RANDOM FACTS for SEE 1 Flashcards
1
Q
Soda lime equation
A
CO2 + Ca(OH)2 → CaCO3 + H2O + heat (in the presence of water
2
Q
How would excessive tubing affect a-line waveform
A
OVERDAMPING
3
Q
How would multiple stopcocks affect the a-lie waveform
A
Overdamping
4
Q
Dandrolene use to treat 2 conditions
A
MH and Neuroleptic Malignant syndrome
5
Q
MOA of Dandrolene is
A
Reduces Calcium (Ca2+) release from SR, relaxes skeletal muscle
6
Q
How do you mix dandrolene is?
A
20 mg in 60 mLs
7
Q
Preparation for a patient with known MH include
A
Change breathing circuit
CO2 absorbent
Disable or remove vaporizers
8
Q
Filters use for MH include
A
Charcoal filters
9
Q
Malignant Hyperthermia Association of US recommends for patients with MH
A
Charcoal filters
High Fresh gas flow (10L/min) throughout maintenance phase of anesthesia.
10
Q
Malignant Hyperthermia Association of US (MHAUS) recommends for patients with MH
A
Charcoal filters
High Fresh gas flow (10L/min) throughout maintenance phase of anesthesia.
11
Q
Receptor involves in MH
A
Ryanodine Receptor.
12
Q
MH triggers are
A
VA
Succinylcholine
13
Q
Acute MH sequence of action (nagelhout)
A
- Immediately d/c Va and succinylcholine
- Call for help and tell surgeon to conclude the procedure promptly
- Prepare and administer DANTROLENE 2.5mg/kg and repeat every 5-10 minutes until symptoms go away
- Hyperventilate with 100% O2
14
Q
Cushing’s reflex triad is
A
Bradycardia
Hypertension
Widening Pulse pressure (rising SBP, declining DBP)
15
Q
Cushing’s reflex triad is
A
Bradycardia
Hypertension Widening Pulse pressure (rising SBP, declining DBP)
Irregular respirations
16
Q
What does 2 main things cushing reflex presence means?
A
- Late signs of increased ICP
2. Herniation is IMMINENT
17
Q
Focused Neurological exam first sign of ICP increase is
A
Papilledema
18
Q
EEG: Order in which Frequency DECREASE and Amplitude Increases: BAT Drink
A
Beta
Alpha
Teta
Delta
19
Q
EEG: Order in which DECREASE Frequency and Amplitude Increases (DFAI) BAT Drink
A
Beta (low)
Alpha (high)
Teta (high)
Delta (Max)
20
Q
Wave for AWAKE with EYE OPEN
A
Beta waves
21
Q
BAT DRINK BLOOD- in sleep (EEG waveform for awake –> DEEP SLEEP)
A
Awake with eyes open--> BETA Awake with eyes closed--> ALPHA Stage I light sleep: Theta waves Stage II Intermediate sleep: SLEEP SPINDLES Stage 3/4 Delta waves REM / Paradoxical SLEEP: Beta waves.
22
Q
CBF is kept constant by________range of _____to _____
A
Autoregulation 65 mmHg to 150 mmHg
23
Q
Autoregulation of CBF is
A
Arterioles adjust keep CPP and MAP over wide range of pressure changes.
24
Q
When the MAP is < 65 OR greater than 150mmHg what happens in the brain?
A
brain is not able to autoregulation and becomes dependent on MAP
25
As long as CPP>60 mmHg, what is more important to control?
ICP control is more important than further increases In CPP
26
What is the MONRO-KELLIE hypothesis?
Cranial compartment is enclosed in a NONexpandable case of bone, thus the volume inside the cranium is fixed, , BLOOD , CSF and BRAIN exists in the state of equillibrium.
27
When Should CVP measurement be measured? why?
End exhalation; lowest negative intrathoracic pressure.
28
2 main determinants of CVP
1. Right ventricular function
| 2. Venous return.
29
What can determine venous return (TV CRI)
```
Total blood volume
Venous tone
CO
Right ventricular contractility
Intrathoracic pressure.
```
30
3 contraindications to PAC insertion
LBBB
| WPW and Epsteins anomaly
31
What is Mixed venous O2 saturation (SvO2)?
% of Oxygen BOUND TO HGB returning to the right side of the heart.
32
Factors that LOWER SvO2? 2 main reasons;
Decrease O2 delivery
| Increase O2 consumptiom
33
Factors that INCREASE SvO2? 2 main reasons;
Increasing O2 delivery (high FiO2, hyperoxia)
Decreasing O2 demand (Hypothermia, NMB)
High FLOW states (sepsis, liver disease)
34
High Flow states occurs in
Sepsis
| liver disease
35
When does the diastolic PAOP offers the best approximation of the LVEDP when what wave is present ?
LARGE v Waves
36
SVR formula
MAP-CVP/CO x 80
37
When do you see large V waves? MiMrDacIs
MI
MR
DAC (decrease atrial compliance)
IS Increased SVR
38
Calorimeter CO2 detector requires how many breaths to detect?
6 breaths
39
Factors that increase CO2?
```
Hypoventilation
Hyperthermia
Hyperthyroidism
Rebreathing (baseline elevation)
Release of cross clamp
```
40
Factors that decrease CO2?
Hyperventilation
Low cardiac output
Hypothyroidism
PE
41
How does PE affect CO2?
Decrease CO2
42
Calorimeter turns ____in people with intact circulation
yellow
43
Flat ETCO2 waveform
Cardiac arrest
Vent disconnect
Airway misplaced in esophagus
44
Pulse Ox explained by the
Beer Lambert law
45
Pulse oximetry work on the principle of
Absorption spectophotometry
46
How does Methemoglobin affect O2 saturation?
Tends to trends toward < 85%
47
Methemoglobin shifts the O2 oxhemoglobin curve to the
LEFT
48
Methemoglobinemia is confirmed by
COoximetry
49
CO and O2 affinity to Hg
CO has 200X the affinity as O2
50
High levels of Carboxyhemoglobin (COHgb) on the oxygen carrying capacity
Reduced Oxygen carrying capacity of blood. and will give FALSE HIGH pulse ox reading.
51
If COHgb is > 25%
Hyperbaric oxygen
52
Low SPO2 by dyes, name 3
Methylene blue
Indigo Carmine
Indicyanine green
53
4 phases of capnogram: Phase I
Exhalation of CO2 free gas from dead space
54
4 phases of capnogram: Phase II
Combination of dead space and alveolar gas
55
4 phases of capnogram: Phase III
Exhalation of mostly alveolar gas
56
4 phases of capnogram: Phase IV
inhalation of Co2 free gases
57
Types of capnometers: 2
mainstream
| sidestream
58
Cuvette heated to 40C is what type of capnoeter
Mainstream
59
Mainstream capnometer is placed between E
ET tube and breathing circuit
60
Response time of MAINSTREAM is
Fast
61
RESPONSE time of Sidestream is
Slow
62
Capnography vs capnometer
Capnography shows WAVEFORM
| Capnometry shows numbers
63
Dicrotic notch is the
closure of the aortic valve.
64
Late sign of hypoxemia is
Cyanosis
65
IABP provide counter pulsation during ______for 2 main reasons which are?
Diastole
| INCREASE Coronary perfusion, Decrease afterload.
66
Cerebral oximetry measures global or regional ? how does it work?
REGIONAL ; Transcutaneous measure of the cerebral cortex.
67
Cerebral oximetry uses measure oximetry through
NIRS (Near Infrared spectroscopy)
68
Cerebral oxygen supply is determined
Cerebral blood flow
| Arterial oxygen content
69
Cerebral oxygen demand is determined by
CMRO2
70
First alert of impending organ dysfunction: Which monitor?
Cerebral oximetry
71
What is the part of the brain with limited oxygen supply and is more susceptible to ischemic injury?
Cerebral cortex.
72
SSEP signals recordings are obtained from which 3 different points?
```
Peripheral nerve at a proximal level (integrity of peripheral nerve)
Brainstem (sensory tracks of the spinal cord)
Cerebral cortex (sensory cortex)
```
73
Intraparturm fetal monitoring mnemonic :
VEAL CHOP MINE
Variable deceleration --> Cord compression/prolapse
Early deceleration --> Head compression
Acceleration --> Okay or O2
Late decelerations --> Placental insufficiency.
Move position
Initiate secondary measures
Nothing
Emergency delivery
74
Normal fetal heart rate varies from
110-160 bpm
75
Fetal monitoring DECELERATIONS means
Decrease in O2 delivery to the fetus.
76
Decelerations are characterized by
decrease from baseline of at least 15 minutes lasting 15s or longer than 2 min
77
Most common heart arrythmia
Atrial fibrillation
78
When to use a pacemaker magnet?
Surgical Site within 6 inches to the pacemaker
79
If you don't have enough time to interrogate pacemaker, what are your course of action?
Place A-line
Magnet over PM
Tell surgeon to use SHORT BURSTS with electrocautery.
80
Traditional GOLD standard modality among ANCILLARY test for brain death is
Four-vessel cerebral angiography
81
Are CONFIRMATORY /Ancillary test that confirm the loss of bioelectrical activity of the brain in brain death always mandatory?
NO/
82
Most IMPORTANT and MANDATORY test for the determination of brain death is
APNEA TESTING
83
Absent corneal reflex in brain death is demonstrated by
touching cornea with a piece of tissue or paper or a cotton swab, NO EYELID MOVEMENT SHOULD BE SEEN
84
Apnea testing : the patient must have
complete absence of documented respiratory effort by formal apnea testing, demonstrating a PaCO2 60mmHg and 20 mmHg or greater increase above baseline. if NO respiratory effort is observed after initiation of the time of PaCO2 60mmHg or 20 mmHg above baseline, the APNEA test is consistent with BRAIN DEATH
85
Brain death , pt should be what before the test?
Preoxygenate with 100% oxygen for 5-10 minutes before the test.
86
In brain death: Absent oculovestibular test is tested by
irrigating each ear with ice water 10-15ml (caloric testing), after patency of the external auditory canal is confirmed. Head is elevated 30 degrees. MOVEMENT OF THE EYE SHOULD BE ABSENT during 1 minute of observation.
87
Temperature in brain death testing
Normothermia > 36C ; hypothermia must be corrected before the criteria for brain death are applied.
88
Doll's test in brain death is
The oculocephalic reflex, also known as Doll's eyes response, is elicited upon brisk turning of the head from middle position to 90° on both sides. In comatose patients without lesions of the brainstem, the eyes normally conjugately deviate to the other side. In BD no eye movements are observed
89
Normal caloric test in brain death, eyes deviate to
Side of ice water application
| if BRAIN DEATH, no eyes deviation occur.
90
Normal caloric test for NON BRAIN death patient? What about in brain dead patients?
Head to the right, EYES to the left
Head to the left, eyes to the right
NO EYE MOVEMENT in brain death patients.
91
ASA I
A normal healthy patient
| Healthy, non-smoking, no or minimal alcohol use
92
ASA II
A patient with mild systemic disease
93
Mild diseases only without substantive functional limitations.
ASA II
94
Current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease
ASA II
95
ASA III
A patient with severe systemic disease
96
Classify this ASA poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse,,
III
97
ESRD undergoing regular dialysis ASA
III
98
Pt with implanted pacemaker, moderate reduction of ejection fraction no other issues ASA
III
99
Premature infant PCA < 60 weeks, ASA is
III
100
History (>3 months) of MI, CVA, TIA, or CAD/stents.ASA
III
101
A patient with severe systemic disease that is a constant threat to life --> ASA
IV
102
ASA for recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or
IV
103
ESRD not undergoing regularly scheduled dialysis ASA
IV
104
A moribund patient who is not expected to survive without the operation ASA
V
105
ASA Ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect
V
106
ASA for ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction
V
107
A declared brain-dead patient whose organs are being removed for donor purposes ASA
ASA VI
108
MRI safety zone I is
All areas freely accessible to staff with no restrictions
109
MRI safety zone II is
Restricted , under supervision of radiology personnel.
110
Designated for Screening and safe from the magnet field, which MRI zone
Zone II
111
MRI safety zone III is
Restricted, ONLY MR personnel and patients FOLLOWING screening and interview have access.
112
MRI control room and monitoring areas is what zone?
Zone III
113
MRI safety zone IV is
Immediate area around the scanner
114
OMPHALOCELE how to remember whether or not covered by peritoneum
Big O to remember a circle and that the abdominal contents are sealed by the O, and thus are covered by the peritoneum
115
GASTROCHICIS how to remember whether or not covered by peritoneum
G is a almost a circle but has an OPENING, meaning the abdominal contents come out of that little opening therefore the ABDOMINAL contents NOT covered by peritoneum.
116
What remains intact during brain death? what is one implication?
SPINAL and AUTONOMIC reflexes? Still need NMB agents.
117
Organ procurement drugs used are LMH TV
Lasix
Mannitol
Heparin
T3 hormone and /or Vasopressin.
118
When is anesthetic concluded during organ procurement surgery?
Once aortic cross clamp isapplied, COLD CARDIOPLEGIA solution is infused, Ventilation is D/C'd and the anesthetic management is concluded.
119
What principle is based on patient's RIGHT to make decision about their medical care?
Autonomy
120
What principle is based on obligation of Clinicians to NOT HARM PATIENTS?
Nonmaleficence.
121
Clearly defined codes of conducts that govern the actions of all clinicians and to novel moral dilemmas is
ETHICS
122
What does HIPAA stands for?
Health Insurance Portability and Accountability Act
123
When was HIPAA enacted
1996
124
2 provisions of HIPAA
1. define procedures and guidelines for covered entities protecting privacy and security of individuals
2. Setting civil and criminal penalties for guidelines violations.
125
What rule of the HIPAA regulates the use and disclosure of Protected Health Information (PHI)?
Privacy rule
126
The security rule of HIPAA only covers
PHI in electronic form only
127
All medical records, be they be oral written, electronic are covered by the
HIPAA Privacy rule.
128
Name 2 class III antidysrhtymics
Amiodarone
| Sotalol
129
90% of congenital diaphragmatic hernias occur: through the
left posterolateral foramen of Bochdalek
130
What are the hallmarks of diaphragmatic herniation (HBS)
Hypoxia
Bowel in the thorax (evidence of )
Scaphoid abdomen
131
During Diaphragmatic herniation repair, Peak airway pressures should not _______why?
exceed 30 cm H2O to minimize the risk of pneumothorax during surgical correction.
132
Severity of injury in malpractice claims is decreasing as indicated by the lower claims for death and brain damage due to
Use of pulse oximetry
| Capnography
133
2 most frequents sites of injury nerve related
ULNAR nerve
| Brachial plexus
134
Adverse outcomes associated with ________ events were found as the SINGLE LARGEST CLASS INJURY with ____% in the ASA CLOSED CLAIMS PROJECTS
Respiratory ; 37%
135
Most common eye injury under anesthesia is
CORNEAL ABRASION.
136
3 causes of postop visual loss
1.Retinal artery occlusion
2. Ischemic optic neuropathy
Cortical blindness.
137
Why is a magnet place over a pacemaker?
Convert from SYNCHRONOUS to asynchronous or Fixed rate
138
Minimize pacemaker interference Unipolar or bipolar?
Bipolar
139
Remembering the factors mnemonic
| What factors isn't included or is non existent: Factor VI.
