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NCE Review Material > APEX > Flashcards

APEX Flashcards

1
Q

What lung volume increases with aging?

A

Residual Volume

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2
Q

What are usually the first signs of PE?

A

A precipitous fall in EtCO2 and tachycardia

also hypotension, bronchospasm

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3
Q

What are the treatment options for PE?

A
  • Immediate treatment is 100% FiO2 and hemodynamic support with IV fluids and inotropes
  • The pulmonary embolectomy or thrombolysis if needed
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4
Q

What is an indication for retrograde Intubation?

A

Cervical Spine Injury

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5
Q

What is the most reliable method to reduce postoperative pulmonary complications?

A

Smoking Cessation

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6
Q

Anesthetic management of patient undergoing surgery for Bullae removal?

A
  • Spont. Ventilation till the chest is open
  • Small TV with high RR
  • Avoid N2O
  • DLT preferred
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7
Q

What are the 4 nerves involved in the airway?

A

Glossopharyngeal
RLN
Internal SLN
External SLN

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8
Q

What happens to the airway if the vagus nerve is damaged?

A

Unilateral: hoarseness

B/L: Aphonia

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9
Q

What happens to the airway if the external branch of the SLN is damaged?

A

Unilateral: Minimal effects

B/L: Hoarsness/easily fatigued voice

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10
Q

What happens to the airway if the Internal branch of the SLN is damaged?

A

Sensory only NO effect on vocal cords

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11
Q

What happens to the airway if the RLN is damaged?

A

Unilateral: Hoarsness

B/L: Stridor, Dyspnea (acute injury), aphonia (Chronic injury)

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12
Q

What are the sizes of LMA based on weight?

A 
LMA 1 = <5kg
LMA 1.5 = 5-10 kg
LMA 2.0 = 10-20 kg
LMA 2.5 = 20-30 kg
LMA 3.0 = 30-50 kg
LMA 4.0 = 50-70 kg
LMA 5.0 = 70-100 kg
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13
Q

What are the respiratory changes that occur with inadequate pain management?

A
  • Decreased VC, TV, TLC, & FRC

- Decreased ability to clear secretions

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14
Q

Where is the inspiratory pacemaker?

A

The DRG

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15
Q

What is primarily responsible for causing active exhalation?

A

The VRG

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16
Q

What area triggers inhalation?

A

The Apneustic center (stimulations the DRC)

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17
Q

What area triggers the end of inhalation?

A

The pneumotaxic center

Inhibits the DRC

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18
Q

What is the AFFERENT limb of the oculocardiac reflex?

A

Long and short ciliary nerves > ciliary ganglion > ophthalmic division of the trigeminal nerve > Gasserian ganglion

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19
Q

What is the initial dose for cardio version of A-Fib?

A

50-100 Joules

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20
Q

How long to delay elective surgery for drug eluting stent?

A

6 Months

bare metal stent minimum 30 days

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21
Q

Formula for MAP?

A

1/3 SBP + 2/3 DBP

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22
Q

What drugs do not affect SSEP’s?

A

Ketamine, precedex, etomidate, opioids, and droperidol

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23
Q

VAA most affected by right to left shunt?

A

Desflurane (low solubility 0.42)

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24
Q

What are the components of LA?

A
  • Aromatic ring: confers lipid solubility
  • Intermediate chain: determines metabolism and allergic potential
  • Tertiary amine: confers water solubility
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25
Q

What effect does Mu receptor activation have on the nerves in the dorsal horn?

A
  • Inhibits adenylyl Cyclase > Dec cAMP
  • Presynaptic nerve: Decreased CA conductance > decreases neurotransmitter release
  • Postsynaptic Nerve: Increase K-conductance hyper polarizes the cell
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26
Q

List the events that correlate with 50, 60, 70, and 80% blockade

A
  • 80%: TV > 5mL/kg
  • 70%: TOF 4/4
  • 60%: Double burst w/o fade
  • 50%: Bite tongue blade for > 5 seconds
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27
Q

Only narcotic that is known to prolong QT interval?

A

Methadone (Can cause torsades)

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28
Q

How to calculate width of BP cuff?

A

40% of the circumference

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29
Q

What happened if the BP cuff is too small? too big?

A
  • Too small: false high

- Too big: false low

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30
Q

What does Near Infrared Spectroscopy (NIRS) measure?

A

Near Infrared Spectroscopy (NIRS) measure cerebral venous oxygen saturation
- limitations: only measures regional saturation (prefrontal cortex) and is not useful for global ischemia

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31
Q

Airway complication seen with adenosine?

A

Bronchospasm (especially in asthmatics)

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32
Q

Draw the SODA LIME reaction

A

1) CO2 + H2O H2CO3
2) H2CO3 + NaOH –> Na2CO3 + H2O + heat
3) Na2CO3 + Ca(OH)2 CaCO3 + NaOH

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33
Q

The only CCB that has been proven to reduce the risk of morbidity and mortality from cerebral vasospasm?

