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Board Exam > Principles of Anesthesia > Flashcards

Principles of Anesthesia Flashcards

1
Q

Anticholinergic Syndrome

[signs and symptoms]

A

tachycardia, mydriasis, dry mouth, delirium

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2
Q

Cholinergic Syndrome

[signs and symptoms]

A

bradycardia miosis, salivation, confusion

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3
Q

In a newborn, access to the vena cava can be gained by passage of a catheter through the _____

A

ductus venosus

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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

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5
Q

a change in [HCO3-] of 10 mEq/L from 24 will results in ____ pH units in the same direction

A

0.15

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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

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7
Q

PaCO2 will decrease about ___ mmHg for every 1 mEq/L decrease in [HCO3-] below 24

A

1

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8
Q

1mmHg change in PaCO2 from 40mmHg results in ____ unit change in pH in the opposite direction

A

0.008

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9
Q

0.9% NaCl

[components]

A

154 Na and 154 Cl

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10
Q

0.9% NaCl

[osmolality]

A

308

(isotonic)

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11
Q

1 oC changes CBF ____

A

5 - 7%

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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
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13
Q

14G IV Catheter

[flow rate]

A

240 mL/min

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14
Q

16G IV Catheter

[flow rate]

A

180 mL/min

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15
Q

18G IV Catheter

[flow rate]

A

90 mL/min

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16
Q

1:200,000 mixture of epi corresponds to how much?

A

5 mcg/mL

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17
Q

1st Degree AV Block

[EKG characteristics]

A

PR conduction greater than 0.2 seconds

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18
Q

2-Chloroprocaine

[maximum dose]

A

12 mg/kg

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19
Q

20 mg Cortisol equals _____ Solu-Medrol

A

4 mg

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20
Q

20G IV Catheter

[flow rate]

A

60 mL/min

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21
Q

20mg Cortisol equals _____ Decadron

A

0.75 mg

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22
Q

22G IV Catheter

[flow rate]

A

36 mL/min

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23
Q

24G IV Catheter

[flow rate]

A

20 mL/min

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24
Q

5% Albumin

[osmolality]

A

300

(isotonic)

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25
Q

50 mg of Prednisone equals ______ Decadron

A

7.5 mg

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26
Q

a decrease in pH of 0.1 unit will result in ____ [K+] of ____ mEq/L

A

increase of 0.6 mEq/L

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27
Q

A-line

[cannulation site causing the most thrombi]

A

axillary

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28
Q

Abciximab

[drug class]

A

Glycoprotien IIa/IIIb inhibitor

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29
Q

Achalasia

[definition]

A

failure of smooth muscle to relax which can cause sphinters to remain closed

  • achalasia of the rectum is Hirschsprung’s disease
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30
Q

Acromegaly

[airway considerations]

A

narrow upper airways

(will require smaller ETT)

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31
Q

acute hepatitis

[volatile agents of choice]

A

isoflurane and sevoflurane

  • presevation of hepatic blood flow and oxygen delivery
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32
Q

Acute Kidney Injury

[risk factors (9)]

A
  • age > 65
  • male
  • active CHF
  • ascites
  • hypertension
  • emergency surgery
  • intraperitoneal surgery
  • renal insufficiency
  • diabetes
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33
Q

acute vs recent MI

[time span]

A

acute within 7 days

recent within 30 days

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34
Q

Addison’s Disease

[anesthetic considerations]

A

adequate steroid replacement therapy perioperatively

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35
Q

Addison’s Disease

[etiology]

A

glucocorticoid deficiency

(primary adrenal insufficiency)

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36
Q

Addison’s Disease

[symptoms]

A

hyponatremia and hyperkalemia

hypotension

metabolic acidosis

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37
Q

Adenosine

[drug interactions]

A
  • Dipyrdiamole
    • needs smaller dose of Adenosine
  • competitive antagonists
    • caffeine, theophylline, amrinone
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38
Q

ADP inhiibtor

[example]

A

clopidogrel (plavix)

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39
Q

Adrenal Cortex

[secretions]

A

androgens, mineralcorticoids, and glucocortocoids

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40
Q

Adrenal Cortex

[hormones]

A

aldosterone, cortisol, androgens

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41
Q

Adrenal Medulla

[secretion]

A

catecholamines

(primarily epinephrine)

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42
Q

Adrenal Medulla

[hormones]

A

epinephrine and norepinephrine

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43
Q

Advantage of Milrinone over Amrinone for long term use?

A

thrombocytopenia

  • Amrinone produces clinically significant thrombocytopenia, especially after prolonged use
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44
Q

Agents

[mL of vapor in each mL of liquid]

A

about 200 mL

iso < sevo < des

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45
Q

Albumin

[normal values]

A

3.5 - 5.5 g/dL

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46
Q

Allodynia

[definition]

A

pain caused by a stimulus that does not normally provoke pain

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47
Q

Amyotrophic Lateral Sclerosis

[etiology]

A

rapidly progressive disorder of upper and lower motor neurons

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48
Q

Alveolar Gas Equation solving for PaO2

A

PaO2 = (PB - 47)*FiO2 - (PaCO2/R)

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49
Q

Alveolar O2 Tension (PAO2)

[equation]

A

PAO2 = PiO2 - (PaCO2 / RQ)

  • can estimate by multiplying FiO2 by 6
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50
Q

amphetamines

[effect on MAC]

A

acute use increases MAC, chronic decreases MAC

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51
Q

Amrinone

[drug class]

A

phosphodiesterase III inhibitor

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52
Q

Amrinone

[uses and effects]

A

positive inotropic and vasodilatory

no anti-dysrhythmic effects

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53
Q

Anaphylaxis

[blood test]

A

Tryptase

  • neutral protease released from mast cells during analphyalctic, but not anaphylactoid reactions
  • should be measured within 1 - 2 hours
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54
Q

Anatomic Dead Space

[approximation per kg]

A

2 mL/kg

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55
Q

Anion Gap

[normal value]

A

12 mEq/L +/- 4

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56
Q

Anion Gap

[equation]

A

Na+ - (HCO3- + Cl-)

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57
Q

Anion Gap

[normal values]

A

7 - 16 mEq/L

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58
Q

Ankle Block

[nerves]

A

deep and superficial peroneal

saphenous

posterior tibial

sural

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59
Q

Anterior Pituitary

[hormones]

A

ACTH, FSH, GH, LH, prolactin, and TSH

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60
Q

Anti-arrhythmic most likely to cause thyroid problems

A

Amiodarone

  • chemical structure similar to thyroxine
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61
Q

Anti-Platelets

[3 classes]

A

COX inhibitors

Glycoprotein IIb/IIIa inhibitors

ADP inhibitor

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62
Q

Antibiotics

[which increase neuromuscular blockade]

A

aminoglycosides (strepto-, genta-)

lincosamides (clindamycin)

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63
Q

Anticholinesterase

[which agent crosses BBB]

A

physostigmine

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64
Q

Anticoagulants

[4 classes]

A

direct thrombin inhibitors

indirect thrombin inhibitors

vitamin K reductase inhibitor

direct Xa inhibitor

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65
Q

antithrombin III

[origin of synthesis]

A

liver

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66
Q

Aortic Regurge

[treatment]

A

diuretics and afterload reduction

(ACE inhibitors)

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67
Q

Aortic Regurge

[anesthetic goals]

A

maintian normal to high HR

  • bradycardia and increases in SVR increase regurgitant volume
  • tachycardia can contribute to myocardial ischemia
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68
Q

Aortic Regurge

[arterial waveform]

A

bisferiens pulse

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69
Q

Aortic Regurge

[drugs to avoid]

A

those that increase SVR

(phenylephrine)

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70
Q

Aortic Regurge

[monitoring signs]

A

large v waves on CVP waveform

and

pulsus bisferiens

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71
Q

Aortic Regurge

[pathophysiology]

A

left ventricular eccentric hypertrophy

largest end-diastolic volumes of any heart disease

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72
Q

Aortic Regurgitation

[arterial waveform]

A

bisferiens pulse

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73
Q

Aortic Stenosis

[anesthetic goals]

A

maintain heart rate and vascular resistance with normal to increased preload and afterload

  • avoid bradycardia
    • cardiac output is very rate dependent
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74
Q

aortic stenosis

[loss of atrial systole]

A

can precipitate congestive heart failure or hypotension

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75
Q

Aortic Stenosis

[neuraxial anesthesia]

A

relatively contraindicated

(epidural preferable to spinals)

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76
Q

Aortic Stenosis

[severe transvalvular gradient]

A

above 40 mmHg

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77
Q

Aortic Stenosis

[arterial waveform]

A

pulsus tardus and pulsus parvus

(delayed pulse wave with a diminished upstroke)

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78
Q

Aortic Stenosis

[effects on myocardial supply/demand]

A

increases demand because of hypertrophy

decreases supply due to increased systolic pressures

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79
Q

Aortic Stenosis

[peak velocities on an echo]

A

greater than 4.5 m/sec indicate severe aortic stenosis

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80
Q

Aortic Stenosis

[triad of symptoms]

A

dyspnea, angina, and syncope

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81
Q

Aortocaval Compression

[first occurance during pregnancy]

A

18 - 20 weeks gestation

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82
Q

Apnea-Hypopnea Index

[definition]

A

quantifies the number of apnea episodes that occur per hour

  • apnea defined by periods of 10 seconds or more
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83
Q

Aprepitant

[other effects]

A

anxiolytic and antidepressant

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84
Q

aPTT

[factor(s) tested]

A

VIII and IX

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85
Q

aPTT

[normal values]

A

20 - 40 sec

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86
Q

Alternative to heparin for cardiopulmonary bypass

A

Argatroban

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87
Q

Argatroban

[mechanism of action]

A

direct thrombin inhibitor

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88
Q

Arterial Oxygen Tension

[approximation]

A

120 - Age/3

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89
Q

Artery of Adamkiewicz

[damage results]

A

ischemia for lower 2/3 of spinal cord causing paraplegia

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90
Q

Artery of Adamkiewicz

[origin]

A

T9 - T12

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91
Q

Ascites

[fluid replacement]

A

following removal of ascitic fluid, aggressive intravenous fluid replacement is often necessary to prevent profound hypotension and kidney failure

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92
Q

Ascities

[pathophysiology]

A
  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
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93
Q

Difference between Atracurium and Cisatracurium

A

Atracurium causes histamine release

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94
Q

Atrial Septal Defects

[anesthetic goals]

A

aovid large increases in SVR

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95
Q

Atrial Septal Defects

[common associated problems]

A

congestive heart failure and pulmonary hypertension

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96
Q

Atrial Septal Defects

[common location]

A

fossa ovalis

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97
Q

Autonomic Hyperreflexia

[temporary anesthetic prevention]

A

regional or deep general anesthesia

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98
Q

Autonomic Reflexia

[pathophysiology]

A

stimulation below injury leads to vasoconstriction below transection and a baroreceptor-mediated reflex bradycardia and vasodilation above transection

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99
Q

B-type Natriuretic Peptide (BNP)
[biomaker of which organ?]

A

heart

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100
Q

Balloon Angioplasty

[delay for surgery]

A

14 days

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101
Q

Bare-Metal Stent

[delay for surgery]

A

30 - 45 days

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102
Q

baroreceptor reflex

[effects of volatile agents]

A

depress normal response

  • isoflurane and desflurane seem to have less effect
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103
Q

Baroreceptor Reflex

[response]

A
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104
Q

baroreceptors

[aortic arch innervation]

A

innervated by aortic nerve which then combines with the vagus nerve

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105
Q

baroreceptors

[locations]

A

carotid sinus and aortic arch

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106
Q

baroreceptors

[carotid MAP range]

A

80 - 160 mmHg

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107
Q

baroreceptors

[carotid sinus innervation]

A

sinus nerve of Hering

(branch of the glossopharyngeal nerve)

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108
Q

Bathmotropy

[definition]

A

muscular excitation in response to a stimulus

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109
Q

Beckwith-Wiedemann

[common features]

A
  • macroglossia
  • macrosomia
  • omphalocele
  • hypoglycemia
  • large fontanelles
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110
Q

Beta-2 Agonist

[mechanism of action]

A

increases cAMP

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111
Q

Beta-2 Antagonists

[effects]

A

bronchoconstriction and peripheral vasoconstrction

  • inhibits insulin release and glycogenolysis
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112
Q

Bivalirudin

(angiomax)

[uses]

A

anticoagulant for CPB in patients with HIT type III

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113
Q

Bleomycin

[adverse effet]

A

pulmonary fibrosis

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114
Q

“Bone Cement Implantation Syndrome”

[symptoms]

A

hypotension

arrhythmias

hypoxia (from pulmonary hypertension leading to right-to-left shunting)

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115
Q

Which portion of the upper extremity is NOT innervated by the brachial plexus?

A

posterior medial portion

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116
Q

Bradycardia seen in pediatrics due to Sux is caused by what mechanism?

