[Monday] Key points you can't miss · Anesthesiology senior professional title test center 04

Back toSchool pre-test sprint knowledge point summary Chen Lingjun's notes collation Copyright belongs to Luffy Anesthesia Channel All reprints please contact the background management staff 1.
Pain perception and response activities involve: limbic system, cerebral cortex, brainstem reticular structure, thalamus, inferior thalamus
.

2.
Long-term application of ether, methoxyflurane and halothane can inhibit platelet aggregation and cause hyperfibrinolysis
.

N2O marked myelosuppression
.

3.
Halothane: liver damage, prolonged PT; methoxyflurane: acute and chronic liver damage, kidney damage, contraindicated in liver cirrhosis
.

4.
Cardiac Index (CI): Output per minute calculated per square meter of body surface area
.

Generally, the adult body surface area is about 1.
6~1.
7m2, the output per minute at rest is 4.
5~6.
0L, and the cardiac index is 3.
0~3.
5 L/(min·m2)
.

The cardiac index can change with different physiological conditions.
Generally, the resting cardiac index is the largest at the age of 10, which can reach more than 4.
0 L/(min·m2), and then decline with age
.

If the cardiac index is less than 2.
2 L/(min·m2), the possibility of heart failure must be considered
.

5.
Cardiotoxicity is more closely related to cardiac action potential.
Bupivacaine's Na+ channel block reversal speed is slow, and ropiper is fast
.

6.
Propofol has no direct effect on sinus node function, atrioventricular conduction and intraventricular conduction
.

Propofol causes bradycardia: reduce sympathetic efferent impulses and excite the vagus nerve
.

7.
Picuronium bromide is a long-acting non-depolarizing muscle relaxant
.

Pancuronium bromide has the effect of stimulating the secretion of catecholamines, which can increase the heart rate and blood pressure, so it is contraindicated in patients with hypertension, tachycardia and myocardial ischemia
.

8.
Isoflurane has a pungent odor and is not suitable for induction; the anesthesia is stable and the recovery is quick; the muscle relaxation is good; repeated use has no obvious adverse reactions; it can increase the heart rate
.

9.
PCA classification: Intravenous, epidural, subcutaneous, PCSA, regional, perineural, incisional, intranasal
.

10.
The T-shaped tube belongs to the MaplesonE system, has no valve and storage bag, and has small resistance and ineffective cavity.
It is suitable for neonatal infants and low-weight children under 5 years old
.

Spontaneous breathing/control/assisted breathing can be used, and the CO2 removal efficiency is high
.

11.
Mitral valve prolapse is when the mitral valve leaflets (anterior, posterior, or both) prolapse into the left atrium (bulge to the left atrium) during ventricular systole, with or without mitral regurgitation
.

The incidence in adults is about 5%
.

The entire mitral valve is flaccid and can be raised in a dome-like or dome-like shape
.

Such changes can also be seen in a variety of connective tissue diseases, such as Marfan syndrome, osteogenesis imperfecta and coronary heart disease
.

Mitral valve prolapse most commonly involves the posterior leaflets
.

When the ventricle contracts, the overly long leaflets push the valve further up into the left atrium
.

Abrupt cessation of valve activity produces clicks, and leaflet insufficiency results in regurgitation murmurs in the middle and late stages of systole
.

12.
Allen's test for 5-10s is suspicious positive and needs further examination; when it is longer than 10s, it proves that the collateral circulation cannot be satisfied
.

13.
General anesthetics inhibit the activity of phosphodiesterase, activate the activity of adenylate cyclase, and increase the concentration of intracellular camp
.

14.
The maintenance time of spinal anesthesia in children is relatively shorter than that in adults, and the anesthetic drugs are easily excreted
.

Therefore, infants and young children require relatively more local anesthetics based on body weight administration
.

Children have less headache after spinal anesthesia, low incidence of nausea and vomiting, and the block plane is easy to spread
.

Blood pressure is stable
.

15.
Pharmacological characteristics of ketamine: separation of anesthesia, inhibition of thalamo-neocortical system, inhibition of brain connection pathways
.

16.
Muscle twitch is inhibited by more than 90%, endotracheal intubation and most abdominal operations can be successfully completed, and the effect of non-depolarizing muscle relaxants can be antagonized.
Generally, antagonism should be performed when muscle twitch recovers to more than 25%.
17.
In The most effective way to correct metabolic acidosis during CPR is to improve the quality of CPR, increase cardiac output and tissue perfusion, and restore spontaneous circulation as soon as possible
.

Routine use of sodium bicarbonate is not advocated during resuscitation
.

Because the cardiac output is very low during cardiac compression.
Although the PH of arterial blood can be maintained close to normal through artificial ventilation, the acidic metabolites and CO2 in venous blood and tissues cannot be discharged, resulting in an increase in PCO2 and a decrease in PH
.

If sodium bicarbonate is given, more CO2 can be dissociated to lower the pH
.

Due to the strong diffusivity of CO2, it can freely pass through the blood-brain barrier and cell membrane, resulting in more severe acidosis in brain tissue and cells
.

For preexisting severe metabolic acidosis hyperkalemia, tricyclic or barbiturate overdose, sodium bicarbonate solution may be considered
.

The first dosage is 1mmol/kg, and 0.
5mmol/kg can be repeated every 10 minutes
.

