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SEE NCE Boards CoreConcepts > STRUBE TIPS > Flashcards

STRUBE TIPS Flashcards

1
Q

Methemoglobin absorbs light in a manner equal to. As a result,

A

oxyhemoglobin

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2
Q

How does the methemoglobinemia affect oxygen saturation?

A

If the oxygen saturation is over 85%,methemoglobinemia will cause the pulse oximeter to falsely underestimate the hemoglobin saturation. If the oxygen saturation is under 85%, it will cause it to falsely overestimate it

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3
Q

Placement of the transducer below the level of the heart will ______over/underestimate the actual blood pressure and vice-versa.

A

overestimate

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4
Q

If the NIBP cuff is not level with the heart, what should be done?

A

then a correction must be made to compensate for the difference between arm and systemic pressure.

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5
Q

How do you compensate BP arm and systemic?

A

For every 10 cm the cuff is above the level of the heart, you must add 7.5 mm Hg to estimate the systemic pressure accurately.

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6
Q

Likewise, for every 10 cm the NIBP cuff is below the level of the heart, you must

A

subtract 7.5 mm Hg to correctly estimate the systemic pressure.

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7
Q

Placing a blood pressure cuff that is too loose, too small, or positioned below the level of the heart will result in a blood pressure that

A

overestimates the actual blood pressure.

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8
Q

These actions lower intracranial hypertension and cerebral edema, which in turn lower the ICP

A

Fluid restriction, diuretics, corticosteroids, CSF drainage, propofol, MAP reduction, and hyperventilation.

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9
Q

The Cushing reflex consists of (3) .

A

bradycardia, hypertension, and respiratory irregularity

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10
Q

When ICP levels rise so significantly, what happens?

A

Brain stem herniation occurs.

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11
Q

Nicardipine and Cerebral Blood flow

A

Nicardipine preserves cerebral blood flow.

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12
Q

Where does the preganglionic sympathetic nervous system fibers originate?

A

between the T-1 and L-2 nerve roots.

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13
Q

The choroid plexuses are located in the

A

four ventricles.

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14
Q

Neurons and its glycogen supply

A

The neurons only contain about a 2-minute supply of glycogen.

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15
Q

Which 2 choroid plexuses provides the greatest quantity of CSF?

A

The ones located in the two lateral ventricles produce the greatest quantity of cerebrospinal fluid.

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16
Q

The brain % of the body mass occupies?

A

about 2% of body mass but receives about 15% of the cardiac output.

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17
Q

How much of the Cardiac output does the brain receive?

A

15%

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18
Q

The left and right carotid arteries and

A

Look up

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19
Q

left and right vertebral arteries

A

Look up

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20
Q

What is the normal blood flow of brain ? In the average adult? At about 2.0 MAC, the EEG may temporarily exhibit electrical silence. This is referred to as burst suppression.

A

The normal blood flow to the brain is about 50-65 milliliters per 100 grams of brain tissue per minute. This amounts to about 750-900 milliliters/minute in the average adult.

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21
Q

Volatile anesthetics effects on EEG?

A

All volatile anesthetics suppress the electroencephalogram (EEG) in a dose-dependent manner

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22
Q

When a volatile agent is administered, How does it affect amplitude and frequency?

A

there is an initial increase in amplitude followed by a decrease in both amplitude and frequency.
DAF,IL

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23
Q

MAC at which there is electrical silence? What is is referred to as ?

A

At about 2.0 MAC, the EEG may temporarily exhibit electrical silence. This is referred to as burst suppression.

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24
Q

What is the most serious side effect of chronic amiodarone administration?

A

is pulmonary toxicity resulting in alveolitis (pneumonitis).It is believed that amiodarone increases the production of free radicals that results in pulmonary toxicity.

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25
Q

What % of people treated with amiodarone develop pulmonary toxicity ?

A

5-15% of patients treated with amiodarone.

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26
Q

How do you provide Oxygen therapy during anesthesia for a patient on Amiodarone?

A

Because of this, it is recommended to avoid high inspired oxygen concentrations during general anesthesia for these patients as oxygen increases the production of free radicals.

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27
Q

Nitroprusside action on veins and arteries.

A

causes dilation in both veins and arteries (an increase in vessel diameter). The result is a reduction of both preload and afterload which causes a reduction of cardiac filling pressures.

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28
Q

WHAT IS THE ONLY ANALOGUE OF LIDOCAINE?

A

The antiarrhythmic MEXILETINE is an orally administered analogue of lidocaine.Electrophysiological, it is most similar to lidocaine.

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29
Q

ONLY ORAL ANALOGUE OF lidocaine and It is used for the chronic treatment of ventricular arrhythmias

A

MEXILETINE

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30
Q

Amiodarone and cardiac death ?

A

reduces the risk of sudden cardiac death by 29% in patients with congestive heart failure. Therefore, it is the best alternative for patients who refuse or are not candidates for an AICD.

