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Anesthesiology > True Learn. Basic. > Flashcards

True Learn. Basic. Flashcards

1
Q

What is the Haldane effect?

A

Deoxygenated hemoglobin has higher affinity for CO2

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2
Q

Spread of local anesthetic within the CSF is primarily affected by what?

A

Baricity of anesthetic and patient position

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3
Q

St. John’s Wart induces what enzyme?

A

P450 3A4

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4
Q

What is the recommended technique to verify venous placement of central line?

A

Performing column mamometry

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5
Q

What is the first sign of intravenous Lidocaine toxicity/

A

Numbness of the lips

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6
Q

What has the largest effect on epidural spread of local anesthetic?

A

Total mass of local anesthetic

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7
Q

What are 5 side effects of sodium bicarb administration?

A 
Increases: 
-PaCO2
-EtCO2
-Intracranial Pressure
Decreases:
-Serum Calcium
-Serum Potassium
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8
Q

Name 8 conditions that cause up-regulation of nicotinic acetylcholine receptors

A
  1. Stroke
  2. Burns
  3. Prolonged immobility
  4. Duchenne muscular dystrophy (myopathies)
  5. MS
  6. Guillan Barre
  7. ALS
  8. Spinal Cord injuries
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9
Q

Why is Myasthenia Gravis not a contraindication to Succs?

A

Because it is caused by an antibody to the NAChR which actually decreased the number of receptors. (upregulation is contraindication)

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10
Q

What is the major landmark for performing a stellate ganglion block?

A

Chassaignac tubercle which is transverse process of C6

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11
Q

What is the appropriate treatment for methemoglobinemia in patient with G6PD deficiency?

A

Ascorbic Acid

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12
Q

What is assist-control ventilation?

A

If the patient is not breathing it is essentially VCV. Tidal volumes and minimal RR are set. If patient is breathing the ventilator synchronizes to deliver tidal volume in a positive pressure breath. Spontaneous breathing of the ventilator is not allowed.

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13
Q

What is approximate vital capacity for 70 kg adult?

A

About 5L

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14
Q

What is ED95 (NMBD)?

A

The dose of a paralytic at which 95% twitch suppression is achieved in 50% of population

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15
Q

What affects how Nitric oxide will function in the body?

A

Site of production

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16
Q

At what Magnesium level do you begin to see ECG changes?

A

6-12 mg/dL

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17
Q

What are two ways to increase output of vaporizer?

A

Increasing fresh gas flow and decreasing barometric pressure*

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18
Q

What is the unique side effect of IV anesthetic Methohexital?

A

Seizures

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19
Q

There are three types of MAC. List them in order

A

MAC awake

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20
Q

What are the risk factors of POCD (postoperative cognitive disfunction)?

A

Advanced age, lower education level, history of previous cerebral vascular accident without residual impairment.

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21
Q

What class of drugs cause extrapyramidal symptoms and what class treats them?

A

Antidopaminergic. Anticholinergic.

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22
Q

Which test is most useful to diagnose acute abnormalities in hepatic synthesis?

A

Prothrombine time

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23
Q

What are the functions of the first and second stage oxygen regulators?

A

First: shut off lower pressure O2 tank when high pressure pipeline is sensed. Second: decrease pressure to slightly above atmospheric pressure

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24
Q

What factor most influences initial recovery from an induction dose of thiopental?

A

Redistribution to peripheral tissues.

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25
Q

What is most likely observed on ECG after multiple blood transfusions in liver dysfunction patient?

A

Prolonged QT interval 2/2 hypocalcemia.

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26
Q

What are the 5 elements of the Aldrete PACU discharge criteria?

A

Extremity activity. Breathing. O2 sat. BP. Consciousness

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27
Q

Of the common gasses which has the highest blood:gas coefficient? Lowest?

A

Isoflurane. Desflurane

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28
Q

Name 5 drugs associated with pain on injection

A

Propofol, Rocuronium, Diazepam, Etomidate, Methohexital

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29
Q

Which nerve is responsible for bronchoconstrictiom?

A

Vagus

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30
Q

In LAST how is epinephrine dosed?

A

Less than normal (1 mg). Dose at <1 mcg/kg

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31
Q

What is the arterial oxygen content equation?

A

CaO2=(Hbg1.36SaO2)+(0.003*Pa02)

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32
Q

What is treatment for hyperkalemia?

A

C BIG K DROP

Calcium gluconate. 10 ml
Beta agonist
Bicarbonate
Insulin 10 units 
Glucose D50 one ampule

Kayexalate 15-30 g

Diuretics
Renal unit for dialysis of Patient

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33
Q

what is the effect of nicardipine?

A

Reduces BP by reducing afterload with minimal effect on preload.

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34
Q

What is nesiritide?

A

Recombinant form of BNP. Causes vasodilation, diuresis, natriuresis

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35
Q

What is the equation for SVR?

A

SVR= [80 * (MAP-RAP)] / CO

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36
Q

Describe the branches and function of Superior Laryngeal Nerve

A

Internal and external branches. Internal branch provides sensation to larynx above vocal cords. The external branch is motor and innervates the cricothyroid muscle.

