Anatomy & Special Flashcards
(204 cards)
1
Q
Doubling the distance from a radiation source, decreases exposure by a factor of _____?
A
4
2
Q
LES tone with cricoid pressure
A
decreased
3
Q
Sensory innervation to medial leg and ankle?
A
saphenous nerve
4
Q
sensory and motor to plantar foot?
A
posterior tibial nerve
5
Q
location of deep peroneal nerve on foot?
A
lateral to dorsalis pedis pulse
6
Q
sensory to anterior leg, ankle, dorsal foot, and toes (excluding web between 1st and 2nd toe)?
A
superficial peroneal nerve
7
Q
Innervates all muscles of the larynx except the cricothyroid muscle?
A
RLN
8
Q
Unilateral RLN injury results in…?
A
hoarseness
9
Q
Partial BILATERAL RLN injury results in…?
A
Complete obstruction, stridor, and respiratory distress because adductors unopposed (most dangerous injury)
10
Q
Complete BILATERAL RLN injury results in…?
A
aphonia or aspiration risk
11
Q
Hypotension after spinal anesthesia due to 3 main mechanisms:
A
(1) arterial dilation (decreased after load)
(2) venodilation (decreased preload) - this is most dramatic!
(3) bradycardia 2/2 PANS dominance (bc cardioaccelerator fibers T1-T4 are blocked) -AND- Bezold Jarisch reflex.
**Use epinephrine early to prevent poor cerebral perfusion
12
Q
mid esophageal aortic valve short axis view identifies which structures?
A
The RV and right coronary cusp which are always ANTERIOR
The non-coronary cusp which is always located next to the interatrial septum
13
Q
Operator 1 vs Operator 2 responsibilities during manual in-line stabilization
A
operator 1 maintains head/neck neutrality
operator 2 stabilizes shoulders against OR table
14
Q
Cause of back pain after large volume injection of 2-choroprocaine?
A
muscle spasms due to EDTA - a preservative that chelates Ca2+ of nearby muscles. These spasms are self-limited.
15
Q
TAP block landmarks?
A
bottom of rib cage superiorly
top of pelvis inferiorly
latissimus dorsi lateral side
external oblique other lateral side
16
Q
anesthetic concerns with ankylosing spondylitis?
A
difficult airway 2/2 fused cervical spine
epidural hematoma 2/2 multiple attempts in setting of platelet dysfunction from NSAID use
17
Q
nerves and arteries in the antecubital fossa
A
Notice median nerve, ulnar nerve, and radial nerve locations with respect to vessels
18
Q
Bier block time limit?
A
90 minutes, ideally less than 1 hour
19
Q
Bier block mechanism?
A
(1) diffusion of local anesthetic from veins into capillaries and then into vasa nervosa –> nerve conduction block
(2) local anesthetic diffuses into small nerves that supply overlying skin
(3) tourniquet causes distal ischemia which also impairs nerve conduction leading to anesthesia
20
Q
which nerve provides sensation to anterior tongue?
A
V3 - mandibular branch of trigeminal nerve
21
Q
nerve that supplies posterior tongue?
A
glossopharyngeal (CN IX)
22
Q
Nerve that supplies soft palate?
A
glossopharyngeal nerve (CN IX)
23
Q
Nerve that supplies oropharynx?
A
glossopharyngeal nerve (CN IX)
24
Q
Nerve that supplies hypopharynx (below the epiglottis all the way to the vocal cords)?
A
SLN internal branch (CN X)
*mnemonic SIME
25
sensory innervation of larynx and trachea (all below the vocal cords)?
RLN (CN X)
26
Narrowest part of airway in adults versus neonates?
adults: glottic opening, i.e. vocal cords
neonates: cricoid cartilage
27
MOTOR innervation of vocal cords?
RLN = both ABduction and ADDuction
28
All the muscles of the larynx are innervated by RLN except?
cricothyroid muscle - innervated by external branch of SLN
29
Which type of pneumocytes participate in gas exchange?
Type I
30
Which type of pneumocytes produce surfactant?
type II
31
Coronary supply to anterior distribution?
LAD
32
Coronary supply to anterolateral distribution?
LCX
33
Coronary supply to anteroseptal distribution?
LAD
34
Coronary supply to inferior distribution?
RCA
35
Coronary supply to inferolateral distribution?
