RANDOM/ PRODIGY TRIVIA/VALLEY BOOK Flashcards

1
Q

Parasympathetic does not include fibers of

A

CN8

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2
Q

What is the opioids with the highest protein binding?

A

Sufentanil

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3
Q

NDNMB are what kind of compounds?

A

Quaternary compounds

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4
Q

What type of diuretics can cause hyperKalemia?

A

Spironolactone (Potassium sparing diuretics)

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5
Q

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

A

70%

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6
Q

70% of hepatic blood flow comes from the

A

PORTAL VEIN

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7
Q

What % of calcium is in the ionized form?

A

50%

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8
Q

Serotonin act as a _________in all tissues, except

A

Vasodilator ; HEART and skeletal muscles

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9
Q

All of the following should be avoided in carcinoid syndrome

A

Morphine
Atracurium
fentanyl

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10
Q

Apneic oxygenation during bronchoscopy can lead to

A

HYPERCARBIA

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11
Q

Fenoldopam on BP

A

Decreases arterial BP

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12
Q

ARDS is defined as

A

Acute respiratory failure due to pulmonary injury.

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13
Q

Most suitable for inductin controlled hypotension agent

A

sodium nitroprusside

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14
Q

CHF is usually caused by

A

Systolic dysfunction

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15
Q

High cardiac output heart failure is associated with

A

Sepsis

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16
Q

How does midazolam depresses ventilation?

A

By decreasing the Hypoxic drive.

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17
Q

Butyrephenones drugs classes are

A

droperinol and haloperidol

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18
Q

Pt taking MAOIs should avoid

A

Avocado

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19
Q

The most common manifestation of folic acid deficiency of

A

Megaloblastic anemia

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20
Q

Carbamezepine helps prevent seizures by primarily

A

blocking Na+ Channels.

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21
Q

Folic acid antagonists

A

methotrexate

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22
Q

Acetazolamide is used in treatment of

A

Altitude sickness

Glaucoma.

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23
Q

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

A

Pheochromocytoma.

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24
Q

Dopexamine is similar to Dopamine except that it is devoid

A

alpha-1

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25
Q

Other name for German measles

A

Rubella

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26
Q

Prions are responsible for what type of encephalopathy?

A

SPONGIFORM

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27
Q

Pacemaker of the respiratory system

A

Dorsal Respiratory Group

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28
Q

Bronchospam with what level of Ca2+

A

Hypocalcemia

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29
Q

Most common blood transfusion is transmitted via

A

Hep C

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30
Q

Desflurane differs from isoflurane is chemical structure by how many atoms

A

1

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31
Q

Condition also known as acute idiopathic polyneuritis

A

GBS

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32
Q

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

A

Edrophonium

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33
Q

ABG associated with asthma is

A

Respiratory alkalosis

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34
Q

Platelets half life is

A

1-2 weeks

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35
Q

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

A

IX

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36
Q

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

A

HTN

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37
Q

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

A

thromboembolism

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38
Q

Cheyne-Stokes respiration

A

Bilateral dysfunction of cerebral hemispheres

Midbrain and upper pons

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39
Q

Central neurogenic hyperventilation

A

Low midbrain and upper pons

Increased intracranial pressure with head trauma

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40
Q

Deep, rapid, and regular pattern of breathing

A

Central neurogenic hyperventilation

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41
Q

Describe Cheyne-Stokes respiration

A

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

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42
Q

Apneusis breathing

A

A pause at full inspiration occurs; may see prolonged

inspiratory pause alternating with prolonged expiratory pause

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43
Q

Ataxic breathing Location of Injury and Other Causes

A

Medulla

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44
Q

Irregular breathing with shallow, deep respirations

and irregular apneic episodes; usually slow

A

Ataxic breathing

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45
Q

Acute ischemic stroke BP range for thrombolysis / no thrombolysis

A

Keep < 180/110 mm Hg if thrombolysis

Treat only BP > 220/120 if no thrombolysis

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46
Q

Intracerebral hemorrhage BP range

A

Keep SBP < 180 and MAP < 130 mm Hg

ideal SBP < 160 and MAP < 110 mm Hg

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47
Q

Subarachnoid hemorrhage BR range.

A

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

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48
Q

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

A

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

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49
Q

Virchow’s triad includes

A

hypercoagulability, venous stasis, and vessel wall abnormalities.

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50
Q

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

A

high risk for pulmonary embolism.

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51
Q

Pericardial sac approximately

A

10 to 25 mL of serous fluid,

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52
Q

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

A

coronary sinus
the anterior cardiac veins
Thebesian veins

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53
Q

Three major internodal tracts exist:.

A

the anterior, middle, and posterior

internodal tracts

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54
Q

The anterior internodal tract, or Bachmann bundle,

A

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

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55
Q

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

A

superior vena cava before descending to

the AV node.

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56
Q

The posterior internodal tract, or Thorel’s pathway,

continues along the terminal crest to enter the

A

atrial septum and then passes to the AV node.

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57
Q

From anterior to posterior tract

A

BWT

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58
Q

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

A

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

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59
Q

Pericardial tamponade affect what?

A

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

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60
Q

Pericardial tamponade IV anesthetic of choice

A

Ketamine

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61
Q

Connective disease associated with corneal disturbances

A

Scleroderma

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62
Q

Trisomy 13 aka

A

Patau’s disease

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63
Q

Ludgwig’s angina is characterized by

A

Rapidly expanding cellulitis of the mouth, infection of trismus.

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64
Q

Relative contraindication in hypertrophic cardiomyopathy

A

VASODILATORS

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65
Q

WPW may present as

A

Paroxysmal SVT

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66
Q

Cocaine effects on HR mainly through

A

Blockade of Na+ Channels

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67
Q

Bleomycin leads to what kind of toxicity

A

Pulmonary

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68
Q

Paget’s disease is a disorder that affects

A

Bone

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69
Q

Largest parenchymal organ is

A

LIVER

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70
Q

AKI most frequently

A

ATN

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71
Q

Herbal associated with prolonged sedation

A

Kava Kava

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72
Q

Decrease pain transmission signal

A

Enkephalin

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73
Q

Cisatracurium class

A

Benzoisoquinolinium

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74
Q

Beta Blocker with the highest degree of protein binding

A

PROPRANOLOL

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75
Q

% of CO goes to the Kidney

A

25% of CO every minute

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76
Q

3 types of FLOW

A

Laminar
Turbulent
Transitional

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77
Q

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

A

Constriction

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78
Q

Theoretical temp of absolute zero

A

0 degree Kelvin

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79
Q

Vapor pressure of liquid solely dependent on

A

Temperature

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80
Q

Reynold > 2000

A

Turbulent flow

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81
Q

Reynolds < 2000

A

Laminar

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82
Q

Nebulizers rely on this effect to deliver medication

A

Venturi effect

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83
Q

Whose equation corrects the universal gas law

A

Van der waal

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84
Q

Cell splits into 2 new cells

A

Mitosis

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85
Q

How many pair of chromosomes

A

23

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86
Q

Chemical substance that can cause cellular mutation

A

Carcinogens

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87
Q

Dark areas crossing cardiac muscle fibers

A

Intercalated discs

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88
Q

Calcium release channels are known as

A

Ryanodine receptors

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89
Q

Nitroprusside generates

A

Nitric oxide–> cGMP

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90
Q

Antiarrythmic drugs inhibiting K+ ions

A

Amiodarone/sotalol

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91
Q

Digitalis toxicity treated with

A

Phenytoin

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92
Q

Synthetic NONcatecholamine medication

A

Ephedrine

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93
Q

ALpha adrenergic antagonist used for BPH/HTN

A

Prazosin

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94
Q

Carbonic anhydrase inhibitor example? What is it used for

A

Acetazolamide, glaucoma

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95
Q

Upon what receptors does nalbuphine act? (select two)

A

Mu and Kappa

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96
Q

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

A

redistribution to highly-perfused organs

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97
Q

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

A

Diltiazem &Verapamil

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98
Q

Propofol metabolized by

A

Partially 3A4 BUT CYP 2B6 main one

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99
Q

Which class of CCBs is verapamil?

A

Phenylakalanine

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100
Q

Onset of heparin SQ

A

1-2h

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101
Q

Describe relationship of between LVEDV/SV

A

Frank Starling.

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102
Q

Coronary Perfusion Pressure formula

A

Diastolic BP - LVEDP

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103
Q

Most common congenital cardiac abnormality in infants and children

A

VSD

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104
Q

Most common CYANOTIC congenital heart abnormality

A

Tetralogy of Fallow

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105
Q

Ebstein anomaly involves what valve

A

Tricuspid

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106
Q

Normal venous O2 sat

A

75%

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107
Q

Equation can be used to estimated physiologic-dead space ventilation

A

Bohr

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108
Q

Vital capacity in elderly

A

Increased

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109
Q

2 lungs parameters increase with pneumoperitoneum

A

PIP, Intrathoracic pressure.

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110
Q

First line of defense against unfavorable changes in pH

A

Buffers

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111
Q

Physiologic dead space =

A

Anatomic + functional dead space

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112
Q

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

A

Cytokines & Phospholipase A2

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113
Q

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?

A

Pyriformis syndrome

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114
Q

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

A

3 weeks

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115
Q

Remifentanil have lower _____and _____clearance when compared to fentanyl

A

Vd; clearance

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116
Q

What is the most important buffering system in the body

A

HCO3 (bicarboate system)

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117
Q

What is the enzyme necessary for Prostaglandins synthesis?

