Anesthesia EFFECTS, COMMONs, Triads, DISSOCIATION CURVES, REFLEXES Flashcards
1
Q
Carbon dioxide dissociation curve: When blood contains mainly oxygenated hemoglobin , the CO2 dissociation curve shifts to the _______
A
Right
2
Q
When does the CO2 dissociation curve shifts to the Right?
A
When blood contains mainly oxygenated hemoglobin
3
Q
When blood contains mainly oxygenated hemoglobin and the CO2 dissociation curve shifts to the RIGHT what does that do?
A
REDUCE the BLOOD CAPACITY to HOLD CO2
4
Q
When blood contains mostly DEOXYhemoglobin , the CO2 dissociation curve shifts to the _______
A
LEFT
5
Q
When does the CO2 dissociation curve shifts to the LEFT?
A
When blood contains mostly DEOXYhemoglobin
6
Q
When blood contains mainly DEOXYhemoglobin and the CO2 dissociation curve shifts to the LEFT what does that do?
A
Increasing the capacity to carry CO2
7
Q
CO2 dissociation curve mnemonic to remember
A
Right O2
Left
8
Q
Explain the HALDANE EFFECT?
A
Allows the blood to LOAD more CO2 at the tissue level where more deoxyhemoglobin is present
And to UNLOAD CO2 at the lung, where more HgbO2 is present .
9
Q
This effect permits more CO2 to be carried in the form of bicarbonate ions
A
Haldane effect
10
Q
With this effect: The associated of H+ with the amino acids of hemoglobin lowers the affinity of hgb of O2, shifting the HgbO2 dissociation curve to the right at low pH or HIGH CO2
A
Bohr effect
11
Q
The Haldane Effect (along with the Bohr Effect) facilitates the
A
release of O2 at the tissues and the uptake of O2 at the lungs.
12
Q
The Haldane Effect results from the fact that deoxygenated hemoglobin has a
A
higher affinity (~3.5 x) for CO2 than does oxyhemoglobin.
13
Q
HALDANE EFFECT MAINLY states that
A
Deoxygenated blood can carry increasing amounts of carbon dioxide, WHEREAS oxygenated blood has a reduced carbon dioxide capacity.
14
Q
The Haldane Effect describes the effect of
A
oxygen on CO2 transport.
15
Q
Bohr effect describes the effect of
A
carbon dioxide on oxygen transport
16
Q
Central chemoreceptors respond to
A
H+ in the CSF
17
Q
Peripheral chemoreceptors respond to
A
↑ H+, ↑ CO2, and ↓ PaO2
18
Q
What is the primary stimulus for ventilatory response?
A
PaCO2
19
Q
Hamburger shift”
A
Cl- exchange for HCO3- in RBC’s:
HCO3- out, Cl- in; non-pulmonary
20
Q
Occulocardiac Reflex: Afferent and Efferent Pathway
A
Afferent pathway = Trigeminal nerve Efferent pathway = Vagus nerve
21
Q
Cushing’s triad : What is it and what does it tell you?
A
HTN
Bradycardia
Irregular respirations
Increased ICP
22
Q
Triple H Therapy: is used for
A
For treatment of cerebral vasospasm
23
Q
What is the triple H therapy ?
A
Hypervolemia = CVP > 10 mm Hg PCWP = 12-20 Hypertension = SBP 160-200 mmHg Hemodilution = Hct 33%
24
Q
Obesity Hypoventilation syndrome triad
A
Obesity
Daytime hypoventilation
Sleep disordered breathing
25
What does Virchow's triad tells you?
