Principles of Anesthesia Flashcards
1
Q
Anticholinergic Syndrome
[signs and symptoms]
A
tachycardia, mydriasis, dry mouth, delirium
2
Q
Cholinergic Syndrome
[signs and symptoms]
A
bradycardia miosis, salivation, confusion
3
Q
In a newborn, access to the vena cava can be gained by passage of a catheter through the _____
A
ductus venosus
4
Q
Patient with previous MI is schedule for a cardiac surgery, when would this patient be at highest risk for another myocardial infarction?
A
3 day post-op
5
Q
a change in [HCO3-] of 10 mEq/L from 24 will results in ____ pH units in the same direction
A
0.15
6
Q
Pulmonary artery wedge pressure increases with sudden V waves appearing on monitor
What drug should be given?
A
Nitroglycerin
Indicates ischemia of posterior wall of LV leading to a prolapse of the mitral valve
7
Q
PaCO2 will decrease about ___ mmHg for every 1 mEq/L decrease in [HCO3-] below 24
A
1
8
Q
1mmHg change in PaCO2 from 40mmHg results in ____ unit change in pH in the opposite direction
A
0.008
9
Q
0.9% NaCl
[components]
A
154 Na and 154 Cl
10
Q
0.9% NaCl
[osmolality]
A
308
(isotonic)
11
Q
1 oC changes CBF ____
A
5 - 7%
12
Q
Recommendations for preoperative 12-lead EKG
A
Recommended for patients who:
- exhibit at least 1 clinical risk factor who are undergoing vascular surgery
- known CHD, PAD, or cerebrovascular disease undergoing intermediate-risk surgery
13
Q
14G IV Catheter
[flow rate]
A
240 mL/min
14
Q
16G IV Catheter
[flow rate]
A
180 mL/min
15
Q
18G IV Catheter
[flow rate]
A
90 mL/min
16
Q
1:200,000 mixture of epi corresponds to how much?
A
5 mcg/mL
17
Q
1st Degree AV Block
[EKG characteristics]
A
PR conduction greater than 0.2 seconds
18
Q
2-Chloroprocaine
[maximum dose]
A
12 mg/kg
19
Q
20 mg Cortisol equals _____ Solu-Medrol
A
4 mg
20
Q
20G IV Catheter
[flow rate]
A
60 mL/min
21
Q
20mg Cortisol equals _____ Decadron
A
0.75 mg
22
Q
22G IV Catheter
[flow rate]
A
36 mL/min
23
Q
24G IV Catheter
[flow rate]
A
20 mL/min
24
Q
5% Albumin
[osmolality]
A
300
(isotonic)
25
50 mg of Prednisone equals ______ Decadron
7.5 mg
26
a decrease in pH of 0.1 unit will result in ____ [K+] of ____ mEq/L
increase of 0.6 mEq/L
27
**A-line**
[cannulation site causing the most thrombi]
axillary
28
Abciximab
[drug class]
Glycoprotien IIa/IIIb inhibitor
29
**Achalasia**
[definition]
failure of smooth muscle to relax which can cause sphinters to remain closed
* achalasia of the rectum is Hirschsprung's disease
30
**Acromegaly**
[airway considerations]
narrow upper airways
| (will require smaller ETT)
31
**acute hepatitis**
[volatile agents of choice]
isoflurane and sevoflurane
* presevation of hepatic blood flow and oxygen delivery
32
**Acute Kidney Injury**
[risk factors (9)]
* age \> 65
* male
* active CHF
* ascites
* hypertension
* emergency surgery
* intraperitoneal surgery
* renal insufficiency
* diabetes
33
acute vs recent MI
[time span]
acute within 7 days
recent within 30 days
34
**Addison's Disease**
[anesthetic considerations]
adequate steroid replacement therapy perioperatively
35
**Addison's Disease**
[etiology]
glucocorticoid deficiency
| (primary adrenal insufficiency)
36
**Addison's Disease**
[symptoms]
hyponatremia and hyperkalemia
hypotension
metabolic acidosis
37
**Adenosine**
[drug interactions]
* Dipyrdiamole
* needs smaller dose of Adenosine
* competitive antagonists
* caffeine, theophylline, amrinone
38
**ADP inhiibtor**
[example]
clopidogrel (plavix)
39
**Adrenal Cortex**
[secretions]
androgens, mineralcorticoids, and glucocortocoids
40
**Adrenal Cortex**
[hormones]
aldosterone, cortisol, androgens
41
**Adrenal Medulla**
[secretion]
catecholamines
| (primarily epinephrine)
42
**Adrenal Medulla**
[hormones]
epinephrine and norepinephrine
43
Advantage of Milrinone over Amrinone for long term use?
thrombocytopenia
* Amrinone produces clinically significant thrombocytopenia, especially after prolonged use
44
**Agents**
[mL of vapor in each mL of liquid]
about 200 mL
iso \< sevo \< des
45
**Albumin**
[normal values]
3.5 - 5.5 g/dL
46
**Allodynia**
[definition]
pain caused by a stimulus that does not normally provoke pain
47
**Amyotrophic Lateral Sclerosis**
[etiology]
rapidly progressive disorder of upper and lower motor neurons
48
Alveolar Gas Equation solving for PaO2
PaO2 = (PB - 47)\*FiO2 - (PaCO2/R)
49
**Alveolar O2 Tension (PAO2)**
[equation]
PAO2 = PiO2 - (PaCO2 / RQ)
* can estimate by multiplying FiO2 by 6
50
**amphetamines**
[effect on MAC]
acute use increases MAC, chronic decreases MAC
51
**Amrinone**
[drug class]
phosphodiesterase III inhibitor
52
**Amrinone**
[uses and effects]
positive inotropic and vasodilatory
no anti-dysrhythmic effects
53
**Anaphylaxis**
[blood test]
Tryptase
* neutral protease released from mast cells during analphyalctic, but not anaphylactoid reactions
* should be measured within 1 - 2 hours
54
**Anatomic Dead Space**
[approximation per kg]
2 mL/kg
55
**Anion Gap**
[normal value]
12 mEq/L +/- 4
56
**Anion Gap**
[equation]
Na+ - (HCO3- + Cl-)
57
**Anion Gap**
[normal values]
7 - 16 mEq/L
58
**Ankle Block**
[nerves]
deep and superficial peroneal
saphenous
posterior tibial
sural
59
**Anterior Pituitary**
[hormones]
ACTH, FSH, GH, LH, prolactin, and TSH
60
Anti-arrhythmic most likely to cause thyroid problems
Amiodarone
* chemical structure similar to thyroxine
61
**Anti-Platelets**
[3 classes]
COX inhibitors
Glycoprotein IIb/IIIa inhibitors
ADP inhibitor
62
**Antibiotics**
[which increase neuromuscular blockade]
aminoglycosides (strepto-, genta-)
lincosamides (clindamycin)
63
**Anticholinesterase**
[which agent crosses BBB]
physostigmine
64
**Anticoagulants**
[4 classes]
direct thrombin inhibitors
indirect thrombin inhibitors
vitamin K reductase inhibitor
direct Xa inhibitor
65
**antithrombin III**
[origin of synthesis]
liver
66
**Aortic Regurge**
[treatment]
diuretics and afterload reduction
| (ACE inhibitors)
67
**Aortic Regurge**
[anesthetic goals]
maintian normal to high HR
* bradycardia and increases in SVR increase regurgitant volume
* tachycardia can contribute to myocardial ischemia
68
**Aortic Regurge**
[arterial waveform]
bisferiens pulse
69
**Aortic Regurge**
[drugs to avoid]
those that increase SVR
| (phenylephrine)
70
**Aortic Regurge**
[monitoring signs]
large v waves on CVP waveform
and
pulsus bisferiens
71
**Aortic Regurge**
[pathophysiology]
left ventricular *eccentric* hypertrophy
largest end-diastolic volumes of any heart disease
72
**Aortic Regurgitation**
[arterial waveform]
bisferiens pulse
73
**Aortic Stenosis**
[anesthetic goals]
maintain heart rate and vascular resistance with normal to increased preload and afterload
* avoid bradycardia
* cardiac output is very rate dependent
74
**aortic stenosis**
[loss of atrial systole]
can precipitate congestive heart failure or hypotension
75
**Aortic Stenosis**
[neuraxial anesthesia]
relatively contraindicated
| (epidural preferable to spinals)
76
**Aortic Stenosis**
[severe transvalvular gradient]
above 40 mmHg
77
**Aortic Stenosis**
[arterial waveform]
pulsus tardus and pulsus parvus
(delayed pulse wave with a diminished upstroke)
78
**Aortic Stenosis**
[effects on myocardial supply/demand]
increases demand because of hypertrophy
decreases supply due to increased systolic pressures
79
**Aortic Stenosis**
[peak velocities on an echo]
greater than 4.5 m/sec indicate severe aortic stenosis
80
**Aortic Stenosis**
[triad of symptoms]
dyspnea, angina, and syncope
81
**Aortocaval Compression**
[first occurance during pregnancy]
18 - 20 weeks gestation
82
**Apnea-Hypopnea Index**
[definition]
quantifies the number of apnea episodes that occur **per hour**
* apnea defined by periods of 10 seconds or more
83
**Aprepitant**
[other effects]
anxiolytic and antidepressant
84
**aPTT**
[factor(s) tested]
VIII and IX
85
**aPTT**
[normal values]
20 - 40 sec
86
Alternative to heparin for cardiopulmonary bypass
Argatroban
87
**Argatroban**
[mechanism of action]
direct thrombin inhibitor
88
**Arterial Oxygen Tension**
[approximation]
120 - Age/3
89
**Artery of Adamkiewicz**
[damage results]
ischemia for lower 2/3 of spinal cord causing paraplegia
90
**Artery of Adamkiewicz**
[origin]
T9 - T12
91
**Ascites**
[fluid replacement]
following removal of ascitic fluid, aggressive intravenous fluid replacement is often necessary to prevent profound hypotension and kidney failure
92
**Ascities**
[pathophysiology]
1. Portal Hypertension
1. increases hydrostatic pressure and favors transudation of lfuid across the intestine into peritoneal cavity
2. hypoalbuminemia
1. decreases plasma oncotic pressure and favors fluid transudation
3. seepage of protein-rich lymphatic fluid
4. renal sodium and water retention
93
Difference between Atracurium and Cisatracurium
Atracurium causes histamine release
94
**Atrial Septal Defects**
[anesthetic goals]
aovid large increases in SVR
95
**Atrial Septal Defects**
[common associated problems]
congestive heart failure and pulmonary hypertension
96
**Atrial Septal Defects**
[common location]
fossa ovalis
97
**Autonomic Hyperreflexia**
[temporary anesthetic prevention]
regional or deep general anesthesia
98
**Autonomic Reflexia**
[pathophysiology]
stimulation below injury leads to vasoconstriction below transection and a baroreceptor-mediated reflex bradycardia and vasodilation above transection
99
**B-type Natriuretic Peptide (BNP)**
[biomaker of which organ?]
heart
100
**Balloon Angioplasty**
[delay for surgery]
14 days
101
**Bare-Metal Stent**
[delay for surgery]
30 - 45 days
102
**baroreceptor reflex**
[effects of volatile agents]
depress normal response
* isoflurane and desflurane seem to have less effect
103
**Baroreceptor Reflex**
[response]
104
**baroreceptors**
[aortic arch innervation]
innervated by aortic nerve which then combines with the vagus nerve
105
**baroreceptors**
[locations]
carotid sinus and aortic arch
106
**baroreceptors**
[carotid MAP range]
80 - 160 mmHg
107
**baroreceptors**
[carotid sinus innervation]
sinus nerve of Hering
| (branch of the glossopharyngeal nerve)
108
**Bathmotropy**
[definition]
muscular excitation in response to a stimulus
109
**Beckwith-Wiedemann**
[common features]
* macroglossia
* macrosomia
* omphalocele
* hypoglycemia
* large fontanelles
110
**Beta-2 Agonist**
[mechanism of action]
increases cAMP
111
**Beta-2 Antagonists**
[effects]
bronchoconstriction and peripheral vasoconstrction
* inhibits insulin release and glycogenolysis
112
**Bivalirudin**
## Footnote
(angiomax)
[uses]
anticoagulant for CPB in patients with HIT type III
113
**Bleomycin**
[adverse effet]
pulmonary fibrosis
114
**"Bone Cement Implantation Syndrome"**
[symptoms]
hypotension
arrhythmias
hypoxia (from pulmonary hypertension leading to right-to-left shunting)
115
Which portion of the upper extremity is NOT innervated by the brachial plexus?
posterior medial portion
116
Bradycardia seen in pediatrics due to Sux is caused by what mechanism?