```
Foolish- Fibrinogen - I
People - Prothrombin - II
Try - Tissue thromboplastin - III
Climbing - Calcium - IV
Long - labile factor - V
Slopes - Stable FACTOR - VII
After - Anti Hemophilliac Factor A - VIII
Christmas - Christmas factor - IX
Some - Stuart PROWER FACTOR - X
People - Plasma Thromboplastin antecedent - XI
Have - Hageman factor - XII
Fallen - Fibrin stabilizing factor - XIII
```
140
Pain originating from abnormal function of an internal organ is
Visceral pain
141
Pain arising from nociceptive input from the skin , subcutaneous tissues, and mucous membrane. characterized by sharp, throbbing and burning
Somatic.
142
Chemical mediators of pain (2)
Substance P
| Glutamate
143
Goal of management in the patient with CRPS (Complex regional pain synrome)
Restore movement and strength in the region.
144
What is POSTHERPETIC NEURALGIA?
Common pain syndrome that transpire after an episode of herpex zoster.
145
What is shingles?
Reactivation of the latent VARICELLA ZOSTER VIRUS, that remains in the DORSAL ROOT GANGLION>
146
Shingles follow or spread
Spread within a sensory dermatome.
147
Pain induced by a stimulus not normally painful is defined as
Allodynia
148
What is the major disadvantage of the traditional circle systems in a pediatric patient is
Unpredictability of and accuracy of TV delivery .
149
Only anesthetic that can be administered IM
Ketamine.
150
Parkland formula
total fluid requirement in 24 hours is as follows:
4ml x TBSA (%) x body weight (kg);
50% given in first 8 hours; 50% given in next 16 hours.
151
The risk of Postanesthetic respiratory depression is _________related to ______-age and ________ at the time of anesthesia
Inversely related
| Gestational age and Postconceptual age.
152
Central apnea MOSTLY associated with top 2 factors
anemia
Sepsis
Opioids
153
Central apnea from immaturity of the respiratory drive center is treated with
Xanthine derivatives such as CAFFEINE and THEOPHILLINE
154
Most practical way to manage infant at risk for central apena
Admit and monitor all infants less than 60 weeks PCA until they are free of symptoms
155
Neonates are obligate______breathers
NOSE
156
Bronchopulmonary dysplagia treatment is
Supportive
157
4 classic findings of Tetralogy of Fallot
1. VSD
2. RV outflow tract obstruction (RVOT)
3. RV hypertrophy
4. Overriding aorta
158
Patients with Tetralogy of fallot are at risk for
TET SPELLS cause by acute spasm of the infundibulum, brought on by crying, feeding or ANY THING THAT INCREASE OXYGEN CONSUMPTION
159
What to do with patient with Tetralogy of fallot having a tet spell?
Increase SVR
| Decrease PVR in order to reverse the shunt from R TO LEFT to left to right and allow for better oxygenation
160
TET spell : infants having tet spells what position
Knee to chest to increase SVR
161
Transposition of the great arteries main goal
Maintenance of CO
162
VACTERL mnemonic vs VATER associated with what 2 condictions
Esophageal Atresia and TrancheoEsophageal Fistula.
```
Vertebral defects
Anus imperforated
Cardiovascular abnormalities
TEF
Radial and renal
Limb anomalies
```
VATER excludes, LIMB and Cardiovascular abnormalities.
163
Most common type of TEF
Type IIIB/ C
164
Diagnosis of TEF is made by
Chest and abddominal radiography reveal inability to pass an Orogastric tube which lodges in the blind esophageal pouch.
165
How should the infant with TEF be nurse
Prone or in lateral position an an incline of 30 degrees to decrease the risk of aspiration.
166
Staged repair of what lesion ?
TEF
167
How do you intubate the patient with TEF, first step is to
Suction the upper esophageal pouch and adminsitration of oxygen
168
What is intentionally done when intubating a child with TEF?
An intentional right mainstem endobronchial intubation is initially performed. Then the ETT is slowly withdrawn while auscultating. the left thorax until breath sound are heard to make sure you are just above the carina and past or below the fistula.
169
Common way of feeding infant with TEF include
Gastrotomy and TPN .
170
Pyloric stenosis is
Gastric outlet obstruction
171
Cardinal features of Pyloric stenosis
Persistent Projective NONbilious vomiting
Peristalsis (visible)
HYPOCHLOREMIC METABOLIC ALKALOSIS
172
Acid base disorder associated with pyloris stenosis is
HYPOCHLOREMIC METABOLIC ALKALOSIS>
173
Diagnosis of pyloric stenosis is
Abdominal US and PALPABLE OLIVE-SIZED mass in the UPPER ABDOMEN or distal pylorus.
174
Anesthetic management in pyloric stenosis
Full stomach, RSI
| even if children comes with NG tube, stomach should be suctioned with a red rubber catheter.
175
How do you suction the patient with pyloric stenosis before induction?
SUPINE, RIGHT, and LEFT lateral positions immediately before induction of anesthesia to cover all 4 quadrants of the stomach
176
What is the most common surgical emergency in neonates?
Necrotizing Enterocolitis (NEC)
177
What is necrotizing enterocolitis? who is more at risk?
Inflammatory necrosis of the bowel. micropremies
178
2 things that confirm NEC is
Pneumatosis Intestinalis
| Portal venous air.
179
A line isolation monitor -- > An alarm does not mean there
is imminent danger to the patient or anyone else.
180
Line Isolation Monitor, The alarm therefore simply calls
attention to the fact that the system has converted
| to a partially grounded system
181
Microshock: As little as_____ can cause VF.
100 μA
182
Threshold of perception, a slight tingling at the fingertips
1 milliA (mA)
183
mA—maximum harmless current.
5 milliA (mA)
184
pain, fainting, and exhaustion.
50 mA
185
Ventricular fibrillation (VF) will likely result. with ____mA
100 mA
186
Single-twitch stimulation: A single supramaximal electric current is applied at a frequency ranging from
1.0 Hz ((one every second) to 0.1 Hz (one every
| 10 s)
187
Train-of-four stimulation:
Four stimuli at 2 Hz are applied (four stimuli in 2 s) that are repeated every 10 to 12 s if needed
188
NMB blockade degree is measuredd.
The ratio of the fourth response to the first response (T4/T1 ratio) is used to assess the presence of
neuromuscular blockade and its degree.
189
What concerns are there whenever a patient with persistent AF is cardioverted? What test is needed?
There is a concern that a thrombus could be located in the left atrial appendage which could embolize to the brain and cause a stroke. A transthoracic echocardiogram or transesophageal echocardiogram is usually performed to rule out the existence of a thrombus.
190
The major causes of maternal cardiac arrest are: From most to least common
Pulmonary embolism 29%
Hemorrhage 17%
Sepsis 13%
Peripartum cardiomyopathy 8%
191
Measures of the extrinsic coagulation pathway
Prothrombin time (PT) and its derivative the international normalized ratio (INR)
192
Factors that are made in the liver are
Factors I (fibrinogen), II (prothrombin),V, VII, and X are made in the liver. (1,2,5,7,10)
193
For liver issues: The Child-Pugh score considers five factors, three of which assess the synthetic function of
the liver ____,____,_____along with two more
subjective clinical factors ____and _____
(total bilirubin level, serum albumin, and INR) (degree of ascites and hepatic encephalopathy).
194
The Model for End-Stage Liver Disease (“MELD”) score uses (BIC)
Bilirubin
INR
Creatinine
195
Management of DIC should involve:
1. Treatment of the underlying cause
| 2. Supportive therapy and replacement of blood components
196
The major focus of management of DIC is
specific and vigorous treatment of the underlying disorder.
197
The platelet count is expected to rise by
30–50 × 10−9/L after the transfusion of a single pooled unit.
198
Fresh frozen plasma: a standard dose of____ml/kg for active hemorrhage
10–15 mL/kg should be used during active hemorrhage
199
What coagulation factors would most likely be elevated in obese patients? (select two)
Fibrinogen, factors VII, VIII, von Willebrand factor, and plasminogen activator inhibitor are elevated in obese patients.
200
NDMA -When stimulated by the excitatory neurotransmitter, glutamate, the ion channel
opens and allows calcium, potassium, and sodium ions to enter the cell.
CaKNa
201
The development of the central sensitization of chronic pain syndromes which receptor
NDMA
202
What is the largest interlaminar space?
L5
203
The sensory innervation for the nasal cavity is provided by the
opthalmic (V1) and maxillary (V2) branches of the trigeminal nerve.
204
The muscles that elevate the ribs are
inspiratory muscles.
205
The muscles that lower the ribs are .
expiratory muscles.
206
The most powerful Inspiratory muscles are the
external intercostals
207
The sternocleidomastoid muscles raise the sternum and contribute to inspiration as do the
anterior serratus and scalene muscles.
208
A good example of a variable intrathoracic obstruction is
tracheomalacia.
209
C1 esterase deficiency is responsible for a condition called The primary concern is airway obstruction. Even slight trauma to the airway can produce severe airway edema.
hereditary angioedema.
210
C1 esterase deficiency is responsible for a condition called
hereditary angioedema.
211
Primary concern for patient with C1 esterase deficiency at risk for angioedema.
The primary concern is airway obstruction. Even slight trauma to the airway can produce severe airway edema.
212
Which of the following explains why children have a faster uptake and more rapid increase in alveolar levels of inhaled anesthetic? (select two)
Increased cardiac output
| Increased minute ventilation
213
The kidney position is similar to the _____position but utilizes ___________ to increase exposure of the kidney
lateral jackknife position but utilizes an elevated rest under the iliac crest to increase exposure of the kidney.
214
In the extrinsic coagulation pathway, disruption of the endothelium leads to exposure of tissue factor which binds to
Factor VII
215
Tissue Factor forms a complex with Factor VII, and in an enzymatic reaction requiring
Calcium, catalyzes the activation of Factor X.
216
Which of the following is most likely to occur as a result of respiratory alkalosis from hyperventilation?
Hypophosphatemia
217
Respiratory alkalosis from hyperventilation decreases phosphate levels because it
increases the use of ATP by the cells.
218
Respiratory alkalosis from hyperventilation decreases phosphate levels because it
increases the use of ATP by the cells.
219
The appropriate preoperative dose of cimetidine is
150 mg- 300 mg oral or IV.
220
The most common resident flora are
diphtheroids and coagulase-negative Staphylococci
221
Hallmark manifestations of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
DUO UOH SOL
Decreased urine
UrineOsmoHigh
SerumOsmo Low
222
Large hepatic resections or resections of tumors near the vena cava or portal vessels carries a significant risk for
air embolism.
223
A tool for assessing the severity of liver disease.
MELD
224
End stage liver disease is generally associated with ____SVRvery low SVR,and increased mixed venous oxygen saturation. .
VERY low SVR
225
End Stage Liver Disease is associated with _____CI and ______resting HR
increased cardiac index, increased resting heart rate,
226
INR in liver disease
Increase
227
Unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof is referred to as
Sentinel event
228
Process variation that didn't affect patient outcomes, but carries a high risk for serious injur
A near miss
229
Identifies three components to quality: SOP
structure, process, and outcomes.
230
Is the facilities and environment in which care is administered and includes policies and procedures, governance, noise levels, ease of access, privacy, etc.
Structure
231
Is how the care is actually delivered and includes concepts such as compassion, communication, development of trust, etc.
Process
232
Involve the measurements of results of the care provided and includes elements such as mortality, morbidity, and speed of recovery.
Outcomes
233
The amount of time that a plaintiff has to file an action is called the
statute of limitation
234
When is the statute of limitation determined?
It is determined by state law and usually begins at the time the plaintiff discovers the negligent act,
235
The normal plasma osmolarity is about _______ mOsm, and most of this is due to _______ and its related ions.
290; Sodium
236
What are the primary inhibitory transmitters used by interneurons in the dorsal horn to modulate pain information? (select two)
GABA
| Glycine
237
is a descending pathway involved in the modulation of pain signals.
The periaqueductal gray-rostral ventromedial medulla
238
Ascending spinal pathways are
The spinothalamic, spinohypothalamic, spinobulbar, and spinomedullary tracts
239
The majority of visceral afferent fibers are
A-delta and unmyelinated C fibers
240
You are inducing a patient for coronary artery bypass surgery and administer a large loading dose of fentanyl. The patient becomes difficult to mask ventilate and you suspect chest wall rigidity from the narcotic. What step should you take?
administer succinylcholine
241
Large doses of narcotics, particularly fentanyl, sufentanil, and alfentanil, can result in
chest wall rigidity that can make ventilation difficult or impossible.
242
Which of the following corticosteroids has the shortest elimination half-time?
Cortisone
243
Corticosteroids have elimination half-times between 3.5 and 5 hours.
Triamcinolone, betamethasone, and dexamethasone
244
Elimination half time of Dexamethasone
3.5-5 h
245
Much of the initial dose of local anesthetics such as lidocaine, bupivacaine, and prilocaine are removed from the circulation by the
Lungs
246
What is the initial bolus dose of 20% lipid emulsion therapy for a patient suffering from severe local anesthetic toxicity?
The initial bolus dose of 20% lipid emulsion for the treatment of local anesthetic toxicity should be 1.5 mL/kg followed by an infusion of 0.25 mL/kg/min continued for at LEAST 10 MINUTES AFTER hemodynamic stability is achieved.
247
Which H2 receptor antagonist would be most likely to interfere with drug metabolism by cytochrome P450 enzymes?
CIMETIDINE
248
As a result, cimetidine administration can result in increased plasma concentrations of several drugs including
LiQuiThe PPP W
lidocaine, quinidine, theophylline,,
procainamide, propranolol, phenytoin.warfarin, and
249
Most antiepileptic drugs are highly bound to
albumin.
250
As a result, hypoalbuminemia can result in an
increased concentration of the free form of the drug.
251
Medications that are also highly bound to albumin such as thyroxine and salicylates can do what to antiepileptic drugs.
can displace antiepileptic drugs from the protein and result in increased plasma concentrations as well.
252
Chlorpropamide is a long-acting sulfonylurea. It will produce ______
hyponatremia with serum sodium levels less than 129 mEq/L in about 5% of patients
253
actors that increase the incidence of hyponatremia in patients taking chlorpropamide include age greater than
60 years, female gender, and the use of thiazide diuretics.
254
The most common events that result in anesthesia malpractice claims include
regional blocks (1/5 of all claims), respiratory issues (17%), cardiovascular problems (13%), and equipment problems (10%).
255
Occupational exposure to methyl methacrylate can produce
skin irritation, burns, allergic reactions, headache, neurologic symptoms, and reproductive disorders.
256
In patients, exposure to methyl methacrylate can produce
pulmonary hypertension, bradycardia, and hypotension.
257
A large, metal piece of equipment has become attached to an MRI magnet. The staff are preparing to turn off the magnet so that it can be removed. You know that (select two)
It normally takes a few minutes to turn off the magnet
| all personnel must vacate the scanner room while it is being turned off Because helium gas is vented,
258
Croup involves edema of the Airway above or BELOW the vocal cord
airway below the vocal cords (Thick C is below B)
259
The actual level at which shock (meaning the lack to oxygen delivery to the tissues) occurs is known as
Critical DO2 level.
260
In a patient who is otherwise healthy, the critical DO2 level can be reached at a hemoglobin level between
3 and 3.5 g/dL.
261
What preoperative criteria is the strongest predisposing factor to postoperative delirium?
Pre-existing delirium
262
During an inhalation induction, the presence of a right-to-left shunt will
decrease the arterial partial pressure of the anesthetic
263
The volatile anesthetics all produce a dose-dependent decrease in mean arterial pressure. This is due primarily to a decrease in
systemic vascular resistance
264
What component of the hanger yoke prevents the cross-filling of gas from one cylinder to another?
Check valve
265
Prevents the backflow of gas out of the anesthesia machine or the cross-filling from one tank to another.
Check valve.
266
The oxygen low-pressure alarm on your anesthesia machine begins sounding. What is the first step you should take?
