RANDOM FACTS for SEE 4 Flashcards
1
Q
All local anesthetics cause vasodilation except for
A
ROLICO
cocaine, lidocaine, and ropivacaine.
2
Q
The duration of action of which local anesthetic would be prolonged the least by the addition of epinephrine prior to injection?
A
Bupivacaine
3
Q
Action of sodium bicarbonate
A
It also prolongs the duration of action and reduces pain on injection.
4
Q
Which of the following is a contraindication to performing a peripheral nerve block on a patient?
A
Bleeding diathesis
5
Q
The femoral nerve maintains a lateral position in the femoral canal. In order from lateral to medial the structures are remembered by the acronym NAVEL
A
(nerve, artery, vein, empty space, and lymphatics).
6
Q
Studies have shown that C fibers (which are unmyelinated and transmit pain and temperature impulses) are
A
more resistant to blockade than A-delta fibers and B fibers.
7
Q
Which nerve fibers would you expect to be more resistant to the effects of local anesthetics?
A
A-delta fibers
8
Q
A patient has experienced a high spinal and exhibits hypotension, bradycardia, and weakened respirations. Which intervention would be most appropriate to help prevent further cephalad spread of the local anesthetic?
A
Flex the head at the neck
9
Q
Which of the following ECG changes is an indication of subendocardial ischemia?
A
ST depression
10
Q
Hypertension without signs of end-organ damage is termed
A
‘hypertensive urgency’.
11
Q
HTN with evidence of end organ damage?
A
hypertension with evidence of end-organ damage such as myocardial ischemia, dissecting aortic aneurysm, renal insufficiency, pulmonary edema, encephalopathy, eclampsia, or intracerebral hemorrhage.
12
Q
Patients with Hypertensive emergency would present with?
A
These patients often present with hypertension and symptoms such as headache, epistaxis, or anxiety.
13
Q
Hypertensive emergency is defined as Hypertension without signs of end-organ damage is termed ‘hypertensive urgency’. The exception to the rule is
A
parturients. A parturient with a diastolic blood pressure greater than 109 mmHg is defined as being in a state of hypertensive emergency even if no other symptoms are present.
14
Q
A poorly-controlled hyperthyroid patient is undergoing emergency surgery for an appendectomy. At what point would the patient be most likely to experience a thyrotoxic crisis?
A
6 to 18 hours postoperatively.
15
Q
Following induction and intubation of a patient with hypothyroidism, the blood pressure falls to 80/40 mmHg. The most appropriate intervention for this patient would be to administer? and why?
A
In patients with hypothyroidism, the administration of alpha agonists such as phenylephrine could substantially increase the systemic vascular resistance against a heart that has limited capacity to compensate by increasing its contractility. The best option for these patients is to administer epinephrine, ephedrine, or dopamine.
16
Q
The best options of vasopressors for hypothyroidism
A
DEE) epinephrine, ephedrine, or dopamine.
17
Q
What is the predominant serum protein in fetal blood?
A
alpha-1 fetoprotein
18
Q
Which anatomic structure is responsible for formation of aqueous humor?
A
Ciliary body
19
Q
Aqueous humor production
A
Two-thirds of the aqueous humor in the eye is formed by the ciliary body in the posterior chamber of the eye. The remaining third is formed by passive filtration from vessels through the anterior surface of the iris.
20
Q
Nasal intubation is contraindicated in which of the following surgeries?
A
LeFort II fracture repair
21
Q
Nasal intubation is acceptable and occasionally preferable in most oral and dental surgeries, but is specifically contraindicated in LeFort II and LeFort III fractures why?
A
because of the risk of a coexisting basilar skull fracture and CSF rhinorrhea.
22
Q
What is the most important action to take after the surgeon has placed a mouth gag in a patient undergoing tonsillectomy?
A
Check Breath sounds.
23
Q
What is the most appropriate fluid for volume resuscitation during the first 24 hours following a burn injury?
A
Crystalloids (after you can give LR or albumin 5%)
24
Q
A patient with myasthenia gravis presents for surgery. She takes pyridostigmine. What is the primary risk of underdosing pyridostigmine in this patient?
A
respiratory compromise
25
Pyridostigmine is an
anticholinesterase drug used to treat the symptoms of myasthenia gravis.
26
Underdosing vs Overdosing Pyridostigmine can lead to
myasthenic crisis (severe muscle weakness that can result in respiratory compromise). Overdosing can produce a depolarizing block at the neuromuscular junction because of too much acetylcholine and result in weakness as well.
27
Medications class that increase insulin secretion by beta cells,), and a
Sulfonylureas
28
Medications class that enhance tissue sensitivity to insulin
thiazolinediones and metformin (a biguanide)
29
Decrease postprandial glucose absorption.
Alpha-glucosidase inhibitors
30
Which of the following is associated with paradoxical embolus?
ASD
31
In addition to positive Mantoux skin tests, chest pain, night sweats, and nonproductive cough, tuberculosis is associated with chest x-ray findings such as
bilateral upper lobe infiltrates (often with cavitation), apical and subapical infiltrates, and vertebral osteomyelitis (Pott's disease) which is common in advanced extrapulmonary tuberculosis.
32
Vertebral osteomyelitis (Pott's disease) which is common in
advanced extrapulmonary tuberculosis.
33
Which of the following statements regarding muscular dystrophy is true? Death due to
Death usually occurs due to congestive heart failure or pneumonia
34
Muscular dystrophy is a T Death usually occurs due to congestive heart failure or pneumonia.
sex-linked, recessive trait observed in males.
35
What is the onset is typically between the ages of
2 and 5 years.
36
Muscular dystrophy It is characterized by
painless, progressive muscle degeneration.
37
Muscular dystrophy cardiac symptoms are
mitral valve prolapse, mitral regurgitation, decreased contractility, and diminished R wave progression.
38
What is the most dramatic and consistent effect of aortic cross-clamping?
Increased systemic vascular resistance
39
With AORTIC CROSS clamping, The blood pressure can increase by ______with an infrarenal clamp
2-10%
40
With AORTIC CROSS clamping, The blood pressure can increase by and as much as 50% with a
supraceliac clamp.
41
Which of the following conditions is associated with chronic renal failure?
Hyperlipidemia
42
Which of the following conditions is associated with a progressive, ascending paralysis following an infectious process?
GBS (GBASCENDING)
43
The most important factor determining the rate of diffusion of a drug across a membrane is
concentration gradient across the membrane
44
According to the Fick equation, the most important factor in determining the rate of diffusion of a drug across a membrane is the
concentration gradient of the drug. Membrane thickness is an important factor in the rate of diffusion as is molecular weight, which affects the diffusion coefficient (p) in the equation, but neither of these variables are as important as the concentration gradient.
45
Compared to resection of another portion of the liver, a right hepatic lobectomy places the patient at risk for an increased incidence of____why>
Air embolism
46
A patient undergoing a total knee replacement asks why he is required to wear a sequential compression device. You explain that without prophylaxis, the risk of deep vein thrombosis associated with his surgery is
40-80 percent
47
NSA1Ds inhibit which COX
COX-1 receptor
48
COX-1 receptor inhibition by NSAIDs is responsible for the
gastric irritation, decrease in renal blood flow, and platelet inhibition associated with nonselective NSAIDs.
49
COX-2 inhibitors and protein binding are
highly protein bound
50
COX-2 inhibitors and protein binding
highly protein bound
51
COX-2 inhibitors inhibit
prostaglandin synthesis
52
COX-2 inhibitors and GI effect
have a lower incidence of gastrointestinal side effects than non-selective NSAIDs
53
A CricoThyrotomy is performed by inserting a cannula into
thyroid cartilage and cricoid cartilage TC
54
A coupling gel must be placed between the skin and a Doppler probe when assessing for the presence of a pulse because
air reflects ultrasound waves
55
Approximately what fraction of administered fentanyl is available for transfer across the placenta to the fetus?
30%
56
What sensory level block would be appropriate for performing a cesarean section under epidural anesthesia?
T4
57
It is the only benzodiazepine approved by the FDA for use in neonates
Midazolam
58
During induction for a parathyroidectomy for relief of hyperparathyroidism, which ECG alteration would you most expect to see?
shortened QT Interval and prolonged PR interval. (SQI-PPI)
59
The most common causative agent of acute epiglottitis is
Haemophilus influenza type B
60
Hypotension in carcinoid patients: What should be avoided?
Administration of vasoactive drugs should be avoided in episodes of hypotension
61
The popliteal fossa is bounded by all of the following structures
semitendinosus tendon
semimembranosus tendon
biceps femoris tendon
62
The elevated serotonin level frequently results in
Right-sided heart failure
63
Huntington's chorea is characterized by Decreased plasma cholinesterase may prolong the effect of succinylcholine. There are no specific contraindications to the use of any inhaled or intravenous anesthetics with Huntington's chorea.
choreiform movements, athetosis, and dystonia resulting from genetically-linked neuronal atrophy.
64
Huntington's chorea, As the disease progresses, weakness of the pharyngeal muscles predisposes the patient to
aspiration pneumonia, a common cause of death.
65
Drugs that _______reduce the severity of chorea
dopaminergic transmission such as thioxanthines, butyrophenones, and phenothiazines reduce the severity of chorea.
66
Which of the following statements regarding the use of epidural steroids for the treatment of low back pain is true?
Epidural steroids reduce the degree of leg pain and sensory deficit
67
A caudal epidural is inserted in the
sacral hiatus just inferior to S5.
68
Which of the following precautions should be taken in the patient with Wolff-Parkinson-White syndrome about to undergo anesthesia? (select two)
Instruct the patient to continue taking antidysrhythmics up to the day of surgery
Avoid hypovolemia
69
When preparing the patient with WPW for anesthesia, have the patient continue taking antidysrhythmics up to the day of surgery, avoid situations that could result in sympathetic outflow such as pain or hypovolemia, avoid verapamil or digoxin (which could enhance anterograde conduction through an accessory pathway) in the treatment of any arising dysrhythmia, and have
adenosine, and/or amiodarone available for treatment of tachydysrhythmias.
