TL part 2 Flashcards
(204 cards)
1
Q
FHR: >15 bpm decel >30 s after uterine contraction
A
late deceleration: placental insufficiency
2
Q
FHR: normal variability
A
5-25 bpm
3
Q
85% of the population have [left/right] dominant circulation
A
right; PDA and AV node supplied by RCA
4
Q
define grand multiparity
A
> 5 live or still at W20+
5
Q
major concern during off-pump CABG
A
distal anastomosis of grafts to diseased arteries
6
Q
most comprehensive TEE view for wall motion abnormalities
A
short axis transgastric view
7
Q
two categories of obstructive shock
A
pulmonary vascular and mechanical
8
Q
mechanism of local visceral pain from pancreatic adenocarcinoma
A
release of substance P and calcitonin gene-related peptide from vagal afferent neurons
9
Q
relationship between intraop oliguria and postop AKI
A
no correlation
10
Q
occipital horn syndrome is characterized by a deficiency in what
A
biliary copper excretion; enteral cells accumulate copper
11
Q
PCV vs VCV: higher mean airway pressure
A
PCV
12
Q
PCV vs VCV: higher plateau pressure
A
VCV
13
Q
PCV vs VCV: constant inspiratory pressure
A
PCV
14
Q
PCV vs VCV: constant inspiratory flow
A
VCV
15
Q
consideration for young female receiving platelet transfusion
A
Rh typing
16
Q
periop immunosuppression during renal transplant (2)
A
methylprednisolone and thymoglobulin
17
Q
most common cardiac defect associated with omphalocele
A
septal defects (VSD); up to 80%
18
Q
most common lung pathology in drowning
A
pulmonary edema
19
Q
umbilical [artery/vein] better represents the acid/base status of the fetus
A
vein
20
Q
polycythemia is defined as a hemocrit > …%
A
54%; increased risk of perioperative mortality
21
Q
T/F: congenital muscular dystrophy patients have an increased risk of rhabdo and cardiac arrest due to MH
A
false; increased risk is true but not attributed to MH
22
Q
gastroschisis is formed by occlusion of which vessel
A
omphalomesenteric artery
23
Q
following donor hepatectomy when does INR peak
A
postop day 2; normal by day 5
24
Q
T/F functional residual capacity cannot be determined by spirometry
A
true
25
centrifugal vs roller pump: air embolism
vapor-lock the centrifugal pump; roller pump will propel air embolism
26
timing of diagnosis for peripartum cardiomyopathy
last month of pregnancy up to 5 months after delivery
27
best type of anesthesia for AV fistula creation to minimize vasospasm
brachial plexus block
28
optimal flow in AV fistula
600 mL/min
29
2 primary etiology for hypocalcemia in ESRD
elevated phosphorus complexing with ionized Ca and decreased 1,25 vitamin D
30
albumin levels in ESRD
low; decreased synthesis and increased catabolism
31
sympathetic ganglion innervating the pelvic organs
superior hypogastric plexus
32
anatomical landmark for superior hypogastric plexus
anterior L5 caudal to aortic bifurcation
33
ganglion impar plexus rests anterior to which structure
sacrococcygeal ligament
34
first line treatment for congenital myasthenic syndrome
AChEi
35
mechanism of 4-diaminopyridine
increases amount of ACh released in the synaptic cleft
36
the hepatic arterial buffer system is regulated by what substance
adenosine
37
T/F caudal epidural provide relief for only stage 1 of labor
false; stages 1 (cervical dilation) and 2 (expulsion)
38
pretreatment with what 2 drugs can help mitigate the symptoms of febrile transfusion reaction
acetaminophen and diphenhydramine
39
mechanism for decreased O2 delivery in hypophosphatemia
decreased 2,3-DPG and left-shift of disassociation curve
40
half-life of bivalirudin
30 minutes via spontaneous proteolytic cleavage
41
describe the carotid baroreceptor reflex
increased in BP leads to increased parasympathetic and decreased sympathetic outflow (IX, X)
42
pathophysiology of preeclampsia involves ... arteries
myometrial spiral arteries
43
preeclampsia: production of thromboxane and nitric oxide by endothelial cells
increased thromboxane production with decreased nitric oxide production
44
chemical composition of phosgene
COCl2
45
most common cause of death in hospitalized drowning patients
post-hypoxic encephalopathy
46
gestational age at which sufficient concentration of surfactant is achieved
W35
47
neonatal respiratory distress syndrome patient who fails to improve with exogenous surfactant suspect
congenital heart defect or patent ductus arteriosus
48
MOA for alvimopan
mu-opioid antagonist that does not cross BBB
49
diphenoxylate is paired with what other drug to decrease its abuse potential
atropine
50
MOA loperamide
phenylpiperidine opioid that does not cross BBB
51
opioid receptor responsible for respiratory depression
mu-2
52
what is the active metabolite of nitroglycerin
nitric oxide
53
