RANDOM/ PRODIGY TRIVIA/VALLEY BOOK 2 Flashcards
Where is the DORSAL RESPIRATORY GROUP located
Medulla
Ventral Respiratory Group can influence both
Inspiratory and expiratory
Pneumotaxic located in (thinkPP)
PONS
Pneumotaxic center now called
PRG (Pontine Respiratory GROUP)
Peripheral chemoreceptors are found MOSTLY in the
Carotid bodies but also in aortic bodies
Peripheral chemoreceptors responds to
Decreased PaO2 < 60 mmHg
Increased H+ (low pH)
increased PaCO2
Peripheral chemoreceptors ARE MOST RESPONSIVE TO
Decrease in arterial blood O2, when PaO2, falls below 60mmHg
The glossopharyngeal nerve carries afferent information from the
CAROTID BODIES
VAGUS nerve carries afferent information from the
AORITC BODIES and LUNG STRETCH receptors
Central chemoreceptors response to
Hydrogen ions
WHat normally drives Co2
VENTILATON
The pleural membranes couple the
Lungs to the chest wall
What is intrapleural pressure
The pressure in the space between the inside of the chest wall and the lungs
Intrapleural pressure is always
NEGATIVE (subatmospheric) during normal Tidal breathing.
Intrapleural pressure becomes more negative during ______and more less negative during
during inspiration; Expiration
Intrapulmonary pressure is ______during inspiration and______during expiration .
negative, positive
When does INTRAPLEURAL PRESSURE BECOMES POSITIVE
Forced expiration OR during exp effort against a closed glottis, such as the Valsava maneuver.
1 atm = ____mmhg = _____cm H2O
760; 1033 cm H2O
MV is normally____
4Lmin
CO is normally
5L min
The average V/Q for the lungs is
0.8
In the upright position, the dependent lung is at the
Base
In the upright position, the nondependent lung is at the
APEX
When the patient in the lateral decubitus position is anesthesized and paralyzed what occurs
a V/Q mismatch develops, ventilation is the non-dependent lung increases (because the dependent lung is difficult to insufflate) but the distribution of blood flow does not changes, compared to the awake, spontaneously breathing patient.
Always decreases whenever there is a V/Q mismatch
PaO2
The decrease in PaO2 seen with V/Q mismatch may be accompanied with
Hypocapnia,
Normocapnia
Hypercapnia
A-A gradient change with age
PAO2 - PaO2 = 0.21 x (age + 2.5)
Estimating PaO2
Multiple percent O2 in the inspirate gas mixture by 5 ( EX: 0.6 FiO2 is 60 x 5 = 300mmhg
Estimating PAO2
Multiple percent O2 in the inspirate gas mixture by 5
When V/Q is 0 there is
ABSOLUTE right to Left shunt
Normal PAO2 - PaO2 when breathing room air
5-15 mmHg
Normal PAO2 - PaO2 when 100 % O2
100 mmHg
Do you CPAP the dependent or nondependent lung
the NONDEPENDENT
Do you PEEP the dependent or nondependent lung
DEPENDENT
Most effective intervention for the NONdependent lung
CPAP
West zone describe _______in the lung
PERFUSION
West zone are not
Anatomically fixed zones, they are variable, functional zones, dependent upon body position
Compared with zone 1, zone 3 is
Better ventilated, better perfused has a lower V/Q ratio
Zone 1 vs Zone 3 negative intrapleural pressure
less negative intrapleural pressure
Zone 1 vs Zone 3 size alveoli
Zone 3 smaller alveoli
The zone 4 lung requires
4th pressure, P interstitial fluid
Zone1, 2, 3 , 4
Zone 1: PA>Pa.Pv
Zone 2: Pa> PA>Pv
Zone 3: Pa> Pv> PA
Zone 4: Pa>Pisf>Pv> PA
Zone 4 mnemonic
aiVA
The patient is preoxygenated to
Fill the FRC with O2,
What is oxygen consumption
250 ml O2/min
Found in the FRC
2500 ml so divided by 250 per min, you have 10 minutes
In response to alveolar hypoxia, The alveolar arterioles constrict
thereby decreasing shunt blood flow
When does VA inhibit HPV
> 1 MAC
Cannot be measured by spirometry
FRC, RV and TLC
Ratio that is useful in distinguishing between restrictive and obstructive disease
FEV1/FRC
What is the best lung volume test for assessing for small airway disease>
FEF 25-75 (MMEF) MidMaximal expiratory flow
Normal FEV1/FVC
4 L / 5 L =0.8 FEV1/FVC ratio
Obstructive FEV1/FVC Examples
FEV1 = 1.3 L/ FVC 3.1
FEV1/FRC ratio is 0.42 (42%)
Obstructive disease is present when
Both FEV1 and FVC are low
What is the Normal FEV1/FVC ratio
> 0.7
Restrictive disease is present when
both FEV1 and FVC are LOW but the RATION is equal or greater than 0.7
For restrictive and obstructive disease always calculate
the FEV1/FRC ratio
Criteria to cancel case FEV1 and FEV1/FRC ratio
If FEV1 < 2L and FEV1/FRC ratio < 50% more sophisticated lung fuction tests are needed.