A

muscarinic stimulations at the sinus node

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117
Q

bronchiectasis

[common cause]

A

recurrent bronchial infections

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118
Q

Bupivacaine

[maximum dose]

A

3 mg/kg

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119
Q

C5 Isoenzyme Variant

[key concepts]

A

increased plasma cholinesterase

shorter duration of succinylcholine

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120
Q

Ca2+ ionized

[normal values]

A

4.65 - 5.28 mg/dL

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121
Q

Ca2+ total

[normal values]

A

8.5 - 10.5 mg/dL

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122
Q

Calcitonin

[effect on kidney]

A

decreases reabsorption of calcium and phosphate

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123
Q

Calcitonin

[effect on bone]

A

inhibits osteoclastic reabsorption

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124
Q

Carbonic Anhydrase Inhibitor

[mechanism of action]

A

inhibiots HCO3- and Na+ reabsorption

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125
Q

Carcinoid Syndrome

[clinical manifestations]

A

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”
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126
Q

Carcinoid Syndrome

[etiology]

A

secretion of vasoactive substances from an enteroepinephrine tumor (carcinoid)

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127
Q

Carcinoid Syndrome

[principal mediators]

A

serotonin

kallikren

histamine

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128
Q

Cardiac Action Potential

[phase 0 - cellular ion movement]

A

Na+ entry and decreased K+ permeability

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129
Q

Cardiac Action Potential

[phase 0 - event]

A

activation of voltage-gated Na+ channels

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130
Q

Cardiac Action Potential

[phase 1 - cellular ion movement]

A

K+ out

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131
Q

Cardiac Action Potential

[phase 1 - event]

A

inactivation of Na+ channels

transient increase in K+ permeability

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132
Q

Cardiac Action Potential

[phase 2 - cellular ion movement]

A

Ca2+ entry

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133
Q

Cardiac Action Potential

[phase 2 - event]

A

activation of slow Ca2+ channels

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134
Q

Cardiac Action Potential

[phase 3 - cellular ion movement]

A

K+ out

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135
Q

Cardiac Action Potential

[phase 3 - event]

A

inactivation of Ca2+ channels

increased permeability to K+

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136
Q

Cardiac Action Potential

[phase 4 - cellular ion movement]

A

K+ and Ca2+ in

Na+ out

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137
Q

Cardiac Action Potential

[phase 4 - event]

A

normal permeability restored

intrinsic leak of Ca2+ into cells

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138
Q

Cardiac Output

[changes in obesity]

A

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
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139
Q

Cardiac Output

[Fick’s Equation]

A

(CaO2 - CvO2) * 10

  • VO2 can be approximated by 4 mL/kg
  • CO2 = (1.36*Hb*SaO2) + (0.003*PaO2)
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140
Q

(6) Cardiac Risk Factors

(prediction of cardiac risk of non-cardiac surgery)

A
  • high-risk surgery
  • ischemic heart disease
  • congestive heart failure
  • cerebrovascular disease
  • diabetic insulin therapy
  • creatinine > 2 mg/dL
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141
Q

Cardiac Surgery

[post-operative hypertension cause]

A

possible denervation of carotid baroreceptors

  • denervation of carotid body blunts the ventilatory response to hypoxemia
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142
Q

Cardiac sympathetic fibers

[origin]

A

T1 - T4

  • travel to the heart through cervical (stellate) ganglia and from the ganglia as cardiac nerves
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143
Q

cardiac tamponade

[arterial waveform]

A

pulsus paradoxus

(exaggerated inspiratory decline in systolic BP)

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144
Q

Cardiac Tamponade

[arterial wave form]

A

pulsus paradoxus

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145
Q

Cardiac Tamponade

[CVP waveform]

A

loss of y-descent

may also have an accentuated x-descent

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146
Q

Cardiac Tamponade

[definition]

A

accumulation of fluid in pericardial space

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147
Q

Cardiac Tamponade

[hemodynamic features]

A

decreased cardiac output and stroke volume

increase in CVP

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148
Q

Cardiac Tamponade

[signs and symptoms]

A

tachycardia

sudden hypotension

jugular venous distention

muffled heart shounds

pulsus paradoxus

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149
Q

Cardiac Tamponade

[ventilation]

A

must maintain spontaneous ventilation

  • positive pressure ventilation can further reduce preload, causing hypotension and possible cardiac arrest
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150
Q

Cardiac Tamponde

[hemodynamic goals]

A

increased preload, afterload, and HR

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151
Q

Cardiopulmonary Bypass

[signs of incorrect positioning of aortic cannula]

A

unilateral facial blanching

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152
Q

Cardiopulmonary Bypass

[signs of incorrect positioning of venous cannula]

A

facial edema

(bulging sclera)

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153
Q

Catecholamines

[activate which receptors?]

A

adrenergic

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154
Q

Central Chemoreceptors

[mechanism of action]

A

respond to changes in CSF [H+]

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155
Q

Central Line

[location with lowest risk of infection]

A

subclavian vein

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156
Q

Central Line

[risks of left IJ not seen in right cannulation]

A

damage to thoracic duct

  • left IJ also has a more direct and less winding path to the superior vena cava
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157
Q

Central Pontine Myelinolysis

[cause]

A

rapid correction of hyponatremia

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158
Q

Cerebral Autoregulation

[CPP range]

A

50 - 150 mmHg

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159
Q

Cerebral Autoregulation

[definition]

A

intrinsic capability of the cerebral vasculature to adjust its resistance to maintain CBF constant over a wide range of MAPs

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160
Q

cerebral blood flow

[autoregulation during ischemia]

A

no autoregulation, flow directly dependent upon CPP

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161
Q

Cerebral Blood Flow

[correlation to PaCO2]

A

directly proportional between 20 - 80 mmHg

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162
Q

Cerebral Blood Flow

[effect by temperature]

A

5% per 1oC in temperature

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163
Q

Cerebral Blood Flow

[Normal range]

A

50 mL/100g/min

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164
Q

Cerebral Blood Flow

[rate at which EEG becomes isoelectric]

A

less than 15 mL/100g/min

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165
Q

cerebral blood flow

[rate at which ischemia appears on EEG]

A

less than 22 mL/100g/min

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166
Q

Cerebral Blood Flow

by what percentage does CBF change for each mmHg increase in PaCO2?

A

2%

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167
Q

Cerebral Blood Flow

[autoregulation]

A

maintained between MAPs of 60 - 160 mmHg

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168
Q

Cerebral Mass Lesions

[induction technique]

A

Propofol with hyperventilation

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169
Q

Cerebral Metablic Rate

[change for each 1oC decrease]

A

6%

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170
Q

Cerebral Metabolic Rate

[normal rate]

A

3 mL/100g/min

(50 mL/min)

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171
Q

Cerebral Oxygen Consumption

[normal rate]

A

3 mL/100g/min

  • greatest in the grey matter of the cerebral cortex, generally parallels electrical activity
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172
Q

Cerebral Oxygen Delivery

[optimal hematocrit]

A

30%

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173
Q

Cerebral Perfusion Pressure

[autoregulation]

A

decreases in CPP result in cerebral vasodilation

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174
Q

Cerebral Perfusion Pressure

[at what pressures can disrupt the BBB}

A

150 - 160 mmHg

  • may result in cerebral edema and hemorrhage
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175
Q

Cerebral Perfusion Pressure

[normal range]

A

80 - 100 mmHg

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176
Q

Cerebral Perfusion Pressure

[equation]

A

MAP - ICP

(or -CVP if greater than ICP)

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177
Q

Cerebral Perfusion Pressure

[normal range]

A

80 - 100 mmHg

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178
Q

Cerebral Protection

[hypothermia]

A

decreases both basal and electrical metabolic requirements throughout the brain

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179
Q

Cerebral Salt Wasting Syndrome

[triad of symptoms]

A

hyponatremia

volume contraction

high sodium content in urine

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180
Q

Cerebral Salt Wasting Syndrome

[treatment]

A

isotonic or hypertonic saline

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181
Q

Cerebrospinal Fluid

[pathway through ventricles]

A

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

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182
Q

Chronic Bronchitis

[definition]

A

productive cough for 3 consecutve months for at least 2 years

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183
Q

Chvostek’s Sign

[definition]

A

painful twitching of the facial musculature following tapping of facial nerve

  • result of hypocalcemia
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184
Q

Cirrhosis

[coagulopathies]

A

hyperfibrinolysis

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185
Q

Cirrhosis

[physiologic changes]

A

increased cardiac output

low peripheral vascular resistance

increased intravascular volume

  • avoid vasodilators (milrinone)
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186
Q

Clonidine

[drug class]

A

alpha-2 agonist

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187
Q

Clopidogrel

[antidote]

A

platelets

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188
Q

Clopidogrel

[delay of surgery]

A

5 - 10 days

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189
Q

Clopidogrel

[mechanism of action]

A

ADP receptor blocker

(adenosine diphosphate)

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190
Q

Closing of the tricuspid valve is represented by what on the CVP?

A

C wave

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191
Q

Clotting Factors

[which has the shortest half-life]

A

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
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192
Q

CO poisoning

[half-life in HBO]

A

15 - 30 minutes

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193
Q

CO poisoning

[half-life on room air]

A

4 - 6 hours

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194
Q

CO poisoning

[half-life with 100% oxygen]

A

1 hour

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195
Q

Which gas is most soluble in water?

(CO2,N2, O2, air)

A

CO2

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196
Q

CO2

[tank color]

A

gray

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197
Q

Coagulation Factors

[factors not produced by the liver]

A

VIII and von Willebrand

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198
Q

Coagulation Factors

[vitamin K dependent]

A

prothrombin (factor II), and factors VII, IX, and X

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199
Q

Coagulation Test Abnormalities

[Factor VII deficiency]

A

increased PT

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200
Q

Coagulation Test Abnormalities

[Hemophilia]

A

increased PTT

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201
Q

Coagulation Test Abnormalities

[heparin therapy]

A

greatly increased PTT

increased PT

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202
Q

Coagulation Test Abnormalities

[vitamin K deficiency]

A

greatly increased PT

increased PTT

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203
Q

Cocaine

[which induction drugs should be avoided]

A

ketamine and pancuronium

potentiate cardiovascular toxicity

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204
Q

Codeine

[metabolism]

A

enzyme CYP2D6

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205
Q

Complex Regional Pain Syndrome

[difference between I and II]

A

Type II has a known etiology

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206
Q

Complex Regional Pain Syndrome

[features]

A

burning and continuous pain

cool, red, clammy skin

hair loss

atrophy and osteoporosis

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207
Q

Compression Factor

[definition]

A

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

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208
Q

Compression Factor

[equation]

A

[(MVdelivered - MVmeasured) / RR )] divided by PIP

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209
Q

Conn’s Syndrome

[clinical features]

A

hyperaldosteronism

hypertension and low blood potassium levels

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210
Q

Constrictive Pericarditis

[associated problems]

A

jugular venous distension

hepatomegaly

ascites

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211
Q

Conus Medullaris

[definition]

A

end of the spinal cord

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212
Q

Coronary Perfusion Pressure

[equation]

A

arterial diastolic pressure - LVEDP

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213
Q

Coronary Perfusion

[characteristics]

A

LV perfused almost entirely during diastole

RV perfused during both

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214
Q

Correlation of Cr to GFR

A

inversely proportional

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215
Q

Corticospinal Tract

[type of pathway]

A

motor

  • therefore is not involved in SSEP transmission
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216
Q

Cranial Mass Lesions

[premedication]

A

avoid sedative and opioids

  • risk of hypercapnia secondary to respiratory depression increasing ICP
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217
Q

Creatinine

[normal values]

A

0.6 - 1.2 mg/dL

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218
Q

Cricothyroid Muscle

[innervation]

A

external branch of the superior laryngeal

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219
Q

Cromolyn

[drug class]

A

mast cell stabilizer

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220
Q

Croup

[signs and symptoms]

A

inspiratory stridor

mild fever

age < 2 yo

rhinorrhea

“barking cough”

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221
Q

CSF volume is _____ to spinal level

A

inversely related

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222
Q

Cushing’s Response

[definition]

A

increases in BP with bradycardia due to increases in ICP

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223
Q

Cushing’s Response

[definition]

A

increased ICP resulting in increased blood pressure, irregular breathing, and bradycardia

(cushing’s triad)

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224
Q

Cushing’s Syndrome

[etiology]

A

excess glucocorticoids

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225
Q

Cushing’s Syndrome

[anesthetic considerations]

A

patients may be volume overloaded and have hypokalemic metabolic alkalosis

  • careful positioning due to osteoporosis
  • may require supplemental steroids
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226
Q

Cushing’s Syndrome

[symptoms]

A

muscle wasting and weakness

osteoporosis

central obesity

glucose intolerance

hypertension

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227
Q

Cutaneous innervation of the plantar surface

[which nerve]

A

posterior tibial

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228
Q

Guess this disorder:

premature infant that is cyanotic but is relieved by coughing

A

choanal atresia

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229
Q

Dalteparin

[delay for neuraxial anesthesia]

A

if low dose, for thromboprophylaxis, 12 hours

if high dose, to treat DVT, 24 hours

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230
Q

Dantrolene

[expected side effects]

A

diuresis

  • formulated with mannitol to promote diuresis
  • myoglobinuria accumulates in renal tubules and can cause kidney failure if urine output is not maintained
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231
Q

dead space

[average mL/kg]

A

2 mL/kg

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232
Q

Deadspace

[explain the difference between etCO2 and arterial PaCO2]

A

due to lack of gas exchange, etCO2 will be less than from an arterial blood gas

  • examples:
    • morbid obesity, pulmonary embolism, and COPD
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233
Q

Defibrillation

[joules/kg]

A

2 joules/kg

  • second dose should be 4 joules/kg
  • do not exceed 10 joules/kg or 100 joules
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234
Q

Defibrillators

[biphasic vs. monophasic]

A

biphasic require lower energy for equally effective defibrillation

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235
Q

Demeclocycline

[uses]

A

antibiotic that interferes with ADH

often used for treatment of SIADH

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236
Q

Dermatomes

[level of C6]

A

Thumb

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237
Q

Desflurane

[cardiovascular effects]

A

increased HR

decrease SVR and CI

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238
Q

Diabetes - Type II

[definition]

A

insulin resistance

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239
Q

Diabetes - Type I

[definition]

A

insulin deficiency

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240
Q

Diabetes Insipidus

[signs and symptoms]

