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Apex > Boot Camp Week 1 > Flashcards

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
Q

What lung volumes are increased in COPD?

A

RV
FRC
TLC

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26
Q

What spirometry readings are diagnostic of restrictive disease?

A

FEV1 AND FVC < 70%

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27
Q

What are the risk factors for Mendelson Syndrome?

A

pH < 2.5
Gastric Volume > 25ml (0.4ml/kg)

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28
Q

What is the hallmark sign of Mendelson Syndrome?

A

Hypoxemia

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29
Q

When can a patient who aspirated but is showing no s/s can be discharged from the PACU?

A

2 hours

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30
Q

Which symptoms in PACU justify keeping an aspiration patient longer?

A

New cough or wheeze
+ XRay
>10% reduction in SpO2 on RA from baseline
A-a > 300

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31
Q

In neurosurgical patients, the risk of VAE is highest in which position?

A
  1. Sitting
  2. Lateral
  3. Prone
  4. Supine
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32
Q

What PA mean constitutes pHTN?

A

> 25

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33
Q

What drugs increase PVR?

A

Nitrous
Ketamine
Des

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34
Q

PVR is reduced by:

A

Hyperventilation
NO
NTG

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35
Q

PVR is increased by:

A

Hypoxia
Hypercarbia
Nitrous
Hypothermia
PEEP

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36
Q

100% FiO2 should be administered until CoHgb is:

A

<5%

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37
Q

What is a normal vital capacity?

A

65-75 ml/kg

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38
Q

What vital capacity indicates a need for mechanical ventilation?

A

< 15 ml/kg

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39
Q

What is a normal inspiratory force?

A

75-100 cmH2O

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40
Q

What inspiratory force indicates a need for mechanical ventilation?

A

<25 cm H2O

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41
Q

What is a normal Aa gradient on room air?

A

< 10-15 mmHg

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42
Q

What is a normal Aa gradient on 100% FiO2?

A

<100

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43
Q

If a patient is on 100% FiO2, what Aa gradient indicates a need for intubation?

A

> 450 mmHg

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44
Q

What are the BEST predictors of poor outcomes for patients needing pulm sx

A

FEV1 < 40%
DLCO < 40%
VO2 Max < 15ml/kg

Any of these values warrant split lung testing

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45
Q

What are ABSOLUTE indications for OLV?

A

Infection
Massive Hemorrhage
Bronchopleural Fistula

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46
Q

What are RELATIVE indications for OLV?

A

Improved Exposure
Pulm Edema
Severe Hypoxemia d/t lung disease

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47
Q

How does lateral positioning effect the alveolar compliance curve in the anesthetized patient?

A
48
Q

Unlike a DLT, a bronchial blocker cannot:

A

Prevent contamination from a contralateral infection

49
Q

The lumen of the bronchial blocker can be used to:

A

Suction AIR
Insufflate O2

50
Q

An absolute contraindication to mediastinoscopy is:

A

A previous Mediastinoscopy

51
Q

PIV for mediastinoscopy should be placed:

A

in lower extremity in case large vessels are damaged

52
Q

Oat cell carcinoma is associated with:

A

ELS

53
Q

Patients with ELS are sensitive to:

A

Succ AND non-deps

54
Q

How do you calculate loading dose?

A

Vd x (desired Cp/Bio)

If it’s being given IV, the bioavailability is always 1

55
Q

What is the calculation for total body water in adults?

A

0.6 L/kg

56
Q

A drug with a Vd that exceeds TBW is assumed to be:

A

lipophilic

57
Q

A drug with a Vd below TBW is assumed to be:

A

Hydrophilic

58
Q

Generally, how does ionization dictate drug effect?

A

Ionized = not active, unable to cross any membrane, and more likely to be eliminated

59
Q

Local anesthetics are weak _____

A

bases

60
Q

Which LAs are most and least likely to cause ion trapping?

A

Most: lidocaine
Least: Chloroprocaine

61
Q

Albumin primarily binds with _____ drugs

A

acidic

62
Q

Alpha 1 primarily binds with ______ drugs

A

basic

Basic bitches are Alphas

63
Q

The plasma concentration of alpha 1 is INCREASED in:

A

Old age and Bad things:

surgical stress, MI, pain, RA

64
Q

The plasma concentration of albumin is increased by

A

NOTHING

65
Q

The plasma concentration of alpha 1 is DECREASED in:

A

neonates
pregnancy

66
Q

In the elderly, how do plasma proteins change?

A

Albumin (acidic binding) decreases

Alpha 1 (basic binding) increases

67
Q

How is protein binding related to volume of distribution?

A

inversely

the more protein binding, the lower the volume of distribution

68
Q

When do zero order kinetics occur?