A

Cyclooxygenase

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118
Q

NSAIS on cyclooxygenase

A

inhibits

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119
Q

Avoid this drugs with porphyria

A

DILANTIN

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120
Q

Alveolar gas equation is used to estimated

A

PaO2

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121
Q

Cyclosporine is most likely to cause toxicity to the

A

kidneys

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122
Q

Drugs with little to no effect on systemic circulation

A

N2O

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123
Q

H2 receptor antagonists will cause an

A

Increase in gastric fluid pH

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124
Q

Drugs must likely beneficial to patient with WPW

A

Droperinol (dopamine antagonist)

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125
Q

Most common cause of Mitral stenosis

A

Rheumatic fever

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126
Q

Not an ACYNOTIC but a CYANOTIC heart defect

A

TOF

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127
Q

What medication antagonize the action of ADENOSINE

A

THEOPHYLLINE

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128
Q

WPW avoid this drug

A

VERAPAMIL or cardizem

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129
Q

Commotio cordis is

A

Blunt chest wall impact

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130
Q

Commotio cordis affects what organ

A

Heart

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131
Q

20% of athletic injury

A

commotio cordis

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132
Q

Stimulus for the release of arginine vasopressin arises from

A

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

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133
Q

Not an indirect lung injury

A

Near drowning

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134
Q

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

A

Fourth

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135
Q

Normal pressure hydrocephalus TRIAD (DUG)

A

DEMENTIA
Urinary incontinence.
Gait changes

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136
Q

Obstructive hydrocephalus is when

A

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

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137
Q

Tuberous sclerosis aka

A

Bournovilles disease

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138
Q

Erwing’s sarcoma is a malignancy that affects

A

bone

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139
Q

2 most common symptoms of SLE

A

Polyarthritis AND Dermatitis

MALAR RASH 1/3 patients

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140
Q

Gitelman’s disease is an inherited

A

Renal salt wasting disorder

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141
Q

What is the most common neoplasm in infants

A

NEUROBLASTOMA

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142
Q

Laryngeal Papillomatosis is caused by

A

HPV types 6 and 11

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143
Q

Crouson’s syndrome is a

A

Cranial dysostosis

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144
Q

Atrial systole increase CO by

A

20-30%

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145
Q

Left coronary artery division

A

LAD and Circumflex

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146
Q

What creates Lead II (NRAPLL)

What creates Lead III (NLAPLL)

A

Negative Right Arm Positive Left Leg

Negative lead on L arm and positive lead on L leg.

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147
Q

Junction between S wave and ST segment

A

J-point

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148
Q

Where is lead V2 placed

A

Left sternal border @ 4th intercostal space

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149
Q

Unipolar limb leads

A

avF

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150
Q

BLood type with neither A or B Agglutinogen

A

Type O

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151
Q

Where in AV node located

A

Right Atrium

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152
Q

What is Stokes-Adams syndrome?

A

Fainting spells associated with periodic cessation of A-V conduction

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153
Q

Angiotensin II on sodium

A

Sodium retention

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154
Q

Filtration fraction =

A

GFR/ RBF

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155
Q

Visual signals terminate in what lobe of the brain?

A

OCCIPITAL

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156
Q

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

A

Brown Sequard syndrome

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157
Q

Concentration of dissolved gas/solubility coefficient equals

A

Partial pressure.

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158
Q

Mapleson circuits requires the lowest low FGF

A

Mapleson D

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159
Q

Most commonly used laser for laryngeal surgery

A

CO2

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160
Q

Blepharospasm (involunteray movement of eyelid) is a

A

tonic spasm of orbicularis oculi

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161
Q

Sympathetic innervation and insulin

A

causes a decrease in insulin secretion via ALPHA-2

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162
Q

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

A

Dexdemetomidine

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163
Q

Larynx levels

A

C3-C6

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164
Q

How many segments in the RLL

A

5

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165
Q

Difficulty swallowing would reveal dysfunction of what CN

A

IX

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166
Q

Diencephalon 2 parts

A

Thalamus

Hypothalamus

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167
Q

SA Node aka

A

Keith Flack node

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168
Q

Batman whacked THOR (AMP)

A

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

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169
Q

Digitalis (digoxin) is a

A

Cardiac glycosides

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170
Q

Inotropic effect of digitalis is achieved by

A

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

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171
Q

S/s of digitalis toxicity

A

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

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172
Q

What is contraindicated in patient taking digitalis

A

Calcium (may lead to cardiac arrest)

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173
Q

Larynx begins at the ______and extends to the _____-

A

Epiglottis; Cricoid cartilage

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174
Q

Most common electrolyte abnormality in hospitalized patients?

A

Hyponatremia

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175
Q

Changes in banked blood : Factors missing

A

LaCk Factor V and VIII

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176
Q

Resting cardiac cell membrane is relatively permeable to what electrolytes

A

POTASSIUM

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177
Q

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

A
Procainamide
Hydralazine
Isoniazid
D-Penicilllamine
Methyldopa
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178
Q

Heart issues with SLE

A

Diffuse SEROSITIS leads to PERICARDIAL effusion

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179
Q

Drugs to treat SLE

A

Antimalarials
Corticosteroids
Immunosuppresants (reduce corticosteroids requirements)

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180
Q

Condition able to precipitate SLE (PIS)

A

Pregnancy
Infection
Surgical stresses

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181
Q

SLE : on pulmonary : restrictive vs obstructive

A

Restrictive

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182
Q

SLE prone to

A

pleural effusion, pneumonitis, alveolar damage, pulmonary HTN.

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183
Q

Cyclophosphamide consideration

A

inhibits plasma cholinesterase so may prolong ESTER LA and SUCCINYLCHOLINE

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184
Q

Equation of H2O + CO2 –>

A

H2CO3 –>

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185
Q

Sensory nerve supply to nasal mucosa comes from

A

Trigeminal nerve

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186
Q

Stimulation of the atrial stretch receptors will produce

A

Diuresis

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187
Q

Hemodynamic management of Cardiac tamponade

A

Increased PRELOAD

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188
Q

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

A

7:1.

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189
Q

Clonidine alpha 2 to alpha 1 ratio

A

200 : 1

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190
Q

Dexmedetomidine alpha 2 to alpha 1 ratio

A

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

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191
Q

Should clonidine be continued during the perioperative period?

A

yes, because ABRUPT discontinuation can lead to HTN and tachycardia

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192
Q

What is the hallmark of ASPIRATION PNEUMONITIS?

A

Arterial Hypoxemia

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193
Q

Beta-2 receptor stimulation on fat cells

A

lipolysis

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194
Q

CN supplies PNS innervation to the parotid Gland

A

CN IX

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195
Q

Metabolite of Norepinephrine

A

Vanillylmandelic acid

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196
Q

Gas with the highest VP

A

Desflurane

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197
Q

Primary action on clonidine to reduce BP

A

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

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198
Q

Primary indication for dexdemetomidine is

A

Short sedation in critically ill patients

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199
Q

2 main side effects of dexdemetodimidine

A

Hypotension , bradycardia

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200
Q

Intended drug effects of dexmedetomidine

SAAS

A

Sedation
Anxiolysis
Analgesia
Sympatholysis

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201
Q

Clonidine causes analgesia via

A

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

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202
Q

Gas with low molecular weight

A

N2O

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203
Q

Is Nitrous flammable

A

NO

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204
Q

Another name for scopolamine

A

Hyoscine

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205
Q

Highest pKA among opiods

A

MEPERIDINE

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206
Q

What is the only corticosteroid amount other administered orally

A

Prednisone

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207
Q

What are the 3 methyxanthines

A

Caffeine
Theophylline
Theobromide

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208
Q

Tricuspid stenosis on CVP waveform

A

Large A wave

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209
Q

Nitrogen mustards drugs

A

Mechloretamine, CYCLOPHOSPHAMIDE

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210
Q

Pts on MAOIs should avoid

A

LIVER, AGED CHEESE, FAVA beans.

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211
Q

Blockade of what receptor causes neuroleptic malignant syndrome

A

DOPAMINE

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212
Q

Amrinone produces dose dependent

A

decrease in LVEDP

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213
Q

Edinger-westphat nucleus is located in CN

A

III

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214
Q

Sympathetic NS neurons arise from

A

T1 to L2

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215
Q

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

A

TETRACAINE

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216
Q

Procaine to tetracaine

A

Substitute a butyl group for an amine group

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217
Q

Is Glutamate a biogenic amine?

A

NO

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218
Q

What is the drug with the lowest hepatic Extraction ratio?

A

DIAZEPAM

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219
Q

Could cause serotonin syndrome in patients taking MAOIs,

A

Meperidine

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220
Q

What structures are found in transitional airways?

A

Alveolar ducts

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221
Q

What is the VP of Sevoflurane at ___C

A

157 mmHg, 20 degrees C

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222
Q

Fentanyl potency relative to morphine

A

100x

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223
Q

Fournier gangrene affects what parts

A

Genitalia

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224
Q

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

A

Angiotensin II.

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225
Q

Where are the CENTRAL CHEMORECEPTORS LOCAED

A

MEDULLA

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226
Q

Diuretics exerts its effects on the Proximal tubule

A

MANNITOL

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227
Q

CREST syndrome presence is used in the diagnosis of what

A

Scleroderma

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228
Q

CREST Mnemonic stands for

A

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.

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229
Q

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

A

Nalbuphine

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230
Q

Which opioid receptor produces diuresis when stimulated?

A

Kappa

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231
Q

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

A

MORPHINE

CODEINE

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232
Q

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

A

Nalaxone (Narcan)

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233
Q

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

A

Nalbuphine

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234
Q

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

A

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

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235
Q

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

A

Naltrexone

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236
Q

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

A

Windup

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237
Q

The muscle relaxant cyclobenzaprine is structurally most similar to :

A

amitriptyline

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238
Q

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

A

RESPIRATORY DEPRESSION

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239
Q

Select two excitatory neurotransmitters

A

Glutamate & substance P

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240
Q

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

A

Obstetric anesthesia.

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241
Q

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

A

Within 2 weeks of the appearance of the rash

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242
Q

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

A

Glutamate

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243
Q

The dorsal horn of the spinal cord includes

A

laminae I to VI

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244
Q

The chief danger in performing a cervical transforaminal steroid injection is

A

vascular injury

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245
Q

Isotonic fluids 2

A

Plasmalyte

0.9% NS

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246
Q

VA that potentiate NMB the most

A

Desflurane

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247
Q

Cushing’s syndrome

A

Trunchal obesity
Osteopenia
HTN

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248
Q

Acidosis is associated with (calcium)

A

Increased ionized calcium

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249
Q

What substance is physiologically inhibit platelet activation?

