RANDOM/ PRODIGY TRIVIA/VALLEY BOOK

Question 1

Parasympathetic does not include fibers of

Answer 1

CN8

Question 2

What is the opioids with the highest protein binding?

Answer 2

Sufentanil

Question 3

NDNMB are what kind of compounds?

Answer 3

Quaternary compounds

Question 4

What type of diuretics can cause hyperKalemia?

Answer 4

Spironolactone (Potassium sparing diuretics)

Question 5

What amount of hepatic blood flow comes from the portal vein?

Answer 5

70%

Question 6

70% of hepatic blood flow comes from the

Answer 6

PORTAL VEIN

Question 7

What % of calcium is in the ionized form?

Answer 7

50%

Question 8

Serotonin act as a _________in all tissues, except

Answer 8

Vasodilator ; HEART and skeletal muscles

Question 9

All of the following should be avoided in carcinoid syndrome

Answer 9

Morphine
Atracurium
fentanyl

Question 10

Apneic oxygenation during bronchoscopy can lead to

Answer 10

HYPERCARBIA

Question 11

Fenoldopam on BP

Answer 11

Decreases arterial BP

Question 12

ARDS is defined as

Answer 12

Acute respiratory failure due to pulmonary injury.

Question 13

Most suitable for inductin controlled hypotension agent

Answer 13

sodium nitroprusside

Question 14

CHF is usually caused by

Answer 14

Systolic dysfunction

Question 15

High cardiac output heart failure is associated with

Answer 15

Sepsis

Question 16

How does midazolam depresses ventilation?

Answer 16

By decreasing the Hypoxic drive.

Question 17

Butyrephenones drugs classes are

Answer 17

droperinol and haloperidol

Question 18

Pt taking MAOIs should avoid

Answer 18

Avocado

Question 19

The most common manifestation of folic acid deficiency of

Answer 19

Megaloblastic anemia

Question 20

Carbamezepine helps prevent seizures by primarily

Answer 20

blocking Na+ Channels.

Question 21

Folic acid antagonists

Answer 21

methotrexate

Question 22

Acetazolamide is used in treatment of

Answer 22

Altitude sickness

Glaucoma.

Question 23

Clonidine 0.3mg will not decrease plasma catecholamine in patient w/

Answer 23

Pheochromocytoma.

Question 24

Dopexamine is similar to Dopamine except that it is devoid

Answer 24

alpha-1

Question 25

Other name for German measles

Answer 25

Rubella

Question 26

Prions are responsible for what type of encephalopathy?

Answer 26

SPONGIFORM

Question 27

Pacemaker of the respiratory system

Answer 27

Dorsal Respiratory Group

Question 28

Bronchospam with what level of Ca2+

Answer 28

Hypocalcemia

Question 29

Most common blood transfusion is transmitted via

Answer 29

Hep C

Question 30

Desflurane differs from isoflurane is chemical structure by how many atoms

Answer 30

1

Question 31

Condition also known as acute idiopathic polyneuritis

Answer 31

GBS

Question 32

Drug that increases Lower esophagus sphincter tone and lower aspiration risk ? reversal

Answer 32

Edrophonium

Question 33

ABG associated with asthma is

Answer 33

Respiratory alkalosis

Question 34

Platelets half life is

Answer 34

1-2 weeks

Question 35

In the presence of Ca2+ activated factor XI, will activate factor

Answer 35

IX

Question 36

What is the most significant risk factor for an acute ischemia stroke?

Answer 36

HTN

Question 37

The most common complication associated with this procedure is stroke caused by

Answer 37

thromboembolism

Question 38

Cheyne-Stokes respiration

Answer 38

Bilateral dysfunction of cerebral hemispheres | Midbrain and upper pons

Question 39

Central neurogenic hyperventilation

Answer 39

Low midbrain and upper pons | Increased intracranial pressure with head trauma

Question 40

Deep, rapid, and regular pattern of breathing

Answer 40

Central neurogenic hyperventilation

Question 41

Describe Cheyne-Stokes respiration

Answer 41

Regular increase in the rate and depth of breathing that peaks and is followed by a decreasing rate and depth of breathing, which progresses to apnea; then the cycle repeats itself

Question 42

Apneusis breathing

Answer 42

A pause at full inspiration occurs; may see prolonged | inspiratory pause alternating with prolonged expiratory pause

Question 43

Ataxic breathing Location of Injury and Other Causes

Answer 43

Medulla

Question 44

Irregular breathing with shallow, deep respirations | and irregular apneic episodes; usually slow

Answer 44

Ataxic breathing

Question 45

Acute ischemic stroke BP range for thrombolysis / no thrombolysis

Answer 45

Keep < 180/110 mm Hg if thrombolysis | Treat only BP > 220/120 if no thrombolysis

Question 46

Intracerebral hemorrhage BP range

Answer 46

Keep SBP < 180 and MAP < 130 mm Hg | ideal SBP < 160 and MAP < 110 mm Hg

Question 47

Subarachnoid hemorrhage BR range.

Answer 47

Keep SBP < 160 mm Hg before aneurysm treated Do not lower BP after aneurysm treated Traumatic brain injury Keep MAP to maintain CPP > 60 mm Hg

Question 48

In cell-mediated immunity, the antigen is presented to the

Answer 48

T lymphocyte by infected cells or by antigen-presenting cells such as dendritic cells, macrophages, or B lymphocytes.

Question 49

Virchow's triad includes

Answer 49

hypercoagulability, venous stasis, and vessel wall abnormalities.

Question 50

Virchow's triad is a set of three factors that predict a

Answer 50

high risk for pulmonary embolism.

Question 51

Pericardial sac approximately

Answer 51

10 to 25 mL of serous fluid,

Question 52

Venous drainage ==> What are the 3 major systems?

Answer 52

coronary sinus the anterior cardiac veins Thebesian veins

Question 53

Three major internodal tracts exist:.

Answer 53

the anterior, middle, and posterior | internodal tracts

Question 54

The anterior internodal tract, or Bachmann bundle,

Answer 54

extends into the LA and then travels downward through the atrial septum to the AV node.

Question 55

The middle internodal tract, or Wenckebach tract, curves behind the

Answer 55

superior vena cava before descending to | the AV node.

Question 56

The posterior internodal tract, or Thorel’s pathway, | continues along the terminal crest to enter the

Answer 56

atrial septum and then passes to the AV node.

Question 57

From anterior to posterior tract

Answer 57

BWT

Question 58

Proposed mechanism whereby the inhaled anesthetic agents cause depression of myocardial contractilityInhibition of calcium

Answer 58

Influx into cardiac muscle cells is the proposed mechanism whereby the inhaled anesthetic agents cause depression of myocardial contractility

Question 59

Pericardial tamponade affect what?

Answer 59

Restricts filling of the cardiac chambers during diastole and produces a fixed low cardiac output

Question 60

Pericardial tamponade IV anesthetic of choice

Answer 60

Ketamine

Question 61

Connective disease associated with corneal disturbances

Answer 61

Scleroderma

Question 62

Trisomy 13 aka

Answer 62

Patau's disease

Question 63

Ludgwig's angina is characterized by

Answer 63

Rapidly expanding cellulitis of the mouth, infection of trismus.

Question 64

Relative contraindication in hypertrophic cardiomyopathy

Answer 64

VASODILATORS

Question 65

WPW may present as

Answer 65

Paroxysmal SVT

Question 66

Cocaine effects on HR mainly through

Answer 66

Blockade of Na+ Channels

Question 67

Bleomycin leads to what kind of toxicity

Answer 67

Pulmonary

Question 68

Paget's disease is a disorder that affects

Answer 68

Bone

Question 69

Largest parenchymal organ is

Answer 69

LIVER

Question 70

AKI most frequently

Answer 70

ATN

Question 71

Herbal associated with prolonged sedation

Answer 71

Kava Kava

Question 72

Decrease pain transmission signal

Answer 72

Enkephalin

Question 73

Cisatracurium class

Answer 73

Benzoisoquinolinium

Question 74

Beta Blocker with the highest degree of protein binding

Answer 74

PROPRANOLOL

Question 75

% of CO goes to the Kidney

Answer 75

25% of CO every minute

Question 76

3 types of FLOW

Answer 76

Laminar Turbulent Transitional

Question 77

Bernoulli's principle relates the effect of flow a tube that contains

Answer 77

Constriction

Question 78

Theoretical temp of absolute zero

Answer 78

0 degree Kelvin

Question 79

Vapor pressure of liquid solely dependent on

Answer 79

Temperature

Question 80

Reynold > 2000

Answer 80

Turbulent flow

Question 81

Reynolds < 2000

Answer 81

Laminar

Question 82

Nebulizers rely on this effect to deliver medication

Answer 82

Venturi effect

Question 83

Whose equation corrects the universal gas law

Answer 83

Van der waal

Question 84

Cell splits into 2 new cells

Answer 84

Mitosis

Question 85

How many pair of chromosomes

Answer 85

23

Question 86

Chemical substance that can cause cellular mutation

Answer 86

Carcinogens

Question 87

Dark areas crossing cardiac muscle fibers

Answer 87

Intercalated discs

Question 88

Calcium release channels are known as

Answer 88

Ryanodine receptors

Question 89

Nitroprusside generates

Answer 89

Nitric oxide--> cGMP

Question 90

Antiarrythmic drugs inhibiting K+ ions

Answer 90

Amiodarone/sotalol

Question 91

Digitalis toxicity treated with

Answer 91

Phenytoin

Question 92

Synthetic NONcatecholamine medication

Answer 92

Ephedrine

Question 93

ALpha adrenergic antagonist used for BPH/HTN

Answer 93

Prazosin

Question 94

Carbonic anhydrase inhibitor example? What is it used for

Answer 94

Acetazolamide, glaucoma

Question 95

Upon what receptors does nalbuphine act? (select two)

Answer 95

Mu and Kappa

Question 96

After intravenous administration of fentanyl, there is an initial rapid increase in plasma concentration of the drug followed by a rapid decline in plasma administration. This initial, rapid decline is due primarily to

Answer 96

redistribution to highly-perfused organs

Question 97

Which calcium channel blockers inhibit CYP450? (select two):

Answer 97

Diltiazem &Verapamil

Question 98

Propofol metabolized by

Answer 98

Partially 3A4 BUT CYP 2B6 main one

Question 99

Which class of CCBs is verapamil?

Answer 99

Phenylakalanine

Question 100

Onset of heparin SQ

Answer 100

1-2h

Question 101

Describe relationship of between LVEDV/SV

Answer 101

Frank Starling.

Question 102

Coronary Perfusion Pressure formula

Answer 102

Diastolic BP - LVEDP

Question 103

Most common congenital cardiac abnormality in infants and children

Answer 103

VSD

Question 104

Most common CYANOTIC congenital heart abnormality

Answer 104

Tetralogy of Fallow

Question 105

Ebstein anomaly involves what valve

Answer 105

Tricuspid

Question 106

Normal venous O2 sat

Answer 106

75%

Question 107

Equation can be used to estimated physiologic-dead space ventilation

Answer 107

Bohr

Question 108

Vital capacity in elderly

Answer 108

Increased

Question 109

2 lungs parameters increase with pneumoperitoneum

Answer 109

PIP, Intrathoracic pressure.

Question 110

First line of defense against unfavorable changes in pH

Answer 110

Buffers

Question 111

Physiologic dead space =

Answer 111

Anatomic + functional dead space

Question 112

The administration of epidural steroids can produce an antiinflammatory effect primarily by the inhibition of

Answer 112

Cytokines & Phospholipase A2

Question 113

sacroiliac joint with radiation to the groin, medial buttocks, and posterior thigh with occasional radiation below the level of the knee is consistent with what syndrome?

Answer 113

Pyriformis syndrome

Question 114

How long after a single epidural injection of methylprednisolone 80 mg would you expect the patient's ability to secrete cortisol to be impaired?

Answer 114

3 weeks

Question 115

Remifentanil have lower _____and _____clearance when compared to fentanyl

Answer 115

Vd; clearance

Question 116

What is the most important buffering system in the body

Answer 116

HCO3 (bicarboate system)

Question 117

What is the enzyme necessary for Prostaglandins synthesis?

Answer 117

Cyclooxygenase

Question 118

NSAIS on cyclooxygenase

Answer 118

inhibits

Question 119

Avoid this drugs with porphyria

Answer 119

DILANTIN

Question 120

Alveolar gas equation is used to estimated

Answer 120

PaO2

Question 121

Cyclosporine is most likely to cause toxicity to the

Answer 121

kidneys

Question 122

Drugs with little to no effect on systemic circulation

Answer 122

N2O

Question 123

H2 receptor antagonists will cause an

Answer 123

Increase in gastric fluid pH

Question 124

Drugs must likely beneficial to patient with WPW

Answer 124

Droperinol (dopamine antagonist)

Question 125

Most common cause of Mitral stenosis

Answer 125

Rheumatic fever

Question 126

Not an ACYNOTIC but a CYANOTIC heart defect

Answer 126

TOF

Question 127

What medication antagonize the action of ADENOSINE

Answer 127

THEOPHYLLINE

Question 128

WPW avoid this drug

Answer 128

VERAPAMIL or cardizem

Question 129

Commotio cordis is

Answer 129

Blunt chest wall impact

Question 130

Commotio cordis affects what organ

Answer 130

Heart

Question 131

20% of athletic injury

Answer 131

commotio cordis

Question 132

Stimulus for the release of arginine vasopressin arises from

Answer 132

osmoreceptors in the hypothalamus that sense an increase in plasma osmolality.

