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Anesthesia > Questions/High-yield > Flashcards

Questions/High-yield Flashcards

1
Q

Causes of Oxy-Hb right shift

A 
Inc H+ (dec pH)
Inc CO2
Inc temp
Inc 2,3 -DPG
Pregnancy
Abn Hb (sickle cell)
Dec PaO2
Inhaled anesthetics
Infants/kids
Stopping smoking (dec carboxyHb)

This leads to Hb higher affinity at peripheral tissues = inc unloading of O2

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2
Q

Causes of Oxy-Hb left shift

A 
Dec H+ (inc pH)
Dec CO2
Dec 2,3-DPB
Dec temp
Fetal Hb/NEWBORNS
Carboxy, meth, sulfHb
High altitude
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3
Q

Best predictor of post-op mortality after thoracotomy

A

VO2-Max <12-15ml/kg/min

This = >2 flights of stairs

Other predictors:
ppoDLCO <40%
<20% = unacceptable risk

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4
Q

O2 cylinder psi and volume

A

2000psi = 660L

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5
Q

N2O cylinder psi and volume

A

750psi = 1590L

75% exhausted = 400L

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6
Q

Best Mapleson for spontaneous ventilation

A

A

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7
Q

Best Mapleson for controlled ventilation

A

D

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8
Q

Safest bellow design

A

ASCENDING

Ascends in expiration
Bellow collapse w/ disconnect

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9
Q

EKG lead that detects most ischemia

A

V5 = 75%

II + V5 = 90%

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10
Q

Correct BP cuff size

A

Width = 40-50% arm circumference

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11
Q

Causes of falsely high BP

A

Cuff too small
Loose cuff
Extremity below heart

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12
Q

Causes of a-line over dampening

A

1 = Air

Clot, stopcocks, vasospasm, large catheter size, long, narrow or compliant tubing

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13
Q

Myasthenia & NMBDs

A

MORE sensitive to ND-NMBDs

Resistance to SUX

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14
Q

LEMS & NMBDs

A

MORE sensitive to BOTH

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15
Q

Causes of prolonged SUX blockade

A
  1. Dec cholinesterase production
    - cyclophosphamide, severe chronic liver dz, pregnancy, malnutrition, hypothyroidism
  2. Anti-cholinesterase drug
    - echtiophate, neostigmine (phase 1)
  3. Dec pseudocholinesterase - huntington dz
  4. CCBs
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16
Q

Enhancers of ND-NMBDs

A 
Volatiles (Des the most)
Aminoglycosides (gent), Clinda, polymyxins, Pen V/G
Magnesium
LAs
Dantrolene
CCBs
Lithium
Acidosis, hypoCa, hypothermia, hypoK
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17
Q

Burn patients & NMBDs

A

Inc sens to SUX

Dec sens to ND-NMBDs

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18
Q

Stroke & NMBDs

A

Resistance to BOTH on hemiplegic side

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19
Q

CP & NMBDs

A

Resistance to ND-NMBDs

Normal response to Sux - NO risk of hyperK

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20
Q

SLE & NMBDs

A

Inc sens to both

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21
Q

LAs most likely to cause allergic reaction

A

Esters –> PABA

Prilocaine & Benzocaine

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22
Q

LA potency

A

lipid solubility

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23
Q

LA onset

A

pKa (low = fast)

Acidic tissue = slower onset

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24
Q

LA duration

A

Protein binding (high = long)

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25
Q

LA systemic absoprtion

A

IV > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > sciatic > subq

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26
Q

Opioid receptor responsible for resp depression, constipation

A

Mu-2

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27
Q

Turbulent flow proportional to?

A

DENSITY

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28
Q

Laminar flow proportional to?

A

Viscosity

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29
Q

Spinal + bradycardia, hypotension, dysphagia, dysphoria, dyspnea, LOC

A

Total spinal

- intubate + volume + epi

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30
Q

Highest MAC age

A

1-6months

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31
Q

High altitude effect on Desflurane administration

A

Need higher dial %

lower partial pressure for given dial %

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32
Q

Gas metabolized the most and highest Flouride levels

A

Sevo

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33
Q

Things that dec Ach release

A 
Antibiotics (clinda, polymyxin)
Magnesium (antagonizes Ca)
HypoCa
Anticonvulsants
Diuretics
LEMS
Botulinum toxin
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34
Q

1 allergic reaction

A

NMBDs

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35
Q

What % of receptors are blocked with 1/4 TOF, 2/4, 3/4, 4/4?