RCA & LCX
36
Coronary supply to inferoseptal distribution?
RCA & LAD
37
1st line treatment for aortic dissection?
beta blockers to decrease HR and contractility (shear force on dissection)
additional anti-hypertensives after beta-blockade
38
treatment of chylothorax?
chest tube
low carb & high fat/protein diet
PEEP
39
anterior spinal cord blood supply?
via 1 spinal artery:
superior - vertebral arteries and posterior intercostal arteries
inferior - Artery of Adamkiewics which arises from a single posterior intercostal artery between T8-L1
40
blood supply to posterior spinal cord?
via 2 (paired) posterior spinal arteries from the vertebral artery
41
anterior spinal artery infarction affects?
lateral corticospinal (motor) tract
spinothalamic (pain & temp) tract
42
spinal cord termination in adults vs neonates?
adults = L1
neonates = L3
43
innervation of facet joint?
medial branch of the POSTERIOR division of spinal nerves
aka dorsal rami
44
Stellate ganglion block at which level?
C6-C7
45
SANS blockade via stellate ganglion results in?
ipsilateral Horner's syndrome: ptosis, miosis, anhidrosis, psuedoenophthalmos, and hyperemia;
nasal congestion
temperature increase in ipsilateral arm
-AND- unopposed PANS
Also possible: globus sensation, RLN block
46
intercostobrachial block is a field block of which 2 nerves?
median brachial cutaneous nerve (C8-T1)
intercostobrachial nerve (T2)
47
landmarks of classic sciatic nerve block
PSIS
greater trochanter
sacral hiatus
48
cauda equina syndrome associated with?
pooling & maldistribution of hyperbaric local anesthetic via pencil point needles or spinal micro catheters
49
muscle that ABducts vocal cords?
POSTERIOR cricoarytenoid (innervated by RLN)
50
muscle that ADDucts vocal cords?
LATERAL cricoarytenoid innervated by RLN
51
Carotid sinus stimulation results in...?
hypotension and bradycardia
"think sinus pressure"
52
name of calcium channel receptor on sarcoplasmic reticulum that leads to muscle contraction?
Ryanodine recepter 1 (these receptors open only briefly in normal muscle but have prolonged opening in malignant hyperthermia)
53
pathogenesis for malignant hyperthermia?
sustained muscle contraction --> general hypermetabolic state --> incr CO2, lactate, and heat production --> muscle breakdown --> rhabdo, hyperkalemia, and myoglobinuria--> cardiac arrhythmias and renal dysfunction
54
treatment for malignant hyperthermia related cardiac arrhythmias?
Avoid calcium channel blockers because treatment with dantrolene already reduces Ca2+ from sarcoplasmic reticulum
standard antiarrhythmics safe: procainamide, amiodarone, lidocaine
55
Preferred type of anesthesia in multiple sclerosis?
general anesthesia with a careful eye on body temperature because even a 1 degree increase can cause an MS exacerbation
Avoid spinal anesthesia; epidurals and PNBs have been used safely in the past
**these patients often have autonomic instability that can lead to marked hypotension
56
Avoid nitrous for how long after air injection during eye surgery?
5 days
57
Avoid nitrous for how long after sulfur hexafluoride (eye surgery)?
10 days
58
Avoid nitrous for how long after perfluorocarbons (eye surgery)?
90 days
59
Is pheochromocytoma an absolute or relative contraindication to ECT?
Absolute
60
Is a recent MI (<4-6 weeks) an absolute or relative contraindication to ECT?
absolute
61
Is a recent CVA ( <3 months) an absolute or relative contraindication to ECT?
absolute
62
Is recent intracranial surgery an absolute or relative contraindication to ECT?
absolute
63
Is an unstable cervical spine an absolute or relative contraindication to ECT?
absolute
64
Is angina an absolute or relative contraindication to ECT?
relative
65
Is congestive heart failure an absolute or relative contraindication to ECT?
relative
66
Is a cardiac rhythm device an absolute or relative contraindication to ECT?
relative
67
Is severe pulmonary disease an absolute or relative contraindication to ECT?
relative
68
Is major bone fracture an absolute or relative contraindication to ECT?
relative
69
Is glaucoma an absolute or relative contraindication to ECT?
relative
70
Is retinal detachment an absolute or relative contraindication to ECT?