Switch on the backup oxygen cylinder and consider switching to manual ventilation since many ventilators use the oxygen supply to drive the ventilator bellows.
267
The gases from the anesthesia flowmeters are first mixed in the
Common manifold
268
Oxygen should be positioned where in the flowmeters and why?
last in the flowmeters. That way, in case there is a crack in the flowmeter, it decreases the chance that a hypoxic gas mixture will be administered since it is added to the common manifold last.
269
Compared to sea level, if you turn on a Tec 6 vaporizer at a high altitude, it will
deliver a LOWER partial pressure of desflurane
If you set a Tec 6 vaporizer to 6% at 10,000 feet, it will still output a constant 6%, but since the atmospheric pressure is only 500 mmHg, the partial pressure will decrease from about 45 mmHg to 30 mmHg.
270
For example, in both the non-rebreathing circuits and circle system, the circuit is considered SEMI-OPEN if the
fresh gas flow rate is greater than the minute ventilation.
FG > MV
271
Circuit class is considered semi-closed.
If the FG < MV then the patient must be rebreathing some of the exhaled gases
272
Most mishaps related to the anesthesia machine scavenging system occur due to
user error.
273
What component in a gas-driven ventilator is responsible for producing the 2-3 cm H2O of PEEP seen when mechanical ventilation is applied?
The ventilator relief valve
274
During inspiration, the pressure from the driving gas closes the ____Valve.The APL valve and the breathing bag are both eliminated from the circuit when the ventilator is in mechanical ventilation mode.
ventilator relief valve so that the circuit can pressurize and inflate the patient's lungs.
275
During the early part of expiration, a weight in the ventilatory relief valve holds the valve open until the bellows have filled. This weight against the patient's expiration creates what ?
creates a PEEP of 2-3 cm H2O.
276
The inspiratory valve______on inspiration and ______on expiration to prevent the backflow of exhaled gas into the inspiratory limb.
opens ; closes
277
The expiratory valve ______on expiration and ______on inspiration and prevents rebreathing of gases in the expiratory limb. By opening and closing in this way, the unidirectional valves prevent the
opens; Closes ; rest of the circle system from contributing to the circuit deadspace.
278
The pressure gauge on your oxygen E-cylinder shows that it is at exactly half of the full service pressure. How many minutes will the tank last if you are using 10 liters of oxygen a minute? (Calculate your answer to the nearest whole number)
33 minutes
279
The most commonly used patient assessment scoring tool in PACUs is the T
Aldrete postanesthetic scoring system.
280
The Aldrete score includes assessments of blood
pressure, level of consciousness, oxygen saturation, the ability to move extremities on command, and the ability to breathe deeply and cough.
281
A patient experiences an anaphylactic reaction to an antibiotic while under anesthesia. The patient remains hypotensive despite epinephrine and hydration. The next appropriate step would be to administer
Arginine Vasopressin
282
Increasing the mechanical deadspace in an anesthesia circuit will
Make rebreathing of CO2 more likely
283
The introduction of tubing or some other respiratory apparatus between the patient and the y-piece of the circuit will
increase the deadspace
284
What are the primary goals for the anesthetic of a patient with sickle cell disease? (select two)
Adequate hydration
Adequate pain control
Avoid hypoxia
Maintain hgb 10-11
285
The drugs most commonly involved in anesthesia-related allergic reactions are (select two)
NMBA
| ABTs
286
The Tec-6 vaporizer is heated because
desflurane has a high vapor pressure
287
TEC 6 vs Variable bypass vaporizer?
Unlike a variable-bypass vaporizer, the fresh gas flow does not come into contact with the liquid desflurane
288
The variable-bypass vaporizer you were about to install and use on your next case gets tilted onto its side. What should you do before this vaporizer can be used? (select two)
Drain the anesthetic from the vaporizer
| Run fresh gas flow through the vaporizer for a period of time
289
The normal thyromental distance should be,
at least 7 cm or about the length of three fingerbreadths.
290
A normal intercisor distance is
at least 4 cm.
291
Rocuronium, vecuronium, atracurium, cisatracurium, fentanyl, sufentanil, remifentanil, and induction doses of propofol should be based on
lean body weight.
292
Succinylcholine, dexmedetomidine, neostigmine, and sugammadex doses should be based on
total body weight.
293
The normal aortic valve area is
2.0-2.5 square cm.
294
The normal flow rate or aortic valve during systole is
250 mL/min.
295
Following a parathyroidectomy, a patient is suspected of having bilateral recurrent laryngeal nerve damage. Your chief concern is that this patient may require
REINTUBATION
296
Can result from bilateral paralysis of the recurrent laryngeal nerve, and the patient may require reintubation.
Acute airway compromise
297
Unilateral paralysis of the RLN can result in
of the recurrent laryngeal nerve can result in hoarseness.
298
Which value will decrease in response to the pneumoperitoneum for a laparoscopy?
Stroke volume
299
Myasthenia gravis is characterized by autoimmune destruction of
acetylcholine receptors
300
The current treatment of choice for myasthenia gravis is
thymectomy.
301
Succinylcholine is contraindicated
more than 24 hours after a significant burn injury
302
Why should succinylcholine avoided more than 24 hours after a burn injury?
The upregulation may take a few days to occur, so succinylcholine should be avoided more than 24 hours after a burn injury.
303
ECG changes with Pregnancy
This makes the heart appear larger on chest xray and produces a left axis shift on the ECG. I
304
Supine hypotensive syndrome in a parturient is most likely to occur at
36-38 weeks of gestation
305
Hyperglycemia in the parturient can produce _____ in the fetus soon after delivery.
HYPOGLYCEMIA
306
Why do parturients with Hyperglycemia have neonates with hypoglycemia?
As increased levels of glucose pass through the placenta, the fetus is stimulated to produce more insulin. This can result in fetal hypoglycemia after delivery.
307
A total spinal typically occurs very rapidly. The patient may exhibit dyspnea and difficulty speaking or swallowing. If the local anesthetic blocks the cardioacceleratory fibers in the T1-T4 spinal cord segments, then ____ and _____may ensue.
severe hypotension and bradycardia
308
The addition of epinephrine does not significantly affect the duration of action of whereas
bupivacaine, etidocaine, or prilocaine
309
The addition of epinephrine Significantly prolong duration of what 3 LAs?
procaine, mepivacaine, and lidocaine are significantly prolonged.
310
Accounts for most of the heat lost in a surgical patient.
Radiant heat loss (radiation)
311
Patient factors associated with an increased risk of postoperative nausea and vomiting include: ASIDE from What I already know?
- large body habitus
- young age Laparoscopic surgeries are prone to - -- producing nausea as are procedures greater than one hour.
I already know:
Nonsmoker
female gender
prior history of postoperative vomiting, and a history of motion sickness.
312
The primary mechanisms responsible for peripheral nerve injury are (3) , but the component that stems from these mechanisms and is common to all peripheral nerve injuries is.
CKST
transection, compression, stretch, and kinking;
ischemia
313
When placed in the seated position, the cardiac index, pulmonary artery wedge pressure, and central venous pressure (Increase/decrease) ?
decrease substantially
314
The only parameter that increases when patient is in the Seated position?
SVR
315
A patient with severe peripheral vascular disease exhibits a blood pressure that is higher in the left arm than in the right arm. In this instance, you should
RECORD the higher BP
316
If the blood pressure readings between two extremities vary significantly in patients with peripheral vascular disease, you should record the
higher pressure.
317
Factors associated with increased MAC values.
```
Increased catecholamines
Hyperthermia,
Cyclosporine, red hair
hypernatremia,
history of chronic ethanol abuse are
```
318
What does increase catecholamines do to MAC?
Increase
319
What does hypernatremia do to MAC?
Increase
320
Modern volatile anesthetics decrease the blood pressure primarily by their effect on
systemic vascular resistance
321
Modern volatile anesthetics decrease the blood pressure in a dose-dependent fashion by decreasing
vascular resistance.
322
What is coronary reserve?
Coronary reserve is the difference between maximal and resting coronary blood flow.
323
Which intravenous anesthetic has the fastest elimination half-life?
Propofol 30 minutes to 1.5 hr.
324
midazolam elimination half-life of
2-4 hours. (
325
The elimination half-life of ketamine is about
2-3 hours.
326
Etomidate elimination half-life of
elimination half-life of
327
Select two potassium-sparing diuretics that block the epithelial sodium channel.
Amiloride
| Triamterene
328
What is the most common cause of acute kidney injury (AKI) in surgical patients?
Acute tubular necrosis
329
TRIAD of DKA? HAK
Acidemia, ketonemia, hyperglycemia
330
Nerve fibers are associated with motor and proprioception.
A-alpha
331
Fibers are associated with pain and touch
A-delta
332
Fibers are associated with muscle tone.
A-gamma
333
Which of the following statements reflects an accurate understanding of the respiratory changes that occur during pregnancy?
Metabolic acidosis
| No change in TLC
334
Which epidural techniques would be effective in preserving motor function in a laboring parturient without compromising analgesia? (select two)
Add a lipid-soluble opioid to the local anesthetic
| Administering a large volume of dilute local anesthetic
335
What are changes that occur in banked blood?
Acidosis and the absence of factors V and VIII
336
Banked blood and potassium levels of
Hyperkalemia,
337
Banked blood changes in endothelium?
increased adhesion to the vascular endothelium, oxidative damage, depletion
338
Banked blood and 2,3 DPG, ATP depletion
2,3 DPG (also known as 2,3 BPG), depletion of ATP, hemolysis, accumulation of microaggregates, absence of viable platelets after 2 days of refrigerated storage, and altered morphology of RBCs also occur.
339
Which agent is an analog of somatostatin that is administered to blunt the bronchoconstrictive and vasoactive effects of carcinoid tumor products?
Octreotide
340
What is the medication octreotide?
Octreotide is an analog of somatostatin and is administered to blunt the bronchoconstrictive and vasoactive effects of carcinoid tumor products.
341
Inflation of an IABP balloon is timed to occur with the of the______ arterial waveform just after closure of the
dicrotic notch; aortic valve.
342
Most significant predictor of a difficult mask ventilation?In order of importance: BBLAH
```
Beard (most significant)
Body mass index > 26
Lack of teeth
Age > 55 years, and a
History of snoring are independent risk factors associated with difficult mask ventilation.
```
343
By what weeks of gestation is surfactant production is sufficient in most cases.
35 weeks gestation
344
Which intravenous agents would be most capable of producing burst suppression on the EEG? (select two)
Etomidate and Propofol.
345
Which sign or symptom has the most ominous prognosis in a patient experiencing malignant hyperthermia?
The development of DIC has an ominous prognosis when associated with malignant hyperthermia and is common in cases that are fatal.
346
common features of malignant hyperthermia.
Hypercarbia
increase in body temperature
increase in serum potassium
347
According to the Vortex approach to the difficult airway, which of the following should be done between each noninvasive airway attempt?
Make a change in the airway visualization conditions
348
According to the Vortex approach to the difficult airway, between each noninvasive airway attempt, a change should be made that would affect the airway visualization conditions. These would constitute a
Manipulation of the position of the head, neck, or larynx, and change in device or device size, a change in the operator, implementation of airway adjuncts such as oral or nasal airways, or pharmacologic adjuncts such as muscle relaxants or reversal of muscle relaxants.
349
Both seen with Dextemedetomidine
Hypertension --> Hypotension
350
What factors have the greatest effect on the composition of the inspired gas mixture a patient receives? (select two)
Vaporizer dial setting
| FGF
351
Branches of what nerve provide sensation to the ANTERIOR two-thirds of the tongue?
Lingual nerve of the TRIGEMINAL NERVE>
352
Hyperchloremic metabolic acidosis can worsen that is _______already present in renal patient population.
hyperkalemia
353
There are three phases involved in a liver transplant:Induction of anesthesia,
the preanhepatic, anhepatic, and neohepatic phases.
354
Liver Transplant : Anhepatic Phase
Clamping of the hepatic blood supply would occur during the anhepatic phase.
355
Occur during the preanhepatic phase of a liver transplant?
- isolation of the infrahepatic and suprahepatic vena cava
| - exposure of the hilar structures of the liver
356
Liver Transplant: The neohepatic phase would include
reperfusion of the new liver.
357
Common outlet internal diameter
There is only one common gas outlet which has a 15 mm inner diameter and an
358
Common outlet outer diameter of.
22 mm
359
The common gas outlet is designed to help
prevent accidental disconnection.
360
Metabolic disturbances associated with OSA include
dyslipidemia, glucose intolerance, and insulin resistance.
361
Compared to a VATS, the Robotic VATS procedure has similar lengths of hospital stay and risk of perioperative morbidity. The risks of _______and _______ are actually increased with an RVATS.
chylothorax and recurrent laryngeal nerve injury
362
What information can a Doppler provide that a two-dimensional echocardiogram cannot?
Information about blood flow velocities within the heart
363
Which of the following is caused by an anterior pituitary tumor?
Cushing's disease.
364
Cushing's disease is distinct from Cushing's syndrome in that it is due specifically to
an anterior pituitary tumor.
365
The production of excess growth hormone is also often caused by a tumor in the anterior pituitary gland.
Acromegaly
366
Cushing syndrome refers to any condition involving
corticosteroid excess.
367
BUN levels of 20 to 40 mg/dL suggest
decreased GFR
dehydration
high nitrogen levels.
368
Levels < 8 mg/dL are seen in
overhydration or an underproduction of urea,
369
The first day postop following a large hepatic resection, a patient exhibits a prolonged INR. You know that this
is typical and usually resolves in 5 days
370
You are preparing to anesthetize a patient for emergency trauma surgery. What intervention would exert the most protective influence on postoperative renal status in this patient?
Maintaining the intravascular volume
371
Which law of thermodynamics states that the entropy of a system approaches a constant value at absolute zero?
3rd law of thermodynamics
372
The law of entropy states that all energy moves towards a state of greater entropy, which means it moves toward a greater state of randomness.
2nd law of thermodynamics
373
Patients who suffer a myocardial infarction following noncardiac surgery have an elevated in-hospital mortality rate of
15-25%
374
Compared to suprarenal and infrarenal clamping, a______________ is associated with the most significant changes in hemodynamics including alterations in mean arterial pressure, pulmonary capillary wedge pressure, and ejection fraction.
supraceliac aortic cross clamp
375
92% of patients undergoing supraceliac clamping will exhibit
abnormal cardiac wall motion.
376
A typical, tertiary amine local anesthetic needs to be _____ to enter an axon and _____ to exert its effect once inside the neuron.
nonionized, ionized
377
A condition in which painful stimuli are perceived as much more painful than expected.
hyperalgesia,
378
Several areas of the brain are activated by painful stimuli including the
Prefrontal cortex
Insular cortex
Anterior cingulate cortex
Hypothalamus, and the somatosensory cortices (SI and SII).
379
All of these except for the _________ receive somatosensory input from thalamic neurons
the prefrontal cortex
380
What supraspinal regions contribute to the emotional and motivational aspects of pain sensation? (select two)
anterior cingulate cortex
| insular cortex
381
The limbic and paralimbic regions (anterior cingulate cortex and insular cortex) are involved in the
emotional and motivational aspect of pain sensation.
382
The SI and SII somatosensory cortices are involved in determining
the location and intensity of pain sensations.
383
Which ascending spinal pathway is most involved in the homeostatic and behavioral aspects of pain?
Spinobulbar
384
The major ascending spinal pathways involved in the transmission of nociceptive information include the
spinothalamic, spinohypothalamic, spinomedullar, and spinobulbar tracts.
