FINAL EXAM MO (Felicia) Flashcards
EMG to the lateral rectus monitors what nerves?
Abducens
*On a diagram, what area of the brain would be supplied by the anterior cerebral artery?
outer layer of the brain, Left/Top side. (blue on exam)
anterior meaning top
*On a diagram, what area of the brain is supplied by the posterior cerebral artery?
outer lower right side of the brain. (green on exam)
posterior- lower area
Calculate CPP: BP = 100/70 HR = 65 RAP = 10 ICP = 15
CPP = MAP - ICP
MAP is diastolic x 2 plus systolic / 3.
Thus 80-15 = 65 = CPP
SSEP assesses the integrity of what part of the spinal cord?
posterior spinal cord
Name structures pierced during lumbar puncture? (short answer)
Skin subcutaneous tissue supraspinous ligament interspinous ligament ligamentum flavum epidural space dura mater subdural space* arachnoid mater subarachnoid space
Patient with increased ICP that suddenly rises to 30 mmHg will exhibit? SELECT 3
Irregular respiration
bradycardia
hypertension
Which potential is MOST RESISTANT to anesthesia?
BAEP- Auditory
- Where is the subarachnoid space on diagram?
look at a diagram for this one until an image is added lol
Which nerve can be blocked to decrease pain from tourniquet inflation during IV regional anesthesia?
Intercostalbrachial nerve
Aqueduct of sylvius supplies?
third and fourth ventricle
*Cerebral blood flow and partial pressure graph, know what each line represents.
x = PaCO2 (line that starts low and ends at the top) y = PaO2 (line that starts high and levels out in the middle)
*Tell me where on the hand (posterior and anterior) which nerves innervate what parts of the hand.
ulnar is pinky and half of ring finger of hand on both sides (blue)
Radial is typically green on diagram and median is yellow lol
Which evoked potential is measured during pituitary surgery
Visual evoked potential
What part of the brain controls the activity of interneurons in the substantia gelatinosa?
Periventricular and periaqueductal gray matter
Gray Ramus contains what kind of fibers?
Postganglionic sympathetic fibers
Patient has eyelid drooping, pupil fixed and dilated, not reactive to light. What nerve is damaged?
Oculomotor the third cranial nerve
Name a drug combination that decreases cerebral blood flow?
Fentanyl- droperidol
A 55-year-old is undergoing an intracranial tumor resection under GA. Preoperatively, the patient is alert & oriented and has no focal neurological deficit. Within what range should the PaCO2 be maintained during surgery?
25-30
Which bone supports the pituitary gland
Sphenoid bone
Ketamine, tell me if it has any change on CMR, CBF, CSF production, CSF re-absorption, CBV, or ICP?
Ketamine:
has little or no change to CMR or CSF production.
Increases CBF, CBV, ICP.
Decreases only CSF re-absorption.
If someone has head trauma and you are choosing an agent to treat them with, what would you want said agent to possess?
be able to decrease CMR, CBF, CBV, ICP
and re-absorb CSF
Masseter muscle and temporalis muscle responses are monitored using which nerve?
Trigeminal CN V
In the case of venous air embolism, aspiration with a single-orificed catheter is done by placing the tip ________ the SVC-atrial junction.
3 cm above
In the case of venous air embolism, aspiration with a multi-orificed catheter is done by placing the tip ________ the SVC-atrial junction.
2 cm below
If a man is smiling and half of his face only is smiling then what nerve is injured?
Facial VII
Pain, afferent nerve fibers, dorsal horn ascend 1-3 seg ____ in before entering synapse dorsal horn?
Track of lissauer
Berry aneurysm picture, damage is where?
Anterior communicating artery
Picture of drop hand (wrist drop) what nerve is damaged?
radial nerve damage
Describe a baby with Erb-Duchenne palsy?
Excessive stretch of neck during delivery, damage to superior trunk of C5, C6. Can occur in falls, traumas. Pronated forearm, arm turned medially
Posterior spinal artery occlusion with loss of dorsal column tract, what sensations will you lose? Choose 2
Fine touch
vibration
What two things could make Venous Air Embolism more likely to occur?
Lateral 15 degrees, head up
use of PEEP
Regulation of Cerebral blood flow:
Extrinsic mechanism, you have a what % increase for each mmHg PCO2?
2% increase for each mmHg PCO2
What nerve is monitored through the vocal cords in major tumor resections?
Vagus
Claw hand would be an injury to what nerve?
Ulnar nerve injury
Ape hand injury would be what nerve?
Median nerve injury
Warfarin is part of which pathway?
Extrinsic pathway
Vitamin k dependant factors are?