A 
1/4 = >90%
2/4 = 85%
3/4 = 75%
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36
Q

How many receptors are blocked with sustained head lift?

A

50% or less

Reliable recovery = sustained head lift/handgrip, tongue depressor test
Max insp pressure >40-50cmH2O

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37
Q

SE of cholinesterase inhibitors

A

Unopposed cardiac muscarinic –> brady or asystole

Bronchospasm, secretions, intestinal spasm, inc bladder tone, miosis

SLUDGE-Mi = salivation, lacrimation, urination, defecation, GI upset, emesis, miosis

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38
Q

CYP2C9 metabolism drugs

A

Warfarin

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39
Q

CYP3A4 metabolism drugs

A

Most anesthetics

HIV Protease inhibitors —> inhibit CYP3A4 for several days after stopping —> higher [benzo] and [opioids]

St. John’s Wort inducer = Inc metabolism of alfentanil, midazlolam, lidocaine, OCPs, NSAIDs, ARVs

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40
Q

CYP2D6 metabolism drugs

A

Codeine, beta-blockers, dilt, tramadol

poor analgesia w/ codeine, oxycodone, hydrocodone
Rapid metabolizers —> overdose

SSRIs inhibit and slow conversion of hydrocodone = need higher doses

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41
Q

Mechanism and SE of HCTZ

A

Blocks Na/Cl channel in DCT

SE = hyperglycemia, hyperuricemia, hyperlipidemia, hyperCa, hypochloremic metabolic alkalosis

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42
Q

Effect of hetastarch on coagulation

A

Dec GP IIb-IIIa, VIII, vWF

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43
Q

Tx dystonic reactions

A

Anticholinergics (diphenhydramine, benztropine)
Benzos
Propanolol

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44
Q

Causes of dec CBF

A

1 = hypothermia

Dec PaCO2
Dec MAP <50

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45
Q

Type 1 error

A

incorrectly accepting the alternate hypothesis

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46
Q

Supine positioning on FRC and CC

A

Dec FRC

No change in CC

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47
Q

Coronary artery blockage –> complete heart block

A

RCA –> PDA

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48
Q

Volatile metabolized the most

A

Sevo&raquo_space; Iso&raquo_space; Des

49
Q

Sudden PAINLESS vision loss

A

Ischemic optic neuropathy

50
Q

Risk factors for ischemic optic neuropathy

A 
males
large blood loss
anemia
prone position
large crystalloid resusitation  
hypotension
DM, smokers
51
Q

In what case are anterior ischemic optic neuropathy more likely vs. posterior?

A

Anterior = anterior cardiac surgery

Posterior = prone spine surgery

52
Q

OLV/endobronchial intubation affect on induction speed

A

SLOW Des the most

53
Q

Effect of CO on induction speed

A

Afffects ISO the most

- inc CO = slows induction

54
Q

Effect of ventilation on induction speed

A

Affects ISO the most (insoluble agents)

- Inc ventilation = speed induction

55
Q

Effect of intrapulmonary shunt on induction speed

A

Affects Des the most = SLOWS induction

56
Q

Effect of R –> L intracardiac shunt on IV and inhaled induction speed

A

Slows inhaled induction

Speeds IV induction

57
Q

Portion of heart supplied by RCA

A

Inferior and inferoseptal LV

58
Q

Tx for prolonged R time on TEG

A

FFP

long time to clot formation = low on clotting factors or on heparin, warfarin

59
Q

Tx prolonged K time on TEG

A

Fibrinogen

60
Q

Landmark for stellate ganglion block

A

TP of C6 (at level of cricoid)

Best indicator of successful block = temperature change

61
Q

Risk factors and procedures where IE ppx is indicated

A

Prosthetic valve
Prior IR
Unrepaired congenital heart defect or repaired in 1st 6 mo
Heart transplant + valve disease

