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Anesthesia In-Service Examination > Anesthesia 1st year > Flashcards

Anesthesia 1st year Flashcards

1
Q

Larynx C6 level?

A

C3-C6

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2
Q

3 unpaired cartilages

A

Thyroid cartilage
Cricoid cartilage
Epiglottis

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3
Q

3 paired cartilages

A

Arytenoid cartilages
Cuneiform cartilages
Corniculate cartilages

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4
Q

Laryngeal Extrinsic muscles (Elevators) (6)

A 
1 - Digastric
2 - Stylohyoid
3 - Geniohyoid
4 - Omohyoid
5 - Stylopharyngeus
6 - Palatopharyngeus
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5
Q

Laryngeal Extrinsic muscles (Depressors) (3)

A

1 - Sternohyoid
2 - Sternothyroid
3 - Omohyoid

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6
Q

Laryngeal Intrinsic muscles that narrow the inlet (1)

A

oblique arytenoid muscle

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7
Q

Laryngeal Intrinsic muscles that widen the inlet (1)

A

thyroepiglottic muscle

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8
Q

Muscles

Tensors: 
Relaxors:
Adductors: 
Abductors: 
Approximates arytenoids:
A

Tensors: cricothyroid muscle
Relaxors: thyroarytenoid (vocalis) muscle
Adductors: lateral cricoarytenoid muscle
Abductors: posterior cricoarytenoid muscle
Approximates arytenoids: transverse arytenoid muscle

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9
Q

Laryngeal Blood Supply

Comes from the 
1.
2. 
which are derived from the 1.
2.
A

Comes from the superior & inferior laryngeal artery and veins which are derived from the superior & inferior thyroid vessels

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10
Q

Larynx Nerve Supply

Innervated bilaterally by two branches of each vagus nerve:

A

superior laryngeal nerve

recurrent laryngeal nerve

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11
Q

Larynx Nerve Supply

Sensory and motor?

A

vagus nerve

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12
Q

Larynx Nerve Supply

Sensory above vocal folds?

A

Internal branch of superior laryngeal nerve

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13
Q

Larynx Nerve Supply

Sensory below vocal folds?

A

Recurrent laryngeal nerve

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14
Q

Larynx Nerve Supply Motor?
All supplied by?
Except?

A
  1. Recurrent laryngeal nerve

Except
Cricothyroid muscles

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15
Q

Cricothyroid muscles nerve supply?

A

External branch of the superior laryngeal nerve

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16
Q

Glottis level
Normal adult? (1) or (3)
Full term infant? (1) Infant/child? (3)
Preterm infant? (1)

A

Normal adult - C5
Adult - C4,C5,C6
Full term infant - C4 Infant/child - C3,C4,C5
Preterm infant - C3

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17
Q

Larynx shape
Adult?
Infant?

A

Adult: cylindrical
Infant: funnel

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18
Q

Larynx narrowest
Adult?
Infant?

A

Adult: Vocal cords
Infant: cricoid ring

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19
Q 
Trachea level?
Length in adults?
How many C-shapaed cartilages?
1st tracheal ring is located?
Ends where?
A 
C6 - T5
15 cm
17-18
Anterior to the C6 vertebrae
at the carina ( 5th thoracic vertebra), where it bifurcates in the principal bronchi
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20
Q

A line drawn between the iliac crests crosses the body of L4 or the L4-L5 interspace

A

Vertebral line or tuffier line

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21
Q

Ligamentum flavum is composed of?
Where is it thickest?
Measurement?

A

Elastin

Thickest in the midline, measuring 3 to 5 mm at the L2–3 interspace of adults

3 - 5 mm

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22
Q

3 spinal meninges

A

Dura mater
Arachnoid mater
Pia mater

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23
Q

It is a meninge where it is largely acellular except the one that forms the border between the dura and the arachnoid mater

A

S2

Dura mater

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24
Q

It is a delicate, avascular membrane composed of overlapping layers of flattened cells with connective tissue fibers running between the cellular layers

A

Arachnoid mater

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25
Q

It is the principal physiologic barrier for drugs moving between the epidural space and the spinal cord

A

Arachnoid mater

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26
Q

It lies between the arachnoid mater and the pia mater and contains the CSF and the spinal nerve roots and rootlets

A

Subarachnoid space

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27
Q

Is adherent to the spinal cord and is composed of a thin layer of connective tissue cells interspersed with collagen

A

Pia mater

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28
Q

Spinal cord ends

  1. At birth?
  2. In adults?
  3. How many pairs?
A
  1. L3
  2. L1
  3. 31 pairs
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29
Q

Muscles of inspiration (4)

A
  1. Diaphragm
  2. External intercostal muscles
  3. Sternocleidomastoid muscle
  4. Pectoralis muscle
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30
Q

Muscles for expiration (5)

A
  1. Rectus abdominis
    2 & 3. External and internal oblique muscles
  2. Internal oblique muscles
  3. Transversus abdominis muscle
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31
Q

Has dichotomous division of the airway?

Involves how many divisions?

A
  1. Tracheobronchial Tree

2. 23

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32
Q

3 types of functional airway divisions?

A
  1. Conductive
  2. Transitional
  3. Respiratory
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33
Q

Structures

  1. Conductive
  2. Transitional
  3. Respiratory
A
  1. Trahcea to terminal bronchioles
  2. Respiratory bronchioles o alveoalr ducts
  3. Alveoli
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34
Q

Conducting zones (4)

A
  1. Trahcea
  2. Bronchus
  3. Bronchiole
  4. Terminal bronchiole
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35
Q

Last airway component that does not participate in gas exchange

A

Terminal bronchiole

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36
Q

Gas exhange begins to appear at the?

A

Pulmonary bronchiole

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37
Q

Gas flow in the lungs (2)
Can be predicted by?
Formula?

A
  1. Laminar or turbulent
  2. Reynolds number
  3. linear velocity x diameter x gas density x gas viscosity
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38
Q

Low Reynolds no 1500 -

A

Laminar flow

Turbulent flow

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39
Q

What flow occur only at distal to small bronchiole?

occur in larger airways?

occurs at high gas flow, at sharp angles, at abrupt changes in airway diameter?

A

Laminar flow

Turbulent flow

Turbulent flow

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40
Q

True/false

Ratio of FEV1 to FVC is directly proportional to degree of obstruction

A

True

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41
Q

Normal FEV1/FVC?

A

> /= to 80%

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42
Q

Forced mid expiratory flow ?

A

25-75%

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43
Q

More reliable measurement for obstruction

A

Forced mid expiratory flow

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44
Q

Distribution of pulmonary perfusion

A

PA-alveolar, Pa-arterial,Pv-venous

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45
Q

Represents alveolar dead space (alveoli not perfused)

Alveolar pressure occludes pulmonary capillaries

PA>Pa>PV

A

Zone 1

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46
Q

Pulmonary capillary flow is INTERMITTENT

Flow varies during respiration according to the arterial-alveolar pressure gradient

Pa>PA>PV

A

Zone 2

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47
Q

Pulmonary capillary flow is CONTINUOUS

Flow is proportional to the arterial-venous pressure gradient

Pa>PV>PA

A

Zone 3

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48
Q

Lung parts

Nice to know

A

Lower (dependent) - greater blood flow, LOWER V/Q

Upper (nondependent) - lower blood blood flow, HIGHER V/Q ratio

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49
Q

If:

  1. V/Q = 0
  2. V/Q= infinity
A
  1. V/Q = 0 no ventilation

2. V/Q= infinity no perfusion

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50
Q

Ventilation/Perfusion ratio

Normal alveolar ventilation (VA) =

Normal pulmonary capillary perfusion (Q)=

Overall V/Q ration=

A

Normal alveolar ventilation (VA) = 4L/min

Normal pulmonary capillary perfusion (Q)= 5L/min

Overall V/Q ration= 0.8

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51
Q

Refers to the observation that increases in the carbon dioxide partial pressure of blood or decreases in blood pH result in a lower affinity of hemoglobin for oxygen.

A

Bhor effect

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52
Q

Oxyhemoglobin dissociation curve (left) (6)

A

CABET

  1. Carboxyhemoglobin
  2. Alkalosis, Abn hgb (fetal)
  3. 2,3 BPG(decreased)
  4. E (neurophysiology)
  5. Temperature (Hypothermia)
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53
Q

Oxyhemoglobin dissociation curve (right) (5)

A
  1. Inc Co2
  2. Acidosis, abn hemoglobin
  3. 2,3 BPG (increase)
    4.
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54
Q

Cerebral metabolic rate (CMRO2)?

Greatest where?

