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Basic Exam > Basic and ADVANCED EXAM > Flashcards

Basic and ADVANCED EXAM Flashcards

1
Q

HYPOnatremia and MAC

A

Decreases MAC

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2
Q

Glucagon and cardiac cells

A

Increase intracellular cAMP, which results in increased inotropy

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3
Q

Transducer vs pt

A
  • Raise the tranducer (lowering the pt)>>>lowers the pressure reading
  • Lower the tranducer (raising the pt)>>raises the pressure reading

What happens when the BP cuff is raised 20cm above the heart? BP reading will be 15cm lower than reality

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4
Q

CBF: CMR ratio

A

Volatile agent >1 MAC:

  • increase CBF
  • decrease CMR

Volatile agent <1 MAC:

  • minimal effect on CBF
  • decrease CMR

IV anesthetic:

  • decrease CMR
  • decreases CBF
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5
Q

PLASMA VOLUME and body fluid:
-intracellular

  • extracellular
  • interstitial
  • plasma
A
  • intracellular: 2/3 of total body water
  • extracellular: 1/3 of total body water
  • interstitial fluid: 3/4 of extracellular
  • plasma fluid: 1/4 of extracellular
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6
Q

CAUDAL epidural

A

Sacrococcygeal ligament, THEN epidural space

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7
Q

Pulmonary circulation does NOT degrade:

A
  • dopamine
  • epinephrine
  • histamine
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8
Q

Laryngospasm reflex: afferent limb vs efferent limb

A
  • Afferent limb: superior laryngeal nerve, internal branch
  • Efferent limb: recurrent larygneal nerve
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9
Q

DOPAMINE infusion: receptors

A

Low dose: D1 receptors

High dose: B1 receptors

Highest dose: A1 receptors

*

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10
Q

Volume of liquid anesthetic

-iso 1% at 4L/min

A

3 * fresh gas flow * volume % anesthetic vapor = 12ml/hr

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11
Q

Sulfhemoglobinemia vs methemoglobinemia

A

Similar CP: cyanosis

Sulfhemoglobinemia: shifts curve right, hence better tolerated; no antidote

Methemoglobinemia: shifts cruve left, so poorly tolerated; txt is methylene blue; or ascorbic acid for G6PD pts

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12
Q

Artery of Adamkiewicz (The great radicular artery)

A
  • Comes off aorta between T9-T12
  • Supplies the LOWER anterior portion of the spinal cord
  • Interruption results in ASA (anterior spinal artery) syndrome
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13
Q

Labs a/w ESRD (secondary hyperPARATHYROIDISM)

A
  • HYPERphos
  • Low calcium
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14
Q

COMPLIANCE equation

A

1/C (rs=respiratory system) = 1/C (lungs) + 1/ C (chest wall)

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15
Q

Conus medullaris and dural sac

A

Conus medullaris: terminal end of spinal cord

  • ADULTS: ends at L1-L2
  • Neonates: ends at L3

Dural sac: dura matter terminates distally as the dural sac

  • ADULTS: ends at S1-S2
  • Neonates: S3
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16
Q

CO2 is transported in blood in which 3 forms

A
  • dissolved CO2
  • bicarbonate
  • carbamino compounds
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17
Q

2,3 DPG

  • What increases?
  • What decreases?
A
  • Increases? HyperPHOSPHATEMIA
  • Decreases? 1u pRBC; thus results in left shit;

vs anemia produces right shift

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18
Q

Crichothyroid muscle

  • innervated by?
  • role?
A
  • innervated by the SLN, external branch
  • tenses the vocal cords
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19
Q

First-line vasopressor for pts with TBI and increased urine output?

A

VASOPRESSIN

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20
Q

Onset of local anesthetic

A
  • low pKA and high lipid solubility enables fast onset
  • alfentanil has very low pKA, hence why has 4x faster onset than fentanyl
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21
Q

St. John’s wort

A

CYP inducer

Hence, warfarin breakdown will be enhanced>>increased risk for clot

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22
Q

Chronic steroids: metabolic abnormalities

A

A/w hyperglycemia, hypo K (corticosteroids act on the mineralocroticoid receptor), increased urinary uric acid/calcium (think kidney stones)

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23
Q

Burn patients and NDNMB

A
  • Dosing requirements for NDNMB, including roc, is increased
  • with the exception of mivacurium, which is metabolized by pseudocholinesterase, which exhibits decreased level in burn patients
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24
Q

-Plateaued INSPIRATORY curve

A

-think: vocal cord paralysis, dysfxn

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25
Q

Allergic rxn:

Esters vs amide

A
  • Allergy to ester is more common: secondary to PABA metabolaite
  • Allergy to amide is less common: secondary to methylparaben preservative
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26
Q

PaCO2 vs EtCO2

A

PaCO2 is typically slightly higher, owing to dead space

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27
Q

Lithium and NMB

A

Prolongs both depolarizing and nondepolarizing blockade

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28
Q

CBF

-directly propotional to:

