Roam High-Yield Flashcards
(104 cards)
1
Q
What is in cryoprecipitate?
A
Fibrinogen
vWF
Factor VIII
Use in DIC!
2
Q
What test is used to monitor UFH therapy?
A
aPTT, intrinsic pathway
3
Q
MOA: Enoxaparin
A
Enoxaparin is low-molecular weight heparin (LMWH), enhances effect of antithrombin III (like UFH) but preferentially inhibits factor Xa
4
Q
Methemoglobinemia, signs and sx
A
chocolate brown blood
SpO2 85%
PaO2 normal to high (nl 75-100 mmHg)
Caused by nitrates/nitrites, metoclopramide, benzocaine, priloacine, abx - dapson, TMP
Tx with methylene blue
Tx with ascorbic acid in pts with G6PD-deficiency
5
Q
Electrolyte abnl in Conn Syndrome
A
Conn syndrome - hyperaldosteronism
Hypokalemic metabolic alkalosis
Causes HTN d/t sodium and water retention (+RAAS)
6
Q
Diabetic autonomic neuropathy, signs and sx
A
loss of HR variability
resting tachycardia
loss of awareness of hypoglycemia
dysrhythmia
gastroparesis
impaired ventilatory response to hypoxia, hypercapnia
7
Q
Median nerve, sensation and motor fxn
A
sensation to palm, 2nd and 3rd digits
motor for wrist flexion
8
Q
Long QT syndrome, culprit meds, RF for death, acute management
A
meds - cocaine, epinephrine, sevoflurane, ondansetron, amiodarone
RF - womyn, males with QT3, deafness, QT >500ms
widened T waves can cause torsades
Acute management - IV mag, potassium supplementation, calcium supplementation
Tx torsades - transvenous pacing, asynchronous defibrillation
9
Q
Circulatory shock parameters, treatment
A
Hypovolemic - decrease MAP, CO, CVP, SvO2; increase SVR; tx - volume
Obstructive - decrease MAP, CO, SvO2; increase CVP, SVR; tx - inotropes
Cardiogenic - decreases MAP, CO, SvO2; increase CVP, SVR; tx - inotropes
Distributive - decrease MAP, CVP, SVR; increase CO, SvO2; tx - vasopressors
10
Q
Test most predictive of postoperative pulmonary complications following thoracic surgery
A
ppoFEV1
11
Q
Most common complication from TAVR
A
complete heart block requiring pacemaker
12
Q
What is directly measured by oscillatory cuff pressures and what parameters are calculated?
A
Direct measurement - MAP
Calculated parameters - SBP, DBP
13
Q
Normal valvular changes during pregnancy
A
MR, TR, PR b/c of LV hypertrophy causing annulus diameter to increase
14
Q
Management of massive/submassive PE when anticoagulation contraindicated, ie: ICH
A
Catheter-directed clot aspiration
15
Q
What distinguishes TRALI from TACO
A
TACO has high brain natriuretic peptide levels
16
Q
What is Berlin criteria and what is it used for?
A
Assessment of severity of ARDS, based on PaO2/FiO2 ratio
- mild P/F 200-300
- moderate P/F 100-200
- severe P/F <100
17
Q
Which oral anticoagulant requires renal excretion?
A
Dabigatran (factor IIa inhibitor)
18
Q
How can dagibatran be reversed?
A
Hemodialysis
Idarucizumab
19
Q
Locations to monitor core body temp
A
pulmonary artery
tympanic membrane
nasopharynx
distal 1/3 of esophagus
20
Q
Describe ion flux at motor end-plate with binding AcH
A
Influx - Na, Ca
Efflux - K
21
Q
Risk factors for gastric bleeding caused by NSAIDs
A
hx of ulcers
H.Pylori infection
age >60
higher doses of NSAIDs
concomitant use of aspirin
22
Q
What determines duration of action for suxx?
A
level of plasma pseudocholinesterase available to metabolize suxx
23
Q
What is the MOA gabapentinoids?
A
Binding of alpha2delta subunit of voltage-gated calcium channels in the spinal cord and peripheral nerves.
24
Q
Risk factors for surgical site infection after cesarean delivery
A
- DM
- Obesity
- membrane rupture for >6 hours
- previous CS
- emergent CS
- anemia
- pre-existing infection
25
Criteria for preop exercise stress testing
* a preop risk calculator demonstrates \>1% risk of mortality from the procedure
* when the patient has a low or indeterminate functional status by hx
* when the results of testing will impact care
26
How to manage needing to intubate a patient within 24 hours of giving sugammadex
* if possible, us a nonsteroidal NMBD (benzylisoquinolium, ie: cisatracurium, atracurium, mivacurium)
* give 1.2mg/kg rocuronium (even within 5 min of sugammadex administration!)
