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APEX > Day Before Studying > Flashcards

Day Before Studying Flashcards

1
Q

modified brooke

A

2 mL of LR /kg/%TBSA

(1/2 in the first 8 hours)

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2
Q

Parkland

A

4 mL LR /kg / % TBSA

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3
Q

Reynolds #

A

density x diameter x velocity/viscosity

< 2,000 = laminar
> 4,000 = turbulent

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4
Q

Anion Gap

A

Normal 8 - 12

Na - (Cl + HCO3)

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5
Q

Plasma osmolarity

A

2xNa + Glucose/18 + BUN/2.8

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6
Q

distance square law

A

1 / D2

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7
Q

VO2

A

(CaO2 - CvO2) x CO x 10

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8
Q

SVO2

A

SaO2 - VO2 / DO2

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9
Q

SPO2

A

oxy / deoxy + oxy

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10
Q

static compliance

A

TV/pplat - PEEP

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11
Q

dynamic compliance

A

TV/PIP - PEEP

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12
Q

Therapeutic Index

A

LD50/ED50

a high therapeutic index = high safety margin

a low therapeutic index = low safety margin

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13
Q

extraction ratio

A

arterial - venous / arterial

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14
Q

loading dose

A

Vd x (desired concentration/ bioavailability)

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15
Q

EF

A

EDV - ESV / EDV
x 100

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16
Q

SV

A

EDV - ESV

or CO x 1000/HR

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17
Q

coronary perfusion pressure

A

AoDBP - LVEDP

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18
Q

PVR

A

mPAP - PAOP / CO
x 80

  • 150 - 250 dynes/s/cm^-5
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19
Q

wall stress

A

intraventricular pressure x radius / ventricular thickness

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20
Q

how to set vaporizers in a weird altitude

A

% x 760 / new altitude

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21
Q

child ETT size (cuffed vs uncuffed)

A

cuffed = age / 4 + 3.5
uncuffed = age/4 + 4

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22
Q

DO2

A

CaO2 x 10 x CO

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23
Q

CaO2

A

(1.34 x Hgb x SaO2) + (0.003 x PaO2)

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24
Q

A-a gradient

A

5 - 15

PAO2 - PaO2

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25
Q

PAO2 (aka alveolar gas equation)

A

FiO2 x (Pb - PH2O) - PaCO2/RQ

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26
Q

Law of LaPlace sphere

A

Tension = pressure x radius /2

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27
Q

Law of LaPlace cylinder

A

Tension = pressure x radius

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28
Q

Bohr Equation

A

Vd/Vt =

PaCO2 - PeCO2 / PaCO2

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29
Q

Alveolar ventilation

A

RR x (Tv - Vd)

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30
Q

To prove negligence what 4 things have to be proven

A
  1. duty
  2. breech of duty
  3. causation
  4. harm
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31
Q

metals safe in MRI

A

aluminum
copper
titanium
stainless steel

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32
Q

samter’s triad

A

asthma
allergic rhinitis
polyps

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33
Q

maximum ortho tourniquet time

A

2 hours

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34
Q

Fat embolus syndrome

A

longer onset than BCIS
triad of
1. changes in LOC
2. respiratory failure
3. petechiae

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35
Q

methotrexate

A

antimetabolite - bone marrow suppression

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36
Q

5 - fluorouracil

A

antimetabolite

bone marrow suppression

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37
Q

doxorubicin

A

antitumor antibiotic

cardiotoxic

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38
Q

bleomycin

A

antitumor antibiotic

pulmonary fibrosis
keep fio2 low

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39
Q

vincristine & vinblastine

A

peripheral neuropathy

tubulin binding drugs

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40
Q

cisplatin

A

alkylating agent
nephrotoxic and ototoxic

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41
Q

gastrin

A

G-cells
secrete gastric acid

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42
Q

Secretin

A

S cells
secrete pancreatic bicarbonate

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43
Q

Cholecystikinin

A

I cells
Gallbladder contraction/bile release

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44
Q

Somatostatin

A

D cells
decreases all GI function

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45
Q

common allergic triggers in OR

A

paralytics (sux > roc)
latex
abx

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46
Q

Types of hypersensitivity reactions

A

Type I: anaphylaxis, asthma, IGE
Type II: cell mediated, antibody mediated, IGG & IGM (ABO & HIT)
Type III: immune complex (snake venom)
Type IV: delayed sensitivity

