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APEX > Random Questions > Flashcards

Random Questions Flashcards

1
Q

Discuss the blood supply to the spinal cord

A

There are two posterior arteries and one anterior artery.

Cervical spinal cord receives its blood supply from vertebral and radicular arteries.

Thoracolumbar region receives its blood supply from the radicular arteries only.

Posterior arteries arise from cerebellar arteries.
Anterior artery arises from vertebral arteries.
-Both receive collaterals from intercostal arteries in the thorax and lumbar arteries in the abdomen. The radicular arteries arise from the descending aorta.

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2
Q

What is another name from Beck’s Syndrome?

A

Anterior spinal artery syndrome

-It is flaccid paralysis of LE, bowel and bladder dysfunction, loss of temperature and pain sensation.

PROPIOCEPTION IS INTACT

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3
Q

Losartan and its affect on lithium

A

It increases lithium reabsorption by the kidneys

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4
Q

Minimum amount of time for a DES

A

-6 months (1st gen)
-12 months (2nd gen)
-ACS patient (12 months always)

BMS = 1-3 months

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5
Q

What does SSEP monitor?

A

Sensory only = dorsal part of the spinal cord.

Drugs that interfere with SSEP decrease amplitude and increase latency (VA, propofol, barbiturate, midazolam, diazepam
-ketamine, precedex, etomidate, opioids, droperidol are all okay

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6
Q

What is indicative of neural injury for SSEP?

A

-50% decrease in amplitude
-10% decrease in latency

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7
Q

What is the partition coefficent?

A

The ratio of the volatile agent in the blood compartment relative to the air compartment at equilibrium. Aka the volatile agent partitions between the blood and the alveolus at equilibrium.

The number of parts in the blood is always relative to 1 part in the alveolus.
B/G of sevoflurane = 0.65 = 65 parts in the blood for 100 parts in the alveolus. THus, the onset is faster because FA equilibrates with FI faster.

SOLUBILITY DECREASES AS THE TEMPERATURE OF THE BLOOD IS INCREASED

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8
Q

What are the 3 components of LA building wise

A
  1. aromatic ring = lipid solubility
  2. intermediate chain = metabolism and allergy potention
  3. tertiary amine = water solubility
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9
Q

How does the opioid receptor work?

A

GPCR –> inhibits AC –> decreases cAMP
-presynaptic nerve decreases calcium influx
-postsynaptic nerve increases potassium efflux

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10
Q

What is the dose range for cocaine?

A

1.5 - 3 mg/kg

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11
Q

What is the dose range for physostigmine?

A

15 - 60 mcg/kg

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12
Q

Discuss methodone

A

Racemic mixture that blocks all four processes of pain transmission.

-D-isomer = antagonizes the NMDA receptor which inhibits serotonin and NE reuptake
-L-isomer = antagonizes the opioid receptor

also…. prolongs QT

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13
Q

What are the final products of soda lime reaction?

A

CaCO3 + NaOH (Calcium carbonate and sodium hydroxide)

CO2 + H2O > H2CO3 + NaOH > NA2CO3 + H2O + heat > NA2CO3 + CaOH2

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14
Q

What is brugada syndrome?

A

-Ion channelopathy in the heart
-More common in southeastern asian males
-RBBB, ST elevation in V1 - V3

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15
Q

WPW and EKG changes

A

short PR
Delta wave (premature upsloping of the R wave)
wide QRS

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16
Q

Hydralazine

A

Direct acting vasodilator that increases cGMP. The baroreceptor reflex is preserved!! Tachycardia is common.

Dosing = 2.5 - 20 mg
Onset = 15 - 20 minutes
DOA = 6 - 12 hours

RISK OF LUPUS SYNDROME

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17
Q

When is sodium bicarbonate indicated during metabolic acidsosi?

A

When the pH is < 7.2. It should NEVER be used for respiratory acidosis because the bicarbonate dissociates into more CO2. This worsens the patients condition.

-Calculate the difference between the patient’s HCO3 and normal.
-Multiply by the patients weight (kg) and 0.3
-Divide by 2

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18
Q

How does hyperventilation reduce ionized calcium?

A

H+ are displaced from plasma proteins.
Calcium takes its place.

