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1
Q

s/sx of hypocalcemia after parathyroidectomy

A
  1. perioral parathesias
  2. Retlessness
  3. Neuromusclar irritability (chvostek, trousseau, inspiratory stridor)
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2
Q

5 complications of RBP

A
  1. Hemorrhage
  2. Compromised ventilatory function
  3. Air embolism
  4. Damage to obturator nerve 2* retractos
  5. DVT
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3
Q

Pheochromocytoma

A
  1. Parosysmal HTN
  2. Diaphoresis
  3. Tachycarida
  4. Headache
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4
Q

What is MEN

A

Group of syndromes characterized by tumor formation in several endocrine organs

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5
Q

MEN1

A

Turmors in pancreas, pituitary gland, and parathyroid gland

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6
Q

MEN 2

A

Medulary thyroid carcinoma, pheochromocytoma, and hyperparathyroidsm or mutliple mucosal neuromas

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7
Q

Blood flow to the liver

A

70% portal vein 30 % hepatic artery

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8
Q

arterial buffer response

A

an increase in hepatic arterial flow in response to a decrease in portal blood flow 1. maintain hepatic o2 supply and 2. to maintain total hepatic blood flow, which is essential for clearance of many compounds

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9
Q

7 functions of liver

A
  1. storage and filtration of blood
  2. metabolic functions such as carbo, fat, and protein metabolism
  3. secretion of bile
  4. storage of vitamins
  5. blood coagulation
  6. storage of iron
  7. detoxification and excretion of drugs
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10
Q

Why is bile vomit usually alkaline?

A

Large amounts of alkaline phosphate are normally excreted in the bile. A three-fold or greater increase in alkaline phosphates is indicative of biliary tract obstruction

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11
Q

4 symptoms of pancreatitis

A
  1. dehydration
  2. hypocalcemia
  3. hyperglycemia
  4. ards
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12
Q

4 disease assoicated with thrombocytopenia

A
  1. chemotherapy or unrecognized cancer
  2. liver disease and splenomegaly
  3. DIC
  4. Pre-eclampsia
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13
Q

7 conditions that delay gastric emptying:

A
  1. obesity
  2. pregnancy
  3. opiods
  4. DM
  5. Trauma
  6. Pain
  7. Anxiety
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14
Q

Patients who benefit from antiemtics

A
  1. eye surgery pts
  2. GYN
  3. Obese pts
  4. History of vomiting
  5. ECSW lithotripsy
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15
Q

Droperiodol

A
  1. An antimetic (2* dopamine blockade)
  2. Produces extrapyramidal signs (2* dopamine blockade)
  3. may decrease Bp (2* weak alpha blockade)
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16
Q

treatment for droperidol induced EPS

A

Anticholinergic (benadryl or benztropine, cogentin)

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17
Q

metoclopramide:

A
  1. relaxes pyloric sphincter
  2. promotes gastric motility
  3. increase lower esophageal sphincter tone
  4. relaxes the small intestine
  5. has antiemetic actions
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18
Q

reglan is used to treat:

A
  1. diabetic gastroparesis
  2. reflux esophagitis
  3. pts at risk for aspiration pneumonitis
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19
Q

Drugs that increase gastric pH and decrease gastric volume ( H2 blockers)

A
  1. Tagamet
  2. Zantac
  3. Pepsid
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20
Q

Which drug decrease gastric volume and increase pH the most

A

ranitidine

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21
Q

4 effects of acidosis on CNS function

A
  1. depressed neuronal activity (coma)
  2. cerebral vasodilation ( increase CBF, and ICP)
  3. decrease cerebral perfusion pressure (cerebral ischemia)
  4. increase seizure threshold
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22
Q