relative
71
Is thrombophlebitis an absolute or relative contraindication to ECT?
relative
72
Is pregnancy an absolute or relative contraindication to ECT?
relative
73
What is significant about the FIRST phase (out of 2) of ECT? (5-10 second tonic phase of seizure)
PANS surge --> bradycardia and hypotension
74
What is most significant about the second phase (out of 2) of ECT? (up to 10 minutes max of clonic seizure activity)
SANS activity --> hypertension and tachycardia
75
Types of infections that benefit from hyperbaric oxygen?
soft-tissue necrotizing infections, refractory chronic osteomyelitis, intracranial abscess, mucormucosis
76
Types of gas-bubble diseases that benefit from hyperbaric oxygen?
air embolism, decompression sickness
77
Types of poisonings/envenomations that benefit from hyperbaric oxygen?
carbon monoxide, cyanide, carbon tetrachloride, hydrogen sulfide, brown recluse spider bites
78
Types of acute ischemia that benefit from hyperbaric oxygen?
crush injuries, compromised skin flaps, central retinal after/vein occlusions
79
Types chronic ischemia that benefit from hyperbaric oxygen?
ischemic ulcers, radiation necrosis
80
Types of acute hypoxia that benefit from hyperbaric oxygen?
oxygen support during therapeutic lung lavage, significant blood loss anemia if transfusion delayed or unavailable
81
Types of thermal injuries that benefit from hyperbaric oxygen?
burns
82
Hyperbaric oxygen contributes to which part of this formula:
| 1.39 * SaO2 * Hb) + (0.003 * PaO2
(0.003 * PaO2)
83
Drug that terminates reentrant circuits of the AV node but very unlikely to terminate atrial fibrillation or atrial flutter?
Adenosine
84
Safest tube to prevent fires when using a CO2 laser
metal is most resistant to ignition > red rubber > silicone-based > PVC
85
Safest tube to prevent fire when using Nd:YAG lasers?
silicone or ETT with rubber shaft and silver foil/sponge coating
86
Most common cause of jaundice in the adult population?
Gilbert syndrome - normal bilirubin glucuronyltransferase activity required for hepatic uptake of unconjugated bilirubin decreased by 66%
87
Risk factors for IMPOSSIBLE grade 4 mask ventilation?
history of snoring and decreased TM distance
88
Risk factors for difficult (2-person) grade 3 mask ventilation?
NECK RADIATION changes, BMI >/= 30, presence of beard, high risk modified Mallampati classification, age > 57, lack of teeth, severely limited jaw protrusion and history of snoring (OSA)
89
What is a positive prayer sign?
Inability to oppose palmar surface of interphalangeal joints which is suggestive of difficult laryngoscopy in type I DM
Due to glycosylation of joints and decreased mobility including atlanto-occipital joint
90
Maximum acceptable dose of saline mixed with 0.05% lido plus 1:1,000,000 epinephrine for tumescent lipo?
35-55 mg/kg
91
Hold aspirin for what types of surgeries?
intracranial, middle ear, posterior eye, intramedullary spine surgery, and possibly prostate surgeries
92
MELD Criteria
"I Crush Beer Daily"
INR
Creatinine
Bilirubin
Dialysis
93
Child-Pugh score criteria
"Pour Another Beer At Eleven"
PT/INR
Ascites
Bilirubin
Albumin
Encephalopathy
***No creatinine as in MELD score (I Crush Beer Daily)
***Estimates mortality risk in liver failure
94
Monitored anesthesia care requirements that differentiate it from moderate conscious sedation?
Requires post-procedure PACU transfer with someone trained in ACLS
Provider trained in ability to convert to GA
95
Machine preparation for malignant hyperthermia
(1) CO2 absorbent needs to be removed or changed out
(2) flush machine for 1 hour at 10 L/min
**Alternatively use special MH filters with activated charcoal and only need to flush for 1.5 minutes @ 10 L/min - these filters keep gas concentration below 5 PPM for up to 12 hours
96
Antidote to methanol ingestion (paint thinner, antifreeze, windshield washer fluid, improperly distilled alcohol)?
