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Anesthesia > Jensen1 > Flashcards

Jensen1 Flashcards

1
Q

Bodies response to removal of carotid bodies

A

little change to ventilation at rest, response to hypoxia is lost and there is a 30% reduction in ventilatory response to CO2

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2
Q

chemoreceptors that mediate hyperventilation after carotid and aortic body denervation are located where

A

medulla oblongata - medullary chemoreceptors

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3
Q

PEEP effects (pulmonary)

A

prevent alveolar collapse, promote gas exchange, increases FRC, increases lung compliance, decreases intrapulmonary shunt, increases PaO2, increases dead space

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4
Q

PEEP effects (cardiac)

A

high airway pressure 2/2 to decreased pulmonary compliance can decrease CO - decreases ventricular filling, decreased coronary blood flow

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5
Q

PEEP complications

A

decreases CO, causes fluid retention (depresses ANF, increases ADH), increases pressure in SVC - can increase ICP, barotrauma

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6
Q

PEEP recommended for? not recommended? no evidence?

A

recommended for pulmonary edema, not recommended for localized lung disease (over-distends normal lung and redirects blood to diseased area, creating V/Q mismatch), no evidence that it increases incidence of ARDS, beneficial routinely, or decreases mediastinal bleeding

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7
Q

Eaton-Lambert definition

A

muscular weakness because of decreased release of acetylcholine 2/2 destruction of pre-synaptic voltage gated Ca channels by IgG antibodies

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8
Q

Eaton-:Lambert presentation and associated diseases

A

bronchial CA (oat cell), SLE, thyroid disease, present with dry mouth, proximal muscle weakness, muscle pain, weakness improves with exercise. more in men, sensitive to all NMBD

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9
Q

Eaton-Lambert treatment

A

excision of cancer, 4-aminopyridine (immunosuppressant) stimulates release of pre-synaptic acetylcholine, acetylcholinesterase is not effective

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10
Q

Increased mixed venous

A

left to right shunt, high cardiac output, cyanide poisoning, CO poisoning, methgb, hypothermia (decreased O2 consumption), sepsis, sampling error (permanently wedged PAC)

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11
Q

decreased mixed venous

A

increased O2 consumption (fever, thyroid storm, MH), decreased O2 delivery (hypoxia, decreased CO, decreased Hgb, abnormal Hgb)

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12
Q

mixed venous normal values

A

O2 40 mm Hg, CO2 45 mm Hg, 65-75% sat

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13
Q

shivering, mechanism and treatment

A

when preoptic region of hypothalamus is cooled, increases metabolic heat production up to 600%, increases O2 consumption and CO2 production, hypoxia inhibits shivering response, treatment with meperidine - decreases the shivering threshold

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14
Q

amide locals metabolism dependent on…

A

liver which is dependent on hepatic blood flow (decreased with NE, propranolol, GA) and extraction capacity (decreased with HF, cirrhosis, hypothermia)

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15
Q

ester locals metabolism dependent on…

A

pseudocholinesterase - low in renal failure, severe hepatic failure, pregnancy

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16
Q

which anticholinergic crosses BBB

A

scopolamine and atropine

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17
Q

Cholinergic (parasympathetic) crisis

A

SLUDEBBP - salivation, sweating, lacrimation, urination, defecation, erection, bradycardia, bronchial constriction, pupillary constriction

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18
Q

anticholinergic crisis - central anticholinergic syndrome

A

atropine and scopolamine because cross BBB, treatment is physostigmine; symptoms are fever (blocks sweating), blurred vision, photophobia, tachycardia, restlessness, somnolence

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19
Q

Horner’s syndrome

A

ptosis, miosis, anhidrosis, enophthalmos, flushing of conjunctiva and skin, nasal congestion (engorged blood vessels)

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20
Q

O2 consumption decreases with 1 degree centigrade

A

10%

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21
Q

oculocardiac reflex pathway

A

afferent: ciliary ganglion to ophthalmic division of trigeminal nerve (V), through Gasserian ganglion to sensory nucleus of the 4th ventricle, efferent: vagus nerve –> bradycardia, hypotension, PVCs

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22
Q

Phase II block characteristics

A

fade with twitch and tetanus, TOF <0.7 (T4/T1), post-tetanic potentiation

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23
Q

minimum fresh gas flow

A

150-500 ml/min for metabolic demands and replace anesthetic gas

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24
Q

advantages/disadvantages of closed circuit

A

ad: conservation or heat/humidity, economical, low pollution; dis: anesthetic concentration cannot be changed quickly and delivered anesthetic concentration uncertain, uptake of nitrous oxide can decrease O2

