Truelearn Advanced Flashcards
1
Q
Sodium bicarbonate added to local anesthetic decreases pain and increases onset due to
A
More unionized fraction due to higher pH so more ions pass through unionized cytoplasmic membrane faster
2
Q
Using Succ or volatile anesthetic in patient with Becker’s muscular dystrophy/or chill vac’s can lead to
A
Rhabdomyolysis
Can lead to rapid hyperkalemia formation which leads to wide qrs and then v fib
3
Q
Absolute contraindications to ECT
A
Intracranial mass lesion
Pheo
Unstable cervical spine
Recent MI within 4-6 weeks
Pregnancy is a relative contraindication
4
Q
MH has higher
A
ETC02 and muscle rigidity and temp increas than thyroid storm
5
Q
Veins arterioles more stiff
A
As you age and less compliant. Leads to high SVR and LV hypertrophy
6
Q
Dobutamine on elderly causes
A
Tachycardia/ reduced diastolic filling time and some increase in contractility leading to decreased end diastolic volume and ultimately decreased cardiac output
7
Q
Posterior fossa surgery best way to monitor brain stem ischemia
A
Auditory evoked potentials
8
Q
Opioids usually don’t affect evoked potentials
A
Don’t
9
Q
Apnea brain death test
A
No spontaneous breath up to pac02 of 60
10
Q
After thigh tourniquet release
A
End tidal co2 increases transiently
Distal tissues go from aerobic to anaerobic metabolism
11
Q
Severe drop in ETC02 after tourniquet release think
A
PE
12
Q
SVR is increased in obstructive shock to help with
A
Low cardiac output state
13
Q
Distributive shock
A
Spinal cord injury leading to neurogenic shock
Biggest predictor is a loss of SVR
In hypovolemic shock SVR up
14
Q
Volatile anesthetics least affect
A
Brainstem auditory evoked potentials
15
Q
Need to evaluate SSEPs for
A
Spine surgery
16
Q
Management of hypermagnesium
A
It is renally excreted so more likely in patients with renal disease
5-9 mg/dL normal range for preeclampsia patients
Depresses cardiac muscle contractility and function
Don’t give theophylline to treat
Treatment includes calcium, dialysis, loop diuretic plus saline
It prolongs succ and potentiates NMDBs(makes them work longer)
17
Q
Nerve regeneration after cryoanalgesia takes
A
1-3 months
18
Q
Opioid only regional anesthesia can’t be used for cystoscopy in patient with spinal cord transection
A
Still get autonomic hyperreflexia
19
Q
AH
A
Acute hypertension, reflex bradycardia, cardiac arrhythmias, MI, pallor, coolness is lower extremity, sweating in upper extremity
Starts 2 to 6 weeks after surgery
Get Vasodilation above and vasoconstriction below
20
Q
Volatile inhalational induction faster in infants due to
A
Greater fraction of cardiac output to the vessel rich group
21
Q
Phrenic nerve stimulators are used to improve
A
Atelectasis
22
Q
Hypotension decreases
A
Uterine perfusion.
23
Q
Partial bilateral RLN injury
A
Complete obstruction
Get unopposed adduction
With complete it affects both abduction and adduction so stay in a para median position
24
Q
ECT causes an increase in
A
ICP and cerebral blood flow which is of concern to patients with space occupying lesions
25
During ECT can see
Bradycardia tachycardia and short term memory loss
26
To reverse in pregnant patient with neostigmine use
Atropine bc glycopyrolate doesn’t cross BBB
27
Vasodilation occurs with magnesium therapy and can
Lower BP
Mag competes with calcium inside vascular smooth muscle cells
28
Mag inhibits
Voltage gated calcium channels
29
Don’t add potassium to maintenance fluid until you have good
Urine output
30
Pyloric stenosis high risk for
Postop apnea due to alterations in CSF ph and central chemoreceptor response to C02, therefore minimize opioid use and hyperventilating
31
No shivering thermogenesis in infants from
Norepinephrine, glucocorticoid, and thyroxine
Inhibited by inhalational anesthetics and beta blockers
32
Successful stellate ganglion block
Temporary sympathectimy to face and eye
Stellate ganglion block can lead to inability to sweat and flushed skin
33
ARDS more Fi02
Doesn’t help bc they are shunting leading to hypoxemia
34
ECMO bypasses the lungs and can help with
Gas exchange in ARDS
35
To anesthetize the lateral forearm need to get
Choracobrachialis muscle to anesthetize the musculocutaneous nerve
36
Syringomyelia
Causes central cord syndrome with maintenance of proprioception, touch and vibration and plus loss of pain and temperature sensation
Associated with Chiaari 1 and trauma
Fluid filled cyst in center of spinal cord
37
Diminished sweating with
Autonomic neuropathy
38
When anemia was present
An improvement in clot strength and quality was seen
39
Low biphasic waveform defibrillation has more success than
Monophasic waveform defibrillation
Longer the patient has had an arrhythmia the more difficult it is to defibrillate
Want 12cm electrodes
40
Plasma half life of methadone
13 to 50 hours but analgesic affect is 4-8 hours
For ESRD lower methadone dose 50%
41
Methadone
Mu receptor agonist
NMDA antagonist
MAO reuptake inhibitor
42
Methadone black box warning
Death from respiratory depression
Cardiac effects
Arrhythmias like torsades
43
Congenital emphysema do not give
Nitrous oxide
For a bleb don’t give positive pressure as it may increase the size or rupture the bleb. Use spontaneous ventilation
44
Botox works by
Inhibition of intracellular fusion of Ach containing vesicles
Not inhibition of bonding of AcH to receptor
Toxin only affects exocytosis thus the release of Ach going into the membrane thus those Ach molecules never reach the receptor
45
To avoid Dural puncture headache use
Smallest(27 gauge) non cutting needle
46
Risk factors for PDPH
Young age
Pregnant
Hx headaches
Large bore cutting needle
47
To improve pulmonary artery flow during a tet spell
Increase SVR with phenylephrine
Increase PVR shunts blood through vsd. SVR becomes less than PVR and blood goes to path of least resistance.
