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APEX > APEX is stupid > Flashcards

APEX is stupid Flashcards

1
Q

when should non-particulate antacid for aspiration prophylaxis be redosed

A

after 1 hr

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2
Q

classes of antiarrythmics

A
  • class I = Na+ channel inhibitors
  • class II = beta blockers
  • class III = K+ channel inhibitors
  • class IV = slow Ca2+ channel inhibitors
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3
Q

number 1 site of breast cancer metastasis

A

bone

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4
Q

AIs of isosulfan blue dye used in mastectomy

A

temporarily decreases SpO2

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5
Q

what is Wegener’s Granulomatosis

A

vasculitis in your nose, sinuses, throat, lungs and kidneys

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6
Q

AIs for Wegener’s Granulomatosis

A
  • granulomas lead to vasculitis in airway, lungs, CNS, kidneys
  • Friable necrotic tissue in airway bleeds easily
  • Tracheal granulomas reduce airway diameter
  • Lung granulomas can cause hypoxemia
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7
Q

risks assoc with Kawasaki disease

musculocutaneous lymph node syndrome

A

coronary artery aneurysm and myocardial ischemia

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8
Q

what is Takayasu’s Arteritis

A

occlusive disease of proximal aorta & branches

Aka pulseless disease, occlusive thromboaortopathy, aortic arch syndrome

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9
Q

what is Thromboangiitis Obliterans

aka Buerger’s disease

A
  • Inflammatory vasculitis
  • ultimately occludes small and medium sized arteries and veins in extremities
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10
Q

most common cause of Thromboangiitis Obliterans

A

smoking
(best treatment: smoking cessation)

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11
Q

how is anatomic Vd increased

A

increased by anything that increases volume of airway conduit

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12
Q

how is alveolar Vd increased

A

increased by anything that reduces pulmonary blood flow

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13
Q

how is physiologic Vd increased

A

dec pulm blood flow, dec CO, PE, COPD, old age, facemask, PPV, HME, neck extension, anticholinergics

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14
Q

how much CO2 does a 70 kg adult produce per hour

A

12 L

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15
Q

normal PaO2 of a healthy 20 yr old vs healthy 70 yr old breathing room air

A

Healthy 20 yr old breathing room air: normal PaO2 is 95 mmHg

Healthy 70 year old breathing room air: normal PaO2 is ~70 mmHg (d/t increased shunt)

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16
Q

most significant concern of Ludwig angina

A

posterior displacement of tongue (complete supraglottic airway obstruction)

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17
Q

Best way to secure airway in pt with Ludwig’s angina

A

awake patient

(awake nasal or awake trach)

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18
Q

how do vasoconstrictors affect PVR

A

increase

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19
Q

indicates greatest impairment of renal function in RIFLE criteria

A

Cr > 5 mg/dL

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20
Q

half lives of factor 7, antithrombin, and fibrinogen

A
  • Factor 7 = 3-6 hours
  • Antithrombin = 48-72 hours
  • Fibrinogen = 71-120 hours
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21
Q

MOA of analgesia with tramadol

A

1) mu > kappa and delta
2) Activation of the descending inhibitory pain pathway in the spinal cord (NE and 5-HT reuptake inhibition)

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22
Q

advantages of tramadol

A
  • Little/no respiratory depression
  • Low abuse potential
  • Low risk of systemic organ toxicity
  • Less delay in gastric emptying
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23
Q

disadvantages of tramadol

A
  • seizures
  • high incidence N/V
  • decreased efficacy when co-admin with zofran
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24
Q

AE of phenylephrine as a neuraxial additive

A

Addition of phenylephrine increases risk of transient neurologic symptoms with tetracaine

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25
Q

NMBs that cause histamine release

A
  • Succs
  • Atracurium
  • Mivacurium
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26
Q

treating pruritis from neuraxial opioids

A
  • Can use narcan or nalbuphine (partial agonist) - won’t reverse analgesia from intrathecal opioids but will reverse IV opioids
  • other treatments: propofol, ondansetron, droperidol?, gabapentin?
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27
Q

1st messenger of nitric oxide in vascular smooth muscle

A

NO

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28
Q

H2 antagonists that inhibit CYP

A

cimetidine
ranitidine
(not famotidine)

can augment warfarin effects and increase bleeding

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29
Q

H2 antagonists that inhibit CYP

A

cimetidine
ranitidine
(not famotidine)

can augment warfarin effects and increase bleeding

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30
Q

AE of prolonged use of mannitol

A

hypokalemic hypochloremic alkalosis

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31
Q

what are mineralocorticoid effects

A

tendency of a steroid to cause retention of Na+ and H2O and excretion of H+ and K+