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25
Q

right shift oxy-hgb

A

O2 unloads easily, high H, high CO2, high temp, chronic anemia, high 2,3 DPG

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26
Q

left shift oxy-hgb

A

O2 binds more to hgb, low H, low temp, low 2,3 DPG, met-hgb, fetal hgb, hypophosphatemia, hypothermia

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27
Q

TPN complications

A

hypo/hyperglycemia, hypercarbia, hypophosphatemia (left shift oxy-hgb, muscle weakness), fatty acid deficiency, metabolic acidosis (from amino acid metabolism), sepsis

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28
Q

ECT response

A

parasymp - bradycardia, hypotension, cerebral vasoconstriction, asystole; symp - tachy, HTN, increased cerebral blood flow, increased metabolic demands

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29
Q

ECT drugs

A

ketamine - seizure potential, methohexital lowers seizure threshold, thiopental and propofol tend to suppress seizures, hyperventilation and caffeine can increase seizure duration

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30
Q

does not require cross match

A

FFP, cryo, platelets

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31
Q

type specific/Rh required

A

pRBCs need both, cryo and FFP need ABO (Rh not required), platelets better with both, but not required

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32
Q

Induces ADH secretion

A

Pain, PEEP, decrease intravascular volume, positive pressure ventilation

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33
Q

Monophasic vs biphasic defibrillation

A

Monophasic current travels From one electrode to another in one direction; Biphasic current flows in one direction for 1st phase then reverses for 2nd phase so adjusts for impedance by varying waveform, more effective, less injury prone

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34
Q

trigeminal neuralgia

A

V2 maxillary, can treat with carbamazepine which is membrane stabilizer or gasserian block at middle cranial fossa by meckel’s cave (contains CSF)

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35
Q

treatment of LA CNS toxicity

A

intubate, barb/benzo, hyperventilate (alkalosis increases ionized percentage)

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36
Q

LA weak acids or bases?

A

weak bases except for benzocaine

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37
Q

co-ox for methgb, carboxhgb, and dyes

A

methgb absorbs both wave lengths equally 85%, carboxy absorbs red (660) but not infrared (940) so measurement varies, methylene blue can cause 65%

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38
Q

carbohgb levels mild? mod? severe?

A

10-20%, 20-40%, >40%

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39
Q

hypercalcemia EKG, symptoms

A

PR prolonged, QT short, muscle weakness

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40
Q

hypocalcemia EKG, symptoms

A

Qt prolonged, tetany and laryngospasm, seizures

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41
Q

H’s

A

Hypovolemia, Hyper/Hypokalemia, Hypothermia, Hydrogen ions, Hypoxia, Hypoglycemia

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42
Q

T’s

A

Tension pneumo, Thrombosis (pulmonary, coronary), Trauma, Tamponade (cardiac), Toxins

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43
Q

Hyperventilation/hypocarbia

A

AVCO - apnea, alkalosis, airway constriction, V/Q mismatch, decreased CO, CBF, coronary blood flow, and Ca, oxyhbg left shift

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44
Q

Hypoventilation/hypercarbia

A

A RIPE - acidosis/arrhythmia, right shift oxyhgb, intracerebral steal, PA pressure increase, epi/norepi release (cutaneous vasodilation, splanchnic vasoconstriction)

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45
Q

cardioselective beta blockers

A

Metoprolol, Esmolol, Atenolol, Acebutolol

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46
Q

amiodarone mechanism

A

used for refractory VT/VF, prolongs refractory period and reduces membrane excitability

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47
Q

adverse amiodarone effects

A

pulmonary toxicity due to enhanced O2 free radial formation, increased risk for ARDS

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48
Q

digoxin mechanism and therapeutic margin

A

increases INTRACELLULAR calcium; inhibits the Na-K pump; 0.9-2.0 ng/mL

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49
Q

what is calcium hydroxide? advan/disad?

