QOD

Question 1

what is the renal response to acidemia

Answer 1

-increased reabsorption of bicarbonate anion
-increased excretion of hydrogen ion in the form of titratable acids
-increased production of ammonia

Question 2

what are the renal effects of nitrous ocxide

Answer 2

-decreased renal blood flow secondary to increased renal vascular resistance

Question 3

how much CO does the kidney receive

Answer 3

20-25% total!!
-10 - 15% go to juxtamedullary nephrons
-80% to cortical nephrons

*blood flow can be redirected to juxtamedullary nephrons by increased levels of catecholamines and AT II.
*autoregulation of RBF occurs between 80 - 100

Question 4

neuroleptic malignant syndrome is precipitated by

Answer 4

-antipsychotic therapy
-meperidine & metoclopramide due to dopamine blockade in the basal ganglia
-20 - 30% mortality
-treatment: dantrolene, dopamine agonist, bromocripitine

Question 5

how do you acutely treat hypoglycemia

Answer 5

50% dextrose in water
10 - 25 g IV (20 - 50 mL)
goal blood glucose = 100 mg/dL

BG will rise 30 mg/dL per 15 mL of dextrose 50%

Question 6

examples of right to left shunting

Answer 6

-TOF
-pulmonary atresia
-tricupsid atresia (blood flow can flow out of RA only via PFO. A PDA or VSD is necessary for the blood to flow from the LV to the pulmonary circulation.)
-transposition of great vessels
-truncus arteriosus
-single ventricle
-double outlet ventricle
-total anomalous pulmonary venous return
-hypoplastic left heart

Question 7

a 42 year old man is undergoing a thorascopy. during the procedure, an 8 minute period of apneic oxygenation is required. if the patient’s PaCO2 is 40 mmHg, then expected PaCO2 at the end of the apneic period is

Answer 7

-PaCO2 rises 6 mmHg in the first minute followed by a rise of 3 - 4 mmHg during each subsequent minute.

-answer = 67 - 74 mmHg

Question 8

What forms of mechanical ventilation produce TV at volumes at or below anatomic dead space

Answer 8

HFO (400 - 2400 breaths/min)
High frequency PPV (60 - 120 breaths/m)

Question 9

recommended downward pressure for cricoid cartilage

Answer 9

3 - 4.4 kg

-30 - 44 newtons
-2 kg at first, then 4 kg after LOC

Question 10

What is the P50 of sickle hemoglobin

Answer 10

31 mmHg
(Hgb A = 26.5)

-sickle hemoglobin has a decreased solubility and readily polymerized and precipitates in the red cell. HgbS results from the substitution of valine for glutamic acid on the beta chain

Question 11

what is the basal metabolic oxygen consumption in a 20 kg patient

Answer 11

95 ml/m

VO2 = 10* (kg^(.75)

Question 12

why is disodium edetate or sodium emtabisulfite added to propofol

Answer 12

to inhibit bacterial growth

current propofol formulations contain 0.0005% of disodium edetate or 0.025% of sodium metabisulfite

Question 13

the cv effects of pancuronium are caused by

Answer 13

-vagal blockade
-ganglionic stimulation
-decreased catecholamine re-uptake

Question 14

increased potency of LA is determined by

Answer 14

lipid solubility
-increased carbon atoms & halogen added to aromatic ring = increases lipophilicity