A

hypernatremia

hyperosmolality

polyuria

urine hypoosmolality

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241
Q

Diabetes Insipidus

[treatment]

A

hypotonic saline and vasopressin

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242
Q

Diabetes

[triad of symptoms]

A

polyuria, polydipsia, and polyphagia

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243
Q

Diabetic Ketoacidosis

[initial treatment]

A

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
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244
Q

Diastolic Dysfunction

[Pressure-Volume Loop]

A
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245
Q

heart failure with normal ejection fraction

A

diastolic heart failure

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246
Q

Diastolic Heart Failure

[definition]

A

failure of the left ventricle to relax during diastole

  • signs and symptoms of heart failure without a decrease in ejection fraction
  • problem with filling
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247
Q

DIC

[pathophysiology]

A

activation of coagulation cascade by the release of thromboplastin or by direct activation of factor XII

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248
Q

Digoxin

[cardiac effects]

A

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
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249
Q

Diltiazem

[dose for irregular-narrow tachycardia]

A

0.25 mg/kg

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250
Q

Direct Thrombin Inhibitors

[examples]

A

argatroban

dabigatran (pradaxa)

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251
Q

Direct Xa inhibitor

[examples]

A

ribaroxiban (xarelto)

apixaban (eliquis)

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252
Q

Dopamine

[infusion rate]

A

2 - 10 mcg/kg/min

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253
Q

Down Syndrome

[common cardiac problems]

A

atrioventricular septal defects

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254
Q

Dromotropy

[definition]

A

rate of transmission of cardiac nerve impulses

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255
Q

Droperidol

[treatment for which disorder]

A

Wolff-Parkinson-White

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256
Q

Drug-Eluting Stent

[delay for surgery]

A

1 year

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257
Q

Duloxetine

(cymbalta)

[drug class]

A

selective serotonin and norepinephrine reuptake inhbitor (SNRI)

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258
Q

dural sac

[extends to what length]

A

S2

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259
Q

Average blood loss for vaginal delivery

A

400 - 500 mL

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260
Q

Ebstein’s Anomaly

[definition]

A

abnormal placement of leaflets on tricuspid valve

  • congenital heart defect
  • blood leaks back through the valve into the right atrium
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261
Q

ECT

[ways to increase seizure duration]

A

hyperventilation

intravenous caffeine (125-250 mg)

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262
Q

ECT

[contraindications]

A

recent myocardial infarction

recent stroke

intracranial mass

increased ICP

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263
Q

ECT
[seizure activity measurement without EEG]

A

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
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264
Q

Electroencephalography

[which agents produce burst suppression]

A

Desflurane and Sevoflurane

(> 1.2 and 1.5 MAC)

  • do not produce electrical silence
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265
Q

Eisenmenger Syndrome

[definition]

A

long-standing left-to-right cardiac shunt causes pulmonary hypertension and eventually reverses the shunt to a cyanotic right-to-left shunt

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266
Q

Eisenmenger Syndrome

[effect on PaO2]

A

larger shunt fraction and therefore lower PaO2

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267
Q

EKG

[each large box represents how many seconds]

A

0.2 sec

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268
Q

EKG

[leads showing myocardial ischemia in circumflex coronary artery]

A

I and aVL

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269
Q

EKG

[leads showing myocardial ischemia in LAD]

A

V3 - V5

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270
Q

EKG

[leads showing myocardial ischemia in RCA]

A

II, III, and aVF

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271
Q

Elevated ICP

[preferred agent]

A

Sevoflurane

  • preserves autoregulation of CBF and produces limited vasodilation
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272
Q

Elevated ICP

[ventilation strategies]

A

maintain PaCO2 between 30-35 mmHg

  • avoid PEEP and high airway pressures
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273
Q

emergent patient with C7 spinal cord transection due to MVA

[anesthesia concerns]

A

risk of hypothermia

  • lack thermoregulation below level of injury
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274
Q

EMLA cream

[components]

A

2.5% lidocaine and 2.5% prilocaine

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275
Q

Emphysema

[genetic cause]

A

alpha-antitrypsin deficiency

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276
Q

ephedrine

[cocaine]

A

avoid ephedrine in acute cocaine intoxication

(may not work in chronic users due to depleted catecholamine)

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277
Q

Epidural

[what makes the “snap”]

A

ligamentum flavum

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278
Q

Epiglottitis

[signs and symptoms]

A

inspiratory stridor

age between 2 and 6

rapid onset < 24 hours

high fever

difficulty swallowing

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279
Q

Epinephrine

[max dose]

A

5 ug/kg

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280
Q

Equation for amount of PRBC to increase Hct

A

EBV * (Hctdesired - Hctstarting) divided by Hct of PRBC

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281
Q

Esters

[intrathecal injection]

A

depends on redistribution

  • CSF lacks esterase enzymes
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282
Q

Esters

[metabolism]

A

pseudocholinesterase

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283
Q

ESWL

[dermatome spinal level]

A

T6

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284
Q

Etiology behind SIADH, DI, and Cerebral salt wasting syndrom

A
  • 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
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285
Q

Etomidate

[effect on SSEPs]

A

increases amplitude and latency

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286
Q

expiratory reserve volume

[average adult value]

A

1100 mL

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287
Q

Extension of the neck can cause _____ displacement of the tube

A

cephalad

will go into the pharynx

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288
Q

Factor VIII

[how much to give]

A

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
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289
Q

Fat Embolism Syndrome

[triad of symptoms]

A

dyspnea, confusion, and petechiae

(usually occurs within 72h following long-bone fracture)

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290
Q

FDA Pregnancy Ratings

[Class A]

A

controlled studies show no risk

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291
Q

FDA Pregnancy Ratings

[Class B]

A

no evidence of risk in humans

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292
Q

FDA Pregnancy Ratings

[Class C]

A

risk cannot be ruled out

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293
Q

FDA Pregnancy Ratings

[Class D]

A

positive evidence of risk

  • examples: midazolam and diazepam
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294
Q

FDA Pregnancy Ratings

[Class X]

A

contraindicated in pregnancy

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295
Q

Femoral Nerve

[origin]

A

L2 - L4

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296
Q

Femoral Nerve

[needle stimulation]

A

quad contraction with patellar elevation

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297
Q

Fenoldopam

[similar alternative drug]

A

Sodim Nitroprusside

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298
Q

Fetal Heart Rate

[early decels]

A

fetal head compression causing vagal stimulation

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299
Q

Fetal Heart Rate

[normal range]

A

110 - 160 bpm

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300
Q

Fetal hemoglobin has a _____ affinity for O2 than does maternal Hgb

A

greater

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301
Q

Fetal Hemoglobin

[P50 at term]

A

18 mmHg

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302
Q

Maximum FiO2 that can be administered to a mother without increasing the risk of retinopathy of prematurity

A
  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
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303
Q

FEV1/FVC

[definition]

A

ratio of the forced expiratory volume in the first second of exhalation to the total forced vital capacity

  • effort dependent
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304
Q

FEV1/FVC

[normal value]

A

greater than 80%

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305
Q

Find the Left Ventricle peak pressure

peak velocity of 4 m/sec

BP of 130/80

A

4 * V2

4 * 42 = 64

64 * systolic pressure = peak pressure

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306
Q

First sign of magnesium toxicity

A

decreased deep tendon reflexes

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307
Q

Fluoxetine

(Prozac)

[considerations]

A

potent inhibitor of CYP2D6 enzymes

  • codeine, oxycodone, and hydrocodone will not work
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308
Q

Fondaparinux

{arixtra)

[mechanism of action]

A

factor Xa antagonist

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309
Q

Fontan Procedure

[cardiac anomolaies]

A

used to treat decreases in pulmonary blood flow

Pulmonary atresia, stenosis, tricuspid atresia, and hypoplastic left heart syndrome

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310
Q

Fontan Procedure

[definition]

A

anastomosis of the right atrial appendage to the PA

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311
Q

Fulminant Hepatic Failure

[definition]

A

a. k.a. acute liver failure
* usually from viral hepatitis or a hepatotoxin

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312
Q

Functional Residual Capacity

[composed of which lung volumes?]

A

expiratory reserve and residual volume

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313
Q

Gastroschisis

[definition]

A

herniation lateral to umbilicus which is not contained in a sac

  • higher risk of hypothermia and infection compared to omphalocele
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314
Q

GFR < 25 mL/min

[state of renal health]

A

overt renal failure

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315
Q

GFR of 30 mL/min

[current state of renal health]

A

moderate renal insufficiency

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316
Q

GFR of 40 - 60 mL/min

[state of renal health]

A

mild renal insufficiency

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317
Q

GFR

[at what age does function reach that of adult]

A

2 years

  • 30% at birth
  • 50% by 10 days of life
  • 75% by 6 months
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318
Q

Sensory innervation to the pharyngeal walls and the tonsils

A

glossopharyngeal nerve

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319
Q

Glottis

[level in the adult vs pediatric]

A

pediatric C3

adult C5

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320
Q

Glucose

[normal value]

A

90 - 120 mg/dL

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321
Q

Glycoprotein IIb/IIIa inhibitor

[examples]

A

abciximab

eptifibatide

tirofiban

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322
Q

Guillain-Barre Syndrome

[definition]

A

sudden onset of ascending motor paralysis, areflexia, and paresthesias

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323
Q

Halothane has a similar vapor pressure to which other volatile agent?

A

Isoflurane

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324
Q

Halothane

[cardiovascular changes]

A

no change in HR or SVR

decreased CI

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325
Q

Heart Failure

[compensatory mechanisms]

A

increased preload

activation of sympathetic nervous system

renin-angtiotensin-aldosterone system

increased release of AVP

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326
Q

Heart Rate

[effects on diastolie]

A

increases in HR reduces diastole more than systole

  • impaired ventricular filling at HR > 120 beats/min
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327
Q

Heart Rate

[equation for normal intrinsic rate]

A

118 - (0.57 x age)

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328
Q

Heart Rate

[receptors slowing rate]

A

M2 cholinergic receptors

  • enhanced vagal activity slows the heart rate via stimulation of M2 cholinergic receptors
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329
Q

Heart Transplant

[anesthetic management]

A

direct-acting agents

  • isoproterenol or epinephrine should be readily available
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330
Q

Heart Transplant

[EKG]

A

usually two sets of P-waves

one represents the recipient’s own SA node (which is left intact) and the other representing the donor’s SA node

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331
Q

Heart Transplant

[innervation]

A

no direct autonomic influences

  • absence of vagal influences causes a relatively high resting heart rate (100-120 bpm)
  • myocardial ischemia is often silent
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332
Q

Hematocrit

[normal range]

A

35 - 50%

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333
Q

Hemoglobin Dissociation Curve

[rightward shift]

A

lowers O2 affinity making more oxygen available to the tissues

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334
Q

Hemoglobin

[average for full-term infant]

A

15 - 20 g/dL

can drop down to 10 g/dL at 2-3 months

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335
Q

Hemoglobin

[normal P50]

A

26 mmHg

  • P50 is the PaO2 required to produce 50% saturation of hemoglobin
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336
Q

Hemoglobin

[normal range]

A

12 - 18 g/dL

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337
Q

Hemolytic Uremic Syndrome

[key concepts]

A

most common acquired causes of acute renal failure

  • often caused by E. coli
  • Triad:
    • hemolytic anemia
    • thrombocytopenia
    • acute nephropathy
  • treated with dialysis
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338
Q

Hemophilia A

[missing clotting factor]

A

factor VIII

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339
Q

Hemophilia A

[coagulation test]

A

PTT

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340
Q

Hemophilia B

[missing clotting factor]

A

IX

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341
Q

Heparin Resistance

[cause]

A

anti-thrombin III deficiency

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342
Q

Heparin Resistance

[treatment]

A

fresh frozen plasma or recombinant anti-thrombin III

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343
Q

Hepatorenal Syndrome

[intraoperative management]

A

colloid infusions rather than crystalloid

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344
Q

Hetastarch

[anticoagulant mechanism]

A

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
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345
Q

Hgb A1C

[normal values]

A

5.0 - 7.5 %

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346
Q

Primary cause of severe hypotension with high spinal

A

Decreased CO secondary to decreased preload

  • sympathetic blockade, venodilation, arterial dilation, and a decrease in HR all contribute to hypotension
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347
Q

HIV treatmet drugs (-avir)

[drug interactions]

A

increased sensitivity to midazolam

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348
Q

How does acetazolamide work in opthalmology?

A

inhibits carbonic anhydrase

decreases the production of aqueous humor and lowers the intraocular pressure

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349
Q

how long should surgery be delayed after a stroke?

A

4 - 6 weeks

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350
Q

what percentage of receptors may still be blocked during a “5-sec head lift”

A

50%

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351
Q

How would a right mainstem intubation affect the rate of increase in arterial partial pressure of volatile agents?