70
Patients with Alzheimer's disease are often prescribed cholinesterase inhibitors such as.
tacrine, donepezil, galantamine, and rivastigmine to slow the progression of cognitive deterioration
71
are utilized to reverse nondepolarizing muscle relaxant blockade.
Anticholinesterase drugs
72
Which of the following is a known risk factor for the development of postoperative visual loss following spine surgery?
Obesity
73
Which classes of patients are most at risk for intracranial hemorrhage if thrombolytic therapy is administered in the setting of acute myocardial infarction? (select two)
Patients with uncontrolled hypertension
| Patients over the age of 75
74
All of the available neuromuscular blocking agents bear a structural resemblance to what chemical?
Acetylcholine.
75
Where in the human cell does the citric acid cycle (Kreb's cycle) take place?
Mitochondria
76
Factors known to inhibit hypoxic pulmonary vasoconstriction include:
```
Nitroprusside infusion
Inhalation anesthetics
Hypocapnia
Very low pulmonary artery pressures
very high or very low mixed venous PO2
```
```
BC-VP
Beta Blockers
CCs
Vasodilators (nitroprusside, NTG)
Pulmonary infection
```
77
The patient's minute volume when being ventilated by a self-inflating manual resuscitator is dependent upon (select two)
Tidal volume
| Respiratory rate
78
hat factors can result in falsely high tidal volume readings when using a Wright respirometer?
The administration of nitrous oxide
low flow rates will register falsely decreased tidal volumes.
79
The loss of sympathetic tone and concomitant administration of corticosteroids in patients with spinal cord injury can predispose the patient to
Peptic Ulceration
80
Which of the following represents the normal cerebrospinal fluid pressure?
. 10-20 cm H2O
81
Hyperthermia is defined as anything exceeding
38 degrees Celsius (100.4 degrees Fahrenheit).
82
Complete the statement. __________ is a product of phosphocreatine breakdown in muscle and is normally completely filtered by the kidneys.
Creatinine
83
The formula for creatinine clearance =
(Urinary Creatinine) X (Urinary Flow Rate)/Plasma Creatinine.
84
An extreme form of thyroid enlargement that results from simple goiter in which the thyroid enlargement is severe enough to produce dysphagia and inspiratory stridor is referred to as
Toxic multinodular goiter
85
Myxedema coma most commonly appears in
elderly females with a long history of hypothyroidism
86
The only condition that epidural steroids have proven efficacious in speeding healing is
sciatica from disc herniation
87
In a patient, the MAP increased from 70 to 120. Normally, the CBF remains constant between MAPs of 60 to 140 mmHg. As the MAP increases within this range, the cerebral vessels_____to keep CBF constant.
constrict
88
What test assesses movement and evaluates the integrity of the motor tracts in the ventral spinal column.
The wake-up test
89
Which of the following tests would be most appropriate for testing neural integrity during posterior fossa surgery?
BAEPs
90
assess the integrity of the 8th cranial nerve and the auditory pathways above the pons.
Brainstem auditory evoked potentials
91
Best for monitoring during spinal surgery, carotid endarterectomy, and aortic surgery.
Somatosensory evoked potentials assess the dorsal spinal column and sensory cortex and are
92
Best for monitoring during pituitary resection and why?
Visual evoked potentials assess the integrity of the optic nerve and upper brainstem and are
93
Which of the following most accurately represents the composition of eutectic mixture of local anesthetic (EMLA) cream?
2.5% lidocaine and 2.5% prilocaine
94
Which of the following is a potential side effect from the use of eutectic mixture of local anesthetic (EMLA) cream?
Decreased O2 sats
95
Bupivacaine and PR interval
Prolonged the PR interval
96
Which of the following are examples of a field block? (select two)
Superficial cervical plexus block
| Radial nerve block
97
Bier Block, which cuff is inflated first? DPD
The distal cuff is inflated first followed by the proximal cuff. The distal cuff is then deflated to allow the area under it to become anesthetized. If the proximal cuff of the tourniquet becomes too painful for the patient to tolerate, the distal cuff can be inflated and then the proximal cuff deflated to allow the surgeon more time to complete the procedure.
98
What factors contribute to the development of nausea in patients who receive a subarachnoid block? (select two)
Hypotension
| Opioid premedication
99
You would expect serum troponin levels to become elevated within how many hours following the onset of an acute myocardial infarction?
3 hours
100
The diagnosis of AIDS is based on a decrease in the number of which type of cell?
T lymphocyte
101
A diagnosis of AIDS is made when the
CD4 T cell count drops below 200 cells per cubic millimeter or when the patient begins to succumb to opportunistic infections related to the low T cell count.
102
During an emergency airway procedure, a cricothyrotomy has been performed on a patient using a 14-gauge catheter. You are preparing to manage the airway with transtracheal jet ventilation. What driving pressure is necessary with jet ventilation to ensure sufficient gas flow into the lungs?
50psi
103
Which of the following agents would be more likely to result in a dangerous increase in intraocular pressure in the patient with glaucoma?
Scopolamine
104
Adenoidal hyperplasia can result in nasopharyngeal obstruction resulting in obligate)______ breathing.
mouth
105
Both adenoidal and tonsillar hyperplasia are linked to
sleep apnea with the potential for cor pulmonale and failure to thrive.
106
What medications would you be prepared to administer prior to the reperfusion of a newly transplanted liver?
Bicarbonate and calcium. When the liver reperfuses, you should anticipate the administration of bicarbonate and calcium chloride to counteract the effects of acid and potassium on the heart.
107
Methods to decrease the intracranial pressure should be employed when there is a sustained increase in pressure to at least
20 mmHg
108
Which of the following drugs would be least appropriate for use in a patient with advanced Alzheimer's disease?
Atropine
109
Alzheimer's is associated with a progressive and selective
decrease in cholinergic neurons in the brain. For this reason
110
Anticholinergic not recommended for alzheimer's disease and why?
centrally acting anticholinergics such as atropine and scopolamine are not recommended for use.
111
Incomplete diabetes insipidus is associated with.
hypovolemia, hypernatremia, polydipsia, and high output of poorly concentrated urine but is often not as severe as complete diabetes insipidus as there is still a remnant of functioning glandular tissue
112
Incomplete diabetes insipidus can often be treated with the oral hypoglycemic
chlorpropamide, but its use may be limited by its effects on serum glucose.
113
A hypolipidemic medication has also been used in the outpatient setting for the treatment of incomplete diabetes insipidus.
Clofibrate,
114
What is the most common cause of bacterial pneumonia in adults?
Streptococcus
115
For a patient to meet the diagnosis of Adult Respiratory Distress Syndrome (also known as Acute Respiratory Distress Syndrome), four criteria must be met:
Acute onset,
PAO2 to FiO2 ratio <200 regardless of the level of PEEP applied,
Bilateral infiltrates on chest x-ray, and a
PA wedge pressure less than or equal to 18 mmHg.
116
The profound hypotension seen with spinal shock is related to
the level at which the lesion is located (cervical injuries produce more severe hypotension than do lumbar injuries) and is due primarily to a drop in PRELOAD caused by dilation of the capacitance vessels.
117
Dysrhythmias seen with SPINAL shock?
A wide range of cardiac dysrhythmias ranging from PVCs to complete heart block are seen with spinal shock and the hemodynamic changes associated with spinal shock may last for up to 1-3 weeks after the injury occurs.
118
A patient with a spinal cord lesion at C3 would typically exhibit severe hypotension from dilation of the capacitance vessels due to
Loss of sympathetic tone and bradycardia from a lack of sympathetic input from the cardioacceleratory fibers of T1-T4. Due to the drop in preload, the patient would likely exhibit signs of fluid volume deficit which would translate into a decreased urine output.
119
Which of the following conditions is associated with the development of peripheral neuropathies? (Select two)
Diabetes
| Porphyria
120
Over 95% of patients with scleroderma experience
Raynaud's phenomenon.
121
Which of the following would be appropriate in the anesthetic management of a patient with hypertrophic cardiomyopathy? Avoid what
Avoid an increase in myocardial contractility
122
Antidepressants provide analgesia by inhibiting the
presynaptic reuptake of norepinephrine, serotonin, or both.
123
What internal diameter cuffed endotracheal tube would be appropriate for a full-term infant?
For a full-term infant, a 3.0 cuffed endotracheal tube would be appropriate.
124
Tube with premature infants
Uncuffed 2.5-3.0 tubes are recommended for premature infants.
125
Which of the following arterial pressures would you expect to exhibit the widest pulse pressure if measured in the same patient?
Dorsalis pedis artery
126
As the pulse wave moves from centrally to peripherally, the systolic waveform
increases resulting in a wider pulse pressure than in the more central locations. Thus, the systolic pressure as measured in an arterial line placed in the dorsalis pedis artery would be higher than one measured in the femoral artery.
127
You are performing a general anesthetic for a patient undergoing dissection of the lower neck for malignancy when you notice a 20% drop in oxygen saturation, diminished ECG amplitude, a drop in blood pressure, and diminished breath sounds. Based on these findings, you suspect:
Pneumothorax
128
What is the appropriate dosage for oral midazolam in pediatric patients?
0.25-0.75 mg/kg. The dose for oral midazolam in children is 0.25 to 0.75 mg/kg which will peak in about 30 minutes and last for 30 minutes.
129
The initial recommended intravenous dose for children is
0.05-0.015 mg/kg.
130
Which of the following is a likely potential complication of mediastinoscopy?
Mediastinoscopy can result in a wide range of complications such as tearing of great vessels, pneumothorax, chylothorax, bronchospasm from airway manipulation, air embolism, arrhythmias, recurrent laryngeal nerve palsy, esophageal laceration, and obstruction of blood flow through the innominate artery.
131
The most common cause of death following abdominal aortic aneurysm repair is
myocardial infarction
132
During carotid endarterectomy, a distal stump pressure less than what value is an indicator that a shunt should be placed?