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47
Q

what do mast cells and basophils release

A

histamine, leukotrienes, prostaglandins

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48
Q

laser goggles & colors

A

CO2 - clear (cornea)
NdYAG - green
Ruby - red
Amber - argon

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49
Q

what is normal IOP

A

10 - 20 mmHg

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50
Q

airway fire

A

oxidizer
ignition
fuel

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51
Q

Metabolic syndrome (obesity)

A

fasting glucose > 110
triglycerides > 150
waist > 40 (men) > 35 (women)
HDL <40 (men) <50 (women)
BP > 135/85

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52
Q

ulnar injury

A

claw hand
can’t abduct pinky finger

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53
Q

median injury

A

benediction, ape hand
can’t oppose thumb

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54
Q

radial

A

UE tourniquet, NIBP
wrist drop

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55
Q

avogadros $

A

6.023 x 10^23 = 1 mole

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56
Q

dalton’s law

A

P1 + P2 + P3 = Ptot

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57
Q

henry’s law

A

at constant temperature, the amount of gas that dissolves in a solution is proportional to the partial pressure of that gas over the solution

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58
Q

graham’s law

A

molecular weight of a gas determines how fast it can move through a membrane

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59
Q

how much more soluble is co2 than o2

A

20 x

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60
Q

what is specific heat

A

the amount of heat required to increase the temperature of 1 g of a substance by 1 degree celsius

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61
Q

latent heat of vaporization

A

number of calories required to convert 1 gm of a substance to vapor without a change in temperature in the liquid

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62
Q

1 mm Hg = ___ cm H2O

A

1.36

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63
Q

1 cm H2O = ___ mmHg

A

0.74

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64
Q

1 atm =

A

760 TORR = 760 mmHg = 100 kPa = 1,033 cmH2O = 14.7 PSI = 1 BAR

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65
Q

how much does MAC decrease with age

A

6% per decade after 40

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66
Q

what is Virchow’s triad

A

venous stasis
hypercoagulability
endothelial dysfunction

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67
Q

one MET =

A

3.5 mL/kg/m

and each MET decreases mortality by 11%

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68
Q

post tonsillectomy bleeding

A

occurs within 6 hours of surgery

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69
Q

Catch 22

A

aka DiGeorge syndrome

C- cardiac defects
A- abnormal face
T- thymic hypoplasia
C- Cleft palate
H- Hypocalcemia
22q11 gene deletion

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70
Q

CHARGE

A

C- colboma
H- heart defect
A- choanal atresia
R- retarded growth
G- GU problems
E- Ear anomalies

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71
Q

Laryngotracheobronchitis

A

Croup
viral, gradual onset
< 2 y.o.
mild fever, inspiratory stridor, barking cough
tx: oxygen, racemic epi, steroids, humidification, fluids
STEEPLE SIGN

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72
Q

Epiglottitis

A

bacterial, rapid onset
age 2 - 5
drooling, dysphagia, dysphonia
ENT for induction
O2, intubation, abx
thumb sign

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73
Q

Neonates GFR

A

reaches adult levels at 8 - 24 months

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74
Q

Neonates renal tubular function

A

full concentrating ability at 24 months

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75
Q

Sevo MAC values

A

0 - 6 months 3.2%
6 - 12 months 2.5%

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76
Q

VACTERL

A

Vertebral anomalies
Anal imperforate
Cardiac defects
TEF
esophageal atresia
renal dysplasia
limb anomalies