A

reduced for poorly soluble agents

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352
Q

Hunt and Hess grading scale

[uses]

A

classifies severity of subarachnoid hemorrhage

  • ranges from I - V
    • 1 - asymptomatic
    • V - deep coma
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353
Q

Huntington’s Disease

[considerations]

A

decreased levels of pseudocholinesterase

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354
Q

Huntington’s Disease

[definition]

A

inherited disorder of brain cell death

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355
Q

Hydralazine

[associated disorder]

A

systemic Lupus erythematosus

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356
Q

Hyperbaric Oxygen Chamber

[effect on MAC]

A

decrease

  • increase in partial pressure of agents at higher barometric pressures
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357
Q

Hypercalcemia

[potential causes]

A
  • decreased renal Ca excretion
  • hyperthyroid or parathyroid
  • vitamin D intoxication
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358
Q

Hypercalcemia

[treatment]

A

fluid load with normal saline

diuresis with lasiix

[also pamidronate (Aredia) or etidronate (Didronel)]

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359
Q

p-wave flattening, wide QRS, and peaked t-waves

[electrolyte disorder]

A

hyperkalemia

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360
Q

Hyperkalemia

[potential causes]

A
  • Acute/chronic renal failure
  • hypoaldosteronism
  • spironolactone
  • RAAS inhibitors
  • succinylcholine
  • acidosis
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361
Q

Hyperkalemia

[EKG changes]

A

peaked t-waves

wide and low p-waves

fusion of QRS and t-waves

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362
Q

Hypernatremia

[potential causes]

A
  • diabetes insipidus
  • diarrhea
  • osmotic/loop diuretic
  • hyperaldosteronism
  • Cushing’s syndrome
  • IV HCO3
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363
Q

Hyperosmolar Hyperglycemic State

[most likely candidates]

A
  • greater than 65 y.o.
  • type II diabetic
  • blood glucose > 600
  • serum osmolality > 320
  • lethargic, polyuria, polydipsia
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364
Q

Hyperosmolar Nonketotic Coma

[definition]

A

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
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365
Q

Hypersensitivity Reactions

[Type 1]

A

involves antigens and IgE

  • release of basophils and mast cells with the release of histamine
  • examples: anaphylaxis
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366
Q

Hypersensitivity Reactions

[Type 2]

A

anti-body dependent and cell-mediated

  • ABO incompatibility
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367
Q

Hypersensitivity Reactions

[Type 3]

A

immune-complex reactions

  • antigens and antibodies combine to form insoluble complexes which deposit in microvasculature
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368
Q

Hypersensitivity Reactions

[Type 4]

A

delayed reaction involving antigens and lymphocytes

  • involves killer T-cells
  • example: contact dermatitis and transplant rejection
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369
Q

Hyperthyroid

[best induction drug]

A

thiopental

  • decreases conversion of T4 to T3
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370
Q

Hypertrophic Obstructive Cardiomyopathy

[best pressure support choice]

A

phenylephrine

  • direct acting vasoconstrictor with minimal cardiac effects
  • levophed, milrinone, dopamine, and dobutamine are relatively contraindicated
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371
Q

Why would you hyperventilate during local anesthetic toxicity?

A

hyperventilation induces alkalosis and converts local anesthetics to the pronated (ionized) form, which is less likely to corss the cell membrane

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372
Q

Hypocalcemia

[EKG changes]

A

QTc prolongation

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373
Q

Hypocalcemia

[potential causes]

A
  • hypoparathyroidism
  • rapid blood transfusion
  • malabsorption
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374
Q

Hypokalemia

[potential causes]

A
  • diuretics
  • mineralcorticoids
  • trauma
  • beta agonists
  • insulin
  • hypercalcemia or hypomagnesemia
  • alkalosis
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375
Q

Hypokalemia

[EKG changes]

A
  • prolonged PR
  • T-wave flattening
  • ST segment depression
  • increased P-wave amplitdue
  • increasingly prominent U-wave
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376
Q

Hypomagnesemia

[EKG changes]

A

tall t-waves with depressed ST segment

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377
Q

Hyponatremia

[effect on MAC]

A

increase MAC requirement

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378
Q

Hyponatremia

[potential causes]

A
  • renal tubular acidosis
  • hypoaldosteronism
  • vomitting
  • SIADH
  • hypothyroidism
  • cortisol deficiency
  • CHF
  • cirrhosis
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379
Q

Hyponatremia

[3% NaCl equation for correction]

A

kg * 0.6 * (Nadesired - Nacurrent)

(total body water) * (Na - Na)

  • gives the mEq/L amount
  • infuse no faster than 100 mL/hour
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380
Q

hypoparathyroidism secondray to parathyroid removal will result in hypocalcemia how many hours post-op?

A

24 - 72 hours

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381
Q

Hypoplastic Left Heart Syndrome

[anatomical anomalies]

A

aortic valve atresia and underdevelopment of the left ventricle

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382
Q

Hypotension following TURP

[differential diagnosis]

A
  • hemorrhage
  • TURP syndrome
  • bladder perforation
  • myocardial infarction
  • septicemia
  • DIC
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383
Q

Hypovolemic shock

[hemodynamic changes]

A

low cardiac output caused by decreased preload from hypovolemia and low LVDP

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384
Q

Hypoxemia

[5 causes]

A

low FiO2

hypoventilation

right-to-left shunt

V/Q mismatch

diffusion abnormality

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385
Q

Hypoxia

[effect on MAC]

A

decreases MAC requirement

  • PaO2 less than 38 or severe anemia will decrease MAC
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386
Q

Hypoxic Pulmonary Vasoconstriction

[definition]

A

local response of pulmonary arterial smooth muscule that decreases blood flow in the presence of low alveolar oxygen pressure

(maintains normal V/Q relationships by diverting blood from underventilated areas)

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387
Q

Ibuprofen

[length of anti-platelet effect]

A

3 days

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388
Q

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?

A

obturator nerve

389
Q

inability to adduct the leg; diminished sensation over the medial side of the thigh

[nerve injury]

A

obturator

390
Q

Indirect Thrombin Inhibitors

[examples]

A

heparin

fondaparinux (arixtra)

391
Q

Indirect-acting sympathomimetics

[how it works]

A

enter neurons and displace norepinephrine from postganglionic sympathetic nerve fibers

392
Q

Inhalation of CO2 increases Ve by _____

A

2 - 3 L/min/mmHg

393
Q

Innervation of Heart

[“sidedness”]

A

right sympathetic and right vagus nerves affect SA node

left sympathetic and vagus nerve affects AV node

394
Q

inspiratory reserve volume

[average adult value]

A

3000 mL

395
Q

Inspiratory stridor in children

[possible causes]

A

80% croup

5% epiglottitis

396
Q

Insulin

[glucose change from 1 unit]

A

25 - 30 mg/dL

397
Q

Insulin

[(2) fast examples]

A

lispro and aspart

398
Q

When performing an interscalene block, you note diaphragmatic movement. You should now _____

A

redirect needle in a posterior direction

399
Q

interscalene block

[nerve spared]

A

ulnar nerve

400
Q

Intra-Aortic Balloon Pump

[inflation should occur at what time]

A

diastole

immediately after closure of aortic valve

401
Q

Intracranial Hypertension

[range]

A

above 15 mmHg

402
Q

Intracranial Hypertension

[mmHg]

A

above 15 mmHg

403
Q

Intracranial Pressure

[definition]

A

supratentorial CSF pressure measured in the lateral ventricles

404
Q

Intracranial Pressure

[normal range]

A

10 mmHg or less

405
Q

Intraocular Gas Expansion

[avoidance of nitrous]

A

N2O must be discontinued 15 min prior to bubble

avoid for 5-10 days after surgery

406
Q

Intraocular Pressure

[normal range]

A

12 - 20 mmHg

407
Q

Ischemic Heart Disease

[common causes]

A

coronary arterial vasospasm or thrombosis

severe hypertension or tachycardia

aortic stenosis or regurge

hypoxemia or anemia

408
Q

Isoflurane

[cardiac output]

A

will not reduce CO at MAC < 1

  • unlike the other agents
409
Q

IV contrast induced AKI

[prophylaxis treatment]

A

N-acetylcysteine

410
Q

IV dye acts like what diuretic?

A

Mannitol

411
Q

Ketamine

[IM dose]

A

3 - 5 mg/kg

412
Q

Kidney Stones

[medical management]

A

alpha blockers (Flomax, Cardura, Hytrin)

or

CCB (nifedipine)

413
Q

Korsakoff’s Syndrome

[definition]

A

acute onset of severe memory impairment without any dysfunction in intellectual abilities

414
Q

Korsakoff’s Syndrome

[prevention]

A

Vitamin B supplements

415
Q

Lactated Ringers

[components]

A

Na, Cl, Ca, K, and lactage

416
Q

Lactated Ringers

[osmolality]

A

272

(isotonic)

417
Q

largest vertebral interspace

A

L5 - S1

418
Q

Lasers

[amber glasses]

A

required for argon and krypton

419
Q

Lasers

[glasses for CO2]

A

clear

420
Q

Lasers

[green glasses]

A

Nd:YAG

(red glasses for potassium titanyl phosphare:Nd:YAG)

421
Q

Left Atrial Hypertrophy

[EKG changes]

A

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
Q

Left Ventricular Assist Device

[monitoring considerations]

A

unable to measure BP with cuff

  • non-pulsatile flow, even pulse ox can be difficult
423
Q

Left Ventricular Hypertrophy

[EKG leads showing ST abnormalities]

A

I, aVL, and V4-V6

424
Q

Left Ventricular Hypertrophy

[common cardiac finding]

A

S4 gallop

425
Q

Left Ventricular Hypertrophy

[common causes]

A

hypertension and aortic stenosis

426
Q

Left-Sided Heart Failure

[definition]

A

failure to properly pump blood out to the body

(can be systolic or diastolic)

427
Q

Left-to-Right Shunting

[congenital defects]

A

ventricular and atrial septal defects

patent ductus arteriosus

428
Q

Left-to-Right Shunt

[effect on volatile agents]

A

no effect

429
Q

Level of blockade for Orchiectomty

A

T10

430
Q

Lidocaine

[coagulation effects]

A

decreases platelet aggregation while enhancing fibrinolysis

431
Q

Lidocaine

[maximum dose with epinephrine]

A

7 mg/kg

432
Q

Lidocaine

[maximum dose]

A

4.5 mg/kg

433
Q

Lithotripsy

[contraindication]

A

inability to position the patient so that lung and intestine are away from the sound wave

434
Q

Lithotripsy

[regional concerns]

A

T6 sensory level

(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
Q

Liver Transplant

[anhepatic phase procedure]

A

vessels are clamped and liver is completely excised

436
Q

Liver Transplant

[neohepatic or postanhepatic procedure]

A

revascularization and biliary reconstruction

437
Q

Liver Transplant

[preanhepatic procedure]

A

liver is dissected so that it remains attached only by the inferior vena cava, portal vein, hepatic artery, and common bile duct

438
Q

Liver

[synthesis of which coagulation factors]

A

III, IV, and VIII

antithrombin III

protein C and S

439
Q

LMWH

[anticoagulation test]

A

Anti-Xa Assay

440
Q

Local Anesthetic Toxicity

[drugs to avoid]

A

vasopressin

CCB

beta blockers

epinephrine > 1 ug/kg

441
Q

Local anesthetics

[addition of Bicarb]

A

quickens onset

decreases duration

reduces pain with skin infiltration

442
Q

local anesthetics

[epi has the least effect on which agents?]

A

lipid soluble

  • lidocaine is prolonged much more than bupivacaine
443
Q

Local Anesthetics

[rate of systemic absorption by site]

A

intravenous

tracheal

intercostal

paracervical

epidural

brachial plexus

sciatic

subcuntaneous

444
Q

Local Anesthetics

[vasoconstrictors]

A

prolongs duration and decreases absorption

  • more pronounced on shorter-acting agents
445
Q

Local Anesthetics

[which agent is a weak acid with a pKa of 3.5]

A

benzocaine

446
Q

Local Anesthetics

[which one can be given in an epidural with littel effect to fetus?]

A

Chloroprocaine

  • rapidly metabolized and very little is able to cross the placenta
447
Q

Loop Diuretics

[examples]

A

Lasix (furosemide)

-ide

448
Q

Loop Diuretics

[mechanism of action]

A

binds to the Na-K-2Cl protein

diminishes osmotic gradient

449
Q

Loop Diuretics

[Site of action]

A

ascending loop of Henle

450
Q

Losartan

(minoxidil)

[adverse effects]

A

pulmonary hypertension

pericardial effusion

cardiac tamponade

451
Q

Lovenox

[stop before surgery]

A

24 hours

452
Q

Lung Transplant

[treatment of hypotension]

A

vasopressors

  • avoid large luid boluses
  • loss of lymphatic drainage predisoses lung to pulmonary edema
453
Q

Lusitropy

[definition]

A

cardiac muscle fiber relaxation

454
Q

Lusitropy

[definition]

A

myocardial relaxation or diastole

455
Q

Luxury Perfusion

[refers to what situation in the brain]

A

vasoparalysis

456
Q

“patients at high risk of A-fib following cardiac surgery can be treated with prophylactic _____”

A

Amiodarone

457
Q

Macroshock

[minumum required for V-fib]

A

100 mA

458
Q

Magnesium

[mechanism of action]

A

decreases release of acetylcholine in NMJ

459
Q

main sensory innervation to superior and inferior parts of the hard and soft palate

[nerve]

A

trigeminal nerve

460
Q

Malathion

[key concepts]

A

organophosphate

may prolong duration of succinylcholine

461
Q

Malignant Hypertension

[definition]

A

greater than 210/120 mmHg

often associated with papilledema and encophalopathy

462
Q

Mapleson Circuit

[best for controlled ventilation]

A

D

463
Q

Mapleson Circuit

[best for spontaneous ventilation]

A

A

464
Q

Median Nerve

[motor response to stimulation]

A

flexion of the wrist, pronation of the forearm

465
Q

MELD score

[definition]

A

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
Q

MELD score

[range]

A

1 - 4

1 being the lowest, 4 being the highest

467
Q

membrane potential

[ventricular cell]

A

-90 to -80 mV

468
Q

MEN

[acronym]

A

Multiple Endocrine Neoplasia

469
Q

Meperidine is contraindicated in patients taking which drug for Parkinson disease?

A

Selegiline

(eldepryl)

470
Q

Mepivacaine

[maximum dose with epinephrine]

A

7 mg/kg

471
Q

Mepivacaine

[maximum dose]

A

4.5 mg/kg

472
Q

Which oral diabetic drug does NOT produce hypoglycemia?