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31
Q

Best alternative for patients who refuse or are not candidates for an AICD.

A

Amiodarone

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32
Q

ACE inhibitors and angiotensin?

A

decreased angiotensin II production.

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33
Q

ACEI on sodium and water retention?

A

sodium and water retention are decreased and aldosterone levels are reduced.

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34
Q

Reduction of aldosterone put the patient at risk for which electrolyte abnormality?

A

The reduction in serum aldosterone levels place the patient at increased risk for hyperkalemia.

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35
Q

In the US, BETA BLOCKERS that are available in intravenous form.

A

propranolol, metoprolol, and esmolol

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36
Q

Because of its alpha-adrenergic blocking capability, labetalol produces _______ ? There in risk of

A

less bradycardia than pure beta-adrenergic blockers, but has an increased incidence of orthostatic hypotension.

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37
Q

Beta blockers administration in parturients? Effects on placenta, newborn

A

Beta-adrenergic blockers administered to a parturient cross the placenta and can produce bradycardia, hypoglycemia, and hypotension in the newborn. Beta-blockers are also likely to pass into breast milk.

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38
Q

How does Esmolol administration help with skin incision . What is the dose ?

A

Esmolol administered as 1 mg/kg IV followed by a 250 mcg/kg/min infusion substantially reduces the dosage of propofol required to prevent patient movement upon skin incision. There is no known pharmacokinetic reaction between the two drugs that explains this phenomenon.

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39
Q

Propranolol and LA

A

Propranolol decreases the clearance of amide local anesthetics, but not ester anesthetics such as Chloroprocaine.

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40
Q

Fentany and propranolol: you should know?

A

The pulmonary uptake of fentanyl, however, is substantially decreased in patients taking propranolol. As a result, plasma concentrations shortly after injection can be 2-4 times higher than normal.

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41
Q

Selective phosphodiesterase inhibitors are (2)

A

amrinone and milrinone

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42
Q

Selective phosphodiesterase inhibitors are such as amrinone and milrinone: on CO, cardiac contractility and SVR

A

increase the cardiac output primarily by increasing cardiac contractility and decreasing systemic vascular resistance.

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43
Q

Selective phosphodiesterase inhibitors are such as amrinone and milrinone: on LVEDP, filling pressure, venous return, SVR, and Mean PAP

A

They produce increased cardiac output, decreased LVEDP, decreased filling pressure, decreased venous return to the heart, decreased systemic vascular resistance, and decreased mean pulmonary artery pressures.

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44
Q

Phosphodiesterase inhibitors MOA

A

inhibit phosphodiesterase.This results in a decrease in the hydrolysis of cAMP (and subsequent elevated levels of cAMP within the myocardial and vascular smooth muscle cells).

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45
Q

Phosphodiesterase inhibitor and cAMP

A

decrease in the hydrolysis of cAMP (and subsequent elevated levels of cAMP within the myocardial and vascular smooth muscle cells

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46
Q

Dopamine and Immune system. .

A

can negatively affect the immune system by its effects on hormones and lymphocyte function.

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47
Q

Dopamine and HPA system

A

Can depress the hypothalamic-pituitary system in a manner similar to that seen in chronic stress and critical illness.

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48
Q

Dopamine and protectin levels.

A

It also reduces prolactin levels, which is a regulator of T and B lymphocytes

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49
Q

Dopamine is a fairly nonspecific agonist of

A

alpha, beta, dopamine-1, and dopamine-2 receptors. The vasodilatory effects seen with low dose infusions are attributed to its effects on the dopamine-1 and dopamine-2 receptors

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50
Q

Epinephrine and cerebral effects, if any?.

Volatile anesthetics and opioids may be used to control blood pressure, as may beta-blockers, ACE inhibitors, nitroprusside, alpha-2 agonists such as clonidine, alpha-1 blockers such as droperidol, and calcium-channel blockers. One caution is that nitroprusside may increase intracranial pressure and therefore must be used cautiously in the treatment of hypertensive crises associated with encephalopathy.

A

has few cerebral effects because it is not very lipid-soluble, making it difficult for the drug to cross the blood-brain barrier.

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51
Q

Under periods of high demand what occurs with some sustances?,

A

Vasodilating substances such as
adenosine, potassium ions, carbon dioxide, hydrogen ions, and prostaglandins can dilate the coronary arteries and increase blood flow by three to four hundred percent.

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52
Q

3 endogenous agents with vasoconstrictive properties.

A

Thromboxane, ATP, and endothelin

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53
Q

Sodium nitroprusside and CO

A

preserves cardiac output well,

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54
Q

Sodium Nitroprusside side effects you should:

A

Reflex tachycardia
Rebound hypertension
Pulmonary shunting
risk of cyanide toxicity.