A

Nimodipine

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34
Q

How do changes in PaCO2 affect cerebral blood flow?

A

For every 1 mmHg change in PaCO2 from 40 mmHg, CBF changes in the same direction by 1-2 mL/100g/min

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35
Q

What factors increases the risk of ischemic optic neuropathy in patients undergoing spinal surgery?

A
  • Low ratio of colloid to crystalloid resuscitation
  • Greater estimated blood loss
  • Use of a Wilson frame
  • Male sex
  • Obesity
  • Long duration of anesthesia
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36
Q

What is the timeframe for decompression of spinal hematoma?

A

Within 8 hours

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37
Q

What are the signs of spinal hematoma?

A

Bowel or Bladder dysfunction
Lower extremity weakness
Lower Ext. sensory deficit
Back Pain

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38
Q

List the brachial plexus cords and the nerves they give rise to

A

1) Medial cord -> ulnar nerve
2) Medial + Lateral -> median nerve
3) Posteror cord -> Radial Nerve

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39
Q

Needles with highest risk of PDPH

A

Quincke and Pitkin

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40
Q

Analgesia from lipophilic opioids

A

most likely through systemic actions (aka fentanyl and sufentanil)

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41
Q

Sensation to the webbed space between the thumb and index finger is through what nerve?

A

Radial nerve

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42
Q

Formula to determine amount of BiCarb to administer to arrive and desired HCO3 level

A

(Change in HCO3 x kg x 0.3)/2

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43
Q

What are some common causes in intraoperative hypocalcemia?

A

Hyperventilation

Administration of pRBC

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44
Q

Rapid correction of hyponatremia may result in

A

Central Pontine Myelinolysis

  • Demyelination of neurons
  • Spastic quadrioaresis (demyelination fo motor neurons), psudobulbar pasly, mental dysfunction, and death
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45
Q

What are the S/S of hypercalcemia?

A

HTN

Hypotonia

SHORT QT interval

Polyuria

Dehydration

Cognitive dysfunction

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46
Q

What are indicators of liver synthetic functions?

A

PT

INR

Albumin

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47
Q

What are indicators of hepatocellular injury?

A

AST

ALT

GST

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48
Q

What are indicators of cholelithiasis?

A

Y-Glutamyl Transpeptidase (GGTP)

Alkaline phosphatase

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49
Q

What is the dose for mannitol?

A

0.25-1 g/kg

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50
Q

How does a carcinoid crisis present?

A

Flushing, diarrhea, HTN or Hypotension, ABD Pain, Tachycardia

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51
Q

What drugs can precipitate a carcinoid crisis?

A

Succ, Atracurium, Thiopental, Epinephrine, NE, or Iosproterenol

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52
Q

Medications that are useful in the management of carcinoid tumors?

A

Ondansetron and Ocreotide

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53
Q

Why do we decrease the dose of etomidate in the elderly?

A

Decreased Vd and clearance

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54
Q

What is the onset time for postoperative delirium?

A

1-5 days post op

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55
Q

Anterior wall defect that is commonly associated with other defects

A

Oomphalocele

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56
Q

Gastroschisis is most common in

A

Prematurity

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57
Q

Areas assessed during aldrete scoring

A 
Activity
Neurologic Status
O2 Saturation
Respiration
Circulation
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58
Q

A non-painful stimulus that evokes a painful response

A

Allodynia

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59
Q

An exaggerated pain response

A

Hyperalgesia

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60
Q

Pain localized to a dermatome (peripheral nerve)

A

Neuralgia

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61
Q

An abnormal painful sensation

A

Dysesthia

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62
Q

What is the formula for BMI

A

kg/m2

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63
Q

Antitumor antibiotics

A

Bleomycin and Doxorubicin

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64
Q

What are the nerve roots of the celiac plexus?

A

T5-T12

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65
Q

Side effects from celiac plexus block?

A

Hypotension (Most common)
Diarrhea
Bowel, Kidney, Puncture
Retroperitoneal hemorrhage

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66
Q

Most common cause of intraoperative allergic reaction?

A

Muscle relaxant

latex second most common

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67
Q

A circumstance that won’t benefit from supplemental oxygen

A

Pulmonary edema (right to left shunt

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68
Q

List the 5 causes of arterial hypoxemia

A

1) Low FiO2- high Altitude
2) Hypoventilation- Opioid overdose
3) Diffusion impairment - Pulmonary fibrosis
4) V/Q Mismatch- COPD
5) Shunt- Pulmonary Edema

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69
Q

Examples of acute intrinsic restrictive disease

A

Pulmonary edema
Aspiration Pneumonia
ARDS

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70
Q

Examples of Chronic intrinsic restrictive disease

A 
Idiopathic Pulmonary Fibrosis
Radiation Injury
Cytotoxic Drug
Oxygen toxicity
sarcoidosis
autoimmune disease
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71
Q

