TL Flashcards
Local anesthetics: … have one ‘i’ in their name
ester
Local: … agents have two ‘i’s in their name
amide
initial treatment for CRPS is …
physical therapy
second line treatment for CRPS is …
TCA
CRPS type … have been found to involve interaction between sympathetic nervous system and afferent neurons
1
CRPS type 1 is also known as …
reflex sympathetic dystrophy
CRPS type 2 is also known as …
causalgia
A decrease in left atrium compliance leads to an … ‘v’ wave on left atrial pressure readings
enhanced
In mitral regurgitation increase in heart rate leads to … in left atrial distention/regurgitant volume
decrease
warfarin is [safe/unsafe] in nursing mothers
safe
warfarin is [safe/unsafe] in pregnancy
unsafe
unlike many other drugs, … determines duration of action in opioids
lipid solubility
digoxin competes with … for binding site on Na/K ATPase
potassium
hepatic arterial buffer response: decreased blood flow in the portal vein leads to … of hepatic artery and vice versa
dilation
cirrhosis disrupts the liver sinusoids, which causes a … in endothelial nitric oxide synthase activity
decrease
glucagon causes dose dependent hepatic arterial vaso…
dilation
vasopressin … splanchnic vasoconstriction
increases
vasopressin … resistance to portal venous flow
decreases
8 mg of dexamethasone is equivalent to … mg of hydrocortisone
200
dose of dexamethasone to prevent adrenal insufficiency
8 mg
CSF volume of infants … mL/kg
4
CSF volume of adults … mL/kg
2
CSF volume of children … mL/kg
3
Infants have … vagal tone compared to adults
higher
Spinal cord ends at … in infants compared to … in adults
L3 vs L1
hypokalemic periodic paralysis is inherited …
autosomal dominant
Reflex Triad: hypertension, bradycardia, irregular breathing
cushing’s caused by increased ICP
Imaging technique: intracranial air
CT scan
Phenomenon: repeated stimulation of peripheral C fibers resulting in increased action potentials at the dorsal horn causing an amplified response
wind-up
Landmark: lateral femoral cutaneous nerve block
anterior superior iliac spine
centrifugal vs roller pump: lower risk of air emboli
centrifugal
during alkalosis potassium shifts …
intracellularly
in respiratory alkalosis, decrease of CO2 by 10 mmHg will cause potassium to decrease by … mmol/L
0.5
serum calcium exists in 3 forms: …% protein bound; …% ionized; and the remainder bound to plasma anions
50;50
alkalosis causes … binding of calcium to plasma proteins such as albumin
increased
increase in pH causes … in glycolytic activity
increase
perioperative administration of … mL/kg of isotonic crystalloid over course of anesthetic is acceptable baseline
30 +/- 10 mL/kg
acute administration of phenytoin in naive patients will … neuromuscular blockade by aminosteroid NMB
enhance
spinal anesthesia in infants vs older children/adults: … onset and … duration of action
rapid onset, shorter duration
Toxicity: first sign of spinal toxicity in infants
apnea not cardiovascular collapse because of immature sympathetic system
Blood product treatment for AT3 deficiency
FFP
Pulsatile flow … urine output
increases
OB: drug that provides analgesia and treats neuraxial opioid-induced central pruritus
butorphanol
Nitrous oxide can irreversibly oxidize the cobalt atom of vitamin …
B12
…caine crosses the placenta and can accumulate to toxic levels due to ion trapping from fetal acidosis
Lidocaine
Ultrasound: higher frequency = … resolution and … tissue penetration
higher res; decreased pen
Mivacurium is metabolized by …
pseudocholinesterases
Neurotoxic opioid metabolite
normeperidine from meperidine
lung volume at which small airways begin to close is called
closing capacity
age at which closing capacity may surpass functional residual capacity
65 yo
age at which closing capacity may surpass tidal volume
75 yo
CNS-mediated ventilatory responses to hypoxia, hypercapnia and mechanical stress … with age
decrease
Local: 2 spinal drugs that are isobaric
bupivacaine and ropivacaine
Local: mixing local solutions with … will make the solution hypobaric
sterile water
Local: mixing local solutions with … will make the solution hyperbaric
glucose
Bioavailability of midazolam PO is …%
<50%
Nerve that provides sensation to upper medial arm that is not apart of the brachial plexus
intercostobrachial n.
