Bootcamp Flashcards
BMI
Normal:
Overweight:
Obesity 1:
Obesity 2:
Obesity 3:
Normal: 18 -24
Overweight: 25-29
Obesity 1: 30-34
Obesity 2: 35-39
Obesity 3: 40-50
> # Hgb A1c is abnormal
> 6
Insulin:
Rapid, regular, intermediate, long acting
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
1 unit of insulin reduces serum glucose by:
30 mg/dL
Moderate control of blood sugar
140-180 mg/dL
What med reduces gluconeogensis and enhances AMP kinase?
Metformin (Biquanid)
Things that promote insulin release
- glucose, fructose
- amino acids
- beta stimulation
- GI hormones like glucagon peptide 1
- semiglutides (Ozempic)
Things that inhibit insulin release:
- glucagon -> glycogenolysis
- hypoglycemia
- cortisol
- alpha stimulation
- somatostatin
Pancreatic islet cells:
Beta, alpha, Delta, PP
Beta: insulin
Alpha: glucagon
Delta: somatostatin
PP: pancreatic polypeptide
Which will least cause renal injury?
A. Decreased BP
B. Use of contrast dye
C. Increased CO2
C.
Male GFR
Female GFR
Male GFR 100
Female GFR 95
GFR is the best to monitor renal fx since it’s accessible and inexpensive
Ways to diagnose renal fx:
- Oliguria
- Creatinine > 2x baseline
Systolic HF:
HF with reduced EF
Dystolic HF
HF with preserved EF
Dromotrophy
Lusiotrophy
Dromotrophy: drum rate impulsivity
Lusiotrophy: “loose” relaxation
Obesity cardiomyopathy syndrome
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
Obesity:
Risk of DVT is increased due to
Chronic inflammation and immobility
Decreased protein C and S
Decreased plasminogen
Issues with factor 5
STOP BANG
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
Reglan
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
Hagen Poiseuille Law
What is it directly and indirectly proportional to?
Flow rate is directly proportional to to radius and change in pressure
Indirectly proportional to length
What is Reynolds directly and indirectly proportionate to?
Direct: velocity, radius, density
Indirect: viscosity
Determines if laminar or turbulent
Infrared spectrometry
Measures CO2, N2O, and inhaled agents
all all polyatomic asymmetrical molecules so it does NOT measure O2 and Nitrogen
What is the partial pressure % of O2 mmHg to hemoglobin saturation of P50:
26.5
Hgb saturation % to PaO2 mmHg (Partial pressure of O2)
50%
75%
90%
50% : 26.5 mmHg
75% : 40 mmHg
90% : 58-60 mmHg
Double burst:
750 m sec pause
Variable vaporizers
- portion of FGF enters
- temperature compensated
- sevo: saturated VP at 20C is 160 mmHg
- biphasic metallic strip
Desflurane vaporizer
- 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
How much H2O needed for soda lime?
14-19% H2O
Soda lime 100g =
26 L of CO2
Amiodarone
Prolongs refractory period in myocardial cells
Adenosine
Slows SA and AV nodal conduction
Which muscles narrow the glottis?
Lateral cricoarytenoids
Thyroarytenoids
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
Hgb A1c is reflective of an average plasma glucose over how many days?
60-90 days
Fetal ion trapping of local anesthetics is facilitated by:
Fetal acidosis
Maternal alkalosis
Hypoglycemia treated with 50ml of 50% dextrose raises glucose by?
100 mg/dL
Cocaine is metabolized by:
Hepatic esterases
Tec 6 and Drager D vaporizers:
- boiling point, MAC, saturated vapor pressure?
- boiling point of 22.8 C
- MAC of 6-7%
- Saturated vapor pressure of 669 mmHg at 20 C
Propofol has a pKa of 11. At physiological pH, Propofol is:
Almost completely nonionized
In adults, the spinal cords ends at:
L1
Chronotrophy is decreased at the SA node by:
- Hyperpolarization of the RMP
- increased threshold potential
- decreased slope of phase 4
What % of post op ulnar neuropathy cases occur in males?
70%
Bottom right is dead space
Do CCB increase or decrease afterload?
Decrease afterload
What hormone regulates total body sodium directly by influencing sodium reabsorption at the kidney?
Aldosterone
The substantial gelatinosa is Rexed/s lamina #:
2
Laminar flow is directly proportional to
Tube radius and pressure difference
Laminar flow is indirectly proportional to
Length and viscosity
Positive chronotopes:
Growth hormone
Vasopressin
Thyroid hormones
Angiotension
How many pairs of intrinisic laryngeal muscles receive motor innervation from the RLN?
7
Review why this is correct
Review why this is correct
Where do Angiotension receptor blockers exert their effect?
on Angiotension 2
Where does lisinopril exert its major effect?
Lungs
What % of cardiac output is carried by pulmonary arteries?
100%
Where is the magnus raphe nucleus?