Bryan - Anesthesiology - Final Part 2 - Spring 2Nd Year

Front 1

What percentage of blood is found in the veins? Heart/lungs? Arteries? Capillaries?

Back 1

70% veins
15% heart/lungs
10% arteries
5% capillaries

Front 2

Which part of the ECG waveform corresponds with...
...atrial depolarization?

Back 2

P wave

Front 3

Which part of the ECG waveform corresponds with...
...conduction through the AV node?

Back 3

PR segment

Front 4

Which part of the ECG waveform corresponds with...
...ventricular depolarization?

Back 4

QRS complex

Front 5

Which part of the ECG waveform corresponds with...
...ventricular repolarization?

Back 5

T wave

Front 6

How does inhaled anesthesia interfere with cardiac function?

Back 6

Reduces contractility by reducing Ca.

Front 7

What is the approximate distribution of the cardiac output?

Back 7

75% to vessel rich group (brain/heart/kidney)
20% to muscles/skin
5% to fat
<1% to vessel poor group

Front 8

What are some important factors that should be examined/noted during a physical exam of a patient with suspected cardiovascular disease?

Back 8

Ascult heart
Jugular distention/pulse
Femoral pulse
Respiratory pattern
Abdominal palpation

Front 9

Which diagnostic tool gives the best information about a cardiac case?
a) ECG
b) Ultrasonography
c) Radiography
d) Blood pressure
e) Echocardiography

Back 9

e) Echocardiography (which is technically a form of ultrasonography)

Front 10

What is the first step in a procedure involving cardiac tamponade?

Back 10

Tap tap tap that sucka!

Front 11

Which drugs should be avoided for patients with cardiac disease?

Back 11

Acepromazine
Alpha-2 agonists

Front 12

Which is the most acceptable combination of drugs for preanesthesia in a patient with cardiac disease?
a) Acepromazine + Hydromorphone
b) Ketamine + etomidate
c) Dexmedetomidine + telezol
d) Diazepam + Hydromorphone
e) Etomidate alone

Back 12

d) Diazepam + Hydromorphone

Front 13

T or F:
Isofluorane or sevofluorane alone is not appropriate for maintenance of small animal patients w/cardiac disease.

Back 13

False! However, inhalants are often augmented with opioids or local anesthetics.

Front 14

Which commonly used large animal anesthetic should be avoided in the patient with cardiac disease?

Back 14

Xylazine!

Front 15

Which commonly used class of anesthetic drug presents no problem to a patient with hepatic dysfunction?

Back 15

Inhalants! They're not metabolized by the liver!

Front 16

What effect would a normal dose of diazepam have upon a PSS dog?
a) no effect
b) reduced effect
c) normal effect
d) increased effect

Back 16

d) increased effect; PSS dogs have increased BNZ receptors!

Front 17

The fraction of drug extracted over the delivered load of drug describes the...

Back 17

...extraction ratio

Front 18

The hepatic clearance of a drug with a high extraction ratio is highly dependent on ________.

Back 18

hepatic blood flow

Front 19

T or F:
The hepatic clearance of a drug with a low extraction ratio is not very dependent on hepatic blood flow.

Back 19

True

Front 20

Which is more affected by hepatic disease, drugs with a high or low extraction ratio?

Back 20

Low extraction ratio

Front 21

Describe the extraction ratios of the following drug classes:
Phenothiazines
Benzodiazepines
Alpha-2 agonists
Opioids

Back 21

Describe the extraction ratios of the following drug classes:
Phenothiazines (unknown)
Benzodiazepines (low)
Alpha-2 agonists (unknown)
Opioids (high)

Front 22

What corrective pre-op measures should be explored before an anesthetic procedure is performed on a hepatocomprimised patient?

Back 22

Correct blood glucose levels w/dextrose
Coagulation profile
Colloid support

Front 23

Which is probably the best premedication protocol for a dog with hepatic disease?
a) acepromazine + hydromorphone
b) diazepam + hydromorphone
c) hydromorphone alone
d) ketamine + benzodiazepine

Back 23

c) hydromorphone alone

Front 24

What pre-op measure should be taken in a patient set to undergo hepatic surgery?

Back 24

Cross-match for blood products

Front 25

Respiration occurs at the ___________ level while ventilation occurs at the ___________ level.

