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APEX ANESTHESIA FLASHCARDS > Bootcamp > Flashcards

Bootcamp Flashcards

1
Q

BMI

Normal:
Overweight:
Obesity 1:
Obesity 2:
Obesity 3:

A

Normal: 18 -24
Overweight: 25-29
Obesity 1: 30-34
Obesity 2: 35-39
Obesity 3: 40-50

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2
Q

> # Hgb A1c is abnormal

A

> 6

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3
Q

Insulin:

Rapid, regular, intermediate, long acting

A

Liz Runs Not Great

Rapid: Lispro, onset 15 mins, duration 2-4 hours
Regular: Regular
Intermediate: NPH, onset 1-2 hours, duration 12-16 hours NPH inhibits glucogenolysis and transport glucose
Long: Glargine

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4
Q

1 unit of insulin reduces serum glucose by:

A

30 mg/dL

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5
Q

Moderate control of blood sugar

A

140-180 mg/dL

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6
Q

What med reduces gluconeogensis and enhances AMP kinase?

A

Metformin (Biquanid)

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7
Q

Things that promote insulin release

A
  • glucose, fructose
  • amino acids
  • beta stimulation
  • GI hormones like glucagon peptide 1
  • semiglutides (Ozempic)
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8
Q

Things that inhibit insulin release:

A
  • glucagon -> glycogenolysis
  • hypoglycemia
  • cortisol
  • alpha stimulation
  • somatostatin
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9
Q

Pancreatic islet cells:

Beta, alpha, Delta, PP

A

Beta: insulin
Alpha: glucagon
Delta: somatostatin
PP: pancreatic polypeptide

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10
Q

Which will least cause renal injury?

A. Decreased BP
B. Use of contrast dye
C. Increased CO2

A

C.

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11
Q

Male GFR

Female GFR

A

Male GFR 100

Female GFR 95

GFR is the best to monitor renal fx since it’s accessible and inexpensive

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12
Q

Ways to diagnose renal fx:

A
  • Oliguria
  • Creatinine > 2x baseline
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13
Q

Systolic HF:

A

HF with reduced EF

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14
Q

Dystolic HF

A

HF with preserved EF

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15
Q

Dromotrophy

Lusiotrophy

A

Dromotrophy: drum rate impulsivity

Lusiotrophy: “loose” relaxation

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16
Q

Obesity cardiomyopathy syndrome

A

Greater TBV: increased SV, preload, tension

Chronicity: LV hypertrophy, impaired ventricular relaxation, diastolic dysfunction

Eventually systolic dysfunction, pulmonary HTN, RV hypertrophy, diastolic/systolic failure may result in

OSA can accelerate this

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17
Q

Obesity:

Risk of DVT is increased due to

A

Chronic inflammation and immobility

Decreased protein C and S
Decreased plasminogen
Issues with factor 5

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18
Q

STOP BANG

A

S: Snore
T: Tired
O: Observed apnea during sleep
P: Pressure, is BP high?

B: BMI > 35
A: Age > 50
N: Neck circumference 40 cm
G: Gender male?

> 5 high risk

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19
Q

Reglan

A

Dopaminergic receptor anatagonist
Peripheral cholinergic agonist
Antiemetic at central and peripheral dopamine receptors
GI pro kinetic
No effect on pH
Black box warning: retardive dyskinesia if used > 10-12 weeks
It crosses BBB

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20
Q

Hagen Poiseuille Law
What is it directly and indirectly proportional to?

A

Flow rate is directly proportional to to radius and change in pressure

Indirectly proportional to length

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21
Q

What is Reynolds directly and indirectly proportionate to?

A

Direct: velocity, radius, density

Indirect: viscosity

Determines if laminar or turbulent

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22
Q

Infrared spectrometry

A

Measures CO2, N2O, and inhaled agents
all all polyatomic asymmetrical molecules so it does NOT measure O2 and Nitrogen

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23
Q

What is the partial pressure % of O2 mmHg to hemoglobin saturation of P50:

A

26.5

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24
Q

Hgb saturation % to PaO2 mmHg (Partial pressure of O2)

50%
75%
90%

A

50% : 26.5 mmHg
75% : 40 mmHg
90% : 58-60 mmHg

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25
Q

Double burst:

A

750 m sec pause

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26
Q

Variable vaporizers

A
  • portion of FGF enters
  • temperature compensated
  • sevo: saturated VP at 20C is 160 mmHg
  • biphasic metallic strip
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27
Q

Desflurane vaporizer

A
  • Desflurane has a very low boiling point of about 23.5°C (74.3°F). This means that at room temperature, it can easily evaporate into a gas. When it’s in liquid form, it’s much easier to control and deliver precisely during anesthesia.
  • It heated at 39C at 2 atm P
  • no FGF enters the camber
  • It blends agent into FGF
  • electrically powered
  • desflurane’s saturated VP at 20C is 669 mmHg
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28
Q

How much H2O needed for soda lime?

