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Boot Camp Week 1 Flashcards

1
Q

What vertebrae correspond with the adult larynx?

A

C3 - C6

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2
Q

What vertebrae correspond with the neonatal larynx?

A

C2 - C4

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3
Q

What is the afferent limb of the laryngospasm?

A

Internal SLN

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4
Q

What is the efferent limb of the laryngospasm?

A

External SLN
RLN

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5
Q

What are the borders of Larson’s Maneuver?

A

Skull Base
RAMUS of mandible
Mastoid process

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6
Q

How should Larson’s be applied?

A

3-5 seconds on
10 sec off

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7
Q

What is Muller’s Maneuver?

A

Inhaling against a closed glottis

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8
Q

What is a severely reduced FEV1?

A

< 35%

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9
Q

What cell communication pathway does the M3 receptor use?

A

Gq

PLC -> IP3 -> Ca

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10
Q

What cell communication pathway do pulmonary Beta 2 receptors use?

A

Gs

Adenalyl Cylase -> increased cAMP -> decreased Ca

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11
Q

What cell communication pathway does VIP use?

A

Non-cholinergic PNS nerves release Vasoactive intestinal peptide onto airway smooth mm which increases NO production

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12
Q

NO stimulates _____

A

cGMP, which leads to smooth mm relaxation

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13
Q

What pulmonary function test is the MOST sensitive indicator of small airway disease?

A

Forced Expiratory Flow of 25-75%

ALSO KNOWN AS THE MMEF

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14
Q

What is forced expiratory flow?

A

Average flow during the middle half of the measurement

ALSO KNOWN AS THE MMEF

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15
Q

What is a normal DLCO?

A

17-25 ml/min/mmHg

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16
Q

What surgical procedures are independent risk factors for postop pulmonary problems?

A
  1. Aortic
  2. Thoracic
  3. Ab/Neuro/Peripheral
  4. Emergency
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17
Q

What duration of anesthesia is associated with poor postoperative outcomes?

A

> 2 hours

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18
Q

What albumin level is associated with poor postoperative outcomes?

A

< 3.5

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19
Q

6 weeks of smoking cessation improves:

A

Airway function
Mucociliary clearance
Sputum Production
Pulmonary Immune Fx
Hep. Enzyme Induction subsides

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20
Q

Which disease type leads to reduced FRC?

A

Restrictive

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21
Q

Which disease type leads to reduced RV?

A

Restrictive

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22
Q

What ABG finding in an asthmatic signals impending collapse?

A

Increased PaCO2

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23
Q

What is the treatment for Alpha 1 Antitrypsin Disease?

A

Liver Transplant

It’s the most common metabolic disease effecting the liver

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24
Q

What should you avoid while mechanically ventilating a patient with severe COPD?