Ethanol - competitive inhibitor of EtOH dehydrogenase
-OR-
Fomepizole - a direct EtOH dehydrogenase inhibitor
Both options slow conversion to toxic metabolites formaldehyde and formic acid to allow more time for renal and pulmonary elimination of non-metabolized methanol
**Folinic acid for less severe cases; dialysis also very effective; supportive care including airway and correction of metabolic acidosis
97
Reliable signs of compartment syndrome
(1) compartment pressure > 30 mmHg
(2) creatine phosphokinase > 5000 U/mL
(3) loss of normal phasic pattern of tibial venous blood flow
(4) loss of distal pulses
(5) compartment perfusion pressure < 21 mmHg
**pain and pulse oximetry are not reliable
98
When are bronchial blockers advantageous over DLTs?
- prior oral/neck surgery with challenging AW
- tracheostomy patients
- children under 12
- when postop mechanical ventilation is needed because does not require ETT exchange
99
When are double lumen tubes preferred?
lung isolation including RUL surgery because more reliable than bronchial blockers
100
What would physostigmine do in the setting of organophosphate or nerve agent poisoning?
Will worsen toxicity as this is an anticholinergic (antimuscarinic) drug so will increase ACh at nerve terminal
101
Goal temperature and duration for induced hypothermia post cardiac arrest?
32-36 degrees x 12-24 hours
Re-warming to 37 degrees should occur over 24 hours to avoid significant increase in ICP and arrhythmia-inducing electrolyte shifts
102
```
Changes in following parameters with increased aging:
systolic function
diastolic function
CO
stroke volume
HR
Catecholamines
```
Resting systolic function unchanged
diastolic DYSFUNCTION (delayed LV relaxation)
Exercise induced CO, stroke volume, and HR reduced
Incr catecholamines
103
what is lusitropy?
myocardial relaxation
**improved lusitropy with inodilators such as milrinone
104
Age related change in lung function? what increases and what decreases with regards to FRC, CC, RV, IC and TLC
Everything INCREASES except IC and TLC
CC>FRC
105
Decrease Remifentanil by how much in older patients?
by 50%
106
Which type of intraosseous access supports the highest infusion flow rates?
Which type of intraosseous access supports the fastest uptake of drugs and fluids into the systemic circulation?
humerus supports the highest flow rates (~200 vs 100 mL/min in tibia via pressure bag)
manubrium supports the fastest uptake of drugs and fluids into the systemic circulation
107
High frequency ultrasound probes provide better resolution at what cost?
Decreased tissue penetration due to decreased wavelength
Mnemonic: VFW --> Velocity = Frequency * Wavelength
108
Effect of magnesium on non-depolarizing and depolarizing muscle relaxants?
Magnesium potentiates NMBDs
Magnesium prolongs the effects of depolarizing muscle relaxants
109
Malignant hyperthermia has a strong association with which conditions?
Central core disease
multiminicore disease
King Denborough syndrome
hyper/hypokalemic periodic paralysis
110
Humidification of inspired gases will decrease which type of temperature loss?
evaporative losses
111
Wrapping skin in plastic will decrease which type of temperature loss?
evaporative
112
Warming the operating room will decrease which type of temperature loss?
Conductive - high operating room temps warm the surfaces
113
Using an incubator covered in blankets will decrease which type of temperature loss?
Convective
114
Most effective way to treat intraoperative hypothermia?
Forced air blankets
115
Normal cardiac output
4-8 L/min
116
Normal cardiac index vs cardiac output?
Cardiac index = 2.5-4 L/min/m^2
Cardiac output = 4-8 L/min
117
Normal stroke volume
60-100 mL/beat
118
Normal stroke volume index versus normal stroke volume?
33-47 mL/m^2/beat (SVI)
| 60-100 mL/beat (SV)
119
Eye protection during CO2 laser?
Clear plastic/glass is sufficient to block energy
120
Eye protection for krypton or argon lasers?
Orange or amber tinted glasses
121
Eye protection for Nd-YAG lasers?
Green tinted glasses
122
Fusion of cervical vertebrae NOT usually present with what syndrome? Typically associated with _________ and _________.
Not usually present in Down syndrome. Typically associated with ankylosing spondylitis and Klippel-Feil syndrome.
123
How is atlantoaxial instability (AAI) defined? Identified by which type of imaging? How does the interval change with flexion versus extension?
AAI is defined by an anterior atlantodental interval (AADI) greater than 4-5 millimeters due to the laxity in the transverse ligament of the first cervical vertebra. Identified by lateral cervical spine radiographs.