A

14-19% H2O

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29
Q

Soda lime 100g =

A

26 L of CO2

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30
Q

Amiodarone

A

Prolongs refractory period in myocardial cells

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31
Q

Adenosine

A

Slows SA and AV nodal conduction

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32
Q

Which muscles narrow the glottis?

A

Lateral cricoarytenoids

Thyroarytenoids

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33
Q

Best approach to prepare the machine for MH pt:

A) place vapor clean filters on inspiratory and expiratory circuit limbs

B) use low flows and do not turn on vaporizers

C) Plan to use TIVA

A

A

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34
Q

Hgb A1c is reflective of an average plasma glucose over how many days?

A

60-90 days

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35
Q

Fetal ion trapping of local anesthetics is facilitated by:

A

Fetal acidosis

Maternal alkalosis

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36
Q

Hypoglycemia treated with 50ml of 50% dextrose raises glucose by?

A

100 mg/dL

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37
Q

Cocaine is metabolized by:

A

Hepatic esterases

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38
Q

Tec 6 and Drager D vaporizers:

  • boiling point, MAC, saturated vapor pressure?
A
  • boiling point of 22.8 C
  • MAC of 6-7%
  • Saturated vapor pressure of 669 mmHg at 20 C
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39
Q

Propofol has a pKa of 11. At physiological pH, Propofol is:

A

Almost completely nonionized

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40
Q

In adults, the spinal cords ends at:

A

L1

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41
Q

Chronotrophy is decreased at the SA node by:

A
  • Hyperpolarization of the RMP
  • increased threshold potential
  • decreased slope of phase 4
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42
Q

What % of post op ulnar neuropathy cases occur in males?

A

70%

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43
Q
A

Bottom right is dead space

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44
Q

Do CCB increase or decrease afterload?

A

Decrease afterload

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45
Q

What hormone regulates total body sodium directly by influencing sodium reabsorption at the kidney?

A

Aldosterone

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46
Q

The substantial gelatinosa is Rexed/s lamina #:

A

2

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47
Q

Laminar flow is directly proportional to

A

Tube radius and pressure difference

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48
Q

Laminar flow is indirectly proportional to

A

Length and viscosity

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49
Q

Positive chronotopes:

A

Growth hormone

Vasopressin

Thyroid hormones

Angiotension

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50
Q

How many pairs of intrinisic laryngeal muscles receive motor innervation from the RLN?

A

7

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51
Q

Review why this is correct

A
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52
Q

Review why this is correct

A
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53
Q

Where do Angiotension receptor blockers exert their effect?

A

on Angiotension 2

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54
Q

Where does lisinopril exert its major effect?

A

Lungs

55
Q

What % of cardiac output is carried by pulmonary arteries?

A

100%

56
Q

Where is the magnus raphe nucleus?

A
57
Q

If the vaporizer tilted with the patient not connected to the system what should you do?

A
  • flush with high flow O2
  • drain vaporizer
  • set the dial to max

Because 1 ml of agent produces 200 ml of vapor at 20C and this tilted vaporizer can contaminate the breathing circuit

58
Q

What is the approximate % percent body water in a healthy adult male with BMI of 24?

A

60% in males

50% in females

59
Q

Mediators of anticoagulation include

A
  • anti thrombin
  • protein C
  • protein S
  • tissue pathway factor inhibitor
60
Q

A proton donor that incompletely dissociates in an aqueous solution

A

Weak acid

Acids DONATE

61
Q

On the pressure volume loop when mitral valve closes what else is happening?

A
  • it’s also EDV
  • ventricular wall tension is called preload
62
Q

What increases with pregnancy and what doesn’t change?

  • CO, MV, platelets, red blood cell volume
A

CO, MV, red blood cell volume increase

Platelets- no change

63
Q

Weak acids or weak bases?

Propofol, ASA, barbs, lasix

A

Weak acids

64
Q

Weak acids or bases?

