article reviews- Josh Flashcards by Josh Newby

ARF Postop:

what are 2 main prerenal faliure causes?

Diminished CO

Volume depletion

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ARF Postop:

with prerenal cause of Diminished CO, what are some couses of the decreased Co

CHF
Cardiogenic shock
Acut MI
Dysrhythmia

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ARF Postop:

with prerenal causes what causes volume depletion

hemorrhage
Spsis
GI blood/fluid loss
Hypoalbuminemia
3rd spacing

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ARF Postop:

what are 3 postrenal causes

ureteral obstruction

Bladder neck obstruction

Vascular obstruction

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ARF Postop

w/ post renal failure, what causes the ureteral obstruction?>

surgical ligation
Papillary necrosis
calculi
Blood clot

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ARF Postop:

w/ post renal failure what are some causes of Bladder neck obstruction?

prostate enlargement

Bladddr calculi

Urethral stricture

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ARF Postop:

w/ post renal failure what are some causes of vascular obstruction

Renal vein thrombosis
Surgical ligation

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ARF Postop:

what are 3 causes of intrarenal failure?

tubular damage

Interstitium damage

Vascular damage

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ARF Postop:

w/ intrarenal failure what causes tubular damage?

ATN
Endogenous toxins
Exogenous toxins

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ARF Postop:

w/ intrarenal failure what causes interstitium failure?

Drugs (abx, NSAIDS)
Infections

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ARF Postop:

w/ intrarenal faliure what causes Vascular failure?

drugs

thrombotic states

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initially hypercalemia causes hyperexcitability of cellular membranes how?

by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction

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initially hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes what?

less excitable

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what does hyperkalemia due to NMB induced by muscle relaxants

it potentiates the NM blockade by decreasing the excitability of the skeletal muscle

remember (
initially hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes less excitable)

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what are major presentations of residual NM blockade?

airway obstruction
hypoventilation
hypoxemia

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Hyperkalemia can contribult to residual what? (r/t MR)

muscle weakness

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Hemostasis:

how is a platelet plug made?

plts activated at site of injury to form a platelet plug that provides the initial hemostatic response

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Hemostasis:

what the primary events of Clot formation

exposure to tissue factor (III) at the site abd it’s interaction w/ Factor VII and the Factor X (hagman factor)

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Hemostasis:

what are the primary events for termination of clot

involves factor antithrombin, tissue factor pathway inhibtor, and protein C pathway

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Hemostasis:

whay is there clot lysis?

restore vessel patency

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Hemostasis:

steps for clot lysis

plasminogen binds fibrin to tpa
activate proteolytic plasmin
cleaves fibrin, fibrinogen, and a variety of plasma proteins and clotting factors

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what is the impairment of hemostasis and activation of fibrinolysis that occurs d/t severe injury

Acute traumatic coagulopathy (ATC)

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ATC:

what are standard test?

PT/INR
aPTT
finrinogen level
plt count

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ATC:

pt’s w/o preexisting coag defects that have a prolonged PT and/ot PTT > _____ x’s normal have ATC

> 1.5x’s normal

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ATC: what type of coag monitoring is useful for monitoring ongoing resuscitation in injured pts

Thomboelastography

what test measure the VISOELASTIC properties of clot formation providing information on clot initiation, clot strength, and fibrinoysis

TEG

ATC: what is plasma based resuscitation for a pt dx w/ ATC

PRBCs FFP PLT

ATC: what are 3 hemostatic agents for severe coagulopathy?

Factor VIIa Prothrombin complex concentrate antifibrinolytic agents

what is a metalloprotease that cleaves vWF within developing platelet-rich thrombi to prevent hemolysis, thrombocytopenia, and tissue infarction

ADAMTS13

Most adult cases of ITTP are d/t acquired antibodes that inhibit what?

