Anatomy & Special Flashcards
Doubling the distance from a radiation source, decreases exposure by a factor of _____?
4
LES tone with cricoid pressure
decreased
Sensory innervation to medial leg and ankle?
saphenous nerve
sensory and motor to plantar foot?
posterior tibial nerve
location of deep peroneal nerve on foot?
lateral to dorsalis pedis pulse
sensory to anterior leg, ankle, dorsal foot, and toes (excluding web between 1st and 2nd toe)?
superficial peroneal nerve
Innervates all muscles of the larynx except the cricothyroid muscle?
RLN
Unilateral RLN injury results in…?
hoarseness
Partial BILATERAL RLN injury results in…?
Complete obstruction, stridor, and respiratory distress because adductors unopposed (most dangerous injury)
Complete BILATERAL RLN injury results in…?
aphonia or aspiration risk
Hypotension after spinal anesthesia due to 3 main mechanisms:
(1) arterial dilation (decreased after load)
(2) venodilation (decreased preload) - this is most dramatic!
(3) bradycardia 2/2 PANS dominance (bc cardioaccelerator fibers T1-T4 are blocked) -AND- Bezold Jarisch reflex.
**Use epinephrine early to prevent poor cerebral perfusion
mid esophageal aortic valve short axis view identifies which structures?
The RV and right coronary cusp which are always ANTERIOR
The non-coronary cusp which is always located next to the interatrial septum
Operator 1 vs Operator 2 responsibilities during manual in-line stabilization
operator 1 maintains head/neck neutrality
operator 2 stabilizes shoulders against OR table
Cause of back pain after large volume injection of 2-choroprocaine?
muscle spasms due to EDTA - a preservative that chelates Ca2+ of nearby muscles. These spasms are self-limited.
TAP block landmarks?
bottom of rib cage superiorly
top of pelvis inferiorly
latissimus dorsi lateral side
external oblique other lateral side
anesthetic concerns with ankylosing spondylitis?
difficult airway 2/2 fused cervical spine
epidural hematoma 2/2 multiple attempts in setting of platelet dysfunction from NSAID use
nerves and arteries in the antecubital fossa
Notice median nerve, ulnar nerve, and radial nerve locations with respect to vessels
Bier block time limit?
90 minutes, ideally less than 1 hour
Bier block mechanism?
(1) diffusion of local anesthetic from veins into capillaries and then into vasa nervosa –> nerve conduction block
(2) local anesthetic diffuses into small nerves that supply overlying skin
(3) tourniquet causes distal ischemia which also impairs nerve conduction leading to anesthesia
which nerve provides sensation to anterior tongue?
V3 - mandibular branch of trigeminal nerve
nerve that supplies posterior tongue?
glossopharyngeal (CN IX)
Nerve that supplies soft palate?
glossopharyngeal nerve (CN IX)
Nerve that supplies oropharynx?
glossopharyngeal nerve (CN IX)
Nerve that supplies hypopharynx (below the epiglottis all the way to the vocal cords)?
SLN internal branch (CN X)
*mnemonic SIME
sensory innervation of larynx and trachea (all below the vocal cords)?
RLN (CN X)
Narrowest part of airway in adults versus neonates?
adults: glottic opening, i.e. vocal cords
neonates: cricoid cartilage
MOTOR innervation of vocal cords?
RLN = both ABduction and ADDuction
All the muscles of the larynx are innervated by RLN except?
cricothyroid muscle - innervated by external branch of SLN
Which type of pneumocytes participate in gas exchange?
Type I
Which type of pneumocytes produce surfactant?
type II
Coronary supply to anterior distribution?
LAD
Coronary supply to anterolateral distribution?
LCX
Coronary supply to anteroseptal distribution?
LAD
Coronary supply to inferior distribution?
RCA
Coronary supply to inferolateral distribution?
RCA & LCX
Coronary supply to inferoseptal distribution?
