ITE Review 1.23.16
1. E Hypocalcemia2. D Subarachnoid injection of LAa. Stellate
ganglion blocki. Indications: CRPS, angina, phantom lib painii.
Anatony: Inferior cervical ant T1 and T1 sympathetic ganglioniii.
We inject at C6 to decrease risk of pneumothoraxiv. Horners sign
should occur EVERY time you do this block3. Aa. Opioids/LA Weak
basesb. Salicylates/barbiturates Weak acidsc. Henderson-Hasselbach
equation
4. E Hyperthermia MACa. Acute EtOH MAC, chronic MAC5. B
Hypotension is not a side effect of intrathecal morphinea. Common
SE: Resp depression, urinary retention, N/V, pruritusb. Bimodal
Resp depressioni. 1-2 hrs: systemic absorptionii. Delayed 6-24
hours6. C Respiratory centers are located in medulla7. D Zones of
Westa. Think of slinky.at the top they are pulled apart and at the
bottom they are still tightb. TopDS; Bottom, shunt8. DSickle Cell:
Autosomal recessive-- Hematocrit would be much lower if the baby
had SC9. D10. D a. Mass spec: will show expired nitrogen--Most
specificb. TEE: most sensitivec. Precordial Doppler: most sensitive
non-invasive11. D12. A13. C-- Diagnostic criteria: must have score
> 5: Petechial rash, CXR, hypoxemia, fever, HR, RR, confusion14.
A Cricothyroid: innervated by external branch of SLN15. B
Oculocardiac reflex16. E Atheroemboli are the MCC of distal
ischemia17. DMuscular dystrophy18. BBeckwith Wiedeman: Growth
disorder with midline defects: Enlarged tongue, low glucose,
abdominal walld effects, pits or creases in ear, risk of cancers19.
C20. B Retrobulbars block: a. Most common complication: retrobulbar
hemorrhageb. Central spread lf LA can occur by injection into dural
sheath or retrograde arterial spread. Other complications
Oculocardiac, Subarachnoid block21. DTriggering agents for
porphyria: barbiturates, diazepam, toradol, etomidate, phenytoin,
birth control pills, sulfonam22. B Double lumen tubes (Draw on
exam)23. ADibucaine numbera. Pseudocholinesterase: Mivacurium,
Local anesb. RBC esterase: Remi/esmolol24. DIntrathecal spread of
Local anesthetica. Major factors: baricity, dose, positionb. Minor
factors: level of injection, speed of injection, size of needle,
physical status, intraabdominal pressure25. B Pneumothorax will
double in volume in 10 min w/ 75% nitrous. 300% in 30 min26. E
Endpoint: O2 delivery to end organs/UOPa. Parkland Formula: RL =
4cc x % BSA x wt (1/2 in 1st 8 hrs, in next 16 hrs)27. B the pad on
the patient is NOT a grounding pad. It disperses the energy28.
CInfant of diabetic mother29. EDecreased FRCa. Upright to supine:
15% decreaseb. Induction of anesthesia: 10-20% decreasec. Supine to
prone: no effect or increased. Peds/obese/pregnant30. CPost-dural
puncture headachea. Risk Factors:i. Beveled (Quincke) needle
(pencil-point needles are preferable)ii. Larger needle (22 G)iii.
Female/pregnancyiv. Younger age31. EMapleson Circuitsa. Spontaneous
ventilataion in order of efficiency: ADCB (All Dogs Can Bite)b. For
controlled ventilation (DBCA) (Dead bodies cant argue)32. CAxillary
nerve block: musculocutaneous nerve lies outside of the sheath33.
Da. Deoxy660 nmb. Oxy 940c. Red = infrared 85%34. A 35.
Dpseudohyponatremia36. B a. 1st stage: onset to 10cm dilation:
T10-L1b. 2nd stage: S2-S4c. 3rd stage: delivery of placenta37.
EAbsolute indications for OLVa. Lung isolation to prevent
damage/contamination of healthy lungb. Control of distribution of
ventilationc. Single lung lavaged. VATS38. Phase II block39. E40.
C41. Ba. SE of celiac plexus block: hypotension, diarrhea42.
B-anterior spinal artery43. Aa. Thiopental will not cause prolonged
apneab. Abx that prolong NMB: Clinda, Amino, Polymyxins, Tetra44.
D45. Ba. Myotonia is characterized by an abnormal delay in muscle
relaxation after contraction. It exists in three forms: myotonic
dystrophy (dystrophia myotonica, myotonia atrophica, Steinert's
disease), myotonia congenita (Thomsen's disease), and paramyotonia
congenita.b. Diagnosisc. Repeated nerve stimulation leads to a
gradual but persistent increase in muscle tension. The EMG is
pathognomonic; myotonic after-discharges are seen in peripheral
muscle, consisting of rapid bursts of potential produced by tapping
the muscle or moving the needle. They produce typical dive-bomber
sounds on the loudspeaker.d. Response to Muscle Relaxantse. The
characteristic abnormality is a sustained, dose-related contracture
after succinylcholine that makes ventilation difficult for 25
min.225 The response to nondepolarizing drugs is normal, although
myotonic responses have been observed after reversal with
neostigmine.226 f. Anesthesiag. Succinylcholine should be avoided
and respiratory depressants used with care. Atracurium or
mivacurium, without reversal, is an appropriate choice for
relaxation.46. BReview SSEP pathways47. C Cerebral autoregulation
can be focala. Normal CBF: 50mL/100g/minb. EEG changes: 20
ML/100g/minc. Cell death: 1048. D49. D50. E51. E52. EPropofol
latency and amplitude53. Ca. Steroids may have affect on
inflammatory mediators made by the cellsi. Mostly used for
vasogenic edema. Contraindicated in TBIb. For every 1mmHg change in
PaCO2CBF changes 1mL/100g/min54. EReviewa. Neuronal injury from
ischemia is due to ATP depletioni. K leaks from cells..Na influx55.
Aa. susceptible to Suxb. susceptible to NMBc. Eaton Lambert: AutoAb
target pre-synaptic voltage gated calcium channels sensitivity to
BOTH Sux and NMB56. C57. EHead injuries: DIC, diabetes insipidus,
SIADH, hyperglycemia, hypercarbia58. BAvoid phenothiazines, reglan,
butyrophenones in Parkinsons Disease59. ARisk of rebleed highest
day1. Risk of vasospasm highest day 6. 60. ANitrous CBF and
CMRO2
Unstable in the presence of soda lime: Sevo/HaloIso VP : IsoWhat
volatile is not an ether? HaloB:G partition coefficient of 1.4:
IsoRisk of seizures w/ hypocapnea: Enflurane
Indirect sympathomimetic: EphedrineInhibits HPV: Nitroprusside.
Dibutamine, isoStructurally similar to thyroid: AmiodaroneDigoxin
is potentiated by hyperCa and HypoKTachyphylaxis: Ephedrine,
Nitroprusside, labetalolStructural Ester: Esmolol