Risk factors for venous thrombosis
26
Virchow's triad (HIS)
Venous stasis
Venous injury (endothelial)
Hypercoagulable State
27
Hepatopulmonary syndrome Triad (PHW)
PORTAL HTN
Hypoxemia (Arterial deoxygenation)
Widespread pulmonary vasodilation
28
Cholecystitis triad:
Sudden RUQ tenderness
Fever
Leukocytosis
29
Clinical significant Hypoglycemia WHIPPLE TRIAD
Hypoglycemia (catecholamine)
Low blood glucose
Relief of symptoms after IV glucose
30
DKA Triad
Hyperglycemia
Ketonemia
ACIDEMIA
31
Pheochomocytoma Triad
Paroxysmal diaphoresis
Tachycardia
Hypertension
32
Hypothermia TRIAD
ACIDOSIS
Hypothermia
COAGULOPATHY
33
SPINAL shock TRIAD
Hypotension
Bradycardia
Hypothermia
34
SAMTER syndrome Triad
Nasal polyps
Asthma
Aspirin allergy
35
FIRE TRIAD
Fuel
Oxidizer
Ignition source
36
Beck's triad indicates
Cardiac Tamponate
37
What is beck's triad?
JVD
Hypotension
Muffled heart sounds
38
Aortic stenosis Triad
Angina
Syncope
CHF (dyspnea)
39
Ruptured Abdominal Aortic Aneurysm triad
Severe abdominal pain radiates to back
Pulsatile abdominal mass
Hypotension
40
Chronic pancreatitis triad
Steatorrhea
Pancreatic calcification
Diabetes mellitus
41
Myotonic dystrophy triad in males
Frontal baldin
premature ocular cataracts
testicular atrophy
42
Bezold-Jarish reflex is associated with this triad?
hypotension, bradycardia, and coronary vasodilation
43
The Bezold-Jarisch reflex results in
unmyelinated vagal afferent stimulation in response to noxious ventricular stimuli (chemical or mechanical),
44
2 things that are increased with Bezold-Jarisch reflex
increased parasympathetic tone
| Increased ANP and BNP
45
Up to 25% of patients undergoing surgery in the beach chair position under general or regional anesthesia can experience hemodynamically significant hypotensive bradycardic events thought to be caused by
ventricular underfilling and the Bezold–Jarisch reflex.
46
Bainbridge reflex causes an
increase in heart rate when the right atrium or great veins are stretched by increased vascular volume.
47
Associated with the Bainbridge reflex are the
Venous baroreceptors--> are located in the right atrium and great veins
48
When blood pressure increases which receptors are stimulated?
the baroreceptors are stimulated
49
When baroreceptor are stimulated, what happens to myocardial contractility, venous tone, heart rate, systemic vascular resistance (SVR), and blood pressure?
When stretched, the baroreceptors fire --> inhibit the *sympathetic nervous system outflow resulting in a decrease in myocardial contractility, a decrease in heart rate, a decrease in venous tone, a decrease in SVR, and a decrease in blood pressure. *Parasympathetic outflow is simultaneously increased, which also decreases heart rate.
50
What nerves carry the afferent and efferent signals o f the Bainbridge reflex?
When the great veins and right atrium are STRETCHED BY INCREASED vascular volume, stretch receptors send AFFERENT signals to the medulla VIA the VAGUS nerve. The medulla then transmits EFFERENT signals via the sympathetic nerves to increase heart rate (by as much as 75%) and myocardial contractility.
51
What does the Bainbridge reflex help prevent?
prevent damming up of blood in veins, the atria, and the pulmonary circulation.
52
The Bainbridge reflex, in which stimulation of
right atrial stretch receptors leads to vagal afferent stimulation of the medulla and subsequent inhibition of parasympathetic activity (increasing the heart rate, or, in the case of decrease atrial pressure, lowering heart rate)
53
What three maneuvers can trigger the
| oculocardiac reflex?
1) traction on the extraocular mus-
cles, especially the medial rectus
(2) ocular manipulation
(3) manual pressure on the globe of the eye.
54
What nerves carry the afferent and effer- ent action potentials in the oculocardiac reflex arc?
The trigeminal nerve (cranial nerve V) carries afferent (sensory) action potentials and the vagus nerve (cranial nerve X) carries efferent (motor) action potentials. This is the five (V) and dime (X) or nickel (V) and dime (X) reflex.