RCA & LAD
1st line treatment for aortic dissection?
beta blockers to decrease HR and contractility (shear force on dissection)
additional anti-hypertensives after beta-blockade
treatment of chylothorax?
chest tube
low carb & high fat/protein diet
PEEP
anterior spinal cord blood supply?
via 1 spinal artery:
superior - vertebral arteries and posterior intercostal arteries
inferior - Artery of Adamkiewics which arises from a single posterior intercostal artery between T8-L1
blood supply to posterior spinal cord?
via 2 (paired) posterior spinal arteries from the vertebral artery
anterior spinal artery infarction affects?
lateral corticospinal (motor) tract
spinothalamic (pain & temp) tract
spinal cord termination in adults vs neonates?
adults = L1
neonates = L3
innervation of facet joint?
medial branch of the POSTERIOR division of spinal nerves
aka dorsal rami
Stellate ganglion block at which level?
C6-C7
SANS blockade via stellate ganglion results in?
ipsilateral Horner’s syndrome: ptosis, miosis, anhidrosis, psuedoenophthalmos, and hyperemia;
nasal congestion
temperature increase in ipsilateral arm
-AND- unopposed PANS
Also possible: globus sensation, RLN block
intercostobrachial block is a field block of which 2 nerves?
median brachial cutaneous nerve (C8-T1)
intercostobrachial nerve (T2)
landmarks of classic sciatic nerve block
PSIS
greater trochanter
sacral hiatus
cauda equina syndrome associated with?
pooling & maldistribution of hyperbaric local anesthetic via pencil point needles or spinal micro catheters
muscle that ABducts vocal cords?
POSTERIOR cricoarytenoid (innervated by RLN)
muscle that ADDucts vocal cords?
LATERAL cricoarytenoid innervated by RLN
Carotid sinus stimulation results in…?
hypotension and bradycardia
“think sinus pressure”
name of calcium channel receptor on sarcoplasmic reticulum that leads to muscle contraction?
Ryanodine recepter 1 (these receptors open only briefly in normal muscle but have prolonged opening in malignant hyperthermia)
pathogenesis for malignant hyperthermia?
sustained muscle contraction –> general hypermetabolic state –> incr CO2, lactate, and heat production –> muscle breakdown –> rhabdo, hyperkalemia, and myoglobinuria–> cardiac arrhythmias and renal dysfunction
treatment for malignant hyperthermia related cardiac arrhythmias?
Avoid calcium channel blockers because treatment with dantrolene already reduces Ca2+ from sarcoplasmic reticulum
standard antiarrhythmics safe: procainamide, amiodarone, lidocaine
Preferred type of anesthesia in multiple sclerosis?
general anesthesia with a careful eye on body temperature because even a 1 degree increase can cause an MS exacerbation
Avoid spinal anesthesia; epidurals and PNBs have been used safely in the past
**these patients often have autonomic instability that can lead to marked hypotension
Avoid nitrous for how long after air injection during eye surgery?
5 days
Avoid nitrous for how long after sulfur hexafluoride (eye surgery)?
10 days
Avoid nitrous for how long after perfluorocarbons (eye surgery)?
90 days
Is pheochromocytoma an absolute or relative contraindication to ECT?
Absolute
Is a recent MI (<4-6 weeks) an absolute or relative contraindication to ECT?
absolute
Is a recent CVA ( <3 months) an absolute or relative contraindication to ECT?
absolute
Is recent intracranial surgery an absolute or relative contraindication to ECT?
absolute
Is an unstable cervical spine an absolute or relative contraindication to ECT?
absolute
Is angina an absolute or relative contraindication to ECT?
relative
Is congestive heart failure an absolute or relative contraindication to ECT?
relative
Is a cardiac rhythm device an absolute or relative contraindication to ECT?
relative
Is severe pulmonary disease an absolute or relative contraindication to ECT?
relative
Is major bone fracture an absolute or relative contraindication to ECT?
relative
Is glaucoma an absolute or relative contraindication to ECT?
relative
Is retinal detachment an absolute or relative contraindication to ECT?
relative
Is thrombophlebitis an absolute or relative contraindication to ECT?
relative
Is pregnancy an absolute or relative contraindication to ECT?
