APP II Exams Flashcards
EMG to the lateral rectus monitors what nerves?
Abducens
insert brain pic The area with the blue color is supplied by? The area with the green color is supplied by?
blue: Anterior cerebral artery Green: Posterior cerebral artery
Calculate CPP: BP = 100/70, HR = 65, RAP = 10, ICP = 15? SHORT ANSWER
CPP = MAP - ICP; CPP = 80 - 15; CPP = 65
SSEP assesses the integrity of ________ spinal cord.
Posterior
How is cerebral blood flow autoregulated?
SHORT ANSWER
Name structures pierced during lumbar puncture.
SHORT ANSWER Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, subdural space*, arachnoid mater, subarachnoid space
Patient with increased ICP that suddenly rises to 30 mmHg will exhibit? SELECT 3
Irregular respirations, bradycardia, Hypertension
Which potential is MOST RESISTANT to anesthesia?
BAEP- Auditory
insert image of epideral verterbra Which number represents the subarachnoid space?
10
Describe Horner’s Syndrome?
SHORT ANSWER
Which nerve can be blocked to decrease pain from tourniquet inflation during IV regional anesthesia?
Intercostalbrachial nerve
Aqueduct of Sylvius supplies?
Third and fourth ventricle
insert vertebra picture Which number represent the lamina?
8
insert paco2/po2 image graph What does “X” represent:
x = PaCO2
Insert image of hand/nerves innervation what nerve is represented by blue?
blue = ulnar
Which evoked potential is measured during pituitary surgery
Visual evoked potential
Describe falx cerebri
Short answer
Differentiate between cerebral steal and inverse steal.
short answer
Differentiate between supraspinal and spinal anesthesia.
short answer
Brain controls the activity of interneuron in substantia gelatinosa?
Periventricular and periaqueductal gray matter
Gray Ramus contain_____fibers?
Postganglionic sympathetic
Patient has eyelid drooping, pupil fixed and dilated, not reactive to light. What nerve is damaged?
Oculomotor
Which would decrease cerebral blood flow?
Fentanyl-Droperidol
A 55-year-old is undergoing an intracranial tumor resection under GA. Preoperatively, the patient is alert & oriented and has no focal neurological deficit. Within what range should the PaCO2be maintained during surgery?
25-30 SHORT ANSWER
Which bone supports the pituitary gland / location of sella turcica:
Sphenoid bone
insert graph diagram Which agent describes ketamine? Which agent would be best to use in head trauma?
- ketamine = 5 2. head trauma= 1
Masseter muscle and temporalis muscle responses are monitored using which nerve?
Trigeminal CN (V)
insert electrode diagram Electrode position diagram – where would you place the electrode for tibial stimulation?
a. Z
In the case of venous air embolism, aspiration with a SINGLE-orificed catheter is done by placing the tip ________ the SVC-atrial junction.
3 cm ABOVE
In the case of venous air embolism, aspiration with a MULTI-orificed catheter is done by placing the tip ________ the SVC-atrial junction.
2 cm below
Picture of a man only smiling with half of his face. Which nerve is injured?
Facial (VII)
30 y/o jumped and pool and injured C3-C4. Neurological damage showed bilateral blindness. Describe injury -
SHORT ANSWER
Pain afferent nerve fibers dorsal horn ascend 1-3 seg ____ in before entering synapse dorsal horn?
Track of lissauer
Berry aneurysm picture? Damage is to where?.
Anterior communicating artery
Picture of drop hand, image 3? what nerve is associated with injury?
Radial nerve damage
Picture of baby with Erb-Duchenne Palsy. Short answer
Excessive stretch of neck during delivery, damage to superior trunk of C5, C6. Can occur in falls, traumas. Pronated forearm, arm turned medially
Posterior spinal artery occlusion with loss of dorsal column tract, which will you lose? Choose 2
Fine touch Vibration
Venous Air Embolism all the following EXCEPT
Lateral 15 degrees, head up Use of PEEP
Extrinsic mechanism, ____ increase for each mmHg PCO2
2%
____ nerve monitored through vocal cords in major tumor resection
Vagus
insert image of tract of lis What is X?