Back 25

Respiration = cellular
Ventilation = alveolar

Front 26

Which of the following can effect functional residual capacity?
a) pregnancy
b) positioning
c) obesity
d) colic

Back 26

all of the above!

Front 27

What is the KEY component in neural control of ventilation?

Back 27

Arterial CO2

Front 28

What effect does mechanical ventilation have on cardiac output?
a) reduced CO
b) no effect
c) increased CO

Back 28

a) reduced CO; positive pressure ventilation reduces venous return

Front 29

What is the ventilation:perfusion of physiologic dead space? Of a shunt?

Back 29

Dead space = no perfusion but good ventilation = infinitity;
Shunt = good perfusion but no ventilation = 0

Front 30

The defense mechanism that deflects perfusion away from poorly ventilated regions of the lung is known as...

Back 30

...hypoxic pulmonary vasoconstriction

Front 31

What does a LEFT SHIFT mean in the oxyhemoglobin dissociation curve? Name some things that can cause a left shift...

Back 31

Left shift = increased O2 affinity (doesn't unload O2 as readily);
Caused by DECREASED temp, 2,3 DPG, or increased pH

Front 32

What fraction of oxygen is read by a blood gas machine?

Back 32

Dissolved (unbound) oxygen (only about 2%)

Front 33

What is a quick formula to determine the projected PaO2 levels?

Back 33

5 * inhaled concentration (eg: 5 * 20% atmospheric = 100 mm Hg)

Front 34

Alveolar ventilation has the greatest effect upon:
a) Pa O2
b) Pa CO2
c) Proportionally inverse relationship between PaO2 and PaCO2
d) O2 saturation

Back 34

b) PaCO2

Front 35

What is the best way to evaluate ventilatory function?

Back 35

Arterial blood gas

Front 36

T or F:
Hypoxemia and hypoventilation both occur at 60mm Hg.

Back 36

True! However they are measuring different things (60mm Hg O2 for hypoxemia and 60mm Hg CO2 for hypoventilation)

Front 37

What are the components of brachycephalic syndrome?

Back 37

Stenotic nares
Elongated soft palate
Everted laryngeal vesicles
Hypoplastic trachea

Front 38

T or F:
Tracheal intubation can overcome the issues associated with brachycephalic syndrome.

Back 38

True!

Front 39

Patients with ____________ disease experience perhaps the most catastrophic of all inductions.

Back 39

RESPIRATORY

Front 40

Which of the following are good choices when administering pre-anesthetic drugs to a patient with respiratory disease?
a) Benzodiazepines
b) Phenothiazines
c) Alpha-2 Agonists
d) Anticholinergics
e) Opioids

Back 40

a) Benzodiazepines
b) Phenothiazines
d) Anticholinergics (maybe)
e) Opioids

Front 41

What should be used instead of propofol when inducing a patient with respiratory disease?

Back 41

Etomidate

Front 42

How should large animal protocol be changed when respiratory disease is present?

Back 42

Rarely changed

Front 43

What are two issues with azotemia that may affect anesthesia and surgical procedure?

Back 43

Azotemia interferes with the BBB and platelet function

Front 44

With what type of kidney dysfunction is hyperkalemia most often associated?

Back 44

Post renal azotemia

Front 45

What is the rule of thumb regarding the degree of hyperkalemia and anesthesia?

Back 45

If K is > 6meq/L DON'T ANESTHETIZE

Front 46

What are some treatment options for hyperkalemia? Which is used for life-threatening situations?

Back 46

Dilution
Dextrose + insulin
NaHCO3
Ca gluconate or CaCl2 (first choice for life threatening arrhythmias)

Front 47

What are the ECG features of hyperkalemia?

Back 47

Low P wave
PR Prolongation
Widening of QRS
Peaked T wave

Front 48

Which drugs should be avoided in patients with renal disease and why?

Back 48

Drugs with renal excretion (ketamine, diazepam, morphine)
Drugs that can potentiate nephropathy (aminoglycosides, NSAIDs)

Front 49

What is the MAP range within which blood pressure autoregulation occurs?

Back 49

between 60 and 160 mm Hg

Front 50

Catecholamines produce this important cause of reduced renal blood flow...

Back 50

...alpha 1 activation (vasoconstriction)

Front 51

What are intraoperative goals for patients with kidney disease in terms of MAP?