relative
What is significant about the FIRST phase (out of 2) of ECT? (5-10 second tonic phase of seizure)
PANS surge –> bradycardia and hypotension
What is most significant about the second phase (out of 2) of ECT? (up to 10 minutes max of clonic seizure activity)
SANS activity –> hypertension and tachycardia
Types of infections that benefit from hyperbaric oxygen?
soft-tissue necrotizing infections, refractory chronic osteomyelitis, intracranial abscess, mucormucosis
Types of gas-bubble diseases that benefit from hyperbaric oxygen?
air embolism, decompression sickness
Types of poisonings/envenomations that benefit from hyperbaric oxygen?
carbon monoxide, cyanide, carbon tetrachloride, hydrogen sulfide, brown recluse spider bites
Types of acute ischemia that benefit from hyperbaric oxygen?
crush injuries, compromised skin flaps, central retinal after/vein occlusions
Types chronic ischemia that benefit from hyperbaric oxygen?
ischemic ulcers, radiation necrosis
Types of acute hypoxia that benefit from hyperbaric oxygen?
oxygen support during therapeutic lung lavage, significant blood loss anemia if transfusion delayed or unavailable
Types of thermal injuries that benefit from hyperbaric oxygen?
burns
Hyperbaric oxygen contributes to which part of this formula:
1.39 * SaO2 * Hb) + (0.003 * PaO2
(0.003 * PaO2)
Drug that terminates reentrant circuits of the AV node but very unlikely to terminate atrial fibrillation or atrial flutter?
Adenosine
Safest tube to prevent fires when using a CO2 laser
metal is most resistant to ignition > red rubber > silicone-based > PVC
Safest tube to prevent fire when using Nd:YAG lasers?
silicone or ETT with rubber shaft and silver foil/sponge coating
Most common cause of jaundice in the adult population?
Gilbert syndrome - normal bilirubin glucuronyltransferase activity required for hepatic uptake of unconjugated bilirubin decreased by 66%
Risk factors for IMPOSSIBLE grade 4 mask ventilation?
history of snoring and decreased TM distance
Risk factors for difficult (2-person) grade 3 mask ventilation?
NECK RADIATION changes, BMI >/= 30, presence of beard, high risk modified Mallampati classification, age > 57, lack of teeth, severely limited jaw protrusion and history of snoring (OSA)
What is a positive prayer sign?
Inability to oppose palmar surface of interphalangeal joints which is suggestive of difficult laryngoscopy in type I DM
Due to glycosylation of joints and decreased mobility including atlanto-occipital joint
Maximum acceptable dose of saline mixed with 0.05% lido plus 1:1,000,000 epinephrine for tumescent lipo?
35-55 mg/kg
Hold aspirin for what types of surgeries?
intracranial, middle ear, posterior eye, intramedullary spine surgery, and possibly prostate surgeries
MELD Criteria
“I Crush Beer Daily”
INR
Creatinine
Bilirubin
Dialysis
Child-Pugh score criteria
“Pour Another Beer At Eleven”
PT/INR
Ascites
Bilirubin
Albumin
Encephalopathy
**No creatinine as in MELD score (I Crush Beer Daily)
**Estimates mortality risk in liver failure
Monitored anesthesia care requirements that differentiate it from moderate conscious sedation?
Requires post-procedure PACU transfer with someone trained in ACLS
Provider trained in ability to convert to GA
Machine preparation for malignant hyperthermia
(1) CO2 absorbent needs to be removed or changed out
(2) flush machine for 1 hour at 10 L/min
**Alternatively use special MH filters with activated charcoal and only need to flush for 1.5 minutes @ 10 L/min - these filters keep gas concentration below 5 PPM for up to 12 hours
Antidote to methanol ingestion (paint thinner, antifreeze, windshield washer fluid, improperly distilled alcohol)?
