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
2
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
3
Q
1 unit of insulin reduces serum glucose by:
A
30 mg/dL
4
Q
Moderate control of blood sugar
A
140-180 mg/dL
5
Q
What med reduces gluconeogensis and enhances AMP kinase?
A
Metformin (Biquanid)
6
Q
Things that promote insulin release
A
- glucose, fructose
- amino acids
- beta stimulation
- GI hormones like glucagon peptide 1
- semiglutides (Ozempic)
7
Q
Things that inhibit insulin release:
A
- glucagon -> glycogenolysis
- hypoglycemia
- cortisol
- alpha stimulation
- somatostatin
8
Q
Pancreatic islet cells:
Beta, alpha, Delta, PP
A
Beta: insulin
Alpha: glucagon
Delta: somatostatin
PP: pancreatic polypeptide
9
Q
Which will least cause renal injury?
A. Decreased BP
B. Use of contrast dye
C. Increased CO2
A
C.
10
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
11
Q
Ways to diagnose renal fx:
A
- Oliguria
- Creatinine > 2x baseline
12
Q
Systolic HF:
A
HF with reduced EF
13
Q
Dystolic HF
A
HF with preserved EF
14
Q
Dromotrophy
Lusiotrophy
A
Dromotrophy: drum rate impulsivity
Lusiotrophy: “loose” relaxation
15
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
16
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
17
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
18
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
19
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
20
Q
What is Reynolds directly and indirectly proportionate to?
A
Direct: velocity, radius, density
Indirect: viscosity
Determines if laminar or turbulent
21
Q
Infrared spectrometry
A
Measures CO2, N2O, and inhaled agents
all all polyatomic asymmetrical molecules so it does NOT measure O2 and Nitrogen
22
Q
What is the partial pressure % of O2 mmHg to hemoglobin saturation of P50:
A
26.5
23
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
24
Q
Double burst:
A
750 m sec pause
25
Variable vaporizers
- portion of FGF enters
- temperature compensated
- sevo: saturated VP at 20C is 160 mmHg
- biphasic metallic strip
26
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**
27
How much H2O needed for soda lime?
14-19% H2O
28
Soda lime 100g =
26 L of CO2
29
Amiodarone
Prolongs refractory period in myocardial cells
30
Adenosine
Slows SA and AV nodal conduction
31
Which muscles narrow the glottis?
Lateral cricoarytenoids
Thyroarytenoids
32
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
33
Hgb A1c is reflective of an average plasma glucose over how many days?
60-90 days
34
Fetal ion trapping of local anesthetics is facilitated by:
Fetal acidosis
Maternal alkalosis
35
Hypoglycemia treated with 50ml of 50% dextrose raises glucose by?
100 mg/dL
36
Cocaine is metabolized by:
Hepatic esterases
37
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
38
Propofol has a pKa of 11. At physiological pH, Propofol is:
Almost completely nonionized
39
In adults, the spinal cords ends at:
L1
40
Chronotrophy is decreased at the SA node by:
- Hyperpolarization of the RMP
- increased threshold potential
- decreased slope of phase 4
41
What % of post op ulnar neuropathy cases occur in males?
70%
42
Bottom right is dead space
43
Do CCB increase or decrease afterload?
Decrease afterload
44
What hormone regulates total body sodium directly by influencing sodium reabsorption at the kidney?
Aldosterone
45
The substantial gelatinosa is Rexed/s lamina #:
2
46
Laminar flow is directly proportional to
Tube radius and pressure difference
47
Laminar flow is indirectly proportional to
Length and viscosity
48
Positive chronotopes:
Growth hormone
Vasopressin
Thyroid hormones
Angiotension
49
How many pairs of intrinisic laryngeal muscles receive motor innervation from the RLN?
7
50
Review why this is correct
51
Review why this is correct
52
Where do Angiotension receptor blockers exert their effect?
on Angiotension 2
53
Where does lisinopril exert its major effect?
Lungs
54
What % of cardiac output is carried by pulmonary arteries?