When is it recommended to redose a citrated antacid

A

1 hour after 1st dose

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72
Q

What is the formula for PAO2? PaO2

A
  1. )PAO2 = FiO2 x (Pb x 47 mmHg) - (PaCO2/0.8)

2. ) PaO2 = PAO2 - A-a Gradient

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73
Q

What axis must be aligned for intubation

A

Oral
Pharyngeal
Laryngeal

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74
Q

DLT insertion depth

A

29 cm in males

27 males in females

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75
Q

MOA of A2 agonist

A

GPCR (Gi) inhibit adenylate cyclase and therefore cAMP

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76
Q

When do we see pulses biserfiens

A

Aortic regurgitation

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77
Q

Pulsus alternans is seen with

A

Systolic left ventricular failure

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78
Q

pulses parvus is seen with

A

aortic stenosis

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79
Q

What INCREASES after infrarenal cross clamp placement?

A

Preload,

Mixed venous O2 saturation

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80
Q

How to identify the VAA based on the organic molecule structure?

A

Sevo: 7 fluoride
Des: 6 fluoride
Iso: 5 fluoride
Halothane 3 fluoride, 1 Cl, 1 Br

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81
Q

Clearance is inversely proportional to

A
  • Half-Life

- Concentration in the central compartment

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82
Q

Drugs to avoid in patients with porphyria

A

All barbs and etomidate

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83
Q

Consideration for patients with Acute Intermittent porphyria

A

Liberal hydration
Glucose supplementation
Prevention of hypothermia

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84
Q

CV changes of N2O

A

(it affects the SNS)

Increased SVR, BP and HR

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85
Q

N2O inhibits what pathway

A

Methionone synthase: B-12 metabolism and DNA synthesis

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86
Q

What enzyme is inhibited by etomidate?

A

11-beta- hydroxylase (inhibits stereos synthesis)

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87
Q

What drug is the most potent amnestic?

A

Lorazepam

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88
Q

Order the opioids based on context sensitive half lives

A

Fentanyl (Longest) > Alfentanil > Sufentanil > remifentanil (Shortest)

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89
Q

What muscle is monitored when evaluating twitches from the ulnar nerve?

A

Adductor Pollicis

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90
Q

Components of EMLA cream

A

2.5% prilocaine and 2.5% lidocaine

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91
Q

Time for onset with EMLA

A

60 minutes

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92
Q

Rank the speed of LA absorption after injection based on speed

A

Interplerual > Intercostal > Caudal > Brachial plexus

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93
Q

List the hydrophilic opioids

A

Morphine, meperidine, hydrocodone

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94
Q

List the Lipophilic opioids

A

fentanyl, sufentanil

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95
Q

Describe mass spectrometry

A

bombards the gas sample with electrons

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96
Q

Describe Raman Scatter Spectrometry

A

uses a high powered argon laser to produce photons; scattered photons are then measures

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97
Q

Describe the use of piezoelectric crystals

A

detects individual gases by their interaction with a lipid bilayer crystal

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98
Q

How to calculate TV for a machine that couple FGF

A

1) convert FGF to mL/min
2) FGF x fraction spent in inspiration [using I:E; I/(I+E)]
3) divide anger by RR
4) add value to set TV

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99
Q

Best ECG lead for rhythm abnormalities

A

Lead II

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100
Q

Where is CSF reabsorbed

A

in the arachnoid villi of the saggital sinus

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101
Q

CSF production rate in the choroid plexus

A

30 mL/hr

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102
Q

Classic presentation of autonomic hyperreflexia

A

HTN and Bradycardia

  • Vasoconstriction below lvl of injury
  • Vasodilation above lvl of injury
  • LV failure may lead to Pulmonary edema
  • Cerebral HTN may lead to seizures
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103
Q

Diseases that increase the risk of MH

A

Central core Disease
Minicore disease
King Denborough Syndrome

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104
Q

Sensory innervation of the median nerve is to what part of the hand?

A

1) Palm of hand
2) Ventral region of the thumb
3) Distal index, middle, and medial half of the ring finer

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105
Q

Triggers for a sickle crisis

A

Pain
hypothermia
acidosis
dehydration

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106
Q

What is non gap acidosis

A

Due to loss of HCO3 (or increased Cl)

- Examples diarrhea, renal tubular acidosis, excessive sodium chloride administration

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107
Q

The triad for metabolic syndrome

A

HTN, Obesity, DM

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108
Q

What are the hormones released from the POSTERIOR pituitary gland?

A

ADH and oxytocin

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109
Q

What are the hormones released from the ANTERIOR pituitary gland?

A

FLAT PiG

  • Follicle stimulating hormone (FSH)
  • Leuteinizing Hormone (LH)
  • Adrenocorticotropic hormone (ACTH)
  • Thyroid Stim. Hormone (TSH)
  • Prolactin
  • Growth Hormone (GH)
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110
Q

Hypoadrenalism is also known as?

A

Addisons disease

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111
Q

What are the anesthetic considerations for patients with hypothyroidism?