55
What reflex best explains bradycardia during spinal anesthesia?
The Bainbridge reflex relates to the characteristic but paradoxical slowing of the heart rate seen with spinal anesthesia..
56
The usual mechanism given for bradycardia with spinal anesthesia is
blockade of the sympathetic efferents from Tl-T4 (cardioaccelerator fibers) with subsequent unopposed parasympathetic stimulation (bradycardia)
57
However, bradycardia during spinal anesthesia is more clearly related to the development of arterial hypotension than to the height of the block. The primary deficiency in the development of spinal hypotension is a
Decrease in venous return.
The reduced venous pressure is sensed by low pressure venous baroreceptors, resulting in a reflex bradycardia.
58
A decrease in cardiac filling pressures may also stimulate vagally mediated bradycardia via the.
Bezold– Jarisch reflex.
59
A decrease in cardiac filling pressure may stimulate what?
A decrease in cardiac filling pressures may also stimulate vagally mediated bradycardia via the Bezold– Jarisch reflex (SLOWS THE HR SO THAT HEART CAN FILL)
60
An INCREASE in cardiac filling pressure
increase HR to get rid of extra fluid
BAINBRIDGE
RA & great veins → Bainbridge reflex, stretch of Right Atrium
Increases HR with inspiration via vagus nerve.
61
Hering-Breuer reflex:
Vagus nerve, prevents over-stretching
62
The primary components of this DESCENDING pain inhibition system, but certainly not all-inclusive, is the “triad” of the
- Periaqueductal gray (PAG)
- Rostral ventral medulla (RVM)
- Dorsolateral pontine tegmentum (DLPT).
63
One of the principal goals during early management of the hemorrhaging trauma victim is to avoid the development of the so-called vicious cycle or lethal triad, consisting of -->
Hypothermia
Acidosis
Dilutional coagulopathy
64
Signs of cyanide toxicity include the triad of
Elevated mixed venous O2 (SVO2)
Increasing requirements for SNP (tachyphylaxis)
metabolic acidosis.
65
Preeclampsia is diagnosed by the triad of
HEP
| hypertension, edema, and proteinuria.
66
Occurs in 15-30% of patients and can be treated by volume, atropine, and ephedrine. what reflex?
Bezold -Jarish REFLEX
67
Treatment for Bainbridge reflex
None (per APEX)
68
How do you treat Symptoms of Bezold Jarish refelx
```
Restore preload (IVF, raise legs above heads, EPI)
Increase HR, atropine, ephedrine
```
69
Full heart --> Increase HR
BainBridge
70
Empty heart --> Decrease HR
Bezold-jarisch
71
Autotransfusion during childbirth is an example of what reflex
Bainbridge
72
Sensors of Bezold Jarisch located in
RV
Mechanoreceptors (VR)
Chemoreceptors (Ischemia)
73
1st -3rd treatment step of oculocardiac receptor
Surgeon removes stimulus
100 oxygen , proper ventilation, deepen anesthetic
Anticholinergics
74
Inhalation on intrathoracic pressure/ venous return / HR
Decrease intrathoracic pressure
Increase venous return
Increase heart rate
75
Exhalation on intrathoracic presssure/venous return/ HR
Increase intrathoracic pressure
decrease venous return
decrease heart rate.
76
In a patient with a history of a spinal cord lesion higher than T7, ___________ and ________is concerning for autonomic hyperreflexia.
marked hypertension and bradycardia
77
AUTONOMIC DYSREFLEXIA explain
Normally, descending inhibitory impulses travel down the spinal cord to block reflex arcs to cutaneous, visceral, or proprioceptive stimuli. This arc is disrupted in spinal cord injury and can lead to autonomic instability, most notably severe hypertension followed by a sustained vagal response including bradycardia, vasodilation, and cutaneous flushing.
78
AUTONOMIC DYSREFLEXIA Treatment
Treatment is supportive, including stopping the inciting stimulus (ask surgeons to pause) and lowering the blood pressure to normal levels via vasodilators and assuring adequate levels of anesthesia.