A

Metformin

473
Q

Methadone

[mechanism of action]

A

opioid agonist and NMDA antagonist

474
Q

Methemoglobinemia

[signs]

A

SaO2 of 85%

475
Q

Methergine

[contraindications]

A

hypertension

asthmatics

coronary artery disease

476
Q

Methylmethacrylate

[adverse effects]

A

fat embolism

vasodilation and reduction in SVR

hypercoagulable state due to thromboplastin

477
Q

Methylnaltrexone

(relistor)

[uses]

A

opioid antagonist that does not cross the CNS

  • can treat opioid-induced constipation without reversing analgesia
478
Q

MgSO4

[sign indicating toxicity]

A

loss of deep tendon reflexes

(occurs at 10 mEq/L)

479
Q

MgSO4

[therapeutic range]

A

4 - 8 mEq/L

(4 - 10 mg/dL)

480
Q

Microshock

[minimum required for Vfib]

A

100 uA

(0.1mA)

481
Q

Mitral Regurge

[anesthetic goals]

A

maintain higher HR

  • avoid increases in afterload
482
Q

Mitral Regurge

[“4 F’s of anesthetic management]

A

full, fast, and forward

(increased preload, increased heart rate, and decreased afterload)

483
Q

Mitral Stenosis

[sequelae]

A

a-fib and pulmonary hypertension

484
Q

Mitral Stenosis

[anesthetics goals]

A

maintain sinus rhythm

avoid tachycardia

  • also avoid large increases in CO, hypovolemia, and fluid overload
485
Q

Mitral Valve Prolapse

[heart sounds]

A

late diastolic click preceded by mid-diastolic murmur

486
Q

Mixed Venous O2 Tension

[normal mmHg]

A

40 mmHg

487
Q

mixed venous oxygen saturation

[estimation of ____]

A

cardiac output

488
Q

Mixed Venous Oxygen Saturation

[normal value]

A

65-75%

489
Q

Mixed Venous Oxygen

[factors causing a high value]

A

increased CO or decreased O2 consumption

  • hypothermia
  • cyanide poisoning
490
Q

Mixed Venous Oxygen

[factors causing a low value]

A

increased comsumption and decreased elivery

  • hypoxia
  • low cardiac output
  • anemia
491
Q

Morphine

[parenteral vs oral conversion]

A

1:3

492
Q

most common cause of mortality associated with administration of blood

A

TRALI

493
Q

Most common inherited coagulopathy

A

von Willebrand disease

(affects 1 in 500 people)

494
Q

Most common electrolyte imbalance

A

Na

495
Q

Most common reason for hypoxia in PACU

A

ventilation/perfusion mismatch

496
Q

Most common transfusion-related infection

A

Hepatitis B

497
Q

Motor innervation to the cricothyroid membrane

[nerve]

A

external branch of the superior laryngeal

498
Q

motor innervation to the intrinsic muscles of the larynx, except cricothyroid muscle

[nerve]

A

recurrent laryngea

499
Q

Multiple Endocrine Neoplasia Type II

[triad of disorders]

A

medullary carcinoma of the thyroid

hyperparathyroidism

pheochromocytoma

500
Q

Multiple Endocrine Neoplasia

[etiology]

A

tumors in several endocrine organs

  • Type I
    • gastrinomas, insulinomas, chromophobes (pituitary), and parathyroid tumors
  • Type II
    • medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism
501
Q

Multiple Sclerosis

[neuraxial anesthesia]

A

avoid spinals

epidurals or other peripheral nerve blocks are of less concern

502
Q

Musculocutaneous Nerve

[motor response to stimulation]

A

flexion of the forearm at the elbow

503
Q

Myasthenia Gravis

[anesthetic considerations]

A

prone to respiratory depression

(avoid or minimize narcotics and benzos)

voltaile agents may provide sufficient muscle relaxation

unpredictable response to Sux, may need larger doses

504
Q

Myasthenia Gravis

[cardiovascular agents that may potentiate weakness]

A

beta blockers

lidocaine

procainamid

verapamil

quinidine

505
Q

Myasthenia Gravis

[Misc. drugs that may potentiate weakness]

A

lithium

phenytoin

magnesium

NDMR

506
Q

Myasthenia Gravis

[pharmacological treatment]

A

pyridostigmine

507
Q

Myasthenia Gravis

[antibiotics that may potentiate weakness]

A

ampicillin

ciprofloxacin

Erythromycin

Gentamycin

Sulfonamides

508
Q

Myasthenia Gravis

[etiology]

A

autoimmune destruction of post-synaptic acetylcholine receptors and the NMJ

509
Q

Mydriasis

[definition]

A

dilation of pupil

510
Q

Myocardial Ischemia

[most vulnerable]

A

endocardium

  • subjected to the greatest intramural pressures during systole
511
Q

Myocardial O2 Consumption

[normal resting]

A

8 mL/100g/min

512
Q

Myocardial Oxygen Consumption

[primary determinants in order]

A

heart rate > afterload > preload

513
Q

Myocardial Oxygen Demand

[characteristics]

A

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
Q

Myocardial Oxygen Demand

[factors]

A

heart rate

contractility

ventricular wall tension

515
Q

Myocardial Oxygen Supply

[factors that decrease demand]

A

decreased:

heart rate

contractility

ventircular size

ballow counter pulsation

516
Q

Myocardial Oxygen Supply

[factors that increase supply]

A

increased:

oxygen content

coronary blood flow

coronary perfusion pressure

517
Q

Myotonia Congenita

[anesthetic considerations]

A

avoid Succinylcholine

  • causes sustained muscle contraction and may produce massive release of K+ leading to cardiac arrest
518
Q

Myotonia Congenita

[definition]

A

delayed relaxation after voluntary muscle contraction

519
Q

Myotonic Dystrophy

[definition]

A

multisystem disorder characterized by slowing of relaxation after muscle contraction

520
Q

N2O

[frost developing on tank]

A

rapid flow from cyclinder to anesthesia machine

521
Q

Naltrexone

(ReVia)

[uses and treatments]

A

blocks euphoric effets of heroin

522
Q

Nasal Cannula

[maximum FiO2]

A

0.45

523
Q

Neohepatic Phase

[considerations]

A

reperfusion syndrome and reperfusion injury

524
Q

What drug can lead to abdominal pain in the PACU?

A

Neostigmine

525
Q

Nephron - P-cells

[function]

A

secrete K+ and participate in aldosterone-stimulated Na+ reabsorption

526
Q

Nephron

[two cell types]

A

principal (P-cells) and intercalated (I-cells)

527
Q

Nerve Fibers

[which ones carry pain impulses?]

A

C and A-delta

528
Q

Neurogenic Diabetes Inspidius

[difference compared to nephrogenic DI]

A

can be treated witih desmopressin

529
Q

Neuroleptic Malignant Syndrome vs Malignant Hyperthermia

[key difference]

A

muscle relaxants will cause paralysis in NMS, but not in MH patients

530
Q

Neuroleptic Malignant Syndrome

[differential diagnosis]

A

malignant hyperthermia and serotonin syndrome

531
Q

Neuroleptic Malignant Syndrome

[etiology]

A

dopamine blockade in the basal ganglia and hypothalamus

  • secondary to metoclopromide or meperidine use
532
Q

Neuroleptic Malignant Syndrome

[symptoms]

A

muscle rigidity, fever, and autonomic instability

533
Q

New York Association’s Classification of Heart Disease

[categories]

A

I - asymptomatic

II - symptomatic with moderate activity

III - symptomatic with minimal activity

IV - symptomatic at rest

534
Q

Nitrogen

[tank color]

A

Black

535
Q

Nitrous Oxide

[renal effects]

A

decreased renal blood flow secondary to increased renal vascular resistance

  • decreased GFR and urine output
536
Q

Norepinephrine

[infusion rate]

A

0.1 - 0.5 mcg/kg/min

537
Q

normal or increased PR interval

short QT interval

[electrolyte abnormality]

A

Hypercalcemia

538
Q

Normal oxygen saturaton of newborn

A

1 minute after may be as low as 60%

5 minutes 80-85%

may only reach 95% by 10 minutes

539
Q

Normal resting coronary artery blood flow

A

75 mL/100g/min

(250 mL/min)

4% of cardiac output

540
Q

numbess over the lateral aspect of the thigh

[nerve injury]

A

lateral femoral cutaneous nerve

541
Q

O neg blood is given because there is no ____

A

A/B antigens

542
Q

O2 Partial Pressure (PiO2)

[equation]

A

PiO2 = (PB - PH2O) x FiO2

(760mmHg - 47mmHg) x 0.21) = 149 mmHg

543
Q

Obstructive Hydrocephalus

[cause]

A

intratentorial mass obstructing CSF flow through 4th ventricle or cerebral aqueduct

544
Q

Octreotide

[drug type]

A

somatostatin derivative of human growth hormone

545
Q

Octreotide

[treatment]

A

carcinoid syndrome

may relieve vasoactive symptoms and restore hemodynamic stability

546
Q

Oculocardiac Reflex

[clinical manifestations]

A

bradycardia

  • may also lead to junctional rhythm, ectopic beats, AV block, and asystole
547
Q

Oculocardiac Reflex

[anesthetic management]

A

retrobulbar block may block afferent limb, preventing arrythmias

548
Q

Oculocardiac Reflex

[risk factors]

A

most often in young patients undergoing strabismus surgery

549
Q

Omphalocele and Gastroschisis

[anesthetic considerations]

A
  • NG tube before induction
  • fluid replacement with crystalloid and colloid
    • often suffer from hypoproteinemia
  • avoid nitrous
550
Q

Omphaloceles

[definition]

A

abdominal herniation occuring at the umbilicus

  • contained in a sac
  • often associated with Down’s, diaphragmatic hernia, and cardiac and bladder malformations
551
Q

Opioid-induced Sphincter of Oddi spasm

[treatment]

A

naloxone and glucagon

552
Q

Outflow Obstruction

[congenital defects]

A

coarctation of the aorta

aortic and pulmonic valve stenosis

553
Q

Oxygen Content (CaO2)

[equation]

A

(0.003 x PO2) + (SO2 x Hb x 1.31)

554
Q

oxygen requirement for a newborn

A

7 - 9 mL/kg/min

555
Q

Oxygen requirement for adult

A

3 - 4 mL/kg/min

556
Q

Pacemakers

[upper tracking rate]

A

prevents rapid venricular rate in response to a rapid atrial rate

  • only availble in DDD and VDD pacemakers
557
Q

PaO2 of 95 mmHg

[saturation]

A

almost 100%

558
Q

PaO2

[correction by temperature]

A

measured PaO2 should be decreased about 6% for each oC cooler than 37

559
Q

PaO2

[normal values on AGB]

A

75 - 105 mmHg

560
Q

PAOP < LVEDP

[when would this occur?]

A

aortic insufficiency

decreased left ventricular compliance

561
Q

PAOP > LVEDP

[when would this occur?]

A

mitral stenosis

left atrial myxoma

pulmonary venous obstruction

elevated alveolar pressure

562
Q

Paradoxical Air Embolism

[heart defect]

A

patent foramen ovale

563
Q

Parasympathetic Neurons

[preganglionic neurons originate from which CN?]

A

III, VII, IX, and X

and sacral segments 2-4

564
Q

Parathyroid Hormone

[effect on bone]

A

increases reabsorption of calcium and phosphate

565
Q

Parkinson Disease

[premedication for tremor]

A

diphenhydramine

566
Q

Parkinson Disease

[treatment of hypotension]

A

direct-acting vasopressor

567
Q

Parkinson Disease

[contraindicated drugs]

A

Droperidol and metoclopromide

568
Q

Parkinson Disease

[etiology]

A

progressive loss of Dopamine in the nigrostriatum

569
Q

Parkland Formula

[equation]

A

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
Q

Patient is taking both aspirin and clopidogrel. How should these be managed prior to surgery.

(s/p bare-metal stent)

A

stop clopidogrel and continue aspirin

571
Q

Pulseless Electrical Activity

[5 H’s]

A

hydrogen ion (acidosis)

hypo- or hyper-kalemia

hypoxia

hypovolemia

hypothermia

572
Q

Pulseless Electrical Activity

[5 T’s}

A

toxins

tamponade

tension pneumo

coronary thrombosis

pulmonary thrombosis

573
Q

First signs of high spinal block in pediatric patients

A

respiratory depression leading to hypoxia and associated bradycardia

574
Q

Children maintain stable hemodynamics until what percentage of blood loss?