Ethanol - competitive inhibitor of EtOH dehydrogenase
-OR-
Fomepizole - a direct EtOH dehydrogenase inhibitor
Both options slow conversion to toxic metabolites formaldehyde and formic acid to allow more time for renal and pulmonary elimination of non-metabolized methanol
**Folinic acid for less severe cases; dialysis also very effective; supportive care including airway and correction of metabolic acidosis
Reliable signs of compartment syndrome
(1) compartment pressure > 30 mmHg
(2) creatine phosphokinase > 5000 U/mL
(3) loss of normal phasic pattern of tibial venous blood flow
(4) loss of distal pulses
(5) compartment perfusion pressure < 21 mmHg
**pain and pulse oximetry are not reliable
When are bronchial blockers advantageous over DLTs?
- prior oral/neck surgery with challenging AW
- tracheostomy patients
- children under 12
- when postop mechanical ventilation is needed because does not require ETT exchange
When are double lumen tubes preferred?
lung isolation including RUL surgery because more reliable than bronchial blockers
What would physostigmine do in the setting of organophosphate or nerve agent poisoning?
Will worsen toxicity as this is an anticholinergic (antimuscarinic) drug so will increase ACh at nerve terminal
Goal temperature and duration for induced hypothermia post cardiac arrest?
32-36 degrees x 12-24 hours
Re-warming to 37 degrees should occur over 24 hours to avoid significant increase in ICP and arrhythmia-inducing electrolyte shifts
Changes in following parameters with increased aging: systolic function diastolic function CO stroke volume HR Catecholamines
Resting systolic function unchanged
diastolic DYSFUNCTION (delayed LV relaxation)
Exercise induced CO, stroke volume, and HR reduced
Incr catecholamines
what is lusitropy?
myocardial relaxation
**improved lusitropy with inodilators such as milrinone
Age related change in lung function? what increases and what decreases with regards to FRC, CC, RV, IC and TLC
Everything INCREASES except IC and TLC
CC>FRC
Decrease Remifentanil by how much in older patients?
by 50%
Which type of intraosseous access supports the highest infusion flow rates?
Which type of intraosseous access supports the fastest uptake of drugs and fluids into the systemic circulation?
humerus supports the highest flow rates (~200 vs 100 mL/min in tibia via pressure bag)
manubrium supports the fastest uptake of drugs and fluids into the systemic circulation
High frequency ultrasound probes provide better resolution at what cost?
Decreased tissue penetration due to decreased wavelength
Mnemonic: VFW –> Velocity = Frequency * Wavelength
Effect of magnesium on non-depolarizing and depolarizing muscle relaxants?
Magnesium potentiates NMBDs
Magnesium prolongs the effects of depolarizing muscle relaxants
Malignant hyperthermia has a strong association with which conditions?
Central core disease
multiminicore disease
King Denborough syndrome
hyper/hypokalemic periodic paralysis
Humidification of inspired gases will decrease which type of temperature loss?
evaporative losses
Wrapping skin in plastic will decrease which type of temperature loss?
evaporative
Warming the operating room will decrease which type of temperature loss?
Conductive - high operating room temps warm the surfaces
Using an incubator covered in blankets will decrease which type of temperature loss?
Convective
Most effective way to treat intraoperative hypothermia?
Forced air blankets
Normal cardiac output
4-8 L/min
Normal cardiac index vs cardiac output?
Cardiac index = 2.5-4 L/min/m^2
Cardiac output = 4-8 L/min
Normal stroke volume
60-100 mL/beat
Normal stroke volume index versus normal stroke volume?
33-47 mL/m^2/beat (SVI)
60-100 mL/beat (SV)
Eye protection during CO2 laser?
Clear plastic/glass is sufficient to block energy
Eye protection for krypton or argon lasers?
Orange or amber tinted glasses
Eye protection for Nd-YAG lasers?
Green tinted glasses
Fusion of cervical vertebrae NOT usually present with what syndrome? Typically associated with _________ and _________.
Not usually present in Down syndrome. Typically associated with ankylosing spondylitis and Klippel-Feil syndrome.
How is atlantoaxial instability (AAI) defined? Identified by which type of imaging? How does the interval change with flexion versus extension?
AAI is defined by an anterior atlantodental interval (AADI) greater than 4-5 millimeters due to the laxity in the transverse ligament of the first cervical vertebra. Identified by lateral cervical spine radiographs.
Flexion increases AADI while extension decreases AADI.
