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JM Review for Exam I
review
57
Physiology
Graduate
06/04/2014

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Term
Name 3 hyper-coagulable states:
Definition
Anti-thrombin III deficiency
Protein C deficiency
Protein S deficiency
Term
Name 2 anti-clotting factors that are vitamin K dependent:
Definition
Protein C & Protein S
Term
Protein C inhibits what clotting factors?
Definition
Factors V & VIII
Term
Major Anesthetic implications in HIV/AIDS?
Definition
1. Drug holiday
2. Complete workup (echo?)
3. AIDS= NO SAB/epidural
4. Caution w/SUCC's= autonomic instability d/t upregulation *ALINE
5. Meticulous pulmonary care & early extubation
6. Elective C/s vs. Vag delivery, SAB/epidural w/blood patches safe
Term
Treatment for vWF deficiency?
Definition
DDAVP (onset in 30 minutes, lasts 4-6 hours)
Cryoprecipitate
Concentrated Factor VIII
Term
Vitamin K dependent factors include?
Definition
Factors 2, 7, 9, 10
Term
Factors in cryoprecipitate?
Definition
Factors I, VIII, XIII
Term
Vitamin K begins working w/in ?
Definition
3 to 6 hours
Term
Name 2 conditions associated with anti-thrombin III deficiencies
Definition
Liver cirrhosis & Nephrotic syndrome
Term
The "Hallmark" of HIV
Definition
Generalized lymphadenopathy
Term
Treatment of Tetanus includes?
Definition
1. Early intubation/supportive airway measures
2. Valium or NDMR for spasms
3. Beta-antagonists (esmolol) for tachycardia & htn
4. PCN tx exotoxin
5. Aline
6. Volatiles
7. Lidocaine (arrythmias), magnesium, nipride, nicardipine
Term
Treatment for necrotizing soft tissue infections?>
Definition
1. Surgical intervention
2. Broad spectrum coverage
3. Natural honey to digest necrotic tissue
4. Hyperbaric
5. CL/Aline, blood products
6. Catecholamine/cortisol depeletion & DIC may occur
Term
Subclass of sepsis that are surgical emergencies?
Definition
Necrotizing soft tissue infections:
1. gas gangrene
2. toxic shock syndromes
3. severe cellulitis
4. flesh eating infections
Term
Treatment goals for sepsis include?
Definition
1. MAP >65
2. CVP 8-12
3. u/o at least 1ml/kg/hr
4.mixed venous sat > 70%
Term
1st priority in sepsis
Definition
Antibiotic administration (baseline labs)
Term
Indications of SIRS include?
Definition
1. WBC <4 or >11 (or > 20% immature forms)
2. Temp < 36 or > 38
3. HR >90
4. RR > 20 or paCO2 < 32
Term
SSI prevention measures include:
Definition
1. antibiotic administration w/in 1 hour of incision
2. increased tissue oxygen tension (*colorectol)
3. Pain control
4. avoid hypocapnia
5. avoid hypothermia
6. avoid hyperglycemia
7. wound probing
Term
Risk factors for SSIs include:
Definition
1. extremis of age
2. Diabetes
3. Corticosteroid therapy
4. Immunocompromised
5. Chronic illness
Term
5th Generation cephalosporin's (names) and benefit?
Definition
Best for MRSA, newest (Teflaro/ceftarolin)
Term
4th Generation cephalosprin (name) and benefit?
Definition
Maxipime/cefipime, extended activity & more resistance to Beta lactamase
Term
3rd generation cephalosporins (names & benifit)
Definition
cefotaxime & ceftriaxone
less g- coverage
better against beta lactamase producers
Term
Cefotetan
Definition
2nd generation, good g- coverage.
1-2 gm's, redosed @ 4 hours
Term
Cefoxitin
Definition
2nd gen, good g- coverage
1-2gm's, short 1/2 life, redose @ 2 hours
Term
Cefazolin (keflex/ancef)
Definition
1st gen cephalosporin, broad spec, low incidence of SEs, ideal for prophylaxis, penetrates most tissue except CNS, 1gm (2gm >100kg), redose @ 3 hours, lg blood loss/admin, 2nd procedure
Term
Clindamycin
Definition
Lancosamide, G+ anaerobic coverage, GI SEs, CDIFF, NDMR prolongation, not 1st line, 600-900mg w/in 60 min of incision, give over 30 min, redose @ 3 hours
Term
What antibiotic blocks the release of acetycholine at the NMJ prolonging the effects of NDMR's
Definition
Clindamycin
Term
Flagyl
Definition
1st line for anaerobic bacteria, protazoal, and parasitic infections
500mg w/in 60 min of incision
Avoid alcohol (disulfiram like reaction)
GI symptoms common
Term
An example of a prodrug
Definition
Flagyl
Term
Risk factors for gentamycin toxicity include?
