APEX Flashcards
(287 cards)
1
Q
What lung volume increases with aging?
A
Residual Volume
2
Q
What are usually the first signs of PE?
A
A precipitous fall in EtCO2 and tachycardia
also hypotension, bronchospasm
3
Q
What are the treatment options for PE?
A
- Immediate treatment is 100% FiO2 and hemodynamic support with IV fluids and inotropes
- The pulmonary embolectomy or thrombolysis if needed
4
Q
What is an indication for retrograde Intubation?
A
Cervical Spine Injury
5
Q
What is the most reliable method to reduce postoperative pulmonary complications?
A
Smoking Cessation
6
Q
Anesthetic management of patient undergoing surgery for Bullae removal?
A
- Spont. Ventilation till the chest is open
- Small TV with high RR
- Avoid N2O
- DLT preferred
7
Q
What are the 4 nerves involved in the airway?
A
Glossopharyngeal
RLN
Internal SLN
External SLN
8
Q
What happens to the airway if the vagus nerve is damaged?
A
Unilateral: hoarseness
B/L: Aphonia
9
Q
What happens to the airway if the external branch of the SLN is damaged?
A
Unilateral: Minimal effects
B/L: Hoarsness/easily fatigued voice
10
Q
What happens to the airway if the Internal branch of the SLN is damaged?
A
Sensory only NO effect on vocal cords
11
Q
What happens to the airway if the RLN is damaged?
A
Unilateral: Hoarsness
B/L: Stridor, Dyspnea (acute injury), aphonia (Chronic injury)
12
Q
What are the sizes of LMA based on weight?
A
LMA 1 = <5kg LMA 1.5 = 5-10 kg LMA 2.0 = 10-20 kg LMA 2.5 = 20-30 kg LMA 3.0 = 30-50 kg LMA 4.0 = 50-70 kg LMA 5.0 = 70-100 kg
13
Q
What are the respiratory changes that occur with inadequate pain management?
A
- Decreased VC, TV, TLC, & FRC
- Decreased ability to clear secretions
14
Q
Where is the inspiratory pacemaker?
A
The DRG
15
Q
What is primarily responsible for causing active exhalation?
A
The VRG
16
Q
What area triggers inhalation?
A
The Apneustic center (stimulations the DRC)
17
Q
What area triggers the end of inhalation?
A
The pneumotaxic center
Inhibits the DRC
18
Q
What is the AFFERENT limb of the oculocardiac reflex?
A
Long and short ciliary nerves > ciliary ganglion > ophthalmic division of the trigeminal nerve > Gasserian ganglion
19
Q
What is the initial dose for cardio version of A-Fib?
A
50-100 Joules
20
Q
How long to delay elective surgery for drug eluting stent?
A
6 Months
bare metal stent minimum 30 days
21
Q
Formula for MAP?
A
1/3 SBP + 2/3 DBP
22
Q
What drugs do not affect SSEP’s?
A
Ketamine, precedex, etomidate, opioids, and droperidol
23
Q
VAA most affected by right to left shunt?
A
Desflurane (low solubility 0.42)
24
Q
What are the components of LA?
A
- Aromatic ring: confers lipid solubility
- Intermediate chain: determines metabolism and allergic potential
- Tertiary amine: confers water solubility
25
What effect does Mu receptor activation have on the nerves in the dorsal horn?
- Inhibits adenylyl Cyclase > Dec cAMP
- Presynaptic nerve: Decreased CA conductance > decreases neurotransmitter release
- Postsynaptic Nerve: Increase K-conductance hyper polarizes the cell
26
List the events that correlate with 50, 60, 70, and 80% blockade
- 80%: TV > 5mL/kg
- 70%: TOF 4/4
- 60%: Double burst w/o fade
- 50%: Bite tongue blade for > 5 seconds
27
Only narcotic that is known to prolong QT interval?
Methadone (Can cause torsades)
28
How to calculate width of BP cuff?
40% of the circumference
29
What happened if the BP cuff is too small? too big?
- Too small: false high
| - Too big: false low
30
What does Near Infrared Spectroscopy (NIRS) measure?
Near Infrared Spectroscopy (NIRS) measure cerebral venous oxygen saturation
- limitations: only measures regional saturation (prefrontal cortex) and is not useful for global ischemia
31
Airway complication seen with adenosine?