MOA nitric oxide
increase intracellular cGMP
54
burns >...% have increased mortality due to infection
40
55
major RF for developing post-herpetic neuralgia
age; 50% in patients >50 years old
56
volatile with most emergence agitation/delirium
sevo
57
indication for CPR in VAD patient (2)
MAP < 50 mmHg or etCO2 < 20 mmHg
58
LVADs are sensitive to acute drops in [preload/afterload]
preload
59
in supine hypotension syndrome blood bypasses the inferior vena cava and returns to the heart via which pathway
paravertebral epidural veins
60
describe the hemodynamic changes from aortocaval compression
hypertension in upper extremities; hypotension in lower extremities
61
route for sux during laryngospasm in patient without IV access
intramuscular (4-5 mg/kg), lingual
62
magnesium toxicity is a result of blockade of which channels (3)
intracellular and extracellular Ca, and intracellular K
63
pathology of Lambert-Eaton syndrome
destruction of presynaptic Ca channels
64
nerve regeneration after cryoanalgesia occurs when
1-3 months after
65
what variable decreases from West Zone 1 to 3
alveolar pressure
66
what class of medication should be avoided in upper airway obstruction
NMB
67
patients with abdominal ascites have lung dynamics similar to [obstructive/restrictive] lung disease
restrictive; all lung volumes decreased but FEV1/FVC unchanged
68
nerve block that relieves pain only during second stage of labor
pudendal nerve block
69
HBV transmission rate by contaminated needle
30%
70
GCS: withdrawal from painful stimulus score
4
71
initial goal in management of patient with intracerebral hemorrhage is what
SBP < 140
72
T/F: seizure prophylaxis in all patients with intracerebral hemorrhage
false; only give if signs of seizure
73
why are children more likley to become symptomatic after venous air embolism
smaller circulatory volume and heart size
74
how does applying pressure to the abdomen affect preload and afterload
temporary increase in preload and afterload
75
what is the predicted change in etCO2 during sepsis
decreased due to respiratory compensation for metabolic acidosis
76
assay for HIT
serotonin release assay
77
differentiate type 1 vs 2 hepatorenal syndrome
type 1: acute rapid onset with high mortality within 3 weeks
78
what is the definitive treatment for hepatorenal syndrome
liver transplant
79
treatment for lower extremity complex regional pain syndrome
serial lumbar plexus blocks
80
hypoxic ventilatory response is mediated by what?
peripheral chemoreceptors
81
major contraindication for carboprost
asthmatics
82
age most appropriate for cleft lip repair
2 (+/- 1) months
83
age most appropriate for velopharyngeal insufficiency correction
6 (+/- 1) years
84
describe orthodeoxia
dyspnea and oxygenation worsening when standing vs supine. seen in hepatopulmonary syndrome
85
O2 consumption per kg in infants
6 mL/kg
86
threshold for intubation in patient with botulism
vital capacity < 30%
87
antitoxin therapy for botulism in patient > 1 year old
equine serum
88
when is peritoneal dialysis preferred over hemodialysis
when patient cannot tolerate large hemodynamic changes
89
which type of cerebal edema is associated with traumatic brain injury
cytotoxic edema; avoid corticosteroids
90
which organization oversees the credentialing process for pediatric procedural sedation
the joint commission
91
ARDSnet trial revealed that reducing what type of pressure improved mortality
plateau pressure < 30 mmHg
92
most efficacious PONV prevention in peds
ondansetron
93
TRALI: development of acute lung injury within how many hours of a transfusion
6 hours
94
measurement to differentiate cardiac vs non-cardiogenic pulmonary edema
PCWP; > 18 for cardiogenic
95
FENa < 1% suggests what location of injury
prerenal
96
most likely mechanism for asystole after insufflation
vagal response to peritoneal stretching
97
periodicity of recording vital signs in pediatric moderate sedation
every 10 minutes
98
periodicity of recording vital signs in pediatric deep sedation
every 5 minutes
99
initial fluid resuscitation in pediatric patient with severe dehydration is
20 mL/kg of isotonic salt solution
100
initial colloid resuscitation in pediatric patient with shock is
10 mL/kg of 5% albumin
101
mechanism for ECG changes during subarachnoid hemorrhage
catecholamine release causing subendocardial ischemia
102
electrolytes decreased with administration of TPN (3)
phosphate, potassium, magnesium
103
autonomic hyperreflexia syndrome occurs in patients with spinal cord injuries above what level
T5
104
resistance to airflow varies with airway radius to what power
4th
105
which type of thalassemias is more difficult to diagnose in neonatal assays?
