Yao Book Flashcards
(613 cards)
1
Q
Dyspnea wheezing coughing periodic attacks think
A
Asthma
2
Q
Asthma is seen more in males in
A
2:1 ratio
3
Q
Bronchospasm is usually
A
Cholinergic mediated
4
Q
Airway hyperactivity, chronic inflammation, expiratory airflow obstruction
A
Asthma
5
Q
Inhaled allergens are common triggers of
A
Asthma
Activate mast cells with bound IgE, directly leading to the immediate release of a bronchoconstrictor
6
Q
Hypoxemia is a universal finding in
A
Asthmatic attacks
Don’t see C02 retention as much. More hyperventilation
7
Q
Preop eval asthma
A
Frequency, hospital visits, use of systemic steroid, prior mechanical ventilation for severe attack
8
Q
Airway resistance is high in
A
Obstructive disease
9
Q
ERV
A
Max volume of gas that can be exhaled after normal expiration
10
Q
Residual volume
A
What stays in lungs after forced expiration
11
Q
VC normal
A
60 yo 70 ml/kg
12
Q
TLC
A
VC + RV
13
Q
Obstructive lung disease
A
Long expiration phase
14
Q
CC
A
Lung volume at which small airways in dependent parts of lung begin to close
15
Q
COPD
A
CO2 retention
16
Q
2 to 3 weeks after clinical recovery in children from URI to do
A
Anesthesia
17
Q
30mg of hydrocortisone is released
A
Each day from body
18
Q
Histamine mediates bronchoconstriction through
A
H1
19
Q
Asthmatic induction want to
A
Block airway reflexes before laryngoscopy and intubation
Relax airway smooth muscle
Prevent release biochemical mediators
20
Q
Propofol best for
A
Asthmatic induction
21
Q
Light anesthesia in an asthmatic will lead to
A
Bronchospasm
22
Q
D tubocuranine
A
Can cause bronchospasm through histamine release
23
Q
Manage severe wheezing attack
A
Deepen level of anesthesia and increase Fi02
Then relieve mechanical stimulation
Suction endotracheal tube
Can give albuterol
24
Q
Most common cause of asthmatic attack during surgery is
A
Light anesthesia
25
Non small cell you can treat
Surgically but small cell is medical
26
TNM
T is for tumor size
N if lymph node involvement
M distal metastasis beyond ipsilateral hemothorax
27
Pancoast syndrome
Pain and upper extremity weakness due to invasion of the brachial plexus
28
COPD
Chronic bronchitis and emphysema
29
Aerobic capacity gold standard is
VO2 Max
30
Cervical mediastinoscopy
To establish diagnosis don’t use on patients with cancer spread lymph nodes
Can cause pneumo or perforation of bleeding structures so might need to pack SVC so need access in lower extremities
31
Right VATS
Put a line on left radial
32
Most double lumen tubes are made with
Polyvinyl chloride
33
DLT five sizes
28, 35, 37, 39 and 41 French
34
When bronchial cuff is deflated on double lumen tube you should hear an
Air leak
35
Absolute for double lumen tube
VATS for surgical exposure
Bronchopleural fistula
Isolation of contamination- bronchiectasis lung abscess or massive hemorrhage
36
No DLT if
Difficult anatomy
Lesions that could be traumatized when moving tube in
Small patient where 35 is too big and 28 is too small
37
Left mainstem bronchus is much longer than the
Right
38
Advantage of bronchial blocker
If too small to fit DLT
Difficult airway
If DLT contraindicated
39
Disadvantage of bronchial blocker
Can’t suction well
Possible stapling of stump if not retracted appropriately
Need to use fiberoptic to position
40
Depxyhemoglobin 660
Oxyhemoglobin 940mm
41
Right lung gets
55% of blood flow
| Left lung gets 45%
42
Inhalation agents inhibit
HPV
43
Once atelectactic all the blood flowing into the
Nonventilated lung is shunt flow
44
Improve oxygenation in single lung ventilation
```
Use 100% oxygen
Check position of tube with fiberoptic
Ventilate manually you see tidal volume that is good
Add peep if larger tidal volumes helped
Use two lung ventilation intermittently
```
Can decrease the shunt
Use drugs to augment HPV(phenylephrine, norepinephrine)
Clamp liver vessels or the pulmonary artery of the nonventilated lung temporarily
45
DLT tubes have large outer diameter which can cause airway edema and
Trauma if left in too long
Can convert to single lumen tube if need post op ventilation
46
Intrathecal opioids can act for
18 to 24 hours
47
Intrathecal morphine can cause
Late respiratory depression
48
Lipophilic narcotics
Fentanyl methadone meperidine
Act quick
Can last 6 to 7 hours
49
Morphine is hydrophilic and has slow onset of action(15 to 30 minutes)
Max pain relief at 1 hr
Lasts for more than 12 hours
50
.2 ucg/kg/hr
Ketamine or precedex infusion
Precedex can lead to hypotension and bradycardia
51
Intercostal/Paravertebral nerve block for
Thoracoscopy or thoracotomy pain control
52
80% of patients who have undergone lung resection complain of
Ipsilateral shoulder pain unresponsive to epidural block or systemic opioid
53
Aspiration
Big cause of mortality in elderly/those who have overdosed
54
Chemical aspiration pneumonitis
Respiratory distress, bronchospasm, cyanosis, tachycardia, dyspnea. CXR shows irregular mottled densities
55
Critical pH of aspirate causing problems
PH<2.5
56
Aspiration pneumonia
Infiltrate in a patient who is at risk for oropharyngeal aspiration
57
Initial management post aspiration
Rapidly tilt operating room table to 30 degree head down position
Have assistant hold cricoid while you suction mouth and pharaynx
Do intubation
OG tube to empty stomach
58
No abx for
Aspiration pneumonitis
Also corticosteroids are not recommended
59
Metochlopramide increases
LES tone and can be protective against aspiration pneumonitis
PPI before and OG give and giving antaacid solution can help
60
ARDS more severe than ALI
ARDS pa02/Fi02<200
| ALI<300
61
Compliance is worse at
Extremes of lung volumes
62
Respiratory failure
Hypoxemia, hypercarbic, dyspnea
63
BIPAP for
Mild to moderate respiratory failure
| Risk of aspiration
64
Intermittent PPV
Associated with decrease in cardiac output and in arterial blood pressure
65
Mechanical ventilation
```
Decrease CO
Infection
ALI
Oxygen toxicity if inspired oxygen more than 60%
Endobronchial intubation, cuff leak
Fractured turbinates/epistaxis it nasal
```
66
Oxygen delivery formula
CO x 1.34 x hgb x Sa02 + 0.031 x Pa02
First fix cardiac output, next hgb, finally improve lung mechanics
67
Intrapulmonary shunting due to aspiration treat with
Avoid excessive tidal volumes
Increase PEEP
Make sure patient isn’t fighting the ventilator
68
5 to 10cm peep usually good and I’d not associated
With hemodynamic disturbances
69
PEEP improves arterial oxygenation with increase in
FRC
70
PEEP decreases venous return through increase in intrathoracic pressure
Leads to decrease in cardiac output
71
PSV is based on
Pressure and time
Flow cycled
72
PSV
Achieve larger tidal volume with lower airway pressures
Decreased work of breathing
Promote weaning from ventilator bc of decreased respiratory muscle weakness