40-50 mmHg
133
Contraindications to performing laparoscopic spinal surgery include previous
laparotomy, severe abdominal adhesions, abdominal trauma, and cardiopulmonary disease that would prevent the patient from tolerating hypercarbia associated with CO2 insufflation. Because it is performed in the supine position, an inability to tolerate the prone position would not be a contraindication.
134
Fluid losses are greatest when after a burn ?
in the first 12 hours after the burn
135
Ca and muscle relaxants
increased calcium can antagonize muscle relaxants-
136
Hyperparathyroidism is associated with an increased sensitivity to
succinylcholine and a resistance to nondepolarizing muscle relaxants.
137
Acidosis on calcium levels
increases the serum calcium level, so hypoventilation should be avoided.
138
Hyperparathyroidism patient, what fluid is preferred?
Normal saline is preferred over Lactated Ringer's solution for fluid management
139
Hypercalcemia and digoxin
The patient may be more sensitive to the effects of digoxin.
140
With parathyroidectomy, As with thyroidectomy, there is a risk of damage to the
recurrent laryngeal nerve during surgery, so a Nim(Registered) tube or similar device should be used to monitor nerve function during surgery. It is important to position patients with a risk of pathologic fractures carefully.
141
Regarding combined spinal and epidural analgesia is true?
The epidural space should be identified with the use of air to prevent confusion of saline with CSF
142
Patients with class III obesity (formerly called morbid obesity)
may metabolize volatile anesthetics more extensively
143
When planning to perform a popliteal block, you recognize that the normal volume of LA for a popliteal block is
35-40 mL
144
The sciatic nerve does divide into the
tibial and common peroneal nerve, but does so at the upper boundary of the popliteal fossa, not inferior to it.
145
The popliteal artery may be found immediately
lateral to the semitendinosus tendon
146
A branch of the femoral nerve
The saphenous nerve
147
It may be helpful to remember the causes of a high anion gap acidosis using SLUMPED mnemonic
SLUMPED = Salicylates, Lactate, Uremia, Methanol, Paraldehyde, Ethanol and Ethylene Glycol, and Diabetic Ketoacidosis.
148
Normal anion gap acidosis:
renal tubular acidosis, carbonic anhydrase inhibitors, lysine or arginine HCl, pancreatic fistula, diarrhea, ammonium chloride, and ureterosigmoidostomy.
149
Complex regional pain syndrome type II is precipitatedby
injury to the nerve
150
Causalgia, the former name of complex regional pain syndrome type II, means
burning pain.
151
Complex regional pain syndrome Type 2 onset
It has an immediate onset
152
CRPS Type 2 is associated with VSAH
| WEE
vasomotor and
sudomotor dysfunction
allodynia,
hyperpathia, and in the region of pain, resulting in erythema, edema, and warmth in the area of pain. It is more common in women.
153
CRPS type II is more common in men/ vs women
Women
154
What would be an appropriate dose of intravenous desmopressin for the treatment of uremic bleeding?
0.3 mcg/kg
155
Acidosis and/or hypercarbia on convulsive threshold of LA.
will decrease the convulsive threshold of local anesthetics (more likely to have a seizure)
156
Acidosis on plasma protein binding of LA
decreases the plasma protein binding, which increases the free form of the drug in the bloodstream which results in an increased amount available for diffusion into the brain.
157
Temperature fibers
C
158
Touch fibers
A-Beta
159
Proprioception fibers
A-Alpha
160
Aortic Regurgitation ; It results in a ____in CO ? why?
decrease in cardiac output because of regurgitation of a portion of the ejected stroke volume back into the left ventricle. The left ventricle compensates by becoming hypertrophied and enlarges to accommodate the fluid volume overload.
161
What is the most frequent complication occurring in obstetric patients undergoing central neuraxial blockade?
Hypotension due to sympathectomy
162
Carbon dioxide insufflation during laparoscopic surgery can result in what in HEALTHY patients? SV, HR, SVR< QT , MAP
In healthy patients, stroke volume decreases, heart rate increases, systemic vascular resistance increases, the QT interval may prolong, and mean arterial pressure increases with insufflation.
163
Gas that can increase ICP
Desflurane
164
All of the volatile anesthetic agents and nitrous oxide have been shown to have what effect on ICP?
increase intracranial pressure.
165
2 IV anesthetics that decreases ICP
Etomidate and propofol
166
How does chronic hypertension affect the left ventricle? (select two)
It can reduce left ventricular subendocardial perfusion
| It increases left ventricular oxygen demand
167
Factor VIII concentrate should be administered to the patient with what disease ?________ until levels are at or near ___% of normal prior to surgery, which may require a dose of _____ to ____units /kg
hemophilia A until levels are at or near 100% of normal prior to surgery, which may require a dose of 50-60 units/kilogram. Factor IX preparations are for use in patients with hemophilia B.
168
Dose of Factor VIII concentrate for hemophillia A patients
dose of 50-60 units/kilogram.
169
Midazolam preserves the ability of the blood vessels to
vasoconstrict in response to a decrease in blood flow.
170
Midazolam on CPP
Despite a decrease in cerebral perfusion pressure, the intracranial pressure would be relatively unaffected.
171
Midazolam adult IV vs PO dose
The dose for IV or IM midazolam is 0.02-0.04 mg/kg compared to 0.4 to 0.8 mg/kg for the PO dose.
172
Midazolam is water or lipid soluble? It is formuled in what type of solution?
Water-soluble and formulated in an aqueous solution that causes minimal pain on injection.
173
Benzos on swallowing reflex and upper airway reflexes.
Benzodiazepines decrease the swallowing reflex and the upper airway reflexes.
174
What controls water reabsorption in the distal tubule and collecting duct?
ADH
175
Antidiuretic hormone increases the absorption of solute-free water in the
Collecting ducts
176
Antidiuretic hormone (ADH), also known as arginine vasopressin, works in the distal tubule/collecting tubule and duct. ADH is secreted in response to dehydration and renders the lumen of the collecting tubule permeable to water through the expression
of water channel proteins called aquaporin-2 channels.
177
What can suppress the release of ADH, rendering the lumen of the collecting tubule impermeable to water.
Adequate hydration
178
The oxygen supply failure alarm sets off an alarm if the oxygen pressure falls below a standard set by the manufacturer which is typically_____psig
30 psig
179
The oxygen supply failure alarm : How is it engage? Can it be disabled?
must engage within 5 seconds of the disconnect and cannot be disabled by the anesthetist.
180
Oxygen supply failure alarm is designed to help prevent hypoxia from lack of oxygen flow, but does not
prevent the flow of anesthesia gases (and could still possibly allow a hypoxic mixture of gases to be delivered).
181
Heliox is a mixture of helium and oxygen. Helium is less dense than oxygen and improves . .
respiratory mechanics by increasing laminar flow through the airways and decreasing the work of breathing.
182
Reynolds number is an evaluation of
gas flow turbulence
183
As laminar flow increases, the Reynolds number
decreases
184
Heliox can alleviate the symptoms of increased airway resistance, but doesn't
dilate the airways like a bronchodilator.
185
A chemical carbon dioxide detector changes color when exposed to
carbonic acid
186
Hyponatremia due to hypoaldosteronism is most noted to produce
orthostatic hypotension
187
Which anesthetic agent would be taken up by the bloodstream the SLOWEST TO FASTEST? UPTAKE
```
Nitrous
Desflurane
Sevoflurane
Isoflurane
Halothane
```
188
The 3-OH metabolites of both vecuronium and pancuronium possess about.
50% of the neuromuscular blocking activity of parent compound
189
Succinylcholine is metabolized to
choline, succinic acid and succinylmonocholine.
190
Succinylmonocholine also has some
neuromuscular blocking activity.
191
A small amount of rocuronium is metabolized to the
17-OH compound, which lacks activity.
192
Most rocuronium is excreted by the
kidneys and liver as intact drug.
193
Succinylcholine undergoes _______by
Hydrolysis; Plasma cholinesterase
194
Succinylcholine is not metabolized by
True cholinesterase and termination of neuromuscular blockade occurs as succinylcholine diffuses away from the NMJ
195
Atracurium and cis-atracurium both drugs can
undergo ESTER HYDROLYSIS by nonspecific plasma esterases.
196
The rate of seroconversion after exposure of MUCOUS membranes to HIV-infected blood is approximately:
0.09%
197
The rate of seroconversion after exposure NEEDLESTICK exposure to HIV-infected blood is approximately:
0.3%
198
Rocuronium has an ED95 of
0.3 mg/kg. .
199
The ED95 of vecuronium is
0.05 mg/kg.
200
The ED95 of atracurium is
0.25 mg/kg
201
The ED95 of cisatracurium is
0.05 mg/kg.
202
Normal average total cerebral blood flow?
50ml/100g/min
203
For LA, The closer the pKa is to physiologic pH,
the more of it will exist in nonionized form and be able to cross the lipid membrane of the neuron, thus speeding onset.
204
Most allergic reactions to local anesthetics are to
ester anesthetics because of the metabolite para-aminobenzoic acid.
205
Although methylparaben, the preservative found in
amide anesthetics is similar to para-aminobenzoic acid, allergic reactions to it are not as common.
206
What is the preservative found in lorazepam and diazepam?
propylene glycol
207
What is the preservative found in halothane?
Thymol
208
Which peripheral nerve block, when combined with a popliteal fossa nerve block would provide complete anesthesia for foot and ankle procedures?
Saphenous nerve block
209
The anterior spinal and posterior artery ?
vertebral artery and supplies the anterior 2/3 of the cord while the posterior spinal arteries are derived from the posterior inferior cerebellar arteries and supply the posterior 1/3 of the spinal cord.
210
Normally, in the supine position, the most dependent portion of the spinal column occurs at
T4.
211
Severe obesity is commonly associated with
HYPERINSULINEMIA
212
are all associated with severe obesity. T
Hyperinsulinemia, hypertension, and increased mineralocorticoid levels
213
Obesity and CO
The associated increases in circulatory requirements result in an increase in cardiac output of about 0.1 L/min for every additional kilogram of body fat.