C-fibers
Picture of hand injuries, image 1: Claw hand
Ulnar nerve injury
Picture of hand injuries, image 2: Ape Hand
Median Nerve injury
escribe structure and function of BBB
short answer
MOA of morphine in the substantia gelatinosa.
Short answer
Brachial plexus diagram- nerve 1 recognition
Musculocutaneous Nerve
Warfarin is part of
Extrinsic pathway
Vitamin k dependant factors
II, VII, IX, X (2, 7, 9,10) and protein c & s
Pt is getting ready for heart surgery and is being heparinized. Pt ACT is not getting past 250, what do you do?
Give FFP
Erythroblastosis fetalis:
Mother is Rh- having a fetus Rh+
Pt on heparin starts bleeding. What do you give?
Protamine
MOA of Dipyridamole -
Increases cAMP
MOA of Ticlopidine -
inhibit ADP
Inhibition by NSAID lasts:
24-48 hrs
COX inhibition by Aspirin lasts
7-12days
abciximab
GP iib/IIIa inhibitor
Reversal for coumadin
vitamin K
What is the best test for platelet function:
bleeding time
What is the factor deficiency in Hemophilia B?
Factor IX (9)
Most common hereditary bleeding disorder:
Von Willedbrand’s disease
Tests used to monitor Warfarin (choose 2):
PT INR
Heparin is part of what pathway?
intrinsic
Treatment for vWD
dDAVP
Fibrin stabilizing factor:
Factor XIII (13)
After tissue injury, Thromboplastin activates:
Factor VII (7)
Patient with priapism
sickle cell anemia
Which of the following would not be associated with a patient with sickle cell anemia:
splenomegaly
Reticulocytes are responsible for:
RBC’s
Male patient that has a high TIBC, low iron what diagnositc study would be done next?
occult stool colonscopy - all men with anemia r/o colon ca (they have it until it’s ruled out)
Patient complains of weakness, lightheadedness after menstruation. Tx -
Ferrous Sulfate
Pt living in high altitude polycythemia Treatment:
no treatment
A patient that had stomach resection … they would most likely have:
B12 deficiency
Male Pt(baby) cannot stop bleeding after a heel stick. History of prolonged bleeding time after circumcision. Bruises on elbows Which of the coag test represents this patient?
Hemophilia
Pregnant woman comes into the hospital. She is Rh(+), husband is Rh(-) and it’s there second child. What do you do.
Nothing
Patient with Polycythemia Vera -
Increased Blood Viscosity
All of the following are chemical accelerators of clot formation except -
PGI2
vWF is responsible for stabilizing:
VIII (8)
Patient receiving multiple blood infusions will be deficient in:
Platelets
ICU patient has oozing from line sites (was this the patient with bacteremia, leading to paint the picture of thrombocytopenia secondary to DIC? I was thinking DIC)
Decreased PLT, Increased BT, PT, PTT
Hemolytic Anemia will more than likely cause increased circulation of:
Free Bilirubin
Describing a patient with B12 deficiency:
Give B12 and Folic Acid
How to treat the patient with anemia due to renal failure:
Erythropoietin
A pt is treated for DVT with heparin, he comes back a week later and has a decrease in PLT…. What is the treatment?
DC Heparin
Which factor activates prothrombin for conversion to thrombin?
Factor X
sickle cell
megoloblastic anemia
microcytic hypochromic cells
patient presented with pain in abdomen, (I think it said pink tinged urine too?), accumulation of aminolevulinic acid (ALA) and uroporphyrins
. Acute intermittent porphyria
Female pt with heavy periods last 8-9 days and difficult to stop bleeding after cut.
Platelets Normal, bleeding time increased, pt normal, ptt increased (von Willebrand’s disease)
Asprin inhibits:
Cycloxygenase 1
Which of the following is not true about platelet aggregation?
A. Aspirin inhibits COX, leading to increased formation of thromboxane A2
Life of a RBC?
4 mos
66 yr old woman comes to ER 30 mins after the onset of chest pain that radiates to neck and left arm. She is diaphoretic and hypotensive; the serum troponin-I is elevated. Thrombolytic therapy is begun. Which of the following drugs is most likely to be administered?
tPA
All of the following promote platelet aggregation EXCEPT:
Prostacyclin (PG12)
What is the major cause of diffuse bleeding after 25 pints of whole blood transfusion?
