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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
When to use washing of PRBCs?
IgA def
26
27
Bronchopulm dysplasia and RDS
RDS -> bronchopulm dysplasia
28
RF for bronchopulm dysplasia
neonates < 32 weeks O2 toxicity sepsis inflammation infxn barotrauma
29
Meds to avoid w/ hyperthyroidism
Things that stimulate the symp NS PANcuronium ketamine atropine ephedrine epi
30
Which NMB is degraded by pseudocholinesterase
succ mivacurium
31
Concerns for PPN, which pts won't tolerate
-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)
32
Absolute indications for TPN
Short bowel syndrome small bowel obstruction Active GI bleed pseudo-obstruction w/ intolerance to food -high output enter-cutaneous fistulas
33
Post anesthetic d/c scoring system
Vital Signs (stable BP and pulse w/i 20% of normal Activity level (gait steady) N/V Pain (tolerable or nah) Surgical site bleeding
34
Meds trigger acute intermittent porphyria
Ketamine Etomidate Barbs CCB Amiodarone estrogens metabolic stress (infxn, surgery0
35
Burn resuscitation
4 cc/kg x weight in kg x % TBSA over 24 hrs -1st half in8 hours
36
Post burn when to avoid succ
after 48 hours -avoid for 3 months post burn
37
Coagulation changes w/ burns
inc in fibronogen b/c acute phase reactant -> activation of plts and aggregation -> thrombocytopenia
38
Na and GBS
HypoNa -> can get SIADH post GBS
39
epidural opioids and gastric emptying in pregnancy
decreased when opioids used -no change if just local anesthesia
40
gastric emptying in pregnancy
normal in non-laboring pt, dec w/ labor
41
Klippel-Feil syndrome
fusion of cervical spine scoliosis strabismus heart and spine conditions likely
42
Beckwith-Wiedemann
hypoglycemia macroglossia organomealy omphalocele
43
high altitude pulm edema ppx
Nifedipine, PDE 5inh like sildenafil -prevents hypoxic pulm vasoconstriction
44
Static compliance of lungs
measured during periods of zero airflow: plateu pressure -so no change w/ bronchospasm -diff b/w plateau pressure and PEEP
45
Dynamic compliance
resistance to airflow through small airways of the lung -diff b/w peak pressure and plateau pressures
46
V-A v V-V ECMO
V-A: cardioresp suport V-V: resp failure
47
CVVHF how are solutes cleared
Convection hydrostatic pressure gradient that drives solutes and water across a semipermeable membrane into a filter -no dialysate
48
Ultrafiltration
movement of plasma water *NOT solute clearance
49
CVVHD solute transport mechanism
Diffusion solutes move across a semipermeable membrane down concentration gradient -facilitated by dialysate
50
spastic diplegia
MC form of cerebral palsy -isolated lower extremity spasticity -> not progressive
51
Spinobulbar muscular atrophy
progressive neurodeg d/o w/ degen of neurons in SC and brain stem
52
Hereditary spastic paraplegia
group of progressive neurodegen d/o that affect axons of neurons w/i corticospinal and bulbar tracts in SC
53
Goals of hypertrophic cardiomyopathy anesthesia
-reduced myocardial contractility -maintenance of SVR -inc preload and cardiac output why etomidate is a good choice
54
Acute v delayed hemolytic anemia intravasc or extravascular?
Acute: both intravascular and extravascular delayed: extravascular
55
What anatomic structure most responsible for regulation of temp in humans?
Hypothalamic nuclei
56
When u/s beam reaches interface of 2 tissues w/ diff acoustic impedance at angle of incidence of 90 deg, what happens?
Reflection -reflection = image, refraction is artifact -> occurs w/ acute angles
57
CO2 transported in blood in which forms?
dissolved CO2 bicarb carbamino compounds
58
What percentage of SC blood supply comes from anterior spinal artery?
75%
59
When do you get cannon A waves?
When an atria contracts against closed valve -> complete AV block
60
When do you have no a waves o nCVP?
a fib
61
When do you get a and v waves of equal size and sharp y descent with no c wave on CVP?
constrictive pericarditis -b/c stiff pericardium limits vent relaxation -> diastolic pressures in heart are elevated and equal
62
When do you get blunting of y wave and elevated a and v wave son CVP?
cardiac tamponade
63
Kussmaul sign
constrictive pericarditis during inspiration there is an inc in JVD
64
Morphine epidural onset time and duration
onset 30-60 minutes duration: 24 hours
65
fentanyl epidural onset time and duration
onset: 5-15 minutes duration: 2-3 hours
66
Reversal agent for dabigatran
Idarucizumab
67
Reversal for apixaban
Andexanet alfa
68
Which pts more likely to have anaphylactoid rxn or anaphylaxis to protamine
prev protamine exposure NPH insulin fish allergy vassectomy Type II rxn
69
What protamine reaction mediated by thromboxane A2
pulm HTN, systemic hypoTN, R heart failure -heparin-protamine complexes in pulm circulation -> release of thromboxane A2 Type III rxn
70
Protamine type I reaction
systemic hypoTN give pressors and slow admin due to histamine release
71
Tx for type III protamine rxn
stop protamine RV support w/ epi or milrinone
72
Above critical temp of a gas what happens
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
Above critical pressure what happens
prev incompressible liquids become compressible solubility characteristics of a liquid may change
74
PAO2 equation
PAO2 = (Patm - 47) x FiO2 - (PaCO2/.8)
75
Electromagnetic ray emission from the skin
Radiation MOST SIGNIFICANT source of heat loss from body
76
peribulbar v retrobulbar block: more reliable akinesia of the orbicularis oculi?