A
  1. 3-3.8ml/100gm/min

2. Gray matter of cerebral cortex

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55
Q

(mL/100gm/min)

  1. CBF in gray matter?
  2. CBF in white matter?
  3. Total CBF in adults?
A
  1. 80
  2. 20
  3. 750 ml/min
    40-60 mL/100 gm/min
    (15-20% of cardiac output)
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56
Q

(mL/100gm/min)

  1. Cerebral impairment?
  2. Flat (isoelectric) EEG?
  3. Irreversible brain damage?
A
  1. 20-25
  2. 15-20
  3. <15
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57
Q

Pressures > how much can disrupt BBB (cerebral edema,he)

A

> 150-160 mmHg

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58
Q

CBF changes (% ?) per 1 degree change in temperature

A

5-7%

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59
Q

CSF

  1. formed
  2. normal CSF production per hour? per day?
  3. total CSF per day
A
  1. choroid plexus of lateral ventricles
  2. 21 mL/H or 500 mL/day
  3. 150 mL
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60
Q

Normal ICP?

A

10-18 mmHg

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61
Q

Cerebral blood volume inc by how much of CSF in per 1 mmHg increase in PaCO2

A

0.05ml/100gm

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62
Q

Systemic absorption of local anesthetics : decreasing order (5)

A
  1. Intercostals
  2. caudal
  3. epidural
  4. brachial plexus
  5. sciatic/femoral
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63
Q

Affects

  1. Potency
  2. Duration of action
  3. Speed of onset
A
  1. Lipid solubility
  2. Protein binding
  3. pKa
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64
Q

Esters pKa

  1. Chlorprocaine
  2. Procaine
  3. Tetracaine
A
  1. 7
  2. 9
  3. 5
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65
Q

Amide pKa

  1. Bupivacaine
  2. Ropivacaine
  3. Prilocaine
  4. Lidocaine
  5. Etidocaine
  6. Mepivacaine
A
  1. ( 8.1 )
  2. ( 8.1 )
  3. ( 7.9 )
  4. ( 7.9 )
  5. ( 7.7 )
  6. ( 7.6 )
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66
Q

Dose dependent effects of lidocaine (mcg/mL)

  1. 1-5
  2. 5-10 ( 3 )
  3. 10 - 15 ( 2 )
  4. 15 - 25 ( 2 )
  5. > 25 ( 1 )
A

1 - 5
Analgesia

5 - 10

  1. Lightheadedness
  2. Tinnitus
  3. Numbness of tongue

10-15

  1. Seizure
  2. Unconsciousness

15-25

  1. Coma
  2. Respiratory arrest

> 25
1. Cardiovascular depression

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67
Q

What content of esters induces allergic reaction?

A

p-amino benzoic acid

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68
Q

What content of amides induces allergic reaction?

A

methyparaben

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69
Q

Myotoxic local anesthetics according to order (most to least)

A
  1. bupivacaine
  2. lidocaine
  3. procaine
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70
Q

What local anesthetic has?

Are the pure S- form of the drug, less cardiotoxic than the R isomer

Compared to bupivacaine, it is half as lipid soluble, onset and duration of action are similar but provides less motor block, lower potency

A

Ropivacaine / levobupivacaine

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71
Q

What local anesthetic has?

A 50:50 racemic mixture of both the S- and R- enantiomers

Cardiotoxic

A

Bupivacaine

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72
Q

Drug of choice for treatment of bupivacaine induced ventricular arrhythmia

A

Amiodarone

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73
Q

Local anesthetic with low risk of sytemic toxicity because it is rapidly metabolized?

A

2 - chlorprocaine

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74
Q

Local anesthetic nice to know

A

The concentration of the nonionized portion is significant because this is the amount available to pass through the lipophilic membrane.

However, once inside the membrane, it is the ionized portion which then blocks the sodium channels.

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75
Q

EMLA cream is composed of?

A
  1. 5% lidocaine

2. 5% prilocaine

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76
Q

Adverse effect of

  1. prilocaine (> 600 mg) and benzocaine
  2. cocaine
A
  1. methemoglobinemia
    give intravenous methylene blue (1 to 2 mg/kg)
  2. intense vasoconstriction
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77
Q

Local anesthetic nice to know

A

LA with epinephrine is more acidic.

This is why “fresh” epinephrine is added to LA prior to administration.

LA are less effective in acidic environments such as infected tissue. Low tissue pH increases the ionized portion of the LA

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78
Q

Which is rapidly metabolized esters or amides?

A

Esters

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79
Q

Has been implicated as a cause of Transient Neurologic Symptoms.

Use of the lithotomy position may be a contributory factor.

A

Intrathecal lidocaine

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80
Q

Has stretch receptors in the walls of the heart and blood vesses(carotid sinus CN IX, aortic arch CN X receptors).

Increased in blood pressure is the stimulus while response is sympathetic inhibition and increase in parasympathetic activity

A

Baroreceptor reflex

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81
Q

The stimuli is forced expiration against glottis closure, while the response is increased cerebral venous pressure, decrease right heart venous return causing decreased BP, CO and reflexed increased in HR.

A

VALSALVA MANEUVER REFLEX

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82
Q

LV mechanoreceptor with afferent pathway in vagal C fiber.

The stimuli is noxious stimuli to LV wall (as in myocardial infarct) the response is hypotension, bradycardia and coronary vasodilation induced by parasympathetic.

A

BEZOLD-JARISCH REFLEX

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83
Q

Increased right atrial pressure directly stretches SA node and enhances it automaticity. This response occurs only in increased vagal tone (low initial HR) while rapid infusion of blood or saline distends right atrium and central veins.

A

CUSHING’S RELEX

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84
Q

The stimuli is traction on the extraocular muscles(medial lateral rectus) or pressure on the globe, response is bradycardia and hypotension. This reflex can be attenuated by IV atropine.

A

OCULOCARDIAC REFLEX

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85
Q

The stimuli is vagal stimulation via mesenteric traction, rectal distensionm traction on the gall bladder, response is bradycardia, apnea, hypotension with narrow pulse pressure.

A

VAGAL REFLEX

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86
Q

Carotid baroreceptors sense MAP most effectively between pressures of?

A

80-160 mmHg

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87
Q

Left coronary artery supplies the (5)

A
  1. Anterior descending branch
  2. Right bundle branch
  3. Left bundle branch
  4. Anterior and posterior papillary muscles (mitral)
  5. Anterolateral left ventricle
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88
Q

Circumflex branch supplies the (1)

A

Lateral left ventricle

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89
Q

Right coronary artery supplies the (5)

A
  1. SA and AV node
  2. R atrium and ventricle
  3. Posterior interventricular septum
  4. Posterior fascicles of the left bundle branch
  5. Interatrial septum
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90
Q

Occlusion of right coronary artery

  1. ECG leads affected
  2. Area of mycoardium involved? (3)
A
  1. II, III, aVL

2. Right atrium and ventricle, AV node

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91
Q

Occlusion of left anterior descending artery

  1. ECG leads affected
  2. Area of mycoardium involved? (1)
A
  1. V3 - V5

2. Anterolateral portion of left ventricle

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92
Q

Occlusion of left circumflex coronary artery

  1. ECG leads affected
  2. Area of mycoardium involved? (1)
A
  1. I, aVL

2. Lateral left ventricle

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93
Q 
Define the phases of cardiac action potential
0:
1:
2:
3:
4:
A

0: upstroke
1: early rapid depolarization
2: plateau
3: final repolarization
4: resting potential and diastolic repolarization

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94
Q 
Cardiac action potentials events
0:
1:
2:
3:
4:
A

0: Activation (opening) of fast Na+ channels
( Na+ in and decreased permeability to K+ )

1: Inactivation of Na+ channel and transient increase in K+ permeability
(K+ out, Na- in)

2: Activation of slow Ca2+ channels
( Ca2+ in )

3: Inactivation of Ca2+ channels and increased permeability to K+
( K+ out )

4: Normal permeability restored (atrial and ventricular cells)
( K+ out Na+ in )

Intrinsic slow leakage of Ca2+ into cells that spontaneously depolarize
( Ca2+ in )

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95
Q

Cardiac waves (4)

A

1: a
2. c
3. v
4. x

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96
Q

Cardiac wave that is due to atrial systole?

A

a

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97
Q

Cardiac wave that coincides with ventricular contraction and is said to be caused by bulging of the AV valve into the atrium.

A

c

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98
Q

Cardiac wave that is the result of pressure buildup from venous return before the AV valve opens again.

A

v

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99
Q

Cardiac wave that is the decline in pressure between the c and v waves and is thought to be due to a pulling down of the atrium by ventricular contraction.

A

x

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100
Q

Incompetence of the AV valve on either side of the heart abolishes the x descent of that side, resulting in a prominent what wave?

A

cv

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101
Q

Follows the v wave and represents the decline in atrial pressure as the AV valve opens.

A

y descent

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102
Q

Liver nerve supply (3)

A
  1. sympathetic T6- T11
  2. parasympathetic (R & L vagus)
  3. Right phrenic nerve
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103
Q

Normal hepatic blood flow

25-30%
70 - 75%

A

1,500 mL/min
hepatic artery
portal vein

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104
Q

Supplies 45-50% of liver’s oxygen requirement?

A

Hepatic artery

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105
Q

Supplies 50-55% of liver’s oxygen requirement?

A

Portal vein

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106
Q

Normal hepatic oxygen saturation?

