2018 Flashcards
1
Q
APL location
A
in expiratory limb before reservoir bag
2
Q
fresh gas flow location
A
in inspiratory limb before inspiratory valve
3
Q
mapleson for controlled ventilation
A
dead bodies can’t argue: D>B>C>A
4
Q
mapleson for spontaneous ventilation
A
all dingos can breathe
5
Q
Jackson-reese minimum flow
A
3 x MV
6
Q
components of low pressure system of anesthesia machine
A
flow indicator, vaporizer, vaporizer circuit control valves, back pressure safety valve, low pressure safety device, common gas outlet
7
Q
advantages of CO2 absorber
A
less gas flow, less pollution, head/moisture conservation, contained gasses, inhaled mixture is more constant
8
Q
CO2 absorber and compound A
A
soda lime is a risk. calcium hydroxide free decreases risk
9
Q
desiccated soda lime
A
makes CO
10
Q
signs of soda lime exhaustion
A
impaired CO2 on capno, color change, warm feeling at top
11
Q
Boyle Law
A
PV=PV
12
Q
Charles law
A
V/T=V/T
13
Q
Gay-Lussac law
A
P/T=P/t
14
Q
avogador’s hypothesis
A
1mole gas at 1STP = 22.4 L STP= 0C and 1atm
15
Q
full O2 cylinder
A
660L at 2200 psi
16
Q
full N2O cylinder
A
1590 L, 750 psi
17
Q
full air cylinder
A
625L 1800 psi
18
Q
metabolism of N2O
A
in intestine by reductive anaerobic metabolism (no renal/hepatic)
19
Q
elimination half life of N2O
A
5min
20
Q
MAC N20
A
105%
21
Q
blood:gas coefficient N2O
A
0.46
22
Q
adverse side effects of N2O
A
aplastic anemia(metabolism of b12 and folate), n/v, CNS toxicity
23
Q
anion gap
A
Na-CL-HCO3. 9-15 normal
24
Q
signs of hyponatremia
A
arrhythmia, hypotension, pulmonary edema, mental changes, weakness/muscle cramps
25
what causes hypokalemia
alkalosis, insulin, b2 stimulation(albuterol/terbutaline)
26
sign of rapid decrease in Ca
tetany/spasm
27
chovstek's sign
contracture of facial muscle with tapping signaling hypocalcemia
28
ekg changes with hypocalcemia
prolonged QT, flat/inverted T waves
29
T1/2 : Vd and Cl
directly related to Vd and inverse to clearance
30
groups of drugs metabolized by cyp450
barbiturates, opioids, benzo, amide locals, TCA, antihistamine
31
for each up 1 degree C, effect on bmr
up 7%
32
effective dose in 95% correlated to Mac
1.3
33
volatile that causes acute hepatotoxicity
halothane because of oxidative trifluouracetyl metabolite
34
acceptable levels of N2O w/ volatile
25ppm N2O and 0.5 volatile. if only volatile 2ppm
35
volatile least degraded by soda lime
des
36
drug that act synergistically with volatiles
ca channel blockers
37
best anti arrhythmic for MH
procainamide
38
mortality rate of MH
10%
39
cord abductor
posterior cricoarytenoid. you take it out back
40
cord adductor
lateral cricoarytenoid
41
length of ETT
12 + age/2
42
ETT size
age/4 +4
43
induction agent most likely to cause venous thrombosis
etomidate, diazepam and lorazepam
44
ketamine MOA
antagonizes NMDA receptor and kappa opioid receptor agonist
45
induction agent that decreases seizure threshold
ketamine
46
thiopental facts
80% bound to albumin, 10-15second onset. elimination half life is 11 hours
47
how to treat intra arterial injection of thiopental
phenoxybenzamine
48
muscle relaxants causing histamine release
mivacurium, atracurium, tubocurarine
49
atracurium and cisatracurium metabolism
both Hoffman. Tara also ester hydrolysis
50
laudanosine
lipid soluble metabolite of atracurium that can cause CNS stimulation in high concentrations
51
barbiturates MOA
prolong attachment of GABA to its receptor in the RAS
52
who barbiturates are contraindicated in
status asthmatics and porphyria
53
mu1 receptor actions
euphoria, miosis, bradycaria, hypothermia, urinary retention, pruritis
54
mu2 receptor actions
respiratory depression, marked constipation, physical dependence