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19
Q

S/S of Hypercalcemia

A

(> 12)
-HTN, short QT, kidney stones, polyuria, hypotonia, N&V, bone pain, cognitive dysfunction

‘stones, thrones, bones, belly groans, and psychiatric overtones’

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20
Q

What are the sesory dermatomes for GU?

A

Bladder = T11 - L2
Prostate = S2 - S3

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21
Q

C-fibers

A

transmit slow pain
diameter = 0.4 - 1.2 micrometers
unmyelinated
-tourniquet pain come from these guys.

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22
Q

Is carbon monoxide a 2nd messenger?

A

yes

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23
Q

what is serotonin derived from

A

tryptophan –> 5 hydroxytryptophan –>. serotinin

*metabolized by MOA

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24
Q

What congenital conditions require a patent PDA to maintain systemic perfusion?

A

-hypoplastic left heart
-tricuspid or aortic atresia
-aortic stenosis
-coarctation of the aorta

use 21 fio2 % to keep it open

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25
Q

where is the only area in the heart that does not contain a fibrous barrier?

A

the bundle of His (AV BUNDLE)
the fibrous sheet acts as a gatekeeper that directs all impulses to the AV bundle. occasionally, an aberrant pathway may penetrate the fibrous barrier causing arrythmias

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26
Q

how long does it take for an impulse to travel from SA to AV

A

0.03 seconds

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27
Q

how long does it take for impulses to travel through atrioventricular node

A

0.09 seconds (conduction is delayed)

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28
Q

how long does it take for impulses to travel through atrioventricular bundle?

A

0.04 seconds.

in total, there is a built-in 0.16 second delay before the impulse from the SA node reaches the ventricles

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29
Q

bundle branches to purkinje fiber conduction timinig

A

0.06 seconds

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30
Q

moderate aortic stenosis numbers

A

peak velocity = 3 - 4 m/s
mean gradient = 20 - 40 mmHg
valve area = 1-1.5 cm2

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31
Q

severe AS numbers

A

peak velocity = > 4 m/s
mean gradient > 40 mmHg
valve area < 1

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32
Q

mild aortic stenosis numbers

A

peak velocity = 2.6 - 2.9
mean gradient < 20
valve area > 1.5

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33
Q

which cell type is responsible for initiation of thrombosis?

A

endothelial

-its negative charge repels platelets.
releases platelet inhibitors (NO, prostacyclin I2)

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34
Q

what characterizes severe mitral regurgitation?

A

regurgitant fraction > 50%
enlarged LV
> 60 mL/beat
enlarged LA

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35
Q

what is the main factor for EDP vs EDV

A

pericardium compliance

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36
Q

what two conditions contribute to silent MI?

A

HTN
DM

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37
Q

VSD & pulmonary blood flow relaationship

A

increases pulmonary blood flow d/t volume overload

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38
Q

TOF and pulmonary blood flow relationship

A

decreased pulmonary blood flow due to obstruction

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39
Q

how does truncus arteriosis cause cyanosis?

A

common mixing chamber

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40
Q

How do you calculate the arteriovenous oxygen difference

A

Cao2 - Cvo2

(1.34 x hgb x spo2) - (1.34 x hgb x svO2)

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41
Q

What is Kawasaki’s disease

A

-children
-fever, vasculitis, red strawberry tongue, cervical lymphadenopathy, swollen hands & feet, inflamed mucuous membranes
-affects CORONARY ARTERIES AND MEDIUM SIZED ARTERIES

aka “mucocutaneous lymph node syndrome”

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42
Q

What is Wegener’s granulomatosis?

A

necrotizing granulomas lead to vasculitis (inflamed arteries) in the airway, lungs (hypoxia), CNS, kidneys
-friable, necrotic tissue in the airway bleeds easily. tracheal granulomas reduce tracheal diameter.

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43
Q

Takayasu’s Arteritis

A

-occlusive disease of proximal aorta and its main branches
‘pulseless disease or occlusive thromboaortopathy or aortic arch syndrome’

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44
Q

thromboangitis obliterans

A

-inflammatory vasculitiss that ultimately occludes the small and medium size arteries and veins in the extremities. s/sx like Raynaud’s
-d/t smoking
-aka ‘buerger’s disease’

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45
Q

kussmaul’s sign and CVP waveform

A

x and y descents are exaggerated

46
Q

where do dihydropyridines bind?