73
ECMO used for patients in
Severe acute respiratory failure with potentially reversible lung disease, who are dying despite max vent care
74
Indications for ECMO by NIH
Pa02 less than 50 with 100% Fi02 and peep
75
Only absolute contraindication to not doing artificial lung(aka ECMO)
Active bleeding
76
HFJV
Small tidal volume at high flow rate
77
Don’t use HFV if can’t do passive expiration can lead to bad
Barotrauma
Also need adequate humidification
HFV need adequate training
78
Nitric oxide works in endothelium and goes to
Vascular smooth muscle where it activates cGMP
79
Inhaled NO may decrease pulmonary hypertension in ARDS due to
Hypoxic pulmonary vasoconstriction
80
Selection criteria for lung transplant
Severe ESLD with life expectancy<2 years
Minimal disease of other organ systems
Can follow strict regimen for rehabilitation and immunosuppressive therapy
81
Only absolute contraindication yo single lung transplant
Infectious lung disease(cystic fibrosis/bronchiectasis)
82
Premedication for lung transplant
Midazolam or midazolam plus diphenhydramine to protect lung against drug induced histamine release
83
For lung transplant need
Central venous access for pulmonary artery Catheter placement
84
Lung transplant it is hard to do preoxygenation so need to do it for a
Longer period of time
Rapid induction agent better to shorten excitement stage
Gradual induction bc don’t want abrupt withdrawal of sympathetic tone
85
Inhibition of HPV by
Volatile anesthetics
86
Isolated ventilation of dependent lung can lead to
Increase in peak inspiratory pressure and gradual progressive rise in pulmonary artery pressure
87
Clamping of pulmonary artery moves all cardiac output to
One lung
88
During process of vascular and bronchial anastomosis can get
Hypotension and regional wall motion abnormalities
89
Pulmonary artery pressure drops post
Reperfusion of new lung
90
CBP during lung transplant for
Right ventricular dysfunction not responding to medical therapy
Graft dysfunction
Surgical mistakes
91
Factors leading to more blood products being given
CBP
Double lung
Patients with cystic fibrosis
92
Complications of lung transplant
Early graft dysfunction
Infection
Rejection
Can have gross pulmonary edema
93
Triple vessel CAD
Progressive atherosclerosis of major branches of coronary arteries
94
Coronary arteries main ones
RCA
LAD branch of left main
Left Circumflex branch of left main coronary artery
95
Primary weakness of PCI is
Restenosis- mainly in first 6 mo
96
Reason for CABG
Significant left main disease
Multi vessel disease with left ventricular dysfunction
Three vessel disease that includes proximal LAD coronary artery
97
Evaluate Lft ventricular function
```
Medical hx
Symptoms
Cardiac cath/ECho
EF
PAOP
Cardiac Index
```
98
Myocardial oxygen supply
Coronary blood flow x arterial oxygen content
99
Myocardial oxygen supply
Coronary blood flow x arterial oxygen content
100
Arterial oxygen content equation
1.34 x hgb x 02 saturation
101
Digitalis intoxication fueled by
Hypopotasium and hypercalcemia
| Stop dig 1-2 days before cardiac bypass surgery
102
During CABG need to continue beta blocker even
Periop
103
Metoprolol half life
3 hours
104
Nifedipine
Calcium channel blocker
105
Verapamil is very
Antiarrhythmic
106
CVP line only if good left ventricular function during
CABG
107
Absolute contraindication to TEE
Esophagectomy
Active upper GI bleed
Oropharyngeal pathology
Esophageal pathology
108
Allen test looks for
Adequate collateral ulnar circulation
109
Core temp
Esophageal bladder nasopharyngeal tympanic sites
Not rectal
110
Diastolic pressure is higher in
PA than in RV
111
PAOP normal is
4 to 12 mm Hg
Heart failure is over 18
RV has large waves, PA smaller then PAOP
112
PA pressure for
High vs low pressure pulmonary edema
Primary pulmonary hypertension diagnosis
Monitoring and management of complicated acute mi
Management of hemodynamic stability after cardiac surgery
113
PA catheterization leads to
Infection
Hematoma
Air embolus
Thrombosis
Subclavian approach leads to
Pneumothorax
Hemo
Hydrothorax
114
Earliest and most sensitive sign of MI is
Regional wall motion abnormality
115
TEE can diagnose
Thoracic aortic aneurysm
116
CABG need
Smooth induction
Midazolam can be given to help prevent excitation leading to MI
Fentanyl 5 to 10 ucg/kg
Propofol 2 to 3 mg/kg
Don’t give benzos it over 70
117
Isoflurane
Most potent coronary vadodilator
118
Pancuronium causes
Tachycardia and HTN
119
In first time sternotomy
Ventilation must be held to protect the lungs from injury from the electric saw
120
Don’t keep swan ganz inflated continuously
Pulmonary infarction distal to the occlusion May ensue
121
Hgb higher than 11 per dL to donate
Blood for autologous transfusion
122
Intraop normovolemic hemodilution
Removal of blood post induction before CBP or administration of heparin
123
Salvaged blood is deficient in
Coagulation factors and platelets
124
Heparin at what dose for bypass
300 units per kg
125
AT3 forms
Irreversible complexes with thrombin
126
Heparin broken down by
Reticuloendothelial system
127
Heparin half life
100 minutes
128
MAP=
CO x TPR
129
Hypotension at beginning of bypass due to
Inadequate pump flow at beginning
| Decreased plasma levels of catecholamines by hemodilution
130
Nicardipine
Systemic and coronary arterial dilator. Afterload is decreased, while preload not affected
131
Hypothermia decreases
Oxygen consumption
132
Hemodilution reduces
Hemoglobin concentration and hence decreases oxygen content
133
Blood viscosity varies
Inversely with temperature
134
Hypothermia prolongs
Onset of paralysis
135
Best way to monitor relaxation
Peripheral nerve stimulator
136
Oxygenater has flow can be decreased if
Pa02 is high and Pac02 is low
137
If hematocrit is below 18% during hemodilution
Blood is added to CBP circuit
138
Decrease myocardial o2 demand with
Cardioplegia and hypothermia
139
LV fraction below 25% can add
Milrinone or IABP or both
140
Protamine itself is an
Anticoagulant
141
IABP should be inflated immediately following
Closure of aortic valve at dicrotic notch of arterial tracing
142
Complications of IABP
```
Ischemia of leg
Aortic dissection
Thrombus formation
Renal artery occlusion
Thrombocytopenia
Infection
```
143
Stable blood gas to wean from bypass
PH 7.35 to 7.45
Pa02 80mm hg
Fi02 40
Pac02 35 to 45
Vital capacity> 10 to 15 ml per kg
Hemostasis<100 ml of chest tube drainage
144
Eccentric
Away from the center
145
Chronic AI shifts loop to the
Right
146
MR hallmark
Elevation in left atrial pressure
| Giant CV wave and elevated pulmonary artery pressures
147
Mitral regurg you want afterload
Reduction
May have normal EF even though things are messed up
148
Can’t come off bypass post aortic mitral replacement think
