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Apex Flashcards > Mock Exam 1 > Flashcards

Mock Exam 1 Flashcards

1
Q

what is included in the afferent limb of the oculocardiac reflex?

A

long and short ciliary nerves > ciliary ganglion > opthalmic division of trigeminal nerve > gasserian ganglion

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2
Q

what is included in the efferent limb of the oculocardiac reflex?

A

vagus nerve > SA node

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3
Q

treatment of oculocardiac reflex?

A

remove stimulus, administer 100% oxygen, administer atropine or glycopyrrolate

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4
Q

what is the heart rate of a transplanted (denervated) heart reliant on?

A

phase 4 of SA node depolarization (100-120 BPM)

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5
Q

For every 1 unit of PRBC’s transfused, the HGB and HCT should increase by

A

1g/dL and 2-3% respectively

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6
Q

the two posterior spinal arteries arise from the _____________ and perfuse the ____________ part of the spinal cord

A

cerebellar arteries, dorsal (sensory)

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7
Q

the anterior spinal artery arises from the _______________ and perfuses the ____________ part of the spinal cord

A

vertebral arteries, ventral (motor)

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8
Q

SE’s of ARB’s

A

hyperkalemia
increases lithium absorption by kidneys
increase maternal and fetal mortality (same with ACEI’s)
avoid in renal artery stenosis

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9
Q

what is cardioversion used to treat?

A

supraventricular and ventricular arrhythmias caused by re entry. This includes, afib, aflutter, AV nodal re entry, tachycardia secondary to pre excitation syndrome

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10
Q

what is the appropriate dose of energy to deliver for the first shock of cardio version for aflutter?

A

50-100 joules to start, up to 360 joules. remember, you are synchronizing with the R wave

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11
Q

a shock during which time in the cardiac cycle can cause vtach or vfib?

A

a shock on the t wave (relative refractory period)

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12
Q

how long after a drug eluding stent is placed should a patient wait for elective surgery?

A

6 months

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13
Q

how long after a bare metal stent is placed should a patient wait for elective surgery?

A

30 days

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14
Q

what does SSEP monitor?

A

dorsal (sensory) but not ventral (motor) part of spinal cord

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15
Q

which drugs interfere with SSEP monitoring and how does that manifest?

A

volatile anesthetics
nitrous oxide
propofol
barbiturates
midazolam
diazepam
decrease amplitude (sensory) and increase latency (time it takes for stimulus to travel from point A to point B)

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16
Q

blood: gas partition coefficient of sevoflurane

A

0.65

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17
Q

blood: gas partition coefficient of nitrous oxide

A

0.47

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18
Q

blood: gas partition coefficient of isoflurane

A

1.4

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19
Q

blood: gas partition coefficient of desflurane

A

0.42

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20
Q

describe blood: gas partition coefficient

A

it describes how many parts are in the blood in relation to the alveolus. For example, there are 65 parts in the blood for every 100 parts in the alveolus of sevoflurane (0.65)

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21
Q

what does it mean when the blood: gas partition coefficient is smaller?

A

the gas isn’t very soluble in the blood. FA equilibrates with FI faster, and therefore the onset is faster

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22
Q

is blood: gas solubility dependent on temperature?

A

yes, solubility is decreased as temperature is increased (onset is faster)

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23
Q

in the FA/FI curve, name the gases from top to bottom curve

A
  1. nitrous oxide
  2. desflurane
  3. sevoflurane
  4. isoflurane (bottom)
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24
Q

how does a right to left shunt affect induction of anesthesia for desflurane?

A

because the gas has the lowest solubility, much less uptake by the blood happens, and the dilution effect goes “unchecked”. In theory, this would slow induction time of low solubility gases but it really doesn’t.

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25
Q

therapeutic index calculation

A

median lethal dose/median effective dose

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26
Q

3 chemical components of a local anesthetic

A

aromatic ring (lipid solubility)
intermediate chain (metabolism and allergic potential)
tertiary amine (water solubility, ionization)

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27
Q

which anesthetics are allergic reactions more common with?

A

esther anesthetics

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28
Q

what kind of receptor is the opioid receptor?

A

GPCR

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29
Q

opioids inhibit _____________ and block the conversion of _______ to _________

A

adenylyl cyclase
ATP to cAMP

30
Q

increased inositol triphosphate is associated with _________ and _________ receptor agonism

A

alpha 1 and V1

31
Q

in the presynaptic nerve, reduced calcium conductance does what?

A

reduces neurotransmitter release

32
Q

in the postsynaptic nerve, increased potassium conductance does what?