214
The presence of a Q wave on the electrocardiogram is considered pathologic when its duration exceeds
0.04 seconds
215
The presence of a Q wave on the electrocardiogram is considered pathologic when its duration exceeds
0.04 seconds corresponds to 1 mm wide on the standard tracing.
216
Which of the following antiplatelet drugs used in patients with a history of myocardial ischemia works by blocking adenosine diphosphate receptors?
Clopidogrel (Plavix)
217
Which of the following pharmacologic treatments may result in increased intracranial pressure when treating hypertensive emergencies associated with encephalopathy?
NItroprusside
218
The termination of action of thiopental is due to
redistribution
219
What does not play a significant role in the duration of action of a single dose of thiopental.
Metabolism
220
The normal intraocular pressure is about and pressures presumably from venous congestion due to the eyes being closed.
10 to 21 mmHg
221
Intraocular HTN is Ocular pressure above
above 22mmHg is considered intraocular hypertension.
222
Intraocular pressure what time of day ?
higher in the morning,
223
All decrease intraocular pressure by
Dextran, mannitol, urea, and sorbitol
224
How does mannitol decrease IOP?
exerting a hyperosmotic effect that decreases aqueous humor formation.
225
You are preparing to perform nasal intubation for a patient undergoing dental surgery and are administering 4% cocaine intranasally to constrict the nasal passages. What is the maximum volume of the cocaine solution that can be administered?
4 mL
226
often necessary to compensate for the large intrinsic air leak around the rigid bronchoscope and maintain adequate ventilation and anesthetic depth.
High gas flows, large tidal volumes, and high inspired volatile agent concentrations are
227
Which of the following routes of administration of midazolam would be least recommended for a five year-old patient?
Intramuscular. The IM route is not recommended because of pain and the risk of a sterile abscess.
228
Carbon MONOXIDE SHIFTS the oxyhemoglobin curve to the
LEFT impairing the unloading of oxygen to the tissues.
229
CO poisoning and mitochondria?
mpairs mitochondrial function, uncouples oxidative phosphorylation and reduces ATP production resulting in metabolic acidosis, and shifts the oxyhemoglobin dissociation curve to the left,
230
A patient with a pacemaker with a program code of VVI has a heart rate of 104 and you see pacer spikes on the ECG. You would most accurately assume that
the pacemaker ventricular sensing is faulty
231
Hyperventilation on ICP
Hyperventilation (to a PaCO2 of no lower than 22-25 mmHg) results in respiratory alkalosis and vasoconstriction. As the degree of vasoconstriction increases, the blood flow to the brain decreases, thus decreasing the volume of the intracranial compartment.
232
The value traditionally used as the threshold for too little urine output (oliguria) is
0.5 mL/kg/hour for at least 6 hours
233
ACROMEGALY AND AIRWAY ISSUES
prolonged mandible, overgrowth of pharyngeal tissue, recurrent laryngeal nerve damage, and decreased subglottic diameter. Hoarseness or stridor are indications that the upper airway is probably involved.
234
Which of the following clinical findings would be consistent with a diagnosis of hyperaldosteronism?
Diastolic blood pressure of 125 mmHg
235
Hyperaldosteronism (Conn's syndrome) exhibits signs and symptoms including
headache, systemic hypertension (diastolic blood pressure often between 100 mmHg and 125 mmHg), hypokalemia, hypernatremia, hypomagnesemia, and abnormal glucose tolerance.
236
NORMAL magnesium level
Magnesium levels are between 1.5 and 3 mEq/L
237
Pheochromocytoma usually occurs in patients between the ages of
30 and 50 years
238
Pheochromocytoma and malignancy ?
fewer than 10% are malignant,
239
Pheochromocytoma is associated with
multiple endocrine neoplasia (MEN) and although 20% of pheochromocytomas involve multiple sites, fewer than 10% involve both adrenal glands.
240
Patients with Cushing's disease have increased serum cortisol levels resulting in K+ _______ BG_________ skeletal muscles?
hypokalemia, hyperglycemia, and skeletal muscle relaxation which may require a decreased non-depolarizing muscle relaxant dose.
241
Because patients undergoing bilateral adrenalectomy exhibit a
Rapid decrease of serum cortisol levels, steroid replacement therapy should be initiated prior to or during surgery.
242
Which of the following is most likely to result in an exacerbation of the symptoms of multiple sclerosis following general anesthesia? How ?
An increase in body temperature of 1 degree Celsius. It is possible that the increase in body temperature results in complete conduction block in demyelinated nerves.
243
Which of the following is typically the first sign of Acute Respiratory Distress Syndrome?
Hypoxemia refractory to oxygen therapy
244
The critical level for the development of autonomic hyperreflexia due to a spinal cord lesion is
T6
245
Lesions at or below ____do not consistently produce symptoms of autonomic hyperreflexia.
T10
246
Which of the following agents would be most likely to produce an exacerbation of systemic lupus erythematosus?
Hydralazine
247
Can precipitate an exacerbation of SLE.
Infection, pregnancy, and surgical stresses
248
Over 80 drugs have been reported to precipitate an SLE exacerbation, most common are PHIMD
```
procainamide
hydralazine,
isoniazid,
methyldopa
d-penicillamine, and are drugs most frequently implicated in SLE exacerbation.
```
249
What is the most common complication of mediastinoscopy?
Hemorrhage
250
What interventions are appropriate for the treatment of complex regional pain syndrome? (select two)
Gabapentin
| Sympathetic Blockade
251
The recurrent laryngeal nerve provides sensation to the larynx.
below the vocal cords
252
The recurrent laryngeal nerve also provides motor innervation to all of the laryngeal muscles except for the
cricothyroid muscle, which is innervated by the external laryngeal nerve.
253
Which of the following crystalloid solutions does not contain potassium?
7.5% NaHCO3
254
Lactated Ringer's and D5LR both contain_____meq potassium,
4 mEq/L of
255
Plasmalyte contains ___mEq/L of potassium.
5
256
7.5% NaHCO3 is extraordinarily ______with ____of sodium but does not contain
hypertonic with 893 mEq/L ; Potassium
257
Correcting hypernatremia too fast lead to
Cerebral edema
258
Correcting Hyponatremia too fast lead
Central pontine myelonosis
259
Correcting Hyponatremia too fast lead
Central pontine myelinoLysis
260
What detect minute increases is serum osmolarity?
OSMORECEPTORS in the hypothalamus.
261
Sodium level" 135-130 symptoms
No s/s mild neuro s/s possible
262
Sodium level 129-125 s/S
Nausea/malaise
263
Sodium level 124-115
HA, letharty altered level of consciousness
264
Sodium level less than 115
Seizures, coma,resp arrest, CEREBRAL HERNIATION
265
Most common electrolyte abnormality in hospitalized patients?
hyponatremia
266
SIADH and water intoxication lead to
Hyponatremia from EXCESS Water not loss of sodium.
267
FeNA less than 1 is
Prerenal
268
FenA> 2
Intrinsic renal
269
Free water deficit formula
Na/140 -1. x TBW
270
Free water deficit formula
(Na/140) -1 x TBW
271
Hypomagnesium on Potassium
Decrease ICV potassium.
272
After inserting a Combitube, you should
inflate both the proximal and distal cuffs
273
What primarily explains the prolonged duration of midazolam in an elderly patient?
decreased hepatic perfusion
274
If a right-to-left shunt is present, an inhalation induction proceeds more
Slowly because the anesthetic concentration of arterial blood increases more slowly. The opposite is true with a left-to-right shunt because the rate of transfer of anesthetic from the lungs to the blood is more rapid. This effect is rarely evident in the clinical setting, however.
275
You are performing a general anesthetic for a patient undergoing an MRI. You know that you should place the ECG leads
close together on the patient's chest
276
Which statement is true of EEG monitoring during a carotid endarterectomy?
It does not monitor deep brain structures
277
You are preparing to induce a patient undergoing general anesthesia for resection of a carcinoid tumor. If possible, all of the following drugs should be avoided in this patient except:
Vecuronium
278
Adequate understanding of the principles of general anesthesia for a patient undergoing enucleation of the eye
Deep extubation should be considered on emergence
C. Atropine may need to be administered during dissection of the ocular muscles
D. Pretreatment with antiemetics is recommended
279
During repair of a tracheoesophageal fistula,
the bevel of the endotracheal tube should face anteriorly after it is passed through the cords. This is done to prevent ventilation of the fistula.
280
During repair of a tracheoesophageal fistula, the endotracheal tube should be advanced intentionally into the
right mainstem bronchus and then slowly withdrawn until the first point at which breath sounds are heard in both lung fields.
281
The obese patient should be in the
sitting position when the epidural is placed to help in identifying landmarks. Because rostral spread of the anesthetic is more prevalent in obese patients and they are more prone to suffer respiratory symptoms as a result, you should have them sit up for a longer period of time after injection.
282
The normal range for phosphorus is
2.7 to 4.5 mg/dL.
283
The symptoms correspond to hypophosphatemia.
paresthesias, myopathy, delirium, seizures, and com
284
The characteristics consistent with a left bundle branch block are:
QRS > 0.12 secs, lack of septal Q waves in V4-V6, I and aVL, RR' QRS pattern in I, aVL, and V4-V6, and secondary ST or T wave changes in I, aVL, and V4-V6.
285
RBB signs
A deep, rounded S wave in leads I and aVL is typical of a right bundle branch block,
286
One of the characteristics of left ventricular hypertrophy.
while a V5 amplitude > 26 mm is one of the characteristics of left ventricular hypertrophy.