Phenylephrine increases SVR thus increasing pulmonary blood flow and reflex brady decreases hypercontractility
48
Intrascalene blocks commonly cause ipsilateral
Horners syndrome which includes ptsois, miosis, and Anhydrosis
Good for upper arm/shoulder surgery
49
Be careful doing intrascalene on patient with preexisting lung disease
Can hit phrenic leading to ipsilateral diaphragmatic paralysis which can lead to respiratory failure
50
MS patients have respiratory muscle weakness leading to
Aspiration, pneumonia, or acute respiratory failure
51
Loss of fetal heart rate variability is an early sign of
Fetal hypoxia
52
Magnesium potentiates the action of both
NMDB and depolarizing muscle relaxants
Give same dose of succ for intubation but lower dosage of rocuronium
53
Early decelerations occur
Simultaneously with uterine contractions
Late decelerations lag 10-30 seconds past uterine contractions
54
Treatment of choice for surgical bleeding prophylaxis in patients with VWD is
Desmopressin
55
Volume of aspiration and pH<2.5 major risk factors for
Pneumonitis
Increasing pH reduces risk of aspiration pneumonitis
56
After what week of pregnancy high risk of aspiration
18th
57
Delay emptying with opioids
Neuraxial and parenteral
58
Avoid hypotonic fluids on
Traumatic brain injury
59
Goal is to maintain CPP
50-70
60
CO causes endothelial cells and platelets for release
Nitric oxide
61
High NG output increases
SID and therefore causes alkalosis
62
Decrease SID
Lowers pH leading to acidosis
63
Children have slower redistribution of heat from core to
Periphery
64
Greatest heat loss comes from
Radiation
65
Shivering can increase oxygen consumption
A lot
66
C diff toxin enzyme immunoassay if concern for
C diff
67
Thyroid storm
Hyperthermia, tachycardia, agitation and confusion
68
CDH
Low tidal volume
PIP<25
Preductal sat want 90-95%
69
Low medial Thigh nerve root
L3
70
Best way to monitor RLN injury during thyroid surgery
EMG
71
Nasal CPAP has lowered BPD when compared to
Intubation and ventilation in neonates
72
Hypophosphatemia
Dysfunction of skeletal muscle
73
Hyperphos
Prolonged qt
74
Increased hemoglobin
More oxygen delivery
75
If someone is on high ventilatory support need another
Confirmatory death test bc apnea test inaccurate
76
SAH greater admission hgb decreased incidence of
Cerebral infarction
77
Vasospasm during SAH peaks at
5-7 days
78
Chronic renal insuffiency
Not an independent risk factor for compartment syndrome
Laparoscopic surgery is
79
Obturator nerve block goes between adductor
Longus and brevis
80
Obturator is not a branch of the
Femoral nerve
81
Quickest way to lower ICP transiently is a
Propofol bolus
Head up position
Diuretics maintain map drain csf
82
Bradycardia following carotid stent deployment
Carotid sinus baroceptor stimulation causing sympathetic inhibition
83
Carotid body senses
Pa02 and increases ventilation if hypoxia
84
Most effective treatment for refractory hypotension causes by AceI is
Norepinephrine not vasopressin
85
Massive venous air embolus cardiovascular collapse due to
RVOT obstruction resulting from air lock phenomenon in RV
86
Determining who is responsible for an event is not an endpoint of
Root cause analysis
87
Hyperbaric oxygen therapy works by
Increasing Pa02 and thus the amount of dissolved oxygen
88
Pyloromyotomy
Normalization of chloride most important metabolic change suggesting surgical optimization
89
Diaphragm is too anterior in intrascalene hitting phrenic so move needle more
Posterior
90
If sartoriius twitches during femoral block move needle more
Lateral
91
Most common congenital anomaly recognized at birth
Perimembranous VSD
92
PDA
Continuous machine like murmur at upper left sternal border
93
Organophosphate poisoning treat with
Atropine
94
After hemodialysis patients can get
Hypokalemia
95
ESRD patients have
Anemia not polycythemia
96
Supraclavicular block is next to the
Subclavian artery
97
Patient with chronic alcohol use have
Hypomagnesium
98
Glucose loading during TPN leads to
Hypophosphatemia
99
Patient should be monitored how long after raceemic epinephrine
4-5 hours at least
100
ESI has high success rate for providing
Short term analgesia for acute radicular pain due to disk herniation or spinal stenosis with nerve impingement
101
Epinephrine is not
Metabolized in the lungs or while in the pulmonary circulation
102
Would have skin pallor in lower
Extremities not flushing
103
Autonomic hyperreflexia shows up
2 weeks to 6 months after spinal cord injury
104
Do not use naloxone on neonatal resuscitation even if mother received large dose of
Morphine and is a drug user
105
Max lidocaine with epi dose is
7 mg/kg
1% lidocaine is 10mg per ml
106
Thoracic aortic aneurysms repair give
Fenoldopam which increases renal blood flow
107
Naturesis
Urine sodium excretion
108
Fenoldopam increases intraocular pressure so be careful using in a patient
With glaucoma or intraocular HTN
109
Radiation induced injury to thyroid via nuclear event can use
Potassium iodide
110
Peak and plateau pressure big difference usually due to
Kinking of endotracheal tube
111
Lupus anticoagulant prolongs activates PTT but not prothrombin time
PT
112
Factor 7 requires
Vitamin K for synthesis
113
Cryoprecipitate contains
Fibrinogen, fibronectin, VwF, and factors 8 and 13
114
Hypothermia decreases the metabolic rate of the
Brain.
