TrueLearn Basic 2.0 Flashcards
Name two nerves that make up oculocardiac reflex
Trigeminal nerve (ophthalmic division)
Vagus
Increased analgesia from morphine is associated with what enzyme polymorphism (and physical characteristic)?
MC1R
Red hair
Enzyme associated with omeprazole?
CYP2C19
Enzyme associated with Tramadol?
CYP2D6
The preoptic anterior hypothalamus plays a key role in what?
Temperature regulation
Ketamine, Methadone, Tramadol, Nitrous oxide act at what receptor?
NMDA
What is pneumonic for B-1 selective beta blockers?
BEAM
Bisopropol
Esmolol
Atenolol
Metoprolol
In liver disease what two coagulation factors are increased and why?
Factor VIII
vWF
They are produced in endothelial cells
Propofol acts on what receptor?
GABAa
breathing 100% oxygen increased the shunt fraction through what mechanism?
Blunting hypoxic pulmonary vasoconstriction
MAC requirements peak at what age?
3 months
Increasing the alpha will ______ the power.
Increase
Which opioid is believed to cause least amount of biliary sphincter tone and therefore used in biliary colic?
Butorphanol
What can be injected at the site in case of extravasation of a vasoconstrictor?
Phentolamine
NMDA receptors mediate its effects through what mechanism?
Increased intracellular calcium
The Hoffman elimination is temperature and pH dependent. How so?
Reactions proceeds more readily when pH and temperature are increased
What is the second messenger for insulin and glucagon?
cAMP
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
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
What are two risk factors of bradycardia following Succs?
Young age
Repeat dosing
Which order of kinetics is dependent on liver blood flow?
First order
What does Lithium do to both Succs and NDNMB’s?
Prolongs both
FRC is decreased in obese most likely 2/2 decrease in what volume?
Expiratory reserve volume
In pRBC’s what happens to:
pH
2,3 DPG
Potassium
over time?
pH: Decreases
2,3 DPG: Decreases
K+: Increases
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?
LR
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?
3FGF (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):
- Decreased viscosity
- Increased density
- Increased flow rate
- 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?
- 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:
- Partial pressure of gas
- pH
- 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
- 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?
.5
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
