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Truelearn Flashcards

1
Q

perioperative conditions leading to sickling:

A

SIX H’s cause SICKling (HbS)

  1. Hypothermia
  2. Hyperthermia
  3. Hypoxemia
  4. Hypotension
  5. Hypovolemia
  6. H+ ions (acidosis)
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2
Q

Lumbar plexus block, what is blocked and what spared?

A 
Aka psoas compartment block:
Blocked:
- femoral
- obturator
- iliohypogastric
- genitofemoral
- lat fem cut

Spared:
- sciatic nerve

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3
Q

Law of laplace

A

T(wall tension)=(P*r)/(2h)

h= wall thickness
P= pressure in ventricle.
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4
Q

Meld vs child Pugh

A

Meld:
I Crush Several Beers Daily
(INR, creatinine, sodium, bilirubin, dialysis)

Child-Pugh:
Pour Another Beer At Eleven
(PT, ascites, bilirubin, albumin, is encephalopathy)

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5
Q

Factors increasing MAC:

A

Drug

  • amphetamine
  • cocaine
  • ephedrine
  • Chronic Etoh
  • highest street 6 months

Electrolyte:
- hypernatremia

Hyperthermia
Red hair

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6
Q

Factors decreasing MAC:

A

Drugs:

  • alpha 2 antagonists(clonidine, precidex)
  • acute Etoh
  • local anesthetic
  • lithium
  • verapamil
  • chronic amphetamine use

Electrolyte:
Hyponatremia

Elderly
Anemia
Hypothermia 
Hypoxia 
Pregnancy
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7
Q

Gabapentin receptor for action

A

Calcium channnel A2-delta

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8
Q

Chemotherapeutic toxicity’s:

A
  • Cisplatin/carboplatin: acoustic nerve, nephrotoxicity
  • vincristine: peripheral neuropathy
  • bleomycin/busulfan: pulm fibrosis
  • Trastuzumab: cardiotoxicity
  • Doxorubicin: cardiotoxicity
  • 5-FU, 6-MP, methotrexate: myelosuppression
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9
Q

Papillary muscle blood supply

A

Posterior-medial: RCA

Antero-lateral: Lcx and LAD

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10
Q

Major source of heat production in neonates and infants?

A

Nonshivering thermogenesis, triggered by:

  • Norepinephrine
  • glucocorticoids
  • thyroxine

Inhibited by:

  • volatile anesthetic
  • B blockers
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11
Q

Drugs that typically follow zero-order kinetics are:

A

THE PAW: theophylline, heparin, ethanol, phenytoin, aspirin, warfarin.

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12
Q

Agents with low blood:gas partition coefficients

A

sevoflurane, desflurane

I.e. faster onset (more in the alveoli and so more in the brain)

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13
Q

Alpha stat pH correction for hypothermia vs pH stat

A

pH: temp corrected system. Aims at constant pH and adds CO2.

  • Allow faster cerebral cooling and better O2 delivery.
  • Concern for loss of auto-regulation and increases microemboli

Alpha: primary buffers Hco2 and phosphate decreased efficacy and so AMINO ACIDS = most important buffers.
- Maintains uncorrected CO2, pH at nml levels (more physiologic)

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14
Q

Alveolar Gas Equation

A

PAO2 = FiO2 * (Pb - PH2O) - PaCO2 / R

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15
Q

Amount of fibrinogen In cryo?

A

200mg

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16
Q

Amount of liquid volatile anesthetic

A

3 x fresh gas flow(L/min) x volume % = liquid of volatile anesthetic per hour

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17
Q

Anaphylactic vs anaphylactoid

A

Same clinical picture but anaphylactic are IgE mediated.

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18
Q

antinausea, antiemetic medications target what receptors?

A

chemoreceptor trigger zone (CTZ) of the brainstem. also known as the area postrema and, along with the nearby nucleus tractus solitarius, is felt to contain dense quantities of emetogenic chemoreceptors.
Receptors include dopamine, serotonin, acetylcholine, histamine, and NK1 types.

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19
Q

Aortic regurgitation

Heart rate goal?