385
The spinothalamic tract is most important for transmission of
most important for the transmission of pain, temperature, and itch sensations.
386
The spinobulbar tract is important in integrating pain information with
homeostasis and behavior mechanisms
387
The spinohypothalamic tract is involved in the
autonomic, neuroendocrine, and emotional aspects of pain.
388
The effect-site equilibration time of alfentanil is compared to and as long as
1.4 minutes
389
The effect-site equilibration time ____ for fentanyl,
6.8 minutes
390
The effect-site equilibration time ____ for sufentanil,
6.2 minutes for sufentanil
391
The effect-site equilibration time ______for morphine.
15-30 minutes
392
Tramadol administered intrathecally provides analgesia via 2 mechanisms.
mu receptor activity and the inhibition of serotonin and norepinephrine uptake.
393
Capsaicin exerts its analgesic effects on
Capsaicin is a component of hot chili peppers that agonizes TRPV1 receptors on the endings of unmyelinated C fibers.
394
It is available as a cream and a transdermal patch and has been proven efficacious in the treatment of postherpetic neuralgia.
CAPSAICIN
395
The primary mechanism by which digitalis glycosides produce their inotropic effect is by increasing
intracellular calcium levels
396
You are administering large amounts of banked blood intraoperatively to a patient who takes calcium channel blockers. This patient is at an increased risk for developing
HYPERKALEMIA
397
Calcium channel blockers slow the movement of
potassium into the cell.
398
Can occur occasionally with the use of a transdermal scopolamine patch.
Anisocoria (unequal pupil size). It can produce visual disturbances and is most likely due to contamination of the eye after manipulating the patch. In 90% of cases, the dilated pupil is on the same side as the patch.
399
The primary etiologic factor in the development of retinopathy of prematurity (ROP) is
the gestational age.
400
Factors such as (3) are also associated with an increased risk of developing ROP.
hyperoxia, hypocarbia, and acidemia
401
Which test is most widely used to assess the intrinsic coagulation pathway?
PTT
402
Which test is most widely used to assess the Extrinsic coagulation pathway?
PT
403
The primary cellular difference between smooth muscle cells and skeletal muscle cells are that smooth muscle cells lack
visible cross striations. This is because, unlike skeletal muscle, actin and myosin are not arranged in regular arrays. Instead of T-tubules, smooth muscle cells contain pockets called caveoli.
404
Flow should be read at the____of a bobbin or in the ____ of a ball TBoMBa
top; middle
405
Soda lime is manufactured to have a mesh size between 4 and 8 to (select two)
optimize surface area
| optimize gas flow resistance
406
Before installing a new oxygen cylinder on your anesthesia machine, you should
crack the valve open slightly for a second. This will clean away any grease, dust, or debris that would otherwise be released into the anesthesia machine. Because of the serious consequences that occur should a pressurized cylinder fall and break the valve off, you should lay a tank flat on the ground if it cannot be secured in an upright position.
407
The total response time has two components:
the transit time (also known as the lag time) that it takes for the gas sample to get to the analyzer and the rise time. The rise time represents how long it takes the analyzer to respond to a change in the gas composition.
408
Specifically, the rise time is defined as the
time it takes for the analyzer to change from 10% of the total change in gas composition to 90% of the total change in gas composition.
409
What is the most frequent cause of hospitalization in patients older than 65?
HF
410
The drug of choice for infections caused by methicillin-resistant staphylococcus aureus is
. vancomycin (60 minutes before case)
411
Class of vancomycin
bactericidal glycopeptide.
412
Compared to the aortic root pressure, as the location of the arterial catheter gets more distal, the
diastolic pressure decreases, systolic pressure increases
413
For optimal positioning in an adult, an esophageal temperature probe sensor should be positioned about ______ cm from the nose.
45
414
This will place the probe in the distal third or distal fourth of the esophagus of the average adult, which will help avoid
cooling by respiratory gases in the trachea.
415
The main purpose of
disconnection in the breathing circuit.
416
When monitoring neuromuscular blockade after induction to determine optimum intubating conditions, it is recommended that you set the peripheral nerve stimulator to deliver
. single twitches at 0.1 Hz every 10 seconds
417
Using train of four at 10 to 12 second intervals may falsely accelerate the
apparent blockade at the site of monitoring and misrepresent the blockade of the laryngeal muscles.
418
The most common cause of hyperthermia in a patient under general anesthesia is
iatrogenic overwarming
419
You are preparing to purge an anesthesia machine prior to administering an anesthetic for a patient with malignant hyperthermia. When performing a purge, you should use a fresh gas flow rate of
10 L/min
420
Four crystalloids considered to be isotonic include:
Normal saline (308 mOsm/L)
D51/4NS (283 mOsm/L)
Lactated Ringer's solution (273 mOsm/L)
Plasmalyte (294 mOsm/L)
421
Normal saline_____ mOsm/L)
308
422
D51/4NS (____mOsm/L)
283
423
Plasmalyte (______mOsm/L)
294
424
Lactated Ringer's solution (____mOsm/L)
273
425
Green-tinted protected eyewear with the markings 'OD5 or greater for 1,064 nm' would be appropriate for which type of laser?
Eyewear with the markings 'OD5 or greater for 1,064 nm' would be appropriate protection for potential exposure to a Nd:YAG laser. Note: although the lenses are often green for this type of lens, the color cannot be relied upon as some Nd:YAG glasses are clear.
426
Why is the threshold for local anesthetic toxicity lower when injected intra-arterially than when injected intravenously?
Because the lungs account for a significant portion of local anesthetic uptake
427
Segmental spread of an epidural block is primarily dependent upon what factor? DES
DES (Dose and Site)
428
Segmental spread of an epidural block is primarily dependent upon what factor? SBP (SpinaL)
baricity of the solution, and the patient's position to determine the spread of the anesthetic
429
Epidural steroid injection has been demonstrated to be effective at
- reducing leg pain
- the degree of sensory deficit
- need for opioids during the acute phase of the injury.
430
The speed of emergence following an inhalational anesthetic is: (select two)
Solubility and MV
Directly proportional to alveolar ventilation
| Inversely proportional to the agent's blood solubility
431
The most common cause of delayed awakening following surgery is
prolonged action of anesthetic drugs
432
In order of incidence, the most common causes of delayed awakening following surgery are:
1) prolonged action of anesthetic drugs, 2) metabolic causes, and 3) neurologic injury.
433
An anesthetized patient undergoing neurologic surgery has a monitor in place that utilizes a stroboscopic flash with recording electrodes placed on the scalp. What intraoperative test is being performed?
Visual evoked potentials
434
In visual evoked potentials, a stroboscopic flash
stimulus is used, with recording electrodes placed on the patient's scalp.
435
The mixing of the donor and recipient blood in a trial transfusion prior to administering the donor blood to the patient is referred to as
crossmatching
436
Determines the patient's blood type and predicts compatible transfusions 99.94% of the time.
Blood typing (a type and screen)
437
Actual mixing of the donor and recipient blood in a trial transfusion increases the possibility of a compatible transfusion by only one-hundredth of 1%.
Crossmatching
438
Banked blood contains an
anticoagulant containing sodium citrate which binds to calcium in the bloodstream
439
The ETCO2 waveform suddenly drops to near zero and the waveform disappears. What are the potential causes you must immediately consider? (select four)
```
Malposition of the endotracheal tube
cardiac arrest
pulmonary embolism
circuit disconnection
obstruction of the sampling line are potential causes that must be immediately considered if the ETCO2 waveform drops to zero or disappears.
```
440
The chief danger in performing a cervical transforaminal steroid injection is
vascular injury
441
The path of the needle for these blocks has been demonstrated to be within 2 millimeters of the vertebral, ascending cervical, and
deep cervical artery making intra-arterial injection or vascular trauma a significant risk.
442
What percent of the cardiac output is supplied to the vessel-rich group (brain, heart, kidney, liver, and GI tract)?
75%
443
Which IV sedative-hypnotic agent has the highest degree of protein binding?
From greatest to least, the degree of protein-binding is as follows: Propofol > Midazolam > Etomidate > Ketamine
444
When given in low doses, which two muscarinic antagonists may produce paradoxical bradycardia?
```
Atropine
Scopolamine (when administered in low dosages)
```
445
When given in low doses, which two muscarinic antagonists may produce paradoxical bradycardia?
```
Atropine
Scopolamine (when administered in low dosages)
```
446
Which narcotic is rapidly metabolized by blood and tissue esterases?
Remifentanyl
447
Depolarizing agents work at the end plate and desensitize the channel to which they bind. At what type of receptor does this occur? On what type of voltage-gated channel does this take place?
Nicotinic, sodium voltage-gated channel
448
What side effect would you most expect to see from high doses of oxytocin?
. Diastolic hypotension
449
What side effect would you most expect to see from high doses of oxytocin?
Diastolic hypotension
450
High doses of oxytocin can produce
diastolic hypotension (and some degree of systolic hypotension), flushing, and tachycardia.
451
What clotting factor has decreased activity in pregnant patients?
Factors XI and XIII are decreased in pregnancy.
452
Factors unchanged in pregnancy?
II and V
453
What would be considered an advantage of combined spinal-epidural analgesia?
It is highly effective when initiated during fast progressing labor
454
Combined spinal-epidural analgesia results in a
rapid onset of analgesia with minimal motor block.
455
Which of the following statements is true of a continuous brachial plexus block? (select two)
It prevents vasospasm in revascularization procedures
| It decreases the need for postoperative opioids
456
Twitch depression results in the blockage of what type of receptor?
Postsynaptic nicotinic acetylcholine receptor
457
Rapid correction of serum sodium in a chronically hyponatremic patient can produce
myelinosis
458
Which structure is most likely to be injured during a nasal intubation?
inferior nasal concha
459
The tough, fibrous tissue positioned around the atrioventricular valves and at the base of the aortic and pulmonary trunks is called the
annulus fibrosus
460
The pulmonary circulation is considered to be what type of system? Presssure_ volume___
low pressure, high volume
461
According to the difficult airway algorithm, if you are unable to ventilate an induced patient via mask or supraglottic airway, what is the next step you should take?
. Call for help
462
According to the difficult airway algorithm, if you are unable to ventilate an induced patient via mask or supraglottic airway, what is the next step you should take?
Call for help; If a two-man approach is not successful, then you may have to consider invasive airway management methods.
463
What nerve provides sensory innervation to the base of the tongue, the posterior epiglottis, the aryepiglottic folds, and the arytenoids?
The internal branch of the superior laryngeal nerve
464
Which anesthetic agent undergoes the greatest degree of metabolism?
5-8 % of sevoflurane undergoes metabolism
| Isoflurane and nitrous oxide undergo less than 1% and desflurane undergoes less than 0.1% metabolism.
465
Which of the following statements regarding the use of a first generation laryngeal mask airway (LMA) is true?
The presence of a pharyngeal abscess is a contraindication to its use
466
You are transporting a patient on oxygen by face mask at 3 L/min. The pressure gauge on the E-cylinder oxygen tank you are using shows that 1/2 of the tank remains. How many minutes do you have before the tank is empty? Calculate your answer to the nearest whole number.
110
467
Which condition is an absolute contraindication to electroconvulsive therapy?
Pheochromocytoma
468
Approximately what percentage of pulmonary blood flow goes to the dependent lung in a healthy, mechanically-ventilated patient in the lateral decubitus position?
60%
469
Which of the following would be predisposing factors to obstructive sleep apnea? (Select two)
Obesity
| Genetic inheritance
470
A pulse oximeter alarms that a patient's saturation has dropped below the alarm threshold. This is an example of what type of an alarm?
Unlatched
471
Sound only as long as the criteria (in this case a saturation threshold) for sounding are met. If the patient's saturation rises above threshold, the alarm will quit sounding on its own.
Unlatched alarms
472
Once triggered, a latched alarm will sound until it is
silenced by interaction with the monitor.
473
Which method would be most appropriate for cleaning a TEE probe?
Disinfection with glutaraldehyde-based solution
474
A 12 French catheter would have an outer diameter of
4 mm
475
Transesophageal pacing is possible because the esophagus is directly posterior to what structure(s)?
the atria
476
Upon what structure in the nephron do loop diuretics work?
The thick, ascending segment of the loop of Henle
477
Loop diuretics-> exert their action in the thick, ascending segment of the loop of Henle by
furosemide, ethacrynic acid, and bumetanide
478
Loop diuretics work by
inhibiting the sodium, chloride, potassium co-transport system.
479
In what position is the patient typically placed for an open nephrectomy?
Lateral jackknife
480
What physiologic change in patients with chronic kidney disease is most often responsible for increasing the free fraction of administered drugs?
Hypoalbuminemia
481
Which intervention has the highest incidence of acute kidney injury (AKI)?
Thoracic aortic surgery
482
The most common cause of cholecystitis is
gallstones
483
Symptoms associated with cholecystitis most frequently are the result of an
obstruction, infection, or combination of the two.
484
Are the most common cause of acute cholecystitis.
Gallstones
485
Biliary colic results from the
obstruction of the cystic duct, which if prolonged, causes the gallbladder to distend and become edematous and inflamed.
486
The primary function of phase II conjugation reactions are to make the molecule more
water-soluble
487
Which factor is most associated with an increased risk for gallstones?
Female gender
488
The most common risk factors for the development of cholelithiasis include:
female gender, increasing age; obesity; pregnancy; rapid weight loss; consumption of a Western diet.
489
The most common risk factors for the development of cholelithiasis include:
female gender, increasing age; obesity; pregnancy; rapid weight loss; consumption of a Western diet.
490
The hepatic venous pressure gradient is calculated using the portal venous pressure and the
hepatic vein pressure
491
Portal hypertension is defined as a hepatic venous pressure gradient (HVPG) greater than
5-6 mmHg,
492
Portal HTN which is calculated by the
difference between portal and hepatic vein pressure.
493
Portal hypertension results in
```
Ascites
Formation of varices,
Hepatorenal syndrome
Splenomegaly
Splanchnic vasodilation, and gastropathy.
```
494
Hepatic venous pressure gradient (HVPG) HVPGs in excess of
12 mmHg place the patient at risk for variceal bleeding.
495
Chronic administration of exogenous glucocorticoids can suppress the HPA axis and produce
Adrenal insufficiency
496
Secondary adrenal insufficiency occurs due to suppression of the HPA axis by administration of exogenous glucocorticosteroids or
ACTH deficiency due to dysfunction of either the hypothalamus or pituitary gland
497
What is the best assessment for long-term glucose control in a diabetic?
Hemoglobin A1C
498
The normal hemoglobin A1C level is between
4 and 6 percent.
499
What is the approximate blood loss per minute during the resection phase of a transurethral prostate resection?
2-4 mL
500
The tendency for a gas to flow along a curved path at a bifurcation point is known as the
Coanda effect
501
The substantial factor test is a component of which of the four elements of assignment of malpractice?
Causation
502
Failure to obtain informed consent prior to anesthesia would be an example of
Breach of duty
503
Following a carotid endarterectomy, a patient in the recovery area exhibits significant headache and slurred speech followed by the onset of seizures. This would be consistent with
cerebral hyperperfusion syndrome
504
The primary goals are the treatment of
hypertension and control of cerebral perfusion.
505
What is the most common reason for reintervention following an endovascular aneurysm repair?
Endoleak
506
A transcranial doppler (TCD) measures the velocity of blood flow through the
middle cerebral artery
507
Which local anesthetic only exists in a nonionized state?
Benzocaine
508
What initial arrhythmia would you most likely see in a patient experiencing cardiovascular toxicity from a local anesthetic?
Bradycardia
509
LA : a safer cardiovascular profile than bupivacaine.