Question 133

Not an indirect lung injury

Answer 133

Near drowning

Question 134

Ependymoma can most commonly be found in the floor of what ventrile

Answer 134

Fourth

Question 135

Normal pressure hydrocephalus TRIAD (DUG)

Answer 135

DEMENTIA Urinary incontinence. Gait changes

Question 136

Obstructive hydrocephalus is when

Answer 136

CSF outflow is blocked at the LEVEL OF THE AQUEDUCT OF SILVIUS in the 4th ventricle

Question 137

Tuberous sclerosis aka

Answer 137

Bournovilles disease

Question 138

Erwing's sarcoma is a malignancy that affects

Answer 138

bone

Question 139

2 most common symptoms of SLE

Answer 139

Polyarthritis AND Dermatitis | MALAR RASH 1/3 patients

Question 140

Gitelman's disease is an inherited

Answer 140

Renal salt wasting disorder

Question 141

What is the most common neoplasm in infants

Answer 141

NEUROBLASTOMA

Question 142

Laryngeal Papillomatosis is caused by

Answer 142

HPV types 6 and 11

Question 143

Crouson's syndrome is a

Answer 143

Cranial dysostosis

Question 144

Atrial systole increase CO by

Answer 144

20-30%

Question 145

Left coronary artery division

Answer 145

LAD and Circumflex

Question 146

What creates Lead II (NRAPLL) | What creates Lead III (NLAPLL)

Answer 146

Negative Right Arm Positive Left Leg | Negative lead on L arm and positive lead on L leg.

Question 147

Junction between S wave and ST segment

Answer 147

J-point

Question 148

Where is lead V2 placed

Answer 148

Left sternal border @ 4th intercostal space

Question 149

Unipolar limb leads

Answer 149

avF

Question 150

BLood type with neither A or B Agglutinogen

Answer 150

Type O

Question 151

Where in AV node located

Answer 151

Right Atrium

Question 152

What is Stokes-Adams syndrome?

Answer 152

Fainting spells associated with periodic cessation of A-V conduction

Question 153

Angiotensin II on sodium

Answer 153

Sodium retention

Question 154

Filtration fraction =

Answer 154

GFR/ RBF

Question 155

Visual signals terminate in what lobe of the brain?

Answer 155

OCCIPITAL

Question 156

Syndrome when only ONE site of the SPINAL CORD is TRANSECTED (incomplete)

Answer 156

Brown Sequard syndrome

Question 157

Concentration of dissolved gas/solubility coefficient equals

Answer 157

Partial pressure.

Question 158

Mapleson circuits requires the lowest low FGF

Answer 158

Mapleson D

Question 159

Most commonly used laser for laryngeal surgery

Answer 159

CO2

Question 160

Blepharospasm (involunteray movement of eyelid) is a

Answer 160

tonic spasm of orbicularis oculi

Question 161

Sympathetic innervation and insulin

Answer 161

causes a decrease in insulin secretion via ALPHA-2

Question 162

Which agent causes no change in the LATENCY or amplitude of SEEP waveform

Answer 162

Dexdemetomidine

Question 163

Larynx levels

Answer 163

C3-C6

Question 164

How many segments in the RLL

Answer 164

5

Question 165

Difficulty swallowing would reveal dysfunction of what CN

Answer 165

IX

Question 166

Diencephalon 2 parts

Answer 166

Thalamus | Hypothalamus

Question 167

SA Node aka

Answer 167

Keith Flack node

Question 168

Batman whacked THOR (AMP)

Answer 168

Batman - Bachmann bundle--> anterior tract Whacked - Wenckebach tract --> middle tract Thor - Thorel --> posterior tract

Question 169

Digitalis (digoxin) is a

Answer 169

Cardiac glycosides

Question 170

Inotropic effect of digitalis is achieved by

Answer 170

Binding to the alpha subunit of the sodium potassium ATPase in cardiac cells.

Question 171

S/s of digitalis toxicity

Answer 171

Diarreha, n/v, headache, fatigue, colored vision

Question 172

What is contraindicated in patient taking digitalis

Answer 172

Calcium (may lead to cardiac arrest)

Question 173

Larynx begins at the ______and extends to the _____-

Answer 173

Epiglottis; Cricoid cartilage

Question 174

Most common electrolyte abnormality in hospitalized patients?