A

regurgitant volume depends on the diastolic time and the pressure gradient across the aortic valve
kept above 80 bpm to prevent increases in the time for regurgitation

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20
Q

Aortic stenosis

A

valve area less than 0.8 cm2

mean pressure gradient > 40 mmHg,

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21
Q

AV node blood supply

A

PDA branch of RCA in 75% of people.

In other 25% PDA comes from circumflex

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22
Q

B-blocker overdose treatment

A

Glucagon

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23
Q

Blood gas interpretation: Acute and chronic changes expected.

A
  • pH will decrease by 0.05 for every acute 10 mmHg increase in PaCO2.
  • Bicarbonate increases 2.0 mEq/L per 10 mmHg acute increase in PaCO2.
  • increase 4 mEq/L per chronic 10 mmHg increase in PaCO2, and pH will return toward normal if hypercarbia persists long enough (i.e. 1-2 days).
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24
Q

Volatile anesthetics currently in use. Physiological changes

A

decrease arterial blood pressure, SVR, and myocardial function comparably and in a dose-dependent manner

Halothane decreases CO

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25
Q

Volatile anesthetic with highest vapor pressure? Lowest?

A
  • Desflurane (highest) in gas form at room temp. Vaporizer helps to not evaporate away.
  • Sevoflurane (lowest)
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26
Q

Volatile anesthetic that augments neuromuscular blockade

A

Desflurane

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27
Q

Vasopressin-2 receptors

A

responsible for increased water reabsorption in states of hyperosmolarity or hypovolemia via increased translocation of aquaporin 2 channels in the distal convoluted tubule and collecting ducts

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28
Q

vasopressin-1 (V1) receptors

A

Causes vasoconstriction

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29
Q

unpaired t-test

A

comparison of two populations with respect to a single variable with numerical data

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30
Q

Triad of aortic stenosis

A

angina, syncope, and shortness of breath (dyspnea).

The degree of symptoms does not correlate with the degree of stenosis

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31
Q

treatment of choice for methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency.

A

Ascorbic acid

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32
Q

Treatment for anticholinergic overdose or prophylaxis against organophosphate poisoning

A

Physostigmine—only cholinesterase inhibitor that crosses the blood brain barrier

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33
Q

Timeframe for smoking cessation benefits.

A

Immediately less Carbonmonoxide.
48-72 hours: increased secretions and a more reactive airway
• 2-4 weeks: decreased secretions and less reactive airway
• 4-6 weeks: immune system and metabolism normalize
• 8-12 weeks: improved mucociliary transport and small airway function

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34
Q

Thromboelastography (TEG)

A

MA value decreased -> platelets.
K value prolonged -> cryoprecipitate.
R value prolonged -> FFP.
Teardrop configuration -> antifibrinolytics.

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35
Q

Thoractomy predictive cutoff for FEV1?

VO2 max?

A

40 if less than 40 then bad outcome likely.

VO2 max
< 10 ml/kg/min high risk

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36
Q

SVR calculation

A

SVR = [80 * (MAP - RAP)] ÷ CO]

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37
Q

Sucralfate

A

no effect on gastric volume and only a local effect on gastric pH

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38
Q

stellate ganglion blockade.

A
  • diagnose and treat complex regional pain syndrome (CRPS) of the upper extremity
  • transverse process of C6. Chassaignac tubercle (or carotid tubercle).

Ipsilateral temperature changes is the most reliable for block success.
Also should get Horner syndrome

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39
Q

Static respiratory system compliance equation:

A

CS = VT ÷ (PPL - PEEP).

