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Chapter 1 Flashcards

1
Q

Intrascalene block doesn’t block what nerve

What dermatome

A

Ulnar nerve

C8-T1

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2
Q

Neuraxial block level of blockade

Which is first second third from bottom up

Sensory motor sympathetic

A

Motor is lowest

1 dermattome above sensory

1 more dermatome above is sympathetic

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3
Q

Intercostobrachial nerve innervates what dermatome

A

T2

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4
Q

Dorsal respiratory center initiates

Ventral respiratory center initiates

A

Inspiration is dorsal

Passive exhalation is ventral

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5
Q

Apnustic center in pons sends signals to dorsal respiratory center in medulla to

A

Sustain inspiration.

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6
Q

Reticular activating system does what?

Where is it found

A

Increases ventilators rate and volume of inspiration

Found in midbrain

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7
Q

Bezold jarish reflex

A

Parasympathetic leading to bradycardia vasodilation and hypotension when stimulating cardiac myocytes

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8
Q

Carotid body chemoceptors interact with respiratory centers via which nerve

A

Glossopharyngeal

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9
Q

Aortic arch chemocepters deliver signal via what nerve

A

Vagus

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10
Q

Infarct of the hypothalamus would involve which artery

A

Anterior cerebral artery

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11
Q

Which artery supplies broca and wernickes area

A

Middle cerebral artery

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12
Q

Gray matter of spinal cord

A

Consists of neurons andneuroglia
Butterfly shaped
Gray to white matter ratio is highest at cervical and lumbar regions

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13
Q

Dorsal column tract

A

Ascending signal pathway
First order neurons are in dorsal root ganglion
Second order in dorsal horn
Third order in hypothalamus

For fine touch, proprioception, vibration

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14
Q

Reticulospinal tract

A

Descending for voluntary movement and reflexes

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15
Q

Corticospinal tract

Descending or ascending

A

Descending that innervates skeletal muscle

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16
Q

Descending pathways generally how many neuron system?

First order is in what cortex

A

3

Cerebral cortex

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17
Q

Spinothalamic tract

A

Pain and temperature

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18
Q

Meningies main function

A

Protect brain and spinal cord from injury
Blood supply to skull and hemispheres
Space for CSF

They do not produce CSF
This is formed by the lateral cerebral ventricles of the choroid plexus

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19
Q

Which layer of meningies is pain sensitive

A

Dura mater

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20
Q

Between arachnoid and pia is the

A

Subarachnoid space

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21
Q

CPP is primarily determined by the

Normal CPP range

A

MAP

80-100 mm/hg

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22
Q

CBF increases 1-2 ml/100g per minute for a

A

Increase in co2

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23
Q

H+ does not cross blood brain barrier thus

A

Does not affect cerebral blood flow

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24
Q

Auto regulation is constant at maps of

Higher blood pressure causes autoregulation curve of CBF to shift

A

60-160 map

Right

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25
Q

Volatile anesthetics

A

Dilated cerebral vessels
Impair autoregulatoon
Increase CBF

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26
Q

Circulatory steal

A

Giving blood to normal areas of brain instead of ischemic areas

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27
Q

Volatile anesthetivs increase CBF when above

Ketamine increases

Nitrous oxide increases

A

1 MAC

ICP

CBF

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28
Q

Nitrous oxide increase

A

CBF and CMR02

Volatile anesthetivs decrease CMRO2

Halothane causes the most increase in cerebral blood flow, Sevoflurane the least

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29
Q

Which volatile anesthetivs facilitates CSF absorption

A

Isoflurane

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30
Q

To prevent neuronal damage you don’t need

A

Tight glucose control

Makes patient hypoglycemic leading to more issues

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31
Q

Arachnoid villi absorb

How much CSF volume is maintained

A

CSF

100-150 ml

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32
Q

Production of CSF is by

A

Lateral cerebral ventricles of choroid plexus

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33
Q

Furosemide, acetazolamide, thiopental decrease CSF production

Ketamine increases

A

CSF production

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34
Q

Halothane impedes CSF

A

Absorption

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35
Q

Barbiturates can help in the brain with

A

Focal, not global ischemia

Etomidate increases cmrO2

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36
Q

In neurosurgery cases high PEEP

A

Should be avoided! Increses I tear Horacio pressure and may impede cerebral venous drainage worsening icp

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37
Q

Fentanyl has minimal affect on

Elevating head of bed can decrease

A

ICP and CBF

ICP

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38
Q

Fev1/FVC ratio

A

Can provide indication of degree of airway obstruction

Normal subjects can expire 75-85% of FVC in one sec

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39
Q

FVC

A

Volume of gas expired forcefully after maximal inspiration

Usually equal to VC

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40
Q

FRC =

A

Volume remaining in lung after passive expiration

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41
Q

TLC =

A

VC + RV

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42
Q

IRV plus tidal volume =

A

IC

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43
Q

MVV largest volume that can be breathed in 1 minute with voluntary effort

A

MVV usually normal in restrictive lung disease

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44
Q

FRC decreases when you

A

Lay down

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45
Q

Laplace law = 2T/R

A

Net pressure for inflation of the alveolus

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46
Q

Type 2 alveolar cells produce

A

Surfactant

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47
Q

Type 3 alveolar cells are

A

Macrophages

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48
Q

On flow volume loop

A

COPD has concave expiratory portion which is the effort independent portion of expiration

