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misc. Flashcards

1
Q

why does primary adrenal insufficiency cause metabolic acidosis

A

aldosterone usually causes acid secretion in kidneys which theres not neough aldoeterone so then u have aciosis (hydrogen channel or some nonsense)

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2
Q

how does heliox (helium + oxygen) help thoe w stridor

A

heliu has lower density, therefor decreasing reynolds number, therefore allowing for more laminar flow rather than turbulent flow

reynolds number is directly proportional to velocity, density, diameter

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3
Q

what can cause overdampening of a line

A

air bubbles
additioanl stop cocks
increased compliance in circuit thing blood clot causes dampening whic is why u flush it

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4
Q

what electrolyte abnormalities are seen with respiratory alk

A

hypocalcemia (ca binds to the proteins that release H+)
hypokalemia (think K/H exchanger )
hypophosphate

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5
Q

what decreases the chance of non hemolytic transfusion reaction

A

leukoreduction

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6
Q

blood pressure management for AVM malformation?

A

want permission hypotension so the embolization agent doesnt spread further than the AVM

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7
Q

what is the haladane effect

A

oxygen binding to hgb and displacing co2 causing downward shift in hemogolobin o2 curve

the opposite of this is the bohr effect where co2 displaces oxxygen on hgb

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8
Q

what ion has the highest concentration intracellularly

A

K+

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9
Q

neuromonitoring evoked potentials from most to lease sensitive to MAC gas

A

visual
motor
somatosensory
auditory

think first gas makes u blind

last gas will effect the hearing

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10
Q

what lab test monitors low molecular weight heparin (enoxparin)

A

factor Xa activity

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11
Q

what congenital heart condition will have ST segment elevations in v1-v3

A

brugada syndrome
asian people
avoid sodium channel blocking agents

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12
Q

how to determine between cerebral salt wasting and SIADH

A

cerebral salt wasting patient will be hypovolemic
in SIADH THEY WILL BE hypervolemic or euvolemic

think the fluid follows the salt out the body and they are hella dehydrated

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13
Q

is ECT parasympathetic or symmpathetic response

A

ECT is briefly parasympathetic then sympathetic prolonged response so you iwill see transient bradycardia at first

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14
Q

where is the most common location for cardiac myxoma

A

left atrium

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15
Q

function of preoptic anterior hypothalmus

A

thermoregulation

**medial tubercle hypothalamus secretes vasopressin and oxytococin to posterior pituitary

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16
Q

issue with transplanted lungs to consider during next surgery

A

its denervated so

impaired ciliary function, cough reflex and lymphatic drainage

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17
Q

when is vasospasms after SAH most likely to occur

A

between 2-14 days

rebleeding likely in first 24 hours

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18
Q

when is retrograde cardioplegia preferred

A
  1. diffuse CAD
  2. aortic insufficiency
  3. manipulation of aorta
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19
Q

what is the sensory innervation of the anterior abdominal wall

A

anterior and lateral branche of the cutaneous branches of the lower thoracic spinal nerve

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20
Q

how long should u wait to remove neuroaxial cath after DVT ppx low dose has been given

A

wait 12 hours

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21
Q

type 1 pnuemocytes

A

where gas exchange occurs

made out of sqaumous cells

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22
Q

type 2 pneumocytes

A

where surfactant is produced

cuboidal cells

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23
Q

factors that increase Fa:Fi ratio

A

increase minute ventilation
decreased cardiac output
low blood: gas solubility
low alveolar partial pressure

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23
Q

factors that increase Fa:Fi rati

A

increase minute ventilation
decreased cardiac output
low blood: gas solubility
low alveolar partial pressure

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24
Q

do the true vocal chords abduct or adduct on inspiration

A

they abduct
think that they stay open to allow air to flow

cricothyroid muscle is the only laryngeal muscle not innervated by the recurrent laryngeael nerve

its innervated by the external branch of the superior laryngeal nerve

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25
Q

factors that increase citrate toxicity

A 
blood products 
liver disease 
peds populatiojn 
hyperventilated 
hypothermic

think breathing in citrate when hyperventilationg and not using it all cause its a cold body so then u have incrasing citrate