A
  • directly proportional to: body temp and PaCO2
  • inversely proptional to: PaO2 when <50mmHg
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29
Q

R wave

A

Signifies the beginning of LV systole, when the MV closes and LV contraction begins

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30
Q

Sugammadex adverse effects

A
  • Anaphylaxis
  • Severe bradycardia
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31
Q

Factors that increase MAC

A
  • Chronic alcohol
  • Cocaine
  • MAO inhibitors
  • HyperNATREMIA
  • Red hair
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32
Q

pRBC storage

A
  • a/w decreased 2,3-DPG
  • also, decrease in pH and hence increase in K to maintain electrochemical neutrality
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33
Q

Ischemic optic neuropathy

  • Anterior neuropathy
  • Posterior neuropathy
A

Anterior: think cardiac surgery

Posterior: think posterior spine surgery

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34
Q

NMDA antagonist

A
  • Ketamine
  • Nitrous oxide
  • Methadone
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35
Q

Anticholinesterease to treat CENTRAL ANTICHOLINERGIC SYNDROME

A

PHYsostigmine

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36
Q

MYASTHENIA GRAVIS

==

LAMBERT EATON

A

MG

Autoimmune destruction of Ach channels

  • resistant to succinylcholine
  • very sensitive to rocuronium

==

Lambert Eaton

  • Autoimmune destruction of presynpatic calcium channels
  • senstiive to both succinylcholine and rocuronium
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37
Q

R to L shunt:

Inhalation induction vs IV induction

A
  • Inhalational induction: slowed
  • IV induction: hastened
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38
Q

MALIGNANT HYPERTHERMIA

A

Txt: dnatrolene 2.5mg/kg; should be repeated every 5-10 minutes

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39
Q

DIC vs ESLD

A

DIC: factor 8 will be decreased

ESLD: factor 8 will be preserved

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40
Q

Latex allergy:

who is at risk?

A
  • Healthcare workers
  • children with spina bifida and urogenital syndrome
  • allergies to tropical fruit
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41
Q

Vd: which drugs have LARGE Vd

A
  • Vd: the degree to which a drug is distributed in body tissue rather than plasma
  • Large Vd: lipophilic drugs, drugs with a high amount of TISSUE PROTEIN binding
  • Low Vd: drugs with high degree of plasma protein binding, low degree of tissue protein binding, hydrophilic nature
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42
Q

Depleting the O2 cylinder

A

Pressure/3. Gives rough estimate of volume in L remaining in the tank.

SO if 1500 psg, that’s 500L. If rate is 4L/min, that’s 125 min.

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43
Q

ACE enzyme

A

Converts angiotensin I to angiotensin II

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44
Q

NDNMB pretreatment of succinylcholine

A

-does NOT prevent increases in IOP

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45
Q

Liquified gases (eg nitrous oxide, CO2)

A

-Use cylinder weight to determine the amount of gas remaining

vs

Non-liquified gas:

-pressure in the tank will directly correspond to the amount of gas remaining

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46
Q

MORPHINE metabolites:

A

M3G: has no analgesic activity

M6G: in setting of RF, can cause respiratory depression

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47
Q

Etomidate

MOA:
Adrenal suppresion:

A

MOA: GABA agonist

Adrenal suppresion: 11-beta hydroxylase inhibitor

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48
Q

TOF twitches and ACh receptor blockade

A

0 twitches: 100% blockade

1 twitch: 90% blockade

2 twitch: 80% blockade

3 twitch: 75% blockade

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49
Q

SUCCINYLCHOLINE:

Phase 1 block:

Phase 2 block:

A

Phase 1 block (nl block):

  • neostigmine results in NMB prolongation
  • TOF ratio >0.7

Phase 2 block:

  • can be partially reversed with neostigmine
  • dosei s NO MORE than 0.03mg/kg for Phase 2 block
  • TOF ratio <0.3

Rocuronium:
-TOF ratio <0.3

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50
Q

Low cardiac output state and volatile anesthetic

A

Soluble anesthestics are MOST AFFECTED.

-Less blood to take up anesthetic gas, miminzing the dilutional effect

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51
Q

Dibucaine 20

A
  • very significant pseudocholinesterase deficiency
  • succ action prolonged to 4-8 hrs
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52
Q

Pip and Pplateau

A

Pip (airway resistance problem:

  • bronchospasm
  • asthma attack
  • mucus plug

Pplateau (compliance issue):

  • abdominal insufflation
  • pulm edema
  • ptx
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53
Q

Forced exhalation

A

-Airway closure occurs first in the lung bases

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54
Q

ASA 4, 5, 6

A

5: won’t survive without surgery
6: braind-ead, organs are being removed for surgery