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77
Q

Lecithin/Sphingomyelin

A

> 2 = mature lungs

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78
Q

cyanotic shunts

A

TOF
transposition of the great arteries
total anomalous pulmonary venous circuit
truncus arteriosus
tricuspid valve abnormality (ebstein’s anomaly)

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79
Q

right to left shunt inhalation

A

slower
affects desflurane the most

IV induction is faster

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80
Q

left to right shunt and induction

A

doesn’t affect inhalation
prolongs IV

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81
Q

TOF features

A

Overriding aorta
VSD
RVH
RVOTO

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82
Q

what drugs do not cross placenta

A

glyco
paralytics
insulin
heparin

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83
Q

first stage of labor

A

latent - up to 2 cm
active - 2 - 10 cm
T10 - L1

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84
Q

second stage of labor

A

10 cm - delivery of fetus
S2 - S4

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85
Q

MAC changes with pregnancy

A

30 - 40% decrease at 8 - 12 weeks

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86
Q

normal FHR

A

110 - 160

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87
Q

1 mg/dL mag

A

seizures

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88
Q

5 mg/dL

A

drowsiness

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89
Q

8 mg/dL

A

loss of DTRs

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90
Q

15 mg/dL

A

respiratory depression

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91
Q

when are pregnant patients full stomachs

A

18 weeks

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92
Q

what is the absorbed volume in TURP? EBL

A

10 - 30 mL/m
2 - 5 mL/m (EBL)

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93
Q

portal vein vs hepatic artery

A

portal vein = 75% Q, 50% OXYGEN
hepatic artery = 25% Q, OXYGEN 50%

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94
Q

duration of action in order of insulins

A

humalog
humulin R
humulin N
lantus

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95
Q

zona glomerulosa

A

aldosterone

96
Q

zona fasiculata

A

glucocorticoids

97
Q

zona reticularis

A

androgens

98
Q

which exogenous steroid has equal glucocorticoid and mineralocorticoid effects

A

cortisol

99
Q

which steroids do not have mineralocorticoid effects

A

dexamethasone, betamethasone, triamcinolone

100
Q

which steroid resembles coritsol the most

A

prednisone

101
Q

what are carcinoid s/s

A

tachycardia
labile BP
abdominal pain

102
Q

carbonic anhydrase inhibitors

A

dorzolamide, acetozolamide
acidosis
acts at PCT

103
Q

osmotic diuretics

A

mannitol, isorbide, glycerin
PCT and ascending LOH

104
Q

loop diuretics

A

furosemide, erythyric acid, bumex
ascending LOH

105
Q

thiazides

A

HCTZ, indapamide
Distal tubule
hypercalcemia, hyperglycemia

106
Q

potassium sparing diuretics

A

spironolactone, triamterene, amiloride

collecting ducts

107
Q

proximal convoluted tubule

A

65% of the sodium is absorbed
water, potassium, chloride follow

108
Q

descending LOH

A

separates handing of sodium and water to concentrate urine

highly permeable to water (20% reabsorbed)

concentrates NaCl

109
Q

ascending LOH

A

not permeable to water
more sodium is removed

110
Q

distal convoluted tubule

A

impermeable to water except for in the presence of ADH and aldosterone

aldosterone - water and sodium reabsorbed, potassium excreted
ADH - increases water reabsorption
PTH: promotes calcium reabsorption

111
Q

intrinsic pathway

A

longer
measures PTT
heparain
contact activation pathway

112
Q

extrinsic pathway

A

shorter
PT/INR
warfarin

113
Q

vit k dependent factors

A

2, 7, 9, 10

114
Q

normal aptt

A

25 - 35s

115
Q

normal PT

A

12 - 15s

116
Q

normal ACT

A

90 - 120s

117
Q

Type 1 VWDx

A

mild-moderate reduction in vWF produced

118
Q

Type 2 vwdx

A

vwf doesn’t work well

119
Q

type 3 vwdx

A

severe reduction in the amount of vwf produced

120
Q

hemophiliia a vs b

A

a = 8
b = 9

121
Q

name the clotting factors

A
  1. fibrin
  2. thrombin
  3. tissue factor
  4. calcium
  5. labile factor
  6. stable factor
  7. antihemophilia
  8. christmas tree
  9. stuart prower
  10. plasma thromboplastin antecedent
  11. hageman
  12. fibrin stabilizing factor
122
Q

