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In Training Exam TL > ITE block 9 > Flashcards

ITE block 9 Flashcards

1
Q

Leading cause of ASA malpractice claims in 2000s

A

Death

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2
Q

Alpha error

A

Type I error
Incorrect rejection of null hypothesis

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3
Q

Beta error

A

type II error
Maintaining null hypothesis when there is actually a difference

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4
Q

Controlled Substance Act Schedule I substances

A

high abuse potential, no medical use
Cannabis, LSD, MDMA

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5
Q

Controlled Substance Act Schedule II

A

high abuse potential, severe physcial or psychological depedence
ex: Topical cocaine, morphine, oxycodone, hydrocodone

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6
Q

Controlled Substance Act Schedule III

A

Less abuse than I, low to moderate physical dependance
ex: ketamine, buprenorphine, thiopental, codeine

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7
Q

Controlled Substance Act Schedule IV

A

limited physical or psych depedence
ex: benzos, phenobarbital, tramadol, methohexital, zolpidem

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8
Q

Controlled Substance Act Schedule V

A

limited pyshical or psych dept less than IV
antitussives or antidiarrheals ex: cough syrup w/ codeine

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9
Q

Osmolality equation

A

(2 x Na) + (Glucose/18) + BUN/2.8
gap > 10

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10
Q

What causes osmolar gap?

A

> 10
ethanol, methanol
sugars: mannitol and sorbitol
ketones
lactate

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11
Q

intrapulm percussive ventilator

A

high-flow, high-freq air jets to airway through mouthpiece

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12
Q

Difficulty weaning from vent, no other issues, how to change TPN?

A

Inc % of lipids -> lower RQ to dec CO2 production
0.7
versus .8 for protein, or 1 for carbs

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13
Q

Chronic change in bicarb for inc in PaCO2

A

1 PaCO2 = .4 bicarb
-add to normal bicarb of 24

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14
Q

Acute change in bicarb for inc in PaCO2

A

1 PaCO2 = .2 bicarb
-add to normal bicarb of 24

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15
Q

Statistical test for categorical values

A

Chi-square

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16
Q

Post CPB pt bleeding, but protamine used and normal ACT, tx?

A

Plts!
plts dysfxn post bypass due to activation/degranulation of plts during CPB

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17
Q

Lyte changes during pyloric stenosis

A

hypoK hypoCl met alkalosis

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18
Q

How to decide when to proceed w/ pyloric stenosis case?

A

Normalization of chloride shows best optimization

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19
Q

Baroreceptor reflex

A

dec BP sensed by stretch receptors in carotid sinus and aortic arch -> glossopharyneal n -> inc HR and vasoconstriction
**carotid sinus = baroreceptor

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20
Q

Chemoreceptor reflex

A

low partial pressure of O2 inc resp drive and red HR and contractility
**carotid body = chemoreceptor
-afferent: glossopharyngeal n

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21
Q

Normal cardiac output

A

~5-6 L/min

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22
Q

Locus ceruleus

A

communicates wakefulness

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23
Q

Best way to reduce risk of transfusion related immunomodulation

A

Leukocyte reduction

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24
Q

Best way to avoid G v H disease

A

irradiation

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25
Q

When to use washing of PRBCs?

A

IgA def

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26
Q
A
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27
Q

Bronchopulm dysplasia and RDS

A

RDS -> bronchopulm dysplasia

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28
Q

RF for bronchopulm dysplasia

A

neonates < 32 weeks
O2 toxicity
sepsis
inflammation
infxn
barotrauma

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29
Q

Meds to avoid w/ hyperthyroidism

A

Things that stimulate the symp NS
PANcuronium
ketamine
atropine
ephedrine
epi

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30
Q

Which NMB is degraded by pseudocholinesterase

A

succ
mivacurium

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31
Q

Concerns for PPN, which pts won’t tolerate

A

-solutions w/ osmolarity > 750 mOsm/L cant be given peripherally -> needs HIGH VOLUMES at lower osmolairty
-need to be careful in pts w/ CHF, ESRD, liver dx, burn pts (issue w/ peripheral IV)

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32
Q

Absolute indications for TPN

A

Short bowel syndrome
small bowel obstruction
Active GI bleed
pseudo-obstruction w/ intolerance to food
-high output enter-cutaneous fistulas

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33
Q

Post anesthetic d/c scoring system

A

Vital Signs (stable BP and pulse w/i 20% of normal
Activity level (gait steady)
N/V
Pain (tolerable or nah)
Surgical site bleeding

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34
Q

Meds trigger acute intermittent porphyria

A

Ketamine
Etomidate
Barbs
CCB
Amiodarone
estrogens
metabolic stress (infxn, surgery0

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35
Q

Burn resuscitation

A

4 cc/kg x weight in kg x % TBSA over 24 hrs
-1st half in8 hours

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36
Q

Post burn when to avoid succ

A

after 48 hours
-avoid for 3 months post burn

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37
Q

Coagulation changes w/ burns

A

inc in fibronogen b/c acute phase reactant -> activation of plts and aggregation -> thrombocytopenia

