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NCE Review Material > Review Session Stars > Flashcards

Review Session Stars Flashcards

1
Q

What is the RMP and TP for excitable tissue?

A

RMP -90mV

TP -60mV

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2
Q

How does hypokalemia affect RMP?

A

Makes it more negative i.e. hyper-polarizes the cell making it less excitable

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3
Q

How does hyperkalemia affect RMP?

A

Makes it more positive i.e. Hypopolarizes and tissue is more excitable

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4
Q

Potassium concentration in cardioplegia

A

15-40 mEq/L

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5
Q

Affect of hypercalcemia on conduction system?

A

TP becomes less negative (shifts away from RMP) and tissue becomes less excitable

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6
Q

Affect of hypocalcemia on conduction system?

A

TP becomes more negative (shifts closer tp RMP) and tissue becomes more excitable

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7
Q

Treatment option for hyperkalemia to stabilize membrane?

A

IV calcium

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8
Q

Free ionized calcium decreases with _________

A

Alkalosis (More protein bound)

Parathyroidectomy

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9
Q

Major neurotransmitter released from A-delta Fibers

A

Glutamate

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10
Q

Sensory input from A-Delta Fibers

A

Fast-Sharp Pain

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11
Q

Glutamate binds to

A

AMPA & NMDA

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12
Q

The major neurotransmitter released by C-Fibers

A

Substance-P

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13
Q

Pain from C-Fibers

A

Slow-Chronic Pain

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14
Q

Substance-P binds to

A

NK-1 (neurokinin-1)

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15
Q

What are the Ions for each phase of ventricular action potential?

A 
Phase 4: K OUT  (leak channels)
Phase 0: Na+ INTO 
Phase 1: Na Closed; Cl IN; K OUT
Phase 2: Ca IN
Phase 3: K OUT
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16
Q

List the phases of the ventricular action potential?

A 
Depolarization Phase 0
Initial Repolarization Phase 1
Plateau Phase 2
Repolarization Phase 3
Resting Phase 4
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17
Q

What is responsible for establishing RMP in ventricular cells?

A

K+

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18
Q

What is responsible for absolute refractory period in ventricular cell?

A

Na+ channels in the inactive state (Phase 1)

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19
Q

Hemodynamic events that accompany acute increase in preload?

A 
Increased EDV (Inc PCWP)
Increased SV(PV-Loop wider and taller) 
No change to ESV
BP Increases
Baroreceptor decrease in HR and SVR
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20
Q

Hemodynamic events that accompany acute decrease in preload?

A 
Decreased BP (Dec SVR)
Decreased ESV & EDV
Increased HR (baroreceptor)
Increased SV (Dec SVR)
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21
Q

PV-Loop changes for acute decrease in preload?

A

Shifts DOWN and to the LEFT

i.e. lower pressure smaller volumes

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22
Q

PV-Loop changes for acute Increase in preload?

A

Shifts to the RIGHT and TALLER

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23
Q

Hemodynamic changes seen with acute increases in contractility?

A

Increased SV/BP

Decreased ESV/EDV, HR, SVR

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24
Q

What PV-loop changes are seen with acute increases in contractility?

A

PV-Loop shifts UP and to the LEFT (i.e. digitalis and calcium)

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25
Q

Hemodynamic changes seen with acute decrease in contractility?

A

Increased ESV/EDV, HR, & SVR

Decrease in SV & BP

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26
Q

What PV-loop changes are seen with acute decrease in contractility?

A

PV-Loop shifts DOWN and to the RIGHT

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27
Q

Goals in anesthetic management of AS?

A

Low HR (60-90), SR ( depend one atrial kick), Maintain preload/afterload/contractilty

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28
Q

Most common valvular lesion in the US?

A

Aortic Stenosis

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29
Q

Hypertrophy seen with AS

A

Concentric Hypertrophy (Thick walls)

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30
Q

Normal aortic valve area?