A

85%

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107
Q

% of total cardiac output which goes to the liver?

A

25 - 30 %

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108
Q

What the drug does to the body

A

Pharmacodynamics

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109
Q

What the body does to the drug?

A

Pharmacokinetics

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110
Q

The time necessary for the plasma drug concentration to decrease to 50% DURING THE ELIMINATION PHASE?

The time necessary for the plasma drug concentration to decrease by 50% AFTER DISCONTINUING AN INFUSION of a specific duration (context means infusion duration)?

A

Elimination half time

Context-sensitive half time

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111
Q

Is directly proportional to its Vd and inversely proportional to its clearance.
(inc. elimination half time,inc. volume of distribution, decrease clearance)

Renal or hepatic disease that alters Vd and/or clearance will alter it.

A

Elimination half time

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112
Q

The time necessary to eliminate 50% of the drug from the body after its rapid IV injection

The amount of drug remaining in the body is related to the number of elimination half times that have elapsed

For ex. If 50% of a drug is eliminated in 10 minutes, another 10 minutes will be needed for elimination of one-half of the remaining drug.

A

Elimination half-time

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113
Q

It considers the combined effects of distribution and metabolism as well as duration of continuous IV administration on drug pharmacokinetics.

It bears no constant relationship to the drug’s elimination half-time

A

Context-sensitive half-time

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114
Q

Is a mathematical expression of the sum of apparent volumes of the compartments that constitute the compartmental model.

Calculated as the dose of drug administered IV divided by resulting plasma concentration of drug before elimination begins.

A

Volume of distribution

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115
Q

Factors that affect volume of distribution (3)

A
  1. Lipid solubility
  2. Binding to plasma proteins
  3. Molecular size
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116
Q

Of poor lipid soluble drugs with Vd similar to ECF volume are (1)

A

NMBAs

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117
Q

A lipid soluble drug, highly concentrated in tissues, results in low plasma concentration, will have a calculated Vd that exceeds total body water example (2)

A
  1. Thiopental

2. Diazepam

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118
Q

Ionized or non-ionized?

Active, lipid soluble, cross lipid barriers, no renal excretion, undergoes hepatic metabolism

A

non-ionized

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119
Q

The largest anterior segmental medullary artery.

It typically arises from a left posterior intercostal artery between T9-T11, which branches from the aorta and supplies the lower two thirds of the spinal cord via the anterior spinal artery

A

Artery of adamkiewicz

arteria radicularis magna

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120
Q

Chassaignac tubercle is found at what level?

A

C6

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121
Q

Stellate ganglion block complications (

A
  1. Horners syndrome ( intra arterial or IV injection )
  2. Difficulty of swallowing
  3. Vocal cord paralysis
  4. Pneumothorax
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122
Q

Location of stellate ganglion?

A

Lies in front of the neck of the 1st rib

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123
Q

Femoral nerve block/“Three-in- one” block (blocks 3 nerves)

A
  1. Femoral nerve
  2. Lateral femoral cutaneous nerve
  3. Obturator nerve
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124
Q

Ankle block( 5 nerves blocked)

A
  1. Saphenous nerve
  2. Deep peroneal nerve
  3. Common peroneal nerve
  4. Superficial peroneal nerve
  5. Posterior tibial nerve
  6. Sural nerve
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125
Q

Paramedian approach in spinal anesthesia

What level?

A
  1. TAYLOR APPROACH

2. L5-S1

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126
Q

For Routine “Awake” Extubation

  1. Subjective (6)
  2. Objective (4)
A

Subjective Clinical Criteria:

  1. Follows commands
  2. Clear oropharynx/hypopharynx (e.g., no active bleeding, secretions cleared)
  3. Intact gag reflex
  4. Sustained head lift for 5 seconds, sustained hand grasp
  5. Adequate pain control
  6. Minimal end-expiratory concentration of inhaled anesthetics

Objective Criteria:

  1. Vital capacity: ≥10 mL/kg
  2. Peak voluntary negative inspiratory pressure: >20 cm H2O
  3. Tidal volume >6 cc/kg
  4. Sustained tetanic contraction (5 sec)
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127
Q

Criteria for difficult mask ventilation (6)

A
  1. Inability for one anesthesiologist to maintain oxygen saturation >92%
  2. Significant gas leak around face mask
  3. Need for ≥IS 4 min gas flow (or use of fresh gas flow button more than twice)
  4. No chest movement
  5. Two-handed mask ventilation needed
  6. Change of operator required
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128
Q

Independent risk factors for difficult mask ventilation

A

Odds ratio

  1. Beard ( 3.18 )
  2. BMI >26 ng/m2 ( 2.75 )
  3. Lack of teeth ( 2.28 )
  4. Age >55 ( 2.26 )
  5. Snoring ( 1.84 )
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129
Q

This devastating injury occurs after hyperflexion of the neck, with or without rotation of the head,
and is attributed to stretching of the spinal cord with resulting compromise of its vasculature in
the midcervical area.

An element of spondylosis or a spondylotic bar may be involved.116,117

The
result is paralysis below the general level of the fifth cervical vertebra.

Although most reports in
the literature have described the condition as occurring after the use of the sitting position,
midcervical tetraplegia has also occurred after prolonged, nonforced head flexion for intracranial
surgery in the supine position.

A

Midcervical Tetraplegia

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130
Q

Lithotomy (nerves affected)
(3)

  1. Injured when the head of the fibula (lateral aspect of the knee is compressed against the leg support device;most commonly injured lower extremity nerve? What is the clinical condition?
  2. Can be stretched by exaggerated flexion of the hips during positioning
  3. From extreme flexion and abduction of the thighs
A
  1. Common peroneal nerve
    Foot drop
  2. Sciatic nerve
  3. Femoral nerve
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131
Q

Pressure from the vertical bar of an anesthesia screen or a similar device against the lateral aspect of the arm and excessive
cycling of an automatic blood pressure cuff have been implicated in causing damage to the radial
nerve.

A

Radial Nerve Compression

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132
Q

Most frequently injured peripheral nerve because of its superficial location at the elbow. During OR, nerve may be compressed between the patient and the OR table.

Clinical condition?

A

Ulnar nerve

Claw hand

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133
Q

Use to monitor depth of anesthesia

A

Bispectral index

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134
Q
  1. BIS value of 0
  2. BIS of 40 and 60
  3. BIS of 65-85
  4. More than 85
A
  1. Isoelectric encephalogram
  2. Appropriate for GA
  3. Sedation
  4. Awake, memory intact
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135
Q
  1. Hypothermia is body temperature of?
  2. Mild hypothermia
  3. Moderate?
  4. Severe?
A
  1. Less than 36 C
  2. 32-35
  3. 27-32
    4.
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136
Q

Shivering is modulated through the hypothalamus and can increase the body’s heat production by up to how many percentage?

A
  1. 300 - 400%
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137
Q

MAC of inhalational agents is decreased about how many percent per centigrade decrease in core temperature

A

5-7%

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138
Q

Refers to rays emanating from all objects above absolute temperature

A

Radiation

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139
Q

Refers to the transfer of heat from contact with objects

A

Conduction

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140
Q

Refers to the transfer of heat from air passing by objects

A

Convection

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141
Q

Monitor P waves, inferior wall ischemia, dysrhythmisas

A

Lead II

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142
Q

Most sensitive for detection of anterior and lateral ischemia

A

V5

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143
Q

Muscle most sensitive?

Most resistant?

A

Extraocular muscles

Vocal cords

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144
Q

In neuromuscular blockade IOP increases by how much?

A

5 - 15 mmHg

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145
Q

Succinyl is rapidly hydrolyzed by?

A

plasma cholinesterase

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146
Q

Is an abnormal genetic variant of the plasma cholinesterase enayme that lacts the ability to hydrolyze ester bonds in drugs like succyl and mivacurium. Clinically, the presence of these enzyme manifests as prolonges skeletal muscle paralysis.

A

Atypical plasma cholinesterase

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147
Q

A local anesthetic which inhibits normal pseudocholinesterase activity by 80% but inhibits atypical enzyme activity by only 20%.

Normal no. is?

