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APEX ANESTHESIA FLASHCARDS > SHIT TO KNOW > Flashcards

SHIT TO KNOW Flashcards

1
Q

How is FRC affected in aging?

A

FRC is increased. Due to loss of elastic recoil and increase in lung compliance

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2
Q

Where is the proximal and distal balloon of the combitube placed?

A

Proximal balloon is placed in hypopharynx.

Distal balloon is placed in esophagus. If it’s place here, the lungs can be ventilated

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3
Q

What are these symptoms of?
- Decreased ETCO2
- Tachycardia
- Deadspace = arterial hypoxemia
- Bronchospasm = increasing PIP

A

P.E.

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4
Q

Retrograde tracheal intubation contraindications:

A
  • Goiter
  • Coagulopathy
  • Neck flexion deformity
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5
Q

Where do you puncture for retrograde tracheal intubation?

A

Puncture cricothyroid membrane, pass wire through cords and out of mouth, put ETT over wire and advance into trachea

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6
Q

Where is a transtracheal nerve blocked?

A

Cricothyroid membrane

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7
Q

Indications for retrograde tracheal intubation

A
  • Unstable cervical spine
  • Upper airway bleeding and you can’t see the glottis, but this takes time and only used when ventilation is still possible.
  • It can be performed in awake pt

AVOID: in goiter, coagulopathy, and neck deformities

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8
Q

Short term benefits of smoking cessation

A
  • Reduction in carboxyhemoglobin
  • improved P50
  • It does NOT reduce the risk of postop pulmonary complications
  • Carbon monoxide t 1/2 = 4-6 hours
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9
Q

Intermediate-terms effects of smoking cessation

A

Return of pulmonary function takes at least 6 weeks:
- Airway function
- Mucociliary function
- Sputum production
- Pulmonary immune function
- Hepatic enzyme induction also subsides

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10
Q

4 main nerves related to respiratory

A

1) Glossopharyngeal (innervated by CN 9)

(All are innervated by Vagus):
2) Internal SLN- sensory only
3) External SLN- motor
4) RLN- acute issue: Dyspnea, chronic issue: aphonia

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11
Q

LMA size for:
- 70-100kg
- 50-70 kg
- 30-50 kg
- 20-30 kg
- 10-20 kg
- 5-10 kg
- < 5 kg

A
  • 70-100kg: 5
  • 50-70 kg: 4
  • 30-50 kg: 3
  • 20-30 kg: 2.5
  • 10-20 kg: 2
  • 5-10 kg: 1.5
  • < 5 kg: 1
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12
Q

LMA size for 5-10kg

A

1.5

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13
Q

LMA size for 20-30kg

A

2.5

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14
Q

LMA size for 10-20kg

A

2

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15
Q

Changes to due inadequate pain management?
- SVR
- Platelet aggregation
- Urinary spinchter tone
- TV, VC, TLC, FRC
- Ability to clear secretions

A
  • SVR increased
  • Platelet aggregation increased
  • Urinary spinchter tone increased
  • TV, VC, TLC, FRC decreased
  • Ability to clear secretions decreased
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16
Q

Respiratory center is located where in which system?

A

Medulla and Pons in the Reticular activating system

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17
Q

Dorsal respiratory center is located? What is it?

A

In the medulla and it is the inspiratory pacemaker

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18
Q

Ventral respiratory center is located? What is it?

A

Medulla. Active exhalation

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19
Q

Apneustic respiratory center is located? What is it?

A

Pons. Stimulates DRC, triggers inhalation

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20
Q

What fracture runs horizontal across the maxilla: nose and hard palate?

A

Le fort 1

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21
Q

What fracture is located at the bridge of the nose and lateral wall maxilla?

A

Le fort 2

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22
Q

What fracture separates mid facial skull from the cranial bae. Transversing root of the nose, ethmoid bone, eye orbits, and sphenopalatine fossa?

A

Le Fort 3

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23
Q

What are the basilar skull fractures that disrupt the cribiform palate?

A

Le fort 2 and 3

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24
Q

Name 2 nerves that innervates the occuloardiac reflex

A

Five & a dime

CN V & CN X

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25
Q

Afferent occulocardiac reflex includes

A
  • Long and short ciliary nerves= bradycardia and hypotension
  • Ciliary ganglion
  • Opthalamic division of trigeminal nerve
  • Gasserian ganglion
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26
Q

Is this Afferent or Efferent occulocardiac reflex?

  • Long and short ciliary nerves
  • Ciliary ganglion
  • Opthalamic division of trigeminal nerve
  • Gasserian ganglion
A

Afferent

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27
Q

Efferent occulocardiac reflex

A

Vagus nerve -> SA node

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28
Q

What situations would you need prophylaxis antibiotics for endocarditis?

A
  • Prothetic heart valve
  • Unrepaired cyanotic congenital heart disease
  • Cardiac transplantation with valvuloplasty
  • Previous ineffective endocarditis
  • Repaired congenital heart defect within 6 months of procedure
  • Dental procedures involving gingival manipulation or damage to mucosal lining
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29
Q

Heart transplanted schedule for surgery. What is the cardiac output dependent on? Heart rate or preload?

A

Preload. Heart rate is fixed, and not affected by autonomic nervous system because it’s severed. (The heart rate is usually determined by the intrinsic rate of phase 4 depolarization of the SA node)

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30
Q

For every 1 unit of PRBCs, Hgb and Hct change by?

A

Hgb is 1g/dL

Hct is 2-3%

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31
Q

A pt’s HCT is 24% and you gave 2 units of PRBCs what is the expected new Hgb?

A

Hgb is 1/3 of Hct.
Convert Hct to hgb = 24 / 3 = 8 Hgb
We know 1 unit of PRBC increases Hgb by 1g/dL
8 + 2 = 10 g/dL

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32
Q

Spinal cord has how many anterior and posterior spinal arteries?

A

1 anterior spinal artery: motor
2 posterior spinal arteries: sensory

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33
Q

How to protect spinal cord during aortic aneurysm repair

A
  • Want hypertension during cross clamping
  • CSF drain
  • Hypothermia
  • Avoid hyperglycemia
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34
Q

ARBS: side effects

A

It is a Angiotension 2 blocker

  • Hyperkalemia
  • Lithium toxicity (increases absorption in kidneys)
  • Maternal and fetal mortality
  • Can cause vasoplegia (refractory hypotension)
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35
Q

A.flutter. Do you defibrillate or cardiovert? How many joules?

A
  • Cardiovert sync on the R wave
  • 1st shock 50 -100 joules
  • 2nd shock increase incrementally
  • Max 360 joules

We can cardiovert for: Afib, A.flutter, AV node re-entry tachycardia

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36
Q

How long should you delay surgery for pt who just had a drug eluding coronary stent?
What about for bare metal stent?

A

Delay sx for 6 months for drug eluding coronary stent

Delay sx for bare metal stent for 30 days

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37
Q

How much is eliminated and remaining?

1 half life
2 halve lives
3 halve lives
4 halve lives
5 halve lives

A

1 half life: 50% eliminated, 50% remains
2 halve lives 75% eliminated, 25% remains
3 halve lives 87.5% eliminated, 12.5% remains
4 halve lives 93.75% eliminated, 6.25% remains
5 halve lives 96.875% eliminated, 3.125% remains

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38
Q

3 halve lives how much is eliminated and remains?

A

87.5% eliminated, 12.5% remains

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39
Q

2 halve lives, how much is eliminated and remains?

A

75% eliminated, 25% remains

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40
Q

4 halve lives, how much is eliminated and remains?

A

93.75% eliminated, 6.25% remains

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41
Q

Drugs that interfere with SSEP monitoring
They cause DAIL: Decrease amplitude, increase latency

A
  • Volatile gases
  • Benzos
  • Barbituates
  • Propofol (less)

SSEPs directly monitor the integrity of the dorsal (sensory) of the spinal

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42
Q

Drugs that don’t interfere with (DAIL) decrease amplitude and increased latency in SSEPs

So these drugs would increase amplitude

A
  • Ketamine
  • Etomidate
  • Opioids
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43
Q

The lower a gas coefficient is

A

Less soluble it is in blood and prefers to stay in the air

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44
Q

Higher the gas coefficient is more likely to

A

Dissolve in blood but it’s slower to work

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45
Q

Partition coefficients are temperature dependent. When the temperature is increased the solubility is:

A

Decreased..

When temperature is decreased and cold, the solubility is increased. It likes staying in the blood and this is why it takes longer for the patient to wake up.

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46
Q

Does left-to-right shunt or right-to-left shunt affect inhalation induction time?

A

Right- to- left shunt. It decreases inhalation induction time. Desflurane is affected the most over nitrous

Left-to-right shunt does not affect inhalation induction time

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47
Q

In a right-to-left shunt will an agent with higher solubility or lower solubility be affected more?

A

An agent with lower solubility will undergo little uptake by the blood and is most affected by the right to left shunt and it decreases inhalation induction time

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48
Q

Therapeutic index formula

A

Therapeutic index = LD 50/ ED 50

Effective dose= is the dose to produce given affect in 50% of population not the dose required to produce maximum affect

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49
Q

Which is more likely to cause allergic reaction?