Answer 174

Hyponatremia

Question 175

Changes in banked blood : Factors missing

Answer 175

LaCk Factor V and VIII

Question 176

Resting cardiac cell membrane is relatively permeable to what electrolytes

Answer 176

POTASSIUM

Question 177

SLE : medications that can be exacerbate SLE are PHID-ME

Answer 177

``` Procainamide Hydralazine Isoniazid D-Penicilllamine Methyldopa ```

Question 178

Heart issues with SLE

Answer 178

Diffuse SEROSITIS leads to PERICARDIAL effusion

Question 179

Drugs to treat SLE

Answer 179

Antimalarials Corticosteroids Immunosuppresants (reduce corticosteroids requirements)

Question 180

Condition able to precipitate SLE (PIS)

Answer 180

Pregnancy Infection Surgical stresses

Question 181

SLE : on pulmonary : restrictive vs obstructive

Answer 181

Restrictive

Question 182

SLE prone to

Answer 182

pleural effusion, pneumonitis, alveolar damage, pulmonary HTN.

Question 183

Cyclophosphamide consideration

Answer 183

inhibits plasma cholinesterase so may prolong ESTER LA and SUCCINYLCHOLINE

Question 184

Equation of H2O + CO2 -->

Answer 184

H2CO3 -->

Question 185

Sensory nerve supply to nasal mucosa comes from

Answer 185

Trigeminal nerve

Question 186

Stimulation of the atrial stretch receptors will produce

Answer 186

Diuresis

Question 187

Hemodynamic management of Cardiac tamponade

Answer 187

Increased PRELOAD

Question 188

The ratio of effective beta: alpha-blockade is approximately (BA)

Answer 188

7:1.

Question 189

Clonidine alpha 2 to alpha 1 ratio

Answer 189

200 : 1

Question 190

Dexmedetomidine alpha 2 to alpha 1 ratio

Answer 190

1600:1. (about 7 times more than clonidine)

Question 191

Should clonidine be continued during the perioperative period?

Answer 191

yes, because ABRUPT discontinuation can lead to HTN and tachycardia

Question 192

What is the hallmark of ASPIRATION PNEUMONITIS?

Answer 192

Arterial Hypoxemia

Question 193

Beta-2 receptor stimulation on fat cells

Answer 193

lipolysis

Question 194

CN supplies PNS innervation to the parotid Gland

Answer 194

CN IX

Question 195

Metabolite of Norepinephrine

Answer 195

Vanillylmandelic acid

Question 196

Gas with the highest VP

Answer 196

Desflurane

Question 197

Primary action on clonidine to reduce BP

Answer 197

Primarily on CENTRAL (not peripheral) ALPHA-2 receptors.

Question 198

Primary indication for dexdemetomidine is

Answer 198

Short sedation in critically ill patients

Question 199

2 main side effects of dexdemetodimidine

Answer 199

Hypotension , bradycardia

Question 200

Intended drug effects of dexmedetomidine | SAAS

Answer 200

Sedation Anxiolysis Analgesia Sympatholysis

Question 201

Clonidine causes analgesia via

Answer 201

SUPRASPINAL and SPINAL adrenergic receptors and DIRECT INHIBITORY effects on PERIPHERAL nerve conduction (A and C nerve fibers)

Question 202

Gas with low molecular weight

Answer 202

N2O

Question 203

Is Nitrous flammable

Answer 203

NO

Question 204

Another name for scopolamine

Answer 204

Hyoscine

Question 205

Highest pKA among opiods

Answer 205

MEPERIDINE

Question 206

What is the only corticosteroid amount other administered orally

Answer 206

Prednisone

Question 207

What are the 3 methyxanthines

Answer 207

Caffeine Theophylline Theobromide

Question 208

Tricuspid stenosis on CVP waveform

Answer 208

Large A wave

Question 209

Nitrogen mustards drugs

Answer 209

Mechloretamine, CYCLOPHOSPHAMIDE

Question 210

Pts on MAOIs should avoid

Answer 210

LIVER, AGED CHEESE, FAVA beans.

Question 211

Blockade of what receptor causes neuroleptic malignant syndrome

Answer 211

DOPAMINE

Question 212

Amrinone produces dose dependent

Answer 212

decrease in LVEDP

Question 213

Edinger-westphat nucleus is located in CN

Answer 213

III

Question 214

Sympathetic NS neurons arise from

Answer 214

T1 to L2

Question 215

Substituting a butyl group for an amine group of procaine's benzene ring creates

Answer 215

TETRACAINE

Question 216

Procaine to tetracaine

Answer 216

Substitute a butyl group for an amine group

Question 217

Is Glutamate a biogenic amine?

Answer 217

NO

Question 218

What is the drug with the lowest hepatic Extraction ratio?

Answer 218

DIAZEPAM

Question 219

Could cause serotonin syndrome in patients taking MAOIs,

Answer 219

Meperidine

Question 220

What structures are found in transitional airways?

Answer 220

Alveolar ducts

Question 221

What is the VP of Sevoflurane at ___C

Answer 221

157 mmHg, 20 degrees C

Question 222

Fentanyl potency relative to morphine

Answer 222

100x

Question 223

Fournier gangrene affects what parts

Answer 223

Genitalia

Question 224

Which factor would increase the reabsorption of NA by the renal tubule

Answer 224

Angiotensin II.

Question 225

Where are the CENTRAL CHEMORECEPTORS LOCAED

Answer 225

MEDULLA

Question 226

Diuretics exerts its effects on the Proximal tubule

Answer 226

MANNITOL

Question 227

CREST syndrome presence is used in the diagnosis of what

Answer 227

Scleroderma

Question 228

CREST Mnemonic stands for

Answer 228

Carcinosis Raynaud's phenomenon: spasm of blood vessels in response to stress Esophageal dysfunction- Acid reflux, decrease motility in esophagus Sclerodactyly- Thickening or tightening Telangiectasias _dilation of capillaries causing red marks.

Question 229

A patient is experiencing pruritus from the administration of an opioid for surgical pain. What is the most appropriate treatment for the itching?

Answer 229

Nalbuphine

Question 230

Which opioid receptor produces diuresis when stimulated?

Answer 230

Kappa

Question 231

2 opioids that cause the release of histamine from mast cells when administered in high doses

Answer 231

MORPHINE | CODEINE

Question 232

Which agent has the ability to reverse opioid induced respiratory depression, yet maintain analgesia?

Answer 232

Nalaxone (Narcan)

Question 233

Which agent is a pure opioid antagonist that reverses opioid induced respiratory depression and analgesia?

Answer 233

Nalbuphine

Question 234

Which of the following statements is true concerning the effect of opioids on the CO2 response curve?

Answer 234

They shift the curve to the right, which represents a decrease in responsiveness to CO2

Question 235

Which agent is administered to patients undergoing treatment for substance abuse to prevent the euphoric effect of opioids?

Answer 235

Naltrexone

Question 236

Repeat stimulation caused by nerve damage or chronic inflammation can cause a condition known as :

Answer 236

Windup

Question 237

The muscle relaxant cyclobenzaprine is structurally most similar to :

Answer 237

amitriptyline

Question 238

What is the most common serious complication associated with opioid intrathecal and epidural administration?

Answer 238

RESPIRATORY DEPRESSION

Question 239

Select two excitatory neurotransmitters

Answer 239

Glutamate & substance P

Question 240

Anesthetic malpractice claims have decreased over the past two decades in which area of practice?

Answer 240

Obstetric anesthesia.

Question 241

When is the optimal time to perform an epidural block for the treatment of post-herpetic neuralgia?

Answer 241

Within 2 weeks of the appearance of the rash

Question 242

Which of the following substances is the principal neurotransmitter in the activation of dorsal horn neurons following painful stimuli?

Answer 242

Glutamate

Question 243

The dorsal horn of the spinal cord includes

Answer 243

laminae I to VI

Question 244

The chief danger in performing a cervical transforaminal steroid injection is

Answer 244

vascular injury

Question 245

Isotonic fluids 2

Answer 245

Plasmalyte | 0.9% NS

Question 246

VA that potentiate NMB the most

Answer 246

Desflurane

Question 247

Cushing's syndrome

Answer 247

Trunchal obesity Osteopenia HTN

Question 248

Acidosis is associated with (calcium)

Answer 248

Increased ionized calcium

Question 249

What substance is physiologically inhibit platelet activation?

Answer 249

Nitric oxide

Question 250

Perisinusoid space of DISSE can be found where

Answer 250

liver

Question 251

Hepatocyte produce bile and secrete it into

Answer 251

biliary calculi via CANALS OF HERING

Question 252

Metabolite of procaine associated with anaphylaxis reactions?

Answer 252

PABA

Question 253

Conn's aka

Answer 253

HYPERALDOSTERONISM

Question 254

Sevoflurane is

Answer 254

FLUORINATED METHYL ISOPROPYL

Question 255

Not a chiral compound

Answer 255

Propofol

Question 256

what is the metabolite of Diazepam

Answer 256

Oxazepam.

Question 257

Meperidine a.k.a

Answer 257

Pethidine

Question 258

Toxicity of which drug is associated with PULSUS ALTERNANS

Answer 258

DIGOXIN

Question 259

Triangle of Koch is located in what organ

Answer 259

HEART

Question 260

What Corticosteroid with the longest duration?

Answer 260

Bethamethasone

Question 261

Other name for this synthetic opioid is Diacetylmorphine

Answer 261

Heroin

Question 262

Nerve fibers with the fastest conduction velocities

Answer 262

MOTOR NEURON

Question 263

Minor Calyx part of the

Answer 263

Kidneys

Question 264

Thin CT of the liver

Answer 264

Glisson's capsule

Question 265

Kuffer cells are

Answer 265

Specialized macrophages.

Question 266

Majority of blood flow to liver provided by

Answer 266

Portal vein

Question 267

Sensory deficit to the lateral thigh w.o motor deficit indicates what kind of injury -->

Answer 267

Lateral femoral cutaneous

Question 268

Brainstem composed of

Answer 268

MMP | Medulla, Midbrain, pons.

Question 269

Term use to related SV + elasticity of arteries to the arterial pressure waveform

Answer 269

Windkessel effect

Question 270

Therapeutic index

Answer 270

LD50/ED50

Question 271

Example of phase II enzyme

Answer 271

N-acetyltransferase

Question 272

2 major calcium channels

Answer 272

L-type and T-type

Question 273

Important channel is the role of cardiac pacemaker

Answer 273

Funny current

Question 274

Type I hypersensitivy

Answer 274

IgE antibodies

Question 275

ABO blood group reactions are classic examples of what type of hypersensitivy reactions

Answer 275

Type III

Question 276

The key antigens triggering reaction in transplant recipient's are the

Answer 276

HLA molecules.

Question 277

Xenogenic transplants are between

Answer 277

different specied

Question 278

Most common substance secreted by GLOMUS TUMOR

Answer 278

NE

Question 279

What are glomus tumors?

Answer 279

Glomus tumors, or paragangliomas, are slow-growing, usually benign tumors in the carotid arteries (major blood vessels in your neck), the middle ear or the area below the middle ear (jugular bulb).

Question 280

Drugs to be avoided in patient with a hx of Acute porphyric crisis

Answer 280

Pentazocine

Question 281

Von Gierke's disease has excess levels

Answer 281

of GLYCOGEN

Question 282

Chemo agent with cardiotoxicity

Answer 282

Doxorubicin

Question 283

Most common patter of Fetal HR changes in intrapartum period

Answer 283

Variable decels

Question 284

Factors decrease the depolarization threshold of a cardiac PM

Answer 284

Hypokalemia

Question 285

Kartagener's syndrome consists of which TRIAD

Answer 285

Sinusitis Sinus inversus Bronchiectasis

Question 286

ADministration of a decarboxylase inhibitor will prevent

Answer 286

conversion of levodopa to dopamine

Question 287

Vitamin D can reveal

Answer 287

Thoracic kyphosis

Question 288

Mandibulofacial dystosis

Answer 288

Trachear collins

Question 289

ISOFLURANE is

Answer 289

HALOGENATED METHYL ETHYL ETHER

Question 290

Propofol has antioxidants to

Answer 290

Vit D

Question 291

Scopolamine is derived for what plant?

Answer 291

Bella donna

Question 292

Prilocaine metabolite is

Answer 292

O-toluidine, which is capable of oxidizing hemoglobin to methemoglobin.

Question 293

AV dissociation seen with

Answer 293

Cannon A waves

Question 294

Used for Vtach

Answer 294

Fleicanamide

Question 295

Class 1C

Answer 295

Fleicanamide

Question 296

Class 1B

Answer 296

Lidocaine

Question 297

Class 1A

Answer 297

Procainamide, Quinidine

Question 298

Fast sodium channels blocker Antiarrythmic

Answer 298

Class 1

Question 299

Class II antiarrythmic :

Answer 299

Beta Blockers

Question 300

Class III antiarrythmic :

Answer 300

Amiodarone Sotalol Ibutilide Dofetilide

Question 301

Class IV antiarrythmic :

Answer 301

Calcium Channel Blockers Verapamil Diltiazem

Question 302

Class V antiarrythmic

Answer 302

Adenosine Digoxin Magnesium Sulfate

Question 303

Changes in Co2 Transport because O2 sat describe

Answer 303

Haldane effect (think Chaldane)

Question 304

Protamine sulfate should be used cautiously with patient with

Answer 304

VASECTOMY

Question 305

Macrolide ABT

Answer 305

Erythromycin

Question 306

Origin of pathology of 2nd Degree Type I HB

Answer 306

Wenckebach AV node

Question 307

High output cardiac failure

Answer 307

Sepsis AV fistulas Pregnancy Anemia

Question 308

In what position would a patient with Epiglotitis be placed for emergent intubation

Answer 308

SITTING

Question 309

May exacerbate sx in patient with parkinson's

Answer 309

Droperinol Chlorpromazine Metoclopramide

Question 310

Electrolyte imbalance that may exacerbate s/s of Myasthenia gravis

Answer 310

HYPONATREMIA

Question 311

Produce by parietal cells of stomach

Answer 311

INTRINSIC FACTOR

Question 312

Target site of ADH

Answer 312

Collecting tubules

Question 313

3am low BS, morning high

Answer 313

SOMGYI (SO MOCH insulin)

Question 314

3am NORMAL , morning high

Answer 314

DAWN phenomenon

Question 315

Too rapid administration of DDAVP IV can cause

Answer 315

hypotension.

Question 316

Sympathetic detrusor and trigone muscles(DRTC)

Answer 316

Detrusor Relax | Trigone Contract

Question 317

Sympathetic and penis

Answer 317

EJACULATION

Question 318

Parasympathetic and penis

Answer 318

ERECTION

Question 319

Parasympathetic on arterioles

Answer 319

NONE

Question 320

Beta 2 responsilbe for

Answer 320

Glycogenolysis Lipolysis Bladder wall relaxation

Question 321

Sympathetic on gallbladder and bile duct

Answer 321

Relaxation

Question 322

Action of sympathetic on liver

Answer 322

Tell liver to release glucose.

Question 323

Sympathetic on renal

Answer 323

Decrease urine output

Question 324

Sympathetic on renin

Answer 324

INCREASE renin secretion

Question 325

Sympathetic on skeletal muscle

Answer 325

Glycogenolysis

Question 326

Parasympathetic on adrenal medulla

Answer 326

None

Question 327

What is the most common spinal deformity?

Answer 327

SCOLIOSIS

Question 328

Assess integrity of the unidirectional valve what test?

Answer 328

FLOW TEST

Question 329

Arteriogram risks

Answer 329

Kidney and vessel damage, allergic reaction

Question 330

ACidosis and catecholamines

Answer 330

Decreased responsiveness to catecholamines

Question 331

Barbiturates on CMRO2

Answer 331

Reduce

Question 332

Barbiturates on CBF

Answer 332

Reduce

Question 333

What nerve provides motor innervation to the cricothyroid muscle?

Answer 333

The external branch of the superior laryngeal nerve

Question 334

To determine the outer diameter of the French gauge system, the French gauge is

Answer 334

divided by 3, and the answer will be in millimeters.

Question 335

Hunsaker tubes.

Answer 335

. They are used primarily for jet ventilation | They are double lumen tubes

Question 336

Which endotracheal tube stylet allows the stylet angle to be adjusted during laryngoscopy?

Answer 336

Schroeder stylet

Question 337

ETT LPHV

Answer 337

LPHV

Question 338

Seward laryngoscope blade? (select two)

Answer 338

It should be used in patients under five years of age | C. It is useful for nasotracheal intubation

Question 339

The LMA Fastrach will accommodate an

Answer 339

8.5 ID endotracheal tube.

Question 340

Does barbiturate lower cerebrovascular resistance

Answer 340

NO

Question 341

Preferred energy source of the brain

Answer 341

Glucose

Question 342

Mother of Anesthesia

Answer 342

Alice Magaw (St mary's hospital, Rochester minnesota)

Question 343

Who first coined term Laughing gas for N2O

Answer 343

Humphry Davy

Question 344

1st person to use chloroform for labor pain

Answer 344

James young Simpson

Question 345

Who is credited with developing the first direct video laryngoscope?

Answer 345

ALFRED KIRSTEIN

Question 346

Who is credited in the development of the cuffed ETT

Answer 346

Arthyr Guedel .

Question 347

For POGO the clinician describe

Answer 347

The clinician describes the linear percentage of the glottis that is visible from the anterior commissure to the interarytenoid notch.

Question 348

The retrograde technique is useful for situations where traditional intubation is

Answer 348

not possible, but ventilation is possible.

Question 349

The retrograde technique is useful for situations where traditional intubation is

Answer 349

not possible, but ventilation is possible. So NOT IDEAL for cannot ventilate and cannot intubate situation

Question 350

2 LMA contraindications

Answer 350

Intestinal obstruction | Poor lung compliance

Question 351

Invented IV Regional anesthesia

Answer 351

August BIER

Question 352

1st synthesize ether

Answer 352

Valerius Cordus

Question 353

In the neonate, calcium delivery to the cardiac myocytes is primarily reliant upon

Answer 353

diffusion through the sarcolemma

Question 354

An infant undergoing surgery for necrotizing enterocolitis is in the ICU but not yet intubated. Which induction method would you anticipate being the most appropriate in this patient?

Answer 354

Ketamine induction

Question 355

Which topical anesthetic does not contain lidocaine?

Answer 355

Ametop

Question 356

What area of the brain in the micro-preemie is most at risk for damage?

Answer 356

Periventricular white matter

Question 357

The neonatal response to hypoxia is typically a short period of _____ followed by _____.

Answer 357

Hyperventilation, hypoventilation

Question 358

Which inhalation agent should be avoided in micro-preemies?

Answer 358

N2O

Question 359

In pediatric patients, drugs whose termination of action depends upon redistribution into muscle tissue would most likely exhibit a _____ peak plasma concentration and _____ duration of action.

Answer 359

higher; longer

Question 360

Earliest known nurse anesthetist

Answer 360

Sister Mary Bernard, St vincent's hospital, ERIE PA, 1887

Question 361

Who described the 5 stages of narcotism in repsonse to anesthesia using chloroform

Answer 361

John Snow

Question 362

Adult brain weights

Answer 362

2-3 % body weight

Question 363

SLE patients are at increased risk of

Answer 363

Dementia, stroke, seizure.

Question 364

First to serve chief of the army nurse corps

Answer 364

Colonel Mildred Irene Clark

Question 365

Founder of NANA (then AANA,now)

Answer 365

Agatha (AAnA 3 as) Hodgkins

Question 366

Most common arrythmia with lithotripsy

Answer 366

PVC, supraventricular premature complexes

Question 367

Why is quality ECG important during lithotripsy

Answer 367

Shock waves timed with R wave to prevent arrythmias

Question 368

Anesthesia for lithotripsy what dermatomes level

Answer 368

T4-T6

Question 369

Contraindications to lithotripsy

Answer 369

Pregnancy | Untreated bleeding disorders.

Question 370

PM and lithotripsy

Answer 370

Shut off -reactivates after lithotripsy

Question 371

Parasympathetic nerve fibers from CN IX innervate

Answer 371

Parotid gland

Question 372

Where are parasympathetic nerve fibers exit?

Answer 372

3, 7,9,10 S2-S3

Question 373

Where are CELL bodies of SYMPATHETIC PREGANGLIONIC NEURONE FOUND?

Answer 373

IntermedioLATERAL HORN of SC

Question 374

Spinal cord segment originates from

Answer 374

T1 - L2

Question 375

75% of all parasympathetic can be found in CN

Answer 375

X

Question 376

Adrenergic receptors are

Answer 376

Alpha 1, Alpha 2 | beta 1, beta 2, beta 3

Question 377

What beta receptor is responsible for THERMOGENESIS?

Answer 377

Beta 3

Question 378

Nerve fiber that terminate in ADRENAL MEDULLA are ________and therefore secrete

Answer 378

Preganglionic; ACH

Question 379

Where are POST ganglionic neurons of parasympathetic

Answer 379

Within wall of effector organ

Question 380

Majority of sympathetic post ganglionic neurons are

Answer 380

Adrenergic and secrete NE

Question 381

Sympathetic post ganglionic neurons in ONLY 3 areas are

Answer 381

cholinergic | SWEAT GLANDS, PILOERECTOR MUSCLES OF HAIR< SMALL NUMBER OF BLOOD VESSELS>

Question 382

Inhibition of neurotransmitter when stimulated which receptor

Answer 382

Alpha-2

Question 383

What spinal cord tract modulates pain (DDT)

Answer 383

DESCENDING DORSALATERAL TRACT

Question 384

Delayed respiratory depression occurs after neuraxial injection of which opioid?

Answer 384

MORPHINE

Question 385

Pain afferent nerve fibers enters the dorsal cord and ____or _______ how many segmentts/ in what tract before entering and synapsing in the dorsal horn?

Answer 385

Ascend or descend 1-3 segments; TRACT of LISSAUER,

Question 386

Early depression of ventilation after neuraxial opioids result from

Answer 386

Systemic absorption of opioid

Question 387

Remember SAD

Answer 387

Sensory , Afferent , dorsal

Question 388

DORSAL Leminiscal system include

Answer 388

Cuneatus and Gracilis tracts in spinal cord.

Question 389

Effects of NE released from sympathetic postganglionic neurosn are terminated mainly by

Answer 389

REUPTAKE by the nerve terminal

Question 390

Vasopressors devoid of beta 2 activity

Answer 390

NE

Question 391

Low levels of epinephrine leads to ___why?

Answer 391

Decrease in SVR, beta dominates

Question 392

Patient took propranolol preop , be cautious administering

Answer 392

Phenylephrine

Question 393

Chronically beta Blocked , upregulation or downregulation?

Answer 393

Upregulation

Question 394

Alpha adrenergic BLOCKADE (pay attention to agonist vs blocking)

Answer 394

Venodilation , and decrease in venous return.

Question 395

Organophosphate insecticides treat with

Answer 395

Atropine | Pralidoxime

Question 396

2nd messenger promotes bronchoconstriction

Answer 396

IP3

Question 397

2 most important stimuli for aldosterone release

Answer 397

Angiotensin II | High Potassium

Question 398

Why is dopamine a different kind of vasopressors?

Answer 398

It simultaneously increases contractility, GFR, RBF, sodium excretion and urine output.

Question 399

Pheochromocytoma: Which one is IV which one is PO

Answer 399

Phenoxybenzamine IV 0.5-1 mg/kg | Phentolamine IV 50-70 mcg/Kg IV

Question 400

Treatment of EXCESS beta blockade

Answer 400

Glucagon 1-10 mg IV f/b 5mg/hr | Atropine incremental doses 7mcg/kg IV

Question 401

Chronic exposure to agonist

Answer 401

DOWN regulation

Question 402

OB patient become hypotensive best vasopressor and why?

Answer 402

Ephedrine, does not decrease UBF

Question 403

CN IX and X arise from the

Answer 403

Medulla

Question 404

Parasympathetic arises from

Answer 404

CN III, VII, IX, X

Question 405

CN III arises from the

Answer 405

Midbrain

Question 406

CN VII fromthe

Answer 406

PONS

Question 407

MiPoMed

Answer 407

III, VII, IX , X Midbrain Pons Medulla

Question 408

Chronic therapy with this medication is a contraindication for the use of succinylcholine and mivacurium

Answer 408

Cholinesterase inhibitor ECHOTHIOPHATE (used to treat glaucoma)

Question 409

Inhibitor of mast cell release

Answer 409

CROMOLYN SODIUM prevents mast cell release and bronchoconstriction.

Question 410

cAMP on bronchioles

Answer 410

Producs bronchodilation

Question 411

Insulin receptors contain an

Answer 411

Active tyrosine kinase domain

Question 412

What is the function of a kinase?

Answer 412

Catalyze the addition of a PHOSPHATE group to a substrate

Question 413

Not Innervated by a stellate ganglia

Answer 413

Bronchioles

Question 414

The substrate of phospholipase C is

Answer 414

Phosphatidylinositol 4,5 biphophate

Question 415

SSEPs are recorded from the electrodes placed over the

Answer 415

LONGITUDINAL SULCUS if the Tibial nerve is stimulated bilaterally. The foot and ankle are represented in the brain in the cortex of the longitudinal fissure

Question 416

SSEPs are recorded from the electrodes placed

Answer 416

Laterally from the midline if the ulnar and median nerves are stimulated

Question 417

Peripheral nerve stimulation travel in the

Answer 417

Cuneatus and Gracillis tracts located in the posterior cord.

Question 418

Pathway of fast sharp pain | SAD-> Lissauer-->Lam 1-5--> Contraleteral STT --> Brain

Answer 418

Pain afferent nerve fibers enters the dorsal cord and ascend or descend 1-3 in the tract of Lissauer before entering and synapsing in the dorsal horn. After leaving the tract of Lissauer, the axons of the Adelta fibers enter the dorsal horn and terminate in the REXED's LAMINA I and Lamina V. 2nd order neurons leaving Lamina I and lamina V cross the CONTRALATERAL LATERAL SPINOTHALAMIC TRACT and ascend to the brain

Question 419

Pathway of fast sharp pain: what fibers

Answer 419

A delta

Question 420

Pathway of slow - CHRONIC pain

Answer 420

C fibers terminate primarily in Lamina II and III. Interneurones transmit C fibers impulse to LAMINA V from Lamina II and III. NEurons leaving Lamina V CROSS IMMEDIATLY to the contralateral LATERAL Spinothalamic tract and ascend to the brain.

Question 421

Lamina II is the

Answer 421

Substantia Gelatinosa (some sources say Lamina II and III)

Question 422

The major neurotransmitter released from A delta fibers is

Answer 422

Glutamate

Question 423

Glutamate binds to

Answer 423

AMPA and NDMA receptors on the Postsynaptic membrane.

Question 424

The major neurotransmitter released from C fibers is

Answer 424

Substance P which binds to Neurokinin-1 (NK-1) recepotns on the Post synaptic membrane

Question 425

Major neurotransmitters release mnemonic

Answer 425

ADeG | C-Sub

Question 426

What Does Substance P bind to

Answer 426

Neurokinin-1

Question 427

Receptors responsible for sedation and dysphoria

Answer 427

Kappa

Question 428

Physical dependence opioid receptors

Answer 428

Mu-2

Question 429

Respiratory depression opioid receptors

Answer 429

Mu-2

Question 430

Opioid receptor for these 2 things not yet identifid

Answer 430

Miosis | N/V

Question 431

Opioid receptor responsible for Bradycardia and euphoria

Answer 431

Mu-1 receptor

Question 432

Arterial blood is delivered to the spinal cord

Answer 432

One Anterior spinal artery Two posterior spinal arteries Small segmental spinal arteries.

Question 433

Which substance decrease the release of substance P in the spinal cord ?

Answer 433

Enkephalin

Question 434

What gland is found in the sella turcica of the sphenoid bone?

Answer 434

Pituitary

Question 435

The brainstem and cerebellum are found in the

Answer 435

Posterior cranial fossa

Question 436

What fontanelle closes at about 2 "YEARS" of age

Answer 436

POSTEROLATERAL

Question 437

Another name for CEREBRAL STEAL

Answer 437

Luxury pefusion

Question 438

Muscles for chewing controlled by CN

Answer 438

VII

Question 439

What is coma?

Answer 439

Condition of non-arousal due to damage to the RAS

Question 440

CSF circulation route

Answer 440