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49
Q

Flow volume loop tracheal stenosis

A

Both inspiratory and expiratory curves are decreased compared with baseline

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50
Q

Lung parenchyma

A

Respiratory bronchioles, alveolar ducts, alveoli,

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51
Q

More negative intraeural pressure at the

A

Apex of the lung

Most tidal volume reaches the gravity dependent portion of the lung

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52
Q

Blood flow into lungs is

A

Gravity dependent

West zone 1 gets ventilation in absence of perfusion

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53
Q

Ideal V/Q ratio is 1:1 occurs at what rib space

A

3rd

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54
Q

No perfusion =

A

Dead space

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55
Q

Direct inhibitors of HPV

A

Infection
Vasodilator drugs
Hypocarbia

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56
Q

Pa02 of 20-40

A

Saturation goes to 25%

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57
Q

Hyperoxia

A

Lowers ICP

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58
Q

Respiratory center

A

Located in the brainstem(pons and medulla)

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59
Q

Peripheral chemoceptors made up of

A

Carotid and aortic bodies

Stimulated by decrease in pa02

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60
Q

Central chemoreceptors are primarily sensitive to

A

Hydrogen ion concentration

Carbon dioxides effect is indirect

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61
Q

Ventilator rhythmicity controlled by

A

Dorsal medullary reticular formation

Dorsal respiratory group contains inspiratory centers

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62
Q

Above what pa02 do you not influence carbon dioxide response curve

A

100

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63
Q

Beta 2 on bronchial smooth muscle leads to formation of

A

cAMP

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64
Q

Leukotrienes

A

Arachodonic acid metabolites

They antagonize the leukotriene receptor

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65
Q

Dexametbasone has more anti inflammatory than

A

Hydrocortisone

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66
Q

Most energy used in cardiac cycle is during

A

Isovolumetric contraction

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67
Q

Frank starling relationship

A

Relationship between preload and contractile performance

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68
Q

Early indicator of MI are increased LVEDV and decreased compliance

A

ECG wall motion abnormalities are later findings

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69
Q

Sv02 is oxygen utilization in body

Mixed venous is measured in

A

Pulmonary artery

Increased hemoglobin, increased cardiac output will increase sv02

If you use more oxygen such as in hyperthermia will lower sv02

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70
Q

Diastolic dysfunction

A

Impaired relaxation of LV

E to A ratio is less than 1

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71
Q

Pressure baroceptors r located in the carotid sinus and aortic arch

A

SA and AV node decrease heart rate and vascular tone to decrease blood pressure

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72
Q

SBP is higher in femoral artery than in the

A

Aorta

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73
Q

Diaphragm goes down it drops

A

Intrathoracic pressure

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74
Q

Most blood lies in the

A

Venous system

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75
Q

Compliance of venous system

A

Much higher to that of arteries

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76
Q

Capillary blood flow

A

Determined by

Transmural pressure and tone of precapillary and postcapillary sphincters

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77
Q

Tissue with greatest capillary density

A

Are tissues with high metabolic rate such as heart and skeletal muscle

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78
Q

How much of cardiac output goes to liver

A

25%

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79
Q

CPR should continue for

A

At least 2 minutes after return of spontaneous circulation after defibrillation

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80
Q

Asystole

A

First medication after starting CPR is epinephrine 1mg

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81
Q

Symptomatic bradycardia

A

12 lead
Atropine 0.5 mg every 5 minutes
Then do transcutaneous pacing, epinephrine 2-10 ug/min or dopamine

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82
Q

Dilute drugs with 10ml saline when administered via

A

Endotracheal tube

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83
Q

Narrow complex tachycardia

A

Initial is
vagal manuever
Adenosine 6mg is next then 12mg

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84
Q

STEMI management

A

Door to balloon time of 90 minutes
Door to needle time 30 minutes fibrinolysis
Emergency room of 10 minute or less

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85
Q

With an mi with papillary muscle the one most likely to rupture is the

A

Posteromedial papillary muscle

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86
Q

Posterior interventricular artery is located in the

A

Inferior interventricular groove

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87
Q

Mitral valve has two leaflets

A

Anterolateral and posteromedial

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88
Q

What structure is responsible for conduction of impulses from right to left atrium

