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ITE Guide > 2018 > Flashcards

2018 Flashcards

1
Q

APL location

A

in expiratory limb before reservoir bag

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2
Q

fresh gas flow location

A

in inspiratory limb before inspiratory valve

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3
Q

mapleson for controlled ventilation

A

dead bodies can’t argue: D>B>C>A

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4
Q

mapleson for spontaneous ventilation

A

all dingos can breathe

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5
Q

Jackson-reese minimum flow

A

3 x MV

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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

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7
Q

advantages of CO2 absorber

A

less gas flow, less pollution, head/moisture conservation, contained gasses, inhaled mixture is more constant

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8
Q

CO2 absorber and compound A

A

soda lime is a risk. calcium hydroxide free decreases risk

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9
Q

desiccated soda lime

A

makes CO

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10
Q

signs of soda lime exhaustion

A

impaired CO2 on capno, color change, warm feeling at top

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11
Q

Boyle Law

A

PV=PV

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12
Q

Charles law

A

V/T=V/T

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13
Q

Gay-Lussac law

A

P/T=P/t

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14
Q

avogador’s hypothesis

A

1mole gas at 1STP = 22.4 L STP= 0C and 1atm

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15
Q

full O2 cylinder

A

660L at 2200 psi

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16
Q

full N2O cylinder

A

1590 L, 750 psi

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17
Q

full air cylinder

A

625L 1800 psi

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18
Q

metabolism of N2O

A

in intestine by reductive anaerobic metabolism (no renal/hepatic)

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19
Q

elimination half life of N2O

A

5min

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20
Q

MAC N20

A

105%

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21
Q

blood:gas coefficient N2O

A

0.46

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22
Q

adverse side effects of N2O

A

aplastic anemia(metabolism of b12 and folate), n/v, CNS toxicity

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23
Q

anion gap

A

Na-CL-HCO3. 9-15 normal

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24
Q

signs of hyponatremia

A

arrhythmia, hypotension, pulmonary edema, mental changes, weakness/muscle cramps

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25
Q

what causes hypokalemia

A

alkalosis, insulin, b2 stimulation(albuterol/terbutaline)

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26
Q

sign of rapid decrease in Ca

A

tetany/spasm

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27
Q

chovstek’s sign

A

contracture of facial muscle with tapping signaling hypocalcemia

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28
Q

ekg changes with hypocalcemia

A

prolonged QT, flat/inverted T waves

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29
Q

T1/2 : Vd and Cl

A

directly related to Vd and inverse to clearance

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30
Q

groups of drugs metabolized by cyp450

A

barbiturates, opioids, benzo, amide locals, TCA, antihistamine

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31
Q

for each up 1 degree C, effect on bmr

A

up 7%

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32
Q

effective dose in 95% correlated to Mac

A

1.3

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33
Q

volatile that causes acute hepatotoxicity

A

halothane because of oxidative trifluouracetyl metabolite

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34
Q

acceptable levels of N2O w/ volatile

A

25ppm N2O and 0.5 volatile. if only volatile 2ppm

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35
Q

volatile least degraded by soda lime

A

des

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36
Q

drug that act synergistically with volatiles

A

ca channel blockers

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37
Q

best anti arrhythmic for MH

A

procainamide

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38
Q

mortality rate of MH

A

10%

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39
Q

cord abductor

A

posterior cricoarytenoid. you take it out back

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40
Q

cord adductor

A

lateral cricoarytenoid

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41
Q

length of ETT

A

12 + age/2

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42
Q

ETT size

A

age/4 +4

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43
Q

induction agent most likely to cause venous thrombosis

A

etomidate, diazepam and lorazepam

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44
Q

ketamine MOA

A

antagonizes NMDA receptor and kappa opioid receptor agonist

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45
Q

induction agent that decreases seizure threshold

A

ketamine

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46
Q

thiopental facts

A

80% bound to albumin, 10-15second onset. elimination half life is 11 hours

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47
Q

how to treat intra arterial injection of thiopental

A

phenoxybenzamine

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48
Q

muscle relaxants causing histamine release

A

mivacurium, atracurium, tubocurarine

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49
Q

atracurium and cisatracurium metabolism

A

both Hoffman. Tara also ester hydrolysis

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50
Q

laudanosine

A

lipid soluble metabolite of atracurium that can cause CNS stimulation in high concentrations

