RANDOM FACTS for SEE 3 Flashcards
SVR and pregnancy
Decrease by 21% by term
Which of the following drugs used in the treatment of rheumatoid arthritis can prolong the duration of succinylcholine?
Cyclophosphamide
The use of cyclophosphamide can
inhibit plasma cholinesterase and prolong the duration of action of succinylcholine.
Agents used in the treatment of rheumatoid arthritis.
Etanercept and adlimumab are anticytokine
The five categories of scoliosis are based on their etiology. They are:..
idiopathic, congenital, neuropathic, myopathic, and traumatic
Neuropathic scoliosis is caused by diseases such as
polio, cerebral palsy, and syringomyelia
Myopathic scoliosis is caused by conditions such as
muscular dystrophy and amyotonia.
Is the most prevalent form of Scoliosis
Idiopathic scoliosis
What is the appropriate dose of 0.3 M sodium citrate in mL for a 20 kg pediatric patient? (provide your answer accurate to a single decimal place)
The pediatric dose of 0.3 M sodium citrate is 0.4 mL/kg. For this patient, the dose would be 8 mL.
What is the appropriate volume of 1:1000 epinephrine to add to a spinal anesthetic to prolong the duration of the block?
0.1-0.2 mL
The subarachnoid space of the spinal canal normally contains between —to —ml of CSF
30 and 80 mL of cerebrospinal fluid.
The spinal cord is enlarged in two locations. Where are the enlarged areas? (select two)
The cervical enlargement occurs at C4-T1 and the lumbar enlargement which occurs from L2-S3.
The 2 cervical enlargement is due to the
nerve roots that produce the brachial plexus and the lumbar enlargement produces the lumbar plexus.
BAEPs are not significantly affected by b.
Benzodiazepines, ketamine, propofol, muscle relaxants, N2O, or barbiturates
Can Inhalation agents affect BAEPs?
BAEPs mildly, affect is proportional to the dose administered.
Nitroprusside administration will result in a decrease in (select three)
Preload
Afterload
cardiac filling pressures
Damage to central or peripheral neural structures that results in abnormal processing of painful stimuli is characteristic of
Neuropathic pain
Hypotonic solutions : Name 2
D5W
1/2 NS
Mannitol should be avoided in patients with which of the following conditions? (select two)
Depressed cardiac function
Intracranial hematoma
Radial artery monitoring during hypothermic cardiopulmonary bypass on aortic pressure
Underestimation
Air in the transducer tubing aortic pressure
Underestimation
Parathyroid hormone on serum calcium ?
increases serum calcium levels by increasing bone resorption of calcium, limiting its renal excretion, and enhancing the gastrointestinal absorption of calcium by activating vitamin D.
PTH on serum phosphate?
It decreases serum phosphate by increasing the renal excretion of phosphate.
How is ondansetron metabolized and eliminated?
metabolized by liver
Thiazide-type diuretics include:
hydrochlorothiazide, chlorthalidone, metolazone, and indapamide.
The normal glomerular filtration pressure is about
60% of the mean arterial pressure or about 60 mmHg.
It is opposed by plasma oncotic pressure which exerts a pressure of about ______ mmHg and bowman’s capsure pressure which exerts about ___mmhg
32 mmHg and Bowman’s capsule pressure which exerts about 18 mmHg.
Pressure : Glomerular filtration, plasma oncotic pressure and bowman’s capsule
Bowman’s Capsule 18
Plasma oncotic pressure 28-32
Glomerular filtration 60
COPD heart signs
Heart sounds Split S2, pulmonary/tricuspid insufficiency
COPD Blood gas exchange
Reduced DLCO; Hypoxemia (most characteristic of
prominent emphysema
Glomerular filtration is also dependent on several physiologic factors:
•s
The pressure inside the glomerular capillaries
• The pressure in the Bowman capsule
• The colloid osmotic pressure of the plasma protein
Myogenic mechanism –>
When arterial pressure rises, the arterial wall is stretched, the vessel constricts, and blood flow remains normal. When arterial pressure decreases, the opposite effect occurs. Therefore, renal blood flow remains constant over a wide range of pressure changes
is an inward force that tends to hold fluid within the glomerulus.
The colloid osmotic pressure created by proteins in the glomerulus (28 mm Hg)
Pressure in the_______ opposes filtration.
Bowman capsule (18 mm Hg)
2 byproducts of sevoflurane
Compound A
Fluoride
Apex of the lumbar curve
L3-L4
The FiO2 delivered by a nasal cannula can vary significantly, but the ranges you can predict that would be delivered by varying flow rates are:
2L/min: 0.26 and 4L/min: 0.36
What postoperative anesthetic complication is common in infants after surgery to treat pyloric stenosis? why?
Ventilatory depression; It is thought this may be due to alkalosis of the cerebrospinal fluid. Because of this potential complication, these patients must be fully awake and responsive prior to tracheal extubation.
2 murmurs associated with MVP
Midsystolic click
Late systolic murmur
What valvular is associated with opening snap?
Mitral stenosis
Pulsus paradoxus is more common in patients with tamponade.
Pulsus paradoxus
Prominent y-descent on a CVP tracing
Kussmaul’s sign
Ventricular discordance
Constrictive pericarditis is similar to cardiac tamponade in many of its features. They both exhibit
pulsus paradoxus and Kussmaul’s sign (jugular vein distention during inspiration) which are signs of ventricular discordance.
Constrictive pericarditis also exhibits Freidreich’s sign, which is a
prominent y-descent on the central venous pressure tracing.
Constrictive pericarditis also exhibits Freidreich’s sign, which is a
prominent y-descent on the central venous pressure tracing.
Which of the following signs and symptoms are consistent with hypoaldosteronism? (select four)
Hyponatremia
Hyperkalemia
Metabolic acidosis
Orthostatis hypotension
How does aldosterone regulate potassium levels?
Aldosterone affects the body’s ability to regulate blood pressure. It sends the signal to organs, like the kidney and colon, that can increase the amount of sodium the body sends into the bloodstream or the amount of potassium released in the urine.
Low aldosterone will lead to high or low K+
High
Plasma cortisol levels less than______indicate adrenal insufficiency (Addison’s disease). Hyperkalemia and hyponatremia are also symptoms.