muscarinic stimulations at the sinus node
117
**bronchiectasis**
[common cause]
recurrent bronchial infections
118
**Bupivacaine**
[maximum dose]
3 mg/kg
119
**C5 Isoenzyme Variant**
[key concepts]
increased plasma cholinesterase
shorter duration of succinylcholine
120
**Ca2+ ionized**
[normal values]
4.65 - 5.28 mg/dL
121
**Ca2+ total**
[normal values]
8.5 - 10.5 mg/dL
122
**Calcitonin**
[effect on kidney]
decreases reabsorption of calcium and phosphate
123
**Calcitonin**
[effect on bone]
inhibits osteoclastic reabsorption
124
**Carbonic Anhydrase Inhibitor**
[mechanism of action]
inhibiots HCO3- and Na+ reabsorption
125
**Carcinoid Syndrome**
[clinical manifestations]
bronchospasm
dramatic swings in blood pressure
supraventricular arrhythmias
* "carcinoid syndrome is associated with right-sided heart disease caused by valvular and myocardial plaque formation, and, in some cases, implantation of tumors on the tricuspid and pulmonary valves"
126
**Carcinoid Syndrome**
[etiology]
secretion of vasoactive substances from an enteroepinephrine tumor (carcinoid)
127
**Carcinoid Syndrome**
[principal mediators]
serotonin
kallikren
histamine
128
**Cardiac Action Potential**
[phase 0 - cellular ion movement]
Na+ entry and decreased K+ permeability
129
**Cardiac Action Potential**
[phase 0 - event]
activation of voltage-gated Na+ channels
130
**Cardiac Action Potential**
[phase 1 - cellular ion movement]
K+ out
131
**Cardiac Action Potential**
[phase 1 - event]
inactivation of Na+ channels
transient increase in K+ permeability
132
**Cardiac Action Potential**
[phase 2 - cellular ion movement]
Ca2+ entry
133
**Cardiac Action Potential**
[phase 2 - event]
activation of slow Ca2+ channels
134
**Cardiac Action Potential**
[phase 3 - cellular ion movement]
K+ out
135
**Cardiac Action Potential**
[phase 3 - event]
inactivation of Ca2+ channels
increased permeability to K+
136
**Cardiac Action Potential**
[phase 4 - cellular ion movement]
K+ and Ca2+ in
Na+ out
137
**Cardiac Action Potential**
[phase 4 - event]
normal permeability restored
intrinsic leak of Ca2+ into cells
138
**Cardiac Output**
[changes in obesity]
increases about 100 mL/min for every kg of weight
* due to ventricular dilation and increased stroke volume as resting HR are not generally increased
139
**Cardiac Output**
[Fick's Equation]
VO2
---------------
(CaO2 - CvO2) \* 10
* VO2 can be approximated by 4 mL/kg
* CO2 = (1.36\*Hb\*SaO2) + (0.003\*PaO2)
140
(6) Cardiac Risk Factors
## Footnote
(prediction of cardiac risk of non-cardiac surgery)
* high-risk surgery
* ischemic heart disease
* congestive heart failure
* cerebrovascular disease
* diabetic insulin therapy
* creatinine \> 2 mg/dL
141
**Cardiac Surgery**
[post-operative hypertension cause]
possible denervation of carotid baroreceptors
* denervation of carotid body blunts the ventilatory response to hypoxemia
142
**Cardiac sympathetic fibers**
[origin]
T1 - T4
* travel to the heart through cervical (stellate) ganglia and from the ganglia as cardiac nerves
143
**cardiac tamponade**
[arterial waveform]
pulsus paradoxus
(exaggerated inspiratory decline in systolic BP)
144
**Cardiac Tamponade**
[arterial wave form]
pulsus paradoxus
145
**Cardiac Tamponade**
[CVP waveform]
loss of y-descent
## Footnote
may also have an accentuated x-descent
146
**Cardiac Tamponade**
[definition]
accumulation of fluid in pericardial space
147
**Cardiac Tamponade**
[hemodynamic features]
decreased cardiac output and stroke volume
increase in CVP
148
**Cardiac Tamponade**
[signs and symptoms]
tachycardia
sudden hypotension
jugular venous distention
muffled heart shounds
pulsus paradoxus
149
**Cardiac Tamponade**
[ventilation]
must maintain spontaneous ventilation
* positive pressure ventilation can further reduce preload, causing hypotension and possible cardiac arrest
150
**Cardiac Tamponde**
[hemodynamic goals]
increased preload, afterload, and HR
151
**Cardiopulmonary Bypass**
[signs of incorrect positioning of aortic cannula]
unilateral facial blanching
152
**Cardiopulmonary Bypass**
[signs of incorrect positioning of venous cannula]
facial edema
| (bulging sclera)
153
**Catecholamines**
[activate which receptors?]
adrenergic
154
**Central Chemoreceptors**
[mechanism of action]
respond to changes in CSF [H+]
155
**Central Line**
[location with lowest risk of infection]
subclavian vein
156
**Central Line**
[risks of left IJ not seen in right cannulation]
damage to thoracic duct
* left IJ also has a more direct and less winding path to the superior vena cava
157
**Central Pontine Myelinolysis**
[cause]
rapid correction of hyponatremia
158
**Cerebral Autoregulation**
[CPP range]
50 - 150 mmHg
159
**Cerebral Autoregulation**
[definition]
intrinsic capability of the cerebral vasculature to adjust its resistance to maintain CBF constant over a wide range of MAPs
160
**cerebral blood flow**
[autoregulation during ischemia]
no autoregulation, flow directly dependent upon CPP
161
**Cerebral Blood Flow**
[correlation to PaCO2]
directly proportional between 20 - 80 mmHg
162
**Cerebral Blood Flow**
[effect by temperature]
5% per 1oC in temperature
163
**Cerebral Blood Flow**
[Normal range]
50 mL/100g/min
164
**Cerebral Blood Flow**
[rate at which EEG becomes isoelectric]
less than 15 mL/100g/min
165
**cerebral blood flow**
[rate at which ischemia appears on EEG]
less than 22 mL/100g/min
166
**Cerebral Blood Flow**
by what percentage does CBF change for each mmHg increase in PaCO2?
2%
167
**Cerebral Blood Flow**
[autoregulation]
maintained between MAPs of 60 - 160 mmHg
168
**Cerebral Mass Lesions**
[induction technique]
Propofol with hyperventilation
169
**Cerebral Metablic Rate**
[change for each 1oC decrease]
6%
170
**Cerebral Metabolic Rate**
[normal rate]
3 mL/100g/min
| (50 mL/min)
171
**Cerebral Oxygen Consumption**
[normal rate]
3 mL/100g/min
* greatest in the grey matter of the cerebral cortex, generally parallels electrical activity
172
**Cerebral Oxygen Delivery**
[optimal hematocrit]
30%
173
**Cerebral Perfusion Pressure**
[autoregulation]
decreases in CPP result in cerebral vasodilation
174
**Cerebral Perfusion Pressure**
[at what pressures can disrupt the BBB}
150 - 160 mmHg
* may result in cerebral edema and hemorrhage
175
**Cerebral Perfusion Pressure**
[normal range]
80 - 100 mmHg
176
**Cerebral Perfusion Pressure**
[equation]
MAP - ICP
| (or -CVP if greater than ICP)
177
**Cerebral Perfusion Pressure**
[normal range]
80 - 100 mmHg
178
**Cerebral Protection**
[hypothermia]
decreases both basal and electrical metabolic requirements throughout the brain
179
**Cerebral Salt Wasting Syndrome**
[triad of symptoms]
hyponatremia
volume contraction
high sodium content in urine
180
**Cerebral Salt Wasting Syndrome**
[treatment]
isotonic or hypertonic saline
181
**Cerebrospinal Fluid**
[pathway through ventricles]
lateral ventricles
[foramina of Monro]
third ventricle
[cerebral aquedcut of Sylvius]
fourth ventricle
[foramen of Magendie]
lateral apertures of fourth ventricle
[foramina of Luschka]
cerebellomedullary cistern
182
**Chronic Bronchitis**
[definition]
productive cough for 3 consecutve months for at least 2 years
183
**Chvostek's Sign**
[definition]
painful twitching of the facial musculature following tapping of facial nerve
* result of hypocalcemia
184
**Cirrhosis**
[coagulopathies]
hyperfibrinolysis
185
**Cirrhosis**
[physiologic changes]
increased cardiac output
low peripheral vascular resistance
increased intravascular volume
* avoid vasodilators (milrinone)
186
**Clonidine**
[drug class]
alpha-2 agonist
187
**Clopidogrel**
[antidote]
platelets
188
**Clopidogrel**
[delay of surgery]
5 - 10 days
189
**Clopidogrel**
[mechanism of action]
ADP receptor blocker
| (adenosine diphosphate)
190
Closing of the tricuspid valve is represented by what on the CVP?
C wave
191
**Clotting Factors**
[which has the shortest half-life]
Factor VII
* first factor to become deficient in patients with severe hepatic failure, warfarin therapy, and vitamin K deficiency
* PT is most sensitive to decreases in factor VII
192
**CO poisoning**
[half-life in HBO]
15 - 30 minutes
193
**CO poisoning**
[half-life on room air]
4 - 6 hours
194
**CO poisoning**
[half-life with 100% oxygen]
1 hour
195
Which gas is most soluble in water?
| (CO2,N2, O2, air)
CO2
196
**CO2**
[tank color]
gray
197
**Coagulation Factors**
[factors not produced by the liver]
VIII and von Willebrand
198
**Coagulation Factors**
[vitamin K dependent]
prothrombin (factor II), and factors VII, IX, and X
199
**Coagulation Test Abnormalities**
[Factor VII deficiency]
increased PT
200
**Coagulation Test Abnormalities**
[Hemophilia]
increased PTT
201
**Coagulation Test Abnormalities**
[heparin therapy]
greatly increased PTT
increased PT
202
**Coagulation Test Abnormalities**
[vitamin K deficiency]
greatly increased PT
increased PTT
203
**Cocaine**
[which induction drugs should be avoided]
ketamine and pancuronium
potentiate cardiovascular toxicity
204
**Codeine**
[metabolism]
enzyme CYP2D6
205
**Complex Regional Pain Syndrome**
[difference between I and II]
Type II has a known etiology
206
**Complex Regional Pain Syndrome**
[features]
burning and continuous pain
cool, red, clammy skin
hair loss
atrophy and osteoporosis
207
**Compression Factor**
[definition]
part of the tidal volume produced by a mechanical ventilator that is prevented from reaching a patient by compression of the gas and expansion of the flexible tubing in the equipment.