A

When the enzymes are saturated

69
Q

What are the three phases of drug metabolism?

A
70
Q

What drugs are dependent on liver perfusion for clearance?

A

Drugs that have a high hepatic extraction ratio (>0.7)

Fentanyl, sufentanil, morphine, ketamine, propofol

71
Q

What drugs are dependent on the liver’s extraction capacity for clearance?

A

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
Q

Name two drugs that undergo enterohepatic circulation

A

diazepam and warfarin

73
Q

Which opioid isn’t a good choice for someone taking SSRIs?

A

Codeines. Interferes with converting codeine to morphine

74
Q

Name three enzyme inducers

A

tobacco
phenytoin
ETOH

75
Q

Name three enzyme inhibitors

A

SSRIs
Omeprazole
Grapefruit

75
Q

Ammonia makes urine:

A

acidotic

76
Q

Acetazolamide makes urine:

A

Alkalotic

77
Q

Name four drugs metabolized by nonspecific esterases

A

esmolol
remifentanil
atracurium (+ hoffman)
clevidipine

78
Q

Which drugs are broken down by hoffman elimination?

A

Atracurium (+ nonspec)
Cisatracurium

79
Q

Which paralytics are broken down by pseudocholinesterase?

A

Succ and Mivacurium

80
Q
A
81
Q

An example of potentiation is Penicillin + _________

A

Probenecid

82
Q

How do you calculate therapeutic index?

A

Divide the lethal dose by the effective dose

83
Q

What creates chirality?

A

A carbon atom bonded to four DIFFERENT atoms

84
Q

In terms of bupivicaine and ketamine, which enantiomer is better?

A

S

85
Q

Which drugs are NOT supplied as racemic mixtures?

A

Levobupivacaine
Ropivacaine

86
Q

What is a normal CaO2?

A

20 ml/dl

87
Q

Concentric =

A

parallel

88
Q

What side effect is unique to fospropofol?

A

Anal burning

89
Q

What are the CNS effects of etomidate?

A

Decreased CBF
Decreased ICP
CPP remains stable

90
Q

How is etomidate metabolized?

A

Liver and plasma esterases

91
Q

What is the drug class of thiopental?

A

Thiobarbituates

92
Q

Name two oxybarbituates

A

Methohexital
Pentobarbitol

93
Q

Name four features of Thiopental

A
  1. Not a DIRECT myocardial depressant
  2. Causes histamine release

3.Causes reflex tachycardia because baroreceptors are unaffected

  1. Produces less HoTN than propofol
94
Q

What are the CNS effects of Thiopental?

A

Decreases everything

95
Q

Thiopental protects against ______ ischemia

A

focal. NOT global.

96
Q

Acute Intermittent Porphyria is made worse by:

A
  1. Dehydration
  2. ALA synthase
  3. Stress
  4. CYP450 INDUCTION
97
Q

What drugs should be avoided with porphyria?

A

IV anesthetics
CCBs
Toradol
Amio
Birth control

98
Q

How do you treat inadvertent arterial thiopental injection?

A

Phenoxybenzamine
Phentolamine
Sympathectomy (SGB)

99
Q

How are barbiturates metabolized?

A

Liver, except phenobarbitol which is excreted unchanged in the urine

100
Q

Where does precedex produce analgesia?

A

Decreases substance P and Glutamate release in the dorsal horn of the spinal cord

101
Q

Which benzo has the longest half life?

A

Diazepam

102
Q

Which benzo is most potent?

A

Lorazepam

103
Q

Diazepam =

A

Valium

104
Q

Lorazepam =

A

Ativan

105
Q

Which inhaled agent decreases SVR the LEAST?

A

SEvo

106
Q

Which halogenated agents increase HR?

A

Iso and Des do
Sevo does not
“sevo is stable”

107
Q

List the inhaled agents in order of coronary dilation

A

Iso highest
Then des
Sevo is lowest

108
Q

Which agent impairs the hypoxic ventilatory response the LEAST

A

Des

It’s METABOLITES that interfere with hypoxic ventilation, so it makes sense Des has the least effect

109
Q

Des is the best choice for patients with what breathing conditions?

A

Emphysema or severe sleep apnea

110
Q

Which volatile agent increases CSF absorption?

A

Iso

111
Q

What volatile agent increases CSF production?

A

Sevo

112
Q

You should be concerned about nerve ischemia when what SSEP changes are noted?

A

Amplitude DECREASES by 50%

Latency INCREASES by 10%

113
Q

Which evoked signals are MOST resistant to the effects of anesthetics?

A

BAEP

114
Q

Which evoked signals are MOST sensitive to effects of anesthetics?

A

VEP

Apex (46 decks)

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