Exam 2023 Flashcards
Israeli board exam
Locus cereleus and sleep
Secretes noradrenalin
Highest activity during waking up
Lowest during Non REM
CaO2 formula
1.34xHbxSa + 0.003xPO2
DO2 formula
CaO2x Q (cardiac output)
Lung apex vs base. Pressure and compliance
Apex. Less compliance (expands less) Pleural pressure lower
Trans pulmonary pressure higher
Laplace law
Pressure x radius / 2x wall thickness
What happens when there is an increase in heart wall thickness
Decrease radius, O2 consumption, Surface tension
Increase ventricular pressure
TLC
RV
FRC
VC
in restrictive and obstructive
Obs. Decrease VC Increase the rest
Rest. Everything decreases
Effect on motility of drugs
No effect midazolam
Increase Morphine
Decrease Propofol, Sevo Isoflurane
Absolute CI liver transplant
Active uncontrolled sepsis
Severe Cardiopulmonary disease
Alcohol abuse
lack of compliance
Cancer outside of liver
AIDS
Vasodilator systems in kidney. Type and effects
Prostaglandins, Kinins, ANP
Increase GFR / Urine o. / RBF / Na excretion
Therapeutic index
TI = Ld50 / Ed50
Effects of 75% N2O in Thorax and GI
X2 pneumothorax in 10 min
x3 pneumothorax in 30 min
x2 Gi volume in 120 min
Palv definition
Estimation of % of gas in CNS and other highly perfused organs
Isoflurane vs desflurane. Context sensitivity recovery
Larger in Iso compared to Desf
What to check always before use of anesthetic machine
Suction
Monitors
CO2 absorbent
Leak
Gas flow
Morphine in women
Greater potency
slower speed of onset
Why hyperalgesia after opiates
Stimulation of NMDA
COX 1 vs COX 2
COX 1 Gastro / platelets / kidney
COX 2. Inflammation / pain / fever / cardiac
When to expect hyperkalemia after Scoline
Hypovolemia
Met acidosis
Intra abdominal infection
Physical trauma
Sugammadex characteristics
Safe in Neuromuscular D.
Interact with contraceptive pills (decrease efficacy of sugammadex)
No difference in renal failure
No effect on fetus
Tranlendemburg and CO
CO increase 9% in a minute
Malignant hyperthermia treatment
Dantralone 2.5 mg/kg
HCO3-
Control fever
Urine output 1-2 ml/kg/h
Ejection Fraction severity
50- 70 norm
41 -50 Mild
31 - 40 Mod
< 30 Severe
EF = (ED - ES ) / ED
Drugs that cause burst supression
Vapors MAC > 1.5
Barb , Propofol, Etomidate at higher doses
No burst. NO , BZP, Opiates, Ketamine, Dexm
Transmitral pulsed wave doppler
Measure Diastolic function
A - Atrial contraction
E - Peak early filling
What to do in case of rebreathing CO2
Leads to increase CO2, to solve it, increase flow (hyperventilate)
Nephroprotective drugs
Dexmedetomidine, Propofol
Most reliable test for neuromuscular recovery after surgery
Handgrip/leg up/ head up > 5sc
Maximum inspiration support
Tongue depressor test
TOF
PTC
TOF 0 - 4 and fade (from 0.1 - 1)
In fade, TOF = 4
PTC 0 - 15
In PTC, TOF = 0
Arm innervation
C5 Upper forearm
C6 finger 1
C7 2/3 finger
C8 4/5 finger
T1 lower forearm
Feet innervation
Superior peroneal - 2/3 toe
Sural - Lateral feet
Tibial - Talus
TBWater according to age
Neonate, 6m, 1y, 5y, young adult, elderly
Neonate 80%
6m 70%
1y 60%
5y 65%
Y.A. male 60%
female 50%
Elderly 50%
Correction of hyponatremia
Mod. 3% NaCl 1ml/Kg/h. 3-4 mEq/l
Severe. 100 ml 3% (increase 2-3 mEq/l)
Maximum 10 mEq/24h
Magnesium. normal range and effect in hyperMg hypoMg
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
PCO2 in met alk/ac formulas
Met Alk. HCO3x 0.7 + 20
Met ac. HCO3 x 1.5 + 8
Cryoprecipitate content
Factors 8, 13, vW, fibrinogen, fibronectin
More effective predictor of complications of surgery on the side in one lung ventilation
paO2 on the side in two lungs ventilation
Induction in patient with aortic regurgitation. What’s important
To maintain preload high
Acute liver failure
Encephalopathy + INR > 1.5 without previous disease
Usually acetaminophen toxicity
Cardio in pregnant woman
1 sound accentuated, 4 sound present
ST depression (1mm)
increase heart size, EF, HR
TR/PR, sometimes MR
Prevention of Bezold jarisch reflex
Produces bradicardia and hypotension.
Beta blockers and fluids
Age and changes in CV system
Increase: Afterload, Myocardial consumption, Wall stress, Incidence of VTe, Aortic stenosis
Decrease: Sympathetic tone
Liver function and age
Decrease size and function, Blood flow, number of hepatocytes
Most relevant blood flow
Kidney function and age
Decrease in size, GFR, Na
Lung function and age
Diaphragms weakens
Chest wall stiffens
Increase compliance
Decrease Elastin production, VC
Increase CC at the expense of FRC
Late resuscitation goals
Syst > 110
Coagulation
Electrolyte balance
Normal Temp
Normal urine output
Initial TBI treatment
ABC
PCO2 > 35
PO2 > 75 Sat > 94%
Normothermia
Normal ICP
Most common injury in aorta blunt trauma
Distal to the left subclavian artery
Epiglottitis induction in kids
Careful
No RSI, No awake (no crying)
Light anesthesia with spontaneous breathing
Ambulatory surgery in toddler
Post conceptual age > 60
Cardiovascular changes after birth in order
Decrease portal blood pressure — Closure of DA — increase PBF — Closure of foramen ovale
Breathing in infants
Decrease the diameter, increase the resistance
Increase O2 consumption
Type 1 fibers at 2 years, increase the work of breathing
Increase compliance
Predictors of urinary retention
> 50
Fluids > 750 ml
Urine bladder > 270 ml
IVC changes
< 2.1 cm Hypovolemia
Distended Cardiogenic, distributive, obstructive.
CO low except of distributive
