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NU 700 Pharm for Anes. > Basics Comprehensive Exam > Flashcards

Basics Comprehensive Exam Flashcards

1
Q

When does smoking cessation lead to improvement of pulm. mechanics?

A

> 8 weeks

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1
Q

When does smoking cessation not decrease risk of resp. complications?

A

<4 weeks

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2
Q

Mallampati score acronym

A

PUSH

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3
Q

Delay surgery for how long post MI?

A

60 days

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4
Q

Delay surgery for how long post DES?

A

6 months

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5
Q

Delay surgery for how long post BMS?

A

30 days

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6
Q

OSA screening

A

STOPBANG
Snoring
Tired
Observed
high Pressure
BMI
Age>50
Neck circ
Gender (Male)

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7
Q

Liver failure screening and what does it consist of

A

Child-Turcotte-Pugh
Ascites
Bili
Albumin
PT
Encephalopathy

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8
Q

What vessels supply blood to nasal mucosa

A

maxillary
ophthalmic
facial arteries

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9
Q

What innervates the nose

A

maxillary and ophthalmic branches of trigeminal nerve (sensory)
PNS- CN VII (facial)
SNS- superior cervical ganglion

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10
Q

What does the nasopharynx lie anterior to

A

C1

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11
Q

What does the oropharynx lie anterior to

A

C2-C3

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12
Q

Where is the hypopharynx

A

C5-C6

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13
Q

Where is the larynx

A

C3-C6

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14
Q

What innervates the pharynx, larynx, and soft palate

A

glossopharyngeal
vagus
spinal accessory

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15
Q

What does the SLN internal do

A

sensory ABOVE vocal cords

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16
Q

What does the SLN external do

A

motor to cricothyroid muscle

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17
Q

Where is the R. RLN

A

loops around brachocephalic artery

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18
Q

Where is the L. RLN

A

loops around aortic arch

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19
Q

What does the RLN do

A

provides sensory to subglottic area and trachea
motor to ALL except cricothyroid

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20
Q

What nerve provides cough reflex

A

vagus

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21
Q

3 single cartilages

A

cricoid
thyroid
epiglottis

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22
Q

3 paired cartilages

A

arytenoids
corniculate
cuneiform

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23
Q

intrinsic muscles do what

A

control tension of VC and opening/closing of the glottis

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24
Q

extrinsic muscles do what

A

connect the larynx, hyoid bone, and neighboring anatomic structures and adjust the position of the larynx during phonation, breathing, and swallowing

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25
Q

Which muscles depress the larynx

A

omohyoid, sternohyoid, sternothyroid

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26
Q

SNS innervation of trachea

A

1-5 thoracic ganglia

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27
Q

PNS innervation of trachea

A

vagus

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28
Q

Difficult BMV

A

BONES- beard, obesity, no teeth, elderly, snoring

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29
Q

Difficult intubation

A

LEMONS- look, eval 3-3-2, Mallampati, obstruction, neck mobilization, scaring
3-3-2 rule- interincisor, hyoidmental distance, thyrohyoid distance

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30
Q

Difficult cric

A

SHORT- surgery, hematoma, obesity, radiation, tumors

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31
Q

LMA intracuff pressure not to exceed

A

60 cmH2O

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32
Q

Muscles that ADDuct VC

A

lateral cricoarytenoids, thyroarytenoid, cricothyroid

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33
Q

Muscles that ABDuct VC

A

posterior cricoarytenoids

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34
Q

What does the Genioglossus muscle do?