115
During DHCA blood flow is
Non existent
116
Hypothermia is most important factor to decrease
Cerebral ischemia
117
Patients with hypoplastic left heart have Ductal dependent
From pda from RV to pulmonary artery
Pulmonary blood flow increase increases Qp to Qs then can get systemic hypoperfusion
If Fi02 goes up get reversal off hypoxia pulmonary vasoconstriction and decrease in PVR so pulmonary blood flow goes up resulting in systemic hypoperfusion
118
Decrease minute ventilation increases
PVR
119
Hypoplastic heart
First Norwood to Glenn to fontan
120
Bupivicaine highly protein bound so less
Placental transfer
121
If pKA higher than pH it will be
Ionized
122
2-4 days after being in altitude see
Bicarbonate loss in the CSF
123
Femoral and sciatic supply the knee
Can do knee replacement with
Lumbar epidural
124
Breast milk leads to higher gastric volumes than clears this is why it is
4 hours vs 2
NPO guidelines are based on gastric residual volumes
125
Cryoprecipitate does not contain factor
7
126
Neonates when cold use
Non shivering thermogenesis(oxidation of brown fat)
Increases glucose consumption and increases likelihood of hypoglycemia
127
Primary hyperaldosterone treat with
Spirnolactone
128
Transcutaneous pacers first activate the
Right ventricle similar to a VOO mode
129
Skeletal muscle can hurt when doing transcutaneous pacing so should give some
Sedation
130
Asymmetric LVH in
Hypertrophic cardiomyopathy
Avoid tachycardia, increased myocardial contractility, decreased diastolic filling time
131
Brain death can occur without
Herniation
132
Edema during brain injury becomes both
Vasogenic and cytotoxic
133
MG<72 months less likely for
Postop intubation
Also less likely if viral capacity is greater then 3
134
Redirect needle medial if
Foot eversion twitch is seen
Foot eversion twitch means you hit the common peroneal
Need to redirect needle more medial
135
Tibial nerve
Plantarflexion
136
.5 mg/kg oral versed for
Peds
Give 10 minutes before
Seperation anxiety starts at 6 mo
137
Suggamadex is ok on patients with
CHF
Not fda approved on pediatric patients
Patients with severe renal failure
Reversal of other nmbds besides roc or vec
138
Epiglottis management
Direct laryngoscopy under deep general anesthesia
139
Cyanide toxicity
Elevated anion gap
140
Cyanide toxicity
Oxygen is present so Pa02 will increase and oxygen can’t be utilized so Sv02 will increase
141
Chronic pelvic pain
Superior hypogastric
142
Methadone good for patients with
Chronic neuropathic pain
143
Why does maternal blood volume go up in pregnancy
Sodium retention via renin angiotensinogen system
144
Lumbar plexus block spares the
Sciatic nerve
145
LPB
Patient in lateral decubitus
Hit L4 transverse process
Then go cephalad until it slides past transverse process 2 cm deeper
146
Sciatic nerve
L4-S3
147
Patients with myasthenic syndrome
More sensitive to depolarizing and nondepolarizin blockers
148
Omphalocele
Chromosomal abnormalities
149
Cardiac resync therapy for
LVEf less then or equal to 35
| IV conduction delay greater than 120msec
150
Cardiac myoxomas mainly found in the
Left atrium
151
Unstable patient with torsades
Unsynchronized cardioversion
152
Use a short duration stimulus when doing
Sciatic nerve block
153
Acute stretching of peritoneum can lead to
Asystole in laparoscopic procedures
154
Perforation ileofemoral axis during transcatheter aortic valve replacement
Hypotension and retroperitoneal extravasation
155
No lipid anabolism during
Stress response. You do see protein anabolism/catabolism
156
Most important for uterin blood flow is
Blood pressure
157
Zenker diverticulum absolute contraindication to
TEE placement
158
Don’t give what med with ECT
Lidocaine
159
Midazolam bioavailability
Intramuscular>intranasal>rectal>oral
160
Measuring oximetry in patient with lvad with
Oximitrey cerebral
161
Motor potentials
MEPs for anterior spinal cord
162
Patients with severe lung disease have least response to
Bronchodilator therapy
163
What nerve can get injured during repair of a PDA
Recurrent laryngeal nerve
164
Early onset adult ventilator pneumonia is likely due to
MSSA
165
Adding PEEP increases
FRC
166
Decreasing I to E ratio can help with
Breath stacking
167
Spinal cord stimulator directly affects
Dorsal horn of spinal cord and prevents conduction of chronic pain sensation
168
Spinothalamic tract the neurons cross to
Contra lateral side of spinal cord via anterior white commissure
169
Hypoalbumin will increase free fraction of benzos thus
Lower amounts can be given
170
Resistance to NMDBs starts 1 week following burn and peaks at
5-6 weeks
171
MEPs monitor
Anterior spinal cord
172
EEG monitors the
Cortex only
173
During hemodialysis large proteins don’t pass through so get increase in
Prealbumin levels
174
Factors 11 13 tpa and antithrombin 3
Decrease during pregnancy
175
Gabapentin is alpha 2 with
Very little respiratory of cardiac complications
176
Intrascalene May miss C8-T1 so don’t get
Ulnar
177
Best way to prevent post kidney transplant injury is
Good intravascular volume this is why we give mannitol before releasing vascular clamps
178
Cryoprecipitate contains
Factor 8 and fibrinogen(factor 1)
179
Methylergonive
Lasts 2-4 hours and given intramuscular
180
Hyperthyroidism
Decrease SVR
Looks like septic state
181
Insulin requirements go down after
Delivery
Leads to fetal macrosomia due to more glucose
182
Tachycardia
Less time in diastole and use more myocardial oxygen which is bad
183