A

Bachman bundle

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89
Q

Best vasoactive agent for aortic stenosis

A

Phenylephrine

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90
Q

Conduction velocity is fastest through the

A

His-purkinjee system

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91
Q

C wave

A

Isovolumetric Ventricular contraction

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92
Q

Don’t give neostigmine to

A

Heart transplant patients

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93
Q

A wave

A

Atrial contraction

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94
Q

Diastolic dysfunction

A

Increased stiffness of ventricle, higher pressure

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95
Q

V5 lead best for

A

Lateral wall ischemia

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96
Q

Rhythm and conduction disturbance

A

Lead 2

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97
Q

Tachycardia helps with

A

Mitral regurgitation

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98
Q

WPW has an

A

Accessory pathway avoid AV nodal blocking agents like metoprolol and verapamil

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99
Q

Complications of trans catheter aortic valve replacement

A

Embolus stroke, hematoma, MI, LBBB or complete heart block

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100
Q

S3 is for and is

S4 is for and is

A

CHF/transient

Non compliant ventricle and is permanent

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101
Q

Severe tachycardia ca lead to

A

MI - hypokalemia can not

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102
Q

Acetylcholine acts on M2

A

Receptors to slow heart rate

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103
Q

Reverse T puts blood in the legs leading to a decrease in

A

Venous return

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104
Q

Diastolic dysfunction patients rely on the

A

Atrial kick

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105
Q

Midline fold on dura can lead to

A

Unilateral epidural

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106
Q

Renin release is increased in

A

Cirrhotic patients

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107
Q

Cirrhotic patients

A

Vasodilation decrease SVR and increases cardiac output

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108
Q

Retrograde intubation contraindications

A

Coagulopathy
Faint identify landmarks
Thyroid goiter

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109
Q

Systolic filling of atrium =

A

V wave

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110
Q

Atrial relaxation =

A

X descent

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111
Q

CRRT is ideal hemodialysis for

A

Unstable patients in the ICU

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112
Q

If you change pac02 what changes the most is

A

Cerebral blood flow

1-2 ml100g change for each 1mm change in pac02

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113
Q

First line treatment for cyanide toxicity is

A

Hydroxocobalamin

Cyanide inactivates cytochrome oxidase

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114
Q

Plasma creatinine x urine sodium/urine creatinine x plasma sodium =

A

FenA

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115
Q

Myotonic dystrophy

A

Muscle disorders with prolonged contraction and muscle relaxation.

Type1 due to CTG repeats

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116
Q

Propofol can lead to direct

A

Mitochondrial toxicity, leading to respiratory system dysfunction and impaired fatty acid metabolism

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117
Q

Central cord syndrome

A

Cervical spinal cord injury, resulting in loss of sensation and motor function in upper extremities

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118
Q

LR is metabolized to

A

Bicarbonate via mitochondria. Don’t give LR to patients with mitochondrial disease as it leads to elevated serum lactate and metabolic acidosis

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119
Q

Alcoholism and obesity increase

A

Psuedocholinesterase activity

They decrease in pregnancy

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120
Q

Dichotomous variable =

Nominal =

Continuous

A

2 categories available

2 or more categories with no order

Can take on infinite number of values

Ordinal are in groups such as small medium or large

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121
Q

Paired T test

A

Only one group of individuals

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122
Q

Chi square is used to evaluate

A

Two categorical variables

Like comparing PONV and red hair

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123
Q

Compare means of more than 2 groups with

A

ANOVA

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124
Q

Odds of something occurring =

A

Probability it occurs/(1-probability)

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125
Q

Positive skew

A

The tail is to the right

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126
Q

Sensitivity

A

Measures populations of individuals with the disease who are correctly identified as having the disease by the test

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127
Q

PPV

A

A test that is positive indicates the true prescence of the disease

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128
Q

Cohort study

A

Observational study are subjects chosen and followed over period to observe outcome of interest

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129
Q

Cross sectional

A

Survey

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130
Q

Type 1 error

A

Reject the true null hypothesis

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131
Q

Increased SD

A

Increased variability

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132
Q

NNT

A

Number of patients who need to be treated to prevent one adverse outcome

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133
Q

Best NNT is

A

1- because for each you treat don’t need control. The higher the NNT the less effective the treatment

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134
Q

Survival analysis between two comparable treatments is looked at with

A

Hazard ratios

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135
Q

Crossover in statistics means

A

Patients who receive a sequence of different treatments during the trial

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136
Q

Single blinded means you are blinding only to the

A

Subjects

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137
Q

P value

A

Obtaining test statistic value equal to or more extreme than actual test statistics given the null hypothesis is true

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138
Q

R time on TEG is prolonged. What do you give to treat?

A

FFP

Normal R time is 6-8 minutes

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139
Q

Decreased F time is treated with anti-fibrinolytic such as

A

Transexamic acid

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140
Q

Alpha angle is a reflection of clotting kinetics. If decreased it’s due to low fibrinogen and treat with

A

Cryoprecipitate

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141
Q

What nerve is in close proximity to brachial artery

A

Median nerve within antecubital fossa

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142
Q

A line

A

Pressure transducer converts to electric signal

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143
Q

Flush test on A line system to look if dampened

A

Should get 1 large and 1 small oscillation before return to baseline

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144
Q

Overdampened systems

A

Attenuate true arterial pressure waveform leading to low pressures and low pulse pressure

Overdampening causes are kink in line and bubbles in fluid tubing

Underdampening makes systolic look higher and thus can be due to excessive length of tubing

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145
Q

As arterial pressure moves away from aorta the systolic portion becomes peaked/narrowed with increased amplitude