A
  • Airway compromise (ex. goiter)
  • Hypothermia
  • Hypotension
  • Aspiration (D/t gastric emptying)
  • Faster VAA induction
  • NO effect on MAC
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112
Q

What is the function of gastrin?

A

stimulates pepsinogen secretion

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113
Q

What is the function of secretin?

A

Stimulates bile flow

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114
Q

What is the function of Motilin?

A

Stimulates upper GI motility

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115
Q

MAC requirements in a full term parturient

A

Reduced by 40%

116
Q

Formula to convert C to F

A

F = (C x 1.8) + 32

117
Q

What is Samters Triad?

A

Asthma
Nasal Polyps
ASA intolerance

118
Q

Antiemetics that prolong QT interval

A

Droperidol and ondansetron

119
Q

Crossing the legs puts which nerves at risk of damage

A

Sural and superficial peroneal

120
Q

How long to avoid N2O after retinal detachment surgery based on compound used

A

Silicone oil: 0 days

Air bubble: 5 days

Sulfurhexafluoride: 10 days

121
Q 
What is the twitch response for the following nerves:
Femoral N.
Obturator n
Tibial n.
peroneal n.
A

Femoral n: patellar twitch
Obturator: adductor twitch
Tibial: plantar flexion
Peroneal: dorsiflexion

122
Q

What are the physiologic consequences of a pneumoperitoneum?

A
  • Increased MAP
  • CO no change or decrease
  • Increased A-a gradient
  • ICP and CPP increased
  • Renal and hepatic BF decreased
123
Q

What is the formula for arterial oxygen content (CaO2)?

A

CaO2 = (SaO2 x HgB x 1.34) + (PaO2 x 0.003)

124
Q

What are the risk factors for difficult mask ventilation?

A 
Beard
BMI > 26
Snoring
Lack of Teeth
Age > 55 years
125
Q

Max inflation pressure for a classic LMA

A

60 PSI

126
Q

How many O2 molecules are carried by fully saturated Hgb

A

4 molecules O2 (8 atoms)

127
Q

What is the Debakey classification?

A
  • Type I: ascending and descending aorta
  • Type II: Ascending
  • Type III: Descending
128
Q

What is the stanford classification?

A

Type A: ascending aorta with or w/e descending

Type B: descending only

129
Q

What is the crawford classification?

A

I-V involve the thoracoabdominal aorta

130
Q

What is the word for pupil dilation?

A

Mydriasis (Has a D for dilation)

131
Q

How does MAP change as you move above or below the heart?

A

2 mmHg per INCH

0.74 mmHg per CM

132
Q

Gases that exist as liquids in a cylinder

A

CO2 (pp 838 psi)

N2O (pp 745 psi)

133
Q

MOA of Class I - IV antiarrhythmics

A
  • Class I: inhibits fast sodium channels (phase 0)
  • Class II: Decreases rate of depolarization (BB Blocking effect)
  • Class III: Inhibits potassium channels ( prolongs depolarization)
  • Class IV: Inhibits slow calcium channels (Shortens duration of action potential)
134
Q

Anesthetic considerations for a patient with MS

A

1) Spinal anesthesia can exacerbate symptoms
2) Hyperthermia exacerbates weakness
3) Succ can cause hyperkalemia d/y upregulation of exntrajunctional receptors
4) Steroids are useful

135
Q

list the ADP inhibitors and the days before surgery to discontinue

A

Clopidrogel (7 days)
Ticagrelor (1-2 days)
Prasurgel (2-3 days)
Toclopidine (14 days)

136
Q

Types of laser that causes retinal damage

A

Nd: YAG, Ruby, Argon

penetrate deep/short wave

137
Q

Types of laser that causes corneal damage

A

CO2 Laser

Long wave/ shallow penetration

138
Q

Provides innervation to the abdominal viscera

A

Celiac Plexus (except left side of the colon)

139
Q

Provides innervation to the pelvic organs

A

Superior Hypogastric Plexus

140
Q

What is the cause of radial nerve injury?

A

Caused by external pressure on the spiral groove of the humerus (results in wrist drop)

141
Q

Nerve that is most likely to be damages do to compression against a perineal post of the ortho table

A

The pudendal nerve

142
Q

What causes dysesthesia

A

Diabetic Neuropathy

143
Q

What is the normal CO2 production

A

200mL/min

144
Q

What biomarkers are released from infarcted myocardium

A

CKMG (shortest 1/2 life)
Troponin T
Troponin I

145
Q

Subclavian steal syndrome refers to

A

The reversal of flow through the vertebral artery

146
Q

Clearance is directly proportional to

A

Drug dose
extraction ratio
Blood Flow to clearing organ

147
Q

Clearance is indirectly proportional to

A

Half-Life

Concentration in central compartment

148
Q

In what patients do we see INCREASED pseudocholinesterase activity?