Definition
1. Elderly
2. Renal compromised pts
3. high dose > 5 days
Term
This drug inhibits re-junctional release of Ach & reduces post-synaptic sensitivity to Ach prolonging NDMR activity?
Definition
Aminioglycosides
Term
Treatment for pronlonged NDMR action in pt's taking aminoglycosides?
Definition
Calcium & Neostigmine (improves muscle strength)
Term
Aminoglycosides
Definition
G- coverage, polar -poor GI absorption, Lg daily dose, 1.5mg/kg w/max 240mg, Qday dosing, give over 30-60 min, & w/in 1 hour of incision
NEPHROTOXIC & OTOTOXIC
Term
Vancomycin
Definition
G+ bacteriocide, MRSA, dose 1gm q 12 hours. Give over 1 hour, too fast will result in tachycardia & hypotension.
given w/in 60-120 min of incision time
Redman syndrome is most common ADE, d/t histamine release (benadryl helps)
Term
The susbtitute for pts with cephalosporin allergies?
Definition
vancomycin
Term
This drug must be given slowly
Definition
vancomycin
Term
Drug most commonly used for MRSA
Definition
vancomycin
Term
What neck position would cause the trachea to move downward? & how would this effect ETT placement
Definition
Extension, ETT will move upward ** Risk inadvertent extubation
Term
Moving the head side to side affects the trachea how?
Definition
Trachea will move upward, a fixed ETT will sink deeper
Term
the Carina is located where?
Definition
T4-5, @ angle of louis- articulation of 2nd rib
Term
Mucous secreting goblet cells (broncial glands) are innervated by what?
Definition
PSNS via the vagus nerve
Term
Mast cells are located where, how do they affect respiratory smooth muscle?
Definition
Near branches of small vessels & near vagus nerve, throughout smooth muscle, intestinal mucosa & skin.
Key role in allergic reactions
Secrete Vaso active substances that produce respiratory smooth muscle vasoconstriction
Term
What happens to airway pressure when compliance is reduced but volume remains unchanged?
Definition
pressure increases
Term
True/False. A compliant lung will receive more volume than a non compliant lung
Definition
True
Term
What accounts for 2/3 of the total lung compliance?
Definition
Surface tension (force that must be overcome to open & inflate alveoli)
Term
True or False: the larger the surface area, the more the surface tension
Definition
True
Term
Name the respiratory tract segment that is surrounded by spiral muscle fibers; making it susceptible to collapse based on intraplueral and intraalveolar pressures?
Definition
Bronchioles
Term
What is the purpose of the canals of lambert & where are they located?
Definition
collateral ventilation below sites of obstruction- which is not affected by smooth muscle contractions, found between the terminal bronchioles and adjacent alveoli.
Term
Location & purpose of the Pores of Kohn?
Definition
Located in alveoli- allow interface between adjacent alveoli, the number & size of openings increase with age & certain diseases ABSENT in NEWBORNS
Term
The pressure difference between the mouth and the alveoli?
Definition
Transairway pressure (3mmHg= 760-757)
If alveolar pressure is less than atm air moves in
Term
Pressure in the fluid of the pleural space?
Definition
Pleural pressure/intrathoracic pressure. normally negative 5. w/chest expansion becomes more negative to -7.5. W/exhalation, becomes LESS negative
Term
Flexion of the neck causes the trachea to move _______ and ________. Moving the ETT ________.
Definition
Rise & stretch, deeper
Term
The pressure difference b/t alveolar pressure & pleural pressure
Definition
Transpulmonary pressure/recoil pressure.
measures elastic forces in the lungs that tends to collapse the lungs
volume increases as alveolar and pleural pressures become slightly more negative. Lung volume will decrease as the 2 pressures become slightly more positive.
Term
For every 1cmH20 of TPP change the lung will expand ______ ml over ____ to ____ seconds.
Definition
100-200, 10-20 seconds
Term
How is distending (inflating) pressure r/t alveolar radius?
Definition
INDIRECTLY. As the radius increases, the TPP needed to keep it open decreases; once critical pressure has been reached (laplace)
Term
General Causes of surfactant deficiency?
Definition
Acidosis
Hypoxia
Hyperoxia
Atelectasis
Pulmonary Congestion
Term
Specific causes of surfactant deficiency?
Definition
ARDS
RDS
Pulmonary Embolism
Pulmonary edema
Pneumonia
Excessive lavage
Extracorporeal oxygenation
Drowning
Term
Give 2 examples where compliance is dcreased d/t decreased chest wall expansion/compliance?
Definition
Narcotic chest wall rigidity
Obesity-supine position
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