Focus Monitor

Question 1

At what PSI does the O2 pressure alarm, alarm?

Answer 1

Below 30 PSI

Question 2

At what weight does a tank of N2O see a dip in PSI? How many liters are left when the PSI dips?

Answer 2

Below 14.1 Lbs

400 L

Question 3

When can proportioning devices not prevent a hypoxic mixture? Name 4

Answer 3

-Pipeline crossover
-Mechanical failure
-Broken flowmeter
-Third gas

Question 4

Reynolds number <2000

What type of flow?
What law?
What is it dependent on?

Answer 4

Laminar

Poiseulles

Viscosity

Question 5

Reynolds number >4000

What type of flow?
What law?
What is it dependent on?

Answer 5

Turbulent

Graham

Density

Question 6

With fresh gas coupling, How does Tidal Volume increase?

Answer 6

-Increased FGF
-Increased Bellow height
-Increased I:E

-Decreased RR

Question 7

With fresh gas coupling, How does Tidal Volume decrease?

Answer 7

-Decreased FGF
-Decreased Bellow height
-Decreased I:E

-Increased RR

Question 8

What effect does FGF have on End tidal?

Answer 8

Increased FGF will lower end tidal and vice versa

Question 9

How is compliance measured?

Answer 9

Change in volume for given change in pressure

Volume/Pressure

Question 10

Flows less than ____ or Greater than ____ can lead to reduced vaporizer output?

Answer 10

<200mL/Min

> 15L/Min

Question 11

How much does 1mL of liquid anesthetic produce?

Answer 11

200mL of vapor

Question 12

What is the pumping effect? What causes it ?

Answer 12

Anything that causes gas that has already left the vaporizer to re-enter

Due to PPV
or
O2 flush valve

Question 13

What is the calculation for how much liquid anesthetic is used per hour?

Answer 13

Vol % x FGF x 3

Question 14

What is the boiling point of des?

Answer 14

22C

Question 15

Which O2 analyzer needs to be calibrated daily?

Answer 15

Galvanic fuel cell

Question 16

Which O2 analyzer has a faster response time?

Answer 16

Paramagnetic

Question 17

Which O2 analyzer needs to be replaced over time?

Answer 17

Galvanic fuel cell (Makes sense because the other uses magnets)

Question 18

What causes an increase in O2 consumption?

Answer 18

Sepsis
Pain
Sympathetic stimulation
Thyrotoxicosis
Fever

Question 19

What are the 2 functions of the drive gas on a pneumatic ventilator?

Answer 19

Compress the bellows
Opens and closes the ventilator spill valve

Question 20

What are the 2 pressure relief valves in the piston ventilator? At what pressure do they open?

Answer 20

Positive - opens at 75
Negative opens at -8

Question 21

With a ventilator that decouples its gas flow, Vt is consistent regardless of changes in…? Name 3

Answer 21

FGF
RR
I:E

all have no effect on Vt

Question 22

Do piston driven ventilator couple or decouple??

Gas driven couple or decouple?

Answer 22

Piston - decouples

Gas driven - couples

Question 23

Which type of ventilator adds peep automatically?

Answer 23

Gas driven (couples) adds 2 of PEEP

Question 24

What components are fixed in VCV? What is variable?

Answer 24

Tv
Inspiratory flow
Inspiratory time

Variable- pressure

Question 25

What components are fixed in PCV? What is variable?

Answer 25

Fixed - Pressure Inspiratory time Variable Tidal Volume Inspiratory flow

Question 26

What are examples of low lung compliance states?

Answer 26

Pregnancy Obesity Laparoscopy ARDS

Question 27

What are examples of states when high PIP is dangerous and you SHOULD use PCV?

Answer 27

LMA Neonate Emphysema

Question 28

What will happen to Tidal volume when using PCV with increased resistance and decreased compliance?

Answer 28

Reduced tidal volume

Question 29

When is CPAP useful?

Answer 29

Reduces airway collapse

Question 30

When is airway pressure release ventilation used?

Answer 30

Spontaneous ventilation High level of CPAP throughout cycle ARDS

Question 31

What is a risk with IRV?

Answer 31

Auto peep or breath stacking

Question 32

Properties of small soda lime granules?