Back 51

MAP should be >70mm Hg

Front 52

Which sympathomimetics should be avoided in patients with renal disease?

Back 52

Vasopressors (alpha 1 agonists)

Front 53

What is the general age of large animal of neonates? Small animal?
How about pediatrics?

Back 53

LA <1-2 wks
SA < 6wks
Pediatrics are <12wks

Front 54

What are some PK/PD anesthetic considerations in the young patient?

Back 54

Neonatal hypoalbuminemia (incrases free active drug)
Increased BBB permeability
Lower body fat
Immature renal and hepatic fxn
Increased volume of distribution

Front 55

What is the major determinant of CO in the neonate? What is the approximate percentage by which a neonate can increase CO?

Back 55

Heart rate; CO can increase by ~30% (vs 300% in the adult)

Front 56

How does the young animal's pliable ribcage affect ventilation effort and efficiency?

Back 56

Increased effort and reduced efficiency

Front 57

What are normal PCV & TP ranges for neonates?
a) 15-25% PCV; 4-5 gm/dL TP
b) 25-30% PCV; 3-4 gm/dL TP
c) 15-25% PCV; 3-4 gm/dL TP
d) 25-30% PCV; 4-5 gm/dL TP

Back 57

d) 25-30% PCV; 4-5 gm/dL TP

Front 58

Which of the following are acceptable choices for neonatal premedication?
a) Opioids
b) Benzodiazepines
c) Anticholinergics
d) Phenothiazines

Back 58

a) Opioids
b) Benzodiazepines
c) Anticholinergics

Front 59

T or F:
Due to the reduced functional residual capacity and increased minute ventilation of the neonate, propofol is not a good choice for induction.

Back 59

False! Propofol works fine although other agents are commonly used.

Front 60

What is a normal MAP for puppies?

Back 60

~50 mm Hg!!! They're always hypotensive under anesthesia!

Front 61

Why might NSAIDs not be OK in pediatric/neonates?

Back 61

COX may be important for kidney development; don't wanna inhibit this!

Front 62

What is the definition of geriatric?

Back 62

An animal exceeding 75-80% of projected lifespan.

Front 63

Why are geriatric animals less tolerant of hypovolemia?

Back 63

Increased vascular stiffness, lower blood volume, reduced renin/angiotensin responsiveness

Front 64

T or F:
Low dose acepromazine is OK to use in geriatric patients.

Back 64

Yeah it is. Seems a bit counterintuitive though with its hypotensive side effects...

Front 65

T or F:
Drug selection in geriatric anesthesia differs greatly from anesthesia of a patient of normal age.

Back 65

False...not really as far as I can tell. Looks like you just lay-off the ace a bit and consider etomidate for induction. Monitoring is key though!

Front 66

NSAID use is contraindicated in:
a) pediatrics
b) neonates
c) geriatrics
d) none of the above
e) all of the above

Back 66

d) none of the above; pros and cons must be weighed in each case!

Front 67

Which drug can cause regurgitation upon induction?

Back 67

Etomidate

Front 68

When intubating a cat, approximately what air volume should fill the cuff?

Back 68

<3mL

Front 69

What feature of and ET tube prevents bevel obstruction?

Back 69

Murphy eye

Front 70

OH NOOOOOOOOOO!!!! Somebody put iso in my sevo machine!! What to do!!!

Back 70

Drain, dry, refill

Front 71

T or F:
Compressed gas cylinders can punch a hole through walls!

Back 71

Bam its true! Mythbusters approved!

Front 72

Match the bradycardia cutoff with the correct animal:
<25 Sheep
<60 Horse
<80 Cat
<90 Large dog
<100 Titty dog

Back 72

<25 Horse
<60 Large Dog
<80 Ruminant
<90 Titty dog (toy breed)
<100 Cat

Front 73

What are the 4 steps to treating cardiovascular complications while under anesthesia?

Back 73

1. Normalize HR/rhythm
2. Assess anesthetic depth
3. Fluid bolus
4. Administer inotropes/vasopressors

Front 74

Match the tachycardia cutoff with the correct animal:
>60 Sheep
>120 Horse
>140 Cat
>160 Large dog
>220 Titty dog

Back 74

>60 Horse
>120 Ruminant (sheep)
>140 Large dog
>160 Titty dog (toy)
>220 Cat

Front 75

What are two good treatments for tachycardia?

