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Miller's Anesthesia > Exam 2023 > Flashcards

Exam 2023 Flashcards

Israeli board exam

1
Q

Locus cereleus and sleep

A

Secretes noradrenalin
Highest activity during waking up
Lowest during Non REM

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2
Q

CaO2 formula

A

1.34xHbxSa + 0.003xPO2

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3
Q

DO2 formula

A

CaO2x Q (cardiac output)

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4
Q

Lung apex vs base. Pressure and compliance

A

Apex. Less compliance (expands less) Pleural pressure lower
Trans pulmonary pressure higher

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5
Q

Laplace law

A

Pressure x radius / 2x wall thickness

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6
Q

What happens when there is an increase in heart wall thickness

A

Decrease radius, O2 consumption, Surface tension
Increase ventricular pressure

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7
Q

TLC
RV
FRC
VC
in restrictive and obstructive

A

Obs. Decrease VC Increase the rest
Rest. Everything decreases

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8
Q

Effect on motility of drugs

A

No effect midazolam
Increase Morphine
Decrease Propofol, Sevo Isoflurane

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9
Q

Absolute CI liver transplant

A

Active uncontrolled sepsis
Severe Cardiopulmonary disease
Alcohol abuse
lack of compliance
Cancer outside of liver
AIDS

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10
Q

Vasodilator systems in kidney. Type and effects

A

Prostaglandins, Kinins, ANP
Increase GFR / Urine o. / RBF / Na excretion

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11
Q

Therapeutic index

A

TI = Ld50 / Ed50

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12
Q

Effects of 75% N2O in Thorax and GI

A

X2 pneumothorax in 10 min
x3 pneumothorax in 30 min
x2 Gi volume in 120 min

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13
Q

Palv definition

A

Estimation of % of gas in CNS and other highly perfused organs

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14
Q

Isoflurane vs desflurane. Context sensitivity recovery

A

Larger in Iso compared to Desf

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15
Q

What to check always before use of anesthetic machine

A

Suction
Monitors
CO2 absorbent
Leak
Gas flow

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16
Q

Morphine in women

A

Greater potency
slower speed of onset

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17
Q

Why hyperalgesia after opiates

A

Stimulation of NMDA

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18
Q

COX 1 vs COX 2

A

COX 1 Gastro / platelets / kidney
COX 2. Inflammation / pain / fever / cardiac

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19
Q

When to expect hyperkalemia after Scoline

A

Hypovolemia
Met acidosis
Intra abdominal infection
Physical trauma

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20
Q

Sugammadex characteristics

A

Safe in Neuromuscular D.
Interact with contraceptive pills (decrease efficacy of sugammadex)
No difference in renal failure
No effect on fetus

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21
Q

Tranlendemburg and CO

A

CO increase 9% in a minute

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22
Q

Malignant hyperthermia treatment

A

Dantralone 2.5 mg/kg
HCO3-
Control fever
Urine output 1-2 ml/kg/h

23
Q

Ejection Fraction severity

A

50- 70 norm
41 -50 Mild
31 - 40 Mod
< 30 Severe
EF = (ED - ES ) / ED

24
Q

Drugs that cause burst supression

A

Vapors MAC > 1.5
Barb , Propofol, Etomidate at higher doses
No burst. NO , BZP, Opiates, Ketamine, Dexm

25
Q

Transmitral pulsed wave doppler

A

Measure Diastolic function
A - Atrial contraction
E - Peak early filling

26
Q

What to do in case of rebreathing CO2

A

Leads to increase CO2, to solve it, increase flow (hyperventilate)

