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APP II Exams Flashcards

1
Q

EMG to the lateral rectus monitors what nerves?

A

Abducens

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2
Q

insert brain pic The area with the blue color is supplied by? The area with the green color is supplied by?

A

blue: Anterior cerebral artery Green: Posterior cerebral artery

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3
Q

Calculate CPP: BP = 100/70, HR = 65, RAP = 10, ICP = 15? SHORT ANSWER

A

CPP = MAP - ICP; CPP = 80 - 15; CPP = 65

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4
Q

SSEP assesses the integrity of ________ spinal cord.

A

Posterior

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5
Q

How is cerebral blood flow autoregulated?

A

As a result of autoregulation a constant cerebral blood flow is maintain when MAP is within 60-160. Increase in CPP will cause vasoconstriction whereas decreased in CPP will result in vasodilation to maintain a constant blood flow. MAP>160 will result in hemmorhage whereas MAP<60 will lead to inschemia.

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6
Q

Name structures pierced during lumbar puncture.

A

SHORT ANSWER: Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, subdural space*, arachnoid mater, subarachnoid space

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7
Q

Patient with increased ICP that suddenly rises to 30 mmHg will exhibit? SELECT 3

A

Irregular respirations, bradycardia, Hypertension

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8
Q

Which potential is MOST RESISTANT to anesthesia?

A

BAEP- Auditory

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9
Q

insert image of epideral verterbra Which number represents the subarachnoid space?

A

10

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10
Q

Describe Horner’s Syndrome?

A
  • SHORT ANSWER
  • Caused by injury to the stelate ganglion resulting in loss of sympathetic tone and predominant parasympathetic tone.
  • Symptoms include; ptosis, anhidrosis and miosis
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11
Q

Which nerve can be blocked to decrease pain from tourniquet inflation during IV regional anesthesia?

A

Intercostalbrachial nerve

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12
Q

Aqueduct of Sylvius supplies?

A

Third and fourth ventricle

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13
Q

insert vertebra picture Which number represent the lamina?

A

8

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14
Q

insert paco2/po2 image graph What does “X” represent:

A

x = PaCO2

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15
Q

Insert image of hand/nerves innervation what nerve is represented by blue?

A

blue = ulnar

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16
Q

Which evoked potential is measured during pituitary surgery

A

Visual evoked potential

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17
Q

Describe falx cerebri

A

Short answer:

fold that dips into the longitudinal fissure

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18
Q

Differentiate between cerebral steal and inverse steal.

A

short answer:

  • Both conditions occur in a patient with ischemic areas of the brain where vessels are already maximaly dilated. In cerebral steal (luxury perfusion) a vasodilator results in increased flow to nonsichemic areas as they respond to dilation compared to inschemic vessels that are already maximaly dilated. In Inverese steal (robin hood) vasoconstriction results in more blood flow to inschemic areas that remain dilated in the presence of a vasoconstrictor that only affects normal vessels.
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19
Q

Differentiate between supraspinal and spinal anesthesia.

A

short answer:

  • Spinal Analgesia occurs when transmission of pain through SG (L II) is suppressed by neuroaxial admin or when IV opioid acts on periventricular and periaquaductal gray, locus ceruleus, raphe magnus. Mu-2 is the dominant receptor.
  • Supraspinal Analgesia occurs when opioids act on limbic system, hypothalamus and thalamus. Mu-1 is the dominant receptor.
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20
Q

Brain controls the activity of interneuron in substantia gelatinosa?

A

Periventricular and periaqueductal gray matter

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21
Q

Gray Ramus contain_____fibers?

A

Postganglionic sympathetic

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22
Q

Patient has eyelid drooping, pupil fixed and dilated, not reactive to light. What nerve is damaged?

A

Oculomotor

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23
Q

Which would decrease cerebral blood flow?

A

Fentanyl-Droperidol

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24
Q

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?

A

25-30 SHORT ANSWER

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25
Q

Which bone supports the pituitary gland / location of sella turcica:

A

Sphenoid bone

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26
Q

insert graph diagram Which agent describes ketamine? Which agent would be best to use in head trauma?

A
  1. ketamine = 5 2. head trauma= 1
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27
Q

Masseter muscle and temporalis muscle responses are monitored using which nerve?