4 causes of metabolic acidosis

A
  1. ketoacidosis
  2. lactic acidosis
  3. renal failure
  4. toxic dose of salicylates
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23
Q

plasma K increases approximately ____ for each ___ drop in pH

A

0.6 mEq/L for each 0.1 drop in pH

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24
Q

8 signs of hyponatremia

A
  1. arrhythmias
  2. hypotension
  3. pulmonary edema
  4. mental changes
  5. muscle cramps 6. weakness
  6. myoclonia
  7. edema
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25
3 factors that promote hypokalemia
1. alkalosis 2. insulin 3. beta 2 adrenergic stimulation
26
7 ways to treat hyperkalemia:
1. give calcium gluconate 2. give glucose/insulin 3. give sodium bicarbonate 4. give diuretics 5. give kayexalate 7. use HD 7. hyperventilate
27
Plasma K is decrease ___ for each ___ mmHG decrease in PaCO@
0.5 mEq/L for each 10 mmgHg decrease in PaCO2
28
What should be given to the hyperkalemic pt when ventricular dysrhythmias appear?
calcium
29
6 physiologic function that require Ca
1. action potentials in smooth and cardiac muscle 2. blood coagulation 3. bone formation 4. muscle contraction 5. membrane excitability (ca++ controls threshold) 6. neurotransmitter release)
30
A rapid decrease in plasma CA leads to
skeletal muscle spasm (laryngospasm) and tetany
31
9 s/sx of hypocalcemia:
1. numbness 2. circumoral paresthesia 3. confusion 4. seizures 5. hypotension 6. increased LV filling pressure 7. prolonged QT interval 8. Skeletal muscle weakness 9. Fatigue
32
Contracture of facial muscle with tapping monitors seen in hypocalcemia is
Chvostek's sign
33
ECG changes with hypocalcemia:
1. prolonged QT interval 2. Increased ST segment duration 3. Flat or inverted T waves
34
Functions of magnesium
1. functions as a cofactor in may enzyme pathways 2. regulates the Na K pump 3. regulates adenylate cyclase 4. regulates slow ca channels 5. Antagnoizes Ca 6. controls the threshold potential 7. regulation of the release of ach from nerve terminal
35
3 s/sx of hypermag
1. coma 2. hypoventilation 3. hypotension
36
the center for ____ ___ is located in the anterior (preoptic) hypothalamus and the ___ ___ center is located in the posterior hypothalamus
heat loss/ heat gain
37
Hypothermia is associated with:
1. increase SVR and myocardial depression 2. increase blood viscosity 3. left shift 4. impaired coagulation 5. thrombocytopenia 6. decreased drug elimination
38
8 physiologic effects of hypothermia
1. decrease O2 consumption 2. increase SVR 3. Cardiac dysth 4. Left shift 5. Coagulopathy 6. Increase blood viscosity 7. Impaired renal function 8. decreased drug metabolism
39
11 clinical manifestations of MH
1. hypercarbia 2. Tachycardia 3. Tachypnea 4. Hyperthermia 5. HTN 6. Cardiac dysrhythmias 7. Acidosis 8. Hyperkalemia 9. Skeletal muscle rigidity 10. myoglobinuria 11. Hypoxemia
40
3 stimuli for the release of renin
1. decrease renal perfusion pressure 2. hyponatremia 3. Sympathetic NS stimulation of beta-recptors in JG apparatus
41
In ketamine, dysphoria is caused by misperception and or misinterpretaion of auditory and visula stimuli by stimulating the ___ receptor, antagonizing the _____ receptor, and stimulating the ___ receptor
kappa, muscarinic, sigma
42
4 drugs that work on GABA
barbs, benzo, propofol, etomidate
43
CCB work in ventricular action potential? Pacemaker action potent ion?
Phase 2, Phase 4
44
Drugs to avoid with MAOI
tricylic antidepressants, opiods, indirect acting sympathmomimetics fluoxetine
45
5 adverse effects of mannitol
1. pulmonary edema and cardiac decompenstation 2. rebound increase ICP 3. Hypovolemia 4. Hyperkalemia 5. Hyponatremia
46
Why is morphine less protein bound in the neonate?
decrease alpha 1 acid glycoprotein
47
Where do agonist- antagonist opiods work?
Primarily on kappa receptors and also delta receptors
48
3 side effects of tricyclic antidepressants
1. anticholinergic effects 2. orthostatic hypotension 3. sedation
49
tricyclic antidepressants interact with