A

Nitric oxide

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250
Q

Perisinusoid space of DISSE can be found where

A

liver

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251
Q

Hepatocyte produce bile and secrete it into

A

biliary calculi via CANALS OF HERING

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252
Q

Metabolite of procaine associated with anaphylaxis reactions?

A

PABA

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253
Q

Conn’s aka

A

HYPERALDOSTERONISM

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254
Q

Sevoflurane is

A

FLUORINATED METHYL ISOPROPYL

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255
Q

Not a chiral compound

A

Propofol

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256
Q

what is the metabolite of Diazepam

A

Oxazepam.

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257
Q

Meperidine a.k.a

A

Pethidine

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258
Q

Toxicity of which drug is associated with PULSUS ALTERNANS

A

DIGOXIN

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259
Q

Triangle of Koch is located in what organ

A

HEART

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260
Q

What Corticosteroid with the longest duration?

A

Bethamethasone

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261
Q

Other name for this synthetic opioid is Diacetylmorphine

A

Heroin

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262
Q

Nerve fibers with the fastest conduction velocities

A

MOTOR NEURON

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263
Q

Minor Calyx part of the

A

Kidneys

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264
Q

Thin CT of the liver

A

Glisson’s capsule

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265
Q

Kuffer cells are

A

Specialized macrophages.

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266
Q

Majority of blood flow to liver provided by

A

Portal vein

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267
Q

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

A

Lateral femoral cutaneous

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268
Q

Brainstem composed of

A

MMP

Medulla, Midbrain, pons.

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269
Q

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

A

Windkessel effect

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270
Q

Therapeutic index

A

LD50/ED50

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271
Q

Example of phase II enzyme

A

N-acetyltransferase

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272
Q

2 major calcium channels

A

L-type and T-type

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273
Q

Important channel is the role of cardiac pacemaker

A

Funny current

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274
Q

Type I hypersensitivy

A

IgE antibodies

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275
Q

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

A

Type III

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276
Q

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

A

HLA molecules.

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277
Q

Xenogenic transplants are between

A

different specied

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278
Q

Most common substance secreted by GLOMUS TUMOR

A

NE

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279
Q

What are glomus tumors?

A

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).

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280
Q

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

A

Pentazocine

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281
Q

Von Gierke’s disease has excess levels

A

of GLYCOGEN

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282
Q

Chemo agent with cardiotoxicity

A

Doxorubicin

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283
Q

Most common patter of Fetal HR changes in intrapartum period

A

Variable decels

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284
Q

Factors decrease the depolarization threshold of a cardiac PM

A

Hypokalemia

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285
Q

Kartagener’s syndrome consists of which TRIAD

A

Sinusitis
Sinus inversus
Bronchiectasis

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286
Q

ADministration of a decarboxylase inhibitor will prevent

A

conversion of levodopa to dopamine

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287
Q

Vitamin D can reveal

A

Thoracic kyphosis

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288
Q

Mandibulofacial dystosis

A

Trachear collins

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289
Q

ISOFLURANE is

A

HALOGENATED METHYL ETHYL ETHER

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290
Q

Propofol has antioxidants to

A

Vit D

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291
Q

Scopolamine is derived for what plant?

A

Bella donna

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292
Q

Prilocaine metabolite is

A

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

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293
Q

AV dissociation seen with

A

Cannon A waves

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294
Q

Used for Vtach

A

Fleicanamide

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295
Q

Class 1C

A

Fleicanamide

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296
Q

Class 1B

A

Lidocaine

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297
Q

Class 1A

A

Procainamide, Quinidine

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298
Q

Fast sodium channels blocker Antiarrythmic

A

Class 1

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299
Q

Class II antiarrythmic :

A

Beta Blockers

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300
Q

Class III antiarrythmic :

A

Amiodarone
Sotalol
Ibutilide
Dofetilide

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301
Q

Class IV antiarrythmic :

A

Calcium Channel Blockers
Verapamil
Diltiazem

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302
Q

Class V antiarrythmic

A

Adenosine
Digoxin
Magnesium Sulfate

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303
Q

Changes in Co2 Transport because O2 sat describe

A

Haldane effect (think Chaldane)

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304
Q

Protamine sulfate should be used cautiously with patient with

A

VASECTOMY

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305
Q

Macrolide ABT

A

Erythromycin

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306
Q

Origin of pathology of 2nd Degree Type I HB

A

Wenckebach AV node

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307
Q

High output cardiac failure

A

Sepsis
AV fistulas
Pregnancy
Anemia

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308
Q

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

A

SITTING

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309
Q

May exacerbate sx in patient with parkinson’s

A

Droperinol
Chlorpromazine
Metoclopramide

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310
Q

Electrolyte imbalance that may exacerbate s/s of Myasthenia gravis

A

HYPONATREMIA

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311
Q

Produce by parietal cells of stomach

A

INTRINSIC FACTOR

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312
Q

Target site of ADH

A

Collecting tubules

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313
Q

3am low BS, morning high

A

SOMGYI (SO MOCH insulin)

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314
Q

3am NORMAL , morning high

A

DAWN phenomenon

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315
Q

Too rapid administration of DDAVP IV can cause

A

hypotension.

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316
Q

Sympathetic detrusor and trigone muscles(DRTC)

A

Detrusor Relax

Trigone Contract

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317
Q

Sympathetic and penis

A

EJACULATION

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318
Q

Parasympathetic and penis

A

ERECTION

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319
Q

Parasympathetic on arterioles

A

NONE

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320
Q

Beta 2 responsilbe for

A

Glycogenolysis
Lipolysis
Bladder wall relaxation

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321
Q

Sympathetic on gallbladder and bile duct

A

Relaxation

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322
Q

Action of sympathetic on liver

A

Tell liver to release glucose.

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323
Q

Sympathetic on renal

A

Decrease urine output

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324
Q

Sympathetic on renin

A

INCREASE renin secretion

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325
Q

Sympathetic on skeletal muscle

A

Glycogenolysis

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326
Q

Parasympathetic on adrenal medulla

A

None

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327
Q

What is the most common spinal deformity?

A

SCOLIOSIS

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328
Q

Assess integrity of the unidirectional valve what test?

A

FLOW TEST

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329
Q

Arteriogram risks

A

Kidney and vessel damage, allergic reaction

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330
Q

ACidosis and catecholamines

A

Decreased responsiveness to catecholamines

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331
Q

Barbiturates on CMRO2

A

Reduce

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332
Q

Barbiturates on CBF

A

Reduce

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333
Q

What nerve provides motor innervation to the cricothyroid muscle?

A

The external branch of the superior laryngeal nerve

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334
Q

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

A

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

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335
Q

Hunsaker tubes.

A

. They are used primarily for jet ventilation

They are double lumen tubes

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336
Q

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

A

Schroeder stylet

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337
Q

ETT LPHV

A

LPHV

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338
Q

Seward laryngoscope blade? (select two)

A

It should be used in patients under five years of age

C. It is useful for nasotracheal intubation

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339
Q

The LMA Fastrach will accommodate an

A

8.5 ID endotracheal tube.

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340
Q

Does barbiturate lower cerebrovascular resistance

A

NO

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341
Q

Preferred energy source of the brain

A

Glucose

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342
Q

Mother of Anesthesia

A

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

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343
Q

Who first coined term Laughing gas for N2O

A

Humphry Davy

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344
Q

1st person to use chloroform for labor pain

A

James young Simpson

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345
Q

Who is credited with developing the first direct video laryngoscope?

A

ALFRED KIRSTEIN

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346
Q

Who is credited in the development of the cuffed ETT

A

Arthyr Guedel .

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347
Q

For POGO the clinician describe

A

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

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348
Q

The retrograde technique is useful for situations where traditional intubation is

A

not possible, but ventilation is possible.

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349
Q

The retrograde technique is useful for situations where traditional intubation is

A

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

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350
Q

2 LMA contraindications

A

Intestinal obstruction

Poor lung compliance

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351
Q

Invented IV Regional anesthesia

A

August BIER

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352
Q

1st synthesize ether

A

Valerius Cordus

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353
Q

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

A

diffusion through the sarcolemma

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354
Q

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?

A

Ketamine induction

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355
Q

Which topical anesthetic does not contain lidocaine?

A

Ametop

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356
Q

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

A

Periventricular white matter

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357
Q

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

A

Hyperventilation, hypoventilation

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358
Q

Which inhalation agent should be avoided in micro-preemies?

A

N2O

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359
Q

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.

A

higher; longer

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360
Q

Earliest known nurse anesthetist

A

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

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361
Q

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

A

John Snow

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362
Q

Adult brain weights

A

2-3 % body weight

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363
Q

SLE patients are at increased risk of

A

Dementia, stroke, seizure.

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364
Q

First to serve chief of the army nurse corps

A

Colonel Mildred Irene Clark

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365
Q

Founder of NANA (then AANA,now)

A

Agatha (AAnA 3 as) Hodgkins

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366
Q

Most common arrythmia with lithotripsy

A

PVC, supraventricular premature complexes

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367
Q

Why is quality ECG important during lithotripsy

A

Shock waves timed with R wave to prevent arrythmias

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368
Q

Anesthesia for lithotripsy what dermatomes level

A

T4-T6

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369
Q

Contraindications to lithotripsy

A

Pregnancy

Untreated bleeding disorders.

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370
Q

PM and lithotripsy

A

Shut off -reactivates after lithotripsy

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371
Q

Parasympathetic nerve fibers from CN IX innervate

A

Parotid gland

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372
Q

Where are parasympathetic nerve fibers exit?

A

3, 7,9,10 S2-S3

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373
Q

Where are CELL bodies of SYMPATHETIC PREGANGLIONIC NEURONE FOUND?