79
Proposed mechanism of bradycardia when doing ISB block?
Bezold-Jarisch reflex.
80
What is the most common cause of AKI ?
Prolonged renal hypoperfusion
81
What is the leading cause of transfusion-related fatalities and the most common cause of major morbidity and death after transfusion?
TRALI (transfusion-related acute lung injury)
82
The most common cause of cholestasis is
Obstruction of the biliary tract outside of the liver
83
Most common cause of Peptic Ulcer disease is
Ingestion of NSAIDS
84
Major and most common cause of pancreatic insufficiency
Chronic pancreatitis
85
Most common cause of Methemoglobin in clinical practice is
Medications ( Benzocaine and procaine LAs; dapsone ABT; Nitroglycerin and nitric oxide)
86
Most common cause of drug hypersensitivity reactions during anesthesia
Antibiotics
87
Still the most common cause of adult valvular disease
RHD (rheumatic heart disease)
88
Most common cause of Hypercalcemia and 2nd most common cause
Primary hyperparathyroidism
| Malignancy
89
FDA has identified the most common cause of Transfusion related deaths as
TRALI followed by hemolytic transfusion reactions.
90
What is the most common cause of Central Retinal Artery OcclusioN (CRAO)?
Head positioning that result in external pressure on the eye.
91
What is the most common cause of Post operative vision loss associated with prone spine surgery in adult patients?
ISCHEMIC OPTIC NEUROPATHY
92
Most common cause of UNANTICIPATED difficulty with the airway>
Lingual tonsil hyperplasia
93
Most common cause of acute pericarditis is
Viral infection
94
Chronic constrictive pericarditis CURRENTLY (not in the past)
Idiopathic, post cardiac surgery, neoplasia, uremia
95
What is the most common cause of Aortic stenosis
CONGENITAL DEFECT resulting in a BICUSPID AORTIC VALVE and as a SEQUELAE of Rheumatic valvular heart disease
96
Most common dysrhythmias associated with MVP
PVCs.
97
Most common cause of sudden death in pediatric young adult populations>
Hypertrophic Cardiomyopathy.
98
What is the most common cause of peripheral vascular occlusive disease?
Atherosclerosis
99
What is the most common cause of aneurysmal vascular occlusive disease?
Atherosclerosis
100
Most common causes of COPD
Chronic Bronchitis
| EMPHYSEMA
101
Most common cause of Pulmonary edema due to upper airway obstruction?
Laryngospasm after extubation OR GA.
102
What is the most common cause of POSTOP. respiratory dysfunction after or under General anesthesia?
Atelectasis
103
In nonsurgical setting, most common cause of death with chronic renal failure is
Ischemic heart disease.
104
What is the most common cause of death associated with Acromegaly?
Cardiac and respiratory complications
105
The most common cause of Cushing syndrome today is the
Administration of glucocorticoids
106
Outside of Glucorticoids, the most common cause of Cushing syndrome is
Cushing's disease.
107
Primary Adrenocortical insufficiency aka
Addison's disease
108
What is the most common cause of acute Stent thrombosis?
Premature discontinuation of dual anti platelet therapy.
109
AKI is the most common after 5 days of burn injury and the most common cause is
Sepsis.
110
The most common cause of Thyrotoxicosis
Hyperthyroidism
111
The most common cause of HYPERTHYROIDISM
Grave's disease (Multinodular diffuse goiter)
112
The most common cause of postoperative mortality after bariatric surgery is
Thromboembolism
113
The most common signs and symptoms of a leak and %
Tacychardia 72%
Fever 63%
Abdominal pain 54%
114
The most common causes of Anesthesia related maternal mortality in obstetrics include
High cephalic spread of neuraxial block.
115
The most common cause of arrest in non cardiac procedures is
Hyperkalemia
116
The most common cause of AIRWAY obstruction in the immediate postoperative phase is the
loss of pharyngal muscle tone in a sedated/obtunded patient.