Bronchospasm (especially in asthmatics)
32
Draw the SODA LIME reaction
1) CO2 + H2O H2CO3
2) H2CO3 + NaOH --> Na2CO3 + H2O + heat
3) Na2CO3 + Ca(OH)2 CaCO3 + NaOH
33
The only CCB that has been proven to reduce the risk of morbidity and mortality from cerebral vasospasm?
Nimodipine
34
How do changes in PaCO2 affect cerebral blood flow?
For every 1 mmHg change in PaCO2 from 40 mmHg, CBF changes in the same direction by 1-2 mL/100g/min
35
What factors increases the risk of ischemic optic neuropathy in patients undergoing spinal surgery?
- Low ratio of colloid to crystalloid resuscitation
- Greater estimated blood loss
- Use of a Wilson frame
- Male sex
- Obesity
- Long duration of anesthesia
36
What is the timeframe for decompression of spinal hematoma?
Within 8 hours
37
What are the signs of spinal hematoma?
Bowel or Bladder dysfunction
Lower extremity weakness
Lower Ext. sensory deficit
Back Pain
38
List the brachial plexus cords and the nerves they give rise to
1) Medial cord -> ulnar nerve
2) Medial + Lateral -> median nerve
3) Posteror cord -> Radial Nerve
39
Needles with highest risk of PDPH
Quincke and Pitkin
40
Analgesia from lipophilic opioids
most likely through systemic actions (aka fentanyl and sufentanil)
41
Sensation to the webbed space between the thumb and index finger is through what nerve?
Radial nerve
42
Formula to determine amount of BiCarb to administer to arrive and desired HCO3 level
(Change in HCO3 x kg x 0.3)/2
43
What are some common causes in intraoperative hypocalcemia?
Hyperventilation
| Administration of pRBC
44
Rapid correction of hyponatremia may result in
Central Pontine Myelinolysis
- Demyelination of neurons
- Spastic quadrioaresis (demyelination fo motor neurons), psudobulbar pasly, mental dysfunction, and death
45
What are the S/S of hypercalcemia?
HTN
Hypotonia
SHORT QT interval
Polyuria
Dehydration
Cognitive dysfunction
46
What are indicators of liver synthetic functions?
PT
INR
Albumin
47
What are indicators of hepatocellular injury?
AST
ALT
GST
48
What are indicators of cholelithiasis?
Y-Glutamyl Transpeptidase (GGTP)
Alkaline phosphatase
49
What is the dose for mannitol?
0.25-1 g/kg
50
How does a carcinoid crisis present?
Flushing, diarrhea, HTN or Hypotension, ABD Pain, Tachycardia
51
What drugs can precipitate a carcinoid crisis?
Succ, Atracurium, Thiopental, Epinephrine, NE, or Iosproterenol
52
Medications that are useful in the management of carcinoid tumors?
Ondansetron and Ocreotide
53
Why do we decrease the dose of etomidate in the elderly?
Decreased Vd and clearance
54
What is the onset time for postoperative delirium?
1-5 days post op
55
Anterior wall defect that is commonly associated with other defects
Oomphalocele
56
Gastroschisis is most common in
Prematurity
57
Areas assessed during aldrete scoring
```
Activity
Neurologic Status
O2 Saturation
Respiration
Circulation
```
58
A non-painful stimulus that evokes a painful response
Allodynia
59
An exaggerated pain response
Hyperalgesia
60
Pain localized to a dermatome (peripheral nerve)
Neuralgia
61
An abnormal painful sensation
Dysesthia
62
What is the formula for BMI
kg/m2
63
Antitumor antibiotics
Bleomycin and Doxorubicin
64
What are the nerve roots of the celiac plexus?
T5-T12
65
Side effects from celiac plexus block?
Hypotension (Most common)
Diarrhea
Bowel, Kidney, Puncture
Retroperitoneal hemorrhage
66
Most common cause of intraoperative allergic reaction?