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26
Q

when is pulmonary vascular resistance at its highest

A

at the extreme of lung volumes

its the lowest at
FRC

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27
Q

recommended max NO concentration

A

25 parts per million

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28
Q

how quickly can u see PT/INR change when hepatic dysfunction occurs

A

24 hours

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28
Q

how quickly can u see PT/INR change when hepatic dysfunction occurs

A

24 hours

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29
Q

what two disease are related to elevated DLCO

A

asthma

obesity

30
Q

what two disease are related to elevated DLCO

A

asthma

obesity

31
Q

biggest concern for airway management in achondroplasia patients

A

atlantoaxial instability

32
Q

what substance of ett are more likely to cause fires

A

all nom metal ett are at higher risk of causing fires

33
Q

what enzyme in the electron transport chain does cyanide toxicity inhibit

A

cytochrome C oxidase

think cyanIDE makes cytohrome C DIE

34
Q

the orientation of the double lumen tube is where the bronchial cuff is going give example

A

aka when its a left sided double lumen tube the bronchial cuff will go to the left of the carina

35
Q

what extra subunit to immature extrajunctional Ach receptors have that mature ones dont

A

gamma (y) subunit. mature receptor will have epsilon subunit
both have 2 alpa 1, 1 beta 1, and one delta (?) present in fetus but also sepsis, burns immboliation etc.

36
Q

what labs do u get periodically for someone using dantrolene

A

LFTs

37
Q

how does hyperbaric oxygen increase oxygen delivery

A

it increases the amount of disolved oxygen in the blood

38
Q

why is the simaultaneous release of lidocaine and liposomal bupivicaine contraindicated

A

can result in rapid release of bupi and then toxicity–

wait at least 20 min between them

39
Q

exxcercise challenege test criteria for bronchoconstriction

A

10% decrease in fev1 after 406 minutes of 80% exxertion will indicate exercise induced bronchoconstriction

40
Q

difference between anterior ischemic optic neuropathy and posterior ishchenmic optic neuropathy

A

AION will have optic disc edema and pallor, PION will not have any PE findings (things its posterior so its hidden) and is more related to spine surgery

41
Q

criteria to get supplmental oxygen for COPD

A

spo2 < 88% on RA
OR
pao2 < 55

42
Q

carotid body vs. carotid sinus

A

carotid body have chemo receptors that response to changees in O2, H+ co2 in blood
carotid SINUS Has baroreceptors that will decrease SVR ifs systemic pressure increases

think the BODY undergoe CHEMO aka carotid BODY has CHEMOreceptors

43
Q

what two disease states have no pure shunting

A

COPD and asthma will have no shunt

whihc i think is perfusion no ventilation bc dead space is ventilation but no perfusion

44
Q

the dichrotic notch on a line waveform represents what

A

aortic valve closure

45
Q

risk factors for peri operative vaso occlusive events

A
  1. older age
  2. recent hospitaliation
  3. infection
  4. hx of pulm disease
46
Q

best IVF for traumatic brain injury

A

normal saline

47
Q

patients with what syndrome are at a higher risk of jaundice after RBC infusion

A

gilberts syndrome

have less of the enzyme that conjugates bilirubin

48
Q

when you say ascending or descending bellow vent it refers to what phase

A

its describing the expiratory phase

so ascending bellow means ascending during expiratory phase

49
Q

art line transducer height and how it affects BP reading

A

20 cm of hight will change the reading by 15

raising the transducer 20 cm will decrease the blood pressure by 15
lowering tranducer will increase BP reading by 15

50
Q

an autoimmune condition that causes muscle cramping, bag of worms under skin excessive sweating muscle hypertrophy treated by phenytoin and carbamazipine

A

acquited neuromyonia

antibodies against volated gated Ca channel

51
Q

are sympathetic preganglionic fibers long or short

A

they are short coming from the CNS think fight or flight response is QUICK aka SHORT signal