20 mcg/dL
Adrenal insufficiency is called _____Disease
Addison’s
Metabolic disturbance with addison’s disease
K+, Na+, BP, volume, metabolic disturbance.
Hyperkalemia Hyponatremia Hypotension, Hypovolemia, Metabolic acidosis
Cushing’s syndrome metabolic disturbance
HYPOKALEMIC METABOLIC ALKALOSIS
When the adrenal glands make too much aldosterone. T
Conn’s syndrome
Conn’s disease is
HYPERALDOSTERONISM
Hyperaldosteronism (conn’s disease) what will be the metabolic disturbances what about blood pressure?
SYSTEMIC HTN
Sodium retention
HYPOKALEMIA (polyuria)
METABOLIC ALKALOSIS
Most specific test for Pheochromocytoma?
Vanillyl mandelic acid, a catecholamine metabolite.
Pheochromocytomas are________derived most commonly from
catecholamine-secreting tumors ; chromaffin cells in the adrenal medulla, and less commonly from extraadrenal catecholamine secreting paragangliomas
Pheochromocytomas generally adhere to what is known as the “rule of ten.” They involve both adrenal glands in
approximately 10% of adult patients with the tumor; 10% to 15% of the tumors arise from
extraadrenal chromaffin cells; and at least 10% of the tumors are malignant.
Malignant pheochromocytomas are primarily
extraadrenal
Biochemical testing and subsequent diagnosis of a catecholamine- secreting tumor is based on findings of
elevated concentrations of
- fractionated catecholamines (epinephrine, norepinephrine, dopamine),
- fractionated metanephrine and normetanephrine, and VMA in urine or plasma.
What is the primary imaging modality used for diagnosis of pheochromocytoma?
CT of the abdomen and pelvis
Inherited syndromes that have been linked to
pheochromocytoma include vone.180,183 A
Hippel-Lindau syndrome, MEN type
2A and MEN type 2B, neurofibromatosis type 1 (formerly known as von Recklinghausen disease), and familial pheochromocytoma/ paraganglioma syndrom
pproximately 50% of patients with
MEN type 2A or 2B develop
pheochromocytomas and these tumors secrete predominantly epinephrine177
A number of drugs and conditions can precipitate hypertension in pheochromocytoma patients/
Dopamine antagonists (metoclopramide, droperidol), radiographic contrast media
indirect-acting
amines (ephedrine, methyldopa),
drugs that block neuronal catecholamine reuptake (tricyclic antidepressants, cocaine), and histamine
may enhance the physiologic effects of tumor product
The most common postoperative adverse event with pheorchromocytoma is
sustained hypertension
Elevated T3 and T4 levels, in turn, feedback to suppress
the secretion of both
TRH and TSH. TSH
Elevated T3 and T4 levels, in turn, feedback to suppress
the secretion of both
TRH and TSH.
2 intermediate acting insulin
Human NPH
Lente
Thoracic cross clamping effect on ICP
increased cerebrospinal fluid pressure
Thoracic cross clamping effect on PVR
increased pulmonary vascular resistance
Thoracic cross clamping effect on renal artery blood flow
decreased renal artery blood flow
Thoracic cross clamping effect on cranial vault
vascular engorgement in the cranial vault
Cross-clamping the thoracic aorta is associated with significant decreases in blood flow in the
distal anterior spinal artery and renal artery.
Pulmonary complications can arise from aortic cross-clamping due to T
increased pulmonary vascular resistance with resulting increased pulmonary capillary permeability and pulmonary edema.
The cross clamp results in redistribution of the blood volume with
vascular engorgement in the cranial vault. The increased pressure forces cerebrospinal fluid into the spinal compartment and increases CSF pressure.
A spinal fluid drain is sometimes used to help prevent inordinant increases in CSF pressure during what
Thoracic cross-clamping
Supraventricular tachycardia is any tachycardia.
originating above the ventricles, thus, sinus tachycardia, junctional tachycardia, and atrial tachycardia are all forms of SVT.
SVT most commonly occurs due to a
reentry circuit consisting of anterograde conduction over the slower AV nodal pathway and retrograde conduction over a faster accessory pathway
It can also occur due to enhanced automaticity of secondary pacemaker cells.
SVT
Hyperthyroidism symptoms include
tachycardia
Anemia
Thrombocytopenia
Elevated triiodothyronine
You are preparing to administer ketamine orally to a 33 pound three year-old. Which of the following doses would be appropriate?
75 mg 75 mg
Following a fiberoptic bronchoscopy, the PaO2 of the patient is approximately 20 mm Hg below his PaO2 prior to the procedure. You know that
. this normally occurs and will resolve in 1-4 hours
What hemodynamic change would you expect to see when the anhepatic phase of a liver transplant is initiated?
Hypotension
What government agency issues guidelines as to how medical apps on mobile phones should be regulated?
FDA (Food and Drugs adminstartion)_
Under normal conditions, approximately 93% of the hormone released from the thyroid gland is ___and 7% is is
T4 ; T3.
One of the side effect of atorvastatin
Myalgia
The presence of a bicuspid aortic valve predisposes the patient to the development of
Aortic Stenosis
Which of the following would be most likely to produce hypokalemia? Diuretics type medication
Thiazide diuretics
Extreme flexion at the thigh can result in injury to the
sciatic, obturator, and femoral nerves.
What is the most common postoperative complication in the pediatric patient who has undergone tonsillectomy?
Bleeding
Which of the following statements describes the age-related changes in glomerular function accurately?
The glomerular filtration rate decreases by 1 mL/min each year after age 40
Highly protein-bound drugs display a higher concentration of the free form of the drug in the elderly population. Why is this?
Elderly patients have lower albumin levels
Which of the following would be most likely to increase the risk for bradycardia during strabismus surgery?
Hypercapnia, however, increases the risk of bradycardia due to the oculocardiac reflex which can occur due to traction on the ocular muscles.
Positioning for ERCP
Lateral
Prone
Fibers Believed to exhibit dysfunctional activity in the setting of neuropathic pain.
A and C fibers
Eisenmenger’s syndrome is defined by the
Reversal of a left-to-right shunt when pulmonary vascular resistance increases above that of systemic vascular resistance.
