QOD Flashcards
Reduction of HR in seen with the administration of opiates is mediated through the
Mu Receptors
-The cardiovascular effects of narcotics appear to be mediated through the mu receptors. In addition, these receptors seem, at least in part, to be responsible for the ventilatory depression associated with narcotic admnistration.
Effects of 60Hz current on a human for 1 second
- Perception Threshold – 1mAMP
- Let Go Current – 15mAMP
- Microshock – 100uAMP
- V.Fib – 200mAMP
The mortality after liposuction is most commonly the result of:
- PE
- Bowel Perforation
- Fat Embolism
- Reaction to anesthetic gases
Pulmonary Embolism
-Mortality rate is 0.02%. PE accounts for 23.1% of the deaths.
Heart rate:
- sole determinant of CO in the elderly
- normally determined by intrinsic rate of AV node
- decreases with increasing age
- increased by stimulation of M2 cholinergic receptor
Decreases with increasing age
-Cardiac output is the product of stoke volume and heart rate. Heart rate is an intrinsic function of the SA node and decreases with increasing age. Enhanced vagal activity slows the heart via stimulation of the M2 cholinergic receptors.
Pulmonary effects of B-2 adrenergic stimulation include: (select 2)
- inhibition of HPV
- decreased bronchial secretions
- pulmonary vasoconstriction
- bronchodilation
- redirection of blood flow to lower V/Q units
- activation of type II pneumocystis
decreased bronchial secretions
bronchodilation
-The tracheobronchial tree receives sympathetic innervation form the T1 - T4 nerve roots. β2 stimulation causes bronchodilation and decreased secretions. The sympathetic nervous system has minimal effects on pulmonary vascular tone. However, α1 stimulation causes some degree of pulmonary vasoconstriction.
Nervous system changes seen in the pregnant patient at term include: (Select 2)
- increased minimum alveolar concentration
- increased sensitivity to local anesthetics
- decreased CSF volume
- decreased cephalic spread of spinal anesthetics
- decreased epidural space pressure
- increased potential volume of epidural space
- increased sensitivity to local anesthetics
- decreased CSF volume
-Nervous system effects of pregnancy include a decreased MAC, an increased sensitivity to local anesthetics, an increase in epidural blood volume, increased pressure of the epidural space and a decrease in spinal CSF volume. There is an increase in the cephalad spread of both spinal and epidural anesthetics.
Clinical signs of a tension pneumothorax include:
- contralateral absence of breath sounds
- ipsilateral hypo resonance to percussion
- neck vein distension
- all of the above
- neck vein distension
- A tension pneumothorax develops from air entering the pleural space through a one-way valve in the lung or chest wall. Clinical signs include ipsilateral absence of breath sounds, hyperresonance to percussion, contralateral tracheal shift and distended neck veins.
Portal HTN leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the:
- hemorrhoidal veins
- pulmonary veins
- hepatic veins
- azygous veins
- hemorrhoidal veins
- Chronic portal hypertension leads to the development of portal-systemic collateral channels. Four major collateral sites are commonly recognized: gastroesophageal, hemorrhoidal, periumbilical and retroperitoneal.
A nonselective a-antagonist used in the preoperative preparation of a pt. with pheochromocytoma is:
- doxazosin
- propranolol
- phenoxybenzamine
- terazosin
- phenoxybenzamine
- Phenoxybenzamine is a nonselective α-antagonist used in the preoperative preparation of the patient with pheochromocytoma. Doxazosin and terazosin are selective α1-antagonists. Propranolol is a nonselective β-antagonist. In the preparation of patients with pheochromocytoma, α-blockade and intravascular volume replacement must precede β-blockade, so as to prevent the possibility of unopposed α-stimulation.
The portion of the nephron responsible for concentration of urine via the countercurrent mechanism is the:
- glomerulus
- loop of Henle
- proximal convoluted tubule
- distal convoluted tubule
- Loop of Henle
- The loop of Henle is responsible for formation of hypertonic fluid in the (renal) medullary interstitium via the countercurrent multiplier system.