TBW

A

42 L

123
Q

ECF

A

14 L
11 L = ISF
3 L = plasma

124
Q

ICF

A

28 L

125
Q

magnesium dosing for pre-e patient

A

4 g over 10 m
1 g/hr for 24 hours

126
Q

increased anion gap

A

Methanol
Uremia
DKA
Paraldehyde
Isonizad
Lactate
Ethanol
Salicylate

127
Q

normal anion gap acidosis

A

Hyperalimentation
Acetazolamide
Renal tubular acidosis
Diarrhea
Ureteral diversion
Pancreatic fistula

128
Q

acute resp vs chronic resp. acidosis and paco2

A

acute = 0.08 decrease in pH per 10 mmHg co2

chronic = 0.03 decrease in pH per 10 mmHg co2 increase

129
Q

metabolic acidosis paco2 changes

A

paco2 decreases 1 - 1.5 mmHg per HCO3 decrease of 1

130
Q

metabolic alkalosis paco2 changes

A

paco2 increases 0.5 -1 per HCO3 increase 1

131
Q

platelet lifespan

A

8 - 12 days

132
Q

Erector spinae muscles

A

iliocostalis
longissimus
spinalis

133
Q

how many pairs of spinal nerves

A

31

134
Q

autonomic blockade

A

2 - 6 higher than sensory

135
Q

sensory blockade

A

2 higher than motor

136
Q

foot and ankle nerves

A

saphenous
sural
superficial peroneal
deep peroneal
posterior tibial

137
Q

sacral plexus gives rise to what 5 nerves

A

superior gluteal
inferior gluteal
posterior cutaneous
pudendal
sciatic

138
Q

lumbar plexus gives rise to

A

iliohypogastric
ilioinguinal
gentifemoral
LFC
obturator
femoral

139
Q

infraclavicular picture

A

3 o clock = medial
6 o clock = posterior
9 o clock = lateral

140
Q

epidural needles

A

tuohy = 30
hustead = 15
crawford = 0

141
Q

non cutting pencil point needles

A

pencil point - sprotte, whitacre
rounded bevel - green

142
Q

cutting tip needles

A

quincke
pitkin

143
Q

conus medullaris

A

adult - L1, L2
infant - L3

144
Q

dural sac ends

A

adult - S2 (superior iliac spines)
infant - S3

145
Q

total CSF volume & mL/hr

A

150
30 mL/hr

146
Q

CSF s/g

A

1.002 - 1.009

147
Q

CSF pressure

A

5 - 15 mmHg

148
Q

max cerebral v/c

A

PaCO2 @ 25

149
Q

max cerebral v/d

A

PaCO2 @ 80 - 100 mmHg

150
Q

at what PaO2 does vasodilation occur

A

< 50 - 60 mmHg

151
Q

spinal cord circ

A

2 posterior
1 anterior
6 - 8 radicular

152
Q

dantrolene dosing for MH

A

2.5 mg/kg Q 5 - 10 M

153
Q

DANTROLENE vial

A

20 mg dantrolene
3 g mannitol
60 mL of preservative free water

154
Q

PSNS output

A

CN 3, 7, 9, 10

155
Q

CSF flow

A

Lateral
Foramen of Monroe
3rd ventricle
Aqueduct of Silvius
4th ventricle
Foramen of Luschka
Foramen of Magendie
Arachnoid Villi

156
Q

when do you measure ICP

A

< 7 GCS

157
Q

upper motor neuron injury

A

above decussation: contralateral spastic paralysis

below decussation: ipsilateral spastic paralysis

158
Q

lower motor neuron injury

A

flaccid paralysis ipsilateral

159
Q

tensilon test

A

1 - 2 mg edrophonium
MG patient (gets better) = myasthenic crisis

160
Q

MG vs LEMS

A

MG best in morning, worse throughout the day

LEMS worst in morning, better throughout day.