intercostobrachial nerve is the lateral cutaneous branch of the … intercostal nerve
2nd
Full E-cyclinder oxygen tank contains … L of O2 at 2200 psi
680L
Gene defect in malignant hyperthermia patients
RYR1
Myxedemia is caused by deposition of …
mucin
closing capacity = … volume + … volume
closing volume + residual volume
Most important factor in ductus closure in full-term infant
oxygen
inspiration of CO2 in healthy awake patients leads to increase in minute ventilation of … L/min for every 1 mmHg of arterial CO2 tension
3 L/min
BZD and propofol causes this change in the CO2 response curve
decreased slope
Opioids cause this change in the CO2 response curve
right-shift
Modified Cormack-Lehane classification system breaks … into 2 subcategories
Grade 2 into 2a (partial view of glottic opening) and 2b (epiglottis + posterior arytenoids)
Heparin resistance is caused by …
AT3 deficiency
treatment for heparin resistance
FFP
Mnemonic for components of MELD score
Dialysis CrIBS; INR, bilirubin, sodium
In adults the dural sac extends to …
S1/2
Most common cause of death in subarachnoid hemorrhage is … followed by …
bleeding followed by rebleeding which peaks within 24 hours
75% of cancer related pain is caused by … and …
tumor invasion and metastatic tumor formation
pulmonary vascular resistance is lowest when breathing at …
normal tidal volumes
when a vaporizer designed for a lower SVP is misfilled with anesthetic of higher SVP, the volume percentage of volatile anesthetic delivered will be … than the concentration set on the dial
higher
Cole formula
uncuffed ETT = (age/4) + 4
In preeclampsia there is … of thromboxane A2 and … of prostacyclin levels leading to a vasoconstricted state
increase TXA2; decrease prostacyclin
In preeclampsia, uterine and placenta blood flow is …
decreased
Desulfurization of thiopental produces …
pentobarbital A
Neuraxial fentanyl site of action
substantia gelatinosa of the dorsal horn
Neuraxial morphine site of action
CSF spread
Morphine’s effect on preload reduction and vasodilation are due to …
histamine release
attachment point of the tongue to the mandible is called the …
genioglossus
definition of anuria
<50 mL in 12 hours or <100 in 24 hours
oliguria for … hours = stage 2 RIFLE: Injury
12 hours
oligura for … hours = stage 3 RIFLE: Failure
24 hours
Thyrotoxic cardiomyopathy is characterized by infiltration of … and …
lymphocytes and eosinophils
4 sites considered most accurate for temp monitoring
esophagus, nasopharynx, tympanic membrane, pulmonary artery
Marker for sympathetic block is increase in limb …
temperature by 2-3C
valsalva maneuver will … intrapleural pressure
increases
T/F: does bupivacaine readily cross the placenta
false d/t high protein binding and pKa 8.1
Loss of fetal heart rate variability is an early sign of …
fetal hypoxia
Mechanism of early decelerations from fetal head compression
Vagal reflex from transient mild hypoxia
4 risk factors for PONV in children
duration >30min; age >3yo; strabismus sx; h/o PONV in 1st degree relative
HRT transplant: heart rate generation is dependent on the donor/recipient atrium
donor
HRT transplant: resting intrinsic heart rate is … and heart rate variability is … . This is caused by …
HR increased with decreased variability due to parasympathetic denervation
interscalene block: nerve plexus is located … from the carotid artery
lateral and posterior
interscalene block: which nerve is often spared
ulnar nerve
definition of postreperfusion syndrome (PRS)
MAPs >30% below baseline for 1-5 min after reperfusion of liver
hyperventilation will result in … ionized calcium
decreased
citrate toxicity: product most likely to cause it
FFP
citrate toxicity: more common in peds/adults
peds
amniotic fluid embolism: first stage
pulmonary vasospasm and right heart dysfuction leading to left heart dysfunction and pulmonary edema
amniotid fluid embolism: second stage
consumptive coagulopathy from hemostasis
amniotic fluid embolism: third stage
ARF and ARDS
BP target for fibrinolysis in acute stroke
<185/110 mmHg prior to intervention
ICP measurement: gold standard
ventriculostomy catheter
relationship between ketamine and ICP
unknown
pheochromocytoma: which receptor to block first
alpha ideally 10-14 days prior to surgery
chronic AS what is the contribution of the atrial kick
40% of the LVEDV
coronary perfusion equation
CPP = DBP - LVEDP
normal LVEDP
<15 mmHg
goal during induction of patient with severe AS: HR … and SVR …
bradycardia and elevated SVR
effect of hypothermia on post-resuscitation myocardial ischemia
exacerbates due to increased catecholamine release
describe the mechanism for amniotic fluid embolism
disruption of uterus results in entrance of amniotic fluid or fetal cells entering maternal circulation causing anaphylactoid response leading to cardiovascular collapse
patients with uremia should receive lower doses of premedication with midazolam, why?
