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misc Flashcards

1
Q

name 5 risk factors for citrate toxicity

A 
hypothermia 
liver disease 
peds population
blood transfusion 
hyperventilation

the first 3 have to do w decreased metabolism

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2
Q

how does hyperventilation cause citrate toxicity

A

decreases ionized calcium therefore causing hypocalcemia therefore causing citrate toxicity

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3
Q

ingesting water 2 hours preop comapred to 4 hours preop does what to gastric ocntent and pH

A

drinkning water 2 hours preop will result in smaller gastric volumes and higher pH because tehre is a positive feedback loop that when stomach senses liquid in it it will try to empty faster

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4
Q

what are the least stable factors in FFP

A

factor 5 and 8

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5
Q

4 signs of citrate toxicity

A
  1. hypocalcemia
  2. hypomag
    3, myocardial depression –> hypotension
  3. coagulopathy
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6
Q

right to left shunt is going to effect the rate of induction of a more or less soluble voltaline

A

it will slow the rate of induction of a less soluble anesthetic because the low blood:gas the dilutional effect of mixing shunt blood will be greater felt with lower soluble gases

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7
Q

which two gases should be measured by weight to see how much is left rather than cylinder pressure

A

NO, CO2

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8
Q

what is the bainbridge reflex

A

increases HR by blocking parasympathetic activity when stretch receptors located in the RA sense increased pressure

think they feel more blood aka stretch so increase HR to pump it out

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9
Q

hering bruer reflex

A

pulmonary stretch receptors prevents inspiration and triggers expiration to prevent overinflation of lungs

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10
Q

what hormones decrease in stress response

A

GH
T3/T4 think sick euthyroid syndrome
Tsh may increase oor decrease or stay norm

GH increase at first then drop
vasopressin will drop in septic shock

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11
Q

what is the advantage of a bain circuit aka modified mapleson D

A
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12
Q

what ekg leads in combination or alone are the best for detecting MI

A

in combination lead II and V4 are ideal

alone V5 is the best

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13
Q

what will trigger the sub ambient pressure alarm on vent

A

placing suction of NG tube in trachea

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14
Q

benefits of leukoreduction of blood products

A
  1. reduced cmv transmission
  2. decreased febrile non hemolytic rxn
  3. decreased inflammatory response and inflamatory mediators accumulated during storage
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15
Q

what is the first line of treatment w someone displaying cushings triad after brain injury

A

intubate

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16
Q

what lab value reflects synthetic function of liver the best

A

PT

represents extrinisic pathway (factor 7)

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17
Q

changes in what 2 properties will cause a jump to another higher functioning frank starling cure

A
  1. ionotropy jump upwards

2. stroke volume (vasodilators will decrease end diastolic pressure ) causing lefwards jump improves cardiac pressures

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18
Q

which peripheral neurotransmitters cause inhibition at spinal cord

A

GABA
glycine
opioids

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19
Q

what can result in clotting time variability

A

hypothermia
hemodilution
platlets 30-50k
drugs that affect platelets

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20
Q

how much liters in full n2O tank

A

1500 L, 750 psig

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21
Q

whats the main reason infants have a higher voaltile anesthetic update compared to adults

A

increased minute ventilation to FRC ratio

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22
Q

name the three ways nitroprusside toxicity occurs

A
  1. cyanide ions bind to cytochrome C oxidase
  2. formation of cyanomethemeglobin
  3. thiocynate production which causes CNS effects
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23
Q

whats the pre succ dose of roc you would give?

A

10% of ED95 dose

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24
Q

when doing caudal epidural in infant what are the layesr your needle croses

A

skin, subq fat, sacralcoccygeal ligament

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25
Q

what EKG abnormality will be seen in someone with multiple blood transfusions

A

prolonged QT

2/2 to hypocalcemia

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26
Q

what action requires the highest mac to prevent movement

A

endotracheal intubation

NOT DL

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27
Q

as the gas flow through a bobbin rotameter increases, what increases as well?