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55
Q

One caution is that nitroprusside may

A

increase intracranial pressure and therefore must be used cautiously in the treatment of hypertensive crises associated with encephalopathy.

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56
Q

SVO2/ETCO 2 All result in a decreased ETCO2.

A 
Hypothermia
hypothyroidism
hyperventilation
hypoperfusion
Pulmonary embolism
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57
Q

Factors that result in an increased SVO2 include

A

cyanide toxicity
Left-to-right shunts
Sepsis, a wedged pulmonary artery catheter, and hypothermia

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58
Q

Factors that result in a decreased SVO2 include

A

hyperthermia, shivering, hemorrhage, decreased cardiac output, and a decrease in the pulmonary transport of oxygen.

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59
Q

A patient with COPD, the following would be seen in a

A

PFT
FEV1/FVC ratio to Somewhat decreased
FEV 25-75 to Markedly decreased
FRC to Increased.

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60
Q

Factors that increase the metabolic rate and subsequently, the amount of carbon dioxide produced.

A

Hyperthermia, sepsis, malignant hyperthermia, shivering, and hyperthyroidism

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61
Q

What are non-metabolic causes of an increased ETCO2.

A

Hypoventilation and rebreathing

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62
Q

The accuracy of an SpO2 monitor can be adversely affected by.

A

pathologic hemoglobin forms (carboxyhemoglobin, methemoglobin), intravenous dyes (methylene blue, indigo carmine), motion artifact, nail polish, ambient light, and even electrocautery.

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63
Q

Anemia and SPO2 monitor.

A

Anemia can result in an overestimation of the oxygen saturation

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64
Q

Optical interference and SPO2

A

Optical interference caused by ambient lights flickering at a frequency similar to the pulse oximeter LED can cause erratic readings.

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65
Q

Nail polish and intravenous dyes SPO2

A

can result in an underestimation of the oxygen saturation.

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66
Q

A decrease in arterial oxygen content or an increase in arterial oxygen extraction will _____the PvO2.

A

reduce

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67
Q

Severe anemia and SPO2

A

overestimation of the SpO2, particularly at low oxygen saturations.

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68
Q

Non-hypoxic SaO2 and anemic patients

A

normal in anemic patients

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69
Q

Prominent venous pulsations and injection of certain dyes such

A

as indigo carmine, lymphazurin, nitrobenzene, indocyamine green, methylene blue, and patent blue can result in underestimation of the SpO2.

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70
Q

Volatile anesthetics exhibit what on the cardiac system? How?

A

cardiac preconditioning effects. They appear to alter mitochondrial electron transport in myocardial cells.

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71
Q

It is estimated that about 30-40% of the cardioprotective effects of volatile anesthetics occurs by

A

reducing the overload of calcium within the cardiac cells and improving contractility.

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72
Q

Sevoflurane has been shown to demonstrate late preconditioning for how long? When does this effect begins?

A

24-48 hours after administration. The effects begin at 1 MAC with a dose of 1.5 MAC needed for maximum benefit.

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73
Q

Normally, cerebral blood flow is regulated through a range of mean arterial pressures from about

A

50 mmHg to 150 mmHg (some sources cite a narrower range of 60-140 mmHg).

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74
Q

With sevoflurane, cerebral autoregulation is

A

maintained up until about 1 MAC. Even at 1.5 MAC, autoregulation is maintained more effectively by sevoflurane than isoflurane or desflurane

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75
Q

Inhalation agents on respiratory? .

A

depress the respiratory system in a dose-dependent fashion

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76
Q

Inhalation agents on respiratory depress the respiratory system in a dose-dependent fashion? ..

A

The tidal volume is primarily affected, followed by the respiratory rate.

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77
Q

TV and concentration of agent relationship? Down/up

A

The tidal volume is decreased as the concentration of the agent increases. The respiratory rate increases, but this is typically insufficient to prevent increases in arterial CO2 due to hypoventilation.

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78
Q

Burst suppression on the EEG usually occurs

A

between 1.5 and 2.0 MAC with desflurane and around 2.0 MAC with isoflurane and sevoflurane.

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79
Q

Sevoflurane and seizure history

A

can enhance seizure activity and needs to be used with caution in patients with a history of epilepsy.

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80
Q

What is ventilation-perfusion deficit effect on speed of induction?
Where is the effect the greatest?

A

slows the speed of induction.

The effect is greatest in agents with a low blood: gas partition coefficient.

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81
Q

What is the blood: gas partition coefficient of desflurane?

A

0.42

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82
Q

The blood: gas partition coefficient of nitrous oxide it is

A

0.47

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83
Q

The blood: gas partition coefficient of sevoflurane

A

0.6

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84
Q

The blood: gas partition coefficient of isoflurane it is

A

1.4

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85
Q

A ventilation-perfusion deficit slows the speed of induction. The effect may be more visible in which gases?