52
Q

compartment pressure over what number for emergent fasciotomy

A

40 mm hg

think when u hit ur 40s ur muscles breakdown

53
Q

what is the bainbridge reflex

A

aka atrial stretch reflex its when HR increases as preload increases

vagus mediated increase in HR by decreases parasympathetic input

brain bridge BOOST aka ur HR gets a BOOST (increases) with a BOOST of preload

54
Q

what is max cuff pressure in ett vs lma

A

in ett its 30 mm h20

lma its 60 mmh20 (44 mm hg)

55
Q

tight junctions vs gap junctions

A

tight junctions are to form barriers that regulate water and solute movement
gap junctions are for cardiac myocytes for quick propogation

think small GAPS for quick communication
G for GOOD rate of communication

obviously for barrier it would be tight

56
Q

what patient factor most closely relates to the block height of isobaric spinal

A

patients weight is closely related to amount of CSF

height of block and amount of CSF are inversely related

57
Q

most common indication for retrograde cardioplasia

A

retrograde: aortic insufficiency

57
Q

most common indication for retrograde cardioplasia

A

retrograde: aortic insufficiency

58
Q

list the sensitive from least to most sensitive of the modalities in which you can identify venous air embolism

A

EKG, end tidal CO2, pulmonary artery cath, precordial doppler TEE

59
Q

explain how thermodilution cardiac output measurements are interpereted

so the measure youre getting is reflective measure of cardiac output

A

basically u inject a cold solution into the RA (Ti) and then you also measure the ;pulm artery blood temp (Tb) the longer it takes for Tb to come back to normal the slower the cardiac output

60
Q

what will a pregnant ladies blood gas look like

A

hyper ventilation because progesterone stimualtes ventilation so ph will be slightly alk, pco2 on the lower side, a little higher pao2, and bicarb will be mildly decreases bc ur mildly compensated

61
Q

how does partial pressure affect temperature

A

partial pressure is directly proportional to temp so as temp decreases the pa02 goes down, paco2 down down, and therefore pH will increase since paco2 is going down

62
Q

what are the 5 criteria categories in the aldrete scoring system to by pass phase 1 PACU

A 
movement/activity
breathing 
O2 sat
circulation 
consciousness
63
Q

what acid base derrangement would hypoalbumin cause

A

metabolic alkalosis because albumin is a (weak) acid

64
Q

the difference between complex regiona pain syndrome 1 and 2?

A

they differ by the cause
CRPS 1 is a trivial injury
CRPS 2 is caused by traumatic injury

65
Q

elemental vs polymeric feeds

A

elemental diets are more expensive and can cause increased mortality and hospital length of stay

66
Q

what measurement in non invasive blodo pressure monitoring is the least reliable

A

systolic

67
Q

what two volumes equal closing capacity

A

residual volume plus closing volume

forced exhalaiton results in apex emptying and closure of the bases

68
Q

two signs that your injection is intraneural when doing a block

A

high opening injection pressure

electrical stimulation with a motor response < 0.2 mA

69
Q

neonates are more sensitive to what opioid

A

codeine because decreased cyp2d6 avbility in the first 2 weeks to change into morphine

70
Q

at what level does autonomic dysreflexia occur

A

T7 or above

71
Q

how is the intensity of light detected by infrared spectophotometer in gas machine related to paco2

A

intensity of light is inversely proportional to paco2

o2 cannot be analyzesd in this manner

72
Q

what things would trigger the subambient pressure alarm on vent

aka when pressure falls below atmospheric pressure

A
  1. NGT suctionin in trachea
  2. pt inhaling against increases resistence in circuit
  3. pt inhaling against collpased resovoir bag
  4. blocked inspiratory limb during exalation
  5. malfunctioning closed scavenging system
73
Q

what are the sxs of propofol infusion syndrom

A 
metabolic acidosis 
cardiac issues 
hyerpkalemia 
renal failure 
pancreatitis 
hepatomegly 
high triglyceride 
rhabdo

ITE (7 decks)

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