Patent ductus arteriosus is a communication between the
descending aorta and the left pulmonary artery. It normally closes within 48 hours of birth. Prostaglandin inhibition by nonselective COX receptor antagonists such as indomethacin can help promote closure of the defect.
Can can help promote closure of the defect. PDA
Indomethacin
Widened pulse pressure in the ARMS is associated
Coarctation of the aorta
The formula for sevoflurane is .
C4H3F7O.
The formula for desflurane is
C3H2F6O.
The formula for isoflurane is
C3H2ClF5O
The key to distinguishing between them is to count the number of fluorides. Isoflurane has ___desflurane has,___ and sevoflurane has
5,6, 7 fluorides.
To remember the number of flurodise
5,6,7 IDS
The most common congenital abnormality that can result in aortic dissection is
BICUSPID AORTIC VALVE
2 conditions are associated with increased risk for aortic aneurysm and dissection
Although Marfan syndrome and Ehlers-Danlos syndrome are associated with an increased risk for aortic aneurysm and dissection,
Following thoracic aortic surgery, a patient exhibits anterior spinal artery syndrome. What symptoms are associated with this disorder? (select two)
Bowel and bladder dysfunction
Flaccid paralysis of the lower extremities
Tricuspid atresia is a congenital heart defect that is characterized by a
Small right ventricle
Enlarged left ventricle
decreased pulmonary blood flow (that occurs via a ventricular septal defect, patent ductus arteriosus, or bronchial vessels), and arterial hypoxemia.
In tricuspid atresia, Blood passes from the
right atrium to the left atrium (right-to-left shunt) via an atrial septal defect prior to ejection into the systemic circulation causing a cyanotic defect.
Which of the following disorders would be most likely to produce cerebral edema?
Hyponatremia causes the extracellular fluid to become hypotonic. As this occurs, water begins moving into the brain cells causing cerebral edema and intracranial hypertension.
Metabolic alkalosis can be the result of
hyperaldosteronism
Peripheral neuropathies are most common in patients treated with
vincristine
In caucasians, neutropenia is defined as an absolute granulocyte count less than
1500/microliter
Most intraoperative drug reactions are due to exposure to
MUSCLE RELAXANTS
Define preeclampsia
Systolic HTN 140 mmHg or higher or diastolic of 90 mmhg or highter after 20 weeks of gestation with PROTEINURIA
In the absence of proteinuria, the diagnosis can be made when the
new onset HTN with platelet <100K, impaired liver function, renal insufficiency, pulmonary edema, new onset cerebral
Manifestations of preeclampsia include:
hypertension, hypovolemia, oliguria, decreased colloid oncotic pressure, pulmonary edema, arterial hypoxemia, decreased uterine blood flow, disseminated intravascular coagulation, cerebral edema, cerebral hemorrhage, acute tubular necrosis, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).
What is the most common cause of hypotension in the postanesthesia care unit?
Hypovolemia
The critical temperature of nitrous oxide is ___What does it mean?
36.5 degrees Celsius. This means that because its critical temperature is above room temperature, it will remain in liquid form without a refrigeration system.
The vessel-rich group is composed of the T
brain, heart, liver, kidneys, and endocrine glands.
Vesse; rich It comprises _____of the body mass but receives ___% of CO
10% ; 75% of the cardiac output.
The muscle group is comprised of.
muscle and skin
Muscle group accounts for % of body mass and receives _% of CO
50% of the body mass and receives 19% of the cardiac output.
The fat group is comprised of_____ accounts for the ______body mass, and receives __% CO.
adipose tissue; 20%; 6% of the cardiac output.
The vessel-poor group is comprised of ___, __ and ______ accounts for __% of the body mass, and receive ____of the CO
bone, ligament, and cartilage, accounts for 20% of the body mass, and receives a negligible amount (0%) of the cardiac output.
The maximum dose of neostigmine is
0.07 mg/kg.
The usual dose of pyridostigmine is.
0.1 to 0.3 mg/kg
Has the shortest duration of action of the reversal agents.
Edrophonium
Physostigmine has a________ chemical structure.
tertiary amine
Anticholinergic agents like atropine and scopolamine can produce
cycloplegia, which is paralysis of the ciliary muscle of the eye, resulting in mydriasis (pupillary dilation).
Anticholinergic agents like They can decrease
gastric secretions, motility, and peristalsis.
Anticholinergic agents They also decrease the muscle tone in the
bladder (detrusor muscle) which can lead to urinary retention.
Dextran 40 has been shown to improve microcirculation by:
decreasing blood viscosity thereby improving laminar flow in the microcirculatory beds.
Administration of anticholinergics in general results in a ___________gastric secretions, ______peristalsis and intestinal motility, _______Gastric emptying time, ___________esophageal sphincter tone.
decrease in gastric secretions decreased Peristalsis decreased intestinal motility prolonged gastric emptying time reduced Lower esophageal sphincter tone
Anticholinergic and ventricular function or PVR?
There is no significant effect on ventricular function or peripheral vascular resistance.
The pharmacological theory that states that the magnitude of the effect of a drug is proportional to the number of receptors it occupies is known as the
Occupancy theory
Which of the following muscles is responsible for preventing the tongue from falling back against the posterior pharynx and occluding the airway when performing a jaw-thrust maneuver?
Genioglossus
Gas exchange occurs in the airways across which type of cells?
Squamous epithelium
Side effects of histamine include:
increased capillary permeability
When administered concurrently with metoclopramide, those meds increase the likelihood that the patient will experience extrapyramidal symptoms.
phenothiazine derivatives such as thioridazine and chlorpromazine and butyrophenones (droperidol)
Is used in the treatment of extrapyramidal disorders
Benztropine mesylate (Cogentin)
Meds that can antagonize the gastrointestinal effects of metoclopramide.
Anticholinergics such as atropine, glycopyrrolate, and scopolamine
Which of the following is a potential side effect of 5-HT3 receptor antagonists?
QT interval prolongation. They do not produce sedation, extrapyramidal symptoms, or respiratory depression, but can prolong the QT interval slightly and should be used cautiously in patients who already have a prolonged QT interval
Name some 5HT3 receptor antagonists
ondansetron, dolasetron, and granisetron
Which of the following statements regarding buprenorphine is true?