usually 3-5 mL/cmH2O
208
**Compression Factor**
[equation]
[(MVdelivered - MVmeasured) / RR )] divided by PIP
209
**Conn's Syndrome**
[clinical features]
hyperaldosteronism
hypertension and low blood potassium levels
210
**Constrictive Pericarditis**
[associated problems]
jugular venous distension
hepatomegaly
ascites
211
**Conus Medullaris**
[definition]
end of the spinal cord
212
**Coronary Perfusion Pressure**
[equation]
arterial diastolic pressure - LVEDP
213
**Coronary Perfusion**
[characteristics]
LV perfused almost entirely during diastole
RV perfused during both
214
Correlation of Cr to GFR
inversely proportional
215
**Corticospinal Tract**
[type of pathway]
motor
* therefore is not involved in SSEP transmission
216
**Cranial Mass Lesions**
[premedication]
avoid sedative and opioids
* risk of hypercapnia secondary to respiratory depression increasing ICP
217
**Creatinine**
[normal values]
0.6 - 1.2 mg/dL
218
**Cricothyroid Muscle**
[innervation]
external branch of the superior laryngeal
219
**Cromolyn**
[drug class]
mast cell stabilizer
220
**Croup**
[signs and symptoms]
inspiratory stridor
mild fever
age \< 2 yo
rhinorrhea
"barking cough"
221
CSF volume is _____ to spinal level
inversely related
222
**Cushing's Response**
[definition]
increases in BP with bradycardia due to increases in ICP
223
**Cushing's Response**
[definition]
increased ICP resulting in increased blood pressure, irregular breathing, and bradycardia
## Footnote
(cushing's triad)
224
**Cushing's Syndrome**
[etiology]
excess glucocorticoids
225
**Cushing's Syndrome**
[anesthetic considerations]
patients may be volume overloaded and have hypokalemic metabolic alkalosis
* careful positioning due to osteoporosis
* may require supplemental steroids
226
**Cushing's Syndrome**
[symptoms]
muscle wasting and weakness
osteoporosis
central obesity
glucose intolerance
hypertension
227
Cutaneous innervation of the plantar surface
[which nerve]
posterior tibial
228
Guess this disorder:
premature infant that is cyanotic but is relieved by coughing
choanal atresia
229
**Dalteparin**
[delay for neuraxial anesthesia]
if low dose, for thromboprophylaxis, 12 hours
if high dose, to treat DVT, 24 hours
230
**Dantrolene**
[expected side effects]
diuresis
* formulated with mannitol to promote diuresis
* myoglobinuria accumulates in renal tubules and can cause kidney failure if urine output is not maintained
231
**dead space**
[average mL/kg]
2 mL/kg
232
**Deadspace**
[explain the difference between etCO2 and arterial PaCO2]
due to lack of gas exchange, etCO2 will be less than from an arterial blood gas
* examples:
* morbid obesity, pulmonary embolism, and COPD
233
**Defibrillation**
[joules/kg]
2 joules/kg
* second dose should be 4 joules/kg
* do not exceed 10 joules/kg or 100 joules
234
**Defibrillators**
[biphasic vs. monophasic]
biphasic require lower energy for equally effective defibrillation
235
**Demeclocycline**
[uses]
antibiotic that interferes with ADH
often used for treatment of SIADH
236
**Dermatomes**
[level of C6]
Thumb
237
**Desflurane**
[cardiovascular effects]
increased HR
decrease SVR and CI
238
**Diabetes - Type II**
[definition]
insulin resistance
239
**Diabetes - Type I**
[definition]
insulin deficiency
240
**Diabetes Insipidus**
[signs and symptoms]
hypernatremia
hyperosmolality
polyuria
urine hypoosmolality
241
**Diabetes Insipidus**
[treatment]
hypotonic saline and vasopressin
242
**Diabetes**
[triad of symptoms]
polyuria, polydipsia, and polyphagia
243
**Diabetic Ketoacidosis**
[initial treatment]
isotonic fluids, potassium, and insulin infusion
* goal to decrease blood gluocse by 10%/hour
* *as glucose moves intracellularly, so does potassium; therefore, monitor both levels frequently*
244
**Diastolic Dysfunction**
[Pressure-Volume Loop]
245
heart failure with normal ejection fraction
diastolic heart failure
246
**Diastolic Heart Failure**
[definition]
failure of the left ventricle to relax during diastole
* signs and symptoms of heart failure without a decrease in ejection fraction
* problem with *filling*
247
**DIC**
[pathophysiology]
activation of coagulation cascade by the release of *thromboplastin* or by direct activation of *factor XII*
248
**Digoxin**
[cardiac effects]
negative chronotrope and positive inotrope
* direct inhibition of AV node
* inhibits Na/K ATPase pump leading to an increase in [Ca2+] and thereby increasing contractility
249
**Diltiazem**
[dose for irregular-narrow tachycardia]
0.25 mg/kg
250
**Direct Thrombin Inhibitors**
[examples]
argatroban
dabigatran (pradaxa)
251
**Direct Xa inhibitor**
[examples]
ribaroxiban (xarelto)
apixaban (eliquis)
252
**Dopamine**
[infusion rate]
2 - 10 mcg/kg/min
253
**Down Syndrome**
[common cardiac problems]
atrioventricular septal defects
254
**Dromotropy**
[definition]
rate of transmission of cardiac nerve impulses
255
**Droperidol**
[treatment for which disorder]
Wolff-Parkinson-White
256
**Drug-Eluting Stent**
[delay for surgery]
1 year
257
**Duloxetine**
## Footnote
(cymbalta)
[drug class]
selective serotonin and norepinephrine reuptake inhbitor (SNRI)
258
**dural sac**
[extends to what length]
S2
259
Average blood loss for vaginal delivery
400 - 500 mL
260
**Ebstein's Anomaly**
[definition]
abnormal placement of leaflets on tricuspid valve
* congenital heart defect
* blood leaks back through the valve into the right atrium
261
**ECT**
[ways to increase seizure duration]
hyperventilation
intravenous caffeine (125-250 mg)
262
**ECT**
[contraindications]
recent myocardial infarction
recent stroke
intracranial mass
increased ICP
263
**ECT**
[seizure activity measurement without EEG]
isolated limb tournaquet
* tourniquet is inflated around one arm prior to injection of succinylchline, preventing entry of NMB and allowing observation of convulsive motor activity in that arm
264
**Electroencephalography**
[which agents produce burst suppression]
Desflurane and Sevoflurane
(\> 1.2 and 1.5 MAC)
* do not produce electrical silence
265
**Eisenmenger Syndrome**
[definition]
long-standing left-to-right cardiac shunt causes pulmonary hypertension and eventually reverses the shunt to a cyanotic right-to-left shunt
266
**Eisenmenger Syndrome**
[effect on PaO2]
larger shunt fraction and therefore lower PaO2
267
**EKG**
[each large box represents how many seconds]
0.2 sec
268
**EKG**
[leads showing myocardial ischemia in circumflex coronary artery]
I and aVL
269
**EKG**
[leads showing myocardial ischemia in LAD]
V3 - V5
270
**EKG**
[leads showing myocardial ischemia in RCA]
II, III, and aVF
271
**Elevated ICP**
[preferred agent]
Sevoflurane
* preserves autoregulation of CBF and produces limited vasodilation
272
**Elevated ICP**
[ventilation strategies]
maintain PaCO2 between 30-35 mmHg
* avoid PEEP and high airway pressures
273
emergent patient with C7 spinal cord transection due to MVA
[anesthesia concerns]
risk of hypothermia
* lack thermoregulation below level of injury
274
**EMLA cream**
[components]
2.5% lidocaine and 2.5% prilocaine
275
**Emphysema**
[genetic cause]
alpha-antitrypsin deficiency
276
**ephedrine**
[cocaine]
avoid ephedrine in acute cocaine intoxication
(may not work in chronic users due to depleted catecholamine)
277
**Epidural**
[what makes the "snap"]
ligamentum flavum
278
**Epiglottitis**
[signs and symptoms]
inspiratory stridor
age between 2 and 6
rapid onset \< 24 hours
high fever
difficulty swallowing
279
**Epinephrine**
[max dose]
5 ug/kg
280
Equation for amount of PRBC to increase Hct
EBV \* (Hctdesired - Hctstarting) divided by Hct of PRBC
281
**Esters**
[intrathecal injection]
depends on redistribution
* CSF lacks esterase enzymes
282
**Esters**
[metabolism]
pseudocholinesterase
283
**ESWL**
[dermatome spinal level]
T6
284
Etiology behind SIADH, DI, and Cerebral salt wasting syndrom
* SIADH
* excessive amonts of ADH
* hyponatremia
* Diabetes Insipidus
* absent AHD or injury to hypothalamus
* hypernatremia
* Cerebral Salt Wasting
* release of brain natriuretic peptide in SAH
* hyponatremia
285
**Etomidate**
[effect on SSEPs]
increases amplitude and latency
286
**expiratory reserve volume**
[average adult value]
1100 mL
287
Extension of the neck can cause _____ displacement of the tube
cephalad
will go into the pharynx
288
**Factor VIII**
[how much to give]
equal to plasma volume
* example
* solve for blood volume
* knowing hematocrit is about 40%, plasma must be 60%
* multiply 0.6 x blood volume to get plasma volume
289
**Fat Embolism Syndrome**
[triad of symptoms]
dyspnea, confusion, and petechiae
## Footnote
(usually occurs within 72h following long-bone fracture)
290
**FDA Pregnancy Ratings**
[Class A]
controlled studies show no risk
291
**FDA Pregnancy Ratings**
[Class B]
no evidence of risk in humans
292
**FDA Pregnancy Ratings**
[Class C]
risk cannot be ruled out
293
**FDA Pregnancy Ratings**
[Class D]
positive evidence of risk
* examples: midazolam and diazepam
294
**FDA Pregnancy Ratings**
[Class X]
contraindicated in pregnancy
295
**Femoral Nerve**
[origin]
L2 - L4
296
**Femoral Nerve**
[needle stimulation]
quad contraction with patellar elevation
297
**Fenoldopam**
[similar alternative drug]
Sodim Nitroprusside
298
**Fetal Heart Rate**
[early decels]
fetal head compression causing vagal stimulation
299
**Fetal Heart Rate**
[normal range]
110 - 160 bpm
300
Fetal hemoglobin has a _____ affinity for O2 than does maternal Hgb
greater
301
**Fetal Hemoglobin**
[P50 at term]
18 mmHg
302
Maximum FiO2 that can be administered to a mother without increasing the risk of retinopathy of prematurity
1. 0
* the fetal PaO2 does not increase above 60 mmHg because of the high O2 consumption of the placenta and uneven fetal blood flow distribution
303
**FEV1/FVC**
[definition]
ratio of the forced expiratory volume in the first second of exhalation to the total forced vital capacity
* effort *dependent*
304
**FEV1/FVC**
[normal value]
greater than 80%
305
**Find the Left Ventricle peak pressure**
peak velocity of 4 m/sec
BP of 130/80
4 \* V2
4 \* 42 = 64
64 \* systolic pressure = peak pressure
306
First sign of magnesium toxicity
decreased deep tendon reflexes
307
**Fluoxetine**
## Footnote
(Prozac)
[considerations]
potent inhibitor of CYP2D6 enzymes
* codeine, oxycodone, and hydrocodone will not work
308
**Fondaparinux**
## Footnote
{arixtra)
[mechanism of action]
factor Xa antagonist
309
**Fontan Procedure**
[cardiac anomolaies]
used to treat decreases in pulmonary blood flow
Pulmonary atresia, stenosis, tricuspid atresia, and hypoplastic left heart syndrome
310
**Fontan Procedure**
[definition]
anastomosis of the right atrial appendage to the PA
311
**Fulminant Hepatic Failure**
[definition]
a. k.a. acute liver failure
* usually from viral hepatitis or a hepatotoxin
312
**Functional Residual Capacity**
[composed of which lung volumes?]
expiratory reserve and residual volume
313
**Gastroschisis**
[definition]
herniation lateral to umbilicus which is not contained in a sac
* higher risk of hypothermia and infection compared to omphalocele
314
GFR \< 25 mL/min
[state of renal health]
overt renal failure
315
**GFR of 30 mL/min**
[current state of renal health]
moderate renal insufficiency
316
GFR of 40 - 60 mL/min
[state of renal health]
mild renal insufficiency
317
**GFR**
[at what age does function reach that of adult]
2 years
* 30% at birth
* 50% by 10 days of life
* 75% by 6 months
318
Sensory innervation to the pharyngeal walls and the tonsils
glossopharyngeal nerve
319
**Glottis**
[level in the adult vs pediatric]
pediatric C3
adult C5
320
**Glucose**
[normal value]
90 - 120 mg/dL
321
**Glycoprotein IIb/IIIa inhibitor**
[examples]
abciximab
eptifibatide
tirofiban
322
**Guillain-Barre Syndrome**
[definition]
sudden onset of *ascending* motor paralysis, areflexia, and paresthesias
323
Halothane has a similar vapor pressure to which other volatile agent?
Isoflurane
324
**Halothane**
[cardiovascular changes]
no change in HR or SVR
decreased CI
325
**Heart Failure**
[compensatory mechanisms]
increased preload
activation of sympathetic nervous system
renin-angtiotensin-aldosterone system
increased release of AVP
326
**Heart Rate**
[effects on diastolie]
increases in HR reduces diastole more than systole
* impaired ventricular filling at HR \> 120 beats/min
327
**Heart Rate**
[equation for normal intrinsic rate]
118 - (0.57 x age)
328
**Heart Rate**
[receptors slowing rate]
M2 cholinergic receptors
* enhanced vagal activity slows the heart rate via stimulation of M2 cholinergic receptors
329
**Heart Transplant**
[anesthetic management]
direct-acting agents
* isoproterenol or epinephrine should be readily available
330
**Heart Transplant**
[EKG]
usually two sets of P-waves
## Footnote
one represents the recipient's own SA node (which is left intact) and the other representing the donor's SA node
331
**Heart Transplant**
[innervation]
no direct autonomic influences
* absence of vagal influences causes a relatively high resting heart rate (100-120 bpm)
* myocardial ischemia is often silent
332
**Hematocrit**
[normal range]
35 - 50%
333
**Hemoglobin Dissociation Curve**
[rightward shift]
lowers O2 affinity making more oxygen available to the tissues
334
**Hemoglobin**
[average for full-term infant]
15 - 20 g/dL
can drop down to 10 g/dL at 2-3 months
335
**Hemoglobin**
[normal P50]
26 mmHg
* P50 is the PaO2 required to produce 50% saturation of hemoglobin
336
**Hemoglobin**
[normal range]
12 - 18 g/dL
337
**Hemolytic Uremic Syndrome**
[key concepts]
most common acquired causes of acute renal failure
* often caused by E. coli
* Triad:
* hemolytic anemia
* thrombocytopenia
* acute nephropathy
* treated with dialysis
338
**Hemophilia A**
[missing clotting factor]
factor VIII
339
Hemophilia A
[coagulation test]
PTT
340
**Hemophilia B**
[missing clotting factor]
IX
341
**Heparin Resistance**
[cause]
anti-thrombin III deficiency
342
**Heparin Resistance**
[treatment]
fresh frozen plasma or recombinant anti-thrombin III
343
**Hepatorenal Syndrome**
[intraoperative management]
colloid infusions rather than crystalloid
344
**Hetastarch**
[anticoagulant mechanism]
intereference of Factor VIII
* also reduces levels of vWF and availability of glycoprotein IIb/IIIa, and it can become directly incorporated into the fibrin clot
345
**Hgb A1C**
[normal values]
5.0 - 7.5 %
346
Primary cause of severe hypotension with high spinal
Decreased CO secondary to decreased preload
* sympathetic blockade, venodilation, arterial dilation, and a decrease in HR all contribute to hypotension
347
**HIV treatmet drugs (-avir)**
[drug interactions]
increased sensitivity to midazolam
348
How does acetazolamide work in opthalmology?
inhibits carbonic anhydrase
## Footnote
decreases the production of aqueous humor and lowers the intraocular pressure
349
how long should surgery be delayed after a stroke?