``` Choroid plexus Lateral ventricles Foramina of Munro Third Ventricle Aqueduct of Silvius Fourth Ventricle Foramina of Lushka / Foramen of Magendie Subarachnoid space of spinal cord Brain Arachnoid villi ```

Question 441

Site of formation of CSF

Answer 441

Lateral, Third and fourth ventricles

Question 442

Cyanosis is most likely to be seen in which patients?

Answer 442

Obesity hypoventilation syndrome

Question 443

Solution that should not be given to the patient undergoing carotid endarderectomy?

Answer 443

D5W

Question 444

What is the initial dose of Dandrolene ?

Answer 444

2.5 mg/kg

Question 445

What % of soda lime canister should be air?

Answer 445

50%

Question 446

Uptake of 5 volatile to bottom

Answer 446

``` NDSIEH Nitrous Des Sevo Iso Enflurane Halothane ```

Question 447

What is the most common complication of mediatinoscopy?

Answer 447

Hemorrhage

Question 448

Neural pathways that CARRIES (not modulate pain)

Answer 448

ANTEROLATERAL

Question 449

Best ECG lead for initial assessment is

Answer 449

II

Question 450

Flat line CO2 waveform

Answer 450

Esophageal intubation

Question 451

Pneumothorax is most commonly associated with which approach of the brachial plexus.

Answer 451

Supraclavicular

Question 452

Ophtalmologist plan to inject sulfur hexafluoride into the aqueous humor to treat retinal detachment you should avoid?

Answer 452

Nitrous oxide

Question 453

Cardiac T-type calcium channels are maximally open during _____of SA node action potential

Answer 453

Phase 2

Question 454

What MR has antimuscarinic actions?

Answer 454

Pancuronium

Question 455

The patient who cannot ABDUCT the thumb has had what nerve blocked by LA?

Answer 455

Radial

Question 456

Therapeutic plasma concentration of magnesium for Pregnancy induced HTN

Answer 456

4-6 mEq/L

Question 457

The patient with Pregnancy induced HTN, has BP 190/125 you should can give 3 but not 1

Answer 457

Hydralazine Labetalol Nitroprusside NOT ESMOLOL

Question 458

3 conditions with Thrombocytopenia

Answer 458

Cancer Liver disease with splenomegaly Eclampsia

Question 459

2 agents to avoid if the patient is taking MAOIs?

Answer 459

Ketamine, Meperidine

Question 460

2nd heart sound is

Answer 460

closure of Aortic and pulmonic

Question 461

How much of the TOTAL blood volume is in the venous system

Answer 461

65%

Question 462

The most common cause of death associated with CAROTID ENDARTERECTOMy is

Answer 462

Myocardial infraction

Question 463

stick his tongue out:

Answer 463

hypoglossal nerve.

Question 464

shrug shoulders:

Answer 464

spinal accessory nerve

Question 465

The most common cause of death following abdominal aortic aneurysm repair is

Answer 465

Myocardial infraction

Question 466

What are the major contributing factors to the development of peripheral vascular disease? (select two)

Answer 466

DM and smoking

Question 467

CSF passes from the 4th ventricle to the Subarachnoid space through the foramina of

Answer 467

Luschka

Question 468

Where is tissue damage greatest when using a tourniquet?

Answer 468

Under the tourniquet

Question 469

What happens during the PHASE 1 of the ventricular muscle action potential

Answer 469

CL- diffuses in , K+ diffuses out

Question 470

Given to treat prolonged bleeding time?

Answer 470

Platelets

Question 471

Cause P50 to decrease (left shift) from 27 to 19 mmHg?

Answer 471

Metabolic alkalosis

Question 472

You are delivering 5% desflurane to your patient, what is the partial pressure of inspired desflurane?

Answer 472

46 mmHg (5x760/100)

Question 473

PaCo2 of 60 mmHg , how much Co2 is dissolved in each 100 ml of blood?

Answer 473

4. 02 | 0. 067 mL CO2/100 mL blood/mm Hg;

Question 474

O2 saturation to PaO2 how i remember

Answer 474

40. 70% 50 80% 60. 90%

Question 475

Normal adult Hb molecule (Hb A) consists of:

Answer 475

4 heme groups (iron portion of the Hb) - the sites to which oxygen binds 100% Saturation occurs when all four heme sites of each molecule are combined with oxygen 4 amino acid chains: 2 alpha and 2 beta (affect hemoglobins affinity for oxygen, alterations in these chains result in abnormal hemoglobin

Question 476

The concentration of CO2 in solution is given by what law?

Answer 476

Henry’s law, which states that the concentration of CO2 in blood is the partial pressure multiplied by the solubility of CO2.

Question 477

Henry’s law, which states that the

Answer 477

concentration of CO2 in blood is the partial pressure multiplied by the solubility of CO2.

Question 478

What is the solubility of CO2?

Answer 478

0.07 mL CO2/100 mL blood/mm Hg;

Question 479

Henry’s law : dissolved CO2 increases

Answer 479

linearly with increases in PCO2

Question 480

1 atm = ___kPa=_____Torr = ______mmHg ____psi,= ____pa

Answer 480

101.325 kPa = 760.0 torr = 760 mmHg = 14.696 psi = 101,325 Pa.

Question 481

In turn, O2 bound to hemoglobin changes its affinity for CO2, such that when less O2 is bound, the affinity of hemoglobin for CO2

Answer 481

increases (the Haldane effect)

Question 482

Almost all of the CO2 carried in blood is in a chemically modified form,

Answer 482

HCO3−, which accounts for more than 90% of the total CO2.

Question 483

Methemoglobin: | – Has iron in the

Answer 483

oxidized form (Fe+++).

Question 484

The bond with carbon monoxide is

Answer 484

250 times stronger than the bond with oxygen.

Question 485

CO2 | transported in the blood:

Answer 485

–HC03- (70%). –Dissolved C02 (10%). – Carbaminohemoglobin (20%)

Question 486

When Hb saturation with oxygen is high, less carbon dioxide is carred in the blood. What is the relationship called

Answer 486

Haldane effect

Question 487

Carbon dioxide diffuses across the alveolar-capillary membrane about how many times faster than oxygen?

Answer 487

20 times

Question 488

What is the primary determinant of the PAO2?

Answer 488

PO2 in the inspired gas

Question 489

Blood carries O2 in w ways

Answer 489

Physically dissolved in plasma | bound to hemoglobin

Question 490

Compare PAO2 and PaO2 in Zones I and III when the patient is sitting?

Answer 490

PA>Pa>Pv I Pa>PA>Pv II Pa>Pv>PA III Zone 1 PaO2 High Zone 3 PAO2 Low Zone 3 PaCO2 High Zone 3 PACO2 Low

Question 491

Sodium concentration is controlled primarily by

Answer 491

ADH

Question 492

The Virus most EASILY TRANSMITTED BY a BLOOD TRANSFUSION is

Answer 492

CMV (cytomegalovirus)

Question 493

Most frequently damaged nerve in LE

Answer 493

Common PERONEAL

Question 494

Physiologic alterations are least when the patient is

Answer 494

Supine

Question 495

Conus medullaris ends with adults at

Answer 495

L2

Question 496

Suspect MH first action

Answer 496

Turn of VA/ succinylcholine

Question 497

Motor innervation to the tongue?

Answer 497

HYPOGLOSSAL

Question 498

Why are sickle cell patients anemic?

Answer 498

Life span of the Red cell is 12 days (sickled)

Question 499

Avoid in anemic patients

Answer 499

Hypoxemia

Question 500

Most common inherited bleeding disorder is

Answer 500

Von willebrand's disease

Question 501

MH is inherited in an

Answer 501

autosomal dominant pattern

Question 502

In excitable tissues, HYPOCALCEMIA generally promotes

Answer 502

DECREASE THRESHOLD

Question 503

Goal during management of the patient who transected his spinal cord one year ago is to prevent

Answer 503

Autonomic hyperreflexia

Question 504

What is the problem if SERUM ALKALINE PHOSPHATASE IS ELEVATED FOUR-FOLD

Answer 504

Biiary tract obstruction

Question 505

Post transcranial resection of a craniopharyngioma. Large volume of dilute urine indicates

Answer 505

DI , give desmopressin

Question 506

It was decided to perform a pneumonectomy on a patient who has smoked 2 packs of cigarettes per day for 40 years. Which medicaiton should be avoided?

Answer 506

Fentanyl

Question 507

Hormones of carcinoid tumors generally do not have systemic effects because they

Answer 507

UNDERGO THE FIRST PASS EFFECT (GI)

Question 508

During cross-clamping of the descending aorta, you would be most concerned about interrupting flow through what blood vessel supplying the spinal cord

Answer 508

Artery of adamkiewicz

Question 509

Conditions causing incorrect reading with the pulse ox

Answer 509

Hypotension Carbon monoxide poisoning Hypothermia

Question 510

Conditions NOT causing incorrect reading with the pulse ox

Answer 510

Fetal hemoglobin

Question 511

Z79 on tube means

Answer 511

nontoxic

Question 512

What Nerves are blocked first after onset of spinal anesthesia?

Answer 512

B fibers | Mnemonic (BC A-DGBA)

Question 513

Patient is taking aluminum based antacids , sulcrafate and calcium carbonate, these agents were probably used to treat

Answer 513

HYPERPHOSPHATEMIA

Question 514

YOu woud be most concernd if the patient had an increased in

Answer 514

Bleeding time

Question 515

Faster onset of action of LA would be a drug with a pka of

Answer 515

7.4

Question 516

Atelectasis in the patient with ARDS is explained by whose law?

Answer 516

Laplace

Question 517

At what age is the hgb concentration the lowest?

Answer 517

8- 12 weeks

Question 518

One reason the neonate needs more succinylcholine than the adult is because

Answer 518

Motor end plate of NMJ is immature

Question 519

The requirements for manufacturing and transportation of medical gas cylinders are set by the

Answer 519

DOT

Question 520

Current guidelines for treating SAH induced Cerebral vasospasm?

Answer 520

Maintain EUVOLEMIA NIMODIPINE (60 mg q4h on the dot for 21 days) Stepwise augmentation of BP

Question 521

Which change will most profoundly increase intraocular pressure?

Answer 521

Increase CVP

Question 522

Instrument that ionizes a gas sample and then passes it through a magnetic field

Answer 522

Mass Spectrometer

Question 523

Where is the ligamentum flavum located in relation to the epidural space?

Answer 523

posterior

Question 524

Decreases the seizure threshold?

Answer 524

Hypocarbia (Think about when you hyperventilate for ECT)

Question 525

For routine intubation of HIV patienes, the CDC requires all but

Answer 525

GoWN

Question 526

What hemodynamic changes is most likely to result in Myocardial ischemia during surgery if the patient has CAD?

Answer 526

TACHYCARDIA

Question 527

THE MOST EFFECTIVE method of keeping the adult patient warm is the

Answer 527

Forced air warmer

Question 528

What drugs should be avoided in the patient with Alzheimer's disease?

Answer 528

Sedatives

Question 529

The purpose of unidirectional valves in the circle system is to

Answer 529

Prevent rebreathing of exhaled gases

Question 530

What chemotherapeutic causes severe injury to the lung?

Answer 530

Bleomycin

Question 531

The most frequent lawsuit involving the anesthetist relates to

Answer 531

Airway management

Question 532

During hypotensive anesthesia with sodium nitroprusside , MAP which had been maintained at 55 mmHg begins to increase. BP continues to rise despite an increase in the nitroprusside rate, your next action to turn off the nitroprusside and give all the following

Answer 532

Sodium Nitrate Amyl Nitrate Sodium Thiosulfate DO NOT GIVE CALCIUM GLUCONATE

Question 533

Whose law explains the 2nd gas effect?

Answer 533

Fick's

Question 534

What will disinfect the laryngoscope blade after intubating an HIV infected patients?

Answer 534

Glutaraldehyde

Question 535

The dilutional effect occurs during which phase of anethesia?

Answer 535

Emergence

Question 536

Normal umbilical vasculature

Answer 536

2 arteries , one vein

Question 537

Antilipidemic agnets best describedas a BILE ACID SEQUESTRANT

Answer 537

Cholestyramine

Question 538

May be detected using a minimum pressure alarm except:

Answer 538

Increase in resistance

Question 539

The patient with Type A blood has

Answer 539

Anti-B antibodies

Question 540

Which of the following valvular lesions would most likely result in CONCENTRIC LV hypertrophy?

Answer 540

Aortic stenosis

Question 541

Ankylosis spondylitis has the following neurologic complications

Answer 541

Cauda Equina syndrome Atlantlo-occipital subluxation Spinal cord compression

Question 542

Uvula cannot be visualized MAllampati is

Answer 542

3

Question 543

Calculate preop fluid deficit for child 8kg , NPO x 6 hours

Answer 543

192 ml

Question 544

5-HT3 Receptor antagonist is what type of receptor

Answer 544

Inotropic

Question 545

3 endocrine functions of the kidney

Answer 545

Erythropoietin RAAS Vit D

Question 546

Largest: What Amount of Glomerular filtrate reabsorbed where?

Answer 546

67% of filtrate reabsorbed in PROXIMAL TUBULE

Question 547

Poorly reabsorbed by the renal tubules

Answer 547

Urea, uric acid, creatinine , phosphate, sulfate

Question 548

Exquisite control of water excretion

Answer 548

ADH

Question 549

UO and DM

Answer 549

UO increases glucose load exceeds transport max leading to OSMOTIC diuresis.

Question 550

Where is ADH synthesized

Answer 550

Paraventricular and SUPRAOPTIC nuclei of the HYPOTHALAMUS.

Question 551

Stimulate release of Vasopression from posterior pituitary

Answer 551

Nerve action potentials

Question 552

Explain how ADH gets released?

Answer 552

In response to an increase in ECF osmolarity (SODIUM CONCENTRATION ) paraventricular and supraoptic nuclei shrink and nerve axons fire action potential which cause ADH release rom posterior pituitary.

Question 553

What is the MOST POWERFUL stimulus triggering the release of ADH?

Answer 553

Increase in ECF osmolality (kg)

Question 554

OSMOLARITY vs OSMOLALITY

Answer 554

Think OSMO- LARRY DRINKS A LITER | LALI KILLS HIM (LALI - KILO)

Question 555

In the absence of ______ the ____and_____are impermeable to water

Answer 555

ADH; Distal tubule and collecting duct, impermeable to water.

Question 556

When circulating ADH is HIGH

Answer 556

Small volume of CONCENTRATED URINE (1200-1500)

Question 557

When circulating ADH is LOW

Answer 557

LARGE volume of Dilute URINE (50-100 mOsm)

Question 558

Increases the permeability of the distal and collecting tubules to water

Answer 558

ADH

Question 559

Most common cause of Diabetes insipidus is

Answer 559

Failure of ADH synthesis or release (Central ) | Insensitivity of the distal and collecting tubules to ADH

Question 560

With increase ADH , urine OSMOLARITY is _____ volume is ______

Answer 560

HIGH ; Low

Question 561

With decrease ADH , urine OSMOLARITY is _____ volume is ______

Answer 561

LOW: HIGH

Question 562

SIADH can be caused by

Answer 562

Hypothyroidism | Small (oat's cell carcinoma)

Question 563

Diagnostic of SIADH

Answer 563

Increase urine Na+ and osmolality wit HYPONATREMIA | and decrease plasma osmolality

Question 564

Determines ECF volume

Answer 564

Sodium content

Question 565

Most important for regulating ECF volume

Answer 565

Aldosterone

Question 566

Creatinine clearance measures what

Answer 566

GFR

Question 567

Resp alkalosis and free ionized calcium

Answer 567

Free ionized calcium decreases

Question 568

Hyperventilating patients 2 electrolyte abnormalities are

Answer 568

HYPOKALEMIA and HYPOCALCEMIA(decrease free calcium)

Question 569

ph is determined by

Answer 569

HCO3 and PaCO2 (ratio of HCO3 to PaCO2)

Question 570

Normal HCO3

Answer 570

22-27