1. anticholinergics 2. sympathomimetics 3. inhaled anesthics 4. antihypertensives 5. opiods
50
5 adverse effects of mannitol administration
1. pulmonary edema and cardiac decompenstation 2. rebound increase ICP 3. hypovolemia 4. Hyperkalemia 5. Hyponatremia
51
Normal range for anion gap
9-15
52
Equation for anion gap
Na- Cl - HCO3
53
Anaphylactic reaction
Type 1 hypersensitivity reaction. Antibody IgE (immunoglobulin E) is produced in reponse to an antigen (foreign protein). Upon a second exposure to the antigen IgE on the surface of mast cells and basophils triggers the release of mediators including histamine. This causes bronchoconstriction, upper airway edema, vasodilation, increased capillary permeability, and uticardia.
54
Anaphylactoid recations
Do not involve IgE. Foreign substances directly stimulate the emptying of mast cells and basophils
55
TURP Syndrome and NA levels
``` 120 = restlessness and confusion 115= nasuea, somolence, ECG changes 110= seizures and coma with VT and VF ```
56
Nonelectrolyte solutions for TURP
glycine, sorbitol, mannitol
57
Cyanide toxicity
binds to cytochrome oxidase resulting in inhibition of oxidative phophorylation causing inhibition of cell respiration
58
lamber-eaton syndrom
disorder of neuromuscular transmission associated with carcinomas. Autoimmune disease in which immunoglobin G antibodies against voltage-gated sodium channels crossreact with calcium channels at the neuromuscular junction. The result is a decreased release of ach in response to nerve stimulation. Increase sensitive to NDMR and succ is seen
59
ankylosing spondylitis
familial disorder associated with histocompatibility antigen. Typically presents a low back pain associated with early morning stiffness in a young man. Assoicated with progressively restricted movement of the spine. Some patients develop arthritis of the hips and shoulders
60
clinical features of DI
Polyuria > 2-15 L/day Hypernatremia (plasma hyperosmolity) Dilute urine (osmolality <200 mOsm/kg)
61
s/sx of Di
polydipsia, polyuria, hypernatremia, hypovolemia, hypotension
62
diagnosis of SIADH
deceased plasma osmolaity 100-150
63
s/sx of addison's disease
hypotension, hyponatremia, hyperkalemia, hypoglycemia, hemoconcentration, skin pigmentation
64
s/sx cushing's disease
htn, hypokalemia, hyperlgycemia
65
4 reasons for difficulty breathing after thyroidectomy
laryngeal edema, bilateral cord paralysis, hematoma formation, hypocalcemia 2 hypoparathyroidsm
66
s/sx of intraop PE
hypotension, tachycardia, hypoxemia, decrease SpO2, bronchospams, hypocapnia, decrease ETCO2
67
3 signs of fat embolism during surgery
decrease ETCO2 and PaO2 and Increase PA pressure
68
s/sx of acute porphyria
acute abdominal pain, n &v, neurotoxicity ( confusion, SIAD, difficulty swalowing, HTN, tachycardia), sensory and motor neuropathies
69
6 hormones of the anterior pituitary (adenohypophysis)
ACTH, TSH, GH, Prolactin, LH, FSH
70
S/sx of grave's disease
intolerance to heat, increase sweating, mild to extreme weight loss, varying egrees of diarrhea, muscular weakness, nervousness, extreme fatigue, inability to sleep, tremor of the hand
71
drug of choice for treating hyperthyroid related ventricular dysrhythmias
beta antagonist
72
four causes of hypothyroidsm
subtotal lobectomy of thyroid, goiter, autoimmune disease(myxedema), radiation therapy of the thyroid
73
s/sx of hypothyroidsm
slow mental function, slow movements, dry skin, cold intolerance, depressed ventilatory responses, abnormal cardiac conductivity, renal disease
74
what regulates CA and phosphate
parathyroid
75
parathyroid hormone increase ca by
increase: absorption of ca from intestine reabsorption of ca from renal tubule reabsorption of ca from bone
76
complications of parathyroidecotmy
hypocalcemia, parathesias, muscle spasm, tetany, laryngospasm, bronchospasm, apnea, hematoma, airway compromise, pneumothorax
77
major postop concern after parathyroidecotmy
laryngospasm 2 hypocalcemia, bilateral recurrent laryngeal nerve damage, hematoma

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