Overriding aorta gets blood from
LV and RV
184
Avoid hypotension and increases in PVR
With primary P HTN
185
Chronic opioid use leads to
Decreased cortisol levels
186
Sodium deficit
140-serum sodium * total body water(.6)
187
Dantrolene contains
Mannitol
188
Oral versed
0.5 mg/kg in peds
Acts in 15-30 minutes
189
Salicylate poisoning
Metabolic acidosis and respiratory alkalosis
190
Trigger point injections
Do for painful limited range of motion
191
Oculocardiac reflex
Trigeminal and vagus nerve
192
Nd Yag laser passes
Through cornea without damaging it
193
Nd yag protective lens is
Green
C02 is clear plastic
194
Fetal tach
Maternal hyperglycemia
Maternal tachycardia
Terbutaline
195
Anterior cervical spine surgery can lead to vocal cord palsy due to endotracheal tube cuff on
RLN so need to readjust cuff once exposure happens
196
Trendelenberg decrease in
ERV and RV
197
Meperidine blunts
Shivering response to hypothermia which reduces total body oxygen demand
198
Goal temp
32 to 36 out of hospital cardiac arrest
Fasting cooling is endovascular cooling
199
Airway work of breathing in infants higher due to
Highly compliant chest wall
200
Catecholamine levels are much higher in
Geriatric patients
201
Myofascial pain syndrome
Trigger points in skeletal muscle often secondary to overuse and trauma
Will cause non dermatome pattern of radiation when palpated
202
Wait
6 hours after subq heparin to do epidural
203
In Addison’s disease you see
Hypercalcemia
204
SVT with wolf Parkinson’s white
Procainamide
205
Labetalol is more
Beta than alpha
206
iN0 can result in methemoglobinemia resulting in a
Left shift of the oxyhemoglobin curve and a decrease in the P50
207
High spinal blockade
Give fluid bolus and phenylephrine infusion but still endorses nausea what do we give
Atropine
208
Less pain
Less catecholamine release
209
Hyperparathyroidism can cause hyperchloremia
Increases renal bicarbonate loss, which may result in a normal anion gap metabolic acidosis
210
Multiple myeloma is associated with
Anemia not polycythemia
211
If in steep trendelenberg
Minimize laryngeal and facial edema
212
Avoid what drug in a pheo case
Ketamine
213
Remifentanyl is broken down by
Red blood cell and tissue esterases
214
Full term newborn
80-90 ml/kg
215
Premature blood volume
90-105 ml/kg
216
Tetanus acts by
Inhibition of neurotransmitter release from inhibitory neurons in the can
217
Diptheria
Inhibition of elongation factor 2
218
In MG leading factor for postop respiratory failure is
The inability to clear secretions and produce a strong cough
219
P50 of fetal hemoglobin is
Lower bc it is shifted to the left
220
Wife complex SVT
Synchronized cardioversion
221
Retained epidural catheter best is to do a
CT scan
222
Cricoid pressure decreases
LES tone
223
Spinal anestgesia considered over general anesthesia in neonates or infants at risk for
Postop apnea
224
Doubling the distance from a radiation source
Decreases exposure to one quarter of the original
225
Sodium nitroprusside
Elevated mixed venous, SNP tachyphylaxis, and metabolic acidosis
226
Imperforate anus often has
Neural tube defects
227
Aortic cross clamp leads to
Increase in coronary blood flow
228
Inhalation induction faster in
Pregnant patient due to increased minute ventilation, decreased FRC, decreased MAC requirement
229
Hypocalcemia
Prolonged qt
230
Aortic regurgitation
Nitroprusside
231
TPN after one month will lead to
Increased PT time and will require vitamin K supplementation
232
Don’t give inotropes to someone with hocm bc it will increase HR thus
Decrease in strike volume and myocardial perfusion
233
Tourniquet leads to anaerobic metabolism and localized acidosis
When released leads to metabolic acidosis
234
Cardiac surgery goes more with
AION
235
Maintain CPAP during
Inhalational ventilation is useful in a child with acute epiglottis
236
Oligohydramimos does not lead to
Uterine rupture
237
One side effect of terbutaline is
Hypokalemia and hyperglycemia
238
Radiation exposure is inversely proportional to the
Square of the distance
239
PGE1 common side effect is
Apnea
240
Elderly patients have an increased sensitivity to the
Synthetic opioids fentanyl, sufentanil and alfentanil
241
Symptomatic severe hyponatremia one thing not to give is
Normal saline
Can give hypertonic and intubate if needed
242
Troponin is more sensitive than CKMB for detecting
Myocardial injury
243
Type 1 CPRS is due to a
Minor injury
244
Prevent dilutional coagulopathy by giving
FFP
245
Vasopressin increases
Cerebral perfusion pressure and cerebral oxygenation
246
Dosing of single shot caudal epidural
1 mg/kg
247
TEG
MA-> platelets
K value prolonged-> cryoprecipitate
R value prolonged-> FFP
Teardrop configuration-> antifibrinolytics
248
Monopolist cautery is associated with increased potential for AICD
Discharge
249
In infants and children under 5 yo first sign of high or total spinal is
Apnea
250
As temperatures decrease gases become more
Soluble
251
Ulnar nerve is
Medial and up in axillary nerve block
252
Neural tube defects go with
Folate deficiency
253
Iv loading is least effective for preventing
Contrast induced nepropathy
254
C Botulinum gram positive anaerobic treat with
Equine serum antitoxin
255
Seizures can form from
Hyperglycemia
256
Child Pugh score for liver disease does not take into account
Creatinine
257
Morbidly obese patients
Increase in butyrylcholinesterase and extracellular fluid volume
258
Use ideal body weight for
Rocuronium/vecuronium
259
Total body weight
