Anesthesia Interview Questions Flashcards
1
Q
What is the difference between hypoxia and hypoxemia
A
Hypoxemia is the decrease in partial pressure of oxygen in the blood ⬇️PaO2 which will result in hypoxia.
Hypoxia is the reduce level of tissue oxygenation.
2
Q
What is the normal value and how to calculate?
CO ( cardiac output)
A
HR x SV/1000
4.0 – 8.0 l/min
3
Q
What is the normal value and how to calculate?
MAP( mean arterial pressure)
A
MAP = SBP + 2 (DBP)
3
Another way to calculate the MAP is to first calculate the pulse pressure (subtract the DBP from the SBP) and divide that by 3, then add the DBP:
MAP = 1/3 (SBP – DBP) + DBP
MAP goal>65
4
Q
What is the normal value and how to calculate?
SVR (Systemic Vascular Resistance) to
A
80 x (MAP – RAP)/CO
800 – 1200 dynes · sec/cm5
5
Q
What is the normal value and how to calculate?
PVR (Pulmonary Vascular Resistance)
A
80 x (MPAP – PAWP)/CO
< 250 dynes · sec/cm5
6
Q
What is the normal value and how to calculate?
Cardiac Index (CI)
A
CO/BSA
2.5 – 4.0 l/min/m2
7
Q
What is the normal value and how to calculate?
Coronary Artery Perfusion Pressure (CPP)
A
Diastolic BP – PAWP
60 – 80 mmHg
8
Q
What is preload?
A
The amount of ventricular stretch at the end of diastole (LVeDP)
9
Q
What is afterload?
A
The amount of resistance the heart most overcome to open the Arotic Valve and push blood out the LV into the systemic circulation (SVR)
10
Q
What does contractilty mean?
A
Contractility is the strength of the heart ❤️ ❤️
11
Q
What is the normal value and how to calculate?
SV (Stroke Volume)
A
CO/HR x 1000
60 – 100 ml/beat
12
Q
What makes up SV (Stroke Volume)?
A
Preload
Afterload
Contractility
13
Q
Cranial Nerve I
👃
(OH)
A
Olfactory (smell) 👃
Sensory
14
Q
Cranial Nerve II
👁👁
(OH)
A
Optic nerve (vision) 👁👁
Sensory
15
Q
Cranial Nerve III
👀 👁👁 🙄
(OH)
A
Oculomotor Nerve
eye movement & raising eyelids 🥸
16
Q
Cranial Nerve (IV)
🙄🥺
(TO)
A
Trochlear
(eye movement up 🙄⬆️ and down 🥺⬇️)
Motor
17
Q
Cranial Nerve V
🧏🏽♀️🧏🏿🧏🏼♂️🤧😪 😋
(TOUCH)
A
Trigeminal Nerve
(sensation to face🥵🥶, mucus membrane 😪and chewing)
Both
18
Q
Cranial Nerve VI
👀🙄
(AND)
A
Abducen Nerve
(lateral eye movement 👀👀& outward gaze🙄)
Motor
19
Q
Cranial Nerve VII
😜😉😀 👅🥲
(FEEL)
A
Facial Nerve
(facial expressions 😜🤪😆, taste👅 , and secretion gland😭😢🥲)
Both
20
Q
Cranial Nerve VIII
👂
(VERY)
A
Vestibulocochlear Nerve (Hearing 🦻)
Sensory
21
Q
Cranial Nerve IX
😝🤤 👅
(GOOD)
A
Glossopharyngeal Nerve (Swallowing,Salivation and taste 👅)
Sensory
22
Q
Cranial Nerve X
🫁
(Velvet)
A
Vagus Nerve
(Diaphragm movement🫁& parasympathetic supply to visceral organs)
Both
23
Q
Cranial Nerve XI
🗣👥💁🏽
(such A)
A
Accessory Nerve
(speech🗣, shoulder💁🏽 and head movement 👥)
Motor
24
Q
Cranial Nerve XII
😋👅😝😛🤑🤑👻🐍
(HEAVEN)
A
Hypoglossal Nerve (tongue movement)😋😝😛👅👻
25
What is the normal value and how to calculate
| Cerebral Perfusion Pressure (CPP)
Pressure in cranial department
MAP-ICP=CPP
60-80mmHg
⬆️BP —>⬆️CPP (worsening brain 🧠 edema)
⬇️BP—>⬆️ICP=⬇️CPP (blood flow to brain)
26
What is the normal value and how to calculate ?
Coronary Artery Perfusion Pressure (CPP)
Difference between the diastolic pressure and left ventricle end diastolic pressure
DBP-LeDP-CPP
60 – 80 mmHg
27
What atmosphere pressure at sea level?
760mmHg
28
What is protamine sulfate made of?
Sperm of salmon 🍣
29
What makes up Cryo?
Cryo is prepared from plasma and contains:Fibrinogen, factor 8 & 12 and Von Williebrand
30
What is Desmopressin (DDaVP)?
