Comp Questions Flashcards
How much O2 is dissolved in blood if the PaO2 is 300?
0.003 X 300 = 0.9 ml
Which physics law has a constant temperature?
Boyles
Where are Kuppfer cells located?
Liver
Which law of physics explains why a cylinder cools as it empties?
Joule-Thompson
Coracobrachialis nerve?
Musculocutaneous
A smoker is supposed to stop smoking 2-3 days before surgery to?
Reduce carboxyhemoglobin
What types of Hgb does not change the pulse ox value?
Hgb A, Hgb F
Carcinoid tumor?
Serritonin
Eisenmenger syndrome?
Can’t remember, its a R to L shunt
Demylination of the Pontine’s?
Aggressive treatment of hyponatremia
What is the blood gas partition coefficient of Isoflurane?
1.46
Blood gas solubility determines what?
Speed of onset
MAC is inversely related to?
Potency
Which drug decreases cerebral blood flow and cerebral metabolic requirments
Propofol(so does Etomidate and I can’t remember which one was on there)
Sodium substance with pika 8.2 injected into the blood?
The sodium makes it a weak acid so it is less than 50% ionized.(NA+Phosphate with drug name = base/Na+calcium(mag) with drug name = ?)
What is the most important determinate of duration of action?
How protein bound the drug is
What is the significance of the Oil:water partition coefficient?
Determines lipid solubility
Which two are not metabolized by ester pseudocholinesterase?
Cocaine(ester, but metabolized by liver, prilocaine(amide)
How do you treat magnesium toxicity with a loss of deep tendon reflex?
Calcium gluconate
A dibucaine # of 80 is?
normal—>80% of pseudocholinesterase
How does insulin and glucose treat hyperkalemia?
drives potassium back into the cells
What is the major extracellular cation?
Sodium
Which medication slows the process of reabsorption of bicarb by inhibiting carbonic anhydrase?
Acetazolamide(Diamox)
What region of the kidney is most vulnerable to ischemia?
the Inner stripe of the outer medulla
Glucose filtered by the renal tubule is reabsorbed by the?
Proximal tubule
ECG abnormalities in leads V3 and V4, where is the problem? Leads V2-V5?
LAD
How does glucose and insulin fix hyperkalemia?
drives K into the cell via the NA:K pump
Events during depolarization and repolarization as related to Na and K?
depolarization = 3 Na in repolarization = 2 K out
Isovolumetric contraction on pressure volume loop?
right side vertical
Blood Gas Partition of Isoflurane?
1.4
Oil Gas Partition of sevo?
47
Legal questions-patient has nerve injury?
res Ipsa locutur
Hospital is responsible for CRNA problem?
respondent superior
What causes decreased CMR and Cerebral blood flow?
IV anesthetics(except ketamine)-propofol and barbs
Labetalol affects which receptors?
A1, B1, B2
Dermatone at Xiphoid?
T6
Afferent nerve in occulocardiac reflex?
afferent = V, efferent = X
Life span of platelet?
10 days?(I thought it was 5)
Cupful cells are found in the the?
Liver
Calculate CPP, MAP = 110, ICP = 15, CVP = 5
95?
MAP-ICP(or CVP) take the higher number
A short 16 gauge runs as well as a long 16 gauge catheter, why?
Poiseuille’s law
Laminar flow is inversely proportional to? Reynolds number is inversely proportional to?
Viscosity, Density? Pg. 335 valley
Increased dissolved gas and potency?
?
Pressure and volume, whose law?
Boyles
What two things don’t affect sat probe?
HGB A and HGB F
Most at risk for MH?
Duschennes
CRNA gets caught doing drugs, who takes away their license?
state board
Patient quite smoking 2 days preop, whats the benefit?
decreased carboxyhgb
Intrathoracic obstruction, whats the problem?
breathing out
Bicarb is exchanged for what in RBCs?
chloride(Hamburger shift)
What shifts the OxyHgb curve to the left?
decreasing stuff, Hgb F, methgb, carboxyhgb
Xanthines?
theophylline
Ipratroprium NA
antimuscarinic
Subarachnoid morphine acts where?
inhibit substance p?
Stick your tongue out, which CN?
XII
CSF travels through aqueduct of selves to?
4th ventricle
Most inhibits p450?
Tagement
Normal PAD?