Maintenance infusion dose of propofol/ succinylcholine
260
Ovarian arteries supply up to 15% of
Uterine blood flow
261
Pituitary is located in
Sella turcica
Keep pt on steroids and give stress dose if pan hypopituitarism
262
Hypersecretion of pituitary
ACTH results in Cushing syndrome
Excess prolactin leads to galactorrhea
Gigantism excess GH
Also get headache, papilledema, and visual disturbances with compression of optic nerve
263
Oxytocin
Contraction of uterus
| Promotes milk secretion
264
Vasopressin works at
Collecting tubules
| Constriction of vascular smooth muscle
265
Diabetes insipidus
Central due to less vasopressin made by hypothalamus
Nephrogenic the hypothalamus is making it but renal tubules not using it
Very concentrated urine
Hypernatremia
266
Diabetes insipidus
Urine osmol <300 and 24 hour urine volume>50 ml/kg
267
Give DDAVP and isotonic crystalloid for
Nephrogenuc diabetes insipidus
268
Small cell lung carcinoma leads to
SIADH
269
SIADH do
Fluid restriction
270
SIADH
Fluid restriction can consider hypertonic saline and lasix
271
Hyperglycemia is seen in
80% post cardiac surgery
272
Glucose>126 more then 2 occasions is
Diabetes
273
Type 1 diabetes
T cell mediated destruction of pancreatic beta cells
274
Insulin
Stimulation of cellular uptake of glucose specifically in skeletal muscle, adipose, cardiac cells
275
Not dependent on glucose
Brain liver immune cells
Suppression of gluconeogenesis and lipolysis
Leads to glycogen formation
276
Glyburude glipizide leads to
Insulin secretion
277
Met form in
Suppresses excessive hepatic glucose release
278
Stop metformin 24 hours
Before surgery
279
End organ complications DM
Atherosclerosis, increased incidence post op mi
Nepropathy
Neuropathies
280
DM can lead to
Atlantoaxial instability making difficult laryngoscopy
281
Hold oral hypoglycemics
24-48 hours preop
282
Hypo is worse than
Hyperglycemia
Sugar above 200 leads to dehydration poor wound healing
283
10-15 ropi for
Spinal
Should have inability for sustained leg left
284
Epidural hematoma
Progressive loss of sensation or weakness in lower extremities bilaterally
Loss of bowel or bladder function
Severe acute onset severe back pain
More likely if female or hx of GI bleed
285
Epidural hematoma treatment
If weak stop the epidural
Check how much you gave through epidural
Support MAP if hypotension
Get MRI and neurosurgery involved
Need to be fast
286
Get laboratory tests
If needed
287
Don’t pit catheter in
Crazy ppl
288
Infection risk higher at day
7 and after so should take out
289
Pencil point is better than
Cutting needle
290
Get
ASRA app
291
Propofol infusion
50 mcg/kg/min both respiratory depressant and bronchodilaton
Decrease tidal volume increase RR
Attenuates Vagal induced bronchoconstriction
292
Propofol does not enhance
NMB
Peak effect at 100 seconds
Main loss after bolus dose is due to redistribution
293
Administration of what is most effective for vasogenic cerebral edema
Steroids
Help lower ICP
Also use corticosteroids in treatment of pseudo tumor cerebri
294
Loop diuretics like furosemide can
Help lower icp
295
Decrease in ICP with mannitol is seen at about
30 minutes
296
Inhaled volatile anesthetics will have increased pharmacodynamic effect in children with
Cerebral palsy
MAC requirement is much lower
Even lower if on antiepileptic
Thus you need less gas
297
Increase in creatinine clearance occurs with pregnancy returns to prepregnant levels
8 to 12 weeks postpartum
298
The duration of action of epidural bupi and ropi is not changed much by adding
Epi
Not true of peripheral blocks
299
Carbohydrate load can precipitate attack of
Hypokalemic periodic paralysis
Carbohydrates broken into sugars which stimulate the pancreas to secrete insulin
300
Psuedocholinesterase breaks down
Ester local anesthetics
Mivacurium
Succ
301
Safest induction for this patient is
Iv prop and rocc with psuedohypertrophic cardiomyopathy
302
Can’t give cpap to nonventilated lung if being
Lavaged
303
Volatile anesthetics prolong the
QT in a dose dependent manner
304
Less aldosterone leads to less
Water resorption
305
Progesterone mediated smooth muscle relaxation decreases LES tone and impairs
Esophageal peristalsis and intestinal motility during pregnancy
306
Placenta percreta leads to higher risk of
Hemorrhage bc it is more invasive
307
A point of care glucose test strip is best way to see if fluid is
CSF or normal saline
308
Glucose is present in CSF
40-70 but not in normal saline
Intrathecal catheter give ten times less dose
309
Gradual decreases in fetal heart rate at or after the peak of uterine contractions
Are termed late decelerations
310
Large volumes of chloroprocaine can cause
Muscle spasms
311
Prone patients wiry ARDS helps with
Ventilation perfusion matching
312
Sodium citrate increases gastric pH which is good in case patient
Aspirates
313
Lidocaine decreases seizure duration so don’t use for
ECT
314
High leak pressure replace with
Smaller tube
315
Aortic arterial waveform has a less pronounced
Diastolic wave
316
Postherpetic neuralgia
Age is big factor
317
RSBI elevation is bad
Excess C02 what can help is using lower respiratory quotient like more lipid content in the TPN
318
Lipids have lowest respiratory quotient at 0.7
Carbohydrates have highest at 1.0
319
Neostigmine slows
HR and bronchoconstriction
320
Tourniquet to 250 mmHg for
Bier block
Provides muscle relaxation also
Usually .5% lidocaine and don’t need epi
Easy rapid onset
Can give 25 to 50 ml of lidocaine