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51
Q

barbiturates MOA

A

prolong attachment of GABA to its receptor in the RAS

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52
Q

who barbiturates are contraindicated in

A

status asthmatics and porphyria

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53
Q

mu1 receptor actions

A

euphoria, miosis, bradycaria, hypothermia, urinary retention, pruritis

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54
Q

mu2 receptor actions

A

respiratory depression, marked constipation, physical dependence

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55
Q

kappa receptor do what

A

sedation, dysphoria. mostly in spinal

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56
Q

meperidine use and SE

A

shivering. decreases myocardial contractility, increases HR. avoid w/ MAOi

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57
Q

what can reduce opioid-induced sphincter of odd spasm

A

nitroglycerine and glucagon

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58
Q

determinants of local potency, duration and speed of onset

A

potency is lipid solubility, duration protein binding and speed of onset pKa

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59
Q

most toxic ester local anesthetic

A

tetracaine because hydrolyzed more slowly by plasma cholinesterase vs others

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60
Q

common med that can prolong ester local anesthetics

A

anticholinesterases

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61
Q

prilocaine metabolite

A

orthotoluidine which oxidizes hemoglobin to methemoglobin

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62
Q

symptoms when you give demerol w/ MAOI

A

hyperpyrexia, HTN, hypotension, respiratory depression, skeletal muscle rigidity, seizure, coma

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63
Q

adverse effects of mannitol administration

A

pulmonary edema/cardiac decompensation, rebound up ICP, hypovolemia, hyperkalemia, hyponatremia

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64
Q

SE of TCA

A

like amitriptyline: anticholinergic (dry mouth, blurred vision), orthostatic hypotension, sedation

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65
Q

NMS

A

caused by antipsychotic drugs like haldol. get a fever

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66
Q

total volume of csf

A

150cc

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67
Q

csf rate of creation

A

21cc/hr

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68
Q

most common site of csf obstruction

A

aqueduct of sylvius

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69
Q

meds to avoid in parkinsons

A

reglan, compagine and droperidol

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70
Q

hyperventilation on K

A

hypoK

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71
Q

flow of csf

A

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

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72
Q

preganglionic parasympathetic nerve origins

A

CN 3, 7, 9, 10 and S2-4

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73
Q

preganglionic SNS nerve origin in spinal cord

A

intermediolateral horn

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74
Q

pain tract name

A

lateral spinothalamic tract

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75
Q

normal ICP

A

5-15

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76
Q

intracranial contents

A

80% brain, 12% blood, 8% CSF

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77
Q

Alpha waves brain

A

in patients with up ICP

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78
Q

cushings triad

A

up ICP: HTN, bradycardia and irregular respirations

79
Q

acute spinal shock

A

hypotension due to sympathetic blockade and bradycardia b/c block cardioaccelerators

80
Q

therapy for cerebral vasospasm

A

triple H: hyervolemia (CVP over 10), HTN (SBP over 160) and hemodilution (HCT 33%

81
Q

oculocardiac reflex pathway

A

afferent trigeminal. efferent vagus

82
Q

ways CO2 is carried in blood

A

5% dissolved, less than 1% carbonic acid, 90% bicarb, 5% protein bound

83
Q

CO2 produced per min

A

200cc/min

84
Q

enzyme that converts CO2 to HCO3

A

carbonic anhydrase

85
Q

p50 hemoglobin

A

27mm Hg

86
Q

L shift of hemoglobin curve

A

down CO2, up pH, down temp, CO poisoning, fetal hemoglobin. increases affinity for O2 so lets go less

87
Q

hamburger shift

A

Cl exchange for bicarb in rbc

88
Q

bohr effect

A

PaCO2 affects oxyhemoglobin dissociation curve

89
Q

Haldane effect

A

PaO2 affects CO2 dissociation curve

90
Q

O2 content in blood equation

A

(0.003xPaO2) + (1.34x hub x SaO2)

91
Q

PaO2 equation

A

FiO2 x 5

92
Q

CPAP vs PEEP one lung ventilation

A

CPAP to non dependent. PEEP to dependent

93
Q

flow volume loop for obstructive

A

baby carriage

94
Q

flow volume loop for restrictive

A

small normal shape

95
Q

flow volume loop for intrathoracic obstruction

A

tiny baby carriage

96
Q

flow volume loop for extra thoracic obstruction

A

small flat inhalation

97
Q

phosphodiesterase inhibitor moa

A

PDE breaks down camp. if inhibited then more camp around and bronchodilator occurs

98
Q

how beta 2 agonist causes bronchodilation

A

up adenylal cyclase which converts ATP to camp with causes bronchodilation

99
Q

cromolyn sodium moa

A

mast cell stabilizer preventing release of histamine and bradykinin preventing bronchospasm in asthma but doesn’t treat once it happens