A

vsm @ outside the channel

47
Q

where do phenylalkylamines bind?

A

myocardium @ inside the L-type calcium channel, alpha 1 subunit

48
Q

where do benzothiazepines bind?

A

myocardium (unsure of binding site)

49
Q

what can causing HFpEF?

A

DIASTOLIC HF (s4)
-AS, IHD, long standing HTN
-concentric hypertrophy
-old age
-valve stenosis
-HoCM
-cor pulmonale
-obesity

50
Q

How is FA/FI influenced by blood gas solubility?

A

Agents with low solubility undergo less abssorption by the blood.

-FA/FI of an agent with low solubility is more affected than the agent with a high solubility.

des > nitrous > sevo > iso

51
Q

how do you ventilate a patient with bullae?

A

Small TV
High RR

SV until chest is opened.

52
Q

Pyloric stenosis

A

Medical emergency
-hypokalemic, hypochloremic, metabolic alkalosis

53
Q

what is deadly nightshade?

A

Belladonna
-anticholinergic OD = flushing, mydriasis, dry mouth, confusion, hallucinations, hyperthermia, tachycardia

treated with physostigmine 15 - 60 mcg/kg

54
Q

What drugs interfere with the accuracy of SSEP?

A

decrease amplitude & increase latency
-VA, N2O, Propofol, Barbiturates, Midazolam, Diazepam

55
Q

Which drugs do NOT impair the SSEP signal?

A

ketamine
dex
etomidate
opioids
droperidol

56
Q

1mmHg in PACO2 CBF changes by how much?

A

same direction by 1 - 2 mL/100g/m

57
Q

medial rectus

A

adduction
CN3

58
Q

lateral rectus

A

abduction
CN6

59
Q

superior rectus

A

supraduction
CN3

60
Q

inferior rectus

A

infraduction
CN3

61
Q

superior oblique

A

intorsion and depression CN4

62
Q

inferior oblique

A

extorison and elevation
CN3

63
Q

which chemotherapeutics belong to the antitumor abx class?

A

bleomycin
doxorubicin

64
Q

what is different about piston-driven ventilators?

A

-it will not consume O2 in the event of oxygen pipeline failure
-2 pressure relive valves (PPV and Negative Pressure). PPV aat 75 cmH2O. Negative pressure at -8 cm H2O.

-Incorporate fresh gas decoupling.

65
Q

What med causes torsades

A

methadone b/c prolongs QT interval

QT interval > 500 ms = increased risk of lethal tachyarrythmias

66
Q

Dose range for cocaine

A

1.5 - 3 mg/kg

do not exceed 200 mg

67
Q

distances btw CVL insertion and proper tip position

A

subclavian = 10 cm
right IJ = 15 cm
left IJ = 20 cm
femoral vein = 40 cm
right median basilic = 40 cm
left median basilic = 50

68
Q

what happens if the vagus n is injured?

A

unilateral = hoarseness
bilateral = aphonia

external branch of SLN
-unilateral = nothing
-bilateral = hoarseness

internal branch of SLN =nothing

RLN
-unilateral = hoarse
bilateral = stridor

69
Q

what are risks associated with non-OB related surgery on a parturient?

A

DAW
increased aspiratoin
growth restriciton, LBW, demise, preterm labor

70
Q

phenelzine

A

inhibits MAO
-increases 5HT and NE in the brain.

71
Q

onset of delirium vs POCD

A

PCOD onset = 6 months
delirium = 1 - 5 days postop

72
Q

recommended bladder width of blood pressure cuff

A

40% of the circumference of the extremity

circumference x 0.4 = appropriate width

73
Q

what pharm agents will precipitate carcinoid crisis?

A

succ, thiopental, epi, atracurium, NE, isoproterenol

74
Q

MG facts

A

pregnancy exacerbates symptoms
-Anti-AchR IgG antibodies cross the placenta = weakness in neonate for 2 weeks

75
Q

how to calculate therapeutic index

A

median lethal dose/ median effective dose

76
Q

Ether vs Ester

A

Ether = ROR
Ester = RCOOR

77
Q

spinal hematoma must be fixed within how long

A

8 hours

78
Q

desflurane b/g

A

0.42

79
Q

celiac plexus

A

T5 - T12
-does not contain somatic fibers
-SE = hOTn, shoulder pain, diarrhea

80
Q

is the aging brain senssitive to etomidate?