Flexion increases AADI while extension decreases AADI.
124
Active body surface warming (most commonly forced air warming) increases or decreases rate of surgical site infections?
Maintaining normothermia reduces risk of postop infections DESPITE some orthopedic studies showing mixed results from forced air warming.
125
qualifications needed to serve as an expert witness?
Board certification
Current, valid and unrestricted license to practice medicine
active involvement in clinical anesthesiology at time of event
relevant clinical experience and knowledge in the areas involved in proceeding
126
peripheral nerve stimulation of the orbicularis oculi most closely reflects blockade of what?
muscles of the larynx - orbicularis oculi is relaxed more rapidly but LESS INTENSELY when compared to the peripheral muscles (which are better reflected via nerve stimulation of the ulnar nerve)
**by contrast, onset and intensity of relaxation of sux is identical between laryneal and peripheral nerves
127
Best way to assess TOF < 0.3 testing if quantitative monitoring not available?
Double burst testing - 2nd twitch not palpable
128
Blood volume by age?
female: 60 mL/kg
male: 70 mL/kg
child 1-12: 75 mL/kg
infant: 80 mL/kg
full term newborn: 90
premature: 100
129
Blood volume for a woman?
60 mL/kg
130
blood volume for a male?
70 mL/kg
131
blood volume for a child age 1-12
75 mL/kg
132
blood volume for an infant 3 months to 1 year
80 mL/kg
133
blood volume for a full term newborn
90 mL/kg
134
blood volume for a premature infant
100 mL/kg
135
sugammadex is physically incompatible with which two drugs?
ondansetron and verapamil - if used in the same IV line, be sure to flush with saline between administration of the two drugs
136
Most lasers pass through the cornea but cause significant damage to the pigmented retina within milliseconds of exposure EXCEPT which type?
carbon dioxide lasers DO damage the cornea due to high absorptivity
137
Most airway fires are caused by which laser?
Carbon dioxide
138
Equation to determine flow through a narrow orifice (valvular or airway stenosis)?
Pressure gradient = 4 * Velocity^2 (Based on Bernoulli principle)
139
Component of the intervertebral disc that receives very little innervation?
nucleus pulposus
140
Central retinal artery occlusion is almost always associated with?
External pressure on the globe REGARDLESS of position
141
Hallmark signs of CRAO? Bilateral or unilateral?
cherry red spot on the macula and a pale retina
Unilateral 95% of the time
142
law of Laplace? how does it apply to cerebral aneurysms?
wall tension = pressure * radius / wall thickness (h)
pressure is equivalent to CPP so wall tension will increase with higher MAPS or lower ICPs
radius is equivalent to aneurysm size
143
Classic triad of TURP syndrome?
(1) Elevated systolic and diastolic blood pressures with increased pulse pressure due to acute hypERvolemia
(2) REFLEX bradycardia
(3) mental status changes associated with decr sodium (esp Na <120) and/or hypothermia from large volumes of room-temperature irrigation fluids
144
Guidelines for reducing the incidence or severity of TURP syndrome?
(1) Lowering suspension of irrigation fluids to <30 cm above patient
(2) Drain bladder regularly to avoid increased bladder pressures
(3) Limit resection time to less than 1 hour
(4) Avoid hypOtonic IV fluids
(5) Use vasopressors to treat hypotension resulting from spinal anesthesia - because neuroaxial may reduce venous pressures and increase absorption of irrigation fluids!!
145
anesthetic that should be avoided in a patient with dysfunctional folate and homocysteine metabolism?
Nitrous oxide - the problem is a deficiency in the methylenetetrahydrofolate reductase (MTHFR). nitrous oxide inhibits methionine synthase -- further reduces folate levels and increase homocysteine levels.
Elevated homocysteine increases the incidence of thrombosis and adverse coronary events
146
Most common pharmacologic implications of HYPOALBUMINEMIA seen almost universally in major burn victims?
increased opioids due to rapid development of tolerance DESPITE increased free fraction of opoids
decreased benzos due to increased free fraction of drug
insulin resistance due to increased catecholamine/corticosteroid levels
proliferation of exntrajunctional membranes
147
First line therapy for cyanide toxicity?
hydroxocobalamin
**treatment with nitrites and thiosulfate have fallen out of favor because nitrites cause hypotension and byproduct methemoglobin is toxic
148
retropharyngeal soft tissue widening as a radiographic finding is associated with?
retropharyngeal abscess
149
Most common complication of retrobulbar block?
hematoma (even more common than oculocardiac reflex induced bradycardia!)