A

IntermedioLATERAL HORN of SC

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374
Q

Spinal cord segment originates from

A

T1 - L2

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375
Q

75% of all parasympathetic can be found in CN

A

X

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376
Q

Adrenergic receptors are

A

Alpha 1, Alpha 2

beta 1, beta 2, beta 3

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377
Q

What beta receptor is responsible for THERMOGENESIS?

A

Beta 3

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378
Q

Nerve fiber that terminate in ADRENAL MEDULLA are ________and therefore secrete

A

Preganglionic; ACH

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379
Q

Where are POST ganglionic neurons of parasympathetic

A

Within wall of effector organ

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380
Q

Majority of sympathetic post ganglionic neurons are

A

Adrenergic and secrete NE

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381
Q

Sympathetic post ganglionic neurons in ONLY 3 areas are

A

cholinergic

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

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382
Q

Inhibition of neurotransmitter when stimulated which receptor

A

Alpha-2

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383
Q

What spinal cord tract modulates pain (DDT)

A

DESCENDING DORSALATERAL TRACT

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384
Q

Delayed respiratory depression occurs after neuraxial injection of which opioid?

A

MORPHINE

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385
Q

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

A

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

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386
Q

Early depression of ventilation after neuraxial opioids result from

A

Systemic absorption of opioid

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387
Q

Remember SAD

A

Sensory , Afferent , dorsal

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388
Q

DORSAL Leminiscal system include

A

Cuneatus and Gracilis tracts in spinal cord.

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389
Q

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

A

REUPTAKE by the nerve terminal

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390
Q

Vasopressors devoid of beta 2 activity

A

NE

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391
Q

Low levels of epinephrine leads to ___why?

A

Decrease in SVR, beta dominates

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392
Q

Patient took propranolol preop , be cautious administering

A

Phenylephrine

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393
Q

Chronically beta Blocked , upregulation or downregulation?

A

Upregulation

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394
Q

Alpha adrenergic BLOCKADE (pay attention to agonist vs blocking)

A

Venodilation , and decrease in venous return.

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395
Q

Organophosphate insecticides treat with

A

Atropine

Pralidoxime

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396
Q

2nd messenger promotes bronchoconstriction

A

IP3

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397
Q

2 most important stimuli for aldosterone release

A

Angiotensin II

High Potassium

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398
Q

Why is dopamine a different kind of vasopressors?

A

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

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399
Q

Pheochromocytoma: Which one is IV which one is PO

A

Phenoxybenzamine IV 0.5-1 mg/kg

Phentolamine IV 50-70 mcg/Kg IV

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400
Q

Treatment of EXCESS beta blockade

A

Glucagon 1-10 mg IV f/b 5mg/hr

Atropine incremental doses 7mcg/kg IV

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401
Q

Chronic exposure to agonist

A

DOWN regulation

402
Q

OB patient become hypotensive best vasopressor and why?

A

Ephedrine, does not decrease UBF

403
Q

CN IX and X arise from the

A

Medulla

404
Q

Parasympathetic arises from

A

CN III, VII, IX, X

405
Q

CN III arises from the

A

Midbrain

406
Q

CN VII fromthe

A

PONS

407
Q

MiPoMed

A

III, VII, IX , X
Midbrain
Pons
Medulla

408
Q

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

A

Cholinesterase inhibitor ECHOTHIOPHATE (used to treat glaucoma)

409
Q

Inhibitor of mast cell release

A

CROMOLYN SODIUM prevents mast cell release and bronchoconstriction.

410
Q

cAMP on bronchioles

A

Producs bronchodilation

411
Q

Insulin receptors contain an

A

Active tyrosine kinase domain

412
Q

What is the function of a kinase?

A

Catalyze the addition of a PHOSPHATE group to a substrate

413
Q

Not Innervated by a stellate ganglia

A

Bronchioles

414
Q

The substrate of phospholipase C is

A

Phosphatidylinositol 4,5 biphophate

415
Q

SSEPs are recorded from the electrodes placed over the

A

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

416
Q

SSEPs are recorded from the electrodes placed

A

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

417
Q

Peripheral nerve stimulation travel in the

A

Cuneatus and Gracillis tracts located in the posterior cord.

418
Q

Pathway of fast sharp pain

SAD-> Lissauer–>Lam 1-5–> Contraleteral STT –> Brain

A

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

419
Q

Pathway of fast sharp pain: what fibers

A

A delta

420
Q

Pathway of slow - CHRONIC pain

A

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.

421
Q

Lamina II is the

A

Substantia Gelatinosa (some sources say Lamina II and III)

422
Q

The major neurotransmitter released from A delta fibers is

A

Glutamate

423
Q

Glutamate binds to

A

AMPA and NDMA receptors on the Postsynaptic membrane.

424
Q

The major neurotransmitter released from C fibers is

A

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

425
Q

Major neurotransmitters release mnemonic

A

ADeG

C-Sub

426
Q

What Does Substance P bind to

A

Neurokinin-1

427
Q

Receptors responsible for sedation and dysphoria

A

Kappa

428
Q

Physical dependence opioid receptors

A

Mu-2

429
Q

Respiratory depression opioid receptors

A

Mu-2

430
Q

Opioid receptor for these 2 things not yet identifid

A

Miosis

N/V

431
Q

Opioid receptor responsible for Bradycardia and euphoria

A

Mu-1 receptor

432
Q

Arterial blood is delivered to the spinal cord

A

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

433
Q

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

A

Enkephalin

434
Q

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

A

Pituitary

435
Q

The brainstem and cerebellum are found in the

A

Posterior cranial fossa

436
Q

What fontanelle closes at about 2 “YEARS” of age

A

POSTEROLATERAL

437
Q

Another name for CEREBRAL STEAL

A

Luxury pefusion

438
Q

Muscles for chewing controlled by CN

A

VII

439
Q

What is coma?

A

Condition of non-arousal due to damage to the RAS

440
Q

CSF circulation route

A
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
441
Q

Site of formation of CSF

A

Lateral, Third and fourth ventricles

442
Q

Cyanosis is most likely to be seen in which patients?

A

Obesity hypoventilation syndrome

443
Q

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

A

D5W

444
Q

What is the initial dose of Dandrolene ?

A

2.5 mg/kg

445
Q

What % of soda lime canister should be air?

A

50%

446
Q

Uptake of 5 volatile to bottom

A
NDSIEH
Nitrous
Des
Sevo
Iso
Enflurane
Halothane
447
Q

What is the most common complication of mediatinoscopy?

A

Hemorrhage

448
Q

Neural pathways that CARRIES (not modulate pain)

A

ANTEROLATERAL

449
Q

Best ECG lead for initial assessment is

A

II

450
Q

Flat line CO2 waveform

A

Esophageal intubation

451
Q

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

A

Supraclavicular

452
Q

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

A

Nitrous oxide

453
Q

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

A

Phase 2

454
Q

What MR has antimuscarinic actions?

A

Pancuronium

455
Q

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

A

Radial

456
Q

Therapeutic plasma concentration of magnesium for Pregnancy induced HTN

A

4-6 mEq/L

457
Q

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

A

Hydralazine
Labetalol
Nitroprusside

NOT ESMOLOL

458
Q

3 conditions with Thrombocytopenia

A

Cancer
Liver disease with splenomegaly
Eclampsia

459
Q

2 agents to avoid if the patient is taking MAOIs?

A

Ketamine, Meperidine

460
Q

2nd heart sound is

A

closure of Aortic and pulmonic

461
Q

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

A

65%

462
Q

The most common cause of death associated with CAROTID ENDARTERECTOMy is

A

Myocardial infraction

463
Q

stick his tongue out:

A

hypoglossal nerve.

464
Q

shrug shoulders:

A

spinal accessory nerve

465
Q

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

A

Myocardial infraction

466
Q

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

A

DM and smoking

467
Q

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

A

Luschka

468
Q

Where is tissue damage greatest when using a tourniquet?

A

Under the tourniquet

469
Q

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

A

CL- diffuses in , K+ diffuses out

470
Q

Given to treat prolonged bleeding time?

A

Platelets

471
Q

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

A

Metabolic alkalosis

472
Q

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

A

46 mmHg (5x760/100)

473
Q

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

A
  1. 02

0. 067 mL CO2/100 mL blood/mm Hg;

474
Q

O2 saturation to PaO2 how i remember

A
  1. 70%
    50 80%
  2. 90%
475
Q

Normal adult Hb molecule (Hb A) consists of:

A

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

476
Q

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

A

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

477
Q

Henry’s law, which states that the

A

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

478
Q

What is the solubility of CO2?

A

0.07 mL CO2/100 mL blood/mm Hg;

479
Q

Henry’s law : dissolved CO2 increases

A

linearly with increases in PCO2

480
Q

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

A

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

481
Q

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

A

increases (the Haldane effect)

482
Q

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

A

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

483
Q

Methemoglobin:

– Has iron in the

A

oxidized form (Fe+++).

484
Q

The bond with carbon monoxide is

A

250 times stronger than the bond with oxygen.

485
Q

CO2

transported in the blood:

A

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

486
Q

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

A

Haldane effect

487
Q

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

A

20 times

488
Q

What is the primary determinant of the PAO2?

A

PO2 in the inspired gas

489
Q

Blood carries O2 in w ways

A

Physically dissolved in plasma

bound to hemoglobin

490
Q

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

A

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

491
Q

Sodium concentration is controlled primarily by

A

ADH

492
Q

The Virus most EASILY TRANSMITTED BY a BLOOD TRANSFUSION is

A

CMV (cytomegalovirus)

493
Q

Most frequently damaged nerve in LE

A

Common PERONEAL

494
Q

Physiologic alterations are least when the patient is

A

Supine

495
Q

Conus medullaris ends with adults at

A

L2

496
Q

Suspect MH first action

A

Turn of VA/ succinylcholine

497
Q

Motor innervation to the tongue?