Question 571

If an acid base disturbance is completely compensated, it is a

Answer 571

Resp disturbance

Question 572

Complete compensation cannot be achieved if there is

Answer 572

Metabolic acidosis or metabolic alkalosis

Question 573

Most susceptible to ischemia , what region of the kidney?

Answer 573

Inner stripe of outer medulla.

Question 574

Glucose transport out of the nephron only occurs in the _______and is subject to the

Answer 574

PROXIMAL TUBULE ; nephron's maximal capacity to absorb glucose which is known as transport maximum.

Question 575

The loop of HENLE act as a

Answer 575

COUNTERCURRENT MULTIPLIER and CREATES OSMOTIC GRADIENT.

Question 576

What hormone control Extracellular fluid volume? | What hormone control EXTRACELLULAR SODIUM concentration?

Answer 576

ALDOSTERONE | ADH (sodium)

Question 577

ECF Water follows

Answer 577

Sodium

Question 578

ECF volume follows

Answer 578

Aldosterone

Question 579

Combinaion of ANP and Aldosterone that lead to highest sodium excretion

Answer 579

Low aldosterone, HIGH ANP

Question 580

K+ excretion will be low with what extracellular Na+ levels

Answer 580

HIGH

Question 581

Not seen with CRF (electrolyte imbalance)

Answer 581

HYPERCALCEMIA

Question 582

Which diuretic prevent bicarbonate in the proximal tubule.

Answer 582

ACETAZOLAMIDE

Question 583

Which combination of acute electroly abnormalities would make nerve, skeletal muscle and cardiac ventricular muscle cells more excitable?

Answer 583

HYPERkalemia | HYPOCALCEMIA

Question 584

Why is hypokalemia a side effect of mannitol administration?

Answer 584

Promotes a HIGHER FLOW RATES through the distal tubules.

Question 585

Common side effect of erythropoietin treatment in Chronic renal patients?

Answer 585

Shortened bleeding times HTN Decrease intensity of pruritus

Question 586

Most important as far as I'm concerned side effect of erythropoietin

Answer 586

HTN

Question 587

Cell's RMP will be hypopolarized (less negative) due to which ion imbalance

Answer 587

HYPERKALEMIA

Question 588

Which treatmet of HYPERKALEMIA does not correct the underlying ion imbalance

Answer 588

Calcium administration

Question 589

Normal RMP is

Answer 589

-70 mV

Question 590

With HYPERKALEMIA, (think Potassium leaving cell), cells becomes DEPOLARIZED meaning

Answer 590

NEGATIVE (-60mv, -50) so hyperpolarize

Question 591

Normal EXTRACELLULAR K+

Answer 591

4 mEq

Question 592

Normal INTRACELLULAR K+

Answer 592

140 mEq

Question 593

Normal EXTRACELLULAR Na+

Answer 593

145 mEq

Question 594

Normal INTRACELLULAR Na+

Answer 594

10 mEq

Question 595

Major INTRACELLULAR ANION

Answer 595

Phosphate

Question 596

With acute hyperkalemia cells

Answer 596

Depolarize (-60, -50- -40)

Question 597

In the neurones, Voltage gated sodium channels are found principlally in the

Answer 597

AXON and are concentrated in the nodes of RANVIER.

Question 598

How does high potassium concentration of cardioplegia arrest the heart? Succinylcholine on skeletal muscles? LAs with nerve conduction

Answer 598

Causes membrane depolarizion , which LOCKS the SODIUM CHANNELS in the INACTIVE STATE Same with succinylcholine , depolarize skeletal muscle motor end plate inactivate sodium channels. LA inactive by locking sodium channel in the INACTIVE STATE.

Question 599

Responsible for depolarizing the AXON

Answer 599

Diffusion of sodium into the cells

Question 600

Repolarization of the axone

Answer 600

Diffusion of POTASSIUM ions out fht ecells.

Question 601

When the sodium channel is in the ______state , another action potential ____be fired. the neuron is in ______r ____period

Answer 601

INACTIVE; ANOTHER ACTION POTENTIAL CANNOT BE FIRED. ABSOLUTE REFRATORY PERIOD.

Question 602

Ach at the nicotinic receptor is _____feedback loop? which is responsible for the _____seen with NDNMB

Answer 602

POSITIVE; fade

Question 603

Events at NMJ, ions go in and what comes out

Answer 603

Sodium and Calcium goes in | K diffuses out

Question 604

The release of neurotransmitter from all nerve terminals including the motor nerve terminals , depends on

Answer 604

Entry into the terminal of calcium ions

Question 605

______comes in , neurotransmitter comes out

Answer 605

Calcium

Question 606

Hypocalcemia and neurotransmitter release?

Answer 606

Decrease the amount of neurotransmitter released vice versa

Question 607

Hypomagnesemia and neurotransmitter release?

Answer 607

INCREASE amount of neurotransmitter release.

Question 608

Hypermagnesemia and neurotransmitter release?

Answer 608

Decrease the AMOUNT OF NEUROTRANSMITTER RELEASE

Question 609

2 ions with ANGONISTIC EFFECTs at nerve terminals?

Answer 609

Calcium and magnesium.

Question 610

How many molecules of Ach does it take to open Acetylcholine-gated channel ?

Answer 610

2

Question 611

Plasma cholinesterase aka

Answer 611

Butyrylcholinesterase.

Question 612

What are the MONOQUATERNARY Aminosteroids?

Answer 612

Vec and roc

Question 613

What are the BISQUATERNARY Aminosteroids?

Answer 613

Pancuronium

Question 614

What are the BisQUATERNARY Benzylisoquinoliniums?

Answer 614

Atracurium, Cis-atracurium

Question 615

Potency of MR is

Answer 615

relationship between twitch depression and dose

Question 616

ED95% of Muscle relaxants represents

Answer 616

95% of block of a single twitch compared to a control single twitch

Question 617

MR with BILIARY as primary route of elimination

Answer 617

VEC and ROC

Question 618

MR with METABOLISM as primary route of elimination

Answer 618

Succ, atra, cisatra, miva

Question 619

Atracurium is eliminated by

Answer 619

Ester hydrolysis by NONSPECIFIC ESTARASES, and HOFFMAN ELIMINATION ph and temperature dependent.

Question 620

HOFFMAN elimination ONLY

Answer 620

Cis-atracurium (NON specfic estarases NOT INVOLVED)

Question 621

Succinylcholine produces bradycardia why?

Answer 621

Because it directly stimulates muscarinic receptors of the SA node.

Question 622

MR that causes significant HTN

Answer 622

Pancuronium , GALLAMINE

Question 623

MR that elicits histamine S

Answer 623

Succinylcholine Mivacurium Atracurium, d-tubocurarine, metocurarine.

Question 624

MR with reflex tachycardia

Answer 624

d-tubocurarine, metocurarine.

Question 625

Succinylcholine and K+ increase in normal patients

Answer 625

0.5 mEq/L

Question 626

Succinylcholine and K+ increase in burn, trauma or head injury patients

Answer 626

5-10 mEq/L

Question 627

Defect in MH is

Answer 627

Mutation in RyR1 of the SR of skeletal muscle.

Question 628

Earliest and most sensitive and specific signs of MH

Answer 628

Elevation of ETCO2

Question 629

Why isnt cardiac muscle directly involved in MH

Answer 629

Because cardiac myocytes express the RYR2 isoform o the ryanodine recptor.

Question 630

Hypokalemia and NMB (BLock increased/decreased)

Answer 630

block increased

Question 631

ABT that increased NDNMBLock

Answer 631

Neomycin Streptomycin GENTAMYCIN Tetracycline

Question 632

PCN affect NDNMB block

Answer 632

NO

Question 633

Cephalosporins , tetracyclines on block

Answer 633

no effects

Question 634

LA on NDNMB block

Answer 634

increased

Question 635

VA on NDNMB

Answer 635

Increased

Question 636

LA on Succ block

Answer 636

Increased

Question 637

Anticholinestease agents on succinylcholine block

Answer 637

INCREASED

Question 638

DEFAULT ANSWERS for block

Answer 638

INCREASED

Question 639

TOF , how many stimuli, how long, strength

Answer 639

4 stimuli, 0.5 sec 2 Hz

Question 640

What % of receptor occupied when TV returns to normal

Answer 640

75-80 %

Question 641

What % of receptor occupied when single twitch as strong as baseline

Answer 641

75-80%

Question 642

What % of receptor occupied when Diaphragm moves ? how many twitches?

Answer 642

95% NO TRAIN OF FOUR TWITCHES

Question 643

What % of receptor occupied when Abdominal relaxation adequate for most intra-abdominal procedures ? how many twitches?

Answer 643

90% ; 1

Question 644

What % of receptor occupied when no palpable fade in TOF

Answer 644

70-75%

Question 645

What % of receptor occupied when patient passes insp pressure test of at least -40 cm H2o, head life

Answer 645

50%

Question 646

The release of Ach from the NMJ will be increased in the follwoing conditions?

Answer 646

HYPOMAGNESEMIA

Question 647

The presynaptic action of succinylcholine

Answer 647

ENHANCES IT POST SYNAPTIC ACTION>

Question 648

MR with ANTIMUSCARINIC ACTIONS

Answer 648

PANCURONIUM

Question 649

Patient paralyzed on the right side and you put the nerve stimulator on the right side what will you see with the TOF

Answer 649

Greater amplitude of twitches on the right compared to the left.

Question 650

What happens to the depolarizing NMB and nondepolarizing NMB if NEOMYCIN is administered

Answer 650

BOTH increased.

Question 651

Characteristic of a NDNMB

Answer 651

T4/T1 < 70% | Post tetanic facilitation present

Question 652

What happens to the number of nicotinic receptors in skeletal muscle in a patient with spinal cord injury?

Answer 652

NUMBER INCREASES in DENERVATED SKELETAL MUSCLE

Question 653

Patient with biliary disease is given VECURONIUM, how will the vecuronium be eliminated?

Answer 653

By metabolism and renal excretion

Question 654

With a nondepolarizing block, DBS produces

Answer 654

2 unequal fading twitches

Question 655

A good vital capacity of at least 20ml/kg when what % of neuromuscular receptors are blocked?

Answer 655

75%

Question 656

Predominant neutransmitter in the periphery?

Answer 656

Ach.

Question 657

with one exception , NE is released from all SYMPATHETIC POSTGANGLIONIC nerves except

Answer 657

SWEAT GLANDS>

Question 658

Nicotinic ACh receptors are

Answer 658

Ionotropic

Question 659

Muscarinic ACh receptors are

Answer 659

METABOTROPIC

Question 660

Throbbing apin and temperature

Answer 660

dC fibers

Question 661

Conduct with greater velocities Myelinated vs unmyelinated

Answer 661

Myelinated nerve

Question 662

Conduct with greater velocities ; small or large diameter

Answer 662

Larger diameter at greater velocities

Question 663

Sympathetic and parasympathetic preganglionic neurons are

Answer 663

B fibers

Question 664

Stellate ganglion is formed by

Answer 664

Inferior cervical | First thoracic ganglia

Question 665

Sympathetic outflow is

Answer 665

Thoracolumbar

Question 666

Horners syndrome

Answer 666

Ptosis, Miosis, anhydrosis Increased skin temperature Ipsilateral MIOSIS

Question 667

**All sympathetic PREGanglionic fibers pass through

Answer 667

WHITE RAMI

Question 668

Some but not all sympathetic POSTganglionic fibers pass through

Answer 668

GRAY RAMI

Question 669

GRAY RAMI are distributed to

Answer 669

ALL SPINAL NERVES FROM THE GANGLIA

Question 670

GRAY RAMI allows

Answer 670

COORDINATED, mass discharge of the SNS

Question 671

When presynaptic alpha-2 receptors are stimulated by NE or any other drug with alpha 2 agonist activity what happens?

Answer 671

The synthesis and release of NE is decreased . THIS IS NEGATIVE FEEDBACk.

Question 672

In adrenal medulla, NE comprises ____% and epinephrine comprises _____%

Answer 672

20%; 80%

Question 673

Release of NE

Answer 673

Action potential travels along axon of sympathetic post ganglionic neurons Depolarization opens voltage-gated Ca++ channels

Question 674

What is required to release neurotransmitter?

Answer 674

Calcium.

Question 675

Termination of action of Norepinephrine: WHAT IS THE FIRST STEP in the termination of action?

Answer 675

Diffusion of NE away from receptors is the first step in the termination of action (efficacy)

Question 676

What is the fist step in termination of action of a LIGAND?

Answer 676

Diffusion of the ligand away from the receptor.

Question 677

What amount of NE is returned to the nerve terminal? By what mechanism?

Answer 677

REUPTAKE; 80%

Question 678

What happens after Norepinephrine diffuses away from the receptor it attached to?

Answer 678

It is removed from the synaptic cleft by 1. REUPTAKE (80%) 2. Metabolism by MAO in the synaptic cleft 3. Diffusion into the plasma where metabolism by COMT occurs.

Question 679

SA nodes receptors; Increase chronotropy through

Answer 679

Beta-1

Question 680

AV node receptors: Dromotropy

Answer 680

Beta-1

Question 681

Muscle fibers : INotropy

Answer 681

Beta 1

Question 682

Arterial Blood vessels Vasoconstriction

Answer 682

ALPHA-1

Question 683

Skeletal muscle relaxation

Answer 683

Beta -2

Question 684

Veins : Vasoconstriction through what receptor

Answer 684

Alpha1

Question 685

Kidney : RENIN release increase through what receptor

Answer 685

Beta 1

Question 686

Kidney : RENIN release decrease through what receptor

Answer 686

Alpha 1

Question 687

Liver Glycogenolysis and Gluconeogenesis: Through what recepto

Answer 687

Beta-2

Question 688

Uterus relaxation through what receptor

Answer 688

Beta 2

Question 689

Na-K PUMP stimulates pump through what receptor

Answer 689

Beta-2

Question 690

2 most important stimuli for aldosterone release are

Answer 690

Angiotensin II | High Serum Potassium

Question 691

Renin release occurs in response to

Answer 691

Decrease renal BP (renal artery stenosis) | Increase SNS activity and Chloride

Question 692

Clonidine is an

Answer 692

Alpha -2 AGONIST

Question 693

Phenylephrine is an

Answer 693

ALPHA -1 agonist

Question 694

Dobutamine receptor stimulated

Answer 694

BETA 1

Question 695

Isoproterenol receptor stimulated

Answer 695

Beta 1 , and Beta 2

Question 696

Norepinephrine receptors stimulated

Answer 696

Alpha 1, Alpha 2, beta 1

Question 697

Does NE have any beta 2 activity?

Answer 697

NO

Question 698

Dopamine receptor stimulated

Answer 698

Alpha 1, Alpha2, Beta 1

Question 699

Ephedrine (JUSt LIKE METARMINOL) receptors stimulated

Answer 699

Alpha 1, alpha 2, Beta 1, Beta 2

Question 700

Primary mode of action of these 3 drugs is indirect stimulation of presynaptic nerve terminals, which results in the displacement of NE into the synaptic cleft

Answer 700

Metaraminol Ephedrine Mephentermine

Question 701

Diastolic arterial Blood pressure changes in the same direction as

Answer 701

Systemic vascular resistance

Question 702

Decrease in diastolic Blood pressure and possibly also MAP with low dose of epineprhine are attributable to

Answer 702

Beta-2 mediated vasodilation (beta-2 mediated decrease in SVR)

Question 703

Guanethidine (Ismelin) is

Answer 703

No longer in the UNITED STATES

Question 704

Phenoxybenzamine is

Answer 704

Alpha 1 and Alpha 2 antagonists

Question 705

Prazosin is a

Answer 705

Alpha 1 antagonists ONLY alpha 1

Question 706

Labetalol block what receptors

Answer 706

Alpha 1 | Beta 1 and Beta 2

Question 707

Labetalol alpha receptor

Answer 707

Alpha 2

Question 708

PROPRANOLOL BETA SELECTIVE

Answer 708

NO | BETA-2 BLOCKED STRONGER THAN BETA 1

Question 709

YOHIMBINE type of mediction

Answer 709

Selective Alpha 2 adrenergic antagonists u

Question 710

What is YOHIMBINE used to treat?

Answer 710

Impotence.

Question 711

Side effects of Beta Antagonists on bronchioles

Answer 711

Bronchoconstriction

Question 712

Myocardial depression in the PRESENCE OF BETA BLOCKADE --> WORST to better

Answer 712