A

Trigeminal CN (V)

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28
Q

insert electrode diagram Electrode position diagram – where would you place the electrode for tibial stimulation?

A

a. Z

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29
Q

In the case of venous air embolism, aspiration with a SINGLE-orificed catheter is done by placing the tip ________ the SVC-atrial junction.

A

3 cm ABOVE

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30
Q

In the case of venous air embolism, aspiration with a MULTI-orificed catheter is done by placing the tip ________ the SVC-atrial junction.

A

2 cm below

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31
Q

Picture of a man only smiling with half of his face. Which nerve is injured?

A

Facial (VII)

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32
Q

30 y/o jumped and pool and injured C3-C4. Neurological damage showed bilateral blindness. Describe injury -

A

SHORT ANSWER

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33
Q

Pain afferent nerve fibers dorsal horn ascend 1-3 seg ____ in before entering synapse dorsal horn?

A

Track of lissauer

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34
Q

Berry aneurysm picture? Damage is to where?.

A

Anterior communicating artery

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35
Q

Picture of drop hand, image 3? what nerve is associated with injury?

A

Radial nerve damage

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36
Q

Picture of baby with Erb-Duchenne Palsy. Short answer

A
  • Excessive stretch of neck during delivery, damage to superior trunk of C5, C6. Can occur in falls, traumas.
  • Adducted shoulder, pronated forearm, arm turned medially
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37
Q

Posterior spinal artery occlusion with loss of dorsal column tract, which will you lose? Choose 2

A

Fine touch Vibration

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38
Q

Venous Air Embolism all the following EXCEPT

A

Lateral 15 degrees, head up Use of PEEP

  • Notify the surgeon , so that surgical field can be flooded with N/S.
  • Packing and bone wax, JV compression
  • Discontinue nitrous oxide, give 100% O2
  • Aspiration with multi- orificed catheter placing tip 2 cm below the SVC – atrial (cavoatrial) junction.
  • Aspiration with single- orificed catheter placing tip 3 cm above the SVC – atrial junction
  • Left lateral position, 15 °head down
  • IV fluid to increase CVP
  • Vasopressor
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39
Q

Extrinsic mechanism, ____ increase for each mmHg PCO2

A

2%

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40
Q

____ nerve monitored through vocal cords in major tumor resection

A

Vagus

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41
Q

insert image of tract of lis What is X?

A

C-fibers

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42
Q

Picture of hand injuries, image 1: Claw hand

A

Ulnar nerve injury

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43
Q

Picture of hand injuries, image 2: Ape Hand

A

Median Nerve injury

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44
Q

describe structure and function of BBB

A
  • Structuraly made up of Exceptionally tight junctions between brain capillary endothelial cells, Basement membrane and Astrocyte processes
  • Maintains a constant environment for neurons and protect brain from endogenous or exogenous toxins.
  • It prevents the escape of NT from their functional sites in the CNS into general circulation. It allows lipid soluble drugs to cross whereas water soluble substances cannot cross.
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45
Q

MOA of morphine in the substantia gelatinosa. Short answer

A
  • Morphine acts on opioid receptors (mu, keppa, delta) causing inhibition of pain transmission by decreasing Ca++ entry and Increasing K+ out flux resulting in hyperpolarization. As a result, release of substance P is inhibited and Transmission of pain is reduced.
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46
Q

Brachial plexus diagram- nerve 1 recognition

A

Musculocutaneous Nerve

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47
Q

Warfarin is part of

A

Extrinsic pathway

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48
Q

Vitamin k dependant factors

A

II, VII, IX, X (2, 7, 9,10) and protein c & s

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49
Q

Pt is getting ready for heart surgery and is being heparinized. Pt ACT is not getting past 250, what do you do?

A

Give FFP

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50
Q

Erythroblastosis fetalis:

A

Mother is Rh- having a fetus Rh+

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51
Q

Pt on heparin starts bleeding. What do you give?

A

Protamine

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52
Q

MOA of Dipyridamole -

A

Increases cAMP

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53
Q

MOA of Ticlopidine -

A

inhibit ADP

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54
Q

Inhibition by NSAID lasts:

A

24-48 hrs

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55
Q

COX inhibition by Aspirin lasts

A

7-12days

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56
Q

abciximab

A

GP iib/IIIa inhibitor

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57
Q

Reversal for coumadin

A

vitamin K

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58
Q

What is the best test for platelet function:

A

bleeding time

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59
Q

What is the factor deficiency in Hemophilia B?