A

Visible in nitrous oxide than in desflurane despite the difference in blood: gas partition coefficients because of the extremely high concentrations of nitrous oxide normally used compared to that of desflurane.

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86
Q

Effects of sevoflurane on normal CO2?

A

In the normotensive patient with a normal CO2, sevoflurane has no significant effects on cerebral physiology.

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87
Q

Increasing age effect on MAC

A

decreases MAC

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88
Q

Hypoxia, metabolic acidosis, on MAC

A

decreases MAC

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89
Q

Hypothermia, hyponatremia on MAC

A

Decreases MAC

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90
Q

Hypo-osmolality on MAC

A

Decreases MAC

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91
Q

Pregnancy, acute ethanol intoxication on MAC

A

Decreases MAC

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92
Q

Anemia, lidocaine administration effect on MAC

A

Decreases MAC

93
Q

Decreased central neurotransmitter levels on MAC

A

Decreases MAC

94
Q

Blood: gas partition coefficient relationship to cardiac output.

A

The higher the blood: gas partition coefficient is, the more the onset will be slowed by an increase in cardiac output.

95
Q

Active scavenging disposal uses a what kind of system? Requires what kind of vacuum?

A

dedicated evacuation system such as the wall suction and requires a vacuum capability of 30 liters per minute (30 L/min). The exhaust port of the system has to be an adequate distance from healthcare workers.

96
Q

Factors that can result in rSO2 desaturation include:

A

The administration of IV indigo carmine, cardiac arrest, hypothermia, blood steal syndromes, hypoxia, ischemia/embolic strokes, Trendelenburg position (leads to cerebral venous congestion), unilateral or bilateral cerebral atherosclerosis ,and the interference of hair, scalp, or hair follicles. A left-shifted curve can create false positives, and some patients have normal neurological function, yet have low baseline values.

97
Q

An rSO2 value of 70% would be considered abnormal or normal?

A

normal because this encompasses both venous, arterial, and capillary blood.

98
Q

Cerebral oxygen saturation is related to three factors:

A
  1. The light intensity at the source
  2. The detector
  3. The length of the light path through the tissue according to the Beer law
99
Q

What does the Beer law states?

A

There is a logarithmic dependence between the transmission of light through a substance and the product of the absorption coefficient of the substance, and the distance the light travels through the material.)

100
Q

A disadvantage of active disposal is that the

A

wall suction may not be strong enough to serve anesthesia, the surgeon, and the scavenging system.

101
Q

Passive disposal routes for waste anesthetic gas utilize a

A

through-the-wall conduit or the operating room ventilation system.

102
Q

Passive disposal routes there is a through-the-wall disposal system , waste gas exits

A

towards the outside through a duct in the floor, ceiling, wall, or window. This is achieved due to the preferential flow of gases into these disposal ducts because of the slightly positive pressure of the operative room created by OR ventilation.

103
Q

Passive disposal routes there is a through-the-wall disposal system , waste gas exits

A

towards the outside through a duct in the floor, ceiling, wall, or window. This is achieved due to the preferential flow of gases into these disposal ducts because of the slightly positive pressure of the operative room created by OR ventilation.

104
Q

Cerebral Oximetry

Cerebral oximetry is a monitor that uses).

A

near-infrared optical spectroscopy (NIRS) to noninvasively measure the regional blood hemoglobin oxygenation saturation (rSO2

105
Q

It is useful in patient populations at risk for stroke such as

A

vascular or cardiac surgery patients, patients with a history of stroke, and neurosurgical patients. The technology used in cerebral oximetry is similar to that used in pulse oximetry.

106
Q

How is the cerebral oximeter used?

A

To use the monitor, a noninvasive sensor is placed over the forehead, but away from the hair and scalp. The sensor can be placed on the right, left, or both frontal-temporal regions (preferable).

107
Q

Cerebral oximeter sensor emits low intensity light that penetrates the 4 things ? It is then reflected back to the

A

skin, skull, dura, and CSF into the blood located within the cerebral cortex.
skin sensor where the rSO2 is determined based upon the light intensity changes as it passes through the brain.

108
Q

The 2 lights emitted with cerebral oximeter?

A

The light emitted is of two wave-lengths, 730 nm and 805 nm, emitted in alternating fashion through two light-emitting diodes.

109
Q

Positive pressure caused by

A

winds can interfere with this disposal route. Blockage of the exhaust port by birds, insects, and ice can also hinder proper functioning of the passive disposal route.

110
Q

The OR ventilation system can also be used for the passive disposal of waste gas.

A

nonrecirculating (recirculating systems partially recirculate stale air), and it must also satisfy requirements set forth by the American Institute of Architects.

111
Q

Recirculating system should be To avoid inadvertent

A

blockage of the hose connecting the scavenging interface to the ventilation outflow port, the hose should not be left on the floor.