decreased protein binding and increased free fraction
type of anesthesia for cerclage placement
neuraxial
syndrome where manipulation of pacemaker’s pulse generator causes malposition of pacemaker leads leading to pacemaker failure and stimulation of phrenic nerve
twiddler syndrome
urine anion gap equation
uAG = Na + K - Cl
criteria for intracranial pressure monitoring
severe head injury + abnormal CT; age > 40 with SBP <90 or decerebrate/decorticate positioning
desired spinal level for TURP
T10
acceptable cold ischemic times for heart and lungs
4 hours
acceptable cold ischemic time for liver
8 hours
highest frequency brain waves
gamma 25-100 Hz
as temperature decreases, gas solubility …
increases
chronic use of carbamazepine, phenytoin, phenobarbital, St. John’s wort, dexamethasone, and topiramate have what effect on CYP-3A4
induce
systolic wall thickening represents … during ejection
myocardial contraction
3 nerves commonly injured by retractors
brachial plexus, femoral, LFC
describe the Haldane effect
O2 binding hgb to displace CO2 causing left shift of hgb disassociation curve
T/F etomidate is safe to use in pregnant women
true
which subtype of Ach receptor are ionotropic?
nicotinic
use of INR to guide treatment in cirrhotic patients
patients will have elevated INR due to liver dysfuction. TEG is a better test for evaluating coagulopathy
indications on TEG for giving cryoprecipitate
K time > 3 or alpha less than 53
describe the effect of midazolam on ventilation
dose-dependent effect that is insignificant in healthy patients
mechanism for subjective respiratory weakness following thoracic epidural
blockade of afferent proprioceptive signals from the abdomen and chest wall muscles
complications for aneursym clipping
rupture or VTE
contrast induced nephropathy risk factors
age >75, DM on metformin, HTN
HbCO level for hyperbaric oxygen
25%
anti-arrhythmic medication that can cause thyroid storm
amiodarone
3 goals of preop endo airway exam
clear path to larynx, identify posterior pharyngeal masses, or vascular anterior pharyngeal masses
nasopharynx defined as
base of skull to soft palate
oropharynx defined as
soft palate to epiglottis
name the 3 paired cartilages of the larynx
arytenoid, corniculate, cuneiform
name the 3 unpaired cartilages of the larynx
epiglottis, thyroid, cricoid
sux is dosed based on … body weight
total
injection of SF6 or C3F8 within the past … days are contraindications for N2O use
70
acupuncture point known to help treat PONV
P6 inner wrist
2 patient RFs for cardiac or vascular perforation during lead removal
female and BMI >25
NPDB data is maintained for … years
5
MC reason for licensure action
medical negligence
herbal supplement that can cause hypoglycemia with chronic use
ginseng
herbal supplement known to active the cell-mediated immune response
echinacea
T/F malpractice payments made from personal funds are reported to the NPDB
false but all payments made by an insurer on behalf of an individual physician must be reported
T/F simulation is a required part of MOCA
false
How many qualifying points must be obtained in a 5 year cycle for MOCA
50, with no more than 25 in the last year
albumin dose for hepatorenal syndrome
1 g/kg
at what level of sedation is etCO2 monitoring required
moderate
antidote for apixaban
andexanet alfa
abdominal pressures greater than … is defined as abdominal compartment syndrome
20 mmHg
MAC decreases by …% for every decade of life
6
2 reflexes to determine if brainstem is intact
oculocephalic and oculovestibular
2 MC reasons for delayed discharge after surgery
pain and PONV
age range with highest risk of emergence delirium
4 +/- 2 yo
compound responsible for bone cement implantation syndrome
methyl methacrylate
describe findings of POISE-1 trial
preop initiation of BB decreased risk of MI but increased risk of stroke and mortality
jaundice > 3 weeks postop suspect
TPN
effect of sux on intraocular pressure
increase by 9 +/- 3
gold standard for MH testing
halothane-caffeine test
latex-induced allergic response is what type
type 1 IgE-mediated with delayed onset ~30 min