A

This dorsalis pedis has about 20 mmHg higher systolic shown that at aorta

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146
Q

A wave of CVP

Atrial contraction at end of diastole called atrial kick

C wave isovolumetric contraction against a closed tricuspid valve resulting in back pressure through atrium to CVP catheter

X descent- midsystole due to atrial relaxation

A

This is not found in junctional rhythm

In junctional rhythm contraction of right atrium occurs against closed tricuspid resulting in exaggerated A wave called a canon A wave

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147
Q

Tall C wave with

A

Tricuspid regurgitation

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148
Q

Right IJ is typically

A

Lateral and anterior to carotid artery

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149
Q

Peripheral insertion of central catheter

A

Best is basilic which runs medial

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150
Q

Catheter induced pulmonary artery rupture is

A

Hypoxia secondary to lung spillage of contents

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151
Q

Compliance =

A

Change in volume/ change in pressure

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152
Q

Static compliance =

A

Tidal volume /(ppleateau- peep)

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153
Q

Pressure control

A

Pleateau is horizontal

Volume control pleateau is concave down

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154
Q

PEEP

A

Recruits collapsed alveoli and thus increases pulmonary compliance

Causes FRC to increase

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155
Q

Positive pressure Ventilation

A

Decreases preload, afterload, and increases cardiac output

Increased intrathoracic pressure lowers venous return

PPV leads to peak systolic transmural wall pressure to be decreased and afterload is decreased

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156
Q

Oxygen face mask Fi02 from 5-10 liters is

A

.4-.6

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157
Q

NC Fi02

A

2 liters is .24-.28

3 liters .28-.32 and then goes up by 4

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158
Q

Nonrebreather can hit anFi02 of

A

1, partial rebreather hits an Fi02 of 0.75

Both have a bag for expired gas to go out of

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159
Q

Venturi mask

A

A fixed Fi02 is given based on entrainment port of mask, independent on patients minute ventilation

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160
Q

A Paced if pacer spike is before

A

P wave

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161
Q

Different morphologies of P waves are seen in what rhythm

A

MAT

Get heart rate control with beta blockers

Don’t need cardiac consult

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162
Q

D Shaped left ventricle on mid papillary view seen in

A

Pulmonary embolisms bc of shift of interventricular septum toward left ventricle

RV is above LV usually I this view

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163
Q

VOO mode can lead to

A

Under sensing of cardiac activity and can lead to pacer spike before T wave leading to R on T phenomenon

Leading to V fib

Treat by switching pacing mode to DDD

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164
Q

MAP =

A

Cardiac output x SVR

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165
Q

Pericardial tamponade

A

Looks black. Inside the pericardium but outside the ventricles

166
Q

Mid esophageal bicaval view to look for

A

Venous air embolus

167
Q

M mode of IVC subcostal view looks at

A

Volume status

Low pressure = hypovolemia

168
Q

High PPV

A

Give fluid bolus/ should have lots of variation on arterial pressure tracing

169
Q

Awake vs general anesthesia EEG

A

Awake: high frequency low amplitude
GA: low frequency and high amplitude

170
Q

Increased ICP decreases

A

Cerebral perfusion pressure and thus TCD is lower

171
Q

SSEP most affected by in order

A

Isoflurane> propofol> opiodiis> etomidate

Etomidate and ketamine enhance quality of signal with SSEPs

172
Q

Which is commonly least affected by inhalational anesthetics

A

Brainstem auditory EP

173
Q

Etidocaine

A

Longest motor block is very long on epidural at 600 minutes

174
Q

Diphenhydramine

A

Doesn’t help with epidural itching

175
Q

You can bill for

A

Total anesthesia and lines. What you give to maintain anesthesia is bundled in overall payment so knowing what meds you gave doesn’t matter

176
Q

Hemodynamically unstable SVT

A

Synchronized cardioversion

177
Q

For stable SVT

A

First do vagal maneuvers

Next give adenosine 6mg than 12mg

178
Q

Carotid sinus is controlled by

A

Glossopharyngeal nerve, senses high pressure and activates parasympathetic to lower BP and HR

179
Q

Hetastarch

A

Decreases glycoprotein 2b/3a
Messes up platelet aggregation
Reduces factor 8/vWF levels

180
Q

Myotonic dystrophy leads to

A

Gastric atony not spasticity

181
Q

In supine patient most secretions can be found

A

In the posterior segment of the right lower lobe

182
Q

Difficult laryngoscopy

A 
Inter incisor distance less than 4 cm
Higher mallampati
Can’t protrude lower over upper teeth 
Thyromemtal distance less than 6 cm
Neck circumference > 43 cm
Sternomental distance less than 13 cm
183
Q

Line isolation monitor

A

Monitors ungrounded power source in the operating room
Primary circuit is attached to the ground but the secondary circuit is not
It signals when leakage current > 5 mAMP
First fault is not a hazard but the second fault is a hazard

184
Q

Ranitidine will increase gastric pH within

A

One hour of administration

Increases gastric pH before induction helps with aspiration pneumonitis

185
Q

H2 receptor antagonists increases

A

Gastric PH

186
Q

Increased power of study

A

Increase sample size
Increasing alpha p value
Reducing population variability(standard deviation)