It should be noted that levobupivacaine and ropivacaine (although potent/lipid soluble) have
510
Spontaneous ventilation will ______ the uptake of inhalation anesthetics by ________ alveolar ventilation.
decrease, decreasing
511
Afferent fibers from peripheral nociceptors enter the spinal cord through the
dorsal root
512
Central sensitization characterized by a progressive increase in the response of neurons to successive stimulations is known as
wind-up
513
Which ascending spinal pathway is most associated with pain, temperature, and itch sensation?
spinothalamic tract
514
Prolonged opioid therapy can produce an increase in plasma concentrations of
prolactin
515
Prolonged opioid therapy can suppress the
hypothalamic-pituitary-adrenal axis resulting in decreased concentrations of cortisol, follicle-stimulating hormone, estrogen, testosterone and increased levels of prolactin.
516
The major side effects of neuraxial alpha-2 adrenergic agonists are (select two)
hypotension
| bradycardia
517
The proposed mechanism by which glucocorticoids reduce inflammation is by decreasing the production of inflammatory mediators and by
inhibiting phospholipase A2
518
Which calcium channel blocker produces the greatest amount of coronary artery dilation?
Nicardipine
519
Verapamil, nifedipine, nicardipine, and diltiazem all produce coronary artery vasodilation, but ______exerts the greatest effect.
nicardipine
520
You are preparing to induce general anesthesia in a patient taking propranolol for hypertension. Which drug would you anticipate to have substantially higher than normal plasma concentrations after administration?
Fentanyl
521
Propranolol decreases the clearance of amide local anesthetics, but not ester anesthetics such as chloroprocaine. As a result,
plasma concentrations shortly after injection can be 2-4 times higher than normal.
522
H2 receptor antagonists act by what?
decrease hydrogen ion secretion from parietal cells by
523
H2 receptor antagonists decrease hydrogen ion secretion from parietal cells by
decreasing intracellular cAMP levels
524
In parietal cells, histamine
activates adenylate cyclase, which increases cAMP levels.
525
The increased cAMP levels activate the
proton pumps in the parietal cells causing an increase in the secretion of hydrogen ions.
526
By blocking the effect of histamine, H2 receptor antagonists result in a
decrease in intracellular cAMP levels and a decrease in hydrogen ion secretion.
527
You are preparing to induce a patient who takes phenytoin for the treatment of seizures. You know that this patient would likely require a higher dose of
Chronic administration of phenytoin can result in hepatic enzyme induction and result in higher dose requirements for nondepolarizing neuromuscular blockers such as vecuronium.
528
What is the major intracellular ANION?
Phosphate
529
The primary intracellular cation is
potassium
530
The primary extracellular cation is
sodium.
531
Class I antidysrhythmics drugs are as
Quinidine, lidocaine, and flecainide
532
Class I antidysrhythmics drugs work by
inhibit fast sodium channels.
533
Class I antidysrhythmics drugs are
Quinidine, lidocaine, and flecainide
534
Class I antidysrhythmics drugs work by
inhibit fast sodium channels.
535
Class II antidysrhythmics drugs such as_______ and ______
esmolol and propranolol
536
Class II antidysrhythmics work by
decrease the rate of depolarization.
537
Class III antidysrhythmics is
amiodarone
538
Class III antidysrhythmics work by
inhibit potassium ion channels.
539
Which of the following agents is an HMG-CoA reductase inhibitor?
Atorvastatin
540
Gemfibrozil is a
derivative of fibric acid used to lower triglyceride levels.
541
Cholestyramine is
a bile acid resin which binds bile in the intestines and increases hepatic bile synthesis from cholesterol, resulting in a decrease in the blood cholesterol level.
542
Which of the following decreases during pregnancy?
plasma protein concentration
543
Compared to the adult, the neonatal myocardium
more sensitive to NE
544
Cholestyramine is
a bile acid resin which binds bile in the intestines and increases hepatic bile synthesis from cholesterol, resulting in a decrease in the blood cholesterol level.
545
Heparin produces its anticoagulant effects by binding to
antithrombin
546
The ratio of units of packed red blood cells to fresh frozen plasma to platelets recommended by the US military for massive transfusion is
1:1:1
547
Acetylcholine is synthesized in the cytoplasm of the nerve terminal from (select two)
acetyl coenzyme A
| choline
548
When zeroing a right atrial pressure transducer, it ideally should be level with the
Tricuspid valve (phlebotaxis _
549
The anesthesia machine fail-safe mechanism will
interrupt nitrous oxide flow if the oxygen supply pressure drops
550
If a Tec-6 vaporizer is tilted while operational,
it will sound an alarm, shut off the vapor output, and flash a NO OUTPUT warning.
551
The pressure gauge on an E-cylinder nitrous oxide tank registers 745 psig. The most accurate way to determine how much nitrous oxide is left in the tank is to
weigh
552
What is the gold standard for measuring core body temperature?
pulmonary artery catheter
553
Which setting on a peripheral nerve stimulator will produce an electrical stimulation once every ten seconds?
0.1 Hz
554
Intraoperative somatosensory evoked potential monitoring during anesthesia can produce electrical interference on the ECG that would most likely appear as
pacemaker spikes
555
The Jackson-Rees circuit is also known as the
Mapleson F
556
LMA size:
3
4
5
30-50 kg
50-70 kg
70-100 kg
557
When using a combitube, ventilation is attempted through the
Longer (blue) lumen [blue first!!!],
558
A low–birth-weight (LBW) neonate weighs
| regardless of the duration of the pregnancy. and an
less than 2500 g
559
A very low–birth-weight (VLBW) neonate weighs
less than 1500 g,
560
More recently, neonates that weigh
less than 750 g at birth are referred to as “micropremies”;
561
extremely low–birthweight neonate weighs less than
1000 g.
562
2 Most common complication of infant with low Gestational age infants? In order of
Preterm (<37 weeks) SGA
| 1. Respiratory distress syndrome AND 2.Apnea
563
2 Most common complication for normal term children
Congenital anomalies
| Viral infections
564
Prenatal growth is the most important phase in development, comprising
organogenesis in the first 8 weeks
565
By convention, the term prematurity has been applied to neonates who
weigh less than 2500 g at birth
566
By convention, the term prematurity has been applied to neonates who
weigh less than 2500 g at birth
| born before 37 completed weeks of gestation.
567
The most accurate means of assessing gestational age is by measuring the
crown-rump length of the fetus during a first-trimester ultrasonographic examination.
568
Corresponding equation for 18 months to 8 years of age is:
Wt (kg) = 2 × Age(years) + 9.
569
For age >8 years: Wt (kg) =
3 × Age (years).
570
The anterior fontanel closes between
9 and 18 months of age;
571
The posterior fontanel closes by
2 to 4 months of age
572
The critical event in the change from placental to pulmonary gas exchange is
the first inspiration
573
The first breath is a gasp that generates a transpulmonary distending pressure
of 40 to 80 cm H2O
574
What are the two crucial events involved in the immediate transition from the fetal circulation to the normal postnatal pattern
Decreased pulmonary vascular resistance (PVR) and
| increased peripheral systemic vascular resistance SVR (loss of the umbilical circulation)
575
During fetal circulation, The increase in systemic afterload causes an
immediate closure of the flap valve mechanism of the foramen ovale and reverses the direction of shunt through the ductus arteriosus.
576
Hyperbilirubinemia (defined as a total serum bilirubin level
>5 mg/dL)
577
Infants: The cause of nonhemolytic physiologic hyperbilirubinemia is
excessive bilirubin production from breakdown of red blood cells and increased enterohepatic circulation of bilirubin with deficient hepatic conjugation as a result of decreased uridine 5-diphospho-glucuronyl transferase activity
578
The placenta is impermeable to 2 (endocrine)
insulin and glucagon
579
Studies have defined values abnormal glucose
concentrations as follows: plasma glucose concentrations_________ in the first _____after birth; and less than ____mg/dL after _____hours
less than 35 mg/dL; 3 hours
| 45 mg/dL after 24 hours
580
Studies have defined values abnormal glucose
| concentrations as follows: plasma glucose concentrations of _________in the first 3 hours
less than 35 mg/dL
581
Abnormal glucose concentration as follows between 3 and 24 hours, plasma glucose concentrations
less than 40 mg/dL
582
Abnormal glucose concentration as follows less than_____ mg/dL after 24 hours
45
583
The blood volume in a full-term neonate depends on the
time of cord clamping, which modifies the volume of placental transfusion.
584
The blood volume is 93 mL/kg when cord clamping is____________ compared with 82 mL/kg with
delayed after delivery; immediate cord clamping.
585
Venipuncture vs capillary sampling in infants
venipuncture is preferred over capillary sampling.Capillary sampling (e.g., heel stick) generally overestimates the true hemoglobin concentration
because of stasis in peripheral vessels that decreases the volume of plasma and causes hemoconcentration. The net effect may be an increase in hemoglobin concentration by as much as 6 g/dL;
586
Physiologic anemia in children and why ? Is oxygen delivery to the tissues compromised? why or why not
This “anemia” (physiologic anemia of the newborn) is a normal physiologic adjustment to extrauterine life. Despite the reduction in hemoglobin, the oxygen delivery to the tissues may not be compromised because of a shift of the oxygen-hemoglobin dissociation curve (to the right), secondary to an increase of 2,3 diphosphoglycerate
587
Thus all neonates should receive prophylactic this vitamin
vitamin K soon after birth to prevent hemorrhagic disease of the neonate.
Its omission could lead to serious and life-threatening consequences, especially if surgery is undertaken.
588
Infants Myelination is usually complete by.
7 years of age
589
The nervous system is___________ at birth; functionally it with the continuation of myelination and synaptogenesis
anatomically complete; remains immature
590
The brain has two growth spurts: neuronal cell
| multiplication between _________and ______of gestations and glial cell multiplication commencing at
15 and 20 weeks of gestation; 25 weeks and extending into the second year of life.
591
Brain contains 2 growth spurts:
Neuronal cell multiplication
| Glial cell multiplication
592
The strongest predictors of cerebral palsy appear to be
```
congenital anomaly (congenital heart disease in particular), low birth weight, low placental weight, multiple fetuses, preterm delivery, intrauterine
infection, or abnormal fetal position before labor and delivery
```
593
The match between parent and child anxiety level also
| appears to be important. Calm children with anxious parents do
more poorly during induction compared with calm children with calm parents or anxious children with either calm or anxious parents
594
Is a very useful and simple device to monitor heart sounds and the quality of breath sounds, even when our attention is focused away from physiologic monitors.
A precordial or esophageal stethoscope
595
With monitoring The focus must always be on the.
child and the surgical field. Electronic monitors may fail, and if the anesthesiologist focuses too much attention on the monitor in an effort to interpret it, rather than
attending directly to the child, the child may suffer.
596
In an infant, the rate of uptake of inhalation anesthetic agents is _______ than in an adult
more rapid
597
The most important consideration in the safe practice of pediatric anesthesia is to
ensure a patent airway
598
The most important factor in the morbidity and mortality of children undergoing anesthesia
Failure to ventilate adequately
599
Transporting to PACU, These children should be transported in the _________for two major reasons:
tonsil position” or “recovery position” (lateral decubitus position) (1) the dimensions of the upper airway are greater in this position than supine (2) should vomiting occur, the regurgitant material will flow out of the mouth, away from the larynx and will be identified immediately.
600
Child length doubled when?
Length doubles by 4 years of age.
601
Simple way to remember how rapidly infants grow is that birth weight doubles when____and triples when _____
doubles by 6 months of age and triples by 1 year.
602
The anterior fontanel should be palpated to assess whether it is sunken which indicates?
dehydration
603
Permanent teeth begin to appear by
6 years, with the shedding of the deciduous teeth
604
Epiglottis and vocal cords description in the neonate?
long, omega-shaped epiglottis and the pearly white vocal cords in the neonate.
605
Alveoli develop mainly after birth, increasing in number until approximately
8 years of life and in size until growth of the chest wall
| ceases.
606
The bronchial tree down to and including the terminal
| bronchioles forms by week
16 of gestation
607
In neonate, removal of lung fluid may be delayed producing the syndrome called
transient tachypnea of the newborn
608
Respiratory muscles ineffective in infants
The accessory muscles of inspiration are relatively ineffective in infants
609
Muscle strength depends on the presence of an adequate number of.
type I (slow twitch, high oxidative capacity) muscle fibers to respond to an increased workload
610
What increases risk for respiratory failure in the developing infant?
The diaphragm of the neonate and more
| critically, the preterm infant, has limited number type I (slow twitch, high oxidative capacity) muscle fibers .
611
Newborn total lung capacity (ml)
160
612
VO2 (mL/kg per minute) infants
6–8
613
An adult can generate negative pressures in excess of a ______neonate can generate pressures as
great as
70 cm H2O,100 cm H2O;
614
It is not possible to measure closing volume in children that are
younger than 5 years, but because the elastic recoil pressure is small in infancy some airways likely remain closed throughout tidal breathing. This notion is supported by the finding that infants have a large “trapped gas volume”
615
What are “central airways”?
Trachea to the twelfth to fifteenth bronchial generation
616
What are “peripheral airways”
distal to the twelfth to fifteenth generation to the alveoli).
617
In neonates as in adults, 3 things that control ventilation are?
, PaO2, PaCO2, and pH
618
PaO2 acting mainly through what chemoreceptors?
peripheral chemoreceptors in the carotid and aortic bodies
619
PaCO2 and pH acting on what type of chemoreceptors and where?
central chemoreceptors in the medulla
620
In contrast to the adult, an infant's response to hypercapnia is not potentiated by
hypoxia,
621
This actually depress the hypercapnic ventilatory response in term and preterm infants
Hypoxia
622
Commonly occurs in neonates. This should be distinguished from clinical apnea,
Periodic breathing
623
Important risk factor for life-threatening apnea in
| neonates and infants undergoing general anesthesia.
Prematurity is
624
The risk of post-anesthetic respiratory depression is inversely related to
gestational age and post-conception age at the time of anesthesia
625
The position of the oxyhemoglobin dissociation curve depends on the ratio of
adult to fetal hemoglobin.
626
At birth, the increased fetal hemoglobin content shifts the curve to the
left of the adult curve (from a P50 of 27 for Hb A to a P50 of 19 for Hb F). During the first week after birth, the curve
shifts to the right, reflecting the transition from fetal to adult hemoglobin formation
627
Premature HR range
| 111
120–170
628
0–3 months HR range
100–150
629
3–6 months HR range
90–120
630
6–12 months HR range
80–120
631
1–3 years HR range
70–110
632
3–6 years HR range
65–110
633
6–12 years HR range
60–95
634
>12 years HR range
55–85
635
Premature normal BP
Premature SBP 55–75 / 35–45
636
0–3 months Normal BP
SBP 65–85 /45–55
637
3–6 months Normal BP
SBP 70–90/50–65
638
6–12 months Normal BP
SBP 80–100/ 55–65
639
1–3 years Normal BP
SBP 90–105/ 55–70
640
The range of cardiac output in both full-term
| and preterm neonates is
220 to 350 mL/kg per minute
641
Urine production begins in utero at
10 to 12 weeks of gestation
642
Tubular function begins to develop after ____weeks of gestation and reaches adult levels by_____
34 weeks of gestation and reaches adult levels by 2 years of age
643
Nephrogenesis is complete by ___weeks of gestation
36
644
Children --> Adult GFR rates are achieved by approximately
2 years of age
645
In utero, the fetus maintains acid base balance
mild respiratory acidosis
646
Most umbilical venous blood from the placenta passes through the ________to the
ductus venosus; inferior vena cava.