A

causes hyperpolarization and makes the neuron less responsive to stimulation

33
Q

dose range for cocaine and max

A

1.5-3mg/kg, do not exceed 200mg

34
Q

what are the symptoms of an anti cholinergic overdose

A

flushing, mydriasis, dry mouth, confusion, hallucinations, hyperthermia, tachycardia

35
Q

what is the % of receptor blockade associated with being able to bite on a tongue blade for > 5 seconds?

A

50% receptor blockade (most sensitive)

36
Q

what is the % of receptor blockade associated with double burst stimulation without fade?

A

60% receptor blockade

37
Q

what is the % of receptor blockade associated with TOF 4/4

A

70%

38
Q

what is the % of receptor blockade associated with Vt 5mL/kg

A

80%

39
Q

distance for CVL insertion from femoral vein

A

40cm

40
Q

distance for CVL insertion from right median basilica vein

A

40cm

41
Q

distance for CVL insertion from left median basilica vein

A

50cm

42
Q

distance for CVL insertion from right IJ versus left IJ

A

right: 15
left: 20

43
Q

the right coronary artery is monitored by leads ______ and supply

A

II, III, avF
RA, RV, SA, AV, inferior aspect of LV

44
Q

the LAD is monitored by leads _________ and supply the ________

A

V3-V5, anterolateral region of LV

45
Q

the cx is monitored by leads ________ and supply

A

I, AvL, supplies lateral aspect of LV

46
Q

recommended bladder width of a BP cuff is what percent of the extremity?

A

40%

47
Q

near infrared spectroscopy (NIRS) is a way to assess

A

venous oxygen saturation (but only in the prefrontal cortex)

48
Q

adenosine should not be given to patients with

A

asthma, increases risk of brornchospasm

49
Q

in piston driven ventilators, the positive pressure relief valve opens at

A

75cmH2O

50
Q

in the event of an oxygen pipeline failure, the piston driven ventilator

A

does not consume tank oxygen (by contrast, a gas driven ventilator does)

51
Q

are piston driven ventilators fresh gas decoupling ventilators?

A

yes, which means any change to gas flow, RR, or I:E does not change Vt. By contrast, gas driven ventilators are not decoupled

52
Q

final products of soda lime include

A

sodium hydroxide, calcium carbonate

53
Q

west zone 3 is an

A

intrapulmonary shunt

54
Q

west zone 1 is

A

dead space

55
Q

brugada syndrome

A

ion channelopathy in the heart.
dx: RBBB, ST segment elevation in leads V1-V3
common cause of sudden vtach or vfib nocturnal death. more common in males from southeast asia.

56
Q

long QT syndrome

A

most common cardiac ion channelopathy. QT interval >440 msec is dx

57
Q

WPW syndrome

A

pre excitation syndrome that leads to paroxysmal SVT. short PR interval, delta wave, wide QRS complex

58
Q

lenegre’s disease

A

causes defects in his-purkinje system. long pauses, wide QRS complex, bradycardia

59
Q

explain myasthenia gravis

A

anti AchR IgG antibodies cause blockage, inactivation, and reduction of post synaptic nicotinic receptors on skeletal muscle.
concentration of pre junctional Ach receptors is unchanged.

60
Q

cerebral blood flow is directly proportional to

A

PaCO2

61
Q

for every 1 change in PaCO2 from 40mmHg, theres a proportional ________ decrease in CBF

A

1-2mL/100g/min

62
Q

hydralazine MOA

A

direct acting vasodilator (after load reducer). MOA unknown but does increase cGMP and relax vascular smooth muscle (arterial>venous)

63
Q

name the two cutting tip spinal needles

A

quincke and pitkin

64
Q

name the three pencil point needles

A

pencan, whitacre, sprite

65
Q

drugs that can precipitate a carcinoid crisis

A

succinylcholine, atracurium, thiopental, epinephrine, norepinephrine, isoproterenol

66
Q

how to calculate BMI

A

kg/cm^2=kg/m^2

67
Q

how to calculate how much bicarb to give
ex) 79kg patient with pH 7.2 and HCO3- 20, want to get to 25

A

(difference in goal and current x kg x .3) /2

5 x 70 x .3 = 105
105/2 = 53mEq

68
Q

mannitol dose

A

.25-1g/kg

69
Q

fetal risks from anesthesia include

A

growth restriction, LBW, fetal demise, increased incidence of preterm labor

70
Q

what kind of drug is phenelzine

A

MAOI, so dont give any drugs that also increase 5HT or NE (or serotonin. for example, administration of meperidine increases risk of serotonin syndrome)

71
Q

anti tumor abx

A

bleomycin and doxorubicin

72
Q

rank each cause of periop allergic reactions from most to lease
latex
abx
NMB
protamine

A
  1. NMB
  2. latex
  3. abx
  4. protamine

Apex Flashcards (71 decks)

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