‘8-15
PAC is 20 cm deep from right IG, where is it?
RA
Pressure-volume loop pic-large loop shrinks shorter and to the left, but stays within the left border?
mitral stenosis or nitro?
Protamine is a _____ drug?
Neutralizer
Concentric vs. Eccentric questions?
Concentric caused by-chronic aortic stenosis, chronic HTN, coarctation of the aorta causing LVH Eccentric caused by-MVR, morbid obesity, leads to dilated LV
What coag factor is not in the common pathway?
11
Ape hand is caused by damage to which nerve?
Median
The common peroneal and tibial are branches of which nerve?
Sciatic
Which nerve injury would cause diminished sensation to the medial aspect of the thigh?
Obturator
Which block often misses the ulnar nerve?
Interscalene
Which nerve covers the dorsal aspect of the foot where you would feel a dorsalis pedis?
Superficial Peroneal
All of the following except which nerve are part of the three-in-one block?
Femoral, saphenous, common peroneal, Sciatic
Sciatic
Which nerves are innervated by the posterior branch(select two) of the brachial plexus?
Axillary and Radial
Which nerves are blocked first?
B fibers sympathetic
Which nerves conduct the slowest?
C fibers unmylenated
Which dermatome at the xiphoid process?
T6
How is the motor/anterior portion of the spinal cord perfused?
Single anterior artery
If you add sterile water to a solution, what will it become?
Hypobaric
A newborns spinal cord extends to?
L3
Ion trapping in the fetus?
Maternal alkalosis and fetal acidosis
Where is the location of pain in the first stage of labor?
T10-L1
Adherence to the myometrium without invasion?
Accreta Vera
Mirror pattern of uterine contraction and may be caused by compression of the head?
Early Decells
Which LA is most likely to cross the placenta?
Mepivocaine
The mother has the most increase in CO at?
immediately after delivery
Who needs a CT scan?
Trisomy 21
When is the hgb the lowest?
3 month of age
Who is most likely to have MH?
Duschane’s muscular dystrophy
What is the percent O2 if Isoflurane is added?
(760 - 239)=521
521/760x100=68.8%
68.6%
Whose law is vapor pressure?
Dalton’s
If you change the radius or length of an IV catheter, whose law is this?
Poiseuille’s
Turbulent flow depends on what?
Density
A nebulizer works based on what?
Venturi effect/Bernoulli’s Principle
There is a decrease in O2 demand with an increase or decrease in preload?
decrease
ADH neurohypophysis is associated with increased or decreased osmality?
increased osmality
What is the size of ETT for a 2 year old?
Age + 16/4=4.5 cuff(4.0 uncuffed)
How is remifentanil broken down?
by plasma esterases
Does carbon monoxide cause a right shift or a left shift of they oxyhemoglobin disassociation curve?
it causes a left shift
If you stick 20 cm from the right IJ you would be where?
right atrium
BAIN allows for ventilation with what type of patient?
apenic patient
Nardil dosnet use?
demerol
Ketamine is the only anesthetic with these properties.
analgesic
What is the major intracellular ion?
potassium
Know the triad for pheycytocroma
CHF is NOT one of those
Doest the lateral posteriorarytenoids abduct or adduct the vocal cords?
adducts them
Perfusion and ventilation in the awake patient is best at the ___ of the lungs?
base
Does an increase or a decrease in DBP increase coronary perfusion pressure?
an increase
Does NO increase or decrease cGMP?
increases
A right shift in the oxyhemoglobin disassociation curve causes increase or decrease O2 to the cells?
right shift unloads oxygen to the cells
What type of lung cells are responsible for surfactant production?
alveolar type II
Neuro “sitting position” case…patient develops a murmur…what is the problem?
air embolism
Should methregine be given before or after the baby is delivered?
after
If the spinal cord is severed at C2-C4 what is the result?
no breathing
What do you do if the patient experiences extrapyridial symptoms after reglan is given?
benadryl
What structure is posterior to the ligamentum flavum?
Interspinous
What determines potency?
Lipid solubility
What causes closure of the patent ductus arteriousus?
Prostaglandins
What is associated with turp blindness?
glycine
What is the vapor pressure of Sevoflurane?
170 mmHg
What is the vapor pressure of Enflurane?
172 mmHg
What is the vapor pressure of Isoflurane?
240 mmHg
What is the vapor pressure of Halothane?