It can produce naloxone-resistant respiratory depression
It can cause respiratory depression that is resistant to naloxone.
buprenorphine
It can produce withdrawal symptoms in patients who are physically dependent on morphine.
buprenorphine
Intentional lung collapse on the operative side is commonly used to enhanced visualization of the operative field. Side effects are primarily due to the large intrapulmonary shunt that develops because the upper lung is still being perfused but not ventilated. Th
The PA-a gradient widens and hypoxemia typically ensues. One-lung ventilation does not appreciably change the arterial CO2 tension.
Intentional collapse of the lung on the operative side and one-lung ventilation during thoracic surgery results in
widening of the PA-a (alveolar to arterial) gradient
The primary causes of respiratory acidosis can be divided into two categories:
those due to alveolar hypoventilation and those due to increased CO2 production.
Other factors that can produce a normal anion gap acidosis include
hypoaldosteronism, renal tubular acidosis, carbonic anhydrase inhibitors or the administration of large volumes of bicarbonate-free intravenous fluids.
The higher the blood:gas partition coefficient is, the more the onset will be slowed
increase in cardiac output
If you’re using an agent with a HIGH blood:gas partition coefficient, the onset will be _______ if there is an increase in CO and ________if there is a decrease in CO
SLOWER; FASTER
Despite having a lower blood:gas solubility coefficient, the rate of rise of the FA/Fi ratio is higher for nitrous oxide than for desflurane. This is due primarily to the what effect?
Concentration effect
Agents with a lower blood:gas partition coefficient exhibit a ________in the FA/Fi ratio.
faster rate of rise
The exception is that nitrous oxide will exhibit a faster rate of rise than desflurane despite the fact that it has a blood:gas partition coefficient of 0.47 and desflurane has a blood:gas partition coefficient of 0.42. The increase with nitrous oxide is due to the fact that it is administered in doses of
50-70% compared to 3-9% for desflurane. This is referred to as the concentration effect.
Which statement is a correct summary of the Meyer-Overton rule?
Potency of an anesthetic is proportional to its lipid solubility
Which blood vessel brings blood into the glomerulus?
Afferent arteriole
Blood enters the glomerulus via the ____artery and leaves via thearteriole. An easy way to remember this is with the letters each words begins with:
afferent ; efferent; A-fferent arteriole A-pproaches the glomerulus and the E-fferent arteriole E-xits the glomerulus.
Typical findings in a patient with cirrhosis include:
Right-to-left shunting, decreased systemic vascular resistance, increased cardiac output, elevated alkaline phosphatase, prolonged INR, thrombocytopenia, hypoalbuminemia, and hypoglycemia.
SVR and CO in a patient with Cirrhosis
Decrease, Increase CO
Albumin and BS in patient with cirrhosis
Hypoalbuminemia and HYPOGLYCEMIA>
Elevated also in cirrhosis
Elevated alkaline phosphatase.
The normal response to the increased venous return in the Trendelenburg position is vaso_____and _____in HR , why?
asodilation and a decrease in the heart rate due to baroreceptor reflex stimulation.
Pt who are hypotensive response to Trendelenburg?
Variable response
Platelet count during pregnancy is
Decreased
GFR and pregnancy
The glomerular filtration rate increases by as much as 50%.
Peripheral vascular resistance and pregnancy
Decreased
The cardiac output, stroke volume, and heart rate all _____during pregnancy
Increase
4 parameters that are decreased during pregnancy
systolic blood pressure, diastolic blood pressure, peripheral vascular resistance, and pulmonary vascular resistance decrease
By which exchange mechanism do large molecules such as immunoglobulins cross the placental barrier?
Pinocytosis
The primary mechanisms of placental exchange are: 12), and
1) Passive Transport
2) Active Transport
3) Pinocytosis
4) Facilitated diffusion
Passive transport for placental exchange are: transport, by which
small ions, respiratory gases, and most drugs under 600 daltons cross,
Active transport for placental exchange, which is responsible for the transfer of
amino acids, vitamins, calcium, and iron
Pinocytosis transport for placental exchange,, which is ho
larger molecules such as immunoglobulins cross the placental barrier,
Facilitated diffusion for placental exchange , which is
mediated by a carrier and includes substances such as glucose.
You are reviewing the preoperative record for a patient about to undergo anesthesia for eye surgery. Which of the following ocular medications will prolong the duration of action of succinylcholine? How long will it lasts
Echothiophate; The duration of paralysis usually does not exceed 20-30 minutes
Appropriate precautions for fire prevention during laser airway surgery include:
- reducing the FiO2 as low as the patient can tolerate
- fill the tracheal balloon with saline that has been dyed with methylene blue to signal cuff rupture and help dissipate heat,
- limit the laser intensity and duration as much as possible, and keep a source of saline on hand in case of fire.
Appropriate precautions for fire prevention during laser airway surgery include:
- reducing the FiO2 as low as the patient can tolerate
- fill the tracheal balloon with saline that has been dyed with methylene blue to signal cuff rupture and help dissipate heat,
- limit the laser intensity and duration as much as possible
- keep a source of saline on hand in case of fire.
What is the most common injury after anesthesia?
Corneal ABrasion
What are 4 factors that are associated with an increased risk for the development of deep vein thrombosis and pulmonary embolism include: (select four)
Obesity Estrogen therapy Prolonged immobilization Pregnancy Advanced age, major surgical procedures lasting longer than 30 minutes, hereditary thrombophilias, spinal cord injury, malignancy, previous thromboembolism, estrogen therapy, pregnancy, and prolonged immobilization.
factors that are associated with an increased risk for the development of deep vein thrombosis and pulmonary embolism include: Surgery time?
major surgical procedures lasting longer than 30 minutes,
One hereditary disease putting the patient at risk for DVT?
hereditary thrombophilias
What surgical procedure has the highest risk for postoperative delirium in elderly patients?
Orthopedic surgery
Which inhaled anesthetic produces the highest levels of carbon monoxide when exposed to dessicated cabon dioxide absorbent?
Desflurane (next is ISOFLURANE)
Which monitors reliably detect a disconnection in the breathing system? (select two)
End-tidal CO2 monitor
Respirometer
If the breathing circuit is disconnected, the oxygen analyzer would
continue to detect oxygen entrained from ambient air and would not necessarily indicate that a disconnection has occurred.