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55
Q

Citrate tox

A

-can lead to HYPOcalcemia and HYPOmagnesemia

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56
Q

Infant laryngoscopy and intubation

A

At risk for bradycardia d/t predominance of the parasympathetic nervous system

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57
Q

LMWH vs UFH

A

Both bind to antithrombin III

BUT, LMWH is more selective for Factor Xa inhibition

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58
Q

Saphenous nerve

A

Innervated medial lower leg

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59
Q

ASPIRIN OVERDOSE: metabolic derangements

A

First: respiratory alkalosis

Then: metabolic acidosis

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60
Q

Endobronchial intubation: which is slowed more

A

Insoluble anesthetic

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61
Q

Which local anesthetic is most CARDIOtoxic

A

Bupivicaine

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62
Q

Drug metabolism

  • Morphine
  • Warfarin
  • Codein
A
  • Morphine: MC1R
  • Warfarin: CYP2C9
  • Codeine CYP2D6
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63
Q

TTP

Etiology:

Txt:

A

Etiology: abx inhibit ADAMT13, thereby inhibiting breakdown of vWF

Txt: FFP, to replace ADAMT13

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64
Q

Laryngeal muscles INNERVATION

A

-recurrent laryngeal nerve, with the exception of the crithyroid muscle (inntervated by SLN, external branch)

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65
Q

Hepatic blood flow is MEDIATED BY?

A

Adenosine

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66
Q

SUPRACLAV block

A
  • Risk for PTX is highest with SUPRACLAV BLOCK
  • called the “spinal of the arm”
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67
Q

TRALI etiology

A

Donor abs attack host leukocytes, leading to lung inflammation and injury

->can cause leukopenia

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68
Q

What increases power?

A

Power=1-beta

-increasing sample size

  • increasing alpha (the p-value)
  • reducing population variability (choosing a homogenous population)
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69
Q

BOTULISM

txt

A
  • IVIG for < 1 yoa
  • Equine antitoxin for pts >1 yoa

MOA:

ACh release blocked

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70
Q

Fasting guidlelines:

  • breast milk
  • infant formula; non-human milk; light non-fatty meal
A

Breast milk: 4 hrs

Infant formula/non-human milk/light non-fatty meal: 6 hrs

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71
Q

Sufentanil vs fentanyl

Alfentnil vs fentanyl

A

Slightly faster than fentanyl; d/t very high lipid solubility (tho unionized fraction is low)

=

Alfentanil is very fast d/t low pKA; 4x faster onset, 1/4 as potent, 1/4 duration

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72
Q

DEAD SPACE

  • Neck extension
  • PPV
A
  • Neck extension: tube follows the chin; increases dead space
  • PPV: decreases CO and thus pulmonary perfusion, thereby increasing dead space
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73
Q

Trendelenburg position: DEAD SPACE or SHUNT?

A

THINK: shunt

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74
Q

CYANIDE TOX and SVO2

A
  • Increased SVO2 2/2 decreased O2 extraction
  • cyanide inhibits cytochrome oxidase, preventing utilization of O2
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75
Q

SIMV

A
  • SIMV attempts to synchronize the mandatory breaths with a pt’s inspiratory effort
  • therefore, the interval between mandatory breaths may be irregular

vs VCV

-breaths will be delivered at a set schedule

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76
Q

FFP and liver disease

A

No need to give FFP prophylactically to normalize INR in liver pts unless INR >3

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77
Q

Muscle relaxant potentiation:

Which gas?

Which immunosuppresant?

Which abx?

A

Gas? Desflurane

Immunosuppresant? Cylosporine

Abx? Aminoglycoside (getamicin) and tetracycline

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78
Q

Anaphylaxis vs anaphylactoid rxn

A

Anaphylaxis: IgE-mediated

Anaphylactoid: not IgE-mediated; histmaine is released independently

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79
Q

Worst CO2 absorbent

A

Barium hydroxide

  • more fires
  • more compound A with sevo
  • more carbon monoxide
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80
Q

CVP:
A-

C-

Y-

A

A-atrial contraction

C-TV bulging into RA during RV isovolumetric contraction

V-systolic filling of RA

Y-atrial emptying into RV through open TV

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81
Q

Most commonly abused drug AMONGST anesthesiologists

A

Opioids, not MIDAZ

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82
Q

Epidural: midline vs paramedian approach

A

Paramedian approach:

skin>muscle>ligamentum flavum

Midline approach:

skin>supraspinous ligament>interspinous ligament>ligamentum flavum

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83
Q

ASPIRIN inhibits which enzyme?

A

Prevents the synthesis of thromboxane, which is responsible for platelet aggregation

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84
Q

Metocloproamide MOA

A
  • Increases LES
  • Increases gastric motility
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85
Q

Ketamine emergence rxn: who is most at risk?