287
Chronic bronchitis differs from emphysema in that patients with bronchitis
have an elevated hematocrit
288
The hallmark pathologic findings in Alzheimer's such as neurofibrillatory tangles and neuritic plaques are due to
deposition of amyloid plaques
289
A patient undergoing emergency surgery for traumatic injury is in hypovolemic shock. You discover he is on warfarin daily. In addition to crystalloids and packed red blood cells, the most important treatment options would be (select two)
fresh frozen plasma
| vitamin K
290
CP aspiration and hypothermia
The patient is at severe risk for gastric aspiration
| Patients with cerebral palsy are more at risk for hypothermia
291
Baclofen and CP
Abrupt discontinuation of baclofen can result in withdrawal symptoms such as itching, confusion, hallucinations, and seizures .Even though they may suffer muscle weakness and spasticity, patients with
292
CP and hypothermia
They are susceptible of hypothermia and require close temperature monitoring. Gastric reflux is often severe enough that surgery to correct it is necessar
293
Cerebral palsy and Succinylcholine
do not have an exaggerated hyperkalemic response to succinylcholine, nor are they more susceptible to malignant hyperthermia
294
Patients with systemic lupus erythematosus often exhibit
Restrictive defects
295
A patient is about to undergo repair of a thoracic aortic aneurysm. You are placing an arterial line to monitor systemic blood pressure during the case. The arterial line would most appropriately be placed in the
Right wrist
296
Entonox is a 50:50 mixture of (select two)
oxygen
| Nitrous oxide
297
Which of the following oxygen delivery devices is considered a zero-capacity device?
Nasal cannula
298
Ethanol can be
falsely detected as a volatile agent
299
Which alteration would be most likely to produce congestive heart failure or hypotension in the patient with aortic stenosis?
New onset of atrial fibrillation
300
Which diuretic inhibits sodium reabsorption by limiting the number of open sodium channels in the epithelium of the cortical collecting ducts?
amiloride
301
Triamterene and amiloride do not rely on
aldosterone activity.
302
Triamterene and amiloride MOA
They inhibit sodium reabsorption and potassium secretion by limiting the number of open sodium channels in the epithelium of the cortical collecting duct.
303
Which agent can prolong the effect of succinylcholine?
Metoclopramide inhibits plasma cholinesterase and prolongs the duration of succinylcholine.
304
In normal patients, a decrease in blood pressure from 120/60 to 90/60 results in:
As the MAP decreases within this range, the cerebral vessels dilate to keep CBF constant.
305
How are cerebral metabolic rate (CMRO2) and cerebral blood flow (CBF) altered by isoflurane?
decrease in CMRO2 with an increase in CBF
306
A pacemaker that paces the ventricle and does not sense is designated
VOO.
307
Which of the following surgical sites is associated with the highest risk for postoperative pulmonary complications?
UPPER ABDOMEN
308
Hypoaldosterone
hyperchloremic metabolic acidosis, and often, hyperglycemia.
309
INsulin facilitates the transport of glucose and potassium into the cell, and is important for the cellular uptake of glucose with the exception of the
brain and liver where it does not affect glucose transport.
310
A patient with myasthenia gravis is undergoing surgery. This patient would most likely: have a decreased number of
functioning acetylcholine receptors
311
Addisons disease is characterized by autoimmune destruction of the adrenal glands causing a decrease in glucocorticoid and mineralocorticoid production. This results in
hyperpigmentation, hyperkalemia, increased urinary sodium excretion, and decreased androgen production.
312
Which of the following drugs would not exhibit a smaller volume of distribution in the geriatric patient?
Diazepam
313
A patient undergoing a TURP begins to exhibit widening of the QRS complex and ST segment elevation on the electrocardiogram. Based on this evidence, you would estimate the serum sodium to be
115 mEq/L
314
Which of the following methods are most appropriate for securing the airway in a patient undergoing evaluation for cervical spine injury?
. Flexible fiberoptic laryngoscopy
315
Total blood calcium levels parallel the
serum albumin.
316
If the serum albumin decreases, the total blood calcium level will .
decrease as well.
317
Is the most common cause of hypocalemia
Hypoalbuminemia
318
Which of the following would you expect to occur when placing a surgical patient in the sitting position? (select two)
Reduction in central venous pressure
| B. Increase in systemic vascular resistance
319
Patients with which of the following conditions would be most likely to suffer an allergic reaction to protamine? (select two)
Allergy to fish products
| History of protamine zinc insulin use
320
Meperidine on the beat to beat variability
Tachycardia
| Decreased beat-to-beat variability in the heart rate
321
When the thoracic aorta is cross-clamped, blood flow to the tissues distal to the clamp is dependent upon
PERFUSION PRESSURE
322
Which diagnostic aid would most accurately reflect an interruption of anterior spinal cord perfusion in a patient undergoing surgery involving cross-clamping of the thoracic aorta?
Motor evoked potentials
323
The primary site for parathyroid hormone- and vitamin D-mediated calcium reabsorption is the
DISTAL (think DPH)
324
Hypercapnia in the range of 50 to 70 mmHg can produce
A. increased cerebral blood flow
325
A hormone response that initiates signals which amplify the release of the same hormone is referred to as a
positive feedback mechanism
326
Which endotracheal tube stylet allows the stylet angle to be adjusted during laryngoscopy?
Schroeder stylet
327
According to U.S. standards, what is the MAXIMUM contact surface temperature a forced-air device cannot exceed?
48 degrees Celsius
328
What alteration in anesthetic response would you expect to see in a patient who suffers from Conn's syndrome (hyperaldosteronism)? (NDNMB)
Decreased nondepolarizing muscle relaxant dose requirements
329
LMA or Combitube is suitable for placement by paramedics for transport, but it should be
replaced with a definitive endotracheal airway as soon as possible.
330
Which pharmacokinetic model best illustrates how lipid-soluble drugs are distributed?
2- compartment model
331
In a patient with mitral valve regurgitation, corrective surgery is preferred to be performed when the ejection fraction is
>60%
332
What induction agent is most useful for the patient with cardiac tamponade undergoing general anesthesia?
Ketamine
333
Patients with chronic renal failure tend to exhibit
hyperventilation
334
You are preparing to anesthetize an 11 year-old patient for tonsillectomy. Which statement indicates an accurate understanding of an appropriate anesthetic plan for this patient?
A cuffed endotracheal tube should be used
335
The arterioles that surround the loop of Henle are known as the
VASA RECTA
336
Posttraumatic stress disorder (PTSD) is characterized by symptoms of stress that last longer than
One month
337
The mental and psychological effect of being awake for a duration of 24 hours is
the equivalent of a blood alcohol content of 0.10%
338
should be avoided in patients with Parkinson's disease.
Dopamine antagonists (phenothiazines, droperidol, and metoclopramide)
339
Features characteristic of Parkinson's disease include:
Resting tremor, cogwheel rigidity of extremities, bradykinesia, shuffling gait, stooped posture, and facial immobility.
340
Patients taking levodopa for the treatment of Parkinson's disease may exhibit (select two)
Levodopa is a precursor to dopamine.
341
Precursor of dopamine is
LEVODOPA
342
Levodopa is combined with
Tt is combined with a decarboxylase inhibitor to prevent the peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.
343
Common in parkinson's patients are
Orthostatic hypotension is also common in these individuals and levodopa therapy may result in nausea and vomiting as a result of stimulation of the chemoreceptor trigger zone.
344
Parkinson is a decrease in
A decrease in dopamine levels in the basal ganglia
345
What is the most common cardiac abnormality associated with severe scoliosis?
MVP
346
Scoliosis caused by cerebral palsy or syringomyelia is categorized as
Neuropathic scoliosis
347
Kyphoscoliosis The severe chest wall deformity can result in a reduction in lung volumes with
vital capacity, total lung capacity, functional residual capacity, and residual volume all reduced.
348
What is normal in kyphoscoliosis
The FEV1/FVC is normal unless the patient's condition is complicated by concomitant pulmonary disease.
349
Administration of anticholinergics in general results in a _______in gastric secretions, _______peristalsis and intestinal motility,______ gastric emptying time, and. There is no significant effect on ventricular function or peripheral vascular resistance.
decrease; decreased; prolonged
350
ATROPINE on LES tone
reduced lower esophageal sphincter tone
351
Anticholinergic that both decrease the lower esophageal sphincter tone and increase the risk for gastric reflux.
atropine and glycopyrrolate
352
Although atropine can cross the placenta (glycopyrrolate cannot), there is
no significant change in fetal heart rate after intravenous administration to the mother.
353
All anticholinergics combine
reversibly with the muscarinic cholinergic receptors and prevent acetylcholine from binding to the receptor.
354
Ipratroprium bromide is chemically most similar to
Atropine
355
Mnemonic action of anticholinergic
Can't see
Can't pee
Can't spit
Can't shit
356
DUMBBBELL Signs of Cholinergics
```
Diaphoresis
Urination
Miosis (Pin POINT PUPIL)
Bradycardia (decreased HR)
Bronchospasm
Bronchial secretions increase
Emesis (vomiting)
Lacrimation
Loose stool
```
357
Which agents would be most effective in the treatment of motion-induced nausea and vomiting? (select two)
Dimenhydrinate
| Scopolamine
358
Which drug could potentiate the effects of atropine and predispose the patient to central anticholinergic syndrome?
Amitryptiline
359
The typical sequence of CNS symptoms seen from local anesthetic toxicity in order of appearance are
```
Circumoral numbness,
lightheadedness
tinnitus
visual disturbances
slurring of speech, muscle twitching, irrational conversation, unconsciousness, grand mal seizures, coma, and apnea
```
360
All local anesthetics are weak bases consisting of a
lipophilic group (often a benzene ring) attached to a positively charged amine group by either an amide or ester linkage.
361
A resting nerve is less sensitive to local anesthetics because
local anesthetics enter active cells more easily.The more a nerve is firing and the more frequently the channel opens, the more opportunities lidocaine has to enter the cell and bind to the sodium receptor. Local anesthetics bind to the sodium channel on the inside of the cell membrane, not the outside.
362
Local anesthetics can only enter the cell when the
sodium channel is in the activated or open state.
363
Following injection of lidocaine during an epidural anesthetic, the patient begins to complain of numbness of her lips, dizziness, and ringing in the ears. Which of the following would be an appropriate intervention?
Encourage the patient to hyperventilate. In the early stages of toxicity, however, hyperventilation (preferably with 100% oxygen) is the treatment of choice.
364
________worsens the toxic effects of local anesthetics by causing cerebral vasodilation and delivering more drug to the brain, reducing plasma protein binding which leaves more free drug available in the circulatory system, and by causing ion trapping within the neuron due to increased intracellular acidosis.
