APEX is stupid Flashcards
when should non-particulate antacid for aspiration prophylaxis be redosed
after 1 hr
classes of antiarrythmics
- class I = Na+ channel inhibitors
- class II = beta blockers
- class III = K+ channel inhibitors
- class IV = slow Ca2+ channel inhibitors
number 1 site of breast cancer metastasis
bone
AIs of isosulfan blue dye used in mastectomy
temporarily decreases SpO2
what is Wegener’s Granulomatosis
vasculitis in your nose, sinuses, throat, lungs and kidneys
AIs for Wegener’s Granulomatosis
- 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
risks assoc with Kawasaki disease
musculocutaneous lymph node syndrome
coronary artery aneurysm and myocardial ischemia
what is Takayasu’s Arteritis
occlusive disease of proximal aorta & branches
Aka pulseless disease, occlusive thromboaortopathy, aortic arch syndrome
what is Thromboangiitis Obliterans
aka Buerger’s disease
- Inflammatory vasculitis
- ultimately occludes small and medium sized arteries and veins in extremities
most common cause of Thromboangiitis Obliterans
smoking
(best treatment: smoking cessation)
how is anatomic Vd increased
increased by anything that increases volume of airway conduit
how is alveolar Vd increased
increased by anything that reduces pulmonary blood flow
how is physiologic Vd increased
dec pulm blood flow, dec CO, PE, COPD, old age, facemask, PPV, HME, neck extension, anticholinergics
how much CO2 does a 70 kg adult produce per hour
12 L
normal PaO2 of a healthy 20 yr old vs healthy 70 yr old breathing room air
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)
most significant concern of Ludwig angina
posterior displacement of tongue (complete supraglottic airway obstruction)
Best way to secure airway in pt with Ludwig’s angina
awake patient
(awake nasal or awake trach)
how do vasoconstrictors affect PVR
increase
indicates greatest impairment of renal function in RIFLE criteria
Cr > 5 mg/dL
half lives of factor 7, antithrombin, and fibrinogen
- Factor 7 = 3-6 hours
- Antithrombin = 48-72 hours
- Fibrinogen = 71-120 hours
MOA of analgesia with tramadol
1) mu > kappa and delta
2) Activation of the descending inhibitory pain pathway in the spinal cord (NE and 5-HT reuptake inhibition)
advantages of tramadol
- Little/no respiratory depression
- Low abuse potential
- Low risk of systemic organ toxicity
- Less delay in gastric emptying
disadvantages of tramadol
- seizures
- high incidence N/V
- decreased efficacy when co-admin with zofran
AE of phenylephrine as a neuraxial additive
Addition of phenylephrine increases risk of transient neurologic symptoms with tetracaine
NMBs that cause histamine release
- Succs
- Atracurium
- Mivacurium
treating pruritis from neuraxial opioids
- 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?
1st messenger of nitric oxide in vascular smooth muscle
NO
H2 antagonists that inhibit CYP
cimetidine
ranitidine
(not famotidine)
can augment warfarin effects and increase bleeding
H2 antagonists that inhibit CYP
cimetidine
ranitidine
(not famotidine)
can augment warfarin effects and increase bleeding
AE of prolonged use of mannitol
hypokalemic hypochloremic alkalosis
what are mineralocorticoid effects
tendency of a steroid to cause retention of Na+ and H2O and excretion of H+ and K+
steroid potency relative to cortisol
- Aldosterone (3000x)
- Fludrocortisone (250x)
- Cortisol (1)
- Prednisone (0.8x)
- Methylprednisolone (0.5x)
Describes variables that govern laminar flow
Poiseulle’s law
traditional flowmeter
Thorpe tube
where is internal diameter narrowest in flowmeter
at the base and widens along ascent
how does N2O affect IOP
Decreases
which anatomic structures must an epidural needle pass through when using paramedian approach
- skin
- subq tissue
- paraspinal muscles
- ligamentum flavum
What solution is recommended as a test dose when using peripheral nerve stimulation-guided nerve blocks?
5% dextrose in water
increases current density and either maintains or augments the twitch response to stimulation.
What solution is recommended as a test dose when using peripheral nerve stimulation-guided nerve blocks?
5% dextrose in water
increases current density and either maintains or augments the twitch response to stimulation.
What structures are anesthetized when a local anesthetic is injected into the paravertebral space?
sympathetic trunk
mixed spinal nerve
Peak serum levels of lidocaine after tumescent infiltrations for liposuction occur how many hours after injection?
12-14 hours
the vertebral canal is smallest at which level
thoracic
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?
0.5
specific effects of EMLA cream on vasculature of skin
Vasoconstriction in the first hour after application Vasodilation after 2 or more hours after application
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?
vertebral lamina
which components of brachial plexus pass through scalene muscles
roots
max concentrations of lidocaine, mepivacaine, and bupivacaine for PNB infusion
lidocaine or mepivacaine = max 1-1.5%
bupivacaine = max 0.125-0.5%
measured by transcranial doppler
regional cerebral blood flow velocity
what is measured by jugular oximetry
global oxygenation in the brain (invasive)
monitors local oxygenation in the brain
NIRS (Cerebral ox)
absolute contraindications to low flow anesthesia
- smoke inhalation
- conditions assoc with increased O2 consumption (MH, thyroid storm)
relative - mask ventilation, uncuffed ETT, rigid bronch
key benefit of low flow anesthesia & what population is it used in
heat conservation
neonates
monitoring of which spinal pathway is affected by NMBs
corticospinal tract
what is an ataxic resp rate
what does it suggest?