Answer 32

High surface area which means it has high absorptive capacity High resistance

Question 33

Properties of large soda lime granules?

Answer 33

Low surface area (Low absorptive capacity) Low resistance

Question 34

What is the best mesh granule size?

Answer 34

4-8 mesh granules

Question 35

At what pH does soda lime turn purple?

Answer 35

Below 10.3

Question 36

If you can not change the soda lime what should you do?

Answer 36

Increase FGF and convert to semi open system Do not increase minute ventilation

Question 37

Granules are hydrated to? Why?

Answer 37

20% Facilitate reaction in soda lime

Question 38

How does silica effect CO2 absorbent?

Answer 38

-increases hardness and minimizes dust -decreases resistance -reduces efficacy of granules

Question 39

What are the pros and cons of hydroxide lime

Answer 39

Pros -less desiccation -No CO production -Lower risk of fire than with soda lime -No silica Cons -Decreased absorptive capacity -requires frequent replacement -expensive

Question 40

How much CO2 can soda lime absorb? How much can amsorb

Answer 40

26L per 100g 10.6L per 100g

Question 41

What are 4 ways to monitor for circuit disconnect?

Answer 41

Pressure Volume ETCO2 Vigilance

Question 42

Chief patient-related cause of increased peak inspiratory pressure?

Answer 42

Bronchospasm

Question 43

If the patient has high peak pressures but return to normal after switching to the bag, what is likely the cause?

Answer 43

Ventilator spill valve

Question 44

What is the function of the ventilator spill valve?

Answer 44

Vent excess fresh gas from the flowmeter to the scavenger

Question 45

If a high peak pressure does not return to normal after switching a patient to bag from the ventilator and the patient is not bronchospasming, what is likely the cause? Treatment?

Answer 45

Scavenger is occluded or positive pressure relief valve has failed TIVA and hand ventilate

Question 46

How much gas must the scavenger remove? Too much? Too little?

Answer 46

Equal to FGF minus the volume of patients O2 consumption Too much creates negative pressure Too little creates barotrauma

Question 47

Open breathing circuit examples Rebreathing? Reservoir?

Answer 47

Insufflation, simple face mask, NC open drop NO NO

Question 48

Semi-Open breathing circuit examples Rebreathing? Reservoir?

Answer 48

Mapleson, circle system -FGF > Mv Rebreathing - NO Reservoir - YES

Question 49

Semi-closed breathing circuit examples Rebreathing? Reservoir?

Answer 49

Circle system FGF < Mv Rebreathing - Yes (partial) Reservoir - Yes

Question 50

Closed breathing circuit examples Rebreathing? Reservoir?

Answer 50

-Circle system -Complete rebreathing -Low FGF -Closed APL Rebreathing - Yes Reservoir - Yes

Question 51

Does the circle system prevent rebreathing of CO2, O2, Anesthetic agent?

Answer 51

Prevents rebreathing of CO2 Can rebreathe O2, anesthetic agent

Question 52

What happens if a unidirectional valve is stuck open? Closed?

Answer 52

Open - rebreathing Closed- airway obstruction

Question 53

Conduction velocity is a function of what three things?

Answer 53

-RMP -Amplitude of action potential -How fast it will depolarize during phase 0

Question 54

What 5 things affect conduction velocity?

Answer 54

ANS tone Hyperkalemia Ischemia Acidosis Antiarrhythmic drugs

Question 55

What is the gatekeeper between the atria and ventricles?

Answer 55

AV node

Question 56

James fiber connects?

Answer 56

atrium to AV node S bypasses SA node

Question 57

Atrio-hisian fiber connects?

Answer 57

Atrium to HIS bundle

Question 58

Kents bundle connects?

Answer 58

Atrium to ventricle ..? Kent is normal

Question 59

Mahaim bundle connects?

Answer 59

AV node to ventricle

Question 60

What is the absolute refractory period and when is it located?

Answer 60

No stimulus can depolarize the myocyte -Q wave to the first 1/3 T wave

Question 61

What is the relative refractory period and when is it located?

Answer 61

Needs a strong stimulus Last 2/3 of the T wave

Question 62

What condition causes PR interval depression?

Answer 62

Pericarditis

Question 63

What conditions can show peaked T waves?