A

HYPOGLOSSAL

498
Q

Why are sickle cell patients anemic?

A

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

499
Q

Avoid in anemic patients

A

Hypoxemia

500
Q

Most common inherited bleeding disorder is

A

Von willebrand’s disease

501
Q

MH is inherited in an

A

autosomal dominant pattern

502
Q

In excitable tissues, HYPOCALCEMIA generally promotes

A

DECREASE THRESHOLD

503
Q

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

A

Autonomic hyperreflexia

504
Q

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

A

Biiary tract obstruction

505
Q

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

A

DI , give desmopressin

506
Q

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?

A

Fentanyl

507
Q

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

A

UNDERGO THE FIRST PASS EFFECT (GI)

508
Q

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

A

Artery of adamkiewicz

509
Q

Conditions causing incorrect reading with the pulse ox

A

Hypotension
Carbon monoxide poisoning
Hypothermia

510
Q

Conditions NOT causing incorrect reading with the pulse ox

A

Fetal hemoglobin

511
Q

Z79 on tube means

A

nontoxic

512
Q

What Nerves are blocked first after onset of spinal anesthesia?

A

B fibers

Mnemonic (BC A-DGBA)

513
Q

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

A

HYPERPHOSPHATEMIA

514
Q

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

A

Bleeding time

515
Q

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

A

7.4

516
Q

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

A

Laplace

517
Q

At what age is the hgb concentration the lowest?

A

8- 12 weeks

518
Q

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

A

Motor end plate of NMJ is immature

519
Q

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

A

DOT

520
Q

Current guidelines for treating SAH induced Cerebral vasospasm?

A

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

521
Q

Which change will most profoundly increase intraocular pressure?

A

Increase CVP

522
Q

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

A

Mass Spectrometer

523
Q

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

A

posterior

524
Q

Decreases the seizure threshold?

A

Hypocarbia (Think about when you hyperventilate for ECT)

525
Q

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

A

GoWN

526
Q

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

A

TACHYCARDIA

527
Q

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

A

Forced air warmer

528
Q

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

A

Sedatives

529
Q

The purpose of unidirectional valves in the circle system is to

A

Prevent rebreathing of exhaled gases

530
Q

What chemotherapeutic causes severe injury to the lung?

A

Bleomycin

531
Q

The most frequent lawsuit involving the anesthetist relates to

A

Airway management

532
Q

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

A

Sodium Nitrate
Amyl Nitrate
Sodium Thiosulfate

DO NOT GIVE CALCIUM GLUCONATE

533
Q

Whose law explains the 2nd gas effect?

A

Fick’s

534
Q

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

A

Glutaraldehyde

535
Q

The dilutional effect occurs during which phase of anethesia?

A

Emergence

536
Q

Normal umbilical vasculature

A

2 arteries , one vein

537
Q

Antilipidemic agnets best describedas a BILE ACID SEQUESTRANT

A

Cholestyramine

538
Q

May be detected using a minimum pressure alarm except:

A

Increase in resistance

539
Q

The patient with Type A blood has

A

Anti-B antibodies

540
Q

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

A

Aortic stenosis

541
Q

Ankylosis spondylitis has the following neurologic complications

A

Cauda Equina syndrome
Atlantlo-occipital subluxation
Spinal cord compression

542
Q

Uvula cannot be visualized MAllampati is

A

3

543
Q

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

A

192 ml

544
Q

5-HT3 Receptor antagonist is what type of receptor

A

Inotropic

545
Q

3 endocrine functions of the kidney

A

Erythropoietin
RAAS
Vit D

546
Q

Largest: What Amount of Glomerular filtrate reabsorbed where?

A

67% of filtrate reabsorbed in PROXIMAL TUBULE

547
Q

Poorly reabsorbed by the renal tubules

A

Urea, uric acid, creatinine , phosphate, sulfate

548
Q

Exquisite control of water excretion

A

ADH

549
Q

UO and DM

A

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

550
Q

Where is ADH synthesized

A

Paraventricular and SUPRAOPTIC nuclei of the HYPOTHALAMUS.

551
Q

Stimulate release of Vasopression from posterior pituitary

A

Nerve action potentials

552
Q

Explain how ADH gets released?

A

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.

553
Q

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

A

Increase in ECF osmolality (kg)

554
Q

OSMOLARITY vs OSMOLALITY

A

Think OSMO- LARRY DRINKS A LITER

LALI KILLS HIM (LALI - KILO)

555
Q

In the absence of ______ the ____and_____are impermeable to water

A

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

556
Q

When circulating ADH is HIGH

A

Small volume of CONCENTRATED URINE (1200-1500)

557
Q

When circulating ADH is LOW

A

LARGE volume of Dilute URINE (50-100 mOsm)

558
Q

Increases the permeability of the distal and collecting tubules to water

A

ADH

559
Q

Most common cause of Diabetes insipidus is

A

Failure of ADH synthesis or release (Central )

Insensitivity of the distal and collecting tubules to ADH

560
Q

With increase ADH , urine OSMOLARITY is _____ volume is ______

A

HIGH ; Low

561
Q

With decrease ADH , urine OSMOLARITY is _____ volume is ______

A

LOW: HIGH

562
Q

SIADH can be caused by

A

Hypothyroidism

Small (oat’s cell carcinoma)

563
Q

Diagnostic of SIADH

A

Increase urine Na+ and osmolality wit HYPONATREMIA

and decrease plasma osmolality

564
Q

Determines ECF volume

A

Sodium content

565
Q

Most important for regulating ECF volume

A

Aldosterone

566
Q

Creatinine clearance measures what

A

GFR

567
Q

Resp alkalosis and free ionized calcium

A

Free ionized calcium decreases

568
Q

Hyperventilating patients 2 electrolyte abnormalities are

A

HYPOKALEMIA and HYPOCALCEMIA(decrease free calcium)

569
Q

ph is determined by

A

HCO3 and PaCO2 (ratio of HCO3 to PaCO2)

570
Q

Normal HCO3

A

22-27

571
Q

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

A

Resp disturbance

572
Q

Complete compensation cannot be achieved if there is

A

Metabolic acidosis or metabolic alkalosis

573
Q

Most susceptible to ischemia , what region of the kidney?

A

Inner stripe of outer medulla.

574
Q

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

A

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

575
Q

The loop of HENLE act as a

A

COUNTERCURRENT MULTIPLIER and CREATES OSMOTIC GRADIENT.

576
Q

What hormone control Extracellular fluid volume?

What hormone control EXTRACELLULAR SODIUM concentration?

A

ALDOSTERONE

ADH (sodium)

577
Q

ECF Water follows

A

Sodium

578
Q

ECF volume follows

A

Aldosterone

579
Q

Combinaion of ANP and Aldosterone that lead to highest sodium excretion

A

Low aldosterone, HIGH ANP

580
Q

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

A

HIGH

581
Q

Not seen with CRF (electrolyte imbalance)

A

HYPERCALCEMIA

582
Q

Which diuretic prevent bicarbonate in the proximal tubule.

A

ACETAZOLAMIDE

583
Q

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

A

HYPERkalemia

HYPOCALCEMIA

584
Q

Why is hypokalemia a side effect of mannitol administration?

A

Promotes a HIGHER FLOW RATES through the distal tubules.

585
Q

Common side effect of erythropoietin treatment in Chronic renal patients?

A

Shortened bleeding times
HTN
Decrease intensity of pruritus

586
Q

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

A

HTN

587
Q

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

A

HYPERKALEMIA

588
Q

Which treatmet of HYPERKALEMIA does not correct the underlying ion imbalance

A

Calcium administration

589
Q

Normal RMP is

A

-70 mV

590
Q

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

A

NEGATIVE (-60mv, -50) so hyperpolarize

591
Q

Normal EXTRACELLULAR K+

A

4 mEq

592
Q

Normal INTRACELLULAR K+

A

140 mEq

593
Q

Normal EXTRACELLULAR Na+

A

145 mEq

594
Q

Normal INTRACELLULAR Na+

A

10 mEq

595
Q

Major INTRACELLULAR ANION

A

Phosphate

596
Q

With acute hyperkalemia cells

A

Depolarize (-60, -50- -40)

597
Q

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

A

AXON and are concentrated in the nodes of RANVIER.

598
Q

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

A

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.

599
Q

Responsible for depolarizing the AXON

A

Diffusion of sodium into the cells

600
Q

Repolarization of the axone

A

Diffusion of POTASSIUM ions out fht ecells.

601
Q

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

A

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

602
Q

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

A

POSITIVE; fade

603
Q

Events at NMJ, ions go in and what comes out

A

Sodium and Calcium goes in

K diffuses out

604
Q

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

A

Entry into the terminal of calcium ions

605
Q

______comes in , neurotransmitter comes out

A

Calcium

606
Q

Hypocalcemia and neurotransmitter release?

A

Decrease the amount of neurotransmitter released vice versa

607
Q

Hypomagnesemia and neurotransmitter release?

A

INCREASE amount of neurotransmitter release.

608
Q

Hypermagnesemia and neurotransmitter release?

A

Decrease the AMOUNT OF NEUROTRANSMITTER RELEASE

609
Q

2 ions with ANGONISTIC EFFECTs at nerve terminals?

A

Calcium and magnesium.

610
Q

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

A

2

611
Q

Plasma cholinesterase aka

A

Butyrylcholinesterase.

612
Q

What are the MONOQUATERNARY Aminosteroids?

A

Vec and roc

613
Q

What are the BISQUATERNARY Aminosteroids?

A

Pancuronium

614
Q

What are the BisQUATERNARY Benzylisoquinoliniums?

A

Atracurium, Cis-atracurium

615
Q

Potency of MR is

A

relationship between twitch depression and dose

616
Q

ED95% of Muscle relaxants represents

A

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

617
Q

MR with BILIARY as primary route of elimination

A

VEC and ROC

618
Q

MR with METABOLISM as primary route of elimination

A

Succ, atra, cisatra, miva

619
Q

Atracurium is eliminated by

A

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

620
Q

HOFFMAN elimination ONLY

A

Cis-atracurium (NON specfic estarases NOT INVOLVED)

621
Q

Succinylcholine produces bradycardia why?