* second reversal with high-dose sugammadex, ie: 8-20 mg/kg
27
Which opioids are metabolized via CYP2D6?
Codeine (prodrug, becomes morphine)
hydrocodone
oxycodone
\*avoid using any of these drugs in ultrarapid codeine metabolizers!
28
What are safe opioid alternatives to use in ultrarapid codeine metabolizers? Why?
* Fentanyl, Bupernorphine, Hydromorphone, MORPHINE, oxymorphone, methadone
* These opioids do not require CYP2Dc for metabolism
29
Which nerve and muscle is stimulated when monitoring NMB at big toe?
Posterior tibial; flexor hallucis brevis
30
True or false?
Pts with OSA tend to be more sensitive to the respiratory depressant effects of opioids.
True
31
What does the mnemonic STOP-BANG stand for? What is its significance in clinical care?
Snoring
Tired
Observed apnea while breathing
Pressure, known h/o HTN
BMI \>35
Age \>50
Neck circumference \>40cm
Gender, male
\>/=3 means increased r/o OSA
32
Which diuretic class can cause/exacerbate hypercalcemia?
Thiazides
33
Risk factors for development of postherpetic neuralgia
* Increasing age, elderly
* Limitation of physical activity d/t pain during prodromal phase
* Increased pain during infection phase
* Comorbid diseases like lung dz and DM
34
Which local anesthetic class is more allergenic? Why?
Aminoesters.
Metabolite p-aminobenzoic acid is allergen
35
What characteristic of local anesthetics increases speed of onset?
Dose (concentration)
36
Presenting s/sx biliary atresia
Usually occur within first few weeks of birth:
* persistent jaundice
* FTT
* pale stool
* dark urine
* coagulopathy unresponsive to vitamin K
37
Which intraop factor is most associated with increases risk of periop stroke?
Hypotension
* specifically, the duration of hypotension, defined as a reduction in BP \>30% of baseline)
38
Which valvular abnormality is a contraindication for IABP?
AORTIC REGURGITATION!
39
Describe why beta blockade should never be administered before alpha blockade
A nonselective beta blocker should NEVER be administered before alpha blockade because blockade of vasodilatory beta2 receptors results in UNOPPOSED alpha1 agonism, leading to vasoconstriction and HTN crises.
40
What is a vascular ring?
Branches of the aorta entrapping the trachea
41
Which eye muscle may be spared during a retrobulbar block? What is the function of this muscle?
Superior oblique muscle
Contraction causes abduction and internal rotation of globe
42
Which neonatal abdominal wall defect is associated with other congenital anomalies?
Omphalocele
43
Name risks of EPO therapy in pts with anemia of chronic dz d/t ESRD
* stroke
* MI
* VTE
* recurrence of cancer (!)
\*risks increase with elevated Hgb levels \>13, therefore target Hgb with EPO therapy is 10-11
44
Describe differences in ACLS for pregnancy
* Provide manual, continuous lateral uterine displacement of uterus to relieve mechanical obstruction of vena cava and aorta
* if no ROSC in 5 minutes, consider immediate hysterotomy (perimortem cesarean)
45
Which nerve is likely to be affected by deep cervical plexus block?
Phrenic nerve
46
Which abx class can exacerbate weakness in pts with myasthenia gravis?
Aminoglycosides
47
Which test is most useful for predicting post-pneumonectomy outcomes?
VO2max, via exercise testing
\*postop M&M risk low if VO2max \>20 mL/kg/min
48
When should chemoprophylaxis start after neurosurgery?
within 72 hours after end of procedure
49
Which lung cancer type is associated with hypercalcemia?
Squamous cell carcinoma, secretes parathyroid hormone related peptide
50
Which drugs should be avoided in patients with acute intermittent porphyria?
* BARBITURATES!
* thiopental
* methohexital
* etomidate
* ketamine
* ketorolac
* amiodarone
* calcium channel blockers
51
Name factors that increase pulmonary vascular resistance (PVR)
* Hypoxemia
* Hypercarbia
* Pain
* Acidosis
* Hypothermia
52
What does CREST stand for?