A

Ester at the intermediate chain

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50
Q

Morphine binds to the mu receptor in?

A

The dorsal horn

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51
Q

When morphine binds to mu receptor on the dorsal horn:

What does morphine inhibit?
What happens in the presynaptic and post synaptic nerve?

A

Opioid receptor is a G protein coupled receptor that inhibits adenylcylase and blocks the conversion of ATP to cAMP

  • Presynaptic nerve: reduced calcium conductance and decrease neurotransmitter release
  • Post synaptic nerve: increased potassium conductance = Hyperpolarization and makes neuron less response it stimulation
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52
Q

Does morphine cause Depolarization or Hyperpolarization of potassium?

A

Hyperpolarization of potassium

On the post synaptic nerve: increased potassium conductance = Hyperpolarization and makes neuron less response it stimulation

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53
Q

Cocaine dose mg/kg and max

A

3mg/kg
Max 200mg

For cocaine overdose, don’t give BB. They have super high SVR and a BB can decrease SVR = cardiac arrest

Best to give them nitroglycerin instead

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54
Q

Ingestion of Bella Donna S/S:

Treatment:

A
  • Flushing
  • Confusion
  • Mydriasis
  • Dry mouth

TOO MUCH ANTICHOLINGERGIC!

Treatment: Physostigmine. AchE inhibitor

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55
Q

Blockade: what occurs?
50%
60%
70%
80%

A

50% Most sensitive. Bite on tongue blade
60% Double burst without fade (2 burst at 50 Hz)
70% TOF 4/4 4 pulses at 2 Hz
80% TV at 5mL/kg

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56
Q

Blockade of 60%

A

Double burst without fade (2 burst at 50 Hz)

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57
Q

Blockade 70%

A

TOF 4/4 4 pulses at 2 Hz

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58
Q

Blockade 50%

A

Bite on tongue blade most sensitive

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59
Q

Blockade 80%

A

TV at 5ml/kg

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60
Q

ETCO2 is 49 and isn’t returning to baseline what should you do?

A

Fix or replace the inspiratory valve

As pt exhales gas with CO2 fills inspiratory limb, when they take a breath some exhaled gas is mixed with fresh gas

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61
Q

CVC catheter tip does not reside in right atrium = Dysrhythmias

  • R. Subclavian
  • R. IJ
  • L. IJ
  • Femoral vein
  • Right median basilic vein
  • Left median basilic vein
A
  • R. Subclavian 10 cm
  • R. IJ 15 cm
  • L. IJ 20 cm
  • Femoral vein 40 cm
  • Right median basilic vein 40 cm
  • Left median basilic vein 50 cm
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62
Q

Torsades de pointes can occur from administration of which narcotic?

A

Methadone, can cause QT prolongation

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63
Q

CVC is placed for pneumectomy in lateral postion, which side is it placed on the pt?

A

CVC is placed on the same side of the operative side

IJ > EJ

Elevated pressures predispose to lung injury**

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64
Q

Review

A
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65
Q

Circumflex is extremity is 20 inches and BP is width BP is 8 inches. Is it too big or too small?

A

Recommended cuff is 40% of circumflex of extremity

20 x 0.40 = 8 inches

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66
Q

Near infrared spectroscopy (NIRS)

A
  • Measures venous oxygen saturation for cerebral oxygenation extraction
  • It detects regional oxygenation only
  • Relies on cerebral blood volume is 1 part arterial to 3 parts venous. 75% of of blood in the brain is on the venous side of circulation
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67
Q

What antiarhythmmic can increase airway resistance in asthmatic pt?

A

Adenosine

Given 6mg, 12mg, 18mg for SVT

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68
Q

Piston driven machine, how much positive pressure opens it?

A

75 cm H20
Doesn’t need O2 tank to fill like a bellow

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69
Q

Final products of soda lime

A

Sodium hydroxide NaOH

Calcium carbonate CaCO3

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70
Q

Sodium nitroprusside can cause a reduction in SpO2: true or false?

A

True. It increases intrapulmonary shunt in zone 3. It also dilates pulmonary vascular and counteracts HPV

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71
Q

Bruguda

A

Right bundle branch with ST elevation V1-V3, problem with sodium ion channel
Seen in southeast Asians

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72
Q

Treatment for cerebral vasospasm

A

Triple H therapy:
- Hypertension
- Hypervolemia
- Hemodilution

Also can use nimodipine CCB

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73
Q

Myasthenia Gravis:

A
  • Pregnancy makes it worse
  • Anti-Ach IgG antibodies pass through placenta and can cause weakness in neonates
  • Post synaptic nicotinic receptors are reduced
  • More tired throughout day
  • Resistant to sux, sensitive to roc
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74
Q

Cerebral blood flow is directly proportional to PaCO2.
For every 1mmHg change in PaCO2, CBF changes 1-2 ml/100g/min

If pt’s PaCO2 went from 40mmHg to 34 mmHg. What is the CBF change?

A

40 - 34 = Pt’s PaCO2 changed by 6 mmHg.

For every 1mmHg change in PaCO2, CBF changes 1-2 ml/100g/min

6 x 1 = 6
6 x 2 = 12

CBF decreased by 6-12 ml/100g/min

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75
Q

For every 1mmHg change in PaCO2, CBF changes

A

1-2 ml/100g/min

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76
Q

For every 1mmHg change in PaCO2, CBF changes

A

1-2 ml/100g/min

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77
Q

Pt is undergoing spinal fusion. What increases risk of ischemic optic neuropathy?

A
  • Wilson frame see pic
  • Male
  • Low ratio colloid: crystalloid resuscitation
  • > EBL
  • Long sx duration
  • Obesity
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78
Q

Spinal hematoma needs to be decompressed within how many hours?

What are the S/S?

A

8 hours

  • Bowel and bladder weakness
  • Lower extremity weakness
  • Back pain
  • Sensory deficit
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79
Q

Where is the zygophophyseal joint?

A

Aka face joint

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80
Q

Where is the posterior cord?

A
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81
Q

Name cutting tip needles

A
  • Quincke
  • Pitkin
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82
Q

Name pencil point needles

A
  • Sprotte
  • Pencan
  • Whitacre
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83
Q

Name lipophilic opioids

A
  • Fentanyl
  • Sufentanil

Provides analgesia systemically

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84
Q

Name lipophilic opioids

A
  • Fentanyl
  • Sufentanil

Provides analgesia systemically if given in epidural

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85
Q

Name hydrophilic opioids, do they act systemically or on the spinal cord?

A
  • Morphine
  • Hydromorphone

Act on the spinal cord, superior analgesia in epidural catheter

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86
Q

C 1 esterase inhibitor deficiency is a common heredity form of Angioedema. Treatment?

A

FFP- it has C1 esterase inhibitor

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87
Q

Why do you want to avoid giving bicarb to someone that is respiratory acidotic?

A

Bicarb is the treatment for metabolic acidosis not respiratory acidosis.
If you give it to someone with respiratory acidosis:
They are hypoventilating and have a lot of CO2 in their system. Giving them bicarb will dissociate into more CO2 and can worsen the condition.

Treatment for respiratory acidosis is to improve their ventilation: O2, Bronchodilation, mechanical ventilation

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88
Q

Ph is 7.2
70kg
Serum bicarb is 20 meq/L

How much bicarb should be given to correct a serum of bicarb of 25 meq/L?

A

25-20 = 5

Multiply by weight and 0.3 and divide by 2

5 x 70 x 0.3 = 105 meq/dl

105 / 2 = 53 meq/dl

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89
Q

Causes of hypocalcemia in the OR:
S/S?

A
  • Hyperventilation
  • Given blood products (nitrates)

S/S:
- QT prolongation
- Tetany
- Laryngospasm

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90
Q

ABG full compensation

A

Full compensation: pH has to be normal 7.35-7-45

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91
Q

ABG uncompensated:

A

Uncompensated: pH is NOT normal, and another 1 arrow pointing that direction

Ex:

  • opioid overdose - uncompensated respiratory acidosis
  • untreated pain - uncompensated alkalosis
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92
Q

ABG?

pH: 7.22 acidosis
pCO2: 49 respiratory acidosis
HCO3: 28 respiratory alkalosis

A

Partially compensated acidosis: pH abnormal: 2 arrows going one way and 1 arrow going another way

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93
Q

Rapid correction of chronic hyponatremia can cause

A

Central poutine myelinolysis (demyelination upper motor dysfunction)

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94
Q

BB overdose treatment

A

Glucagon- stimulates gluconeogensis in the liver

It increases myocardial contractility by increasing intracellular concentration of cAMP
Useful in CHF, BB overdose, low cardiac following MI, or CPB

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95
Q

Primary hyperparathyroidism
Signs of hypercalcemia:

A
  • HTN
  • Short QT
  • Kidney stones
  • Bone pain
  • > 12 mg/dL
  • Hypotonia muscle tone weakness
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96
Q

Match hepatic function test with abnormality

  • Hepatic injury
  • Cholelithiasis
  • Synthetic function
A
  • Hepatic injury- Aspartate amniotransferase
  • Cholelithiasis- Y glutamyl transpeptidase
  • Synthetic function- Prothrombin time
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97
Q

Y glutamyl transpeptidase tests for

A
  • Cholelithiasis
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98
Q

Aspartame amniotransferase tests for

A

Hepatocelluar injury

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99
Q

What level do you block for these sx?