A

Factor IX (9)

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60
Q

Most common hereditary bleeding disorder:

A

Von Willedbrand’s disease

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61
Q

Tests used to monitor Warfarin (choose 2):

A

PT INR

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62
Q

Heparin is part of what pathway?

A

intrinsic

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63
Q

Treatment for vWD

A

dDAVP

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64
Q

Fibrin stabilizing factor:

A

Factor XIII (13)

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65
Q

After tissue injury, Thromboplastin activates:

A

Factor VII (7)

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66
Q

Patient with priapism

A

sickle cell anemia

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67
Q

Which of the following would not be associated with a patient with sickle cell anemia:

A

splenomegaly

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68
Q

Reticulocytes are responsible for:

A

RBC’s

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69
Q

Male patient that has a high TIBC, low iron what diagnositc study would be done next?

A

occult stool colonscopy - all men with anemia r/o colon ca (they have it until it’s ruled out)

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70
Q

Patient complains of weakness, lightheadedness after menstruation. Tx -

A

Ferrous Sulfate

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71
Q

Pt living in high altitude polycythemia Treatment:

A

no treatment

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72
Q

A patient that had stomach resection … they would most likely have:

A

B12 deficiency

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73
Q

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?

A

Hemophilia

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74
Q

Pregnant woman comes into the hospital. She is Rh(+), husband is Rh(-) and it’s there second child. What do you do.

A

Nothing

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75
Q

Patient with Polycythemia Vera -

A

Increased Blood Viscosity

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76
Q

All of the following are chemical accelerators of clot formation except -

A

PGI2

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77
Q

vWF is responsible for stabilizing:

A

VIII (8)

78
Q

Patient receiving multiple blood infusions will be deficient in:

A

Platelets

79
Q

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)

A

Decreased PLT, Increased BT, PT, PTT

80
Q

Hemolytic Anemia will more than likely cause increased circulation of:

A

Free Bilirubin

81
Q

Describing a patient with B12 deficiency:

A

Give B12 and Folic Acid

82
Q

How to treat the patient with anemia due to renal failure:

A

Erythropoietin

83
Q

A pt is treated for DVT with heparin, he comes back a week later and has a decrease in PLT…. What is the treatment?

A

DC Heparin

84
Q

Which factor activates prothrombin for conversion to thrombin?

A

Factor X

85
Q
A

sickle cell

86
Q
A

megoloblastic anemia

87
Q
A

microcytic hypochromic cells

88
Q

patient presented with pain in abdomen, (I think it said pink tinged urine too?), accumulation of aminolevulinic acid (ALA) and uroporphyrins

A

. Acute intermittent porphyria

89
Q

Female pt with heavy periods last 8-9 days and difficult to stop bleeding after cut.

A

Platelets Normal, bleeding time increased, pt normal, ptt increased (von Willebrand’s disease)

90
Q

Asprin inhibits:

A

Cycloxygenase 1

91
Q

Which of the following is not true about platelet aggregation?

A

A. Aspirin inhibits COX, leading to increased formation of thromboxane A2

92
Q

Life of a RBC?

A

4 mos

93
Q

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?

A

tPA

94
Q

All of the following promote platelet aggregation EXCEPT:

A

Prostacyclin (PG12)

95
Q

What is the major cause of diffuse bleeding after 25 pints of whole blood transfusion?

A

Thrombocytopenia

96
Q

What area is known as countercurrent multiplier? Labeling picture

A

a. Loop of Henle

97
Q

Insert Renal 1 picture Site of Secretion? Site of Reabsorption?

A

secretion - #3 reabsorption - # 2

98
Q

What is used to measure GFR?

A

creatinine clearance

99
Q

dilating efferent arterioles causes?

A

Decreased GFR

100
Q

All are causes of hyperkalemia except for? a. Acidosis b. Tissue trauma c. Extreme exercise d. Hyperventilation

A

hyperventilation

101
Q

Calcium gluconate is used for hyperkalemia for what reason?

A

cardiac stabilization

102
Q

Most important renal buffers? (choose 2)

A

phosphate ammonia

103
Q

Anion gap equation for calculation:

A

Na+ - (Cl- + HCO3 -)

104
Q

Patient who has been vomiting will likely have what condition?