Alpha = type 1 error

Power = 1- beta

187
Q

Power =

188
Q

Alpha =

A

Type 1 error

189
Q

Difficult mask

A 
OSA or history of snoring
Age>55
Male
Bmi>30
Mallampati
No teeth
Beard
Limited mandibular protrusion
190
Q

Glycopyrilate isn’t transferred across

A

Placenta

Blocks peripheral muscarinic receptors

191
Q

Assist control is just like VCV if

A

Patient is not breathing

If they are breathing spontaneously it gives patient enough pressure or volume to get them to the tidal volume you want

SIMV is similar but gives to the pressure you assign

192
Q

Neck flex ion or extension can highly affect

A

Depth of endotracheal tube in Peds patients

193
Q

4 factor PCC contains

A

2, 7, 9, and 10

194
Q

Vasopressin

A

Good choice for improvement of SVR

Doesn’t affect PVR

195
Q

Vasopressin binds to

A

V1a receptors of vascular smooth muscle

196
Q

Most common cause of neurologic deficit during carotid endarterectomy

A

Dislodged empiric plaque leading to thromboembolism

197
Q

Norepinephrine

A

Does not block beta 2

198
Q

Dopamine and doubtamine aren’t used in cardiac surgery much bc they can cause

A

Arrhythmia

199
Q

Amiodarone bolus leads to decrease in

A

SVR

Blocks potassium channels and prolongs repolarization

200
Q

Potent independent risk factor for postop apnea

201
Q

Milrinone

A

Increases cardiac output
PDE 5 inhibitor
Stops breakdown of cAMP

202
Q

In amiodarone you get hypothyroidism through low levels of

203
Q

Clebidipine

A

Dihydroperidine calcium channel blocker broken down by plasma esterases

204
Q

Morphine

A

Very hydrophilic. Onset of respiratory depression is 6-12 hours after injection.

205
Q

More lipophilic opioids will spend more time in the

A

Epidural space

206
Q

Good way to check epidural if patient is pain

A

Bolus lidocaine and recheck 10-15 minutes late

207
Q

What drug is avoided for PCA

A

Meperidine bc of it’s toxic metabolite normeperidine

208
Q

Morphine 6 glucoronide leads

A

To hypotension and respiratory depression

209
Q

Don’t give morphine to

A

Renal failure patient

210
Q

Dilaudid PCA

A

Don’t use background infusion if opioid naive
Hourly lockout of 1-2 hours in adults
Set lockout each 10 min

211
Q

5 HT3 antagonist =

212
Q

Acetaminophen moa

A

Analgesic and antipyretic

Centrally acts and inhibits COX

213
Q

Can use dilaudid in patient with

A

CKD

Be careful giving tizanidine to patient on cipro

214
Q

Good low dose ketamine infusion

A

5-10 ug/kg/min

215
Q

Nitrous oxide and ketamine both block the

A

NMDA receptor

216
Q

SCStimulator creates parenthesia in painful area

A

To mask the pain

217
Q

SCS leads target

A

Dorsal columns

218
Q

Opioid induced hyperalgesia

A

Causes diffuse pain instead of localized. Don’t give more opioids! NMDA receptors involved

219
Q

If suboxone is continued

A

Patients are likely to have increased opioid needs postop

220
Q

Opioid withdrawal

A

Restless legs, nausea, diarrhea, mydriasis

Withdrawal can occur when you give suboxone to someone actively using heroin

221
Q

If alpha is decreased

A

Chance of type 1 error decreases but chance of type 2 increases

222
Q

Grade 2b if you only see

A

Posterior arytenoids

223
Q

Ability to void is not a criteria for

A

Discharge from ambulatory surgery center

224
Q

Misuse of opioids can include

A

Taking more pills than you should

Giving opioids to someone else

225
Q

Chronic pain in cancer patients mainly due to

A

Bone metastasis

Radiation therapy is first like therapy

226
Q

Continuous epidural vs PCA

A

Much faster return of bowel function, better pain control, reduced nausea

227
Q

IABP fills

A

Right after dicrotic notch

Indicating closure of aortic valve augments aortic diastolic pressure

228
Q

Moderate AS patient

A

TTE every 1-2 years

If max>4.0 every 6-12 months

229
Q

Low flow state is bad for

A

Aortic stenosis

Aortic valve area < 1.0 cm^2 is bad

230
Q

Infective endocarditis prophylaxis

A

Manipulation of gingival tissue
Periapical region of teeth
Perforation oral mucosa

Root canal needs IE prophylaxis

231
Q

Patients with AS have increased myocardial oxygen demand bc of concentric hypertrophy

A

Diastolic filling pressure also increases so need to keep HR low to fill heart

Lesion is fixed at the valve so strike volume doesn’t depend on afterload

232
Q

In MR stroke volume represents

A

Volume ejected into systemic circulation

That regurgitated back into LA

Very important to reduce SVR to push blood forward

Full, fast forward

233
Q

In Hocm want high afterload to stent open

A

Lvot obstruction

Phenylephrine is a good drug

234
Q

Onset of pulmonary edema with HTN that is acute most likely diagnosis is

A

Flash pulmonary edema

235
Q

Negative pressure pulmonary edema

A

When the tube comes out

236
Q

Chronic tamponade you see

237
Q

Pulsus patadoxus inspiratory fall in SBP greater than 10

A

In tamponade pericardial fluid pressure exceeds cvp so passive filling doesn’t occur without variations in intrathoracic pressure