A

combination of calcium hydroxide, calcium chloride, calcium sulfate, and polyvinylpyrrolidine (lacks strong bases sodium and postassium which ELIMINATES CO and compound A production), 50% less absorptive than soda lime with higher cost

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50
Q

umbilical artery and vein ABG

A

artery: 7.28/20/50 sat 40% vein: 7.35/30/40 sat 70%

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51
Q

organophosphate mechanism

A

irreversibly inhibits pseudocholinesterase, acetylcholinesterase, and non-specific plasma cholinesterases, also affects GABA and NMDA

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52
Q

organophosphate treatment

A

pralidoxime (oximes) activates acetylcholinesterase (primarily reverses muscle weakness - nicotinic), atropine helps with other symptoms (muscarinic)

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53
Q

stellate ganglion block

A

covers inferior cervical and first thoracic ganglion, blocks head and upper extremity (T2-T9), block at transverse process of C6 at level of cricoid cartilage

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54
Q

CO2 values with apnea

A

6 mmHg increase after 1 minute, 3 mmHg every minute after

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55
Q

ketamine indications

A

burns, shock, COPD, asthma, CHF, cardiac tamponade, hypothyroidism, TOF

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56
Q

ketamine contraindications

A

heart: HTN, cardiac ischemia, digitalis toxicity, brain: increased ICP, CVA, lungs: pHTN, pulm emboli, endocrine: hyperthyroidism, eye: nystagmus, pregnancy: severe pre-eclampsia

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57
Q

ketamine pharmacology

A

phencyclidine derivative, NMDA receptor antagonist, dissociates thalamus from limbic system (reticular activating system to cerebral cortex), provides analgesia (modest LA action)

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58
Q

increased closing capacity

A

ACLSS - age, chronic bronchitis, LV failure, smoking, surgery

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59
Q

decreased FRC

A

PANGOS - pregnancy, ascites, neonates, GA, obesity, supine position

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60
Q

porphyria neurologic problem types, diagnosis, treatment

A

types 1, 3, 4; check urine for aminolevulinic acid (ALA) and pophobilinogen (both not seen in cutanea tarda type); treat with glucose infusion suppresses ALA synthetase

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61
Q

Porphyria triggers (induce ALA synthetase)

A

barbituates, diazepam, chlordiazepoxideam, meprobamate, glutethimide, hydroxydione, imipramine, pentazocine, OCPs, griseofulvin, phenytoin, methsuximide, sulfonamides, chloramphenicol, estrogens, progesterone, (sulfonylureas) chlorpropamide & tolbutamide, lead, ethanol, ergots, amphetamines, methyldopa, etomidate?, hydralazine, phenoxybenzamine, nifedipine

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62
Q

porphyria pathophys

A

enzymatic defect of heme synthesis resulting in over production of heme precursors (increased ALA synthetase activity)

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63
Q

porphyria symptoms

A

n/v, abdominal pain, dehydration, anxiety, electrolyte abnormalities, confusion

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64
Q

complications of mediastinoscopy

A

(suprasternal incision to pass scope anterior to trachea and posterior to innominate vessels and aortic arch) hemorrhage, pneumo, RLN injury, tracheal collapse, “apparent” cardiac arrest (severe vagal reflex), air embolus

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65
Q

mediastinoscopy contraindications

A

previous mediaastinoscopy, distorted anatomy, SVC syndrome, cerebrovascular disease (risk of carotid compression)

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66
Q

special mediastinoscopy considerations

A

pulse ox on both sides of upper extremities (pressure on right innominate can cause radial pulse to disappear), IV lines placed in LE (resuscitation in UE can increase blood loss in mediastinal cavity)

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67
Q

metoclopramide contraindications

A

Parkinson’s (antagonizes dopamine), patients taking phenothiazines, butyrophenones, MAOIs, or TCAs, pheochromocytoma, GIB, bowel obstruction, seizures

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68
Q

MAOIs and meperidine

A

fatal excitatory reactions

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69
Q

MOAI food interactions and why

A

chocolate, beer, wine, cheese because they contain tyramine (monoamine)

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70
Q

MOAIs and pressors

A

see exaggerated response with indirect and direct

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71
Q

postural hypotension and MAOIs

A

accumulation of false neurotransmitter octopamine

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72
Q

most common serious adverse flumazenil side effect

A

convulsions and death (patients with serious underlying disease and s/p ingestion of non-benzo drugs)

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73
Q

garlic

A

used for vasodilatory and anti-cholesterol effects; decreases platelet aggregation

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74
Q

ginseng

A

used for anti-aging, energy, and aphrodisiac; hypoglycemic effect, avoid ASA, NSAIDs, Coumadin, heparin, and neuraxial blocks (like garlic), causes HTN, avoid with MAOIs (manic episodes)

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75
Q

ginkgo

A

used for intermittent claudication, memory loss, tinnitus, impotence; can cause hypema, subarachnoid hemorrhage, and spontaneous subdural hemorrhage, avoid avoid ASA, NSAIDs, Coumadin, heparin, and neuraxial blocks, decreases effectiveness of TCAs and anticonvulsants

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76
Q

st. john’s wort

A

used for anxiety, depression, sleep disorders; can cause photosensitivity, do not use with tetracycline or piroxicam

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77
Q

banked blood survival

A

blood bank survival based on 70% RBC survival 24 hours after transfusion

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78
Q

CPD-A half-life, ACD half-life?