scopalamine vs atropine, which is more likely to cause central anticholinergic syndrome
scopalamine
lab test to determine liver synthetic function
PT/INR
half-life of albumin
20 days
antidote for IV extravasation of vasoconstrictors
phentolamine, dilute to 0.5 mg/mL and inject 1 mL around extravasation site
antidote for IV extravasation of vesicants
hyaluronidase
which core competency revolves around conflict and concern resolution
Interpersonal and communication skill
effect of AchEi on PONV
historically increased risk but new data suggests no effect
nerve at risk for injury with brachial artery catheter insertion
median n.
4 variables to consider for anesthestic of patients with valvular heart disease
HR, contractility, preload, afterload
relationship between blood:gas coefficient and onset
high coefficient = high uptake = 1/onset
initial presenting sx of anthrax intoxication
flu-like and nonspecific
lidocaine dose for tumescent anesthesia
55 mg/kg
types of surgery for awareness under anesthesia (3)
cardiac, obstetric, trauma
reaction between desiccated CO2 and … produces the most heat
sevoflurane
reaction between desiccated CO2 and … produces the most CO
desflurane
max CO2 absorbed by CaOH
10.2 L/ 100g absorbent
max CO2 absorbed by soda lime
26L / 100g
SCh dose to reach phase 2 block
3-5 mg/kg
what is the lab assay used to characterize plasma cholinesterase abnormality
dibucaine number (normal around 80)
what is the term for process at the beginning of malpractice suit where documents are exchanged and depositions are made
discovery
T/F HIPAA does not apply to entities that are workers’ comp insurers, admin agencies or employers
true
what percent of acute HBV infections progress to chronic HBV infection
10%
describe the neuraxial changes that occur with aging (4)
decreased epidural space, decreased CSF, decreased myelinated fibers, increased dura permeability
T/F the ASA has no recommendations for aspiration prophylaxis
true
describe the results of the ASCEND-HF trial
nesiritide improved dyspnea without improvement in 30 day rehospitalization or mortality
percentage of anesthesiology residents with history of opioid abuse successfully re-entering residency
34%
define continual
repeated regularly and frequently in steady rapid succession
compare standard vs guideline vs practice advisory
PA is not considered a requirement
describe the effect of preopeartive carbohydrate load on PONV
no effect
types of surgery where aspirin is contraindicated (4)
intracranial, middle ear, posterior eye, and intramedullary spine
are implants made of aluminum MRI compatible
yes, so are titanium and stainless steel
T/F heart valve prostheses and annuloplasty rings are MRI-safe
true
platelet lifespan is … days
5-10
patients should be evaluated for (3) after being in a quenched MRI room
asphyxia, hypothermia, and ruptured tympanic membranes
duration of DAPT for bare metal stents
1 month
duration of DAPT for drug-eluting stents
3 months
Regional: high opening injection pressure >20 psi is a sign of …
intrafasicular injection
Regional: motor response at … is a sign of intraneural needle tip
<0.2 mA
T/F daily anesthesia machine checks are apart of the basic standards dictated by Joint commision
false
T/F total time needed to recover from neuraxial anesthesia increases with age
false, faster onset and spread but same time to recover
elevated SvO2 is classic sign of
cyanide toxicity
T/F accredidation for office-based anesthesia is the same as ambulatory surgery centers
false
SpO2 sat of 85% is classic for
methemoglobinemia
initial presentation of malignant hyperthermia
respiratory acidosis
in healthy patients serum creatinine remains stable from …
20 - 70 yo
T/F metformin does not need to be stopped preop
true. take day before and restart when normal diet is resumed
TCA can potentiate the effects of which pressor
ephedrine
T/F TCAs should be discontinued preop
false, increased cholinergic syndrome or worsening psych disease
CO2 induces a sympathetic/parasympathetic response
sympathetic
Peak plasma levels of tumescent lidocaine occurs when?