238
Q

Beta1 stimulation causes

A

Lipolysis In fat cells

239
Q

Dopamine 2

A

Inhibits norepinephrine release

240
Q

Dopamine norepinephrine epinephrine

A

Naturally occurring catecholamines

241
Q

MAO breaks down

A

Norepinephrine

242
Q

AcH made up of

A

Acetyl coenzyme A and choline by choline acetyltransfersse

243
Q

Repeated doses of ephedrine demonstrate diminishing response is what concept

A

Tachyphylaxis

Possibly from exhaustion of norepinephrine supply

244
Q

What beta blocker has been shown to reduce death after MI

245
Q

Beta 1 blockers inhibit

A

Lipolysis

Renin secretion

246
Q

Beta 2 blockade inhibits

A

Insulin release

247
Q

Prazosin

A

Selective alpha 1 blocker

248
Q

Muscarinic antagonists

A

Anticholinergics

Mydriasis
Bronchodilation
Increase HR
Inhibition secretions

249
Q

Glycopyrolate can’t cross

250
Q

Pheo is made of

A

Chrommafin tissue most are intraadrenal

251
Q

One pheo is removed

A

Give lots of fluid and phenylephrine

252
Q

Residual volume

A

Volume left in lung after max expiration

253
Q

Vital capacity is different from TLC bc of

A

Residual volume not added

254
Q

Normal FRC

A

1.7-3.5 Liters

Increase with age, height, lung disease like COPD

FRC greatest when standing

255
Q

Closing capacity

A

Point at expiration when small airways start to close

Increase with age intraabdominal pressure

256
Q

Increased closing capacity

A

Is bad! Airways close faster more likely to become hypoxia on induction

257
Q

Resistance to gas flow in tube mainly affected by

258
Q

Compliance

A

Change in volume of lung when pressure applied

When lung is inflated and held at a volume the pressure peaks and then goes down to plateau pressure

259
Q

ARDS leads to

A

Elevated resistance and decreased compliance

260
Q

Laplace law for alveoli

A

2 x tension /radius = pressure

261
Q

Alveolar gas equation

A

Pa02 = fi02(760-47) - paco2/.8

262
Q

Endotracheal intubation decreases

A

An atomic dead space

263
Q

Arterial oxygen content

A

1.34 x hgb x sa02 + (pa02 x 0.003

264
Q

C02 is mainly transferred in blood as

A

Bicarbonate ions

265
Q

Dorsal respiratory center mainly involved with

A

Inspiration

The ventral center is involved with inspiration and expiration

266
Q

High pac02 =

A

Respiratory acidosis due to

Drugs
Asthma
Emphysema
Neuromuscular disorders

267
Q

Major organ involved in rapid acid base regulation.

268
Q

HC03- on blood gas is

A

Calculated whereas c02 is measured

269
Q

Common cause metabolic alkalosis

A

Vomiting/diuretics

270
Q

DLCO is a measure of

A

Functioning alveolar capillary units

271
Q

Flow volume loops show

A

An atomic location of airway obstruction

272
Q

MAC

A

Concentration at 1 atmosphere that blocks motor response to a painful stimulus in 50% of patients

273
Q

Gender
Thyroid
Hyperkalemia

Don’t affect

274
Q

MAC of

Isoflurane
Sevoflurane
Desflurane

275
Q

Factors that decrease alveolar concentration slow onset of volatile induction

A

Increase in cardiac output
Decrease in minute ventilation
High anesthetic lipid solubility
Low flow within breathing circuit

276
Q

Administering 100% oxygen can mitigate

A

Diffusion hypoxia

277
Q

Volatile anesthetics

A

Decrease in tv

Increase in RR

278
Q

MAC decreased by

A 
Old age
Hyponatremia 
Hypothermia 
Opioids
Clonidune
279
Q

Volatile anesthetics increase

280
Q

Methoxyflurane

A

Fluoride toxicity

281
Q

KOH containing absorpents like baralyme cause the most

A

CO production

282
Q

Into right side of bronchus if

A

Double linen tube inflate bronchi and get right side breath sounds only

283
Q

Posterior femoral cutaneous nerve is blocked by

A

Sciatic nerve

284
Q

Nicardipine is a selective

A

Arterial vasodilator and doesn’t increase ICP

285
Q

Paravertebral and epidural block are

286
Q

Increased aortic diastolic pressure with higher

287
Q

Popliteal block is

A

Deep and medial

In relation to tibial to peroneal

288
Q

Percent trach vs open trach

A

Similar rates of complications

289
Q

Central anticholinergic syndrome

A

Delirium from scopolamine

Give physostigmine which crosses BBB to treat

290
Q

E stands for in ASA classification

A

Any unplanned or emergent procedure

291
Q

Bronchociliary finction improves within

A

2 days of stopping smoking

292
Q

TEG measures combined function of

A

Plts and coagulation factors

293
Q

Warfarin half life

Heparin half life

A
  1. 5 days

1. 5 hrs

294
Q

Full e cylinder 02

A

2000 psig

625 L

295
Q

Air and 02 cannot be compressed to liquid at room temp

A

Passed critical temp do exist as gases

296
Q

02 in anesthesia machine

A 
Contribute to fresh gas flow
02 flush 
Provides low 02 alarm
Controls flow of N20
Powers fail safe valve 
Driving gas of vent
297
Q