112
Q

rsO2 and left shifted

A

A left-shifted curve can create false positives, and some patients have normal neurological function, yet have low baseline values.

113
Q

rsO2 and curve shift

A

A left-shifted curve can create false positives, and some patients have normal neurological function, yet have low baseline values.

114
Q

What drugs can cause Serotonin syndrome?

A

can occur due to ingestion of large quantities of medications such as SSRI’s, MAOI’s, cyclic and atypical antidepressants, cough medicines, drugs used to treat migraine headaches, weight reduction drugs, opiates, and illicit drugs such as ‘Ecstasy’.

115
Q

Serotonin syndrome Symptoms are related to autonomic _________and include which five symptoms?

A 
hyperreactivity 
Hyperreflexia
Delirium
Clonus
Agitation
Hyperthermia.
116
Q

When exposed to a cold environment, what happens to core body temperature?

A

there is a reduction in core and/or skin temperature. (A 1-degree reduction in skin temperature is equal to an approximate 0.2-degree reduction in core body temperature.)

117
Q

End stage liver disease is generally associated with what few signs?

A

Very low SVR
Increased cardiac index
Increased mixed venous oxygen saturation.

118
Q

What is the role of Phospholipase A2 with inflammatory pathways?

A

which is the rate-limiting enzyme in the conversion of arachidonic acid into prostaglandins and leukotrienes, is the primary inflammatory mediator implicated in disc herniation

119
Q

What is the action of Corticosteroids injected into the epidural space?

A

inhibit cytokine release, inhibit phospholipase A2 activity, and exert a local anesthetic-like action on C fibers (but specifically, not A-beta fibers).

120
Q

The central termination of visceral afferent fibers synapse spinal neurons in what laminae?

A

I, II, V, and X and deliver visceral sensation information to supraspinal sites through the contralateral spinothalamic tract or the ipsilateral dorsal column.

121
Q

Pyloric stenosis rThe body trades K+ for Na+ in order to hold on to water and fight hypovolemia.

A

results in fulminant, and often projectile, vomiting.Gastric acid (HCl) is lost during this process; this is the reason for the hypochloremia and alkalosis exhibited by the patient.

122
Q

Pyloric Stenosis metabolic disturbances?

A

Hypochloremic metabolic alkalosis

123
Q

Why do patients with pyloric stenosis develop hypochloremic metabolic alkalosis?.

A

The hypokalemia is due to potassium excretion in the kidney

124
Q

Adenoidal hyperplasia can result in

A

nasopharyngeal obstruction resulting in obligate mouth breathing.

125
Q

2 associated and linked with sleep apnea.

A

Both adenoidal and tonsillar hyperplasia are linked to sleep apnea with the potential for cor pulmonale and failure to thrive.

126
Q

What is the Mechanism of action of Baclofen?

A

Baclofen agonizes the GABA-B receptor to suppress neuronal transmission in the CNS.

127
Q

The major risk factors contributing to apnea after anesthesia in preterm infants are 3 things

A

1) the type of anesthetic
2) post-conceptual age
3) the presence of anemia.

128
Q

Dilate the pupils –> drops

A

to Phenylephrine

129
Q

Mannitol and IOP

A

Decrease intraocular pressure to Mannitol.

130
Q

Pilocarpine drops on pupils

A

Constrict the pupils

131
Q

Obesity is characterized by an

A

increased glomerular filtration rate, increased renal tubular resorption, and impaired sodium excretion which further worsens hypertension.

132
Q

Hepatocellular syndrome (HPS) is characterized by the triad of (HPP):

A

Hypoxemia
portal hypertension
pulmonary vascular dilatations.

133
Q

For pregnant patient, as the patient gets closer to term, what happens to the diaphragm ?

A

rises and shifts the heart upward and leftward.

134
Q

For pregnant women, what happens to heart on xray? ECG changes related to pregnancy?

A

This makes the heart appear larger on chest Xray and produces a left axis shift on the ECG.

135
Q

In the third trimester, there is also an increased tendency for what ECG changes?

A

Premature atrial contractions
Supraventricular tachycardia
Ventricular dysrhythmias.

136
Q

The term ‘Cushing’s disease’ refers to Cushing’s syndrome that is cause by the

A

over secretion of ACTH by a pituitary tumor.

137
Q

Symptoms of Cushing’s syndrome are:

A 
Sudden onset of weight gain
Thickening of the facial fat giving a rounded shape to the face
Facial telangiectasias
Glucose intolerance
Hypertension
Decreased libido in men
Oligomenorrhea
Spontaneous bruising
138
Q

Patients with Cushing’s disease have _____in serum ______resulting in Hypokalemia….

A

increased serum cortisol levels resulting in hypokalemia, hyperglycemia, and skeletal muscle relaxation which may require a decreased non-depolarizing muscle relaxant dose.