Useless in telling you if the breathing circuit is disconnected?
Oxygen analyzer
Position is associated with RHABDOMYOLOSIS
Lateral decubitus
Factors that result in an increased SVO2 include:
Cyanide toxicity Left-to-right shunts Sepsis Wedged pulmonary artery catheter Hypothermia
Factors that result in a decreased SVO2 include:
Hyperthermia Hemorrhage, Shivering decreased cardiac output decrease in the pulmonary transport of oxygen.
With a right-to-left shunt, the shunted blood mixes with and dilutes the blood coming from the ventilated alveoli resulting in a _______of alveolar partial pressure of the anesthetic. Effect on the the rise in alveolar concentration _____? How does it affect induction _____?
reduction of alveolar partial pressure of the anesthetic. The decrease in the rise in alveolar concentration slows induction of anesthesia.
The extent of slowing a right-to-left shunt will produce in the rate of increase in the alveolar concentration, varies with the
solubility of the anesthetic
The rate of rise of the alveolar concentration of an insoluble agent (low blood/gas coefficient) will be affected (more or less ) with a RIGHT TO LEFT SHUNT
more than that of a soluble anesthetic (high blood/gas coefficient).
In patients undergoing surgical debridement for burns, placement of the ECG leads can be challenging. In situations where the adhesive pads cannot be placed due to the damage they would cause to the burned tissue, the leads should be
stapled to the patients skin or needle electrodes should be used.
When the anesthesia machine ventilator is in use, the amount of fresh gas flow that contributes to the tidal volume during inspiration is increased by
higher I:E ratios
What is the most reliable method of confirming placement of the endotracheal tube in the trachea?
Detection of exhaled CO2
Which anti-epileptic drug is least likely to produce aplastic anemia?
Gabapentin
Antiepileptic drugs associated with APLASTIC ANEMIA They are most commonly seen with
valproate, carbamazepine, and phenytoin.
Valproate, carbamazepine and phenytoin are all associated with
Aplastic anemia
A child with tetralogy of FALLOT having a test spell? what can you do to help?
Squatting increases peripheral vascular resistance and relieves the right-to-left shunt.
Relieves the _______ shunt for patient with tetralogy of fallot can be done by having the patient ______
right to left shunt
squatting
Name 3 short acting insulin
Human regular
Humalog
Novolog.
Glargine lantus peak
NO PEAK
Which of the following surgical conditions is common in patients with acromegaly?
Carpel tunnel syndrome
According to the Occupational Health and Safety Administration (OSHA), the first step a facility should take to decrease the incidence of workplace violence and disruptive behavior is
perform an organization-wide assessment
EGD allowed in pregnant patients?
yes
Versed, pregnancy and fetal
Midazolam crosses the placenta and results in fetal depression, so it is not indicated for pregnant patients.
Depression of the ST segment is typically associated with
subendocardial ischemia
ECG signs is typically associated with transmural ischemia.
ST segment elevation
In mitral regurgitation, your goal is to maintain an ____HR and Afterload.
increased heart rate and decreased afterload,
While the goal in mitral stenosis is to HR and afterload.
maintain a normal or decreased heart rate and normal afterload.
Mitral regurgitation and stenosis: In both disorders, you should maintain
normal sinus rhythm, avoid increases in pulmonary vascular resistance, and maintain preload at normal to increased levels.
Associated with an ‘opening snap’ that occurs in early diastole and a rumbling diastolic murmur heard best at the axilla or apex. .
Mitral stenosis is associated
A holosytolic murmur at the apex that radiates to the axilla is associated with
mitral valve regurgitation
Mitral valve prolapse is associated with a
midsystolic click and a late systolic murmur.
By what principal mechanism does morphine produce nausea?
. Stimulation of the chemoreceptor trigger zone
Many central nervous system neurotransmitters decline with age. Which one is most closely associated with the development of Alzheimer’s disease
Acetylcholine
Neurotransmitters and aging?
CNS concentrations of dopamine, serotonin, GABA, and acetylcholine all decrease with age.
Should not undergo MEP via magnetic stimulation.
Patients with spinal or bladder stimulators, metallic foreign bodies, pacemakers, or a previous craniotomy
Motor evoked potentials (MEPs) are useful in the monitoring of functional integrity of ______
motor tracts, namely, the corticospinal tract.
Motor evoked potentials monitor integrity of the
Corticospinal
The Bullard laryngoscope is an
indirect fiberoptic laryngoscope that provides direct visualization of the vocal cords. It allows the patient to remain in anatomic position, only requires a mouth opening of 0.64 cm, and is available in adult and pediatric sizes.
Bullard laryngoscope available in pediatric sizes?
Yes
3 that are all associated with the loss of the ‘a’ wave on a CVP waveform.
Atrial fibrillation, ventricular pacing, and asystole
The x descent follows the a wave and represents the
start of atrial systole.
CVP: occurs as a result of the downward pull of the ventricular septum during systole.
The x descent
CVP represents the opening of the tricuspid valve.
y descent
All associated with large ‘v’ waves on the CVP waveform.
VTMR
Tricuspid regurgitation, mitral regurgitation, or a sudden, dramatic increase in intravascular volume are
P wave represents on ECG
Atrial depolarization
End of P to beginning of QRS
Atrial depolarization is completed
QRS is
Ventricular depolarization is beginning and the atria are repolarizing
Isometric line after QRS represents
Ventricular depolarization is completed
T wave of the QRS represents
Ventricular repolarization
Isometric line : Time from T wave to P wave represents
Ventricular repolarization is completed.
A single epidural injection of 80 mg of methylprenisolone can suppress plasma cortisol and the ability to secrete it for how long after injection?
3 weeks after the injection.
Which steroid would be most likely to produce an embolism from inadvertent arterial particulate injection during an epidural steroid injection?
Methylprednisolone
Steroid with the largest particle size?
Methylprednisolone has the largest particle size and would be more likely to produce a significant embolus if injected arterially.
Steroid with the smallest particle size?
Betamethasone has the smallest particles and triamcinolone is between the two.
Steroid with the NO PARTICLE AT ALL ?
Dexamethasone contains no particles at all.