4 - 6 weeks
350
what percentage of receptors may still be blocked during a "5-sec head lift"
50%
351
How would a right mainstem intubation affect the rate of increase in arterial partial pressure of volatile agents?
reduced for poorly soluble agents
352
**Hunt and Hess grading scale**
[uses]
classifies severity of subarachnoid hemorrhage
* ranges from I - V
* 1 - asymptomatic
* V - deep coma
353
**Huntington's Disease**
[considerations]
decreased levels of pseudocholinesterase
354
**Huntington's Disease**
[definition]
inherited disorder of brain cell death
355
**Hydralazine**
[associated disorder]
systemic Lupus erythematosus
356
**Hyperbaric Oxygen Chamber**
[effect on MAC]
decrease
* increase in partial pressure of agents at higher barometric pressures
357
**Hypercalcemia**
[potential causes]
* decreased renal Ca excretion
* hyperthyroid or parathyroid
* vitamin D intoxication
358
**Hypercalcemia**
[treatment]
fluid load with normal saline
diuresis with lasiix
[also pamidronate (Aredia) or etidronate (Didronel)]
359
p-wave flattening, wide QRS, and peaked t-waves
[electrolyte disorder]
hyperkalemia
360
**Hyperkalemia**
[potential causes]
* Acute/chronic renal failure
* hypoaldosteronism
* spironolactone
* RAAS inhibitors
* succinylcholine
* **acidosis**
361
**Hyperkalemia**
[EKG changes]
peaked t-waves
wide and low p-waves
fusion of QRS and t-waves
362
**Hypernatremia**
[potential causes]
* diabetes insipidus
* diarrhea
* osmotic/loop diuretic
* hyperaldosteronism
* Cushing's syndrome
* IV HCO3
363
**Hyperosmolar Hyperglycemic State**
[most likely candidates]
* greater than 65 y.o.
* type II diabetic
* blood glucose \> 600
* serum osmolality \> 320
* lethargic, polyuria, polydipsia
364
**Hyperosmolar Nonketotic Coma**
[definition]
hyperglycemic-induced diuresis leading to dehydration and hyperosmolality
* severe hyperglycemia causes hyponatremia
* for each 100 mg/dL increase in plasma gluocse, plasma sodium concentration lowers by 1.6 mEq/L
365
**Hypersensitivity Reactions**
[Type 1]
involves antigens and IgE
* release of basophils and mast cells with the release of histamine
* examples: anaphylaxis
366
**Hypersensitivity Reactions**
[Type 2]
anti-body dependent and cell-mediated
* ABO incompatibility
367
**Hypersensitivity Reactions**
[Type 3]
immune-complex reactions
* antigens and antibodies combine to form insoluble complexes which deposit in microvasculature
368
**Hypersensitivity Reactions**
[Type 4]
delayed reaction involving antigens and lymphocytes
* involves killer T-cells
* example: contact dermatitis and transplant rejection
369
**Hyperthyroid**
[best induction drug]
thiopental
* decreases conversion of T4 to T3
370
**Hypertrophic Obstructive Cardiomyopathy**
[best pressure support choice]
phenylephrine
* direct acting vasoconstrictor with minimal cardiac effects
* levophed, milrinone, dopamine, and dobutamine are relatively contraindicated
371
Why would you hyperventilate during local anesthetic toxicity?
hyperventilation induces alkalosis and converts local anesthetics to the pronated (ionized) form, which is less likely to corss the cell membrane
372
**Hypocalcemia**
[EKG changes]
QTc prolongation
373
**Hypocalcemia**
[potential causes]
* hypoparathyroidism
* rapid blood transfusion
* malabsorption
374
**Hypokalemia**
[potential causes]
* diuretics
* mineralcorticoids
* trauma
* beta agonists
* insulin
* hypercalcemia or hypomagnesemia
* **alkalosis**
375
**Hypokalemia**
[EKG changes]
* prolonged PR
* T-wave flattening
* ST segment depression
* increased P-wave amplitdue
* increasingly ***prominent U-wave***
376
**Hypomagnesemia**
[EKG changes]
tall t-waves with depressed ST segment
377
**Hyponatremia**
[effect on MAC]
increase MAC requirement
378
**Hyponatremia**
[potential causes]
* renal tubular acidosis
* hypoaldosteronism
* vomitting
* SIADH
* hypothyroidism
* cortisol deficiency
* CHF
* cirrhosis
379
**Hyponatremia**
[3% NaCl equation for correction]
kg \* 0.6 \* (Nadesired - Nacurrent)
(total body water) \* (Na - Na)
* gives the mEq/L amount
* infuse no faster than 100 mL/hour
380
hypoparathyroidism secondray to parathyroid removal will result in hypocalcemia how many hours post-op?
24 - 72 hours
381
**Hypoplastic Left Heart Syndrome**
[anatomical anomalies]
aortic valve atresia and underdevelopment of the left ventricle
382
**Hypotension following TURP**
[differential diagnosis]
* hemorrhage
* TURP syndrome
* bladder perforation
* myocardial infarction
* septicemia
* DIC
383
**Hypovolemic shock**
[hemodynamic changes]
low cardiac output caused by decreased preload from hypovolemia and low LVDP
384
**Hypoxemia**
[5 causes]
low FiO2
hypoventilation
right-to-left shunt
V/Q mismatch
diffusion abnormality
385
**Hypoxia**
[effect on MAC]
decreases MAC requirement
* PaO2 less than 38 or severe anemia will decrease MAC
386
**Hypoxic Pulmonary Vasoconstriction**
[definition]
local response of pulmonary arterial smooth muscule that decreases blood flow in the presence of low alveolar oxygen pressure
## Footnote
(maintains normal V/Q relationships by diverting blood from underventilated areas)
387
**Ibuprofen**
[length of anti-platelet effect]
3 days
388
If a needle is introduced 1.5 cm inferior and 1.5 cm lateral to the pubic tubercle, to which nerve will it lie in close proximity?
obturator nerve
389
inability to adduct the leg; diminished sensation over the medial side of the thigh
[nerve injury]
obturator
390
**Indirect Thrombin Inhibitors**
[examples]
heparin
fondaparinux (arixtra)
391
Indirect-acting sympathomimetics
[how it works]
enter neurons and displace norepinephrine from postganglionic sympathetic nerve fibers
392
Inhalation of CO2 increases Ve by \_\_\_\_\_
2 - 3 L/min/mmHg
393
**Innervation of Heart**
["sidedness"]
right sympathetic and right vagus nerves affect SA node
left sympathetic and vagus nerve affects AV node
394
**inspiratory reserve volume**
[average adult value]
3000 mL
395
**Inspiratory stridor in children**
[possible causes]
80% croup
5% epiglottitis
396
**Insulin**
[glucose change from 1 unit]
25 - 30 mg/dL
397
**Insulin**
[(2) fast examples]
lispro and aspart
398
When performing an interscalene block, you note diaphragmatic movement. You should now \_\_\_\_\_
redirect needle in a posterior direction
399
**interscalene block**
[nerve spared]
ulnar nerve
400
**Intra-Aortic Balloon Pump**
[inflation should occur at what time]
diastole
immediately after closure of aortic valve
401
**Intracranial Hypertension**
[range]
above 15 mmHg
402
**Intracranial Hypertension**
[mmHg]
above 15 mmHg
403
**Intracranial Pressure**
[definition]
supratentorial CSF pressure measured in the lateral ventricles
404
**Intracranial Pressure**
[normal range]
10 mmHg or less
405
**Intraocular Gas Expansion**
[avoidance of nitrous]
N2O must be discontinued 15 min prior to bubble
avoid for 5-10 days after surgery
406
**Intraocular Pressure**
[normal range]
12 - 20 mmHg
407
**Ischemic Heart Disease**
[common causes]
coronary arterial vasospasm or thrombosis
severe hypertension or tachycardia
aortic stenosis or regurge
hypoxemia or anemia
408
**Isoflurane**
[cardiac output]
will **not** reduce CO at MAC \< 1
* unlike the other agents
409
**IV contrast induced AKI**
[prophylaxis treatment]
N-acetylcysteine
410
IV dye acts like what diuretic?
Mannitol
411
**Ketamine**
[IM dose]
3 - 5 mg/kg
412
**Kidney Stones**
[medical management]
alpha blockers (Flomax, Cardura, Hytrin)
or
CCB (nifedipine)
413
**Korsakoff's Syndrome**
[definition]
acute onset of severe memory impairment without any dysfunction in intellectual abilities
414
**Korsakoff's Syndrome**
[prevention]
Vitamin B supplements
415
**Lactated Ringers**
[components]
Na, Cl, Ca, K, and lactage
416
**Lactated Ringers**
[osmolality]
272
| (isotonic)
417
largest vertebral interspace
L5 - S1
418
**Lasers**
[amber glasses]
required for argon and krypton
419
**Lasers**
[glasses for CO2]
clear
420
**Lasers**
[green glasses]
Nd:YAG
(red glasses for potassium titanyl phosphare:Nd:YAG)
421
**Left Atrial Hypertrophy**
[EKG changes]
double notched p-wave in lead II and negatve deflection in V1
* since the left atria is larger, there is a slight conduction delay, causing the left and right atria to depolarize at diferent times
422
**Left Ventricular Assist Device**
[monitoring considerations]
unable to measure BP with cuff
* non-pulsatile flow, even pulse ox can be difficult
423
**Left Ventricular Hypertrophy**
[EKG leads showing ST abnormalities]
I, aVL, and V4-V6
424
**Left Ventricular Hypertrophy**
[common cardiac finding]
S4 gallop
425
**Left Ventricular Hypertrophy**
[common causes]
hypertension and aortic stenosis
426
**Left-Sided Heart Failure**
[definition]
failure to properly pump blood out to the body
(can be systolic or diastolic)
427
**Left-to-Right Shunting**
[congenital defects]
ventricular and atrial septal defects
patent ductus arteriosus
428
**Left-to-Right Shunt**
[effect on volatile agents]
no effect
429
Level of blockade for Orchiectomty
T10
430
**Lidocaine**
[coagulation effects]
decreases platelet aggregation while enhancing fibrinolysis
431
**Lidocaine**
[maximum dose with epinephrine]
7 mg/kg
432
**Lidocaine**
[maximum dose]
4.5 mg/kg
433
**Lithotripsy**
[contraindication]
inability to position the patient so that lung and intestine are away from the sound wave
434
**Lithotripsy**
[regional concerns]
T6 sensory level
## Footnote
(renal innervation is derived from T10-L2)
saline should be used instead of air
(air in the epidural space can dissipate shock waves and may promote injury to neural tissue)
435
**Liver Transplant**
[anhepatic phase procedure]
vessels are clamped and liver is completely excised
436
**Liver Transplant**
[neohepatic or postanhepatic procedure]
revascularization and biliary reconstruction
437
**Liver Transplant**
[preanhepatic procedure]
liver is dissected so that it remains attached only by the inferior vena cava, portal vein, hepatic artery, and common bile duct
438
**Liver**
[synthesis of which coagulation factors]
III, IV, and VIII
antithrombin III
protein C and S
439
**LMWH**
[anticoagulation test]
Anti-Xa Assay
440
**Local Anesthetic Toxicity**
[drugs to avoid]
vasopressin
CCB
beta blockers
epinephrine \> 1 ug/kg
441
**Local anesthetics**
[addition of Bicarb]
quickens onset
decreases duration
reduces pain with skin infiltration
442
**local anesthetics**
[epi has the least effect on which agents?]
lipid soluble
* lidocaine is prolonged much more than bupivacaine
443
**Local Anesthetics**
[rate of systemic absorption by site]
intravenous
tracheal
intercostal
paracervical
epidural
brachial plexus
sciatic
subcuntaneous
444
**Local Anesthetics**
[vasoconstrictors]
prolongs duration and decreases absorption
* more pronounced on shorter-acting agents
445
**Local Anesthetics**
[which agent is a weak acid with a pKa of 3.5]
benzocaine
446
**Local Anesthetics**
[which one can be given in an epidural with littel effect to fetus?]
Chloroprocaine
* rapidly metabolized and very little is able to cross the placenta
447
**Loop Diuretics**
[examples]
Lasix (furosemide)
-ide
448
**Loop Diuretics**
[mechanism of action]
binds to the Na-K-2Cl protein
diminishes osmotic gradient
449
Loop Diuretics
[Site of action]
ascending loop of Henle
450
**Losartan**
## Footnote
(minoxidil)
[adverse effects]
pulmonary hypertension
pericardial effusion
cardiac tamponade
451
**Lovenox**
[stop before surgery]
24 hours
452
**Lung Transplant**
[treatment of hypotension]
vasopressors
* avoid large luid boluses
* loss of lymphatic drainage predisoses lung to pulmonary edema
453
**Lusitropy**
[definition]
cardiac muscle fiber relaxation
454
**Lusitropy**
[definition]
myocardial relaxation or diastole
455
**Luxury Perfusion**
[refers to what situation in the brain]
vasoparalysis
456
"patients at high risk of A-fib following cardiac surgery can be treated with prophylactic \_\_\_\_\_"
Amiodarone
457
**Macroshock**
[minumum required for V-fib]
100 mA
458
**Magnesium**
[mechanism of action]
decreases release of acetylcholine in NMJ
459
main sensory innervation to superior and inferior parts of the hard and soft palate
[nerve]
trigeminal nerve
460
**Malathion**
[key concepts]
organophosphate
may prolong duration of succinylcholine
461
**Malignant Hypertension**
[definition]
greater than 210/120 mmHg
often associated with papilledema and encophalopathy
462
**Mapleson Circuit**
[best for controlled ventilation]
D
463
**Mapleson Circuit**
[best for spontaneous ventilation]
A
464
**Median Nerve**
[motor response to stimulation]
flexion of the wrist, pronation of the forearm
465
**MELD score**
[definition]
Model for End-stage Liver Disease
* used by UNOS to prioritize patients on the waiting list for liver transplant
* based on bilirubin, creatinine ,and INR
466
**MELD score**
[range]
1 - 4
## Footnote
1 being the lowest, 4 being the highest
467
**membrane potential**
[ventricular cell]
-90 to -80 mV
468
**MEN**
[acronym]
Multiple Endocrine Neoplasia
469
Meperidine is contraindicated in patients taking which drug for Parkinson disease?