A

25 - 35%

575
Q

local anesthetics for spinals in infants compared to adults

A

pediatrics require a greater dose, but have a shorter duration

576
Q

Pericardial Effusion vs. Tamponade

[most important difference]

A

pressure

577
Q

Pericardial Tamponade

[Beck’s Triad]

A

low blood pressure

muffled heart tones

jugular venous distension

578
Q

pH and HCO3- changes per 10 mmHg PaCO2

A

0.08 decrease in pH

1 mEq/L increase in HCO3-

579
Q

Phenylephrine

[reflex bradycardia]

A

due to increasing SVR

580
Q

Phosphate

[normal values]

A

2.5 - 4.5 mg/dL

581
Q

Pituitary Gland

[surrounding cranial nerves]

A

III, IV, V1, and VI

582
Q

Placenta Accreta

[definition]

A

placenta attaches itself deeply into the uterine wall

583
Q

Placenta Percreta

[definition]

A

placenta attaches itself through the utuerus, often extending to nearby organs

584
Q

Placenta Previa

[definition]

A

placenta covers the opening of the mother’s cervix

585
Q

Placenta

[insulin and glucose transfer]

A

insulin does not cross the placenta; however, glucose does making larger babies

586
Q

Blood Products

[which is most likely to cause bacterial sepsis]

A

platelets

  • occurs in 1 per 12,000
587
Q

Platelets

[mm3 per unit increase]

A

5,000 - 10,000

(for a typical 70kg patient)

588
Q

Popliteal block

[supplemental block for ankle/foot surgery]

A

saphenous nerve

589
Q

Porphyria

[contraindicated drugs]

A

Etomidate

barbiturates (thiopental)

antieleptics

many benzos

590
Q

Porphyria

[management]

A

maintain adequate nutrition

possibly avoid light

fix electrolyte disturbances

maintain euvolemia

Hematin therapy

591
Q

Porphyria

[etiology]

A

Heme is composed of iron and porphyrins

porphyrias result from defects in the heme biosynthetic pathway, producing accumulations of prophyrin

592
Q

Portopulmonary Hypertension

[diagnostic criteria]

A

mPAP > 25 mmHg

PVR > 240 dyn*sec/cm5

593
Q

Posterior Pituitary

[hormones]

A

oxytocin and ADH

594
Q

Preanhepatic Phase of Liver Transplant

[considerations]

A

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
Q

Preductal Arterial Blood sampling

[location]

A

right radial artery

596
Q

Preeclampsia

[definition and symptoms]

A

hypertension and proteinuria

  • greater than 140/90
  • occurs after the 20th week of pregnancy
  • proteinuria > 300 mg/d
597
Q

Pregnancy

[cardiovascular changes]

A

increasd blood/plasma volume, CO, HR, and SV

decreased BP and pulmonary resistance

598
Q

Pregnancy

[changes in epidural]

A

decreased CSF

decreased potential volume in epidural space

increased epidural pressure

  • the first two enhance the cephalad spread of local anesthetics
599
Q

Pregnancy

[hematologic changes]

A

decreased Hb and platelets

increased clotting factors (up to 250%)

shifts O2Hb curve to the left

600
Q

Pregnancy

[Renal changes]

A

increased GFR

601
Q

Pregnancy

[respiratory changes]

A

increased MV, tidal volume, and oxygen consumption

decreased FRC, airway resistance, and PaCO2

602
Q

Pregnancy

[SVR changes at term]

A

decreased

603
Q

Pregnancy

[time of greatest cardiac output]

A

immediately after delivery

  • can increase 75% above prelabor values
  • due to increased venous return to the heart
604
Q

Pressure-Volume Loop

[effects of afterload]

A

If afterload is reduced, stroke volume and ejection fraction increase, and end-systolic volume decreases

605
Q

Pressure-Volume Loop

[aortic regurge]

A
606
Q

Pressure-Volume Loop

[aortic stenosis]

A
607
Q

Pressure-Volume Loop

[effects of preload]

A

changes in preload affect stroke volume

  • end-systolic volume is unchanged if afterload and inotropy are held constant
608
Q

Pressure-Volume Loop

[Inotropic effects]

A

Decreasing inotropy increases end-systolic volume while decreasing stroke volume and ejection fraction

609
Q

Pressure-Volume Loop

[mitral regurge]

A
610
Q

Pressure-Volume Loop

[mitral stenosis]

A
611
Q

primary determinant of local anesthetic potency

A

lipid solubility

612
Q

Primary Fibrinolysis

[causes]

A

alpha-2 antiplasmin deficiency or an impaired clearance of tPA

613
Q

Procaine

[maximum dose]

A

12 mg/kg

614
Q

Protamine

[what happens when given without heparin?]

A

anticoagulation

615
Q

Prothrombin TIme (PT)

[factor(s) tested]

A

VII

616
Q

Prothrombin Time

[measurement]

A

fibrinogen, prothrombin, and factors V, VII, and X

617
Q

Prothromin Time

[normal range]

A

11 - 14 seconds

618
Q

Pseudocholinesterase

[half-life]

A

12 hours

619
Q

PT

[normal values]

A

10 - 14 sec

620
Q

Pudenal Nerve

[origin]

A

S2 - S4

621
Q

Pulmonary Artery Catheter

[contraindications]

A

complete LBBB

Wolff-Parkinson-White syndrome

Ebstein’s malformation

622
Q

Pulmonary Artery Catheter

[change in BP when entering into right ventricle]

A

increase in systolic pressure

623
Q

Pulmonary Artery Catheter

[change in BP when entering pulmonary artery]

A

increase in diastolic pressure

624
Q

Pulmonary Embolism

[ABG findings]

A

hypoxemia and hypocapnea

(respiratory alkalosis)

625
Q

Increased lung compliance due to loss of elastic recoil of the lung

A

Pulmonary Emphysema

626
Q

Pulmonary Vascular Resistance

[equation]

A

(PAP - PCWP) / CO * 80

627
Q

Pulmonic Stenosis

[anesthetic goals]

A

maintain normal to slightly high HR

avoid increases in PVR

628
Q

Pulmonary Vascular Resistance is the least at which lung volume?

A

Functional Residual Capacity

629
Q

Pt is here for a TIPS procedure, what physiologic findings to consider?

A

liver failure

(decreased albumin)

630
Q

QTc prolongation

[lenth of time considered prolonged]

A

> 0.45 seconds

631
Q

Most important determinant of intracellular osmotic pressure

A

Potassium

632
Q

Which EKG findings may make diagnosis of an MI more difficult?

A

left bundle branch block

  • LBBB changes how the ventricles depolarize and also leads to its own ST segment and t-wave changes
633
Q

“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?

A

0.5 - 1 mg Atropine

634
Q

“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?”

A

procainamide and amiodarone

  • Wolff-Parkinson-White
    • AV node blocking drugs are contraindicated
635
Q

What effect does alkalosis have on serum potassium, serum calcium and shifting of the oxygen hemoglobin dissociation curve?

A

decrease in K and Ca

left shift in O2Hg curve

636
Q

Narrow Complex SVT with stable blood pressure

[first treatment]

A

vagal maneuver (valsalva or carotid massage)

Adenoside 6 mg

637
Q

Radial Nerve

[motor response to stimulation]

A

extension of all digits as well as the wrist

638
Q

Radiation Exposure

[max REM per year]

A

5

639
Q

RBC

[normal range]

A

3.8 - 5.7 x108/uL

640
Q

typical EKG rhythm in severe CAD of the right coronary

A

complete heart block

  • RCA supplies blood to the AV node in 90% of patients
641
Q

recurrent laryngeal nerve

[unilateral damage]

A

hoarseness

642
Q

recurrrent laryngeal nerve

[bilateral damage]

A

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
Q

Relative potency compared to morphine:
Meperidine
Alfentanil

Dilaudid
Fentanyl
Remifentanil
Sufentanil

A

Meperidine: 0.1
Alfentanil/Dilaudid: 10
Fentanyl: 100
Remifentanil: 300
Sufentanil: 1,000

644
Q

Remifentanil

[metabolism]

A

nonspecific esterases

645
Q

Renal Blood Flow

[normal autoregulation range]

A

80 - 180 mmHg

646
Q

Renal Corpuscle

[function]

A

ultrafiltration of blood

647
Q

Renal Transplant

[absolute contraindications]

A

infection and cancer

648
Q

Reperfusion Syndrome

[symptoms]

A

hypotension

right heart failure

arrhytmias with possible cardiac arrest

649
Q

residual volume

[average adult value]

A

1200 mL

650
Q

Resistance during laminar flow is dependent on _____

A

gas viscosity

651
Q

resistance during turbulent flow is dependent on _____

A

density

652
Q

Retrobulbar Block

[CN nerves blocked]

A

CN III, IV, and VI

653
Q

Rhematoid Arthritis

[cardiovascular effects]

A

pericardial thickening and effusion

conduction defects

aortic regurgitation

654
Q

Rheumatoid Arthritis

[pulmonary effects]

A

interstitial pulmonary fibrosis

pleural effusion

655
Q

Rheumatoid Arthritis

[airway concerns]

A

atlantoaxial instability

limited TMJ mobility

656
Q

Right-Sided Heart Failure

[definition]

A

back-up of blood into the right heart and pulmonary circulation

657
Q

Right-to-Left Shunting

[congential defects]

A

tetralogy of fallot

transposition of the great vessels

hypoplastic left heart

pulmonary and tricuspid atresia

658
Q

“Robin Hood Phenomenon”

[definition]

A

blood flow directed from a normal region of the brain to an ischemic region

659
Q

Romano-Ward Syndrome

[characteristics and treatment]

A

prolonged QT interval

  • left stellate ganglion block
    • shortens QT intervals
660
Q

Ropivacaine

[maximum dose]

A

3 mg/kg

661
Q

At high altitudes, the flow of a gas through a rotameter will be _____

A

greater than expected at high flows, but accurate at low flows

662
Q

S3 Gallop

[how and where to hear it]

A

cardiac apex using the bell

  • apex best located in left lateral decubitus position in the 5th intercostal, midcalvicular line
663
Q

Heart sound correlating to congestive heart failure

A

S3 Gallop

664
Q

SA node

[arterial supply]

A

RCA (60% of people) or LAD (40% of people)

665
Q

Sacral Plexus

[develops into which nerves]

A

sciatic nerve

(common peroneal, tibial, and sural)

666
Q

Saddle Block

[definition]

A

“pudendal block”

low lumbar and sacral anesthesia, mostly in OB

667
Q

Saddle Block

[Key Points]

A

hyperbaric solution (glucose/dextrose)

668
Q

Sarin Gas

[signs and symptoms]

A

DUMBELS

diarrhea

urination

miosis

bronchoconstriction

emesis

lacrimation

salivation

669
Q

Sciatic Block

[landmarks]

A

posterior superior iliac spine

greater trochanter

sacral hiatus

670
Q

Nerve Injury

[weakness of all muscles below the knee]

A

Sciatic nerve

671
Q

Secondary Hyperthyroidism

[expected enzyme levels]

A

low TSH and high free T4/T3

672
Q

Seizures from Hyponatremia

[treatment]

A

hypertonic saline

673
Q

Seizures

[physiological effects]

A

initial parasympathetic discharge followed by a more sustained sympathetic discharge

674
Q

sensory innervation below the vocal cords to the carina

[nerve]

A

recurrent laryngeal

675
Q

sensory innervation of the larynx above the vocal cords

[nerve]

A

internal branch of the superior laryngeal nerve

676
Q

Sensory innervation of the mucous membranes of the nose

[nerve]

A

trigeminal

677
Q

Sensory innervation to posterior third of tongue

[nerve]

A

glossopharyngeal

678
Q

sensory of occipital portion of the skull

[nerve]

A

cervical plexus (C2 and C3)

679
Q

Septic Shock

[hemodynamic changes]

A

Hypotension with normal cardiac output and low end-diastolic volume

680
Q

Sequence of highest to lowest level block

A

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
Q

Serotonin Syndrome

[treatment]

A

supportive and 5-HT antagonist

(cyprohepatadine)

682
Q

Serum Albumin

[normal levels]

A

3.5 - 5.5 g/dL

683
Q

Sevoflurane

[effects on HR]

A

decreases until about 1 MAC at which time it produces dose-dependent increases

684
Q

SIADH

[treatment]

A

fluid restriction

685
Q

Sickle Cell Crisis

[causes]

A

hypoxemia

acidosis

dehydration

hypothermia

686
Q

Sickle Cell Hemoglobin

[P50]

A

31 mmHg

687
Q

Sinus Arrhythmia

[cause]

A

cyclic changes in vagal tone

688
Q

Sinus Arrhythmia

[definition]

A

cyclic variation in heart rate corresponding to respiration

  • increases with inspiration
689
Q

Soda Lime

[amount of CO2 absorbed]

A

23L CO2 per 100g absorbent

690
Q

Sodium Bicarb

[adverse effects]

A

paradoxic cerebrospinal fluid acidosis

hypernatremia

hypercarbia

691
Q

Sodium Nitroprusside

[infusion rate causing cyanide toxicity]

A

greater than 2 ug/kg/min

692
Q

Sodium Nitroprusside

[first signs of cyanide toxicity]

A

tachyphylaxis

metabolic acidosis

elevation of mixed venous PO2 values

693
Q

Spinal Anesthesia

[alpha-agonists]

A

have analgesic properties and prolong duration

  • examples: clonidine, epinephrine, and phenylephrine
  • may also enhance hypotension
694
Q

spinal cord ending

[adult vs pediatric]

A

adult L1

pediatric L2

695
Q

Spinal Cord Injury

[level of paraplegia]

A

above L4

696
Q

Spinal Cord Injury

[level of quadriplegia]

A

above T1

697
Q

Spinal Cord Injury

[level of required ventilation]

A

C3 - C5

698
Q

Spinal Cord Injury

[most common sites]

A

C5-6 and T12-L1

699
Q

Spinal Shock

[pathophysiology]

A

hypotension and bradycardia

700
Q

Spironolactone

[mechanism of action]

A

aldosterone antagonist

701
Q

Spondylosis

[definition]

A

degeneration of spinal column

702
Q

SSEPs

[afferent input is carried through which spinal cord tract?]

A

dorsal columns

703
Q

Stable wide-complex tachycardia

[best drug choice]

A

amiodarone and procainamide

704
Q

Starling’s Law of the Heart

[components]

A

cardiac output and left ventricular end-diastolic volume

705
Q

Stellate Ganglion Block

[indication of successful block]

A

warm sensation over arms and face

706
Q

Stellate Ganglion Block

[risks and complications]

A
  • bradycardia
  • recurrent laryngeal nerve paralysis
  • brachial and subarachnoid block
  • seizure
  • phrenic nerve block
707
Q

Stellate Ganglion Block

[symptoms]

A

Horner syndrome

708
Q

stellate ganglion

[lies in close proximity to which artery?]