A

35 days; 21 days

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79
Q

changes to banked blood

A

decreased 2.3 DPG, increased CO2 (acidemia), decreased platelets, increased potassium, decreased factors (esp V and VIII)

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80
Q

interscalene block complications

A

vertebral artery puncture, spinal/epidural injection, brachial plexus injury, phrenic nerve paralysis (100%), pneumo, RLN block, horner’s

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81
Q

hypophosphatemia

A

heart failure, respiratory failure, rhabdomyolysis, hyporeflexia, seizures, decreased mental status, n/v, low levels of ATP and 2.3 DPG cause left shift of oxyhgb

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82
Q

hyperphosphatemia

A

tetany, seizures, laryngospasm

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83
Q

augment NMB

A

volatiles, LA (procaine), anticholinesterases, tetracycline, aminoglycosides (gentamycin), lincosamides (clinda), polymixins, lidocaine, quinidine, Ca channel blockers, magnesium, lithium, hypernatremia, hepatic dysfunction, hypothermia, acidosis

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84
Q

intraarterial thiopental injection treatment

A

inject with lido/procaine/papverine (prevent smooth muscle spasm), sympathetic block at stellate/brachial, heparinize (prevent thrombus), possible alpha block (phentolamine)

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85
Q

hyperbaric O2

A

allows arterial O2 tension to increase 3x than at normal barometric pressure, used for decompression sickness, CO poisoning

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86
Q

hyperbaric O2 complications

A

seizures 2/2 CNS O2 toxicity (lower O2 concentration), lung damage (free O2 radicals), hyperoxic myopia (HBO >20-30), middle ear rupture, pneumothorax

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87
Q

first stage of labor

A

T10-L1, uterus, cervix, upper vagina; can use spinal, epidural, paracervical, caudal, general

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88
Q

second stage of labor

A

S2-S4; can use spinal, epidural, caudal, general, pudendal

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89
Q

beat to beat variability

A

best indicator of fetal well being, decreased happens with sleep and prematurity but can also indicate CNS damage, hypoxia, or drug effects

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90
Q

length of ETT placement

A

1 kg 7 cm
2 kg 8 cm
3 kg 9 cm
3.5 kg 10 cm (at term) OR multiply diameter x 3

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91
Q

diameter of ETT

A

(age + 16)/4

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92
Q

CDH

A

1:4000, defect in left posterior foramen of Bochdalek, associated with cardiac defects, pulmonary hypoplasia/HTN, GI abnormalities, spina bifida/hydrocephalus

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93
Q

CDH management

A

insert NG or OG to decompress stomach, maintain preductal O2 sat 90%, airway pressures <25, and PaCO2 60-65

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94
Q

pralidoxime dose

A

15-30 mg/kg over 20 min IM/IV to avoid laryngospasm, HTN, muscle rigidity, repeat after 4 hours or 1 hour if paralysis worsening

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95
Q

agent protective against organophophate poisoning

A

pyridostigmine - carbamylate-complexed acetylcholinesterase resists attack

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96
Q

sulfonylureas

A

glyburide/glipizide increase insulin secretion, contraindicated with sulfa allergy

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97
Q

metformin

A

is a biguanide that decreases GI glucose absorption and decreases liver glucose production –> decreased insulin resistance and blood glucose

98
Q

metformin contraindications

A

renal insufficiency, metabolic acidosis, hold 48 hours before contrast media (acidosis risk), caution with hypoxemia, liver disease, alcohol abuse (lactic acidosis risk)

99
Q

thiazolidinediones

A

tro/pio/rosiglitazone reduce insulin resistance, potential liver toxicity

100
Q

alpha glucosidase inhibitors

A

acarbose and miglitol delay GI absorption and prevent complex carb breakdown, potential liver toxicity

101
Q

repaglinide

A

is a meglitinide (similar to sulfonylurea) increases insulin secretion , more rapid onset, less risk of hypoglycemia, caution with renal/hepatic dysfunction

