TrueLearn Basic 2.0 Flashcards by Landon Woolf

Name two nerves that make up oculocardiac reflex

Trigeminal nerve (ophthalmic division)

Vagus

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Increased analgesia from morphine is associated with what enzyme polymorphism (and physical characteristic)?

MC1R

Red hair

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Enzyme associated with omeprazole?

CYP2C19

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Enzyme associated with Tramadol?

CYP2D6

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The preoptic anterior hypothalamus plays a key role in what?

Temperature regulation

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Ketamine, Methadone, Tramadol, Nitrous oxide act at what receptor?

NMDA

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What is pneumonic for B-1 selective beta blockers?

BEAM

Bisopropol
Esmolol
Atenolol
Metoprolol

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In liver disease what two coagulation factors are increased and why?

Factor VIII
vWF

They are produced in endothelial cells

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Propofol acts on what receptor?

GABAa

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breathing 100% oxygen increased the shunt fraction through what mechanism?

Blunting hypoxic pulmonary vasoconstriction

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MAC requirements peak at what age?

3 months

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Increasing the alpha will ______ the power.

Increase

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Which opioid is believed to cause least amount of biliary sphincter tone and therefore used in biliary colic?

Butorphanol

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What can be injected at the site in case of extravasation of a vasoconstrictor?

Phentolamine

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NMDA receptors mediate its effects through what mechanism?

Increased intracellular calcium

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The Hoffman elimination is temperature and pH dependent. How so?

Reactions proceeds more readily when pH and temperature are increased

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What is the second messenger for insulin and glucagon?

cAMP

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What is the term for a study that compares groups with respect to a particular intervention and the separation into groups occurs after the intervention?

Case-control study

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What study can be thought of like a randomized control study without the randomization? Also like a case-control but prospective (separation into case and control BEFORE the intervention)?

Cohort

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What are two risk factors of bradycardia following Succs?

Young age

Repeat dosing

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Which order of kinetics is dependent on liver blood flow?

First order

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What does Lithium do to both Succs and NDNMB’s?

Prolongs both

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FRC is decreased in obese most likely 2/2 decrease in what volume?

Expiratory reserve volume

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In pRBC’s what happens to:

pH
2,3 DPG
Potassium

over time?

pH: Decreases
2,3 DPG: Decreases
K+: Increases

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Laminar flow: _______ | Turbulent flow: _______

Viscosity: Low flow (bottom cylinder) Density: High flow (top cylinder)

Nitroglycerin is a pure ____

Venodilator (Y in glycerin and V for vein)

How does burn affect dosing of NDNMBs?

It increases the dosing requirement because the number of ACh receptors in NMJ are increased

What is maxi dosing of Acetaminophen? Adults? Peds?

Adults 4 g/day (FDA now 2.6) | Peds: 50-75 mg/kg/day

Why does Chloroprocaine have a rapid onset?

Concentration. It is rapidly metabolized and doesn't have systemic toxicity so higher concentrations can be used.

Benzodiazepines can have some muscle relaxation effects by what mechanism?

Centrally acting GABA potentiation (spinal cord)

Patients with IgA deficiency are at increased risk for what after transfusion?

Anaphylaxis

Which cell type is most dependent on insulin for glucose uptake?

Cardiac myocytes

Sudden rise in ETCO2 after normal equilibration during laparoscopic surgery is indicative of what?

Subcutaneous emphysema

After how many days is an MI considered "old"?

More than 30 days

What muscle is most resistant to neuromuscular blockade and can be monitored with TOF?

Corrugator supercilii muscle

What is the primary cause of low bicarb in high anion gap metabolic acidosis?

Buffering excess hydrogen ions

What isotonic solution will actually lower serum osmolarity if much is administered?

What is the benefit of epinephrine during ALCS?

Alpha mediated vasoconstriction leading to increased coronary and cerebral perfusion pressure

St. John's Wort induces what enzyme?

CYP450 3A4 | St Johns plays ball and is number 34

What is mechanism and onset time of Ranitidine?

H2 blocker. 1 hour

How is metabolic demand for Oxygen calculated?

3-3.5 mL/kg/min

List order of sensitivity of nerve fibers to local anesthetics

BAC. B-A-C

Carotid body chemoreceptors detect what?

Arteril PaO2

What electrolyte abnormality affects Digoxin and how?

Hypokalemia increases to affect of Digoxin

What is treatment for post operative delirium 2/2 Scopalamine? Why?

Physostigmine. It's an anticholinesterase that can cross the blood brain barrier

In a full O2 cylinder how much O2 and at what psig is in it?

660 L at 2200 psig

Which nail polish color is least likely to interfere with pulse oximetry?

Red

CO2 gas cylinder is color coded as what?

Gray

In elective non cardiac surgery, according to ACC/AHA, how much time should wait after MI with the following interventions: Ballon angioplasty BMS No intervention DES implantation

- 14 days - 30 days - 60 days - 180 days

What is used to calcualte a MELD score?

INR, bilirubin, Creatinine

Classic presentation of TRALI

Bilateral patchy infiltrates without evidence of heart failure

How do you calculate power?