647
3 top causes of jaundice in neonates
Excess bilirubin production
Impaired uptake of bilirubin
Impaired conjugation of bilirubin
648
Phototherapy reduces serum bilirubin concentrations by converting
bilirubin through structural photoisomerization and photooxidation into excretable products
649
Lower esophageal sphincter pressures are reduced at birth but increase steadily, reaching adult values by
3 to 6 weeks postnatal age. Dailyvomiting or “spitting up” is reported in half of all infants between 0-3 months happy spitters
650
Maternal hyperglycemia, particularly when uncontrolled, results in
hypertrophy and hyperplasia of the fetal islets of Langerhans. This leads to increased levels of insulin in the fetus, affecting lipid metabolism and giving rise to a large, overweight neonate characteristic of a mother with
diabetes (infant of a diabetic mother, IDM).
651
Hyperglycemia in neonates is a level of glucose
(plasma glucose ≥150 mg/dL) occurs in stressed
| neonates,
652
At birth, vitamin K–dependent factors
(i.e., II, VII, IX, and X) are 20% to 60% of adult values
653
Preoperative Fasting Recommendations in Infants and Children
Clear liquidsa 2 hours
Breast milk 4 hours
Infant formula 6 hours
Solids (fatty or fried foods) 8 hours
654
Latex ALLERGY - It occurs more frequently in atopic individuals and in those with certain fruit and vegetable allergies PBACK
(e.g., banana, chestnut, avocado, kiwi, pineapple).
655
% cross-reactivity between first-generation cephalosporins and penicillin, there is no similar cross-reactivity with second- and thirdgeneration cephalosporins
5% to 10%
656
Premedication for children with anesthesia(mg/kg) of ketamine, oral, nasla, rectal, IM>
Ketamine Oral 3–6
Nasal 3
Rectal 6–10
Intramuscular 2–10
657
Is the most widely used premedication for children
Midazolam, a short-acting, water-soluble benzodiazepine
658
IV, IM, PO, nasal, rectal midazolam dose,
0.025 to 0.1 mg/kg IV
0.1 to 0.2 mg/kg IM
0.25 to 0.75 mg/kg PO
0.2 mg/kg nasal
1mg /kg rectal
659
CV effects of ECT Explain
initial Parasympathetic discharge 5-10 seconds -> HoTN, and transient Bradycardia, which can progress to Asystole. Then Prominent sympathetic response, that peaks 1-2 minutes, can be observed 5-10 minutes. the sympathetic response is associated with Tachycardia, HTN, and Increased myocardial oxygen demand.
660
ECT is accomplished by
using electrical current creating a bilateral generalized seizures.
661
Exact mechanism of ECT is
unknown.
662
Relative contraindications to ECT
Recent MI, CVA, angina , CHF
663
TCA mechanism of action
Blocking the reuptake of NE, serotonin, dopamine therefore increasing sympathetic tone.
664
ECT why is ketamine avoided?
Worsens sympathetic response
665
HTN and tachycardia seen with ECT is
Self limited. If using medications to treat use ESMOLOL>
666
One drawback of NMB with ECT is that
It can be difficult to assess for generalized seizures. A BP cuff is INFLATED ON AN EXTREMITY to ISOLATE the BLOOD SUPPLY prior to administering the NMB agents. This allow for visualizztion of seizure activity in the isolated extremity.
667
What is the GOLD STANDARD, and first choice hypnotic for ECT? What is the dose?
Methohexital (0.75-1mg/kg) because it does not change seizure activity and has more favorable side effect profile than etomidate.
668
Another key need for ECT is the use of a
Bite BLOCK because dental damage is a common side effect of ECT if precautions are not taken.
669
Lithium anesthetic considerations?
Prolongs NMB
670
How do you assess for OSA in preop area
```
STOP BANG QUESTIONNAIRE
Snoring
Tired
Observe(STOP BREATHING DURING SLEEP)
Pressure Blood pressure
```
BMI > 35
Age > 50
Neck circumference >40
Gender.
671
STOP BANG SCORE AT risk for OSA
3 and up
672
What is an independent risk factor:
A variable is called an independent risk factor if it has a significant contribution to an outcome in a statistical model that includes established risk factors.
673
Classic physical feature of pyloric stenosis?
Palpable olive size mass in the upper abdomen or distal pylorus.
674
Formula of Anion gap (AG) =
Na − (Cl + HCO3)
675
OSA patients minimize use of
Respiratory depressants , and extubate awake.
676
What is the gold standard for Foreign body retrieval?
Rigid Bronchoscopy
677
Child with FB aspiration, most important anesthetic considerations is
Inhalation induction
678
Congenital disease associated with Big Tongue (Macroglossia)
Beckwithin syndrome
| Trisomy 21
679
Small underdeveloped chin (retrognathia) congenital diseases?
```
PGTC (please Get that Chin)
Pierre Robin
Goldenhar
Trisomy 21
Cri du chat
```
680
Congenital disease associated with Cervical spine anomalies?
Kids Try Gold
Klipper Feil
Trisomy 21
Goldenhar.
681
The Osborn wave or J wave is characterized by
positive deflection at the J point (the point where the QRS complex finishes and the ST segment begins)
682
What is the J point?
the point where the QRS complex finishes and the ST segment begins)
683
Causes that produce RIGHT AXIS deviation? nclude but are not limited to Right PRB LeftPO AW
physiologic inspiration
Right bundle branch block
Left posterior fascicular block
ASD secundum, or WPW syndrome
684
Determining the heart axis will have to take into account leads
I and II and AVF.
685
If the QRS complex is negative in lead I but positive in lead II, it is
right axis
686
If the QRS complex is positive in lead I but negative in lead II, it is left axis
left axis
687
If the QRS complex in leads I/II is positive—the heart axis is______and between ___ and ___degrees
normal and between 30 and 90°.
688
What is Brugada (think BrugaNA) syndrome
Genetic sodium ion channel abnormality associated with sudden death
689
All anesthesia machines have failsafe valves which shut off or decrease gas flows when the O2 pressure
drops below 30 PSI, although this system will not prevent the delivery of 100% N2O (thus an oxygen analyzer is necessary).
690
Unlike sodalime, Amsorb does not contain
NaOH or KOH.
691
Amsorb does not degrade
inhaled anesthetics, but soda lime can degrade sevo, des, and isoflurane into CO.
692
Soda lime can degrade inhaled anesthetic gases to
Carbon monoxidee
693
Channeling can be minimized by
shaking the canister before use.
694
What is the principal heat and moisture exchanger of inspired gases?
The upper respiratory tract (mostly the nose) is the principal heat and moisture exchanger of inspired gases.
695
What is the most common cause of post-intubation laryngeal edema?
ETT that is too large.
696
Tongue that falls backwards is known as Glossoptosis and is seen with this anormaly?
Pierre Robin
697
What is the treatment of CROUP?
Racemic epinephrine
698
What is the dose and concentration of the racemic epinephrine use to treat croup ?
0.5ml of 2.25% epinephrine diluted in 2.5ml of 0.9% NaCL
699
What provide the stimulus for vasopressin (ADH) release ?
Osmoreceptors in the anterior hypothalamus
700
What provide the stimulus for vasopressin (ADH) release?
Osmoreceptors in the anterior hypothalamus
701
Osmolarity vs OsmoLALITY
```
LARI LA(Liters) osmol per liter
LALI Ki (kilograms) osmol per kilo
```
702
As long as CPP > 60 mm Hg, keeping ICP
< 20 mm Hg is more important than further increases in CPP
703
Calculating serum osmolality
2 x [Na+] + [BUN]/2.8 [glucose]/18.
704
The syndrome of inappropriate ADH secretion (SIADH) treatment
Fluid restriction
705
2 cornerstone treatment of croup
Racemic epinephrine
| Dexamethasone
706
Children: The dose of dexamethasone for the treatment of croup?
0.25-0.5 mg/kg
707
Supraglottic obstruction is associated with _______while infraglottic obstruction is associated with ________
Stridor; wheezing.
708
Subluxation in down syndrome is located where?
C1 and C2.
709
Cleft lip repair surgery is performed close to
1 month of age
710
Cleft palate repair surgery is performed close to
12 months of age.
711
What is FENA
ratio between the quantity of Na excreted in the urine
| relative to the amount filtered at the glomerulus.
712
Prerenal AKI FENA will be
Less than 1 %
713
When is FENA used?
FENa is often used in the setting of acute renal failure to help distinguish between prerenal (decreased renal perfusion) and intrinsic renal (ATN due to renal hypoperfusion) causes.
714
What FENA determines INTRARENAL causes of AKI?
> 2% between 1 and 2% is indeterminate, and >2% suggests ATN.
715
Systemic Hypotension will stimulate 3 different mechanisms what are they?
RAAS, SNS, ADH
Neurohumoral axis with stimulation of the
renin–angiotensin–aldosterone system (RAAS), sympathetic nervous system (SNS), and arginine vasopressin (AVP).
716
What is the RIFLE CRITERIA?
```
Risk (Cr > or equal 50%)
Injury (Cr > or equal to 100%)
Failure(Cr > or equal to 200%)
Loss of function
End Stage Renal Disease.
```
717
Definition of AKI based on CR and UO
Serum Cr 2–3 times or GFR >50%
| UO decrease <0.5 mL/kg/h for > 12 h
718
Cocaine on MAC
increased MAC
719
Criteria for EKG changes consistent with MI
New significant ST-segment
T wave changes
New left bundle branch block
Development of pathological Q wave
720
Three types of troponins exist—What are they?
troponin I, troponin T, and troponin C
721
State the 3 different functions of the 3 types of troponin?
- Troponin T binds the troponin components to tropomyosin
- Troponin I inhibits the interaction of myosin with actin,
- Troponin C contains the binding sites for
Ca2+ that help initiate contraction
722
What determines AKI with aortic surgery
Aortic clamp proximity to the renal arteries is critical.
723
2 patients at increased risk for Contrast-induced Nephropathy are?
Diabetics
| Preexisting renal insufficiency Serum Cr > 1.2
724
Stages of CKD
1. Increased GFR only
2. GFR 60-89
3. GFR 30 - 59
4. GFR 15-29
5. GFR < 15
725
What is the chief end product of protein metabolism? where is it formed?
UREA; liver
726
Why is BUN level not a good indicator of renal disease?
Because it does not increase in most patients until the GF is reduced by more than 50%
727
What is the most specific test of GFR and the most reliable assessment tool for renal function ?
Creatinine Clearance.
728
What is the normal CrCl?
95-150 ml/min
729
Classify renal dysfunction as mild , mod and dialysis level with CrCl
Mild 50-80
Mod <25
less than 15 requires dialysis
730
Describe Zone I to Zone III Of the lungs: Relationship of PA, Pv, and Pa
Zone 1 : PA > Pa > Pv (Upper)
Zone 2 : Pa > PA > Pv (middle)
Zone 3: Zone 3 Pa > Pv > PA (lower)
731
Zone 1 is not seen in _____Why? when is it seen?
normal lungs. It may be seen in positive pressure ventilation or after hemorrhage or HIGH PEAK PRESSURE Alveolar pressure exceeds pulmonary vascular pressures. Hence the pulmonary vessels are collapsed, and no flow occurs causing alveolar dead space.
732
Zone 2 occurs about
3 cm above the level of the heart.
733
Adding activated charcoal filters to the airway circuit is effective in keeping anesthetic agent concentration
below 5 ppm for up to 12 hours with fresh gas flows of at least 3 L/min
734
During measurement of the pulmonary wedge pressure (PAOP, PWCP), an assumption is made
that _______What is the implication of that?
here is a clear unobstructed communication between the pulmonary artery and veins, as the wedge pressure is measured from the right side of the heart.For the wedge pressure to be an accurate reflection of the left atrial pressure, the measurement needs to be performed in west’s zone 3. If
735
For the wedge pressure to be an accurate reflection of the left atrial pressure, the measurement needs to be performed in
west’s zone 3
736
Closing volume is measured by
nitrogen washout.
737
2 types of DI
Central DI
| Nephrogenic DI.
738
What is central DI?
Central DI – decreased secretion of antidiuretic hormone (ADH, aka AVP)
739
What isNephrogenic DI ?
decrease in the ability to concentrate urine due to a resistance to ADH action in the kidney.
740
ADH: Actions are mediated through at least 2 receptors
V1 mediates vasoconstriction, enhancement of corticotrophin release, and renal prostaglandin synthesis V2 mediates the antidiuretic response
741
DI treatment
Desmopressin
742
Antidiuretic hormone (ADH) is synthesized in the________ and transported to the
supraoptic and periventricular nuclei of the hypothalamus; posterior pituitary by the hypothalamoneurohypophyseal tract.
743
In the kidney, ADH opens
aquaporins in the distal and collecting tubules (in a cAMP-dependent mechanism) resulting in an increase in water resorption.
744
Among the inhaled anesthetic agents, Which agent appears to preserve autoregulation at all doses
sevoflurane
745
In healthy individuals, which 2 anesthetics tend to maintain cerebral autoregulation ?
propofol and remifentanil
746
Define cerebral autoregulation?
The brain maintains a constant blood flow to itself despite changes in cerebral perfusion pressure
747
Cerebral perfusion pressure (CPP) is defined as the difference between the
mean arterial pressure (MAP) and intracranial pressure (ICP) {CPP = MAP − ICP}.
748
If the central venous pressure (CVP) is greater than the ICP, then CPP =
MAP − CVP.
749
The cerebral flow is then modulated by the greater of the two pressures—
CVP or ICP
750
The Mapleson ____system is best for spontaneous respiration with the advantage of less waste of fresh gas flows.
A
751
Overzealous treatment of DI results in
SIADH.
752
Oversecretion of ADH can result in ______while under-secretion of ADH results in _______
the syndrome of inappropriate ADH (SIADH); diabetes insipidus (DI).
753
Digoxin toxicity can occur with High/ low potassium levels?
Low
754
What is Zollinger-Ellison
Gastrinoma, gastric tumor
755
How does Loop diuretics work vs thiazide diuretics? what is the mnemonic to remember?
Loop diuretics block the sodium-potassium-
chloride cotransporter in the THICK Ascending limb of the loop of Henle, while thiazides block the sodium-chloride co-transporter in the distal convoluted tubule
LOOP -TA, THIA-Di
756
How do you diagnosed LVH on an ECG?
Increased QRS voltage
757
What is the definitive diagnosis of hypertrophic cardiomyopathy?
Myocardia biopsy with subsequent DNA analysis.
758
Most common cardiomyopathy with genetic origin?
Hypertrophic Cardiomyopathy
759
What are features of HYPERTROPHIC CARDIOMYOPATHY?
Asymmetric hypertrophy of the UPPER interventricular septum which leads to dynamic OBSTRUCTION OF THE LEFT VENTRICULAR OUTFLOW TRACT.
760
What happens to the mitral valve leaflets with Hypertrophyic cardiomyopathy?
Anterior and posterior mitral leaflets moves anteriorly into the LVOT, producing systolic anterior motion (SAM), incomplete closure of mitral valve leaflets, MR , diminishes effect antegrade CO --> HYPOTENSION
761
List 4 things that worsens SAM (Systolic anterior motion with hypertrophic cardiomyopathy?
Positive Inotropy
Decrease preload and afterload.
Arterial vasodilators.
762
CaO2 is calculated by
Sum of Oxygen bound to Hgb + oxygen dissolved in plasma.
763
O2 dissociation curve is _____on the x-axis and _____on the y-axis
Partial pressure, O2 saturation.
764
Explain the O2 dissociation curve?
The graph is sigmoid or S shaped. Initially, in the steep portion of the curve, the hemoglobin’s affinity for oxygen increases with maximum O2 loading, and then the graph
levels off around PO2 of 60 mmHg with little change even when the PO2 is increased significantly.