A

Old lady

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86
Q

TEG:

  • MA decreased
  • R prolonged
  • K prolonged
A
  • MA decreased: give platelets
  • R prolonged: give FFP
  • K prolonged: give cryoprecipitate
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87
Q

vWF interacts with which factor

A

Factor 8

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88
Q

CRPS I and II

A

CRPS I: no history of injury to the area

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89
Q

Inhaled anesthetic and neuromonitoring

A

Brainstem are barely affected (auditory evoked potential)

Visual are very affected (visual evoked potential)

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90
Q

HYPERventilation and electrolyte abnormalities

A

HYPOeverything:

-hypocalcemia, hypokalemia, hypophosphatemia

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91
Q

Most common periop neuropathy

A

Ulnar neuropathy:

-weakeness with hand flexion, thumb adduction

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92
Q

Spinal anesthesia in INFANTS

A
  • increased speed of onset
  • lack of HD collapse (d/t immature sympathetic system)
  • increased block spread (ie increased risk of high spinal)

==

SO first sign can be: respiratory depression or apnea

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93
Q

Neg pressure pulm edema

A

Pathophys:

  • increases preload
  • increases afterload
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94
Q

Capnogram of incompetent inspiratory valve

A

tracing is not quite normal;; inspiratory phase is shortened, has blunted downstroke

-vs capnogram of comptent expiratory valve

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95
Q

MI:

  • BMS
  • No intervention
  • DES
A
  • BMS: wait 30 days
  • No intervention: wait 60 days
  • DES: wait 180 days
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96
Q

Blood transfusion: most common cause of death

A

TRALI

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97
Q

Hemophilia A

Hemophilia B

Hemophilia C

A

Hemophilia A: deficiency in factor 8

Hemophilia B: deficiency in factor 9

Hemophilia C: deficiency in factor 11

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98
Q

Deep sedation

A
  • Purposeful response to repeated or painful stimulation
  • Airway intervention may be required
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99
Q

What prolongs rocuronium?

(5 things)

A
  • hypocalcemia
  • hypothermia
  • lithium
  • volatile anesthetic
  • abx (gentamicin, doxycycline)
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100
Q

MANNITOL:
-what happens if given too quickly

-contraindication:

A
  • given too quickly: cerebral vasodilation>>causing engorgement and increased ICP
  • should be given over 10 to 15 minutes
  • produces an increase in plasma volume; hence think twice before giving in HF
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101
Q

CORONARY VENOUS ANATOMY

A
  • Great cardiac vein: travels with LAD
  • Anterior cardiac vein: travels with RCA
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102
Q

Efficacy vs potency

A
  • Efficacy is MAX effect
  • Potency: relative dose required to achieve effect
103
Q

HD goals for aortic stenosis

A
  • Maintain afterload and sinus rhythm
  • Avoid tachycardia
104
Q

Capnogram: (inspiration vs expiration)

A

Phase 3-4: end of exhlation

Phase 4-1: inspiration

105
Q

Low FRC menmonic

A

PANGOS:

  • pregnancy
  • ascities
  • neonatal
  • supine position
  • general anesthesia
  • obesity
106
Q

CCB in naive patients and NMB

A

Potentiates both depolarzing AND nondepolarizing muscle relaxants

(HYPOcalcemia also prolonged NMB)

Also desflurane; cyclosporine; aminoglycosides (gentamicin); tetracycline

107
Q

Carotid chemoreceptors (carotid and aortic bodies)

A

Responsive to PaO2

108
Q

Neostigmine:
-effect on depolarizing vs nondepolarizing block

A

-Effect on depolarizing block:

potentiates, by partialling inhibiting pseudocholinesterase

-Effect on nondepolarizing block:

inhibits

109
Q

Brachial artery cannulation:
injury to which nerve?

A

median nerve

110
Q

Volatile anesthetic:

  • Which causes the least amount of airway irritation?
  • Which causes plenty of airway irritation?
  • Which is the most potent?
A
  • Which causes the least amount of airway irritation? Sevoflurane
  • Which causes plenty of airway irritation? Desflurane
  • Which is the most potent? Halothane
111
Q

Opioid-induced biliary colic

A

-Txt: naloxone and atropine

112
Q

Transient neurologic syndrome (RISK FACTOR)

A

High dose lidocaine in the spinal mixture

113
Q

Increases MAC

A
  • Acute intoxication
  • Chronic alcohol abuse
  • Red hair
114
Q

Zero-order kinetics

A

Rate of eliminiation is linear (phenytoin, ethanol, aspirin)

115
Q

Cigarette smoking and P50

A

-Rightward shift in P50 is seen 48hrs AFTER smoking cessation

116
Q

MOST ACCURATE sites for measuring core body temperature

A
  • pulmonary artery
  • distal esophagus
  • tympanic membrane
  • nasopharynx
117
Q

CO poisoning vs methemoglobin

A
  • CO monoxide: pulse ox 100%
  • Methemoglobin: pulse ox 85%
118
Q

Autonomic hyperreflexia: spinal cord transection

A

-Above lesion (VASODILATION):

nasal congestion; sweating; warm, flushed skin

  • Below lesion (VASOCONSTRICTION):
  • cool, pale skin
  • acute HTN, cardiac arrhythmias
119
Q

Which home meds to not take on day of surgery?