Ketamine, fentanyl, procaine

A

Weak bases

65
Q

Newborns vs. adult?

  • lungs:
  • chest wall
A

Newborn’s chest wall are more complaint and flimsy

Newborn’s lungs are stiffer than adult lungs

66
Q

What sensations are transmitted through the dorsal column-medial lemniscal system?

A
  • proprioception
  • fine touch
  • pressure
  • vibration
67
Q

Review where the MAP is

A

MAP occurs prior to or at the diastolic notch in the arterial pressure waveform

68
Q

Under laminar flow conditions through a straight tube, the flow velocity is 0 at the:

A

Inner edge of the tube

69
Q

TLC =

A

TLC = FRC + IC

70
Q

Where does Phenylnephrine work?

A

SVR

71
Q

NT used in the descending pain modulating pathways?

A
  • Serotonin
  • NE
  • Enkephalin
72
Q

Arterial blood pressure is the product of:

A

CO and SVR

73
Q

SA node self excitation (autorhythmicity) is caused by ion influx through:

A
  • Funny channel
  • T-type calcium channel
74
Q

Which nerve fiber is exclusively efferent?

A- beta, A delta, B, C

A

B efferent motor nerves found in pre ganglionic autonomic nerves. They’re the first to be blocked by local anesthetics

75
Q

What is the ejection fraction?

A

EF = SV/ EDV x 100

Answer is 52%

76
Q

The newborn maintains FRC above relaxation volume by:

A
  • higher RR
  • glottic closure during expiration- laryngeal braking
  • diaphragmatic braking- maintains FRC
77
Q

Acute coronary syndrome?

A
  • worsening balance of myocardial O2 demand and supply
  • triggering of coagulation cascade with thrombus formation
78
Q

How does Sugammadex reverse Rocuronium?

A

Encapsulation with formation of tighter water soluble complexes

79
Q
A

Plethysomographer- arterial vs. venous blood

Oxyhgb- infrared light, 940 nm

DeoxyHgb- red light, 660nm

80
Q

How may pairs of intrinsic laryngeal muscles receive motor innervation from the superior laryngeal nerves?

A

1
There’s 8 pairs of intrinsic laryngeal muscles and their motor innervation.

The superior laryngeal nerves supply motor innervation to the cricothyroid muscles.

81
Q

A healthy person lies down on her right side, and breathes normally. Her left lung in comparison to her right will be expected to have an

A. Higher blood flow per alveolus

B. Greater ventilation per alveolus

C. Higher alveolar PO2 and lower PCO2

D. Lower V/Q ratio

A

C. Higher alveolar PO2 and lower PCO2 (high V/Q ratio) in non dependent lung regions

82
Q

Secondary hypertension in 40-60 year old adults:

A
  • Aldosteronism
  • Thyroid dysfunction
  • OSA
  • Cushing’s syndrome
  • Pheochromocytoma
83
Q

Ulnar neuropathy

A

Symptoms may not appear till 48 hours after procedure, most cases are males, due to high BMI, prolonged post op bed rest, elbow flexion, external compression or stretch

84
Q

Inadvertent high breathing circuit pressure during spontaneous ventilation may be caused by: (select 2)

A. Overinflation of ETT cuff

B. Tilted vaporizer that has spilled agent

C. Stuck or occluded expiratory unidirectional valve

D. Failure to properly set APL valve during spontaneous breathing

A

C & D

85
Q

Most intraoperative fires occurring on the patient involve which surgeries?

A

Head and neck surgery under regional anesthesia or MAC where supplemental O2 is delivered

86
Q

Hydralazine

A

Is a direct systemic arterial vasodilator, hyperpolarizes smooth muscle cells and activates guanylate cyclase

Side effect- can cause tachycardia

87
Q
A
88
Q

Chronotrophy is increases at the SA node by:

A
  • hypopolarization of RMP
  • decreased threshold potential
  • increased slope of phase 4
89
Q

How much does MAP decrease for each 1cm rise in distance above the heart?

A

0.75 mmHg

90
Q

In a pt with 10 g/dL of Hgb and 100% O2 saturation, what is the O2 content per deciliter of blood?

A

SaO2 x Hgb x 1.34

1 x 10 x 1.34

= 13.4

91
Q

Tachypnea and hyperventilation during acute asthmatic attack reflect:

A

Neural reflexes in the lungs.