A

Metabolic alkalosis

105
Q

Possible acid base disorder after anesthesia?

A

respiratory acidosis

106
Q

Salicylate overdose acid base disorder?

A

respiratory alkalosis

107
Q

wife who urinates when husband squeezes her; what is the treatment?

A

kegels Alpha Agonist

108
Q

treatment for incomplete emptying :Choose 2

A

Cholinergic Intermittent catheterization

109
Q

Tx for BPH?

A

Alpha adrenergic blocker

110
Q

Acetazolamide works where?

A

Proximal tubule

111
Q

Furosemide works where?

A

thick ascending limb of loop of Henle

112
Q

All cause decrease calcium except for?

A

loop diuretics

113
Q

Which diuretic is an aldosterone antagonist/ spares potassium?

A

spironolactone

114
Q

Which lab is used to determine rena (intrinsic) or pre-renall failure?

A

FEF na

115
Q

All labs are indicative of renal failure except for?

A

hypercalcemia

116
Q

All labs are indicative of renal failure except for?

A

hypernatremia Acute RF you would see HYPOnatremia (and hypocalcemia d/t decreased vit D3)

117
Q

First line of defense?

A

buffer system

118
Q

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

a. 40 ml/min

119
Q

ABG interpretation → pH 7.24, PCO2 60, HCO3 26, O2 80

A

Acute respiratory acidosis

120
Q

ABG interpretation → pH 7.52, PCO2 30, PO2 110, HCO3 24

A

Acute respiratory alkalosis

121
Q

Clearance calculation urine NA was 100, urine flow rate of 2 ml/min, and plasma Na was 20?

A

10 ml/min

122
Q

What is the most common cause of death in chronic renal failure

A

Infections

123
Q

Tetany is seen with a decreased level of?

A

Calcium

124
Q

What does ACEI’s do to GFR?

A

Decreases GFR

125
Q

Vitamin ______ is activated in the kidney?

A

D

126
Q

All of the following stimulate ADH secretion except?

A

Decreased serum osmolarity (this will decrease secretion of ADH)

127
Q

What is seen with acetazolamide administration?

A

Metabolic acidosis with a normal anion gap

128
Q

The source of progesterone and estrogen in second trimester is

A

Placenta

129
Q

The source of progesterone and estrogen in first trimester is:

A

Corpus luteum

130
Q

What letter indicates HCG?

A

X

131
Q

How the reproductive hormones change in postmenopausal woman?

A

Estrogen decreases, FSH, LH, and GnRH are increased

132
Q

(insert the picture) What letter indicates LH? Progesterone?

A

D (the highest peak) - LH B - progesterone

133
Q

Increase urinary excretion rate of VMA dx for:

A

Pheochromocytoma

134
Q

Which set of labs indicates parathyroid adenoma?

A

Increased PTH, Ca and low Phos

135
Q

During normal menstrual cycle, LH surge predicts

A

Ovulation

136
Q

Guy has chronic diarrhea, lack of appetite, colicky abd pain…. Exam revels wheezing and bronchospasm, and flushing. Dx?

A

5-HIAA (urinary 5-hydroxyindoleacetic acid

137
Q

Deficiency of ___ causes decreased level of cortisol and androgen, increased aldosterone

A

17 alpha hydroxylase

138
Q

Incorrect statement about anesthetic management of pt with Grave’s disease;

A

Require increase MAC

139
Q

35 yr old DM 1 with difficulty managing morning hyperglycemia b/c of somogyi effect, what do you do?

A

Decrease evening dose of insulin

140
Q

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

A

SIADH

141
Q

During throidectomy of medullary carcinoma, pts BP suddenly rises. Assuming preexisting pheochromocytoma, what is the most probable dx?

A

MEN Type IIa MEN type III (IIB)

142
Q

Bipolar guy on lithium gets polyuria. Urine osm 90 and not responsive to nasal dDAVP

A

Nephrogenic DI

143
Q

Increases prolactin secretion?

A

Haloperidol

144
Q

Source of ADH

A

-Post. pituitary -Hypothalamic supra optic nuclei

145
Q

Pt presents with HTN, buffalo hump, puffy face. Likely cause?

