From practice tests #2 Flashcards
Technique to decrease local anesthetic from opthalmic to systemic
- Keep eye shut for 1 min
- avoid blinking
- press medial canthus
WBC function:
- T lymphocytes
- B lymphocytes
- Neutrophils
- Basophils
- Eosinophils
- Cell mediated (no antibodies)
- Humoral immunity (antibodies)
- Bacterial/Fungal (most abundant)
- Histamine, serotonin, heparin, bradykinin (hypersensitivity)
- Parasites
Disease caused by a prion? Leads to?
Creutzfelt-Jakob
- Leads to Dementia and encephalopathy
- Caught from animal protein, implants, cadavar pituitary hormones
Vanco must be started within how long of incision?
120 mins
Rigid bronchoscope: 4 ways to ventilate, EtCO2, Airway
Ventilate
- Spontaneous
- Apneic
- PPV (requires ventilating bronchoscope)
- Jet ventilation (best with TIVA)
innacurate EtCO2
Airway not secure
Greatest risk of VAE during mediastinoscopy when?
During spont. breathing
What is the “Hold up” sign?
When using a bougie, its when hitting the carina (35-40cm)
Confirms placement
-Bougies are also good for NT intubation, or through supraglottic airway
Giving “chest rigidity” causing opioids, the difficult ventilation is actually from? Due to?
Laryngeal muscle contraction
From increased dopamine or decreased GABA
Sniffing position alignment
Cervical flexion - aligns pharyngeal/Laryngeal
A-O extention - aligns Pharyngeal/Oral
Most potent glucocorticoid? the rest that are glucocorticoid only?
- Dexamethasone
- Betamethasone
- Triamcolone
Has = glucocorticoid/mineralocorticoid effects
- Cortisol
- Cortisone
Drugs with Glucorticoid > mineralocorticoid effects
- Prednisone
- Methylprednisone
Drug with mineralacorticoid > glucocorticoid effects
- Fludricortisone
Post-op tonsil bleed timing
75% < 6 hours
25% < 24 hours
Loading dose for Mg for seizure prophylaxis (eclampsia)?
Target Mg levels?
4-6 Grams over 10 mins, then 1-2 G/hr
Target plasma: 2-3.5
Cells of the GI tract:
- Gastrin
- Cholecystokinin
- Secretin
- Gastric inhibitory peptide
- G cells
- I cells
- S cells
- K cells
Lasers: Shortwave vs Longwave
Shortwave:
- Deeper
- Retina
- RAN - Ruby, Argon, ND:YaG lasers
Longwave:
- Shallow
- More H20
- Cornea/sclera
- CO2 laser
1 site of metastasis in Breast Cancer
Bone
Mastectomy
- hypercalcemia
- possible low spo2 if isosulfan blue is injected into sentinal node
Effects of bone cement:
- First sign: decreased EtCO2
- Hypotension
- Hypoxemia (air/fat emboli)
- Increased PVR
- Cardiac Arrest
- LOC during regional
Superior Hypogastric plexus
- Innervates pelvic organs
- Block helps in Cancer pain
ASA chance of mortality per 10,000
- 0.04
- 0.5
- 2.7
- 5.5
Nerve injured when arms pronated in supine position
Ulnar
most to least common closed claims cases (categories of anatomic/anesthetic fault)
- Regional
- Respiratory
- Cardiac
- Equipment
Neurotransmitter and their target receptor:
- Substance P
- Glutamate
- Serotonin
- Glycine
Which are excitatory/inhibitory?
Excitatory
- Substance P - Neurokinin 1 (NK1)
- Glutamate - NMDA
Inhibitory
- Serotonin - 5HT
- Glycine - Chloride linked GlyR
Grey matter lamina dorsal/ventral?
1-6 Dorsal
7-9 Ventral
Drugs metabolized by Pseudocholinesterase
- Ester anesthetics (cocaine is Pseudocholinesterase + liver)
- Mivacurium/Succinylcholine
Tumescent local anesthetic contains:
- Dilutent (NaCl)
- Lidocaine (0.05-0.1%)
- Epi
- Bicarb (sometimes)
Peaks 12 hours
DOA 36 hours
Oxybarbiturates and Thiobarbiturates? Best anticonvulsant?
Oxybarbs:
- Methohexital
- Phenobarbital (best anticonvulsant)
- Socobarbital
Thiobarbs:
- Thiopental
- Thiamylal
Reduces gas pressure between O2 tank and intermediate system?