Active body surface warming (most commonly forced air warming) increases or decreases rate of surgical site infections?
Maintaining normothermia reduces risk of postop infections DESPITE some orthopedic studies showing mixed results from forced air warming.
qualifications needed to serve as an expert witness?
Board certification
Current, valid and unrestricted license to practice medicine
active involvement in clinical anesthesiology at time of event
relevant clinical experience and knowledge in the areas involved in proceeding
peripheral nerve stimulation of the orbicularis oculi most closely reflects blockade of what?
muscles of the larynx - orbicularis oculi is relaxed more rapidly but LESS INTENSELY when compared to the peripheral muscles (which are better reflected via nerve stimulation of the ulnar nerve)
**by contrast, onset and intensity of relaxation of sux is identical between laryneal and peripheral nerves
Best way to assess TOF < 0.3 testing if quantitative monitoring not available?
Double burst testing - 2nd twitch not palpable
Blood volume by age?
female: 60 mL/kg
male: 70 mL/kg
child 1-12: 75 mL/kg
infant: 80 mL/kg
full term newborn: 90
premature: 100
Blood volume for a woman?
60 mL/kg
blood volume for a male?
70 mL/kg
blood volume for a child age 1-12
75 mL/kg
blood volume for an infant 3 months to 1 year
80 mL/kg
blood volume for a full term newborn
90 mL/kg
blood volume for a premature infant
100 mL/kg
sugammadex is physically incompatible with which two drugs?
ondansetron and verapamil - if used in the same IV line, be sure to flush with saline between administration of the two drugs
Most lasers pass through the cornea but cause significant damage to the pigmented retina within milliseconds of exposure EXCEPT which type?
carbon dioxide lasers DO damage the cornea due to high absorptivity
Most airway fires are caused by which laser?
Carbon dioxide
Equation to determine flow through a narrow orifice (valvular or airway stenosis)?
Pressure gradient = 4 * Velocity^2 (Based on Bernoulli principle)
Component of the intervertebral disc that receives very little innervation?
nucleus pulposus
Central retinal artery occlusion is almost always associated with?
External pressure on the globe REGARDLESS of position
Hallmark signs of CRAO? Bilateral or unilateral?
cherry red spot on the macula and a pale retina
Unilateral 95% of the time
law of Laplace? how does it apply to cerebral aneurysms?
wall tension = pressure * radius / wall thickness (h)
pressure is equivalent to CPP so wall tension will increase with higher MAPS or lower ICPs
radius is equivalent to aneurysm size
Classic triad of TURP syndrome?
(1) Elevated systolic and diastolic blood pressures with increased pulse pressure due to acute hypERvolemia
(2) REFLEX bradycardia
(3) mental status changes associated with decr sodium (esp Na <120) and/or hypothermia from large volumes of room-temperature irrigation fluids
Guidelines for reducing the incidence or severity of TURP syndrome?
(1) Lowering suspension of irrigation fluids to <30 cm above patient
(2) Drain bladder regularly to avoid increased bladder pressures
(3) Limit resection time to less than 1 hour
(4) Avoid hypOtonic IV fluids
(5) Use vasopressors to treat hypotension resulting from spinal anesthesia - because neuroaxial may reduce venous pressures and increase absorption of irrigation fluids!!
anesthetic that should be avoided in a patient with dysfunctional folate and homocysteine metabolism?
Nitrous oxide - the problem is a deficiency in the methylenetetrahydrofolate reductase (MTHFR). nitrous oxide inhibits methionine synthase – further reduces folate levels and increase homocysteine levels.
Elevated homocysteine increases the incidence of thrombosis and adverse coronary events
Most common pharmacologic implications of HYPOALBUMINEMIA seen almost universally in major burn victims?
increased opioids due to rapid development of tolerance DESPITE increased free fraction of opoids
decreased benzos due to increased free fraction of drug
insulin resistance due to increased catecholamine/corticosteroid levels
proliferation of exntrajunctional membranes
First line therapy for cyanide toxicity?
hydroxocobalamin
**treatment with nitrites and thiosulfate have fallen out of favor because nitrites cause hypotension and byproduct methemoglobin is toxic
retropharyngeal soft tissue widening as a radiographic finding is associated with?
retropharyngeal abscess
Most common complication of retrobulbar block?
hematoma (even more common than oculocardiac reflex induced bradycardia!)