CS: static compliance
VT: tidal volume
PPL: plateau pressure

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40
Q

spironolactone

A

Blocks the Na+/K+/Cl- channels in the distal convoluted tubule

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41
Q

Spinal anesthesia hypotension

A
  • arterial dilation (decreased afterload),
  • venodilation (decreased preload)
  • bradycardia (parasympathetic dominance and/or the Bezold-Jarisch reflex)
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42
Q

SLN branches

A

“SIME” for sensory = internal,

motor = external

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43
Q

Shunts affects soluble or insoluble agents more? IR mainstem

A

insoluble (desflurane)

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44
Q

Severehypocalcemia findings

A 
Hypotension, 
narrow pulse pressure, 
prolonged QT interval, 
widening of the QRS complexes, 
 flattened T waves
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45
Q

sensory innervation below the vocal cords and motor innervation to all of the intrinsic and extrinsic muscles of the larynx

A

recurrent laryngeal nerve

Left side loops under aortic arch

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46
Q

Selective B1 blockers and unique metabolism

A

BEAM

  • Bisopropolol
  • Esmolol (RBC esterases)
  • Atenolol (only one cleared by kidneys)
  • Metoprolol
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47
Q

Reversal agent proper pairing.

A

Atropine—edrophonium

glycopyrrolate—neostigmine, pyridostigmine.

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48
Q

Residual neuromuscular blockade is defined as?

A

train-of-four (TOF) ratio < 0.9 measured at the adductor pollicis muscle

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49
Q

recurarization

A

remain paralyzed or weak, or to develop weakness later in the recovery room from neuro muscular blockade

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50
Q

Benzodiazepines

Effect on Cerebral blood flow and metabolic rate.

A

reduce cerebral blood flow and cerebral metabolic rate.

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51
Q

Body fluid composition percentages.

A

ECV contains one-third of TBW, represents 20% of total body weight and is composed of plasma volume (20-25%) and interstitial fluid volume (75-80%).

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52
Q

Boyle Law

A

constant temperature the volume and pressure of a gas are inversely proportional

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53
Q

BP reading change with transducer height change.

A

7.5 mm Hg per 10 cm height change

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54
Q

Buprenorphine

A

partial mu opioid agonist with possible (controversial) kappa activity

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55
Q

Calculate time in oxygen tank

A

Divide the new pressure by 3 then divide by flow rate.

(1500/3)/4 = 125 minutes.”

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56
Q

Carotid baroreceptors send afferent signals to circulatory brainstem centers via

A

Hering’s nerve (a branch of the glossopharyngeal).

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57
Q

Caudal epidural. Last structure to transverse before epidural space.

A

sacrococcygeal ligament

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58
Q

causes of low FRC

A

PANGOS: Pregnancy, Ascites, Neonatal, General anesthesia, Obesity, Supine position.

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59
Q

Cerebral blood flow per CO2 change.

A

CBF changes 1-2 mL/100 g/min per every 1 mmHg change in PaCO2.

60
Q

Charles Law

A

volume and temperature of a gas will be directly proportional when the pressure of the system is held constant
(e.g. if the temperature is increased the gas will expand)

61
Q

cholinergic symptoms, such as those seen with acetylcholinesterase inhibitors, organophosphate poisoning, and nerve agents.

A

SLUDGE-Mi
Salivation, Lacrimation, Urination, Defecation, Gastrointestinal upset, Emesis, Miosis. Saying the mnemonic as “Sludge Me”

62
Q

cimetidine and famotidine

A

decrease gastric volume and increase gastric pH

Ranitidine only affects pH.

63
Q

Conn syndrome

A

Excess aldosterone

Sodium retention (HTN), hypokalemia
Metabolic alkalosis
64
Q

Contraindications for closed circuit

A 
Alcohol intoxication
Sevofloruane 
Malnutrition
Cirrhosis
Ketoacidosis
65
Q

Coronary artery vein pairings.

A
  • anterior cardiac vein: RCA
  • great cardiac vein: LAD
  • middle cardiac vein: PDA
66
Q

Corynebacterium diphtheriae, facultative anaerobe which causes diphtheria. Mechanism of effect

A

Inhibition of elongation factor 2 of transcription

67
Q

CPP coronary perfusion pressure

A

CPP = (Aortic DBP – LVEDP)

68
Q

cricothyroid muscles

A

external branch of the superior laryngeal nerve)

NOT vocal cords. So no horseness

69
Q

Cushing’s triad

A

hypertension
bradycardia
respiratory changes

70
Q

Cytochrome p450

A

Oxidizes

71
Q

Dabigatran

A

oral direct thrombin inhibitor

72
Q

Dalton Law

A

the total pressure of gas in the system is equal to the sum of the partial pressures of each component gas

73
Q

Dantrolene toxicity and lab monitoring

A

Hepatotoxicity. LFTs.