A

cross-sectional orifice area

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28
Q

how does storage of RBC affect 2,3 BPG

A

storage causes a decrease of 2,3 BPG

think that the hgb wants to keep the O2 so the curve is shifted to left since tehres no tissue in the RBC

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29
Q

what physiologic state can mimic the effects of mannitol

A

hyperglycemia

osmotic diueresis

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30
Q

does prealbumin increase or decrease after HD

A

it increases because its too large to go through the ultrafiltration

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31
Q

which part of the frank starings curve is volume dependent steep or flat

A

the steep part of the curve

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32
Q

local anesthetic systemic absorption based on site

A

ICE BaLLS

intercostal > caudal > epidural> brachial plexus > lower limb > subQ

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33
Q

when you have an incompetent inspiratory valve, increasing fresh gas flow does what

A

minimizes rebreathing

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34
Q

what is kidney stones more common w corticosteroid use

A

because u have increased urinary calcium

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35
Q

transfusion related immunomodulation has what benefit

A

renal allograft survival rates

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36
Q

with non invasive blood pressure measurement how is the MAP deteremined

A

maximum amplitude of oscillations

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37
Q

what advantages do airway exchange cathetars have over gum bougies when performing ETT exchange

A

allows for jet ventilation and end tital CO2 monitoring

38
Q

what infection has highest rate of infection within a blood product

A

CMV

39
Q

if max amp is low or lys 30 is low what do u need

A

for max amp u need platlets
for lys 30 u need plasmin (TXA etc.)

if any other thing is abnormal on TEG u need fibrinogen or FFP

40
Q

how would u manage extravasation of vasopressor

A

elevate limb
irrigate w saline. warm compress
stellate ganglion block in upper extremity
phentolamine

41
Q

when isolation monitor alarms what should be the first step

A

unplug the most recent device plugged in

42
Q

relative ontraindications for closed circuit/low flow anesthesia

A

sevo
acute alcohol
ketoacidsos
malnutrition

43
Q

how is intensity of light detected by infrared related to co2 partial pressure

A

inversely related

44
Q

what vesssel supplies the AV node

A

blood flow comes from the RCA in 90% and left circumflex in 10%

45
Q

what prevents microshocks vs macroshocks

A

micro shocks prevented by eqipment ground wire

macro shocks prevented by ground fault interpreter

46
Q

what products are contained in cryo

A 
fibrinogen 
fibronectin 
vWF 
factor XIII
factor VIII
47
Q

what is the different exam findings for anterior ischemic optic neuropathy vs posterior

A

anterior will have optic disc edema or palor wheras posterior has no exam findings

think posterior is hidden so no findings

48
Q

acoustic impedence of US is based on what two characteristics

A

density

propogation speed of sound

49
Q

describe what a CVP tracing will look like if patient has a fib vs. AV dissociation vs tricuspid regurg

A

a fib A wave is missing
AV dissociation no C wave because youre contracting against closed tricuspid valve
in regurg youll have tall C wave and V wave

50
Q

how does chornic opioid therapy affect hormones

A

increased prolactin

decreased cortisol, FSH, LH, testosterone estrogen

51
Q

should you increase or decrease intubating doses of NMBA in cirrhosis/ CHF / renal failure patients

A

increase dose because volume of distribution is increased since lower plasma concentration

52
Q

if u can smell sevo through n95 mask what does that mean

A

that the safe environmental limit has been exceeded

53
Q

under HIPPA do u need to get permission from patient to give information about workmans compensation

A

no

54
Q

what is the second messenger for NMDA

A

calcium

think mag analgesic effect happens bc its an NMDA antagonist

glutamate or glycine must be bound to receptor

55
Q

what is the components of modified aldreate criteria

A 
activity 
breathing 
circulation 
consciousness 
pulse ox
56
Q

if patient goes into cardiac arrest because of LAST syndrome how do u adjust ur epi dosem

A

epi should be <1 mg every 3-5 minutes instead of 1 mg ever 3-5 min

57
Q

how does clonidine comprare w morphine when given through epidural

A

clonidine has a longer duration of action (could be up to 1 month)
clondine + morphine together provide synergistic analgesic effect