12-14 hours after injection
at which vertebrae level is the esophagus the weakest
C5/6
abdominal compartment syndrome effect on intracranial pressure
increases
opioid of choice for patients on chronic MAOi
fentanyl. morphine/hydromorphone can cause hyperpyretic response
T/F postop patient who has vomited can still be fast-tracked through recovery
false. minimal nausea okay
elevated etCO2 without desaturation during laparoscopy suspect
subcutaneous emphysema
ASRA: how many days of UFH is an indication for platelet count
4 days
normal shunt fraction in one-lung ventilation is
20-30% (normal for DLV is ~5%)
qualifying circumstances for billing (4)
age <1 or >70 yo; deliberate hypothermia; controlled hypotension; emergency
describe the differences between the Aldrete and White scoring systems
for assessing postop recovery transition. White includes pain and PONV
Which is worse for the environment desflurane or sevoflurane
desflurane has 26x global warming and remains 15x longer in the atmosphere
dose of dantrolene for MH
2.5 mg/kg up to 10 mg/kg
amount of dantrolene in Ryanodex
250 mg
T/F applying vasoconstrictor to nose increases airway diameter
true
describe SAFE trial results
saline vs albumin fluid evaluation. Albumin had 2x mortality at 28 days in patients with GCS <13 and brain injury
initial response after ECT is sympathetic/parasympathetic
parasympathetic followed by sympathetic
first line drug for ECT and dose
methohexital 1 mg/kg
INR target for coagulation management in patient with liver disease
none. do not use INR
T/F cardiac MRI does not require contrast
true
when can ppx LMWH be restarted after neuraxial catheter removal
4 hours
mnemonic for ultrasound color scheme
BART (blue away, red towards)
what percentage of people have a L6 vertebrae
10%
what supplies the inferior wall of the L ventricle
R coronary artery
what supplies the AV node
posterior descending artery
what is the line called that connects the peaks of the iliac crests?
intercristal line (Jacoby’s or Tuffier’s)
arteria radicularis magna is also known as …
artery of Adamkiewicz
innervation of the afferent limb of the gag reflex
internal branch of SLN
muscle that dilates pharynx during swallowing
stylopharyngeus
where to inject for lumbar facet joint injections
inferior articular facet
vocal cord abduction muscle
posterior cricoarytenoid
vocal cord adduction muscles
lateral cricoarytenoid, transverse and oblique arytenoids
all intrinsic muscles of the larynx are innervated by … except the …
RLN except cricothyroid which is innervated by SLN (external branch)
T/F VP shunts are a contraindication for spinal anesthesia due to infection
false
innervation of medial lower leg
saphenous (branch of femoral)
at rest what is the intracellular to extracellular ratio of potassium
150:5
at rest what is the equilibrium potential of potassium
-85V
T/F neuronal membranes are freely permeable to potassium
true
T/F neuronal membranes are freely permeable to chloride
false
describe the three phases of heat redistribution
P1: redistribution from vasodilation; P2: slow linear decrease; P3: passive thermal plateau
thermoregulatory vasoconstriction is initiated by core temps of …
33-35C
initial effect on cardiac output when shifting from supine to standing
decrease
respiratory mechanics that do not change during pregnancy (4)
lung compliance, spirometry values, respiratory rate, DLCO
effect of pRBC on O2 disassociation curve
left shift (decreased 2,3-DPG)
effect of anemia on O2 disassociation curve
right shift (increased 2,3-DPG)
P50 for normal O2 disassociation curve
27 mmHg
pressors not metabolized by lung tissue (3)
epi, isoproternol, dopamine
Mapleson: rebreathing during spontaneous
ADCB
Mapleson: rebreathing during controlled
DBCA
hepatopulmonary syndrome, the pulmonary system vaso…
dilates
prolonged hypoxia will have predominance of … waves
delta
target urine output for 1 day old baby
1-2 mL/kg/hr
phase of hepatic metabolism responsible for conjugation
phase 2
prophylactic treatment for hypoxic pulmonary vasoconstriction
nifedipine or inhaled beta2-agonist
heparin dosing for bypass