A

Alcoholism
Obesity
Thyrotoxicosis

149
Q

In what patients to avoid tramadol

A

Patients with seizure disorder

150
Q

What NMB’s release histamine

A

Succ
Miv
Atra

151
Q

LA’s by duration of action

A
  • Short: Procaine, Chloroprocaine
  • Intermediate: Mepivicaine, Lidocaine
  • Long: Bupi, Ropi, Tetracaine
152
Q

List the opioids and their relative potency when compared to morphine

A 
Meperidine 0.1x
Morphine 1x
Hydromorphone 1.4x
Alfentanil 10x
Fentanyl 100x
Remifentanil 100x
Sufentanil 1000x
153
Q

Artery that perfuses the language centers of the brain

A

The LEFT MCA

154
Q

List the terminal branches of the brachial plexus and the roots that contribute to them

A 
MARMU
Musculocutaneous: C5-C7
Axillary: C5-C6
Radial: C5-T1
Median: C5-T1
Ulnar C8-T1
155
Q

What is blocked by the Psoas compartment block

A

Lumbar Plexus

156
Q

What are the treatment options for opioid induced pruritus?

A

Ondansetron
Propofol
Naloxone

157
Q

List the steroids with their relative potency compared to cortisol

A 
Aldosterone (3000x)
Fludrocortisone (250x)
Cortisol (1x)
Prednisone (0.8x)
Methylprednisolone (0.5x)
158
Q

How to calculate EBV of pediatric patients?

A

Premature: 90-100 mL/kg
Term: 80-90 mL/kg
Infant: 75-80 mL/kg
>1 year: 70-75 mL/Kg

159
Q

What is CHARGE association?

A 
C- Colomboa
H- Heart Defect
A- Choanal Atresia
R- Retardation of growth and development
G- Genitourinary Problems
E- Ear Anomalies
160
Q

What is CATCH-22?

A 
C- Cardiac Defects
A- Abnormal face
T- Thymic Hypoplasia
C- Cleft Palate
H- Hypocalcemia
22- 22q11.2 gene deletion
161
Q

What is the defibrillation energy setting in pediatrics?

A 
1st = 2 J/kg
2nd = 4 J/kg
3rd= 4-10 J/kg
162
Q

Common SSRIs

A

Sertraline, Paroxetine, Fluoxetine

163
Q

What are the two causes of Angioedema?

A

ACEi

C1-Esterase Deficiency (hereditary)

164
Q

Conditions that increase the risk of LVOT in patients with hypertrophic cardiomyopathy

A

Decrease Preload
Decrease Afterload
Increased HR
Increased Contractility

165
Q

What correlates with the S1 heart sound

A

Closure of Mitral Valve

166
Q

Suggamadex affinity for NMB

A

Roc>Vec>Panc

167
Q

List the synthetic opioids based on context-sensitive half life

A

Fentanyl > Alfenanil > Sufentanil > Remifentanil

168
Q

Drugs that increase DOA of Succinylcholine

A 
Neostigmine
Echothiopate
Reglan
Esmolol
Oral Contraceptives
Cyclophsphamide
169
Q

Which opioid is resistant to reversal with Naloxone

A

Buprenorphine: high affinity for Mu and is slow to dissociate

170
Q

Indications for percutaneous pacemaker

A

3rd degree Block
Long QT syndrome
Hypertrophic obstructive cardiomyopathy
SA or AV node disease

171
Q

Symptoms of spinal (Neurogenic) shock

A
  • Resp. Failure
  • Bradycardia
  • Hypothermia (Dec SNS Output)
  • Hypotension (Dec SNS tone)
172
Q

What is the first sign of MH in spontaneous ventilating patient?

A
  • Increased Minute vent (Tachypnea)
  • tachycardia
  • Masseter Spasm
  • Warm Soda Lime
  • Dysrhythmias
    (muscle rigidity and Hyperthermia are late signs)
173
Q

Consequences of respiratory alkalosis

A 
Dec Ionized Ca
Dec P50
Dec Coronary BF
Dec PVR
Dec K
174
Q

Gap acidosis results from

A 
Accumulation of Acid
MUDPILES
- Methanol
- Uremia
- Diabetic Ketoacidosis
- Paraldehyde
- Isoniazid
- Lactate (Sepsis/Cyanide)
- Ethanol
- Salicylates
175
Q

Complications from administration of triamcinolone

A
  • Skeletal muscle weakness

- anorexia and sedation

176
Q

List some glucocorticoids

A

Dexamethasone

Betamethasone

177
Q

EPI dose for neonates

A

0.01-0.03 mg/kg

178
Q

list the methods of heat loss from most significant to least

A

Radiation
Convection
Evaporation
Conduction

179
Q

What are some things that inhibit HPV

A 
Hypothermia
Vasodilators
VAA at 1.5 MAC
PDEI
Hypervolemia
Hemodilution
Excessive PEEP
Large TV
Alkalosis
180
Q

What lung volumes increase with emphysema

A

FRC

RV (D/t gas trapping)

181
Q

What is a cobb angle?