55
kappa receptor do what
sedation, dysphoria. mostly in spinal
56
meperidine use and SE
shivering. decreases myocardial contractility, increases HR. avoid w/ MAOi
57
what can reduce opioid-induced sphincter of odd spasm
nitroglycerine and glucagon
58
determinants of local potency, duration and speed of onset
potency is lipid solubility, duration protein binding and speed of onset pKa
59
most toxic ester local anesthetic
tetracaine because hydrolyzed more slowly by plasma cholinesterase vs others
60
common med that can prolong ester local anesthetics
anticholinesterases
61
prilocaine metabolite
orthotoluidine which oxidizes hemoglobin to methemoglobin
62
symptoms when you give demerol w/ MAOI
hyperpyrexia, HTN, hypotension, respiratory depression, skeletal muscle rigidity, seizure, coma
63
adverse effects of mannitol administration
pulmonary edema/cardiac decompensation, rebound up ICP, hypovolemia, hyperkalemia, hyponatremia
64
SE of TCA
like amitriptyline: anticholinergic (dry mouth, blurred vision), orthostatic hypotension, sedation
65
NMS
caused by antipsychotic drugs like haldol. get a fever
66
total volume of csf
150cc
67
csf rate of creation
21cc/hr
68
most common site of csf obstruction
aqueduct of sylvius
69
meds to avoid in parkinsons
reglan, compagine and droperidol
70
hyperventilation on K
hypoK
71
flow of csf
choroid plexus to lateral ventricle to foramen Monroe to 3rd ventricle to aqueduct of sylvius to 4th ventricle to foramen of luschka and magendie to subarachnoid space to brain to arachnoid villi
72
preganglionic parasympathetic nerve origins
CN 3, 7, 9, 10 and S2-4
73
preganglionic SNS nerve origin in spinal cord
intermediolateral horn
74
pain tract name
lateral spinothalamic tract
75
normal ICP
5-15
76
intracranial contents
80% brain, 12% blood, 8% CSF
77
Alpha waves brain
in patients with up ICP
78
cushings triad
up ICP: HTN, bradycardia and irregular respirations
79
acute spinal shock
hypotension due to sympathetic blockade and bradycardia b/c block cardioaccelerators
80
therapy for cerebral vasospasm
triple H: hyervolemia (CVP over 10), HTN (SBP over 160) and hemodilution (HCT 33%
81
oculocardiac reflex pathway
afferent trigeminal. efferent vagus
82
ways CO2 is carried in blood
5% dissolved, less than 1% carbonic acid, 90% bicarb, 5% protein bound
83
CO2 produced per min
200cc/min
84
enzyme that converts CO2 to HCO3
carbonic anhydrase
85
p50 hemoglobin
27mm Hg
86
L shift of hemoglobin curve
down CO2, up pH, down temp, CO poisoning, fetal hemoglobin. increases affinity for O2 so lets go less
87
hamburger shift
Cl exchange for bicarb in rbc
88
bohr effect
PaCO2 affects oxyhemoglobin dissociation curve
89
Haldane effect
PaO2 affects CO2 dissociation curve
90
O2 content in blood equation
(0.003xPaO2) + (1.34x hub x SaO2)
91
PaO2 equation
FiO2 x 5
92
CPAP vs PEEP one lung ventilation
CPAP to non dependent. PEEP to dependent
93
flow volume loop for obstructive
baby carriage
94
flow volume loop for restrictive
small normal shape
95
flow volume loop for intrathoracic obstruction
tiny baby carriage
96
flow volume loop for extra thoracic obstruction
small flat inhalation
97
phosphodiesterase inhibitor moa
PDE breaks down camp. if inhibited then more camp around and bronchodilator occurs
98
how beta 2 agonist causes bronchodilation
up adenylal cyclase which converts ATP to camp with causes bronchodilation
99
cromolyn sodium moa
mast cell stabilizer preventing release of histamine and bradykinin preventing bronchospasm in asthma but doesn't treat once it happens
100
ipratropium moa
antimuscarinic that augments bronchodilation by blocking IP3 so less Ca released
101
differences in neonatal respiratory system