Diameter index safety system is to the

298
Q

02 flow meter must always be on the

299
Q

Fail safe valve

A

Cuts off all flow of gases except 02 when the 02 value falls below a set value about 25 psig

300
Q

Need heat for vaporization of liquid to

A

Gases

High thermal heat conductivity helps restore the heat

301
Q

Partial pressure of the vapor not the concentration in volume percent

A

Is the important factor in depth of anesthesia

Actual output is higher at higher pressure places

302
Q

Desflurane has high vapor pressure

A

Boiling point is at room temp

303
Q

Desflurane vaporizer is not

A

Altitude compensated thus need to give higher percentage of desflurane to achieve MAC at 7000 feet

304
Q

Scavenger system also presents

A

Excess suction or an occlusion from affecting the patient breathing circuit.

Positive/negative relief valves

If doesn’t work patients lungs can blow up like a balloon

305
Q

Pop off valve is located on

A

Expiratory limb in semi closed circle system

306
Q

Closed system goal

A

For fresh gas flow to match patients 02 consumption and anesthetic agent uptake

307
Q

Controlled efficiency

A

D BC A

A is the worst

308
Q

PH sensitive dye is what changes color

A

In soda line canister

309
Q

Closing pop off means the values are

A

Going up on valve

310
Q

Bellows failing to rise think

A

Leak
Disconnect
Patient extubated

311
Q

Supine positioning causes

A

Decreases FRC and TLC secondary to abdominal content on diaphragm

312
Q

Femoral nerve in lithotomy can be avoided by

A

Preventing hip flexion greater than 90 degrees

313
Q

Trendelenberg

A

Increases blood to central compartment

Intracranial and intraocular pressure increase

314
Q

VAE

A

Bc surgical site is above level of heart

Air entrainment into venous circulation is a risk

315
Q

Most common nerve injury

316
Q

Most eye injuries are seen in

A

Cardiac injury

Ischemic optic neuropathy posterior is more common

317
Q

Hypoplastic leftbheart

A

Only have one working ventricle so need to decrease blood flow thus don’t overventulate