74
Q

Dead space

A

Lung that is ventilated but NOT perfused

75
Q

Dynamic effective compliance vs static effective compliance

A

DEC = (Ppeak - PEEP)/delivered tidal volume

SEC= (Pplat - PEEP)/delivered tidal volume

Dynamic is affected by resistance, static is not.

76
Q

ECG leads best for monitoring:

-2

A

2: atrial dysrhythmias

77
Q

Echothiophate

A

inhibits pseudocholinesterase,

- potentiating succinylcholine.

78
Q

Equation for standard error

A

SE = SD / square root (N)

79
Q

estimated vaporizer output.

A

PP is partial pressure or saturated vapor pressure, ATM is atmospheric pressure.

Sevoflurane- 160mmhg; PP:21%; PP/atm:~1/4
Isoflurane-238mmhg; 32%; ~1/2

80
Q

Extravasation of vasopressors

A
  • limb elevation
  • warm compresses
  • irrigating with saline (Gault technique)
  • injection of phentolamine
  • consider stellate ganglion block (for upper limbs)
81
Q

fenoldopam

A

selective dopamine-1 (D1) receptor agonist.
natriuretic and diuretic

No alpha 1 activity. Small amount of alpha 2.

82
Q

Fick equation reveals SvO2. Nml value?

A

SvO2 = SaO2 - [VO2 ÷ (CO * Hgb * 1.36)]

Nml = 75%

  • lower then more being extracted than delivered. Low CO?
  • High then can’t use as well…sepsis etc
SvO2 = mixed venous oxygen saturation
SaO2 = arterial oxygen saturation
VO2 = total body oxygen consumption
CO = cardiac output
Hgb = hemoglobin concentration
83
Q

first-line vasopressor for neurogenic diabetes insipidus following TBI.

A

Vasopressin

84
Q

GABAA from GABAB

A

Baclofen for GABAB

Anesthetics for GABAA. (Propofol)

85
Q

gadolinium-induced contrast nephropathy in patients undergoing MRIs.

A

Nephrogenic systemic fibrosis (NSF)

Risk factors for NSF include severe renal insufficiency (chronic kidney disease, Stage 4 or 5), hepatorenal syndrome, perioperative liver transplantation, or an acute inflammatory condition (e.g., sepsis).

86
Q

Gay-Lussac Law

A

when the volume of a gas is held constant, the temperature and pressure of a gas are proportional

87
Q

Glucagon

A

G-protein coupled receptors, stimulates adenyl cyclase production leading to increased cAMP
leads to increased glycogenolysis and gluconeogenesis while inhibiting glycogen synthesis in the liver.
The major counterregulatory hormone to insulin.

increases cardiac index, mean arterial pressure, and ventricular contractility

88
Q

GLUT transporters

A

GLUT1: Erythrocytes- insulin independent
GLUT2: Hepatocytes- bi-directional insulin-independent glucose transporters
GLUT3: Brain neurons insulin-independent
GLUT4: most cell types (ie muscles)

89
Q

Haldane effect

A

the relationship between the content of carbon dioxide in the blood and the concentration of oxyhemoglobin

90
Q

Hemophilia A factor deficiency.

A

Factor VIII

91
Q

higher blood:gas partition coefficient agents

A

isoflurane, enflurane, halothane

Solvable agents. More dissolved and longer on and offset.

92
Q

Highest concentration of fluoride ions upon metabolism.

A

Sevoflurane

93
Q

Hydrochlorothiazide

A

Blocks the Na/Cl co-transporter in the distal convoluted tubule
directly inhibit calcium excretion leading to hypercalcemia.

94
Q

Hypermagnesemia EKG

A

PR interval prolongation and a widening QRS complex.

Can be seen by lithium use.

95
Q

Subarachnoid hemorrhage: timeframe for rebleeding risk? Timeframe for vasospasm? Treatment?