A

Prolonged steroid use

146
Q

Rathke’s pouch develops

A

Anterior pituitary

147
Q

Angiotension II acts on this to release aldosterone:

A

Zona glumerulosa

148
Q

What hormone is stimulated by EC vol expansion

A

ANP

149
Q

Conversion of 25-OH (inactive vitamin d) to 1.25-OH (active)

A

Kidneys

150
Q

ost sensitive test for thyroid function

A

TSH

151
Q

Which of the following would be expected in a patient with Conn’s Syndrome?

A

Hypokalemia

152
Q

SIADH caused by release of ADH. has the following features EXCEPT

A

Increased urinary flow

153
Q

Alcohol inhibits the release of

A

ADH

154
Q

Pt with HTN leg cramps, hypokalemia, …. Nodule on adrenal cortex…

A

Conn’s syndrome

155
Q

Pt with head injury from skiing. Became polydipsic, serum osm 300’s, urine osmolarity 70s. Treated with dDavp and urine osmolarity increased.

A

Central DI

156
Q

Man presented with changes in his appearance, hands and feet enlarged, hyperglycemic, mri revealed pituitary mass.

A

Acromegaly

157
Q

cGMP hormone

A

Nitric Oxiide

158
Q

Ambiguous genitalia… 9 month old? Baby picture. Testosterone levels are 4 x normal. Brother had similar problem

A

21 beta hydroxylase

159
Q

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

A

Hypoparathyriodism (hypocalemic)

160
Q

6 mos Pregnant , fatigued, TSH is elevated, T3 and t4 are low

A

Hypothyroid

161
Q

Baby found to have elevated TSH. tx?

A

Levothyroxine

162
Q

Milk production in breast

A

Prolactin

163
Q

Milk ejection and let down reflex

A

Oxytocin

164
Q

Why does hypocalcemia cause musculare spasm and tetany?

A

Increases Na permeability across cell membrane

165
Q

Man complains of frequent urination urgency. Rectal exam = BPH. Proscar is prescribed. Proscar is:

A

Inhibits 5 alpha-reductase

166
Q

Destruction of posterior pituitary gland results in deficiency of

A

ADH Oxytocin

167
Q

Hormone to its source:

A

Growth hormone : anterior pituitary

168
Q

Lab values for cretinism

A

High TSH, low T3 and T4

169
Q

Picture of… Probable dx in this 23 yr old female with an untreated medical condition:

A

CAH - 21 beta hydroxylase

170
Q

Pregnant pt with high TBG, T3 and T4, normal TSH

A

No treatment required

171
Q

Which one of the following set of lab values is consistent in the following patient? (pic of hyperthyroid looking person)

A

Low TSH, high T3 and T4

172
Q

Hypercalcemia, thirst, lethargy, and fatigue. Ionized calcium =1.6 (high), phosphate = 0.8 , PTH= 10.3 (high). What is probable dx?

A

hyperparathyroid

173
Q

30 yr old woman, wt loss, amenorrhea for 2 yrs. Significant postpartum bleeding. Most probably diagnosis?

A

Sheehan’s Syndrome

174
Q

Hypotensive patient, Hypoglycemic, Hyperkalemia and Hyponatremia (from low aldosterone), metabolic acidosis; or results from increased ACTH.

A

Addison’s Disease

175
Q

Pars Recta is located:

A

Straight part of PCT

176
Q

67% of NA and K are reabsorbed in the

A

PCT

177
Q

Ace inhibitors impact on GFR

A

Decrease GFR (by dilating efferent arterioles)

178
Q

Acetazolamide works in the

A

(1) Proximal CT

179
Q

Furosemide / loop diuretics work in the

A

(3) ascending loop of henle

180
Q

Thiazides work in the

A

(4) Distal Convoluted tubule

181
Q

Spironolactone works in the

A

(5) collecting tubule and duct

182
Q
A
183
Q
A

addisons

184
Q
A

diarrhea

185
Q
A

lost in desert

excessive sweating

Diabetes insipidus

186
Q
A

isotonic vol expansion - isotonic infusion

Increased ECF

187
Q
A

high NaCl intake

ecf increases

icf descreases

osm of ECF increases

188
Q
A

hypotonic infusion (dextrose /water)

SIADH

ECF vol increases; osm decreases

ICF increases

189
Q
A
190
Q
A
191
Q
A

Regional (2 decks)

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