  • Bladder procedures
  • Prostate
  • TURP
A
  • Bladder procedures- t11-l2
  • Prostate- s2-s3
  • TURP- t10
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100
Q

What level do you block for prostate sx?

A

S2-S3

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101
Q

What level do you block for bladder procedures?

A

T11-L2

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102
Q

Drugs to avoid for carcinoid crisis?

A
  • Epi
  • Sux
  • Thiopental
  • NE
  • Isoproterenol

Things that cause histamine release, tachycardia, stress! Avoid tachycardia

They occur in GI and spread

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103
Q

Metabolic changes in pyloric stenosis:

A
  • Hypokalemia
  • Hypochloremia
  • Metabolic alkalosis
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104
Q

Why do you need to decrease etomidate dose in elderly?

A
  • Decreased clearance
  • Decreased Vd
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105
Q

Pt is experiencing postpartum hemorrhage secondary to retained placenta. What is the best medication to help with manual removal of the placenta?

A

Nitroglycerin it relaxes uterus

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106
Q

Pregnant pt needs GA. The fetus is at risk for?

A
  • Fetal demise
  • Low birth weight
  • Growth restriction
  • Preterm labor
  • Avoid nitrous and benzos!

It doesn’t cause congenital abnormalities in second trimester

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107
Q
A
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108
Q

Early, late, variable decals for FHT

A
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109
Q

MIDLINE protrusion of organs with sac and associated with triosomies, CHD, Beckwith Syndrome:

A

Omphalocele:
- Trimosomies
- CHD
- Beckwith syndrome

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110
Q

Phenalzine- avoid with what drugs? Is morphine okay?

A
  • Inhibits MAO
  • Increases 5HT and NE
  • Relieves depression
  • Avoid: Cocaine, ephedrine, meperidine = serotonin syndrome

Morphine is ok

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111
Q

Serotonin syndrome S/S:

A
  • Hyperpyrexia
  • Respiratory depression
  • Hypotension
  • Coma

Meperidine inhibits SSRIs and can lead to SS

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112
Q

Law of Laplace formula and give an example of

A

T = P x R

Abdominal aneurysm is more likely to rupture during hypotension

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113
Q

Aldrete score to safely discharge from PACU

A

> 9

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114
Q

O2 cylinder is cold after the valve is open, gas is released from high pressure container and loses speed
What law or effect is this?

A

Joule-Thompson

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115
Q

Which nerve fibers transmit tourniquet pain?

A

C fibers

Slow pain

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116
Q

Allodynia

A

Absent painful stimuli causing pain

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117
Q

Dyesthesia

A

Unpleasant/abnormal pain

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118
Q

Tourniquet release causes the ETCO2 increase or decrease?

A

To increase. CO2 builds up in ischemic limb

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119
Q

Closed claim data, incidence of anesthetic malpractice claims is increasing for all:

A
  • Regional anesthesia
  • Acute anesthesia
  • Chronic anesthesia

EXCEPT SURGICAL ANESTHESIA

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120
Q

Overweight BMI:
Obesity 1 BMI:
Obesity 2 BMI:
Obesity 3 BMI:

A

Overweight BMI: 25-29
Obesity 1 BMI: 30-34
Obesity 2 BMI: >35-39
Obesity 3 BMI: > 40

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121
Q

CN 3 for the eye

A
  • Superior rectus
  • Inferior rectus
  • Medial rectus
  • Inferior oblique (extortion and elevation)
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122
Q

CN 4 for the eye

A

Superior oblique (intorsion and depression)

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123
Q

CN 6 for the eye

A

Lateral rectus (abduction)

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124
Q

CN 6 for the eye

A

Lateral rectus (abduction)

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125
Q

Chemo drugs that belong in antitumor class

A
  • Bleomycin- affects lungs
  • Doxorubicin- affects heart
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126
Q

Abdominal compartment syndrome:
How does it affect CO, diaphragm excursion, SVR, HR, pulmonary shunt?

A

Reduces CO and diaphragm excursion

Increases SVR, HR, pulmonary shunt zone 3, pulmonary edema

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127
Q

Things that worsen tracheobronchial compression:

A
  • Supine
  • Induction of GA
  • Positive pressure ventilation
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128
Q

Celiac plexus block complications:

At what level is it performed at?

A
  • Paralysis
  • Hypotension
  • Bowel puncture
  • Subarchnoid epidural injection can occur
  • Increased peristalsis/ diarrhea due to increased PNS

It’s performed at L1

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129
Q

Management with pt receiving bleomycin

A

They’re at risk of O2 toxicity
You want FiO2 < 30%
Lungs lack hydrolase enzyme, and it’s inactivated by bleomycin
High concentrations of bleomycin accumulate in the lungs

The lungs lack hydrolase enzyme, which is the primary mode of inactivation of bleomycin. This means that high concentrations of bleomycin accumulate in the lungs. This can damage the pulmonary capillary endothelium and later to the alveolar epithelium. In the lungs, hyperoxia stimulates production of oxygen free radicals, which may ultimately increase the risk of pulmonary fibrosis**

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130
Q

NR3

RCOOR

ROH

ROR

A

NR3- Amine

RCOOR- Ester

ROH- Alcohol

ROR- Ether

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131
Q

ROR

A

Ether

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132
Q

Rank most common to least common of allergic reactions:

Protamine, ABX, latex, muscle relaxants

A

1) Muscle relaxants
2) Latex
3) Abx
4) Protamine

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133
Q

Glyco increases or decreases LES tone?

A

Decreases

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134
Q

What drug increases LES tone?

A

Reglan

Anatacids

Sux

AchE inhibitors

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135
Q

What drug increases LES tone?

A

Reglan

Anatacids

Sux

AchE inhibitors

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136
Q

Myexedema s/s:

A

Myxedema coma is a complication characterized by coma, hypoventilation, hyponatremia, and hypothermia.

Severe hypothyroidism (myxedema) is an indication to cancel the surgical procedure.

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137
Q

Single lung transplant capnography

A

A double lung transplant in a patient with COPD should reveal a normal-appearing capnography tracing, assuming the transplanted lungs are healthy and no rejection has developed. SO CHOOSE A SINGLE LUNG TRANSPLANT

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138
Q

Dibucaine

A

Dibucaine inhibits normal pseudocholinesterase activity by 80%, meaning a normal patient has a dibucaine number of 80. This number is proportional to the amount of normal pseudocholinesterase.

The atypical homozygous variant has a dibucaine number of 20-30, and the heterozygous variant has a dibucaine number of 50-60.

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139
Q

In obese pts how do you dose sux?

A

Total body weight

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140
Q

Label the circle of Willis

A
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141
Q

CSF circulation

A

Love My 3 And 4 Little Miniature Schnauzers

Lateral Ventricles
Monro (Foramen of Monro)
3rd ventricle
Aqueduct of Sylvius
4th ventricle
Luschka (Foramen of Luschka)
OR
Magendie (Foramen of Megendie)
Subarachnoid space

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142
Q

Meds to dose LBW

A

Roc and Vec
Remi
Propofol induction
Sufentanil maintenance

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143
Q

Meds to dose by TBW:

A

Sux
Cis and atracurium
Versed
Fentanyl

Lipophilic drugs dose TBW
Hydrophilic drugs dose LBW

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144
Q

Obesity:
decrease in what lung volumes?

A

FRC and thoracic volume

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145
Q

Obesity:
decrease in?

A

FRC and thoracic volume

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146
Q

Asynchronous PACING:

A

Underlying ventricular activity is a risk for R on T phenomenon

Best used for pts without an intrinsic rhythm

Example is AOO or VOO this only paces

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147
Q

What rhythm is this?

A

WPW: AV nodal reentry tachycardia along the conduction pathway creates a delta wave, it’s antidromic QRS

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148
Q

What rhythm is this? Treatment?

A

WPW: AV nodal reentry tachycardia along the conduction pathway creates a delta wave, it’s antidromic QRS

Treatment for antidromic AVNRT (wide QRS SVT) includes:
Procainamide
Cardioversion

You can’t give anything else!!!

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149
Q

Absorbed volume for TURP:
Blood loss:

A

Absorbed 10-30ml/min can lead to TURP syndrome. Fluid overload, hyponatremia, water intoxication

Blood loss 2-5 ml/min

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150
Q

Diseases associated with MH

A

King Denborough syndrome
Minicore disease
Central core disease

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151
Q

Treatment for tetanus

A

Debride infected area, antitoxin, intubate

Do not give things that increase SNS like phenylnephrine

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152
Q

Hemophilia A: what lab does it prolong?

A

PTT

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153
Q

Drug A and B are:

A

A: Hydrophilic: Meperidine, morphine, hydromorphone. When injected into CSF has higher block and stays there longer

B: Lipophilic: Fentanyl, Sufentanil. Goes to system circulation

154
Q

Name some hypertonic solutions, what does it do to the cell size?

A

D5 NaCl 0.45
D5LR
D5 NaCl 0.9
NaCl 3%

They cause the cell to shrink

155
Q

D5W is what kind of solution? What does it to do the cell size?