No bupi bc can cause LAST
321
Local anesthetic goes through veins and gets nerves around it with
Bier block
322
Tourniquet with Bier block can come off after
25 minutes
After 25 min get protein binding of LA and don’t release too soon can lead to LAST
323
Local anesthetics have
Inherent vasodilation affects except cocaine
324
Epi 1:200000
5 mcg/ml
325
R isomers of LA are more
Toxic
326
LAST due to too much local anesthetic
Systemically
Get CNS symptoms and hypotensivs
Give benzo
327
20% lipid solution for LAST and use 100 ml bolus and infusion at 2.5 ml/kg
Lower dose epi(1 ug/kg)
328
Succ goes through plasma and psuedocholinesterase can break succ down in
Plasma before it gets to neuromuscular junction
329
Succ binds
Alpha units of nicotinic cholinergic receptors
330
Psuedocholinesterase made in
Liver
331
Dibucaine local anesthetic that usually inhibits psuedocholinesterase
Normal is 80%
If dibucaine of 20 it will prolong Succ duration a long time. Need to start sedation and give psuedocholinesterase through FFP
332
Acetylcholinesterase inhibuted by
Neostigmine to increase Ach to stop neuromuscular blockade
333
Physostigmine passes
BBB
334
Organophosphate poisoning treatments
Atropine
335
Extra junctional nMJ stay open
Longer so get hyperkalemia
336
Somatic nervous system bonds at
Nicotinic receptor
337
Physostigmine does cross
BBB but neostigmine does not
338
Pancuronium prolonged in patients with
ESRD
339
Suggmadex not approved for patients with
ESRD
340
Calcium leads to lots of AcH release and thus
Resistance to neuromuscular blocking agents
Inhaled agents potentiate both depolarizing and nondepolaring. Same with magnesium
341
Opioid tolerance if need to keep giving
Bigger dose
342
Opioid mu receptor itching treat with
Naloxone
Neuraxial not histamine mediated
343
Neuraxial opioids act at
Substantial gelatinosa and periaqueductal gray
Mu2 has bad side effects
344
100 mcg iv =
33 mcg epidural
345
Emergence delirium decreased with
Midazolam when giving ketamine
346
Propofol potentiates
Hypoxic pulmonary vasoconstriction
347
Precedex
Inhibit NE release, decrease MAC, preserve respiratory drive
Decrease SVR and HR
Bolus leads to reflex HTN so give slow
348
Moca need
250 CME credits need to be achieved over a 10 year cycle
349
Intracranial rumors cause central diabetes insipidus
Treat with desmopressin
350
Increased risk of epidural hematoma in patients with
Ankylosis spondylysis
351
Upper extremity tourniquet should be inflated to at least 50 mm Hg above
SBP
Need at least 100 above systolic for lower extremity surgeries
352
Tramadol and TCAs lower
Seizure threshold
353
Tramadol is a
Partial opioid agonist
354
Tension pneumocephalus can occur when nitrous oxides is used after a
Recent craniotomy
Delayed awakening can be seen and the diagnostic study of choice is a CT scan
355
Aminoester reaction think
PABA
Aminoamide reaction think methylperaben
356
Amniotic fluid embolism leads to
Intense pulmonary vasospasm
357
Typical AVM consists of
Feeding arteries, a nidus, and draining veins
358
Neuromonitoring during resection of AVM is important need to look at
Sensory and motor
359
Parasympathetic nervous system predominates in
Newborns so atropine is best for bradycardia
360
Myotonic dystrophy
Gastric atony
361
Sucralfate does not change pH of
Gastric fluid
Helps with ventilator associated pneumonia
362
A lumbar sympathetic block is very close to the
Psoas major
363
PPV increases intrathoracic pressure which in turn increases
IVC pressure
364
IABP is placed via the
Femoral artery
365
Contraindications to IABP
Moderate to severe aortic disease
| Severe peripheral vascular disease
366
Tigecycline helps against
MRSA and gram negatives
367
Inhaled volatile anesthetics will have increased
Pharmacodynamic effect in children with CP
368
Pneumo will double in 10 minutes if giving
Nitrous oxide
Tension pneumocephalus after dural closure
369
SF6
Avoid nitrous oxide for 4 weeks
370
Cuff of ETT keep less then
30
Nitrous can increase this
371
Just using volatile anesthetics causes
Arterial hypocarbia and alveolar ventilation
Apenic threshold is high
372
Volatile anesthetics inhibit
HPV
373
Des
1 Mac = 6% or 6% at sea level 6% of 760 is 46 mm Hg
374
Isoflurane is a variable bypass
Vaporizer
1.2% x 760 mm Hg = 9
No % change needed at altitude
375
ISO into Sevoflurane vaporizer
Sevo has lower vapor pressure
Then will get higher percentwge bc iso has higher vapor pressure
376
Central compartment falls by 50% in infusion
Context sensitive half life
377
Remifentanyl small
Context sensitive half life
378
Phase 1 cyt 450
Oxidation reduction hydrolysis of lipophilic drugs
379
Potency
Relative dose of two drugs
First drug on graph more potent
Efficacy intrinsic ability of a drug to produce clinical affect-which drug goes higher on the curve
380
Anesthetics decrease
Amplitude and increase latency of SSEPs
381
Ketamine and etomidate
Increase amplitude of signals
382
NMBs are good for SSEPs
They eliminate background noise but can’t use when looking at MEPs
383
SSEPs monitor
Posterior columns so can have anterior column injury without knowing it
384
Warfarin inhibits synthesis of
Vit K dependent clotting factors
385
LMWH
Selective inhibition of factor 10a
Monitor with anti factor 10a
Can’t monitor with PT/PTT
386
Heparin acts on
AT3 and look at PTT
387
Xarelto Apixiban
Factor 10a inhibitor
388
Citrate binds
Calcium and is the anticoagulant in stored blood products
389
Citrate metabolized to
C02 and then bicarbonate