100%
55
Where is the magnus raphe nucleus?
56
If the vaporizer tilted with the patient not connected to the system what should you do?
- 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
57
What is the approximate % percent body water in a healthy adult male with BMI of 24?
60% in males
50% in females
58
Mediators of anticoagulation include
- anti thrombin
- protein C
- protein S
- tissue pathway factor inhibitor
59
A proton donor that incompletely dissociates in an aqueous solution
Weak acid
Acids DONATE
60
On the pressure volume loop when mitral valve closes what else is happening?
- it’s also EDV
- ventricular wall tension is called preload
61
What increases with pregnancy and what doesn’t change?
- CO, MV, platelets, red blood cell volume
CO, MV, red blood cell volume increase
Platelets- no change
62
Weak acids or weak bases?
Propofol, ASA, barbs, lasix
Weak acids
63
Weak acids or bases?
Ketamine, fentanyl, procaine
Weak bases
64
Newborns vs. adult?
- lungs:
- chest wall
Newborn’s chest wall are more complaint and flimsy
Newborn’s lungs are stiffer than adult lungs
65
What sensations are transmitted through the dorsal column-medial lemniscal system?
- proprioception
- fine touch
- pressure
- vibration
66
Review where the MAP is
MAP occurs prior to or at the diastolic notch in the arterial pressure waveform
67
Under laminar flow conditions through a straight tube, the flow velocity is 0 at the:
Inner edge of the tube
68
TLC =
TLC = FRC + IC
69
Where does Phenylnephrine work?
SVR
70
NT used in the descending pain modulating pathways?
- Serotonin
- NE
- Enkephalin
71
Arterial blood pressure is the product of:
CO and SVR
72
SA node self excitation (autorhythmicity) is caused by ion influx through:
- Funny channel
- T-type calcium channel
73
Which nerve fiber is exclusively efferent?
A- beta, A delta, B, C
B efferent motor nerves found in pre ganglionic autonomic nerves. They’re the first to be blocked by local anesthetics
74
What is the ejection fraction?
EF = SV/ EDV x 100
Answer is 52%
75
The newborn maintains FRC above relaxation volume by:
- higher RR
- glottic closure during expiration- laryngeal braking
- diaphragmatic braking- maintains FRC
76
Acute coronary syndrome?
- worsening balance of myocardial O2 demand and supply
- triggering of coagulation cascade with thrombus formation
77
How does Sugammadex reverse Rocuronium?
Encapsulation with formation of tighter water soluble complexes
78
Plethysomographer- arterial vs. venous blood
Oxyhgb- infrared light, 940 nm
DeoxyHgb- red light, 660nm
79
How may pairs of intrinsic laryngeal muscles receive motor innervation from the superior laryngeal nerves?
1
There’s 8 pairs of intrinsic laryngeal muscles and their motor innervation.
The superior laryngeal nerves supply motor innervation to the cricothyroid muscles.
80
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
C. Higher alveolar PO2 and lower PCO2 (high V/Q ratio) in non dependent lung regions
81
Secondary hypertension in 40-60 year old adults:
- Aldosteronism
- Thyroid dysfunction
- OSA
- Cushing’s syndrome
- Pheochromocytoma
82
Ulnar neuropathy
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
83
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
C & D
84
Most intraoperative fires occurring on the patient involve which surgeries?
Head and neck surgery under regional anesthesia or MAC where supplemental O2 is delivered
85
Hydralazine
Is a direct systemic arterial vasodilator, hyperpolarizes smooth muscle cells and activates guanylate cyclase
Side effect- can cause tachycardia
86
87
Chronotrophy is increases at the SA node by:
- hypopolarization of RMP
- decreased threshold potential
- increased slope of phase 4
88
How much does MAP decrease for each 1cm rise in distance above the heart?
0.75 mmHg
89
In a pt with 10 g/dL of Hgb and 100% O2 saturation, what is the O2 content per deciliter of blood?