A

Because it directly stimulates muscarinic receptors of the SA node.

622
Q

MR that causes significant HTN

A

Pancuronium , GALLAMINE

623
Q

MR that elicits histamine S

A

Succinylcholine
Mivacurium
Atracurium, d-tubocurarine, metocurarine.

624
Q

MR with reflex tachycardia

A

d-tubocurarine, metocurarine.

625
Q

Succinylcholine and K+ increase in normal patients

A

0.5 mEq/L

626
Q

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

A

5-10 mEq/L

627
Q

Defect in MH is

A

Mutation in RyR1 of the SR of skeletal muscle.

628
Q

Earliest and most sensitive and specific signs of MH

A

Elevation of ETCO2

629
Q

Why isnt cardiac muscle directly involved in MH

A

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

630
Q

Hypokalemia and NMB (BLock increased/decreased)

A

block increased

631
Q

ABT that increased NDNMBLock

A

Neomycin
Streptomycin
GENTAMYCIN
Tetracycline

632
Q

PCN affect NDNMB block

A

NO

633
Q

Cephalosporins , tetracyclines on block

A

no effects

634
Q

LA on NDNMB block

A

increased

635
Q

VA on NDNMB

A

Increased

636
Q

LA on Succ block

A

Increased

637
Q

Anticholinestease agents on succinylcholine block

A

INCREASED

638
Q

DEFAULT ANSWERS for block

A

INCREASED

639
Q

TOF , how many stimuli, how long, strength

A

4 stimuli, 0.5 sec 2 Hz

640
Q

What % of receptor occupied when TV returns to normal

A

75-80 %

641
Q

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

A

75-80%

642
Q

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

A

95% NO TRAIN OF FOUR TWITCHES

643
Q

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

A

90% ; 1

644
Q

What % of receptor occupied when no palpable fade in TOF

A

70-75%

645
Q

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

A

50%

646
Q

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

A

HYPOMAGNESEMIA

647
Q

The presynaptic action of succinylcholine

A

ENHANCES IT POST SYNAPTIC ACTION>

648
Q

MR with ANTIMUSCARINIC ACTIONS

A

PANCURONIUM

649
Q

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

A

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

650
Q

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

A

BOTH increased.

651
Q

Characteristic of a NDNMB

A

T4/T1 < 70%

Post tetanic facilitation present

652
Q

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

A

NUMBER INCREASES in DENERVATED SKELETAL MUSCLE

653
Q

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

A

By metabolism and renal excretion

654
Q

With a nondepolarizing block, DBS produces

A

2 unequal fading twitches

655
Q

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

A

75%

656
Q

Predominant neutransmitter in the periphery?

A

Ach.

657
Q

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

A

SWEAT GLANDS>

658
Q

Nicotinic ACh receptors are

A

Ionotropic

659
Q

Muscarinic ACh receptors are

A

METABOTROPIC

660
Q

Throbbing apin and temperature

A

dC fibers

661
Q

Conduct with greater velocities Myelinated vs unmyelinated

A

Myelinated nerve

662
Q

Conduct with greater velocities ; small or large diameter

A

Larger diameter at greater velocities

663
Q

Sympathetic and parasympathetic preganglionic neurons are

A

B fibers

664
Q

Stellate ganglion is formed by

A

Inferior cervical

First thoracic ganglia

665
Q

Sympathetic outflow is

A

Thoracolumbar

666
Q

Horners syndrome

A

Ptosis, Miosis, anhydrosis
Increased skin temperature
Ipsilateral MIOSIS

667
Q

**All sympathetic PREGanglionic fibers pass through

A

WHITE RAMI

668
Q

Some but not all sympathetic POSTganglionic fibers pass through

A

GRAY RAMI

669
Q

GRAY RAMI are distributed to

A

ALL SPINAL NERVES FROM THE GANGLIA

670
Q

GRAY RAMI allows

A

COORDINATED, mass discharge of the SNS

671
Q

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

A

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

672
Q

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

A

20%; 80%

673
Q

Release of NE

A

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

674
Q

What is required to release neurotransmitter?

A

Calcium.

675
Q

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

A

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

676
Q

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

A

Diffusion of the ligand away from the receptor.

677
Q

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

A

REUPTAKE; 80%

678
Q

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

A

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.
679
Q

SA nodes receptors; Increase chronotropy through

A

Beta-1

680
Q

AV node receptors: Dromotropy

A

Beta-1

681
Q

Muscle fibers : INotropy

A

Beta 1

682
Q

Arterial Blood vessels Vasoconstriction

A

ALPHA-1

683
Q

Skeletal muscle relaxation

A

Beta -2

684
Q

Veins : Vasoconstriction through what receptor

A

Alpha1

685
Q

Kidney : RENIN release increase through what receptor

A

Beta 1

686
Q

Kidney : RENIN release decrease through what receptor

A

Alpha 1

687
Q

Liver Glycogenolysis and Gluconeogenesis: Through what recepto

A

Beta-2

688
Q

Uterus relaxation through what receptor

A

Beta 2

689
Q

Na-K PUMP stimulates pump through what receptor

A

Beta-2

690
Q

2 most important stimuli for aldosterone release are

A

Angiotensin II

High Serum Potassium

691
Q

Renin release occurs in response to

A

Decrease renal BP (renal artery stenosis)

Increase SNS activity and Chloride

692
Q

Clonidine is an

A

Alpha -2 AGONIST

693
Q

Phenylephrine is an

A

ALPHA -1 agonist

694
Q

Dobutamine receptor stimulated

A

BETA 1

695
Q

Isoproterenol receptor stimulated

A

Beta 1 , and Beta 2

696
Q

Norepinephrine receptors stimulated

A

Alpha 1, Alpha 2, beta 1

697
Q

Does NE have any beta 2 activity?

A

NO

698
Q

Dopamine receptor stimulated

A

Alpha 1, Alpha2, Beta 1

699
Q

Ephedrine (JUSt LIKE METARMINOL) receptors stimulated

A

Alpha 1, alpha 2, Beta 1, Beta 2

700
Q

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

A

Metaraminol
Ephedrine
Mephentermine

701
Q

Diastolic arterial Blood pressure changes in the same direction as

A

Systemic vascular resistance

702
Q

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

A

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

703
Q

Guanethidine (Ismelin) is

A

No longer in the UNITED STATES

704
Q

Phenoxybenzamine is

A

Alpha 1 and Alpha 2 antagonists

705
Q

Prazosin is a

A

Alpha 1 antagonists ONLY alpha 1

706
Q

Labetalol block what receptors

A

Alpha 1

Beta 1 and Beta 2

707
Q

Labetalol alpha receptor

A

Alpha 2

708
Q

PROPRANOLOL BETA SELECTIVE

A

NO

BETA-2 BLOCKED STRONGER THAN BETA 1

709
Q

YOHIMBINE type of mediction

A

Selective Alpha 2 adrenergic antagonists u

710
Q

What is YOHIMBINE used to treat?

A

Impotence.

711
Q

Side effects of Beta Antagonists on bronchioles

A

Bronchoconstriction

712
Q

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

A
Ketamine 
Enflurane
Halothane
Opioids
KEHO-

I=S=D

713
Q

2 drugs to avoid with MAOIs

A

Meperidine

Ephedrine

714
Q

Ridodrine is a

A

tocolytic

715
Q

Ritodrine is a

A

Beta-2 adrenergic receptor agonist

716
Q

Beta 2 adrenergic agonist, 3 side effects

A

Hyperglycemia
Hypokalemia
Tachycardia

717
Q

System that is ESSENTIAL for the MAINTENANCE OF LIFE

A

Parasympathetic nervous system.

718
Q

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

A

LOWER esophagel sphincter tone

719
Q

2 Antimuscarinic (Anticholinergics) with the most sedation?

A

Scopolamine, Atropine,

720
Q

Antimuscarinic (Anticholinergics) with the NO sedation

A

Glycopyrrolate

721
Q

Antimuscarinic (Anticholinergics) with the MOST Antisialalogue

A

Scopolamine

722
Q

Antimuscarinic (Anticholinergics) with the LEAST Antisialalogue

A

Atropine

723
Q

Antimuscarinic (Anticholinergics) with the MOST MYDRIASIS CYCLOPEGIA

A

Scopolamine

724
Q

Antimuscarinic (Anticholinergics) with the PREVENTION of MOTION SICKNESS

A

SCOPOLAMINE

725
Q

What can cause anticholinergic syndrome occurs?

A

High doses of atropine or scopolamine

726
Q

Anticholinergic syndrome treatment?

A

Physostigmine (antilirium) 15-60 mcg/kg IV

727
Q

cAMP on bronchioles

A

Vasodilation

728
Q

The effects of ephedrine are due mostly to its

A

Stimulation of the nerve terminal to release norephinephrine

729
Q

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

A

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

730
Q

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

A

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

731
Q

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

A

By communicating channels called white and gray rami communicans.

732
Q

Preganglionic fibers arises from the

A

Intermediolateral horn of the spinal cord.

733
Q

What are the 2 division of the PNS

A

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

734
Q

The basilar artery is supplied by the

A

Right and left vertebral arteries

735
Q

All circle of willis arteries are paired except

A

Basilar

Anterior communicating

736
Q

The MAJOR vessels of the circle of willis

A

Right and left INTERNAL CAROTID arteries

BASILAR artery

737
Q

VA;CBF _____CMRO2

A

Increase, Decreases

738
Q

IV anesthetics of CMRO2, and CBF? Exception is

A

decreases; ketamine

739
Q

The only IV anesthetic increases both CMRO2 and CBF

A

Ketamine

740
Q

The only GAS anesthetic increases both CMRO2 and CBF

A

Nitrous Oxide

741
Q

Major souRce of BLOOD of the spinal cord is the

A

ANTERIOR SPINAL ARTERY

742
Q

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

A

75% of the blood

743
Q

3 blood supplies of the spinal coard

A

1 Anterior
2 POSTERIOR
small segmental spinal arteris.

744
Q

Artery of adamkiewics enter from the

A

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

745
Q

Provide the lower 2/3 of anterior spinal cord

A

Artery of Adamkiewicz.