92
Q

Which muscles relax the vocal ligaments?

A
  • Thyroarytenoids
  • Vocalis

Also called shortening

93
Q

Physiologic dead space is the sum of:

A

Anatomic + alveolar dead space

94
Q
A

Pulmonary edema, all the other are consistent with obstructive diseases.

FEV1/FVC <75% = obstructive diseases

FEV1/FVC > 75% consistent with restrictive diseases

95
Q

Grade 4 Cormack-Lehane view:

A

Only the soft palate can be visualized

96
Q

Where does Angiotension receptor blockers exert their effect on the RAAS?

A

AT 1 receptors

ARBS inhibit AT1 receptors

97
Q
A
98
Q
A
99
Q

Cardiac output is the product of:

A

HR x SV

100
Q

Hypercarbia while using mapleson breathing circuit is most likely due to

A

Inadequate fresh gas flow

101
Q

Primary determinant of whether the circle system is rebreathing or nonrebreathing is the:

A

FGF

When FGF is <1 min ventilation there is rebreathing.

102
Q

Conditions that increase regurgitant volume in mitral insufficient include:

A
  • slower heart rate
  • increased SVR
  • increased pressure gradient between LV and LV
103
Q

Reynold’s number is directly proportional to

A

Velocity, density, diameter (radius x 2)

104
Q

Oxyhgb curve would shift left in response to

A

Decreased temperature, alkalosis, decrease in 2,3 DPG

105
Q

What lung capacity increases with age?

A

CC due to increased RV with age

CC = RV + CV

106
Q

COPD causes:

A
  • deterioration in elasticity and recoil of lung tissue
  • destruction of lung parenchyma with air sacs
  • active bronchospasm and obstruction

-FEV1/FVC is decreased

107
Q

What hormone regulates sodium concentration?

A

Vasopressin - sodium concentration

108
Q

Traditional pulse oximeter measures light absorbance at how many wave lengths?

A

2

109
Q

SA node self-excitation autorhythmicity is caused by leakiness to:

A

Sodium and calcium in phase 4 of the SA nodal action potential

110
Q

Added weight of the chest wall and abdomen in the obese patients creates:

A
  • diaphragm impediment
  • decrement in FRC
111
Q

Law or principle describes tissue blood flow?

A

Ohm’s = pressure/ resistance

112
Q

Most quantitatively abdundant blood protein

A

Hemoglobin

113
Q

Procoagulant mediators:

A

Collagen, vWF, Fibronectin

114
Q

What % of CO constitutes pulmonary blood flow?

A

100%

115
Q
A

Adhesion: GP1b + Von Willebrand

Activation: P2Y12 + ADP

Aggregation: GP2b/3a + Fibrinogen

116
Q

Under laminar flow conditions through a straight tube, the flow velocity is greatest at the:

A

Center of the tube and zero at the inner edge of the tube

117
Q

Hormones that are positive inotropes:

A
  • thyroid
  • growth
  • vasopressin
  • Angiotension
  • VIP vasoactive intenstinal peptide
118
Q

How much of 150mg IV dose of Sux reaches the neuromuscular junction?

A

15

Only 10% reaches NMJ due to rapid hydrolysis

119
Q
A
120
Q

Stroke volume is inversely related to

A

Afterload

121
Q

Which plasma factor plays a role in both intrinsic and final common pathways?

A

Factor 2

122
Q
A
123
Q
A
  • aortic valve opens
  • ventricular tension is called afterload
  • ventricle contains end-diastolic volume
124
Q

Normal residual volume in liters

A

1.2

125
Q

Perioperative diabetic small vessel complications

A
  • impaired autoregulation
  • impaired vascular tone
  • nonocclusive microcirculatory disease
126
Q
A
127
Q
A

Factor x

128
Q

Up to how many hours of adrenal suppression may follow a single IV bolus of etomidate in a septic patient?

A

72 hours

129
Q
A
130
Q

Name weak bases

A
  • local anesthetics
  • opioids
  • benzos
  • ketamine
131
Q

Name weak acids:

A
  • Barbituates
  • Propofol
132
Q

Major perioperative cause of morbidity and mortality in patients with sickle cell hemoglobin induced vaso-occlusive crisis is:

A

Pulmonary and neurological complications

133
Q

What sensations are transmitted through the anterolateral system?

A

Crude touch, pain, temperature, itch/tickle

APEX ANESTHESIA FLASHCARDS (14 decks)

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