A
  • 24-48 hours
  • 2-10 days
  • triple H. Hypertension, hypervolemia, hemodilution
96
Q

Iliac crest corresponds to what vertebral level?

A

L4.

97
Q

Initial recovery from an induction dose of thiopental

A

redistribution to peripheral tissues

98
Q

Liver produced factors.

A

II, VII, IX, X, as well as V, XI, and thrombin. Protein C.

99
Q

Lorazepam metabolism

A

glucuronidation

100
Q

major CVP abnormalities

A

Disorder CVP waveform changes
- Atrial fibrillation: Loss of a wave
- AV dissociation: Cannon a wave
- Tricuspid regurgitation: Tall c & v waves
Loss of x descent
- Tricuspid stenosis: Tall a & v waves Minimal y descent
- RV ischemia: Tall a & v waves Steep x & y descent M or W configuration
- Pericardial constriction: Tall a & v waves
Steep x & y descent M or W configuration
- Cardiac tamponade: Dominant x descent
Minimal y descent

101
Q

Major mechanism of heat loss in operating room.

A

Radiation after redistribution.

102
Q

MAP calculation:

A

MAP = [2*DP + SP]\3

103
Q

Mapelson circuits: Ambu bag vs Jackson reese

A

Ambu: Unidirectional valve system. Not dependent on gas flows cause could use room air if needed.

JR: Mapleson F. Dependent on gas flows.

Mapleson A: most efficient for CO2 elimination and least amount of FGF.

104
Q

Maximal inspiration pressure:

A

Used to determine ability to extubate
- nml = -90

More negative = better… ie -20 = unlikely to succeed extubation.

105
Q

mechanism of pertussis toxin.

A

Ribosylation of the Gi protein inhibits the inhibitor of cyclic AMP, causing an increase in cAMP in the cell

106
Q

medial tuberal hypothalamus

A

contains neurons that extend into the posterior pituitary and secrete vasopressin and oxytocin

107
Q

Metformin

A

decreases hepatic gluconeogenesis and increases insulin sensitivity.

108
Q

Metoclopramide

A

increases lower esophageal sphincter tone

enhances gastric emptying

109
Q

Midazolam and diazepam metabolism

A

Oxidation

110
Q

Morphine metabolites and effects of:

A

morphine-3-glucuronide (M3G) (55%)- inactive but can be neuro toxic in renal failure.

morphine-6-glucuronide (M6G) (10%)- active, respiratory depression.

111
Q

Most likely volatile to cause carbon manoxide with strong base absorbants.

A

Desflurane.

Others don’t cause it.

112
Q

Most potent volatile anesthetic

A

Halothane

113
Q

most representative of abdominal muscle paralysis.

A

corrugator supercilii, eyebrow

114
Q

most useful circuits for controlled ventilation:

A

Dead Bodies Can’t Argue (controlled): D > B > C > A

115
Q

most useful circuits for spontaneous ventilation:

A

All Dogs Can Bite (spontaneously): A > D > C > B

116
Q

Nalbuphine

A

mu opioid receptor antagonist and a kappa receptor agonist

117
Q

Natural licorice inhibits what and what electrolyte abormality is seen?

A

11-beta-hydroxysteroid dehydrogenase

Hypokalemia.

118
Q

Neuromuscular blocker most eliminated by kidneys.

A

Pancuronium

119
Q

Neostigmine mechanism dose and max dose

A

acetylcholinesterase inhibitor.

Max dose 0.7mg/kg or prolonged weakness

120
Q

newly diagnosed hyperthyroidism

A

Elevated thyroid hormone binding ratio is most consistent.

also confirmed by elevated T3, T4 (free and total), and a low or normal TSH.

121
Q

Nitroprusside toxicity mechanism

A

1) Cyanide ions bind to cytochrome c oxidase and inhibit cellular aerobic respiration.
2) Formation of cyanmethemoglobin which is unable to carry oxygen.
3) Thiocyanate production which causes CNS-related effects.