It is best to calculate and give according to the formula according to the results of arterial blood gas analysis: NaHCO3 (mmol) = BEx0.
2x body weight (kg)
.

18.
AG=[Na＋]－{[Cl-]＋[HCO3－]}, the fluctuation range is 12±2 mmol/L
.

At present, it is generally believed that AG>16mmol/L is used as the threshold for judging whether there is metabolic acidosis with increased AG
.

AG normal acid generation: refers to the decrease of HCO3- concentration, accompanied by a compensatory increase of Cl- concentration, it is AG normal type or high chloride metabolic acidosis
.

Features: AG is normal, blood chloride is elevated
.

Infusion of 0.
9% normal saline can correct acidosis
.

19.
HCO3- =0.
6✖PaCO2 The normal average value of standard bicarbonate is 24mmol/L, and the range is 22～27mmol/L
.

20.
The OGTT test cannot be checked immediately and should be performed on an empty stomach in the morning after 8 hours without any calorie intake
.

21.
Acetazolamide is a diuretic drug and a carbonic anhydrase inhibitor.
After taking it, it inhibits carbonic anhydrase in renal tubular epithelial cells, reducing the formation of H2CO3 and the production of H+
.

Therefore, the exchange of H+ and Na+ is greatly slowed down, resulting in increased excretion of HCO3-, Na+, K+, and increased urine output
.

22.
2 hours postprandial blood sugar, exceeding the normal 7.
8mmol/L, but not yet reaching the diagnostic criteria for diabetes of 11.
1mmol/L (or elevated fasting blood sugar, failing to meet the diagnostic criteria for diabetes, that is, fasting blood sugar between 6.
2 and 7.
0) time) is called impaired glucose tolerance (or impaired fasting glucose)
.

23.
Glycated plasma protein is an indicator that reflects the average blood glucose level in the past 2-3 weeks
.

The reaction period is shorter than the "gold standard" glycosylated hemoglobin (8-12 weeks) of blood glucose testing
.

Therefore, GA is the preferred indicator for blood glucose monitoring
.

24.
Hypotension refers to the decrease in blood pressure by more than 20% before anesthesia or a decrease in blood pressure of 80mmHg.
Hypertension refers to an increase in blood pressure of more than 20% before anesthesia or an increase in blood pressure of more than 160/95mmHg.
Hypertension refers to an increase in blood pressure that exceeds anesthesia.
Top 30mmHg
.

25.
Gastroduodenal surgery: puncture part T8-9/T9-10, plane to T4-L1; right colon surgery: puncture part T11-T12, plane to T6-T12; left colon surgery: puncture part T12 -L1, plane to T6-S1; biliary surgery: puncture part T8-9/T9-10, plane to T4-T12; appendix surgery to prevent traction: plane to T4; gynecological whole uterus, ovary, testis, hernia: plane to T8; lower extremity surgery: plane to T12; lower extremity upper tourniquet plane to T10
.

TURP plane to T10
.

Upper abdominal surgery does not exceed T3, and if it is too high, it will cause respiratory depression.
26.
High spinal anesthesia> T4; median spinal anesthesia T5-9; low spinal anesthesia < T10
.

27.
High epidural puncture point: C5-T6; median T6-T12; low: below T12
.

28.
Selection of anesthesia methods for liver transplantation: Intravenous inhalation is the first choice, and deflurane can be used safely
.

Intravenous combined epidural (T7-8) is optional for patients without coagulation disorders
.

70% of patients with end-stage liver disease often experience high-efficiency and low-resistance hemodynamic changes in the cardiovascular system, including a hyperdynamic circulatory state with reduced systemic vascular resistance, manifested as significantly increased cardiac output, decreased peripheral vascular resistance, and decreased vascular resistance.
Low arterial pressure
.

Respiratory system manifestations: hypoxemia, V/Q imbalance, hypoxic pulmonary vasoconstriction unresponsive
.

In portal-pulmonary hypertension and chronic respiratory alkalosis, the alveolar-arterial oxygen partial pressure difference increases
.

29.
Liver transplantation is divided into pre-anhepatic phase, anhepatic phase and new liver phase (reperfusion phase).
Anhepatic phase: blood pressure drop, hypoglycemia, hypocalcemia, acidemia, coagulation dysfunction, hypothermia, oliguria, etc.
Partial recovery period of hepatic blood flow: A large amount of acidic substances and intestinal endotoxins in the intestines caused by congestion enter the circulation, resulting in acidemia, hyperkalemia, coagulation disorder, arrhythmia and hypotension.
30.
Reperfusion syndrome: after recanalization of hepatic blood flow, the systolic blood pressure may drop sharply by 30 mmhg for more than 5 minutes, and the release of prostaglandin at the anastomotic stoma may occur.
, Acute hyperkalemia, reflex vasodilation and hypothermia, available dopamine intravenous infusion
.

31.
It is now considered that it is not suitable to strictly stipulate that elective surgery within 6 months of myocardial infarction is not suitable.
32.
Thiopental sodium increases the irritability of laryngeal and bronchial smooth muscles, which is easy to induce laryngospasm and bronchospasm, which may be related to the inhibition of sympathetic nerves.
The parasympathetic effect is relatively dominant; codeine, morphine and analgesic new, etc.
, all promote the release of histamine in the body, causing bronchospasm and asthma
.

          33.
Mydriasis is the manifestation of overdose of anesthesia, that is, in bulbar anesthesia, breathing stops, mydriasis, blood pressure drop and even circulatory failure
.