1-Beta

What is in cryoprecipitate? (5 things)

Fibrinogen, fibronectin, factor VIII, factor XIII, vWF

Name the vasodilator that actually increases renal perfussion

Fenoldopam

How does Neostigmine affect Succs?

Prolongs the block, because neostigmine is an acetylcholinesterase inhibitor. This also inhibits butyrylcholinesterase which degrades Succs

Which patient is at highest risk of emergence reactions with Ketamine?

Older females receiving large bolus doses

How do you treat an acute dystonic reaction?

Benadryl

What is the difference between the carotid body and carotid sinus?

Sinus is a mechanoreceptor (think "sinus pressure") Body is a chemoreceptor

What is INITIAL hemodynamic changes after giving bolus dosing of Dexmedetomidine?

Increased BP leading to DECREASED HR and CO

What is pneumonic for systemic absorption of regional anesthesia?

ICEBALLS ``` Intercostal Caudal Epidural Brachial plexus Axillary Lower Limb Subcutaneous ```

1 ml of liquid volatile anesthetic equals approximately how much vapor?

200 ml

What is the formula for calculating amount of liquid volatile consumed?

3*FGF (L/min)*%vapor

What is approximate calculation of FRC?

30 ml/kg

What type of data is evaluated with Chi-square?

Categorical

Turbulent flow is promoted by (4):

1. Decreased viscosity 2. Increased density 3. Increased flow rate 4. Increased diameter

What is most common cause of mortality 2/2 transfusion?

TRALI

A simple face mask with flows of 5-10L provide FiO2 at what percentage?

35-50%

Hetastarch has what effect on coagulation? Hint: platelets

Decreases glycoprotein IIa-IIIb availability

Aspirin inhibits platelet aggregation by inhibiting the formation of what?

Thromboxane

What is the common and reliable sign of cyanide toxicity?

Anion gap metabolic acidosis

What is the time to onset and peak effect following placement of a fentanyl patch?

Onset: 6-8 hrs Peak: 30 hrs

What are the 2 hemodynamic goals for aortic stenosis?

1. Maintain/increase afterload (improve CPP) | 2. Reduce HR (55-70 bpm)

What patient should receive stress dose steroids?

Patient previously taking >10 mg Prednisone/day but stopped less than 3 months ago

One lung ventilation has the largest relative effect on speed on induction with which volatile?

Desflurane

Define diastasis

Rest phase of diastole. The time between the filling of the LV and the atrial contraction.

What is the effect of volatile on CBF and CMRO2

Decreases CMRO2 Increases CBF This is termed "uncoupling." Usually these two move in parallel, however volatiles vasodilator cerebral vasculature increasing CBF even though CMRO2 has decreased

In the context of drugs, what is the definition of efficacy?

The maximal effect of the drug. it is independent of dose(remember the dose-response curves. It's the top of the curve)

What is the onset time for epidural chloroprocaine?

6-12 min

On arterial lab draws, what is the relationship between temperature and: 1. Partial pressure of gas 2. pH

1. Directly proportional | 2. Indirectly proportional

What is the effect on PEEP on the following in the setting of acute systolic HF? CVP PAP CI-Why? PCWP

Increases: CVP PAP CI Decreases: PCWP In regards to CI: In systolic HF the patient is volume overloaded. The decreased preload due to PEEP improves CO, as well as increased transmural pressure

PCWP is a surrogate measurement for what?

LVEDP

What is a type I error, what is a Type II error?

Type I: Incorrectly accepting the alternative hypothesis Type II: Incorrectly accepting the null hypothesis

Name two drug classes that shorten NM blockade

1. Anticonvulsants (carbamazepine, phenytoin) | 2. Anticholinergics (Neostigmine)

How do you adjust the intubating dose of NMBDs in the setting of cirrhosis? Why?

Increase the dose. This is because of increased volume of distribution is increased in the setting of increased free water (such as cirrhosis). NMBDs are highly water soluble

What pulmonary parameter is decreased the most following epidural placement and why?

Peak expiratory pressure, because this is dependent on chest wall musculature

What is the vapor pressure of: Desflurane Sevoflurane Isoflurane

Des: 681 Iso: 240 Sevo: 160

Define lusitropy

Myocardial relaxation

Regarding penicillin allergy, a hemolytic reaction is what type of allergic reaction?

Type II, IgM and IgG mediated

A change in PCO2 of 1 mmHg changes CBF by how much?

1-2 ml/100g/min

What are two physiologic goals in treating hypotension in severe AS?

Increase or maintain afterload, decrease HR

Carotid body chemoreceptors signal CNS through what nerve?

glossopharyngeal

What is treatment for TRALI?

Supportive: Fluids and pressors

What are cardiovascular effects of isoflurane?

Increased HR | Decreased SVR

A desflurane vaporizer taken to altitude and set at 6% will yield what MAC?

Findings for CO poisoning: SpO2 SaO2 PaO2 And acid/base

100% 100% 100 Metabolic acidosis

Injection of local into the glossopharyngeal fold anesthetizes what nerve (awake fiber)?

Glossopharyngeal