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Question 1

In patients with chronic respiratory acidosis, what does their bicarb do and why?

Answer 1

It is increased (>26) due to renal compensation (have to be able to retain, have to be well perfused)

Question 2

How is ED95 different in NMB?

Answer 2

Typically effective dose required for 95% of population to have desired effect. In NMB, 95% reduction in maximal twitch response from baseline in 50% of the population

Question 3

MELD score includes 4 things

Answer 3

INR, Na, bilirubin, Cr

Question 4

Child-Pugh score includes

Answer 4

“Pour Another Beer At Eleven”

Prothrombin time
Albumin
Bilirubin
INR
Encephalopathy
Presence of ascites

Subjective measures (encephalopathy), ceiling values (3 for bili regardless of how high), prothrombin time

Question 5

Dose required to produce desired effect

Answer 5

potency

smaller dose needed for same effect, more potent

Question 6

Maximum effect of a drug

Answer 6

Efficacy

does NOT depend on dose -> eg, a full agonist is more efficacious than a partial agonist (flatter dose-effect curve)

Question 7

what does tissue inflammation do to local anesthetics?

Answer 7

SLOWS it.
inflammation is acidic -> more ionized
increased blood flow -> washes away LA

Question 8

Local Anesthetic
ONSET
POTENCY
DURATION

Answer 8

ONSET: pKa (lipid solubility, concentration, pH)
POTENCY: lipid solubility
DURATION: protein binding

Question 9

Patients who receive INCREASED dose of acetylcholinesterase inhibitor (neostigmine) are at a higher risk of what

Answer 9

prolonged weakness

don’t exceed 0.07mg/kg (5mg MAX) -> depolarizing blockade

Question 10

time constant

Answer 10

circuit capacity/fresh gas flow

Question 11

treatment of methemoglobinemia in patients with G6PD deficiency

Answer 11

ascorbic acid (vitamin C)

Question 12

treatment of cyanide toxicity

Answer 12

amyl nitrate (oxidizes O2+ to O3+) -> induce methemoglobinemia to soak up cyanide

almond smelling breath

Question 13

Urology just asked you to give a dye - what happens to your pulse ox?

Answer 13

reads 84-86% for ~30 seconds (up to 20 min!) Caused by indigo carmine, methylene blue, indocyanine green

Question 14

Stress Response hormone chart - what hormones DECREASE

Answer 14

T3 and GRH

Question 15

what urine to plasma osmolality ratio indicates prerenal?

Answer 15

> 1.5

Can kidneys retain Na and water?

Question 16

definition of OSA

Answer 16

Complete apnea for 10 seconds at least 5 times an hour resulting in a decrease of Sa02 4%

gold standard: full polysomnography

Question 17

how does citrate work?

Answer 17

chelates calcium and magnesium (hence, why it’s used as an anticoagulant in blood storage)

majority is in FFP and platelets (not so much PRBCs).

usually rapidly metabolized by liver - but NOT if liver dysfunction, hypothermia, peds, hyperventilation

Question 18

hyperkalemia from blood infusions occurs at what rate?

Answer 18

120ml/min

Question 19

Mapleson Circuit Mnemonics

Answer 19

SEMI-open - part of the gases will be exhaled, part will be inhaled. 
Basic parts:
inlet for fresh gas
outlet for expiratory gases
patient end
bag end

Best for spontaneous ventilation efficacy:
ADCB: All Dogs Can Bite

Best for controlled ventilation

A: only one where fresh gases coming in distal end
B: both (inlet and outlet together by patient end)
C: corrugated-less, closed
D: opposite of A (fresh gas by patient, exhaled away)
E: valveless, no bag, peds
F: valveless, + bag. infants

Question 20

what is the pacemaker for the healthy heart?

Answer 20

the SA node

Question 21

BP conversion factor when cuff is ABOVE (or below) level of heart

Answer 21

0.75hg per cm

Question 22

Meyer-Overton Correlation

Answer 22

Oil: gas coefficient, potency, lipid solubility of volatiles correlate

Iso (1.1) 91
Sevo (1.8) 47
Des (6.6) 19

Question 23

what volatile property most correlates with speed of onset and offset?

Answer 23

blood:gas coefficient

highest: iso > svo > des
speed: des > sevo > iso

Question 24

fentanyl in epidural?

Answer 24

because trapped in placenta - very local

Question 25

bupivicaine

Answer 25

large - stidcks around

Question 26

lidocaine - epidural

Answer 26

tachyphylaxis