150
GCS Motor evaluation
OLD BEN
Obeys commands
Localizes to pain
withDraws to pain
Bends to pain
Extends to pain
None
151
GCS Voice evaluation
```
VOICE:
VoiceLess
Obscure sounds
Incomprehensible words
Confused
Elegant speech
```
152
Mechanism responsible for neuromalignant syndrome vs. delirium?
NMS: central dopaminergic blockade
Delirium: decreased cholinergic activity -PLUS- excess dopamine.
153
Reflexes that correspond with C5, C6 and C7 roots?
C5: biceps reflex
C6: brachioradialis reflex
C7: triceps reflex
154
What is considered a positive result during apnea testing?
PaCO2 > 60 without evidence of ventilation or respiratory effort
155
formula for sodium deficit
(140-serum sodium) * TBW
TBW = weight in kg * 0.6
156
Which is a definitive risk factor for difficult INTUBATION....absolute obesity or relative body mass index?
NEITHER!
increased neck circumference, high risk modified Mallampati score and excessive pre-tracheal adipose tissue are risk factors for difficult intubation in an obese patient population.
157
Most important mode of heat loss? How does it occur?
Radiation: responsible for 40% of heat loss. Occurs when there is a temperature gradient between 2 surfaces.
158
A cold operating room table or unwarmed IV fluids leads to which type of heat loss?
Conduction: responsible for 5% of heat loss.
159
Modes of heat loss in the OR from greatest to least?
radiation: 40% - gradient between two surfaces NOT in direct contact
convection: 30% - speed of air currents and laminar flow in the room (2ndry to ventilation systems)
evaporative: 25% - via respiratory tract, sweating, surgical wounds and surgical prep
and conductive: 5% - transfer of heat when there is DIRECT contact between 2 objects (cold table or cold IV fluids)
160
What is fresh gas decoupling? what is its main disadvantage?
a decoupling valve that isolates fresh gas flow and oxygen flush gases from the patient during positive pressure ventilation -- this prevents ore minimizes the risk of barorauma from high fresh gas flows or activating the oxygen flush valve.
main disadvantage is that it can lead to entrainment of room air into the breathing circuit which will lower oxygen and inhaled anesthetic gas concentrations. There is a series of alarms to help detect this condition.
161
What type of problem in hereditary angioedema?
usually a problem with C1 esterase inhibitor
Type I HAE: ezyme deficient
Type II HAE: enzyme dysfunctional
Type III HAE: mutation of factor XII gene
162
differentiating between pacemaker, defibrillator and a cardiac resynchronizing therapy device on CXR?
PM: two leads with no bright or thickened areas
ICD: two leads with bright and thick areas (shock coils)
CRT: three leads
163
Main anesthetic concerns with methamphetamine abuse?
cardiomyopathy in 40% and cardiac dysrhythmias
depletion of neurotransmitters --> profound hypOtension refractory to indirect-agents
increased MAC
tachycardia, tachypnea, and hyperthermia
164
How are modern day inhalational anesthetics improved?
less flammable
less toxicity
more potent
(due to fluorine addition)
however more difficult to manufacture
165
Damage to the sympathetic fibers of the superior hypogastric plexus can lead to which male problems?
retrograde ejaculation, dry ejacultion and infertility among men
166
Bayonet effect of needle on ultrasound?
Bent appearance because subtle differences of ultrasound velocity through overlying tissue.
167
Risk factors for the oculocardic reflex during eye surgery?
```
increased risk of reflex:
hypercarbia
hypoxia
propofol based anesthetic
remifentanil
```
decreased risk:
ketamine based anesthetic
168
what is a latent type of error?
errors that occur UPstream; not the direct cause of an error: may include equipment failure, organizational process, room layout
169
what is a slip type of error?
slip occurs during a routine familiar task that requires litttle to no conscious thought: for example drawing up pheylephrine into a syringe instead of sux
170
what is a lapse type of error?
occurs during a multistep task and is due to a memory failure such as forgetting to flush each port of a central line
171
what type of nerve fibers synapse in the sphenopalatine ganglion?
only PREganglionic parasympathetic fibers; all other sensory and sympathetic fibers traverse the ganglion
172
formula for mixed venous O2 sat
SVO2 = SaO2 - [VO2 / (CO *Hgb * 1.34)]
173
The K+ STAys
spironolactone
triamterene
amiloride
174
acid base status and electrolytes with acetazolamide?
metabolic acidosis
hyperkalemia
hyponatremia
175
acid base and electrolytes with thiazides?