Restricted loop are associated with
smaller volume
Intrapleural pressure increases with
FORCED VITAL EXPIRATION or VALSAVA maneuvers.
During forced expiration , intrapleural pressure becomes
Positive
AS liquid flow through a tube, the pressure Increases or decreases
DECREASES (falls)
In the airway pressure
decreases, as gas flow along the bronchioles. THIS IS THE PHYSICAL BASES or airway closure.
US 65-45
Upright closing capacity = FRC upright at 65
Sitting ———————–= ——— sitting at 45
Lung compliance with aging
INCREASES
FRC with aginst
Increases
Except for the cricothyroid muscle, the instrinsic muscles of the larynx are innervated by WHAT MOTOR NERVE/
RLN
Oxyhemoglobin curve becomes steep when PaO2 falls below
60 mmhg
The patient is given meperidine for premedication , what happens to the oxyhemoglobin dissociation curve and the Co2 Blood dissociation curve?
Oxyhgb curve to the right
CO2 shifts left
What is the PaO2 when the SaO2 is 90%?
Think 40-90 rule
40mmHg - 70% SPO2
50mmHg - 80% SPO2
60mmHg - 90% SPO2
What % of Co2 is carried in the blood as bicarbonate?
90%
What enzyme (s) is (are) responsible for producing Bicarbonate in the rbc?
Carbonic Anhydrase
If PaCo2 is 30 mmhg how much Co2 is dissolved in blood . Give answer to 2 decimal places
30 x 0.067 = 2.01 mL
Peripheral chemoreceptors are most sensitive to
Decreased PaO2 (< 60 mmHg )
What nerve carries sensory information from the carotid and what nerve carries sensory information from the aortic bodies?
Carotid - Glossopharyngeal
Aortic - VAVUS
What nerve carries sensory information from the carotid and what nerve carries sensory information from the aortic bodies?
Carotid - Glossopharyngeal
Aortic - VAVUS
CGAV
Where are ventilation and perfusion greatest in the normal healthy lung in the awake individuals?
Ventilation greatest in the Dependent lung
Perfusion greatest in the DEPENDENT lung
Compare PACO2 in the base with PACO2 in the apex when the patient is in the prone position?
PACO2 is the same in the base of the supplies
Compared with non-dependent lung each of the following is greater in dependent lung, except:
ALVEOLAR DIAMETER
Compared with non-dependent lung each of the following is greater in dependent lung
Ventilation
Perfusion
PACO2
A patient breathing room air has a PaO2 of 45 mmHg , a PAO2 of 80 mmhg and a PaCO2 of 75 mmHg what is the problem?
There is a Ventilation;perfusion abnormality.
What is the problem if the patient has a segment of the lung with a ventilation:perfusion ratio of zero?
Patient has a RIGHT to LEFT SHUNT
The patient’s spirometric recordings reveal an FEV1 of 2L and an FVC of 4 L that values indicates
Obstructive disease (ratio is 50%)
For obstruction loop : top is _________ and bottom is _______
Expiratory bottom is Inspiratory (it’s flipped compared to volume capacity graph)
To remember if the APEX triangle points more toward EXPIRTORY it
Extrathoracic obstruction
What happens to pulmonary (lung) compliance and chest wall compliance as you age?
Pulmonary compliance increase
Chest wall compliance decrease
Vd is
Theoretical volume, Drug in body / concentration in plasma
Clearance (Cl) is
Theoretical volume of plasma completed cleared of drug in a given period of time.