A
  • ACE/ARB
  • diuretics
  • Metformin is ok
120
Q

Sodium concentration in fluid:
-Plasmalyte

  • LR
  • NS
A

-Plasmalyte: 140

  • LR: 130
  • NS: 154
121
Q

IO lines. Where to place?

A
  • sternum
  • humerus (proximal)
  • tibia (distal and proximal)
122
Q

What is this?

A

Single lung transplantation

  • first peak: represents rapid exhalation from healthy, transplanted lung
  • second peak: slower rate of rise of exhaled CO2 from diseased lung
123
Q

Don’t reverse pregnant woman with neostigmine and glyco

A

Why?

Glyco does not cross the placenta. Rather, reverse with neostigmine and atropine.

124
Q

ACE enzyme

A

Cleaves angiotensin I into angiotensin II

125
Q

Pulmonary circulation does NOT degrade

A
  • dopamine
  • epinephrine
  • histamine
126
Q

Deep sedation vs GA

A

Deep sedation: purposeful response after repeated or painful stimulation

127
Q

Succinylcholine and GI effects

A

-Succinylcholine increases BOTH LES tone and intragastric pressure

128
Q

Lumbar epidural: pulm physiologic change

A
  • Cough and PEP (peak expiratory pressure) are significantly reduced (10-40%)
  • These parameters are more dependent on adominal musculature
129
Q

Gag reflex: which CNs

A

CN9 for sensory

CN10 for cough

130
Q

BP cuff

A

Point of maximal amplitude of oscillations corresponds to MAP

131
Q

Laryngospasms results from:

A

-Sudden closure of both the true and false vocal cords

OR

-Sudden closure of the true cords only

132
Q

Atelectasis

A

Lower lung segments are more prone to atelectasis than upper lung segments

133
Q

BLOOD and ultrasound

A
  • Reflects the LEAST amount of beam rays during ultrasound
  • Has high water content>>thus is hypoechoic (dark)
134
Q

Specificity

A

TF/TF+FP

135
Q

SSRIs MOA

A
  • inhibit CYP enzyme
  • thereby, reduces the activation of many opioids to more potent forms
136
Q

Liver disease: which factors are INCREASED

A

-Factor 8 and vWF are increased as they are produced extra-hepatically

137
Q

MAC requirements by age

A

Highest btwn 1 month and 1 year of age

138
Q

Mixed venous O2 sat; nl SvO2 is 75%

What causes mixed venous O2 sat to increase?

What causes mixed venous O2 sat to drop?

A

Increases:

  • increases cardiac output (sepsis)
  • increases Hgb concetnration
  • decreases O2 consumption/extraction (eg cyanide tox, CO2 poisoning)

Decreases:

  • decreased cardiac output (HF)
  • decrease Hgb concentration
  • increases O2 consumption/extraction
139
Q

PAO2=

A

150-PACO2/0.8

140
Q

Incompetent expiratory valve

A

-inspiratory segement does NOT return to zero

141
Q

FRC increases with:

A
  • height
  • age

==

Decreases with (PANGOS):

  • preg
  • ascites
  • neonatal
  • general anesthesia
  • obeisty
  • supine
142
Q

Why do infants have faster induction with volatile anesthetic compared to adult?

A

-infants have higher MV compared to FRC

143
Q

Echothiophate and succinylcholine

A
  • Echothiophate inhibits cholinesterase to cause miosis in glaucoma patients
  • Systemic absoprtion of echothiophate can cause pseudocholinesterase deficiency, thereby PROLONGOINNG succinylcholine
144
Q

Terbutaline

  • Maternal effects
  • Fetal effects
A

Maternal effect:

  • tachycardia
  • hyperinsulinemia but also hyperglycemia

==

Fetal effect:

-HYPOglycemia, tachycardia

145
Q

Anticholinergic agent and cholinesteraes inhibitor:
-glycopyrrolate and ….

-atropine and …

A
  • Glycopyrrolate and …neostigmine
  • Atropine and edrophonium
146
Q

Desflurane output and barometric pressure:
eg moving to Denver

A

Decreasing barometric pressure will INCREASE vaporizer output

147
Q

Strong ion difference:

  • Acidosis
  • Alkalosis
A
  • Acidosis decreases SID
  • Alkalosis increases SID
  • Nl strong ion difference is ~40
148
Q

What muscle relaxes the vocal cords?

A

Thyroartyenoid muscles

149
Q

EKG changes:

  • HYPERMAGnesemia
  • HYPERCALcemia
A
  • HyperMAGNESEMIA: PR/QRS prolongation
  • HyperCALCEMIA: PR prolongation, QT shortening
150
Q

Posteriomedial papillary muscle

Anterolateral papillary muscle

A

Posteriormedial muscle: RCA alone

Anterolateral papillary muscle: LAD and LCx

151
Q

Bellows ventilator

A

Rises during exhalation. Failure to rise would indicate a leak or disconnection.