GCS Motor evaluation
OLD BEN
Obeys commands
Localizes to pain
withDraws to pain
Bends to pain
Extends to pain
None
GCS Voice evaluation
VOICE: VoiceLess Obscure sounds Incomprehensible words Confused Elegant speech
Mechanism responsible for neuromalignant syndrome vs. delirium?
NMS: central dopaminergic blockade
Delirium: decreased cholinergic activity -PLUS- excess dopamine.
Reflexes that correspond with C5, C6 and C7 roots?
C5: biceps reflex
C6: brachioradialis reflex
C7: triceps reflex
What is considered a positive result during apnea testing?
PaCO2 > 60 without evidence of ventilation or respiratory effort
formula for sodium deficit
(140-serum sodium) * TBW
TBW = weight in kg * 0.6
Which is a definitive risk factor for difficult INTUBATION….absolute obesity or relative body mass index?
NEITHER!
increased neck circumference, high risk modified Mallampati score and excessive pre-tracheal adipose tissue are risk factors for difficult intubation in an obese patient population.
Most important mode of heat loss? How does it occur?
Radiation: responsible for 40% of heat loss. Occurs when there is a temperature gradient between 2 surfaces.
A cold operating room table or unwarmed IV fluids leads to which type of heat loss?
Conduction: responsible for 5% of heat loss.
Modes of heat loss in the OR from greatest to least?
radiation: 40% - gradient between two surfaces NOT in direct contact
convection: 30% - speed of air currents and laminar flow in the room (2ndry to ventilation systems)
evaporative: 25% - via respiratory tract, sweating, surgical wounds and surgical prep
and conductive: 5% - transfer of heat when there is DIRECT contact between 2 objects (cold table or cold IV fluids)
What is fresh gas decoupling? what is its main disadvantage?
a decoupling valve that isolates fresh gas flow and oxygen flush gases from the patient during positive pressure ventilation – this prevents ore minimizes the risk of barorauma from high fresh gas flows or activating the oxygen flush valve.
main disadvantage is that it can lead to entrainment of room air into the breathing circuit which will lower oxygen and inhaled anesthetic gas concentrations. There is a series of alarms to help detect this condition.
What type of problem in hereditary angioedema?
usually a problem with C1 esterase inhibitor
Type I HAE: ezyme deficient
Type II HAE: enzyme dysfunctional
Type III HAE: mutation of factor XII gene
differentiating between pacemaker, defibrillator and a cardiac resynchronizing therapy device on CXR?
PM: two leads with no bright or thickened areas
ICD: two leads with bright and thick areas (shock coils)
CRT: three leads
Main anesthetic concerns with methamphetamine abuse?
cardiomyopathy in 40% and cardiac dysrhythmias
depletion of neurotransmitters –> profound hypOtension refractory to indirect-agents
increased MAC
tachycardia, tachypnea, and hyperthermia
How are modern day inhalational anesthetics improved?
less flammable
less toxicity
more potent
(due to fluorine addition)
however more difficult to manufacture
Damage to the sympathetic fibers of the superior hypogastric plexus can lead to which male problems?
retrograde ejaculation, dry ejacultion and infertility among men
Bayonet effect of needle on ultrasound?
Bent appearance because subtle differences of ultrasound velocity through overlying tissue.
Risk factors for the oculocardic reflex during eye surgery?
increased risk of reflex: hypercarbia hypoxia propofol based anesthetic remifentanil
decreased risk:
ketamine based anesthetic
what is a latent type of error?
errors that occur UPstream; not the direct cause of an error: may include equipment failure, organizational process, room layout
what is a slip type of error?
slip occurs during a routine familiar task that requires litttle to no conscious thought: for example drawing up pheylephrine into a syringe instead of sux
what is a lapse type of error?
occurs during a multistep task and is due to a memory failure such as forgetting to flush each port of a central line
what type of nerve fibers synapse in the sphenopalatine ganglion?
only PREganglionic parasympathetic fibers; all other sensory and sympathetic fibers traverse the ganglion
formula for mixed venous O2 sat
SVO2 = SaO2 - [VO2 / (CO *Hgb * 1.34)]
The K+ STAys
spironolactone
triamterene
amiloride
acid base status and electrolytes with acetazolamide?
metabolic acidosis
hyperkalemia
hyponatremia
acid base and electrolytes with thiazides?