Muscle relaxant
| latex second most common
67
A circumstance that won't benefit from supplemental oxygen
Pulmonary edema (right to left shunt
68
List the 5 causes of arterial hypoxemia
1) Low FiO2- high Altitude
2) Hypoventilation- Opioid overdose
3) Diffusion impairment - Pulmonary fibrosis
4) V/Q Mismatch- COPD
5) Shunt- Pulmonary Edema
69
Examples of acute intrinsic restrictive disease
Pulmonary edema
Aspiration Pneumonia
ARDS
70
Examples of Chronic intrinsic restrictive disease
```
Idiopathic Pulmonary Fibrosis
Radiation Injury
Cytotoxic Drug
Oxygen toxicity
sarcoidosis
autoimmune disease
```
71
When is it recommended to redose a citrated antacid
1 hour after 1st dose
72
What is the formula for PAO2? PaO2
1. )PAO2 = FiO2 x (Pb x 47 mmHg) - (PaCO2/0.8)
| 2. ) PaO2 = PAO2 - A-a Gradient
73
What axis must be aligned for intubation
Oral
Pharyngeal
Laryngeal
74
DLT insertion depth
29 cm in males
| 27 males in females
75
MOA of A2 agonist
GPCR (Gi) inhibit adenylate cyclase and therefore cAMP
76
When do we see pulses biserfiens
Aortic regurgitation
77
Pulsus alternans is seen with
Systolic left ventricular failure
78
pulses parvus is seen with
aortic stenosis
79
What INCREASES after infrarenal cross clamp placement?
Preload,
| Mixed venous O2 saturation
80
How to identify the VAA based on the organic molecule structure?
Sevo: 7 fluoride
Des: 6 fluoride
Iso: 5 fluoride
Halothane 3 fluoride, 1 Cl, 1 Br
81
Clearance is inversely proportional to
- Half-Life
| - Concentration in the central compartment
82
Drugs to avoid in patients with porphyria
All barbs and etomidate
83
Consideration for patients with Acute Intermittent porphyria
Liberal hydration
Glucose supplementation
Prevention of hypothermia
84
CV changes of N2O
(it affects the SNS)
| Increased SVR, BP and HR
85
N2O inhibits what pathway
Methionone synthase: B-12 metabolism and DNA synthesis
86
What enzyme is inhibited by etomidate?
11-beta- hydroxylase (inhibits stereos synthesis)
87
What drug is the most potent amnestic?
Lorazepam
88
Order the opioids based on context sensitive half lives
Fentanyl (Longest) > Alfentanil > Sufentanil > remifentanil (Shortest)
89
What muscle is monitored when evaluating twitches from the ulnar nerve?
Adductor Pollicis
90
Components of EMLA cream
2.5% prilocaine and 2.5% lidocaine
91
Time for onset with EMLA
60 minutes
92
Rank the speed of LA absorption after injection based on speed
Interplerual > Intercostal > Caudal > Brachial plexus
93
List the hydrophilic opioids
Morphine, meperidine, hydrocodone
94
List the Lipophilic opioids
fentanyl, sufentanil
95
Describe mass spectrometry
bombards the gas sample with electrons
96
Describe Raman Scatter Spectrometry
uses a high powered argon laser to produce photons; scattered photons are then measures
97
Describe the use of piezoelectric crystals
detects individual gases by their interaction with a lipid bilayer crystal
98
How to calculate TV for a machine that couple FGF
1) convert FGF to mL/min
2) FGF x fraction spent in inspiration [using I:E; I/(I+E)]
3) divide anger by RR
4) add value to set TV
99
Best ECG lead for rhythm abnormalities
Lead II
100
Where is CSF reabsorbed
in the arachnoid villi of the saggital sinus
101
CSF production rate in the choroid plexus
30 mL/hr
102
Classic presentation of autonomic hyperreflexia
HTN and Bradycardia
- Vasoconstriction below lvl of injury
- Vasodilation above lvl of injury
- LV failure may lead to Pulmonary edema
- Cerebral HTN may lead to seizures
103
Diseases that increase the risk of MH
Central core Disease
Minicore disease
King Denborough Syndrome
104
Sensory innervation of the median nerve is to what part of the hand?
1) Palm of hand
2) Ventral region of the thumb
3) Distal index, middle, and medial half of the ring finer
105
Triggers for a sickle crisis
Pain
hypothermia
acidosis
dehydration
106
What is non gap acidosis
Due to loss of HCO3 (or increased Cl)
| - Examples diarrhea, renal tubular acidosis, excessive sodium chloride administration
107
The triad for metabolic syndrome
HTN, Obesity, DM
108
What are the hormones released from the POSTERIOR pituitary gland?
ADH and oxytocin
109
What are the hormones released from the ANTERIOR pituitary gland?
FLAT PiG
- Follicle stimulating hormone (FSH)
- Leuteinizing Hormone (LH)
- Adrenocorticotropic hormone (ACTH)
- Thyroid Stim. Hormone (TSH)
- Prolactin
- Growth Hormone (GH)
110
Hypoadrenalism is also known as?
Addisons disease
111
What are the anesthetic considerations for patients with hypothyroidism?