746
Q

What is inverse steal called also

A

Robin Hood, reverse steal)

747
Q

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

A

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>

748
Q

Improves blood flow to ISCHEMIC BRIAN

A

HYPERVENTILATION

749
Q

CEREBRAL steal aka

A

Luxury perfusion

750
Q

What is CEREBRAL STEAL?

A

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

751
Q

What bone houses the sella turcica

A

sphenoid

752
Q

Frontal lobes rest on this fossa

A

Anterior cranial fossa

753
Q

Temporal lobes rest on this fossa

A

Middle cranial fossa

754
Q

Brain stem and cerebellum rest on

A

Posterior cranial fossa

755
Q

What is the correct positioning of a single orifice catheter is

A

3cm above the JUNCITON OF THE SVC -atrialjunciton

756
Q

What is the correct positioning of a MULTI ORIFICE

A

2 cm below the SVC-ATRIAL JUNCTION

757
Q

Wave that represents ventricular repolarization

A

T wave

758
Q

Precise activity of this wave unknown

A

U wave

759
Q

Atrial repolarization wave

A

QRS complex

760
Q

Ventricular depolarization wave

A

QRS compex.

761
Q

Action potentilas that are biphasic

A

in the SA node and in the AV nodes

762
Q

Action potentials with plateau phases are found is

A

Atrial muscle cells and ventricular muscle cells.

763
Q

What causes change in the HR?

A

Slope of phase 4 depolarization.

764
Q

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

A

Phase 4

765
Q

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

A

Phase 4

766
Q

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

A

Phase 2

767
Q

What is the first negative deflection of the ECG

A

Q wave

768
Q

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

A

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
769
Q

First positive deflection of ECG

A

R wave

770
Q

A negative deflection following the R wave is the

A

S wave

771
Q

On ECG each mm is

A

0.04 seconds

772
Q

QRS complex results from ventricular depolarization which is phase

A

0

773
Q

T wave results from ventricular repolarization

A

Phase 3

774
Q

QT interval reflects duration of

A

Plateau phase, Phase 2

775
Q

Hypocalcemia on QT

A

PROLONGED

776
Q

Hypercalcemia on QT

A

SHORTENEDED>

777
Q

U waves reflect

A

HYPOKALEMIA

778
Q

MAP is determined by 2 factors

A

CO and SVR

779
Q

SV is determined by 3 factors

A

Preload, afterload , contractility

780
Q

Preload is determined by 3 factors: IVV

A

Intravascular volume, Venous tone, Ventricular compliance

781
Q

The major determinant of Intravascular volume is

A

AMOUNT OF SODIUM IN THE BODY

782
Q

With an increase in preload, filling

A

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

783
Q

With a decrease in preload, filling

A

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

784
Q

What provides evidence of the increased in EDV?

A

INCREASE PULMONARY CAPILLARY WEDGE PRESSURE

785
Q

Cardiac tamponade on preload

A

Decrease

786
Q

When afterload increases, what happens to SV?

A

Decreases

787
Q

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

A

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

788
Q

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

A

Decrease (because the ventricular chamber sHRINKS when afterload decreases)

789
Q

When afterload decreases, what happens to SV?

A

Increases

790
Q

Pressure loop with an increase afterload,

A

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

791
Q

Pressure loop with an decrease afterload,

A

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

792
Q

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?

A

LVEDV

793
Q

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

A

Beta-1 agonist

794
Q

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

A

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

795
Q

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

A

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

796
Q

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

A

AORTIC INSUFFICIENCY

797
Q

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

A

Acute small loop

CHRONIC BIG ass LOOP and almost covers whole

798
Q

Chronic aortic insufficiency is associated with

A

Eccentric (VOLUME)

799
Q

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

A

NOT ISOVOLUMETRIC

800
Q

HOw to remember mitral vs aortic changes

A

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

801
Q

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

A

VAGUS nerve (think AV)

802
Q

Control of BP -> Baroreceptor reflex

A

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

803
Q

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

A

HERING’S NERVE branch of the GLOSSOPHARYNGEAL

804
Q

Hering’s nerve is a branch of the

A

GLOSSOPHARYNGEAL

805
Q

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

A

CAROTID and are primarily responsible for minimizing acute BP alterations

806
Q

Efferent of baroreceptors are the

A

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

807
Q

Fluid flow when there is

A

Pressure gradient

808
Q

Flow is________to the pressure gradient

A

directly proportional to the pressure gradient

809
Q

CO and the area under the curve

A

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

810
Q

3 mechanisms of edema formation

A

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

811
Q

Myocardial Oxygen SUPPLY

A

HR
O2 content,
Coronary vascular resistance
Diastolic BP

812
Q

Myocardial Oxygen Demand

A

HR and SV (preload, contractily , afterload)

813
Q

A venodilator only

A

Nitroglycerin

814
Q

Arterial and venous dilator

A

Nitroprusside

815
Q

Arterial Dilator

A

Hydralazine.

816
Q

Action of inamrinone (Inocor); milrinone (primacor)

A

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

817
Q

Adenosine an endogenous

A

Nucleotide occurring in all cells in the body.

818
Q

Adenosine works by

A

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

819
Q

Elimination half time of Adenosine____why?

A

Less than 10 seconds; owing to rapid metabolism

820
Q

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

A

Bundle Branch block.

821
Q

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

A

increase in stroke volume, and increase in diastolic volume.

822
Q

DIlated LV with unusually LV volume

A

Chronic Aortic stenosis.

823
Q

Isosorbide dinitrate stimulates

A

Nitric oxide mediated vasodilation

824
Q

Isosorbide dinitrate work by

A

donates nitrix oxide molecules to vessel wall.

825
Q

Oppose systemic edema formation

A

Dehydration

826
Q

MI patient who is also HYPOTENSIVE which treatment

A

PHENYLEPHRINE.

827
Q

Pulse pressure highest in which vessels

A

Dorsalis pedis artery

828
Q

Selectively induces venous, but not arterial dilation

A

Nitroglycerin

829
Q

Hypertrophic cardiomyopathy accompanied by

A

LVOT

830
Q

Pathophysiology of hypertrophic cardiomyopathy

A

Diastolic dysfunction reflected by HIGH LVEDP.

831
Q

In HCM,what is narrowed

A

Subaortic area is narrowed.

832
Q

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

A

Increased contractility

833
Q

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

A

Decreased contractility

834
Q

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

A

Decreased preload (hypovolemia, TACHYCARDIA)

835
Q

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

A

increase preload

836
Q

How does PPV affect HCM LVOT

A

Worsened because it decreases preload

837
Q

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

A

Afterload INCREASE
PRELOAD INCREASE
Increase contractility

838
Q

Arterial waveform associated with LVOT

A

bisferiens pulse

839
Q

Can cause regurgitation

A

Aortic annulus dilation

840
Q

Regurgitant volume of acute aortic regurgitation depends on

A

HR and diastolic pressure gradient.

841
Q

Regurgitant volume of acute aortic regurgitation depends on

A

HR

Diastolic pressure gradient across the valve

842
Q

Initial symptoms of aortic regurgitation

A

Exertional dyspnea
Orthopnea
PND (Paroxysmal nocturnal dyspnea)

843
Q

Acute Aortic regurgitation presents as a sudden onset of

A

Pulmonary edema and hypotension

844
Q

Signs of CV collapse with acute aortic regurgitation

A

Severe dyspnea, hypotension, weakness.

845
Q

Chronic aortic regurgitation pulse pressure

A

widened

846
Q

AR best vasopressor

A

Ephedrine.

847
Q

Symptomatic progression of MR : mild symptoms

A

regurgitant factors < 30%

848
Q

Symptomatic progression of MR : moderate symptoms

A

regurgitant factors 30-60%

849
Q

Symptomatic progression of MR: SEVERE SYMPTOMS

A

regurgitant factors >60%

850
Q

Blowing holosystolic murmur

A

MR

851
Q

Best heart at apex

A

MR

852
Q

Radiation the axilla

A

MR

853
Q

MR and neuraxial

A

well tolerated but avoid bradycardia

854
Q

Normal aortic valve area

A

2.5 - 3.5 cm2

855
Q

Severe AS valve area

A

0.8 - 1 cm2

856
Q

Critical severe AS

A

0.5-0.8 cm2 WITH a transvalvular gradient of 50 mmHg

857
Q

Critical Severe AS transvalvular gradient i

A

50 mmhg

858
Q

Classic symptoms of Aortic stenosis

A

SAD NECK
Syncope
Angina
Dyspnea (DOE)

Murmur radiates to neck

859
Q

Severe AS what is contraindicated

A

Spinals and epidurals.

860
Q

Avoid this IV anesthetic in AS

A

Avoid ketamine

861
Q

Normal mitral valve area

A

4-6 cm2

862
Q

For mitral stenosis, which neuraxial is preferred and why?

A

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

863
Q

Mitral stenosis vasopressor preferred

A

Phenylephrine because lack beta adrenergic activity.

864
Q

Murmur MASTER

A

ARDS
MRSA
MSDA
ASS Arch

865
Q

With Mitral stenosis, enlarged LA effects

A

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

866
Q

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

A

Less than 2 cm2

867
Q

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

A

Increasing EDV

868
Q

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?

A

FRANK STARLING

869
Q

MR has a regurgitant volume that is based on

A

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

870
Q

Mitral Regur management : Preload

A

Maintain or slighly increase preload.

871
Q

Aortic stenosis is associated with _____SV how come?