Postoperative ulnar nerve injury:
- results in wrist drop and loss of sensation in the web space between the thumb and index finger
- occurs more frequently in males
- manifests itself in the immediate postoperative period
- is most commonly seen in the patient with a BMI of less than 38
-occurs more frequently in males
-Three attributes which are highly associated with development of postoperative ulnar nerve injury are:
1) male sex - various reports suggest that 70-90% of patients with postoperative ulnar neuropathy are men
2) high body mass index - BMI > or = 38
3) prolonged postoperative bed rest.
Many patients with postoperative ulnar neuropathy have a high frequency of contralateral ulnar nerve dysfunction, suggestive of a pre-existing abnormality. Patients may not develop symptoms of ulnar neuropathy until more than 48 hours postoperatively. Wrist drop and loss of sensation of the web space between the thumb and index finger is associated with radial nerve injury.
The Carlens tube is best represented by:
-The Carlens double-lumen tubes have a carinal hook to aid in proper placement and minimize tube movement after placement. Potential problems with carinal hooks include increased difficulty with proper placement, trauma to the airway, interference with bronchial closure, and break-off of the hook, which can become lost in the bronchial tree.
In contrast to patients undergoing on-pump coronary artery bypass grafting (CABG), patients undergoing off-pump CABG:
- usually require little volume replacement
- do not require anticoagulation
- have isolated left coronary of left anterior descending artery disease
- usually require relatively high mean arterial pressures during distal anastomoses grafting
- usually require relatively high mean arterial pressures during distal anastomoses grafting
- Off-pump CABG (OPCAB) is done in patients with a variety of coronary artery lesions. Since the patient will not be receiving the volume of the pump-prime, crystalloid and/or colloid solutions are used to correct fluid deficit. Anticoagulation is required, but partial heparinization is often used. During distal anastomoses grafting, CPP is maintained by keeping a relatively high MAP.
The single greatest cause of mortality in the patient with sickle cell disease is a result of:
- acute chest syndrome
- sequestration crisis
- aplastic crisis
- vaso-occlusive crisis
- acute chest syndrome
- ACS represents the single greatest threat to the patient with SCD as the mortality is 1% to 20%. The diagnosis of ACS can be made when there are new lung infiltrates on a chest radiograph in the presence of any of the following: chest pain, cough, dyspnea, wheezing, or hypoxemia. Proposed mechanisms of ACS are thrombosis, embolism (clot and fat), and infection. The frequency of ACS after abdominal surgery is 10% to 20%.
The line isolation monitor:
- provides a source of ungrounded electrical power
- reduces the risk microshock
- monitors the integrity of the isolated power system
- monitors the integrity of equipment grounding wires
- monitors the integrity of the isolated power system
- The line isolation monitor continuously monitors the integrity of the isolated power system. The line isolation transformer provides ground isolation. Microshock hazards occur with the delivery of 100 microamps or less of current directly to the endocardium. These small amounts of current are well below the sensing range of the ground isolation monitor. The LIM is unable to detect a faulty grounding connection in the equipment attached to the circuit.
Parasympathetic preganglionic fibers are found in: (Select 3)
- cranial nerve IV
- cranial nerve VII
- cranial nerve IX
- cranial nerve XI
- thoracic nerve 9
- thoracic nerve 11
- sacral nerve 1
- sacral nerve 2
- cranial nerve VII, cranial nerve IX, sacral nerve 2
- Parasympathetic preganglionic fibers are found in cranial nerves III, VII, IX and X as well as sacral nerves 2, 3 and 4.
Electrolyte containing irrigation solutions are avoided during transurethral resection of the prostate because they:
- interfere with the use of the cautery
- can precipitate severe hyponatremia
- can cause hyperglycemia in diabetic patients
- are associated with elevated ammonia levels postoperatively
- interfere with the use of the cautery
- Electrolyte containing solutions conduct electricity and interfere with cautery use during the resection of the prostate. Electrolyte solutions are commonly used in the postop period. Sorbitol solutions have been associated with hyperglycemia, especially in diabetic patients. Glycine solutions have been associated with elevated ammonia levels and transient postoperative visual syndrome. Sorbitol, glycine and distilled water have all been associated with TURP syndrome.
The use of nonionic gadolinium contrast media during MRI:
- can result in ionizing radiation exposure to the patient & anesthesia provider
- results in frequent allergic reactions, urticaria & bronchospasm
- is commonly associated with nausea
- should be avoided in patients with a pacemaker or AICD
- is commonly associated with nausea
- Gadolinium contrast for MRI is not a source of ionizing radiation. The incidence of allergic reactions to MRI contrast is extremely low, especially as compared to conventional radiographic iodine-containing contrasts. Nausea is a common side effect of MRI contrast administration. Although caution must be used in patients undergoing MRI with ferromagnetic implants, which may include both pacemakers and AICDs, the administration of MRI contrast is not contraindicated.