152
Q

Platelet trf

A

Associated with higher risk of rxn than other blood products

153
Q

Stellate ganglion is a SYMPATHETIC GANGLION, located between C6-C7

A

Look out for predominance of parasympathetic sxs

154
Q

Maternal cardiac output:
-when is it max?

-2nd to 3rd trimester

A
  • Peak value is immediately folllowing delivery: 2.5 x prepregannt value
  • 2nd to 3rd trimester: 50% increase over prepregnant state
155
Q

LR vs NS infusion

A

NS infusion: metabolic acidosis

LR infusion: metabolic alkalosis (lactate is metabolized to bicarb)

156
Q

ETIOLOGY of syndromes:

Febrile non-hemolytic transfusion rxn

Graft vs host disease

TRALI

A

Febrile non-hemolytic transfusion rxn:

cytokines from donor leukocytes

Graft vs host disease:
Donor lymphocytes reacting against recipient

TRALI:

Donor abs against HLA

157
Q

Meperidine

Which receptor?

Which molecule structure?

Libby zion case?

A
  • Effects are centered around the: kappa opioid receptor
  • Meperidine is structurally similar to atropine
  • Normeperidine: can cause seizure
  • Meperidine + MAO-inhibitor=serotonin syndrome
158
Q

Corneal reflex

A

CN5 (trigeminal nerve) and CN7 (facial nerve)

159
Q

P50 hgb:

  • when is it lowest?
  • when is it highest?
A

-lowest: in newborns (ie hgb affinity for O2 is very high, thanks to hgb F)

160
Q

Hetastarch vs tetrastarch

A

Hetastrach is a/w a higher risk of coagulopathy; compared to newer, tetrastarches

Hetastarch and PLATELET dysfxn:

causes a decrease in glycoprotein 2b-3a on the platelet surface, negatively affecting platelet aggregation

161
Q

Bohr effect vs haldane effect

A

Bohr effect: maternal fetal interface; high CO2 environment; hgb has less affinity for O2

Haldane effect: deoxygenated hgb has greater affinity for CO2; oxygenated hgb has less affinity for CO2

162
Q
  • Boyle’s law
  • Gay-Lussac’s law
A

-Boyle’s law

P*V=P*V

(hence why an O2 cyclinder can hold 660 liters of O2 despite having a volume of only 6.5L)

-Gay-lussac’s law:

P/T=P/T

163
Q

Stress dose steroids: who to consider?

A

A person taking 20mg/day for more than 3 weeks are at high risk for HPAA supression

164
Q

LAST: which routes increase likelihod

A

IICEBALLS:

IV>intercostal>caudal>epidural

165
Q

COLORS:

Carbon dioxide cylinder

Helium cylinder

A

Carbon dioxide cylinder: gray

Helium: brown

166
Q

Capnogram

A

-expiration vs inspiration

167
Q

Obstetric surgery

  • When should semi urgent surgery be done?
  • When should elective surgey be done?
A
  • When should it be done? 2nd trimester
  • 2 to 6 weeks following delivery
168
Q

Toxic metabolites:

  • desflurane
  • sevoflurane
A
  • Desflurane: produces carbon monoxide
  • Sevoflurane: produces fluoride
169
Q

Sodium nitroprusside TOX

A

CP:

  • elevated mixed venous O2 (cells cannot use O2 d/t impaired cellular oxidative phosphorylation)
  • metabolic acidosis
  • flushing
170
Q

Methylene blue

A
  • can treat cathecholamine-resistant shock
  • happens to be a MAO-inhibitor, so can precipitate serotonin syndrome
  • txt for methemoglobinemia
171
Q

CAROTID and AORTIC bodies: increases minute ventilation through which nerve?

A

CN9 (glossopharyngeal nerve)

172
Q

Aging

CV system?

Pulm system?

A

CV system: aging increases SANS activity

Pulm system: aging increases RV/FRC/closing capacity

173
Q

Local anesthetic spread in the EPIDURAL space: which factor influences spread most

A

Volume

174
Q

Which nerve is blocked at the palatoglossal fold?

A

The glossopharyngeal nerve (CN9)

175
Q

Factors that decrease MAC of anesthetic agents

A
  • Acute alcohol
  • pregnancy
  • metabolic acidosis
  • anemia
  • hyponatremia
  • elderly age
176
Q

Aspirin vs ticlopidine

A
  • Aspirin implacts plt fxn for 7-10 days
  • Ticlopidine impacts platelet fxn for 10-14 days
177
Q

METHADONE MOA:

A
  • Serotonin reuptake inhibitor
  • NMDA antagonist
178
Q

Action potentials:

Neuron

Cardiac Pacemaker

Cardiac mycotoes

A

Neuron: Na in, K out

Pacemaker: Ca in, K out

Mycocyte: Na in; Phase 1- K out; Phase 2- K out, Ca in; Phase 3- K out

179
Q

A-line waveform

A

The farther from the aorta (ie dorsalis pedis):