102
Q

Artificially increased HbA1c

A

increased HgF, CRF, splenectomy, dialysis, thalassemia, increased triglycerides

103
Q

decreased HbA1c

A

chronic blood loss, anemia, HbS

104
Q

why does CO2 leave capillaries to alveoli more than O2 leaves alveoli to capillaries

A

CO2 20x more diffusible across membranes than O2 –> hypercarbia is never due to defective diffusion

105
Q

Ondine’s curse

A

loss of autonomic control of breathing - always need to be awake and thinking of breathing

106
Q

Bainbridge reflex

A

increased right atrial pressure (ass with increased filling) leads to increased HR from afferent inhibition of parasympathetics

107
Q

Bezold-Jarisch reflex

A

triad of apnea, bradycardia, hypotension –> certain noxious stimuli sensed by chemoreceptors/mechanoreceptors in left ventricle stimulates C fibers that increases parasympathetic tone, triggers myocardial infarction/ischemia, thrombolysis, revascularization, syncopy

108
Q

carotid sinus/aortic arch baroreceptor reflex

A

carotid (IX) and aortic (X) afferent signal relays change in BP to nucleus solitarius in CV center of medulla –> changes parasympathetic tone

109
Q

carotid sinus/aortic arch baroreceptor reflex augmentation

A

loses function when BP <50, volatiles, CCB, ACE-I, phosphodiesterase inhibitors, chronic HTN decrease baroreceptor reflex

110
Q

chemoreceptor reflex

A

found in carotid and aortic bodies, respond to changes in pH and PaO2 –> acidotic/hypoxemic causes stim of respiratory center via IX and X (and HR and contractility decrease)

111
Q

cushing reflex

A

increased ICP causes cerebral ischemia which initially cause sympathetic response (tachy, HTN, increased myocard contractility), then HTN causes bradycardia reflex “HTN and bradycardia”

112
Q

Pulmonary stenosis

A

2nd left ICS at left sternal border

113
Q

MR

A

apical (5th ICS midclavicular)

114
Q

AS

A

2nd right ICS at right sternal boarder

115
Q

VSD

A

left sternal border ICS 4-6

116
Q

TR

A

5th ICS at left sternal border

117
Q

acute pericarditis

A

J point elevation, friction rub, referred pain in area of trapezius

118
Q

CV changes with age

A

decreased vascular compliance, decreased hepatic blood flow and decreased protein binding

119
Q

carcinoid treatment

A

bronchospasm - volatiles, steroid, H1&2 blockers, Benadryl, hypotension - volume repletion, HTN (serotonin release) - SNP, NTG –> long acting somatostatin analog, octreotide, treats all

120
Q

pRBCs Hct

A

60

121
Q

blood volume preterm? newborn? infant? child? adult?

A

100, 85, 80, 70-75, 70-75

122
Q

DI

A

absence of ADH or renal insensitivity, see dilute urine, hypernatremia, hypovolemia; treat with IM ADH/DDAVP (vasopressin) or chlorpropamide if renal

123
Q

SIADH

A

seen with surgery, tumors, hypothyroid, porphyria; see concentrated urine, decreased serum osmolality, hyponatremia; treat with fluid restriction, demeclocyline, hypertonic saline (0.5 meq/hr)

124
Q

protamine

A

strong base; can cause flushing, edema, bronchospasm, pHTN; IgE mediated histamine release, complement activation, and thromboxane production

125
Q

protamine susceptibility

A

prior exposure to protamine containing substances (NPH insulin), seafood allergy (derived from salmon sperm), vasectomy; tx: cyclooxygenase inhibitors (NSAIDs, ASA) can decrease adverse

126
Q

retrobulbar complications

A

retrobulbar hemorrhage, globe perforation, optic nerve atrophy, convulsions, oculocardiac reflex, trigeminal block, respiratory arrest, acute neurogenic pulmonary edema

127
Q

thermodilution inaccuracies

A

atrial fibrillation, TR, intracardiac shunts

128
Q

neuromonitoring sensitivity

A

Visual>SSEP>MEP>BAEP

129
Q

pulse ox limitations

A

no pulse - need arterial pulsations to distinguish from background venous (hypotension, hypothermia), hemoglobin variants, severe anemia (Hgb 3, Hct 10), venous pulsations (R heart failure, TR), fluorescent light underestimates, nail polish varies