Selegiline
| (eldepryl)
470
**Mepivacaine**
[maximum dose with epinephrine]
7 mg/kg
471
**Mepivacaine**
[maximum dose]
4.5 mg/kg
472
Which oral diabetic drug does NOT produce hypoglycemia?
Metformin
473
**Methadone**
[mechanism of action]
opioid agonist and NMDA antagonist
474
**Methemoglobinemia**
[signs]
SaO2 of 85%
475
**Methergine**
[contraindications]
hypertension
asthmatics
coronary artery disease
476
**Methylmethacrylate**
[adverse effects]
fat embolism
vasodilation and reduction in SVR
hypercoagulable state due to thromboplastin
477
**Methylnaltrexone**
## Footnote
(relistor)
[uses]
opioid antagonist that does not cross the CNS
* can treat opioid-induced constipation without reversing analgesia
478
**MgSO4**
[sign indicating toxicity]
loss of deep tendon reflexes
| (occurs at 10 mEq/L)
479
**MgSO4**
[therapeutic range]
4 - 8 mEq/L
| (4 - 10 mg/dL)
480
**Microshock**
[minimum required for Vfib]
100 uA
| (0.1mA)
481
**Mitral Regurge**
[anesthetic goals]
maintain higher HR
* avoid increases in afterload
482
**Mitral Regurge**
["4 F's of anesthetic management]
full, fast, and forward
(increased preload, increased heart rate, and decreased afterload)
483
**Mitral Stenosis**
[sequelae]
a-fib and pulmonary hypertension
484
**Mitral Stenosis**
[anesthetics goals]
maintain sinus rhythm
avoid tachycardia
* also avoid large increases in CO, hypovolemia, and fluid overload
485
**Mitral Valve Prolapse**
[heart sounds]
late diastolic click preceded by mid-diastolic murmur
486
**Mixed Venous O2 Tension**
[normal mmHg]
40 mmHg
487
**mixed venous oxygen saturation**
[estimation of \_\_\_\_]
cardiac output
488
**Mixed Venous Oxygen Saturation**
[normal value]
65-75%
489
**Mixed Venous Oxygen**
[factors causing a high value]
increased CO or decreased O2 consumption
* hypothermia
* cyanide poisoning
490
**Mixed Venous Oxygen**
[factors causing a low value]
increased comsumption and decreased elivery
* hypoxia
* low cardiac output
* anemia
491
**Morphine**
[parenteral vs oral conversion]
1:3
492
most common cause of mortality associated with administration of blood
TRALI
493
Most common inherited coagulopathy
von Willebrand disease
| (affects 1 in 500 people)
494
Most common electrolyte imbalance
Na
495
Most common reason for hypoxia in PACU
ventilation/perfusion mismatch
496
Most common transfusion-related infection
Hepatitis B
497
Motor innervation to the cricothyroid membrane
[nerve]
external branch of the **superior** laryngeal
498
motor innervation to the intrinsic muscles of the larynx, except cricothyroid muscle
[nerve]
recurrent laryngea
499
**Multiple Endocrine Neoplasia Type II**
[triad of disorders]
medullary carcinoma of the thyroid
hyperparathyroidism
pheochromocytoma
500
**Multiple Endocrine Neoplasia**
[etiology]
tumors in several endocrine organs
* Type I
* gastrinomas, insulinomas, chromophobes (pituitary), and parathyroid tumors
* Type II
* medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism
501
**Multiple Sclerosis**
[neuraxial anesthesia]
avoid spinals
epidurals or other peripheral nerve blocks are of less concern
502
**Musculocutaneous Nerve**
[motor response to stimulation]
flexion of the forearm at the elbow
503
**Myasthenia Gravis**
[anesthetic considerations]
prone to respiratory depression
## Footnote
(avoid or minimize narcotics and benzos)
voltaile agents may provide sufficient muscle relaxation
unpredictable response to Sux, may need larger doses
504
**Myasthenia Gravis**
[cardiovascular agents that may potentiate weakness]
beta blockers
lidocaine
procainamid
verapamil
quinidine
505
**Myasthenia Gravis**
[Misc. drugs that may potentiate weakness]
lithium
phenytoin
magnesium
NDMR
506
**Myasthenia Gravis**
[pharmacological treatment]
pyridostigmine
507
**Myasthenia Gravis**
[antibiotics that may potentiate weakness]
ampicillin
ciprofloxacin
Erythromycin
Gentamycin
Sulfonamides
508
**Myasthenia Gravis**
[etiology]
autoimmune destruction of post-synaptic acetylcholine receptors and the NMJ
509
**Mydriasis**
[definition]
dilation of pupil
510
**Myocardial Ischemia**
[most vulnerable]
endocardium
* subjected to the greatest intramural pressures during systole
511
**Myocardial O2 Consumption**
[normal resting]
8 mL/100g/min
512
**Myocardial Oxygen Consumption**
[primary determinants in order]
heart rate \> afterload \> preload
513
**Myocardial Oxygen Demand**
[characteristics]
increases in demand require an increase in coronary blood flow
* myocardium cannot compensate for reductions in blood flow by extracting more oxygen from hemoglobin
514
**Myocardial Oxygen Demand**
[factors]
heart rate
contractility
ventricular wall tension
515
**Myocardial Oxygen Supply**
[factors that decrease demand]
**decreased**:
heart rate
contractility
ventircular size
ballow counter pulsation
516
**Myocardial Oxygen Supply**
[factors that increase supply]
**increased**:
oxygen content
coronary blood flow
coronary perfusion pressure
517
**Myotonia Congenita**
[anesthetic considerations]
avoid Succinylcholine
* causes sustained muscle contraction and may produce massive release of K+ leading to cardiac arrest
518
**Myotonia Congenita**
[definition]
delayed relaxation after voluntary muscle contraction
519
**Myotonic Dystrophy**
[definition]
multisystem disorder characterized by slowing of relaxation after muscle contraction
520
**N2O **
[frost developing on tank]
rapid flow from cyclinder to anesthesia machine
521
**Naltrexone**
## Footnote
(ReVia)
[uses and treatments]
blocks euphoric effets of heroin
522
**Nasal Cannula**
[maximum FiO2]
0.45
523
**Neohepatic Phase**
[considerations]
reperfusion syndrome and reperfusion injury
524
What drug can lead to abdominal pain in the PACU?
Neostigmine
525
**Nephron - P-cells**
[function]
secrete K+ and participate in aldosterone-stimulated Na+ reabsorption
526
**Nephron**
[two cell types]
principal (P-cells) and intercalated (I-cells)
527
**Nerve Fibers**
[which ones carry pain impulses?]
C and A-delta
528
Neurogenic Diabetes Inspidius
[difference compared to nephrogenic DI]
can be treated witih desmopressin
529
**Neuroleptic Malignant Syndrome vs Malignant Hyperthermia**
[key difference]
muscle relaxants will cause paralysis in NMS, but not in MH patients
530
**Neuroleptic Malignant Syndrome**
[differential diagnosis]
malignant hyperthermia and serotonin syndrome
531
**Neuroleptic Malignant Syndrome**
[etiology]
dopamine blockade in the basal ganglia and hypothalamus
* secondary to metoclopromide or meperidine use
532
**Neuroleptic Malignant Syndrome**
[symptoms]
muscle rigidity, fever, and autonomic instability
533
**New York Association's Classification of Heart Disease**
[categories]
I - asymptomatic
II - symptomatic with moderate activity
III - symptomatic with minimal activity
IV - symptomatic at rest
534
**Nitrogen**
[tank color]
Black
535
**Nitrous Oxide**
[renal effects]
decreased renal blood flow secondary to increased renal vascular resistance
* decreased GFR and urine output
536
**Norepinephrine**
[infusion rate]
0.1 - 0.5 mcg/kg/min
537
normal or increased PR interval
short QT interval
[electrolyte abnormality]
Hypercalcemia
538
Normal oxygen saturaton of newborn
1 minute after may be as low as 60%
5 minutes 80-85%
may only reach 95% by 10 minutes
539
Normal resting coronary artery blood flow
75 mL/100g/min
(250 mL/min)
4% of cardiac output
540
numbess over the lateral aspect of the thigh
[nerve injury]
lateral femoral cutaneous nerve
541
O neg blood is given because there is no \_\_\_\_
A/B antigens
542
**O2 Partial Pressure (PiO2)**
[equation]
PiO2 = (PB - PH2O) x FiO2
(760mmHg - 47mmHg) x 0.21) = 149 mmHg
543
**Obstructive Hydrocephalus**
[cause]
intratentorial mass obstructing CSF flow through 4th ventricle or cerebral aqueduct
544
**Octreotide**
[drug type]
somatostatin derivative of human growth hormone
545
**Octreotide**
[treatment]
carcinoid syndrome
may relieve vasoactive symptoms and restore hemodynamic stability
546
**Oculocardiac Reflex**
[clinical manifestations]
bradycardia
* may also lead to junctional rhythm, ectopic beats, AV block, and asystole
547
**Oculocardiac Reflex**
[anesthetic management]
retrobulbar block may block afferent limb, preventing arrythmias
548
**Oculocardiac Reflex**
[risk factors]
most often in young patients undergoing strabismus surgery
549
**Omphalocele and Gastroschisis**
[anesthetic considerations]
* NG tube before induction
* fluid replacement with crystalloid and colloid
* often suffer from hypoproteinemia
* avoid nitrous
550
**Omphaloceles**
[definition]
abdominal herniation occuring at the umbilicus
* contained in a sac
* often associated with Down's, diaphragmatic hernia, and cardiac and bladder malformations
551
**Opioid-induced Sphincter of Oddi spasm**
[treatment]
naloxone and glucagon
552
**Outflow Obstruction**
[congenital defects]
coarctation of the aorta
aortic and pulmonic valve stenosis
553
**Oxygen Content (CaO2)**
[equation]
(0.003 x PO2) + (SO2 x Hb x 1.31)
554
oxygen requirement for a newborn
7 - 9 mL/kg/min
555
Oxygen requirement for adult
3 - 4 mL/kg/min
556
**Pacemakers**
[upper tracking rate]
prevents rapid venricular rate in response to a rapid atrial rate
* only availble in DDD and VDD pacemakers
557
**PaO2 of 95 mmHg**
[saturation]
almost 100%
558
**PaO2**
[correction by temperature]
measured PaO2 should be decreased about 6% for each oC cooler than 37
559
**PaO2**
[normal values on AGB]
75 - 105 mmHg
560
**PAOP \< LVEDP**
[when would this occur?]
aortic insufficiency
decreased left ventricular compliance
561
**PAOP \> LVEDP**
[when would this occur?]
mitral stenosis
left atrial myxoma
pulmonary venous obstruction
elevated alveolar pressure
562
**Paradoxical Air Embolism**
[heart defect]
patent foramen ovale
563
**Parasympathetic Neurons**
[preganglionic neurons originate from which CN?]
III, VII, IX, and X
and sacral segments 2-4
564
**Parathyroid Hormone**
[effect on bone]
increases reabsorption of calcium and phosphate
565
**Parkinson Disease**
[premedication for tremor]
diphenhydramine
566
**Parkinson Disease**
[treatment of hypotension]
direct-acting vasopressor
567
**Parkinson Disease**
[contraindicated drugs]
Droperidol and metoclopromide
568
**Parkinson Disease**
[etiology]
progressive loss of Dopamine in the nigrostriatum
569
**Parkland Formula**
[equation]
4 mL/kg for each %BSA burned
* 2/3 of this should be replaced ith isotonic crystalloid during the first 8 hours, the rest over the next 16
570
Patient is taking both aspirin and clopidogrel. How should these be managed prior to surgery.
(s/p bare-metal stent)
stop clopidogrel and continue aspirin
571
**Pulseless Electrical Activity**
[5 H's]
hydrogen ion (acidosis)
hypo- or hyper-kalemia
hypoxia
hypovolemia
hypothermia
572
**Pulseless Electrical Activity**
[5 T's}
toxins
tamponade
tension pneumo
coronary thrombosis
pulmonary thrombosis
573
First signs of high spinal block in pediatric patients
respiratory depression leading to **hypoxia** and associated **bradycardia**
574
Children maintain stable hemodynamics until what percentage of blood loss?