390
Citrate toxicity treatment give
IV calcium
391
Thiazides work at
Distal convoluted tubule
392
Acetazolamide blocks catholic anhydrase which is needed to block
Bicarbonate so you pee bicarbonate out and get acidosis
Acts at proximal convoluted tubule
393
Furosemide acts at
Thick ascending limb
394
Magnesium prolongs
NMDB and depolarizing blockers
Antagonism of NMDA receptors
395
Magnesium side effect rapid
Flushing and hypotension
396
1.5-2 is normal
Mag in plasma
Cardiac arrest at 20
ECG changes at 5-10
Loss of deep tendon reflexes at 10
397
Inhaled nitric oxide
Selective dilation of pulmonary vasculature
CGMP mediated
398
Prostaglandins dilate
Afferent arteriole
COX leads to constriction of afferent arteriole
399
Dig increases intracellular
Calcium
Low K and Mg
Get short qt interval and st segment depression
400
Organophosphate poisoning treatment
Atropine
Competitive muscarinic blocker
401
Prophylaxis for nerve gas
Pyridostigmine
But atropine is the acute treatment which blocks Ach effect
402
Tramadol
Mu receptor agonist
Increases serotonin
Reuptake of norepinephrine
Avoid with MAOis
Tramadol is a prodrug and needs CYP2D6 to be activated
403
TEE most sensitive for detecting
Myocardial ischemia
PCWP is least specific
404
Give precurization dose
10% of ED95 dose it is 0.03 mg/kg
405
Phenylephrine causes increased
Afterload and not good for patients with MR
406
IO line
Proximal humerus
Proximal tibia
Distal Tibia
Sternum
407
Biggest risk factor for meconium passage is
Later gestational age
408
Maternal steroids should be given when birth is anticipated between
24 and 34 weeks gestation, when fetal lungs are immature
409
Prazosin
Selective alpha 1 receptor antagonist
410
Max Epi dose tumescent lidocaine is
0.055 mg/kg
411
Don’t give what medication to children following tonsillectomy
Codeine
412
Barbiturate infusion
Decreases CMR02 and thus increases jugular mixed venous
413
Oliguria
414
Sympathetic activation leads to
Decrease urine output
415
Newborn lung is less compliant than
Adult
416
Gilbert’s disease most increases risk of
Jaundice after multiple transfusions of pRBCs
417
Gilbert’s defective enzyme is
Bilirubin glucuronyl transfersase
418
Cyclosporine can cause
Nephrotoxicity not pulmonary toxicity
419
Difficulty swallowing due to esophageal atresia in patients with
TEF
420
Succ hyperkalemic arrest in patients with muscular dystrophies is due to
Rhabdomyolysis
421
Only do LP
After imaging completed for HA
422
Greater thermistor temperature change in
Low cardiac output states
Less temperature change if high cardiac output bc less time to mix of injectate to blood
423
TR will lower
Cardiac output measure by thermodilution
Takes longer for injectate to reach pulmonary artery where it is measured so will show up as lower CO
424
T12-L1 and S2-S4 is
Secondary stage of labor
425
Fat embolism don’t give
Heparin
426
Nitrous oxide does not cause
Uterine relaxation
427
Pidendal block for
Stage 2
Can also do remi infusion or inhalational induction with nitrous
428
Hepatopulmonary syndrome improves with
Sitting
A-a gradient increased
429
Heart rate generation is dependent on the
Donor atrium
430
Transplanted heart has
Less variability and higher intrinsic HR(eating between 90 to 110
431
Toxic methemoglobinemia
IV methylene blue
432
Ketamine less desirable for patient with
Coronary artery disease it may potentiate the sympathetic surge seen with ECT resulting in increased myocardial o2 demand and potential ischemia
433
Acute herpes zoster most common dermatome distribution is
Thoracic
434
Alkalization of urine using
Carbonic anhydrase inhibitor
435
Don’t use benzos for
Acute mountain sickness
436
LV is perfused during
Diastole
437
Methadone is hard to
Titrate
438
B2 agonists like ritodrine
Relax uterine contractions and increase uterine blood flow
439
To help with thoracic aortic aneurysm stent place heart in
Transient cardiac asystole
440
Superior laryngeal nerve
Voice gets tired when talking more
441
LV is primarily perfused during diastole so
Longer systolic time is bad bc it leads to less diastolic time
442
TPN is most associated with
Thrombophlebitis and infection
443
Safe anesthesia agents in MH include
Nitrous oxide
Can’t use succ or volatile anesthetics
444
Sodium bicarbonate needed for normal pH formula is
0.2 x patient weight in kg x base deficit
445
Myotonic dystrophy you don’t need
PFTs
446
Persistive vegetative state patients can
Open eyes
447
Norepinephrine should not be administered IM
Can cause local ischemia and tissue necrosis
448
Ketamine
Sch 3 drug
449
Sch 1 drugs
Very high abuse potential such as cannibis
450
Most common defect associated with TEF is
Congenital heart defects
451
Glycopyrolate is poorly transferred across
Placenta
452
Hypoplastic left heart associated with
ASDs
453
2% lidocaine can undergo
Ion trapping and potentially accumulate in the fetus causing fetal acidosis
454
Less functional Ach receptors with
Myasthenia gravis
Need to give more Succ
455
Static compliance measures the lung at a
Fixed volume
456
Renin release is increased in
Cirrhotic patients
457
Treatment of methemoglobinemia in G6pd deficiency is
Ascorbic acid not methylene blue
458
Oligohydramimos is not associated with
Placental abruption
459
Impaired platelet aggregation makes hemostasis hard in
Dialysis patients
460
Phenylephrine increases
Afterload thus decreasing cardiac output leading to lower mixed venous
461
Heparin resistance if