A

A measure of the curvature of the spine in scoliosis.

  • An angle >40-50 is a indication for surgery
  • Scoliosis leads to restrictive disease
182
Q

Second line therapy for patient with vasoplegic symptoms who has been on ACE

A

Vasopressin

Methylene Blue

183
Q

Why are they called WHITE rami

A

b/c they are myelinated

- Preganglionic sympathetic fibers

184
Q

What are the symptoms of Horner syndrome?

A

Very Horny PAM:

  • Vasodilation
  • HORNER
  • Ptosis (eye drooping)
  • Anhydrosis
  • Miosis (Pupil constriction)
185
Q

What are the symptoms of Becks Syndrome?

A

Anterior Spinal Artery Syndrome:

  • Flaccid Paralysis of the LE
  • Bowel & Bladder Dysfunction
  • Loss of Temp & Pain
  • Preserved touch & proprioception
186
Q

Anesthetic maintenance of Aortic stenosis?

A 
Increase preload
slightly increase afterload
slow/normal hr
normal contractility
NSR
187
Q

When does the S3 heart sound occur?

A

After AV closure (and MV Open) on the PV loop

- aka a gallop rhythm suggestive of heart failure

188
Q

What is the order of the arteries that arise from the Aortic Arch?

A

1) LT & RT coronary artery
2) Innominate
3) LT common Carotid
4) Left Subclavian

189
Q

What is the MOA of buprenorphine?

A

Partial Mu Agonist

190
Q

How to calculate the MAC of Desflurane at a given altitude

A

MAC = 50.16 mmHg/ Altitude mmHg

191
Q

What is another Cobalamin?

A

Vitamin B12 deficiency

192
Q

What are some cause/risk factors for Cobalamin

A

Pernicious Anemia
Alcoholism
Strict Vegan Diet
Recreational use of N2O

193
Q

Which electrolyte imbalance will have an effect on MAC?

A

Sodium

194
Q

List some CYP inhibitors?

A

Grapefruit juice
Erythromycin
Ketoconazole

195
Q

List the drugs that act on the NMDA receptor?

A 
Ketamine
Xenon
N2O
Dextromethorphan
Methadone
Magnesium
196
Q

Which enzyme is induced by etomidate?

A

ALA synthase

- Avoid in patient with acute intermittent porphyria (or any porphyria)

197
Q

Which enzyme is inhibited by Etomidate?

A

11-beta-hydroxylase

198
Q

What are the Mu-1 effects?

A 
Analgesia
Bradycardia
Euphoria
Low abuse potential
Miosis
Hypothermia
Urinary retention
199
Q

What are the Mu-2 effects?

A

Analgesia (Spinal only)
Respiratory depression
Constipation
Physical dependence

200
Q

What are the Mu-3 effects?

A

Immune suppression

201
Q

What are the excitatory pain modulating systems?

A 
Substance P (NK-1 & NK-2)
Glutamate (NMDA & AMPA)
202
Q

What are the inhibitory pain modulating systems?

A

NE (Apha-2)
Glycine (Cloride Linked Glyr)
Serotonin (5HT3)
Enkephalin (Mu, Delta)

203
Q

Things that increase risk of LAST?

A 
Higher lipid solubility
Hypercarbia
Hyperkalemia
Amide LA
Metabolic Acidosis
Acidosis (increases free fraction)
204
Q

Measures regional cerebral blood flow velocity

A

Transcranial doppler

205
Q

Measure global oxygenation of the brain

A

Jugular Oximetry

206
Q

What is the FiO2 for different flow rates via nasal cannula

A 
Rule of 4
1 L/min = 24%
2 L/min = 28%
3 L/min = 32%
4 L/min = 36%
5 L/min=  40%
6 L/min = 44%
207
Q

Maximum allowable exposure to halogenated agents with and without N2O?

A
  • Halogenated agents 2ppm

- Halogenated agents + N2O 0.5 & 25 ppm

208
Q

Order the mapelson systems based on use for spontaneous ventilation

A

Best A > DFE > CB

209
Q

Order the mapelson systems based on use for controlled ventilation

A

Best DFE > BC > A

210
Q

Effect of a hyperbaric chamber on FGF

A

FGF will be less than indicated

211
Q

which tract is affected by NMB

A

Corticospinal tract

212
Q

The dorsal column is responsible for what?