A

vertebral

709
Q

Stroke Volume

[components]

A

preload, afterload, and contractility

710
Q

Succinylcholine

[mechanism of termination]

A

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
Q

Succinylcholine

[mechanism for tachycardia]

A

stimulation of nicotinic receptors at autonomic ganglia

712
Q

Superior laryngeal nerve

[bilateral damage]

A

hoarseness and predisposition to aspiration

713
Q

Supplementary nerve block with popliteal for surgery on achilles tendon

A

Saphenous

714
Q

Supraclaviuclar Block

[which section of the brachial plexus is blocked?

A

Trunks/Divisions

715
Q

Sural Nerve

[area of coverage]

A

covers the lateral side of the foot

716
Q

SVC Syndrome

[considerations]

A

start IV in lower extremities

717
Q

Lhermitte Sign

[definition]

A

occurs when head flexion causes shooting sensations down the back and into the lower limbs

  • due to posterior column disease
718
Q

Syringomyelia

[etiology]

A

progressive cavitation of the spinal cord

719
Q

Systolic Dysfunction

[Pressure-Volume Loop]

A
720
Q

Systolic Heart Failure

[definition]

A

left ventricle loses ability to contract

721
Q

TAP Block

[nerves blocked]

A

subcostal, ilioinguinal, and iliohypogastric

722
Q

Tapentadol

(nucynta)

[drug class]

A

opioidu agonist and norepinephrine reuptake inhibitor

  • contraindicated with MAOIs and SSRIs
723
Q

Tardive Dyskinesia

[cause]

A

long-term doaminergic antagonist use

  • elderly women and those with psychoactive disorders are at higher risk
724
Q

Tardive Dyskinesia

[definition]

A

involuntary movements of the face and extremities

  • irreversible
725
Q

TEE

[best view for myocardial ischemia]

A

transgastric mid-papillary LV short axis view

  • shows the myocardium supplied by all three major coronary arteries
726
Q

TEE

[smallest detection of air]

A

0.25 mL

727
Q

Tracheoesophageal Fistula

[anesthetic concerns]

A
  • ETT must be distal to fistula
  • copious pharyngeal secretions
  • avoid positive pressure
  • avoid next extension and instrumentation after repair
728
Q

Tracheoesophageal Fistula

[most common type]

A

IIIB

729
Q

Tetracaine

[mechanism of termination]

A

systemic absorption

  • hydrolyzed by cholinesterase enzymes which are not present in CSF, must be absorbed first
730
Q

Tetralogy of Fallot

[anatomical anomalies]

A

right ventricular outflow obstruction

right ventricular hypertrophy

VSD with over-riding aorta

731
Q

Tetralogy of Fallot

[anesthetic goals]

A

maintain intravascular volume and SVR

  • avoid increases in PVR, acidosis, or excessive airway pressures
  • avoid MR that release histamine
732
Q

Tetralogy of Fallot

[induction]

A

Ketamine

maintains or increases SVR, therefore does not aggravate the right-to-left shunting

733
Q

Tetralogy of Fallot

[isoproteronol]

A

avoid

reduces afterload and therefore increases right-to-left shunt

734
Q

Thiazides

[mechanism of action]

A

inhibits Na+ reabsorption

735
Q

Thiazides

[site of action]

A

early distal convoluted tubule

736
Q

Thiopental

[induction considerations]

A

adding an acidic muscle relaxant will cause precipitation and may lead to pulmonary embolism

737
Q

Thyroid Storm

[clinical signs]

A

fever, tachycardia, and hypotension

(altered consciousness in awake patient)

738
Q

Thyroid Storm

[differential diagnosis of MH]

A

thyroid storm does not have the following:

  • muscle rigidity
  • elevated creatinine kinase
  • metabolic and respiratory acidosis
739
Q

Thyroid Storm

[treatment]

A

beta blockers

glucocorticoids

thionamide (methimazole)

iodine

740
Q

Thyroid

[hormones]

A

T3, T4, and Calcitonin

741
Q

Time Constants

[percentages at 1, 2, and 3]

A

63%

84%

95%

742
Q

TIPS procedure

[treatment]

A

portal hypertension

743
Q

TIPS

[acronym]

A

Transjugular Intrahepatic Portosystemic Shunt

744
Q

Tirofiban

[mechanism of action]

A

Blocks binding of fibrinogen and vWF to glycoprotein IIb/IIIa receptor on platelet surface

745
Q

Total Thyroidectomy

[post-operative concerns]

A

hypocalcemia

may manifest as laryngeal stridor 24-96 hours after the procedure

746
Q

Tracheal Capillary Pressure

A

25 - 35 mmHg

747
Q

TRALI

[key features]

A

wide A-a gradient

noncardiogenic pulmonary edema

leukopenia

748
Q

Trans-tracheal block

[drug choice[

A

4mL of 4% lidocaine

749
Q

Transplant Lung

[innervation]

A

no longer cough reflex below carina

  • respiratory pattern is unaffected
750
Q

Transplanted Heart

[atropine]

A

no effect

  • blocks parasympathetic branches of ANS
751
Q

Transposition of the Great Arteries

[anatomical anomalies]

A

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
Q

Transposition of the Great Vessels

[rate of induction]

A

slower inhalational induction and faster intravenous

753
Q

Transsphenoidal Hypophysectomy

[postoperative considerations]

A

avoid CPAP

754
Q

Trauma-Induced Coagulopathy

A

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
Q

Treacher Collins

[airway]

A

mandibular hypoplasia

756
Q

Treatment of dystonic reactions due to Droperidol

(twisted and rigid neck, eye movements)

A

diphenhydramine

(anticholinergic that crosses BBB)

757
Q

Tricuspid Regurge

[management goals]

A

increase HR and preload

decrease afterload

avoid any increases in PVR

758
Q

Tricuspid Regurge

[pathophysiology]

A

slight elevation in mean right atrial and central venous pressures

759
Q

Tricuspid Regurge

[ventilation goals]

A

avoid PEEP and high mean airway pressures

(goal to maintain high CVP and decrease/maintain afterload)

760
Q

“Triple H” Therapy

[definition]

A

hypervolemia, hemodilution, and hypertension

761
Q

“Triple H” Therapy

[treatment]

A

2nd treatment of vasospasms after nimodipine

762
Q

Protein measured in diagnosis of acute ischemia

A

Troponin

  • level was associated with length of ischemia
  • peaks within 12-48 hours, but rise can be seen within 8 hours
763
Q

Trousseau’s Sign

[definition]

A

carpal spasm following inflation of arm tourniquet above systolic pressure for 3 min

  • results from hypocalcemia
764
Q

TURP Syndrome

[causes]

A

absorption of large amounts of fluid

(usually hyposmolar)

765
Q

TURP Syndrome

[treatment]

A

fluid restriction and furosemide

766
Q

TURP

[adverse effects]

A

TURP Syndrome

Coagulopathies

Bladder perforation

septicemia

767
Q

TURP

[coagulopathy]

A

DIC and primary fibrinolysis

768
Q

Type II pneumocytes

[function]

A

secrete surfactant in alveoli

769
Q

Ulnar Nerve

[motor response to stimulation]

A

flexion at the wrist, 4th, and 5th fingers and adduction of the thumb

770
Q

Umbilical Cord Blood

[normal arterial values]

A

7.25 pH

50 PCO2

20 PO2

22 HCO3-

771
Q

unable to oppose thumb and little finger

[nerve damage]

A

median

  • frequently injured at AC during IV cannulation or through neurottoxic drugs
772
Q

Vasopressin

[infusion rate]

A

0.01 - 0.04 units/min

773
Q

Vasospasm

[treatment triad]

A

3 H’s

hypertension, hypervolemic, hemodilution

774
Q

VD/VT

[equation]

A

( PACO<span>2</span> - PECO<span>2</span> ) / PACO2

normally 33%

775
Q

Venous Admixture

[definition]

A

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
Q

Venous Admixture

[equation Qs/Qt]

A

(CCO2 - CaO2) / (CCO2 - CVO2)

777
Q

Venous Air Embolism

[monitoring]

A

TEE and precordial Doppler

778
Q

Venous Air Embolism

[pulmonary artery pressure]

A

rises progressively

  • when the amount of entrained exceeds the rate of pulmonary clearance
779
Q

Venous Air Embolism

[heart sounds - late manifestation]

A

“mill wheel” murmur

780
Q

Verapamil

[dose for irregular-narrow tachycardia]

A

2.5 - 5 mg over two minutes

781
Q

Virtally all pain arising in the thoracic or abdominal viscera is transmitted via _____

A

Sympathetic nervous system in unmyelinated C fibers

782
Q

Vital Capacity

[normal value mL/kg]

A

60 - 70 mL/kg

783
Q

Vitamin K reductase Inhibitor

[example]

A

warfarin

784
Q

Volatile Agents

[cardiogenic shock and Fa/Fi]

A

Isoflurane will be affected most

785
Q

Volatile Agents

[uptake equation based on first minute]

A

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
Q

von Willebrand’s disease

[treatment]

A

desmopressin (DDAVP)

cryoprecipitate or factor VIII concentrate

  • Recombinant factor VIII cannont be used because it does not contain vWF
787
Q

Warfarin Therapy

[emergency treatment]

A

fresh frozen plasma

  • vitamin K should be avoided as it may lead to a hypercoagulable state
788
Q

Weakness of the muscules that extend the knee

[nerve injury]

A

femoral nerve

789
Q

Web space between the great and second toe

[innervation]

A

deep peroneal nerve

790
Q

West Zone 1

[pressure ranking]

A

PA > Pa > PV

791
Q

West Zone 2

[pressure ranking]

A

Pa > PA > Pv

792
Q

West Zone 3

[pressure ranking]

A

Pa > Pv > PA

793
Q

What effect does Propofol have on the CO2 responsiveness on the cerebral vasculature?

A

does not have any affect at clinical doses

794
Q

what part of the tubule reabsorbs the most water

A

proximal convuluted tubule

795
Q

when is the fetus most susceptible to the effects of teratogenic agents?

A

3 - 8 weeks

(during organogensis)

796
Q

Which antibiotic may cause hearing loss?

A

Gentamycin

797
Q

which coefficient is most closely associated with MAC?

A

oil/gas

798
Q

which diuretic is associated with hyperchloremic metabolic acidosis?

A

acetazolamide

(carbonic anhydrase inhibitors)

799
Q

which diuretic is associated with ototoxicity?

A

loop diuretics

800
Q

Which diuretic may lead to hyperkalemia

A

Spironolactone

(potassium sparing)

801
Q

Which drug prodces strong pulmonary arterial dilation with the least amount of systemic artery dilation?

A

nitric oxide

802
Q

which lab test would be most useful in evaluating if a s/p thyroidectomy patient is euthyroid?

A

TSH

803
Q

which muscle relaxant inhibits the reuptake of norepinephrine by the adrengeric nerves?

A

pancuronium

804
Q

which narcotic can be used as the sole agent fr a C-section

(without any local)

A

meperidine

805
Q

which pressor is best in presence of acidemia?

A

vasopressin

806
Q

which vein is just proximal to the SVC?

A

brachiocephalic vein

807
Q

Why do infants require a higher dose of Sux?

A

higher volume of distribution

808
Q

Why does Fentanyl have a faster onset than morphine

A

more ionized

809
Q

Wide Complex Tachycardia with normal BP

[what to do]

A

cardiovert using biphasic defibrillation

  • next step amiodarone or procainamide
810
Q

Withdrawal

[postoperative drug treatment]

A

Clonidine

811
Q

Wolff-Parkinson-White

[EKG findings]

A

delta wave and shortened PR interval

812
Q

Wolff-Parkinson-White

[treatment in a hemodynamically stable patient with regular narrow complex tachycardia]

A

vagal maneuvers or adenosine

813
Q

Wolff-Parkinson-White

[treatment in a hemodynamically stable patient with regular wide complex tachycardia]

A

procainamide or amiodarone

814
Q

Wrist Drop

[nerve damage]

A

radial

815
Q

You give a pt Calcium then a precipitate forms, what was given prior?

A

Bicarb

816
Q

[Cl-]

[normal values]

A

95 - 105 mEq/L

817
Q

[HCO3-]

[normal values]

A

22 - 28 mEq/L

818
Q

[K+]

[normal values]

A

3.5 - 5.3 mEq/L

819
Q

[Mg+]

[normal values]

A

1.3 - 2.4 mEq/L

820
Q

[Na+]

[normal values]

A

135 - 145 mEq/L

821
Q

Anticholinergic Syndrome

[treatment]

A

physostigmine

822
Q

MAC-BAR

[definition]

A

blocks autonomic response to painful stimuli

(> 1.7 MAC)

823
Q

Opioid Receptor

[most responsible for supraspinal analgesia]

A

Mu-1

824
Q

Opioid Receptor

[most resonsible for spinal analgesia]

A

Mu-2

825
Q

Opioid Receptor

[physical dependence]

A

Mu-2

826
Q

Opioid Receptor

[dysphoria]

A

kappa

827
Q

Which opioid has a similar structure to atropine and LA?

A

meperidine

828
Q

Chronic Bronchitis

[Hematologic changes]

A

polycythemia

829
Q

Chronic Bronchitis

[EKG and chest X-ray]

A

right atrium and ventricular hypertrophy

cardiomegaly

830
Q

Obstructive Lung Disease

[TLC]

A

increased TLC

831
Q

cardiogenic shock

[effect on mixed venous oxygen saturation]

A

decrease

832
Q

PaCO2

[effect on hepatic blood flow]

A

increaseing PaCO2 will increase hepatic blood flow

833
Q

Which CCB has the greatest coronary artery vasodilating effects?