Adequacy of myocardial preservation
149
High CVP and high pulmonary pressures
Pulmonary HTN
150
Nitric oxide is a
Potent inhaled pulmonary vasodilator
151
IABP is a
Catheter with large balloon at the tip
In thoracic aorta distal to left subclavian
152
TEE can show takeoff of left subclavian artery for
ISBP placement
Before placement can look at aorta for severe atheromatous disease or dissection which are contraindications of placement
153
Inflation of IABP just after
Dicrotic notch
154
Contraindication to IABP
AI, severe aortic disease
155
VAD used in management of chronic hearty failure after
Exhausting medical therapy
156
Minimally invasive cardiac surgery
Any procedure not performed with a full sternotomy and CB support
157
Main reasons for pacemaker
Sick sinus and complete heart block
158
Pacemaker for
Class 3/4 heart failure with dilated cardiomyopathy eF less than 35%, qRS>120 and sinus rhythm
159
Sick sinus syndrome
Array of disorders resulting from irreversible sinus node dysfunction
160
First degree block PR interval >
0.2 seconds
161
Mobitz type 1 PR increases until it drops
Mobitz type 2 no increase but QRS just drops
162
Paced Sensed Mode of Response
First 3 for pacemakers
163
For example VOO
Paces in the ventricle but does not sense intrinsic activity nor does it inhibits pacing and paces regardless of the hearts electric activity
164
Asynchronous mode paces at
Preset no matter what
165
Single chamber demand pacing paces at a preset rate only when
Spontaneous HR below programmed preset rate
| For example if VVI 70 device would only pace in ventricle only if native HR less than 70
166
Is in synchronous mode hyperventilation can cause HR intrinsically to go
Up with the pacemaker
167
Dual chamber pacemakers can be used for
Sick sinus and all degrees of heart block
168
Current ICDs measure
R-R interval
169
ICD indications
Survivors of V fib V tach not from reversible cause
Ischemic cardiomyopathy EF<30% without recent MI in last 3 mo
Ischemia cardiomyopathy EF <35% with HF symptoms
Long and short QT
Hocm
170
All CIEDs should be interrogated at
3 to 6 mo before surgery
Establish type
Dependency on pacing
CIED function and programming details
171
PPM or ICD interrogation u want to know
```
Battery life
Programmed pacing mode
Pacemaker dependency
Intrinsic rhythm
Behavior of magnet
Pacemaker lead parameters
```
172
For ICd or pacemaker need to determine
WMI during procedure
Grounding pad on
Do we need asynchronous mode
Temporary pacing and defibrillation be available
Only disables tachycardia detection and therapy of the ICD
173
A magnet cannot concert pacemaker in ICD system to
Asynchronous mode pacing
Only disables tachycardia detection and therapy of the ICD
174
Advisable not to use which gas after pacemaker placement
Nitrous
Air can go in pocket of pacemaker
175
For a patient with an ICD and magnet disabled strips who gets V tach mid surgery
Ask surgeon to stop all sources of EMI
Remove magnet to restart antitavhyvardia therapies
Can take 10 seconds to recharge
If it doesn’t work use emergency external defibrillation
176
EWSL ok with ppl with
Pacemakers
177
Need to reprogram pacemaker to asynchronous for
ECT
178
MRI generally contraindicated for ppl with
CIED
179
Two kinds of true aneurysms are saccular and fusiform
Saccular only involve a portion of the vessel
| Fusiform involves diffuse, circumferential dilation of a long vascular segment
180
Aortic dissection presents when blood enters
Arterial wall through intimate tear
181
Biggest risk factor for aortic dissection is
Hypertension
182
Aneurysms can form from
Congenital bicuspid aortic valve or Turner syndrome
183
Type 1 aortic dissection starts in
Ascending aorta and extends throughout the aorta down to the common iliaca arteries
184
Type 2 aortic dissection is limited to the
Ascending aorta only
185
Type 3 dissection begins
Distal to the left subclavian artery
186
Main cause of death with an aneurysm is
Rupture
187
Cell saver induced loss of
Platelets, plasma proteins, coagulation factors
188
Left arterial to femoral bypass if prolonged aortic cross
Clamping
DHCA can help
189
One lung ventilation and two forms of temp and left heart bypass for
Thoracic aneurysm repair
190
TAAA can lead to
End organ ischemia
Aortic cross clamp time affects it
Can affect spinal cord most feared
Kidneys can also be affected- if age>50, preexisting renal problrms, duration renal ischemia>40 min, hemodynamic instability
191
Most common postop complication of TAAA repair (thoracic aneurysm) is
Postop respiratory failure
192
Synaptic pathway disruption
Decreased amplitude
| Increased latency
193
MEPs look at
Anterior horn motor neurons of coryicospinal tract, both areas supplied by anterior spinal arteries
194
Aortic clamping
Proximal hypertension due to sudden increase in afterload
Increase in CVP
Increased preload afterload
Increased SVR and eventually cardiac output goes down
195
Aortic unclamping
Hypotension due to blood volume redistribution and pooling
Hypoxia mediated vasodilation with increased venous capacitance
Release of vasoactive and myocardial depressants mainly lactic acid
Hypoxemia
Acute metabolic acidosis which can decrease myocardial contractility
196
Most common access site for endovascular TAAA repair is
Femoral artery
197
Endovascular TAAA complications
Hypotension- aortic rupture, allergic reaction to contrast dye
Spinal cord ischemia
Postimplantation syndrome- fever, elevated C protein, leukocytosis- treatment is with NSAIDs
198
Single most common cause of early morbidity in AAA resection is an
MI
199
Major pathological cause of aneurysm is
Atherosclerosis
200
Surgical interventions best for aneurysms larger than
5.5cm
201
Reduce myocardial oxygen demand by avoiding
Tachycardia and HTN
Prevent hypotension and anemia
202
Greatest demand on heart comes from increased
HR
203
Single anterior spinal artery
Supplies 75% of the spinal cord
204
Artery of Adamkowitz
Supplies thoracolumbar region
| Arises from T9-T12
205
It is possible to have paralysis with normal SSEPs and paralysis
Blood flow through anterior spinal artery not detected
206
Temp
Anesthetic depth
Changes in blood flow can alter
SSEPs
207
MEPs do monitor
Areas of spinal cord supplied by anterior spinal artery
208
AAA
Epidural helps
Regional May decrease hypercoaguability and thrombotic events
209
Put a line prior to anesthesia for
Triple A
210
Major complications arterial line placement
Vascular insufficient and infection
211
Invasive measure of volume status is needed if
Open AAA repair
212
How long to wait before epidural after giving LMWH
12 hours
213
Therapeutic dose like enoxaparin 1mg/kg wait
24 hours before epidural
214
Oral warfarin should be stopped
4 to 5 days before surgery
215