AT3 levels low platelet count above 300000, preop heparin, use of low molecular weight heparin, age>65
462
SIADH patients are
Euvolemic or hypervklemic
463
Beat to beat variability is normal
Fetal heart rate intermittently varies 10 beats per minute from baseline
464
Late decel
Occurs after onset of uterine contraction
465
TURP main complication is
Hypothermia
466
Alveolar hypoxia is induced due to
Decreased atmospheric pressure resulting in diffuse hypoxic pulmonary vasoconstriction
467
Walking uphill or squatting helps with
Spinal stenosis
468
Compartment syndrome occurs when tissue perfusion exceeds
Local perfusion pressure
469
Idiopathic intracranial HTN
Can put in catheter intrathecal and drain CSF
470
CSF volume is higher on a ml/kg basis in children than in
Adults
471
Cyanide toxicity due to fire first line treatment is
Hydroxycobalamin
472
LV did tension coming off bypass and lateral wall hypokinesis due to
Embolus in left coronary artery
473
For a turp need to also block
Obturator
474
Most appropriate therapy to reduce rate of vasospasm following clipping of a ruptured berry aneurysm is
Nimodipine
475
Terbutaline can cause
Hyperglycemia
476
Anterior mediastinal mass cause compression of the
Tracheobromchial tree
477
If minute ventilation exceeds fresh gas flow
H in j k UK mi my my
Hu mlol
I’m
K kit Lu
478
If patient is anticoagulated can’t do
Neuraxial anesthesia
479
Always start hydration first before giving insulin in a patient with
DKA
480
Decreasing pKa and higher pH means more ionized so works faster
Chloroprocaine is rapid due to high concentration
481
Allalization speeds onset of local
Anesthetic. An abscess is acidic so putting local in it won’t work well
482
Epi 1:200000
5 ucg/ml
483
Epi prolongs shorter acting LAs like
Lidocaine
484
Ester
Paba
485
IV>tracheal>intercostal>caudal>paracervical to
Epidural
486
Suppress local anesthetic seizure with
Benzos
487
Toxicity of local anesthetic potentiate by
Acidosis hypercarbia pregnancy
488
Cocaine to city treat with
Nitroglycerin(don’t give beta blockers first)
489
LA toxicity
Hyperventilate
Lipid emulsion
Low dose Epi
No vasopressin
490
Methemoglobinemia
Oxidized iron from Fe2+ to Fe3+ doesn’t bind Hgb
491
EMLA cream is
Lidocaine and prilocaine
Can cause methemoglobinemia
492
Peak lidocaine levels occur
12-14 hours after injection in tumescent lidocaine injection
493
Local anesthetics are weak bases attached to
Alpha 1 acid glycoprotein
494
2 alpha subunits is where
NMBs bind
495
Acetylcholinesterase is located in
Post junctional receptor
496
Succ increases
LES tone
497
Succ phase 2 similar to
NMDB block
498
Succ can give in
Cerebral palsy and renal failure
499
Succ induced hyperkalemia in
Burns and patients with muscular dystrophy can release potassium with rhabdomyolysis
500
Panc prolonged most with
Renal failure
501
Succ binds
Post junctional receptors
502
Hypokalemic periodic paralysis avoid
Hypothermia, stress, carbohydrate loads(more insulin release) beta agonists
503
Avoid Succ in
Hyperkalemic periodic paralysis
504
Pancuronium can increase
HR
505
Succ can cause
Bradycardia in neonates and infants
506
Neostigmine inhibits
Psuedocholinesterase as well so Succ May be needed
507
Blocks exocytosis of pre synaptic Ach
Botulism and tetanus
508
Atropine for too much
Neostigmine leading to SLUDGE
509
TIVA and nitrous don’t prolong
Neuromuscular blockade do have to give more
510
Mg increases
ND and depolarizing NMBs
And calcium channel blockers
Lithium clindamycin aminoglycosides
511
Adductor Pollicis is last to recover from
Nmdb so if this is good we are good
512
Orbicularis oculi
Block is more rapid and recovery occurs sooner
513
TOF>.9 is
Best
514
Double burst easier to detect fade bc only
Two lines
515
Residual neuromuscular blockade fade is due to
Residual paralysis
516
Desflurane potentiate
NMDB the most
517
Femoral
Ventral Rami L2-4
518
If sartorius stimulated during femoral nerve block redirect
Needle deeper and lateral
519
NAV
Order of structures
520
Saphenous from ventral Rani
L3-L4
Sensory only
521
Sciatic nerve block
Ventral Rami L4-5 and S1-S3
522
For sciatic block want to see
Plantar flexion of ankle/foot
523
2% lidocaine
20mg/ml
524
Uterine rupture
Fetal bradycardia
Diffuse pain even with epidural
525
1/10 for
Intrathecal dose
1cc .2% ropi
526
Skin test gold standard to diagnose
Anaphylaxis
527
DLCO is increased in
Obesity
528
What volatile anesthetic fucks up SSEPs the most
Isoflurane
529
3 to 1
Iv to oral morphine
530
Continue pyridostigmine
On day of surgery
531
For mediastinal mass
Two pulse ox
| Right inonimste artery compression check with right radial artery
532
Lose etc02 during mediastinal mass
First hand ventilate, if can’t then made compression, try to pass rigid brinchoscope past obstruction then move in lateral or prone, if not open chest and CP bypass
533
Right arterial line tracing diminished during mediastinoscopy
Compression of Inonimate artery causing artificially low bp readings
534
Complication of mediatinoscopy is
Recurrent laryngeal nerve injury
| Leads to hoarseness
535
Myasthenia gravis symptoms are usually
Global
536
AOrtic dissection could have massive
Blood loss
537
Tachycardia is a side effect of
Nitroglycerin
538
For aortic dissection if BP 75/45 in lower extremity
Attempt to increase perfusion pressure distal to cross clamp by placing shunt
539
If bp drops after cross clamp and ST changes
Tell surgeon to immediately reapply clamp. Once BP improves slowly remove clamp while adding infusion of norepinephrine to increase SVR