Metabolic alkalosis
hyperGLUC
decr Na/K/Cl
176
"COALSS"
```
INCREASED closing capacity:
chronic bronchitis
obesity
advanced age
LV failure
surgery
smoking
```
177
Only anesthetic drugs to avoid or use with caution in nursing mothers?
Avoid meperidine
| Closely monitor if given morphine or hydromorphone
178
What is well leg syndrome?
lower-extremity compartment syndrome reported after prolonged head-down procedures;
```
factors that contribute:
obesity
well-developed calf muscles
fibrate monotherapy for hyperlipidemia
prolonged surgery
hypotension
vasopressor use
prolonged use of intermittent pneumatic compression device
```
179
other than histamine, which enzyme can be helpful in the detection of anaphylaxis?
tryptase is elevated and has 2-hour half life (compared to histamine with 15 minute half life)
180
Oxygen content formula?
CaCO2 = (1.39 * SaO2 * Hb) + (0.003 * PaO2)
181
Criterion for diagnosing fat emboli syndrome? What are the major criteria?
1 major finding and 4 minor plus fat macroglobulinemia
Major criteria include:
Pulmonary edema or respiratory insufficiency
Petechial rash
Hypoxemia (PaO2 < 60 on FiO2 < 0.4)
CNS depression
182
Only induction agent that causes LOC without lowering esophageal tone?
Ketamine
183
How to achieve better resolution on an ultrasound image?
Increase frequency (by decreasing depth)
184
Bain is which type of mapleson circuit?
Mapleson D: efficient for positive pressure ventilation but only intermediate efficiency for spontaneous breathing
185
The Jackson-Rees modification of the Ayer’s T-piece is which type of Mapleson circuit?
Mapleson F: efficient for positive pressure ventilation but only intermediate efficiency for spontaneous breathing
186
fresh gas flows needed to prevent rebreathing in Mapleson D, E, F?
1.5-3 times minute ventilation
187
Mapleson circuit most efficient for the spontaneously breathing patient?
A
Fresh gas inflow most distal of all circuits with APL closest to patients airway. FGF = Minute ventilation.
Least efficient for positive pressure ventilation!!
188
Chemotoxicity associated with Cisplatin/Carboplatin?
acoustic nerve damage
| nephrotoxicity
189
Chemotoxicity associated with Vincristine?
peripheral neuropathy
190
Chemotoxicity associated with Bleomycin/Busulfan?
pulmonary fibrosis
191
Chemotoxicity associated with doxorubicin/daunorubicin?
cardiotoxicity
192
Chemotoxicity associated with Trastuzumab?
cardiotoxic
193
Chemotoxicity associated with cyclophosphamide?
hemorrhagic cystitis
194
Chemotoxicity associated with 5-fluorouracil (5-FU) or 6-mercaptopurine (6-MP) or methotrexate?
myelosuppression
| hepatic, pulmonary and thyroid toxicity
195
MCIR gene?
increased morphine analgesia (associated with red hair)
196
OPRM gene?
decreased morphine analgesia
197
treatment of hyperkalemic periodic paralysis?
calcium
198
Function of Mu 1 receptors?
```
Supraspinal anesthesia
Muscle rigidity
Euphoria
Miosis
Bradycardia
```
199
Function of Mu 2 / delta receptors?
Respiratory depression
| Constipation
200
Function of Kappa receptors?
Spinal analgesia
Prevents shivering
Sedation
Miosis
201
Function of sigma receptors?
Hallucinations
| Dysphoria
202
Muscle relaxation via benzos are mediated by which receptor?
Gamma subunit of GABA-A receptors in the SPINAL CORD
203
Anxiolysis via benzos are mediated by which receptor?
GABA-A receptors in the brain
204
Anticonvulsant properties via benzos are mediated by which receptor?
Alpha subunit activation of GABA-A