Dental extractions
T&A, bronch
Skin or mucosal tissue procedures

62
Q

Mech of nalbuphine

A

Antagonist at mu
Agonist at kappa

Ceiling effect on resp depression

63
Q

Dx pre-renal AKI

A

UOsm >500
UNa <10
FENa <1%
BUN:Cr >20

64
Q

Formula for Standard Error

A

SE = SD / square root of N

65
Q

Formula for arterial O2 content (CaO2)

A

(Hbg x 1.36 x SaO2) + (0.003 x PaO2)

66
Q

Effect of cholinesterase inhibitors on SUX

A

Prolonged phase 1 block

67
Q

Hyperparathyroidism & NMBDs

A

dec dose and titrate up d/t unpredictable response from muscle weakness and hyperCa

68
Q

Which H2 blocker does NOT dec gastric volume?

A

Ranitidine

Onset ~1hr

69
Q

Mech of buprenorphine

A 
Mu partial agonist
Kappa antagonist (opposite nalbuphine)

25-40x potency of morphine
Ceiling effect on resp depression
Only mild withdrawl symptoms

70
Q

EKG abnormality seen with hypoCa

A

Prolonged QT

71
Q

Mechanism of glucagon

A

inc cAMP –> + ionotropic and chronotropic
- resembles epi, norepi and isoproterenol

Inc glycogenolysis and gluconeogenesis

Contraindicated in Pheo = severe HTN and hyperglycemia

Relaxes sphincter or oddi

72
Q

FFP contains which factors?

A

V
VIII (unstable, resembles vWF)

Highest citrate toxicity

73
Q

NMBDs metabolized to laudanosine

A

Cisastracurium

Atracurium - higher levels, histamine release

74
Q

0 order elimination

A
  1. Elimination is constant/linear
  2. Enzymes are saturated/at capacity
  3. THE-PAW: Theophylline, heparin, ethanol, phenytoin, aspirin, warfarin
75
Q

Order of nerve fiber blockade w/ epidural

A

B-fibers (most sensitive) —> A-fibers —> C-fibers (most resistant)

Blocks sympathetic 1st —> pain, temp, touch —> proprioception —> motor last

76
Q

PaO2 and Oxy-Hb curve with Meth-Hb

A

Normal PaO2

LEFT shift O2-Hb curve

77
Q

Benzo that undergoes glucuronidation (not hepatic oxidation)

A

Lorazepam

Also has greatest receptor affinity

78
Q

Vasopressor metabolized partially in the lungs

79
Q

Drugs that inc cGMP

A

SNP

Nitro & NO

80
Q

Signs of CN toxicity and treatment

A

metabolic acidosis, inc MvO2

Tx = 100% O2 and Bicarb

81
Q

Level of sedation with purposeful response to verbal or tactile stimuli

A

Moderate sedation

82
Q

Level of sedation with purposeful response to repeated or painful stimuli

A

Deep sedation

83
Q

What explains the relationship between CO2 dissociation and oxy-Hb?

A

Haldane effect

CO2 dissociation shifts right when [HbO2] increases
Inc ability for Hb to deliver CO2 in veins

84
Q

What explains the relationship H+ and oxy-Hb dissociation?

A

Bohr effect

Acidosis shifts curve right = less O2-Hb attraction and ability to transport MORE CO2 to lungs

85
Q

Mechanism of botulism

A

Inhibits intracellular fusion of Ach vesicles

86
Q

Pathway for the oculocardiac reflex

A

Trigeminal –> vagus

87
Q

How much fibrinogen is in each unit of Cryo?

88
Q

What factors are in Cryo?

A

VIII
XIII
Fibrinogen
vWF

89
Q

What are indications for using Cryo

A

Hemophilia A (VIII deficiency)
vWD
Low fibrinogen

does NOT need to ABO screened

90
Q

Max FiO2 in nasal cannula

A

4% above room air (21%) for every L = max 44% at 6L

FiO2 dec as MV increases

91
Q

Max FiO2:
Simple facemask
Non-rebreather
Partial rebreather

A

Simple = 35-50%

NRB = 60-90%

PRB = 40-70%

92
Q

things that inc MvO2

A

Inc delivery
- Inc CO, inc Hb-saturation, inc amt of Hb

Cirrhosis and sepsis (high CO)
Dobutamine (in CO)
Transfusion
CO, CN, methHb (less O2 transferred to tissues)
L --> R cardiac shunt
93
Q