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32
Q

steroid potency relative to cortisol

A
  • Aldosterone (3000x)
  • Fludrocortisone (250x)
  • Cortisol (1)
  • Prednisone (0.8x)
  • Methylprednisolone (0.5x)
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33
Q

Describes variables that govern laminar flow

A

Poiseulle’s law

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34
Q

traditional flowmeter

A

Thorpe tube

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35
Q

where is internal diameter narrowest in flowmeter

A

at the base and widens along ascent

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36
Q

how does N2O affect IOP

A

Decreases

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37
Q

which anatomic structures must an epidural needle pass through when using paramedian approach

A
  • skin
  • subq tissue
  • paraspinal muscles
  • ligamentum flavum
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38
Q

What solution is recommended as a test dose when using peripheral nerve stimulation-guided nerve blocks?

A

5% dextrose in water

increases current density and either maintains or augments the twitch response to stimulation.

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39
Q

What solution is recommended as a test dose when using peripheral nerve stimulation-guided nerve blocks?

A

5% dextrose in water

increases current density and either maintains or augments the twitch response to stimulation.

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40
Q

What structures are anesthetized when a local anesthetic is injected into the paravertebral space?

A

sympathetic trunk
mixed spinal nerve

41
Q

Peak serum levels of lidocaine after tumescent infiltrations for liposuction occur how many hours after injection?

A

12-14 hours

42
Q

the vertebral canal is smallest at which level

43
Q

When using a nerve stimulation technique in a peripheral nerve block, a motor response at what milliamperes (mA) indicates an acceptable location to iniect local anesthetic?

44
Q

specific effects of EMLA cream on vasculature of skin

A

Vasoconstriction in the first hour after application Vasodilation after 2 or more hours after application

45
Q

A CRNA is performing a spinal anesthetic targeting the L3-4 interspace using a paramedian approach. The introducer tip has been inserted appropriately relative to the palpated L3 surface landmark. Upon introducing the spinal needle, she encounters bone. Which part of the vertebrae has she most likely hit?

A

vertebral lamina

46
Q

which components of brachial plexus pass through scalene muscles

47
Q

max concentrations of lidocaine, mepivacaine, and bupivacaine for PNB infusion

A

lidocaine or mepivacaine = max 1-1.5%
bupivacaine = max 0.125-0.5%

48
Q

measured by transcranial doppler

A

regional cerebral blood flow velocity

49
Q

what is measured by jugular oximetry

A

global oxygenation in the brain (invasive)

50
Q

monitors local oxygenation in the brain

A

NIRS (Cerebral ox)

51
Q

absolute contraindications to low flow anesthesia

A
  • smoke inhalation
  • conditions assoc with increased O2 consumption (MH, thyroid storm)

relative - mask ventilation, uncuffed ETT, rigid bronch

52
Q

key benefit of low flow anesthesia & what population is it used in

A

heat conservation
neonates

53
Q

monitoring of which spinal pathway is affected by NMBs

A

corticospinal tract

54
Q

what is an ataxic resp rate
what does it suggest?

A

irregular rate and Vt
suggests injury of medulla

55
Q

what is an apneustic resp rate
what does it suggest?

A

prolonged pause at the top of inspiration

suggests injury of pons

56
Q

a Hct above what is a threat to life

57
Q

how is dabigatran’s anticoagulant effect reversed

A

idarucizumab

binds with dabigatran and its metabolites with a higher affinity than dabigatran has for thrombin

58
Q

TXA produces antifibrinolytic effect by blocking:

A

plasminogen to plasmin

59
Q

absolute contraindications for ESWL

A
  • pregnancy
  • bleeding disorder
  • anticoagulation

relative - pacemaker/ICD, calcified aneurysm of aorta/renal a., untreated UTI, obstruction beyond stone, morbid obesity

60
Q

best treatment for chronic orthostatic hypotension 2/2 hypoaldosteronism

A

fludrocortisone

61
Q

Hypocalcemia secondary to inadvertent removal of the parathyroid glands during total thyroidectomy is MOST likely to present how many hours after surgery?

62
Q

sensitive clinical indicator of restrictive lung disease

A

increased resting RR

63
Q

2 primary determinants of ESV

A
  • outflow impedance (afterload)
  • ventricular contractility
64
Q

MOA of local anesthetics

A

selectively bind to alpha subunit of Na+ channel in inactivated-closed state and active-open state

65
Q

nerve fiber types that regulate vascular tone

A

B & C fibers

66
Q

risk factors for hypoxemia if transferred to PACU on RA

A

age > 60
weight > 100 kg

67
Q

where are peripheral chemoreceptors located

A
  • carotid bodies (bifurcation & common carotid)
  • aortic bodies (scattered throughout aortic arch)
68
Q

During quiet breathing, the portion of the respiratory system that offers the greatest resistance to airflow is the:

A

mid-sized bronchi

69
Q

What is the anatomic border between the oropharynx and the laryngopharynx (hypopharynx)?