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38
Q

Na and GBS

A

HypoNa -> can get SIADH post GBS

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39
Q

epidural opioids and gastric emptying in pregnancy

A

decreased when opioids used
-no change if just local anesthesia

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40
Q

gastric emptying in pregnancy

A

normal in non-laboring pt, dec w/ labor

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41
Q

Klippel-Feil syndrome

A

fusion of cervical spine
scoliosis
strabismus
heart and spine conditions likely

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42
Q

Beckwith-Wiedemann

A

hypoglycemia
macroglossia
organomealy
omphalocele

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43
Q

high altitude pulm edema ppx

A

Nifedipine, PDE 5inh like sildenafil
-prevents hypoxic pulm vasoconstriction

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44
Q

Static compliance of lungs

A

measured during periods of zero airflow: plateu pressure
-so no change w/ bronchospasm
-diff b/w plateau pressure and PEEP

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45
Q

Dynamic compliance

A

resistance to airflow through small airways of the lung
-diff b/w peak pressure and plateau pressures

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46
Q

V-A v V-V ECMO

A

V-A: cardioresp suport
V-V: resp failure

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47
Q

CVVHF how are solutes cleared

A

Convection
hydrostatic pressure gradient that drives solutes and water across a semipermeable membrane into a filter
-no dialysate

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48
Q

Ultrafiltration

A

movement of plasma water *NOT solute clearance

49
Q

CVVHD solute transport mechanism

A

Diffusion
solutes move across a semipermeable membrane down concentration gradient
-facilitated by dialysate

50
Q

spastic diplegia

A

MC form of cerebral palsy
-isolated lower extremity spasticity -> not progressive

51
Q

Spinobulbar muscular atrophy

A

progressive neurodeg d/o w/ degen of neurons in SC and brain stem

52
Q

Hereditary spastic paraplegia

A

group of progressive neurodegen d/o that affect axons of neurons w/i corticospinal and bulbar tracts in SC

53
Q

Goals of hypertrophic cardiomyopathy anesthesia

A

-reduced myocardial contractility
-maintenance of SVR
-inc preload and cardiac output
why etomidate is a good choice

54
Q

Acute v delayed hemolytic anemia intravasc or extravascular?

A

Acute: both intravascular and extravascular
delayed: extravascular

55
Q

What anatomic structure most responsible for regulation of temp in humans?

A

Hypothalamic nuclei

56
Q

When u/s beam reaches interface of 2 tissues w/ diff acoustic impedance at angle of incidence of 90 deg, what happens?

A

Reflection
-reflection = image, refraction is artifact -> occurs w/ acute angles

57
Q

CO2 transported in blood in which forms?

A

dissolved CO2
bicarb
carbamino compounds

58
Q

What percentage of SC blood supply comes from anterior spinal artery?

A

75%

59
Q

When do you get cannon A waves?

A

When an atria contracts against closed valve -> complete AV block

60
Q

When do you have no a waves o nCVP?

A

a fib

61
Q

When do you get a and v waves of equal size and sharp y descent with no c wave on CVP?

A

constrictive pericarditis
-b/c stiff pericardium limits vent relaxation -> diastolic pressures in heart are elevated and equal

62
Q

When do you get blunting of y wave and elevated a and v wave son CVP?

A

cardiac tamponade

63
Q

Kussmaul sign

A

constrictive pericarditis
during inspiration there is an inc in JVD

64
Q

Morphine epidural onset time and duration

A

onset 30-60 minutes
duration: 24 hours

65
Q

fentanyl epidural onset time and duration

A

onset: 5-15 minutes
duration: 2-3 hours

66
Q

Reversal agent for dabigatran

A

Idarucizumab

67
Q

Reversal for apixaban

A

Andexanet alfa

68
Q

Which pts more likely to have anaphylactoid rxn or anaphylaxis to protamine

A

prev protamine exposure
NPH insulin
fish allergy
vassectomy
Type II rxn

69
Q

What protamine reaction mediated by thromboxane A2

A

pulm HTN, systemic hypoTN, R heart failure
-heparin-protamine complexes in pulm circulation -> release of thromboxane A2
Type III rxn

70
Q

Protamine type I reaction

A

systemic hypoTN
give pressors and slow admin
due to histamine release

71
Q

Tx for type III protamine rxn

A

stop protamine
RV support w/ epi or milrinone

72
Q

Above critical temp of a gas what happens

A

a substance can no longer be converted to a liquid no matter how much pressure is applied to it
-heat of vaporization is zero at this point b/c no diff b/w liquid and gas

73
Q

Above critical pressure what happens

A

prev incompressible liquids become compressible
solubility characteristics of a liquid may change

74
Q

PAO2 equation

A

PAO2 = (Patm - 47) x FiO2 - (PaCO2/.8)

75
Q

Electromagnetic ray emission from the skin

A

Radiation
MOST SIGNIFICANT source of heat loss from body

76
Q

peribulbar v retrobulbar block: more reliable akinesia of the orbicularis oculi?

A

Peribulbar
-b/c larger volume of local anesthetic -> greater distribution
-if doing retrobular -> need supplemental facial n block

77
Q

Which anesthestic gas most augments NMB?