100
Q

ipratropium moa

A

antimuscarinic that augments bronchodilation by blocking IP3 so less Ca released

101
Q

differences in neonatal respiratory system

A

down lung compliance, up chest wall compliance, down FRC

102
Q

cerebral perfusion pressure auto regulation range

A

50-150

103
Q

coronary perfusion pressure auto regulation range

A

60-160

104
Q

renal perfusion pressure auto regulation range

A

80-180

105
Q

bainbridge reflex

A

stretch of RA increases HR via vagus nerve

106
Q

RA pressure

A

1-8

107
Q

RV pressure

A

15-25

108
Q

LA pressure

A

2-12

109
Q

LV pressure

A

100

110
Q

inferior wall MI

A

2,3, avf

111
Q

lateral wall MI

A

I, aVL, V5-6

112
Q

anterior/septal wall MI

A

V1-4

113
Q

goal of AS

A

decrease HR and up SVR. give phenylephrine

114
Q

goal of AR

A

up preload, decrease SVR, up HR

115
Q

goal of HOCM

A

up preload, up SVR. give phenylephrine

116
Q

goal of MS

A

down HR, up SVR

117
Q

goal of MR

A

up preload, down SVR, up HR

118
Q

Pulm vasc resistance in hypercapnia

A

up, increasing R to L shunt

119
Q

SVR in hypercapnia

A

down

120
Q

SV determined by

A

contractility, preload and after load

121
Q

catecholamines released from adrenal medulla

A

epi 80%, NE 20% and dopamine little

122
Q

digoxin use

A

to treat CHF and SVT by inhibiting NaK pump so up intracellular Ca accumulation

123
Q

liver blood flow breakdown

A

70% portal vein and 30% hepatic artery

124
Q

3 stimuli to release renin

A

down renal perfusion pressure, hyponatremia, sympathetic NS stimulation of beta receptors in juxtaglomerular apparatus

125
Q

adh job

A

distal tubule and collecting tubule to up water resorption

126
Q

aldosterone moa

A

collecting duct and distal tubule increasing Na reabsorption and K secretion

127
Q

extrinsic coagulation factors

A

3 and 7

128
Q

normal act

A

80-150 seconds

129
Q

heparin vs Coumadin labs and intrinsic?

A

heparin intrinsic PTT and ACT. coumadin extrinsic pt/inr

130
Q

factors in cryo

A

1, 8, 13

131
Q

graves is what thyroid

A

hyper

132
Q

presentation of DI

A

polydipsia, polyuria, hypovolemia, hypotension

133
Q

diagnosis of SIADH

A

decreased plasma osmolality(under 270) and up urine Na

134
Q

signs of Addison disease

A

hypo adrenal so hypotension, hyponatremia, hyperkalemia, hypoglycemia, hemoconcentration, skin pigmentation

135
Q

signs of Cushing disease

A

hyper adrenal so HTN, hypokalemia and hyperglycemia

136
Q

anaphylactic ran type

A

I hypersensitivity. IgE mediated

137
Q

signs of acute porphyria

A

abdominal pain, n/v, neurotoxicity(confusion, HTN, SIADH), tachycardia and sensory/motor neuropathies

138
Q

ankylosing spondylitis

A

familial disorder of HLAb27. low back pain with morning stiffness in young man

139
Q

lowest hemoglobin age

A

3months

140
Q

foramen of bochdaleck

A

larger diaphragm whole on L so most hernias on L. keep PIP under 30

141
Q

omphalocele vs gastroschisis

A

O is in umbilical and has sac, associated w/ cardiac. G: lateral umbilical, no sac

142
Q

foramen ovale and PDA

A

FO b/w atrium. PDA b/w PA and aorta

143
Q

age of highest metabolic rate

A

2 years

144
Q

initial dose of FFP

A

10-15cc/kg

145
Q

high spinal to c8

A

numbness pinky and ring finger

146
Q

high spinal to c7

A

numbness middle fingers

147
Q

high spinal to c6

A

numbness thumb and index finger

148
Q

location of sympathetic and motor block compared to site

A

sympathetic 2-6 dermatomes above. motor 2 lower

149
Q

epi 1:200,000

A

5mcg/mL

150
Q

turp solution causing temp blindness

A

glycine

151
Q

how cyanide causes toxicity

A

binds to cytochrome oxidase resulting in inhibition of oxidative phosphorylation so no cell respiration