A

2.5-3.5 cm2

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31
Q

Valve area for severe and critical AS

A

Severe 0.8-1.0 cm2

Critical 0.5-0.8 cm2

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32
Q

Motor innervation of the larynx is via

A

External SLN to the cricothyroid muscle

RLN to all other

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33
Q

Sensory innervation of the larynx

A

Internal branch of SLN (From vocal cords upward)

RLN to laryngeal mucosa inferior to the vocal cords

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34
Q

Function of intrinsic muscles of the larynx

A

Post. crycoarytenoid: Abduct cords (Open)
Lateral Cricoarytenoids : Adduct cords (Close)
Cricothyroid: Tenses Cords (Close/elongate)
Thyroarytenoid: reduce cord tension (relaxes/shorten)

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35
Q

Hypoxia is defined as

A

PaO2 < 60 mmHg

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36
Q

Things that cause a right shift in the oxyhemoglobin curve

A 
(i.e. Right release)
Inc PCO2
Inc temp
Inc 2,3-DPG
Sickle Cell
Decreased pH
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37
Q

Things that cause a left shift in the oxyhemoglobin curve

A 
Fetal hemoglobin
Met HgB
Carboxy HgB
Dec PCO2
Dec Temp
Dec 2,3-DPG
Dec [H] (inc pH/Alkalosis)
38
Q

The Bohr effect refers to

A

the shift in position of the oxyhemoglobin dissociation curve in response to changes in PCO2

39
Q

What is the affect of hypercarbia on the oxygen dissociation curve? Hypocarbia?

A

Inc PCO2 will cause a rightward shift.

Dec PCO2 will cause a left shift

40
Q

Amount of O2 dissolved in blood

A

0.3 mL O2/100mL (0.003 O2/mL)

41
Q

What is P50?

A

The PO2 that produces a 50% saturation of HgB

42
Q

How do changes in P50 affect the oxyhemoglobin dissociation curve?

A
  • Inc P50 causes a rightward shift

- Dec P50 causes a leftward shift

43
Q

What is the amount of oxygen carried by each gram of fully saturated hemoglobin?

A

1.34 mL O2/ g HgB

44
Q

How to calculate hemoglobin bound to O2?

A

SpO2 x HgB x 1.34 mL O2/ g HB

45
Q

Facts for the Dorsal Respiratory Group (DRC)

A

Maintains basic rhythm of respiration
Inspiratory pacemakers
Located in medulla
Efferent action potentials via phrenic and intercostal nerves (diaphragm & ext. intercostals)

46
Q

Fact for the Ventral respiratory Group (VRG)

A

Influence both inspiration and expiration (external intercostals)

47
Q

Function of the Pneumotaxic Center

A

Shuts off inspiration (located high in the PONS)

48
Q

Function of apneustic center

A

promotes a pattern of breathing of maximal lung inflation with occasional brief expiratory gasps (locates low in the PONS)

49
Q

Work together to control the rate and depth in inspiration

A

PnC and ApC

50
Q

What stimulates the central chemoreceptors?

A

Respond to Hydrogen Ions

51
Q

What stimulates peripheral chemoreceptors?

A

Decreased PaO2**
Increased H ion
Increased PaCO2

52
Q

__________ carries afferent information from the carotid body chemoreceptors

A

Glossopharyngeal Nerve

53
Q

___________ carries afferent information from the aortic bodies and lung stretch receptors

A

The Vagus Nerve

54
Q

In what population is the Hering-breur reflex most relevant

A

Neonates

55
Q

Purpose of Heiring-breuer reflex

A

Prevent excess lung inflation

56
Q

Definition of pKa

A

The pH at which 50% of a drug is ionized and 50% is non-ionized

57
Q

When is a weak acid more non-ionized

A

When pH < pKa

58
Q

Which form of a drug crosses biological membranes?

A

non-ionized (aka the weak acid while the ionized form is the conjugate base)

59
Q

When is a weak base more non-ionized?

A

pH > pKa

60
Q

pKa of lidocaine

A

7.7 (7.9)

61
Q

Examples of drugs that are weak bases include

A

ketamine, opioids, and benzos

62
Q

Mnemonic for rate of systematic absorption

A

I (IV) Think (Tracheal) I (Intercostal) Can (caudal) Push (paracervical) Each (epidural) Bolus (Brachial Plexus) SSlowly (subarachnoid/sciatic) For (femoral) Safety (sub-Q)

IV > Tracheal > Intercostal > Caudal > Paracervical > Epidural > Brachial Plexus > Subarachnoid/Sciatic > Femoral > Sub-Q