Elimination half life vs elimination half time
half life –> time it takes for the total amount of drug, in the body to decrease by one half.
elimination half time –> plasma concentration of a drug to fall by one-half.
What the BODY does to the drug
PharmacoKINETICS
Time is
CONCENTRATION
Life is
AMOUNT
TCLA
Time–>concentration
Life –> Amount
Constant amount of drug eliminated per unit of time
Zero Order kinetics
Drugs that undergo zero order kinteics
Phenytoin, Alcohol, ASA
When the plasma concentration of any drugs exceeds the capacity of metabolizing enzymes
Zero Order kinteics.
First order kinetics (think FF)
CONSTANT FRACTION
Alpha phase is
Distribution
bEta phase is
ELIMINATION (B-e)
T 1/2 B (half time Beta) =
0.693 Vd/ Cl
How many half lives are required to eliminates at LEAST 98% of a drug?
6
Type I phase reaction
Oxidation
Reduction
Hydrolysis
Methylation
What is the important pathway of metabolism for PROCAINAMIDE , hydralazine and isoniazid
ACETYLATION
Acid better absorbed in
Acidic
Basic better absorbed in
Basic
For acid , if pH < pka =
if pH > pKa =
Nonionized
IONIZED
For basic, if pH< Pka=
if pH>pKa
Ionized
Nonionized
ANother way to say that a substance has accepted a hYDROGEN H+ ion is to say that the susbtance in
PROTONATED>
What combination will most facilitate trapping of LA by the fetus?
Maternal alkalosis AND fetal acidosis
What combination will most PREVENT PASSAGE of LA to the UTERUS
Fetal ACIDOSIS
Weak acids and weak bases are provided in solution as
SALTS
Weak acids name has the
Cation first (calcium…, mag this, sodium this)
Weak bases name has the
anion last (drug chloride, drug sulfate)
Propofol is a (weak acid or weak base)
WEAK ACID
Propofol in physiologic ph
99.98 % nonionized.
All LAs are
Weak bases
Base + acid
MORE IONIZED
In general the lower the pKa of the local anesthetic, the_____the proportion of LA in ______form
GREATER the proportion of LA in NONIONIZED form at physiologic pH of 7.4 and FASTER ONSET OF BLOC
Potency of LA is based on
LIPID solubility (SLP)
> 90 % protein binding La
Ropivacaine 94%
Bupivacaine 95%
The duration of ACTION is longer for LA that exhibit ______protein and _______lipid solubility
GREATEST PROTEIN BINDING and HIGHEST LIPID SOLUBILITY
More important than lipid solubility when it comes to duration of action
PROTEIN BINDING
LA absorption : generally
the greater the tissue blood flow, the greater the rate of absorption
Mnemonic to remember absorptbion
IvTicPEBSubAC
IV –>Tracheal –>Intercostal—> Paracervical –> Epidural –> Brachial plexus –> Subarachonid,sciatic fem –>Subcutaneous.
Sympathetic block compared to sensory block
2-6 dermatomes HIGHER than sensory block
MOTOR block compared to sensory block
2 dermatomes lower than sensory bloc
For myelinated axons, _____nodes of Ranvier must be blocked to stop nerve conduction
2-3 nodes
The greater the frequency of action potentials, the
Faster the nerve is blocked, by local anesthetic
The LA must attach to the sodium channel when it is in the
INACTIVATED STATE
Both required to a conduciton block
Both nonionized, and ionized forms of LA
the nonionized cross the lipid bilary the ionized form attaches to the inside of sodium channel and LOCKS it shut in the INACTIVATED STATE
Key target of LA is the
Voltage-gated sodium channels.
LA degree of blockade depends on both
Concentration and volume.
Max dose of bupivacaine w/ EPI
2.5 mg/kg
Max dose of bupivacaine w/O EPI
2mg/kg
Max single dose of Bupivacaine
175 mg
Max single dose LIDOCAINE
300 mg
Max single dose of ROPIVACAINE
200
Max dose of Lidocaine w/o epinephrine is
4.5 mg/kg
Max dose of Lidocaine w/ epinephrine is
7mg/kg
Ropivacaine dose per kg
3 mg/kg
Lidocaine plasma concentration 1-5 mcg/ml
Analgesia therapeutic
What is the therapeutic lidocaine plasma concentration?