Vasopressin (antidiuretic) that induce the release of factor 8 and Von Willebrand from the endothelial cells
31
What is the indication for Protamine
Heparin reversal
32
What will be the indication to give FFP?
Bleeding, vitamin K deficiency, DIC
33
What are the drugs that can be given via ETT
N- naloxone
A- atropine
V- vasopressin
E- epi
L- lidocaine
34
What is the proper dosing when giving medication down ET tube?
And the recommended dose saying 2 to 2 1/2 times the IV dose
Dilute 5 to 10 ML sterile water or normal Sailing into the ET tube followed by bag valve ventilation
35
What are the pain receptors?
1. Mu
2. Kappa
3. Delta
4. nociception
5. zeta
36
What is Mu -1 receptor responsible for?
The mu-1 receptor is responsible for analgesia and dependence.
37
What is Mu-2 responsible for?
The mu-2 receptor is vital for euphoria, dependence, respiratory depression, miosis, decreased digestive tract motility/constipation
38
What is Mu-3 responsible for?
Mu-3 receptor causes vasodilation
39
How many Mu
3
40
Where is M you found?
Primarily in the brainstem 🧠 the medial thalamus (supra spinal)
41
Where is kappa receptors found?
Found primarily in the limbic, brainstem spinal cord and dienaphic area
42
What are Kappa receptor responsible for?
They provide analgesia, diuresis, and dysphoria.
43
Where is the Delta receptor located
🧠 brain
44
What are Delta receptor responsible for?
They play a role in analgesia and reduction in gastric motility.
45
What is vitamin K depending clotting factors?
Factor 2, 7,9,10, protein C & S
46
How long does vitamin K take before it’s therapeutic?
24hrs
47
What medication would vitamin K reverse?
To reverse warfarin(Coumadin)
48
How do you monitor heparin?
aPTT
49
Normal aPTT?
Normal:30-40 sec
50
What is the therapeutic level for aPTT when a person is on a heparin drip?
Therapeutic:15-25 sec
51
What is the antidote for heparin?
Protamine Sulfate
52
What is heparin induced thrombocytopenia (HIT)?
⬇️ PLT it worsen clot
53
What does heparin inhibits?
Inhibit thrombin conversion to fibrinogen -> fibrin
54
What lab value is used to measure Coumadin level?
PT/INR
55
What is the normal PT/INR level?
Normal: 0.75-1.25 sec
56
What is the therapeutic PT/INR level for a person who is on Coumadin?
Therapeutic level: 2-3 sec
57
What should you not eat or drink when you are on Coumadin?
Green leafy vegetable.
| No alcohol
58
What pain receptor does morphine and fentanyl work on?
Mu receptor
59
How much more potent fentanyl is then morphine?
50-100 times more
60
Which pain receptor provide spinal allergies it and which provides supra spinal anesthesia?
Mu: supra-spinal
Kappa: spinal
Delta: spinal
61
What is the reversal for narcotics? What is the proper dosage?
Narcan: 0.4-2mg (IV/IM/SC) repeat q 2-3min
| NOT EXCEED 10mg (0.01mg/kg)
62
What is the reversal drug for benzodiazepine?
Flumazenil: 0.2mg IV 15-30 sec
| MAX DOSE 3mg/hr
63
What are the different vent settings?
https://rebelem.com/wp-content/uploads/2018/09/Mechanical-Ventilation-Modes-1-1024x755.png
64
What are the percentage of O2 on RA?
21%
65
What is the percentage of oxygen in 1 L NC?
24%
66
How do you calculate a percentage of oxygen at 2 L, 3 L, 4L…etc?
2L add 4 = 28%
3L add 4 = 32%
4L add 4 = 36%
5L add 4 = 40
6L add 4 = 44%
67
What is the percentage of oxygen in a nonrebreather mask?
Nonrebreather mask:10-15L (60-90%)
68
What percentage of oxygen is given in simple face mask?
6-15L (35-55%)
69
What is the difference between an LMA and ETT?
An LMA does not manipulate the Gladys or the trachea like an ETT
70
How does a pulse ox work?
The pulse oximeter operates on the principle of absorption of light by the solutes in a solution. The Beer-Lambert law states that the amount of light absorbed by a solute is proportional to the concentration of the solute and the distance the light is transmitted through the solution.
71
What does NPH stands for in insulin?
NPH (neutral protamine hagedorn) insulin lowers blood glucose within 1 to 2 hours after administration and exerts a peak effect at 6 to 10 hours.
72
What makes up a bag of Zosyn?
ZOSYN is a combination product consisting of a penicillin-class antibacterial, piperacillin, and a beta-lactamase inhibitor, tazobactam.
indicated for the treatment of patients with moderate to severe infections caused by susceptible isolates of the designated bacteria in the condition.
73
What is the difference between NS and LR?
They are both isotonic solutions which is similar to the body osmotic pressure. They both are crystalloids. This means that they have small molecules that can easily flow through membranes, such as the cell membranes in your body's tissues.
```
The differences in particles mean that LR doesn't last as long in the body as NS does. Lactated ringers contain:
Sodium chloride
Sodium lactate
Potassium chloride
Calcium chloride dihydrate
Water for injection
```
74
What is the normal blood flow through the heart?