Regulator
Bourdin gauge can calculate which gases? Why?
- Nitrogen
- Helium
Liquid in canister
Axis deviation
Leads Leaving each other L axis deviation
- Normal: -30 to +90
- Left: < -30 (extreme is -90 or less)
- Right: > +90
Semi-open Circuits
- Bain
- Mapleson
- Jackson-Reese
Name circuits
Antiarrhythmics action
- Class I
- Class II
- Class III
- Class IV
- Decrease phase 0 (NA channel blockers)
- decrease rate depolarization through SA, phase 4 (Beta blockers)
- prolongs repolarization, phase 3 (K channel blockers)
- decrease action potential (Ca channel blocker)
Multiple Sclerosis
- avoid spinal (epidural/PNB ok)
- Avoid hyperthermia, Succ, stress
- pt on long term steroids (may need stress dose)
disease of abnormal calcium sequestration
Myotonic Dystrophy
Hyper/Hypo-K periodic paralysis, what Ion channels?
HyperK - Na channel
HypoK - Ca channel
Cyclosporins effect which organ the most?
Kidney
Diseases causing kyphosis secondarily cause what?
Aortic Regurg
*Think ankylosing spondylitis, RA, spina bifida, osteoporosis, muscular dsytrophy, Ehlers-Danlos, Marfans
Disruption of _____ in which LeFort fractures?
- Cribiform plate
- Lefort II, III
5 and dime reflex (oculocardiac) effects which receptors?
M2 on SA/AV nodes
Which reflex still intact in heart transplant?
Bainbridge
Herbal alpha 2 blocker?
Treats what?
Yohimbe
treats orthostatic hypotension
RMP and TP of SA node?
Another name for SA node?
RMP -60
TP -45
Keith-Flack node
Supplies SA node?
RCA (in 50-60% ppl)
Cx (in 40-50% ppl)
Decreases supply and increases demand of heart?
Increased
- HR
- Preload
Decreased
- Aortic diastolic BP
Most common cause of mitral stenosis?
Others?
Endocarditis
RA, SLE, Carcinoid syndrome
Where do Cranial nerves originate from?
Midbrain
- 3-4
Brain stem
- Pons: 5-8
- Medulla: 9-12
Hypercarbia effects
Direct effects:
- Myocaridial depressant
- local vasodilation
SNS effects:
- Vasoconstriction
- Increased contractility
- increasesed serum K+
Secretion: Adrenal medulla vs adrenal cortex
Medulla
- Epinephrine
- Norepinephrine
Cortex (zona glomerulas, fasciculata, reticularis)
- Aldosterone
- Glucocorticoids
- Androgens
Thyroarytenoids
They relax
But also ADDuct the VC, closing airway
Additives to Bier block to extend sensory block?
- Toradol
- Tramadol
- Clonidine
Match to area of anatomy:
- Lower motor neuron
- Upper motor neuron
- 2nd order neuron, medial lemniscal
- 2nd order neuron, spinothalamic
- Ventral horn
- precentral gyrus in Cerebral cortex
- gracilis nucleus in Medulla/brainstem (think medial medulla)
- Dorsal horn (think spinothalamic - 1st and 2nd neuron in spinal cord)
ETT cuff pressures less than? in what unit of measure?
<25 cmH2O
C and K temp conversions
C and F conversions
C = K - 273.15
K = C + 273.15
C = (F-32) x 5/9
F = (Cx1.8) + 32
Measurement conversions
mmHg to cmH20
1 atm and others
1 mmhg = 1.36 cmH2O
1 atm = 100 kpa, 1033 cmH2O, 14.7 lbs/inch²
FRC and atelectasis?
an increased FRC is protective against atelectasis (COPD, elderly)
Doesnt mean it cant be caused by other means…
Cricoid pressure is known to?
Decrease LES sphincter tone
Where are M2 receptors?
Cardiac
Increased risk of LAST
- Hypercarbia
- Hyperkalemia
- Resp/Metabolic acidosis
Soda lime: Exhaustion vs dessication
Exhaustion:
- Color change (Change in pH <10.3)
- ability to absorb CO2
Dessication
- dried out (no H2O, typically 13-20% saturated)
- Risk of Compound A and Carbon monoxide
CSF vs Blood
CSF
- More acidic (due to lower protein levels decrease H+ buffer)
- less Glucose, K+
Which volatile attenuates baroreceptor reflex the least?
Isoflurane