Answer 63

Intracranial bleed, MI, LVH effects

Question 64

What is likely if a U wave is present?

Answer 64

Hypokalemia

Question 65

QT changes with hypercalcemia? Hypo?

Answer 65

Shorted QT with hyper Prolonged with hypo

Question 66

What leads monitor the lateral side of the heart

Answer 66

I, aVL, V5, V6

Question 67

Which leads monitor the inferior side of the heart?

Answer 67

II,III, aVF

Question 68

Which leads monitor the LAD?

Answer 68

V1,V2,V3,V4

Question 69

What is a normal axis?

Answer 69

-30 and +90

Question 70

What conditions cause a Right axis deviation?

Answer 70

COPD, bronchospasm, Cor pulmonale, Pulmonary HTN, PE

Question 71

Which conditions cause Left axis deviation?

Answer 71

AS, aortic regurg, mitral regurg

Question 72

What reflex can cause sinus arrythmia ?

Answer 72

Bainbridge

Question 73

What happens when less than 0.5 of atropine is given?

Answer 73

Paradoxical bradycardia due to presynaptic muscarinic receptors

Question 74

What is glucagon for? How does it work?

Answer 74

BB or CCB overdose, increases cAMP through glucagon receptors in the myocardium

Question 75

What is the most common tachyarrhythmia and when does it occur?

Answer 75

Afib Post op day 2-4

Question 76

During aflutter, what stops atrial impulses from being transmitted to the ventricles?

Answer 76

Refractory period

Question 77

What must be performed if afib or aflutter is older than 48 hours?

Answer 77

A TEE to rule out atrial thrombus

Question 78

What medication is used to treat PVCs?

Answer 78

Lidocaine 1mg per kg

Question 79

What is Brugada syndrome? Where and who does it happen in?

Answer 79

Sudden death at night, in southeastern Asia men Na channel issue RBBB and ST elevation

Question 80

What is the etiology of a 3rd degree block?

Answer 80

Lenegre's disease or fibrotic degeneration of atrial system

Question 81

What do class 1 antidysrhythmic block?

Answer 81

Na channel

Question 82

How do 1A Na channel blockers work? What are examples?

Answer 82

Moderate depression of phase 0 and prolongs phase 3 repolarization Procainamide, Quinidine, dispyramide

Question 83

How do 1B Na channel blockers work?

Answer 83

Weak depression of phase 0 and shortens phase 3 Lidocaine, phenytoin

Question 84

How do 1C Na Channel blockers work?

Answer 84

Strong depression on phase 0 Flecainide, propafenone

Question 85

What are class II antidysrhythmic? How do they work>

Answer 85

Beta blockers Slow phase 4 in the SA node

Question 86

What are class III antidysrhythmic?

Answer 86

Potassium channel blockers Prolong phase 3 Amiodarone

Question 87

What are class IV antidysrhythmic?

Answer 87

CCB Decrease conduction velocity Verapamil, diltiazem

Question 88

How does adenosine work? Half life?

Answer 88

Hyperpolarizes the cell through adenosine 1 receptor. 5 seconds

Question 89

What is a side effect of adenosine?

Answer 89

Bronchospasm

Question 90

When is adenosine useful?

Answer 90

SVT, WFW

Question 91

What is the most common cause of tachyarrhythmias?

Answer 91

Reentrant pathways

Question 92

WPW what is it?

Answer 92

most common pre excitation syndrome. DELTA wave Uses Kents bundle Treat through ablation

Question 93

What must be monitored during an ablation?

Answer 93

Esophageal temperature - risk for thermal injury to the LA and esophagus

Question 94

What is the treatment for Afib with WPW?

Answer 94

Procainamide

Question 95

Most AV nodal reentry tachycardias with WPW are classified as ?

Answer 95

Orthodromic - Conducted through the AV node Narrow QRS Block AV node

Question 96

What is the antidromic pathway? What is important

Answer 96

Only 10% Bypasses AV node Wife QRS Treat with procainamide or cardioversion

Question 97

What happens if a magnet is placed over an ICD WITH a pacemaker

Answer 97

Stops the ICD but not the pacemaker

Question 98

What is safer to use with a pacemaker monopolar or bipolar?

Answer 98

Bipolar

Question 99

What is contradicted with pacemakers?

Answer 99

MRI