A

Hypotonic solution and
NaCl 0.45%

Causes cell to swell

156
Q

Label this graph: context sensitive half time of each opioid

A

A: Fentanyl

B: Alfentanil

C: Sufentanil

D: Remi

157
Q

Complications with acute pancreatitis:

A

Myocardial depression
Pericardial effusion
Thrombophlebitis
Loss of portions: hypovolemia
DIC

158
Q

In elderly, which characteristic is associated with greatest risk of 30 day mortality?

A. Acute renal impairment
B. Unplanned ICU admission
C. Emergent surgery
D. ASA 4

A

D. ASA 4

159
Q

Where is CSF reabsorbed?

A

Arachnoid villi of the superior sagittal sinus

160
Q

Nitrous oxide CV effects:

A

Increase SNS: BP, SVR, HR
Can cause myocardial depression

161
Q

What factor will decrease in the elderly?

A. Work of breathing
B. Dead space
C. PaO2
D. Degree of small airway closure

A

C. PaO2

162
Q

Which lead is for diagnosing Dysrhythmias?

A

Lead 2

163
Q

Which changes in SSEPs suggest increased risk of nerve injury? Select 2
A. 10 % increase in latency
B. 10% decrease in amplitude
C. 50% increase in latency
D. 50% decrease in amplitude

A

A & D

164
Q

Which nerves are the highest risk for injury?

A

Superficial peroneal bottom leg
Sural top leg

165
Q

When properly placed the distal tip of the LMA sits at:

A. Base of tongue
B. Pyriform sinus
C. Upper esophageal sphincter

A

C.

166
Q

Compared to an adult what is higher in a newborn? What is lower?

A
  • Extracellular fluid volume
  • Volume of distribution for water soluble drugs

Alpha 1 acid glycoprotein concentration is lower till about 5-6 months. Also intracellular fluid remains the same!

167
Q

Drugs that are not safe to give to pt with porphyria?

What can worsen it?

Name 2 drugs that ARE safe to give

A

AVOID BEKKACB: Barbs, etomidate, ketorlac, ketamine, CCB, birth control

Stimulation of ALA synthetase, emotional stress, prolonged NPO, CYP450 induction

OK TO GIVE: Nitrous and Sux

168
Q

Clearance is directly proportional to:

A

Extraction ratio

Blood flow to the clearing organ

169
Q

Clearance is inversely proportional to:

A

Half life

Concentration in the central compartment

170
Q

(Complex regional pain syndrome)

Type 1 CRPS used to be called

Type 2 CRPS used to be called

Which type is preceded by nerve injury??

A

CRPS neuropathic pain with autonomic involvement
Type 1: reflex sympathetic dystrophy

Type 2: causalgia. Type 2 is always preceded by a NERVE INJURY!!!!!

171
Q

Methionine synthase

A

Inhibits Vitamin B 12 metabolism and DNA synthesis for Nitrous Oxide

172
Q

11-beta-hydroxylase

A

Inhibits steroid synthesis in Etomidate

173
Q

Pulmonary hypertsion is defined as a mean PAP of at least:

A

25 mmHg

It increases work load of the right heart and can lead to cor pulmonale

174
Q

Levodopa side effect

A

Orthostatic hypotension

take it day of surgery

175
Q

Triggers of sickle cell crisis

A

Pain

Hypothermia

Acidosis

Dehydration

176
Q

Intercostal line/Tuffer’s line

A

L4

177
Q

What labs suggest prerenal cause of oliguria?

A

Fractional excretion of sodium <1% Pt is holding onto sodium and water

Urine sodium < 20 mEq/L

Increased urine osmolality (concentrated urine)

178
Q

What increases or decreases as a result of pneumoperitoneum during laproscopic surgery?

  • ICP
  • MAP
  • A-a gradient
  • Renal and liver blood flow
  • Cardiac output
A

Increased:
- ICP
- MAP due to hypercarbia, and increased afterload
- A-a gradient

Decreased:
- Renal and liver blood flow
- Cardiac output due to decreased afterload and venous return

179
Q

What’s most likely to occur in Autonomic hyperreflex? (Select 2)

A. Hypothermia
B. Pulmonary edema
C. Tachycardia
D. Seizures

A

B and D

180
Q

Most potent amnestic?

Diazepam, Midazolam, or lorazepam?

A

Lorazepam

181
Q

Read and review this

A
182
Q

What choices increase after placement of an infra renal aortic cross clamp?

A. Mixed venous oxygen saturation
B. Cardiac output
C. Preload
D. Renal blood flow

A

Preload and mixed venous oxygen saturation

Preload- blood volume is shifted proximal to the clamp

Mixed venous O2 saturation- it increases as a function of decreased O2 consumption, you are putting same amount into the lungs but cells distal to the clamp aren’t receiving it

183
Q

List 2 examples of intrinsic restrictive disease

A

Aspiration pneumonia

Pulmonary edema

184
Q

Review the lines on this graph:
Where is ICP, PaCO2, PaO2, cerebral perfusion pressure?

A

Highlighted line is ICP!

Black line: PaCO2
Purple line: PaO2
Non highlighted green line: cerebral perfusion pressure

185
Q

What should be avoided in pt’s with myelomeningocele?

A

This is also called spina bifida high risk of latex allergy

Avoid latex

186
Q

What part is this that correlates with the CVP wave form?

A

A wave on CVP: atrial contraction

P wave on EKG: atrial depolarization

187
Q

Hypothyroidism anesthesia implications

A

Hypotension
Aspiration

THYROID ISSUES DON’T AFFECT MAC

188
Q

Rank speed of local anesthetic uptake after injection fastest to slowest

Intercostals, brachial plexus, caudal, interpleural

A

Interpleural
Intercostal
Caudal
Brachial plexus

189
Q

What is each peripheral nerve’s function?

A alpha

A beta

A delta

A gamma

A

A alpha: Motor

A beta: Pressure

A delta: Temperature

A gamma: Muscle tone

190
Q

AB has what antibodies?
B has what antibodies?
A has what antibodies?

A

AB has what antibodies? None
B has what antibodies? Anti A
A has what antibodies? Anti B
O has both A and B

191
Q

Which of these pulmonary functions will increase during pregnancy?

FRC, TV, IRV

A

Tidal volume

Inspiratory reserve volume

192
Q

Polyhydramnios should raise suspicion for:

A

Tracheoesophageal fistula

VACTREL: “T”

193
Q

Precedex on the peripheral post synaptic cause cause:

A
  • centrally presynaptic- vasodilation/sedation/analgesia
  • peripherally postsynaptic- vasoconstriction

Reduces Adenylate cyclase activity and reduce cAMP

194
Q

Tripling radius will cause flow to increase by

A

81

R = 3x3x3x3

195
Q

In experimental models all of the following associated with apoptosis in the developing brain except:

A. Sevo
B. Ketamine
C. Dexmedetomidine
D. Midazolam

A

C.

196
Q

What do these drugs work on arteries or veins or both?

  • nitroglycerin, nitroprusside, prazosin
A

Nitroglycerin- venules

Nitroprusside- works on arterioles and venules

Prazosin- works on arterioles

197
Q

What conditions are consistent with this capnograph?

A

MH, opioid overdose, seizures

Notice how baseline returns so it rules out rebreathing

If it was rebreathing it could be: exhausted soda lime, incompetent unidirectional valve, hole in the inner tubing of a Bain circuit

198
Q

A drug has a volume of distribution of 0.5 L/kg. In an 85kg pt what load dose must be administer to achieve a plasma concentration of 6mg/L

A

Loading dose formula = Vd x desired Cp / Bioavailability which is 1

42.5 x 6 = 255 mg

199
Q

TOF monitoring for pt with hemiparesis

A

TOF monitoring on the hemiparetic limb yields falsely elevated response

200
Q

Mass spectrometry

A

Bombarding gas sample with electrons

201
Q

Raman scatter spectrometry

A

Aragon laser to produce photons which collide with the gas molecules

202
Q

Treatment for gout

A
203
Q

Gastrin

CCK

Motilin

Secretin

A
204
Q

Pulmonary edema:
Is it left-to-right shunt or right-to-left shunt?

A

Right to left shunt
And it will not respond to supplemental O2

205
Q

What are contraindications of hypokalemic periodic paralysis?

A

Glucose infusion and Lasix

What is ok is:
- Acetazolamide is useful in both hypo and Hyperkalemia

206
Q

Following retinal detachment surgery how long should nitrous be avoided?

  • Silicone oil
  • Sulfur
  • Air bubble
A
  • Silicone oil 0 days
  • Sulfur 10 days
  • Air bubble 5 days
207
Q

Impaired bile production is a source of

A

Coagulopathy

If its impaired it reduces absorption of fat soluble vitamins, D, A, K, E

K is important in producing factor 2, 7, 9, 10

208
Q

What causes non gap metabolic acidosis?

(Due to lose of HCO3- or increased Cl-)

A

Diarrhea

Renal tubular acidosis

Excessive sodium chloride administration

209
Q

FGF coupling

A

FGF COUPLING:
1) Convert L to ml

2) multiply by fraction of a minute spent in inspiratory time

3) divide by RR

4) Add to volume set on bellows

Where as FGF DE-COUPLING: set tidal volumes and delivered tidal volumes are equal

210
Q

Cyproheptadaine

A

5HT anatagonist

Treatment for serotonin syndrome but it’s only in PO form

Ecstasy intoxication

211
Q

Sepsis:

Pulmonary wedge pressure:
CO:
SVR:

A

Pulmonary wedge pressure: Decreased
CO: Increased
SVR: Increased

212
Q

Patients with which 2 viral infections have a higher incidence of type IV allergic reactions?