Remove neuraxial catheters when INR under
1.5
216
Aortic cross clamp can lead to
Arterial HTN with increase afterload and decreased CO
217
If post cross clamp get ST changes and high PCWP can give
Nitroglycerin to lower LVEDP and help with myocardial ischemia
218
Extubation criteria
```
Vital capacity 15ml/kg
Ph greater than 7.3
Pac02 less than 50
NIF greater than -20
Stable hemodynamic
```
219
Adolescent
Early childhood
Infant
Normal BP
100/75
85/55
70/45
220
Hypertensive emergency
180/120 above with end organ damage
If not it’s urgent
221
Hyper dynamic hypertension
Postop surgical patient, acute systolic HTN, widened pulse pressure, increased CO, HR, SVR
222
Sign of long standing HTN
LVH which increases the risk of an MI
223
Diuretics lower BP by
Increasing urinary sodium excretion, and by reducing plasma volume, extracellular fluid volume, and cardiac output
224
Hydralazine nitroglycerin relax
Smooth muscle of resistance and capacitance vessels to different degrees
225
Should cancel surgery for high
BP
But if asymptomatic can usually proceed
226
Acute withdrawal of beta blockers could lead to
Ischemic myocardial events
227
Hypokalemia
Depresses neuromuscular function
Should check and if potassium below 3 try to replete before surgery
Can give potassium not exceeding 0.5 mEQ per kg of body weight per hour
228
Hypomagnesium can induce
Seizures, confusion, and coma
229
Bruit is a sign of
Vascular disease
230
U can give an
Antihypertensive before surgery
Usually beta blocker is best bc it will lower demand and risk of myocardial ischemia
231
Induction of Hypertensive pt
As ur preoxygenating give 7 to 8 ug per kg fentanyl then prop
Prob don’t give ketamine can cause HTN and tachycardia
232
During and immediately following intubation associated with tachycardia and HTN
Decrease in LVEf
233
Hypotension after induction usually due to
Hypovolemia, Vasodilation, and cardiac depression
234
Can give esmolol
Two minutes before Extubation if worries about HTN
235
Postop HTN causes
```
Pain
Emergence excitement
Hypoxemia
Hypercarbia
Full bladder
Hypothermia
Withdrawal
```
236
SOB inability to lay supine oliguria post cardiac bypass think
Tamponade
237
CO is the product of
Stroke volume x HR
238
Stroke volume
Difference between left ventricular end diastolic and systolic volume
239
Cardiac tamponade
Extrinsic compression of the heart from intrapericardial blood and clots, exudative effusions, nonexidative effusions, and air
240
Significant chest tube output (more then 200ml per hour) immediate postop is a sign of
Increased amount of blood around the heart
241
Delayed tamponade
5 to 7 days after pericardotomy
242
Normal spontaneous inspiration
Extrathoracic to intrathoracic pressure gradient is increased and the filling of the right heart is slightly higher than the left
243
Kussmaul sign
Inspiratory fall of arterial BP increases 10mm Hg
244
As low as 150 ml acutely can lead to
Tamponade
245
With tamponade cardiac silhouette will be
Widened with water bottle configuration of the heart
246
Unfractionated heparin anticoagulant activity through
AT3
247
LMWH
Inhibits factor 10a preferentially
248
LMWH better with less bleeding than
Unfractionated heparin
249
HIT
Immune mediated by complex between heparin and platelet factor 4
250
HIT type 2
Life threatening 5 to 10 days after initiation of heparin therapy
Platelet count down 50% or less then 50000
251
Hit type 2 treatment is
Discontinuation of heparin
Can use direct thrombin inhibitors or LMWH
252
Heparin negatively charged
Protamine positively charged
253
PT
Extrinsic pathway
254
TEG measures
Physical properties of a clot
255
Desmopressin helps with hemostasis by increasing
VWF and factor 7 activity in plasma
Best dose is 0.3 ucg/kg
Might be good in patients with ESRD with less vWF
256
Pathological fibrinolysis is when
Fibrin in a thrombus is broken down before healing
257
E aminocaproic acid and txa are analogues of
Lysine
They inhibit plasminogen and plasmin, resulting in less fibrinogen or fibrinolysis
258
Standard IV for cardiac surgery dose of Aminocaproic acid
5 to 10g follower by infusion of 1g per hour
259
Can give fluid in tamponade even if
CVP is high but PAOP is low
260
Inotropy with vasodilation properties
Milrinone/dobutamine
261
FFP contains
Labels factors 5 and 8 as well as stable coagulation factors 2,7,9,10
262
Cryoprecipitate contains
Factors 8,13, vWf and fibrinogen
263
FFP indications
Replacement of factor deficiencies
Reversal of warfarin
Massive blood transfusions
Treatment of antithrombin 3 deficiency in patients who are heparin resistant
264
Platelet concentrate indications
Active bleeding associated with thrombocytopenia
| Massive blood transfusions
265
Cryoprecipitate indications
Bleeding patients with VWF
Correction of microvascular bleeding in massively transfused patients with fibrinogen concentrations less than 80 to 100 mg per dl
266
One unit of cryoprecipitate per 10kg body weight
Raises plasma fibrinogen concentration approximately 50 mg per dl
267
Risk of HIV when giving blood is
1/500000 for each unit given
268
Most common virus transmitted via blood transfusion is
CMV
269
Preop tamponade give
Supplemental O2
Check chest radiograph
Assess Abg
270
IV ketamine 1mg/kg has a rapid onset
Achieves peak plasma concentration in less than 1 minute
Indirectly depresses the myocardium
271
Fentanyl May decrease
BP
272
Etomidate best during induction when
Cardiovascular collapse is anticipated
273
Cardiac tamponade induction
Have surgical team at bedside with drapes up
Fentanyl
Neuromuscular blocker
Etomidate/Ketamine
274
Negative pressure to positive pressure after intubation causes
Reduced cardiac filling by increasing intrathoracic pressure and afterload
Lower tidal volume will help with filling
275
In tamponade chest opening
Normalizes the pressure relation and can see improvement immediately
276
Labetalol antagonizes both
Alpha and beta receptors
277
Most common reasons for heart transplant
Ischemic coronary artery disease and nonischemic cardiomyopathy
278
Peak V02 max < 10 ml/kg/min indication for
Transplantation
279
Can’t donate heart if
EF<40% or bad LVH with wall thickness>13mm
280
Diabetes insipidus is seen in brain dead donors with urine output of more then 300 ml/hr and have to give
Desmopressin
281
Most common cause of death within 30 days of transplant
Graft failure, multi organ failure, non CMV
282
31 to 365 days post transplant cause of death
Non CMV
| Graft failure, acute rejection
283
Biatrial vs bicaval technique
Biatrial involves anastomosis if recipient and donor atrial cuffs
Bicaval maintains above left anastomoses and attempts to maintain cardiac anatomy with desperate bicaval anastomoses to the right atrium
284
LVAD insertion reasons
Cardiogenic shock