Anesthesia needs to be avoided absolutely or reduced as soon as possible
.

34.
Anesthesia for PIH combined with heart failure: Severe PIH is often accompanied by anemia, and the heart is in a state of low output and high resistance.
When there is severe hypertension or upper respiratory tract infection, heart failure is very likely to occur
.

Before anesthesia, acute left heart failure and pulmonary edema should be actively treated, rapid digitalis, dehydration and diuresis, morphine and blood pressure should be used as appropriate to control heart failure, and cesarean section should be selected on standby
.

If it is difficult to control, the pregnancy should be terminated in time.
Termination of pregnancy can be regarded as one of the important measures to control heart failure
.

35.
Blood loss greater than 2000ml belongs to toxic hemorrhagic shock
.

36.
In children with moderate dehydration, body water loss is equivalent to 5% to 10% of body weight (weight loss of 5% to 10%)
.

The clinical manifestations are more obvious, lack of energy or restlessness, thirst, oliguria, dry lips, sunken eye sockets, and poor skin elasticity
.

                  37.
Smoking cessation for 8-12 weeks is effective in reducing postoperative pulmonary complications.
38.
40% of morphine is metabolized in the kidneys, and it is best not to use it in patients with renal failure
.

The main metabolite of meperidine, normeperidine, is excreted by the kidneys, and easily accumulates in patients with renal failure to cause central nervous system toxicity
.

39.
Preoperative oral hypoglycemic agents or excessive insulin dosage and inappropriate application of long-acting insulin are the main reasons for perioperative hypoglycemia
.

Hypoglycemia is the main symptom of insulinoma, but also seen in other diseases such as liver cirrhosis, hypopituitarism, adrenal insufficiency, liver space occupying lesions and sarcoma
.

Hyperthyroidism is the cause of increased blood sugar
.

For patients who need oral hypoglycemic drugs before surgery, hypoglycemic drugs may not be discontinued before surgery when undergoing minor surgery
.

Blood sugar levels should be measured repeatedly during and after surgery; if major surgery is performed, oral hypoglycemic drugs should be discontinued a few days before surgery and regular insulin therapy should be used instead
.

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41.
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Blood pressure drops below the level of brain autoregulation, hypothermia, hematocrit below 15%, and hypoxia affect somatosensory evoked potentials and motor evoked potentials
.

Air is most likely to enter the blood from open epidural veins, paravertebral veins, and de-cortical sinuses, and filling the surgical field with saline prevents air from entering the blood
.

Pure oxygen ventilation reduces the volume of air emboli, especially in patients using nitrous oxide
.

With hypovolemia and lower CVP, air is more likely to enter the blood because of the increased pressure gradient between the open vein and the right atrium
.

Increased intra-abdominal pressure can be transmitted to the vertebral venous plexus, resulting in increased venous bleeding
.

42.
There is a cross-allergy between thiopental sodium and barbiturates, and there is no exception to ultra-short-acting intravenous general anesthesia
.

This product can pass through the placenta and can be detected in the umbilical vein blood after 2-3 minutes of intravenous injection.
The central nervous system activity of the fetus is also in a state of inhibition
.

It should be used with caution or disabled in the following situations: ①It is contraindicated regardless of acute, intermittent attacks or atypical porphyria, the enzyme induction and clinical signs in porphyrin synthesis can be aggravated by medication; ②Colonal or (and) rectal bleeding, ulcers Or rectal administration is prohibited when the tumor invades.
③It is used with caution for insufficiency of adrenal cortex, thyroid or liver, even if only a small amount is used, the action time can be significantly prolonged; ④Cardiovascular disease, shock hypotension, myasthenia gravis and respiratory Patients with difficulty, airway obstruction, or bronchial asthma, especially those who are debilitated, have a high incidence of respiratory depression, apnea or a sudden drop in blood pressure, and reduced cardiac output after administration, and are often in critical condition
.

The main mechanisms of the reduction of cardiac output caused by sodium thiopental are: ①Reduced venous return; ②Direct myocardial inhibition; ③Reduced central sympathetic efferent effects
.

Liver disease, hypotension, diabetes, severe anemia, asthma patients should not use
.

          43.
Renal elimination of atracurium accounted for less than 5% of the injected dose; vecuronium and rocuronium accounted for 10-20%; and pipecuronium accounted for 69-90%
.

Pancuronium bromide, pipecuronium bromide, and dush chloramine are excreted unchanged by the kidneys
.

Enflurane metabolites are nephrotoxic
.

44.
Most pheochromocytomas are located in the adrenal medulla, and 10% are located in other parts
.

Ketamine indirectly increases catecholamine levels and should be avoided
.

General anesthesia, regional block anesthesia, or a combination of the two can be used alone, and regardless of the method of anesthesia used, it is important to avoid drastic fluctuations in blood pressure
.

Halothane increases the incidence of arrhythmias
.

After tumor resection, hypotension often occurs, possibly due to the disappearance of excess catecholamines and hypovolemia; within 48 hours after surgery, the patient may be lethargic due to a sharp decrease in activated catecholamines; The inhibition of cell function disappears, resulting in increased plasma insulin levels; hypoglycemia itself can also cause drowsiness, and in more severe cases, hypoglycemia may lead to loss of consciousness and respiratory arrest; if there is residual pheochromocytoma, postoperative hyperglycemia persists.
blood pressure
.