A

Patients with Epstein-Barr and cytomegalovirus infections have an increased incidence of type IV allergic reactions.

213
Q

Neostigmine reverses the effects of neuromuscular blockade primarily by

A

preventing the metabolism of acetylcholine

214
Q

The lateral femoral cutaneous nerve is composed of fibers from?

A

L2 and L3

215
Q

What drug is recommended for intravenous treatment of serotonin syndrome?

A

Intravenous chlorpromazine is a serotonin receptor antagonist that is administered for the treatment of serotonin syndrome.

Cyproheptadine is an oral serotonin antagonist that is the drug of choice for treating serotonin syndrome. However, it is available only in an oral formulation.

216
Q

The 3 most important factors in determining spread of local anesthetics in the epidural space

A

1) Local anesthetic volume
2) Level of injection**
3) Drug dose

Less impact:
Concentration
Patient position

217
Q

Hepatopulmonary syndrome is a triad composed of

A

liver dysfunction

intrapulmonary vascular shunting/dilation

unexplained hypoxemia

The definitive treatment is liver transplantation, which resolves the hypoxemia within 1 year.

218
Q

The temperature of an ideal gas in a closed system is held constant. If the volume is doubled, the pressure of the gas:

A

decreases by one-half.

Boyle’s law shows that, at a constant temperature, changes in a gas’s volume (V) are inversely proportional to changes in pressure (P): P1V1 = P2V2.

If the volume doubles, the pressure must decrease to maintain the balance in the equation. For instance, if P1 is 1 atm and V1 is 1 L, when V2 doubles to 2 L, the resulting pressure (P2) will be 1/2 atm, indicating a decrease by one-half.

219
Q

Carbon dioxide is primarily transported in blood as dissolved carbon dioxide as well as:

A
  • bicarbonate 70%
  • plasma 7%
  • bound to hemoglobin as carbamino compounds 23%
220
Q

Respiratory effects in obesity?

MV, ERV, FRC, VC, RV, CC:

A

Minute ventilation (via an increase in respiratory rate) must increase to maintain normal blood gas tensions.***

ERV is decreased, resulting in lower FRC and VC.

RV and closing capacity are unchanged in obese individuals (unlike in restrictive diseases, where it is decreased).**

221
Q

The Fick equation

A

[CO = VO2 / (CaO2—CvO2)] can be used to calculate cardiac output

total oxygen consumption/ differences between arterial and mixed oxygen content

222
Q

Hydrophilic opioids in epidurals

A

Slower onset
Longer duration
Higher CSF solubility**
Extensive CSF spread**

223
Q

Somatosensory-evoked potentials (SSEP) monitor? Where does signal takes place?

MEPS monitor? What does signal take place?

A

SSEPs assess lateral and posterior spinal cord perfusion. Signal takes place in the patient’s brain

Motor-evoked potentials (MEP) are used to evaluate anterior spinal cord perfusion

224
Q

Mapleson circuit A FGF:

Mapleson circuit D FGF:

A

A Mapleson A: 20 L/min to prevent rebreathing during controlled ventilation.
The Mapleson A circuit is best used for spontaneous ventilation.

Mapleson D: FGF rate of ≥ 2.5 times the patient’s minute ventilation rate is required to prevent rebreathing. Best for controlled ventilation

225
Q

5-hydroxyindoleacetic acid is the metabolite of

A

serotonin used to diagnose carcinoid syndrome. This syndrome typically presents with flushing, diarrhea, and wheezing.

226
Q

Acknowledging only information that supports the suspected diagnosis

A

Confirmation bias

227
Q

Performing unindicated maneuvers and deviating from protocol

A

Commission bias

228
Q

Performing unindicated maneuvers and deviating from protocol

A

Commission bias

229
Q

Unwillingness to let go of a failing diagnosis or decision

A

Sunk cost

230
Q

Risk factors for carbon monoxide production following volatile anesthetics administration include:

A

Risk factors for carbon monoxide production following volatile anesthetics administration include
1) dry absorbent
2) type and concentration of the volatile anesthetic
3) the type of absorbent.

Risk factors for soda lime desiccation include using the anesthesia machine for the first case on Monday morning when the oxygen flowmeter was discovered to flow at high rates all weekend, and cannister is warm to touch

231
Q

A bronchial blocker is advantageous rather than a double-lumen tube (DLT) for selective lobar collapse in patients with:

A
  • prior oral or neck surgery and with challenging airways
  • in patients with a tracheostomy
  • in children younger than 8 years of age
  • when postoperative mechanical ventilation is anticipated

Bronchial blockers are not as reliable as DLTs for providing lung isolation, and DLTs are generally used if there is no specific indication for bronchial blocker placement.

232
Q

3 types of protamine reactions

A

Type 1: Histamine: hypotension

Type 2: Anaphylaxis (previous use of NPH insulin, fish allergy, or vasectomy) Epinephrine should be the first-line

Type 3: Heparin–protamine complexes release arachidonic acid byproducts, including thromboxane A2, which causes pulmonary vasoconstriction and systemic hypotension and can lead to right ventricle failure. Give epinephrine or milrinone. May need reheparinization to decrease the number of heparin–protamine complexes and, ultimately, reinstitution of cardiopulmonary bypass.(Low BP, low CO, high PCWP, low LVEDP)

233
Q

What is the MOST LIKELY side effect following a successful diagnostic stellate ganglion block?

A

Signs of Successful Stellate Ganglion Block:

Flushing of the conjunctiva and skin of the face and arm

Horner syndrome (miosis, ptosis, anhidrosis, pseudoenophthalmos, hyperemia)

Nasal congestion

Temperature increase in the ipsilateral arm

234
Q

What type of tracheostomy tube should be used when performing a bedside tracheostomy?

A

A cuffed low-pressure tracheostomy tube is required to avoid aspiration

235
Q

What type of tracheostomy tube should be used when performing a bedside tracheostomy?

A

A cuffed low-pressure tracheostomy tube is required to avoid aspiration

236
Q

After an average induction dose of succinylcholine, prolonged recovery from the neuromuscular blockade is observed. Which patient medication is MOST likely attributed to the prolonged neuromuscular blockade?

A. Magnesium
B. Sodium
C. Lithium

A

Lithium potentiates neuromuscular blockade after dosing depolarizing and nondepolarizing neuromuscular blocking drugs, decreases the minimum alveolar concentration of inhalational anesthetics, and potentiates the action of anesthetic agents.

The proposed mechanism is the presynaptic inhibition of neuromuscular transmission and muscular contraction postsynaptically through the activation of potassium channels.

237
Q

After an average induction dose of succinylcholine, prolonged recovery from the neuromuscular blockade is observed. Which patient medication is MOST likely attributed to the prolonged neuromuscular blockade?

A

Lithium potentiates neuromuscular blockade after dosing depolarizing and nondepolarizing neuromuscular blocking drugs.

Through presynaptic inhibition of neuromuscular transmission and muscular contraction postsynaptically through the activation of potassium channels.

238
Q

What adverse events can occur with intraoperative blood salvage transfusion?

A

hypervolemia
bacterial contamination
hypotension
nonimmune hemolysis
febrile nonhemolytic reactions, allergic reactions
disseminated intravascular coagulation
coagulopathies
air embolus
and nonspecific temperature increases that include chills and skin flushing.

239
Q

Local anesthetics have a higher rate of absorption when injected in areas of higher vascularity:
Greatest to least:

A

“In The ICU, Patients Easily Breathe So Smoothly.”

intravenous > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > sciatic/femoral > subcutaneous

240
Q

Leak pressure in uncuffed ett in peds

A

The ideal leak pressure of an uncuffed endotracheal tube (ETT) in pediatric patients is < 25 cm H2O.

With a leak pressure > 40 cm H2O, the ETT should be replaced with a smaller ETT**

241
Q

A continuous fentanyl epidural gtt provides analgesia by acting

A

Systemtically

242
Q

Anesthetic considerations for patient with Pheochromocytoma: Select 3

A. Morphine
B.Droperidol
C. Nitroprusside
D. Phenoxybenzamine
E. Dextrose

A

Nitroprusside, Phenoxybenzamine, dextrose
Plasma NE falls after tumor is removed and it increases the risk of hypoglycemia. Dextrose is essential

243
Q

What condition is most closely associated with this?

A

Gastroishisis. It’s to the right of the umbilicus and not covered by a sac. It’s common in prematurity

244
Q

What chemo drugs are in these drug classes? What does it affect?

Alkylating agent-

Tubulin-binding drug-

A

Alkylating agent- Cisplantin (affects ears and kidneys)

Tubulin-binding drug-Vincristine (Affects neuropathy)

245
Q

Blood gas coefficient for Sevoflurane

A

0.65

246
Q

Which gas is most affected by right to left shunt?

A

Desflurane compared to nitrous

247
Q

What happens to SVR with inadequate pain management?