A 
Dibucaine
80 (the percentage of inhibition of pseudocholinestearse activity)
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148
Q

Conditions with decreased plasma cholinesterase (6)

A
  1. Pregnancy
  2. Liver disease
  3. Uremia
  4. Malnutrition
  5. Plasmapheresis
  6. Oral contraception
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149
Q

Drugs that also decrease pseudocholinesterase activity (8) PNP CEEMO

A
  1. Echothiopate- organoPO4
  2. Neostigmine,pyridostigmine-cholinesterase inhibitor
  3. Phenelzine-MAO
  4. Cyclophosphamide-antineoplastic
  5. Metoclopromide-antiemetic
  6. Esmolol
  7. Pacuronium
  8. Oral contraceptive
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150
Q

POISEULLE’S LAW ANESTHESIA IMPLICATIONS (3)

A
  1. GAS THROUGH FLOWMETERS
  2. SELECTION OF ETT SIZE
  3. SELECTION OF IV CATHETER SIZE
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151
Q

The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas over the liquid and indirectly proportional to temperature

A

HENRY’S LAW ANESTHESIA IMPLICATIONS

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152
Q

HENRY’S LAW ANESTHESIA IMPLICATIONS (3)

A
  1. OVERPRESSURIZING ANESTHETIC GASES
  2. INCREASING DELIVERY OF O2 BY INCREASING CONCENTRATION/INCREASING MAC
  3. HYPERBARIC CHAMBER
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153
Q

BOYLES LAW ANESTHESIA IMPLICATIONS (4)

A
  1. SQUEEZING BAG TO VENTILATE A PATIENT
  2. DIAPHRAGM CONTRACTS AND INSPIRATION BEGINS, DIAPHRAGM RELAXES AND EXHALATION BEGINS
  3. HYPERBARIC O2 THERAPY
  4. THE BELLOWS
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154
Q

BERNOULLI’S PRINCIPLE ANESTHESIA IMPLICATIONS (3)

A
  1. BENTRAIN, JET VENTILATION
  2. VENTURI MASK
  3. SCAVENGE SYSTEM
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155
Q

What law describes equal volumes of gasses at a constant temperature and pressure have equal amounts of atoms and molecules

A

Avogadro’s Hypothesis

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156
Q

This law states that the pressure of a given mass of gas varies directly with the absolute temperature of the gas, when the volume is kept constant

A

3RD GAS LAW OR GAY LUSSACS LAW

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157
Q

Law stating:

  1. THE AMOUNT OF INHALATION AGENT DELIVERED TO A PATIENT WOULD INCREASE OF DECREASE DEPENDING ON TEMPERATURE COMPENSATIVE VALUES
  2. EMPTYING OF AN E-CYLINDER
A

UNIVERSAL GAS LAW OR IDEAL GAS LAW

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158
Q

What law explains the rate of diffusion of gas is inversely proportional to square root of their molecular weight

  1. FLOW METERS MUST BE CALIBRATED WITH CORRECT GAS OR THEY WOULD BE INACCURATE
  2. HOW ANESTHETIC GAS DIFFUSE AND EFFUSION
A

Grahams Law

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159
Q

What law has the ff:

  1. VENTILATION AND PRESSURE
  2. AORTIC STENOSIS AND PRELOAD
  3. COLLAPSING PRESSURE OF ALVEOLI AND ABILITY TO KEEP OPEN
  4. SURFACE TENSION, ALVEOLI RADIUS, LUNG COMPLIANCE
A

Law of Laplace

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160
Q

Law?

THE TOTAL PRESSURE OF MIXTURE OF GASES IF EQUAL TO EACH GASES’ INDIVIDUAL PARTIAL PRESSURE

A

Dalton’s Law

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161
Q

Law?
A PATIENT WITH COPD WILL HAVE A REDUCED AREA FOR GAS EXCHANGE TO TRANSPIRE AND THEREFORE DECREASED SPEED OF ONSET OF ANESTHETIC AGENTS

Increase surface area, increase diffusion

Increase distance, decrease diffusion

Increase concentration gradient, increase diffusion

A

FICKS LAW

162
Q

NITROUS OXIDE AND OXYGEN COMBINED 50:50

A

Entonox

163
Q

Metabolized by Hoffmann reaction (one third);

Nonezymatic degradation
Ester hydrolysis (two third)

Causes hypotension and tachycardia

Major metabolite?

A

Atracurium

Laudanosine

164
Q

NMBAs which releases histamine (4)

A
  1. tubocurare
  2. mivacurium
  3. atracurium
  4. doxcurium
165
Q

What muscle is used for monitoring recovery?

A

Adductor pollicis muscle

166
Q

Good indicator of intubating conditions

A

Response of the facial nerve around the eye (corrugator supercili-response of eyebrow)

167
Q

A modified gamma cyclodextrin, with a lipophilic core and a hydrophilic periphery

High affinity for rocuronium

Forms a complex and the complex is excreted

No autonomic istability like neostigmine and atropine

Less affinity of other steroidal NMBS like vecuronium and pancuronium

Does not bind benzylisoquinoline type NMBS

A

Sugammadex

168
Q

Extremely insoluble volatile anesthetic.

Patient goes to sleep and wakes up very quickly.

A

Desflurane

169
Q

The minimum concentration of anesthetic agent at which 50% of population will not move in response to a surgical stimulus

A

MAC

170
Q

Desflurane

  1. BGPC?
  2. OGPC?
  3. MAC?
A
  1. 0.42
  2. 18.7
  3. 6
171
Q 
Agent	
Blood/Gas?	
Brain/Blood?	
Muscle/Blood	?
Fat/Blood?
A 
Agent	Blood/Gas	Brain/Blood	Muscle/Blood	Fat/Blood
Nitrous oxide	0.47	  1.1	1.2	2.3
Halothane	2.4	2.9	3.5	60
Isoflurane	1.4	2.6	4.0	45
Desflurane	0.42  1.3	2.0	27
Sevoflurane	0.65	  1.7	3.1	48
172
Q

Volatile anesthetic that is

hepatotocic and sensitizes the heart to arrhythmogenic effects of beta agonists

A

Halothane

173
Q

Results in isoelectric EEG at very high concentration

Coronoary steal

A

Isoflurane

174
Q

May cause seizure with high dose and hypocarbia

A

Enflurane

175
Q

Carbon monoxide-metabolite
Rapid awakening and change in depth of anesthesia
Not for inhalation induction-cause laryngeal spasm
Special vaporizer, dictated by low boiling point

A

Desflurane

176
Q

Some fluoride ion release with high does

Very satisfactory for inhalation induction

A

Sevoflurane

177
Q

Low potency
Suppress airway reflexes and very useful for inhalation induction
Will expand volume of closed gas spaces within the body

A

Nitrous oxide

178
Q

% decrease in MAC per decade of age regardless of volatile anesthetic

A

6%

179
Q 
Highest BGPC?
Highest MAC  value?
Highest metabolized?
Prone to cns irritability?
Unstable under sunlight?
Inhibits methionine sythetase?
Nephrotoxic?
A

Highest BGPC- methoxyflurane

Highest MAC value- nitrous oxide

Highest metabolized- methoxyflurane

Prone to cns irritability- enflurane

Unstable under sunlight- halothane

Inhibits methionine sythetase- N02

Nephrotoxic- methoxyflurane

180
Q

Acidic drugs bind to?

Alkaline drugs bind to?

A
  1. Albumin

2. a1 - acid glycoprotein

181
Q

T/F

Vd is inversely related to protein binding.

A

T

High protein binding limits passage of drugs into tissues, thus resulting in high drug plasma concentration and a small calculated Vd)

182
Q

A constant fraction of available drug is metabolized in a given time period

This kinetics depends on the plasma concentration of drug

A

First order kinetics

183
Q

Order kinetics that occurs when the plasma concentration of drug exceeds the capacity of metabolizing enzymes.

This reflects saturation of available enzymes and results in metabolism of a CONSTANT amount of drug per unit of time.

A

Zero order kinetics

184
Q

T/F

Distribution half-lives of all of the opioids are fairly rapid.

A

T

185
Q

Opioid with a more rapid onset of action, shorter duration of action than fentanyl, eventhough it is less lipid soluble

High non-ionized fraction, small Vd increase the amount of drug available for binding in the brain

Has small volume of distribution, short elimination half-life

A

Alfentanil

186
Q

75-100X more potent than morphine

Short duration of action than morphine

Highly lipid soluble, longer elimination half-time, larger volume of distribution due to its greater lipid solubility

In comparison with morphine, it does not evoke the release of histamine

A

Fentanyl

187
Q

Poorly lipid soluble

Metabolized by liver to morphine-3-glucuronide about 75-85%
and morphine-6-glucuronide about 5%

Morphine-6-glucuronide produces analgesia and depression of ventilation

Morphine-3-glucoronide is pharmacologically inactive

A

Morphine

188
Q

Barbiturate is determined by? and not metabolism or elimination.

A

Redistribution

189
Q

Repetitive administration of barbiturates saturates the peripheral compartments, so that redistribution cannot occur and the duration of action becomes more dependent on?

A

Elimination

190
Q

Less lipid soluble

Less ionized at physiologic pH than thiopental

Shorter elimination half life 3-4x more rapidly than thiopental

Greater hepatic extraction, is cleared by the liver

Metabolized more rapidly than thiopental

Excreted in feces

A

Methohexital

Used in ECTs

191
Q

Intraarterial injection of this drug causes arterial spasm, venous thombosis and allergic reactions

A

Thiopental

192
Q

Water soluble

Shorter elimination half-time than diazepam

Similar volume of distribution with diazepam

More rapid clearance than diazepam

Shorter context-sensitive half-life

Metabolized by cytochrome p450

Hepatic clearance rate of midazolam is 10x greater than that of diazepam

A

Midazolam

193
Q

Lipid soluble, highly protein bound

Injection is painful

Prolonged elimination half-time

A

Diazepam

194
Q

How much drugs actually makes it into the system

A

Bioavailability

195
Q

Microsomal enzymes are located in the?