A

Nicardipine

834
Q
A

venous air embolism

835
Q

Methemoglobin

[saturation]

A

Saturation of 85%

836
Q

Carboxyhemoglobin

[saturation]

A

produces falsely high saturations

837
Q

High Anion-Gap Metabolic Acidosis

[causes acronym]

A

Cat Mudpiles

838
Q

High Anion-Gap Metabolic Acidosis

[“C” causes]

A

carbon monoxide

cyanide

congenital heart failure

839
Q

High Anion-Gap Metabolic Acidosis

[“A” causes]

A

aminoglycosides

840
Q

High Anion-Gap Metabolic Acidosis

[“T” causes]

A

theophylline

841
Q

High Anion-Gap Metabolic Acidosis

[“M” causes]

A

methanol

842
Q

High Anion-Gap Metabolic Acidosis

[“U” causes]

A

uremia

843
Q

High Anion-Gap Metabolic Acidosis

[“D” causes]

A

diabetic ketoacidosis

(can also be from alcohol or starvation)

844
Q

High Anion-Gap Metabolic Acidosis

[“P” causes]

A

paracetamol/acetaminophen

845
Q

High Anion-Gap Metabolic Acidosis

[“I” causes]

A

iron

846
Q

High Anion-Gap Metabolic Acidosis

[“L” causes]

A

latic acidosis

847
Q

High Anion-Gap Metabolic Acidosis

[“E” causes]

A

ethanol

848
Q

High Anion-Gap Metabolic Acidosis

[“S” causes]

A

salicylates

(ASA and aspirin)

849
Q

Normal Anion-Gap Metabolic Acidosis

[mnemonic for causes]

A

ABCD

  • Addisons (adrenal insufficiency)
  • Bicarbonate loss (diarrhea, vomiting)
  • Chloride excess
  • diuretics (acetazolamide)
850
Q

Aliskiren

[drug class]

A

direct renin inhibitor

851
Q

Which drug would be inefficient in heart block?

A

Atropine

  • only increases the SA rate and
852
Q

Pacemaker

[common location of ventricular leads]

A

right ventricular apex

853
Q

Hypertrophic Obstructive Cardiomyopathy

[hemodynamic goals]

A

increase preload and afterload

slow HR

854
Q

alcohol or tobacco

[which is a coronary risk factor?]

A

tobacco use

855
Q

Pulmonary Hypertension

[PAP > _____]

A

25 mmHg

856
Q

Orifice Flow

[definition]

A

special case of turbulent flow where the diameter is larger than the length

  • example: tracheal obstruction
857
Q

What can be used to detect all leaks in the low-pressure circuit of any contemporary anesthesia machine?

A

negative-pressure leak test

858
Q

General anesthesia results from interruption of nervous system activity EXCEPT _____

A

peripheral sensory receptors

859
Q

Locus Ceruleus

[definition and key concept]

A

nucleus in the pons involved with physiological responses to stress and panic

  • no affect by general anesthesia
860
Q

Indels

[definition]

A

insertion or deletion of one or more nucleotides

861
Q

Haplotypes

[definition]

A

nucleotide polymorphisms inherited in blocks

862
Q

most common inherited prothrombotic risk factor

[mutation in which coaulation factor]

A

factor V

“Factor V Leiden”

863
Q

After cardiac surgery, what is the incidence of significant neurologic mobidity?

A

1 - 3%

864
Q

Malignant Hyperthermia follows what pattern of inheritance?

A

autosomal dominant

865
Q

Point mutation in which gene may interfere with Propfol’s mechanism of action?

A

Beta-3 subunit of GABAA receptor

866
Q

Elimination Half-Life

[definition]

A

time it takes the amount of drug in the bdoy to decrease by 50%

867
Q

the kidney primarily excretes _____

(solubility and polarity)

A

water-soluble polar compounds

868
Q

the smaller the volume of distribution, the _____ the half-time of elimination

A

longer

869
Q

What is the half-time of elimination of a drug that undergoes first-orer elimination with a rate constant of 0.1 minute?

A

6.93 minutes

870
Q

Isovolumetric contraciton occurs after _____ valve closure

A

mitral

  • isovolumetric contraction only occurs in the Left Ventricle
871
Q

resting coronary blood flow

{in mL/min]

A

250 mL/min

872
Q

Croup

[imaging]

A

“steeple sign}

873
Q

epiglottitis

[imaging]

A

thumb sign

874
Q

Croup

[medical name]

A

laryngotracheobronchitis

875
Q

the last two digits of the pH should equal HCO3- + _____

A

15

(pH of 7.34 should have a HCO3- of 7.49)

876
Q

Lactated Ringer

[plasma distribution]

A

equal to extracellular fluid

20% * kg

877
Q

D5W

[plasma distribution]

A

60% * kg

878
Q

chronic vomiting leads to ____

A

hypochloremic alkalosis

879
Q

chronic diarrhea leads to _____

A

hyperchloremic acidosis

880
Q

aldosterone promotes _____ of Na in the kidney

A

reabsorption

881
Q

aldosterone promotes exchange of ____ for ______

A

exchange of Na for potassium and hydrogen

882
Q

metabolic alkalosis is associated with _____ [K]

A

decreased

883
Q

metabolic alkalosis is associated with compensatory _____

A

hypoventilation

(hypercarbia)

884
Q

Sodium Bicarb

[initial dose]

A

kg * 0.3 * (24 - actual HCO3)

____________________________

2

885
Q

aldosterone ____ potassium excretion

A

increases

886
Q

acidosis shifts potassium ____

A

extracellularly

887
Q

insulin causes an _____ shift of potassium

A

intracellular

888
Q

how many paired sympathetic ganglia?

A

22

889
Q

Explain the parasympathetic innervation of the heart

A

mainly in the SA and AV nodes

(no innervation in the ventricles

890
Q

symphathetic = _____

parasympathetic = _____

(adrenergic or cholinergic)

A

adrenergic - SNS

cholinergic - PNS

891
Q

in the PNS, the postganglionic receptors secrete _____

A

Ach

892
Q

the preganglionic neurotransmitter is ____ in both the SNS and PNS

A

Ach

893
Q

in the adrenal medulla, the preganglionic neurotransmitter is ____

A

Ach

894
Q

which cells are responsible for the release of catecholamines in the adrenal medulla?

A

chromaffin cells

895
Q

muscarinic receptors in the myocardium are stimulated by _____ and inhibit the release of _____

A

Ach

norepinephrine

896
Q

which catecholamine is the most potent venoconstrictor?

A

norepinephrine

897
Q

activation of presynaptic Beta-2 receptors have the same physiologic response as antagonist to _____

A

alpha-2 receptors

898
Q

Beta-2 receptor

[catecholamine sensitivity]

A

primarily epinephrine

899
Q

Beta-2 receptor

[catecholamine sensitivity]

A

equally sensitive to epi and norepi

900
Q

arterial baroreceptor refle can be best demonstrated by the ______

A

valsalva maneuver

if exaggerated and prolonged hypotension develops, patient may be at risk for autonomic instability

901
Q

Valsalva Maneuover

[explain]

A

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
Q

Fenoldopam

[characteristics]

A

direct renal vasodilator

selective dopamine-1 agonist

has diuretic properties

903
Q

first-line agent in treating hypotension in the septic patient

A

norepinephrine

904
Q

Thiopental

[induction dose]

A

3 - 5 mg/kg

905
Q

Which induction drug may facillitate the interpretation of SSEPs?

A

etomidate

  • increases the amplitude which can be useful when signal quality is poor
906
Q

Which induction drug should be avoided in the presence of tricyclic antidepressants?

A

ketamine

907
Q

Propofol

[elimination half-life]

A

1 - 3 hours

908
Q

Propofol

[dosing]

A

should be based on lean body weight

909
Q

Propofol increases which waves on an EEG?

A

Beta waves

910
Q

Dexmedetomidine

[infusion rate]

A

0.2 - 0.6 mcg/kg/hr

911
Q

Serum Lipase

[indication]

A

acute pancreatitis

912
Q

Poliomyelitis

[diagnosis]

A

febrile with asymmetric paralysis

diagnosis by virus culture

913
Q

Guillain Barre Syndrome

[diagnosis]

A

febrile illness with loss of sensation

diagnosis by CSF analysis and electrophysical studies

914
Q

Myastenia Gravis

[diagnosis]

A

fluctuating weakness

diagnosed by the “tensilon” test

915
Q

Chlorpromazine

[key facts]

A

D2 antagonist

anti-psychotic

  • may lower seizure threshold
  • prolongs QT interval
  • potentiates depressant effects of narcotics
916
Q

Cefazolin

[mechanism of action]

A

inhibiting bacterial cell wall synthesis

(gram positive)

917
Q

Autonomic Hyperreflexia

[level of transection]

A

T6 or above

918
Q

urgent warfarin reversal

A

FFP

919
Q

Vancomycin

[mechanism of action]

A

inhibits bacterial cell wall synthesis

(gram positive including MRSA)

920
Q

Excess lactated ringers

[most likely acid-base disturbance]

A

metabolic alkalosis

921
Q

Pulmonary Hypertension

[induction medications to avoid]

A

ketamine and etomidate

  • suppress pulmonary vasodilation mechanisms leading to pulmonary vasoconstriction
922
Q

Hypocalcemia

[effects]

A

muscular spasm and rigidity

hyperventilation

congestive heart failure

923
Q

Clindamycin

[mechanism of action]

A

binds 50S ribosomal subunit

924
Q

Methemoglobinemia

[treatment]

A

methylene blue

925
Q

4x4 sponge

[how much blood can it hold]

A

10 mL

926
Q

Cryoprecipitate

[components]

A

8, 13, fibrinogen, and vWF

927
Q

Which test is best for determining the presence of an unstable clot?

A

D-dimer

928
Q

DIC

[effect on coaguation tests]

A

no effect on PT or PTT

929
Q

Platelet pheresis pack

[contains how many platelets?]

A

30,000 - 60,000 cells/mcL

930
Q

Plasma-Lyte

[which common electrolyte is not found?]

A

Calcium

931
Q

Plasma-Lyte

[osmolarity]

A

295

932
Q

Severe Acidemia

[effects]

A

decreased contracility due to decreased response to catecholamines

hypotension

hyperventilation

hyperkalemia

933
Q

Lactated Ringers

[which common electrolyte is not found]

A

magnesium

934
Q

massive transfusion

[acidosis or alkalosis?]

A

metabolic alkalosis

935
Q

Biot’s Respirations

[definition]

A

regular and rapid breaths followed by apnea

936
Q

Kussmaul’s Sign

[definition]

A

elevation of JVP seen during inspiration

937
Q

carcinoid tumors

[signs and symptoms]

A

cutaneous flushing

bronchospasm

diarrhea

hypotension

(more likely to have right heart failure)

938
Q

Hemophilia A

[treatment]

A

cryoprecipitate

purified factor VIII

(can give FFP but not as effective)

939
Q

Hespan vs. Hextend

[difference]

A

Hespan in a normal saline

hextend is a lactated ringers

940
Q

PRBC

[average hematocrit]

A

70-80%

941
Q

Rhematoid Arthritis

[pulmonary disorders]

A

restrictive lung disease

942
Q

most common cause of post-renal azotemia in an elderly male

A

prostatic hypertrophy

943
Q

which antibiotics are ototoxic?

A

amioglycosides

(gentamicin)

944
Q

restrictive lung disease

[pulmonary tests]

A

decreased TLC

normal to increased FEV1/FVC

945
Q

3 main obstructive lung diseases

A

asthma, emphysema, and bronchitis

946
Q

multiple sclerosis

[intraoperative management]

A

maintain normothermia

  • increased core body temps and stress are known to precipitate exacerbations
947
Q

what type of receptors are found in the neuromuscular junction?

A

nicotinic

948
Q

maximum Na correction rate

A

0.5 mEq/hour

949
Q

type of acidosis with excessive NS infusion

A

hyperchloremic metabolic acidosis

950
Q

Renin

[origin]

A

juxtaglomerular cells in the kidney

951
Q

Angiotensinogen

[origin]

A

liver

952
Q

pulmonary hypertension

[ekg findings]

A

right axis deviation

tall p-waves in lead II

RBBB

953
Q

hyperlipidemia

[electrolyte effects]

A

falsely low sodium levels

954
Q

quick onset of versed can be attributed to _____

A

high lipid solubility

955
Q

spironolactone

[mechanism of action]

A

inhibits aldosterone at the DCT

956
Q

Lasix

[mechanism of action]

A

blocks Na reabsorption in the ascending Loop and DCT

957
Q

TRALI

[antibody confirmation]

A

lymphocytotoxic

958
Q

normal human plasma osmolarity

A

280

959
Q

Cricoid Pressure

[force in lbs]

A

8 - 10lbs

960
Q

Propofol infusion syndrome

[treatment]

A

charcoal hemoperfusion

supportive care

961
Q

pulmonary embolism

[most common signs]

A

tachypnea and rales

962
Q

Brugada Syndrome

A

causes sudden cardiac death in apparently normal hearts

  • EKG shows ST elevation in V1-V3
963
Q

Cauda Equina

[originates at what level?]

A

L1

964
Q

“millwheel murmur”

A

acute venous air embolism

965
Q

ventilatory drive in a COPD patient is normally in response to ____

A

hypoxemia

966
Q

Mannitol

[mechanism of action]

A

increases osmotic pressure of the glomerular filtrate increasing water excretion

967
Q

Hypothyroid patients are more likely to be _____glycemic

A

hypoglycemic

968
Q

Thyroid Storm

[treatment]

A

propranolol

methimazole

dexmethasone

iodine

969
Q
A

Board Exam (5 decks)

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