161
Q

Name the cranial nerves

A
  1. olfactory
  2. optic
  3. oculomotor
  4. trochlear
  5. trigeminal (V1 opth. V2. max. V3 mand)
  6. abducens
  7. facial (temporal, zygomatic, mandibular, buccal, cervical)
  8. vestibulococlear
  9. GPN
  10. vagus
  11. spinal accessory
  12. hypoglossal
162
Q

Beta waves

A

light anesthesia, awake

163
Q

Alpha waves

A

awake but restful

164
Q

Theta

A

GA and kids sleeping

165
Q

Delta

A

GA or brain ischemia or deep sleep

166
Q

burst suppression

A

GA, hypothermia, CBP, cerebral ischemia

167
Q

pacer position

A
  1. chamber paced
  2. chamber sensed
  3. response to sensing
  4. programmability
  5. multiple sites paced
168
Q

a wave

A

RA contraction
just after P waave

169
Q

c wave

A

mitral valve elevation
just after QRS

170
Q

x descent

A

RA relaxation
St

171
Q

v wave

A

filling of RA
at the beginning of T

172
Q

y descent

A

tricuspid valve opens
after T wave ends

173
Q

mapleson a

A

apl near patient
awake patient

174
Q

mapleson b

A

both APL and FGF at patient

175
Q

mapleson c

A

simple
cpr
B - corrugated tubing

176
Q

mapleson D

A

opposite of A
best for dead patients (think mechanically ventilated)
FGF near patient
aka BAIN

177
Q

mapleson E

A

no bag
no apl
arye’s t-piece

178
Q

mapleson F

A

jackson reese
best for infants
no apl valve

179
Q

semi open circuit

A

FGF > MvE
NO REBREATHING

180
Q

semi closed circuit

A

FGF < MVE
rebreathing
unidirectional valves

181
Q

closed circuit

A

very low FGF, complete rebreathing, APL valve closed

182
Q

normal axis deviation

A

-30 to + 90

I = +
avF = +

183
Q

left axis deviation

A

I = +
avf = -

  • 30 to -90
184
Q

right axis deviation

A

I = -
avF = +
90 - 180

185
Q

extreme right axis deviation

A

I = -
avF = -

180 to - 90

186
Q

what are the 3 internodal tracts

A

anterior - bachmann
middle - wenckbache
posterior - thorel

187
Q

increased resitance =

A

increased PIP
normal pPlat

188
Q

decreased compliance

A

increased PIP and pPLAT

189
Q

bellow’s ventilator determined by

A

bellows movement on expiration

ascending bellows are safer

190
Q

when does line isolation monitor alarms

A

if all currents exceed 2 - 5 mA

191
Q

macroshock vs microshock vfibb

A

macroshock = 100 mA
microshock = 100 microamps

1000x difference

192
Q

what is the max allowable current leak in the OR

A

10 microamps

193
Q

yearly maximum exposure of REM

A

adult = 5
fetus = 0.5, 0.05 rem/mo

194
Q

p wave

A

0.08 - 0.012s

195
Q

PR interval

A

0.12 - 0.20s

196
Q

Q wave

A

< 0.04s

197
Q

QRS

A

<0.1s

198
Q

where is esophageal doppler located

A

35 cm from incisors

199
Q

normal SVO2

A

65 - 75%

200
Q

BP arm positioning

A

Q 10 cm = 7.4 mmHg
Q inch = 2 mmHg change

201
Q

BP bladder ideal length & width

A

length = 80%
width = 40%

202
Q

SPO2 and PaO2 correlations

A

90 = 60
80 = 50
70 = 40
50 - 26.5

203
Q

red vs near-infrared light

A

red - 660 - deoxy
near infrared - 940 - oxy

204
Q

when does barotrauma occur

A

plateau pressure > 35 cmH2O

205
Q

NIOSH recs.