244 mmHg
What is the vapor pressure of Desflurane?
669 mmHg
What is Beck’s triad?
-for cardiac tamponade
low BP, muffled heart sounds and JVD
Where is ADH released from and what causes its release?
- neurohypophysis(post pitutary)
2. due to osmolality
How should HR control be managed with Aortic Stenosis?
HR 50-70 to increase perfusion
What should be given in the event reglan causes extrapyramidal symptoms?
Benadryl
What determines the potency of VA?
lipid solubility
Phenoxybenzamine given for pheochromocytoma works on what receptors?
A1 and A2
Tagamet antagonizes?
Cytochrome P450
What medications should not be given to Parkinson’s patients?
Scopalamine, Reglan and Inapsine
How does Zero order kinectics work?
constant rate over time, does not have compartments
Oil:Gas partitioin coefficient measures what?
lipid solubility
Hypoalbuminemia acauses the volume of distribuion to increase or decrease?
increase
What are the symptoms of Cushings syndrome?
- HTN
- irregular respirations
- bradycardia
Where in the SC does sympathetic POST ganglionic neurons pass through?
gray rami
What law allows us to calculate CO2 dissolved in blood?
Henry’s law
You have 200 mg of 4% Marcaine. How mant mls?
5
How is the amount of O2 dissolved in blood calculated?
partial pressure x .003
What are the high points of the SC in the supine patient?
C3, L3
What are the low points of the SC in the supine patient?
T6, S2
What is the last nerve fiber to be blocked?
A-alpha
What nerve needs to be blocked between Achilles tendon and lateral malleolus?
Sural
What segments of SC are responsible for pain in the 1st stage of labor?
T10-L1
What should be suspected with painless vaginal bleeding?
placenta previa
What are the characteristics of Eccentric hypertrophy?
enlarged muscle-no change in chamber size
What are the characteritics of Concetric hypertrophy?
enlarged chamber size-maybe some enlarged muscle
What clotting factors are not made in the liver?
III, IV, VIII
What labatory results test the intrinsic pathway?
PTT, ACT
PTT and ACT lab test are related to what medication? and what pathway?
Heparin
intrinsic
What clotting factors are related to ptt, act and heparin?
8, 9, 11 and 12
What labatory results test the extrinsic pathway?
PT, INR
PT and INR lab test are related to what medication? and what pathway?
Coumadin
extrinsic
What clotting factors are related to PT, INR and Coumadin?
3, 7
What is the common pathway?
1, 2, 5, 10, 13
What is the normal PVR?
50 -150 dynes/sec/cm^5
In what valvulur disorder is phenylephrine detrimental?
Mitral Regurge
Which kinetics is responsible for elimination of 2 mg/min?
Zero Order Kinetics
A decrease in pCO2 by 10 mmHg will decrease the serum pH by?
0.1(?)
Hyperventilation can decrease potassium by?
0.5 mEq/L
Etomidate inhibits?
Adrenal Cortex(cortisol)
What gland causes Ca reabsorption into the bones?
Parathyroid
What agents should be given in heart transplant patients?
give direct acting drugs(Isuprel)
Where is the best lung perfusion in a patient in the lateral decubitus position?
dependent lung(base)
What is the calculation for coronary perfusion pressure?
CPP= DBP - PCWP
Is asthma restrictive or obstructive?
obstructive
What laws relates to raising an IV bag?
Pousille’s law
Most of the CO2 in the blood is transported as?
HCO3
Bleomycin is toxic to the ___, Doxyrubicin is toxic to the ___?
- lungs
- heart
Geriatric patients have (increased/decreased) pulmonary compliance and (increased/decreased) FRC?
- increased
- increased
MAC is inversely related to?
potentcy
How many 1/2 lives does it take for a drug to be 98% eliminated?
6
What is the nomral IOP?
12-20
What is the normal mag level?
4-6 mEq/L
What is posterior to the ligamentumm flavum?
Interspinous ligament
A patient becomes disconnected from the ventilator…is this a sentinal or critical event?
Critical
If the patient has oozing after surgery what should be suspected?
thrombocytopenia
What are parasympathetic nerves?
3, 7, 9, 10(not 5)
Where in the SC is CSF reabsorbed?
arachnoid villi
What is the total CSF volume?
150 ml
Best induction agent for asthmatics?
ketamine
What is the best diagnositic test for air embolism?