Progressive decline
Inotropy dependence
285
Excessive afterload can hinder
LVAD
286
For heart transplant should reach CP bypass
At time of donor heart arrival to minimize ischemic time
287
Avoid nitrous oxide in heart transplant
Due to its effects on PVR
288
Place patient in head down position for
Air evacuation from left side of heart
289
Can give what drug to increase HR and contractility in heart transplant
Isoproterenol
290
Early postop complications of heart transplant
Right heart failure/pulmonary HTN
Denervated heart
Bleeding
Early graft failure
291
Inhaled No
Selective pulmonary vasodilator in severe pulmonary HTN and RV failure
292
Following cardiac transplant
Cardiac plexus is interrupted and the heart is deenervated
293
Deenervated heart
Lacks ability to respond to acutely your hypovolemia or hypotension with reflex tachycardia but responds to stress with increase in stroke volume
This is why heart transplant patients are preload dependent
294
Within 30 days after heart transplant most common cause of death is
Graft failure
295
Neostigmine can cause
Dose dependent decrease in heart rate in heart transplanted patients
296
Cardiac dysrhythmias can occur in
Heart transplant patients
297
Gold standard to check for allograft rejection
Endomyocardial biopsy
Mainly treated with steroids
298
Chronic steroid treatment results in abnormal stress response so patients should receive
Perioperative steroids
299
Transplanted heart is vulnerable to accelerated process of coronary atherosclerosis called
Cardiac allograft vasculopathy
300
Most heart transplant patients get renal function from using
Cyclosporine
301
Prolonged ST depression check
Troponins
Elevation may start within the first 8 hours post surgery
302
Peak incidence of cardiac disease is within the
First 3 days of surgery
303
Beta blockers
Reduce myocardial oxygen consumption
Improves coronary blood flow
Improves supply/demand
Improves oxygen dissociation from Hgb
304
Nitrates
Decreased LV preload
Systemic venous dilation
Decreased LV afterload
Coronary artery and arteriolar dilation
305
Calcium channel blockers
Reduce myocardial oxygen demand By depression of myocardial contractility and dilation of coronary and collateral vessels, improving blood flow
306
Aspirin inhibits platelet aggregation by blocking production of
Thromboxane A2
307
Alpha 2 agonists stimulate pre junctional alpha receptors and
Decrease norepinephrine release
308
PAC is an insensitive for
MI
309
Hypotension
Hypertension
Tachycardia can lead to
MI
310
Etomidate
0.2 to 0.3 mg/kg for induction
311
During cardiac surgery if you get a new 3mm st segment depression in lead V5
HR control and adequate coronary perfusion pressure
Avoid hypotension
Correct anemia
Correct shivering to lower oxygen demand
312
Calcium channel blockers drug of choice for
Coronary spasm
313
Recommended HR for high risk patients
60 to 70
| Definitely less than 100
314
To prevent tachycardia and HTN of emergence of cardiac patient can give
1 mg/kg lidocaine or esmolol or .1 mg/kg of labetalol
315
Visceral pain
C fibers which is dull and crampy
316
Most common cause of intestinal obstructions
Adhesions then hernia
317
Four cardinal signs of intestinal obstruction
Crampy abdominal pain
Nausea and vomiting
Obstipation,
Abdominal distension
318
Ileus
Functional failure of normal intestinal transit
319
Need to decompress abdomen
For ileus beforehand
320
Most important factors post aspiration
Volume
Ph of gastric content
Presence or abscence of particulate
321
Incomplete LES increases the likelihood of
Regurg and aspiration
322
Aspiration of gastric contents leads to
Chemical pneumonitis with
Hypoxemia
Bronchospasm
Atelectasis
323
Once vomiting or regurgitation occurs
Lateral head down
Suction
Trachea suctioned
Bronchoscopy for patients who aspirated solids leading to significant airway obstruction
324
Liver transplant donor types
Donation after cardiac death(DCD)
Partial livers from living donors
Harvesting marginal donors from cadevers
325
Candidates for liver transplant
Acute liver failure
Decompensated cirrhosis
Hepatocellular carcinoma
326
Most common indication for pediatric liver transplant is
Biliary atresia
327
Portopulmonary HTN
Mean pulmonary artery pressure>25 at rest
| Pulmonary vascular resistance >240
328
As cirrhosis progresses you get a decrease in
SVR
Leading to compensatory activation of RAS leading to ascites, edema, and vasoconstriction of the intrarenal circulation and renal hypoperfusion
329
Cirrohsis leads to
Hypervolemic hyponatremia from increased secretion of ADH thus leading to expanded extracellular volume, ascites and edema
Impairs excretion of solute free water
330
Hepatorenal syndrome
Renal vasoconstriction in response to systemic vasodilation.
Cirrohsis with ascites
Creatinine>1.5
Abscence of shock
No current nephrotoxic meds
Type 1 is rapid with doubling of serum creatinine
331
Hepatopulmonary syndrome
Platypnea (dyspnea in upright position better by laying down)
332
Ascites initially managed with
Low sodium diet
Diuretics
Next step is paracentesis and albumin replacement
333
During TIPS procedure expendable stent is placed in liver
Parenchyma to decrease portal HTN
334
In patients with liver disease muscle relaxant doses are
Increased because fluid retention increases volume of distribution
335
Presence of coagulopathy is a contraindication to
Regional anesthesia especially epidural anesthesia
336
Preanhepatic phase
Induction of anesthesia ends with clamping of hepatic artery
337
Second phase
Anhepatic phase begins after removal of diseased liver and ends with reperfusion of the new liver
Clamp and divide the IVC
338
Without a liver
Patient may get acidosis and hypocalcemia bc lactic and citrate not cleared
339
Venovenous bypass
Divert blood flow from portal circulation and IVC to the right atrium
340
In anhepatic phase
Gluconeogenesis is absent
341
Removal of suprahepatic IVC doesn’t cause any changes but unclamping of the infrahepatic IVC restores
Venous return
342
After unclamping of portal vein
Desaturated blood goes into systemic circulation leading to decrease in BP, HR, SVR, CO etc
343
Hyperkalemia treatment
Diuretics, beta agonists, insulin, alkalinization with sodium bircarb or hyperventilation
344
Anticipate hypocalcemia with liver disease due to failure to clear
Citrate
345
Lethal triad
Coagulopathy
Acidosis
Hypothermia
346
Potential disadvantages of antifibrinolytics such as TXA are
Development of thromboses that could be catastrophic
347
Intraoperative signs a graft is working
Good texture and color
Bile production
Hemodynamic stability
348
A functioning graft liver might not function for
Days so many need clotting factors in early postop period
349
Cerebral perfusion pressure