117
The most common causes of hypoxemia in the PACU include (6)
```
Atelectasis (can lead to increase in R-to-L shunt)
Pulmonary edema
Pulmonary embolism
Aspiration
Bronchospasm
Hypoventilation
```
118
The most common causes of delayed awakening
Prolonged action of anesthetic drugs
119
Common causes of delayed awakening other than anesthetic drugs.
Metabolic causes
| Neurologic injury.
120
Most common causes of pediatric anesthesia adverse events for both therapeutic or diagnostic procedures TOP 3 only
Drugs errors
Nitrous oxide in combination with other sedative
Inability to rescue the patient from an adverse anesthetic event.
121
Most common cause of Postoperative arterial hypoxemia
Atelectasis.
122
The most common cause of significant anesthetic related morbidity and mortality in Laboring women is
Unrecognized intrathecal injection of local anesthetics.
123
The most common cause of upper GI obstruction in the newborn?
Pyloric Stenosis.
124
Most common cause of death or CNS injury during MAC cases
Excessive sedation leading to respiratory compromise
125
Most common cause of hyperphosphatemia is
Renal failure.
126
The most common causes fo the anaphylaxis, IgE mediated events
NMBAs (58%), latex, ABT
127
The leading injuries in anesthesia-related malpractice claims
Death
Nerve damage,
Permanent brain damage
Airway injury
128
Most common cause of serious bronchiolitis and lower respiratory tract disease in infants and young children>
Human RSV
129
Most common cause of ARDS
SEPSIS
130
Most common cause of acute increase in dead space in the acute setting?
Decreased CO
131
Most common cause of Intraoperative death?
Uncontrollable bleeding (80%) f/b brain herniation and air embolism.
132
Most common cause of early trauma mortality
CNS injury and hemorrhage.
133
The most common causes of acute transplanted lung failure
Acute graft rejection
134
Most common cause of 30-day mortality following liver transplantation ?
Cardiovascular disease.
135
The most common cause of AKI
Acute Tubular necrosis (ATN)
136
Most common cause of metabolic alkalosis is
GI loss due to vomiting or NG suctioning.
137
The most common causes of stridor in infants
Laryngomalacia
138
Most common cause of elevated liver enzyme in adults
Nonalcoholic fatty liver disease (NAFLD)
139
Most common cause of acute liver disease
Drug toxicity AND Infection
140
What is the hallmark of MI and ventricular aneurysm?
Dyskinesia (paradoxical movement)
141
What is the hallmark of Asthma? (clinically)
Inflammation of the airways
142
In acute parenchymal injury offers the most rapid and reliable hallmark of liver dysfunction ?
Prothrombin time
143
Hallmark signs of upper airway obstruction in the unanesthesized patient include
Hoarse or muffled voice
Difficult swallowing secretions
stridor and dyspnea.
144
Hallmark of OSA is
habitual snoring
| Fragmented sleep --> Day time somnolence
145
Hallmark of COPD (symptoms)
Chronic productive cough
| progressive exercise limitation
146
Hallmark of COPD (signs)
Reduction of FEV1
147
What is the hallmark of Asthma? (symptoms)
Recurrent wheezing
Dyspnea
cough
148
Traditional hallmark of early pulmonary edema
Detection of basilar crackles on auscultation
149
The hallmark sign of aspiration pneumonitis (and is frequently the first sign of aspiration) is
Arterial hypoxemia
150
Hallmark finding of ARDS
NONCARDIOGENIC pulmonary edema
151
Hallmark of Flail chest is
Paradoxical movement of the chest wall.
152
Hallmark sign of tension pneumothroax
```
Hypotension
hypoxemia
Absent breath sounds on AFFECTED SIDE
Tachycardia
Increased CVP
Increased airway pressure
```
153
Hallmark clinical signs related to TURP (3)
Water intoxicatoion
fluid overload
Hyponatremia
154
Clinical hallmark of Myasthenia Gravis?