TEE/doplar
What is another name for coronary steal?
luxury perfusion
Sodium bicarb plus LA equals?
more unionized
What is the fastest treatment for hyperkalemia?
IV calcium
What hemodynamic changes might be seen in cardiac tamponade?
CVP and Wedge pressrue both high
What postion intervention should be done in cord prolapse?
steep trendelenburg
Which VA has the lowest BGP?
desflurane
What is the fluid/hr for a 25 kg child?
65 ml/hr
What should be the first thing ruled out with bradycardia in an infant?
hypoxemia
What is the second messenger for bronchoconstriction?
IP3
Vaporizers and common gas outlet are examples of ____ pressure systems
low
What medication should not be given for Betha blocker OD?
neosynephrine
Hospital pipeline is ______ pressure?
intermediate
5 ml of epinephrine 1:1000 = mg?
5 mg
What medication do you not give to a glaucoma patient on ecothiophate?
mivacron
What SC segment for TURP?
T10
Cannot adduct thumb?
raidal nerve injury
What changes will be seen on EKG with hypocalcemia?
prolonged QT
What might cause neuro malignant syndrome?
haldol
What medication should be avoided if the patient has neuro malignant syndrome?
reglan
What valvular d/o seen with IHSS?
mitral regurge
Hydralazine works by _____ _____.
nitric oxide
Na concentration is controlled by ____.
ADH
Plasma K decreases by _ mEq/L for every _ decrease in pCO2?
- 5 (?)
- 10
What is maintenance fluid for a 35 kg patieng?
75 ml/hr
What is the main reason for stopping smoking right before surgery?
to decrease carboxyhemoglobin
A flush valve is an example of what type of apparatus?
ball and spring
DISS keeps hoses from being connected to wrong gas source…what is this an example of?
Ball and spring(also has a floating valve)
Epidural catheter-lose of resistance at _cm, thread to _cm and how much in epidural space?
- 9 cm
- 14 cm
- 5 cm
Renal >0.03 = ?
tubular necrosis
IVF can cause an increases in what hemodynamic measurment?
LVEDV
What are two characteristics of Myasthenia gravis associated with the eyes?
- diplopia
- ptosis
In the pregnant patient CO is most increased when and when does it return to normal?
- most right after birth
- normal couple weeks after
What does the Abdiucens do to the eye?
does not adduct lateral eye, but abducts
Early decels indicates?
head compression
Physostigmine is used to treat?
Myasthenia gravis
Do NDNMB cross the BBB?
no
VA and ketamine (inc/dec) CBF?
increases
What is Robin Hood Steal?
hyperventilation improves blood flow to ischemic brain
When does the posterior lateral fontanelle close?
~2 years of age(?)
Hypocalcemia prolongs?
QT
Hyperkalemia = hyperpolarization/hypopolarization?
hypopolarization
What are urine osmol and plasma osmol in SIADH?
- urine osmol is high
- plasma osmol is low
Release of ADH does what to osmolaity?
decreases it
3% saline injected too fast causes Central Pontine ___?
?
What law explaines pulse oximetery?
Beer Lambert Law
What describes how CO2 acts on oxygen disassociation curve?
Bohr Effect
What describes a decrease in lateral pressure when going through a constriction(jet vent, nebulizer, venturi mask)?
Bernoulli Principle
Vitamin K is dependent upon what clotting factors?
2, 7, 9, 10
Theophyilline is a?
Methylcantine(?)
What medications is eliminated by zero order kinectics?
- Dilantin
- aspirin
- alchohol
What electrolyte abnormality increases Dig toxicity?
hypercalcemia
What is the definition of specific heat?
calories required to raise temp 1 degree C
Which nerves are parasympathetic?
3, 7, 9, 10(not 5)
Define Res ipsa loquitor?
the thing speaks for itself
What are the components of FRC?
RV + ERV = FRC
What labaratory test distinguishes pre-renal from post-renal?
- Fractional sodium excretion test
- 0.01 pre-renal
- 0.03 post-renal(?)
HCO3 plus local anesthetic =?
more unionized or faster onset
Second messanger for bronchoconstriction?
IP3
5 ml of 1:10000 epi =?
500 mcg(100 mcg/ml)
If a patient is taking ecothiophate what inducton agent should they not be given?
succinylcholine