A

SVR increases

248
Q

Know which NT are exitatory vs inhibitory

A
  • Excitatory: Sub P, glutamate, acetylcholine, dopamine
  • Inhibitory: GABA, glycine, enkephalin, serotonin, NE (CNS inhibitory, PNS excitatory)
249
Q

Which gas law states that at a constant temperature, the amount of gas dissolved in a liquid is directly proportional to the partial pressure of that gas at equilibrium above the gas-liquid interface?

A

Henrys

250
Q

Hormones that use the phospholipase C system include:

A

APOV
- Alpha receptor catecholamines
- Parathyroid hormone
- Oxytocin
- Vasopressin V1

251
Q

Hormones that use the adenylyl cyclase system include:

A
  • calcitonin
  • ACTH
  • glucagon
  • secretin
  • somatostatin
  • vasopressin V2
  • parathyroid hormone
  • luteinizing hormone
  • beta-receptor catecholamines
252
Q

Stimulation of GABA receptors results in an influx of which electrolyte

A

influx of chloride ions into the cell

253
Q

Which of the following conditions is known to produce increased latency in brainstem auditory evoked potentials?

A

Low PCO2 (hypocapnia) exaggerates BAEPs, resulting in an increased latency and Hypothermia

254
Q

What cardiac reflex?:

Traction on the mesentary=
Increased ICP=
Traction on the medial rectus=
Increase in Intrathoracic pressure=

A

Traction on the mesentary= celiac reflex
Increased ICP= cushing’s reflex
Traction on the medial rectus= oculocardiac reflex
Increase in Intrathoracic pressure= valsalva reflex

255
Q

Which of the following are reliable tests that can be used to determine whether or not a patient has muscle strength adequate enough to sustain ventilation and take a large enough breath to cough effectively?

A

1) TV of 10-12 ml/kg
2) Negative inspiratory force of -25 cm H2O
3) Ability to perform sustained head lift

256
Q

What is the most common cause of an acute increase in deadspace in the acute care setting?

A

Decreased cardiac output

(Got this off prodigy)

257
Q

What are the fundamental factors that reduce the mixed systemic partial pressure of oxygen (PvO2)? (select two)

A
  • decrease in arterial oxygen content
  • increase in oxygen extraction
258
Q

How is patient morbidity related to the volume and pH of aspirated material? What is it directly and indirectly related to?

A
  • directly related to volume
  • indirectly related to pH
259
Q

Sign’s of diabetes inspidus:

A
  • urine specific gravity less than 1.005
  • a urine osmolality of 200 mOsm/kg or less.
260
Q

Pediatrics pt with what condition increases their risk of Propofol syndrome?

A

Mitochondrial disease

261
Q

A patient presents for liver transplantation due to hepatopulmonary syndrome (HPS). This disease is characterized by the triad of:

A

Hepatopulmonary syndrome (HPS) is characterized by the triad of
- hypoxemia
- portal hypertension
- pulmonary vascular dilations

262
Q

A preoperative finding of nystagmus would be consistent with potential abuse of which drug?

A

Phencyclidine (PCP)

263
Q

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

A

Windup

Repeat stimulation caused by nerve damage or chronic inflammation can cause a condition known as windup. This cyclical response to pain ultimately leads to abnormal pain responses and a chronic pain sensation. Due to the chronic discharge of neurons, the inhibitory systems of neuropathways become overwhelmed.

264
Q

You are preparing to induce a patient with a large anterior mediastinal mass for general anesthesia. Which device should you have at your immediate disposal?

A

Rigid bronchoscope cus they’re at risk of immediate airway obstruction

265
Q

A patient is placed in steep Trendelenburg position for a robotically-assisted procedure. This will cause a decrease in lung volumes or lung compliance?

A

Decrease in lung compliance

266
Q

How is an epidural catheter size typically related to the needle?

A

2 gauges smaller

267
Q

Which patient safety initiative outlines a list of serious, reportable adverse outcomes such as surgery on the wrong site?

A

The National Quality Forum

268
Q

The duration of action of ester local anesthetics within the subarachnoid space is primarily dependent upon

A

Systemic absorption

269
Q

Select two laboratory studies that appear to be associated with increased risk of perioperative pulmonary morbidity.

A
  • low serum albumin
  • increased BUN
270
Q

Where should the tip of a central venous pressure catheter be located?

A

above the junction of the superior vena cava and the right atrium

271
Q

A patient exhibits a sodium level of 130 mEq/L and a serum osmolarity of 315 mOsm/L. Previous administration of which drug would most likely explain these findings?

A

Mannitol

This patient has a low serum sodium concentration but a high serum osmolarity. Hyponatremia with a normal or high serum osmolarity results from the presence of non-sodium solutes such as glucose or mannitol.

272
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

A single epidural injection of 80 mg of methylprenisolone can suppress plasma cortisol and the ability to secrete it for 3 weeks after the injection

273
Q

Which opioid should not be used in a neuraxial block?

A

Remifentanil contains glycine as a buffer. Because glycine can cause neurotoxicity, it cannot be administered epidurally or intrathecally.

274
Q

Maximum total dose of lidocaine mg/kg?

A

55mg/kg

275
Q

What is the most common manifestation of sickle cell disease as a result of tissue hypoxia and infarction?

A

Vaso-occlusive crisis

276
Q

What is the pKA for:

Chloroprocaine:
Tetracaine:
Bupivacaine:
Lidocaine:

A

Chloroprocaine: 8.7
Tetracaine: 8.5
Bupivacaine: 8.1
Lidocaine: 7.9

277
Q

Nerves that are most likely to be injured due to improper lithotomy positioning:

A

Sciatic, common peroneal, posterior tibial, saphenous, obturator

278
Q

Carbon dioxide laser can cause what kind of injury?

A

Corneal because it’s a longer wavelength and can’t penetrate deep tissue

Other lasers like ruby, nd-yag, argon can cause retinal injury

279
Q

Which area of myocardium is most susceptible to myocardial ischemia?

A

Left ventricular subendocardium

280
Q

Where would Reynold’s number be the lowest?

A

Terminal and respiratory bronchioles < 2,000

It would be greatest in the trachea and the main stem bronchioles > 4,000

281
Q

How many days to hold?

  • Clopidogrel
  • Ticlopidine
  • Abciximab
  • NSAIDs
A
  • Clopidogrel 7 days
  • Ticlopidine 14 days
  • GP IIb/IIIa receptor antagonist: Abciximab 3 days
  • NSAIDS: 1-2 days, ASA is 7 days
282
Q

Absolute indications for single lung ventilation?

A
  • Massive hemorrhage
  • Bronchopleural fistula
  • Unilateral lung lavage
283
Q

Which drugs show a prolonged effect in the patients with a dibucaine number of 20?

A

Benzocaine and Sux

the patient has atypical homozygous pseudocholinesterase deficiency

284
Q

Match each pain modulating neurotransmitter with its target receptor:

  • Glycine
  • Glutamate
  • Substance P
  • Serotonin
A
  • Glycine: Chloride linked GlyR
  • Glutamate: N-methyl-D-aspartate
  • Substance P: Neurokinin 1
  • Serotonin: 5HT
285
Q
A

A: Trigeminal nerve V2

B: Trigeminal nerve 3

C: Glossopharyngeal nerve

D: Vagus nerve

286
Q
A

Muscular dystrophy (Duchenne’s): Absence of dystrophin

Myotonic dystrophy: excess calcium sequestration

Acute idiopathic polyneuritis: immunologic assault on myelin in the peripheral nerve

Hyperkalemia periodic paralysis: Alteration of sodium channels

287
Q

What does each WBC do?

  • Basophil
  • T cell
  • B cell
  • Neutrophil
A
  • Basophil: releases histamine
  • T cell: cell mediated immunity
  • B cell: humoral immunity with antibodies
  • Neutrophil: most abundant WBC
288
Q

How many valves are present?

  • Ayre’s T piece:
  • Jackson-Reese:
  • Circle breathing system:
A
  • Ayre’s T piece: 0 valves
  • Jackson-Reese: 1 valve
  • Circle breathing system: 3 valves
289
Q

Ways to reduce systemic absorption of opthalamic medication:

A
  • Keep eye shut for 1 minute
  • Avoid blinking
  • Compress the medial canthus of the eye
290
Q

Which volatile agent is most likely to cause a fire inside the breathing circuit?

A

Sevoflurane

291
Q
A
292
Q

Which laws are illustrated in the Fick equation? What things are directly proportional to Fick’s?

A
  • Graham and Henry

Directly proportional to:

  • Partial pressure difference
  • Diffusion coefficient
  • Membrane surface area

Indirectly proportional to:

  • Membrane thickness
  • Weight
293
Q

Which laws are illustrated in the Fick equation? What things are directly proportional to Fick’s?

A
  • Graham and Henry

Directly proportional to:
- Partial pressure difference
- Diffusion coefficient
- Membrane surface area

294
Q

What things are indirectly proportional to Fick’s law?

A
  • Membrane thickness
  • Molecular weight
295
Q
A
296
Q

DOPA decarboxylase facilitates the conversion of:

A

DOPA to dopamine

297
Q

Dopamine-beta-hydroxylase facilitates the conversion of:

A

Dopamine to NE

298
Q

Tyrosine hydroxylase facilitates the conversion of:

A

Tyrosine to DOPA

299
Q

What are the steps involved in the synthesis of NE and EPI?