Calcinosis
Raynauds
Esophageal dysmotility
Sclerodactyly
Telangiectastias
53
Drugs implicated in serotonin syndrome
* Tryptophan
* Methylene blue
* Fentanyl
* Meperidine
* Tramadol
* Cocaine
54
Parameters that make PPV less reliable in assessing fluid responsiveness
* RV dysfunction
* non-sinus rhythm
* decreased lung compliance
* open chest
* increased intrabdominal pressure
* low TV
* spontaneous breathing
55
Calculate volume of RBCs (in mL) needed to raise Hct to desired level
vol of RBC = EBV x [ (Hct desired - Hct now) / 60
\*note: 60 comes from the vol of RBC in PRBC
56
Name a PGE1. What's it used for?
PGE1 = Alprostadil
Potent vasodilator keeps ductus arteriosus patent (used to maintain systemic blood flow in hypoplastic left heart syndrome)
57
Management goals for hypoplastic left heart syndrome
1. maintain PDA (use PGE1) for systemic circulation
2. balance Qp:Qs therefore maintain PVR
* keep FiO2 low (HPV)
* decrease MV (deliberate acidosis)
* increase intrathoracic pressure
58
What electrolyte abnormality occurs in pyloric stenosis?
Hypokalemic hypochloremic metabolic alkalosis
59
Why does Treacher Collins syndrome present a difficult airway?
* Mandibulofacial dysostosis
* Micrognathia (hypoplastic mandible)
* Microstomia (small mouth opening)
* DIFFICULT AIRWAY WORSENS WITH AGE!
* Malformed TMJ
* Glossoptosis (posterior motion of tongue during sleep, GA)
* Cleft palate
60
Whick pediatric syndromes have difficult airways that worsen with age?
* Treacher Collins
* Mucopolysacchardiosis (Hunter and Hurler Syndrome)
61
What is the congenital cause of gastroschisis?
Occlusion of omphalomesenteric artery
62
What is the congenital cause of omphalocele?
Failure of gut migration from the yolk sac into the abdomen; occurs through the umbilicus
63
Which factor places infants at greater risk for LAST compared to adults?
Reduced levels of alpha-1-acid glycoprotein (binding plasma protein)
64
PALS guidelines: ratio chest compression:ventilation
single-rescuer CPR: 30:2
two-rescuer CPR: 15:2
\*once an airway is secured, ventilation no longer synched to compressions, instead 8-10 bpm
65
Mnemonic for DiGeorge syndrome
CATCH-22
microdeletion syndrome d/t abnormality on chromosome 22
* Cardiac
* Abnormal facies
* Thymic aplasia
* Cleft palate
* Hypocalcemia/Hypoparathyroidism
66
Anesthetic objectives for pts with tetrology of fallot
* maintain preload
* maintain SVR
* avoid increases in PVR
67
General criteria for mandatory overnight admission post T&A
* age \<3
* h/o OSA (irrespective of age)
* significant comorbidities
68
Risk factors for postop apnea in formerly premature infants
#1 = preop anemia (Hct \<30%)
h/o apnea inversely related to GA and PCA
h/o apnea observed at home
69
Best peak effect and bioavailability based on administration type for midazolam
IV \> IM \> rectal \> oral
70
Electrolyte abnormality in Williams syndrome
Hypercalcemia
71
Risk factors for postop apnea in peds
* formerly premature with PCA \<60 weeks
* full term infant \<4 weeks old
* pre-existing apnea
* anemia
* comorbidites, esp CNS d/o
72
Peds dermatomal levels for caudals based on volume
1cc/kg LA = T10-S5
1.25cc/kg LA = T6-S5
73
Ultimate ventilatory strategy in neonates with congenital diaphragmatic hernia?
Low tidal volumes and permissive hypercapnia (60-65 mmHg)
74
Formula to estimate cETT size in peds
[Age / 4] + 4
ie: 4 yo
[4/4] + 4 = 5
75
Describe the anatomy of most common type of TEF
Type C; esophageal atresia (blind pouch) with distal fistula
76
Most common syndromes associated with Pierre-Robin sequence
Stickler
Treacher-Collins
Velocardialfacial
Fetal alcohol syndrome
77
Factors that effect placental transfer of drugs in utero
* Size (large molecules don't pass)
* Ionization (protonated drugs don't pass)
* Protein binding (highly protein bound don't pass)
* Binding specifically to alpha1-acid glycoprotein (AAG has higher binding affinity, therefore drugs bound to it don't readily transfer into placenta; albumin has lower binding affinity)
* Fraction of protein bound molecules (highly bound molecules don't pass)
* Placental efflux pumps (transfer molecules out of fetus into maternal circulation)
78
Medical disease with associated increased risk of pre-eclampsia
* Obesity
* cHTN
* DM
* CKD
* Antiphospholipid antibody
* SLE
79
Smoking and r/o pre-eclampsia
30-40% risk REDUCTION! WEIRD
\*mechanism may involve inhibition of thromboxane A2
80
Which uterotonic drug comes with increased r/o stroke?