beta
106
RF for adverse events during pediatric sedation (5)
ASA3, <3 mo, obesity, airway procedures, polypharmacy
107
daily max acetaminophen dose adult
3 grams
108
daily max acetaminophen dose peds
2.6 grams
109
CAM-ICU first question
acute change or fluctuating course
110
CAM-ICU second question
inattentive or easily distracted
111
CAM-ICU third question
altered or RASS that is not 0
112
CAM-ICU fourth question
disorganized thinking
113
mechanism of neonatal myasthenia gravis
maternal anti-AChR antibodies crossing the placenta
114
dose of ondansetron required for significant QT prolongation
32 mg
115
abnormal invasion of cytotrophoblasts into the maternal decidua is a cause of ...
preeclampsia
116
T/F dose of caudal epidurals in peds is based on volume and not concentration of local anesthetic
true
117
caudal epidural for sacral nerve roots dose
0.5 mL/kg
118
effect of TCA on NMDA receptors
antagonist
119
primary cause of morbidity in patients with Afib
stroke
120
left ventricular outflow tract is a common origin site for what arrhythmia
PVC
121
MOA of TXA or aminocaproic acid
decreasing fibrinolysis by binding of plasminogen and plasmin
122
splinting or rapid shallow breathing in the setting of pain increases risk of developing what?
pneumonia; functional restrictive lung disease
123
most common cause of non-OB surgery during pregnancy
cholestasis
124
induction with [IV/inhalation] is faster in right to left shunt
IV; shunt allows bypassing pulmonary circulation
125
VSD: increasing SVR will have what effect on pulmonary blood flow
increase
126
number of episodes per hour needed to diagnose central sleep apnea
10
127
failing right ventricle depends on what structure for stroke volume
intraventricular septum
128
which gas is used to inflate IABPs
helium
129
loop and thiazide diuretics cause an [acidosis/alkalosis]
alkalosis from loss of Cl
130
thermodilution: reducing the volume of injectate will [over/under]estimate the cardiac output
underestimate
131
thermodilution: when in the respiratory cycle to perform procedure for minimal variability
end-expiration
132
what year did the most common transfusion related deaths change from hemolytic to TRALI
2000
133
what change in 2004 decreased the rates of transfusion-associated sepsis?
bacterial detection in apheresis platelets
134
the placenta uses what % of oxygen delivered to it
40%
135
during alkalotic conditions does hemoglobin's affinity for oxygen go [up/down]
up
136
gabapentin binding site
a2d subunit-containing voltage gated calcium channels
137
equation for transmural pressure across cerebral aneurysm
MAP - ICP
138
this is used in the prevention of contrast-induced nephropathy
isotonic crystalloid
139
air trapping with atelectasis and infiltrate on CXR suspect
foreign body aspiration
140
term infant hemoglobin nadir
11 g/dL at 10 weeks
141
preterm infant hemoglobin nadir
8 g/dL at 6 weeks
142
hemoglobin concentration in cord blood
17 g/dL
143
acceleration and decelerations lasting > ... minutes change the baseline fetal heart rate
10 minutes
144
which drug is used for transient cardiac asystole
adenosine
145
3 methods to avoid the windsock effect
hypotension, rapid ventricular pacing (>180), transient asystole
146
minute ventilation increase with PaCO2
2 L/min for every 1 mmHg increase in PaCO2
147
minor allergic transfusion reactions are mediated by what
IgE to soluble antigens in product
148
definition of lusitropy
myocardial relaxation
149
effect on myocardial pressure-volume loop of inodilator therapy
increased contractility, increased SV, increased CPP, decreased ASP
150
age threshold for increased risk of postop AKI
>59 years old
151
BMI threshold for increased risk of popstop AKI
32
152
T/F COPD is a RF for postop AKI
true if on chronic bronchodilator
153
secondary target for antibodies in myasthenia gravis
muscle-specific tyrosine kinase (MuSK)
154
reasons for avoiding neostigmine in patient with myasthenia gravis (2)
incomplete reversal and cholinergic crisis
155
[high/low] platelet count is a RF for heparin resistance