A

Getting the CO2 down to normal

They’re in compensated acidosis, so knocking down CO2 can cause severe alkalosis

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25
What lung volumes are increased in COPD?
RV FRC TLC
26
What spirometry readings are diagnostic of restrictive disease?
FEV1 AND FVC < 70%
27
What are the risk factors for Mendelson Syndrome?
pH < 2.5 Gastric Volume > 25ml (0.4ml/kg)
28
What is the hallmark sign of Mendelson Syndrome?
Hypoxemia
29
When can a patient who aspirated but is showing no s/s can be discharged from the PACU?
2 hours
30
Which symptoms in PACU justify keeping an aspiration patient longer?
New cough or wheeze + XRay >10% reduction in SpO2 on RA from baseline A-a > 300
31
In neurosurgical patients, the risk of VAE is highest in which position?
1. Sitting 2. Lateral 3. Prone 4. Supine
32
What PA mean constitutes pHTN?
>25
33
What drugs increase PVR?
Nitrous Ketamine Des
34
PVR is reduced by:
Hyperventilation NO NTG
35
PVR is increased by:
Hypoxia Hypercarbia Nitrous Hypothermia PEEP
36
100% FiO2 should be administered until CoHgb is:
<5%
37
What is a normal vital capacity?
65-75 ml/kg
38
What vital capacity indicates a need for mechanical ventilation?
< 15 ml/kg
39
What is a normal inspiratory force?
75-100 cmH2O
40
What inspiratory force indicates a need for mechanical ventilation?
<25 cm H2O
41
What is a normal Aa gradient on room air?
< 10-15 mmHg
42
What is a normal Aa gradient on 100% FiO2?
<100
43
If a patient is on 100% FiO2, what Aa gradient indicates a need for intubation?
> 450 mmHg
44
What are the BEST predictors of poor outcomes for patients needing pulm sx
FEV1 < 40% DLCO < 40% VO2 Max < 15ml/kg Any of these values warrant split lung testing
45
What are ABSOLUTE indications for OLV?
Infection Massive Hemorrhage Bronchopleural Fistula
46
What are RELATIVE indications for OLV?
Improved Exposure Pulm Edema Severe Hypoxemia d/t lung disease
47
How does lateral positioning effect the alveolar compliance curve in the anesthetized patient?
48
Unlike a DLT, a bronchial blocker cannot:
Prevent contamination from a contralateral infection
49
The lumen of the bronchial blocker can be used to:
Suction AIR Insufflate O2
50
An absolute contraindication to mediastinoscopy is:
A previous Mediastinoscopy
51
PIV for mediastinoscopy should be placed:
in lower extremity in case large vessels are damaged
52
Oat cell carcinoma is associated with:
ELS
53
Patients with ELS are sensitive to:
Succ AND non-deps
54
How do you calculate loading dose?
Vd x (desired Cp/Bio) If it's being given IV, the bioavailability is always 1
55
What is the calculation for total body water in adults?
0.6 L/kg
56
A drug with a Vd that exceeds TBW is assumed to be:
lipophilic
57
A drug with a Vd below TBW is assumed to be:
Hydrophilic
58
Generally, how does ionization dictate drug effect?
Ionized = not active, unable to cross any membrane, and more likely to be eliminated
59
Local anesthetics are weak _____
bases
60
Which LAs are most and least likely to cause ion trapping?
Most: lidocaine Least: Chloroprocaine
61
Albumin primarily binds with _____ drugs
acidic
62
Alpha 1 primarily binds with ______ drugs
basic Basic bitches are Alphas
63
The plasma concentration of alpha 1 is INCREASED in:
Old age and Bad things: surgical stress, MI, pain, RA
64
The plasma concentration of albumin is increased by
NOTHING
65
The plasma concentration of alpha 1 is DECREASED in:
neonates pregnancy
66
In the elderly, how do plasma proteins change?
Albumin (acidic binding) decreases Alpha 1 (basic binding) increases
67
How is protein binding related to volume of distribution?
inversely the more protein binding, the lower the volume of distribution
68
When do zero order kinetics occur?
When the enzymes are saturated
69
What are the three phases of drug metabolism?
70
What drugs are dependent on liver perfusion for clearance?
Drugs that have a high hepatic extraction ratio (>0.7) Fentanyl, sufentanil, morphine, ketamine, propofol
71
What drugs are dependent on the liver's extraction capacity for clearance?
Drugs that have a low hepatic extraction ratio (<0.3) Rocuronium, diazepam, methadone THESE ARE THE DRUGS MOST EFFECTED BY CHANGES IN ENZYME PATHWAYS
72
Name two drugs that undergo enterohepatic circulation
diazepam and warfarin
73
Which opioid isn't a good choice for someone taking SSRIs?
Codeines. Interferes with converting codeine to morphine
74
Name three enzyme inducers
tobacco phenytoin ETOH
75
Name three enzyme inhibitors
SSRIs Omeprazole Grapefruit
75
Ammonia makes urine:
acidotic
76
Acetazolamide makes urine:
Alkalotic
77
Name four drugs metabolized by nonspecific esterases
esmolol remifentanil atracurium (+ hoffman) clevidipine
78
Which drugs are broken down by hoffman elimination?
Atracurium (+ nonspec) Cisatracurium
79
Which paralytics are broken down by pseudocholinesterase?
Succ and Mivacurium
80
81
An example of potentiation is Penicillin + _________
Probenecid
82
How do you calculate therapeutic index?
Divide the lethal dose by the effective dose
83
What creates chirality?
A carbon atom bonded to four DIFFERENT atoms
84
In terms of bupivicaine and ketamine, which enantiomer is better?
S
85
Which drugs are NOT supplied as racemic mixtures?
Levobupivacaine Ropivacaine
86
What is a normal CaO2?
20 ml/dl
87
Concentric =
parallel
88
What side effect is unique to fospropofol?
Anal burning
89
What are the CNS effects of etomidate?
Decreased CBF Decreased ICP CPP remains stable
90
How is etomidate metabolized?
Liver and plasma esterases
91
What is the drug class of thiopental?
Thiobarbituates
92
Name two oxybarbituates
Methohexital Pentobarbitol
93
Name four features of Thiopental
1. Not a DIRECT myocardial depressant 2. Causes histamine release 3.Causes reflex tachycardia because baroreceptors are unaffected 4. Produces less HoTN than propofol
94
What are the CNS effects of Thiopental?
Decreases everything
95
Thiopental protects against ______ ischemia
focal. NOT global.
96
Acute Intermittent Porphyria is made worse by:
1. Dehydration 2. ALA synthase 3. Stress 4. CYP450 INDUCTION
97
What drugs should be avoided with porphyria?
IV anesthetics CCBs Toradol Amio Birth control
98
How do you treat inadvertent arterial thiopental injection?
Phenoxybenzamine Phentolamine Sympathectomy (SGB)
99
How are barbiturates metabolized?
Liver, except phenobarbitol which is excreted unchanged in the urine
100
Where does precedex produce analgesia?
Decreases substance P and Glutamate release in the dorsal horn of the spinal cord
101
Which benzo has the longest half life?
Diazepam
102
Which benzo is most potent?
Lorazepam
103
Diazepam =
Valium
104
Lorazepam =
Ativan
105
Which inhaled agent decreases SVR the LEAST?
SEvo
106
Which halogenated agents increase HR?
Iso and Des do Sevo does not "sevo is stable"
107
List the inhaled agents in order of coronary dilation
Iso highest Then des Sevo is lowest
108
Which agent impairs the hypoxic ventilatory response the LEAST
Des It's METABOLITES that interfere with hypoxic ventilation, so it makes sense Des has the least effect
109
Des is the best choice for patients with what breathing conditions?
Emphysema or severe sleep apnea
110
Which volatile agent increases CSF absorption?
Iso
111
What volatile agent increases CSF production?
Sevo
112
You should be concerned about nerve ischemia when what SSEP changes are noted?
Amplitude DECREASES by 50% Latency INCREASES by 10%
113
Which evoked signals are MOST resistant to the effects of anesthetics?
BAEP
114
Which evoked signals are MOST sensitive to effects of anesthetics?
VEP

Apex (46 decks)

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