The speed in an inhalation induction is slowed by right-to-left shunting. The change in the rate of induction is LEAST pronounced when using:
- nitrous oxide
- sevoflurane
- desflurane
- isoflurane
- isoflurane
- With right-to-left shunting there is slowing of an inhalation induction. This effect is less pronounced with agents with high blood/gas solubilities.
MAC-BAR is the:
- partial pressure of an anesthetic required to abolish movement in 50% of patients
- partial pressure of an anesthetic at which subjects will open their eyes
- partial pressure of an anesthetic at which autonomic blockade occurs
- partial pressure of an anesthetic at which amnesia occurs
- partial pressure of an anesthetic at which autonomic blockade occurs
- MAC-BAR is the minimum alveolar concentration that blocks autonomic reflexes. MAC-BAR is considerably greater than MAC, particularly in the absence of opioids. It has been estimated that MAC-BAR is approximately 50% above standard MAC.
In a 6-year-old, the appropriate length of an endotracheal tube from distal tip to incisors is:
- how many cm?
- 15-16.5cm
- Several formulas exist to estimate the length of ETT insertion in patients aged 2 to 12 years. One of the most frequently used is:
Age/2 +12
Local anesthetic solutions that are isobaric with the cerebrospinal fluid include: (Select 2)
- tetracaine 0.5% in 5% dextrose
- bupivacaine 0.75% in normal saline
- procaine 10% in sterile water
- lidocaine 2% in normal saline
- bupivacaine 0.3% in sterile water
- lidocaine 5% in 7.5% dextrose
- Bupivicaine 0.75% in NS
- Lidocaine 2% in NS
-Hyperbaric Tetracaine: 0.5% in 5% dextrose Bupivacaine: 0.75% in 8.25% dextrose Lidocaine: 5% in 7.5% dextrose Procaine: 10% in water
-Isobaric Tetracaine: 0.5% in caline Bupivacaine: 0.75% in saline Bupivacaine: 0.5% in saline Lidocaine: 2% in saline
-Hypobaric
Tetracaine: 0.2% in water
Bupicacaine: 0.3 in water
Lidocaine: 0.5% in water
An 82-year-old female arrives to the OR for open reduction of a left intratrochanteric fracture. Significant past medical history includes hypertension, moderate aortic stenosis and dementia. The most appropriate anesthetic technique for this patient is:
- opioid-based general anesthesia
- spinal anesthesia
- volatile-agent-based general anesthesia
- epidural anesthesia
- opioid-based general anesthesia
- In patients with mild to moderate aortic stenosis, a primarily opioid-based technique results in minimal cardiac depression, less tachycardia and suppression of the sympathetic response to surgical stimulation. These are all desired effects as HTN and tachycardia may precipitate ischemia in these patients. Spinal or epidural anesthesia as well as a volatile-agent-based anesthesia can cause a fall in afterload with resulting severe hypotension.
What is the pharmacologic mechanism of action of the anticoagulants below? Please match medications with MOA:
- Anti-thrombin activation
- Vit. K Inhibition
- Thrombin Inhibition
- Factor Xa Inhibition
- Warfarin
- Hirudin
- Heparin
- Rivaroxaban
- Anti-thrombin activations – Heparin
- Vit. K Inhibition – Warfarin
- Thrombin Inhibition – Hirudin
- Factor Xa Inhibition – Rivaroxaban
The rate of seroconversion after exposure of mucous membranes to HIV-infected blood is approximately:
- 0.03%
- 0.09%
- 0.3%
- 0.9%
- 0.3%
- Percutaneous exposure (needle stick) carries a risk of HIV-seroconversion of approximately 0.3% or about 1:300. Mucous membrane exposure carries a risk of approximately 0.09% or about 1:1100.
Actuation of the oxygen flush valve delivers 100% oxygen at a rate of:
- 10 - 20 L/min
- 20 - 30 L/min
- 35 - 75 L/min
- 80 - 100 L/min
- 35-75 L/min
- The oxygen flush valve delivers 100% oxygen at a rate of 35 - 75 L/min with a pressure of 40 - 60 psi.