  • the higher the systolic peak
  • the lower the diastolic peak
  • the wider the pulse pressure
  • the farther the dicrotic notch (marks: the closure of the aoritc valve)
180
Q

Licorice

A

In excess can have a HYPERALDOSTERONISM effect

181
Q

Superior laryngeal nerve injury PRESENTATION

A

-voice that tires easily

==

Recurrent laryngeal nerve injury is much more profound:
hoarseness/breathlessness/stridor

182
Q

Low CO and inhalation induction

A

Very much hastened

  • put low CO pts at risk of overdose
  • Soluble anesthestics are most affected
183
Q

BLOOD VOLUME

Premature infant:
Newborn infant:

A

Premature infant: 90-105cc/kg
​Newborn infant: 80-90cc/kg

184
Q

Pneumonectomy morbidity PREDICTORS

A
  • max VO2 <15cc/kg/min
  • predicted postop FEV1<35%
  • predicted postopo DLDCO<35%
185
Q

Duchenne’s muscular dystrophy

A
  • must get EKG and ECHO
  • not associated with MH; however, succinylcholine is associated with rhabdo and life-threatening K
186
Q

SVT in WPW patients

A

Jump to procainamide

187
Q

Lateral wall bladder tumor: what nerve?

A

Obturator nerve

188
Q

Intraop MI: which lead is most senstive

A

V4

189
Q

TRALI: highest risk blood product

A

FFP, not platelets

190
Q

Safest and least safe local anesthesic to fetus

A

Safest: CPC (rapidly metabolized by pseudocholinesterase)

Least safe: 2% lido

191
Q

Allodynia

Anesthesia dolorosa

A

Allodynia-pain from non-noxious stimulus (eg feather)

Anesthesia dolorosa-pain where there shouldn’t be pain sensation at all

192
Q

Axillary nerve

A

“My useful rylan”

193
Q

Txt of high spinal

A

CSF lavage

194
Q

Aortic valve pressure gradient

A

4*(peak velocity)^2

195
Q

Cardiac output thermodilator

A
  • the faster the Tb return to baseline, the higher the cardiac output estimation
  • the slower the TB return to baseline, the lower the cardiac output estimation
    eg. if the injectate solution is cooler than what is preprogrammed, the cardiac output will be UNDERestimated
196
Q

Cryo contains:

A

vWF, fibrinogen, factor 8 (think hemophilia A), Factor 13

197
Q

TBI management

A
  • Keep CPP btwn 50-70
  • ICP<20
198
Q

Pseudocholinesterase deficiency (3 drugs)

A
  • Succinylcholine
  • CPC
  • Mivacurium
199
Q

Neonate cardiac output

A

Very HR dependent (atropine is a good choice to augment CO)

200
Q

Sugammadex dosing:

A

4mg/kg for 0-1 twiches

2mg/kg for 2+ twitches

201
Q

Umbilical vascularture

A

1 umbilical vein (carries oxygenated blood)

2 umbilical arteries

==

Pulm artery and umbilical artery are the only ones thtat carry deoxygenated blood

202
Q

Pyloric stenosis: medical optimization

A

Chloride normalized?->proceed with surgery

Nl Chloride is 100 btw

203
Q

Knee surgery under MAC: blocks which nerves

A

Femoral and sciatic nerves

204
Q

Peribulbar block (vs retrobulbar block)

A
  • requires more local
  • time to onset is longer
  • less likely to have complete akinesia

BUT SAFER :)

205
Q

Retrobulbar hemorrage vs posterior globe puncture

A
  • Retrobulbar hemorrhage-expect INCREASE in IOP
  • Posterior globe puncture-nl IOP
206
Q

Protamine rxns

A

Type 1: hypotension (mast cell granulation, histamine)

Type II: anaphylaxis (IgE-mediated)

Type III: pulm HTN (thromboxane A2 mediated)

207
Q

Cisatracurium metabolism

A

-Hoffman degradation

208
Q

Peds resuscitation bolus

A

20-30cc/kg of isotonic solution; no dextrose, no potassium

209
Q

Prerenal azotemia vs ATN

A

Prerenal: FENa<1%, UOSM (high), BUN:CR >20:1

ATN: Fena>1%, BUN:CR<20:1, UOSM (low)

210
Q

When do troponins peak?

A

24 hrs

211
Q

Infant diaphgram muscle fiber

A

Type 2 fibers, thus rendering them more prone to resp fatigue or failure

212
Q

Electromagnetic interference

A

BIPOLAR electrocautery is safer!

213
Q

Compared to the proximal aorta, arterial waveforms at more distal sites..

A

-delayed dicrotic notch (marks closure of the aortic valve)

214
Q

Neonates and infants at risk of postop apnea: best form of anesthesia

A

-Spinal anesthesia

215
Q

Klippel-Field syndrome

A

-cervical spine infusion->difficult to intubate

216
Q

Saphenous nerve

A

Branch of the femoral nerve! (not sciatic)

217
Q

Sickle cell disease: Hgb managment

A

Keep Hgb btwn 10-13

218
Q

Centrifugal vs roller pumps

A

Centrifugal is preferred, however…flow will vary with alterations in pump preload and afterload

219
Q

Nausea with neuraxial block: normotensive?

