lung
supine position
low partial pressure of O2 on 2 lung ventilation
R sidied thoractomy

117
Q

Myotonic dystrophy

A

slowly progressive m weakness, cataracts, endocrine distrubances, issues w/ cardioresp and GI

118
Q

MC symp w/ ondansetron

A

HA

119
Q

nitrous oxide washout

A

emergency -> washout can lead to hypocarbia and hypoxia

120
Q

NM d/o w/ no inc risk of MH but avoid succ anyway

A

Myotonic dystrophy

121
Q

Inc risk of MH NM mdx

A

King-Denborough dx
central core and multiminocore dx
nemaline rod myopathy

122
Q

Zones of hepatic acinus

A

organized based on proximity to portal triaid
-zone 1 closest
-zone 3 furthest, most sensitive to hypoxia

123
Q

QT shortening lyte change

A

HyperK

124
Q

QT prolongation lyte change

A

HypoCa

125
Q

Reduced PR interval lyte change

A

HypoCa

126
Q

Dx v severity of COPD

A

dx: FEV1/FVC
severity: FEV1

127
Q

If you have a wet tap, what layers did you just cross?

A

Dura mater and arachnoid mater

128
Q

Layer deep to meningeal layers that are punctured w/ a wet tap

A

Below L1: filum terminale (extension of pia mater after SC ends at conus medullaris)
above L1: pia mater

129
Q

Normal CVP

A

2-6 mmHg

130
Q

Normal PCWP

A

6-12 mmHg

131
Q

Normal Cardiac index

A

2.5-4 L/min/m^2

132
Q

Normal SVR

A

800-1200 dynes*sec/cm^5

133
Q

Type of pain that is poorly localized and described as achy or colicky

A

visceral pain: inflmmation or damage of internal organs

134
Q

pain well localized and sharp in nature

A

somatic pain: inflammation or dx in soft tissue or bone

135
Q

What is the major mechanism of solute clearance in CVVHF? continuous venovenous hemofiltration

A

Convection
-hydrostatic pressure gradient drives solutes and water across a semipermeable membrane into a filter compartment
-dialysate not used

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