- Airway compromise (ex. goiter)
- Hypothermia
- Hypotension
- Aspiration (D/t gastric emptying)
- Faster VAA induction
- NO effect on MAC
112
What is the function of gastrin?
stimulates pepsinogen secretion
113
What is the function of secretin?
Stimulates bile flow
114
What is the function of Motilin?
Stimulates upper GI motility
115
MAC requirements in a full term parturient
Reduced by 40%
116
Formula to convert C to F
F = (C x 1.8) + 32
117
What is Samters Triad?
Asthma
Nasal Polyps
ASA intolerance
118
Antiemetics that prolong QT interval
Droperidol and ondansetron
119
Crossing the legs puts which nerves at risk of damage
Sural and superficial peroneal
120
How long to avoid N2O after retinal detachment surgery based on compound used
Silicone oil: 0 days
Air bubble: 5 days
Sulfurhexafluoride: 10 days
121
```
What is the twitch response for the following nerves:
Femoral N.
Obturator n
Tibial n.
peroneal n.
```
Femoral n: patellar twitch
Obturator: adductor twitch
Tibial: plantar flexion
Peroneal: dorsiflexion
122
What are the physiologic consequences of a pneumoperitoneum?
- Increased MAP
- CO no change or decrease
- Increased A-a gradient
- ICP and CPP increased
- Renal and hepatic BF decreased
123
What is the formula for arterial oxygen content (CaO2)?
CaO2 = (SaO2 x HgB x 1.34) + (PaO2 x 0.003)
124
What are the risk factors for difficult mask ventilation?
```
Beard
BMI > 26
Snoring
Lack of Teeth
Age > 55 years
```
125
Max inflation pressure for a classic LMA
60 PSI
126
How many O2 molecules are carried by fully saturated Hgb
4 molecules O2 (8 atoms)
127
What is the Debakey classification?
- Type I: ascending and descending aorta
- Type II: Ascending
- Type III: Descending
128
What is the stanford classification?
Type A: ascending aorta with or w/e descending
| Type B: descending only
129
What is the crawford classification?
I-V involve the thoracoabdominal aorta
130
What is the word for pupil dilation?
Mydriasis (Has a D for dilation)
131
How does MAP change as you move above or below the heart?
2 mmHg per INCH
| 0.74 mmHg per CM
132
Gases that exist as liquids in a cylinder
CO2 (pp 838 psi)
| N2O (pp 745 psi)
133
MOA of Class I - IV antiarrhythmics
- Class I: inhibits fast sodium channels (phase 0)
- Class II: Decreases rate of depolarization (BB Blocking effect)
- Class III: Inhibits potassium channels ( prolongs depolarization)
- Class IV: Inhibits slow calcium channels (Shortens duration of action potential)
134
Anesthetic considerations for a patient with MS
1) Spinal anesthesia can exacerbate symptoms
2) Hyperthermia exacerbates weakness
3) Succ can cause hyperkalemia d/y upregulation of exntrajunctional receptors
4) Steroids are useful
135
list the ADP inhibitors and the days before surgery to discontinue
Clopidrogel (7 days)
Ticagrelor (1-2 days)
Prasurgel (2-3 days)
Toclopidine (14 days)
136
Types of laser that causes retinal damage
Nd: YAG, Ruby, Argon
| penetrate deep/short wave
137
Types of laser that causes corneal damage
CO2 Laser
| Long wave/ shallow penetration
138
Provides innervation to the abdominal viscera
Celiac Plexus (except left side of the colon)
139
Provides innervation to the pelvic organs
Superior Hypogastric Plexus
140
What is the cause of radial nerve injury?
Caused by external pressure on the spiral groove of the humerus (results in wrist drop)
141
Nerve that is most likely to be damages do to compression against a perineal post of the ortho table
The pudendal nerve
142
What causes dysesthesia
Diabetic Neuropathy
143
What is the normal CO2 production
200mL/min
144
What biomarkers are released from infarcted myocardium
CKMG (shortest 1/2 life)
Troponin T
Troponin I
145
Subclavian steal syndrome refers to
The reversal of flow through the vertebral artery
146
Clearance is directly proportional to
Drug dose
extraction ratio
Blood Flow to clearing organ
147
Clearance is indirectly proportional to
Half-Life
| Concentration in central compartment
148
In what patients do we see INCREASED pseudocholinesterase activity?