A

smooth ER

196
Q

Phase I enzymes (3)

A
  1. cytochrome P-450
  2. noncytochrome P-450
  3. flavin-containing monooxygenase enzymes
197
Q

Phase II enzymes (4)

A

“Transferases”

  1. glucuronosyltrasferases
  2. glutathione-S-transferases
  3. N-acetyl-transferases
  4. sulfotransferases
198
Q

Study Gas Cylinder Table in Morgan

A

Study Gas Cylinder Table in Morgan

199
Q

Operating room noise is normally at?

A

70-80 decibels

200
Q

RISK OF ELECTROCUTION

Leakage current is present in all electrical equipment as a result of (3)

The magnitude of such leaks is normally imperceptible to touch (less than 1 mA and well below the fibrillation threshold of 100 mA).

A
  1. capacitive coupling
  2. induction between internal electrical components
  3. defective insulation
201
Q

maximum leakage allowed in operating room equipment is?

A

10 mA

202
Q

Types of tubes (3)

A
  1. Polyvinyl chloride
  2. Silicone rubber
  3. Red rubber
  4. Metal
203
Q

This type of tracheal tube is

Inexpensive
Nonreflective
Low melting point
Highly combustible

A

Polyvinyl chloride

204
Q

This type of tracheal tube is :

Puncture-resistant
Maintains structure
Nonreflective
Highly combustible

A

Red rubber

205
Q

This type of tracheal tube is:

Nonreflective
Combustible
Turns to toxic ash

A

Silicone rubber

206
Q

This type of tracheal tube is:

Combustion-resistant,
Kink-resistant
Thick-walled flammable cuff
Transfers heat
Reflects laser
Cumbersome
A

Metal

207
Q

What ETT tube most resistant to fire?

A

Metal

208
Q

What ETT tube highly combustible?

A

PVC

PVC>red rubber>silicone rubber>metal

209
Q

Breathing Systems

is the most efficient Mapleson circuit for spontaneous ventilation?

A

Mapleson A

210
Q

The Mapleson type circuit is efficient during controlled ventilation, because fresh gas flow forces alveolar air away from the patient and toward the APL valve.

A

Mapleson D

211
Q

Controlled ventilation (best to worst)

For spontaneous

A

D>B>C>A (DEAD BODIES CANT ARGUE)

A>D>C>B (ALL DOGS CAN BITE)

212
Q

Mapleson type with Ayre’s T-piece?

Mapleson type with Jackson-Ree’s Modification?

A
  1. E

2. F

213
Q

Most commonly used for pediatric populations?

The disadvantage is that it needs high fresh gas flow to prevent rebreathing, has lack of humidification and possibility of airway pressure?

A

F

214
Q

Most common absorbent used?

Capable of absorbing how much?

A
  1. Soda lime

2. 23 L (26 L in barash) per 100 g of absorbent

215
Q

Soda lime

  1. Mesh size of soda lime
  2. Content
  3. Usual indicator dye
  4. Absorptive capacity
  5. Method of hardness
A
  1. 4-8
  2. CaOH (76-81%)
    Sodium OH (4%)
    KOH (1%)
  3. Ethyl violet
  4. 14-23
  5. Silica added
216
Q

Barium OH lime

  1. Mesh size of baralyme
  2. Content
  3. Usual indicator dye
  4. Absorptive capacity
  5. Method of hardness
A
  1. 4-8
  2. Barium OH (20%)
    CaOH(80%)
  3. Ethyl violet
  4. 9-18
  5. Water of crystallization
217
Q

Commercial soda lime water content?

A

14-19%

218
Q

Space of air in CO absorber?

A

2-3x the tidal volume

219
Q

End products of co2 absorber (3)

A
  1. carbonate
  2. water
  3. heat
220
Q

How much usage of absorber is used after replacing a new one?

A

50-70%

221
Q

A part of anesthesia machine used to prevent the delivery of hypoxic gas mixture from the anesthesia machine in the event of failure of the oxygen supply.

A

Fail-safe valve

222
Q

Fail-safe valve is triggered when the pressure in the oxygen delivery line decreases to?

A

less than 30 psi

223
Q

Designed to prevent misconnections of PIPELINE?

A

Diameter index safety system

224
Q

Designed so that only the correct tank can be attached?

A

Pin index safety system

225
Q

ALL MACHINES HAVE OXYGEN SUPPLY LOW PRESSURE SENSOR THAT ACTIVATES A GAS WHISTLE OR ELECTRIC AL ALARM SOUNDS WHEN INLET GAS PRESSURE DROPS BELOW A THRESHOLD VALUE OF?

A

20-35 psig

226
Q

To provide a large volume of of oxygen to the patient quickly, oxygen bypasses the fowmeters and manifold.

Flow of oxygen delivered to the patient is at?

A

Oxygen-flush Valve

35-75L/MIN

227
Q

Where is the dead space in the circle system? (2)

A

Between the Y-piece and the patient.

228
Q

Anesthesia machine high pressure areas? (4)

A
  1. Cylinders
  2. Pressure regulators
  3. Pipelines
  4. Fail-safe valves
229
Q

Anesthesia machine lown pressure areas? (2)

A
  1. Flowmeters

2. Flow proportioning device

230
Q 
POST OP pacU
ALDRETE SCORE (READ MORGAN )
A
  1. COLOR
  2. RESPIRATION
  3. CIRCULATION
  4. CONSCIOUSNESS
  5. ACTIVITY
    ; TOTAL 10- DISCHARGED, MINIMUM-9
231
Q

POSTANESTHESIA DISCHARGE SCORING (PADS)

A
  1. VITAL SIGNS
  2. ACTIVITY LEVEL
  3. NAUSEA AND VOMITING
  4. PAIN: MINIMAL OR NONE ACCEPTABLE TO PATIENT CONTROLLED WITH ORAL MEDICATION
  5. SURGICAL BLEEDING
    ; SCORE >/= 9 REQUIRED FOR DISCHARGED
232
Q

Examples of muscarinic antagonists (4)

A
  1. atropine
  2. scopolamine
  3. glycopyrrolate
  4. ipratropium bromide
233
Q

Is the volume in the lungs at the end of passive
expiration.

Normal value (range)

A

FRC

1.7 - 3.5 L

234
Q

Is the point during expiration when small airways begin to close

A

Closing capacity

The FRC depends on position; the closing capacity is independent of position.

235
Q

Involves the work of overcoming the elastic recoil of the

lung (compliance and tissue resistance work) and the resistance to gas flow.

A

Physiologic work of breathing

236
Q

Formula for Hagen-Poiseuille relationship.

  1. For laminar flow?
  2. for turbulent flow?
A
  1. R = (8xLxu)/(pi x r to the 4th)

At low flow, or laminar flow (nonobstructed breathing), the viscosity is the major
property of the gas that affects flow. Clearly the major determining factor is the radius of the
tube.

  1. R ap/r to the 5th

At these flows the major determinants of resistance to flow are the density of the gas (r) and
the radius of the tube, r.

237
Q

Describes the relationship between pressure (P), tension (T), and the radius
(R) of a bubble and can be applied to the alveoli.

What is the formula?

A

Laplace’s law

P = 2T/R

238
Q

What zone has Interstitial pressure (Pinterstitium) is greater than venous and alveolar pressures;
thus flow is determined by the arterial-interstitial pressure difference.

(Ppa > Pinterstitium >
Ppv > PAlv).

A

Zone 4

239
Q

Causes of hypoxemia (4)

A
  1. Low inspired oxygen tension
  2. Alveolar hypoventilation
  3. Right-Left shunting
  4. V/Q mismatch
  5. Diffusion abnormality
240
Q

Is the volume of lung that does not exchange gas. This includes the nose, pharynx,
trachea, and bronchi. This is about 2 ml/kg in the spontaneously breathing individual and is
the majority of physiologic dead space.

A

Anatomic dead space

241
Q

Is the volume of gas that reaches the alveoli but

does not take part in gas exchange because the alveoli are not perfused.

A

Alveolar dead space

242
Q

VD/VT is the ratio of the physiologic dead space to the tidal volume (VT), is usually about how many percent?

A

33%

VD=VT(alveolar PCO2 -expired PCO2)/alveolar PCO2

243
Q

A condition where blood reaches the arterial system without passing
through ventilated regions of the lung.

A

Absolute shunt

244
Q

Is a local response of pulmonary arterial
smooth muscle that decreases blood flow in the presence of low alveolar oxygen pressure,
helping to maintain normal V/Q relationships by diverting blood from under ventilated areas.

A

Hypoxic pulmonary vasoconstriction

HPV
is inhibited by volatile anesthetics and vasodilators but is not affected by intravenous anesthesia.

245
Q

Where is the respiration center located in the brain?

A

The respiratory center is located bilaterally in the medulla and pons.