A

halogenated < 2ppm
nitrous < 25 ppm
together < 0.5, < 25

206
Q

cylinder #s

A

660/1900PSI (O2)
625/1900PSI (AIR)
1590L/745 PSI (N2O)

n2o full at 20.7lbs
empty at 14.1 lbs

207
Q

components of low pressure system

A

thorpe tubes
CGO
vaporizers
check valve (if present)

208
Q

components of high pressure system

A

hanger yoke
yoke block with check valves
cylinder pressure regulator
cylinder gauge

209
Q

components of the intermediate pressure system (7)

A

pipeline inlets
pressure gauges
oxygen pressure failure device
oxygen second stage regulator
oxygen flush vlave
ventilator power inlet
flowmeter valves

210
Q

what is the dose of nmb for intubating

A

ED95 2 - 3 x

211
Q

dibucaine numbers

A

70 - 80 typical homozygous
50 - 60 heteroxygous
20 - 30 atypical homozygous

212
Q

best place to measure recovery

A

adductor pollicis (ulnar n)
flexor hallucis (post tib)

213
Q

best place to measure onset

A

orbicularis occuli
corrugator supericili

facial nerve

214
Q

max dose of tumescent lido

A

55 mg/kg
peaks in 12h, out of system at 36h

215
Q

lipid emulsion for LAST

A

1.5 mL/kg
0.25 mL/kg/m

216
Q

pka amides

A

bupi/ropi/levo 8.1
lido/prilocaine 7.9
mepivacaine 7.6

217
Q

ester pka

A

procaine 8.9
chlor. 8.7
tetracaine 8.5

218
Q

procaine dosing

A

7 mg/kg
350 - 600 mg

219
Q

mepivacaine dosing

A

7 mg/kg
400 mg

220
Q

prilocaine dosing

A

8 mg/kg
< 70 = 500 mg
> 70 = 600 mg

221
Q

albumin binds with

A

acidic drugs

222
Q

alpha 1 glycoprotein binds with

A

basic drugs

223
Q

zero order kinetics

A

phenytoin
alcohol
warfarin
theophylline
aspirin
heparin

224
Q

enzyme inducers

A

ethan (ethanol)
took (tobacco)
physics (phenytoin)
because (barbs&benzos)
riley (rifampin)
kelley (ketamine)
cares (carbamazepine)

225
Q

enzyme inhibitors

A

snakes (SSRIS)
grappling (grapefruit juice)
ominiously (omeprazole)
is (isonizid)
everything (erythromycin)
kosher (ketoconazoles)

226
Q

n2o vs nitrogen soluble

A

34x

227
Q

n2o and air bubbles

A

S56 = 7 - 10d
air = 5d
perflurorpropane = 30d
silicone oil = none

228
Q

nerve ischemia concern

A

amplitude decr’d 50%
latency increased 10%

229
Q

order of blockade

A

B (preganglionic ANS)
C (postganglionic ANS & slow pain, temperature, touch)
Gamma & Delta (muscle tone, fast pain, temp, touch)
Beta & Alpha (touch, pressure, sk. muscle motor, propioception)

230
Q

LA onset, potency, DOA

A

onset = pka
potency = lipid solubility
DOA = protein binding

231
Q

blood gas partition

A

des = 0.42
n2o = 0.46
sevo = 0.65
iso = 1.4

232
Q

vapor pressure gases

A

n2o = 38, 770
des = 669
iso = 238
sevo = 157

233
Q

lipophilic Vd

A

> 0.6 mL/kg

234
Q

steady state

A

5 1/2 times

235
Q

drug cleared

A

5 1/2 times

236
Q

co affinity for hgb

A

200x

APEX (18 decks)

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