Alcoholism
Obesity
Thyrotoxicosis
149
In what patients to avoid tramadol
Patients with seizure disorder
150
What NMB's release histamine
Succ
Miv
Atra
151
LA's by duration of action
- Short: Procaine, Chloroprocaine
- Intermediate: Mepivicaine, Lidocaine
- Long: Bupi, Ropi, Tetracaine
152
List the opioids and their relative potency when compared to morphine
```
Meperidine 0.1x
Morphine 1x
Hydromorphone 1.4x
Alfentanil 10x
Fentanyl 100x
Remifentanil 100x
Sufentanil 1000x
```
153
Artery that perfuses the language centers of the brain
The LEFT MCA
154
List the terminal branches of the brachial plexus and the roots that contribute to them
```
MARMU
Musculocutaneous: C5-C7
Axillary: C5-C6
Radial: C5-T1
Median: C5-T1
Ulnar C8-T1
```
155
What is blocked by the Psoas compartment block
Lumbar Plexus
156
What are the treatment options for opioid induced pruritus?
Ondansetron
Propofol
Naloxone
157
List the steroids with their relative potency compared to cortisol
```
Aldosterone (3000x)
Fludrocortisone (250x)
Cortisol (1x)
Prednisone (0.8x)
Methylprednisolone (0.5x)
```
158
How to calculate EBV of pediatric patients?
Premature: 90-100 mL/kg
Term: 80-90 mL/kg
Infant: 75-80 mL/kg
>1 year: 70-75 mL/Kg
159
What is CHARGE association?
```
C- Colomboa
H- Heart Defect
A- Choanal Atresia
R- Retardation of growth and development
G- Genitourinary Problems
E- Ear Anomalies
```
160
What is CATCH-22?
```
C- Cardiac Defects
A- Abnormal face
T- Thymic Hypoplasia
C- Cleft Palate
H- Hypocalcemia
22- 22q11.2 gene deletion
```
161
What is the defibrillation energy setting in pediatrics?
```
1st = 2 J/kg
2nd = 4 J/kg
3rd= 4-10 J/kg
```
162
Common SSRIs
Sertraline, Paroxetine, Fluoxetine
163
What are the two causes of Angioedema?
ACEi
| C1-Esterase Deficiency (hereditary)
164
Conditions that increase the risk of LVOT in patients with hypertrophic cardiomyopathy
Decrease Preload
Decrease Afterload
Increased HR
Increased Contractility
165
What correlates with the S1 heart sound
Closure of Mitral Valve
166
Suggamadex affinity for NMB
Roc>Vec>Panc
167
List the synthetic opioids based on context-sensitive half life
Fentanyl > Alfenanil > Sufentanil > Remifentanil
168
Drugs that increase DOA of Succinylcholine
```
Neostigmine
Echothiopate
Reglan
Esmolol
Oral Contraceptives
Cyclophsphamide
```
169
Which opioid is resistant to reversal with Naloxone
Buprenorphine: high affinity for Mu and is slow to dissociate
170
Indications for percutaneous pacemaker
3rd degree Block
Long QT syndrome
Hypertrophic obstructive cardiomyopathy
SA or AV node disease
171
Symptoms of spinal (Neurogenic) shock
- Resp. Failure
- Bradycardia
- Hypothermia (Dec SNS Output)
- Hypotension (Dec SNS tone)
172
What is the first sign of MH in spontaneous ventilating patient?
- Increased Minute vent (Tachypnea)
- tachycardia
- Masseter Spasm
- Warm Soda Lime
- Dysrhythmias
(muscle rigidity and Hyperthermia are late signs)
173
Consequences of respiratory alkalosis
```
Dec Ionized Ca
Dec P50
Dec Coronary BF
Dec PVR
Dec K
```
174
Gap acidosis results from
```
Accumulation of Acid
MUDPILES
- Methanol
- Uremia
- Diabetic Ketoacidosis
- Paraldehyde
- Isoniazid
- Lactate (Sepsis/Cyanide)
- Ethanol
- Salicylates
```
175
Complications from administration of triamcinolone
- Skeletal muscle weakness
| - anorexia and sedation
176
List some glucocorticoids
Dexamethasone
| Betamethasone
177
EPI dose for neonates
0.01-0.03 mg/kg
178
list the methods of heat loss from most significant to least
Radiation
Convection
Evaporation
Conduction
179
What are some things that inhibit HPV
```
Hypothermia
Vasodilators
VAA at 1.5 MAC
PDEI
Hypervolemia
Hemodilution
Excessive PEEP
Large TV
Alkalosis
```
180
What lung volumes increase with emphysema
FRC
| RV (D/t gas trapping)
181
What is a cobb angle?