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37
Q

What are guidelines for surgery in patient with CAD requiring stenting? When to perform surgery and what anti platelet meds to continue perioperatively?

A

Consider: Urgency of surgery, risk of bleeding, severity CAD.

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38
Q

Which nerve fibers transmit nociceptive info? Which is faster?

A

A-delta and C fibers. A-delta a myelinated and faster. C for dull pain

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39
Q

Order of local anesthetic systemic absorption. (Vascularity)

A

IV-tracheal-intercostal-caudal-epidural-brachial plexus-LE blocks

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40
Q

Why is Ketamine contraindicated as sole induction agent in severe CAD?

A

It acts as a sympathomimetic and increases heart rate and BP

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41
Q

How is esmolol metabolized?

A

Red Blood Cell Esterase

Esmolol = esterase

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42
Q

Acronym for Beta 1 selective blockers (cardioselective)

A

BEAM

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43
Q

What is the equation for mixed venous oxygen? What is normal value?

A

SvO2=SaO2-{VO2/(COHbg1.35)}

75%

44
Q

Where is Nicardipine Metabolized?

A

Liver

45
Q

What is the difference between first order and zero order kinetics?

A

In zero order there is a constant amount of drug metabolized. In first order it is a constant percentage that is metabolized. Liver blood flow affect first order no zero order.

46
Q

Metoclopramide (Reglan) is contraindicated in what? Why?

A

SBO. Because it is a promotility antiemetic

47
Q

What are 5 risk factors for CAD?

A
  1. History Ischemic heart disease
  2. CHF
  3. CKD
  4. History Stroke
  5. DM
48
Q

Which cardiovascular med can NOT be administered IM?

A

Norepinephrine

49
Q

What are risk factors for emergence reactions with Ketamine?

A
  1. Age
  2. Female
  3. Dosage
  4. Psychologic Susceptibility
  5. Concurrent Meds (Benzos preop decrease risk)
50
Q

What is the order of non-depolarizing muscle relaxant potentiation?

A

Desflurane>evoflurane>Isoflurane>Halothane>TIVA

51
Q

Why does nitrous have a faster onset than Des even though it is more soluble (higher blood:gas coefficient)?

A

Concentration effect

52
Q

What cardiac side effect can be caused by Methadone?

A

QT prologation

53
Q

Describe the four possible Lehane-Cormack Laryngeal Views

A 
Grade: 
I: Entire laryngeal aperature
II: Posterior third of glotis
IIa: Arytenoids and posterior cords
IIb: Arytenoids and epiglottic edge
III: Only epiglottis visible
IV: No view of any airway structures
54
Q

Treatment for stridor and difficult ventilation in fixed airway obstruction (such as subglottic stenosis)?

A

Helium/oxygen 70/30. This is because Helium is more dense and will decrease resistance in turbulent flow.

55
Q

What is the effect of metabolic alkalosis on respiratory drive?

A

There is a 0.5 mmHg increase in PaCO2 for every 1 mEq/L increase in Bicarb. Alkalosis can cause hypoventilation (retain Co2 to decrease pH)

56
Q

What is the pneumonic for K sparing diuretics?

A

K+ STAys with Spironolactone, Traimterene, Amiloride

57
Q

What is the closing capacity? What reduces it?

A

The volume at which small airways begin to close. it is decreased by (ACLS-S) Age, chronic bronchitis, LV failure, smoking, surgery

58
Q

What is Rocuroniums mechanism of action?

A

Competitive antagonist at postsynaptic nicotinic acetylcholine receptors.

59
Q

What is the Frank-Starling effect of phenylephrine?

A

Increased both preload and afterload (venous and arterial constriction), increased LVEDV and increased stroke volume

60
Q

Is succs safe to use in asthma?

A

Yes. Even though it does cause Histamine release, it is not associated with bronchoconstriction.

61
Q

What is the mechanism of action of Ketamine?

A

NMDA receptor antagonist. NMDA are excitatory glutamate receptors.

62
Q

List inhaled anesthetics in order of metabolism, from greatest to least (3)

A

Sevo>Iso>Des

63
Q

What class of drug is glycopyrrolate?

A

Anticholinergic

64
Q

What class of drug is neostigmine?

A

Cholinesterase inhibitor

65
Q

When reversing, what cholinesterase inhibitor is paired with atropine?

A

Edrophonium

66
Q

ASA should be held for what cases?

A

intracranial neurosurgery, mild ear, posterior eye, intramedullary spine, +/- prostate

67
Q

What is a major side effect of Dantrolene?

A

Liver failure

68
Q

What is the equation for standard error of the mean?

A

SEM= standard deviation/square root of n (where n=population)

69
Q

what factors INCREASE MAC?

A 
Drug
 Amphetamine, Cocaine, Ephedrine, Chronic EToH
Age
  highest at 6 months
Electrolyte
 Hypernatremia
Hyperthermia
Red Haird
70
Q

What factors shift the oxygen dissociation curve right. Mnemonic?