A decrease in cholinesterase activity has been associated with:
- obesity
- thyrotoxicosis
- alcoholism
- burns
- burns
- Burns, liver disease, 3rd trimester of pregnancy, carcinoma, renal failure and collagen diseases as well as certain drug therapy have been associated with a decrease in cholinesterase activity. Increased cholinesterase activity has been associated with obesity, alcoholism, thyrotoxicosis, nephrosis, psoriasis and electro-convulsive therapy.
The incidence of headache with inadvertent dural puncture during epidural anesthesia is decreased:
- with decreasing age
- by keeping the patient supine for more than 12 hours following puncture
- with the use of fluid, instead of air, for loss of resistance
- by inserting the needle with the bevel aligned perpendicular to the long axis of the meninges
- with the use of fluid, instead of air, for loss of resistance
- The use of fluid instead of air has been associated with a significant reduction in the incidence of postdural puncture headache (PDPH). Other factors associated with a reduced incidence of PDPH are: increasing age, insertion of the bevel aligned parallel to the long axis of the meninges and the use of smaller needles. There is no evidence that keeping the patient supine reduces the incidence of PDPH.
Factors decreasing physiologic dead space include:
- the supine position
- anticholinergic agents
- increasing age
- emphysema
- supine position
- Dead space is comprised of gases in non-respiratory airways (anatomic dead space) as well as in alveoli that are not perfused (alveolar dead space). The sum of the two is known as physiologic dead space. Certain factors affect dead space. The supine position is known to decrease dead space, whereas anticholinergics, β2-sympathomimetics, advancing age and COPD all increase dead space.
The most consistent clinical manifestation of aspiration pneumonitis is:
- bronchospasm
- arterial hypoxemia
- pulmonary vasoconstriction
- tachypnea
- arterial hypoxemia
- Inhaled gastric fluid is rapidly distributed throughout the lungs, leading to destruction of surfactant-producing cells, damage to the pulmonary capillary endothelium and resultant atelectasis and pulmonary edema. Arterial hypoxemia is the most consistent clinical finding associated with aspiration pneumonitis. Tachypnea, bronchospasm and pulmonary vasoconstriction with secondary pulmonary hypertension may also be present.
A full-term, 4.2 kg neonate is scheduled for a thoracotomy for resection of congenital lobar emphysema. The infant’s starting hematocrit is 48%. Estimated allowable blood loss to maintain a hematocrit at or above 38% is:
-___ cc?
-70-110cc
-The full-term neonate has approximately 85 ml/kg total blood volume. Therefore:
4.2 kg x 85 ml/kg = 357 ml (blood volume)
MABL = Blood Volume x (HCT(starting) - HCT(final)) / HCT(average)
357 ml x (48 - 38) / 43 = 83 mL
Hormones released by the neurohypophysis include: (Select 2)
- thryotropin
- growth hormone
- arginine vasopressin
- adrenocorticotropic hormone
- follicle stimulating hormone
- oxytocin
- prolactin
- luteinizing hormone
- arginine vasopressin
- oxytocin
-The neurohypophysis is another term for the posterior pituitary gland. The hormones of the neurohypophysis, oxytocin and arginine vasopressin (vasopressin, ADH), are synthesized in the hypothalamus and stored in the posterior pituitary. Stimulus for the release of arginine vasopressin arises from osmoreceptors in the hypothalamus that sense an increase in plasma osmolality.
Pancreatic somatostatin producing cells in the Islets of Langerhans are:
- alpha cells
- beta cells
- gamma cells
- delta cells
- delta cells
- The Islets of Langerhans are comprised of four cell types: alpha cells producing glucagon, beta cells producing insulin, delta cells producing somatostatin and PP cells producing pancreatic polypeptide.
Causes of normal-anion-gap acidosis include:
- renal failure
- starvation
- diarrhea
- lactic acidosis
- diarrhea
- Normal-anion-gap acidosis is also called hyperchloremic acidosis and results from the selective loss of bicarbonate anion or the introduction of large amounts of chloride anion. Common causes include: diarrhea, hypoaldosteronism, renal tubular acidosis and increased intake of chloride containing acids sometimes found in hyperalimentation.