A measure of the curvature of the spine in scoliosis.
- An angle >40-50 is a indication for surgery
- Scoliosis leads to restrictive disease
182
Second line therapy for patient with vasoplegic symptoms who has been on ACE
Vasopressin
| Methylene Blue
183
Why are they called WHITE rami
b/c they are myelinated
| - Preganglionic sympathetic fibers
184
What are the symptoms of Horner syndrome?
Very Horny PAM:
- Vasodilation
- HORNER
- Ptosis (eye drooping)
- Anhydrosis
- Miosis (Pupil constriction)
185
What are the symptoms of Becks Syndrome?
Anterior Spinal Artery Syndrome:
- Flaccid Paralysis of the LE
- Bowel & Bladder Dysfunction
- Loss of Temp & Pain
- Preserved touch & proprioception
186
Anesthetic maintenance of Aortic stenosis?
```
Increase preload
slightly increase afterload
slow/normal hr
normal contractility
NSR
```
187
When does the S3 heart sound occur?
After AV closure (and MV Open) on the PV loop
| - aka a gallop rhythm suggestive of heart failure
188
What is the order of the arteries that arise from the Aortic Arch?
1) LT & RT coronary artery
2) Innominate
3) LT common Carotid
4) Left Subclavian
189
What is the MOA of buprenorphine?
Partial Mu Agonist
190
How to calculate the MAC of Desflurane at a given altitude
MAC = 50.16 mmHg/ Altitude mmHg
191
What is another Cobalamin?
Vitamin B12 deficiency
192
What are some cause/risk factors for Cobalamin
Pernicious Anemia
Alcoholism
Strict Vegan Diet
Recreational use of N2O
193
Which electrolyte imbalance will have an effect on MAC?
Sodium
194
List some CYP inhibitors?
Grapefruit juice
Erythromycin
Ketoconazole
195
List the drugs that act on the NMDA receptor?
```
Ketamine
Xenon
N2O
Dextromethorphan
Methadone
Magnesium
```
196
Which enzyme is induced by etomidate?
ALA synthase
| - Avoid in patient with acute intermittent porphyria (or any porphyria)
197
Which enzyme is inhibited by Etomidate?
11-beta-hydroxylase
198
What are the Mu-1 effects?
```
Analgesia
Bradycardia
Euphoria
Low abuse potential
Miosis
Hypothermia
Urinary retention
```
199
What are the Mu-2 effects?
Analgesia (Spinal only)
Respiratory depression
Constipation
Physical dependence
200
What are the Mu-3 effects?
Immune suppression
201
What are the excitatory pain modulating systems?
```
Substance P (NK-1 & NK-2)
Glutamate (NMDA & AMPA)
```
202
What are the inhibitory pain modulating systems?
NE (Apha-2)
Glycine (Cloride Linked Glyr)
Serotonin (5HT3)
Enkephalin (Mu, Delta)
203
Things that increase risk of LAST?
```
Higher lipid solubility
Hypercarbia
Hyperkalemia
Amide LA
Metabolic Acidosis
Acidosis (increases free fraction)
```
204
Measures regional cerebral blood flow velocity
Transcranial doppler
205
Measure global oxygenation of the brain
Jugular Oximetry
206
What is the FiO2 for different flow rates via nasal cannula
```
Rule of 4
1 L/min = 24%
2 L/min = 28%
3 L/min = 32%
4 L/min = 36%
5 L/min= 40%
6 L/min = 44%
```
207
Maximum allowable exposure to halogenated agents with and without N2O?
- Halogenated agents 2ppm
| - Halogenated agents + N2O 0.5 & 25 ppm
208
Order the mapelson systems based on use for spontaneous ventilation
Best A > DFE > CB
209
Order the mapelson systems based on use for controlled ventilation
Best DFE > BC > A
210
Effect of a hyperbaric chamber on FGF
FGF will be less than indicated
211
which tract is affected by NMB
Corticospinal tract
212
The dorsal column is responsible for what?