A

epiglottis

70
Q

how does mu agonism decrease neural transmission

A
  • Increased K+ exit from the post-synaptic membrane
  • Decreased Ca+2 permeability in the pre-synaptic terminal
71
Q

which mapelson system is missing a reservoir bag

72
Q

conditions that increase risk of LAST

A
  • hyperkalemia (alters RMP)
  • hypercarbia (cerebral vasodilation)
  • resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
Q

conditions that increase risk of LAST

A
  • hyperkalemia (alters RMP)
  • hypercarbia (cerebral vasodilation)
  • resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
Q

conditions that increase risk of LAST

A
  • hyperkalemia (alters RMP)
  • hypercarbia (cerebral vasodilation)
  • resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
Q

conditions that increase risk of LAST

A
  • hyperkalemia (alters RMP)
  • hypercarbia (cerebral vasodilation)
  • resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
Q

conditions that increase risk of LAST

A
  • hyperkalemia (alters RMP)
  • hypercarbia (cerebral vasodilation)
  • resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
Q

conditions that increase risk of LAST

A
  • hyperkalemia (alters RMP)
  • hypercarbia (cerebral vasodilation)
  • resp & metabolic acidosis (dec sz threshold, altered protein binding)
74
Q

conditions that increase risk of LAST

A
  • hyperkalemia (alters RMP)
  • hypercarbia (cerebral vasodilation)
  • resp & metabolic acidosis (dec sz threshold, altered protein binding)
75
Q

common presentation of transient neurologic symptoms

A

radiating buttock pain

76
Q

common presentation of cauda equina syndrome

A

sensory deficit with incontinence

77
Q

common presentation with epidural hematoma

A

prolonged motor block, sensory loss, GU dysfunction

78
Q

promoting forward flow with VSD

A

increase PVR
decrease SVR

79
Q

s/s glutocorticoid excess in Cushing’s

A

osteoporosis
muscle weakness
hyperglycemia
weight gain
mood changes
increased infection risk

80
Q

most likely complications of each brachial plexus block

A
  • interscalene = phrenic n. paralysis
  • supraclavicular = PTX
  • infraclavicular = subclavian a. puncture
  • axillary = hematoma
81
Q

mechanical events that occur between S1 and S2

A

isovolumetric contraction
ejection

82
Q

Which effect of muscarinic antagonism has equal efficacy among atropine, glycopyrrolate, and scopolamine?

A

decreased gastric acid secretion

83
Q

Which effect of muscarinic antagonism has equal efficacy among atropine, glycopyrrolate, and scopolamine?

A

decreased gastric acid secretion

84
Q

CN that arise from brainstem

A
  • Pons = 5, 6, 7, 8
  • Medulla = 9, 10, 11, 12

Midbrain = 3, 4

85
Q

CN that arise from brainstem

A
  • Pons = 5, 6, 7, 8
  • Medulla = 9, 10, 11, 12

Midbrain = 3, 4

86
Q

CN that arise from brainstem

A
  • Pons = 5, 6, 7, 8
  • Medulla = 9, 10, 11, 12

Midbrain = 3, 4

87
Q

CN that arise from brainstem

A
  • Pons = 5, 6, 7, 8
  • Medulla = 9, 10, 11, 12

Midbrain = 3, 4

87
Q

CN that arise from brainstem

A
  • Pons = 5, 6, 7, 8
  • Medulla = 9, 10, 11, 12

Midbrain = 3, 4

88
Q

CN that arise from brainstem

A
  • Pons = 5, 6, 7, 8
  • Medulla = 9, 10, 11, 12

Midbrain = 3, 4

88
Q

CN that arise from brainstem

A
  • Pons = 5, 6, 7, 8
  • Medulla = 9, 10, 11, 12

Midbrain = 3, 4

89
Q

structures in carotid sheath

A
  • Common carotid artery
  • Internal carotid artery
  • Internal jugular vein
  • Vagus nerve
90
Q

what data are needed to determine if a drug is at steady state

A

infusion rate
rate of elimination

91
Q

Local anesthetics bind to which part and configuration of the sodium channel?

A

Alpha subunit of an inactivated-closed channel

Local anesthetics selectively bind to the alpha subunit of the sodium channel in the inactivated-closed state and the active-open state.

92
Q

route of admin with lowest bioavailability

A

intrathecal

93
Q

NMDA receptor AGONIST

APEX (54 decks)

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