Patients with type _______blood can receive any type of blood.
AB
Because the cells of type O blood don’t contain
contain the A or B surface antigens, it can be administered universally.
The most common reaction from the mixing of type A blood with type B blood is the
agglutination (clumping together) of the cells.
A patient who has the D antigen is referred to as_____If the D antigen is absent, they are called Rh______
Rh positive; RH negative.
Approximately 90% of Americans are Rh ______
positive
The first exposure of an Rh negative patient usually produces _______ Then, what happens? What happens when the patient receives another transfusion of RH positive,
no reaction.Over the next 2-4 weeks, however, the patient develops enough antibodies to produce agglutination of the previously transfused cells still circulating. This is referred to as a delayed transfusion reaction. If the patient receives another transfusion of Rh positive blood, the reaction is as quick and severe as a transfusion of mismatched type A or type B blood.
Thoracic paravertebral block (TPVB) produces both a
somatic and sympathetic block on the side of the injection
Most common complication of a Thoracic paravertebral block?
The most common is pneumothorax.
all potential complications of a thoracic paravertebral block
Although intravascular injection
Nerve damage
Failed block
Axillary Block : A well-defined, localized pulsation of the
Axillary artery is more important to successful blockade than the point at which needle insertion occurs within theaxilla.
Axillary Typically, the median nerve is
anterior to the axillary artery
Provides sensation to lateral aspect of the FA
MCN
What mandates a chest film to evaluate for pneumothorax when performing TPVB?
The aspiration of air
During a TPVB, Once the needle contacts the bone, it should be
walked off the process superiorly and advanced until a loss of resistance is encountered as the needle crosses the superior costotransverse ligament. Usually, this is another 1-1.5 cm beyond the transverse process.
Which ventilator setting guidelines would be the most appropriate for the patient with sepsis?
The current recommended protocol is a low tidal volume, low inspiratory pressure, and the application of PEEP.
The most common cause of hyperphosphatemia is T
renal failure.
Can be used as a temporary treatment for hyperphosphatemia.
The administration of saline and acetazolamide
Will increase gastrointestinal losses of phosphate.
Aluminum hydroxide w
Which conditions will increase the chances of a paradoxical embolus in a patient with a right-to-left cardiac defect? (select two)
Pulmonary hypertension
Valsalva maneuver
In congestive heart failure, sympathetic activation is______(increased or decreased).
increased, which results in increased secretion of norepinephrine
CHF and Circulating vasopressin levels
nearly twice the normal value in patients with congestive heart failure.
Natriuretic peptide levels and CHF,
increase as the ventricles become the principal source of the hormone’s release.
In CHF , there is a chronic increase in
Circulating catecholamines
The chronic increase in circulating catecholamines seen in CHF produces widespread______Then what happens to blood flow to the kidneys?
arteriolar vasoconstriction which shunts blood away from the skin, gastrointestinal tract, heart, and brain. As blood flow to the kidneys decreases, the renin-angiotensin-aldosterone axis is activated which results in sodium retention and interstitial edema.
Which of the following is an oral nonparticulate antacid?
Sodium citrate
MOA of sodium citrate
Increase gastric pH
In the intrinsic pathway, what is the component required to convert factor XII to factor XI?
Prekallikrein
Factor XII reacts with these two to activate Factor XI.
Prekallikrein and other components like High Molecular Weight Kininogen
A patient who is severely ill from chronic ulcerative colitis is presenting for colon resection. You know that this patient’s labwork would likely reveal
Decrease serum albumin
Antacids can slow the absorption of 2 drugs
cimetidine and digoxin
Antacids SPEED the absorption
NSAIDs, like asa, naproxen,
Patients with COPD, the total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC) are all
normal or increased.
Lung parameters most decreased in patients with COPD
FEV25-75 is decreased the most.
The FEV1/FVC ratio is _______in COPD
Decreased
Hypocalcemia in the presence of a low or normal phosphate level is usually indicative of a 2 things
vitamin D or magnesium deficit.
Which of the following would you expect to see with a myocardial contusion?
Increased serum troponin
Enzymes that may be elevated with y
Chest pain, palpitations, dysrhythmias, ST and T wave abnormalities, and elevated LDH, creatine kinase, and troponin levels
Autonomic dysreflexia 2 main things
Vasoconstriction below the level of spinal cord injury
Vasodilation above the level of spinal cord injury
During acute phase of a high-level SCI patients often develop this shock ______Characterized by
Neurogenic shock
Hypotension requires inotropic support
Autonomic dysreflexia occur s with lesion
above T6
Stimuli that can cause autonomic dysreflexia
Bladder or COLORECTAL DISTENTION
Management of autonomic dysreflexia is to
correct the noxious stimuli
Rapid reduction of BP with nitrates , CAPTOPRIL, hydralazine, and labetalol.
Maximum dose of sodium nitroprusside is
10 mcg/kg per min
Sodium nitroprusside main hemodynamic effect
Decrease both afterload and preload
Decrease cardiac filling pressure
Increase SV and CO
Left ventricular volume are _____With sodium nitroprusside
Decreased
The chemical structure of sodium nitroprusside contains
5 cyanide ions. One binds to methemoglobin to form CYANmethemoglobin. The other 4 undergoes rhodanese-catealyzed conversion to THYOCYANATE By the liver, which thyocyanate undergo renal elimination
To decrease the risk of THYOCYONATE toxicity what should be used with what medications
Infusion pump always with sodium nitroprusside
Name the 3 classes of Calcium channel blockers?
1, 4 Dihydropyridine derivatives (Nifedipine) Benzothiazepines derivatives (Cardizem) Phenylakalanine derivatives (Verapamil)
Non DHPs CCBs are
Verapamil and cardizem
All CCBs have
negative inotropic and chronotropic effects
CCBs on the conduction system
Depress electrical impulses in the SA and AV nodes
CCB and coronary and systemic
They produce coronary and systemic vasodilation.
What is the first sign of adult respiratory distress syndrome?
Hypoxemia resistant to oxygen therapy
2 antibiotics that potentiates NMB
Aminoglycosides (Clindamycin)
Tetracycline
What is it and Why is there a cross reactivity with PCN and cephalosporins?
10% . Because of their common beta lactam ring.