Fine touch and proprioception
213
The spinothalamic tract is responsible for
Pain and temperature
| Inlcudeds the tract of Lissaur
214
Ataxic breathing is characterized by
Irregular rate and TV
| - injury to medulla
215
Apneustic breathing is characterized by
Prolonged pause at the top of inspiration
| - injury to PONS
216
Kussmauls breathing is characterized by
Fast and deep breaths
| - Metabolic acidosis
217
Cheyne-Stokes breathing is characterized by
Rhythmic pattern where Vt becomes progressively gets later then smaller follows by apnea (Torsades pattern)
- Injury to cerebral hemispheres
218
List the methods to block the brachial plexus and what part of the plexus they target
- Interscalene: Roots
- Supraclavicular: Trunks/Divisions
- Infraclavicular: Cords
- Axillary: Terminal Branches
219
List the Epi concentrations
(everything before the "," is equal to diluent volume)
- 1:1,000: 1mg/ml = 1000mcg/ml
- 1:10,000: 1mg/10mL = 100mcg/mL:
- 1: 100,000: 1mg/100mL = 10 mcg/mL
- 1: 200,000: 1mg/200mL = 5 mcg/mL
- 1: 400,000: 1mg/400mL = 2.5 mcg/mL
- 1:1,000,000: 1mg/1000mL = 1 mcg/mL
220
What effects do anesthesia have on glucose?
Improve glucose utilization
| Decreased Gluconeogenesis
221
Blocks that provide complete anesthesia for a knee arthroplasty
Sciatic and femoral
222
How does pH change when PaCO2 changes?
Acute respiratory. acidosis:
- 0.08 decrease for every 10 mmHg increase in PaCO2
Chronic Respiratory Acidosis:
- 0.03 decrease for every 10 mmHg increase in PaCO2
223
HCT level that is life-threatening
60%
224
What is the treatment for thyroid storm?
The for B's
- Block synthesis (Methimazole, PTU, Carbimazole, Potassium Iodide)
- Block release (radioactive iodine, potassium iodide)
- Block T4 - T3 conversion (PTU, Propranolol)
- Beta Blocker (Esmolol, Propranolol)
225
Large tongue syndromes
Big Tongue
- Beckwith Syndrome
- Trisomy 21
226
Small underdeveloped middle syndromes
Please Get That Chin
- Pierre Robin
- Goldenhar
- Treacher Collins
- Cri Du Chat
227
Congenital conditions with issues concerning the Cervical spine
Kids Try Gold
- Klippel Fleil
- Trisomy-21
- Goldenhar
228
PO dose for midazolam in pediatrics
0.25-1 mg/kg
229
PO dose for ketamine in pediatrics
5-10 mg/kg
230
PO dose for precedex in pediatrics
2-5 mcg/kg
231
Defects that cause right to left shunt
The 5 T's (CYANOTIC defects)
- TOF
- Transposition great arteries
- Tricuspid Valve abnormality (Ebstein Anomaly)
- Truncus arteriosus
- Total anomalous pulmonary venous connection
232
What is the most common left to right shunt
VSD (ACYANOTIC defect)
233
Pediatric factors that contribute to rapid desaturation?
Increased O2 consumption
liable ribs
- leads to decrease lung volumes
234
What is the most significant method of heat loss in the neonate?
radiation (wrap the patient in warm blankets & use radiant heat lamps)
235
Temperature for therapeutic hypothermia after cardiac arrest
32-34 degrees C for 12-24 hours
236
Class of drugs that don't require dose adjustment in the elderly
NMB's
237
What is the most common comorbidity in sickle cell patients?
Asthma
238
Which approach to the brachial plexus has the highest incidence of pneumothorax?
Supraclavicular
239
What is the standard of care for monitoring VAE?
EtCO2
| Precordial doppler
240
AST/ALT ratio that indicates significant disease
>2
241
What electrolyte abnormalities are associated with a prolonged QT Interval ?
Hypocalcemia
Hypokalemia
Hypomagnesemia
242
Between what pressures is CPP auto regulated?
50-150 mmHg
- below 50: Maximally dilated and pressure dependent
- Above 150: Maximally constricted and flow dependent
243
At what MAC are awareness and recall prevented?
0.4-0.5 MAC
244
Distal muscle weakness that ascends is a sign of
Guillain-Barre Syndrome
245
Early signs of myasthenia Gravis
cranial nerve dysfunction: ocular, laryngeal, pharyngeal
246
List the TURP solutions and their associated complications
- Glycine: Transient vision loss
- Sorbitol: Osmotic Diuretic
- Distilled Water: Hemoglobinuria
- NaCl 0.9%: Electrocution with Unipolar Cautery (Use Bipolar only)
247
What cuff pressure causes tracheal ischemia?
25mmHg (keep at LESS than 25)
248
When does the S1 hear sound occur? S2? S3 & S4?
S1: MV/TV closure (AV Valves)
S2: AV/PV closure (Semilunar valves
S3: After AV closure and MV opening
S4: before MV closure
249
What is responsible for halothane hepatitis?