25 - 35%
575
local anesthetics for spinals in infants compared to adults
pediatrics require a greater dose, but have a shorter duration
576
**Pericardial Effusion vs. Tamponade**
[most important difference]
pressure
577
**Pericardial Tamponade**
[Beck's Triad]
low blood pressure
muffled heart tones
jugular venous distension
578
pH and HCO3- changes per 10 mmHg PaCO2
0.08 decrease in pH
1 mEq/L increase in HCO3-
579
**Phenylephrine**
[reflex bradycardia]
due to increasing SVR
580
**Phosphate**
[normal values]
2.5 - 4.5 mg/dL
581
**Pituitary Gland**
[surrounding cranial nerves]
III, IV, V1, and VI
582
**Placenta Accreta**
[definition]
placenta attaches itself deeply into the uterine wall
583
**Placenta Percreta**
[definition]
placenta attaches itself through the utuerus, often extending to nearby organs
584
**Placenta Previa**
[definition]
placenta covers the opening of the mother's cervix
585
**Placenta**
[insulin and glucose transfer]
insulin does not cross the placenta; however, glucose does making larger babies
586
**Blood Products**
[which is most likely to cause bacterial sepsis]
platelets
* occurs in 1 per 12,000
587
**Platelets**
[mm3 per unit increase]
5,000 - 10,000
| (for a typical 70kg patient)
588
**Popliteal block**
[supplemental block for ankle/foot surgery]
saphenous nerve
589
**Porphyria**
[contraindicated drugs]
Etomidate
**barbiturates (thiopental)**
antieleptics
many benzos
590
**Porphyria**
[management]
maintain adequate nutrition
possibly avoid light
fix electrolyte disturbances
maintain euvolemia
Hematin therapy
591
**Porphyria**
[etiology]
Heme is composed of iron and porphyrins
porphyrias result from defects in the heme biosynthetic pathway, producing **accumulations of prophyrin**
592
**Portopulmonary Hypertension**
[diagnostic criteria]
mPAP \> 25 mmHg
PVR \> 240 dyn*sec/cm5
593
**Posterior Pituitary**
[hormones]
oxytocin and ADH
594
**Preanhepatic Phase of Liver Transplant**
[considerations]
blood loss and surgical compression of major vessels
* carefully manage hyponatremia
* rapid correction may promote development of central pontine myelinolysis
* citrate toxicity (hypocalcemia)
* due to rapidly transfused blood, check calcium carefully and administer calcium chloride as neccessary
* especially after liver is removed
595
**Preductal Arterial Blood sampling**
[location]
right radial artery
596
**Preeclampsia**
[definition and symptoms]
hypertension and proteinuria
* greater than 140/90
* occurs after the 20th week of pregnancy
* proteinuria \> 300 mg/d
597
**Pregnancy**
[cardiovascular changes]
increasd blood/plasma volume, CO, HR, and SV
decreased BP and pulmonary resistance
598
**Pregnancy**
[changes in epidural]
decreased CSF
decreased potential volume in epidural space
increased epidural pressure
* the first two enhance the cephalad spread of local anesthetics
599
**Pregnancy**
[hematologic changes]
decreased Hb and platelets
increased clotting factors (up to 250%)
shifts O2Hb curve to the left
600
**Pregnancy**
[Renal changes]
increased GFR
601
**Pregnancy**
[respiratory changes]
increased MV, tidal volume, and oxygen consumption
decreased FRC, airway resistance, and PaCO2
602
**Pregnancy**
[SVR changes at term]
decreased
603
**Pregnancy**
[time of greatest cardiac output]
immediately after delivery
* can increase 75% above prelabor values
* due to increased venous return to the heart
604
**Pressure-Volume Loop**
[effects of afterload]
If afterload is reduced, stroke volume and ejection fraction increase, and end-systolic volume decreases
605
**Pressure-Volume Loop**
[aortic regurge]
606
**Pressure-Volume Loop**
[aortic stenosis]
607
**Pressure-Volume Loop**
[effects of preload]
changes in preload affect stroke volume
* end-systolic volume is unchanged if afterload and inotropy are held constant
608
**Pressure-Volume Loop**
[Inotropic effects]
Decreasing inotropy increases end-systolic volume while decreasing stroke volume and ejection fraction
609
**Pressure-Volume Loop**
[mitral regurge]
610
**Pressure-Volume Loop**
[mitral stenosis]
611
primary determinant of local anesthetic potency
lipid solubility
612
**Primary Fibrinolysis**
[causes]
alpha-2 antiplasmin deficiency or an impaired clearance of tPA
613
**Procaine**
[maximum dose]
12 mg/kg
614
**Protamine**
[what happens when given without heparin?]
anticoagulation
615
**Prothrombin TIme (PT)**
[factor(s) tested]
VII
616
**Prothrombin Time**
[measurement]
fibrinogen, prothrombin, and factors V, VII, and X
617
**Prothromin Time**
[normal range]
11 - 14 seconds
618
**Pseudocholinesterase**
[half-life]
12 hours
619
**PT**
[normal values]
10 - 14 sec
620
**Pudenal Nerve**
[origin]
S2 - S4
621
**Pulmonary Artery Catheter**
[contraindications]
complete LBBB
Wolff-Parkinson-White syndrome
Ebstein's malformation
622
**Pulmonary Artery Catheter**
[change in BP when entering into right ventricle]
increase in systolic pressure
623
**Pulmonary Artery Catheter**
[change in BP when entering pulmonary artery]
increase in diastolic pressure
624
**Pulmonary Embolism**
[ABG findings]
hypoxemia and hypocapnea
| (respiratory alkalosis)
625
Increased lung compliance due to loss of elastic recoil of the lung
Pulmonary Emphysema
626
**Pulmonary Vascular Resistance**
[equation]
(PAP - PCWP) / CO \* 80
627
**Pulmonic Stenosis**
[anesthetic goals]
maintain normal to slightly high HR
avoid increases in PVR
628
Pulmonary Vascular Resistance is the least at which lung volume?
Functional Residual Capacity
629
Pt is here for a TIPS procedure, what physiologic findings to consider?
liver failure
| (decreased albumin)
630
**QTc prolongation**
[lenth of time considered prolonged]
\> 0.45 seconds
631
Most important determinant of intracellular osmotic pressure
Potassium
632
Which EKG findings may make diagnosis of an MI more difficult?
left bundle branch block
* LBBB changes how the ventricles depolarize and also leads to its own ST segment and t-wave changes
633
"You note a heart rate of 32 in sinus bradycardia, with a blood pressure of 72/44, and a respiratory rate of 16." What is your first intervention?
0.5 - 1 mg Atropine
634
"On a preoperative EKG, you note delta waves preceding the QRS complex. During the procedure the patient's heart rhythm changes into a-fib followed by wide-complex irregular tachycardia. The patient is otherwise stable. What is the best initial option in management?"
procainamide and amiodarone
* Wolff-Parkinson-White
* AV node blocking drugs are contraindicated
635
What effect does alkalosis have on serum potassium, serum calcium and shifting of the oxygen hemoglobin dissociation curve?
decrease in K and Ca
left shift in O2Hg curve
636
**Narrow Complex SVT with stable blood pressure**
[first treatment]
vagal maneuver (valsalva or carotid massage)
Adenoside 6 mg
637
**Radial Nerve**
[motor response to stimulation]
extension of all digits as well as the wrist
638
**Radiation Exposure**
[max REM per year]
5
639
**RBC**
[normal range]
3.8 - 5.7 x108/uL
640
typical EKG rhythm in severe CAD of the right coronary
complete heart block
* RCA supplies blood to the AV node in 90% of patients
641
**recurrent laryngeal nerve**
[unilateral damage]
hoarseness
642
**recurrrent laryngeal nerve**
[bilateral damage]
airway obstruction during inspiration
* complete transection would cause vocal cords to remain 2-3mm apart
* partial bilateral paralysis would cause the cords to close completely
643
**Relative potency compared to morphine:**
Meperidine
Alfentanil
Dilaudid
Fentanyl
Remifentanil
Sufentanil
Meperidine: 0.1
Alfentanil/Dilaudid: 10
Fentanyl: 100
Remifentanil: 300
Sufentanil: 1,000
644
**Remifentanil**
[metabolism]
nonspecific esterases
645
**Renal Blood Flow**
[normal autoregulation range]
80 - 180 mmHg
646
**Renal Corpuscle**
[function]
ultrafiltration of blood
647
**Renal Transplant**
[absolute contraindications]
infection and cancer
648
**Reperfusion Syndrome**
[symptoms]
hypotension
right heart failure
arrhytmias with possible cardiac arrest
649
**residual volume**
[average adult value]
1200 mL
650
Resistance during laminar flow is dependent on \_\_\_\_\_
gas viscosity
651
resistance during turbulent flow is dependent on \_\_\_\_\_
density
652
**Retrobulbar Block**
[CN nerves blocked]
CN III, IV, and VI
653
**Rhematoid Arthritis**
[cardiovascular effects]
pericardial thickening and effusion
conduction defects
aortic regurgitation
654
**Rheumatoid Arthritis**
[pulmonary effects]
interstitial pulmonary fibrosis
pleural effusion
655
**Rheumatoid Arthritis**
[airway concerns]
atlantoaxial instability
limited TMJ mobility
656
**Right-Sided Heart Failure**
[definition]
back-up of blood into the right heart and pulmonary circulation
657
**Right-to-Left Shunting**
[congential defects]
tetralogy of fallot
transposition of the great vessels
hypoplastic left heart
pulmonary and tricuspid atresia
658
**"Robin Hood Phenomenon"**
[definition]
blood flow directed from a normal region of the brain to an ischemic region
659
**Romano-Ward Syndrome**
[characteristics and treatment]
prolonged QT interval
* left stellate ganglion block
* shortens QT intervals
660
**Ropivacaine**
[maximum dose]
3 mg/kg
661
At high altitudes, the flow of a gas through a rotameter will be \_\_\_\_\_
greater than expected at high flows, but accurate at low flows
662
S3 Gallop
[how and where to hear it]
cardiac apex using the bell
* apex best located in left lateral decubitus position in the 5th intercostal, midcalvicular line
663
Heart sound correlating to congestive heart failure
S3 Gallop
664
**SA node**
[arterial supply]
RCA (60% of people) or LAD (40% of people)
665
**Sacral Plexus**
[develops into which nerves]
sciatic nerve
| (common peroneal, tibial, and sural)
666
**Saddle Block**
[definition]
"pudendal block"
low lumbar and sacral anesthesia, mostly in OB
667
**Saddle Block**
[Key Points]
hyperbaric solution (glucose/dextrose)
668
**Sarin Gas**
[signs and symptoms]
DUMBELS
diarrhea
urination
miosis
bronchoconstriction
emesis
lacrimation
salivation
669
**Sciatic Block**
[landmarks]
posterior superior iliac spine
greater trochanter
sacral hiatus
670
**Nerve Injury**
[weakness of all muscles below the knee]
Sciatic nerve
671
**Secondary Hyperthyroidism**
[expected enzyme levels]
low TSH and high free T4/T3
672
**Seizures from Hyponatremia**
[treatment]
hypertonic saline
673
**Seizures**
[physiological effects]
initial parasympathetic discharge followed by a more sustained sympathetic discharge
674
sensory innervation below the vocal cords to the carina
[nerve]
recurrent laryngeal
675
sensory innervation of the larynx above the vocal cords
[nerve]
internal branch of the superior laryngeal nerve
676
Sensory innervation of the mucous membranes of the nose
[nerve]
trigeminal
677
Sensory innervation to posterior third of tongue
[nerve]
glossopharyngeal
678
sensory of occipital portion of the skull
[nerve]
cervical plexus (C2 and C3)
679
**Septic Shock**
[hemodynamic changes]
Hypotension with normal cardiac output and low end-diastolic volume
680
Sequence of highest to lowest level block
sympathetic \> sensory \> motor
* Sympathetic block may be 2-6 dermatomes higher than sensory
* Sensory may be 2-3 dermatomes higher than motor block
* However, epidural anesthesia tends to have identical levels for sensory and sympathetic
681
**Serotonin Syndrome**
[treatment]
supportive and 5-HT antagonist
| (cyprohepatadine)
682
**Serum Albumin**
[normal levels]
3.5 - 5.5 g/dL
683
**Sevoflurane**
[effects on HR]
decreases until about 1 MAC at which time it produces dose-dependent increases
684
**SIADH**
[treatment]
fluid restriction
685
**Sickle Cell Crisis**
[causes]
hypoxemia
acidosis
dehydration
hypothermia
686
**Sickle Cell Hemoglobin**
[P50]
31 mmHg
687
**Sinus Arrhythmia**
[cause]
cyclic changes in vagal tone
688
**Sinus Arrhythmia**
[definition]
cyclic variation in heart rate corresponding to respiration
* increases with inspiration
689
**Soda Lime**
[amount of CO2 absorbed]
23L CO2 per 100g absorbent
690
**Sodium Bicarb**
[adverse effects]
paradoxic cerebrospinal fluid acidosis
hypernatremia
hypercarbia
691
**Sodium Nitroprusside**
[infusion rate causing cyanide toxicity]
greater than 2 ug/kg/min
692
**Sodium Nitroprusside**
[first signs of cyanide toxicity]
tachyphylaxis
metabolic acidosis
elevation of mixed venous PO2 values
693
**Spinal Anesthesia**
[alpha-agonists]
have analgesic properties and prolong duration
* examples: clonidine, epinephrine, and phenylephrine
* may also enhance hypotension
694
**spinal cord ending**
[adult vs pediatric]
adult L1
pediatric L2
695
**Spinal Cord Injury**
[level of paraplegia]
above L4
696
**Spinal Cord Injury**
[level of quadriplegia]
above T1
697
**Spinal Cord Injury**
[level of required ventilation]
C3 - C5
698
**Spinal Cord Injury**
[most common sites]
C5-6 and T12-L1
699
**Spinal Shock**
[pathophysiology]
hypotension and bradycardia
700
**Spironolactone**
[mechanism of action]
aldosterone antagonist
701
**Spondylosis**
[definition]
degeneration of spinal column
702
**SSEPs**
[afferent input is carried through which spinal cord tract?]
dorsal columns
703
**Stable wide-complex tachycardia**
[best drug choice]
amiodarone and procainamide
704
**Starling's Law of the Heart**
[components]
cardiac output and left ventricular end-diastolic volume
705
**Stellate Ganglion Block**
[indication of successful block]
warm sensation over arms and face
706
**Stellate Ganglion Block**
[risks and complications]
* bradycardia
* recurrent laryngeal nerve paralysis
* brachial and subarachnoid block
* seizure
* phrenic nerve block
707
**Stellate Ganglion Block**
[symptoms]
Horner syndrome
708
**stellate ganglion**
[lies in close proximity to which artery?]
vertebral
709
**Stroke Volume**
[components]
preload, afterload, and contractility
710
**Succinylcholine**
[mechanism of termination]
diffusion into extracellular space
* pseudocholinesterase is not present at the NMJ, so termination of action is actually once it diffuses into the extracellular fluid
711
**Succinylcholine**
[mechanism for tachycardia]
stimulation of nicotinic receptors at autonomic ganglia
712
**Superior laryngeal nerve**
[bilateral damage]
hoarseness and predisposition to aspiration
713
Supplementary nerve block with popliteal for surgery on achilles tendon
Saphenous
714
**Supraclaviuclar Block**
[which section of the brachial plexus is blocked?