When is 2,3 DPG the highest?

A

RIGHT.

Rise In 2,3 DPG, H+, temperature.

Highest at 12 months of age. This results in lowest affinity and highest P50

71
Q

What are NPO guidelines?

A

2 Hr: Clear liquids
4 Hr: Human Breastmilk
6 Hr: Light meal, non-human breast milk
8 Hr: Fatty foods

72
Q

What happens to serum osmolarity after large LR infusion? Why?

A

Serum osmolarity with decrease because LR is actually slightly hypoosmolar. 273-275 mOsm/L where serum is 275-295 mOsm/L

73
Q

What is the relationship of partial pressure of inhaled anesthetics between CNS, blood and alveoli?

A

PCNS=Pblood=Palveoli

74
Q

What is the mechanism of action of dantrolene?

A

Directly blocks calcium release from sarcoplasmic reticulum intracellularly.

75
Q

At what spinal cord level does to artery of adamkiewicz generally originate?

A

T9-T12

76
Q

What adrenergic receptors are associated with cardiac sympathetic stimulation?

A

Alpha 1, beta 1, Beta 2

77
Q

What factor is most likely responsible for release of vasopressin?

A

increased plasma osmolality

78
Q

Carotid body chemoreceptors are stimulated by what?

A

decrease in PaO2 less than 60-65 mmHg

79
Q

Describe series of events after Mannitol administration

A

Initially increase in plasma volume and cardiac output. This is followed by diuresis leading to reduced intravascular volume and potentially reduced BP and CO

80
Q

What medication is best for n/v associated with high spinal blockade?

A

Atropine

81
Q

What is the formula for static respiratory compliance?

A

Cs=Vt/(Ppl-PEEP)

82
Q

What percentage of platelets are restored one day after discontinuing antiplatelet medication?

A

10-14% (per day)

83
Q

What is the metabolite of hydromorphone? Is it active or inactive? What is its effect in renal failure (accumulation)?

A

hydromorphone-3-glucuronide (H3G).
Inactive.
Neuroexcitatory/neurotoxic

84
Q

What causes a plateaued inspiratory flow on flow-volume loop?

A

Variable extra thoracic lesion (unilateral vocal cord paralysis)

85
Q

What is the result of excessive dose of neostigmine and what is the recommended max dose?

A

Prolonged weakness.

0.07mg/kg

86
Q

What are two complications occur more frequently in left-sided central line placement?

A

Chylothorax (unique to left side)

Carotid artery puncture (more common)

87
Q

Patient has been receiving Heparin for more than 5 days. What needs to be checked before placing epidural? Why?

A

Platelets. To check for HIT

88
Q

How does ischemic optic neuropathy present?

A

Sudden painless vision loss

89
Q

Is propofol a vesicant?

A

Nope

90
Q

Where does Vasopressin work?

A

V1 receptors

91
Q

What is the most common risk of autologous blood transfusion?

A

Infection (from improperly stored blood)

92
Q

Transfusion-associated sepsis (TAS) is most associated with transfusion of what product?

A

Platelets

93
Q

Patients with IgA deficiency receiving blood are at increased risk of what?

A

Anaphylactic response to IgA in donor blood

94
Q

What is reason for low grade fevers following blood transfusion?

A

Host antibodies to HLA antigens on donor leukocytes

95
Q

What are Amiodarone’s side effects?

A

bradycardia, hypotension, hypothyroidism, thyroid storm, QT prolongation, pulmonary fibrosis, elevated liver enzyme markers.

96
Q

What is the alveolar gas equation?

A

PAO2=FiO2(PB-PH20)-PCO2/RQ

PB=760
PH20=47
RQ=0.8

97
Q

What is the mechanism of action of Metformin?

A

Decreased hepatic gluconeogenesis and increases insulin sensitivity

98
Q

Under what two circumstances does the odds ratio estimate the risk ratio?

A

Cohort study, low incidence

99
Q

What is the NYHA classification of heart failure?

A

Based on symptoms
Class I: No limitation in normal activity
Class II: minor limitation, slight symptoms with normal activity
Class III: Significant activity limitations, only comfortable at rest
Class IV: Symptoms at rest

100
Q

Primary hyperparathyroidism has what affect on acid/base status?

A

Normal anion gap metabolic acidosis as it can increase renal bicarb loss

101
Q

What is first line treatment for stable Afib with RVR?

A

Beta blocker

102
Q

What is mechanism of action of barbituates (and propofol)?

A

Decrease dissociation of GABA from its receptor

103
Q

What are Propofol’s affects on the respiratory system? (3)

A
  1. Dose-dependent apnea
  2. Bronchodilation in COPD
  3. Potentiation of hypoxic pulmonary vasoconstriction
104
Q

Treatment for stable SVT?

A

Adenosine

105
Q

Name three congenital heart defects dependent on PDA.

A
  1. Transposition great vessels
  2. Pulmonary atresia
  3. Hypoplastic heart

Anesthesiology (12 decks)

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