MAP-ICP or CVP whichever is higher
350
Posterior fossa tumors
In contact with cranial nerves and brainstem nuclei so need to be very careful
351
Intracranial HTN treatments
```
Corticosteroids
Head elevation
Diuretics
Hypertonic saline
Hyperventilation
Ventriculostomy usually clamped on transport
Drug induced cerebral vasoconstriction and coma with thiopental
Deliberate hypothermia
```
352
Sitting position leads to decreased
Preload so need fluids
353
Central access is needed for giving
Hypertonic saline
354
Giving sodium bicarbonate lowers
Potassium
355
For peds advocate to give
20 to 40 ml per kg of an isotonic fluid over course of anesthetic
356
Analgesic effects of methadone last
4-8 hours
357
Methadone is a full agonist at
U receptors
358
In ESRD a decrease of
50 to 75% of methadone dosage is needed
359
Methadone black box warnings
Death from respiratory depression
Cardiac effects
Arrhythmias such as torsades
360
Propofol decreases the dissociation of GABA and
It’s receptor
361
GABA and chloride ion come closer together with
Benzodiazepines
362
Carotid disease
Asynptomatic bruit or TIA
363
Accepted indications for carotid surgery include
TIA with angio evidence of stenosis
Reversible ischemic neurologic deficits with greater than 70% stenosis of vessel wall
Unstable neurologic status persisting despite anticoagulation
364
Right common carotid off
Brachiocephslic trunk
Left comes off aortic arch
365
Common carotid bifurcates into internal and external carotids at
Thyroid cartiledge
366
If after carotid endarterectomy the intima is too thin can close the vessel with a
Vein graft or a synthetic(dacron) graft
367
Normal CBF is
50 ml/100g/min for the entire brain
368
At pressures less then 50mm Hg cerebral vessels are maximally vasodilator, so that CBF decreases as
MAP falls
369
Chronically ischemic vascular beds are maximally vasodilated and can not
Dilate further in response to hypercapnea
370
EEG tells you if certain areas of the brain are at risk for
Infarction
371
Advantage of regional anesthesia during carotid endarterectomy is
Repeated neurologic exams
372
Regional anesthesia can lead to
Seizures
Alteration of mental status with cerebral ischemia
Loss of patient cooperation associated with cerebral hypoperfusion
373
Deep or cervical plexus blocks can get
C2-C4 for a carotid endarterectomy
374
Reperfusion injury involves
Cerebral hemorrhage or the development of cerebral edema after obstruction to flow through the carotid artery has been relieved
375
Amiodarone
Pneumonitis
Causes fibrosis and decrease in DLCO
Maintain lowest amount of Fi02 possible
376
Amiodarone can cause
Pulmonary fibrosis
Liver dysfunction and hepatitis
Hypo and hyperthyroidism
377
Lesions in eloquent cortex don’t require
Lumbar drain
Lesions are too small
378
VAE associate with
Posterior fossa craniotomy and cervical spine surgery
379
Small doses of Propofol 10 mg will suffice to
Stop seizure during awake craniotomy
380
Loading dose of precedex
1 ug per kg over 10 minutes before maintenance infusion
381
Treat seizures with
Benzodiazepines
382
Primary vs secondary injury
Primary is due to initial impact
| Secondary is what happens after the impact
383
Mannitol
.25 to 1 g per kg
| Reduces ICP after 15 minutes
384
Stress response after severe head injury
Release of catecholamines and hyperglycemia
385
Severe hyponatremia below 120 can lead to
Cerebral edema and seizures
386
Magnesium falls during
TBI
387
Decimpressive crani
Decrease high ICP due to brain edema
First line is moderate hypocapnia, mannitol, sedation, normothermia
388
Palpate to look for
Cervical spine injury
389
Give defasicukating dose before giving
Succ so ICP doesn’t go up
390
Hyperventilation for control of
ICP and reversal of acidosis in brain tissue
391
Corticosteroids help with
Cortical vasogenic edema
392
Control ICP with
Hyperventilation
Head up tilt
CSF drainage
Mannitol
393
Seizures
Increase ICP
394
Tylenol first line for
Fever
395
Any malpractice payments made on behalf of an individual physician must be reported to the
NPDB
396
Part 4 mocha requirement can be achieved with
Creating a quality improvement plan
397
Nitrous oxide
Irreversibly binds to and oxidizes cobalt in Vitamin b12, converting it to an inactive state
398
To make thyroid hormone you need
Iodine
399
T3 much shorter half life than
T4
90% of hormone released from thyroid gland is T4
400
Thyroid increases
Cholesterol secretion into bile
401
90% of all hyperthyroidism is from
Graves’ disease
402
Iodine can’t be given to
Children
| Pregnant women or breast feeding
403
Methimazole can be given rectally
Rectal
404
Treat thyroid storm with
Beta blockers
405
Malignant hyperthermia
Hypercarbia
Metabolic acidosis
Muscle rigidity
406
Tracheomalacia make sure vocal cords are
Moving and airway doesn’t collapse
407
Don’t use aspirin for
Thyroid storm
408
Thyroid storm usually happens
6 to 18 hours post surgery
409
Dislodgement of bronchial blocker into trachea causes
Higher peak pressures and sp02 to decrease
410
Obese patients have more
Acetylcholinesterasse
411
Ascites leads to
Restrictive lung disease
No change in FEV1/FVC ratio
412
Acute drop in ICP from reduction in CSF volume can lead to
Cerebral aneurysm rupture with subarachnoid hemorrhage
413
Transmural pressure across aneurysm is
MAP-ICP
414
Pancreatic grafts require
Constant blood flow. Graft thrombosis should get reexplored
415
Definitive treatment for DM is
Pancreas transplant
416
Patients with peripartum cardiomyopathy should be offered a trial of
Vaginal delivery
417
What influences the spread of spinal anesthesia with plain bupivicaine
CSF volume
418
Bupivicaine and ropivicaine are isobaric
Most affected by CSF fluid volume
419
Nitrous oxide can ignite so shouldn’t be used in
Laser airway surgery
420
Halogenated gases are considered
Greenhouse gases
421
Sudden sustained increase in BP is a sign of
Aneurysm rupture
422
Gold standard for cerebral vasospasm diagnosis is
Angiography
423
Primary hyperthyroidism due to
T3
424
FRC
Amount of air in the lungs after a normal respiration
425
Previous vaginal delivery doesn’t lead to
Uterine rupture
426
Increased intrabdominal pressure from pneumopetitoneum from laporoscopic pressure can lead to
Outflow of CSF fluid being reduced from a shunt
427
MA value down give
Platelets
428
Before surgery on patients with type 1 VWF give
Desmopressin
429
SV02
Percentage of oxygen bound to hemoglobin returning to right side of heart
430
Measure SV02 at the
PAC
431
Respiration less efficienct in infants due to
Highly compliant chest wall
432
Stellate ganglion block is performed at
C6 level even though ganglion lies at C7
433
Multiple groups categorical data is
Chi square
434
Accuracy which a sample represents piopulstion is
Standard error of the mean