high; >300k
156
initial treatment for heparin resistance
more heparin
157
when is the IABP inflated
early to late diastole
158
monitor that demonstrates earliest indication of inadequate ventilation in children
capnography
159
duration of living with myasthenia gravis before having increased risk of postop mechanical ventilation
72 months (6 years)
160
what is used for filtration in hemodialysis
semipermeable membrane
161
pancuronium side effect
SNS stimluation
162
8-20% of adults with asthma will experience bronchospasm after being (2)
aspirin or NSAID
163
early sign of respiratory failure in patient with severe asthma attack
pseudonormalization of PaCO2
164
ICP target in patient with head injury
< 20 mmHg
165
best preop test to predict AKI in setting of suprarenal aortic cross-clamping in a rupture AAA
creatinine clearance
166
onset time of intranasal fentanyl
7 minutes
167
treatment for TTP
FFP
168
deficiency in TTP
vWF-cleaving
169
3 major components of intracranial space
brain parenchyma, blood, and CSF
170
oxygen sat goal in the venous cannula during CPB
65%
171
target MAP during CPB
> 50 mmHg
172
anterior spinal arteries provide what percentage of the blood supply to the spinal cord
75%
173
techniques to ablate seizure from cortical stimulation during awake craniotomy
propofol or cold saline
174
INR indication for FFP
> 1.8 with signs of bleeding
175
antithrombin 3 levels in DIC
decreased
176
reason for prolonged PT in DIC
consumption of clotting factors
177
where are spinal cord stimulators placed
dorsal column
178
effect of decreased lung compliance on peak inspiratory pressure and plateau pressure
increases to both
179
treatment for retained placenta
nitroglycerin
180
order of reinfusion during acute normovolemic hemodilution
reverse order of withdrawal
181
for how long after acute normovolemic hemodilution can the blood be used
8 hours at room temperature
182
reason for deliberate hypotension during AVM embolization
decrease risk of injectate traveling to systemic circulation
183
type of lithotripsy safe in pregnant patients
intracorporeal laser not extracorporeal shockwave
184
mechanism for decreased calcium levels during ESRD
decreased conversion of 25-vitaD to 1,25-vitaD
185
metabolite of codeine
morphine (CYP 2D6)
186
T/F ibuprofen increases bleeding post-tonsillectomy
false
187
amount of time after achieving target temperature for initiating circulatory arrest in CPB
20-30 min
188
target temperature for deep hypothermic circulatory arrest
18C
189
congenital anomaly with maxillary hypoplasia
Crouzon
190
congenital anomaly that becomes easier to intubate with age
Robin sequence
191
onset time for idiopathic sudden sensorineural hearing loss
< 3 days; treat with hyperbaric oxygen
192
heart valve defect associated with ostium primum ASD
cleft anterior mitral leaflet
193
chronic muscle pain that can be reproduced with palpation of trigger points is called what
myofasical pain syndrome
194
what nerve fibers are stimulated with transcutaneous electrical nerve stimulation
A-beta, which inhibits signaling through A-delta and C pain fibers
195
what is the increase in maternal oxygen consumption during the second stage of labor
75%
196
concentration of fibrinogen in cryoprecipitate
200 mg/unit
197
10 units of cryoprecipitate will raise a 70 kg patients fibrinogen by what?
70 mg/dL
198
earliest signs (2) of diabetic autonomic neuropathy
decreased pulse rate variability followed by resting tachycardia
199
CPAP generally reduces cardiac output except in patients with ...
cardiogenic pulmonary edema
200
unmyelinated nerve fibers are [easier/harder] to block with local anesthetics
easier due to increased intraneural penetration
201
half-life for medications is longer in [infants/children]
infants due to immature renal and hepatic systems
202
HBV e-antigen [postive/negative] has a higher seroconversion rate
e antigen positive
203
acute intermittent porphyria is exacerbated by [inducers/inhibitors] of CYP450
inducers
204
hyaline membrane disease is AKA
respiratory distress syndrome