A

opens nasopharynx: relaxation causes OSA obstruction

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35
Q

Narrowest region of larynx for adult

A

glottic opening

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36
Q

Narrowest region of larynx for child (fixed and dynamic)

A

fixed- cricoid ring
dynamic- VC

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37
Q

Where is the trachea

A

C6-T4

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38
Q

What innervates the diaphragm and where does it arise

A

phrenic innervation (arises from C3-5)

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39
Q

What muscles are used for inspiration

A

diaphragm, external intercostals, accessory muscles

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40
Q

What muscles are used for normal expiration

A

passive recoil and internal intercostals

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41
Q

What muscles are used for forced expiration

A

I let the air out of my TIRES (transverse abdominis, internal oblique, rectus abdominis, external oblique)

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42
Q

What is the intrapleural pressure at end exp

A

-4

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43
Q

What does the intrapleural pressure do during inspiration

A

becomes more negative

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44
Q

What does the intrapleural pressure do during forced expiration

A

more positive

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45
Q

What does a Mapleson D- Bain system contain

A

pop off valve only

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46
Q

What L and psi is the O2 flush valve

A

50 psi
35-75L

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47
Q

What type of valve is the O2 flush valve

A

type 3

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48
Q

In event of double hanger yolk, one tank is empty, other has 2200 psi, floating check valve prevents what

A

transfilling of the tanks

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49
Q

What type of valve is the first stage regulator

A

diaphragm style

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50
Q

How is O2 produced

A

fractional distillation of liquefied air

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51
Q

How is N2O produced

A

thermal decompensation of ammonium nitrate

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52
Q

Soda lime reaction

A

Water + Co2=
Carbonic acid breaks down into ions
End product: sodium and calcium carbonate and water

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53
Q

How much water do the sodalime molecules need to contain

A

11-19%

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54
Q

Steel cylinder abbrev

A

AA

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54
Q

Most complex part of gas scavenging system

A

interface

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55
Q

Aluminum cylinder abbrev

A

AL or ALM

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56
Q

What does the GE pressure sensor shut off do

A

shuts off N2O and doesn’t proportionally restrict

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57
Q

PISS for air, O2, N2O

A

Air 1,5
O2 2,5
NO2 3,5

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58
Q

Who regulates purity?

A

Who regulates purity- FDA and pharmacopeia

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59
Q

Full tank of O2

A

660L, 2000psi

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60
Q

How long does a 500g soda lime canister last

A

10 hr

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61
Q

100g soda lime absorbs how much CO2

A

26L

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62
Q

International O2 color

A

white

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63
Q

How often to check cylinder

A

q5yr unless special permission for q10 years

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64
Q

Features of des vaporizer

A

heated to 39, pressurized to 2 atm, CPU chip, dual circuit design, back pressure, diaphragm

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65
Q

Retaining screw and there’s a cylinder on hanger yolk, crank it down but its hissing

A

washer issue-one time use

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66
Q

Full N2O canister

A

745 psi
1590 L

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67
Q

intraalveolar/intrapulm pressure in absence of air movement

A

atm

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68
Q

intraalveolar/intrapulm pressure during insp

A

decreases

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69
Q

intraalveolar/intrapulm pressure during exp

A

increases

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70
Q

transpulm pressure define

A

net pressure that distends lungs during insp or PPV
Difference b/w intraalveolar and intrapleural pressure
measure of lung compliance

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71
Q

transpulm pressure pneumo

A

0

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72
Q

transpulm higher pressure =

A

more distended lungs

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73
Q

What can dynamic compliance detect

A

obstruction

74
Q

what can static compliance detect

A

lung elasticity

75
Q

Closing volume define

A

volume above residual vol where small airways close

76
Q

Airways close during tidal breathing if

A

closing vol>FRC

77
Q

FRC can oxygenate healthy person for how long

A

8 min

78
Q

normal anatomic dead space

A

2ml/kg

79
Q

alveolar ventilation equation

A

VA= RR x (Vt-Vd)

80
Q

where is alveolar ventilation greater

A

in areas of higher compliance (dependent areas)

81
Q

Alveolar gas equation define

A

calculated maximal partial pressure of O2 in alveolus for given FiO2

82
Q

PAO2=

A

FiO2 x (Patm-PH2O)- (PaCO2/RQ)