``` Ketamine Enflurane Halothane Opioids KEHO- ``` I=S=D

Question 713

2 drugs to avoid with MAOIs

Answer 713

Meperidine | Ephedrine

Question 714

Ridodrine is a

Answer 714

tocolytic

Question 715

Ritodrine is a

Answer 715

Beta-2 adrenergic receptor agonist

Question 716

Beta 2 adrenergic agonist, 3 side effects

Answer 716

Hyperglycemia Hypokalemia Tachycardia

Question 717

System that is ESSENTIAL for the MAINTENANCE OF LIFE

Answer 717

Parasympathetic nervous system.

Question 718

What is a disadvantage feature of anti-muscarinic agents on the GI tract?

Answer 718

LOWER esophagel sphincter tone

Question 719

2 Antimuscarinic (Anticholinergics) with the most sedation?

Answer 719

Scopolamine, Atropine,

Question 720

Antimuscarinic (Anticholinergics) with the NO sedation

Answer 720

Glycopyrrolate

Question 721

Antimuscarinic (Anticholinergics) with the MOST Antisialalogue

Answer 721

Scopolamine

Question 722

Antimuscarinic (Anticholinergics) with the LEAST Antisialalogue

Answer 722

Atropine

Question 723

Antimuscarinic (Anticholinergics) with the MOST MYDRIASIS CYCLOPEGIA

Answer 723

Scopolamine

Question 724

Antimuscarinic (Anticholinergics) with the PREVENTION of MOTION SICKNESS

Answer 724

SCOPOLAMINE

Question 725

What can cause anticholinergic syndrome occurs?

Answer 725

High doses of atropine or scopolamine

Question 726

Anticholinergic syndrome treatment?

Answer 726

Physostigmine (antilirium) 15-60 mcg/kg IV

Question 727

cAMP on bronchioles

Answer 727

Vasodilation

Question 728

The effects of ephedrine are due mostly to its

Answer 728

Stimulation of the nerve terminal to release norephinephrine

Question 729

Could an opioid agonists/antagonists reverse opioid-induced respiratory depression?

Answer 729

yes because opioid agonists/antagonists such as nalbuphine , butorphanol, and buprenorphine can be used. They competitive inhibit MU RECEPTORS< effectively displacing opioid from MU-2 and reversing respiratory depression

Question 730

What is the advantage of using an opioid agonists/antagonists to reverse opioid-induced respiratory depression?

Answer 730

Its good because some degree of spinal analgesia and SUPRASPINAL analgesia would be maintained because the opioid agonist/ antagonists stimulate KAPPA and DELTA RECEPTORS.

Question 731

How is the spinal nerve root connected to the paravertebral sympathetic ganglia?

Answer 731

By communicating channels called white and gray rami communicans.

Question 732

Preganglionic fibers arises from the

Answer 732

Intermediolateral horn of the spinal cord.

Question 733

What are the 2 division of the PNS

Answer 733

Somatic division (motor nerves to skeletal muscles and sensory nerves for pain, touch, pressure, temperature), and AUTONOMIC DIVISION (ANS, PNS)

Question 734

The basilar artery is supplied by the

Answer 734

Right and left vertebral arteries

Question 735

All circle of willis arteries are paired except

Answer 735

Basilar | Anterior communicating

Question 736

The MAJOR vessels of the circle of willis

Answer 736

Right and left INTERNAL CAROTID arteries | BASILAR artery

Question 737

VA;CBF _____CMRO2

Answer 737

Increase, Decreases

Question 738

IV anesthetics of CMRO2, and CBF? Exception is

Answer 738

decreases; ketamine

Question 739

The only IV anesthetic increases both CMRO2 and CBF

Answer 739

Ketamine

Question 740

The only GAS anesthetic increases both CMRO2 and CBF

Answer 740

Nitrous Oxide

Question 741

Major souRce of BLOOD of the spinal cord is the

Answer 741

ANTERIOR SPINAL ARTERY

Question 742

THE ANTERIOR SPINAL ARTERY IS THE MAJOR SOURCE OF BLOOD OF THE spinal cord providing

Answer 742

75% of the blood

Question 743

3 blood supplies of the spinal coard

Answer 743

1 Anterior 2 POSTERIOR small segmental spinal arteris.

Question 744

Artery of adamkiewics enter from the

Answer 744

LEFT SIDE in the majority of patients in the lower thoracic region or UPPER lumbar region.

Question 745

Provide the lower 2/3 of anterior spinal cord

Answer 745

Artery of Adamkiewicz.

Question 746

What is inverse steal called also

Answer 746

Robin Hood, reverse steal)

Question 747

What is inverse, (robin hood , reverse) steal?

Answer 747

When the patient with an ischemic region of brain is hyperventilated, such that PACO2 falls, BLood vessels in NONISCHEMIC brain constrict and blood is diverted to ISCHEMIC BRAIN. GIVE TO THE POOR>

Question 748

Improves blood flow to ISCHEMIC BRIAN

Answer 748

HYPERVENTILATION

Question 749

CEREBRAL steal aka

Answer 749

Luxury perfusion

Question 750

What is CEREBRAL STEAL?

Answer 750

In ischemic brain regions, blood vessels are maximally dilated, in nonischemic brain regions, blood vessels have tone When vasodilator such as nitroprusside is given, or when the patient is HYPOVENTILATED, CO2 accumulates, vessels in nonischemic areas of the brain dilates, flow to non-ischemiec brain increases, and flow to ischemic brain decreases. VASODILATORS and HYPOVENTILATION promote cerebral steal

Question 751

What bone houses the sella turcica

Answer 751

sphenoid

Question 752

Frontal lobes rest on this fossa

Answer 752

Anterior cranial fossa

Question 753

Temporal lobes rest on this fossa

Answer 753

Middle cranial fossa

Question 754

Brain stem and cerebellum rest on

Answer 754

Posterior cranial fossa

Question 755

What is the correct positioning of a single orifice catheter is

Answer 755

3cm above the JUNCITON OF THE SVC -atrialjunciton

Question 756

What is the correct positioning of a MULTI ORIFICE

Answer 756

2 cm below the SVC-ATRIAL JUNCTION

Question 757

Wave that represents ventricular repolarization

Answer 757

T wave

Question 758

Precise activity of this wave unknown

Answer 758

U wave

Question 759

Atrial repolarization wave

Answer 759

QRS complex

Question 760

Ventricular depolarization wave

Answer 760

QRS compex.