1-5 mcg/ml
Lidocaine plasma concentration 5-10 mcg/ml
Light headedness Tinnitus Visual disturbances' Tongue numbness Muscle twitching
The recommended maximum leakage current allowed in operating room equipment is:
10 μA
Lidocaine plasma concentration 10-15 mcg/ml
Seizures
Convulsions
Lidocaine plasma concentration 15-25 mcg/ml
Unconsciousness
Coma
Respiratory arrest
Lidocaine plasma concentration >25 mcg/ml
Cardiovascular depression
Drug will be eliminated slowly it is back
Clearance is small and Vd is large
Potency is directly related to
Lipid solubility
MAC to potency
INVERSELY related to potency
Oil gas partition coefficeints
NDSIEH (nitrous, des, sevo, iso, enflu, halothane)
1.4, 18, 55, 98,98, 224
Greatest sensitization to catecholamines occur with
Halothane.
Oil gas partition coefficients is a measure of
LIPID SOLUBILITY
Decrease CO induction is
FAST
Increase CO induction is
SLOW
Sevoflurane decrease arterial BP and SVR vs des/iso
Greater decrease with des and iso than sevo
Solubility of a gas and temperature
Inverse relationship
as temperature increases, solubility decreases
More inhlational agent will dissolve in blood if the patient is
HYPOTHERMIC
More inhlational agent will dissolve in blood if the patient is HYPOTHERMIC , what explains this phenomenon
Le Chatelier’s principle.
Blood/ Gas coefficient HIGH to low
HIS ND Halothane 2.54 Isoflurane 1.46 Sevoflurane 0.69 Nitrous oxide 0.46 Desflurane 0.42
Alveoli are
WINDOWS TO THE BRAIN
Speed of uptake of anesthetic and elimination from the brain is________ related to blood solubility
INVERSELY RELATED
Mirror the brain partial pressure at steady state.
Alveolar partial pressure of the anesthetic
The CNS effects after bolus injection of an IV anesthetic are terminated primarily by
REDISTRIBUTION
Diazepam and protein binding
98%
2 that ketamine causes
nystagmus
Hypertonous
IV anesthetic with bronchodilation properties
Ketamine
Meperidine to morphine potency
1/10th
Meperidine metabolite
Normeperidine
Phenylpiperidine derivative
Fentanyl, meperidine
Fentanyl to morphine potency
Fentanyl 75-125x more potent
Fentanyl what organ serve as inactive storage site?
LUNGS with 75% of the INITIAL DOSE UNDERGOING FIRST PASS PULMONARY UPTAKE.
Meperidine crosses placenta
YES ALL OPIOIDS DO
Thienyl analogue of fentanyl
Sufentanil
Sufentanil potency
5-10x more than fentanyl
Alfentanil potency
1/5 to 1/10 less potent than fentanyl
VP pressure measure at
20C
VP pressure of gases: HIGH to low (DHIES)
Desflurane Halothane Isoflurane Enflurane Sevoflurane
VP pressure of gases: Des (mmHg)
669
VP pressure of gases: Halothane
244
VP pressure of gases: Isoflurane
240
VP pressure of gases: Enflurane
172
VP pressure of gases: Sevo
157 -170
Vapor pressure and output MNEMONIC (HLH)
Higher vapor pressure agent PLACED in a vaporizer with LOWER vapor pressure agent , the concentration of agent delivered to the patient will be HIGHER than the dial setting
Vapor pressure and output MNEMONIC (LHL)
Lower vapor pressure agent placed in a vaporizer with HIGHER vapor pressure agent, the concentration of agent delivered to the patient will be LOWER than the dial setting.
The partial pressure of saturated water vapor at 37C is
47 mmHg
Law of LAPLACE
T = (P x r) /2
Law that. applied to blood vessels
Law of Laplace
LAW of laplace explains why smaller alveoli empty into
LARGE ALVEOLI causing atelectasis in patients with ARDS
POISEUILLE”S law
Q = Pi r^4 Change in P/ 8 n L
Diffusion hypoxia explains by which law
GRAHAM’s
Boyles is the
VP (Volume/Pressure relationship)
Charles goes into
Vtach (Volume to Temperature)
Gay Lussac’s law is the
PT (pressure to Temp)
Is uterine blood flow autoregulated
NO
TI =
TD50/ED 50
What is the number that shows how much a gas will dissolve in a liquid at a certain temperature?