83
Q

Where is the tip of the PA catheter placed

A

Zone 3

84
Q

FRC supine, sitting, Tburg

A

sitting>supine>Tburg

85
Q

How is CO2 stored

A

Bicarb ions in RBCs (80-90%)

86
Q

Hamburger shift

A

bicarb leaves RBC and chloride enters to maintain neutrality

87
Q

Haldane Effect

A

CO2 transport and exchange in lungs

88
Q

Bohr effect

A

O2 transport and exchange in lungs (opposite of Haldane)

89
Q

Respiratory pacemaker

A

dorsal respiratory group

90
Q

what ramps up action potentials to the inspiratory muscles

A

inspiratory ramp signal

91
Q

what is responsible for expiration

A

ventral respiratory group

92
Q

Na content in NS

A

154

93
Q

pH of NS

A

5.5

94
Q

pH of LR

A

6.5

95
Q

pH of plasmalyte

A

7.4

96
Q

Na content in LR

A

130

97
Q

Na content in plasmalyte

A

140

98
Q

K content in LR

A

4

99
Q

K content in plasmalyte

A

5

100
Q

what fine tunes resp pattern by sending impulses to switch off insp ramp, limiting time in filling phase of insp cycle

A

pneumotaxic center

101
Q

what turns off the insp off switch from pneumotaxic center

A

apneustic center

102
Q

What is the Hering-Breuer reflex

A

increase in exp time and slows RR and switches off insp ramp to provect against overinflation

103
Q

What is the Hering-Breuer deflation reflex

A

increases ventilation when lungs deflate abnormally (pneumo) or periodic deep breaths that prevent atelectasis

104
Q

How much does ventilation increase for every 1mmHg increase in PaCO2

A

2-3L/min

105
Q

Define hypoxic ventilatory response

A

PaO2<60 triggers response
Action potential along Hering’s nerve stimulates central controller to increase min. ventilation

106
Q

When is Hering’s nerve impaired

A

it is cut during carotid endarterectomy

107
Q

Lung protective ventilation Vt

A

5-7 mL/kg IBW

108
Q

Lung protective ventilation PIP

A

<35

109
Q

Lung protective ventilation PP

A

<28

110
Q

Lung protective ventilation PEEP

A

<16

111
Q

Controlled mandatory ventilation

A

predetermined settings. No compensation for patient-initiated breaths. Ideal for apneic patients

112
Q

Assist control/ continuous mandatory ventilation

A

predetermined settings. Patient breaths receive predetermined settings. Can hyperventilate

113
Q

SIMV

A

intermittent mandatory breaths delivered in synchrony with patient’s spontaneous breaths. Patient efforts above settings are unassisted

114
Q

CPAP

A

PSV with PEEP

115
Q

Airway pressure release ventilation (APRV)

A

BIVENT but patients can overbreathe

116
Q

Inverse ratio ventilation (IRV)

A

BIVENT- requires muscle relaxant

117
Q

High-frequency ventilation

A

high RR, low Vt

118
Q

plasma osmo

A

280-290

119
Q

NS osmo

A

310

120
Q

LR osmo

A

275

121
Q

plasmalyte osmo

A

295

122
Q

use LR cautiously in what population

A

diabetics

123
Q

contraindication for using LR

A

TBI- cerebral edema

124
Q

SE of albumin

A

pulm. edema with endothelial injury

125
Q

which lytes are found in ECF

A

Na
K

126
Q

which lytes are found in ICF

A

Mag
Phos

127
Q

how to replace sodium

A

1-2 mEq/hr

128
Q

treating hyponatremia too quickly can cause

A

central pontine myelinolysis

129
Q

treating hypernatremia too quickly can cause

A

cerebral edema

130
Q

fully soaked sponge can hold

A

10 ml

131
Q

fully soaked lap can hold

A

100-150 ml

132
Q

replace : with crystalloids

A

3:1

133
Q

replace : with colloids

A

1:1

134
Q

How fast to replace NPO deficit

A

1/2 first hour
1/4 second hour
1/4 third hour

135
Q

NPO deficit calculation

A

maintenance rate x hours fasted

136
Q

4:2:1 rule for fluid replacement

A

4cc/kg/hr for first 10kg
2cc/kg/hr for next 10kg
1cc/kg/hr after 20kg
(just add 40 if over 20kg)