down lung compliance, up chest wall compliance, down FRC
102
cerebral perfusion pressure auto regulation range
50-150
103
coronary perfusion pressure auto regulation range
60-160
104
renal perfusion pressure auto regulation range
80-180
105
bainbridge reflex
stretch of RA increases HR via vagus nerve
106
RA pressure
1-8
107
RV pressure
15-25
108
LA pressure
2-12
109
LV pressure
100
110
inferior wall MI
2,3, avf
111
lateral wall MI
I, aVL, V5-6
112
anterior/septal wall MI
V1-4
113
goal of AS
decrease HR and up SVR. give phenylephrine
114
goal of AR
up preload, decrease SVR, up HR
115
goal of HOCM
up preload, up SVR. give phenylephrine
116
goal of MS
down HR, up SVR
117
goal of MR
up preload, down SVR, up HR
118
Pulm vasc resistance in hypercapnia
up, increasing R to L shunt
119
SVR in hypercapnia
down
120
SV determined by
contractility, preload and after load
121
catecholamines released from adrenal medulla
epi 80%, NE 20% and dopamine little
122
digoxin use
to treat CHF and SVT by inhibiting NaK pump so up intracellular Ca accumulation
123
liver blood flow breakdown
70% portal vein and 30% hepatic artery
124
3 stimuli to release renin
down renal perfusion pressure, hyponatremia, sympathetic NS stimulation of beta receptors in juxtaglomerular apparatus
125
adh job
distal tubule and collecting tubule to up water resorption
126
aldosterone moa
collecting duct and distal tubule increasing Na reabsorption and K secretion
127
extrinsic coagulation factors
3 and 7
128
normal act
80-150 seconds
129
heparin vs Coumadin labs and intrinsic?
heparin intrinsic PTT and ACT. coumadin extrinsic pt/inr
130
factors in cryo
1, 8, 13
131
graves is what thyroid
hyper
132
presentation of DI
polydipsia, polyuria, hypovolemia, hypotension
133
diagnosis of SIADH
decreased plasma osmolality(under 270) and up urine Na
134
signs of Addison disease
hypo adrenal so hypotension, hyponatremia, hyperkalemia, hypoglycemia, hemoconcentration, skin pigmentation
135
signs of Cushing disease
hyper adrenal so HTN, hypokalemia and hyperglycemia
136
anaphylactic ran type
I hypersensitivity. IgE mediated
137
signs of acute porphyria
abdominal pain, n/v, neurotoxicity(confusion, HTN, SIADH), tachycardia and sensory/motor neuropathies
138
ankylosing spondylitis
familial disorder of HLAb27. low back pain with morning stiffness in young man
139
lowest hemoglobin age
3months
140
foramen of bochdaleck
larger diaphragm whole on L so most hernias on L. keep PIP under 30
141
omphalocele vs gastroschisis
O is in umbilical and has sac, associated w/ cardiac. G: lateral umbilical, no sac
142
foramen ovale and PDA
FO b/w atrium. PDA b/w PA and aorta
143
age of highest metabolic rate
2 years
144
initial dose of FFP
10-15cc/kg
145
high spinal to c8
numbness pinky and ring finger
146
high spinal to c7
numbness middle fingers
147
high spinal to c6
numbness thumb and index finger
148
location of sympathetic and motor block compared to site
sympathetic 2-6 dermatomes above. motor 2 lower
149
epi 1:200,000
5mcg/mL
150
turp solution causing temp blindness
glycine
151
how cyanide causes toxicity
binds to cytochrome oxidase resulting in inhibition of oxidative phosphorylation so no cell respiration
152
tort
civil wrongdoing
153
MAC changes in pregnancy
decrease of Mac by 40% and increased risk of awareness. more sensitive to NDMR
154
CO in pregnancy
3rd trimester up 50%. latent labor up another 25%, active up another 15%(90%total) to 2nd stage 115%total
155
resp w/ no change prego
vital capacity
156
5 causes of thrombocytopenia in pregnancy
gestational(dilutional), ITP, pre-eclampsia, DIC(b/c AFE, PPH, sepsis), HELLP
157
sigs of DIC