Generalized muscle weakness that IMPROVES WITH REST
| Inability to sustain or repeat muscular contractions.
155
Hallmkar of DI is the
Excretion of abnormally large volume of dilute urine (polyuria)
156
Hallmark of initial therapy for burn?
Fluid resuscitation
| Airway management
157
Minimum UO for burn patients
0.5 - 1 ml/kg/hr
158
American Burn consensus formula for fluid resuscitation?
2-4 ml x kg body weight x % of TBSA burned
159
Hallmark of burn shock is
Reduction in CO
160
May develop within 5 years of post lung transplantation
Bronchiolitis obliterans syndrome (BOS)
161
Bronchiolitis obliterans syndrome (BOS) hallmark is
Development of airway obstruction with a reduction of FEV1 that does not respond to bronchodilation
162
Hallmark of both primary and secondary immunodeficiency
Increased susceptibility to infection
163
Hallmark of quality anesthetic care
Evidence-based practice (EBP)
164
During cryoablation, _____% of the CO is lost when the pulmonary artery is occluded
25%
165
Coanda Effect explains the
tendency of fluid flow to follow a curved surface upon emerging from a constriction
166
With the coanda effect If a constriction occurs at a bifurcation due to
due to increase in velocity and reduction of pressure, hence the fluid/air tends to stick to the side of the branch causing maldistribution.
167
Application of Coanda Effect in anesthesia
1. Mucus plug at the branching of tracheo-bronchial tree may cause maldistribution of respiratory gases.
2. Unequal flow may result because of atherosclerotic plaques in the vascular tree
168
Bernoulli's principle describes what?
Described the effect of fluid flow through a tube containing a constriction
169
Bernoulli's principle states that as flow pass through a ________, the velocity of flow ________and there is a corresponding _______in pressure
narrowing in a tube; decreases; decrease
170
Jet ventilation is based on which effect
Venturi effect
171
2 key players in the mechanism of anesthesia
neurotransmitter-gated ion channels
| K+ Channels
172
What is the approximate blood loss per minute during the resection phase of a transurethral prostate resection?
2-4 mL
173
The average amount of fluid absorbed during a TURP is about
20 mL/min of resection time.
174
The most commonly used endogenous marker of renal reserve or GFR is
Creatinine clearance
175
For trigeminal neuralgia (tic douloureux). What is the MOST appropriate first-line pharmacologic treatment?
Carbamazepine
176
What is the most common cause of death in the period following resection of a pheochromocytoma??
Hypotension
177
How much of the cardiac output does the kidney receive?
15-25%
178
The liver gets its blood supply from the portal vein and the hepatic artery which together receives what % of cardiac output?
20-25%
179
% of CO to the brain is
20%
180
The most common cause (organism) of epiglottis infection
haemophilus influenza
181
The 4Ds of epiglottis are
Drooling
Dysphonia
Dysphagia
Dyspnea
182
What is the most common serious complication associated with opioid intrathecal and epidural administration?
Respiratory depression
183
All local anesthetics cause vasodilation except for (ROLICO)
cocaine, lidocaine, and ropivacaine.
184
LA with low potency and short duration is
Procaine
185
Elevated carbon dioxide levels can increase the potential for toxicity for
all local anesthetics, including tetracaine.
186
Duration of which local anesthetic is prolonged the most by the addition of the epinephrine?
Lidocaine
187
Prevent the euphoric effect of opioids?
Naltrexone
188
Butorphanol is different from nalbuphine in that it is a kappa receptor agonist and a weak mu receptor antagonist, but it has ______analgesic qualities, and _______sedative effects
greater analgesic qualities
| greater sedative effects
189
Opioids and the CO2 responsiveness curve
They shift the curve to the right, which represents a decrease in responsiveness to CO2
190
What is the main determinant of the rate at which an amide local anesthetic is metabolized?