Intraoperative routine monitoring of CVP, IABP and blood glucose
.

Preoperative preparation: Combined use of alpha and beta adrenergic receptor blockers is the most common method
.

Calcium channel blockers and methyltyrosine (inhibiting catecholamine synthesis) can be used as adjuncts to alpha combined beta-adrenergic blockade regimens
.

The peak time of oral plasma drug concentration of phenoxybenzamine is 4 to 6 hours, and the plasma half-life is 24 hours
.

The maximum effect occurs 1 hour after intravenous injection, and the plasma half-life is 24 hours.
Once oral administration, the α antagonistic effect can be maintained for 3 to 4 days, and it can last for 1 week after continuous daily administration
.

                     45.
Common causes of upper airway obstruction are: tongue falling back, throat secretions or foreign bodies, laryngospasm
.

Causes of lower airway obstruction: kink of tracheal intubation, blockage of trachea and bronchi after aspiration of secretions or vomitus, bronchospasm
.

 46.
​​PaC02 refers to the pressure generated by C02 dissolved in plasma
.

Since PaCO2 is the result of the balance between pulmonary ventilation function and C02 production, and C02 has high fat solubility and strong diffusing ability, PaC02 can quickly balance with C02 in alveolar air
.

Therefore, PaC02 can best reflect the lung ventilation status
.

     47.
After air embolism, put the patient in the left lateral position with head low and feet high, so that air enters the right ventricle and avoids the entrance of the pulmonary artery.
Due to the beating of the heart, the air is mixed into foam and enters the pulmonary artery in small amounts
.

Other treatment measures include: stop N2O and change to pure oxygen; increase ventilation; circulatory support
.

                                      48.
HELLP syndrome is characterized by hemolysis, elevated liver enzymes and thrombocytopenia.
Patients with preeclampsia can be diagnosed as severe preeclampsia if any of the following adverse conditions occur: ① Continuously elevated blood pressure: systolic blood pressure ≥ 160 mmHg and (or ) Diastolic blood pressure ≥ 110mmHg; ② Proteinuria ≥ 2.
0g/24 hours or random proteinuria ≥ (++); ③ Serum creatinine ≥ 1.
2 mg/dL unless known to have been elevated before; ④ Platelets < 100,000/ml (< 100×109/L); ⑤ Microangiopathic hemolysis—increased LDH; ⑥ increased serum aminotransferase levels—ALT or AST; ⑦ Persistent headache or other brain or visual disturbances; ⑧ Persistent upper abdominal pain
.

    49.
CT pulmonary angiography is an important non-invasive technique for diagnosing pulmonary embolism, with a sensitivity of 90% and a specificity of 78-100%
.

50.
"2010 American Heart Association Guidelines for Cardiopulmonary Cerebral Resuscitation" recommends a PaC02 of 40-45 mmHg during cerebral resuscitation.
At the same time, only the pupillary light reflex and corneal reflex loss ≥ 72 hours are recommended as credible indicators for prognostic evaluation
.

Defibrillation: One-way is less efficient than two-way
.

One-way recommended 360J defibrillation
.

Two-way selection 150-200J, the first use of straight two-way 120J, the second time later higher
.

The recommended shock energy for intrathoracic defibrillation is 0.
5J/kg
.

The effect of epinephrine during cardiopulmonary resuscitation is mainly α-receptor action, which causes systemic vasoconstriction, thereby increasing aortic diastolic pressure and improving myocardial and cerebral perfusion
.

Excessive calcium ion concentration can make the myocardium in a state of continuous contraction, and is generally only used for hyperkalemia, hypocalcemia or calcium channel blocker poisoning
.

Do not interrupt CPR while taking any medication
.

51.
Low-dose dopamine is not recommended for renal protection in septic shock
.

In septic shock, active fluid resuscitation is recommended as soon as possible, and the resuscitation goals should be achieved within 6 hours of the initial resuscitation: ① Central venous pressure (CVP) 8-12 mmHg; ② Mean arterial pressure (MAP) ≥ 65 mmHg; ③ Urine output ≥ 0.
5 ml/ kg/h; ④Central venous oxygen saturation (ScvO2) or mixed venous oxygen saturation (SvO2) was ≥70% or ≥65%, respectively
.

Intravenous antibiotics are initiated as early as possible within 1 hour of diagnosis of severe sepsis and septic shock; appropriate cultures should be obtained prior to initiation of antibiotics
.

Central venous application of norepinephrine or dopamine is the preferred vasopressor, and epinephrine is the preferred alternative when the response is poor.
52.
PEEP treatment increases FRC and lung compliance, reduces shunting and improves oxygenation, but does not reduce lung Capillary exudation and extravascular lung water
.

Increased intrathoracic pressure and decreased left ventricular preload during PEEP improve left ventricular function and treat pulmonary edema
.

53.
Indications for weaning: ①Stable hemodynamics, normal cardiac output and blood volume; ②The patient's general condition improved, spontaneous breathing RR≤25bpm; ③Vt>5ml/kg, Vc>10-15ml/kg; ④Inhalation Negative air pressure ≥25cmH2O; shallow and fast breathing index <100; ⑤FiO2<0.
6, PaO2>70mmHg, PaCO2<45mmHg, pH≥7.
35; CPAP<5cmH2O; Vd/Vt (physiological dead space/tidal volume) <0.
6
.