246
Q

Three major centers contribute to respiratory regulation.

A
  1. dorsal respiratory center
    (inspiration) (most impt)
  2. ventral respiratory center
    (inspiration and expiration)
  3. pneumotaxic center
    (breathing rate and pattern)
247
Q

Is located within the nucleus solitarius where vagal and glossopharyngeal nerve fibers terminate and carry signals from peripheral chemoreceptors and baroreceptors (including the
carotid and aortic bodies) and several lung receptors.

A

Dorsal repiratory center

248
Q

What are the major buffering systems of the body? (4)

What is the primary organ involved in rapid acid-base regulation?

A
  1. bicarbonate
  2. albumin
  3. intracellular proteins
  4. phosphate

Lungs

249
Q

What is meant by pH?

Severe acidemia is defined as blood pH

Severe alkalemia is defined as blood pH >?

A

pH is the negative logarithm of the hydrogen ion concentration ([Hþ]). pH is a convenient descriptor for power of hydrogen.

  1. 2
  2. 6
250
Q

Discuss issues associated with estimating volume status in outpatients.

A

A patient’s hourly metabolic requirement is roughly 4 ml/kg for the first 10 kg, 2 ml/kg for the
second 10 kg, and 1 ml/kg for the remainder of his or her weight.

251
Q

Solution (dissolved in either normal saline or lactated Ringer’s
solution) is another colloid preparation. The heterogeneous preparation contains polymerized
molecules with molecular weights of between 20,000 and 100,000 daltons. Metabolized by
amylase, it accumulates in the reticuloendothelial system and is renally excreted.

A

Hydroxyethyl starch in a 6% solution

It is
recommended that not more than 20 ml/kg be administered.

252
Q

What is the normal range for serum osmolality?

A

Normal serum osmolality ranges

between 285 and 305 mOsm/L.

253
Q

How do you estimate fluid loss during a surgical procedure?

A

Surgical sponges can be weighed; a large laparotomy sponge can hold more than 100 ml of blood.

254
Q

Blood pressure is not significantly affected until approximately ___ of blood volume is lost.

A

30%

255
Q

If potassium is administered, how much should be administered and how fast
should it be administered?

A

Potassium should be administered at a rate no greater than 0.5 to 1 mEq/L. As a safety measure, no more than 20 mEq of potassium, diluted in a carrier and run through a controlled infusion pump, should be connected into a patient’s intravenous lines at any one time.

256
Q

Hyperchloremia has been increasingly recognized after administration of what
standard resuscitation fluid?

A

Hyperchloremia is associated with massive resuscitation with normal saline and with metabolic
acidosis caused by dilution of sodium bicarbonate.

257
Q

What type of blood should be used in an emergency situation?

A

O
Rh -
uncrossmatched blood

Type-specific, uncrossmatched blood
would be the next choice, followed by type-specific, partially crossmatched blood and finally fully crossmatched blood.

258
Q

Three intertwined processes ensure that blood remains in a liquid state until vascular injury
occurs: (3)

A
  1. primary hemostasis
  2. secondary hemostasis
  3. fibrinolysis
259
Q

Binding of fibrinogen to activated platelets is facilitated by:

A

Glycoprotein IIb/IIIa

260
Q

Within seconds of vascular injury, platelets become activated and adhere to the
subendothelial collagen layer of the denuded vessel via glycoprotein receptors; this
interaction is stabilized by: (1)

A

von Willebrand’s factor (vWF)

261
Q

When a clot is formed, ________ is incorporated and then converted to
plasmin by __________ and fragments of factor XII

A
  1. plasminogen

2. tissue plasminogen activator (tPA)

262
Q

It is a potent vasodilator that inhibits platelet activation and helps confine primary hemostasis to the injured area.

A

Plasminogen

263
Q
  1. Intraoperative bleeding can be severe with platelet counts of? (range)
  2. Spontaneous bleeding usually occurs at counts: (value)
A
  1. 40,000– to
    70,000/mm3

2.

264
Q

A disease where there is a decrease of both factor VIII antigen and factor VIII:vWF.

A

von

Willebrand’s disease

265
Q

Is necessary for both platelet adhesion and

formation of the hemostatic plug through regulation and release of factor VIII antigen

A

Factor VIII:vWF

266
Q

Vitamin K-dependent clotting factors

A

IX, X, VII, II

267
Q

The _____ pathway is affected first by vitamin K
deficiency because the factor with the shortest half-life is factor ___, found only in the extrinsic
pathway. With further deficiency both extrinsic and intrinsic pathways are affected.

A
  1. extrinsic

2. VII

268
Q

Is a polyanionic mucopolysaccharide that accelerates the interaction between antithrombin
III and the activated forms of factors II, X, XI, XII, and XIII, effectively neutralizing each.

A

Heparin

269
Q

Measures the clotting ability of all factors in the intrinsic and common pathways except
factor XIII.

Partial thromboplastin is substituted for platelet phospholipid and eliminates
platelet variability. Normal PTT is about 40 to 100 seconds; >120 seconds is abnormal.

A

PTT

270
Q
  1. Normal bleeding time:
  2. Normal PTT
  3. Normal aPTT
  4. Normal ACT
  5. Normal PT
  6. Normal INR
A
  1. 4 to 9 mins
  2. 40 100 seconds
  3. 25 to 35 seconds
  4. 90 to 120 seconds
  5. 10 to 12 seconds
  6. 2 to 3 (standard)
  7. 5 to 3.5 (high-dose)
271
Q

Is widely used to monitor heparin therapy in the operating

room.

A

Activated clotting time

272
Q

Measures the extrinsic and common pathways. Tissue thromboplastin is
added to the patient’s plasma.

A

Prothrombin time (PT)

273
Q

Was introduced to improve the consistency of oral

anticoagulant therapy.

A

INR

274
Q

Is the cold-insoluble white precipitate formed when FFP is thawed. It is removed by centrifugation, refrozen, and thawed immediately before use.

It contains (4)

Will increase finrinogen levels to?

Lacks factor?

A
  1. Cryoprecitpitate
  2. factor VIII, vWF, fibrinogen, and factor XIII
  3. 50 mg/dL
  4. 5
275
Q

Factor VIIa complexes with tissue factor to activate factors __ and X__.

Factor __ subsequently
aids in the conversion of prothrombin to thrombin, which leads to the activation of fibrinogen
to fibrin.

A
  1. IX and X

2. Xa

276
Q

Measures the viscoelastic properties of blood as it is induced
to clot in a low shear environment resembling venous flow, providing some measure of clot
strength and stability, including the time to initial clot formation, the acceleration phase,
strengthening, retraction, and clot lysis.

A

Thromboelastography (TEG)

277
Q

Examination of the neck:

A neck circumference of greater than ___ inches has
been reported to be associated with difficult airways.

A

18 inches

278
Q

Is the largest and most prominent cartilage of the neck, forming the anterior and lateral walls.

A

Thyroid cartilage

279
Q

Cartilage that is shaped like a signet ring, faces posteriorly, and is the only complete cartilaginous ring of the laryngotracheal tree.

A

Cricoid cartilage

280
Q

In a patient with an anterior airway the _____ may be the only visible structures.

A

Arytenoids

281
Q

The superior and recurrent laryngeal nerves, both branches of the ____, innervate
the larynx.

A

Vagus nerve

282
Q

The superior laryngeal nerves decussate into internal and external branches.

The ____ branches provide sensory innervation of the larynx above the vocal cords.

Whereas the external branches provide motor innervation to the _____ muscle

A
  1. Internal

2. Circothyroid muscle, a tensor

283
Q

The recurrent laryngeal nerves provide sensory innervation below the level
of the cords and motor innervation of the posterior _____, the only abductors of
the vocal cords.

A

Cricoarytenoid muscles

284
Q

Most frequent cause of

airway obstruction?

A

Obstructed tongue

285
Q

The ____ blades are inserted into the vallecula, immediately ___ to the epiglottis, which is literally flipped out of the
visual axis to expose the laryngeal opening.

A
  1. curved

2. anterior

286
Q

The ___ blade is inserted past the epiglottis,

which is simply lifted out of the way of laryngeal viewing.

A

Miller

287
Q

What structures must be aligned to accomplish visualization of the larynx? (3)

A
  1. oral
  2. pharyngeal
  3. laryngeal
288
Q

Elevation of the head
about __ cm with pads below the occiput and with the shoulders remaining on the table
aligns the laryngeal and pharyngeal axes.

A

10 cm

289
Q

Internal diameter of ETT ranges from:

A

2 to 10 mm

290
Q

Is the sum of IRV, tidal volume (TV), ERV, and RV.

A

Total lung capacity (TLC)

291
Q

Is the sum of IRV, TV, and ERV.

A

Vital capacity (VC)

292
Q

Is the volume of air in the lung at the end of a normal expiration and is the sum of RV and ERV.

Is the cornerstone for determining the remainder of the lung volumes.

A

Functional residual capacity (FRC)

293
Q

Is the sumof IRV and TV.