27
Q

Nephroprotective drugs

A

Dexmedetomidine, Propofol

28
Q

Most reliable test for neuromuscular recovery after surgery

A

Handgrip/leg up/ head up > 5sc
Maximum inspiration support
Tongue depressor test

29
Q

TOF
PTC

A

TOF 0 - 4 and fade (from 0.1 - 1)
In fade, TOF = 4
PTC 0 - 15
In PTC, TOF = 0

30
Q

Arm innervation

A

C5 Upper forearm
C6 finger 1
C7 2/3 finger
C8 4/5 finger
T1 lower forearm

31
Q

Feet innervation

A

Superior peroneal - 2/3 toe
Sural - Lateral feet
Tibial - Talus

32
Q

TBWater according to age
Neonate, 6m, 1y, 5y, young adult, elderly

A

Neonate 80%
6m 70%
1y 60%
5y 65%
Y.A. male 60%
female 50%
Elderly 50%

33
Q

Correction of hyponatremia

A

Mod. 3% NaCl 1ml/Kg/h. 3-4 mEq/l
Severe. 100 ml 3% (increase 2-3 mEq/l)
Maximum 10 mEq/24h

34
Q

Magnesium. normal range and effect in hyperMg hypoMg

A

Norm 1.7 -2.3 mg/dl
HyperMg N+V, decrease QRS, can lead to bradycardia if >24
Decrease tendon reflexes if > 20
> 48 Coma
HypoMg Vertigo, Trausseau + Chovstek. Prolong PR

35
Q

PCO2 in met alk/ac formulas

A

Met Alk. HCO3x 0.7 + 20
Met ac. HCO3 x 1.5 + 8

36
Q

Cryoprecipitate content

A

Factors 8, 13, vW, fibrinogen, fibronectin

37
Q

More effective predictor of complications of surgery on the side in one lung ventilation

A

paO2 on the side in two lungs ventilation

38
Q

Induction in patient with aortic regurgitation. What’s important

A

To maintain preload high

39
Q

Acute liver failure

A

Encephalopathy + INR > 1.5 without previous disease
Usually acetaminophen toxicity

40
Q

Cardio in pregnant woman

A

1 sound accentuated, 4 sound present
ST depression (1mm)
increase heart size, EF, HR
TR/PR, sometimes MR

41
Q

Prevention of Bezold jarisch reflex

A

Produces bradicardia and hypotension.
Beta blockers and fluids

42
Q

Age and changes in CV system

A

Increase: Afterload, Myocardial consumption, Wall stress, Incidence of VTe, Aortic stenosis
Decrease: Sympathetic tone

43
Q

Liver function and age

A

Decrease size and function, Blood flow, number of hepatocytes
Most relevant blood flow

44
Q

Kidney function and age

A

Decrease in size, GFR, Na

45
Q

Lung function and age

A

Diaphragms weakens
Chest wall stiffens
Increase compliance
Decrease Elastin production, VC
Increase CC at the expense of FRC

46
Q

Late resuscitation goals

A

Syst > 110
Coagulation
Electrolyte balance
Normal Temp
Normal urine output

47
Q

Initial TBI treatment

A

ABC
PCO2 > 35
PO2 > 75 Sat > 94%
Normothermia
Normal ICP

48
Q

Most common injury in aorta blunt trauma

A

Distal to the left subclavian artery

49
Q

Epiglottitis induction in kids

A

Careful
No RSI, No awake (no crying)
Light anesthesia with spontaneous breathing

50
Q

Ambulatory surgery in toddler

A

Post conceptual age > 60

51
Q

Cardiovascular changes after birth in order

A

Decrease portal blood pressure — Closure of DA — increase PBF — Closure of foramen ovale

52
Q

Breathing in infants

A

Decrease the diameter, increase the resistance
Increase O2 consumption
Type 1 fibers at 2 years, increase the work of breathing
Increase compliance

53
Q

Predictors of urinary retention

A

> 50
Fluids > 750 ml
Urine bladder > 270 ml

54
Q

IVC changes

A

< 2.1 cm Hypovolemia
Distended Cardiogenic, distributive, obstructive.
CO low except of distributive

Miller's Anesthesia (43 decks)

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