137
Q

fluid challenge amount for adults and peds

A

2L adults
20ml/kg peds
over 15 mins

138
Q

hyperventilation does what to calcium

A

hypocalcemia

139
Q

if SVV is > than what %, a 250 bolus is indicated

A

10-15%

140
Q

intrinsic coag pathway

A

12, 11, 9, 10

141
Q

extrinsic coag pathway

A

3+7=10

142
Q

common coag pathway

A

1x2x5=10

143
Q

thrombotic teg wide or narrow

A

wide and fat

144
Q

hemorrhagic teg wide or narrow

A

narrow

145
Q

k time in a TEG means what

A

fibrinogen and platelet number

146
Q

alpha angle in a TEG means what

A

fibrinogen and platelet number

147
Q

MA in a TEG means what

A

platelet number and function

148
Q

G value in a TEG means what

A

entire coag cascade

149
Q

LY 30 in TEG means what

A

fibrinolysis

150
Q

Estimated blood volume for a female

A

65ml/kg

151
Q

Estimated blood volume for a male

A

70ml/kg

152
Q

ABL=

A

EBVx [(initial hgb-accepted hgb)/initial hgb]

153
Q

cryo contains which factors

A

1, 8, 13, vWF

154
Q

how much cryo to give to increase by 50-100

A

1 unit/10kg

155
Q

Lateral EKG leads

A

I, aVL, V5, V6

156
Q

Inferior EKG leads

A

II, III, aVF

157
Q

Anterior/Septal EKG leads

A

V1-V4

158
Q

Which EKG lead is recommended to monitor for assessment of narrow QRS complex rhythms and P-waves

A

II

159
Q

Which EKG lead is recommended if no preop EKG

A

V3, V4, V5, III, aVF

160
Q

Distance from subclav to RA

A

10

161
Q

Distance from R IJ to RA

A

15

162
Q

Distance from L IJ to RA

A

20

163
Q

Distance from fem to RA

A

40

164
Q

Distance from R IJ to RV

A

25-35

165
Q

Distance from R IJ to PA

A

35-45

166
Q

Distance from R IJ to PAOP

A

40-50

167
Q

CVP A-wave means

A

contraction of RA

168
Q

CVP C wave means

A

closure of tricuspid valve

169
Q

CVP V-wave means

A

passive filling of RA (RV systole)

170
Q

PVRI calculation

A

(MPAP-PAOP)/CI * 80

171
Q

SVRI calculation

A

(MAP-RAP)/CI*80

172
Q

CI calculation

A

CO/BSA

173
Q

heat and warmth receptors travel which fiber

A

unmyelinated C fibers

174
Q

cold receptors travel along which fiber

A

a delta

175
Q

Change in BP _mmHg per inch of height change

A

2

176
Q

chronic cubital nerve injury presents as

A

claw hand

177
Q

5 risk factors for ischemia optic neuropathy

A

crystalloids instead of colloid
longer operative time >5hrs
Lg blood loss <1L
cardiac surgery
spinal fusion

178
Q

what causes central retinal artery occlusion

A

external compression of the eye from improper positioning

179
Q

what is the most common cause of airway obstruction in immediate post op phase

A

loss of pharyngeal muscle tone

180
Q

what is the most common cause of airway obstruction in PACU

A

tongue

181
Q

what is the most common cause of postop hypoxemia

A

atelectasis

182
Q

what is the most severe type of aspiration

A

gastric contents-chemical pneumonitis

183
Q

7 things that prolong NMBDs

A

hypoK
hypermag
hypothermia
resp. acidosis
aminoglycoside abx (clinda, gent, neomycin)
Mag
Lithium

NU 700 Pharm for Anes. (6 decks)

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