765
What is P50? P
50 is the oxygen tension at which hemoglobin is 50% saturated which is typically around 26.5 mm Hg and is a measure of hemoglobin’s affinity for oxygen.
766
What is P50 a measure of?
Hemoglobin's affinity for oxygen.
767
What is the formula for CaO2?
CaO2 = (1.39 × Hb × SaO2/100) + (PaO2 × 0.003).
768
Cyanosis can be detected at an SaO2 of approximately
80%
769
Shifting the OxyHgb to the the right P50
Increasing P50
770
Shifting the OxyHgb to the left effect of P50
decreasing P50
771
Define right shift and left shit meaning on oxygenation?
A rightward shift indicates that a higher PO2 is required for the same 50% Hb saturation. This means lower
oxygen affinity. This is seen in the peripheral tissues where oxygen “unloading” happens. Conversely, a leftward shift increases hemoglobin’s affinity for oxygen
[1, 2]. This is seen in the lungs where oxygen “loading” happens.
772
The Fick equation expresses the relationship between
oxygen consumption (VO2), arteriovenous oxygen content difference (CaO2 − CvO2), and cardiac output
773
CaO2 = arterial oxygen content =
20 m/dL
774
CvO2 = mixed venous oxygen content =
15 mL/dL
775
CaO2 − CvO2 = normal extraction for oxygen =
5 mL/dL
776
Is a good measure of the overall adequacy of
| oxygen delivery.
The arteriovenous difference
777
Normal extraction ratio for oxygen (CaO2 − CvO2)/CaO2 is______; What is the meaning of that?
5 mL/20 mL or 25%; the body normally consumes
| only 25% of the oxygen carried on hemoglobin
778
The Bohr effect is a physiological phenomenon, and it describes the.
inverse relationship of the hemoglobin’s affinity for oxygen to acidity and to the concentration of carbon dioxide
779
An increase in CO2 (which reacts with water to form
| carbonic acid) increases acid and lowers pH which leads to
O2 unloading by hemoglobin.
780
High CO2 and acid effect on O2
O2 unloading by hgb This effect facilitates the oxygen transport as hemoglobin binds to oxygen in the lung (less CO2 and acid) and releases it in the tissues (more CO2 and acid).
781
What is the Haldane effect?
Oxygenated hemoglobin has a reduced capacity for CO2, and conversely reduced Hb has an increased capacity.
782
What is the haldane effect important for?
physiologic importance in governing CO2 transport. Reduced Hb in the tissues facilitates CO2 “pickup,” and in the oxygen-rich capillaries of the lung, this property promotes dissociation of CO2 from the Hb and thereby elimination
783
Which lung volume cannot be measured by spirometry and how can it be obtained?
The residual volume (RV) cannot be measured by spirometry. Radiographic planimetry, nitrogen washout, helium dilution, and body plethysmography may
all be used to calculate residual volume
784
The five causes of vision loss during prone procedures in patients undergoing nonopthalmologic surgery are
central retinal vein occlusion, 2) glycine toxicity, 3) ischemic optic neuropathy, 4) central retinal artery occlusion, and 5) cortical blindness.
785
A patient is undergoing general anesthesia for a colon resection. During manipulation of the mesentery, a patient suddenly exhibits hypotension, tachycardia, cutaneous hyperemia, and the oxygen saturation drops from 99% to 88%. This reaction is most likely mediated by
Prostacyclin/prostaglandin
786
Seventy percent of anesthesia-related allergic reactions are
IgE-mediated type I reactions
787
Common cause of type I reactions and the incidence is highest with
Neuromuscular blocking agents; succinylcholine.
788
What is the definitive treatment for anaphylaxis?
Epinephrine
789
All of the following are factors contributing to the development of rhabdomyolysis in the lateral decubitus position except
Tachycardia
790
Rhabdomyolysis is associated with the lateral decubitus position. Factors that are considered to contribute to this phenomenon include.
prolonged surgical time, hypotension, and the pressure of the operating room table against the gluteal and flank muscles
791
Position associated with rhabdomyolosis
Lateral decubitus
792
What is the most common cause of postoperative vision loss from a spine operation?
Ischemic optic neuropathy
793
The sternal retractor used during cardiac surgery can compress the brachial plexus between the
clavicle and the first rib.
794
To avoid cervical injury from hyperflexion of the neck in the sitting or prone positions, it is recommended that you maintain a distance of at least _____ fingerbreadth(s) between the mandible and sternum.
two
795
What surgical position carries the highest risk for compartment syndrome?
Lithotomy
796
What worsens GLOBAL and focal hypoxic brain injury
Hyperglycemia
797
Neuronal cell use what as the main energy source?
Glucose
798
Other than glucose as main energy source, other sources are
Ketone bodies and lactate
799
Dexdemetomidine act where ?
Locus ceruleus of brain and spinal
800
What make precedex a good drug?
Sedation
| NO SIGNIFICANT RESPIRATORY DEPRESSION
801
Side effects of Precedex
Hypotension and bradycardia
802
2 treatments for von willebrand?
Cryoprecipitate
| Desmopressin
803
Explain differential blockade,
sympathetic nerve fibers are blocked by the lowest concentration of local anesthetic followed by nerve fibers responsible for pain, touch and finally motor function.
804
Most common pipeline supply problem?
Crossover
805
2 main action in order of priority when crossover is suspected?
Turn on backup oxygen supply
| Disconnect pipeline supply hose from the wall.
806
Why should you disconnect the pipeline when you suspect a crossover?
Gas will flow from whichever source is at a higher pressure — the pipeline(at 50 psi, containing, for example, nitrous oxide) or the emergency tank supply of oxygen (supplied to the machine at 45 psi).So you must disconnect the pipeline supply.
807
Decrease CO and onset of action of VA
Faster
808
Increase CO and onset of action of VA
Slower
809
What is ANP ?
Atrial natriuretic peptide (ANP) is a peptide hormone released by cardiac myocytes in response to atrial stretching due to increased extracellular volume/volume overload. This stretch leads to the precursor ProANP being cleaved and released.
810
What 2 disorders account for 81% of all cases of POVL with prone positioning?
Ischemic optic neuropathy and central retinal artery occlusion
811
Carcinoid tumor arise from _________and they secrete excessive______
neuroendocrine cells; Serotonin
812
Carcinoid tumors typically secrete excessive amounts ofhey arise from neuroendocrine cells throughout the body.
the hormone serotonin (although they may secrete many hormones)
813
Serotonin causes
Vasodilation, increased blood clotting (stimulation of platelet aggregation
814
With carcinoid syndrome, excessive production of serotonin both lead to
red hot flushing of face, severe and debilitating diarrhea, and asthma attacks (tachykinins).
815
Carcinoid tumors that are isolated to the gastrointestinal tract usually
do not result in the systemic manifestations of the carcinoid syndrome
816
Carcinoid tumors are usually on which side of the heart?
Right side of the heart
817
Histamine-stimulating drugs and adrenergic agonists may precipitate the
flushing, hypotension, and tachyarrhythmias related to serotonin release.
818
Carcinoid tumors commonly found in
GI tract
819
Carcinoid tumors diagnosis
Elevated levels of 5-HIAA in the urine are a marker of excess serotonin production and, therefore, the presence of a carcinoid tumor
820
Patient with 5-hydroxyindoleacetic acid (5-HIAA) in urine is an indication of
Carcinoid tumor
821
What probably responsible for the bronchospasm seen in some carcinoid patients, and it also may be the cause of flushing
Histamine
822
The most common site of metastasis is the
Liver
823
Anesthesia may precipitate a carcinoid crisis
| characterized by
hypotension, bronchospasm, flushing, and tachycardia
| predisposing to arrhythmias
824
Drugs of choice for carcinoid symptoms control
(octreotide and lanreotide) are now the drugs of choice for symptom control. 150–200 mcg of octreotide is administered every 6–8 hours for 24–48 hours prior to
surgery and continued throughout the procedure
825
Pt with carcinoid syndrome and tumors, what is mandatory for monitoring?
Invasive monitors should be inserted before the induction of anesthesia, and their use should be continued postoperatively. The hypotension commonly associated with induction agents may trigger a carcinoid crisis, so the insertion of an arterial catheter is mandatory
prior to the induction of anesthesia
826
Atm = psi = kpa= cmH20= mmHg
1 atm = 14.7 psi = 100 Kpa = 1030cmH20 = 760 mmHg
827
Empty E-cylinder is how many lbs?
14
828
E-cylinder of O2 : L and PSI
660L and 1900-2200psi
829
E-cylinder of N2O : L and PSI
1590 L and 745 psi
830
E-cylinder of Air: L and PSI
625 L and 1900 Psi-2200 Psi
831
What is the most reliable means of IDENTIFYING O2 content?
The label.
832
Should the cylinder color be relied upon for identification ?
NO
833
Pipeline failure best to
Switch to manual ventilation to conserve oxygen
834
Negative consequences to instilling saline into the trachea are
it can dislodge bacteria or secretions from the tracheal tube wall and wash them into the lower airways.
835
2 main system of the anesthesia machine
pneumatic and electrical
836
If the power indicator shows loss of mains electrical power or that the battery is in use what should you do?
First check the power line has not become loose or disconnected.
837
Backup anesthesia machines will provide power for how long
30 minutes depending on usage.
838
The yoke should not be left
Vacant. Put a plug to prevent gas from escaping from the machine.
839
What is the role of the check valve?
Allows gas from cylinder to enter the machine but prevent gas from exiting the machine when there is no cylinder in the yoke.
840
Cylinder valve Contaminated with oil or grease, because it can cause
fire.
841
4 Components of High pressure system
Hanger yoke
Check valve
Cylinder pressure Gauge(Indicator)
Pressure Regulator.
842
Intermediate pressure system
```
Master switch pneumatic component
Pipeline inlet connections
Pipeline pressure gauge
Oxygen pressure failure device.
2nd stage pressure regulator
Oxygen flush
```
843
Oxygen failure safety valve other name
Fail safe
844
The fail safe valve does what?
Shuts off or proportionally decreases and ultimately interrupts the supply of other gas if the oxygen supply pressure decreases.
845
How do you determine whether a machine has a properly functioning oxygen failure safety device?
Turn oxygen and nitrous on
The source of Oxygen pressure is then removed (Pipeline or cylinder)
if the oxygen failure safety device is functioning properly, the flow indicator for the other gas will fall to the bottom of the tube just before the oxygen indicator falls to the bottom of its tube.
846
Oxygen supply failure alarm will sound within
5 seconds of the oxygen pressure falling below 30 psi.
847
When do you not use the oxygen flush valve?
Do not use upon inspiration when using a ventilator. This can result in delivery of HIGH tidal volumes and possible barotrauma. Ventilator that excludes fresh gas flow from the breathing system during inspiration prevent that risk.
848
Low pressure system components -->
Flowmeters
Unidirectional check valves
pressure relief device
Common gas outlet
849
Float read on
Top
850
Ball read at
Center
851
What is the difference between hypoxia prevention device and oxygen pressure failure device?
the oxygen pressure failure device prevents hypoxia due to a loss of oxygen pressure in the machine, whereas the Hypoxia prevention devices prevent the operator from accidentally setting a hypoxic gas mixture.
852
If the concentration of O2 is less 25%, the device will lower the
nitrous oxide flow to maintain an O2 concentration of at least 25 %.
853
Carcinoid patients have chronic
Right ventricular (RV) valvular lesions and heart failure, anesthetic factors that increase RV work and may precipitate acute RV failure should be avoided.
854
Factors that increase RV work in carcinoid syndrome patients and that should be avoided
include hypoxemia, hypercarbia, and a light anesthetic plane.
855
For Carcinoid tumor, Hypotension should be treated with
an α-receptor agonist such as Neo- Synephrine to avoid β-adrenergic activation.
856
Why is 2- Chlorprocaine use in OB?
Quick onset, rapidly metabolized, ester, NO TOXICITY
| Does not cross placenta
857
Universal recipient type
AB
858
Universal donor
O type
859
What is the only volatile agent that facilitates CSF absorption and has a favorable effect on CSF dynamics.
Isoflurane
860
When doing controlled hypotension , which is best suited for preservation of CO?
nitroprusside is best suited for the preservation of cardiac output
861
Sympathomimetics such as ephedrine and histamine-releasing drugs such as (4) should be avoided if possible as they can trigger the release of hormones from the tumor as well.
morphine, succinylcholine, thiopental, and atracurium
862
Sympathomimetics to be avoided with carcinoid syndrome are
Ephedrine (because you want Beta stimulation prevention)
| Norepinephrine (unpredictable response)
863
Which of the Rexed laminae are located in the dorsal horn of the spinal cord?
Lamina VI
864
Rexed laminae I through laminae VI are located in the. Laminae VII, VIII, and IX comprise the ventral horn.
dorsal horn of the spinal column
865
With SIMV 2 parameters that must be selected
A mandatory tidal volume and ventilatory rate must be selected
866
2 herbal supplements with bleeding potential?
Garlic and ginseng (Inhibit platelet aggregation)
867
Ginseng risk
Inhibit platelet aggregation
868
Gas law stating: the temperature is held constant, the amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the gas-liquid interface.
ording to Henry's law
869
Gas law stating: the temperature is held constant, the amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the gas-liquid interface.
Henry's law
870
With multiple sclerosis what is associated with relapse
Studies have demonstrated that general anesthesia and regional anesthesia do not increase the incidence of exacerbation of multiple sclerosis. Pregnancy is associated with a reduced incidence of exacerbation, while the postpartum period is associated with an increased risk of relapse.
871
Pregnancy on MS
Reduced incidence of exacerbation
872
Signs of cyanide toxicity include:
increased mixed venous 02
increased nitroprusside dosage requirements (tachyphylaxis),
and metabolic acidosis.
873
CCB with the greatest negative inotropic effect?
Verapamil
874
Risk for damage during a carotid endarterectomy.
The recurrent laryngeal nerve is
875
After CEA, Damage to the RLN nerve could manifest as
inspiratory stridor following emergence.
876
Flumazenil has an elimination half-life of approximately
1 hour.
877
Which narcotic has been reported to produce hypertensive crisis, convulsions, and coma in patients taking MAO inhibitors?
Meperidine
878
The use of hyperbaric local anesthetics such as lidocaine 5% in spinal anesthesia is associated with
cauda equina syndrome
879
What cross allergy is of concern with a DM patient on NPH insulin presenting for cardiac surgery?
Protamine exhibits an increased risk of allergic reaction in patients taking NPH insulin.
880
Remifentanil has a context-sensitive half-life of
2 to 4 minutes.
881
Its plasma concentration can decrease by nearly half in as little as 40 seconds.
Remifentanil
882
3 that may be used for the treatment of spasms of sphincter of Oddi.
Naloxone, nitroglycerin, or glucagon
883
Which nerve fibers will have their function attenuated when opioids are administered via spinal?
Spinal administration of opioids gives analgesia primarily by attenuating the transmission of C-fiber nociceptive impulses.
884
Intravenous agents whose induction or initial doses should be calculated according to total body weight in the obese individual are
succinylcholine, neostigmine, sugammadex, and dexmedetomidine.
885
What is the single biggest predictor of problematic intubation in morbidly obese patients?
Neck circumference
886
Single best predictor of a difficult airway
Neck circumference
887
Hormones that use the phospholipase C system include:
Parathyroid hormone
Alpha receptor catecholamines
Vasopressin V1.
Oxytocin
888
Hormones that use the adenylyl cyclase system include
```
Calcitonin
ACTH
Glucagon,
secretin,
somatostatin,
vasopressin V2
parathyroid hormone
luteinizing hormone, and beta-receptor catecholamines.