Hepatic clearance
191
The Cockcroft and Gault equation can be used to estimate based upon__________ (select three) SAW
creatinine clearance
Serum Creatinine
Age
Weight (SAW)
192
Creatinine Clearance formula
(140-age) x weight / Serum Cr x 72
193
Most drug metabolism is performed by microsomal enzymes in the smooth endoplasmic reticulum of the
liver cells
194
Most potent endogenous glucocorticoid produced by the adrenal cortex is
cortisol.
195
Hepatic clearance is the product of the 2 things :
Hepatic blood flow
| Hepatic extraction ratio of the drug.
196
The percent of a drug that the liver can clear as it passes through it is referred to as the
hepatic extraction ratio
197
The primary etiologic factor in the development of retinopathy of prematurity (ROP) is the
gestational age.
198
Factors such as (3) are also associated with an increased risk of developing ROP.
hyperoxia, hypocarbia, and acidemia
199
What layer of skin is the rate-limiting layer for the absorption of eutectic mixture of local anesthetic (EMLA) cream?
stratum corneum
200
The only process that does not involve the cytochrome P450 pathway is
hydrolysis
201
The most frequent cause of hospitalization in patients older than 65 is
heart failure.
202
Glucagon increases the blood glucose concentration by
Stimulating glycogenolysis in the liver
203
The primary inhibitory neurotransmitter in the "***brain***
GABA
204
The primary inhibitory neurotransmitter in the :"***spinal cord***
Glycine
205
Which anesthetic agent is most associated with a transient increase in liver enzyme levels?
Desflurane
206
Changes in alveolar ventilation affect which agent more? a soluble agent or a non-soluble agent?
a soluble agent more than a poorly-soluble agent.
207
Spontaneous ventilation will ______ the uptake of inhalation anesthetics by ________ alveolar ventilation.
decrease, decreasing
208
Which volatile agent increases cerebrospinal fluid absorption?
Isoflurane
209
Chemotherapy drugs that can produce renal and hepatic dysfunction.
Methotrexate
210
Peripheral neuropathies are most common in patients treated with
Methotrexate
211
Doxarubicin (Adriamycin) can result in
cardiomyopathy and congestive heart failure.
212
Alkylating agent that can produce pulmonary toxicity and pulmonary fibrosis.
Cyclophosphamide is an
213
Alkylating agent that can produce pulmonary toxicity and pulmonary fibrosis.
Cyclophosphamide
214
The alveolar-arterial difference for oxygen increases from approximately ______-at age 20 and to ___mmHg at age 70
8 mm Hg at age 20 to approximately 20 mm Hg at age 70.
215
What are the most common arterial blood gas findings in the presence of asthma?
Hypocarbia
| Respiratory Alkalosis
216
What is the most common life-threatening manifestation of ventilator-induced barotrauma?
Tension Pneumothorax
217
3 that suggests tension pneumothorax
Hypotension
Worsening hypoxemia
Increased airway pressure
218
The most common cause of cardigenic shock is
acute myocardial infarction involving 40% or more of the Left ventricular mass.
219
What is the Most common etiology of hyper dynamic distributive shock ?
Sepsis
220
Obstruction to cardiac outflow is most commonly encountered in patients with a
Pulmonary embolism
221
What is the most common preventable cause of hospital death?
PE
222
What is the most common in distributive shock?
Loss of vascular tone leading to cardiovascular collapse
223
The most common cause of relative adrenal insufficiency ?
Septic shock
224
What is an indication for steroid replacement
Septic shock refractory to volume resuscitation and vasopressor therapy
225
What are the first line drugs to treat non-neuropathic pain in critically ill patients?
IV opioids
226
For management of neuropathic pain what 2 medications?
Gabapentin
| Carbamezipine
227
What should be considered for postoperative analgesia in patients undoing AAA surgery or management of RIB FRACTURES?
Thoracic Epidural anesthesia/analgesia
228
When is nonopioid analgesia indicated?
Should only be considered only to decrease the dose of opioids used and decrease the opioid related side effects
229
What is the most common side effect of nitrate treatment
Headache.