SaO2 x Hgb x 1.34
1 x 10 x 1.34
= 13.4
90
Tachypnea and hyperventilation during acute asthmatic attack reflect:
Neural reflexes in the lungs.
91
Which muscles relax the vocal ligaments?
- Thyroarytenoids
- Vocalis
Also called shortening
92
Physiologic dead space is the sum of:
Anatomic + alveolar dead space
93
Pulmonary edema, all the other are consistent with obstructive diseases.
FEV1/FVC <75% = obstructive diseases
**FEV1/FVC > 75% consistent with restrictive diseases**
94
Grade 4 Cormack-Lehane view:
Only the soft palate can be visualized
95
Where does Angiotension receptor blockers exert their effect on the RAAS?
AT 1 receptors
ARBS inhibit AT1 receptors
96
97
98
Cardiac output is the product of:
HR x SV
99
Hypercarbia while using mapleson breathing circuit is most likely due to
Inadequate fresh gas flow
100
Primary determinant of whether the circle system is rebreathing or nonrebreathing is the:
FGF
When FGF is <1 min ventilation there is rebreathing.
101
Conditions that increase regurgitant volume in mitral insufficient include:
- slower heart rate
- increased SVR
- **increased pressure gradient between LV and LV**
102
Reynold’s number is directly proportional to
Velocity, density, diameter (radius x 2)
103
Oxyhgb curve would shift left in response to
Decreased temperature, alkalosis, decrease in 2,3 DPG
104
What lung capacity increases with age?
CC due to increased RV with age
CC = RV + CV
105
COPD causes:
- deterioration in elasticity and recoil of lung tissue
- destruction of lung parenchyma with air sacs
- active bronchospasm and obstruction
-FEV1/FVC is decreased
106
What hormone regulates sodium concentration?
Vasopressin - sodium concentration
107
Traditional pulse oximeter measures light absorbance at how many wave lengths?
2
108
SA node self-excitation autorhythmicity is caused by leakiness to:
Sodium and calcium in phase 4 of the SA nodal action potential
109
Added weight of the chest wall and abdomen in the obese patients creates:
- diaphragm impediment
- decrement in FRC
110
Law or principle describes tissue blood flow?
Ohm’s = pressure/ resistance
111
Most quantitatively abdundant blood protein
Hemoglobin
112
Procoagulant mediators:
Collagen, vWF, Fibronectin
113
What % of CO constitutes pulmonary blood flow?
100%
114
Adhesion: GP1b + Von Willebrand
Activation: P2Y12 + ADP
Aggregation: GP2b/3a + Fibrinogen
115
Under laminar flow conditions through a straight tube, the flow velocity is greatest at the:
Center of the tube and zero at the inner edge of the tube
116
Hormones that are positive inotropes:
- thyroid
- growth
- vasopressin
- Angiotension
- VIP vasoactive intenstinal peptide
117
How much of 150mg IV dose of Sux reaches the neuromuscular junction?
15
Only 10% reaches NMJ due to rapid hydrolysis
118
119
Stroke volume is inversely related to
Afterload
120
Which plasma factor plays a role in both intrinsic and final common pathways?
Factor 2
121
122
- aortic valve opens
- ventricular tension is called afterload
- ventricle contains end-diastolic volume
123
Normal residual volume in liters
1.2
124
Perioperative diabetic small vessel complications
- impaired autoregulation
- impaired vascular tone
- nonocclusive microcirculatory disease
125
126
Up to how many hours of adrenal suppression may follow a single IV bolus of etomidate in a septic patient?
72 hours
127
128
Name weak bases
BOLK!
- benzos
- opioids
- local anesthetics
- ketamine
129
Name weak acids:
- Barbituates
- Propofol
130
Major perioperative cause of morbidity and mortality in patients with sickle cell hemoglobin induced vaso-occlusive crisis is:
Pulmonary and neurological complications
131
What sensations are transmitted through the anterolateral system?
Crude touch, pain, temperature, itch/tickle