A

Inspiratory capacity (IC)

294
Q

Is most accurate for determining FRC in patients with obstructive airway
disease and applies Boyle’s law, which states that the volume of gas in a closed space varies
inversely with the pressure to which it is subjected.

A

Plethysmography

295
Q

Measures the rate of uptake of the nonphysiologic gas carbon monoxide (CO).

A

diffusing capacity for the single-breath diffusion capacity (DLCO)

296
Q

Upper abdominal procedures result in a decrease in FRC within ___; FRC gradually returns
to normal by ___.

A
  1. 10 to 16 hours

2. 7 to 10 days

297
Q

Which is the concentration required to block autonomic reflexes to nociceptive stimuli (1.7 to
2 MAC)

A

MAC-BAR

298
Q

The concentration required to block appropriate voluntary reflexes and measure perceptive awareness (0.3 to 0.5 MAC)

A

MAC awake

299
Q

For every Celsius degree drop in body temperature, MAC decreases
approximately how many %?

A

2% to 5%

300
Q

Describes the distribution of a given agent at equilibrium between two
substances at the same temperature, pressure, and volume

A

Partial coefficient

301
Q

Which anesthetic agent is most associated with:

  1. cardiac dysrhythmias
  2. nephrotoxicity
  3. seizure
  4. hepatotoxicity
A
  1. halothane
  2. methoxyflurane
  3. enflurane
  4. halothane
302
Q

Soda lime can also degrade sevoflurane. One of the metabolic by-products is a vinyl ether known as:

A

Compound A

303
Q

Volatile anesthetics that produce CO (3) (least to greatest)

A

desflurane > enflurane > isoflurane

304
Q

Volatile anesthetic that is teratogenic in rats. Which causes inhibition of methionine synthesis. It iprevents cobalamin (vitamin B12) to act as a coenzyme for methionine synthase.

A

Nitrous oxide

305
Q

Are analgesic and sedative drugs that contain opium or an opium derivative from the poppy plant (Papaver somniferum).

A

Opiates

306
Q

Is any substance with morphine-like activity that acts as an agonist or antagonist at an opioid receptor.

A

Opioid

307
Q

Is not specific for opioids and refers to any substance with addictive potential that induces analgesia, euphoria, or altered sensorium.

A

Narcotic

308
Q

3 classes of endogenous peptides

A
  1. endorphins
  2. enkephalins
  3. dynorphins
309
Q

Is a diminution in the physiologic effects of a substance resulting from repeated administration.

A

Tolerance

310
Q

May be physical or psychological and refers to the repeated use of a substance to avoid withdrawal symptoms.

A

Dependence

311
Q

Refers to the habitual use of a substance despite adverse consequences, including social and interpersonal problems.

A

Abuse

312
Q

Examples of u and k opiod receptor partial agonists (4)

A

pentazocine
butorphanol
buprenorphine
nalbuphine

313
Q

Most opioids cause bradycardia except?

A

meperidine

314
Q

Which opioids are associated with histamine release? (3)

A

meperidine
morphine
codeine

315
Q

Treatment of opioid-induced constipation? (1)

A

Methylnaltrexone

316
Q

Which opioids may be associated with seizure activity in patients with renal failure?

A

Hydromorphone

Meperidine

317
Q

Is an ultrashort-acting opioid with a duration of 5 to 10 minutes and a contextsensitive half-time of 3 minutes.

A

Remifentanil

318
Q

Is a codeine analog that acts as a m-, d-, and k-receptor agonist and a reuptake inhibitor of norepinephrine and serotonin.

A

Tramadol

319
Q

All intravenous induction agents with the exception of?

A

ketamine

320
Q

is an N-methyl-D-aspartate receptor antagonist with profound analgesic properties.

Chemically related to phencyclidine.

Also causes bronchodilation.

A

Ketamine

321
Q

Decreases serum cortisol levels by blocking two enzymes in the cortisol pathway:
11-b-hydroxylase and 17-a-hydroxylase.

A

Etomidate

322
Q

Is the best induction agent for hypovolemic trauma patients as long as there is no risk for increased intracranial pressure.

A

Ketamine

323
Q

Critically ill children are at
the highest risk. Risk is increased with the administration of exogenous steroids and catecholamines and inadequate carbohydrate intake. Manifestations include cardiac failure, rhabdomyolysis, severe metabolic acidosis, hyperlipidemia, renal failure, and sometimes death.

A

Propofol infusion syndrome

324
Q

This receptor is contained within the motor cell membrane and consists of five
glycoprotein subunits: two alpha and one each of b, d, and e

A

Ach receptor

325
Q

When between _% and _% of the receptor channels are open and a threshold potential is reached, a muscle action potential (MAP) is generated.

A

5% and 20%

326
Q

Tachycardia is usually a

side effect of what NMBa because of ganglionic stimulation and vagolysis.

A

Pancuronium

327
Q

A nerve stimulator should be capable of delivering single-twitch stimulation at ___ (1 stimulus every 10 seconds), train of four (TOF) at ___ (2 per second), and tetanic stimulation at ___ (50 per second).

A
  1. 0.1 Hz
  2. 2 Hz
  3. 50 Hz
328
Q

Which mode is most commonly used to assess degree of blockade? How is
it done?

A

TOF stimulation is the most common modality used to assess degree of blockade.

The four twitches of the TOF disappear in reverse order as the degree of blockade deepens.

329
Q

Loss of contraction during tetanic stimulation, known as ___, is a sensitive
indicator of residual neuromuscular blockade.

A

Tetanic fade

330
Q

Is a modified cyclodextrin that forms extremely tight water-soluble complexes with relaxants having steroidal nuclei
(rocuronium > vecuronium > pancuronium)

A

Sugammadex

331
Q

What determines local anesthetic potency?

A

The higher the solubility, the greater the potency.

332
Q

Maximum safe doses:(mg/kg)

  1. procaine
  2. chlorprocaine
  3. tetracaine
  4. lidocaine
  5. mepivacaine
  6. bupivacaine
  7. etidocaine
A
  1. ( 7 )
  2. ( 8-9 )
  3. ( 1.5 ) topical
  4. ( 5 or 7 ) (w/ epinephrine)
  5. ( 5 )
  6. ( 2.5 )
  7. ( 5 )
333
Q

Epinephrine, usually in ___ concentration, is also a useful marker of
inadvertent intravascular injection.

A

1:200,000

334
Q

Which local anesthetic is associated with the risk of methemoglobinemia? (2)

A
  1. Prilocaine

2. Benzocaine

335
Q

States that increased myocardial fiber length (i.e., end-diastolic volume) improves contractility up to a point of optimal
contractile state, further stretching results in declining performance.

A

Frank-Starling Law

336
Q

This drug acts to increase contractility without elevating
intramyocardial calcium levels. This is achieved by stabilizing troponin C in an active form, thus providing inotropic support in similar fashion to other agents but with much lower intracellular
calcium requirements.

A

Levosimendan

337
Q

it is acceptable to allow patients to take preoperative medications, including the patient’s
usual medications, with up to ___ of water in the hour

A

150 ml

338
Q

How often does the preoperative evaluation alter care plans?

A

It has been found that care plans were altered in 20% of all patients (including 15% of
American Society of Anesthesiologists [ASA] class 1 and 2 patients) because of conditions
identified at the preoperative evaluation.

339
Q

The minimal number of normally functioning platelets to prevent surgical bleeding is

A

50,000/mm3

340
Q

Leaving out the safety features and monitors, the anesthesia machine is divided into three
sections: (3)

A
  1. A gas delivery system
  2. The patient breathing system
  3. A scavenger system
341
Q

Oxygen and air in the E-cylinders is pressurized up to approximately ___ psig?

But the anesthesia machine needs to work with gas at an initial pressure of about __ psig

A

2200 psig

50 psig

342
Q

Wall gas pressures are typically about __ psig.

Tank pressure is
generally regulated by the first-stage regulator to __ psig.

A

55 psig

45 psig

343
Q

A full green E-cylinder of O2 has a pressure of __ psi and contains about L of O2.

A

2000 psi

625 L

344
Q

At room temperature N2O condenses into a

liquid at ___ psi.

A

747 psi

345
Q

E-cylinders of N2O contain the equivalent of about _ L of gas when full,
whereas E-cylinders of O2 and air hold only about 600 L.

A

1600 L

346
Q

All wall-supply gas connectors are keyed so only the O2 supply hose can be plugged
into the O2 connector on the wall, the N2O hose into the N2O outlet, and so on. This is
known as

A

Diameter-Index-Safety-System (DISS)

347
Q

The gas cylinders are keyed using a ___, so

that only the correct tank can be attached to the corresponding yolk on the anesthesia machine

A

Pin-Index-Safety-System

348
Q

Flowmeters, also known as ___, are also specific to the gas for which they have been designed and are not interchangeable with other gases.

A

Thorpe tubes

349
Q

What happens if you put the wrong agent in a vaporizer calibrated for another agent?