318
Q

Acidosis increases

A

PVR but SVR is decreased

319
Q

Visceral sympathetic T10-L1

A

Pain during first stage of labor

320
Q

Lack of Vagal input to transplanted heart means

A

Resting HR 100-120

321
Q

Dabigatran directly inhibits

322
Q

With big burns

A

See decreased cardiac output and pulmonary function. Less fluid

323
Q

Increased drug effect depending on how long it’s being infused

A

Context sensitivity

324
Q

Thiopental increases latency of

325
Q

Male sex of fetus leads to increased risk of placenta

326
Q

Interaction with IgE antibodies are usually seen in

A

Anaphylaxis

327
Q

Cerebral salt wasting

A

Hypooolar hyponatremic hyponatremia

328
Q

Epidural to dura to

A

Subarachnoid space

329
Q

Acute alcohol intoxication more risk

A

For lung injury

330
Q

Higher residual volume is not a good

331
Q

Theophylline toxicity can lead to

A

Tachyarhythmia and has a narrow therautic window

332
Q

Use right sided double lumen tube for surgery involving

A

Left mainstrm

333
Q

Best place to measure CVP

A

Tricuspid valve

334
Q

In aortic stenosis don’t want

A

Tachycardia or bradycardia

335
Q

Left dominant with ST elevations in 2,3, or aVf think

A

Left circumflex

Not right coronary

336
Q

Conus medularis

337
Q

CSE

A

Same risk of postural puncture headache

338
Q

T10-L1 for

A

First stage of labor

339
Q

ETT size

A

Age/4 + 4

Measure internal diameter

340
Q

Venous return is highest when

341
Q

Sufentanil on EEG

A

Increase in amplitude and decrease in frequency of EEG

342
Q

Nitrous oxide goes into bloodstream and binds hgb to

A

Get degraded

343
Q

Regional block wears off at

A

8-10 hrs

Femoral TAP adductor sciatic popliteal ankle

344
Q

IVRA

A

Prilocaine better than lidocaine

345
Q

Metochlopramide

A

Block dopaminergic D2 receptors and enhances gastric emptying

346
Q

ION after spine surgery risk factors

A 
Male
Obese
Wilson drake
Duration
Blood loss
347
Q

Midazolam

A

No anticholinergic properties

348
Q

Baroceptor activity increased with more

A

Stretching

349
Q

If you initiate the breath in AC mode you will get

A

Full volume

In simv extra breaths just get whatever pressure is added

350
Q

Nitroprusside can lead to

A

Methemoglobinemia after a few days

351
Q

PVR

A

Papmean-paop/co x 80

352
Q

BMI

A

Kg/height squared in meters

353
Q

Most likely to have MI

A

Third day play surgery

354
Q

MAT doesn’t work on

A

Direct cardipversion

355
Q

TPN does not cause

A

Ketoavidosis

356
Q

02 requirement for adult is 3-4 ml/kg

357
Q

Droperidol can help with

A

Wolf Parkinson’s white

358
Q

Psuedocholinesterase breaks down

A

Succ
Mivacurium
Ester type local anesthetics

Half life is 12 hpsuedocholinesterase lower in pts with liver disease

359
Q

COX2 inhibitors

A

Higher risk for thrombotic state or stroke

360
Q

8 of dexamethasone is like

A

50 of prednisone

361
Q

Atracurium and cisatracuriuk are broken in plasma so

A

Not affected by aging

362
Q

Succ cases

A

Neuromuscular blockade, but also stimulates all cholinergic receptors including the nicotinic receptors of the sympathetic and parasympathetic ganglia as well as muscarinic receptors of hearty leading to bradycardia in children

363
Q

Neuromuscular blockade happens faster in

A

Larynx has diaphram and recovers quicker then in adductor of thumb

Adductor of thumb comes back it means your larynx and diaphragm are good

364
Q

95% of drug is cleared after

A

3 half life’s

365
Q

Meperidine and methadone can cause

A

Serotonin syndrome in patient taking MAOi

366
Q

Most pts don’t like etomidate bc of the

A

Nausea and vomiting

367
Q

Naltrexone duration of action is 24 hrs

368
Q

When u inject NMDB into plasma it goes into

A

The neuromuscular junction

Intubation doses go back into plasma

369
Q

Buprenorohine acts for

A

8 hrs and not reversed by naloxone

370
Q

Naloxone has no affect on

371
Q

Psuedocholinesterase only found in blood

A

Not at neuromuscular junction

372
Q

Miosis and constipation do not exhibit

373
Q

Dopamine depletion leads to

374
Q

Psuedocholinesterase inhibited by

A

Dibucaine

Number of 57 means succ will last up to 30 min since heterozygous

375
Q

Naloxone does not help with

376
Q

Nitroprusside worry about cyanide toxicity when goes above

A

2 ug/kg/min

377
Q

Amrinone

A

PDE3 inhibitor

378
Q

G2b/3a antagonist

379
Q

Dantrolene causes

380
Q

Opioid withdrawal dont get

381
Q

Phase 1 depolarizing block enhanced with use of

A

Anticholinesterase drugs

382
Q

Lithium and opioids decrease

383
Q

Gender does not affect

A

MAC

Severe hypoxia/anemia decreases MAC

384
Q

Atropine has best blocking effect on

A

Muscarinic receptors of heart

385
Q

Aprtocaval compression starts being important at

386
Q

CP occurs during

A

Development

387
Q

Insulin does not regularly cross

388
Q

FDA does not mandate screening for

389
Q

O- whole blood contains anti a and b antibodies so don’t give to someone with

A

Type A pRBCs

390
Q

Sickle cell disease

A

Valine for glutamic acid

391
Q

Newer blood banking techniques makes citrate toxicity

A

Less likely

392
Q

Cryoprecipitate contains

A

Factor 8 13
VWF
Fibrinogen

393
Q

Distance from Y piece to terminal bronchioles contributes to

A

Dead space

394
Q

Dead space

A

Tidal volume not undergoing gas exchange

395
Q

Mapleson circuit

A

For mapleson D best order is

Breathing bag, APL valve, breathing tube, fresh gas inlet, to mask

396
Q

Hypotension can lead to

A

Hypoxia

Hypothermia can not

397
Q

Macroshock

A

Current outside body

398
Q

Microshock

A

Current inside the body

1 mA or below

399
Q

Flow

A

Radius to fourth power

400
Q

Flowmeters should be off when performing

401
Q

Tipping of vaporizer during a case actually leads to

A

Overdose of anesthetic

402
Q

LIM

A

Tells you if grounded by alarming

You want it to stay ungrounded

Purely a monitor

403
Q

Low pulse ox won’t be bc of

A

Severe anemia

404
Q

Guidelines provide

A

Basic recommendations

405
Q

Hole in bellow leads to

A

Hyperventilating or barotrauma

406
Q

Bipolar cautery better if patient has

407
Q

Need to reprogram pacemaker prior to surgery if surgery above

A

Unbilivus to asynchronous mode

408
Q

Transcutaneous pacing

A

Must sedate patient if awake it is very uncomfortable

Dial up amplitude until capture

Want trans venous pacing which is better

409
Q

Recs for pacemaker aicd

A 
Identify device
Review interrogation report
Battery life and lead function
Dependence
Magnet response
Consider needs fir reprogramming vs magnet
Always have magnet available 
Consider need for transcutaneous pacing
410
Q

Electrolyte abnormalities like hypocarbia can cause pacemaker to stop

411
Q

Standard for sickle cell hgb minimim is

Areviewbook (12 decks)

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