methylergometriene
81
Name some tocolytics
* Mg sulfate
* Ethanol
* prostaglandin inhibitors
* calcium channel blockers
* beta 2 agonist - terbutaline, ritodrine
82
Side-effects of terbutaline, ritodrine
beta 2 agonist causing uterine relaxation (tocolysis), HoTN, bronchial dilation, HYPOKALEMIA, HYPERGLYCEMIA, pulmonary edema and tachycardia
83
Which coagulation factors increase, decrease and have no change during pregnancy?
INCREASE:
* **FIBRINOGEN \>FVII** \>\>\>\>\> VIII, IX, X, XII, vWF, plasminogen
DECREASE:
* XI, AT3, XIII, tPA, protein S
NO CHANGE:
* **protein C, FII, FV**
84
Describe pseudocholinesterase deficiency genotype and dibucaine number results
* Normal (no deficiency) = Dibucaine 80, nl response to suxx
* Atypical heterozygous = Dibucaine 50, prolonged response to suxx
* Atypical homozygous = Dibucaine 20, prolonged response to suxx \>4 hours
85
Risk factors for amniotic fluid embolism
* **cesarean delivery!**
* advanced maternal age
* placenta previa
* precipitous labor ("fast and furious")
86
Name pharmacologic interventions to relieve Tet spell in peds with TOF
* phenylephrine (increase SVR, decrease R to L shunt fraction)
* esmolol or propranolol (decrease RVOT obstruction by relaxing RV infundibular spasm, ultimately reduces R to L shunt))
87
Most sensitive sign of uterine rupture?
Fetal bradycardia
88
Match nerve root to muscle reflex test
C5 = biceps
C6 = brachioradialis
C7 = triceps
89
Describe LAST resuscitation
* **#1: secure airway (hypoxia and acidosis can worsen cardiovascular collapse)**
* intralipid emulsion bolus 1.5cc/kg then infxn 0.25cc/kg/min
* arrhythmia:
* reduce dose of epi (arrhythmogenic)
* **AVOID VASOPRESSIN (can cause pulm hemorrhage)**
* seizure:
* benzos are #1 drug choice
* if all else fails, start cardiac bypass
90
List highest to lowest risk of PTX for upper extremity blocks
Supraclavicular \> Infraclavicular \> Interscalene
91
Preventative measures for CRPS development
* Early mobilization following surgery, stroke, injury
* Physical therapy, OT
* Maintaining functionality of injured body part
* Vitamin C (in s/o fractures)
* SMOKING CESSATION
92
Prevention of Olney's lesions? Also, what the heck is Olney's lesions?
* Olney's lesions - neuronal necrosis caused by NMDA antagonists, ie: ketamine, memantine, amantide
* Co-administer with benzodiazepine (GABA protection) and clonidine (alpha2 agonist)
93
Greatest risk factors for phantom limb pain?
Presence of pre-amputation pain
94
Reversal agent for rivaroxaban and apixaban?
Andexanet alfa
95
List maintance anesthetics that potentiate NMBA duration from most to least
Desflurane \> Sevoflurane \> Isoflurane \>\>\> propofol
96
SOFA score components
* PaO2/FiO2
* Mechanical ventilation?
* plt ct
* GCS score
* bilirubin
* MAP/pressor req
* Cr
97
When to cancel elective surgery d/t HTN
SBP \>200 mmHg
DBP \> 115 mmHg
\*continue surgery once BP \<180/110
98
Which antibiotic classes potentiate NMB action?
* Aminoglycosides (gentamicin)
* Lincosamides (clindamycin)
* Polymyxins
99
Initial sign of impending hypotension in kids
Narrowing pulse pressure
100
Which benzodiazepine has pharmacokinetics NOT affected by renal dfxn?
Lorazepam
\*also not affected by obesity!
101
What is the most significant clinical predictor of failed mask ventilation?
Neck radiation changes
102
Name independent predictors of failed mask ventilation
* #1: neck radiation changes
* male
* OSA
* mall 3 or 4
* beard
103
Gold standard test for brain death dx
4-vessel cerebral angiography
104
Absolute contraindication for IABP placement
Aortic regurgitation