A

1) Tyrosine to DOPA: tyrosine hydroxylase

2) DOPA to dopamine: DOPA decarboxylase

3) Dopamine to NE: Dopamine-beta-hydroxylase

4) NE to EPI: Phenylethanolamine N- methyltransferase

300
Q

Which steroid has the most potent glucocorticoid properties?

A

Decadron and Betamethasone are the only ones affected by glucocorticoid

301
Q

Debakey

Type 1:
Type 2:
Type 3:

A

Type 1: involves ascending and descending aorta
Type 2: ascending aorta
Type 3: descending aorta

302
Q

Crawford classifications

Which type is least likely to cause aortic insufficiency?

A

Type 1-4 involve descending thoracoabdominal aorta only and type 1 is the least likely to cause aortic insufficiency

303
Q

Stanford classification for aneurysms:

A

Type A: ascending and may or may not involve descending aorta
Type B: descending aorta

304
Q

Superior hypogastric plexus block

A

useful for cancer pain in pelvic organs

305
Q

Bronchial blocker

A
  • Allows isolated lung to be suctioned
  • Can be used if pt requires nasotracheal intubation
  • Can be used for lung separation in the pt with a trach
  • < 12 years
  • Placed with a FOB for assistance
306
Q

Common cause of death with an LVAD

A

SEPSIS

307
Q

Spinothalamic tract:

A

1st order neuron- dorsal root
2nd order neuron- dorsal horn
3rd order neuron- thalamus

308
Q

Vanco must be started within how many minutes of surgical incision?

A

Vanco needs to be started within 120 minutes (2 hours) of surgical incision. All other abx need to be started within in 1 hour

309
Q

Rank lowest to greatest amount of pain caused by the procedure:

Topical, retrobulbar, peribulbar, sub tendon block

A

Lowest to greatest pain:
1) Topical
2) Sub-tenon block
3) Peribulbar block
4) Retrobulbar block

310
Q

Pt is undergoing masectomy with the sentinel node biopsy:

What electrolyte change is commonly seen? What monitor may be inaccurate?

A
  • Hypercalcemia is common
  • SpO2 may be inaccurate during the surgery
311
Q

Laminae 1-6 reside in:

A

Laminae 1-6 reside in dorsal grey matter and they are sensory

312
Q

Laminae 7-9 reside in:

A

Laminae 7-9 reside in the ventral grey matter and are motor

313
Q

Which agents are oxybarbituates?

A

Methohexital, phenobarbital, secobarbital

They have an O2 at the 2nd position

314
Q

Which agents are thiobarbiuates?

A

Thiopental and thiamylal

They have a sulfur at the 2nd position.

315
Q

Is MAC changed by obesity?

A

No

316
Q

Drug class?

  • Amiodarone
  • Diltiazem
  • Phenytoin
  • Metoprolol
A
  • Amiodarone: Class 3
  • Diltiazem: Class 4
  • Phenytoin: Class 1B
  • Metoprolol: Class 2
317
Q

What is associated with radial nerve injury?

A
  • Wrist drop
  • External pressure at the spiral groove of the humerus
  • Caused by surgical retractor or an IV pole that puts pressure on the arm
318
Q

When would coronary artery stenting be best over a CEA?

A
  • EF < 30%
  • Unstable angina, abnormal stress test or MI < 1 month
  • Valve disease
  • Severe obesity
  • Contralateral RLN dysfunction
319
Q

Effects on the eyes:

  • Heroin
  • Methampetamine
  • Phencyclidine
A
  • Heroin: miosis
  • Methampetamine: mydriasis
  • Phencyclidine: nystagmus
320
Q

What % of morbidity and mortality is associated with the following events?

  • CV events
  • Resp events
  • Regional events
  • Equipment failure
A
  • CV events: 13%
  • Resp events 17%
  • Regional events 20%
  • Equipment failure 10%
321
Q

Nerves blocked by axillary approach to the brachial plexus approach?

A
  • Radial, ulnar, musculocutaneous, median nerve

Axillary nerve is not blocked by the axillary block!!!!!!!

322
Q

Second messenger of nitric oxide

A

Cyclic guanosine monophosphate

NO activates cGMP, this activates protein kinase = vascular smooth relaxation

323
Q

Diclofenic

A

Non-selective COX inhibitor

it can cause thromboxane platelet dysfunction and bleeding, tissue protective prostanoids with gastric ulcers, and renal vasodilates prostanoids with renal impairment

324
Q

Atrial natriuretic peptide increases what 3 things?

A
  • GFR
  • Water excretion
  • Sodium excretion

ANP is released in response to atrial distention from increased volume

325
Q

A patient who experiences malignant hyperthermia requires active cooling. When should active cooling be discontinued?

A

When the core temp drops below 38C

326
Q

Bourdan pressure gauge can be used to calculate the cylinder volume for:

A

Helium and nitrogen

327
Q

Which valve issue is most common in ankylosing spondylitis?

A

Aortic insufficiency

328
Q

Max inflation pressure for an LMA classic?

A

60 cm H2O

329
Q

Aortic stenosis is considered severe aortic valve

A

< 0.8cm^2

330
Q

Cortisol synthesis is dependent on

A

Cholesterol

331
Q

Fibromyalgia is associated with

A

Allodynia: non noxious stimulus that produces pain

332
Q

Choose the letter that represents the hormone produced in the supraoptic nucleus’s of the hypothalamus

A

D: Antidiuretic hormone

ADH is produced in the paraventricular nuclei of the hypothalamus

333
Q

According to American Society of Anesthesiologists what is the incidence of anesthetic mortality in the ASA 1 patient population?

A

ASA 1: 0.04 per 10,000 anesthetics

ASA 2: 0.5 per 10,000 anesthetics

ASA 3: 2.7 per 10,000 anesthetics

ASA 4: 5.5 per 10,000 anesthetics

334
Q

Components in cryoprecipitate?

A

1) Fibrinogen and fibronectin

2) Von willebrand factor

3) Factor 8 and 13

335
Q

During shoulder surgery, in the beach chair position the MAP in the upper arm is 60 mmHg. If the external auditory meatus is 14 inches higher than the blood pressure cuff. What is the MAP in the circle of Willis?

A

For every 1 inch above the heart the real MAP is 2 mmHg less than what you see on the monitor.

For every 1 inch blow the heart, the real MAP is 2 mmHg more than what you see on the monitor.

There is a 14 inch difference. So 14 x 2 = 28

MAP is 60 so 60-28 = 32 mmHg!

336
Q

How many oxygen atoms are bound to 1 hemoglobin molecule when mixed venous oxygen saturation is 75%?

A

Each hemoglobin molecule can carry 4 oxygen molecules, oxygen is diatomic so this means 8 oxygen atoms

If hgb saturation is 100% it carries 4 O2 molecules (8 oxygen atoms)

If hgb saturation is 75% it carries 3 O2 molecules (6 oxygen atoms)

If hgb saturation is 50% it carries 2 O2 molecules (4 oxygen atoms)

If hgb saturation is 25% it carries 1 O2 molecule (2 oxygen atoms)

337
Q

Highest to lowest protein bound local anesthetics:

A

larry brown runs monster trucks prince phillip and charles (highest to lowest)

Levobupivacaine (most)
Bupivacaine
Ropivacaine
Mepivacaine
Tetracaine
Lidocaine
Prilocaine
Procaine
A
Chloroprocaine 0% (least)

338
Q

You ran out of D50 amps. But you have a D5NS liter bag how many ml can you give to achieve the same amount as 25mL of D50?

A

D50 is prepared as 50% glucose in water. It has 25g of dextrose in 50 ml of water.

D5NS is 5% glucose in 0.9% NaCl. It contains 50g of dextrose in 1 liter of 0.9% NaCl. So each g/ml is 0.05g/ml. Because 50/1000 = 0.05

You were asked to give 25mL of D50 which is 12.5G of dextrose

12.5g/ml = x/ ml = 0.05 g / 1ml = 250 ml

339
Q

What hemodynamic change is this?

Increased CVP + Increased PADP + normal PAOP=

Is it right ventricular failure or pulmonary hypertension?

A

Pulmonary hypertension

340
Q

What hemodynamic change is this?

Normal CVP + Increased PADP + Increased PAOP

Is it left ventricular failure or right ventricular failure?

A

Left ventricular failure

341
Q

What hemodynamic change is this?

Increased CVP + normal PADP + normal PAOP

Is it pulmonary hypertension or right ventricular failure?

A

Right ventricular failure

342
Q

When performing an infraclavicular block, which 2 muscles will be penetrated before reaching the target for blockade?

A

Pec major and pec minor are penetrated

343
Q

When blood flows through a nonatherosclerotic section of the artery, what vascular or fluid change would lead to the GREATEST reduction in flow?

A. Double the blood viscosity

B. Double the length of the tube

C. Halving the radius of the artery

D. Half the blood viscosity

A

Halving the radius of the artery reduces flow exponentially THE MOST!