Thrombocytopenia
What area is known as countercurrent multiplier? Labeling picture
a. Loop of Henle
Insert Renal 1 picture Site of Secretion? Site of Reabsorption?
secretion - #3 reabsorption - # 2
What is used to measure GFR?
creatinine clearance
dilating efferent arterioles causes?
Decreased GFR
All are causes of hyperkalemia except for? a. Acidosis b. Tissue trauma c. Extreme exercise d. Hyperventilation
hyperventilation
Calcium gluconate is used for hyperkalemia for what reason?
cardiac stabilization
Most important renal buffers? (choose 2)
phosphate ammonia
Anion gap equation for calculation:
Na+ - (Cl- + HCO3 -)
Patient who has been vomiting will likely have what condition?
Metabolic alkalosis
Possible acid base disorder after anesthesia?
respiratory acidosis
Salicylate overdose acid base disorder?
respiratory alkalosis
wife who urinates when husband squeezes her; what is the treatment?
kegels Alpha Agonist
treatment for incomplete emptying :Choose 2
Cholinergic Intermittent catheterization
Tx for BPH?
Alpha adrenergic blocker
Acetazolamide works where?
Proximal tubule
Furosemide works where?
thick ascending limb of loop of Henle
All cause decrease calcium except for?
loop diuretics
Which diuretic is an aldosterone antagonist/ spares potassium?
spironolactone
Which lab is used to determine rena (intrinsic) or pre-renall failure?
FEF na
All labs are indicative of renal failure except for?
hypercalcemia
All labs are indicative of renal failure except for?
hypernatremia Acute RF you would see HYPOnatremia (and hypocalcemia d/t decreased vit D3)
First line of defense?
buffer system
Calculation for renal clearance. 4320 ml in a 24 hour urine collection (180 ml/hr or 3 ml/minute), urine concentration of sodium (or whatever it was) is 40, and plasma concentration of 3.
a. 40 ml/min
ABG interpretation → pH 7.24, PCO2 60, HCO3 26, O2 80
Acute respiratory acidosis
ABG interpretation → pH 7.52, PCO2 30, PO2 110, HCO3 24
Acute respiratory alkalosis
Clearance calculation urine NA was 100, urine flow rate of 2 ml/min, and plasma Na was 20?
10 ml/min
What is the most common cause of death in chronic renal failure
Infections
Tetany is seen with a decreased level of?
Calcium
What does ACEI’s do to GFR?
Decreases GFR
Vitamin ______ is activated in the kidney?
D
All of the following stimulate ADH secretion except?
Decreased serum osmolarity (this will decrease secretion of ADH)
What is seen with acetazolamide administration?
Metabolic acidosis with a normal anion gap
The source of progesterone and estrogen in second trimester is
Placenta
The source of progesterone and estrogen in first trimester is:
Corpus luteum
What letter indicates HCG?
X
How the reproductive hormones change in postmenopausal woman?
Estrogen decreases, FSH, LH, and GnRH are increased
(insert the picture) What letter indicates LH? Progesterone?
D (the highest peak) - LH B - progesterone
Increase urinary excretion rate of VMA dx for:
Pheochromocytoma
Which set of labs indicates parathyroid adenoma?
Increased PTH, Ca and low Phos
During normal menstrual cycle, LH surge predicts
Ovulation
Guy has chronic diarrhea, lack of appetite, colicky abd pain…. Exam revels wheezing and bronchospasm, and flushing. Dx?
5-HIAA (urinary 5-hydroxyindoleacetic acid
Deficiency of ___ causes decreased level of cortisol and androgen, increased aldosterone
17 alpha hydroxylase
Incorrect statement about anesthetic management of pt with Grave’s disease;
Require increase MAC
35 yr old DM 1 with difficulty managing morning hyperglycemia b/c of somogyi effect, what do you do?
Decrease evening dose of insulin
Pt came in with fall, is on all kinds of medications for a million other things. I think Na 4.5, serum osm 254, urine 180 ish, … ct normal
SIADH
During throidectomy of medullary carcinoma, pts BP suddenly rises. Assuming preexisting pheochromocytoma, what is the most probable dx?