Question 761

Action potentilas that are biphasic

Answer 761

in the SA node and in the AV nodes

Question 762

Action potentials with plateau phases are found is

Answer 762

Atrial muscle cells and ventricular muscle cells.

Question 763

What causes change in the HR?

Answer 763

Slope of phase 4 depolarization.

Question 764

On what phase of the NODAL action potential does DIGOXIN work to slow the heart rate?

Answer 764

Phase 4

Question 765

On what phase of the NODAL action potential does CCBs work to slow the heart rate?

Answer 765

Phase 4

Question 766

On what phase of the VENTRICULAR action potential does CCBS work to slow the heart rate?

Answer 766

Phase 2

Question 767

What is the first negative deflection of the ECG

Answer 767

Q wave

Question 768

Congenital heart diseases associate with right-to-left shunting include : 5 Ts PH single double

Answer 768

Pulmonary Atresia Hypoplastic left heart syndrome Single ventricle Double-outlet ventricle, ``` Tricuspid atresia Tetralogy of Fallot Transposition of the great vessels Truncus arteriosus Total anomalous pulmonary venous return ```

Question 769

First positive deflection of ECG

Answer 769

R wave

Question 770

A negative deflection following the R wave is the

Answer 770

S wave

Question 771

On ECG each mm is

Answer 771

0.04 seconds

Question 772

QRS complex results from ventricular depolarization which is phase

Answer 772

0

Question 773

T wave results from ventricular repolarization

Answer 773

Phase 3

Question 774

QT interval reflects duration of

Answer 774

Plateau phase, Phase 2

Question 775

Hypocalcemia on QT

Answer 775

PROLONGED

Question 776

Hypercalcemia on QT

Answer 776

SHORTENEDED>

Question 777

U waves reflect

Answer 777

HYPOKALEMIA

Question 778

MAP is determined by 2 factors

Answer 778

CO and SVR

Question 779

SV is determined by 3 factors

Answer 779

Preload, afterload , contractility

Question 780

Preload is determined by 3 factors: IVV

Answer 780

Intravascular volume, Venous tone, Ventricular compliance

Question 781

The major determinant of Intravascular volume is

Answer 781

AMOUNT OF SODIUM IN THE BODY

Question 782

With an increase in preload, filling

Answer 782

Increases bu the ventricles empties to the same level, SV increases

Question 783

With a decrease in preload, filling

Answer 783

Decrease but the ventricles empties to the samel level (SV decreaseS)

Question 784

What provides evidence of the increased in EDV?

Answer 784

INCREASE PULMONARY CAPILLARY WEDGE PRESSURE

Question 785

Cardiac tamponade on preload

Answer 785

Decrease

Question 786

When afterload increases, what happens to SV?

Answer 786

Decreases

Question 787

When afterload increases, what happens to EDV, and ESV?

Answer 787

Increases, (because the ventricular chamber dilates when afterload increases)

Question 788

When afterload decreases, what happens to EDV, and ESV?

Answer 788

Decrease (because the ventricular chamber sHRINKS when afterload decreases)

Question 789

When afterload decreases, what happens to SV?

Answer 789

Increases

Question 790

Pressure loop with an increase afterload,

Answer 790

shifts toward greater pressure and greater volume (UP to the RIGHT)

Question 791

Pressure loop with an decrease afterload,

Answer 791

Shifts toward smaller pressure and smaller volume (down and to the left)

Question 792

Ken Cooper, a 63 year old long distance runner undergoes a cardiac catherization to assess his LV function after he has noticed difficulty in completing a recent marathon. What is the best parameter to use as the index of his cardiac preload?

Answer 792

LVEDV

Question 793

After a medication given , patient with an increase SV and no other changes in pressure most likely was

Answer 793

Beta-1 agonist

Question 794

In response to an acute increase in afterload, the pressure volume shifts

Answer 794

UP (greater pressure) and to the right (greater volume)

Question 795

In response to an acute decrease in afterload, the pressure volume shifts

Answer 795

DOWN (lower pressures) and to the left (less volume)

Question 796

EARLY RELAXATION phase :of the Isovolumetric relaxation phase is NOT ISOVOLUMETRIC (meaning the volume changes)

Answer 796

AORTIC INSUFFICIENCY

Question 797

THINK A R We know that the AORTIC INSUFFICIENCY when Isovolumetric relaxation phase is NOT ISOVOLUMETRIC , what differentiate acute vs chronic

Answer 797

Acute small loop | CHRONIC BIG ass LOOP and almost covers whole

Question 798

Chronic aortic insufficiency is associated with

Answer 798

Eccentric (VOLUME)

Question 799

Think M S EARLY SYSTOLIC PHASE of the pressure loops is ____________ in MITRAL INSUFFICIENCY

Answer 799

NOT ISOVOLUMETRIC

Question 800

HOw to remember mitral vs aortic changes

Answer 800

ARMS Aortic insuffi. not isovolum. RELAXATION Mitral insuffic not isovolum Systolic phase

Question 801

Afferent action potentials from the baroreceptors of the AORTIC ARCh are carried to the brainstem centers via the

Answer 801

VAGUS nerve (think AV)

Question 802

Control of BP -> Baroreceptor reflex

Answer 802

Increase arterial BP --.> increased stretch of baroreceptors in AORTIC SINUS and AORTIC ARCH--> Increase action potentials in afferents VAGUS NERVE and HERING"S nerve from carotid sinus

Question 803

Afferent action potentials from the baroreceptors of the CAROTID SINUS are carried to the brainstem centers via the

Answer 803

HERING'S NERVE branch of the GLOSSOPHARYNGEAL

Question 804

Hering's nerve is a branch of the

Answer 804

GLOSSOPHARYNGEAL

Question 805

Which one is more important physiologically carotid baroreceptors, vs aortic arch baroreceptors

Answer 805

CAROTID and are primarily responsible for minimizing acute BP alterations

Question 806

Efferent of baroreceptors are the

Answer 806

VAGUS NERVE (to the SA node in hearts,) and SYMPATHETIC nerve, to the ventricles of the heart and the systemic vasculature.

Question 807

Fluid flow when there is

Answer 807

Pressure gradient

Question 808

Flow is________to the pressure gradient

Answer 808

directly proportional to the pressure gradient

Question 809

CO and the area under the curve

Answer 809

INVERSELY PROPORTIONAL under the thermodilution curve (smaller AUC, bigger CO)

Question 810

3 mechanisms of edema formation

Answer 810

Increase plasma hydrostatic pressure Decreased plasma colloid osmotic pressure Lymphatic obstruction.

Question 811

Myocardial Oxygen SUPPLY

Answer 811

HR O2 content, Coronary vascular resistance Diastolic BP

Question 812

Myocardial Oxygen Demand

Answer 812

HR and SV (preload, contractily , afterload)

Question 813

A venodilator only

Answer 813

Nitroglycerin

Question 814

Arterial and venous dilator

Answer 814

Nitroprusside

Question 815

Arterial Dilator

Answer 815

Hydralazine.

Question 816

Action of inamrinone (Inocor); milrinone (primacor)

Answer 816

Block breakdown of cAMP, Increase myocardial contractility, decrease SVR,

Question 817

Adenosine an endogenous

Answer 817

Nucleotide occurring in all cells in the body.

Question 818

Adenosine works by

Answer 818

slowing the conduction through the AV nodes. Interrupt reentry pathways through the AV node

Question 819

Elimination half time of Adenosine____why?

Answer 819

Less than 10 seconds; owing to rapid metabolism

Question 820

ECG tracing has an unusually wide QRS complex, what type of cardiac electrical abnormality is most likely

Answer 820

Bundle Branch block.

Question 821

Increase in BV, venoconstriction , and ventricular compliance lead to an

Answer 821

increase in stroke volume, and increase in diastolic volume.

Question 822

DIlated LV with unusually LV volume

Answer 822

Chronic Aortic stenosis.

Question 823

Isosorbide dinitrate stimulates

Answer 823

Nitric oxide mediated vasodilation

Question 824

Isosorbide dinitrate work by

Answer 824

donates nitrix oxide molecules to vessel wall.

Question 825

Oppose systemic edema formation

Answer 825

Dehydration

Question 826

MI patient who is also HYPOTENSIVE which treatment

Answer 826

PHENYLEPHRINE.

Question 827

Pulse pressure highest in which vessels

Answer 827

Dorsalis pedis artery

Question 828

Selectively induces venous, but not arterial dilation

Answer 828

Nitroglycerin

Question 829

Hypertrophic cardiomyopathy accompanied by

Answer 829

LVOT

Question 830

Pathophysiology of hypertrophic cardiomyopathy

Answer 830

Diastolic dysfunction reflected by HIGH LVEDP.

Question 831

In HCM,what is narrowed

Answer 831

Subaortic area is narrowed.

Question 832

Obstruction of the LV ouflow is worst with what type of contractility ?

Answer 832

Increased contractility

Question 833

Obstruction of the LV ouflow is BEST with what type of contractility ?

Answer 833

Decreased contractility

Question 834

Obstruction of the LV ouflow is worst with what type of preload? such as

Answer 834

Decreased preload (hypovolemia, TACHYCARDIA)

Question 835

Obstruction of the LV ouflow is BEST with what type of preload?

Answer 835

increase preload

Question 836

How does PPV affect HCM LVOT

Answer 836

Worsened because it decreases preload

Question 837

Where do you want afterload, preload and contractility with patient with HCM LVOT

Answer 837

Afterload INCREASE PRELOAD INCREASE Increase contractility

Question 838

Arterial waveform associated with LVOT

Answer 838

bisferiens pulse

Question 839

Can cause regurgitation

Answer 839

Aortic annulus dilation

Question 840

Regurgitant volume of acute aortic regurgitation depends on

Answer 840

HR and diastolic pressure gradient.

Question 841

Regurgitant volume of acute aortic regurgitation depends on

Answer 841

HR | Diastolic pressure gradient across the valve

Question 842

Initial symptoms of aortic regurgitation

Answer 842

Exertional dyspnea Orthopnea PND (Paroxysmal nocturnal dyspnea)

Question 843

Acute Aortic regurgitation presents as a sudden onset of

Answer 843

Pulmonary edema and hypotension

Question 844

Signs of CV collapse with acute aortic regurgitation

Answer 844

Severe dyspnea, hypotension, weakness.

Question 845

Chronic aortic regurgitation pulse pressure

Answer 845

widened

Question 846

AR best vasopressor

Answer 846

Ephedrine.

Question 847

Symptomatic progression of MR : mild symptoms

Answer 847

regurgitant factors < 30%

Question 848

Symptomatic progression of MR : moderate symptoms

Answer 848

regurgitant factors 30-60%

Question 849

Symptomatic progression of MR: SEVERE SYMPTOMS

Answer 849

regurgitant factors >60%

Question 850

Blowing holosystolic murmur

Answer 850

MR

Question 851

Best heart at apex

Answer 851

MR

Question 852

Radiation the axilla

Answer 852

MR

Question 853

MR and neuraxial

Answer 853

well tolerated but avoid bradycardia

Question 854

Normal aortic valve area

Answer 854

2.5 - 3.5 cm2

Question 855

Severe AS valve area

Answer 855

0.8 - 1 cm2

Question 856

Critical severe AS

Answer 856

0.5-0.8 cm2 WITH a transvalvular gradient of 50 mmHg

Question 857

Critical Severe AS transvalvular gradient i

Answer 857

50 mmhg

Question 858

Classic symptoms of Aortic stenosis

Answer 858

SAD NECK Syncope Angina Dyspnea (DOE) Murmur radiates to neck

Question 859

Severe AS what is contraindicated

Answer 859

Spinals and epidurals.

Question 860

Avoid this IV anesthetic in AS

Answer 860

Avoid ketamine

Question 861

Normal mitral valve area

Answer 861

4-6 cm2

Question 862

For mitral stenosis, which neuraxial is preferred and why?

Answer 862

Epidural, due to gradual onset of sympathetic block with epidural.

Question 863

Mitral stenosis vasopressor preferred

Answer 863

Phenylephrine because lack beta adrenergic activity.

Question 864

Murmur MASTER

Answer 864

ARDS MRSA MSDA ASS Arch

Question 865

With Mitral stenosis, enlarged LA effects

Answer 865

May apply pressure to the LEFT recurrrent laryngeal nerve and cause hoarseness.

Question 866

When does symptoms of mitral stenosis will begin to manifest as far as valve area goes?

Answer 866

Less than 2 cm2

Question 867

In a patient with mitral regurgitation , the LV ventricle will compensate by

Answer 867

Increasing EDV

Question 868

In a patient with mitral regurgitation , the LV ventricle will compensate by Increasing EDV while initially maintaining normal ESV, these compensations are explained by which law or principles?

Answer 868

FRANK STARLING

Question 869

MR has a regurgitant volume that is based on

Answer 869

Mitral valve size , HR, pressure gradient between atria and ventricle.

Question 870

Mitral Regur management : Preload

Answer 870

Maintain or slighly increase preload.

Question 871

Aortic stenosis is associated with _____SV how come?

Answer 871

Maintained SV because of Ventricular concentric hypertrophy

Question 872

Your patient has severe AS. Where would you expect to see the effects of concentric hypertrophy on the 12-lead ECG?

Answer 872

R wave

Question 873

Diastolic murmur best heart at the left sternal border

Answer 873

AR

Question 874

AR is termed minimal when the regurgitant volume is _____and is severe if regurgitant volume is

Answer 874

< 40% of SV; > 60%

Question 875

What will a magnet do to a pacemaker/ICD in a patient with Hypertrophic obstructive cardiomyopathy?

Answer 875

Asynchronus pacing , turn ICD off

Question 876

Where would you expect to see hypertrophy in patient with HCM?