344
Q

ICU Management of Patients with Severe TBI: Parameters

  • ICP:
  • Glucose:
  • CPP:
  • PaCO2:
A
  • ICP: 10-20 mmHg. Want it less than 20
  • Glucose: <180
  • CPP: 50-70 mmHg
  • PaCO2: PaCO2: 35–40 mm Hg, not lower than 35

Hyperventilation leads to hypocapnia, which reduces intracranial pressure (ICP) via a reduction in the cerebral blood flow (CBF). However, this is typically a transient fix, and prolonged hyperventilation has been shown to potentially worsen cerebral ischemia. Therefore, **it is not recommended for indefinite management of a traumatic brain injury (TBI).*8
Instead, recommendations call for keeping TBI patients normocapnic (PaCO2 of 35–40 mm Hg).

345
Q

Things that can cause overdamping of art line:

A
  • Stopcocks
  • Tubing size
  • Air in the pressure monitoring system.
  • Disappearance of the dicrotic notch is a sign of overdamping
346
Q

What condition will MOST likely increase the plateau pressure during positive-pressure mechanical ventilation?

A. Anaphylaxis

B. Endotracheal tube partial obstruction

C. Acute asthma attack

D. Transfusion-related acute lung injury

A

D. Transfusion-related acute lung injury

Plateau pressure is the pressure in the small airways and alveoli after reaching the target tidal volume.
Since there is no airflow when the target tidal volume has been reached, airway resistance does not affect the plateau pressure.

Complications of elevated plateau pressures include pulmonary edema (such as seen with transfusion-related acute lung injury), ventilator-associated lung injury, pneumothorax, pneumomediastinum, and subcutaneous emphysema

347
Q

Review the dermatomes

A
348
Q

What organs can the celiac plexus block be good for?

A

stomach, pancreas, diaphragm, liver, spleen, small intestine, large colon, transverse colon, adrenal glands, and kidney

349
Q

What is the action of each structure?

A
  • Frontal lobe : Cognition
  • Globus pallidus : Fine motor movement
  • Amygdala: Emotion
  • Hippocampus: Learning
350
Q

How does ketamine affect CMRO2 and CBF?

A

↑ CMRO2 ↑ CBF

Increases both

351
Q

How does sevo affect CMRO2 and CBF?

A

↓CMRO2 ↑CBF

352
Q

How does Propofol affect CMRO2 and CBF?

A

↓CMRO2 ↓CBF

Decreases both

353
Q

How does benzos and Etomidate affect CMRO2 and CBF?

A

Decreases both like propofol

354
Q

How does precedex affect CMRO2 and CBF?

A

No affect on CMRO2, decreases CBF

355
Q
A

D is MA: clot strength

The maximum amplitude (D) of the thromboelastogram indicates the mechanical strength of the fibrin clot and, thus, platelet function. A value lower than 50-60 mm indicates a possible problem with thrombocytopenia, thrombocytopathy, or the presence of antiplatelet agents.

356
Q

What type of nerves are responsible for the transmission of burning pain?

A

The C fibers are nonmyelinated fibers that slowly carry mechanical, chemical, and thermal pain perceived as a dull, prolonged burning sensation.

357
Q
A

A. In Eaton-Lambert syndrome, IgG autoantibodies directly attack voltage-gated calcium channels

358
Q

The primary tactile landmark for the placement of a stellate ganglion block is the ____________________ which is the transverse process of ______.

A

Tubercle of Chassaignac, C6

359
Q

The lateral approach to sciatic nerve blockade that involves the external landmarks of the:

  • greater trochanter
  • the posterior superior iliac spine
  • and the sacral hiatus

is refered to as the approach of:

A

Labat

360
Q

For most blocks, when using a nerve stimulator, stimulation should be acquired below ________ mA but above _______ mA to insure adequate blockade while minimizing risk of intraneuronal injection.

A

0.5, and 0.2

361
Q

The initial bolus dose of 20% intralipid used for treatment of local anesthetic systemic toxicity is:

A

1.5ml/kg

Not mg!

362
Q

In performing an intercostal nerve block, it is important to remember that:

a) the nerve travels just below the artery on the superior surface of the rib
b) the nerve travels just above the artery on the superior surface of the rib
c) the nerve travels just below the artery on the inferior surface of the rib
d) the nerve travels just above the artery on the inferior surface of the rib

A

d) the nerve travels just above the artery on the inferior surface of the rib

363
Q

In performing an intercostal nerve block, it is important to remember that:

a) the nerve travels just below the artery on the superior surface of the rib
b) the nerve travels just above the artery on the superior surface of the rib
c) the nerve travels just below the artery on the inferior surface of the rib
d) the nerve travels just above the artery on the inferior surface of the rib

A

d) the nerve travels just above the artery on the inferior surface of the rib

364
Q

A deep cervical plexus block can be performed by (select two):

a) Injecting 12 mL of local anesthetic at the C4 transverse processes
b) Injecting 5 mL of local anesthetic along the posterior border of the sternocleidomastoid
c) Injecting 3-4 mL of local anesthetic at the C2, C3, and C4 transverse processes
d) Injecting 10 mL of local anesthetic in the epidural space at the C3 level

A

a) Injecting 12 mL of local anesthetic at the C4 transverse processes

c) Injecting 3-4 mL of local anesthetic at the C2, C3, and C4 transverse processes

365
Q

Para-aminobenzoic acid is a metabolite of:

A

Procaine

366
Q

In the performance of an ankle block, which 3 nerves are blocked by a subcutaneous injection?

A

Saphenous, Sural, Superficial Peroneal

367
Q

The duration of action of which local anesthetic would be prolonged the least by the addition of epinephrine prior to injection?

A

Bupivacaine

368
Q

The _______________ block is the least likely to significantly raise intraocular pressure because it involves the lowest volume of local anesthetic.

a) retrobulbar
b) peribulbar
c) Sub-Tenon’s
d) Tenaculam

A

a) retrobulbar

369
Q
A

Expiratory valve incompetence, the capnograph tracing does not return to 0 during inspiration.

370
Q
A

Expiratory valve incompetence results in marked elevation of the inspiratory segment of the end-tidal carbon dioxide capnography waveform.

The capnograph tracing does not return to zero during inspiration.

This is because of the rebreathing of exhaled gases from the expiratory limb in a reverse direction, which also results in a mildly elevated expiratory segment.

A similar tracing may also occur in the setting of exhausted carbon dioxide absorbent.

371
Q

Late FHT decelerations

Drop in beats/min for how long?

A

A deceleration is described as a temporary decline in fetal heart monitoring, with a drop of > 15 beats/min for a maximum of 2 minutes

If a deceleration lasts 2-10 minutes, it is considered a prolonged deceleration caused by severe uteroplacental insufficiency.

372
Q
A

An incompetent inspiratory valve allows exhaled gas to enter the inspiratory limb. The capnograph in the stem demonstrates a decreased slope (a widening beta angle). A portion of the exhaled breath reenters the inspiratory limb, and the patient will breathe the previously exhaled carbon dioxide. The waveform may reach 0, depending on the fresh gas flow.

373
Q

Which congenital heart defect MOST favorably responds to the administration of prostaglandin E2 for the maintenance of pulmonary blood flow?

A. Atrial septal defect

B. Pulmonary atresia

C. Hypoplastic left heart

D. Ventricular septal defect

A

B. Pulmonary atresia

Prostaglandin E2 administration maintains ductal patency and pulmonary blood flow in neonates with pulmonary atresia.

Cardiac lesions that depend on a patent ductus arteriosus to provide pulmonary circulation include pulmonary atresia, tetralogy of Fallot, and tricuspid atresia.

374
Q

Which congenital heart defect MOST favorably responds to the administration of prostaglandin E2 for the maintenance of pulmonary blood flow?

A. Atrial septal defect

B. Pulmonary atresia

C. Hypoplastic left heart

D. Ventricular septal defect

A

B. Pulmonary atresia

Prostaglandin E2 administration maintains ductal patency and pulmonary blood flow in neonates with pulmonary atresia.

Cardiac lesions that depend on a patent ductus arteriosus to provide pulmonary circulation include pulmonary atresia, tetralogy of Fallot, and tricuspid atresia.

375
Q

Draw out cardiac AP and ionic movement

A

Depolarization: Sodium influx
Initial repolarization: Chloride influx and potassium efflux
Plateau: Calcium influx and potassium efflux
Final repolarization: Potassium efflux and sodium-potassium ATPase pump

376
Q

Draw out cardiac AP and ionic movement

A

Depolarization: Sodium influx
Initial repolarization: Chloride influx and potassium efflux
Plateau: Calcium influx and potassium efflux
Final repolarization: Potassium efflux and sodium-potassium ATPase pump

377
Q

Name the order of the fibers

A

B, C, alpha gamma, alpha delta, alpha a, alpha b

378
Q

Weak acids:
◦ Lower pH than pKa = nonionized
◦ Higher pH than pKa = ionized

A

Barbiturates and Propofol

379
Q

• Weak bases:
◦ Higher pH than pKa = nonionized
◦ Lower pH than pKa = ionized

A

Local anesthetics, benzos, opioids, ketamine

380
Q

Inserting PA cath can cause

A

Pulmonary infarction and complete heart block

APEX ANESTHESIA FLASHCARDS (14 decks)

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