230
Most common side effect of Beta-blocker therapy
Fatigue and insomnia
231
What are contraindications to beta blockers? (less obvious listed first)
***Sick Sinus Syndrome
***Uncontrolled CHF
Severe reactive airway disease
2nd- 3rd degree AVB
Severe Bradycardia
232
What are Relative contraindications to beta blockers?
DM , may mask s/s of hypoglycemia
233
Pt post cardiac transplantation most common of cause of early death?
Opportunistic infection as a result of immunosuppressive therapy
234
2 factors are associated with the development of AS-->
First --> process of aging --> Calcification and degeneration of aortic leaflets
Second --> Bicuspid aortic valve.
235
What is the most common form of valvular heart disease?
MVP
236
What is the most common metabolic disorder seen in newborns and young infants?
Hypoglycemia
237
Dysfunction of the serratus anterior muscle and winging of the scapula are consistent with injury to the
long thoracic nerve.
238
What is considered the gold standard in evaluating cardiac function and volume status?
Esophageal doppler monitoring
239
According to ASTM standards, what is the minimum FiO2 a self-inflating manual resuscitator should be able to deliver when connected to an oxygen source?
40%
240
what 2 parts of the nephron participate in aldosterone-mediated sodium reabsorption?
The late, distal convoluted tubule and the cortical portion of the collecting tubule
241
When the amount of sodium chloride passing by the macula densa drops (such as a drop in blood pressure), the macula densa cells produce two major effects:
1. They decrease the resistance to blood flow in the afferent arterioles
2. They stimulate the JG cells to release renin.
242
What is the role of the macula dense? where does it do the job?
The macula densa cells sense the amount of sodium chloride in the DISTAL TUBULE (DenseD)
243
Renin release results in the constriction of the _______ arterioles which helps do what? The feedback mechanism can maintain constant GFR between pressures of _____and ______
efferent arterioles which helps increase glomerular filtration. This feedback mechanism can maintain a relatively constant glomerular filtration rate between pressures of 50 and 180 mmHg
244
Correct sequence of vessels as they enter and pass through the renal circulation?
Lobar artery, Interlobar artery (LI-Lobar Alobu_
| Arcuate artery, interlobular artery
245
What is the most serious complication associated with the withdrawal of barbiturates?
Grand mal seizures
246
The normal response to the increased venous return in the Trendelenburg position is ______and ________-why?
vasodilation and a decrease in the heart rate due to baroreceptor reflex stimulation.
247
Hyperthyroidism on Hemoglobin and platelet?
Anemia AND thrombocytopenia
248
Characteristics of G-protein receptors include
Modulation of ligand channels
Activation of adenylyl cyclase
Act. PHOSPHOLIPASE C. (MAPI)
Inhibition of adenylyl cyclase
249
The principal indication for CARDIAC TRANSPLANTATION in adults and children is
Dilated cardiomyopathy
250
What are the two major capillary systems in the renal circulation?
The glomerular and peritubular capillary systems
251
Depolarizing agents work at the end plate and desensitize the channel to which they bind. At what type of receptor does this occur? On what type of voltage-gated channel does this take place?
Nicotinic, potassium voltage-gated channel
252
The most common reason for reintervention following an endovascular aneurysm repair.
Endoleak
253
Which calcium channel blocker produces the greatest amount of coronary artery dilation?
Nicardipine
254
The most sensitive factor of the effect of obesity on pulmonary function is the.
Expiratory reserve volume
255
Those diuretics produce mild hyperchloremic metabolic acidosis.
Carbonic anhydrase (Acetazolamide)
256
What are the first substances that begin to accumulate in the plasma as renal failure progresses? (select two)
Urea
| Creatinine
257
The half-life of morphine is prolonged in neonates (6 to 9 hours). The elimination half-life decreases to adult values by what age?
4-6 months. The clearance and elimination of morphine is age-dependent. The clearance of morphine is reduced during the neonatal period and increases with increasing age but there is significant inter-individual variability. Most studies suggest total body morphine clearance is 80% that of adult values by 6 months of age.