400 U/kg body weight
cortisol deficiency leads to … secretion of ADH
increased because corticotropin-releasing hormone is a ADH secretagogue
ppoFEVI calculation
FEV1 * ( 1 - % lung resected); cutoff 40%
how many lung segments in right lung
22/42
preoperative peak o2 consumption (VO2 max) of less than … mL/kg/min indicates an increased risk of morbidity and mortality
15; >20 is ideal
which adrenal layer is responsible for catecholamine secretion
inner medulla
first test to order after return of spontaneous circulation is
ECG
transpulmonary pressures are highest in patients with … lung disease
restrictive due to decreased lung compliance
differences in neonate respiratory anatomy
large tongue, short omega epiglottis, cephalic funnel-shaped larynx, angled vocal cords
full suppression of EEG occurs at what temperature
18C
after 20 weeks gestation what regulates uterine blood flow
pressure, no autoregulation because maximally dilated
name the three stages of ventricular filling
isovolumetric relaxation, filling (rapid then diastasis), and atrial systole
physiologic dead space in upright adult is what percent of tidal volume
33% of TV (100-150 mL)
% decrease in cerebral metabolic rate per degree C
7%
alpha-1 agonists … pulmonary vasoconstriction
increase
ovarian arteries supply …% of uterine blood flow
15
% of cardiac output directed to uterus at term
20%
villi form on which side of the placenta
fetal
upregulation of nAChRs peaks at what time after spinal cord injury
7-10 days
ICU patients immoblized for > … days have upregulated nAChRs
16 days, do not give sux
Preg: plasma albumin concentrations decrease by …%
30%
normal urine-plasma osmolality ratio
1-3
mAChR signaling pathway
Gq
myotonic dystrophy is associated with gastic …
atony
effect of propofol bolus on motor evoked potential (MEP) signal
decrease amplitude and increase latency
corrected age calculation
chronological age - weeks born before 40
after being released from the sarcoplasmic reticulum, what does calcium bind to initiate muscle contraction
troponin C
ATP binds to a cocked/uncocked myosin head
uncocked
…glycemia is associated with worse neurological outcomes in acute cerebral ischemia
hyperglycemia by exacerbating lactic acidosis
nitric/nitrous oxide is a pulmonary vasodilator
nitric
sense of smell is mediated by the … lobe
parietal
pons vs medulla: respiration
pons
pons vs medulla: reflexes
midbrain
pons vs medulla: swallowing
pons
pons vs medulla: blood pressure control
midbrain
turning patient’s head to the right will make insertion of bronchial blocker into which bronchus easier
left main
the ICU liberation bundle is used to liberate patients from what?
mechanical ventilation
epoprostenol drug class
prostacyclin used for pHTN
skin temperature monitoring is usually within … C of core temperature
2 degrees C
dye used for dye dilution
indocyanine green
absorption of indocyanine green
805 nm
dye dilution is more accurate than thermodilution during … cardiac output states
low; because it does not get absorbed into the surrounding tissue
ultrasound frequency is above which range
20k cycles per second
ground fault current interupter responds to currents greater than what
5 mAs
describe the let-go value
10-20 mA; current at which the hand is unable to let go
laser associated with fatal gas embolism
neodynmium-doped:yttrium aluminum garnet
medical device used to calibrate the tidal volume and minute ventilation measurements on portable transport ventilators
respirometer (measure flow in one direction vs spirometer that measure both directions)
volatile anesthetic with highest fat/blood solubility
sevo
T/F pacemaker in asynchronous mode will continue to sense
false, magnet induces either AOO, VOO, or DOO
by ASTM international guidelines, alarm must sound if anesthesia circuit pressure drops below … for a second
-10 cmH2O
clark electrode is used to measure
PaO2
sanz electrode is used to measure
serum pH
severinghaus electrode is used to measure
PaCO2
what is absolutely required if the sampling line is not filtered from the patient in the setting of a respiratory viral pandemic?