152
Q

tort

A

civil wrongdoing

153
Q

MAC changes in pregnancy

A

decrease of Mac by 40% and increased risk of awareness. more sensitive to NDMR

154
Q

CO in pregnancy

A

3rd trimester up 50%. latent labor up another 25%, active up another 15%(90%total) to 2nd stage 115%total

155
Q

resp w/ no change prego

A

vital capacity

156
Q

5 causes of thrombocytopenia in pregnancy

A

gestational(dilutional), ITP, pre-eclampsia, DIC(b/c AFE, PPH, sepsis), HELLP

157
Q

sigs of DIC

A

thrombocytopenia, prolonged PT and PTT, decreased fibrinogen

158
Q

coagulation factors in pregnancy

A

most increased. fibrinogen increase to 350-550. factor XI and XIII decreased

159
Q

local anesthetic most likely to cross placenta

A

lidocaine because less protein binding

160
Q

important meds that do not cross placenta

A

He Is Going Nowhere Soon: heparin, insulin, glyco, NDMR, sux

161
Q

why place cerclage

A

recurrent loss b/c cervical insufficiency,

162
Q

anesthetic plan for cerclage

A

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
Q

EXIT anesthesia plan

A

MAC 2-3 for uterine relax, oxytocin and decrease gas when cord clamped

164
Q

why paracervical block isn’t preformed for labor

A

up to 40% chance of fetal bradycardia

165
Q

mag dosing pre eclampsia

A

loading dose 4-6g then 1-2g/hr depending on renal fan(complete excretion renal)

166
Q

therapeutic goal of mag in pre eclampsia

A

4-6: sedation, flushing, some motor weakness

167
Q

effects of giving mom mag on baby

A

less FHT variability, hypotonia at birth and cerebral protection for CP if given before 32 weeks

168
Q

what causes gestational diabetes

A

placenta makes HPL which increases insulin resistance

169
Q

amniotic fluid embolism

A

50% mortality, hypotension, tachypnea, cardiovascular collapse, DIC and 50% get seizures

170
Q

definition of post partum hemorrhage

A

500cc vaginal or 1000cc c/s

171
Q

causes of uterine atony after delivery

A

fatigue/long labor, distention from multiple, drugs, infection, anatomy like fibroids

172
Q

uterine receptors

A

beta relax. alpha contract

173
Q

terbutaline pregnant

A

beta agonist to cause relaxation/stop pre term labor for 24-48hr.

174
Q

terbutaline pregnant side effect

A

hypotension, tachycardia, hyperglycemia, hypokalemia. rare: pulmonary edema

175
Q

indomethacin pregnant

A

stops prostaglandin synthesis. inhibits COX and prostaglandin E2. causes nausea and heartburn

176
Q

fetal side effects of indomethacin

A

early PDA closure so only use before 32 weeks and for less than 72 hours. can also cause oligohydramnios

177
Q

when to use nitroglycerine pregnancy

A

degradation to NO causes direct vascular smooth m dilation for fetal head entrapment, uterine inversion, manual extraction of placenta, tachysystole contractions

178
Q

oxytocin pregnancy

A

increases tone. IV/IM/IU. cause hypotension, n/v, up PAP, ST depressions EKG

179
Q

methylergonovine pregnancy

A

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
Q

hemabate

A

prostaglandin F2 alpha agonist uterotonic. avoid in asthma

181
Q

misoprostol pregnancy

A

cytotec: prostaglandin E1 analog for hemorrhage unresponsive to oxytocin

182
Q

level of spinal determined by

A

baricity of LA, patient position, dose of med, site of injection

183
Q

pencil point spinal needles

A

Whitacre and sprotte. up PDPH

184
Q

goal dermatome level for c/s

A

T4-6

185
Q

decelerations on FHT

A

early due to head compression, variable due to cord compression, late due to uteroplacental insuffeciency

186
Q

fetal hub p50

A

19

187
Q

signs of meconium aspiration

A

tachycardia, delayed cap refill, cyanosis, cold skin. hypotension is a late sign

188
Q

if allergic to local, which type?

A

ester

189
Q

EDTA in chlorprocaine

A

caused arachnoiditis in spinals so not used anymore

190
Q

why lumbosacral trunk compression labor

A

L5 sensory plus foot drop and associated with big baby

191
Q

correcting low Na too fast causes what

A

central pontine myelinosis

192
Q

how to treat hypercalcemia

A

re-hydration then diuresis

193
Q

body water content by age

A

75% birth, 65% 1 month, 60 male, 50% adult female

194
Q

thirst center of brain

A

lateral preoptic area of the hypothalamus

ITE Guide (1 decks)

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