OSTWALD.
A principle for calculating CO from oxygen uptake or CO elimination and Oxygen or CO2 concentration in arterial and venous blood
Fick principle
Describe behavior of non-ideal gases
Van der waal
Gas pressure is inversely proportion to gas volume at constant Temperature?
Boyle’s
Total pressure of a mixture of gases is equal to the sum of all partial pressure
DALTON”s
6.02 x 10 ^23
AVOGADRO
Gas pressure increase if temperature increases and volume does not change.
Gay-lussac
One mole of ideal gas occupies 22. 4 L at 0C and 1 atm
Avogadro
Law”: Volume increases when temperature increases , if pressure is constant
Charles
Twice as much O2 will dissolve in arterial blood if alveolar pressure of O2 is doubled
HENRY’s LAW
if alveolar pressure of O2 is doubled, how much O2 will dissove
twice as much
Number revealing laminar vs turbulent flow
Reynolds
Concentration effect which law
FICK’s law of diffusion
Explained how pressure, tube radius, length and fluid viscosity contribute to laminar flow
Hagen-Poiseuille law
Tension in the wall of blood vessel is_______ to the radius
PROPORTIONAL
Tension in the wall of blood vessel is proportional to the radius which law
Laplace
The lateral pressure of fluid flowing through a CONSTRICTED SEGMENT of tubing is decrease
Bernoulli principe
What law explains normal tidal breathing?
Boyles’
Muscle relaxants are what kind of compounds
Quarternary ammonium
Desflurane, enflurane isoflurane and sevoflurane are
halogenated ETHERS
SVR = MAP - CVP/CO x80 which law permits this calculation
OHM’s LAW
Salt form or a weak acid naming examples
Sodium “drug” example
If ph of stomach is 2.0 which orally admininstered drug will be most NONIONIZED
A weak acid with pKa 6.2
A local anesthetics is a
WEAK BASE with a PKA greater than 7.4
4-8 mesh soda lime prevents
Channeling while providing an adequate surface area for CO2 absorption.
What is the partial pressure of a gas if its concentration is 5%?
38 mmHg (760 mmHg x 5/ 100)
If a gas exerts a partial pressure of 15 mmHg its concentration is ____%
2.0 % (1.97 % to be exact)
set up proportion
760mmHg/100% = 15 mmHg/ x
In the reaction of CO2 with soda lime the final producs are
CARBONATES
Which pulmonary function test uses boyle’s law?
Plethysmotraphy for determination of FRC
THE GENERATION OF colloid osmotic pressure in the plasma is the principle function of
Albumin
A 3% stock solution of drug is available. You need to make 50 ml of a 0.6 mg/ml solution. How many mL will you take from stock solution to make the dilute solution
1ml
0.6 mg = 1 ml for 50 ml you need 30 mg
3% solution is 30 mg/ml
Sevoflurane is added to a flask sitting on a table, what is the concentration of sevoflurane above the liquid?
22%
The lipid bilayer of the cell membrane is most IMPERMEABLE to what
Charged ion such as Potassium ions
Between gases not including Nitrous which one has the lowest Blood gas coefficient
Desflurane
What is the relative humidity of alveolar gas?
100%
When the tank pressure gauge on a tank of N2O begins to fall, the tank
NO LONGER CONTAINS N2O liquid form
The rotator flowmeter is an example of
Variable orifice flowmeter
An agent with a Blood gas partition of 12 an an oil gas partition coefficient of 0.5 builds up ______and ____potency
Slowly; and lacks potency
Substance that most readily cross the placenta or blood/brain barrier?
highly lipid soluble, NONIONIZED
Lowest oil:gas partition coefficient
Desflurane
Immediately after onset of 50% N2O administration, the volume of the stomach may
Increase
If flow is laminar and the radius of a tube is tripled , the flow through the tube will increase
81 fold HOw: Lets assume to radius you started with was 2 so r^4 of 2 is 16 Now: radius tripled (2 x3 =6 ) so r^4 of 6 is 1296
When you divide 1296 / 16 = 81
What can be measured with a wright respirometer?