A

-Give glyco or atropine

220
Q

Nenonatal resusciation

A

HR <100 BPM: PPV should be initiated

HR <60bpm: chest compressions

221
Q

GCS scale: mild, mod, severe

A

Mild: 13-15

Mod: 9-12

Severe: <9

222
Q

UE vs LE tourniquet

A
  • Inflate UE to at least 50mmHg above SBP
  • Inflate LE to at least 100mmHg above SBP
223
Q

Nl PCWP

A

4-12mmHg

>20, think HF

224
Q

GCS scale:

A

Eye-opening:

  • Spontaneous: 4
  • to sound: 3
  • to pain: 2
  • nil: 1

Verbal response

-Oriented: 5

-Approriate words: 4

  • Inappropriate words: 3
  • Moans: 2
  • Nil: 1

Motor response:

  • Obeys commands: 6
  • Localizes to pain: 5
  • Withdraws to pain: 4
  • Flexion: 3
  • Extension: 2
  • Nil: 1
225
Q

PEEP physiology

A
  • decrease preload
  • increase RV afterload
226
Q

What covers both MRSA and gram-neg bacteria?

A

Tigecycline

227
Q

Ultrasound Probes

A

Lower frequency: better depth perception

High frequecny: better resolution

228
Q

ECT and CBF

A

ECT is known to increase CBF and ICP, which is why space-occuping lesions are CONTRAINDICATIVE

229
Q

Myasthenic gravis—predictors of needing postop mechanical ventilation?

A
  • VC <2.9L
  • Pyridostigmine>750mg daily
  • duration of disease >6yrs
230
Q

Sodium deficit

A

sodium deficit=(140-serum sodium) x total body water

total body water=kg * 0.6

231
Q

Laparoscopic surgery physiology

A
  • increased afterload
  • decreased preload
  • increased ICP (by decreasing cerebral venous return)
232
Q

HCM management

A
  • avoid tachycardia
  • maintain preload
  • maintain afterload

eg neo is good, epi is not

233
Q

Autonomic hyperreflexia: which anesthesia is better?

A

Both general and neuraxial anesthesia are ok

234
Q

qSOFA

A

0-3

  • altered mental status (GCS <15)
  • RR >22
  • SBP<100
235
Q

TPN electrolyte abnormality

A

Watch out for HYPOphosphatemia

236
Q

Vasopressin receptors (ADH)

A
  • the V1 unit is vascular
  • the V2 unit is on the kidney
237
Q

Fetal blood gas post delivery

A

pH: 7.24 / paCO2 52 / PaO2 22

238
Q

Beckwith-Wiedmann CP

A

hypoglycemia, omphalocele, and large tongues

239
Q

Refractory hypotension 2/2 ACE-i/ARB

A

NOREPINEPHRINE is the pressor of choice

240
Q

Ped oral midaz dosing

A

0.5mg/kg (ie 10x the IV dose)

241
Q

Pregnancy and HR

A

HR and SV increase, causing an increasein CO

242
Q

Child-Pugh score: what goes into it?

A

“Pour another beer at eleven”

  • PT
  • Ascities
  • Biliriubin
  • Albumin
  • Encephalopathy
243
Q

DKA: type 1 or type 2

A

Type 1

244
Q

MS patients: anesthesia flare ups with…

A
  • general and spinal anesthesia
  • not epidural anesthesia
245
Q

NL anion gap acidosis

A
  • gut bicarb loss
  • renal tubular acidosis
  • chloride-containing acid administration (NaCl)
246
Q

Refractory hemophilia

A

Context: hemophiliac patients with antibodies to their deficient factor

-txt is Kcentra or recombinant factor VIIa

247
Q

Pregnancy clotting factors

A

-Most clotting factors increase

-EXCEPTION is Factor XI and XIII; they decrease

248
Q

Stage I labor dermatomes

Stage II labor dermatome

A

Stage I labor dermatome: cover T10-L1

Stage II labor dermatome: cover T10-L1 AND S2-S4

249
Q

Hepatopulmonary syndrome vs portopulmonary HTN

A
  • Hepatopulmonary syndrome is associataed with nl PVR, platypnea, excess nitric oxide
  • Portopulmonary HTN is associated with elevated PVR
250
Q

Peds patients undergoing elective surgery: fluid management

A

-give 20-40cc/kg of isotonic fluid over 2 to 4hrs

251
Q

Alveolar partial pressure of oxygen

A

PAO2 = FiO2 * (Patm – PH2O) – (PaCO2 / R)

***FiO2=0.21; PH20=47

252
Q

Neuraxial anesthesia opioid MOA

A

impairing afferent input at receptors in the substantial gelatinosa at the dorsal horn of the spinal cord

253
Q
A

Basic Exam (5 decks)

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