A

Fine touch and proprioception

213
Q

The spinothalamic tract is responsible for

A

Pain and temperature

Inlcudeds the tract of Lissaur

214
Q

Ataxic breathing is characterized by

A

Irregular rate and TV

- injury to medulla

215
Q

Apneustic breathing is characterized by

A

Prolonged pause at the top of inspiration

- injury to PONS

216
Q

Kussmauls breathing is characterized by

A

Fast and deep breaths

- Metabolic acidosis

217
Q

Cheyne-Stokes breathing is characterized by

A

Rhythmic pattern where Vt becomes progressively gets later then smaller follows by apnea (Torsades pattern)
- Injury to cerebral hemispheres

218
Q

List the methods to block the brachial plexus and what part of the plexus they target

A
  • Interscalene: Roots
  • Supraclavicular: Trunks/Divisions
  • Infraclavicular: Cords
  • Axillary: Terminal Branches
219
Q

List the Epi concentrations

A

(everything before the “,” is equal to diluent volume)

  • 1:1,000: 1mg/ml = 1000mcg/ml
  • 1:10,000: 1mg/10mL = 100mcg/mL:
  • 1: 100,000: 1mg/100mL = 10 mcg/mL
  • 1: 200,000: 1mg/200mL = 5 mcg/mL
  • 1: 400,000: 1mg/400mL = 2.5 mcg/mL
  • 1:1,000,000: 1mg/1000mL = 1 mcg/mL
220
Q

What effects do anesthesia have on glucose?

A

Improve glucose utilization

Decreased Gluconeogenesis

221
Q

Blocks that provide complete anesthesia for a knee arthroplasty

A

Sciatic and femoral

222
Q

How does pH change when PaCO2 changes?

A

Acute respiratory. acidosis:
- 0.08 decrease for every 10 mmHg increase in PaCO2

Chronic Respiratory Acidosis:
- 0.03 decrease for every 10 mmHg increase in PaCO2

223
Q

HCT level that is life-threatening

A

60%

224
Q

What is the treatment for thyroid storm?

A

The for B’s

  • Block synthesis (Methimazole, PTU, Carbimazole, Potassium Iodide)
  • Block release (radioactive iodine, potassium iodide)
  • Block T4 - T3 conversion (PTU, Propranolol)
  • Beta Blocker (Esmolol, Propranolol)
225
Q

Large tongue syndromes

A

Big Tongue

  • Beckwith Syndrome
  • Trisomy 21
226
Q

Small underdeveloped middle syndromes

A

Please Get That Chin

  • Pierre Robin
  • Goldenhar
  • Treacher Collins
  • Cri Du Chat
227
Q

Congenital conditions with issues concerning the Cervical spine

A

Kids Try Gold

  • Klippel Fleil
  • Trisomy-21
  • Goldenhar
228
Q

PO dose for midazolam in pediatrics

A

0.25-1 mg/kg

229
Q

PO dose for ketamine in pediatrics

A

5-10 mg/kg

230
Q

PO dose for precedex in pediatrics

A

2-5 mcg/kg

231
Q

Defects that cause right to left shunt

A

The 5 T’s (CYANOTIC defects)

  • TOF
  • Transposition great arteries
  • Tricuspid Valve abnormality (Ebstein Anomaly)
  • Truncus arteriosus
  • Total anomalous pulmonary venous connection
232
Q

What is the most common left to right shunt

A

VSD (ACYANOTIC defect)

233
Q

Pediatric factors that contribute to rapid desaturation?

A

Increased O2 consumption
liable ribs
- leads to decrease lung volumes

234
Q

What is the most significant method of heat loss in the neonate?

A

radiation (wrap the patient in warm blankets & use radiant heat lamps)

235
Q

Temperature for therapeutic hypothermia after cardiac arrest

A

32-34 degrees C for 12-24 hours

236
Q

Class of drugs that don’t require dose adjustment in the elderly

A

NMB’s

237
Q

What is the most common comorbidity in sickle cell patients?

A

Asthma

238
Q

Which approach to the brachial plexus has the highest incidence of pneumothorax?

A

Supraclavicular

239
Q

What is the standard of care for monitoring VAE?

A

EtCO2

Precordial doppler

240
Q

AST/ALT ratio that indicates significant disease

A

> 2

241
Q

What electrolyte abnormalities are associated with a prolonged QT Interval ?

A

Hypocalcemia
Hypokalemia
Hypomagnesemia

242
Q

Between what pressures is CPP auto regulated?

A

50-150 mmHg

  • below 50: Maximally dilated and pressure dependent
  • Above 150: Maximally constricted and flow dependent
243
Q

At what MAC are awareness and recall prevented?

A

0.4-0.5 MAC

244
Q

Distal muscle weakness that ascends is a sign of

A

Guillain-Barre Syndrome

245
Q

Early signs of myasthenia Gravis

A

cranial nerve dysfunction: ocular, laryngeal, pharyngeal

246
Q

List the TURP solutions and their associated complications

A
  • Glycine: Transient vision loss
  • Sorbitol: Osmotic Diuretic
  • Distilled Water: Hemoglobinuria
  • NaCl 0.9%: Electrocution with Unipolar Cautery (Use Bipolar only)
247
Q

What cuff pressure causes tracheal ischemia?

A

25mmHg (keep at LESS than 25)

248
Q

When does the S1 hear sound occur? S2? S3 & S4?

A

S1: MV/TV closure (AV Valves)
S2: AV/PV closure (Semilunar valves
S3: After AV closure and MV opening
S4: before MV closure

249
Q

What is responsible for halothane hepatitis?

