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49 Cards in this Set
- Front
- Back
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What does MET’s stand for?
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Metabolic equivalent test
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What does 1 MET equal?
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The O2 consumption of a 70 Kg, 40 y/o male at rest
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What are the ranges of MET’s for poor, moderate, good, and excellent?
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a. <4
b. 4-7 c. 7-10 d. >10 |
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What degree of cardiovascular risk are most OMS procedures?
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Intermediate
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What is the CV risk of perioperative cardiac death or MI if the pt has been revascularized in the past 5 yrs, or PCI from 6 mo to 5 yrs prior?
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Extremely low
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What are the 5 major clinical predictors risk for a periooperative cardia event?
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a. Recent MI (in past 6 weeks)
b. Severe or unstable angina c. Decompensated heart failure d. Significant dysrhythmia e. Severe valvular dz |
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Myocardial work is related to what 4 factors related to myocardial O2 demand?
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a. Rate
b. Contractility c. Preload d. Afterload |
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Headache, altered level of consciousness, and less severe manifestations of central nervous system dysfunction are classic signs of what condition?
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Hypertensive encephalopathy
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What is the classic ophthalmological finding of a hypertensive crisis?
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Papilledema
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What is the difference between hypertensive crisis and urgency?
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Clinical evidence of end-organ damage in crisis
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What is the dosage of NTG in presumed ischemic CP?
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0.4 mg
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Signs of chronic decompensated congestive heart failure
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a. S3 heart sound
b. Crackles c. Pedal edema d. Hepato-jugular reflex e. Hepatomegaly |
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What are signs of acute heart failure?
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a. Paroxysmal nocturnal dyspnea
b. Orthopnea c. Worsening dyspnea |
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What effect do the volitle anesthetics have on the automaticity of the SA and AV nodes?
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Directly decreases the automaticity
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What volatile anesthetic demonstrates significant arrhythmogenicity when co-administered with epinephrine?
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Halothane
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What is the name of the accessory pathway in WPW?
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Bundle of Kent
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What are the classic ECG findings of WPW?
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a. Shortened P-R interval (<0.12sec)
b. Prolonged QRS interval (>.10sec) c. Delta wave (slurring of the upstroke of the R wave) |
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What is the concern for WPW, and what is the dysrhythmia that causes it?
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a. Sudden death
b. V-fib |
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How many PVC’s per minute are needed to be considered V-tach?
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6, especially if multifocal
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Quick way to determine if acidosis/alkalosis is metabolic or respiratory?
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a. Determine the pH, and thus acidosis (<7.35) or alkalosis (>7.45)
b. If the pH sign (>/<) is the same as the sign for the PaCO2 (relative to 40 mm Hg) then it is metabolic i. pH < 7.35 and PaCO2 < 40 (or vice versa) c. If the pH sign (>/<) is the opposite as the sign for the PaCO2 (relative to 40 mm Hg) then it is respiratory i. pH < 7.35 and PaCO2 > 40 (or vice versa) |
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How do you calculate the Anion gap and what is it used for?
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a. AG = Na+ – ([Cl-] + [NaCO3-])
b. Normal range is 10-14 mEq/L, greater than this indicates AG c. To determine presence of AG or non-AG metabolic acidosis |
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What are the 2 most sensitive areas to ischemia in the kidney?
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a. Tubule cells of the thick ascending loop of Henle
b. Proximal convoluted tubule in the medulla |
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What is normal percentage of variation in FEV1:
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20%
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A moderate degree of exacerbation is determined by what percentage of FEV1 below normal in the asthmatic pt?
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50-80% below baseline
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A severe degree of exacerbation is determined by what percentage of FEV1 below normal in the asthmatic pt?
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<50% of baseline
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For how long can the airway remain reactive after a URI
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6 wks
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What class of medication is the first line of therapy for acute bronchospasm? What are the effects?
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a. Β2 agonist (anticholinergic)
b. Directly relax smooth mucle c. Stabilize mast cells d. Inhibit release of acetylcholine from postganglionic cholinergic nerves (bronchospasm is often mediated by a vagal response) |
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What does the pulse-ox monitor directly measure?
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It measures red (660nm) and infrared (940nm) wavelengths
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What does the pulse-ox monitor indirectly measure?
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The partial pressure of oxygen in arterial blood
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How is the percent saturation calculated in the pulse-ox monitor?
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The ratio of oxygenated hemoglobin to the total hemoglobin
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What are common causes in erroneous pulse-ox readings?
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a. Hypothermia
b. Hypotension c. Vasopressors d. Electrocautery e. Nail polish f. BP cuff or a-line in same arm g. Carboxyhemoglobinemia h. Methemoglobinemia i. Hyperbilirubinemia |
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Apnea is defined as:
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10 sec or more of complete cessation of air flow
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Hypopnea is defined as:
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a. 30-50% decrease in air flow
b. or a reduction significant to produce a 4% decrease in O2 saturation |
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What is a significant level of apnic or hypopnic episodes per hour?
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5
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What part of sleep does OSA occur
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REM
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When in the post-op period is OSA most detrimental?
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3rd-5th night due to excessively increased level of REM activity
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Morbid obesity has what effect on a. functional residual capacity, b. expiratory residual volume, c. total lung capacity?
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Decreases with all
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What happens with diabetics with autonomic neuropathy? What symptoms would they otherwise have? What medication would you NOT give these patients.
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a. There is blunting of the adrenergic response associated with hypoglycemia
b. Anxiety, tachycardia, HTN, diaphoresis, restlessness, arrhythmias, angina (due to catecholamine release) c. β-blockers |
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Each mL of D50 raises the BG by approx how much?
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2 mg/dL
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What 3 medications can be given in response to sulfonyl urea-induced hypoglycemia?
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a. Glucagon
b. Diazoxide c. Octreotide |
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At what BG level will you exceed the capacity of the kidneys and begin to spill sugar (glycosuria)
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>180 mg/dL
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One unit of regular insulin will typically lower the BG how much in a 70 kg pt?
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25-30 mg/dL
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What is the other name for primary adrenal insufficiency? Is ACTH increased or decreased? Are aldosterone levels low or high, is the pt dehydrated or flooded and what happens to Na and K as a result?
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a. Addison’s dz
b. Only in Addison’s is ACTH elevated c. Low (dehydration ensures) d. Hyponatremia (aldosterone results in Na resorption) e. Hyperkalemia (aldosterone results in K excretion) |
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For up to how long can ACTH be suppressed after glucocorticoid therapy?
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1 yr
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What would you expect the BP and pulse pressure to be in someone experiencing adrenal crisis
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a. Hypotensive
b. Narrow pulse pressure |
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What is the cause of exophthalmosis in hyperthyroidism?
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Fatty infiltrate and edema
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What is the cause of tachycardia and high-output cardiac failure in thyroid storm?
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Increased sensitivity of β-receptors
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What medications are administered to pts in thyrotoxicosis? What are their mechanisms of action?
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a. β-blockers [decrease HR and inhibit deiodination of thyroxine (T4) to triodothyronine (T3)]
b. Propylthiouracil (PTU) [inhibits deiodination of thyroxine (T4) to triodothyronine (T3), and inhibits synthesis of thyroid hormones] c. Methimazole (same) |
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What are the signs of acute thyrotoxicois”
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Tachycardia, hyperthermia, weakness, altered LOC, progressing to heart failure and/or cardiovascular collapse
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