Trunks/Divisions
715
**Sural Nerve**
[area of coverage]
covers the lateral side of the foot
716
**SVC Syndrome**
[considerations]
start IV in lower extremities
717
**Lhermitte Sign**
[definition]
occurs when head flexion causes shooting sensations down the back and into the lower limbs
* due to posterior column disease
718
**Syringomyelia**
[etiology]
progressive cavitation of the spinal cord
719
**Systolic Dysfunction**
[Pressure-Volume Loop]
720
**Systolic Heart Failure**
[definition]
left ventricle loses ability to contract
721
**TAP Block**
[nerves blocked]
subcostal, ilioinguinal, and iliohypogastric
722
**Tapentadol**
## Footnote
(nucynta)
[drug class]
opioidu agonist and norepinephrine reuptake inhibitor
* contraindicated with MAOIs and SSRIs
723
**Tardive Dyskinesia**
[cause]
long-term doaminergic antagonist use
* elderly women and those with psychoactive disorders are at higher risk
724
**Tardive Dyskinesia**
[definition]
involuntary movements of the face and extremities
* irreversible
725
**TEE**
[best view for myocardial ischemia]
transgastric mid-papillary LV short axis view
* shows the myocardium supplied by all three major coronary arteries
726
**TEE**
[smallest detection of air]
0.25 mL
727
**Tracheoesophageal Fistula**
[anesthetic concerns]
* ETT must be distal to fistula
* copious pharyngeal secretions
* avoid positive pressure
* avoid next extension and instrumentation after repair
728
**Tracheoesophageal Fistula**
[most common type]
IIIB
729
**Tetracaine**
[mechanism of termination]
systemic absorption
* hydrolyzed by cholinesterase enzymes which are not present in CSF, must be absorbed first
730
**Tetralogy of Fallot**
[anatomical anomalies]
right ventricular outflow obstruction
right ventricular hypertrophy
VSD with over-riding aorta
731
**Tetralogy of Fallot**
[anesthetic goals]
maintain intravascular volume and SVR
* avoid increases in PVR, acidosis, or excessive airway pressures
* avoid MR that release histamine
732
**Tetralogy of Fallot**
[induction]
Ketamine
## Footnote
maintains or increases SVR, therefore does not aggravate the right-to-left shunting
733
**Tetralogy of Fallot**
[isoproteronol]
avoid
reduces afterload and therefore increases right-to-left shunt
734
**Thiazides**
[mechanism of action]
inhibits Na+ reabsorption
735
**Thiazides**
[site of action]
early distal convoluted tubule
736
**Thiopental**
[induction considerations]
adding an acidic muscle relaxant will cause precipitation and may lead to pulmonary embolism
737
**Thyroid Storm**
[clinical signs]
fever, tachycardia, and hypotension
(altered consciousness in awake patient)
738
**Thyroid Storm**
[differential diagnosis of MH]
thyroid storm does not have the following:
* muscle rigidity
* elevated creatinine kinase
* metabolic and respiratory acidosis
739
**Thyroid Storm**
[treatment]
beta blockers
glucocorticoids
thionamide (methimazole)
iodine
740
**Thyroid**
[hormones]
T3, T4, and Calcitonin
741
**Time Constants**
[percentages at 1, 2, and 3]
63%
84%
95%
742
**TIPS procedure**
[treatment]
portal hypertension
743
**TIPS**
[acronym]
Transjugular Intrahepatic Portosystemic Shunt
744
**Tirofiban**
[mechanism of action]
Blocks binding of fibrinogen and vWF to glycoprotein IIb/IIIa receptor on platelet surface
745
**Total Thyroidectomy**
[post-operative concerns]
hypocalcemia
may manifest as laryngeal stridor 24-96 hours after the procedure
746
Tracheal Capillary Pressure
25 - 35 mmHg
747
**TRALI**
[key features]
wide A-a gradient
noncardiogenic pulmonary edema
leukopenia
748
**Trans-tracheal block**
[drug choice[
4mL of 4% lidocaine
749
**Transplant Lung**
[innervation]
no longer cough reflex below carina
* respiratory pattern is unaffected
750
**Transplanted Heart**
[atropine]
no effect
* blocks parasympathetic branches of ANS
751
**Transposition of the Great Arteries**
[anatomical anomalies]
aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle
* Survival is only possible through a foramen ovale and PDA
752
**Transposition of the Great Vessels**
[rate of induction]
slower inhalational induction and faster intravenous
753
**Transsphenoidal Hypophysectomy**
[postoperative considerations]
avoid CPAP
754
Trauma-Induced Coagulopathy
during periods of tissue hypoperfusion, thrombomodulin released by the endothelium complexes with thrombin
* prevents cleavage of fibrinogen to fibrin
* activates Protein C
* reduces further thrombin generatoin through factors V and VIII
755
**Treacher Collins**
[airway]
mandibular hypoplasia
756
Treatment of dystonic reactions due to Droperidol
(twisted and rigid neck, eye movements)
diphenhydramine
| (anticholinergic that crosses BBB)
757
**Tricuspid Regurge**
[management goals]
increase HR and preload
decrease afterload
avoid any increases in PVR
758
**Tricuspid Regurge**
[pathophysiology]
slight elevation in mean right atrial and central venous pressures
759
**Tricuspid Regurge**
[ventilation goals]
avoid PEEP and high mean airway pressures
## Footnote
(goal to maintain high CVP and decrease/maintain afterload)
760
**"Triple H" Therapy**
[definition]
hypervolemia, hemodilution, and hypertension
761
**"Triple H" Therapy**
[treatment]
2nd treatment of vasospasms after nimodipine
762
Protein measured in diagnosis of acute ischemia
Troponin
* level was associated with length of ischemia
* peaks within 12-48 hours, but rise can be seen within 8 hours
763
**Trousseau's Sign**
[definition]
carpal spasm following inflation of arm tourniquet above systolic pressure for 3 min
* results from hypocalcemia
764
**TURP Syndrome**
[causes]
absorption of large amounts of fluid
| (usually hyposmolar)
765
**TURP Syndrome**
[treatment]
fluid restriction and furosemide
766
**TURP**
[adverse effects]
TURP Syndrome
Coagulopathies
Bladder perforation
septicemia
767
**TURP**
[coagulopathy]
DIC and primary fibrinolysis
768
**Type II pneumocytes**
[function]
secrete surfactant in alveoli
769
**Ulnar Nerve**
[motor response to stimulation]
flexion at the wrist, 4th, and 5th fingers and *adduction* of the thumb
770
**Umbilical Cord Blood**
[normal arterial values]
7.25 pH
50 PCO2
20 PO2
22 HCO3-
771
unable to oppose thumb and little finger
[nerve damage]
median
* frequently injured at AC during IV cannulation or through neurottoxic drugs
772
**Vasopressin**
[infusion rate]
0.01 - 0.04 units/min
773
**Vasospasm**
[treatment triad]
3 H's
hypertension, hypervolemic, hemodilution
774
**VD/VT**
[equation]
( PACO2 - PECO2 ) / PACO2
normally 33%
775
**Venous Admixture**
[definition]
amount of mixed venous blood that would have to be mixed with pulmonary end-capillary blood to account for the difference in O2 tension
776
**Venous Admixture**
[equation Qs/Qt]
(CCO2 - CaO2) / (CCO2 - CVO2)
777
**Venous Air Embolism**
[monitoring]
TEE and precordial Doppler
778
**Venous Air Embolism**
[pulmonary artery pressure]
rises progressively
* when the amount of entrained exceeds the rate of pulmonary clearance
779
**Venous Air Embolism**
[heart sounds - *late manifestation*]
"mill wheel" murmur
780
**Verapamil**
[dose for irregular-narrow tachycardia]
2.5 - 5 mg over two minutes
781
Virtally all pain arising in the thoracic or abdominal viscera is transmitted via \_\_\_\_\_
Sympathetic nervous system in unmyelinated C fibers
782
**Vital Capacity**
[normal value mL/kg]
60 - 70 mL/kg
783
**Vitamin K reductase Inhibitor**
[example]
warfarin
784
**Volatile Agents**
[cardiogenic shock and Fa/Fi]
Isoflurane will be affected most
785
**Volatile Agents**
[uptake equation based on first minute]
the amount of volatile agent taken up in the first minute is equal to the amount taken up between the squares of any two consequtive minutes
786
**von Willebrand's disease**
[treatment]
desmopressin (DDAVP)
cryoprecipitate or factor VIII concentrate
* *Recombinant* factor VIII cannont be used because it does not contain vWF
787
**Warfarin Therapy**
[emergency treatment]
fresh frozen plasma
* vitamin K should be avoided as it may lead to a hypercoagulable state
788
Weakness of the muscules that extend the knee
[nerve injury]
femoral nerve
789
Web space between the great and second toe
[innervation]
deep peroneal nerve
790
**West Zone 1**
[pressure ranking]
PA \> Pa \> PV
791
**West Zone 2**
[pressure ranking]
Pa \> PA \> Pv
792
**West Zone 3**
[pressure ranking]
Pa \> Pv \> PA
793
What effect does Propofol have on the CO2 responsiveness on the cerebral vasculature?
does not have any affect at clinical doses
794
what part of the tubule reabsorbs the most water
proximal convuluted tubule
795
when is the fetus most susceptible to the effects of teratogenic agents?
3 - 8 weeks
| (during organogensis)
796
Which antibiotic may cause hearing loss?
Gentamycin
797
which coefficient is most closely associated with MAC?
oil/gas
798
which diuretic is associated with hyperchloremic metabolic acidosis?
acetazolamide
| (carbonic anhydrase inhibitors)
799
which diuretic is associated with ototoxicity?
loop diuretics
800
Which diuretic may lead to hyperkalemia
Spironolactone
| (potassium sparing)
801
Which drug prodces strong pulmonary arterial dilation with the least amount of systemic artery dilation?
nitric oxide
802
which lab test would be most useful in evaluating if a s/p thyroidectomy patient is euthyroid?
TSH
803
which muscle relaxant inhibits the reuptake of norepinephrine by the adrengeric nerves?
pancuronium
804
which narcotic can be used as the sole agent fr a C-section
(without any local)
meperidine
805
which pressor is best in presence of acidemia?
vasopressin
806
which vein is just proximal to the SVC?
brachiocephalic vein
807
Why do infants require a higher dose of Sux?
higher volume of distribution
808
Why does Fentanyl have a faster onset than morphine
more ionized
809
**Wide Complex Tachycardia with normal BP**
[what to do]
cardiovert using biphasic defibrillation
* next step amiodarone or procainamide
810
**Withdrawal**
[postoperative drug treatment]
Clonidine
811
**Wolff-Parkinson-White**
[EKG findings]
delta wave and shortened PR interval
812
**Wolff-Parkinson-White**
[treatment in a hemodynamically stable patient with regular narrow complex tachycardia]
vagal maneuvers or adenosine
813
**Wolff-Parkinson-White**
[treatment in a hemodynamically stable patient with regular wide complex tachycardia]
procainamide or amiodarone
814
**Wrist Drop**
[nerve damage]
radial
815
You give a pt Calcium then a precipitate forms, what was given prior?
Bicarb
816
**[Cl-]**
[normal values]
95 - 105 mEq/L
817
**[HCO3-]**
[normal values]
22 - 28 mEq/L
818
**[K+]**
[normal values]
3.5 - 5.3 mEq/L
819
**[Mg+]**
[normal values]
1.3 - 2.4 mEq/L
820
**[Na+]**
[normal values]
135 - 145 mEq/L
821
**Anticholinergic Syndrome**
[treatment]
physostigmine
822
**MAC-BAR**
[definition]
blocks autonomic response to painful stimuli
(\> 1.7 MAC)
823
**Opioid Receptor**
[most responsible for supraspinal analgesia]
Mu-1
824
**Opioid Receptor**
[most resonsible for spinal analgesia]
Mu-2
825
**Opioid Receptor**
[physical dependence]
Mu-2
826
**Opioid Receptor**
[dysphoria]
kappa
827
Which opioid has a similar structure to atropine and LA?
meperidine
828
**Chronic Bronchitis**
[Hematologic changes]
polycythemia
829
**Chronic Bronchitis**
[EKG and chest X-ray]
right atrium and ventricular hypertrophy
cardiomegaly
830
**Obstructive Lung Disease**
[TLC]
increased TLC
831
**cardiogenic shock**
[effect on mixed venous oxygen saturation]
decrease
832
**PaCO2**
[effect on hepatic blood flow]
increaseing PaCO2 will increase hepatic blood flow
833
Which CCB has the greatest coronary artery vasodilating effects?