Acidosis
365
Hyperventilation with 100% oxygen increases the plasma
pH to counteract these effects and denitrogenates the lungs in the event emergency intubation becomes necessary
366
You have performed a Bier block anesthetic with 50 mL of lidocaine 0.5% for a patient undergoing closed reduction of a distal radius and ulna fracture. The procedure is complete, and your current tourniquet time is 20 minutes. An appropriate action would be to
To avoid a rapid bolus of intravenous local anesthetic that could result in local anesthetic toxicity, the tourniquet should remain inflated for a minimum of 20 minutes. If 40 minutes has elapsed, the tourniquet can be deflated in a single maneuver. If the duration is between 20 and 40 minutes, the tourniquet should be deflated, reinflated immediately, and then deflated 1 minute later to prevent the rapid absorption of local anesthetic into the circulation
367
A femoral nerve block will provide anesthesia for the ,
anterior thigh, knee, and a portion of the medial aspect of the foot.
368
would be more appropriate for a lateral thigh procedure
A lateral femoral cutaneous nerve block
369
Which Block would be appropriate for procedures on the medial thigh such excision of a medial thigh mass or a release procedure on the medially located adductor muscles.
Obturator nerve block
370
The sympathetic blockade on peristalsis
produces increased peristalsis
371
Sympathetic blockade from a spinal anesthetic decreases the
stress response and results in lowered production of cortisol as well as producing arterial vasodilation.
372
The formula for calculating ideal body weight is
height in centimeters minus 100 for men and height in centimeters minus 105 for women.
373
The concomitant use of zidovudine and corticosteroids can place the patient at risk for
myopathy and respiratory muscle dysfunction.
374
The elimination half-life of carbon monoxide is about 4 to 6 hours which means that a smoke free interval of _____________results in marked decreases in carboxyhemoglobin levels and a corresponding increase in oxygen carrying capacity.
12 to 18 hours results
375
Patients with cardiac valvular disorders undergoing tonsillectomy are at risk for endocarditis from chronic tonsillar infection by
Streptococcal organisms
376
What is the most common causative diagnosis for patients requiring renal transplant?
TYPE II DIABETES
377
The next three most common causative diagnoses in order AFTER DIABETES are
hypertensive nephrosclerosis, renal graft failure, and type 1 diabetes.
378
What is the earliest sign of graft function after liver transplantation surgery?
Base deficit normalizes with rapid fresh frozen plasma administration
379
Liver transplantation is associated with administration of.
large volumes of fresh frozen plasma to maintain euvolemia and correct bleeding due to hypofibrinogenemia
380
During Liver transplantation, the administration of plasma is associated with
citrate binding of calcium and will require intravenous calcium administration. If a graft is functioning normally, the base deficit will normally resolve within 30 minutes despite continued FFP administration as the new liver begins metabolizing the citrate.
381
If the liver graft is functioning properly , What will happen?
base deficit will normally resolve within 30 minutes despite continued FFP administration as the new liver begins metabolizing the citrate.
382
is the most potent stimulus for pulmonary vasoconstriction.
Generalized alveolar hypoxia
383
When HPV occurs
When it occurs locally, it serves to shunt blood to areas that are better oxygenated. Systemic acidosis also promotes pulmonary vasoconstriction but is not as strong a stimulus as hypoxia.
384
Not as strong as hypoxia but also promotes pulmonary vasoconstriction?
Systemic acidosis
385
Which of the following laboratory changes are most specific for hepatobiliary obstruction?
5' nucleotidase elevation
386
5' nucleotidase is a form of alkaline phosphatase that is present in most tissues, but elevated serum levels are always
hepatobiliary in origin and are markedly elevated in intrahepatic or extrahepatic obstruction.
387
5' nucleotidase is a form of
alkaline phosphatase
388
Attempt to reconstruct ravaged bone
Osteoblasts (build bones)
389
Diagnostic feature of bone disease and Hyperparathyroidism?
Elevated alkaline Phosphatase
390
Advanced sustained elevated PTH leads to
exaggerated osteoclast activity
391
Which of the following lab results would be consistent with glycogen storage disease?
Metabolic acidosis
392
Glycogen storage disease results in a lack of the enzyme. As a result, glycogen cannot be hydrolyzed in hepatocytes and other cells and becomes inappropriately stored in the intracellular space. Hypoglycemia can be severe and metabolic acidosis develops as a consequence.
glucose-6-phosphatase
393
Most common functioning tumor of the pancreas
Insulinoma
394
Insulinoma triad is known as the
WHIPPLE TRIAD
Hypoglycemia (catecholamine release)
Low blood glucose (40-50)
Relief of symptoms after IV glucose.
395
Acromegaly is associated with an increased incidence of
osteoarthritis, systemic hypertension, ischemic heart disease, ventilation-perfusion mismatching, glucose intolerance, neuropathy, skeletal muscle weakness, and thick, oily skin.
396
Hyperaldosteronism is associated with
hypokalemia (serum potassium less than 3.5 mEq/L).
397
Which of the following interventions would be an appropriate initial treatment for the derangement in serum potassium caused by hyperaldosteronism?
Spironolactone is a competitive aldosterone antagonist that, unlike furosemide and bumetanide, will induce diuresis while sparing serum potassium levels.
398
3 associated with pheochromocytoma
INcreased serum metaneprhine levels
Normal magnesium
LVH on ECG
399
Hypoglycemia is associated with a sympathetic response and symptoms such as
hypertension, tachycardia, diaphoresis, and lacrimation.
400
Does multiple sclerosis affect peripheral nerves
NO
401
Multiple sclerosis is associated with prolonged latency of evoked potentials due to
slowed nerve conduction resulting from demyelination of central nerves, including the brainstem and cerebellum.
402
Prolonged LATENCY of EVOKED POTENTIALS is associated with
MS
403
Patients with congestive heart failure often exhibit hyponatremia due to
activation of the vasopressin system.
404
Administration of 10 mL of 10% calcium chloride for HYPERKALEMIA should be over
10 minutes
405
Electrical alternans is a variation in the ECG caused by
the shifting of the heart within the distended pericardium as it beats.
406
Electrial Alternans is seen with
Cardiac tamponade
407
Anaphylactic reactions are related to prior sensitization by exposure to an antigen with production of antigen-specific
IgE
408
Meperidine produces______ respiration depression in neonates than morphine
LESS
409
Naloxone may be administered IV directly into the newborn at a dose of
10 mcg/kg.
410
Hepatic blood flow in the elderly
decreases by as much as 40% by 80 years of age.
411
Shoulder arthroscopies are usually performed in which position?
Beach chair position ; (also known as beach chair, barber chair, or modified Fowler's position) or lateral decubitus position.
412
Preferred position for shoulder arthroscopies
Semi-sitting position is often preferred as it facilitates maintaining the MAP < 80 mmHg to reduce subacromial bleeding.
413
When the body temperature is less than 20 degrees Celsius, circulatory arrest can be tolerated for
up to about 30 minutes.
414
Profound hypothermia provides greater protection againsts.
cerebral ischemia than oxygen administration or anesthetic agent
415
During neurosurgical procedures where the brain is at risk for ischemic damage, a goal temperature of
35C to 36C is acceptable.
416
The mucous membranes of the nose are innervated by the opthalmic division of the trigeminal nerve
(V1) anteriorly and the maxillary division of the trigeminal nerve (V2) posteriorly. These nerves are also known as the anterior ethmoidal and sphenopalatine nerves respectively.
417
V1: Ophtalmic division is also known as
Anterior ethmoidal nerve
418
V2: Maxillary division is aka
Sphenopalatine nerve
419
The lateral and medial cricoarytenoids are innervated by the
recurrent laryngeal nerve.
420
You are performing a general anesthetic when you notice sustained high circuit pressures. You switch to BAG mode and manually ventilate the patient. The circuit pressures return to normal until you switch back to ventilator mode and they rise again. The patient exhibits adequate muscle relaxation. What is the likely problem?
The ventilator relief valve is malfunctioning
421
If the circuit exhibits sustained high pressures only during mechanical ventilation and not during manual ventilation, then the problem is likely a
malfunctioning ventilator relief valve.
422
If the scavenger was obstructed or the endotracheal tube is obstructed with secretions, then the circuit pressures would remain
elevated during mechanical or manual ventilation.
423
If nitrous oxide is also used, the maximum exposure to halogenated agents allowed by OSHA is
0.5 ppm.
424
If nitrous oxide is NOT used, then the maximum exposure is
2 ppm.
425
The most common critical incidents in anesthesia are due to
circuit disconnection at the y-piece
426
In the patient with epiglottitis, symptoms of impending airway obstruction airway are (3). Also, the importance of a complete blood count and chest x-ray are secondary to securing the airway. The preoperative evaluation should be brief and the efforts of the anesthesia staff should be focused on rapidly securing a difficult airway. Inhalation induction, especially for a pediatric patient, is a suitable induction method.
airway obstruction such as drooling, dysphagia, and increasing stridor, it is imperative that
427
In the patient with epiglottitis, symptoms of impending airway obstruction airway are (3).
airway obstruction such as drooling, dysphagia, and increasing stridor, it is imperative that
428
2nd to airway securement in the child with epiglottitis
Also, the importance of a complete blood count and chest x-ray are secondary to securing the airway.
429
Induction method for epiglottitis
Inhalation induction, especially for a pediatric patient, is a suitable induction method.
430
The mediastinoscope can compress the
Innominate artery which gives rise to the right subclavian, right common carotid, and right vertebral arteries. (THINK I RIGHT SCc V)
431
During carotid endarterectomy, which of the following techniques for management of ventilation would be the most appropriate?
Maintain normocarbia to mild hypocapnea
432
During CEA both can potentially result in alterations in cerebral blood flow. . Hypocapnea can theoretically constrict cerebral blood vessels and potentially reduce blood flow causing a reverse steal effect. There is little clinical data to demonstrate that this occurs, however. In fact, a mild degree of hypocapnea has been shown to reduce the size of the region at risk for ischemia. The common practice is to maintain normocapnea to mild hypocapnea during a carotid endarterectomy.