435
90 percent of pheos are found in
Adrenal medulla
436
Adrenal medulla secretes
Epinephrine, norepinephrine, dopamine
437
Most endogenous catecholamine termination is by
Reuptake
438
Severe headache diaphoresis palpitations think
Pheo
439
Plasma metanephrines best for diagnosis of a
Pheo
440
Morphine curare atracurium cause
Histamine release
441
Norepinephrine and fluids may be needed after
Pheo removed
442
Diagnosis of diabetes
Symptoms plus random glucose>200
HemoglobinA1c>6.5%
Fasting glucose>126
Two hour plasma glucose>200
443
Met form in
Increased peripheral uptake of glucose by tissues
444
Worsened neurologic and cardiac problems and wound healing with
Diabetes and high glucose during surgery
445
Glucose above 180 causes
Protein glycation and osmotic diuresus
446
Hemodynamic collapse associated with
Hypoglycemia
447
Placenta percreta is
The most dangerous
| Placenta through the myometrium with possible into other adjacent structures
448
Nd YAG laser can lead to fatal
Gas embolus
449
Caudal epidural for
Lower abdomen and lower extremity surgery
450
Ropivicaine toxic dose is above
3 mg/kg
451
Can’t get the FRC with
Spirometry
452
Following smoking cessation there is actually an
Increase in sputum production
453
Thiazides inhibit sodium transport in the
Distal convoluted tubule
454
Lasix diuresis occurs within 5 minutes and lead effect by
1 hour
455
Can do left hepatectomy to give liver to
Child which is an easier technique for the surgeon
456
Lumbar nerve roots exit from the
Same numbered pedicle
457
HCTZ acts on Na/Cl transporter
For HTN and edema
458
Continue anti angina meds and beta blockers until
Day of surgery
459
Dilution also hyponatremia occurs during a
TURP
Best fluid is normal saline
460
TURP syndrome patient can go
Unresponsive
461
Several liters of bladder irrigation pass through during
TURP
Can lower body temperature a good amount
462
TURP syndrome due to large volume mainly hypotonic bladder irrigation
Can lead to CNS, hematologists, renal, etc
Headache nausea SOB are early signs
463
Respiratory and CV arrest if
Serum sodium less than 110
464
If TURP syndrome
Terminate surgery
Administer 20mg lasix
Oxygen
Get blood gas
465
Glycine is an
Inhibitory neurotransmitter
Can be toxic to heart and retina
466
Hyperglycemia
Can cause transient visual disturbance during TURP
467
TURP similar to
Hysteroscopy
468
Cos atracurium
Hoffman elimination
469
Hiv can get
Renal transplant if low cd4 count but not aids patient
470
Prolonged neuromuscular blockade with
Renal disease
471
Increased neuromuscular blockade
```
Abx like aminoglycosides
Local anesthetics
Lasix
Lithium
Hypermagnesium
Hypothermia
```
472
Hypotension May occur during kidney transplant after unclamping the iliaca vessel and
Reperfusion of the graft
473
Far less diaphragm loss and pulmonary loss with
Laparoscopic surgery
474
Laparoscopic surgery is ok in
Pregnant patient
475
C02 is insufflation has of choice bc
Nonflammable, rapidly removed from lungs, highly soluble bc of rapid buffering in whole blood
476
200 ml of CO2 is made per
Day
477
Convert laparoscopy to laparotomy if
Major bleeding or organ damage
478
Hypercarbia leads to
Depression of myocardial contractility and rate of contraction
479
Intraabdomen pressure greater than 30
Decrease in BP cardiac output CVP due to pressure on vena cava leading to decrease venous return
480
C02 crosses
BBB not H+
481
Painlessvaginal bleedingthink
Previa
Don’t do digital exam bc if previa leads to hemorrhage
Do transvaginal US first
482
To prevent graft vs host need to
Irradiate blood
483
Lumbar plexus sympathy blocks for crps
May cause ejaculation problems
484
SEM
SD/square root sample size
485
Loop and thiazides cause
Hypochloremic metabolic alkalosis
486
Brachial artery runs in close proximity to
Median nerve
487
IABP through femoral artery into
Descending aorta
488
Oliguria
<0.5 ml/kg/hr
489
Anuria
Less than 50 ml/day
490
Internal branch of superior laryngeal nerve sensation to entire
Larynx above the glottis
491
Most appropriate initial drug for shoulder dystocia is
Nitroglycerin
492
Child over 12 mo has blood volume
70-75 ml/kg
493
To prevent rebreathing fresh gas flow must be
1-2 times minute ventilation in the Mapleson D semi open breathing system
494
PEEP can worsen
Increased PVR and mean airway pressures
495
Risk for uterine rupture higher with previous
C section
496
Oxytocin increases frequency and
Duration of uterine contractions
497
Acute stretching of peritoneum by abdominal insufflation can lead to
Huge Vagal response
498
Hydrocortisone lowers
NMB potential
499
Single most common sign of fetal compromise
Reduced beat to beat variability
500
Potential disadvantages of antifibrinolytics such as TXA are
Development of thromboses that could be catastrophic
501
Intraoperative signs a graft is working
Good texture and color
Bile production
Hemodynamic stability
502
A functioning graft liver might not function for
Days so many need clotting factors in early postop period
503
Cerebral perfusion pressure
MAP-ICP or CVP whichever is higher
504
Posterior fossa tumors
In contact with cranial nerves and brainstem nuclei so need to be very careful
505
Intracranial HTN treatments
```
Corticosteroids
Head elevation
Diuretics
Hypertonic saline
Hyperventilation
Ventriculostomy usually clamped on transport
Drug induced cerebral vasoconstriction and coma with thiopental
Deliberate hypothermia
```
506
Sitting position leads to decreased
Preload so need fluids
507
Central access is needed for giving
Hypertonic saline
508
Giving sodium bicarbonate lowers
Potassium
509
For peds advocate to give
20 to 40 ml per kg of an isotonic fluid over course of anesthetic
510
Analgesic effects of methadone last
4-8 hours
511
Methadone is a full agonist at
U receptors
512
In ESRD a decrease of
50 to 75% of methadone dosage is needed
513
Methadone black box warnings
Death from respiratory depression
Cardiac effects
Arrhythmias such as torsades
514
Propofol decreases the dissociation of GABA and
It’s receptor
515
GABA and chloride ion come closer together with
Benzodiazepines
516
Carotid disease
Asynptomatic bruit or TIA
517
Accepted indications for carotid surgery include
TIA with angio evidence of stenosis
Reversible ischemic neurologic deficits with greater than 70% stenosis of vessel wall
Unstable neurologic status persisting despite anticoagulation
518
Right common carotid off
Brachiocephslic trunk
Left comes off aortic arch
519
Common carotid bifurcates into internal and external carotids at
Thyroid cartiledge
520
If after carotid endarterectomy the intima is too thin can close the vessel with a
Vein graft or a synthetic(dacron) graft
521
Normal CBF is
50 ml/100g/min for the entire brain
522