139
Q

A low-dose infusion of etomidate may be helpful in patients with

A

Cushing’s disease

140
Q

Because patients undergoing bilateral adrenalectomy exhibit rapid decrease of

A

serum cortisol levels, steroid replacement therapy should be initiated prior to or during surgery

141
Q

Because patients undergoing bilateral adrenalectomy exhibit rapid decrease of serum cortisol levels, what should be initiated prior and during surgery?

A

steroid replacement therapy should be initiated prior to or during surgery.

142
Q

Because of the tendency toward skeletal muscle weakness, it is recommended that patients with Cushing’s disease be

A

mechanically ventilated whenever possible.

143
Q

About 85% of pheochromocytomas are located in theT

A

medulla of one of the adrenal glands.

144
Q

Pheochromocytomas can also be found in ?

A

Spleen, broad ligament of the ovary, right atrium, or at the bifurcation of the aorta.

145
Q

What is the preferred for the treatment of hypertension (systolic pressures over 200 mmHg are common) during surgical excision of pheochromocytomas?

A

Nitroprusside

146
Q

what Typically occurs following ligation of the vein draining the pheochromocytoma tumor?

A

Hypotension

147
Q

For pheochromocytoma resection, To prevent hypotension, the patient should undergo volume expansion until a

A

pulmonary capillary wedge pressure of 16-18 mmHg is reached prior to ligation of the vein.

148
Q

For pheochromocytoma resection, vasopressors should be utilized only after —-

A

after adequate volume expansion has been achieved.

149
Q

What are the agents of choice if it is primarily an epinephrine-secreting tumor?.

A

Esmolol or labetalol

150
Q

Advantage of esmolol during a pheochromocytoma resection?

A

short duration of action

151
Q

Pheochromocytomas typically release______ norepinephrine and_______epinephrine

A

85% ; 15% epinephrine.

152
Q

The parathyroid glands release______hormone which regulates?

A

parathyroid hormone which regulates calcium balance.

153
Q

Condition that stimulate the release of parathyroid hormone.

A

condition that results in even a slight decrease in calcium ion concentration in the extracellular fluid

154
Q

The parathyroid glands become hyperactive and hypertrophied in conditions such as

A

rickets, pregnancy, and lactation.

155
Q

The parathyroid______ phosphate by increasing the renal excretion of phosphate.

A

decreases

156
Q

Parathyroid hormone______ serum calcium levels by _______bone resorption of calcium, ________and ______________

A

increases; increasing
limiting its renal excretion, and enhancing the gastrointestinal absorption of calcium by regulating vitamin D metabolism.

157
Q

Parathyroid hormone increases bone resorption of calcium and phosphate in two stages:

A
  • the first stage begins within minutes and increases the resorption activity of osteoclasts.
  • The second stage is much slower and may require several days or weeks as it stimulates the increased production of osteoclasts.
158
Q

Parathyroid hormone can cause a rapid loss of

A

phosphate ions in the urine by its effect on the proximal tubule.

159
Q

As more phosphate is excreted, calcium is

A

retained.

160
Q

The increased calcium reabsorption takes place primarily where in the nephron?

A

collecting tubules and the late distal tubules.

161
Q

Cardiac signs and symptoms of hyperparathyroidism:

A

Hypertension, prolonged PR interval, and a shortened QT interval.

162
Q

Neuromuscular signs hyperparathyroidism:

A

Skeletal muscle weakness
Bone demineralization
Vertebral collapse
Pathologic fractures.

163
Q

Your anesthetic with hyperparathyroidism should be aimed at dealing with underlying –>

A

hypercalcemia

164
Q

Your anesthetic with hyperparathyroidism should be aimed at dealing with underlying, because of this , 2 things are essential?

A

hydration with normal saline

Monitoring of urinary output

165
Q

Hypercalcemia and anesthetic requirements

A

Because hypercalcemia is associated with somnolence, the anesthetic requirement may be decreased.

166
Q

If personality changes due to chronic hypercalcemia are present, then what medication should be avoided?

A

ketamine may need to be avoided.

167
Q

Baseline skeletal weakness may necessitate a decreased dose of_______; however you should know that the _________

A

nondepolarizing muscle relaxants; however, the increased calcium can antagonize muscle relaxants–in short, hyperparathyroidism is associated with an increased sensitivity to succinylcholine and a resistance to nondepolarizing muscle relaxants.

168
Q

Increased calcium and effects of dosing of succinylcholine and NDNMBs

A

associated with an increased sensitivity to succinylcholine and a resistance to nondepolarizing muscle relaxant

169
Q

Acidosis and serum calcium

A

Acidosis increases the serum calcium level, so hypoventilation should be avoided.

170
Q

Hypercalcemia–> It is important to position patients because there is risk of

A

risk of pathologic fractures

171
Q

During parathyroidectomy, As with thyroidectomy, there is a risk of damage to the______nerve; what must be used?