ADAMTS13

ITTP: 805 of pt's respond to what treatment?

plasma exchange (removes antibody and replinishes ADAMS13)

ITTP: Immunosupression w/ what drug may be as effective as salvage therapy

rituximab

what is teh most frequent complications that require admission r/t Sickle Cell Disease (SCD)

acute bone problems painful vaso-occlusive crises and osteomyelitis

Bone Involement in SCD: what complication startes in late infancy and continues throughout life

Vaso-occlusive crises

Bone Involement in SCD: what is a complex pathogenisis that involves the activation and adhesion of Leukocytes, plts, endotheliel cells, and HgbS, can occur in any organ but most common in bone marrow?

microvascular occlusion

Bone Involement in SCD: Osteolyelitis is thoought o be caused by what?

Hyposplenism

Bone Involement in SCD: what bacteria is most commonly the cause of osteomyelitis list fom most to least common

Salmonella staph A Gram neg enteric bacilli

Bone Involement in SCD: what is the most disabling chronic bone d/o

osteonecrosis

GERD and It's effect in DL and Intubation: changes at the cellular level can produce ____ and subglottic ______ making the airway difficult

edema stenosis

GERD and It's effect in DL and Intubation: Hx of what should alert you to ptential abnormalities from GERD and erosion of laryngotracheal mucosa

Chronic cough hoarseness throat clearing dysphagia

GERD and It's effect in DL and Intubation: if GERD causes occult aspiration it can mimic what other diseases

Asthma Bronchitis

GERD and It's effect in DL and Intubation: subglottic edema seen w/ GERD can be dramatically decreased w/

preop meds

GERD and It's effect in DL and Intubation: what ttype of drugs are cimetidine, Famotidine, nizatidine, rantididine?

H2 antagonist

GERD and It's effect in DL and Intubation: what type of drugs are alka-selzwer, di-gel, gavison, maalox, mylanta, riopan plus, rolaids, tums

antacids

GERD and It's effect in DL and Intubation: what type of drugs are cisapride, Metoclopramide?

Gastrokinetics

GERD and It's effect in DL and Intubation: what type of drug is omeprazole

PPIs

GERD and It's effect in DL and Intubation: combos of the previous drugs should be started at least ___ hours before anticipated GA

Genetic Nutrition: Nutritional issues in older adults: the involuntary loss of \> 5-10% of older adults usual weight during 1 year = what

increased risk for mortality

Genetic Nutrition: Nutritional issues in older adults: involutary weight loss is generally r/t 1 or a combo of what 4 conditions

1. inadquate dietary intake 2. Appetite loss (anorexia) 3. Muscle atrophy 4. Imflammatory effects of disease

Genetic Nutrition: Nutritional issues in older adults: inadequate dietary intake can be r/t what issues

social psychospcial medical physiological

Genetic Nutrition: Nutritional issues in older adults: what isi teh most prevelent condition that causes weight loss in the older adult

depression

Genetic Nutrition: Nutritional issues in older adults: what is te 2nd most common cause of weight loss

Cancer

Genetic Nutrition: Nutritional issues in older adults: sarcopenia (a degenerative loss of muscle mass) is often r/t what?

testosterone and estroge reductions increase in insulin resistance

Genetic Nutrition: Nutritional issues in older adults: if a DM pt is having issues with weight, do you place them on a diabetic diet still

fuck no, just monitor them closer

Genetic Nutrition: Nutritional issues in older adults: should you treat w/ appetite stimulamnts such as megestrol and dronabinol?

nope they show no benefits

Genetic Nutrition: Nutritional issues in older adults:t 15% of ppl \> 60 have what vit def

B12

Electrolyte changes.....TURP: the study recomend checking what levels in prop for TURP pt's

K+ Na+ Ca++

Electrolyte changes.....TURP: why o you want to optimize their electrolytes b4 sx

to prevent serious and fatal complications

Electrolyte changes.....TURP: normally there is a fall of what in Na+ during a TURP?