63
Q

Order of nerve fiber blockade after epidural

A

B > C/Adelta > Agamma > Abeta > Aalpha

64
Q

Roots blocked by the cervical Plexus block

A

C2-C4

65
Q

Volume of LA for cervical Plexus block

A

3-5 mL per level

66
Q

Cervical plexus block is used for what surgeries

A

Lymph Node dissection
Plastic repairs
CAE

67
Q

Fluid maintenance for infants < 6 months

A

4 mL/kg for 1st 10 kg
2 mL/kg for next 10 kg (up to 20kg)
1 mL/kg over 20 kg

68
Q

Fluid maintenance for infants and children > 6 months

A

10-40 mL/kg over 1-4 hours

69
Q

Components of fetal circulation

A

RA to LA via PFO

PA to Aorta via ductus arteriosus

70
Q

Associated anomalies for trisomy 21

A 
SUBGLOTTIC STENOSIS:
Also Congenital heart dz, 
Recurrent pulm infection, RTracheoesophageal fistula (TEF), Seizures,
Floppy soft palate, 
Bowel atresia, 
Enlarged tonsils, 
OSA, 
Macroglossia, 
ASD/VSD, 
Endocardial cushion defect, 
PDA, 
TOF
71
Q

What causes increased Work of Breathing in the geriatric population?

A

Skeletal calcification, increased airway resistance

72
Q

What is the most common postoperative complication in older adults?

A

Post-operative Delirium

73
Q

Postoperative delirium is characterized by

A

Disruption of perception, phsychomotor behavior, consciousness, thinking’s/memory, sleep-wake cycle, and attention

74
Q

Risk factors for postoperative delirium

A 
Older age,    male, 
dementia,    hx of EtOH, 
depression,     duration of anesthesia, 
poor functional status, 
abn. electrolytes and glucose, 
parkinsons,    CV disease, 
dehydration,    metabolic dz, 
anticholinergic drugs used intraoperatively, 
patient admission to ICU, 
type of sx
75
Q

In what procedures is post-operative delirium most common?

A

Ortho procedures, patients undergoing cardiac surgery

76
Q

Define apnea

A

Airflow cessation greater than 10 seconds, >= 5x per hour in combination with a 4% decrease in arterial O2 saturation

77
Q

Define OSA

A

A cessation of breathing for periods longer than 10 seconds during sleep.
- Includes apnea and hypopnea

78
Q

Risk factors for OSA in obese patients

A

Male,
Middle age,
BMI > 30,
Evening EtOH consumption

79
Q

What is the hallmark of OSA

A

Snoring, daytime symptoms of sleepiness, impaired concentration, memory problems, & morning headaches

80
Q

Definitive diagnosis of OSA

A

polysomnography

81
Q

What is pickwickian syndrome

A

a complication of extreme obesity, characterized by OSA, hypercapnea, daytime hypersomnolence, arterial hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, and right-sided failure.

82
Q

Define central apnea

A

apnea without respiratory effort. ( seen in OHS)

83
Q

OHS is defined as

A
  • BMI>30 kg/m2
  • Daytime hypoventilation with awake PCO2 > 45 mmHg
  • Sleep disordered breathing in the absence of other causes of hypoventilation.
84
Q

Formula for IBW

A 
Female= Height (cm) - 105
Male= Height (cm) - 100
85
Q

How does CO change in obese patients

A

increased by 20-30 mL/kg of excess body fat

86
Q

What is metabolic syndrome?

A

A constellation of metabolic abnormalities including abdominal obesity, glucose intolerance, HTN, and dyslipidemia.

87
Q

Metabolic syndrome is associated with an increased risk of

A

Vascular events

88
Q

Diagnosis of metabolic syndrome

A

At least 3 of the following:

  • Central (android) obesity; i.e. waist circumference . 102cm in males or >88 cm in females
  • Elevated serum triglycerides: >= 150 mg/dL
  • Reduced serum HDL: men <= 40 mg/dL; women <= 50 mg/dL
  • HTN: >130/85 mmHg, or taking antihypertensive medication
  • Elevated fasting serum glucose >= 100 mg/dL
89
Q

the most common mononeuropathy after bariatric surgery

A

Carpal Tunnel Syndrome

90
Q

Affect of supine position in obese patient

A

ventilatory impairment: decreased FRC and oxygenation

91
Q

Provides the longest safe apnea period during induction of anesthesia in an obese patient

A

Head-Up Position

NCE Review Material (8 decks)

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