A

recurrent laryngeal nerve during surgery, so a Nim(Registered) tube or similar device should be used to monitor nerve function during surgery.

172
Q

Hypercalcemia (hyperparathyroidism) preferred fluid?

A

Normal saline is preferred over Lactated Ringer’s solution for fluid management.

173
Q

Signs and symptoms of hypoparathyroidism:

A

prolonged QT interval
muscle spasms
hypotension
decreased responsiveness to beta agonists

174
Q

The treatment of hypoparathyroidism is aimed at

A

restoring low calcium levels to normal.

175
Q

Hypocalcemia , an infusion of

A

10 mL of calcium gluconate 10% IV should be administered until signs of neuromuscular irritability resolve.

176
Q

Hypocalcemia , an infusion of

A

10 mL of calcium gluconate 10% IV should be administered until signs of neuromuscular irritability resolve.

177
Q

How does thiazide diuretics help with hypocalcemia?

A

Thiazide diuretics may be helpful as they result in sodium depletion without the loss of potassium which tends to increase calcium levels.

178
Q

Patients with aortic valve stenosis have a fixed obstruction, whereas about 25% of patients with hypertrophic cardiomyopathy exhibit a _______obstruction

A

a dynamic obstruction which peaks in mid-to-late systole, can vary from beat to beat, and can worsen with enhanced ventricular contractility, decreased ventricular volume, and decreased left ventricular afterload.

179
Q

Patients with hypertrophic cardiomyopathy typically suffer from

A

diastolic dysfunction which is exhibited by increased left ventricular end-diastolic pressures despite an often hyperdynamic left ventricular function.

180
Q

With hypertrophic cardiomyopathy, the diastolic stiffness is due to the

A

increased muscle mass of the left ventricle which is typically concentrated in the upper septum just below the aortic valve.

181
Q

Many patients are asymptomatic, but those that do exhibit symptoms exhibit

A

dyspnea on exertion, fatigue, syncope, or angina.

182
Q

With hypertrophic cardiomyopathy, patients often exhibit what kind of obstruction? What other signs and symptoms will you see?

A 
dynamic left ventricular outflow tract obstruction
mitral regurgitation
Diastolic dysfunction
Myocardial ischemia
Dysrhythmias.
183
Q

Paradoxical embolus is the transfer of

A

an embolus from the venous system to the arterial system and often to the brain via a patent foramen ovale or atrial septal defect.

184
Q

Hypertrophic cardiomyopathy involves

A

enlargement of the interventricular septum which results in left ventricular outflow obstruction.

185
Q

The obstruction seen with hypertrophic cardiomyopathy is worsened by

A

increased heart rate or increased myocardial contractility as well as decreases in preload or afterload. Anesthesia is usually maintained by controlled myocardial depression using volatile anesthetics.

186
Q

The obstruction seen with hypertrophic cardiomyopathy is worsened by __________ or _______

A

increased heart rate or increased myocardial contractility as well as decreases in preload or afterload. Anesthesia is usually maintained by controlled myocardial depression using volatile anesthetics.

187
Q

With hypertrophic cardiomyopathy, as flow through the mitral valve opening into the left ventricle is decreased

A

(thus decreasing the left ventricular volume), left atrial pressure increases, resulting in left atrial hypertrophy and distention. The increased pressure is transmitted into the pulmonary vasculature as the volume of pulmonary blood increases.

188
Q

With hypertrophic cardiomyopathy, the increased pulmonary vascular pressure represents an increase in

A

right ventricular afterload and will cause right ventricular hypertrophy and failure. As pulmonary venous pressure increases above about 25 mmHg, fluid can leak into the pulmonary interstitial space resulting in a decrease in pulmonary compliance and increased work of breathing. If the change in pulmonary venous pressure occurs over a long period of time, an increase in pulmonary lymph flow can partially compensate for the fluid accumulation.

189
Q

Coarctation of the aorta to

A

Widened pulse pressure in the arms

190
Q

Aortic stenosis murmur Is to

A

Systolic murmur over the 2nd right interspace

191
Q

Patent ductus arteriosus can be treated with

A

treated with cyclooxygenase inhibitors

192
Q

Eisenmenger’s syndrome to Reversal of a

A

left-to-right shunt.

193
Q

Kussmaul’s sign and pulsus paradoxus are both indicative of

A

ventricular discordance (also known as ventricular dyssynchrony) that occurs due to the opposing response of the ventricles to filling during the respiratory cycle.

194
Q

Pericarditis is often due to a

A

viral illness

195
Q

This condition may often occur 1-3 days after a myocardial infarction.

A

Pericarditis

196
Q

Pericarditis , what worsens the pain

A

Deep inspiration

197
Q

What often relieves the pain of pericarditis?