5-8mEq/L

Electrolyte changes.....TURP: procedure lasting longer than _____ min and volume of prostate gland greater than ____ could be associated w/ more complication

think 60 60 min 60 ml

Electrolyte changes.....TURP: limit height of irrigation fluid column to \_\_\_\_cm can provide optimal vision to surgeon and reduce complications of fluid absorption

60 cm (23-24 inch) i think bill stated a lower height of 16-18 inches

Electrolyte changes.....TURP: what is a widely used irrigant, b/c of it's good optical properties, and non-electrolytic properties that prevent dissipation of diathermy current durrent resection

Glycine 1.5%

Electrolyte changes.....TURP: is glycine 1.5 % hypo/hyper/or isotonic

slightly Hypotonic

Electrolyte changes.....TURP: early identification of TURP syndrome and it's treatment should be based on administration of what?

hypertonic saline

Electrolyte changes.....TURP: S/S of TURP syndrome CNS

restlessness H/A Confusion Convulsions Coma Visual disturbances N/V

Electrolyte changes.....TURP: S/S TURP syndrome CV and respiratory

* HTN * Tachycardia * Tachypnea * Hypoxia * Pulm edema * Hypotension * bradycardia

Electrolyte changes.....TURP: S/S of TURP syndrome metabolic and renal

Hyponatremis Hyperglycemia IV hemolysis Acute renal failure

Perioperative management of pt w/ liver dz: the conerstone of periop maagement are medical treatment of liver disease complications such as what?

* Coagulapathy * Ascites * Encephalopathy * Malnutrition

Perioperative management of pt w/ liver dz: what do you want to pay close attention to post op

risk factors for infection

Perioperative management of pt w/ liver dz: Sepsis, coagulopathy, and emergency sx are most strogly associated w/ what?

post op mortality

Perioperative management of pt w/ liver dz: what are risk stratification systems?

CTP score MELD score ASA

Perioperative management of pt w/ liver dz: Surgery is contraindicated if what CTP class

Perioperative management of pt w/ liver dz: why should you use sedatives and MR w/ caution

prolonged duration of action

Perioperative management of pt w/ liver dz: how do you want to optimize Cirrhosis pt's

* correct coag (PTT w/in 3 sec of NL) * Goal Plt count \> 50-100,000 * Minimize ascites * Address nutritional status

Perioperative management of pt w/ liver dz: what narc is prefered

fenatanyl

Perioperative management of pt w/ liver dz: how do you treat coagulopathy

* Vit K * FFP if Vit K ineffective * Cryoprecipitate * DDAVP if bleeding time prolonged * goal PT w/oin 3 sec NL

Perioperative management of pt w/ liver dz: how to treat encephalopathy

* Lactulose

Perioperative management of pt w/ liver dz:h ow to treat ascites

Diuretics Fluid restriction large volume paracentesis

Diagnosing HIT in Cardiac surgical pts...: Cardiac sugical pts are at increased risk for post op HIT d/t what factors

High dose heparin platelet activation CPB

Diagnosing HIT in Cardiac surgical pts...:h How does HIT occur?

immune mediated response * teh anticoagulant causes a procoagulant effect via platelet activating antibodies that reconize multimeric platelet factoe 4 (PF4) heaprin complexes on platelet surfaces

Diagnosing HIT in Cardiac surgical pts...: what are CV pt's so hard to diagnose?

b/c they have thrombocytopenia for frst 72 hours post op anyways

Diagnosing HIT in Cardiac surgical pts...: prompt reconition is crucial b/c cessation of haparin and treatment w/ what reduces the risk of thromboembolic events

direct thrombin inhibitor

Diagnosing HIT in Cardiac surgical pts...: what are 2 types of assays to detect HIT

Functional assays enzyme imunoassays

Diagnosing HIT in Cardiac surgical pts...: whaich assay has the highest sensitivity and specificity?

Functional assay

Diagnosing HIT in Cardiac surgical pts...: why is the functional assays not used ofter?

impractical due to being very time intensive and lack of avilability

Diagnosing HIT in Cardiac surgical pts...: what are 2 ex of funtional essays

HIPA (Heparin induced platelet activation assay) SRA (serotonin release assays)

Diagnosing HIT in Cardiac surgical pts...: so the enzyme immunoassays (EIA) also have a high sensitivity and rapid result but what is bad about them?

a high number of false positives

Airway management w/ ALL: ALL is the most comon malignancy in who

children

Airway management w/ ALL: pulmonary comlications

* PNA'oulm leukostasis * malignant pleural effusion * upper airway obstrction

Airway management w/ ALL: what isteh malignancy of blast cells d/t failure of cell maturation leads to accumulation of useless cells at the expense of normal hemopoietic cells

Acute leukemia

Airway management w/ ALL: S/S

fatique bone/joint pain fever w/o infection weightloss abnormal masses splenomegaly leymphadenopathy hepatomegaly sternal tenderness anterior mediastinal masses petechiae/purpura mucus membrane bleeding fundal hemarrhage CNS involbement ARF

Airway management w/ ALL: diagnosis of ALL is made how

demostration of 20% lymphoblasts in teh bone marrow

Airway management w/ ALL: in kids why is there a difficult airway?