58
Q

how can propofol infusion syndrome present

A

pancreatitis
hepatomegly

rhabdo
renal failure
hyper K
lactic acidosis

cardiac failure
high tryglyceride

59
Q

what size ETT can fit through LMA size 3,4,5,6

A

3/4 6.0 ett

5/6 7.0ett

60
Q

what does ths celiax plexus innervate start and end of GI tract

A

start : distal third esophagus to distal descending colon

61
Q

GFR changes around pregnancy

A

3 months into pregnancy GFR increses to 50%
goes back to normal 3 months post partum

GFR 3 letters think 3 is key

62
Q

name two nerves that can be acceidentally blocked w deep cervical plexus block (c2-4)

A

superior laryngeal
phrenic

superficial cervical block can accidentally block the accessory nerve

63
Q

is glutamine and calcitonin related peptide excitatory or inhbitory

A

excitatory

think glue two things together its a ppositive so exiting

calcitonin is like calcium ice cream which is hella exciting

64
Q

is glycine inhibitory or excitatory

A

GLy think LYING inhibits happiness and therefore its inhibitory

65
Q

TURP syndrome w distilled water

A

hypotonic solution causes volume issues, also can cause RBC lysis and impair surgical visualization

66
Q

TURP syndrome w NS or balanced salt

A

significant current dispersion

67
Q

TURP syndrome w glycine

A

transient blindness

68
Q

TURP syndrome w mannitol/soribital

A

cause cause hyperglycemia, wildly used.

69
Q

what happens to intrinsic heart rate after heart transplant

A

the intrinsic heart rate is higher (think newer heart) due ot parasymmatetic denervation. also less variability in HR. HR originates from donor atria

70
Q

hiv exposure ppx

A

two drugs if known hiv status needle stick
3 drug ppx if severe exposure to known hiv

71
Q

two opioid meds whos metabolites are problematic in kidney failure patients

A

hydromorphine–> hydromorphone -3-glucoronide (cognitive dysfunction and myoclonus)

meperidine –> normeperidine (seizures agitation myoclonus)

72
Q

what issue is going to occur with cogenital diaphragmatic hernia

A

pulm hypoplasia

allow permissive hypercapnia up to 65 so you can do low lung tidal volumes

73
Q

how does Nitrous affect CBF, ICP, CMRO

A

increases it all CMRO CBF and ICP

increases CMRO and CBF whereas iso and sevo uncouple them and decrease CMRO

74
Q
A
75
Q

TEG interpretation, what to do in :

prolonged R time

decreased K or alpha angle

decreased MA

A

give FFP, clotting factors

given fibrinogen think if the ALPHA girlie just keeps saying “K” shes prob fibbing

give platelets

76
Q

targets of deep brain stim for parkings

A

internal globis pallidus
subthalmic nucleus

77
Q

first sign of diabetic autnomic neuropathy

A

tachycardia resting around 100

78
Q

presenting sign of subcutaneous emphysema after abdominal insufflation

A

very high hypercarbia

79
Q

for billing one anesthesia unit is how many minutes

A

15 min

80
Q

does sympathetic or parasympathetic tone increase in elderly

A

sympathetic

81
Q
A
82
Q

stimulation of which nerve causes reflex bronchoconstricution

A

vagus nerve,

think cold air or histamine will cause the senory affeerent and M2 M3 receptors stimualted by vagus nerve will cause constriction

83
Q

how do volatile anesthetics help w ischemic preconditioning

A

when cells see ischmie there is activation of kATP channels that cause cellular changes that make them more protected from ischemia– volatile anesthetics also trigger this pathway

84
Q

what organ metabolizes precedex

A

liver

85
Q
A
85
Q

does etomidate increase or decreased hepatic blood flow

A

decreases

86
Q

physiology anemia happens in new borns at how many weeks and wahts the hgb

A

happens at 8-12 weeks and drops to 10-12

87
Q
A
87
Q

which material of ETT is nonflammable

A

metal stainless steel

88
Q
A
89
Q
A
90
Q
A

Basic (9 decks)

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