```
889
Although the addition of bicarbonate will speed the onset of a lidocaine epidural, the addition of bicarbonate to
bupivacaine will cause it to precipitate.
890
Opthalmologists may inject expanding gases such as sulfur hexafluoride or perfluoropropane into the eye to press a torn retina back into place. The use of nitrous oxide can cause the injected bubble to expand rapidly, causing a dramatic increase in intraocular pressure and possibly interrupting retinal blood flow. Nitrous oxide should be avoided for up to
3 months in these patients.
891
Opthalmologists may inject expanding gases such as 2
sulfur hexafluoride or perfluoropropane
892
Which local anesthetic has the highest potency and longest duration?
Tetracaine
893
LA both intermediate in potency and duration,
Lidocaine and mepivacaine are
894
The terminal branch of the femoral nerve is the
saphenous nerve
895
A nondepolarizing block is characterized by several factors when assessed by a peripheral nerve stimulator. What are three of the factors?
Decrease in twitch tension, fade during repetitive stimulation, post-tetanic potentiation
896
Tetanic fade is a response to blocking which type of receptor?
Presynaptic nicotinic acetylcholine receptors
897
A patient in the anesthesia preop clinic informs you that they were slow to wake up after their last procedure and needed a breathing tube for a few hours afterward. They cannot provide any additional information. You suspect a pseudocholinesterase deficiency. Your hospital does not have the ability to test for a dibucaine number. What test could you order?
A fluoride resistance test can help confirm a diagnosis of atypical pseudocholinesterase function. . A result of 36 is consistent with the homozygous atypical pseudocholinesterase function.
898
A fluoride resistance test: A result of 60 indicates
normal pseudocholinesterase function
899
A fluoride resistance test: A result of 30 indicate
homozygous atypical pseudocholinesterase function.
900
You notice that the pulse oximeter waveform of an anesthetized patient undergoing an elective colon resection varies greatly and skips occasional beats. When you pause mechanical ventilation, the waveform appears normal. You should
administer a fluid bolus
901
Hypovolemia has been cited as a cause of the pulse oximeter waveform to
skip beats, perform erratically, and cause variation in the pulse waveform during positive-pressure ventilation.
902
If pausing ventilation causes the waveform to return to normal, then a fluid bolus trial should be attempted to see if hypovolemia is the underlying cause when having issues with
Pulse ox reading
903
The esophageal doppler technique is based on the principle that states that the
flow within a cylinder is equal to the cross-sectional area of the cylinder multiplied by the velocity of fluid flowing through it. By placing an ultrasound probe into the esophagus, the doppler can detect changes in the frequency of sound waves flowing through the descending aorta. This allows determination of the blood velocity and an estimation of stroke volume and cardiac output.
904
What happens when there is hyponatremia?
intracellular space is hyperosmolar relative to the extracellular space and fluid shifts intracellularly
905
The absolute contraindications to shock wave lithotripsy include
bleeding disorder (or anticoagulation) and pregnancy.
906
Which of the following EEG changes would most likely be seen during periods of circulatory compromise to the brain?
Low frequency, high voltage activity
907
You are preparing your anesthesia machine for a general anesthetic on a small child. You should select a breathing bag with a volume that is approximately
three times the patient tidal volume
908
HOw to remember trigeminal branches top to bottom
O MAX MAN
Ophtalmic V1
Maxillary V2
Mandibular V3
909
Sensory innervation to the anterior two-thirds of the tongue is provided by the
mandibular (V3) branch of the trigeminal nerve. S
910
Sensory innvervation to the
posterior one-third of the tongue is provided by the glossopharyngeal nerve.
911
A fixed airway obstruction can be caused by a foreign body in the airway, a lesion like
tracheal stenosis, or anatomical compression by a tumor or goiter.
912
In a fixed obstruction, the flow-volume loop exhibits decreased flow during
both inspiration and expiration. It looks as if the top and bottom of the loop are chopped off.
913
There are three potential reasons that the CO2-ventilatory response curve would shift to the left and/or develop a steeper slope. These are the only causes of true hyperventilation (where the patient's minute ventilation increases to the point that respiratory alkalosis results). They are:
Metabolic acidosis
Arterial hypoxemia
Central nervous system alteration.,
914
The celiac reflex can produce hypotension and bradycardia and is caused by
pressure on the mesentery or the gallbladder.
915
The Cushing reflex is an
increase in arterial blood pressure in response to an increase in intracranial pressure.
916
What can elicit the oculocardiac reflex which will produce sinus bradycardia and other bradydysrhythmias?
Pressure on the globe of the eye or the extraocular muscles (especially the medial rectus) will
917
The Valsalva reflex is a
decrease in heart rate, cardiac contractility, and blood pressure caused by an increase in intrathoracic pressure (usually by forced expiration against a closed glottis).
918
Which inhalation treatment would be least appropriate for patient with CAD?
Racemic epinephrine
919
Tests that indicate that a patient has muscle strength adequate enough to sustain ventilation and take a large enough breath to cough effectively include:
the ability to perform a sustained head lift, a negative inspiratory force of -25 cm H2O, a successful train-of-four stimulation, and a forced vital capacity of 10-12 mL/kg.
920
The most common cause of an acute increase in deadspace.
Decreased cardiac output
921
PvO2 reduction is a result of
A decrease in arterial oxygen content or an increase in arterial oxygen extraction will reduce the
922
The hallmark signs that help identify diabetes insipidus are a u
rine specific gravity less than 1.005 and a urine osmolality of 200 mOsm/kg or less.
923
Separation anxiety begins at about
8-10 months of age.
924
What is the most common metabolic disorder seen in newborns and young infants?
Hypoglycemia
925
Which of the following should take priority in your airway management plan for a pediatric patient with bronchopulmonary dysplasia?
Choose an endotracheal tube that has an internal diameter 0.5-1.0 smaller than normal
926
What is considered the minimum adequate interincisor gap in an adult?
4cm
927
Dysfunction of the serratus anterior muscle and winging of the scapula are consistent with injury to the
long thoracic nerve
928
You are applying local anesthetic soaked pledgets to the middle turbinates of a patient's nasal cavity prior to a nasal intubation. What nerves are you anesthetizing?
Branches of the trigeminal nerve
929
Which of the following is considered a retroglottic airway device?
Combitube
930
What is the largest size ETT the LMA Fastrach (intubating LMA) will accommodate?
8.5mm
931
When using jet ventilation through an airway exchange catheter, it is appropriate to
administer a neuromuscular blocker to prevent the glottis from closing around the catheter and leading to possible barotrauma due to lack of egress of insufflated air.
932
Crossmatching blood involves
mixing the blood of the donor and recipient together in the lab
933
Blood typing (a type and screen) determines the patient's
blood type and predicts compatible transfusions 99.94% of the time.
934
Crossmatching, which is the actual
mixing of the donor and recipient blood in a trial transfusion increases the possibility of a compatible transfusion by only one-hundredth of 1%.
935
A patient presents for liver transplantation due to hepatopulmonary syndrome (HPS). This disease is characterized by the triad of:
Hypoxemia
portal hypertension
pulmonary vascular dilatations
936
Which would be considered a contraindication to lung transplantation?
Malignancy within the last 2 years
| A patient's BMI 35 or greater
937
When the N2O tank pressure drops below 745psi The amount of nitrous oxide in the gas phase at that point
is about a quarter of the tank or around 400 liters. At 2 liters per minute, you would have approximately 200 minutes of nitrous oxide left.
938
A preoperative finding of nystagmus would be consistent with potential abuse of which drug?
PCP Phencyclidine
939
Shorten the seizure duration of electroconvulsive therapy.
Fentanyl, midazolam, lidocaine, and diltiazem
940
Prolong the seizure duration of ECTs
Caffeine, ketamine, aminophylline, and clozapine
941
Repeat stimulation caused by nerve damage or chronic inflammation can cause a condition known as
Windup
942
Which surgical procedure is most commonly associated with chronic postsurgical pain (CPSP)?
Thoracotomy
943
Laryngospasm that is unresponsive to positive pressure ventilation can be treated with
0.15-0.5 mg/kg succinylcholine IV or 4 mg/kg IM. In this case, the patient weighs 60 kg, so the appropriate intramuscular dose would be 240 mg.
944
The most common cause of arterial hypoxemia in the postoperative period is
atelectasis
945
You are preparing to induce a patient with a large anterior mediastinal mass for general anesthesia. Which device should you have at your immediate disposal?
Rigid bronchoscope
946
Cardiac is performed in the supine position.
Thoracoscopic sympathectomy for hyperhydrosis
947
It is an outpatient procedure and involves no chest tubes.
Thoracoscopic sympathectomy for hyperhydrosis
948
he most reliable stimulator of arousal in persons with obstructive sleep apnea is
work of breathing
949
You administer scopolamine preoperatively to an elderly patient. The patient becomes agitated, confused, and severely obtunded. Which drug would be the most appropriate agent to alleviate these symptoms?
physostigmine
950
A patient is placed in steep Trendelenburg position for a robotically-assisted procedure. This will cause a decrease in which parameter?
Lung compliance
951
Which epidural needle has wings at the hub in order to stabilize the needle and assist grip during insertion?
Weiss
952
Which patient safety initiative outlines a list of serious, reportable adverse outcomes such as surgery on the wrong site?
The National Quality Forum
953
are involved in elevating the degree of inflammation due to injury.
Neuropeptides such as substance P
954
The composition of the inspired gas mixture a patient receives depends primarily upon the
fresh gas flow rate, the volume of the breathing circuit, and any absorption by the circuit.
955
The inspired gas concentration will be closer to the fresh gas concentration if the
circuit volume and level of absorption by the circuit are low and the fresh gas flow is high
956
What anesthesia machine alarms are based on the circuit pressure?
The disconnect alarm
| The high pressure alarm
957
What substance is responsible for transmission of fast pain in the central nervous system?
Glutamate
958
A series of electron transfers coupled to the formation of adenosine triphosphate
Oxidative phosphorylation
959
Responsible for about 90% of all oxygen consumed in the body.
Oxidative phosphorylation
960
What are the two primary determinants of coronary perfusion pressure? (select two)
Left ventricular end-diastolic pressure
| Aortic diastolic pressure
961
It is most commonly due to an adenoma in the anterior pituitary gland.
Acromegaly
962
The underlying cause of organ failure due to disseminated intravascular coagulation is
The widespread bleeding and thrombosis from DIC can cut off the blood supply to tissues and organs, resulting in ischemia.
963
Dexmedetomidine provides
anxiolysis, sedation, analgesia, and sympatholysis.
964
Dexmedetomidine does not produce
significant respiratory depression.
965
Potential side effects of dexmedetomidine include:
hypotension, bradycardia, oversedation, and delayed recovery.
966
EF is calculated by
EF = SV/EDV
967
How is SV calculated?
SV= EDV -ESV
968
Heat that is lost as body moisture converts from the liquid phase to gas phase is referred to as
Evaporative heat loss
969
Pulmonary function tests should be performed in
patients with severe scoliosis as a vital capacity < 40% of predicted is associated with the likelihood of postoperative ventilatory support.
970
Factors that decrease the amount of prolapse in patients with mitral valve prolapse include
Drug-induced myocardial depression
Increased preload
Hypertension
Vasoconstriction
971
Both intrinsic and extrinsic restrictive disorders produce resistance to
lung expansion.
972
Chronic intrinsic restrictive lung disease includes pathologies that alter the lung parenchyma such as
pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis, and alveolar proteinosis.
973
Chronic extrinsic restrictive lung disease is typically due to disorders of the thoracic cage such as
kyphosis, scoliosis, flail chest, and ankylosing spondylitis.
974
The initial signs and symptoms of Duchenne muscular dystrophy are due to the effect of the disease on
proximal skeletal muscle groups
975
The initial signs of Duchenne muscular dystrophy are related to weakness in the proximal skeletal muscle groups and manifest as an
alteration in gait, difficulty climbing stairs, and frequent falls.
976
The progressive and symmetric deterioration in muscle strength is associated with fatty infiltration of the muscles which results in pseudohypertrophy of the muscles.
Duchenne muscular dystrophy
977
Which of the following characteristics are consistent with Cushing's syndrome?
Hypertension
Rounded facial appearance
Spontaneous bruising
Glucose intolerance
978
Are all symptoms consistent with Cushing's syndrome.
Sudden onset of weight gain, thickening of the facial fat giving a rounded shape to the face, facial telangiectasias, glucose intolerance, hypertension, decreased libido in men, oligomenorrhea, and spontaneous bruising
979
Which of the following clinical signs are consistent with a diagnosis of hypothyroidism? (select four)
Listlessness
Decreased cardiac output
Peripheral edema
Decreased serum levels of free T4
980
Patients with hypothyroidism often exhibit
thick skin and periorbital and peripheral edema.
981
In hypothyroidism, CO
There is a decrease in cardiac output due to reductions in both heart rate and stroke volume.
982
Peripheral vascular resistance is increased, and blood volume is reduced in HYPERTHYROIDISM or hypothyroidism
Hypothyroidism
983
It is diagnosed by the presence of decreased levels of free T4, total T4, T3, R-T3U, free T4 index, and an elevated TSH level.
Hypothyroidism
984
MR that have minimal if any prolongation of effect in patients with renal disease.
Mivacurium, atracurium, and cisatracurium
985
Laudanosine, the principal metabolite of
atracurium and cisatracurium, does rely on renal excretion.
986
Which of the following are consistent with a diagnosis of ACTH-independent Cushing's disease? (select two)
high cortisol levels
| low corticotropin levels
987
2 valvular disorders associated with carcinoid
pulmonic stenosis
| tricuspid regurgitation
988
What is the most common long-term effect associated with the use of electroconvulsive therapy?
Memory impairment
989
What primarily determines the resistance to gas flow in an anesthesia circuit?
Circuit diameter and length
990
What are the 3 advantages of the use of a lighted stylet over traditional laryngoscopy?
less affected by anterior airway
It is associated with a lower incidence of sore throat
It is less stimulating than traditional laryngoscopy
991
What ventilator modality is described by a setting that has a target gas delivery pressure and where the tidal volume varies from breath to breath depending upon the patient's resistance and compliance?
PCV
992
At the beginning of inspiration, the ventilator rapidly increases the pressure to the determined level and maintains that pressure until the beginning of exhalation.
PCV
993
Which test assesses the integrity of the extrinsic hemostasis pathway?
PT
994
All preganglionic neurons are
Cholinergic
995
Sympathetic nerve fibers originate between the spinal levels of
T1-L2 (Thoracolumbar)
996
Which hematologic alteration is associated with hyperthyroidism?
anemia and thrombocytopenia.
997
Which of the following is true of an oxygen concentrator?
High humidity can reduce the oxygen concentration delivered by a concentrator
998
An oxygen concentrator utilizes a technology called. High humidity can reduce the oxygen concentration delivered by a concentrator. A concentrator requires a compressor, and the device can stop delivering oxygen if the compressor fails.
pressure swing adsorption which filters out nitrogen, carbon dioxide, carbon monoxide, water, and hydrocarbons while allowing oxygen and trace gases such as argon to pass through
999
For an oxygen concentrator, The FiO2 delivered ranges between
Ranges between 90 and 96 percent. Although argon concentrations can reach as high as 5%, there are no known detrimental effects from short-term or long-term exposure to argon.
1000
A manual resuscitator with a self-expanding bag is not the ideal choice for spontaneously breathing patients because
It cannot exert a sufficient negative pressure to open the inspiratory port, they may inhale room air via the expiratory port.