130
Q

CVP waves

A

All College Xams Vary Yearly - a wave atrial contraction, c wave tricuspid closure, x descent atrial relaxation, v wave atrial filling, y descent atrial emptying

131
Q

a wave absent

A

atrial fibrillation or flutter

132
Q

cannon a waves

A

junctional rhythms, TS, RVH, pulmonary/mitral stenosis, pHTN

133
Q

artificially high PCWP > LVEDP

A

mitral stenosis, atrial myxoma, PEEP

134
Q

artificially low PCWP < LVEDP

A

noncompliant LV, LVEDP >25, AI, premature closure of mitral valve

135
Q

sensitivity to air embolism

A

TEE (gold standard), TT Doppler (0.25 ml), decreased ETCO2, increased nitrogen, increased PA pressure, hypotension, mill-wheel murmur

136
Q

retrobulbar blocked nerves

A

II, III, V, VI

137
Q

concentration effect

A

the higher the concentration of gas used the faster the alveolar concentration of that gas

138
Q

2nd gas effect

A

large volume uptake of one gas accelerates the rate of increase of a concurrently administered gas

139
Q

underdamped

A

short tubing (1.5 mm), long tubing (1.5 m), stiff tubing, big catheter (18g)

140
Q

overdamped

A

high viscosity, soft/high compliance tubing

141
Q

preductal measurement

A

(proximal to ductus arteriosus) right radial or temporal aa

142
Q

awareness

A

routine monitoring of brain not recommend, small percentage of patients that report awareness will file a claim, they are only 2% of the claims, awareness is more likely under TIVA than volatiles, hemodynamics are also unreliable markers

143
Q

ROP retinal O2 tension goals

A

60-90 mm Hg

144
Q

hyperventilation disadvantages

A

Bohr effect results in a left shift of the hgb to have a greater affinity for O2, reducing the amount of O2 delivered to organs, PaCO2 < 30 mmHg, CBF can fall below a critical level and cause cerebral ischemia; pulmonary effects of alkalosis include increased permeability, decreased surfactant and decreased pulmonary compliance - acute lung injury.

145
Q

VATER

A

VSD, vertebral defects, vascular problems, Anal stenosis, TEF, Esophageal atresia, Radial/renal anomalies

146
Q

TEF complications

A

pre surgery: aspiration, PNA, congenital anomalies, post surgery: pneumo, atelectasis, anastomotic leaks, esophageal strictures

147
Q

Lead V1-V2 changes

A

LCA:LAD septal branch, damage HIS, BB, septum

148
Q

Lead V3-V4 changes

A

LCA:LAD diagonal, damage anterior wall

149
Q

Lead V5-V6 changes

A

LCA:circumflex branch, damage high lateral wall

150
Q

II, III, aVF changes

A

inferior wall LV, post LV

151
Q

V4R (II, III, aVF) changes

A

RCA proximal branches damage RV, inferior wall, LV, posterior wall LV

152
Q

V1-V4 changes

A

LCA circumflex or RCA posterior descending branch, damage posterior wall LV

153
Q

R-L shunt effect on alveolar concentration

A

decreases 2/2 blood bypassing lungs, most effect on least soluble agents

154
Q

CO2 response left

A

increased sensitivity to CO2: arterial hypoxemia, metabolic acidemia, central causes (ICP, anxiety, fear, cirrhosis), drugs (doxapram, strychnine, picrotoxin-analeptics

155
Q

CO2 response right

A

decreased sensitivity to CO2: aminophylline, salicylates, catecholamines, opioids, Physiologic changes (metabolic alkalemia, denervation of peripheral chemoreceptors, normal sleep, drugs, hypothermia)

156
Q

CO2 response down and right

A

high dose opioids, potent anesthetics - higher doses curve become horizontal (enflurane>halothane>isoflurane), neuromuscular blockade

157
Q

no effect CO2 response

A

droperidol

158
Q

sphincter of Oddi spasm

A

narcotics: morphine>fentanyl=alfentanyl>meperidine>butorphanol>nalbuphine, can be reversed with naloxone (except meperidine), glucagon, atropine, volatiles

159
Q

dorsal colum medial lemniscal

A

tactile sense and limb proprioception

160
Q

anterolateral (spinothalamic)

A

pain and temperature

161
Q

signs of successful stellate block

A

best-temperature increase, can also use horners, cobalt sweat test, psychogalvanic reflex, plethysmography, and thermography

162
Q

major CV risk

A

acute/recent MI, unstable/severe angina, decompensated HF, significant arrhythmia, severe valvular disease