1972 (X IX, VII, II)
Pt is getting ready for heart surgery and is being heparinized. Pt ACT is not getting past 250, what do you do?
Give FFP
If a patient is being heparinized for heart surgery you want their ACT 400-450, you will not proceed with surgery if below 400.
Erythroblastosis fetalis is?
Mother is Rh- having a fetus who is Rh+
Pt on heparin starts bleeding. What do you give?
Protamine
Dipyridamole (a blood thinner) increases what?
increases cAMP (that prevents platelet aggregation)
Ticlopidine job?
inhibit ADP
Inhibition by NSAID lasts?
24-48 hours
How long does cox inhibition by aspirin last?
cox inhibition by aspirin lasts for about 7-12 days
Abciximab is what kind of drug?
GP iib/IIIa inhibitor
Reversal for coumadin?
vitamin K
What is the best test for platelet function?
Bleeding time
Deficiency of ____ causes Hemophilia B?
factor IX
hemophilia A is IIX
Most common inherited coagulopathy is:
Von Willebrand’s disease
Two tests used to check Warfarin levels?
PT and INR
Heparin is part of which pathway?
Intrinsic pathway
Treatment for vWD is?
dDAVP
Fibrin stabilizing factor?
XIII
After tissue injury Thromboplastin activates what factor?
factor VII
If a patient has priapism they most likely have what disease?
Sickle Cell Anemia
A 20 year old African American male with sickle cell Anemia (ss homozygous) has had several episodes of painful crises. The LEAST likely physical finding in this patient is:
Splenomegaly
spleen shrinks in Sickle cell
Reticulocytes are?
Immature RBCs thus if you have an over production then it would mean an anemia may have been or is present. The body produces more during times of anemia.
(I blv RBC was the answer on the test)
Male Patient that has a High TIBC and low iron, what diagnostic study would be done next?
Occult stool and colonoscopy (rule out colon cancer; verified on review)
Patient complains of weakness and lightheadedness after menstruation, treatment would be?
Ferrous Sulfate
Pt living in a high altitude has polycythemia, what is the treatment?
no treatment needed
64 year old male patient develops a macrocytic anemia after surgery to remove a large part of his stomach. Which of the following is the most likely cause of this patients problem?
Inadequate Vit. B12 absorption
Male Pt(baby) cannot stop bleeding after a heel stick. History of prolonged bleeding time after circumcision. Bruises on elbows, what disorder does he most likely have?
Hemophilia
Pregnant woman comes into the hospital. She is Rh(+), husband is Rh(-) and it’s there second child. What do you do.
Nothing, it is only an issues if the mom is Rh - and the child is Rh +
Patient with Polycythemia Vera has?
Increased blood viscosity
All of the following are chemical accelerators of clot formation except?
PG12
vWF is responsible for stabilizing?
VIII (8)
Patient receiving multiple blood infusions will be deficient in?
Platelets
If a clinical picture of a patient with DIC is described, what will that look like?
Bleeding from tubes, wounds, vascular access sites
Shock, ischemia, infection
Multiple organ failure
Increased PT, PTT, FDP, dimer.
Decreased Fibrinogen and platelets
Hemolytic Anemia due to mismatched blood transfusion would most likely lead to elevated blood levels off?
Free Bilirubin
What is the treatment of megaloblastic anemia?
Give B12 and Folic Acid
Anemia in a patient with chronic kidney disease or end stage renal failure, what is the treatment?
Erythropoietin
A 64 year old male is hospitalized with TIA and is evaluated for carotid disease. PE normal. CBC normal. The patient is started on heparin. A repeat cbc one week later show Hb of 14 g/dl. You should?
D/C Heparin
Which factor activates prothrombin for conversion to thrombin?
Factor X
Xa combines with V and converts prothrombin to thrombin
Patient presented with pain in abdomen, (I think it said pink tinged urine too?), accumulation of aminolevulinic acid (ALA) and uroporphyrins, what do they have?
Acute intermittent porphyria
Deficiency of factor ____ causes hemophilia.
Factor VIII (Hemophilia A)
Female pt with heavy periods last 8-9 days and difficult to stop bleeding after cut. What is increased or decreased and what disorder does she have?
Normal - platelets, PT
Increased - BT, PTT
she has vWD
Female pt with heavy periods last 8-9 days and difficult to stop bleeding after cut. What is increased or decreased and what disorder does she have?
(PLT, PT, BT, PTT)
Platelets and PT - NORMAL
bleeding time and PTT- INCREASED
increased (von Willebrand’s disease)
Asprin inhibits?
Cycloxygenase 1