A

Maintained SV because of Ventricular concentric hypertrophy

872
Q

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

A

R wave

873
Q

Diastolic murmur best heart at the left sternal border

A

AR

874
Q

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

A

< 40% of SV; > 60%

875
Q

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

A

Asynchronus pacing , turn ICD off

876
Q

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

A

Ventricular septum

877
Q

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

A

Mid-to-late systole.

878
Q

What does von willebrand’s do or promote

A

Platelet adhesion

879
Q

Von willebrands factor is manufactured by

A

Endothelial cells

880
Q

Von willebrands factor is released by

A

Endothelial cells

881
Q

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

A

DDAVP

882
Q

Among numerous mediators released from the activated platelets are 2

A

THROMBOXANE A2 and ADP

883
Q

Role of thromboxane A2 and ADP

A

promotes platelet aggregation

884
Q

What activate the platelet

A

Thrombin (aka factor II)

885
Q

The platelet after being activated by thrombin releases

A

Thromboxane A2 and ADP which promotes platelet aggregation

886
Q

Thromboxane A2 and ADP promotes platelet aggregation by

A

binding to receptors and activating signal transduction

887
Q

What actually aggregates the platelets

A

FIBRINOGEN (FACTOR I)

888
Q

NSAIDS vs ASA

A

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

889
Q

The acetyl group of ASA causes

A

Acetylation of cyclooxygenase.

890
Q

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

A

Cyclooxygenase

891
Q

Tirofiban (aggrastat) discontinue how long before surgery

A

24 hours

892
Q

Abciximab (reopro) discontinue how long before surgery

A

3 days (72 hours)

893
Q

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

A

D/C 24 hours before surgery.

894
Q

The most common acquired blood clotting defect is due to

A

Inhibition of cyclooxygenase production by ASA or NSAIDS.

895
Q

Source of the PRO-coagulant fibrinogen (I)

A

LIVER

896
Q

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

A

LIVER

897
Q

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

A

Vascular wall and extravascular cell membranes

898
Q

Source of the PRO-coagulant CALCIUM (IV)

A

DIET

899
Q

Source of the PRO-coagulant von willebrand (VIII)

A

ENDOTHELIAL CELLS

900
Q

Vit K dependent factors

A
2, 7, 9, 10  (Procoagulants)
Anticoagulants factors (C+S)
901
Q

Fibrin Stabilizing factor is factor

A

XIII

902
Q

What are the 3 factors NOT MADE in the livet

A

VIII(vwf); III, IV (348)

903
Q

How do you remember extrinsic pathway

A

For 37 cents you can have the extrinsic pathway.

904
Q

How do you remember intrinsic pathway

A

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

905
Q

How do you remember COMMON PATHWAY

A

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

906
Q

2 Labs that assess extrinsic pathway

A

PT/ INR

907
Q

Med that interfere with extrinsic pathway

A

Ex means war

WARFARIN

908
Q

2 Labs that assess intrinsic pathway

A

PTT

ACT

909
Q

Med that interfere with intrinsic pathway

A

HEPARIN

910
Q

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

A

The history

911
Q

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

A

lack of functioning platelets.

912
Q

All procoagulants except ______ are present in _____

A

All procoagulants except PLATELETS are present in FFPs.

913
Q

RBC and increase in Hct

A

1cc/kg of RBC increase HCT by 1%

914
Q

One unit of RBCs increase HCT by

A

3-4%

915
Q

Appropriate heparinization indicated by ACT of

A

400seconds - 450 seconds

916
Q

What is normal bleeding time

A

3-10 minutes

917
Q

PT normal

A

12-14 secon

918
Q

aPTT normal

A

25-35

919
Q

PTT assess what pathways

A

Intrinsic + common

920
Q

ACT normal

A

80-150

921
Q

Plasminogen to it active form which is

A

PLASMIN

922
Q

What converts plasminogen to plasmin?

A

Tissue type plasminogen activator (tPA)

Urokinase type plasminogen activator. (upa)

923
Q

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

A

Breaks down fibrin to Fibrin degradation products.

924
Q

Two medication that works by inhibiting plasmin

A

Amicar

Aprotinin

925
Q

When plasmin is inhibited , fibrin that is formed is

A

breaks down slowly, so bleeding is decreased.

926
Q

Most common cause of an isolated high PT

A

LIVER DISEASE>

927
Q

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

A

II (thrombin)

928
Q

Cryopreciptate contains what factors

A

I,8, 13

929
Q

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

A

Lack of functioning platelets (THROMBOCYTOPENIA)

930
Q

How does protamine work to reverse heparin?

A

PROTAMINE combines ELECTROSTATICALLY with heparin, a neutralization reaction

931
Q

3 substances that convert plasminogen to plasmin

A

uPa
tPa
streptokinase

932
Q

How does coumadin work?

A

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

933
Q

How does heparin work?

A

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

934
Q

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

A

standardized skin bleeding time

935
Q

Enzyme that break down fibrin

A

Plasmin

936
Q

Average life span of platelets in NORMAL BLOOD

A

8-12 days

937
Q

Average life span of platelets in TRANSFUSED BLOOD

A

1-2 days

938
Q

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

A

GP 1B

939
Q

1st line tx of von willebrand’s disease is

A

DDAVP

940
Q

How does Eptifibatide inhibit platelet aggregation?

A

RECAPS fibrinogen receptor on platelets

941
Q

Oral corticosteroids may inhibit platelet aggregation because steroids

A

Prevent PHOSPHOLIPASE A2 from acting on membrane phospholipids

942
Q

Thrombin induces a _____Feedback cycle in secondary hemostasis

A

POSTIVE

943
Q

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

A

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

944
Q

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

A

Postions clotting factors on platelet surface

945
Q

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

A

Cryoprecipitate

946
Q

Molecule that inhibits plasmin activity

A

APROTININ

947
Q

Common precipitating factor for DIC

A

Ischemia

948
Q

The most common cause of an ISOLATED PT value is

A

Liver disease.

949
Q

External branch of the SLN innervates the

A

Cricothyroids muscle

950
Q

What is the MAJOR MOTOR nerve of the larynx

A

RECURRENT LARYNGEAL nerve

951
Q

What is the MAJOR SENSORY nerve of the larynx

A

Internal branch of the superior laryngeal nerve.

952
Q

aBDucts Vocal cords (take out back door)

A

Posterior cricoarytenoids.

953
Q

aDDUCT vocal cords

A

Lateral cricoarythenoids

954
Q

Which closes the rima glottidis?

A

Transverse

955
Q

Tense Vocal cords

A

cricoThyroid (TENSE)

956
Q

Relax vocal cords

A

thyroiaRytenoids (they relax)

957
Q

Widens the inlet *ThyroW

A

THYROEPIGLOTTICS

958
Q

Narrows inlet (ARINA)

A

Aryepiglottics

959
Q

Damage to the external branch of the SLN

A

weakness and huskiness of the voice

960
Q

Damage to the Ext. branch of the SLN nerve paralyzed

A

Cricothyroid

961
Q

Unilateral RIGHT RLN damage characterized by

A

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

962
Q

What is the most common injury after a SUBTOTAL THYROIDECTOMY?

A

Unilateral RIGHT RLN damage

963
Q

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

A

Unilateral RLN paralysis

964
Q

Unilateral RLN paralysis signs

A

Hoarseness

965
Q

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

A

Bilateral RLN paralysis

966
Q

Bilateral RLN paralysis signs

A

APHONIA (LOST OF SPEECH)

AIRWAY OBSTRUCTION

967
Q

Normal P 50

A

26-28 mmHg

968
Q

PaO2 to SaO2

A

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

969
Q

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

A

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.

970
Q

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

A

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.

971
Q

Fetal hgb on the Oxyhemoglobin dissociation curve

A

Left

972
Q

Maternal hgb on the Oxyhemoglobin dissociation curve

A

RIGHT

973
Q

Leftward shift

A

All weird hemoglobin (Fetal, carboxyhgb, methemoglobi)

974
Q

P50 increases when there is a (

A

RIGHT SHIFT

975
Q

P50 decrease when there is a

A

LEFT SHIFT

976
Q

What is the Bohr effect?

A

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

977
Q

Opioids shift the hgb to where?

A

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

978
Q

Leftward shift

A

LOVE (loading O2 love )

979
Q

Rightward shift

A

RELEASE (unload) O2

980
Q

Dissolved O2 makes

A

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

981
Q

Calculating the amount of dissolved oxygen in the blood

A

PaO2 x 0.003 at 37C

982
Q

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

A

Henry’s law.

983
Q

O2 carried in 2 forms

A

Dissolved

hgb bound

984
Q

if you’re given the SaO2, use it to

A

estimate partial pressure

40-90 rule

985
Q

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

A

0.12

986
Q

What is the HALDANE EFFECT?

A

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

987
Q

The CO2 dissociation curve shifts UP to the left when

A

PO2 decreases

988
Q

The CO2 dissociation curve shifts DOWN to the RIGHT when

A

PO2 increases

989
Q

Breakdown of how Co2 is carried in the blood?

A
5% dissolved in plasma water
3% dissolved in RBC water
2 CARBAMINOHGB
20% in RBCs
HCO3 in plasma 70%
990
Q

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

A

HCO3.

991
Q

CO2 is carried in the blood in 3

A

Dissolved
As BICARBONATE
chemically bound to plasma proteins and hgb.

992
Q

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

A

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

993
Q

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

A

Henry’s LAW.

994
Q

The central chemoreceptors are stimulated by

A

Increased H+

995
Q

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

A

Increase in cerebral spinal CO2

996
Q

What drives respiration normally?

A

CO2

997
Q

Peripheral chemoreceptors are stimulated by

A

Increased PCO2, Decreased pH or decreased PaO2 < 60 mmHg

998
Q

The glossopharyngeal nerves carries_______while the vagus nerve carries ______

A

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)

999
Q

What is the INSPIRATORY pacemaker?

A

Dorsal Inspiratory Group

1000
Q

Dorsal Inspiratory Group controls what

A

Diaphragm and External INTERCOSTAL MUSCLES