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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
what EKG abnormality will be seen in someone with multiple blood transfusions
prolonged QT 2/2 to hypocalcemia
26
what action requires the highest mac to prevent movement
endotracheal intubation NOT DL
27
as the gas flow through a bobbin rotameter increases, what increases as well?
cross-sectional orifice area
28
how does storage of RBC affect 2,3 BPG
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
29
what physiologic state can mimic the effects of mannitol
hyperglycemia osmotic diueresis
30
does prealbumin increase or decrease after HD
it increases because its too large to go through the ultrafiltration
31
which part of the frank starings curve is volume dependent steep or flat
the steep part of the curve
32
local anesthetic systemic absorption based on site
ICE BaLLS intercostal > caudal > epidural> brachial plexus > lower limb > subQ
33
when you have an incompetent inspiratory valve, increasing fresh gas flow does what
minimizes rebreathing
34
what is kidney stones more common w corticosteroid use
because u have increased urinary calcium
35
transfusion related immunomodulation has what benefit
renal allograft survival rates
36
with non invasive blood pressure measurement how is the MAP deteremined
maximum amplitude of oscillations
37
what advantages do airway exchange cathetars have over gum bougies when performing ETT exchange
allows for jet ventilation and end tital CO2 monitoring
38
what infection has highest rate of infection within a blood product
CMV
39
if max amp is low or lys 30 is low what do u need
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
how would u manage extravasation of vasopressor
elevate limb irrigate w saline. warm compress stellate ganglion block in upper extremity phentolamine
41
when isolation monitor alarms what should be the first step
unplug the most recent device plugged in
42
relative ontraindications for closed circuit/low flow anesthesia
sevo acute alcohol ketoacidsos malnutrition
43
how is intensity of light detected by infrared related to co2 partial pressure
inversely related
44
what vesssel supplies the AV node
blood flow comes from the RCA in 90% and left circumflex in 10%
45
what prevents microshocks vs macroshocks
micro shocks prevented by eqipment ground wire | macro shocks prevented by ground fault interpreter
46
what products are contained in cryo
``` fibrinogen fibronectin vWF factor XIII factor VIII ```
47
what is the different exam findings for anterior ischemic optic neuropathy vs posterior
anterior will have optic disc edema or palor wheras posterior has no exam findings think posterior is hidden so no findings
48
acoustic impedence of US is based on what two characteristics
density | propogation speed of sound
49
describe what a CVP tracing will look like if patient has a fib vs. AV dissociation vs tricuspid regurg
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
how does chornic opioid therapy affect hormones
increased prolactin | decreased cortisol, FSH, LH, testosterone estrogen
51
should you increase or decrease intubating doses of NMBA in cirrhosis/ CHF / renal failure patients
increase dose because volume of distribution is increased since lower plasma concentration
52
if u can smell sevo through n95 mask what does that mean
that the safe environmental limit has been exceeded
53
under HIPPA do u need to get permission from patient to give information about workmans compensation
no
54
what is the second messenger for NMDA
calcium think mag analgesic effect happens bc its an NMDA antagonist glutamate or glycine must be bound to receptor
55
what is the components of modified aldreate criteria
``` activity breathing circulation consciousness pulse ox ```
56
if patient goes into cardiac arrest because of LAST syndrome how do u adjust ur epi dosem
epi should be <1 mg every 3-5 minutes instead of 1 mg ever 3-5 min
57
how does clonidine comprare w morphine when given through epidural
clonidine has a longer duration of action (could be up to 1 month) clondine + morphine together provide synergistic analgesic effect
58
how can propofol infusion syndrome present
pancreatitis hepatomegly rhabdo renal failure hyper K lactic acidosis cardiac failure high tryglyceride
59
what size ETT can fit through LMA size 3,4,5,6
3/4 6.0 ett | 5/6 7.0ett
60
what does ths celiax plexus innervate start and end of GI tract
start : distal third esophagus to distal descending colon
61
GFR changes around pregnancy
3 months into pregnancy GFR increses to 50% goes back to normal 3 months post partum GFR 3 letters think 3 is key
62
name two nerves that can be acceidentally blocked w deep cervical plexus block (c2-4)
superior laryngeal phrenic superficial cervical block can accidentally block the accessory nerve
63
is glutamine and calcitonin related peptide excitatory or inhbitory
excitatory think glue two things together its a ppositive so exiting calcitonin is like calcium ice cream which is hella exciting
64
is glycine inhibitory or excitatory
GLy think LYING inhibits happiness and therefore its inhibitory
65
TURP syndrome w distilled water
hypotonic solution causes volume issues, also can cause RBC lysis and impair surgical visualization
66
TURP syndrome w NS or balanced salt
significant current dispersion
67
TURP syndrome w glycine
transient blindness
68
TURP syndrome w mannitol/soribital
cause cause hyperglycemia, wildly used.
69
what happens to intrinsic heart rate after heart transplant
the intrinsic heart rate is higher (think newer heart) due ot parasymmatetic denervation. also less variability in HR. HR originates from donor atria
70
hiv exposure ppx
two drugs if known hiv status needle stick 3 drug ppx if severe exposure to known hiv
71
two opioid meds whos metabolites are problematic in kidney failure patients
hydromorphine--> hydromorphone -3-glucoronide (cognitive dysfunction and myoclonus) meperidine --> normeperidine (seizures agitation myoclonus)
72
what issue is going to occur with cogenital diaphragmatic hernia
pulm hypoplasia allow permissive hypercapnia up to 65 so you can do low lung tidal volumes
73
how does Nitrous affect CBF, ICP, CMRO
increases it all CMRO CBF and ICP increases CMRO and CBF whereas iso and sevo uncouple them and decrease CMRO
74
75
TEG interpretation, what to do in : prolonged R time decreased K or alpha angle decreased MA
give FFP, clotting factors given fibrinogen think if the ALPHA girlie just keeps saying "K" shes prob fibbing give platelets
76
targets of deep brain stim for parkings
internal globis pallidus subthalmic nucleus
77
first sign of diabetic autnomic neuropathy
tachycardia resting around 100
78
presenting sign of subcutaneous emphysema after abdominal insufflation
very high hypercarbia
79
for billing one anesthesia unit is how many minutes
15 min
80
does sympathetic or parasympathetic tone increase in elderly
sympathetic
81
82
stimulation of which nerve causes reflex bronchoconstricution
vagus nerve, think cold air or histamine will cause the senory affeerent and M2 M3 receptors stimualted by vagus nerve will cause constriction
83
how do volatile anesthetics help w ischemic preconditioning
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
what organ metabolizes precedex
liver
85
85
does etomidate increase or decreased hepatic blood flow
decreases
86
physiology anemia happens in new borns at how many weeks and wahts the hgb
happens at 8-12 weeks and drops to 10-12
87
87
which material of ETT is nonflammable
metal stainless steel
88
89
90

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