163
Q

intermediate CV risk

A

mild angina, previous MI, compensated/prior CHF, DM, CKD, CVA

164
Q

minor CV risk

A

advanced age, abnormal ECG, rhythm other than sinus, low functional capacity, uncontrolled HTN

165
Q

exaggerated x and y descents

A

restrictive pericarditis

166
Q

abolished y descent

A

cardiac tamponade

167
Q

carbon monoxide half-life

A

4-6 hours with air, 40-80 min with O2, 15-30 min HBO

168
Q

CO HBO indications

A

Co >40%, pregnant >15%, coma

169
Q

mannitol onset,peak,duration

A

onset 15 min, peak 30-60 min, duration 3-6 hours

170
Q

CSF drain

A

placed 15-20 cm above ext auditory meatus to avoid big drops in ICP, leave it closed until dura is open

171
Q

transmural pressure

A

difference between arterial pressure minus CSF pressure

172
Q

normal PaO2

A

102-(age/3)

173
Q

abciximab, tirofiban, eptifibatide

A

platelet GIIb/IIIa inhibitors

174
Q

ticlodipine, clopidogrel

A

inhibits binding of ADP to platelet receptors

175
Q

ASA

A

irreversible inactivation of COX enzyme which decreases prostaglandin and thromboxane

176
Q

common finding with epidural and first stage of labor

A

fever more common than prolonged labor

177
Q

one lung ventilation indications

A

hemorrhage, abscess/infection, bronchopleural fistula, lung cyst, tracheobronchial disruption (tracheoesophageal fistula), unilateral bronchial lavage

178
Q

relative one lung ventilation

A

thoracic aortic aneurysm, upper lobectomy, pneumonectomy, esophageal resection, middle/lower lobectomy

179
Q

NO mechanism and precautions

A

NO stim cGMP which decreases intracellular Ca, NO is tightly bound to hemoglobin, limit of NO exposure is 2 ppm, >150 ppm fatal

180
Q

laminar flow equation

A

Flow(Q) = pi/8 x (change in pressure x r^4)/(viscosity x L)

181
Q

turbulent flow

A

when Reynolds number is >2000, Reynolds number = (V x r x density)/(viscosity)

182
Q

cm to mm Hg conversion

A

1.36 cm = 1 mm Hg

183
Q

treatment of pneumothorax

A

decompression at mid axillary line of 2nd intercostal space at right sternal border (can hit internal mammary artery aka internal thoracic artery)

184
Q

NO expansion

A

34 x more soluble than nitrogen and 30 x more soluble than CO2, this will occur more rapidly in blood (PA catheter/air embolus expand faster than pneumo)

185
Q

Etomidate on neuro monitoring

A

increased amplitude and increased latency

186
Q

pediatric airway

A

more cephalad, larger tongue/epiglottis/tonsils/adenoids, cricoid most narrow, narrow, more anterior glottis, more angled (adult perpendicular)

187
Q

hyperglycemic hyperosmolar non-ketotic coma

A

BG >600, serum osm >310, no acidosis, serum bicarb >15, normal anion gap

188
Q

propofol CNS effects

A

decrease CMRO2, CBF (via cerebral vasoconstriction, ICP, CBV, and EEG activity

189
Q

pRBCs component disappearance

A

I, V, VIII, platelets

190
Q

whole blood component disappearance

A

platelets, I, V, VIII

191
Q

LA toxicity ECG changes

A

prolonged PR, wide QRS

192
Q

definitive test for acute hemolytic reaction

A

direct coombs (RBCs into serum) to rule out attachment of attachment of RBC antibody to donor RBCs

193
Q

acute AF treatment

A

digitalis, verapamil, propranolol, D/C countershock, pacing (a flutter not AF), avoid lidocaine because increases AV conductance

194
Q

digitalis uses

A

CHF and AF to slow ventricular response

195
Q

dig toxicity symptoms

A

ventricular arrhythmias, anorexia, n/v

196
Q

dig toxicity causes and treatment

A

hypokalemia, hypomagnesemia, hypothyroid, hypercalcemia - treat with potassium, magnesium, lidocaine, phenytoin, fab fragment antibodies (no cardioversion because can cause Vfib)

197
Q

TET spell pathophys

A

2/2 spasm of RV outflow tract and infundibulum –> increased outflow resistance, decreased pulm blood flow, increased R-L shunt

198
Q

TET spell treatment

A

beta blocker to decrease HR and stop infundibular spasm, phenylephrine to increase SVR and decrease R-L shunt