122
Q

Nitrous oxide receptors

A
  • α-adrenergic receptors (analgesia and sympathomimetic effects),
  • NMDA (analgesia and CNS depression)
  • dopamine (analgesia via downstream induction of opioid release).
123
Q

Non-depolarizing neuromuscular blockers mechanism

A

Post synaptic nicotinic receptor competitive antagonists.

124
Q

Number needed to treat

A

1/ARR

125
Q

Oxygen consumption in an adult

A

3-4 mL/kg/min

FRC = 30/kg

FRC divides by consumption times the %O2 = time of hypoxia.

126
Q

oxygen content of blood equation

A 
CaO2 = (0.003 x PaO2) + (Hgb x 1.34 x SaO2)
CaO2 = arterial oxygen content (mL/dL), 
Hgb = hemoglobin (g/dL), 
SaO2 = oxygen saturation, 
PaO2 = arterial partial pressure of oxygen (mm Hg)
127
Q

OXYGEN DELIVERY:

A

DO2 = CaO2 x CO x 10

128
Q

paired t-test

A

one population with respect to two variables with numerical data

129
Q

Phase 1 metabolism.

A

oxidation, reduction, or hydrolysis.

130
Q

Phase 2 metabolism

A

conjugation

131
Q

Physiologic dead space calculation

A

(PaCO2-PETCO2)/PaCO2

132
Q

Physostigmine

A

anticholinesterase. used as a treatment for central anticholinergic syndrome.

Crosses blood brain barrier

133
Q

Point at which laminar flow becomes turbulent. And equation.

A 
Reynolds number (Re) 
Re=pvd/n

p=density of fluid
v=flow velocity
d=orifice diameter
n= viscosity

<2000 is laminar flow
>4000 turbulent dlow

134
Q

possible causes of sub-ambient alarm include:

A
  • Patient inhalation against an increased resistance in the circuit
  • Patient inhalation against a collapsed reservoir bag
  • A malfunctioning active closed scavenging system (excessive vacuum or valve dysfunction)
  • A blocked inspiratory limb during exhalation
135
Q

Post op outcome for thoractomy PPO

A

PPO = Pre (remaining segments/42)

136
Q

potential allergen in local anesthetics

A

methylparaben

But main allergy is paba in aminoesters

137
Q

Pouiseullie equation

A

Q=(delta)Ppier to the fourth/8nl

Only valid for laminar flow

138
Q

precurarization dosage for any nondepolarizing agent prior to succinylcholine

A

10% of the ED95 dose

139
Q

preoptic anterior hypothalamus

A

temperature homeostasis and thermoregulation

140
Q

Prerenal AKI

A

(UOSM : POSM) >1.5
BUN:Cr >20:1
FeNa <1%

  • FENa: [(PCr x UNa ) / (PNa x UCr)] x 100.
141
Q

Propofol infusion syndrome

A
  • Rhabdomyolysis
  • metabolic ACIDOSIS
  • hepatomegaly,
  • hemodynamic instability,
  • multi organ failure.
142
Q

pulmonary vascular resistance (PVR) calculation:

A

PVR = [80 * (MPAP - PAOP)] ÷ CO

  • MPAP = mean pulmonary arterial pressure (mm Hg)
  • PAOP = pulmonary artery occlusion pressure or pulmonary capillary wedge pressure (mm Hg)
143
Q

Pulse oximetry waves elevations/lower:

A
  • red 660
  • near Infared. 940

Falsely Elevated:
Methemoglobinemia, carboxyhemoglobinemka

Lower:
Blue green or black nail polish decreases reading.

144
Q

Pyridostigmine

A

Used for prophylactic treatment.

145
Q

range for differences between alfentanil and fentanyl.

A

Alfentanil has about 4 times faster onset.
Alfentanil lasts about 1/4 the duration.
Alfentanil is about 1/4 the potency (4x the dose of fentanyl).

146
Q

Ranitidine

A

Increase gastric pH. No affect on volume.

147
Q

Specificity vs sensitivity

A

Specificity TN= TN/(TN + FP) - rules in disease.
Sensitivity TP= TP/(TP + FP)- rules out

SpIn and snOut

Crush ITE (2 decks)

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