Answer 876

Ventricular septum

Question 877

When does the obstruction peak in a patient with hypertrophic cardiomyopathy?

Answer 877

Mid-to-late systole.

Question 878

What does von willebrand's do or promote

Answer 878

Platelet adhesion

Question 879

Von willebrands factor is manufactured by

Answer 879

Endothelial cells

Question 880

Von willebrands factor is released by

Answer 880

Endothelial cells

Question 881

What is the first line of treatment for Von willebrand's disease?

Answer 881

DDAVP

Question 882

Among numerous mediators released from the activated platelets are 2

Answer 882

THROMBOXANE A2 and ADP

Question 883

Role of thromboxane A2 and ADP

Answer 883

promotes platelet aggregation

Question 884

What activate the platelet

Answer 884

Thrombin (aka factor II)

Question 885

The platelet after being activated by thrombin releases

Answer 885

Thromboxane A2 and ADP which promotes platelet aggregation

Question 886

Thromboxane A2 and ADP promotes platelet aggregation by

Answer 886

binding to receptors and activating signal transduction

Question 887

What actually aggregates the platelets

Answer 887

FIBRINOGEN (FACTOR I)

Question 888

NSAIDS vs ASA

Answer 888

NSAIDS only prevents platelet aggregation but the depression of Thromboxane A2 only last 24-48 hours

Question 889

The acetyl group of ASA causes

Answer 889

Acetylation of cyclooxygenase.

Question 890

The rate limiting enzyme in the conversion of ARACHIDONIC ACID to Thromboxane A2

Answer 890

Cyclooxygenase

Question 891

Tirofiban (aggrastat) discontinue how long before surgery

Answer 891

24 hours

Question 892

Abciximab (reopro) discontinue how long before surgery

Answer 892

3 days (72 hours)

Question 893

Eptifibatide (Integrillin) and surgery? when do you discontinue?

Answer 893

D/C 24 hours before surgery.

Question 894

The most common acquired blood clotting defect is due to

Answer 894

Inhibition of cyclooxygenase production by ASA or NSAIDS.

Question 895

Source of the PRO-coagulant fibrinogen (I)

Answer 895

LIVER

Question 896

What is the source of the PRO-coagulant Prothrombin (II)

Answer 896

LIVER

Question 897

Source of the PRO-coagulant TISSUE factor of (III)/Thromboplastin

Answer 897

Vascular wall and extravascular cell membranes

Question 898

Source of the PRO-coagulant CALCIUM (IV)

Answer 898

DIET

Question 899

Source of the PRO-coagulant von willebrand (VIII)

Answer 899

ENDOTHELIAL CELLS

Question 900

Vit K dependent factors

Answer 900

``` 2, 7, 9, 10 (Procoagulants) Anticoagulants factors (C+S) ```

Question 901

Fibrin Stabilizing factor is factor

Answer 901

XIII

Question 902

What are the 3 factors NOT MADE in the livet

Answer 902

VIII(vwf); III, IV (348)

Question 903

How do you remember extrinsic pathway

Answer 903

For 37 cents you can have the extrinsic pathway.

Question 904

How do you remember intrinsic pathway

Answer 904

If you cannot buy the intrinsic pathway for 12, you can get it for 11.98 (12, 11, 9,8)

Question 905

How do you remember COMMON PATHWAY

Answer 905

The final pathway can be purchase at the FIVE and DIME for 1 or 2 dollars on the 13th of the month.

Question 906

2 Labs that assess extrinsic pathway

Answer 906

PT/ INR

Question 907

Med that interfere with extrinsic pathway

Answer 907

Ex means war | WARFARIN

Question 908

2 Labs that assess intrinsic pathway

Answer 908

PTT | ACT

Question 909

Med that interfere with intrinsic pathway

Answer 909

HEPARIN

Question 910

Most important clue to clinically significant bleeding disorder in an otherwise healthy patient remains

Answer 910

The history

Question 911

The most common reason for coagulopathy in patients receiving massive blood transfusion is

Answer 911

lack of functioning platelets.

Question 912

All procoagulants except ______ are present in _____

Answer 912

All procoagulants except PLATELETS are present in FFPs.

Question 913

RBC and increase in Hct

Answer 913

1cc/kg of RBC increase HCT by 1%

Question 914

One unit of RBCs increase HCT by

Answer 914

3-4%

Question 915

Appropriate heparinization indicated by ACT of

Answer 915

400seconds - 450 seconds

Question 916

What is normal bleeding time

Answer 916

3-10 minutes

Question 917

PT normal

Answer 917

12-14 secon

Question 918

aPTT normal

Answer 918

25-35

Question 919

PTT assess what pathways

Answer 919

Intrinsic + common

Question 920

ACT normal

Answer 920

80-150

Question 921

Plasminogen to it active form which is

Answer 921

PLASMIN

Question 922

What converts plasminogen to plasmin?

Answer 922

Tissue type plasminogen activator (tPA) | Urokinase type plasminogen activator. (upa)

Question 923

Plasminogen is converted to plasmin by tpa and upa which in turn down what

Answer 923

Breaks down fibrin to Fibrin degradation products.

Question 924

Two medication that works by inhibiting plasmin

Answer 924

Amicar | Aprotinin

Question 925

When plasmin is inhibited , fibrin that is formed is

Answer 925

breaks down slowly, so bleeding is decreased.

Question 926

Most common cause of an isolated high PT

Answer 926

LIVER DISEASE>

Question 927

What clotting factor activates the platelet at the site of vascular injury>

Answer 927

II (thrombin)

Question 928

Cryopreciptate contains what factors

Answer 928

I,8, 13

Question 929

What is the most common cause of coagulopathy after a massive blood tranfusion?

Answer 929

Lack of functioning platelets (THROMBOCYTOPENIA)

Question 930

How does protamine work to reverse heparin?

Answer 930

PROTAMINE combines ELECTROSTATICALLY with heparin, a neutralization reaction

Question 931

3 substances that convert plasminogen to plasmin

Answer 931

uPa tPa streptokinase

Question 932

How does coumadin work?

Answer 932

competitively inhibits the vitamin K dependent factors, 2, 7, 9,10

Question 933

How does heparin work?

Answer 933

Increase the activity of (turns it on) of antithrombin III

Question 934

What is the best test for PRIMARY HEMOSTASIS, platelet function?

Answer 934

standardized skin bleeding time

Question 935

Enzyme that break down fibrin

Answer 935

Plasmin

Question 936

Average life span of platelets in NORMAL BLOOD

Answer 936

8-12 days

Question 937

Average life span of platelets in TRANSFUSED BLOOD

Answer 937

1-2 days

Question 938

Von willebrand's factor normally binds to platelets at which receptor

Answer 938

GP 1B

Question 939

1st line tx of von willebrand's disease is

Answer 939

DDAVP

Question 940

How does Eptifibatide inhibit platelet aggregation?

Answer 940

RECAPS fibrinogen receptor on platelets

Question 941

Oral corticosteroids may inhibit platelet aggregation because steroids

Answer 941

Prevent PHOSPHOLIPASE A2 from acting on membrane phospholipids

Question 942

Thrombin induces a _____Feedback cycle in secondary hemostasis

Answer 942

POSTIVE

Question 943

How does thrombin induce a positive feedback cycle in secondary hemostasis?

Answer 943

by increasing activation of which upstream factors 5, 8, 11

Question 944

What role does factor IV (CALCIUM) play in the coagulation cascade?

Answer 944

Postions clotting factors on platelet surface

Question 945

Which blood product selectively contains high concentration of factor I, 8, 13

Answer 945

Cryoprecipitate

Question 946

Molecule that inhibits plasmin activity

Answer 946

APROTININ

Question 947

Common precipitating factor for DIC

Answer 947

Ischemia

Question 948

The most common cause of an ISOLATED PT value is

Answer 948

Liver disease.

Question 949

External branch of the SLN innervates the

Answer 949

Cricothyroids muscle

Question 950

What is the MAJOR MOTOR nerve of the larynx

Answer 950

RECURRENT LARYNGEAL nerve

Question 951

What is the MAJOR SENSORY nerve of the larynx

Answer 951

Internal branch of the superior laryngeal nerve.

Question 952

aBDucts Vocal cords (take out back door)

Answer 952

Posterior cricoarytenoids.

Question 953

aDDUCT vocal cords

Answer 953

Lateral cricoarythenoids

Question 954

Which closes the rima glottidis?

Answer 954

Transverse

Question 955

Tense Vocal cords

Answer 955

cricoThyroid (TENSE)

Question 956

Relax vocal cords

Answer 956

thyroiaRytenoids (they relax)

Question 957

Widens the inlet *ThyroW

Answer 957

THYROEPIGLOTTICS

Question 958

Narrows inlet (ARINA)

Answer 958

Aryepiglottics

Question 959

Damage to the external branch of the SLN

Answer 959

weakness and huskiness of the voice

Question 960

Damage to the Ext. branch of the SLN nerve paralyzed

Answer 960

Cricothyroid

Question 961

Unilateral RIGHT RLN damage characterized by

Answer 961

hoarseness, and a PARALYZED cord that assumes an intermediate position , midway between abduction and adduction

Question 962

What is the most common injury after a SUBTOTAL THYROIDECTOMY?

Answer 962

Unilateral RIGHT RLN damage

Question 963

If one cord is flaccid and in an intermediate position what kind of damage

Answer 963

Unilateral RLN paralysis

Question 964

Unilateral RLN paralysis signs

Answer 964

Hoarseness

Question 965

If both cords are flaccid and in an intermediate position what kind of damage

Answer 965

Bilateral RLN paralysis

Question 966

Bilateral RLN paralysis signs

Answer 966

APHONIA (LOST OF SPEECH) | AIRWAY OBSTRUCTION

Question 967

Normal P 50

Answer 967

26-28 mmHg

Question 968

PaO2 to SaO2

Answer 968

40mmhg - 70 % 50mmHg - 80% 60 mmHg - 90%

Question 969

What does the flat portion of the oxygen dissociation curve represents? (you put something flat to load up)

Answer 969

it facilitates the loading of O2 by the blood because in the flat portion of this curve, LARGE CHANGES IN THE PARTIAL PRESSURE OF ARTERIAL BLOOD (paO2,) only produces small changes in SaO2.

Question 970

What does the STEEP portion of the oxygen dissociation curve represents? (steep , hard to unload)

Answer 970

Facilitates the UNLOADING of Oxygen at tissues because large amounts of oxygen are unloaded from hemoglobin. (large decrease in Oxygen saturation) in response to a small change in the partial pressure of O2.

Question 971

Fetal hgb on the Oxyhemoglobin dissociation curve

Answer 971

Left

Question 972

Maternal hgb on the Oxyhemoglobin dissociation curve

Answer 972

RIGHT

Question 973

Leftward shift

Answer 973

All weird hemoglobin (Fetal, carboxyhgb, methemoglobi)

Question 974

P50 increases when there is a (

Answer 974

RIGHT SHIFT

Question 975

P50 decrease when there is a

Answer 975

LEFT SHIFT

Question 976

What is the Bohr effect?

Answer 976

Refers to the shift in the oxyhemoglobin dissociation curve in response to an increase or decrease in PCO2

Question 977

Opioids shift the hgb to where?

Answer 977

Opioids produces resp depression, which increase Co2, so to the RIGHT

Question 978

Leftward shift

Answer 978

LOVE (loading O2 love )

Question 979

Rightward shift

Answer 979

RELEASE (unload) O2

Question 980

Dissolved O2 makes

Answer 980

Only a very small contribution to the O2- carrying capacity of the blood

Question 981

Calculating the amount of dissolved oxygen in the blood

Answer 981

PaO2 x 0.003 at 37C

Question 982

Whose law permits calculation of the amount of dissolves oxygen in the blood

Answer 982

Henry's law.

Question 983

O2 carried in 2 forms

Answer 983

Dissolved | hgb bound

Question 984

if you're given the SaO2, use it to

Answer 984

estimate partial pressure | 40-90 rule

Question 985

If SvO2 is 70% , how much oxygen is dissolved in venous blood?

Answer 985

0.12

Question 986

What is the HALDANE EFFECT?

Answer 986

How a change in partial pressure of O2 (PaO2) in the blood influences the blood Co2 dissociation curve

Question 987

The CO2 dissociation curve shifts UP to the left when

Answer 987

PO2 decreases

Question 988

The CO2 dissociation curve shifts DOWN to the RIGHT when

Answer 988

PO2 increases

Question 989

Breakdown of how Co2 is carried in the blood?

Answer 989

``` 5% dissolved in plasma water 3% dissolved in RBC water 2 CARBAMINOHGB 20% in RBCs HCO3 in plasma 70% ```

Question 990

Approximately 90% of the CO2 is transported by the blood is in the form of

Answer 990

HCO3.

Question 991

CO2 is carried in the blood in 3

Answer 991

Dissolved As BICARBONATE chemically bound to plasma proteins and hgb.

Question 992

How do you calculate the amount of CO2 dissolved in blood?

Answer 992

Multiply PCo2 x 0.067. and the result is the mL of Co2 dissolved in each 100 ml of blood

Question 993

Which law allows you to calculate the amount of CO2 dissolved in blood?

Answer 993

Henry's LAW.

Question 994

The central chemoreceptors are stimulated by

Answer 994

Increased H+

Question 995

What in the brain can automatically cause an increased in H+

Answer 995

Increase in cerebral spinal CO2

Question 996

What drives respiration normally?

Answer 996

CO2

Question 997

Peripheral chemoreceptors are stimulated by

Answer 997

Increased PCO2, Decreased pH or decreased PaO2 < 60 mmHg

Question 998

The glossopharyngeal nerves carries_______while the vagus nerve carries ______

Answer 998

Sensory information from the carotid bodies (GC) | Vagus nerve carries sensory impulses from the AORTIC bodies and also STRETCH receptors found in the lung parenchyma (VA)

Question 999

What is the INSPIRATORY pacemaker?

Answer 999

Dorsal Inspiratory Group

Question 1000

Dorsal Inspiratory Group controls what

Answer 1000

Diaphragm and External INTERCOSTAL MUSCLES