Back 75

Fentanyl or esmolol

Front 76

What are 5 causes of hypoxemia and which is most important?

Back 76

V/Q mismatch (most important)
Decreased inspired O2
Severe hypoventilation
Diffusion impairment
Intra/extrapulmonary shunting (form of V/Q mismatch)

Front 77

What are causes of tachypnea?

Back 77

Pain
Hypoxia
Hyperthermia
Inadequate anesthetic depth

Front 78

Word association time!
Myopathies are to horses as __________ are to cattle?

Back 78

Neuropathies

Front 79

What are two ways to prevent myopathies/neuropathies?

Back 79

Adequate perfusion
Padding

Front 80

Why are vital signs taken at least every 5 minutes?

Back 80

Neuronal injury occurs within 5 min of hypoxia!

Front 81

What are the signs of cardiopulmonary arrest? Which are pretty much useless during anesthesia?

Back 81

Absence of cardiac activity
Cyanosis (worthless when on 100% O2)
Agonal gasps
Unconsciousness (worthless when under anesthesia)

Front 82

What are the 4 ECG RHYTHMS OF DEATH!!!

Back 82

Asystole
Fibrillation (V-fib)
Pulseless indioventricular rhythm (least common)
Pulseless electrical activity

Front 83

What factor is the most important in successful cardiopulmonary cerebral resuscitation?

Back 83

TIME

Front 84

What are the MUST HAVE drugs in a crash cart?

Back 84

Atropine
Epinephrine
Lidocaine
Dopamine

Front 85

What is the first step in basic life support of the anesthetized patient?

Back 85

Turn off the vaporizer!!

Front 86

In the ABCs of basic life support of the anesthetized patient, what does "A" stand for and what should be checked with this?

Back 86

A = airway
Check for obstructions
Check to see if pop-off valve is closed (shouldn't be)

Front 87

What is the suggested rate for mechanical breathing in the anesthetized patient in a life-threatening situation?

Back 87

8-12 bpm

Front 88

What is the theoretical difference between the cardiac and thoracic pump? In which animals is each used?

Back 88

Cardiac pump (heart is OK and is being mechanically pumped; used for animals <10kg)
Thoracic pump (heart is not OK; differences in intrathoracic pressures collapse great veins to move blood; used for animals >10kg)

Front 89

What are some indications for internal cardiac massage?

Back 89

Any time the thoracic wall is compromised (rib fracture, open thorax, diaphragmatic hernia)
Pericardial dz
Open abdomen

Front 90

What diagnostic tool provides the best assessment of chest compression effectiveness? How do specific readings correlate with prognosis?

Back 90

Capnography!
ET CO2 <10 (poor prognosis)
ET CO2 >20 (associated w/survival)

Front 91

What are the three arrthymias preceding cardiopulmonary arrest and how is each treated?

Back 91

Bradyarrthymia (Atropine)
Sinus tachycardia (treat underlying problem)
Ventricular tachy (treat underlying prob; use lidocaine)

Front 92

Which drug is used to treat asystole?

Back 92

Epinephrine
Maybe vasopressin

Front 93

What is used to treat ventricular fibrillation?

Back 93

Electrical stimulation (defib)
Amiodarone

Front 94

What are the goals of euthanasia?

Back 94

Rapid loss of consciousness
No pain
Respiratory/cardiac arrest
Loss of brain fxn
reliability
Compatible with other requirements (post mortem & etc)
Minimal unfavorable aesthetics

Front 95

What are the inhalant agents used in euthanasia? Where are these usually used?

Back 95

CO2, Ar, N2, CO;
Used in shelter med, poultry operations, or for rodents

Front 96

What are the ONLY acceptable sites for injectible euthanasia solution?

Back 96

IV
IP
MAYBE intracardiac (last resort)

Front 97

What are the following injectable anesthetics is/are acceptable in awake animals in the US?
a) barbiturates
b) KCl
c) Chloral Hydrate
d) MgSO4
e) T-61

Back 97

a) barbiturates
c) Chloral Hydrate

Front 98

What are some examples of UNACCEPTABLE injectable anesthesia?

Back 98

Strychnine, Nicotine, KCl/MgSO4 (awake), muscle relaxant alone, surfactant, solvent

Front 99

What drug can be administered along with barbiturates to smooth out the euthanasia?

Back 99

Propofol (expired)