irregular rate and Vt
suggests injury of medulla
what is an apneustic resp rate
what does it suggest?
prolonged pause at the top of inspiration
suggests injury of pons
a Hct above what is a threat to life
60%
how is dabigatran’s anticoagulant effect reversed
idarucizumab
binds with dabigatran and its metabolites with a higher affinity than dabigatran has for thrombin
TXA produces antifibrinolytic effect by blocking:
plasminogen to plasmin
absolute contraindications for ESWL
- pregnancy
- bleeding disorder
- anticoagulation
relative - pacemaker/ICD, calcified aneurysm of aorta/renal a., untreated UTI, obstruction beyond stone, morbid obesity
best treatment for chronic orthostatic hypotension 2/2 hypoaldosteronism
fludrocortisone
Hypocalcemia secondary to inadvertent removal of the parathyroid glands during total thyroidectomy is MOST likely to present how many hours after surgery?
24-48 h
sensitive clinical indicator of restrictive lung disease
increased resting RR
2 primary determinants of ESV
- outflow impedance (afterload)
- ventricular contractility
MOA of local anesthetics
selectively bind to alpha subunit of Na+ channel in inactivated-closed state and active-open state
nerve fiber types that regulate vascular tone
B & C fibers
risk factors for hypoxemia if transferred to PACU on RA
age > 60
weight > 100 kg
where are peripheral chemoreceptors located
- carotid bodies (bifurcation & common carotid)
- aortic bodies (scattered throughout aortic arch)
During quiet breathing, the portion of the respiratory system that offers the greatest resistance to airflow is the:
mid-sized bronchi
What is the anatomic border between the oropharynx and the laryngopharynx (hypopharynx)?
epiglottis
how does mu agonism decrease neural transmission
- Increased K+ exit from the post-synaptic membrane
- Decreased Ca+2 permeability in the pre-synaptic terminal
which mapelson system is missing a reservoir bag
E
conditions that increase risk of LAST
- hyperkalemia (alters RMP)
- hypercarbia (cerebral vasodilation)
- resp & metabolic acidosis (dec sz threshold, altered protein binding)
conditions that increase risk of LAST
- hyperkalemia (alters RMP)
- hypercarbia (cerebral vasodilation)
- resp & metabolic acidosis (dec sz threshold, altered protein binding)
conditions that increase risk of LAST
- hyperkalemia (alters RMP)
- hypercarbia (cerebral vasodilation)
- resp & metabolic acidosis (dec sz threshold, altered protein binding)
conditions that increase risk of LAST
- hyperkalemia (alters RMP)
- hypercarbia (cerebral vasodilation)
- resp & metabolic acidosis (dec sz threshold, altered protein binding)
conditions that increase risk of LAST
- hyperkalemia (alters RMP)
- hypercarbia (cerebral vasodilation)
- resp & metabolic acidosis (dec sz threshold, altered protein binding)
conditions that increase risk of LAST
- hyperkalemia (alters RMP)
- hypercarbia (cerebral vasodilation)
- resp & metabolic acidosis (dec sz threshold, altered protein binding)
conditions that increase risk of LAST
- hyperkalemia (alters RMP)
- hypercarbia (cerebral vasodilation)
- resp & metabolic acidosis (dec sz threshold, altered protein binding)
common presentation of transient neurologic symptoms
radiating buttock pain
common presentation of cauda equina syndrome
sensory deficit with incontinence
common presentation with epidural hematoma
prolonged motor block, sensory loss, GU dysfunction
promoting forward flow with VSD
increase PVR
decrease SVR
s/s glutocorticoid excess in Cushing’s
osteoporosis
muscle weakness
hyperglycemia
weight gain
mood changes
increased infection risk
most likely complications of each brachial plexus block
- interscalene = phrenic n. paralysis
- supraclavicular = PTX
- infraclavicular = subclavian a. puncture
- axillary = hematoma
mechanical events that occur between S1 and S2
isovolumetric contraction
ejection
Which effect of muscarinic antagonism has equal efficacy among atropine, glycopyrrolate, and scopolamine?
decreased gastric acid secretion
Which effect of muscarinic antagonism has equal efficacy among atropine, glycopyrrolate, and scopolamine?
decreased gastric acid secretion
CN that arise from brainstem
- Pons = 5, 6, 7, 8
- Medulla = 9, 10, 11, 12
Midbrain = 3, 4
CN that arise from brainstem
- Pons = 5, 6, 7, 8
- Medulla = 9, 10, 11, 12
Midbrain = 3, 4
CN that arise from brainstem
- Pons = 5, 6, 7, 8
- Medulla = 9, 10, 11, 12
Midbrain = 3, 4
CN that arise from brainstem
- Pons = 5, 6, 7, 8
- Medulla = 9, 10, 11, 12
Midbrain = 3, 4
CN that arise from brainstem
- Pons = 5, 6, 7, 8
- Medulla = 9, 10, 11, 12
Midbrain = 3, 4
CN that arise from brainstem
- Pons = 5, 6, 7, 8
- Medulla = 9, 10, 11, 12
Midbrain = 3, 4
CN that arise from brainstem
- Pons = 5, 6, 7, 8
- Medulla = 9, 10, 11, 12
Midbrain = 3, 4
structures in carotid sheath
- Common carotid artery
- Internal carotid artery
- Internal jugular vein
- Vagus nerve
what data are needed to determine if a drug is at steady state
infusion rate
rate of elimination
Local anesthetics bind to which part and configuration of the sodium channel?
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.
route of admin with lowest bioavailability
intrathecal
NMDA receptor AGONIST