A

If an agent with a high vapor pressure is put into a vaporizer meant for a less volatile agent, the output will be excessive. If an agent with a vapor pressure lower than the agent intended for the vaporizer is accidentally used, the anesthetic output will be lower than anticipated.

350
Q

Desflurane has a vapor pressure of ___mm Hg at 20 C

A

664 mm Hg

351
Q

What circuit is most commonly used in anesthesia delivery systems today?

A

The circle system provides the most advantages

352
Q

How can you check the competency of a circle system?

A

You should close the pop-off valve, occlude the Y-piece, and press the O2 flush valve until the pressure is 30 cm H2O.

353
Q

Is a measure of distensibility and is expressed as the change in volume for a given
change in pressure.

A

Compliance

354
Q

Is measured during the delivery of airflow at the end of inspiration.

A

Peak pressure

355
Q

is measured during an end-inspiratory pause, during a no-flow condition, and reflects the static compliance of the respiratory system, including the lung parenchyma, chest wall, and abdomen.

A

Static or plateau pressure

356
Q

What leads are most helpful when looking for a bundle-branch block?

A

V1, V6, I, and to some extent II

357
Q

In V1 there is a broad, deep S wave (or QS wave), with ST segment elevation, that may be preceded by a very narrow R wave. Clinical condition?

A

LBBB

358
Q

Is ST-segment depression that occurs in patients with an ST-elevation MI.

A

Reciprocal change

359
Q

Essentially states that the intensity of transmitted light
passing through a vascular bed decreases exponentially as a function of the concentration of the absorbing substances in that bed and the distance from the source of the light to the detector.

A

Beer-Lambert law

360
Q

Is the most common method of CO2 analysis.

A

Infrared absorption

361
Q

The baseline of the capnogram may not return to zero at high respiratory rates. However, if the
baseline is elevated more than approximately ______ CO2, the patient is receiving CO2 during inspiration, and this is often termed _____

A

2 mm Hg

Rebreathing

362
Q

Possible causes of

rebreathing include the following: (4)

A

An exhausted CO2
absorber

Channeling of the gas
within the CO2
absorber

An incompetent
unidirectional
inspiratory or
expiratory valve

Accidental
administration of CO2
(perhaps from a CO2 tank used for laparoscopy)

Inadequate fresh gas flow

363
Q

CVP (SUBCLAVIAN APPROACH)
The skin puncture is made just lateral to, and one fingerbreadth below,
the ____, which can be identified by a notch two thirds of the length down the clavicle.

A

costoclavicular ligament

364
Q

CVP (SUBCLAVIAN APPROACH)
The needle is directed along the posterior border of the ___ in the
direction of the __ until VENOUS blood is aspirated.

A

Clavicle

sternal notch

365
Q

Describe the external jugular vein approach.

A

The needle is advanced in a direction paralleling the vessel and is introduced into the vein approximately two finger widths below the inferior border of the mandible.

366
Q

How is a catheter introduced into the central venous circulation?

A

Seldinger technique.

An 18- or 20-G needle is introduced into the vessel, and a guidewire is threaded through the needle and into the vein.

367
Q

At what point on the body should central venous pressure be measured?

A

The ideal point at which to measure CVP is at the level of the tricuspid valve.

An external landmark for the tricuspid is a point 2 inches behind the sternum, roughly the anterior axillary line, at the fourth intercostal space.

368
Q

The normal CVP waveform shows a pattern of __ upstrokes and ___ descents that correspond to certain events in the cardiac cycle

A

three

two

369
Q

What pressures are measured by pulmonary artery catheters?

A

The PA catheter continuously measures right atrial pressure (or central venous pressure [CVP]) and pulmonary artery pressures.

370
Q

Strategies to decrease the risk of pulmonary hemorrhage include not advancing the PA catheter beyond __ cm

A

55

371
Q

There are three phases of thermoregulation:

A
  1. afferent sensing
  2. central thermoregulatory
    integration
  3. efferent response
372
Q

Impulses travel through what fibers?

  1. cold
  2. warmth
A
  1. A-delta

2. C fibers

373
Q

One unit of refrigerated

blood or 1 L of room-temperature crystalloid decreases the body temperature about ___ C.

A

0.25

374
Q

Below 32 C an elevation of the junction of the QRS and ST segments known as the _____ or __ or __ wave may be seen.

A

hypothermic hump
Osborne
J

it usually is seen in leads II and V6 and may spread to leads V3 and V4

375
Q

Speed of onset of volatile anesthetics is increased by (4)

A
  1. increasing the delivered concentration of anesthetic
  2. increasing the fresh gas flow
  3. increasing alveolar ventilation
  4. using nonlipid-soluble anesthetics
376
Q

Termination of effect of intravenous anesthetics is by?

A

REDISTRIBUTION

not biotransformation and breakdown

377
Q

Gases that condense into liquid (2)

A

N2O

CO2

378
Q

Most commonly used anesthesia circuit

A

Semiclosed circuit using a circle system

379
Q

Components of a circle system (6)

A
  1. inspiratory limb
  2. expiratory limb
  3. unidirectional valves
  4. CO2 absorber
  5. gas reservoir bag
  6. pop-off valve on the expiratory limb
380
Q

Every patient ventilated with an ascending bellows anesthesia ventilator receives
approximately how much mmHg of PEEP?

A

2.5 to 3 cmH2O

Because of the weight of the bellows

381
Q

Risk factors for auto-PEEP

A
  1. high minute ventilation
  2. small endotracheal tube
  3. chronic obstructive pulmonary disease
  4. asthma
382
Q

ALI/ARDS criteria (5)

A

(1) Acute onset
(2) PaO2/FiO2 ratio of 300 for ALI
(3) PaO2/FiO2 ratio of 200 for ARDS
(4) Chest radiograph with diffuse infiltrates
(5) Pulmonary capillary wedge pressure of 18 mm Hg

383
Q

Mechanical ventilation settings for patients with ARDS or ALI:

A

1) tidal volume of at 6 to 8 ml/kg
2) plateau pressures to <30 cm H2O
3) PEEP should be adjusted to prevent end-expiratory collapse
4) FiO2 maintain with O2sat: 88-92%

384
Q

Ways to decrease PA pressure

A

1) vasodilator therapy
2) correcting acid-base status
3) normothermia
4) deepening the anesthetic (decrease stress)

385
Q

PaCO2 to promote decrease in ICP

A

25 to 30 mmHg

386
Q

The sine qua non of MH are (3)

A

1) Unexplained rise in end-tidal carbon dioxide
2) simultaneous increase in minute ventilation
3) unexplained tachycardia

387
Q

Nice to know

A

Patients with Alzheimer’s disease may become more confused and disoriented with PREOPERATIVE sedation.

388
Q

Nice to know

A

In patients with multiple sclerosis spinal anesthesia should be used with caution and only in situations in which the benefits of spinal anesthesia over general anesthesia are clear.

Multiple sclerosis is an inflammatory demyelinating disease of the CNS in which activated immune cells invade the central nervous system and cause inflammation, neurodegeneration, and tissue damage.

389
Q

What is a prayer sign?

A

The inability to touch the PALMAR aspects of the INDEX fingers when palms touch

390
Q

The initial goal of burn resuscitation is?

A

To correct hypovolemia

391
Q

From about 24 hours after injury until the burn has healed, succinylcholine may cause hyperkalemia because of?

A

Proliferation of EXTRAJUNCTIONAL neuromuscular receptors

May need two to five times the normal dose (NON-DEPOLARIZING NMBs)

392
Q

First step in treating a pulmonary hypertensive event

A

Hyperventilation with 100% oxygen

393
Q

What to do when a child with tetralogy of Fallot has a hypercyanotic spell during induction of anesthesia?

A

Gentle external compression of the abdominal aorta

394
Q

O-negative blood is the universal donor for packed red blood cells, but for plasma it is what type?

A

For plasma it is AB positive

395
Q

Nice to know

A

If a patient is pacemaker dependent, the interference by electrocautery may be interpreted by the device as intrinsic cardiac activity, leading to profound inhibition of pacing and possible asystole. Devices should be programmed to the ASYNCHRONOUS mode before
surgery.

396
Q

Loss of afferent sensory and motor stimulation renders a patient sensitive to sedative medications secondary to?

A

DEAFFERENTIATION

For the same reason neuraxial anesthesia decreases the minimum alveolar concentration of volatile anesthetics.

397
Q

Nice to know

A

Patients with liver disease commonly have an INCREASED volume of distribution, necessitating an increase in initial dose requirements.
However, because the drug metabolism may be reduced, smaller doses are subsequently administered at LONGER intervals.

398
Q

Nice to know

A

There is no best anesthetic technique during cardiopulmonary bypass.

399
Q

Methods to improve oxygenation during one-lung ventilation also include (1)

A

Clamping the blood supply to the nonventilated lung

400
Q

True or false?

Neuropathic pain is usually less responsive to opioids than pain originating from nociceptors.

A

True

Anesthesia In-Service Examination (64 decks)

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