thrombocytopenia, prolonged PT and PTT, decreased fibrinogen
158
coagulation factors in pregnancy
most increased. fibrinogen increase to 350-550. factor XI and XIII decreased
159
local anesthetic most likely to cross placenta
lidocaine because less protein binding
160
important meds that do not cross placenta
He Is Going Nowhere Soon: heparin, insulin, glyco, NDMR, sux
161
why place cerclage
recurrent loss b/c cervical insufficiency,
162
anesthetic plan for cerclage
place trendelenberg, give uterine relaxation(volatile/tocolysis) to help minimize membrane injury and prevent complication of ROM. T10 level if regional. don't do after 18 weeks
163
EXIT anesthesia plan
MAC 2-3 for uterine relax, oxytocin and decrease gas when cord clamped
164
why paracervical block isn't preformed for labor
up to 40% chance of fetal bradycardia
165
mag dosing pre eclampsia
loading dose 4-6g then 1-2g/hr depending on renal fan(complete excretion renal)
166
therapeutic goal of mag in pre eclampsia
4-6: sedation, flushing, some motor weakness
167
effects of giving mom mag on baby
less FHT variability, hypotonia at birth and cerebral protection for CP if given before 32 weeks
168
what causes gestational diabetes
placenta makes HPL which increases insulin resistance
169
amniotic fluid embolism
50% mortality, hypotension, tachypnea, cardiovascular collapse, DIC and 50% get seizures
170
definition of post partum hemorrhage
500cc vaginal or 1000cc c/s
171
causes of uterine atony after delivery
fatigue/long labor, distention from multiple, drugs, infection, anatomy like fibroids
172
uterine receptors
beta relax. alpha contract
173
terbutaline pregnant
beta agonist to cause relaxation/stop pre term labor for 24-48hr.
174
terbutaline pregnant side effect
hypotension, tachycardia, hyperglycemia, hypokalemia. rare: pulmonary edema
175
indomethacin pregnant
stops prostaglandin synthesis. inhibits COX and prostaglandin E2. causes nausea and heartburn
176
fetal side effects of indomethacin
early PDA closure so only use before 32 weeks and for less than 72 hours. can also cause oligohydramnios
177
when to use nitroglycerine pregnancy
degradation to NO causes direct vascular smooth m dilation for fetal head entrapment, uterine inversion, manual extraction of placenta, tachysystole contractions
178
oxytocin pregnancy
increases tone. IV/IM/IU. cause hypotension, n/v, up PAP, ST depressions EKG
179
methylergonovine pregnancy
aka methergine. IM/IU ergot alkaloid to stimulate alpha. causes severe n/v, vasoconstriction, htn, don't give if cHTN, gHTN or pre-eclampsia
180
hemabate
prostaglandin F2 alpha agonist uterotonic. avoid in asthma
181
misoprostol pregnancy
cytotec: prostaglandin E1 analog for hemorrhage unresponsive to oxytocin
182
level of spinal determined by
baricity of LA, patient position, dose of med, site of injection
183
pencil point spinal needles
Whitacre and sprotte. up PDPH
184
goal dermatome level for c/s
T4-6
185
decelerations on FHT
early due to head compression, variable due to cord compression, late due to uteroplacental insuffeciency
186
fetal hub p50
19
187
signs of meconium aspiration
tachycardia, delayed cap refill, cyanosis, cold skin. hypotension is a late sign
188
if allergic to local, which type?
ester
189
EDTA in chlorprocaine
caused arachnoiditis in spinals so not used anymore
190
why lumbosacral trunk compression labor
L5 sensory plus foot drop and associated with big baby
191
correcting low Na too fast causes what
central pontine myelinosis
192
how to treat hypercalcemia
re-hydration then diuresis
193
body water content by age
75% birth, 65% 1 month, 60 male, 50% adult female
194
thirst center of brain
lateral preoptic area of the hypothalamus