Nicardipine
834
venous air embolism
835
**Methemoglobin**
[saturation]
Saturation of 85%
836
**Carboxyhemoglobin**
[saturation]
produces falsely high saturations
837
**High Anion-Gap Metabolic Acidosis**
[causes acronym]
Cat Mudpiles
838
**High Anion-Gap Metabolic Acidosis**
["C" causes]
carbon monoxide
cyanide
congenital heart failure
839
**High Anion-Gap Metabolic Acidosis**
["A" causes]
aminoglycosides
840
**High Anion-Gap Metabolic Acidosis**
["T" causes]
theophylline
841
**High Anion-Gap Metabolic Acidosis**
["M" causes]
methanol
842
**High Anion-Gap Metabolic Acidosis**
["U" causes]
uremia
843
**High Anion-Gap Metabolic Acidosis**
["D" causes]
diabetic ketoacidosis
(can also be from alcohol or starvation)
844
**High Anion-Gap Metabolic Acidosis**
["P" causes]
paracetamol/acetaminophen
845
**High Anion-Gap Metabolic Acidosis**
["I" causes]
iron
846
**High Anion-Gap Metabolic Acidosis**
["L" causes]
latic acidosis
847
**High Anion-Gap Metabolic Acidosis**
["E" causes]
ethanol
848
**High Anion-Gap Metabolic Acidosis**
["S" causes]
salicylates
| (ASA and aspirin)
849
**Normal Anion-Gap Metabolic Acidosis**
[mnemonic for causes]
ABCD
* Addisons (adrenal insufficiency)
* Bicarbonate loss (diarrhea, vomiting)
* Chloride excess
* diuretics (acetazolamide)
850
**Aliskiren**
[drug class]
direct renin inhibitor
851
Which drug would be **inefficient** in heart block?
Atropine
* only increases the SA rate and
852
**Pacemaker**
[common location of ventricular leads]
right ventricular apex
853
**Hypertrophic Obstructive Cardiomyopathy**
[hemodynamic goals]
increase preload and afterload
slow HR
854
alcohol or tobacco
[which is a coronary risk factor?]
tobacco use
855
Pulmonary Hypertension
[PAP \> \_\_\_\_\_]
25 mmHg
856
**Orifice Flow**
[definition]
special case of turbulent flow where the diameter is larger than the length
* example: tracheal obstruction
857
What can be used to detect all leaks in the low-pressure circuit of any contemporary anesthesia machine?
negative-pressure leak test
858
General anesthesia results from interruption of nervous system activity EXCEPT \_\_\_\_\_
peripheral sensory receptors
859
**Locus Ceruleus**
[definition and key concept]
nucleus in the pons involved with physiological responses to stress and panic
* no affect by general anesthesia
860
**Indels**
[definition]
insertion or deletion of one or more nucleotides
861
**Haplotypes**
[definition]
nucleotide polymorphisms inherited in blocks
862
**most common inherited prothrombotic risk factor**
[mutation in which coaulation factor]
factor V
"Factor V Leiden"
863
After cardiac surgery, what is the incidence of significant neurologic mobidity?
1 - 3%
864
Malignant Hyperthermia follows what pattern of inheritance?
autosomal dominant
865
Point mutation in which gene may interfere with Propfol's mechanism of action?
Beta-3 subunit of GABAA receptor
866
**Elimination Half-Life**
[definition]
time it takes the amount of drug in the bdoy to decrease by 50%
867
the kidney primarily excretes \_\_\_\_\_
| (solubility and polarity)
water-soluble polar compounds
868
the smaller the volume of distribution, the _____ the half-time of elimination
longer
869
What is the half-time of elimination of a drug that undergoes first-orer elimination with a rate constant of 0.1 minute?
6.93 minutes
870
Isovolumetric contraciton occurs after _____ valve closure
mitral
* isovolumetric contraction **only** occurs in the Left Ventricle
871
**resting coronary blood flow**
{in mL/min]
250 mL/min
872
**Croup**
[imaging]
"steeple sign}
873
**epiglottitis**
[imaging]
thumb sign
874
**Croup**
[medical name]
laryngotracheobronchitis
875
the last two digits of the pH should equal HCO3- + \_\_\_\_\_
15
(pH of 7.34 should have a HCO3- of 7.49)
876
**Lactated Ringer**
[plasma distribution]
equal to extracellular fluid
20% \* kg
877
**D5W**
[plasma distribution]
60% \* kg
878
chronic vomiting leads to \_\_\_\_
hypochloremic alkalosis
879
chronic diarrhea leads to \_\_\_\_\_
hyperchloremic acidosis
880
aldosterone promotes _____ of Na in the kidney
reabsorption
881
aldosterone promotes exchange of ____ for \_\_\_\_\_\_
exchange of Na for potassium and hydrogen
882
metabolic alkalosis is associated with _____ [K]
decreased
883
metabolic alkalosis is associated with compensatory \_\_\_\_\_
hypoventilation
| (hypercarbia)
884
**Sodium Bicarb**
[initial dose]
kg \* 0.3 \* (24 - actual HCO3)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
2
885
aldosterone ____ potassium excretion
increases
886
acidosis shifts potassium \_\_\_\_
extracellularly
887
insulin causes an _____ shift of potassium
intracellular
888
how many paired sympathetic ganglia?
22
889
Explain the parasympathetic innervation of the heart
mainly in the SA and AV nodes
(no innervation in the ventricles
890
symphathetic = \_\_\_\_\_
parasympathetic = \_\_\_\_\_
(adrenergic or cholinergic)
adrenergic - SNS
cholinergic - PNS
891
in the PNS, the postganglionic receptors secrete \_\_\_\_\_
Ach
892
the preganglionic neurotransmitter is ____ in both the SNS and PNS
Ach
893
in the adrenal medulla, the preganglionic neurotransmitter is \_\_\_\_
Ach
894
which cells are responsible for the release of catecholamines in the adrenal medulla?
chromaffin cells
895
muscarinic receptors in the myocardium are stimulated by _____ and inhibit the release of \_\_\_\_\_
Ach
norepinephrine
896
which catecholamine is the most potent venoconstrictor?
norepinephrine
897
activation of presynaptic Beta-2 receptors have the same physiologic response as antagonist to \_\_\_\_\_
alpha-2 receptors
898
**Beta-2 receptor**
[catecholamine sensitivity]
primarily epinephrine
899
**Beta-2 receptor**
[catecholamine sensitivity]
equally sensitive to epi and norepi
900
arterial baroreceptor refle can be best demonstrated by the \_\_\_\_\_\_
valsalva maneuver
if exaggerated and prolonged hypotension develops, patient may be at risk for autonomic instability
901
**Valsalva Maneuover**
[explain]
BP increases momentarily as the intrathoracic blood is forced into the heart (preload)
sustained pressure decreases venous return, reducing cardiac output and blood pressure
relex vasoconstriction and tachycardia ensue
902
**Fenoldopam**
[characteristics]
direct renal vasodilator
selective dopamine-1 agonist
has diuretic properties
903
first-line agent in treating hypotension in the septic patient
norepinephrine
904
**Thiopental**
[induction dose]
3 - 5 mg/kg
905
Which induction drug may facillitate the interpretation of SSEPs?
etomidate
* increases the amplitude which can be useful when signal quality is poor
906
Which induction drug should be avoided in the presence of tricyclic antidepressants?
ketamine
907
**Propofol**
[elimination half-life]
1 - 3 hours
908
**Propofol**
[dosing]
should be based on lean body weight
909
Propofol increases which waves on an EEG?
Beta waves
910
**Dexmedetomidine**
[infusion rate]
0.2 - 0.6 mcg/kg/hr
911
**Serum Lipase**
[indication]
acute pancreatitis
912
**Poliomyelitis**
[diagnosis]
febrile with asymmetric paralysis
diagnosis by virus culture
913
**Guillain Barre Syndrome**
[diagnosis]
febrile illness with loss of sensation
diagnosis by CSF analysis and electrophysical studies
914
**Myastenia Gravis**
[diagnosis]
fluctuating weakness
diagnosed by the "tensilon" test
915
**Chlorpromazine**
[key facts]
D2 antagonist
anti-psychotic
* may lower seizure threshold
* prolongs QT interval
* potentiates depressant effects of narcotics
916
**Cefazolin**
[mechanism of action]
inhibiting bacterial cell wall synthesis
(gram positive)
917
**Autonomic Hyperreflexia**
[level of transection]
T6 or above
918
urgent warfarin reversal
FFP
919
**Vancomycin**
[mechanism of action]
inhibits bacterial cell wall synthesis
| (gram positive including MRSA)
920
**Excess lactated ringers**
[most likely acid-base disturbance]
metabolic alkalosis
921
**Pulmonary Hypertension**
[induction medications to avoid]
ketamine and etomidate
* suppress pulmonary vasodilation mechanisms leading to pulmonary vasoconstriction
922
**Hypocalcemia**
[effects]
muscular spasm and rigidity
hyperventilation
congestive heart failure
923
**Clindamycin**
[mechanism of action]
binds 50S ribosomal subunit
924
**Methemoglobinemia**
[treatment]
methylene blue
925
**4x4 sponge**
[how much blood can it hold]
10 mL
926
**Cryoprecipitate**
[components]
8, 13, fibrinogen, and vWF
927
Which test is best for determining the presence of an unstable clot?
D-dimer
928
**DIC**
[effect on coaguation tests]
no effect on PT or PTT
929
**Platelet pheresis pack**
[contains how many platelets?]
30,000 - 60,000 cells/mcL
930
**Plasma-Lyte**
[which common electrolyte is not found?]
Calcium
931
**Plasma-Lyte**
[osmolarity]
295
932
**Severe Acidemia**
[effects]
decreased contracility due to decreased response to catecholamines
hypotension
hyperventilation
hyperkalemia
933
**Lactated Ringers**
[which common electrolyte is not found]
magnesium
934
**massive transfusion**
[acidosis or alkalosis?]
metabolic alkalosis
935
**Biot's Respirations**
[definition]
regular and rapid breaths followed by apnea
936
**Kussmaul's Sign**
[definition]
elevation of JVP seen during inspiration
937
**carcinoid tumors**
[signs and symptoms]
cutaneous flushing
bronchospasm
diarrhea
hypotension
(more likely to have **right** heart failure)
938
**Hemophilia A**
[treatment]
cryoprecipitate
purified factor VIII
(can give FFP but not as effective)
939
**Hespan vs. Hextend**
[difference]
Hespan in a normal saline
hextend is a lactated ringers
940
**PRBC**
[average hematocrit]
70-80%
941
**Rhematoid Arthritis**
[pulmonary disorders]
restrictive lung disease
942
most common cause of post-renal azotemia in an elderly male
prostatic hypertrophy
943
which antibiotics are ototoxic?
amioglycosides
| (gentamicin)
944
**restrictive lung disease**
[pulmonary tests]
decreased TLC
normal to increased FEV1/FVC
945
3 main obstructive lung diseases
asthma, emphysema, and bronchitis
946
**multiple sclerosis**
[intraoperative management]
maintain normothermia
* increased core body temps and stress are known to precipitate exacerbations
947
what type of receptors are found in the neuromuscular junction?
nicotinic
948
maximum Na correction rate
0.5 mEq/hour
949
type of acidosis with excessive NS infusion
hyperchloremic metabolic acidosis
950
**Renin**
[origin]
juxtaglomerular cells in the kidney
951
**Angiotensinogen**
[origin]
liver
952
**pulmonary hypertension**
[ekg findings]
right axis deviation
tall p-waves in lead II
RBBB
953
**hyperlipidemia**
[electrolyte effects]
falsely low sodium levels
954
quick onset of versed can be attributed to \_\_\_\_\_
high lipid solubility
955
**spironolactone**
[mechanism of action]
inhibits aldosterone at the DCT
956
**Lasix**
[mechanism of action]
blocks Na reabsorption in the ascending Loop and DCT
957
**TRALI**
[antibody confirmation]
lymphocytotoxic
958
normal human plasma osmolarity
280
959
**Cricoid Pressure**
[force in lbs]
8 - 10lbs
960
**Propofol infusion syndrome**
[treatment]
charcoal hemoperfusion
supportive care
961
**pulmonary embolism**
[most common signs]
tachypnea and rales
962
**Brugada Syndrome**
causes sudden cardiac death in apparently normal hearts
* EKG shows ST elevation in V1-V3
963
**Cauda Equina**
[originates at what level?]
L1
964
"millwheel murmur"
acute venous air embolism
965
ventilatory drive in a COPD patient is normally in response to \_\_\_\_
hypoxemia
966
**Mannitol**
[mechanism of action]
increases osmotic pressure of the glomerular filtrate increasing water excretion
967
Hypothyroid patients are more likely to be \_\_\_\_\_glycemic
hypoglycemic
968
**Thyroid Storm**
[treatment]
propranolol
methimazole
dexmethasone
iodine
969