What is it and Why is there a cross reactivity with PCN and cephalosporins?
10% . Because of their common beta lactam rings.
Drug of choice for many surgeries
Cefazolin
Cefazolin is effective against
Streptococcus
Methicillin susceptible Staphylococci
Gram NEGATIVE BACTERIA.
A patient has a higher risk for allergic reaction to protamine if he/she has a known allergy to (select two)
Protamine insulin
Fish products
Guillain-Barre syndrome is associated with (select two)
Previous infection by Campylobacter bacteria
Arreflexia
The clinical presentation of GBS usually includes.
symmetrical paresthesias and weakness starting at the distal extremities and progressing to the proximal extremities and cranial muscles
Pain often accompanies the syndrome as well as
sensory loss and arreflexia. GBS is self-limiting and full recovery usually occurs.
Guillain-Barre syndrome (GBS) is often preceded by a
mild course of gastrointestinal or influenza-like illness caused by the Campylobacter jejuni bacteria, Epstein-Barr virus, or cytomegalovirus. I
Angiotensin converting enzyme inhibitors are associated with
increased bradykinin levels produce angioedema and cough
During laparoscopic surgery on a healthy patient, what hemodynamic effect would you expect to see as a result of insufflation of the abdomen to a pressure of 12-15 mm Hg?
A decrease in stroke volume
During what period following general anesthesia are premature neonates most likely to exhibit apnea and bradycardia?
4-6 hours following surgery
End stage liver disease is generally associated with a very low SVR, increased cardiac index, and increased mixed venous oxygen saturation.
Increase in CI
Within the first hour of the neohepatic period, the patient exhibits a decrease in cardiac output and an increase in systemic vascular resistance. What does this change indicate?
The graft is functioning well
Change during NEOHEPATIC PERIOD Indicative that the graft is functioning well,
Decrease in CO
Increase in SVR
When use Posttetanic count (PTC) use?
When there is no response to the commonly used tests due to 100% paralysis
The value of the PCT is to
attempt to give a rough time estimate as to when recovery may occur.
PTC involves the use of a
50-Hz tetanic stimulation for 5 seconds. followed in 3 seconds by a series of single 1-Hz twitch stimulation.
PTC : you must first understand this
Posttetanic stimulation or potentiation
What is the POSTTETANIC STIMULATION or potentiation?
When the 50-Hz tetanus is applied, there is no response because the patient is 100% blocked. However, application of the 50-Hz tetanus TRANSIENTLY MOBILIZES EXCESS ACH so that after a 3 second pause, you are able to produce a short series of single-twitch response in the hand. Because they only occur after tetanus is applied, that ‘s why its called posttetanic stimulation. The # of twich elicited is counted, THE HIGHER THE COUNT, the less intense the block. Usual count is between 0 (deep block) and 8 (less intense)
With Posttetanic stimulation, the higher the count,
The less intense the block
For rocuronium, for example neogstimine reversal of an intense block where the PTC was 1 to 2 takes
50 minutes
At a PTC of 6 to 8, reversal should occur in
less than 10 minutes.
How is a two-level combined spinal-epidural performed?
The epidural catheter is inserted, then the spinal is performed two interspaces below the epidural
When performing an epidural using the ‘Hanging Drop’ technique, you know that the use of this technique helps verify that the epidural needle
has entered the epidural space. A visible drop of fluid is placed on the hub of the epidural needle. Because the epidural space has a slightly negative pressure, as the needle enters the epidural space, the drop of fluid will be sucked into the epidural space.
Elderly and receptor response changes
a diminished cardiac response to beta-receptor stimulatio
Severely obese patients often have elevated liver enzymes. Which enzyme is elevated due to the blockage of bile canaliculi by triglyceride depositions?
Alanine aminotransferase
ECG changes consistent with obesity.
Low QRS voltage
LVH criteria
left atrial enlargment
t-wave flattening in the inferior and lateral leads, and prolonged QT interval
What is the recommended dose of intravenous nalbuphine in a laboring parturient?
10 mg
What is the recommended route and dosage of butorphanol for a laboring parturient? (select two)
1-2 mg IM
1-2 mg IV
Neonate dose of naloxone
0.1mg
Butorphanol and nalbuphine are which class of medication
Opioid agonist-antagonist
2 meds associated with a ceiling effect?
Butorphanol and Nalbuphine
Butorphanol and nalbuphine are associated with a “CEILLING EFFECT” what does that mean?
incrementally higher doses do not result in increasing respiratory depression.
Advantages of butorphanol and nalbuphine
Less respiratory depression.
Typical Butorphanol dose for labor
1-2 mg IV or IM.
Butorphanol vs morphine
5 times as potent than morphine.
Butorphanol increases PULMONARY artery presure and myocardial work.
Nalbuphine dose for labor
5-10 mg IV, IM or SC
Nalbuphine 5-10mg is equivalent to
10mg of morphine
In pregnancy, insulin resistance
increases due to the effects of lactogen
In pregnancy , insulin resistance is due to the effect of
Lactogen
Caudal anesthetic dosage for kids
0.5 to 1 mL of solution per kg of bodyweight should be injected in a caudal anesthetic to achieve an umbilical level of anesthesia.
Blockade of the medial branch of the _____can relieve pain from sacroiliac joint syndrome.
dorsal rami of L5 and S1-S3 via a facet joint injection
Which evoked potential test is used the LEAST in surgical patients?
VEP
Hypothermia is defined as a core temperature below
Anything less than 36 degrees Celsius (96.8 degrees Fahrenheit) i
What drug is the standard opioid for the treatment of cancer pain?
MORPHINE
What are the two leading causes of end-stage renal disease? (select two)
HTN
DM
The most common congenital heart defect in infants and children
Ventricular septal defects
Which of the following parameters would you expect to increase upon release of an aortic cross-clamp ?
Pulmonary artery pressure
Motor evoked potentials are contraindicated in patients with
spinal or bladder stimulators, metallic foreign bodies, pacemakers, or a previous craniotomy.
What is the most common symptom of overmedication with phenoxybenzamine in the treatment of pheochromocytoma?
ORTHOSTATIC HYPOTENSION
Which of the following is a precipitating factor for acute intermittent porphyria?