Deoxygenated blood enters the inferior or superior vena cava or coronary sinus and ➡️enters the right atrium blood ⬇️
passes through the tricuspid valve
and enters right ventricle blood moves ➡️through the pulmonic valve and enters the pulmonary arteries were blood is carried to the lungs 🫁
the lungs blow off CO2 and picks up O2 into the blood in the pulmonary capillaries from there the oxygenated blood enter the pulmonary veins from the vein blood 🩸 enter the left atrium ➡️ passes through the mitral valve to enter the left ventricle, the left ventricle contract moving blood through the aortic valve into the aorta and to the systemic arteries and system
75
What does inotropic drugs do?
⬆️ contractility
76
What are the effects of chronotropic agents?
⬆️ or ⬇️ heart rate and rhythm by affecting rhythm produced by SA node
77
What are the two types of chronotropic?
Positive chronotropes ⬆️ increase heart rate. ex: Atropine, milrinone, theophylline
negative chronotropes ⬇️ decrease heart rate.
ex: digoxin, metoprolol, acetylcholine
78
What effect does dromotropic agents?
affects the conduction speed (in fact the magnitude of delay) in the AV node, and subsequently the rate of electrical impulses in the heart.
Positive dromotropy increases conduction speed (e.g. epinephrine stimulation) ex: phenytoin
negative dromotropy decreases stimulation(e.g. vagal stimulation) ex:verapamil
79
What are the receptors associated with sympathetic nervous system?
Alpha: smooth muscle contraction and vasoconstriction (andrenergic receptor)
Beta1: ❤️ heart. Beta 2: 🫁 lungs (adrenergic receptor)
Dopa: renal,splenic, coronary and brain
Causes vasodilation
80
Dopamine effects on CO?
⬆️ HR
⬆️ preload
⬆️ afterload
☑️ vasopressor effects
⬆️ contractility
Beta1 receptor or alpha depends on dose
81
Epi effects on CO ?
⬆️ HR
⬆️ preload
⬆️ afterload
☑️ vasopressor effects
⬆️ contractility
Alpha & beta receptors
82
Dobutamin effects on CO ?
Slight ⬆️ HR
Slight vasodilator
⬆️ contractility
83
Norepinephrine effects on CO ?
⬆️ HR
⬆️ preload
⬆️ afterload
☑️ vasopressor effects
⬆️ contractility
Alpha 1 some beta receptor
84
Phenylephrine effects on CO ?
Slight ⬆️ HR
⬆️ preload
⬆️ afterload
☑️ vasopressor effect
⬆️ contractility
Alpha receptor only
85
Vasopressin effects on CO ?
Slight ⬆️ HR
⬆️ preload
⬆️ afterload
☑️ vasopressor effect
86
Milrinone effects on CO ?
Slight ⬆️ HR
Slight ⬆️ preload
Slight ⬇️ afterload
Slight vasodilator
⬆️ contractility
PDE 3 receptor (Phosphodiesterase 3)
87
Nitroglycerin effects on CO?
⬇️ preload
⬇️ afterload
☑️ vasodilator
88
Digoxin effects on CO?
⬇️ HR
⬆️ contractility
89
Nipride effects on CO?
⬇️ preload
⬇️ afterload
☑️ vasodilator
90
Calcium chloride effects on CO?
⬆️ contractility
91
Amiodarone effects on CO?
⬇️HR
92
Beta Blocker effects on CO!
⬇️ HR
⬇️ then ⬆️ preload
⬇️ afterload
☑️ vasodilator
⬇️ contractility
93
Ace Inhibitors effects on CO?
⬇️ preload
⬇️ afterload
☑️ vasodilator
94
Nicardipine effects on CO?
⬇️ then ⬆️ preload
⬇️ afterload
☑️ vasodilator
⬇️ contractility
95
Dopamine concentration and dosage?
Concentration: 4mg/250
Dosage: 2-20mcq/mcq/min
96
Epi for concentration and dosage?
Concentration: 2mg/250
Dosage: 0.05mcq-5mcq
1-10mcq
97
Dobutamin concentration and dosage?
Concentration : 500mg/250ml
Dosage: 2.5 mcq-20mcq/kg/min
98
Norepinephrine concentration and dosage?
Concentration: 4mg/250
Dosage: 0.5-30mg/min
0.01mcq-3mcq/kg/min
99
Phenylephrine concentration and dosage?
Concentration: 40mg/250
Dosage: 50-200mcq/min
100
Vasopressin concentration and dosage?
Concentration: 20units/100
Dosage: 0.02-0.04u/min
101
Nitroglycerin concentration and dosage?
Concentration: 50mg/250
Dosage: 5mcq-20mcq
102
Amiodarone concentration and dosage?
Concentration:150mg/100 over 10 mins
Infusion: 360mg/100
1mg/hr for 6hrs than ⬇️ 0.5mg /hr for 18hrs
103
Digoxin dosage?
Dosage:0.0625mg- 0.25mg