54.
PAEDP=PCWP=LVEDP when there is no lung disease or cardiac insufficiency
.

Left ventricular dysfunction, LVEDP>PAWP
.

PAWP>12mmHg is abnormal,>18mmHg is not suitable for volume expansion,>25-30mmHg occurs pulmonary congestion or pulmonary edema
.

                        55.
ECG manifestations of atrial premature systole: ① P' waves appearing early, the shape is different from normal P waves, the P'-R interval is ≥ 0.
12 seconds, the QRS is generally supraventricular, the compensatory interval is incomplete, and the atrial premature If not transmitted, the P'-R interval can be prolonged
.

                56.
Patent ductus arteriosus: a large amount of blood diverts into the pulmonary circulation, which increases the pulmonary arterial pressure, gradually thickens the pulmonary blood vessels, increases the resistance, and increases the afterload, causing the right ventricle to expand and hypertrophy; When the aortic pressure is exceeded, bidirectional shunt or right-to-left shunt occurs, and cyanosis can appear clinically
.

56.
Abdominal puncture point: choose the junction of the umbilicus and the anterior superior iliac spine at the junction of the Chinese and the outer 1/3 or the intersection of the horizontal line through the umbilicus and the anterior axillary line
.

 57.
The pathogens of primary peritonitis are mostly hemolytic streptococcus, pneumococcus or Escherichia coli
.

The ways of bacterial invasion are generally: (1) hematogenous spread, the pathogenic bacteria spread from the respiratory tract or infection focus to the peritoneum through blood, and primary peritonitis in infants and children mostly belongs to this category; (2) ascending infection, bacteria from the female reproductive tract Directly spread upward through the fallopian tube to the peritoneal cavity, such as gonorrhea peritonitis; ③ direct spread, in the case of urinary tract infection, bacteria can directly spread to the peritoneal cavity through the peritoneal layer; ④ transmural infection, in special cases, such as cirrhosis ascites, kidney disease When the body's resistance is reduced, such as scarlet fever or malnutrition, the bacteria in the intestinal cavity can enter the abdominal cavity through the intestinal wall, causing peritonitis
.

                 58.
Type I is also known as allergic reaction: mediated by IgE, effector cells such as mast cells and basophils participate in the reaction by releasing biologically active mediators
.

Type II allergy IgG and IgM bind to antigens on target cells, resulting in complement-mediated cell lysis
.

Type Ⅲ allergy (immune complex disease) has the most important role in causing tissue damage - neutrophils
.

Type IV is mediated by specifically sensitized effector T cells
.

The most life-threatening manifestation of allergy: bronchospasm
.

Allergic reactions are caused by drugs that directly stimulate mast cells and basophils to release histamine, because the mechanism is non-immunological and does not belong to type I-IV hypersensitivity reactions
.

Clinical manifestations are no different from hypersensitivity reactions or hypersensitivity reactions activated by the complement system, but do not require prior sensitization or the presence of specific antibodies
.

The amount of histamine released during anaphylactoid reactions is related to the drug dose and injection speed.
The high concentration in plasma caused by rapid intravenous injection is more likely to stimulate the degranulation of mast cells and basophils than slow intravenous infusion
.

 59.
Temporary hypocalcemia is common in acute severe pancreatitis.
The degree of hypocalcemia is parallel to the severity.
If the blood calcium is less than 1.
5mmol/L, it indicates a poor prognosis
.

Blood amylase in hemorrhagic necrotizing pancreatitis may be normal or subnormal
.

60.
Hypertensive crisis: refers to the sudden and significant increase in blood pressure under the action of some incentives during the development of the disease in patients with primary or secondary hypertension, and the condition deteriorates sharply, accompanied by progressive cardiac, cerebral, renal , retinal and other important target organ dysfunction performance
.

A hypertensive sub-emergency was defined as a sharp increase in systolic or diastolic blood pressure without acute target organ damage
.

Target organ damage is the key to distinguish hypertensive emergencies from hypertensive subemergency
.

Hypertensive encephalopathy is an acute cerebral circulatory disorder syndrome caused by a sharp and continuous increase in blood pressure during the course of hypertension
.

61.
Twisted sigmoid colon is more common in elderly men, who often have constipation habits, or have a history of multiple episodes of abdominal pain relieved by exhaust and defecation in the past
.

In addition to abdominal cramps, the clinical manifestations include obvious abdominal distension, while vomiting is generally not obvious
.

Such as low pressure enema, often less than 500ml can no longer be injected
.

The barium enema X-ray examination showed that the barium was blocked at the torsion site, and the tip of the barium shadow was in the shape of a "bird's beak"
.

Acute peritonitis was treated non-operatively for more than 12 hours, and timely surgery
.

62.
Indications for retrograde cholangiopancreatography: obstructive jaundice of unknown etiology suspected of extrahepatic biliary obstruction
.

Suspected of various biliary tract diseases such as stones, tumors, sclerosing cholangitis and other undiagnosed persons
.

Suspected congenital biliary abnormalities or recurrence of symptoms after gallbladder surgery
.

Pancreatic diseases: pancreatic tumor, chronic pancreatitis, pancreatic cyst,
etc.

Contraindications: severe cardiopulmonary or renal insufficiency; acute pancreatitis or acute exacerbation of chronic pancreatitis; severe biliary tract infection; allergic to iodine contrast agents
.