At pressures less then 50mm Hg cerebral vessels are maximally vasodilator, so that CBF decreases as
MAP falls
523
Chronically ischemic vascular beds are maximally vasodilated and can not
Dilate further in response to hypercapnea
524
EEG tells you if certain areas of the brain are at risk for
Infarction
525
Advantage of regional anesthesia during carotid endarterectomy is
Repeated neurologic exams
526
Regional anesthesia can lead to
Seizures
Alteration of mental status with cerebral ischemia
Loss of patient cooperation associated with cerebral hypoperfusion
527
Deep or cervical plexus blocks can get
C2-C4 for a carotid endarterectomy
528
Reperfusion injury involves
Cerebral hemorrhage or the development of cerebral edema after obstruction to flow through the carotid artery has been relieved
529
Amiodarone
Pneumonitis
Causes fibrosis and decrease in DLCO
Maintain lowest amount of Fi02 possible
530
Amiodarone can cause
Pulmonary fibrosis
Liver dysfunction and hepatitis
Hypo and hyperthyroidism
531
Lesions in eloquent cortex don’t require
Lumbar drain
Lesions are too small
532
VAE associate with
Posterior fossa craniotomy and cervical spine surgery
533
Small doses of Propofol 10 mg will suffice to
Stop seizure during awake craniotomy
534
Loading dose of precedex
1 ug per kg over 10 minutes before maintenance infusion
535
Treat seizures with
Benzodiazepines
536
Primary vs secondary injury
Primary is due to initial impact
| Secondary is what happens after the impact
537
Mannitol
.25 to 1 g per kg
| Reduces ICP after 15 minutes
538
Stress response after severe head injury
Release of catecholamines and hyperglycemia
539
Severe hyponatremia below 120 can lead to
Cerebral edema and seizures
540
Magnesium falls during
TBI
541
Decimpressive crani
Decrease high ICP due to brain edema
First line is moderate hypocapnia, mannitol, sedation, normothermia
542
Palpate to look for
Cervical spine injury
543
Give defasicukating dose before giving
Succ so ICP doesn’t go up
544
Hyperventilation for control of
ICP and reversal of acidosis in brain tissue
545
Corticosteroids help with
Cortical vasogenic edema
546
Control ICP with
Hyperventilation
Head up tilt
CSF drainage
Mannitol
547
Seizures
Increase ICP
548
Tylenol first line for
Fever
549
Any malpractice payments made on behalf of an individual physician must be reported to the
NPDB
550
Part 4 mocha requirement can be achieved with
Creating a quality improvement plan
551
Nitrous oxide
Irreversibly binds to and oxidizes cobalt in Vitamin b12, converting it to an inactive state
552
To make thyroid hormone you need
Iodine
553
T3 much shorter half life than
T4
90% of hormone released from thyroid gland is T4
554
Thyroid increases
Cholesterol secretion into bile
555
90% of all hyperthyroidism is from
Graves’ disease
556
Iodine can’t be given to
Children
| Pregnant women or breast feeding
557
Methimazole can be given rectally
Rectal
558
Treat thyroid storm with
Beta blockers
559
Malignant hyperthermia
Hypercarbia
Metabolic acidosis
Muscle rigidity
560
Tracheomalacia make sure vocal cords are
Moving and airway doesn’t collapse
561
Don’t use aspirin for
Thyroid storm
562
Thyroid storm usually happens
6 to 18 hours post surgery
563
Dislodgement of bronchial blocker into trachea causes
Higher peak pressures and sp02 to decrease
564
Obese patients have more
Acetylcholinesterasse
565
Ascites leads to
Restrictive lung disease
No change in FEV1/FVC ratio
566
Acute drop in ICP from reduction in CSF volume can lead to
Cerebral aneurysm rupture with subarachnoid hemorrhage
567
Transmural pressure across aneurysm is
MAP-ICP
568
Pancreatic grafts require
Constant blood flow. Graft thrombosis should get reexplored
569
Definitive treatment for DM is
Pancreas transplant
570
Patients with peripartum cardiomyopathy should be offered a trial of
Vaginal delivery
571
What influences the spread of spinal anesthesia with plain bupivicaine
CSF volume
572
Bupivicaine and ropivicaine are isobaric
Most affected by CSF fluid volume
573
Nitrous oxide can ignite so shouldn’t be used in
Laser airway surgery
574
Halogenated gases are considered
Greenhouse gases
575
Sudden sustained increase in BP is a sign of
Aneurysm rupture
576
Gold standard for cerebral vasospasm diagnosis is
Angiography
577
Primary hyperthyroidism due to
T3
578
FRC
Amount of air in the lungs after a normal respiration
579
Previous vaginal delivery doesn’t lead to
Uterine rupture
580
Increased intrabdominal pressure from pneumopetitoneum from laporoscopic pressure can lead to
Outflow of CSF fluid being reduced from a shunt
581
MA value down give
Platelets
582
Before surgery on patients with type 1 VWF give
Desmopressin
583
SV02
Percentage of oxygen bound to hemoglobin returning to right side of heart
584
Measure SV02 at the
PAC
585
Respiration less efficienct in infants due to
Highly compliant chest wall
586
Stellate ganglion block is performed at
C6 level even though ganglion lies at C7
587
Multiple groups categorical data is
Chi square
588
Accuracy which a sample represents piopulstion is
Standard error of the mean
589
90 percent of pheos are found in
Adrenal medulla
590
Adrenal medulla secretes
Epinephrine, norepinephrine, dopamine
591
Most endogenous catecholamine termination is by
Reuptake
592
Severe headache diaphoresis palpitations think
Pheo
593
Plasma metanephrines best for diagnosis of a
Pheo
594
Morphine curare atracurium cause
Histamine release
595
Norepinephrine and fluids may be needed after
Pheo removed
596
Diagnosis of diabetes
Symptoms plus random glucose>200
HemoglobinA1c>6.5%
Fasting glucose>126
Two hour plasma glucose>200
597
Met form in
Increased peripheral uptake of glucose by tissues
598
Worsened neurologic and cardiac problems and wound healing with
Diabetes and high glucose during surgery
599
Glucose above 180 causes
Protein glycation and osmotic diuresus
600
Hemodynamic collapse associated with
Hypoglycemia
601
Placenta percreta is
The most dangerous
| Placenta through the myometrium with possible into other adjacent structures
602
Nd YAG laser can lead to fatal
Gas embolus
603
Caudal epidural for
Lower abdomen and lower extremity surgery
604
Ropivicaine toxic dose is above
3 mg/kg
605
Can’t get the FRC with
Spirometry
606
Following smoking cessation there is actually an
Increase in sputum production
607
Thiazides inhibit sodium transport in the
Distal convoluted tubule
608
Lasix diuresis occurs within 5 minutes and lead effect by
1 hour
609
Can do left hepatectomy to give liver to
Child which is an easier technique for the surgeon
610
Lumbar nerve roots exit from the
Same numbered pedicle
611
HCTZ acts on Na/Cl transporter
For HTN and edema
612
Retinopathy of prematurity usually not important after
44 wks
613
Lateral femoral cutaneous nerve contains fibers from the
L2-L3