MEN Type IIa MEN type III (IIB)
Bipolar guy on lithium gets polyuria. Urine osm 90 and not responsive to nasal dDAVP
Nephrogenic DI
Increases prolactin secretion?
Haloperidol
Source of ADH
-Post. pituitary -Hypothalamic supra optic nuclei
Pt presents with HTN, buffalo hump, puffy face. Likely cause?
Prolonged steroid use
Rathke’s pouch develops
Anterior pituitary
Angiotension II acts on this to release aldosterone:
Zona glumerulosa
What hormone is stimulated by EC vol expansion
ANP
Conversion of 25-OH (inactive vitamin d) to 1.25-OH (active)
Kidneys
ost sensitive test for thyroid function
TSH
Which of the following would be expected in a patient with Conn’s Syndrome?
Hypokalemia
SIADH caused by release of ADH. has the following features EXCEPT
Increased urinary flow
Alcohol inhibits the release of
ADH
Pt with HTN leg cramps, hypokalemia, …. Nodule on adrenal cortex…
Conn’s syndrome
Pt with head injury from skiing. Became polydipsic, serum osm 300’s, urine osmolarity 70s. Treated with dDavp and urine osmolarity increased.
Central DI
Man presented with changes in his appearance, hands and feet enlarged, hyperglycemic, mri revealed pituitary mass.
Acromegaly
cGMP hormone
Nitric Oxiide
Ambiguous genitalia… 9 month old? Baby picture. Testosterone levels are 4 x normal. Brother had similar problem
21 beta hydroxylase
Pt had a seizure. Had thyroid surgery a year ago. CC fatigue, circumoral and foot numbness, hand fascculation, calf cramps. When her bp was check a wrist spasm was seen
Hypoparathyriodism (hypocalemic)
6 mos Pregnant , fatigued, TSH is elevated, T3 and t4 are low
Hypothyroid
Baby found to have elevated TSH. tx?
Levothyroxine
Milk production in breast
Prolactin
Milk ejection and let down reflex
Oxytocin
Why does hypocalcemia cause musculare spasm and tetany?
Increases Na permeability across cell membrane
Man complains of frequent urination urgency. Rectal exam = BPH. Proscar is prescribed. Proscar is:
Inhibits 5 alpha-reductase
Destruction of posterior pituitary gland results in deficiency of
ADH Oxytocin
Hormone to its source:
Growth hormone : anterior pituitary
Lab values for cretinism
High TSH, low T3 and T4
Picture of… Probable dx in this 23 yr old female with an untreated medical condition:
CAH - 21 beta hydroxylase
Pregnant pt with high TBG, T3 and T4, normal TSH
No treatment required
Which one of the following set of lab values is consistent in the following patient? (pic of hyperthyroid looking person)
Low TSH, high T3 and T4
Hypercalcemia, thirst, lethargy, and fatigue. Ionized calcium =1.6 (high), phosphate = 0.8 , PTH= 10.3 (high). What is probable dx?
hyperparathyroid
30 yr old woman, wt loss, amenorrhea for 2 yrs. Significant postpartum bleeding. Most probably diagnosis?
Sheehan’s Syndrome
Hypotensive patient, Hypoglycemic, Hyperkalemia and Hyponatremia (from low aldosterone), metabolic acidosis; or results from increased ACTH.
Addison’s Disease
Pars Recta is located:
Straight part of PCT
67% of NA and K are reabsorbed in the
PCT
Ace inhibitors impact on GFR
Decrease GFR (by dilating efferent arterioles)
Acetazolamide works in the
(1) Proximal CT
Furosemide / loop diuretics work in the
(3) ascending loop of henle
Thiazides work in the
(4) Distal Convoluted tubule
Spironolactone works in the
(5) collecting tubule and duct
addisons
diarrhea
lost in desert
excessive sweating
Diabetes insipidus
isotonic vol expansion - isotonic infusion
Increased ECF
high NaCl intake
ecf increases
icf descreases
osm of ECF increases
hypotonic infusion (dextrose /water)
SIADH
ECF vol increases; osm decreases
ICF increases