63.
Analgesia for acute pancreatitis: intramuscular injection of pethidine
.

Morphine increases the tone of the sphincter of Oddi, and the cholinergic receptor antagonist atropine induces aggravation of intestinal paralysis and should not be used
.

64.
The flatulence of mechanical intestinal obstruction is limited to the part of the bowel above the obstruction, and the colon does not have flatulence
.

In acute complete intestinal obstruction, the intestinal tube expands rapidly, the intestinal wall becomes thinner, and the pressure in the intestinal cavity increases
.

Strangulation intestinal obstruction: persistent severe abdominal pain, vomiting can not relieve abdominal pain and abdominal distension, vomiting occurs early and more frequently
.

Systemic changes appear in the early stage, such as increased pulse rate, increased body temperature, increased white blood cell count, or a tendency to shock in the early stage
.

Abdominal distention: Obvious abdominal distention in low intestinal obstruction, asymmetric abdominal distention in closed loop small intestinal obstruction, isolated distended large intestinal loops can be touched, and no defecation
.

Continuous observation: It can be found that the body temperature is increased, the pulse is accelerated, the blood pressure is decreased, and the disturbance of consciousness and other septic shock manifestations, and the bowel sounds have changed from hyperactivity to weakening
.

Obvious signs of peritoneal irritation, bloody vomit or anal discharge
.

65.
25% of the normal human blood output enters the liver, and the hepatic blood flow is about 1275-1790ml per minute, of which 70%-80% comes from the portal vein, and only 20%-30% comes from the hepatic artery
.

Liver dysfunction, manifested as: ① hypoalbuminemia; ② reappearance of A-fetoglobulin (AFP); ③ increased plasma amino acid content; ④ decreased urea synthesis
.

66.
The nerves of the liver originate from the left sympathetic trunk T7-10 ganglia to form the prehepatic plexus, and the T7-10 ganglia originate from the right sympathetic trunk to form the posterior hepatic plexus
.

During epidural block, the changes of hepatic blood flow vary depending on whether the local anesthetic contains epinephrine or not.
The effect of adrenaline absorbed into the blood circulation: cardiac output increases, splanchnic vascular resistance decreases, and hepatic blood flow is not maintained.
change
.

67.
Halothane causes a significant decrease in hepatic blood flow
.

Isoflurane is almost non-toxic to the liver and has the least inhibitory effect on the myocardium, and is the first choice for liver transplantation
.

68.
The most diagnostic clinical manifestation of acute severe hepatitis: CNS symptoms within two weeks
.

69.
The natural evolution of infiltrative tuberculosis: the formation of cavities and the spread of the lesions along the bronchi
.

70.
Tetanus is a specific infection that Clostridium tetani invades the human body through skin or mucous membrane wounds, grows and reproduces in an oxygen-deficient environment, produces toxins and causes muscle spasm
.

Tetanus toxin mainly attacks motor neurons in the nervous system, so the disease is clinically characterized by trismus, paroxysmal spasm and tonic spasm
.

71.
The afferent nerve fibers of the carotid sinus follow the glossopharyngeal nerve, and the afferent nerve fibers of the aortic arch enter the brainstem cardiovascular center separately with the vagus nerve
.

72.
55% of people's sinus node blood supply comes from the right coronary artery, and 45% from the left circumflex branch of the left coronary artery
.

The left main coronary artery runs between the aorta and the left atrium, and the anterior descending branch and the left circumflex branch are divided at a length of 10-15 mm
.

The anterior descending branch descends in the anterior interventricular sulcus to the apex, where it supplies the anterior wall of the left ventricle and the right ventricle
.

The left circumflex branch descends in the anterior atrioventricular groove and has branches to the left atrium, left ventricular wall, and posterior wall
.

The right coronary artery descends in the posterior atrioventricular groove and has branches to the sinoatrial node, the atrioventricular node, and the posterior upper part of the left ventricle
.

In the posterior interventricular sulcus is the posterior descending branch of the right coronary artery, which supplies the posterior walls of the left and right ventricles
.

  73.
Antiarrhythmic drugs: Class I blocks fast sodium, class II blocks beta receptors, class III blocks potassium channels (amiodarone prolongs the refractory period), and class IV blocks slow calcium channels
.

74.
Cardiogenic asthma is episodic asthma caused by left heart failure and acute pulmonary edema
.

Cough, cough foamy, especially bloody sputum, cardiomegaly, arrhythmia and abnormal heart sounds
.

Cardiogenic asthma syndrome (Ridley syndrome) refers to a group of syndromes with paroxysmal nocturnal dyspnea as the prominent clinical manifestation of left heart failure caused by various reasons
.

Cardiogenic edema is characterized by: 1.
The gradual formation of edema, oliguria, edema of the lower extremities and the whole body
.

2.
Edema starts from the sagging parts of the body and gradually develops into generalized edema
.

Generally, pitting edema of the lower extremities first appears, especially in the ankle
.

3.
Other symptoms and signs associated with right heart failure and elevated venous pressure, such as palpitations, asthma, jugular vein distention, hepatomegaly, chest, ascites,
etc.

75.
Lido for ventricular tachycardia and verapamil for supraventricular
.

Chronic congestive heart failure with rapid atrial fibrillation is more effective with digitalis
.

Among the antiarrhythmic drugs, the side effects of beta-blockers: induced heart failure, bronchial asthma, dyspnea
.