A

no
but it is to propofol and VA

81
Q

cardioversion for aflutter, afibb etc

A

50 - 100 J

82
Q

define PAH

A

mean PAP > 25 mmHg
PAOP no greater than 15

83
Q

where should the distal tip of the LMA sit?

A

upper esophageal sphincter = cricopharyngeus muscle

84
Q

Proseal vs Classic maximum PPV

A

aka LMA supreme = 30 cm H2O vs 20 cm H2O for classic

85
Q

pulmonary edema what type of cardiac shunt

A

right to left
if it exceeds > 50% oxygen will not help

86
Q

if the case is delayed, how often should you re-dose BICITRA

A

1 hour after initial dose.

87
Q

Head elevated on bed. What axes are aligned.

A

PA and LA

88
Q

Head with head extension only.

A

PA and LA

89
Q

s/s of subclavian steal

A

syncope
vertigo
ataxia
hemiplegia

90
Q

what triggers porphyria

A

ALA synthase stimulation
stress
npo status
cyp450 induction

treat: heme arginate and glucose

91
Q

what is the most potent amnestic? DOA?

A

lorazepam = 6 hours of amnesia

92
Q

uptake for LA

A

interpleural > intercostal > caudal > brachial plexus

93
Q

what does the median nerve supply?

A

palm of hand
ventral region of thumb
distal portions of fingers

94
Q

discuss hemophilia A

A

severe is defined as < 1% of F8. PTT will be prolonged severely.

PT is normal because TF 7 dependent pathway is not affected.

Treat: FFP, cryo, F8

95
Q

VW disease

A

qualitative platelet dysfunction.

Type 1 = mild - moderate reduction in vwf
2 = vwf produced doesnt work well
3 = severe reduction in vwf

treat: ddavp 0.3 mcg/kg

96
Q

what is gap vs non-gap acidosis

A

gap = due to accumulation of H + (lactic acidosis, ketoacidosis, RF)
non-gap = d/t loss of bicarbonate or increased chloride (diarrhea, renal tubular acidosis, excessive NaCl admin)

97
Q

how much fluid is absorbed during TURP resection?

A

10 - 30 mL/m
EBL = 2 - 5 mL/m

98
Q

what is the most common TEF?

A

C = upper esophagus dead ends, lower communicates with distal trachea

99
Q

what is neonatal total body water

A

80%
ecf = 40%

albumin and aaag reduced. 5 - 6 months until they reach adult levels

100
Q

what is orthodromic AVRT

A

antergrade conduction through the AV node

normal QRS
no delta
Retrograde P wave after QRS

101
Q

what is antidromic AVRT

A

retrograde conduction through the AV Node

wide QRS
no P wave

102
Q

what volume increases in the parturient?

A

inspiratory reserve volume because FRC decreases.

103
Q

hypokalemic periodic paralysis

A

anything that decreases the serum potassium will exacerbate this disease

-acetazolamide is useful for treating both hypo and hyperkalemic periodic paralysis.
it protects against hypokalemia by creating a non-gap acidosis. it protects against hyperkalemia by promoting potassium excretion.

104
Q

which lead will demonstrate rhythm abnormalities?

A

lead II bipolar

105
Q

what is reflex sympathetic dystrophy?

A

type I CRPS

106
Q

how to treat gout

A

-gout is an excess of uric acid in the blood. primary gout is a result of a genetic defect of purine metabolism.
-liberal hydration, alkalize urine with sodium bicarb, allopurinol to inhibit purine conversion to uric acid, colchicine to reduce inflammation

107
Q

decreased renal blood flow labs

A

pre-renal oliguria

-concentrated urine and low fractional excretion of sodium. the body is holding sodium and water in an effort to preserve intravascular volume

urine sodium < 20
fractional excretion of sodium < 1%

108
Q

gastrin stimulates

A

pepsinogen secretion

109
Q

secretin stimulates

A

bile flow

110
Q

motilin stimulates

A

upper GI motility

APEX (18 decks)

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