Both hypercapnea and hypocapnea c
433
During CEA both can potentially result in alterations in cerebral blood flow. . There is little clinical data to demonstrate that this occurs, however.
Both hypercapnea and hypocapnea
434
The common practice is to maintain
normocapnea to mild hypocapnea during a carotid endarterectomy.
435
Hypocapnea can theoretically constrict
cerebral blood vessels and potentially reduce blood flow causing a reverse steal effect.
436
In fact, a mild degree of hypocapnea has been shown to
reduce the size of the region at risk for ischemia.
437
What might be the only indicator that a bladder perforation has occurred during a cystoscopy in a patient under general anesthesia?
Poor return of irrigating fluid
438
Strabismus surgery is also associated with a higher than normal incidence of
malignant hyperthermia
439
Fluid to avoid in a patient with pyloric stenosis
Because lactate is metabolized to bicarbonate, Lactated Ringer's should not be used.
440
Pyloric stenosis associated electrolyte imbalance
Hypochloremic metabolic alkalosis
441
When performing a brachial plexus block using the axillary approach, it is often necessary to perform separate blocks of the
medial brachial cutaneous and intercostobrachial nerves because the former exits the sheath just below the clavicle and the latter doesn't travel in the sheath at all. These two nerves provide sensation to the skin of the medial and posterior proximal arm.
442
The most common side effects of intraoperative blood salvage are
air embolism, abnormalities in coagulation, and DIC-like syndrome (also known as salvaged-blood syndrome).
443
Fentanyl undergoes extensive It has a
first-pass metabolism, so the oral route is typically insufficient for administration.
444
Fentanyl half life, Because it has a high lipid solubility and a slow rate of re-entry into the central compartment, it has a relatively
long half-life of 8 hours.
445
Peak effect of fentanyl
peak effect of 3-5 minutes and its effects are terminated principally by redistribution away from the central nervous system.
446
From erect to supine position
Decrease in peripheral vascular resistance
| Increase in cardiac output
447
When moving from the erect to supine position, there is a considerable increase in
central blood volume. The resulting stretch of baroreceptors in the central circulation results in a decrease in MAP, heart rate, and peripheral vascular resistance, whereas cardiac output and stroke volume increase.
448
Increased when move from erect to supine
CO and SV
449
Although hepatic and renal blood flow both decrease, this is well preserved
hepatic microsomal enzyme activity is generally well preserved in the elderly.
450
The effect of aging on the pulmonary system is a
decrease in elastic tissue and an increase in the amount of collagen resulting in a 15% reduction in the functional alveolar surface area.
451
The alveolar-arterial difference for oxygen increases from approximately
8 mm Hg at age 20 to approximately 20 mm Hg at age 70.
452
Which of the following effects of succinylcholine administration will not be prevented by the administration of a defasciculating dose of a nondepolarizing muscle relaxant?
Increase in INTRAOCULAR PRESSURE
453
The administration of succinylcholine can raise intraocular pressure up to.
15 mmHg
454
Although there is no documented cases where the administration of succinylcholine has led to blindness or the extrusion of ocular contents, the use of succinylcholine in what type of surgeries is avoided?
open-eye injuries is widely avoided.
455
Are both forms of COPD
Bronchitis and emphysema
456
Associated with decreased elastic recoil of the lungs
Emphysema
457
Bronchitis is associated with
copious sputum production
458
Associated with an elevated hematocrit
Emphysema is
459
Associated with an elevated hematocrit
Emphysema
460
Which region of the epidural space contains no fat?
cervical
461
When chronically exposed to an antagonist, the receptors upregulate, which means that both the
number of receptors and their sensitivity both increase.
462
Principal cells in the cortical collecting duct are primarily responsible for
secreting potassium
463
The principal cells in the cortical collecting duct are primarily responsible for
secreting potassium.
464
They also play a role in the aldosterone-mediated absorption of sodium.
principal cells
465
In the spontaneously breathing, anesthetized patient in the lateral decubitus position, FRC ? The nondependent lung shifts to a position of greater compliance. The dependent lung loses FRC and becomes less compliant. As a result, ventilation is preferentially distributed to the nondependent lung.
the functional residual capacity decreases almost immediately.
466
In the spontaneously breathing, anesthetized patient in the lateral decubitus position, FRC ?
the functional residual capacity decreases almost immediately.
467
In the spontaneously breathing, anesthetized patient in the lateral decubitus position, The dependent lung l
oses FRC and becomes less compliant. As a result, ventilation is preferentially distributed to the nondependent lung.
468
In the spontaneously breathing, anesthetized patient in the lateral decubitus position, The dependent lung l
Loses FRC and becomes less compliant
469
In the spontaneously breathing, anesthetized patient in the lateral decubitus position, ventilation is preferentially distributed to the
nondependent lung.
470
The phenomenon of channeling in a carbon dioxide absorber cannister can be minimized by
Shaking the CO2 cannister prior to use
471
You are testing your anesthesia machine in the morning before cases begin. You disconnect the pipeline supply and turn on the backup oxygen cylinder to make sure it functions correctly. The oxygen cylinder is full and connected correctly, but the anesthesia machine still does not pressurize. You know that the problem could be due to a
. fault in the oxygen pressure failure device
472
What lab finding is most associated with hypoaldosteronism?
Hyperkalemia
473
What is the only laryngeal muscle that does not receive its motor innervation from the recurrent laryngeal nerve?
The cricothyroid muscle, which is innervated by the external laryngeal nerve, is the only laryngeal muscle not innervated by the recurrent laryngeal nerve.
474
Volatile anesthetics are eliminated from the body primarily by the
alveoli
475
What are the components of the vessel-rich group? (select four)
Kidneys
Liver
Brain
Endocrine
476
Where in the nephron is the majority of sodium reabsorbed?
Proximal CT; Sodium is reabsorbed throughout the nephron, but the majority of it (about 65%) is reabsorbed in the proximal convoluted tubule.
477
How is a patient positioned for tonsillectomy?
Supine; The patient is positioned supine and the table is often rotated 45 to 90 degrees away from the anesthesia provider.
478
The clinical picture of hypercortisolism includes
central obesity, hypertension, glucose intolerance, weakness, bruising and osteoporosis.
479
Cushing's disease--> Mineralocorticoid effects include
fluid retention and hypokalemic alkalosis.
480
The most consistent clinical manifestation of aspiration pneumonitis is:
arterial hypoxemia --> Tachypnea, bronchospasm and pulmonary vasoconstriction with secondary pulmonary hypertension may also be present.
481
Aspiration pneumonitis is:
Inhaled gastric fluid is rapidly distributed throughout the lungs, leading to destruction of surfactant-producing cells, damage to the pulmonary capillary endothelium and resultant atelectasis and pulmonary edema.
482
Absolute contraindications to electroconvulsive therapy (ECT) include: (PRIRU
```
Pheochromocytoma
Recent MI < 4-6 weeks ago
Intracranial mass lesion
Recent CVA 3months ago or less
Unstable cervical spine
```
483
Replace 1 mL blood with: how much crystalloids, colloids, albumin and whole blood and PRBCs
3 mL crystalloid (i.e. NS, Dextrose, LR) 1 mL colloid (i.e. albumin**, Hespan®, Dextran®) 1 mL whole blood 1 mL PRBC
484
An accurate sampling the mixed venous blood must be done by drawing from the
PA port of the Swan-Ganz catheter.
485
Normal SvO2
60-80%
486
SVV what number predicts preload responsiveness
>13%
487
Normal SVR
800-1200
488
Normal SV
60-100ml/beat
489
Normal ScVO2
70%
490
Index of pulmonary edema
EVLWI
| Extravascular lung water index.
491
Extravascular lung water index normal
3-7 ml/kg
492
What does the extravascular lung water index do?
Measure of fluid filtration into the interstitial space of the lung.
493
Normal A-a gradient
Normal = age/4 + 4
494
if PaO2/FiO2 < 200, shunt fraction
> 20%.
495
Cannot be corrected by 100% oxygen.
Shunt: pneumonia, atelectasis, pulmonary embolism, etc
496
Normal values are Vd/Vt (physiologic dead space to TV)
0.20–0.40.
497
Right to Left (IV): (induction fast or slow)
rapid induction (easy to remember – blood bypasses lungs, straight to brain)
498
Right to Left (volatile): (induction fast or slow)
slower induction
499
Left to Right (IV):(induction fast or slow)
little effect on induction
500
Left to Right (volatile):(induction fast or slow)
little effect on induction
501
Slower induction with this shunt
RIGHT TO LEFT SHUNT
502
The effect of V/Q mismatching on uptake of volatile anesthetics is dependent on the
solubility of the anesthetic agent.
503
Uptake of Inhaled Anesthetics: V/Q mismatch
| INSOLUBLE agent
Insoluble agents (desflurane): markedly decreased rise in arterial partial pressure of anesthetic agent
504
Uptake of Inhaled Anesthetics: V/Q mismatch Soluble agents
Soluble agents (isoflurane): decreased rise in arterial partial pressure of anesthetic agent is partially attenuated by relatively higher alveolar partial pressure in ventilated areas
505
Acidosis on HPV
improves HPV
506
HPV takes effect over_____ although peak effect takes up to_____
30 minutes; two hours
507
HPV functions best when
30-70% of the lung is hypoxic
508
Because OLV produces hypoxia in the range of because
30-70% of the total lung volumes, and
509
HPV is thought to reduce blood flow to the operative lung by
50%
510
Importantly, during one lung ventilation, volatile anesthetics can only reach the operative lung through
the bloodstream (not through the alveoli),
511
Why is there more chance of hypoxemia during surgery to the right lung?
Right lung is larger than left so proportionally there is a greater amount of perfusion to the right. therefore hypoxemia is worst with right sided surgery.