scavenging
describe 4 interventions to minimize mechanical trauma during CVC placement
- site selection
- patient positioning
- needle insertion
- confirming needle and guidewire placement
transcutaneous pacing is a form of atrial/ventricular pacing
ventricular
initial transcutaneous settings … bpm and … mA
80 bpm, and 70 mA
thermodilution: factors that cause overestimation
warmer solution, lower volume
transcardiopulmonary thermodilution sampling occurs where (3)
femoral, brachial, or axillary artery
needle cricothyroidotomy cannula requires a high/low-pressure O2 source and does/does not rely on a patent upper airway
high pressure with patent upper airway for exhalation
accurate stroke volume variation calculations requires tidal volumes … mL/kg and a respiratory rate < …
TV > 8 mL/kg and RR < 17 bpm
heliox vs room air in density
heliox has lower density
best ultrasound orientation for doppler flow calculation is parallel/perpendicular to flow
parallel
T/F double burst stimulation is more accurate than TOF
false; benefit is improved visual and tactile detection of neuromuscular function
wide complex QRS in children is defined as > … ms
90 ms; 120 ms for adults
T/F CO2 lasers are not visible
true;
what is the most common visible laser
argon
anesthesia machines preferable use the highest/lowest pressure gas
highest
high-pressure regulators decrease tank pressures to … psig
30-40 psig
respiratory rate target in a critically ill patient on PSV
20-35 bpm
another name for tracheal tube introducer
bougie
T/F armored tubes are nonflammable
false
synonym for periodic sigh maneuver
recruitment maneuver
T/F no long-term benefit has been seen with periodic recruitment maneuvers
true
T/F oxyhemoglobin absorbs more red light than deoxyhemoglobin
false
oxyhemoglobin absorption and emission wavelengths
absorbs infrared 950-1000nm and emits red 940nm
NASPE/BPEG Generic code, what does position V represent
multisite pacing
4 factors to improve defibrillation success
- larger paddles
- biphasic waveform
- conductive materials
- end expiration
T/F paddles with gel are more efficacious than paddles with self-adhesive pads
false; no difference
US color codes: brown
air
US color codes: gray
CO2
US color codes: black
helium
US color codes: yellow
air
Gas(s) with 1590L in E-cycliner
N2O and CO2
more dangerous zone in MRI
zone 4
NIBP: conversion factor for cmH2O to mmHg
3:2
desflurane vaporizers deliver gas dependent/independent of altitude
independent; must increase % at higher altitudes
variable bypass vaporizers deliver constant … at different altitudes
partial pressure; do not adjust for changing barometric pressures
primary indication of intraoperative EEG is …
monitor adequacy of cerebral oxygenation
main frequencies captured during intraoperative EEG are between
1-30 Hz
indwelling nerve catheters for > … days has shown to increase catheter colonization
4 days
T/F the cerebellum is not apart of the brainstem
true
partial pressure of water vapor
47 mmHg
ordinal data
qualitative data with ranking
nominal data
qualitative data without ranking
parametric data
continuous
central tendency of nominal data
mode
central tendency of ordinal data
median
T/F red cell volume is decreased in pregnancy
false; higher mineralocorticoid activity increases total body water which increases plasma and total blood volume
T/F pacemaker action potentials lack phase 2 and 3
false; lack phase 1 and 2 (depol mediated by Ca and not Na)
JG apparatus release renin in response to decreased …
chloride
T/F Chi-squared test will is a non-parametric test
true; requires categorical data
Bland-Altman plot is AKA
Tukey mean-difference plot
Clark error grid is broken down into … regions
5
which is usually greater standard deviation or standard error
standard deviation
which test to make diagnosis of chylothorax
pleural fluid analysis
root of scapular spine corresponds to which nerve root level
T3
inferior angle of scapula corrresponds to which nerve root level
T7
site of action for IV regional anesthesia
peripheral nerves and trunks
how many subunits in nAChR
five
stellate ganglion is the confluence of what two structures
inferior cervical plexus and first thoracic sympathetic ganglion
two most common agents for celiac plexus neurolysis are what
ethyl alcohol and phenol
T/F visualization of chest wall rise and fall is sufficient for monitoring ventilation
true
RFs for bradycardia following spinal (3)
above T5, high vagal tone, low cardiac output
describe the inverse steal phenomenon
hyperventilation induces respiratory alkalosis causing cerebral vasoconstriction leading to a redistribution of CBF to ischemic areas via anastomotic channels
neonates have a more pliable rib cage. what is the effect on work of breathing
increased
compare compliance of lungs and chest wall in neonates vs children
lower lung compliance with increased chest wall compliance
adrenergic receptor what when blocked causes bronchoconstriction
beta-2 (Gs)
brain glucose consumption rate
5 g/100g/min
cerebral oxygen consumption rate
3 mL/100g/min
how long after cardiac arrest does brain death begin?