The repeated occurrence of ventricular tachycardia or ventricular fibrillation after the opening of the infarcted vessel is mostly related to the high excitation of the sympathetic nerves and the increase of catecholamines in the body
.

Therefore, the early use of β-blockers can inhibit the high excitation of sympathetic nerves and reduce the occurrence of ventricular fibrillation and sudden cardiac death caused by myocardial infarction
.

For persistent and hemodynamically unstable ventricular tachycardia, treatment with antiarrhythmic drugs (eg, amiodarone) or electrical cardioversion is required
.

Electrical cardioversion is the first choice for rapid atrial fibrillation with hemodynamic instability, and hemodynamic stability can be treated with drugs
.

76.
A suprathreshold stimulation of the ventricular muscle can produce pre-systole during the end of rapid repolarization of the action potential (relative to the refractory period) and during atrial systole
.

Factors causing ventricular myocardium block: blocked fast sodium channel opening; cardiomyocytes in front of excitation conduction are in refractory period
.

77.
Cholinergic fibers include: preganglionic fibers of autonomic nerves, postganglionic fibers of most parasympathetic nerves, and a small part of postganglionic fibers of sympathetic nerves
.

Very few postganglionic fibers of sympathetic nerves are cholinergic fibers that innervate sweat glands, adrenal medulla, and skeletal muscle vasodilation
.

78.
Left ventricular afterload is affected by ventricular volume, wall thickness, peripheral vascular resistance and other factors
.

79.
Coronary blood flow is mainly regulated by the metabolic level of the myocardium itself.
When the myocardial metabolism level increases, the coronary blood flow increases
.

At rest, coronary blood flow accounts for 4% to 5% of cardiac output
.

Coronary blood flow can be regulated autonomously at 60-150mmHg
.

Left ventricular coronary blood flow is interrupted during systole
.

The right ventricle is always supplied by the coronary circulation
.

The main factors affecting coronary circulation: LVEDP, aortic diastolic pressure, autonomic nervous system excitation
.

When the partial pressure of oxygen in the arterial blood decreases, the coronary vessels dilate and the blood flow increases
.

Coronary perfusion pressure CPP = aortic diastolic pressure - left ventricular end-diastolic pressure
.

80.
Renal blood flow remains constant when arterial blood pressure varies in the range of 80-180 mmHg
.

But when the arterial blood pressure drops below (80mmHg), the effective filtration pressure decreases and the glomerular filtration rate also decreases
.

When the arterial blood pressure drops below (40-50mmHg), the glomerular filtration rate (the amount of ultrafiltrate produced by the two kidneys per unit time) will drop to zero, resulting in anuria
.

In the event of massive blood loss, the causes of decreased renal blood flow: sympathetic nerve excitation, increased epinephrine secretion, and increased antidiuretic hormone secretion
.

                                              81.
The main factors regulating antidiuretic hormone are plasma crystalloid osmotic pressure, circulating blood volume and arterial blood pressure
.

Massive blood loss stimulates blood volume receptors, causing the release of vasopressin
.

                                                                       82.
Acute glomerulonephritis: a transient decrease in serum complement C3 (more than 2 weeks after onset, and gradually returning to normal within 8 weeks) is of great significance for the diagnosis of this disease
.

Clinical manifestations include four major symptoms of non-pitting edema, oliguria, hematuria and hypertension
.

Oliguria occurs due to decreased glomerular filtration rate
.

The most common complication of nephrotic syndrome: infection
.

83.
The main reason for the increase of urine output caused by rapid intravenous injection of a large amount of normal saline: the decrease of colloid osmotic pressure caused by plasma protein dilution
.

84.
Renin-dominated hypertension, manifested as hypovolemia and vasospasm
.

Renin is secreted by paraglomerular granulosa cells in the paraglomerular apparatus, and its secretion is mainly affected by factors such as glomerular arterial pressure and the amount of sodium in urine that flows through the plaque
.

Blood pressure drops, sympathetic excitement, and the concentration of sodium chloride in the original urine drops
.

85.
Cardiac output has the greatest influence on renal blood flow
.

Exhaled acid, exhaled base, and PEEP all cause decreased renal blood flow
.

Hypoxia dilates renal blood vessels and increases renal blood flow; when PaO2 <40mmHg, renal vasoconstriction
.

Renal tubular epithelial cells secrete one H+, which is accompanied by one Na+ and HCO3- reabsorption into the blood
.

Therefore, the secretion of H+ increases, the reabsorption of Na+ and HCO3- increases, the secretion of K decreases, and the secretion of NH3 increases.

.

                            86.
Plasma colloid osmotic pressure also affects glomerular filtration rate and renal tubular reabsorption; chronic renal failure combined with hyperuricemia, impaired glucose tolerance
.

Acute renal failure: oliguria: three lows (decreased sodium, calcium, PH) and three highs (increased potassium, phosphorus, and creatinine), edema
.

Polyuric stage: blood urea nitrogen and creatinine can still rise, prone to hypokalemia, gastrointestinal bleeding,
etc.

Recovery period: blood urea nitrogen and creatinine are close to normal
.

In nephrotic syndrome, albumin is decreased, in addition, IgG, metal-binding protein (transferrin), and endocrine-binding protein are also decreased
.

Hormones produced by the kidneys: prostaglandin family; renin (angiotensinogen produced in the liver); kallikrein, kinin system; active vitamin D; erythropoietic hormone (erythropoietin)
.