Metabolic alkalosis
hyperGLUC
decr Na/K/Cl
“COALSS”
INCREASED closing capacity: chronic bronchitis obesity advanced age LV failure surgery smoking
Only anesthetic drugs to avoid or use with caution in nursing mothers?
Avoid meperidine
Closely monitor if given morphine or hydromorphone
What is well leg syndrome?
lower-extremity compartment syndrome reported after prolonged head-down procedures;
factors that contribute: obesity well-developed calf muscles fibrate monotherapy for hyperlipidemia prolonged surgery hypotension vasopressor use prolonged use of intermittent pneumatic compression device
other than histamine, which enzyme can be helpful in the detection of anaphylaxis?
tryptase is elevated and has 2-hour half life (compared to histamine with 15 minute half life)
Oxygen content formula?
CaCO2 = (1.39 * SaO2 * Hb) + (0.003 * PaO2)
Criterion for diagnosing fat emboli syndrome? What are the major criteria?
1 major finding and 4 minor plus fat macroglobulinemia
Major criteria include:
Pulmonary edema or respiratory insufficiency
Petechial rash
Hypoxemia (PaO2 < 60 on FiO2 < 0.4)
CNS depression
Only induction agent that causes LOC without lowering esophageal tone?
Ketamine
How to achieve better resolution on an ultrasound image?
Increase frequency (by decreasing depth)
Bain is which type of mapleson circuit?
Mapleson D: efficient for positive pressure ventilation but only intermediate efficiency for spontaneous breathing
The Jackson-Rees modification of the Ayer’s T-piece is which type of Mapleson circuit?
Mapleson F: efficient for positive pressure ventilation but only intermediate efficiency for spontaneous breathing
fresh gas flows needed to prevent rebreathing in Mapleson D, E, F?
1.5-3 times minute ventilation
Mapleson circuit most efficient for the spontaneously breathing patient?
A
Fresh gas inflow most distal of all circuits with APL closest to patients airway. FGF = Minute ventilation.
Least efficient for positive pressure ventilation!!
Chemotoxicity associated with Cisplatin/Carboplatin?
acoustic nerve damage
nephrotoxicity
Chemotoxicity associated with Vincristine?
peripheral neuropathy
Chemotoxicity associated with Bleomycin/Busulfan?
pulmonary fibrosis
Chemotoxicity associated with doxorubicin/daunorubicin?
cardiotoxicity
Chemotoxicity associated with Trastuzumab?
cardiotoxic
Chemotoxicity associated with cyclophosphamide?
hemorrhagic cystitis
Chemotoxicity associated with 5-fluorouracil (5-FU) or 6-mercaptopurine (6-MP) or methotrexate?
myelosuppression
hepatic, pulmonary and thyroid toxicity
MCIR gene?
increased morphine analgesia (associated with red hair)
OPRM gene?
decreased morphine analgesia
treatment of hyperkalemic periodic paralysis?
calcium
Function of Mu 1 receptors?
Supraspinal anesthesia Muscle rigidity Euphoria Miosis Bradycardia
Function of Mu 2 / delta receptors?
Respiratory depression
Constipation
Function of Kappa receptors?
Spinal analgesia
Prevents shivering
Sedation
Miosis
Function of sigma receptors?
Hallucinations
Dysphoria
Muscle relaxation via benzos are mediated by which receptor?
Gamma subunit of GABA-A receptors in the SPINAL CORD
Anxiolysis via benzos are mediated by which receptor?
GABA-A receptors in the brain
Anticonvulsant properties via benzos are mediated by which receptor?
Alpha subunit activation of GABA-A