A

DES
DES DOES MORE with NMB esp aminosteroids like roc

78
Q

where oxytocin made and released from?

A

made: supraoptic and paraventricular nuclei of hypothalamus
released: posterior pituitary
(same as vasopressin)

79
Q

Neurophysins

A

inactive carrier proteins that bind oxytocin and vasopressin to transport it from hypothalamus to pituitary

80
Q

Where is growth hormone synthesized?

A

Anterior pituitary

81
Q

When do you see K complexes on EEG?

A

w/ sleep spindles -> stage 2 of non-REM sleep

82
Q

Beta waves assoc w/?

A

wakefulness
waves w/ > 12 Hz freq

83
Q

When to check anti-factor Xa activity w/ rivaroxaban?

A

Altered GI anatomy
morbid obesity
potential drug-drug interactions
concerns regarding drug regimen adherence
morbid obesity

84
Q

Bier block and bupivicaine

A

Never use as LA for block b/c cardiotoxic and risk for cardiac arrest
-but can use to infiltrate surgical site to assist w/ postop analgesia prior to torniquet deflation

85
Q

First line therapy for trigeminal neuralgia

A

Carbamazepine

86
Q

Carbamazepine toxicity symp

A

cardiac: widening of QRS, prlonged QT, vent arrythmias, hypoTN
Anticholinergic: hyperthermia, flushing, mydriasis
nystagmus
urinary retention

87
Q

Behind the larynx b/w the epiglottis and cricoid cartilage

A

hypopharynx

88
Q

region from soft palate to epiglottis

A

oropharynx

89
Q

Morquio syndrome

A

lysosomal storage d/o
short trunk dwarfism
corneal deposits
skeletal dysplasia
-odontoid hypoplasia w/ atlantoaxial instability

90
Q

What causes the most secretion of vasopressin?

A

hypoTN

91
Q

w/ transsphenoidal pituitary surgery CO2 goals

A

hypercapnia to inc ICP to bring pituitary gland down into the sella

92
Q

Acromegaly and art lines

A

a radial artery line should be avoided if carpal tunnel present
-ligament hypertrophy causes ulnar a to become occluded -> reliant on radial, if flow compromised could lose blood flow to hand

93
Q

Which hyperfxn pit adenoma MC?

A

prolacintoma
more common in women 20:1

94
Q

Tx for prolactinoma

A

Bromocriptine
DA agonist

95
Q

lumbar catheters and pituitary surgerys

A

lumbar intrathecal catheter may be placed preop to allow for better visualization of tumor by removing CSF or injecting contrast

96
Q

post brain surgery hyperNa, polyuria w/ diluate and voluminous urine

A

diabetes insipidous
tx: desmopressin

97
Q

post brain surgery hypoNa, hypoosmolar serum, hyperosmolar urine, and euvolemic state

A

SIADH
-fluid restriction!

98
Q

Dantrolene dose for MH

A

2.5 mg/kg

99
Q

obese kids v normal BMI kids: wheezing post op

A

obese kids have dec FRC and inc wheezing after GA

100
Q

obese kids v normal BMI kids: propofol clearance

A

inc plasma clearance in obese children

101
Q

Medical standard entity to practice anesthesia

A

there is NO centralized standard or medical exam entity that indicates who is safe to practice anesthesia
-if practitioner has a possibly disabling condition, up pto provider to tailor practice

102
Q

BIS 80

A

light/mod sedation

103
Q

BIS 60

A

GA, low probability of recall

104
Q

BIS 40

A

deep hypnotic state

105
Q

BIS 20

A

burst suppression

106
Q

How long after injxn is peak plasma lidocaine conc after tumescent liposuction?

A

12-16 hrs

107
Q

Max dose of epi for tumescent lipo?

A

0.07 mg/kg
1:1,000:000 conc

108
Q

Max dose of lidocaine for tumescent lipo?

A

55 mg/kg
0.1% or 1 mg/cc

109
Q

Pt on ticagrelor and ASA 6 month post DES and want to do spinal, when to hold each?

A

Ticagrelor 5-7 days prior
ASA continue

110
Q

dx of septic shock requires

A

lactate > 2
vasopressors to keep MAP > 65 despite adequate fluids

111
Q

Lab changes after 6L NS

A

hyperchloremic metabolic acidosis
-inc K
-dilutional dec in Hct and albumin
dec in bicarb

112
Q

DLCO assoc w/improved outcomes in lung resection?

A

> 40%

113
Q

FVC assoc w/improved outcomes in lung resection?

A

> 50%

114
Q

FEV1 assoc w/ poor outcomes in lung resection?

A

< 30%

115
Q

MVV assoc w/ poor outcomes in lung resection?

A

< 50%

116
Q

RV/TLC assoc w/ poor outcomes in lung resection?

A

> 50%

117
Q

vital capacity assoc w/ poor outcomes in lung resection?

A

< 2L

118
Q

ABG values assoc w/ poor outcomes in lung resection?

A

PaO2 < 60
PaCO2 > 46

119
Q

Req for a change in baseline of fetal HR

A

decel/accel 2-10 min prolonged
change of baseline if they last > 10 minutes

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