  87.
Usually plasma urea nitrogen>28.
6mmol/L (80mg/dl), creatinine>707.
2umol/L or creatinine clearance rate<10ml/min; severe metabolic acidosis, CO2 binding rate<13mmol/L; serum potassium >6.
5mmol/L; pulmonary edema; hypertension with water and sodium retention; pericarditis; obvious anemia, when Hct<15%, dialysis treatment should be started
.

                                        88.
Kidney pathological activity indicators of lupus nephritis: proliferative changes of glomerular cells; fibrinous necrosis and nuclear lysis; cellular crescent; vitreous thrombus; glomerular neutrophil infiltration; renal interstitial mononucleus cell infiltration
.

             89.
When the heart is normal, inotropic drugs can enhance myocardial contractility and increase myocardial oxygen consumption; but when heart failure occurs, inotropic drugs can reduce myocardial oxygen consumption
.

When myocardial activity increases, the body relies on coronary dilation to increase blood flow to meet the oxygen demand of the myocardium
.

The oxygen saturation of the coronary sinus is 30%, and the myocardial uptake of oxygen from coronary blood flow accounts for 65%
.

90.
Paroxysmal supraventricular tachycardia is characterized by sudden and sudden stop, the heart rate is often 160-250/min, and the heart rhythm is absolutely regular
.

The intensity of the first heart sound during auscultation is completely consistent, and the heart rate is relatively constant and regular during the attack
.

91.
Contraindications for electrical cardioversion (defibrillation): tachyarrhythmias caused by digitalis poisoning, supraventricular arrhythmias with high or complete atrioventricular block or persistent atrial fibrillation without the use of drugs that affect atrioventricular conduction Lower ventricular rate has been very slow, with sick sinus syndrome (ie fast-slow syndrome), recent arterial embolism, there is a thrombus in the atrium and no anticoagulation therapy
.

Non-paroxysmal junctional tachycardia does not require special treatment, etiological treatment, self-limiting
.

92.
Two stenosis of rheumatic heart disease: left atrial enlargement, atrial fibrillation, right ventricular hypertrophy, right bundle branch block
.

Massive hemoptysis is more common in mitral stenosis: ① pulmonary congestion or capillary rupture; often accompanied by nocturnal paroxysmal dyspnea; hemoptysis can also be caused by pulmonary infarction in the late stage of mitral stenosis; ② massive hemoptysis is due to left atrial pressure Sudden increase, resulting in bronchial vein rupture and bleeding
.

③ Pink foamy sputum, caused by rupture of capillaries, is a characteristic of acute pulmonary edema
.

93.
Main stenosis: dyspnea (exertion and nocturnal paroxysmal), angina pectoris, syncope triad
.

94.
The mechanism of action of thrombolytic drugs: degrade fibrin, degrade fibrinogen, and activate the fibrinolytic system in the blood
.

95.
Complications of subacute infective endocarditis: heart failure (most common), bacterial aneurysm, glomerulonephritis, metastatic abscess, myocardial infarction
.

Principles of antibacterial drugs: early stage, sufficient amount, and long course of treatment; intravenous drugs are mainly used, and bactericidal antibiotics (subacute streptococcus) are selected
.

96.
Patients with dilated cardiomyopathy have various arrhythmias, and some patients have thromboembolism (18%) or sudden death (30%)
.

The main signs are cardiac enlargement, galloping rhythm, pulmonary circulation and systemic circulation congestion signs
.

Pathological Q waves, atrial fibrillation, increased PCWP
.

97.
Atrial defect ECG: atrioventricular block; incomplete or complete right bundle branch block; right and left ventricular hypertrophy; ST-T changes
.

     98.
Split second heart sound: Under normal circumstances, the left and right ventricles are not completely synchronized during diastole, the right heart blood refluxes more during inspiration, the right ventricle emptying time is long, the pulmonary valve closure is further delayed, and the left heart reflux does not increase, which can make The distance between the aortic valve component and the pulmonary valve component of the second heart sound increases, and the second heart sound split is heard more than 0.
03s
.

The split disappears on expiration, and is best heard in the second and third ribs at the left sternal border in adolescents and children
.

99.
When a large amount of pericardial effusion occurs, the heart moves to the left and posteriorly, compressing the left lung, causing atelectasis of the lower lobe of the left lung, and lung consolidation appears in the left subscapular angle area, which is called the Ewart sign
.

Manifested as dullness in the left subscapular angle of the back, increased tremor and bronchial breath sounds, which are signs of exudative pericarditis
.

100.
The influencing factors of cardiac output are: venous return to the heart, peripheral vascular resistance, peripheral tissue oxygen demand, blood volume, body position, breathing pattern, heart rate and myocardial contractility
.

The main factors are heart rate and volume per stroke.
END Recommended reading [Monday] Anesthesia Elementary and Intermediate Test Center Intensive Lecture 01 [Monday] Key Points You Can't Miss · Anesthesia Junior and Intermediate Test Center Intensive Lecture 02 [Monday] You Can't Miss the Key Points Anesthesia Elementary and intermediate test center lecture 03 [Monday] Key points you can't miss · Anesthesia junior and intermediate test center lecture 04 [Monday] Key points you can't miss · Anesthesiology senior professional title test center 01 [Monday] Key points you can't miss · Anesthesia Learning senior professional title test center 02 [Monday] You can't miss the key points.
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