A

Sitting forward

198
Q

The ECG changes seen in acute pericarditis occur in

A

four stages.

199
Q

In stage I of acute pericarditis, there is and

A

diffuse ST segment elevation and depression of the PR segment.

200
Q

In stage 2 during pericarditis, what happens to the ST and PR changes

A

the ST and PR changes normalize

201
Q

What happens in pericarditis In stage 3?

A

the T wave inverts,

202
Q

What happens in pericarditis in stage 4?

A

he T waves normalize.

203
Q

If no other associated pericardial disease is present, acute pericarditis does or does not affect cardiac function ?

A

Does not alter cardiac function.

204
Q

The choroid plexuses are located where?

An increase in hydrogen ion concentration depresses neuronal activity. It also causes an increase in blood flow to the brain. By doing so, it will help ‘wash away’ the hydrogen ions, carbon-dioxide, and other acid precursors away from the brain which returns the hydrogen ion concentration back to normal.

A

in the four ventricles.

205
Q

Which ventricles produce the greatest quantity of CSF?

A

The ones located in the two lateral ventricles produce the greatest quantity of cerebrospinal fluid. When lying in a horizontal position, the normal cerebrospinal fluid pressure is about 130 mm of water or 10 mmHg.

206
Q

When lying in a horizontal position, the normal cerebrospinal fluid pressure is about

A

130 mm of water or 10 mmHg.

207
Q

The brain only comprises about ____of body mass but receives about____ of the cardiac output.

A

2%; 15%

208
Q

What vessels supply the blood to the brain?

A

The left and right carotid arteries and left and right vertebral arteries

209
Q

Rexed laminae I through laminae VI are located in the

A

dorsal horn of the spinal column.

210
Q

Laminae ____, ____ and ____comprise the ventral horn.

A

VII, VIII, and IX

211
Q

Normally, the body maintains a constant cerebral blood flow between mean arterial pressures of

A

60 and 140 mmHg.

212
Q

Chronic hypertension on the CBF

A

will shift both the upper and lower limits of the cerebral autoregulation curve to the right.

213
Q

Secretion of cerebrospinal fluid by the choroid plexus is dependent upon the

A

active transport of sodium through the epithelium of the choroid plexus.As the sodium is transported out, chloride is pulled outward as well because of its electrochemical attraction to sodium.

214
Q

The combination of sodium and chloride increases the osmotic pressure on the outside of the plexus which results in the

A

osmosis of water through the plexus membrane. It is the fluid that forms the principal constituent of cerebrospinal fluid.

215
Q

The preganglionic sympathetic nervous system fibers originate between the

A

T-1 and L-2 nerve roots.

216
Q

Central nervous system symptoms of hyponatremia such as

A

confusion, restlessness, nausea, and vomiting begin to appear at about 120 mEq/L, with ECG changes occurring at 115 mEq/L, and

217
Q

Ventricular tachycardia and fibrillation occurring below what sodium levels?

A

100 mEq/L.

218
Q

What are the regions involved in the emotional and motivational aspect of pain sensation?

A

The limbic and paralimbic regions (anterior cingulate cortex and insular cortex)

219
Q

The SI and SII somatosensory cortices are involved in determining the location and intensity of pain sensations.

A

1816

RX: 1123178

220
Q

The major ascending spinal pathways involved in the transmission of nociceptive information include t

A

spinothalamic, spinohypothalamic, spinomedullar, and spinobulbar tracts.

221
Q

What is the most important for the transmission of pain, temperature, and itch sensations?

A

The spinothalamic tract (SPI sensation, pain, itch)

222
Q

What is the most important in integrating pain information with homeostasis and behavior mechanisms of the tracts?

A

The spinobulbar tract

223
Q

What is the most important tract involved in the autonomic, neuroendocrine, and emotional aspects of pain?

A

The spinohypothalamic tract

224
Q

The central termination of visceral afferent fibers synapse spinal neurons in what laminae? And what do they do?

A

Laminae I, II, V, and X and deliver visceral sensation information to supraspinal sites through the contralateral spinothalamic tract or the ipsilateral dorsal column

225
Q

The majority of visceral afferent fibers are

A

A-delta and unmyelinated C fibers with a tiny portion of them being A-beta fibers in the mesentery.

226
Q

Group C fibers are

A

unmyelinated

227
Q

Blockade of which branch can relieve pain from sacroiliac joint syndrome?

A

Blockade of the medial branch of the dorsal rami of L5 and S1-S3 via a facet joint injection

228
Q

An _______in hydrogen ion concentration depresses neuronal activity. What else happens?

A

increase. It also causes an increase in blood flow to the brain. By doing so, it will help ‘wash away’ the hydrogen ions, carbon-dioxide, and other acid precursors away from the brain which returns the hydrogen ion concentration back to normal.

SEE NCE Boards CoreConcepts (44 decks)

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