Production of trifluoroacetic acid (TFA)
250
List the origin of the cranial nerves
Midbrain: 3-4
Pons (Brainstem): 5,6,7,8
Medulla(brainstem): 9,10,11,12
251
A three sided pyramid shaped cartilage of the larynx
Arytenoid
252
What are the components of the carotid sheath?
Common carotid artery
Internal carotid artery
Internal Jugular vein
Vagus nerve
253
How is oxygen consumption affected by temperature?
Decreases by 5-7% per degree C
254
Transient neurologic syndrome is associated with
radiating buttock pain
255
Epidural Hematoma is associated with
Prolonged motor block with GU dysfunction
256
What is the twitch response for the interscalene block?
Biceps contraction
Inward shoulder rotation
- (Hiccups too shallow, contraction of trapezius is too deep)
257
How do you calculate static compliance?
TV/(Plateau pressure - PEEP)
258
Why does Acute EtOH intoxication reduce MAC requirements
Potentiation of GABA-A receptor
259
What are the SNS effects of Hypercarbia?
SNS stimulation
- Vasoconstriction
- Inc. Myocardial contractility
- Inc. Serum Potassium
260
Where do the spinal nerves exit the spinal column?
Intervertebral foramen (Between vertebral body and facet joints)
261
What is the most common complication from mediastinoscopy?
Hemorrhage
262
At what BIS does burst suppression occur
20
263
What part of the Sodium channel do LA's bind to
The Alpha subunit in the open-active and inactivated closed
264
The area of the Thromboelastogram that corresponds with fibrinogen function
```
K time (beginning of split)
Alpha Angle
```
265
What is the R Time on the Thromboelastogram?
The time till clot formation (The flat line at the beginning)
- Indicates the presence of adequate clotting factors in the plasma
266
What is the MA on the Thromboelastogram?
Maximum Amplitude (MA)
- Measure the strength of a formed clot
- Availability of sufficient and functional platelets
267
Where do cell bodies of the 1st, 2nd and 3rd order neurons reside?
1st: Dorsal root ganglia
2nd: Dorsal Horn
3rd: RAS and Thalamus
268
A vagal stimulus edicts bronchoconstriction via what receptor
Muscarinic-3
269
Area of the brain that controls fine movement
Basal Ganglia
| - Parkinsons affects the substantial nigra of this region
270
Things that stimulate NO release
- Bradykinin
- Thrombin
- Acetylcholine release onto M3 receptors in the vascular endothelium
271
How do Mu receptor agonist decrease neural transmission?
- Decrease Ca2+ permeability in the presynaptic terminal
| - Increase K+ exit from post-synaptic membrane
272
Facts for Mantoux test
Read between 48-72 hours
- erythema
- Induration > 10mm or > 5mm in immunocompromised
273
Nerve that supplies the lateral side of the lower extremity below the knee
The Common Peroneal
274
Why is succinylcholine contraindicated in patients with ALS
Due to risk of Hyperkalemia
275
The only NMBs that can be administered IM
Rocuronium and Succinylcholine
276
Another word for excessive saliva
Sialorrhea
277
The only lab test to evaluate the efficacy of LMWH
anti-X level
278
Side effects from thiazide diuretics
Hyperglycemia
| Hypercalcemia
279
Vitamin deficiencies seen with bariatric (Malabsorptive) surgeries
Vitamin B9 (Folic Acid)
Vitamin B12 (Cobalamin)
Fat soluble vitamins (DAKE)
Iron
280
Signs of excess glucocorticoids from Cushings disease
- Osteoporosis
- muscle weakness
- hyperglycemia
- weight gain
- mood changes
- high risk of infection
281
what is the normal motor response of the femoral nerve?
Hip Flexion
| Knee extension
282
what is the normal motor response of the obturator nerve?
Lower Extremity adduction
283
what is the normal motor response of the Common Peroneal nerve?
Foot eversion
| Dorsal toe extension
284
what is the normal motor response of the sciatic nerve?
- Rotate thigh laterally
- Abducts thigh when limb is flexed
- flexes leg
- extends thigh
285
What is the normal FRC by weight?
35 mL/kg
286
List the plasma protein binding of commonly used anesthetics
```
Propofol= 98%
Precedex = 94%
Midazolam = 94%
Etomidate = 75%
Ketamine = 12%
```
287
Serotonin release is associated with what physiological response
HTN, Bronchoconstriction Flushing, diarrhea