Tidal Volume
1: 500,000 concentration is _____mcg/ml
2 mcg/ml. (remember all ratio divide 1,000,000 by the :xxxxxxx )
What property of helium makes it a useful agent?
LOW DENSITY (makes flow more laminar)
When halothane is added to a flask containing 100% O2, the new concentration of O2 will be
68%
How: use VP of desflurane which is 244 mmHg /760 mmHg x 100 % = 32%
100%-32% = 68% for O2
The cylinder of N2O cools after it is turned on , what explains this cooling?
Joule-Thompson effect
Tension in the blood vessel wall will be lowest in the
Capillary
During diastole, the tension in the LV wall increases, what explains this
Law of laplace
When you put an ETT in an autoclave, the cuff expans, this is an application of
Charles LAW
When the length of an IV needle is doubled, what happens to flow from the IV bag, and what law applies?
Flow is halved, Hagen-poiseuilles’ law applies
How much Co2 is dissolved in arterial blood when PaCo2 is 70 mmHg
4.69 mL CO2/ 100 mL blood
When is the partial pressure of CO2 increases, more hydrogen ions and bicarbonate ions are produced: Which law or principle applies?
Le Chatelier’s principle
The reaction of CO2 with soda lime is a
NEUTRALIZATION
What is the concentration of a solution in % if 250mg is added to 50ml of water?
250/50 = 5 mg/ml
the way i do it
I know 2% lidocaine is 20 mg /ml
2 % = 20 mg/ml
x = 5 mg/ml
(5 x2) / 20 = 0.5%
Soda lime greatest concentration is
Calcium Hydroxide Ca(OH)2
Which law explains atelectasis with patient with ARDS
LAPLACE
If MAP is 100mmHg , CVP is 10mmHg, CO is 4.5L/min , the resistance to flow through the Systemic circulation in dynes-cm^-5 is
1600
Formula is : MAP-CVP/CO x 80
When flow is turbulent, the resistance to flow is dependent on what property of the fluid?
DENSITY
What important changes occurs when laminar flow changes to turbulent flow?
Resistance increases
Carbonic anhydrase inhibitors decrease the ability of the kidneys to reabsorb bicarbonate, resulting a
hyperchloremic acidosis.
Carbonic anhydrase inhibitors would be avoided in patients with
acidosis, especially a normal-anionic-gap acidosis
As a result, because bicarbonate is filtered by the ciliary process in the formation of aqueous humor,
carbonic anhydrase inhibitors reduce the formation of aqueous humor and can be used to decrease intraocular pressure
Bicarbonate is filtered by the
ciliary process in the formation of aqueous humor,
A bourdon gauge reads 100 psi, what is the pressure inside the cylinder ? 1 atm= 14.5 psi
114.5 psi. (it is the pressure GAUGE reading + 14.5)
If your tire gauge reads 34 psi (pounds per square inch), then the absolute pressure is
34 psi plus 14.7 psi = 48.7
2 bubbles, one with a radius of 2mm called P(s) and the other one with a radius of 4mm P (L) how does the pressure inside the large bubble compared to the pressure inside the small bubble (Ps)
The pressure of the large bubble is half the pressure of the small bubble
VP from Low to HIGH (SEI-HD)
170-172-240-244-669
Sevoflurane, 170 mmHg Enflurane, 172 mmHg Isoflurane, 240 mmHg Halothane, 244 mmHg Desflurane, 669 mmHg
What happens to alveoli that do not have surfactant?
Smaller alveoli collapse into larger ones.
Parameters used to calculate reynold’s number ?
Velocity of the fluid
Viscosity
Diameter of the tube
With laminar flow the gas flow rate is
directly proportional to the pressure gradient along the tube
Nebulizers use
venturi tubes
As an E-cylinder of oxygen empties, ice crystals form near the outlet, this is explained by what?
Joule-Thompson
What explains why opening a cylinder slower , allow the expanding gas to draw energy from the environment to maintain an equal distribution of energy, we observe no changes in temperature of the gas
2nd law of Thermodynamics (Entropy)
Rapid expansion of a gas causes the temperature to ________as explains by the ______Effect
decrease ; Joule-Thompson Effect
Reynolds number formula is
Vpd/n
v: velocity
d: diameter
p density
