Assessment Exam 2

Front 1

A HR under ___________on the APGAR scale receives 1 point

Back 1

100; over 100 is 2 points

Front 2

The pediatric larynx is at C_____ compared to C_____ in the adult

Back 2

C3-4 in kids, C5-6 in adults

Front 3

Children have reduced FRC because of increased _____ and decreased ________.

Back 3

Increased chest wall compliance, decreased lung volumes

Front 4

URI within _____ increases anesthetic risk

Back 4

4 weeks

Front 5

Children have _____ the O2 consumption of adults, ______ cc/kg/min

Back 5

twice the consumption, 6-8 cc/kg/min

Front 6

Alveolar development is complete by _______ years

Back 6

8 years

Front 7

________ can be a normal pediatric heart sound

Back 7

S3

Front 8

Children may have a _____ S1, S2

Back 8

fused

Front 9

What 6 classes of patients are at highest risk/ most susceptible to heat loss intraoperatively?

Back 9

1.Children & Elderly
2.Pre-operative temperature <36 degrees C
3. Combined general and regional anesthesia
4. major or intermediate surgery
5. prolonged surgery
6. ASA 3-5 patients

Front 10

The majority of heat lost is due to ________ and occurs in the ___________

Back 10

Redistribution from core to periphery, occurs in the first hour

Front 11

After the first hour, the majority of heat is lost by _____, and can be prevented by __________

Back 11

Radiation, prevent this loss by increasing ambient (room) temp- accounts for 40% of heat loss

Front 12

What is the minimum temperature for surgery on an infant?

Back 12

78 F

Front 13

The second greatest cause of heat loss intraoperatively other than redistribution and radiation is _____ and can be prevented by _______

Back 13

Convection; treat by covering patient (Bair hugger)

Front 14

The five sources of heat loss (other than redistribution) are:

Back 14

Radiation, convection, conduction, evaporation, respiratory loss

Front 15

True of false: Warming fluids is a relatively inefficient way to conserve heat

Back 15

True

Front 16

The ambient room temp for an adult should be > ____

Back 16

21

Front 17

Name 7 side effects of hypothermia

Back 17

1. cardiac arrhythmias
2. ischemia
3. left shift of the O2 dissociation curve
4. reversible coagulopathy (platelet dysfunction)
5. post-op protein catabolism
6. altered mental status
7. impaired renal function

Front 18

You cannot reverse a patient with a temp < ____ because _____

Back 18

35.5; drug metabolism will be altered and patient will become weak in PACU

Front 19

What are the changes to the CV system during pregnancy?

Back 19

Cardiac output increases +50%; HR increases +25%
Systemic vascular resistance and blood pressure fall

Front 20

At how many weeks should you be able to palpate the fundus?

Back 20

12-14 weeks

Front 21

When can the baby's heart beat be heard with a doppler?

Back 21

10-12 weeks; 18 weeks with fetoscope

Front 22

Where is the apical impulse in the pregnant patient?

Back 22

4th ICS, MCL (compared to 5th ICS in non-pregnant)

Front 23

Pregnant women frequently have _____ heart sounds

Back 23

S3 is common, S4 occurs in 16% of pregnant women

Front 24

What is the average Hgb and Hct in pregnant patients?

Back 24

11.6 & 35.5%- plasma volume increases more than red blood cell volume and results in hemodilution

Front 25

Blood volume increases ___ during pregnancy

Back 25

45%

Front 26

Pregnant patients have _____ schincter tone because of what hormone? Gastic pH is _____ because of what hormone?

Back 26

UES tone decreased d/t progesterone, gastin caueses decreased pH of stomach contents

Front 27

Pregnant patients have ________ volume and decreased gastric ______

Back 27

Increased gastric volume and decreased pH; ALWAYS treat as a full stomach (give Bicitra)

Front 28

How do you calculate an EDD?

Back 28

take the first date of the LMP, add one week, subtract three months and add one year

Front 29

Maternal report of fetal movement begins at:

Back 29

18-24 weeks

Front 30

Pre-ecclampsia is defined as:

Back 30

elevated blood pressure >140/>90
beginning after 20 weeks’ gestation with protein in the urine

Front 31

capillary
engorgement of the
nasal & oral mucosa
& larynx begins

Back 31

in the first trimester

Front 32

From 20-32 weeks, the fundal height________

Back 32

From 20 weeks to 32 weeks, the fundal height in
centimeters should approximate the number of weeks of gestation

Front 33

How do you calculate BMI?

Back 33

BMI = Weight (kg)/Height (m2)

Front 34

Obesity is defined as a BMI > ________

Back 34

30

Front 35

Elderly patients have _______ compliance and may require _______ PIP

Back 35

decreased compliance, increased peak pressures

Front 36

After age 40, what does an S3 imply? An S4?

Back 36

S3 is almost never normal after age 40- strongly indicates heart failure; S4 can be heard in healthy people in this age group but implies decreased ventricular compliance

Front 37

S1 ______ the carotid pulse, S2 ______ the carotid pulse

Back 37

S1 precedes the carotid pulse, S2 follows the carotid pulse

Front 38

What do each of the grades of murmurs mean?

Back 38

Grade I just audible with a good stethoscope in a quiet room

Grade 2 quiet but readily audible with a stethoscope

Grade 3 easily heard with a stethoscope

Grade 4 a loud, obvious murmur with a palpable thrill

Grade 5 very loud, heard only over the pericardium but elsewhere in the body

Grade 6 heard with stethoscope off chest

Front 39

Aortic murmurs are best heard:

Back 39

Right sternal border, 2nd ICS

Front 40

_______ people are accident prone, and ______ people are likely to have STDs

Back 40

;)

Front 41

What groups of people are likely to have an abnormal pre-op EKG (and that we should consider getting a baseline EKG on for comparison)?

Back 41

Age > 65 years
History of CHF
History of angina
History of MI
History of severe valvular disease
High cholesterol

Front 42

What two EKG findings have been shown to correllate with increased risk of perioperative MI?

Back 42

R. and L. BBB

Front 43

Who is at increased risk for peri-operative adverse cardiac events?

Back 43

CAD
CHF
Cerebrovascular disease
DM
Renal disease (Cr > 2.0 g/dL)
High risk surgical procedures
Vascular is highest
Emergency surgery
Age (risk increases relatively linearly by decade after 40)
HTN
Obesity

Front 44

Surgery longer than _____ hours is associated with adverse cardiac events

Back 44

3 (or 3.8)

Front 45

What types of surgeries put patients at the highest risk for adverse perioperative cardiac events?

Back 45

Vascular surgery (AAA, peripheral vascular)

Front 46

What types of surgeries put patients at medium risk for adverse perioperative cardiac events?

Back 46

Intrathoracic, peritoneal surgeries, CEA, head and neck, ortho, prostate

Front 47

Who should undergo testing before non-cardiac surgery?

Back 47

Severe valvular heart disease, unstable coronary syndromes, decompensated CHF, significant arrythmias