199
Q

Cushings symptoms

A

HTN, hypokalemic alkalosis, hyperglycemia, hypernatremia, osteoporosis, easy bruising, polyuria, buffalo hump, moon facies, hirsute, menstrual abnormalities

200
Q

standard deviation

A

measure of variability: 1 68%, 2 95%, 3 99%

201
Q

type I error

A

null incorrectly rejected (probability of this error - alpha)

202
Q

type II error

A

null incorrectly accepted (probability of this error - beta)

203
Q

p value

A

probability that result could have happened by chance is less than 1/5 in 100

204
Q

compare means of two different groups (continuous)

A

unpaired t-test

205
Q

compare means of >2 groups (continuous)

A

ANOVA

206
Q

Wilcox rank sum

A

used like a t-test when the data is normally distributed

207
Q

compare means of two different groups (categorical)

A

chi-square

208
Q

power

A

= 1 - beta

209
Q

confidence interval 95

A

95% chance that true population parameter is contained within interval

210
Q

normal urine osm

A

300

211
Q

normal urine sodium

A

> 20

212
Q

FeNa

A

1% (>ATN or other kidney injury)

213
Q

antibiotic prophylaxis

A
  1. prosthetic cardiac valve 2. previous IE 3. congenital heart disease - unrepaired, repaired with device in last 6 months, repaired with residual defect 4. cardiac transplant with valvulopathy
214
Q

ROP presentation and pathophys

A

usually <1500g, norm retinal vasc develops 40-44 wks, hyperoxia disrupts this process

215
Q

ROP management

A

O2 sat 93-95%, PaO2 50-80 mm Hg

216
Q

tocolytics

A

beta agonists, magnesium, ethanol, prostaglandin synthetase inhibitor, NSAIDS, CCB

217
Q

ethanol as tocolytic

A

given in 10% solution of D5W, probably inhibits oxytocin

218
Q

prostaglandin synthetase inhibitor SE

A

premature close of PDA, primary pHTN, inhibits cox, which decreases thromboxane production - decrease platelet adhesiveness

219
Q

ephedrine in pregnancy

A

beta agonist that crosses placenta, increases beat to beat variability and fetal HR

220
Q

epiglotitits

A

supraglottic inflammation, H. Influenza, intubation in OR, thumb sign

221
Q

croup

A

laryngo-tracheo-bronchitis, barking cough, narrowing of subglottic inlet - steeple sign , treat with racemic epi neb, cool mist, steroids, intubation in OR

222
Q

esmolol metabolism

A

RBC esterases, short half life

223
Q

rhabdomyolysis triggers

A

suc, volatiles, ketamine, propofol

224
Q

termination of thoracic duct

A

left subclavian and left jugular veins

225
Q

paresthesia vs dyesthesia

A

parethesia no unpleasant vs dyesthesia unpleasant

226
Q

dibucaine

A

amide local that inhibits pseudocholinesterase - 80 homozygous normal

227
Q

3rd degree heart block vessel

A

RCA - most often supplies SA and AV nodes

228
Q

best TEE view for ischemia

A

Transgastric mid short axis view

229
Q

volatile metabolism

A

methoxyfluran 40%, halothane 20%, enflurane 2%, iso 0.2%, des <0.2%

230
Q

mivacurium

A

anticholinesterase and NDMR will prolong duration 2/2 mivacurium metabolized by pseudocholinesterase

231
Q

cocaine intoxication contraindicated drugs

A

beta blockers, beta agonists, alpha agonists, meperidine

232
Q

dexmedetomidine

A

alpha agonist that causes analgesia and sedation with little resp depression - supraspinal site of action for sedation (locus coeruleus)

233
Q

dexmed metabolism

A

liver

234
Q

dexmed side effects

A

transient HTN and bradycardia followed by decrease in BP and stabilization of HR

235
Q

dexmed contraindications

A

patients with bradycard disorders, severe ventricular dysfunction, CHF - conditions where need sympathetic tone

236
Q

sentinel event

A

unexpected occurrence involving death or serious physical or psychological injury or risk thereof

237
Q

bleomycin

A

pulmonary fibrosis

238
Q

doxirubicin

A

cardiomyopathy, GI upset, alopecia, myelosupression

239
Q

dead space on ventilator

A

distal to y-piece

240
Q

Guanethidine

A

antihypertensive drug that reduces the release of catecholamines

Anesthesia (16 decks)

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