4-6 minutes
how does aging affect volume of distribution?
increases due to increased fat and decreased muscle
which volatile anesthetic potentiates nNMB the most?
desflurane
drugs associated with zero-order kinetics (3)
phenytoin, ethanol, aspirin
electrolyte change caused by digoxin
increased intracellular calcium
early sign of propofol infusion syndrome can be detected with which lab test
lipid panel (hypertriglyceridemia)
treatment for paradoxical reaction to midazolam
flumazenil
effect of steroids on prostaglandin synthesis
inhibition
pain medication with the greatest propensity for QT prolongation
methadone
T/F meperidine causes QT prolongation
false
75% N2O can expand a pneumo to 2x in … minutes
10 minutes
T/F molecular mechanism for sux-induced hyperkalemia is unknown
true
definition of hypertensive urgency
BP > 180/110 without signs of end organ damage
etomidate receptor target
GABAa
2 indications for bicarb during CPR
hyperkalemia and TCA intoxication
local anesthetic with lowest chance of placental transfer
2-chloroprocaine
indication for citric acid + sodium citrate
aspiration ppx for emergent surgery
effect of opioids on sphincter of Oddi
increase tone and biliary duct pressure
T/F allergy to NMB is more common in men
false; believed to due exposure to topical cosmetics/personal products
describe effect of calcium on phase 3 cardiac action potential
calcium activates potassium efflux channels
describe the Meyer-Overton correlation
increased chain = increased lipid solubility = higher potency
dose for precurarization
10% of ED95
lithium interacts with which ion channels
potassium both pre and post-synaptic
opioids that exhibit some NMDA antagonism (2)
tramadol and methadone
N2O receptor
NMDA (mixed competitive/noncomp antagonist)
alfentanil and fentanyl numeric correlation
4
most common side effect of sugammadex
bradycardia
propofol infusion pain mechanism
bradykinin release
effect of methohexital on seizure threshold and duration
none
toxicity associated with vinca alkaloids
peripheral neuropathy
propofol effect on GABA receptor is similar to which other class of drugs
barbiturates (increased duration of channel opening)
how do local anesthetics potentiate nNMB
stabilization of postsynamptic membrane through AChR desensitization
effect of calcium on nNMB
attenuate (Mg potentiates)
why do corticosteroids attenuate nNMB
increased ACh release and increased immature AChR at postsynaptic membrane
loss of pulses is an [early/late] sign of compartment syndrome
late; not needed for diagnosis
steroid-induced glaucoma is a [open/closed] angle glaucoma
open
epinephrine is contraindicated in [open/closed] angle glaucoma
closed due to mydriatic effect
HCTZ is contraindicated if patient has allergy to what
sulfa
HCTZ alternative in patient with sulfa allergy
ethacrynic acid
sevo vs iso: lower vapor pressure
sevo
block onset time is correlated to which property
pH
pH of epi ampules
4
most common side effect of fospropofol
parasethesia
relation of fospropofol to propofol
fospropofol is a water-soluable prodrug that requires alkaline phosphatases for metabolizing to propofol