Peribulbar -b/c larger volume of local anesthetic -> greater distribution -if doing retrobular -> need supplemental facial n block
77
Which anesthestic gas most augments NMB?
DES DES DOES MORE with NMB esp aminosteroids like roc
78
where oxytocin made and released from?
made: supraoptic and paraventricular nuclei of hypothalamus released: posterior pituitary (same as vasopressin)
79
Neurophysins
inactive carrier proteins that bind oxytocin and vasopressin to transport it from hypothalamus to pituitary
80
Where is growth hormone synthesized?
Anterior pituitary
81
When do you see K complexes on EEG?
w/ sleep spindles -> stage 2 of non-REM sleep
82
Beta waves assoc w/?
wakefulness waves w/ > 12 Hz freq
83
When to check anti-factor Xa activity w/ rivaroxaban?
Altered GI anatomy morbid obesity potential drug-drug interactions concerns regarding drug regimen adherence morbid obesity
84
Bier block and bupivicaine
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
First line therapy for trigeminal neuralgia
Carbamazepine
86
Carbamazepine toxicity symp
cardiac: widening of QRS, prlonged QT, vent arrythmias, hypoTN Anticholinergic: hyperthermia, flushing, mydriasis nystagmus urinary retention
87
Behind the larynx b/w the epiglottis and cricoid cartilage
hypopharynx
88
region from soft palate to epiglottis
oropharynx
89
Morquio syndrome
lysosomal storage d/o short trunk dwarfism corneal deposits skeletal dysplasia -odontoid hypoplasia w/ atlantoaxial instability
90
What causes the most secretion of vasopressin?
hypoTN
91
w/ transsphenoidal pituitary surgery CO2 goals
hypercapnia to inc ICP to bring pituitary gland down into the sella
92
Acromegaly and art lines
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
Which hyperfxn pit adenoma MC?
prolacintoma more common in women 20:1
94
Tx for prolactinoma
Bromocriptine DA agonist
95
lumbar catheters and pituitary surgerys
lumbar intrathecal catheter may be placed preop to allow for better visualization of tumor by removing CSF or injecting contrast
96
post brain surgery hyperNa, polyuria w/ diluate and voluminous urine
diabetes insipidous tx: desmopressin
97
post brain surgery hypoNa, hypoosmolar serum, hyperosmolar urine, and euvolemic state
SIADH -fluid restriction!
98
Dantrolene dose for MH
2.5 mg/kg
99
obese kids v normal BMI kids: wheezing post op
obese kids have dec FRC and inc wheezing after GA
100
obese kids v normal BMI kids: propofol clearance
inc plasma clearance in obese children
101
Medical standard entity to practice anesthesia
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
BIS 80
light/mod sedation
103
BIS 60
GA, low probability of recall
104
BIS 40
deep hypnotic state
105
BIS 20
burst suppression
106
How long after injxn is peak plasma lidocaine conc after tumescent liposuction?
12-16 hrs
107
Max dose of epi for tumescent lipo?
0.07 mg/kg 1:1,000:000 conc
108
Max dose of lidocaine for tumescent lipo?
55 mg/kg 0.1% or 1 mg/cc
109
Pt on ticagrelor and ASA 6 month post DES and want to do spinal, when to hold each?
Ticagrelor 5-7 days prior ASA continue
110
dx of septic shock requires
lactate > 2 vasopressors to keep MAP > 65 despite adequate fluids
111
Lab changes after 6L NS
hyperchloremic metabolic acidosis -inc K -dilutional dec in Hct and albumin dec in bicarb
112
DLCO assoc w/improved outcomes in lung resection?
> 40%
113
FVC assoc w/improved outcomes in lung resection?
> 50%
114
FEV1 assoc w/ poor outcomes in lung resection?
< 30%
115
MVV assoc w/ poor outcomes in lung resection?
< 50%
116
RV/TLC assoc w/ poor outcomes in lung resection?
> 50%
117
vital capacity assoc w/ poor outcomes in lung resection?
< 2L
118
ABG values assoc w/ poor outcomes in lung resection?
PaO2 < 60 PaCO2 > 46
119
Req for a change in baseline of fetal HR
decel/accel 2-10 min prolonged change of baseline if they last > 10 minutes

In Training Exam TL (11 decks)

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