A

Production of trifluoroacetic acid (TFA)

250
Q

List the origin of the cranial nerves

A

Midbrain: 3-4
Pons (Brainstem): 5,6,7,8
Medulla(brainstem): 9,10,11,12

251
Q

A three sided pyramid shaped cartilage of the larynx

A

Arytenoid

252
Q

What are the components of the carotid sheath?

A

Common carotid artery
Internal carotid artery
Internal Jugular vein
Vagus nerve

253
Q

How is oxygen consumption affected by temperature?

A

Decreases by 5-7% per degree C

254
Q

Transient neurologic syndrome is associated with

A

radiating buttock pain

255
Q

Epidural Hematoma is associated with

A

Prolonged motor block with GU dysfunction

256
Q

What is the twitch response for the interscalene block?

A

Biceps contraction
Inward shoulder rotation
- (Hiccups too shallow, contraction of trapezius is too deep)

257
Q

How do you calculate static compliance?

A

TV/(Plateau pressure - PEEP)

258
Q

Why does Acute EtOH intoxication reduce MAC requirements

A

Potentiation of GABA-A receptor

259
Q

What are the SNS effects of Hypercarbia?

A

SNS stimulation

  • Vasoconstriction
  • Inc. Myocardial contractility
  • Inc. Serum Potassium
260
Q

Where do the spinal nerves exit the spinal column?

A

Intervertebral foramen (Between vertebral body and facet joints)

261
Q

What is the most common complication from mediastinoscopy?

A

Hemorrhage

262
Q

At what BIS does burst suppression occur

A

20

263
Q

What part of the Sodium channel do LA’s bind to

A

The Alpha subunit in the open-active and inactivated closed

264
Q

The area of the Thromboelastogram that corresponds with fibrinogen function

A 
K time (beginning of split)
Alpha Angle
265
Q

What is the R Time on the Thromboelastogram?

A

The time till clot formation (The flat line at the beginning)
- Indicates the presence of adequate clotting factors in the plasma

266
Q

What is the MA on the Thromboelastogram?

A

Maximum Amplitude (MA)

  • Measure the strength of a formed clot
  • Availability of sufficient and functional platelets
267
Q

Where do cell bodies of the 1st, 2nd and 3rd order neurons reside?

A

1st: Dorsal root ganglia
2nd: Dorsal Horn
3rd: RAS and Thalamus

268
Q

A vagal stimulus edicts bronchoconstriction via what receptor

A

Muscarinic-3

269
Q

Area of the brain that controls fine movement

A

Basal Ganglia

- Parkinsons affects the substantial nigra of this region

270
Q

Things that stimulate NO release

A
  • Bradykinin
  • Thrombin
  • Acetylcholine release onto M3 receptors in the vascular endothelium
271
Q

How do Mu receptor agonist decrease neural transmission?

A
  • Decrease Ca2+ permeability in the presynaptic terminal

- Increase K+ exit from post-synaptic membrane

272
Q

Facts for Mantoux test

A

Read between 48-72 hours

  • erythema
  • Induration > 10mm or > 5mm in immunocompromised
273
Q

Nerve that supplies the lateral side of the lower extremity below the knee

A

The Common Peroneal

274
Q

Why is succinylcholine contraindicated in patients with ALS

A

Due to risk of Hyperkalemia

275
Q

The only NMBs that can be administered IM

A

Rocuronium and Succinylcholine

276
Q

Another word for excessive saliva

A

Sialorrhea

277
Q

The only lab test to evaluate the efficacy of LMWH

A

anti-X level

278
Q

Side effects from thiazide diuretics

A

Hyperglycemia

Hypercalcemia

279
Q

Vitamin deficiencies seen with bariatric (Malabsorptive) surgeries

A

Vitamin B9 (Folic Acid)
Vitamin B12 (Cobalamin)
Fat soluble vitamins (DAKE)
Iron

280
Q

Signs of excess glucocorticoids from Cushings disease

A
  • Osteoporosis
  • muscle weakness
  • hyperglycemia
  • weight gain
  • mood changes
  • high risk of infection
281
Q

what is the normal motor response of the femoral nerve?

A

Hip Flexion

Knee extension

282
Q

what is the normal motor response of the obturator nerve?

A

Lower Extremity adduction

283
Q

what is the normal motor response of the Common Peroneal nerve?

A

Foot eversion

Dorsal toe extension

284
Q

what is the normal motor response of the sciatic nerve?

A
  • Rotate thigh laterally
  • Abducts thigh when limb is flexed
  • flexes leg
  • extends thigh
285
Q

What is the normal FRC by weight?

A

35 mL/kg

286
Q

List the plasma protein binding of commonly used anesthetics

A 
Propofol= 98%
Precedex = 94%
Midazolam = 94%
Etomidate = 75%
Ketamine = 12%
287
Q

Serotonin release is associated with what physiological response

A

HTN, Bronchoconstriction Flushing, diarrhea

NCE Review Material (8 decks)

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