512
Lateral positioning with mechanical ventilation
Imbalances V/Q mismatching by giving more ventilation to the NONDEPENDENT LUNG and GRAVITY gives more perfusion to the DEPENDENT LUNG>
513
In fact, PaO2 is found to be significantly worse in procedures withe patient lateral or supine?
SUPINE
514
DURING lateral position ONE LUNG VENTILATION ,what is beneficial
The direction of all ventilation to the DEPENDENT LUNG create a more beneficial match of ventilation and perfusion
515
What improves arterial oxygenation during OLV?
ALVEOLAR RECRUITMENT MANEUVERS
| PEEP at 8cm H2O
516
Stepwise response to worsening hypoxemia during OLV
ICE RRT
1. Increase FiO2
2. Confirm tube position with Fiberoptic
3. Ensure adequacy of CO
4. Remedy effects of anemia or vasodilators.
5. Recruitment maneuvers to DEPENDENT LUNG
6. TITRATE PEEP to DL
7. CPAP 5-10 cm to NDL
517
Ventilation with OLV :
| TV, RATE(what is acceptable) FIO2, PEEP , I:E ratio
```
TV : 6-8 ml/kg
rate : 12-15 (permissive HYPERCAPNIA ok)
FiO2 : 0.4-0.8
PEEP: 5-10cm (2.5 - 5cm if COPD)
I:E ratio: 1:2 (1:3 if COPD )
```
518
2 medications that can increase perfusion to the dependent lung
```
N2O
Inhaled EPOPROSTERONOL (PROSTACYCLIN)
```
519
Propofol and HPV
(100-200 ucg/kg/min) does not affect HPV
520
VA and HPV
All volatile anesthetics inhibit HPV in a dose-dependent fashion
521
LIVER TRANSPLANT--> The postreperfusion syndrome is a syndrome of severe
hemodynamic compromise, arrhythmia, or asystole that occurs immediately after reperfusion.
522
LIVER TRANSPLANT--> The postreperfusion syndrome DEFINITION
A decrease in systemic mean BP > 30% below baseline for at least 1 minute during the first 5 minutes of liver reperfusion.
523
Management of postreperfusion syndrome includes close communication with the surgical team regarding the
timing of reperfusion, pretreatment of the patient with the antihistamines (ranitidine and diphenhydramine) in the 15 minutes prior to reperfusion, and close hemodynamic monitoring at the time of graft outflow unclamping. Hypotension is treated with volume resuscitation and vasopressor agents, including infusion of phenylephrine, norepinephrine, vasopressin, and epinephrine.
524
Management of postreperfusion syndrome: in cases of hypotension refractory to vasopressors
Methylene blue may be considered
525
Indications for One-Lung Ventilation
| Absolute (VCUP_
Protective Isolation (Massive Hemorrhage /Infection
Control of Ventilation Distribution
Bronchopleural or bronchopleural cutaneous fistula
Giant cyst or bullae (risk of rupture with PPV)
Major bronchial disruption or trauma
Unilateral Lung Lavage
VATS
526
Relative (Strong) – Surgical Exposure
| INDICATIONS FOR OLV
Thoracic aortic aneurysm
Pneumonectomy
Upper lobectomy
527
Key FOB landmarks in DLT placement include
[tracheal lumen initially]1) lack of herniated bronchial cuff 2) visualization of three orifices in the RUL (only lobe to have three orifices), [bronchial lumen] 3) LUL and RUL orifices
528
The MOST effective method by which PaO2 can be increased during OLV is
application of CPAP to the operative lung
529
PEEP in the Dependent Lung why?
advantages of increasing FRC in the dependent lung, thus improving the V/Q ratio and preventing atelectasis, and does not require cessation of surgery
530
BARASH said keep PACO2 at
PaCO2 of 35 mm Hg, as significant hypocapnia may inhibit the hypoxic pulmonary vasoconstriction response
531
Lower FiO2 should be considered in any patient on this medication
bleomycin.
532
Predict who will desaturate during one lung ventilation intraoperative factors include
1) supine positioning 2) R-sided thoracotomy [
533
Approach to One-Lung Ventilation: primary goal?
| GOAL SPO2
hypoxemia is the primary goal, and while there are no evidence-based recommendations regarding the lower limit of acceptable SpO2,
534
Critical to avoiding hypoxemia is an understanding of the basic goal of physiologic management in OLV –
maximizing PVR in the operative lung, and minimizing PVR in the dependent lung.
535
During OLV, FRC occurs at slightly________ volumes due to paralysis, lateral positioning, the open operative hemithorax, and the weight of mediastinal structures
lower-than-normal
536
Bicarbonate therapy for the purpose of improving hemodynamics or reducing vasopressor requirements is not recommended for treatment of hypoperfusion-induced lactic acidemia with
pH > 7.15
537
Steroids antiinflammatory from MOST POTENT TO LEAST
| CCFH PPM TBD
Cortisol
Cortisone
Fludrocortisone
hydrocortisone
Prednisone
Prednisolone
Methylprednisolone
Triamcinolone
Betamethasone
Dexamethasone.
538
Subdural hematoma is sickle shaped like a
banana.
539
Subdural hematoma is sickle shaped like a
banana (CRESCENT SHAPE)
540
Epidural hematoma shaped like a
lemon (BICONVEX SHAPE)
541
Bezold-Jarisch reflex results in unmyelinated vagal afferent stimulation in response to noxious ventricular stimuli (chemical or mechanical), leading to the triad of
hypotension, bradycardia, and coronary vasodilation
542
Shoulder joing innervation
Axillary (C5-C6, all trunks)
| Suprascapular (C4-C6, upper trunk or C5 root) Subscapular nerves (C5-C6, middle cord),
543
Distributions Missed by the Interscalene Technique
Cephalad cutaneous shoulder (above the clavicle): innervated by the supraclavicular nerves (from the lower cervical plexus, i.e. C3-C4). In order to assure complete analgesia for arthroscopic shoulder surgery, the supraclavicular nerves must be blocked
Inferior trunk: often inadequately blocked
Supplementation
Posterior arthroscopic port: local infiltration Intercostobrachial NERVE BLOCK: Supraclavicular nerves:
544
Intercostobracheal nerve (T2, cutaneous branch of an intercostal nerve, innervates the
upper medial arm, and potentially part of the shoulder. Must be supplemented if a brachial plexus block is used
545
ISB Important landmarks include the
anterior and middle scalene muscles and the subclavian artery.
546
Cutaneous Innervation of the Brachial plexus
Superior lateral cutaneous nerve (continuation of the posterior cord of the axillary nerve, which derives from all three trunks). Innervates lateral shoulder and skin over the deltoid
Medial brachial cutaneous nerve (C8-T1, arises from the medial cord of the brachial plexus): upper medial arm
Intercostobracheal nerve (T2, cutaneous branch of an intercostal nerve, innervates the upper medial arm, and potentially part of the shoulder. Must be supplemented if a brachial plexus block is used
547
The rate limiting enzyme in catecholamine synthesis is
Tyrosine Hydroxylase.
548
Tyrosine Hydroxylase is responsible for the conversion of
tyrosine to L-DOPA, which is readily converted into dopamine.
549
Converts dopamine ot NE
Dopamine Betal Hydroxylase
550
Converts dopamine to NE
Dopamine Betal Hydroxylase
551
Membrane Phospholipids : 1st step in arachidonic acid pathway
Phospholipids reacts with PHOSPHOLIPASE A2 to lead to ARACHIDONIC ACID
552
Membrane Phospholipids : ARACHIDONIC ACID -- 2 pathways
CYCLOOXYGENASE PATHWAY
| 5- LIPOOXYGENASE PATHWAY
553
With the arachidonic acid,5-lipooxygenase pathway leads to
LEUKOTRIENES PRODUCTION
554
CYCLOOXYGNEASE PATHWAY leads to
```
Cycloendoperoxides
Platelets (Thromboxane A2)
Endothelium (prostacyclin) vasodilation
smooth muscle (Prostaglandin, PGE2, PGF)
```
555
PGE2 is
Vasodilation
556
TXA2 causes
Vasoconstriction
557
PGF2alpha causes
Vasoconstriction
558
Let go current
10-20 mA
559
Complete physiologic damage current
6000 mA
560
Vfib current
100-300 mA
561
Ohms Law
E= IR
| E volts I current(ampere) R resistance
562
What does Ohm's law measure
Resistance to electrical flow
563
Pancreatic somatostatin producing cells in the Islets of Langerhans are:
delta cells
564
Pancreatic alpha cells producing, delta cells producing somatostatin and
glucagon
565
Pancreatic beta cells producing
insulin
566
PP cells producing
pancreatic polypeptide.
567
Late depression of ventilation seen with opioids is due to
ROSTRAL SPREAD in CSF
568
Neuraxial lipophillic causes ____(early vs late) respiratory depression due to
Early , Systemic uptake
569
Supraspinal analgesia is mediated by
Mu-1 (DOMINANT one)
| Kappa and delta.
570
With supraspinal analgesia, the patient's response to pain is
Altered, (I feel the pain, I don't care)
571
When does spinal analgesia occurs?
Transmission of pain impulses through the substantia gelatinosa (rexed lamina II) is suppressed.
572
Supraspinal dominantly mediated by ______ while spinal dominantly mediated by
Mu-1; Mu-2
573
Mechanisms of renal compensation during acidosis include:
increased production of ammonia
574
The renal response to acidemia is:
increased reabsorption of bicarbonate anion
increased excretion of hydrogen ion in the form of titratable acids
increased production of ammonia
575
Compensatory mechanism in acidemia is ______, it is accomplished by
Increased carbon dioxide elimination Increased alveolar ventilation
576
RSBI is frequently used to help
predict who can be successfully weaned from mechanical ventilation.
577
How is the Rapid Shallow Breathing Index (RSBI) performed?
With the patient breathing spontaneously, the ventilatory rate is divided by the tidal volume (liters).
578
RSBI that predicts successful extubation?
Successful extubation can be predicted by an RSBI of less than 100. (some sources say MORE than 105 likely to fail)
579
RSBI Formula
RSBI (breaths/min/L) = f/VT, where f is respiratory rate and VT is tidal volume in L.