Describe the Haldane effect

A

Deoxygenated blood = inc CO2 carrying capacity

94
Q

Things that dec FRC

A 
PANGOS:
Pregnancy
Ascities
Neonate
GA
Obesity
Supine

Females, dec height, upright –> supine = greatest decrease or T-berg >30 degrees

95
Q

Things that INC closing capacity

A 
ACLS-S:
Age
COPD
LV failure
Smoking
Surgery
96
Q

Inc peak and plateau pressure problem

A

compliance problem

CO2 insufflation, PTX, ARDS, pulm edema, auto-peep, asynchronous w/ vent

97
Q

Inc peak and normal plateau pressure problem

A

Airway resistance problem

Kinked ETT, aspiration, bronchospasm, mucous plug
Tx = suction airway + bronchodilator

98
Q

What factors improve hypoxic pulmonary vasoconstriction?

A
  1. Inc Insp O2 —> worsened V/Q mismatch —> hypercapnia in COPD patients
  2. Correct acidosis
  3. Inhaled NO
  4. HypOcapnia
99
Q

Dx of obesity hypoventilation syndrome

A
  1. Respiratory acidosis + compensated metabolic alkalosis (HCO3 30 +/- 4), and hypoxemia
    - 7.37/58/53/32
  2. BMI >30
  3. Awake hyperCO2 (PaCO2 >45)
  4. No other cause for chronic hypoventilation
  5. Abnormal sleep study w/ hypoventilation w/ nocturnal hyperCO2 w or w/o OSA or hypopnea events
  6. Usually Males, 50-70, chronic fatigue, mood disorders, headaches, DOW, hypersomnolence
100
Q

Causes of anion-gap metabolic acidosis

A
  1. Lactic acidosis
  2. Ketoacidosis
  3. Renal failure
  4. Toxins - aspirin, ethylene glycol, methanol
101
Q

Causes of NON-anion-gap metabolic acidosis

A
  1. RTA
  2. Expansion - rapid saline infusion
  3. GI HCO3- loss (diarrhea)
  4. Drugs —> hyperK
102
Q

What happens when you put Iso into a vaporizer for Sevo?

A

Higher vapor pressure gas = higher concentration delivered

103
Q

What happens when one-way valves are stuck open?

A

Rebreathing, hypercapnia

104
Q

What happens when expiratory limb valves are stuck open?

A

Breath stacking and barotrauma

105
Q

CO2 absorbent with greatest CO production

106
Q

How much Des will be delivered with a Des vaporizer at higher altitude?

A

Lower concentration = dial in higher amount

107
Q

What is Boyle’s Law?

A

P1V1 = P2V2

“Water Boyle’s at a constant temp and Prince Charles is under constant pressure”

108
Q

What is Charles’ Law?

A

Volume of a mass of gas = temp at constant pressure
V1/T1 = V2/T2

“Water Boyle’s at a constant temp and Prince Charles is under constant pressure”

109
Q

PT tests what factor(s)?

110
Q

PTT tests what factor(s)?

A

VIII and IX

111
Q

Name the direct thrombin inhibitors

A
  1. Hirudin
  2. Argatroban
  3. Dabigatran (Pradaxa)
  4. Lepirudin
  5. Bivalrudin
112
Q

Name the ADP receptor antagonists

A

Ticlopidine (longest duration), clopidogrel, ticagelor, plasugrel

113
Q

Name the GP-IIb/IIIa inhibitors

A

Tirofiban, abciximab, eptifibatide

114
Q

Tx vWD

A

DDAVP

Factor VIII

115
Q

Febrile NON-hemolytic reaction

A

Host antibodies bind to donor leukocytes

116
Q

Hemolytic transfusion reaction labs

A

+ direct antiglobulin test (Coombs)
Inc bilirubin, inc LDH
Dec Haptoglobin (binds Hb)

117
Q

How to reduce TRALI risk

A 
<14d old
No female donors
Apheresis platelets
?Cause - transfused antibodies to recipients leukocytes
 Most often with FFP and platelets
118
Q

Calculate allowable blood loss

A

EBV x (Hct starting - Hct lowest acceptable)/ Hct starting

EBV 65ml/kg

Anesthesia (25 decks)

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