\> compression of upper airway and inability of narrower lumen to accomadate edema =airway obstruction

Airway management w/ ALL: what med has been used w/o abx in oropharyngeal obstruction

Dexmethasone

Society for ambulatory ....... Management of PONV: can antiemetic prophylaxis eliminate PONV

nope but it can reduce it

Society for ambulatory ....... Management of PONV: sorry McD but 5-HT3 receptor antagonist are more effective in prophylaxis when given when

at end of sx

Society for ambulatory ....... Management of PONV: decadron is recomended at a dose of ___ at the induction to decrease PONV

4 mg

Society for ambulatory ....... Management of PONV: adults at a _____ risk for PONV should receive combination therapy w/ oone or more prophylactc drugs from different classes

moderate

Society for ambulatory ....... Management of PONV: when a rescue therapy is needed what type of antiemetic should be given

one from a defiierent class than used for prophylaxis

Society for ambulatory ....... Management of PONV: if PONV occurs w/in ___ hours postop pts should not receive a repeat dose of prophylactic antiemetic

6 hours

Society for ambulatory ....... Management of PONV: if it has been more the ____ hours an emetic episode can be treated w/ any of the g=drugs used for prophylaxis except decadron and scopolamine

Society for ambulatory ....... Management of PONV:wh at are the pt specific risk factors

* female * Nonsmoker * hx of PONV * Motion sickness

Society for ambulatory ....... Management of PONV: what are anesthestic risk factors

VAAS N2O intrap/postop opioids

Society for ambulatory ....... Management of PONV: what are surgical risk factors

* Duration of sx (each 30 min increases risk by 60 %) * type of sx (lap, laparotomy, breast, stribismus, plastic sx, maxillofacial, gyn, abd, neuro, opthalmic, and uro)

Anticancer...anesthesia implications: Chemo agents can cause ____ and _____ complications in the lungs

pneumontis and Pulmonary fibrosis

Anticancer...anesthesia implications: what is a red flag for the development of pneumonitis and pulm fibrosis

dyspnea at rest

Anticancer...anesthesia implications: pt's eho had bleomycin should not receive ____ inspired O2 and _____ (a type of fluids) should be used during and after sx

high Colloids

Anticancer...anesthesia implications: \_\_\_\_toxicity occurs w/ most anticancer drugs

hepatotoxicity

Anticancer...anesthesia implications: what drug class can reduce the excretion of methotrexate

NSAIDs

Anticancer...anesthesia implications: \_\_\_\_\_\_\_\_ causes central and autonomic nervous sytem toxicity and peripheral neuropathies thus regional anesthesia is contraindicated

Vincristine

Renal: the thick ascending loop gets close to the glomerulus (cortex) and cuddles next to the afferent arteriole. thsi part of the loop is called the what?

MACULA DENSA

Renal: the macula densa has specialized cells and the arteriole has specialized cells and together these celles are called the what

juxtaglomerular apparatus

Renal: the juxtaglomerular apparatus has an important role in the excretion of what?

renin

Renal: renin secretion is stimulated by what 2 things

1. renal hypoperfusion 2. SNS stimulation

Renal: what are the 2 major systemic effects of ATII

1. systemic vasoconstriction * by enhancing NE release 2. Na+ and H20 retention

Renal: aldosterone is released from where?

the adrenal cortex particulary the zona glomerulose

Renal: in the collecting tubules there is 2 type of cells?

1. principle cells * reabsorb Na+, Cl-, and secrete K+ 2. Intercalated Cells * secrete H+ or HCO3 and reabsrb K+

that is I am done there is more but I am done with flash cards for this test I am whooped

shoot me in the head

article reviews- Josh Flashcards

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