Random2

Question 1

trans-tracheal blocks

Answer 1

recurrent laryngeal via cricothyroid membrane (vocal cords and trachea)

Question 2

how to decrease tissue necrosis caused by agents like levophed, propofol infiltration

Answer 2

phentolamine, 5-10mg in 10-15ml saline

Question 3

two classes of antithrombotic drugs

Answer 3

antiplatelet prevent platelet activation and/or aggregation

anticoagulations primarily reduce fibrin formation

Question 4

what is the dominant system in bronchial airway constriction?

Answer 4

parasympathetic

negligible SNS innervation and SNS actually COUNTERACTS bronchoconstriction

Question 5

Heme effects of hyperthyroidism

Answer 5

thrombocytopenia, anemia

Question 6

what is the only muscarinic receptor to function under the SNS?

Answer 6

sweat gland innervation

sympathetic preganglion -> muscarinic receptor -> sympathetic postganglion -> nicotinic receptor

Question 7

what is the only muscarinic receptor to function under the SNS?

Answer 7

sweat gland innervation

eccrine: primary form of sweating. everywhere but lips, tip of penis, clitoris -> cholinergic -> muscarinic

apocrine large, armpits, don’t help with cooling -> adrenergic -> alpha 1

sympathetic preganglion -> muscarinic receptor -> sympathetic postganglion -> nicotinic receptor

** this is different because typitically it is NE/Epi that are released by postganglionic fibers in SNS

For PSNS innervation:
PSNS preganglionic (loong)-> nicotinic) -> postganglionic (short) -> muscarinic

Question 8

biggest risk of LIJ vs RIJ?

Answer 8

chylothorax -> thoracic duct drains by LIJ and left subclavian

dx: high triglyceride and high T-lymphocyte count after thoracentesis

similar rates of complications:
infection, brachial plexus injury, hemothorax

Question 9

determinants of myocardial oxygen supply

Answer 9

oxygen content and blood flow

NOT affected by left ventricular systolic pressure. associated instead with changing DEMAND (not supply)

HR: LV perfused during diastole
CPP: AoDP - LVEDP
Coronary Vascular Resistance (bad: vasospasm, atherosclerosis. good: nitro)

Question 10

natural licorice can cause what?

Answer 10

hypokalemia

mimics hyperaldosteronism (Na retention, hypertension, hypoK, metabolic alkalosis)

Question 11

MOA of Sarin

Answer 11

inhibits acetylcholinesterase

Question 12

MOA of botulism toxin

Answer 12

prevents release of Ach vesicles into synaptic cleft -> muscle paralysis. Acts at axon terminal of NMJ

tetanus is RETROGRADE

Botulism - the 4 D’s: diplopia, dysarthria, dysphagia, dyspnea

Question 13

Prothrombin/INR measures which pathway

Answer 13

extrinsic (WEPT - warfarin, extrinsic, PT)

factor 7 - shortest halflife (4-6hr)

best measure of synthetic liver function
prolonged by: vitamin K deficiency, liver dysfunction, anticoagulants

Question 14

difference between conjugated and unconjugated bilirubin?

Answer 14

unconjugated: heme breakdown product. water-insoluble. neurotoxin. can be taken up by liver and combined with glucaronic acid
conjugated: increased in liver or biliary disease

Question 15

vitamin K dependent factors

Answer 15

2, 7, 9, 10

Question 16

intrathoracic obstructions (distal tracheal tumor, mediastinal mass) impact which part of flow-volume loop?

Answer 16

expiratory

because during expiration, which is positive pressure, airway diameter is further decreased, degree of obstruction is enhanced,

Question 17

extrathoracic obstructions (proximal tracheal tumor, vocal cord paralysis, glottic structures) impact which part of flow-volume loop?

Answer 17

inspiratory

Question 18

what impacts both inspiratory and expiratory phases?

Answer 18

FIXED airway obstruction - like tracheal stenosis, foreign body, large airway tumor. smushed on both ends

Question 19

what are the synthetic opiates and what effect do they have on synergistic volatile admin?

Answer 19

fentanyl, alfentanil, sufenta, remi

they decrease MAC more than morphine/dilaudid would

Question 20

preservation of total hepatic blood flow at 1 MAC from most to least

Answer 20

sevo > iso > halothane

Question 21

which lead, when used alone, is most sensitive for detecting ischemia?

Answer 21

v5

v2-5 most monitored bc most at risk

when using TWO - II and v4 most sensitive (with II and v5 right behind)

Question 22

what lead is most sensitive for rhythm monitoring?

Answer 22

II because it gives the largest p-wave

Question 23

benzos mechanism

Answer 23

centrally acting GABA potentiation (which controls chloride channels)

Question 24

had a heart attack, no intervention. how long to wait until noncardiac surgery?

Answer 24

60 days

balloon angio = 14 days
BMS = 30 days while continuining DAPT
DES = 180 days

Question 25

how does MAC-BAR relate to standard MAC?

Answer 25

50% HIGHER

~1.7-2.0 MAC

Question 26

what’s MAC-awake

Answer 26

volatile at which voluntary reflexives and perceptive awareness are lost.

15-50% of MAC

generally higher at induction (50%) than emergence (15%)