PROLONGED NPO TIMES
Identified as a precipitating factor for Acute Intermittent Porphyria.
Fasting
Neuroleptic malignant syndrome closely resemble
MH
When is the optimal time to perform an epidural block for the treatment of postherpetic neuralgia?
Within 2 weeks of the appearance of the rash
May be activated by low blood pressure, increased tubular chloride concentration, or by sympathetic stimulation.
Renin release
Select two ways in which renin release is triggered.
Hypotension
Increased tubular potassium concentration
Renin release may be activated by which 3 mechanisms (HIS)
HoTN (low BP)
Increased tubular chloride concentration
Sympathetic stimulation.
The highest rehabilitation success rate for substance abuse occurs with a minimum of ___ inpatient treatment days and at least ___ treatment days total.
28 and 90
The elimination half life of CO is.
4-6 hours
Elimination half life of CO, therefore, after 3 half lives
3 half lives, and existing CO blood levels would have fallen by over 80%.
May take several weeks to begin to function normally after cessation of smoking.
Mucociliary function
3 factors that determine the regurgitant volume in mitral regurgitation.
The size of the mitral valve opening
The heart rate, and
the pressure gradient across the valve
How does an increase in the diastolic blood pressure affect the severity of aortic regurgitation? (select two)
It results in an increase in the backward pressure gradient across the valve
It increases the left ventricular regurgitant volume
An increase in the diastolic blood pressure increases the backward pressure gradient which results in an increase in the proportion of stroke volume that regurgitates back into the left ventricle.
Hemophilia A is a________ disorder but affects is
sex-linked recessive. both males and females (males are just much more likely to have the disease). It
Decrease in Factor VIII levels
Hemophillia A
Hemophilia B is also known as
Christmas disease because Factor IX
Patients with hemophilia A will exhibit a______PTT
prolonged
The addition of hyaluronidase in LA facilitates the
spread of the local anesthetics into the tissue and speeds the onset of the block.
The addition of dextran to a local anesthetic solution
increases the duration of action. Studies indicate that this effect is most pronounced when the pH of the solution is high.
The addition of a vasoconstrictor such as epinephrine and phenylephrine will
prolong the effect of local anesthetics.
Opioids shift the CO2 response curve to the
RIGHT
There are four types of indicators:.
nonrotating float
skirted float
Ball float
Plumb bob float.
Are referred to as rotating indicators because they have vanes or grooves cut into the top portion that causes them to spin while they float in the tube. This allows the anesthetist to be certain that the float has not simply become stuck in the tube and is accurately measuring the gas flow
The skirted float and plumb bob float
The worst case scenario would be a ______float in the tube giving the impression that adequate oxygen flow is being delivered, when in fact the patient may be in jeopardy of hypoxia.
non-rotating or ball float stuck
Descending bellows are attached to the top of the cylinder. The bellows fall during_____ and rise during the_________ The bottom plate of the bellows is usually weighted to facilitate its fall during exhalation. If a disconnection occurs in the circuit between the bellows and the patient, the bellows will still fall.
exhalation ; inhalation phase.
The local anesthetic with the highest degree of protein binding is
bupivacaine
LAs with the have the highest degree of protein binding (97%).
Bupivacaine and levobupivacaine
The bottom plate of the DESCENDING bellows and why it isn’t ideal if there is a disconnection?
It is usually weighted to facilitate its fall during exhalation. If a disconnection occurs in the circuit between the bellows and the patient, the bellows will still fall.
The rapid onset of chlorprocaine is because of the
HIGH Concentration that is used.
The rapid onset of chlorprocaine is because of the
HIGH Concentration that is used because its pka is far from physiologic pH
A properly inserted laryngeal mask airway will
protect the airway from pharyngeal secretions
Will show a decline in EEG activity.
Hypoxia and cerebrovascular ischemia
Subanesthetic doses of inhalation agents with nitrous oxide and subanesthetic doses of intravenous anesthetic drugs can
increase EEG activity.
Ketamine administration on EEG activity
increase EEG activity.
Placing a blood pressure cuff on an extremity that is below the level of the heart will
Overestimation of the actual BP
Phospholipase A2, which is the rate-limiting enzyme in the conversion of
arachidonic acid into prostaglandins and leukotrienes, is the primary inflammatory mediator implicated in disc herniation
Cervical epidural steroid injections should be performed at
C6-C7 or C7-T1 and no higher.
Which of the following agents used in controlled hypotension techniques is most likely to produce myocardial depression?
Esmolol
The Kell antigen system is related to
autoimmune diseases.
Type O blood have what antibodies>? T
anti-A antibodies and anti-B antibodies, and patients with Type AB have neither.
The most common reaction from the mixing of type A blood with type B blood is theT
agglutination (clumping together) of the cells.
The type D Rh antigen is____ ____ than the other Rh subtypes.
more antigenic
What increases the risk of postoperative pneumonia by 300%?
Chronic respiratory disease
Factors other than respiratory diseases that increase the risk of postop pna?
Obesity
Age greater than 70 years, and surgery lasting longer than 2 hours
PPV on venous return decreases right ventricular stroke volume during inspiration, and decreases LVEDV during expiration.
Positive pressure ventilation reduces venous return,
PPV on ventricular afterload?
increases right ventricular afterload,
PPV on venous return
Positive pressure ventilation reduces venous return,
PPV on LVEDV?
decreases LVEDV during expiration.
PPV and RV SV
decreases right ventricular stroke volume during inspiration
Most common cause of hyperphosphatemia.
Renal failure is the
Carbohydrate loading can induce _____hosphatemia via an insulin-mediated uptake of phosphorus.
hypophosphatemia. This is the most common form of hypophosphatemia seen in hospitalized patients.
Respiratory alkalosis from
hyperventilation decreases phosphate levels.
Respiratory alkalosis is also presumed to be the cause of hypophosphatemia associated with
gram-negative sepsis and salicylate poisoning.
What is the most common cardiac defect through which a paradoxical embolus will occur?
Patent foramen ovale
It can also occur in other right-to-left cardiac defects such as a
patent ductus arteriosus or atrial septal defect.
The triple therapy drug regimen used for patients with congestive heart failure consists of an
ACE inhibitor, a beta-blocker, and a diuretic (which is often an aldosterone antagonist).
