APEX is stupid Flashcards
1
Q
when should non-particulate antacid for aspiration prophylaxis be redosed
A
after 1 hr
2
Q
classes of antiarrythmics
A
- class I = Na+ channel inhibitors
- class II = beta blockers
- class III = K+ channel inhibitors
- class IV = slow Ca2+ channel inhibitors
3
Q
number 1 site of breast cancer metastasis
A
bone
4
Q
AIs of isosulfan blue dye used in mastectomy
A
temporarily decreases SpO2
5
Q
what is Wegener’s Granulomatosis
A
vasculitis in your nose, sinuses, throat, lungs and kidneys
6
Q
AIs for Wegener’s Granulomatosis
A
- granulomas lead to vasculitis in airway, lungs, CNS, kidneys
- Friable necrotic tissue in airway bleeds easily
- Tracheal granulomas reduce airway diameter
- Lung granulomas can cause hypoxemia
7
Q
risks assoc with Kawasaki disease
musculocutaneous lymph node syndrome
A
coronary artery aneurysm and myocardial ischemia
8
Q
what is Takayasu’s Arteritis
A
occlusive disease of proximal aorta & branches
Aka pulseless disease, occlusive thromboaortopathy, aortic arch syndrome
9
Q
what is Thromboangiitis Obliterans
aka Buerger’s disease
A
- Inflammatory vasculitis
- ultimately occludes small and medium sized arteries and veins in extremities
10
Q
most common cause of Thromboangiitis Obliterans
A
smoking
(best treatment: smoking cessation)
11
Q
how is anatomic Vd increased
A
increased by anything that increases volume of airway conduit
12
Q
how is alveolar Vd increased
A
increased by anything that reduces pulmonary blood flow
13
Q
how is physiologic Vd increased
A
dec pulm blood flow, dec CO, PE, COPD, old age, facemask, PPV, HME, neck extension, anticholinergics
14
Q
how much CO2 does a 70 kg adult produce per hour
A
12 L
15
Q
normal PaO2 of a healthy 20 yr old vs healthy 70 yr old breathing room air
A
Healthy 20 yr old breathing room air: normal PaO2 is 95 mmHg
Healthy 70 year old breathing room air: normal PaO2 is ~70 mmHg (d/t increased shunt)
16
Q
most significant concern of Ludwig angina
A
posterior displacement of tongue (complete supraglottic airway obstruction)
17
Q
Best way to secure airway in pt with Ludwig’s angina
A
awake patient
(awake nasal or awake trach)
18
Q
how do vasoconstrictors affect PVR
A
increase
19
Q
indicates greatest impairment of renal function in RIFLE criteria
A
Cr > 5 mg/dL
20
Q
half lives of factor 7, antithrombin, and fibrinogen
A
- Factor 7 = 3-6 hours
- Antithrombin = 48-72 hours
- Fibrinogen = 71-120 hours
21
Q
MOA of analgesia with tramadol
A
1) mu > kappa and delta
2) Activation of the descending inhibitory pain pathway in the spinal cord (NE and 5-HT reuptake inhibition)
22
Q
advantages of tramadol
A
- Little/no respiratory depression
- Low abuse potential
- Low risk of systemic organ toxicity
- Less delay in gastric emptying
23
Q
disadvantages of tramadol
A
- seizures
- high incidence N/V
- decreased efficacy when co-admin with zofran
24
Q
AE of phenylephrine as a neuraxial additive
A
Addition of phenylephrine increases risk of transient neurologic symptoms with tetracaine
25
NMBs that cause histamine release
- Succs
- Atracurium
- Mivacurium
26
treating pruritis from neuraxial opioids
- Can use narcan or nalbuphine (partial agonist) - won’t reverse analgesia from intrathecal opioids but will reverse IV opioids
- other treatments: propofol, ondansetron, droperidol?, gabapentin?
27
1st messenger of nitric oxide in vascular smooth muscle
NO
28
H2 antagonists that inhibit CYP
cimetidine
ranitidine
(not famotidine)
| can augment warfarin effects and increase bleeding
29
H2 antagonists that inhibit CYP
cimetidine
ranitidine
(not famotidine)
| can augment warfarin effects and increase bleeding
30
AE of prolonged use of mannitol
hypokalemic hypochloremic alkalosis
31
what are mineralocorticoid effects
tendency of a steroid to cause retention of Na+ and H2O and excretion of H+ and K+
32
steroid potency relative to cortisol
- Aldosterone (3000x)
- Fludrocortisone (250x)
- Cortisol (1)
- Prednisone (0.8x)
- Methylprednisolone (0.5x)
33
Describes variables that govern laminar flow
Poiseulle's law
34
traditional flowmeter
Thorpe tube
35
where is internal diameter narrowest in flowmeter
at the base and widens along ascent
36
how does N2O affect IOP
Decreases
37
which anatomic structures must an epidural needle pass through when using paramedian approach
* skin
* subq tissue
* paraspinal muscles
* ligamentum flavum
38
What solution is recommended as a test dose when using peripheral nerve stimulation-guided nerve blocks?
5% dextrose in water
## Footnote
increases current density and either maintains or augments the twitch response to stimulation.
39
What solution is recommended as a test dose when using peripheral nerve stimulation-guided nerve blocks?
5% dextrose in water
## Footnote
increases current density and either maintains or augments the twitch response to stimulation.
40
What structures are anesthetized when a local anesthetic is injected into the paravertebral space?
sympathetic trunk
mixed spinal nerve
41
Peak serum levels of lidocaine after tumescent infiltrations for liposuction occur how many hours after injection?
12-14 hours
42
the vertebral canal is smallest at which level
thoracic
43
When using a nerve stimulation technique in a peripheral nerve block, a motor response at what milliamperes (mA) indicates an acceptable location to iniect local anesthetic?
0.5
44
specific effects of EMLA cream on vasculature of skin
Vasoconstriction in the first hour after application Vasodilation after 2 or more hours after application
45
A CRNA is performing a spinal anesthetic targeting the L3-4 interspace using a paramedian approach. The introducer tip has been inserted appropriately relative to the palpated L3 surface landmark. Upon introducing the spinal needle, she encounters bone. Which part of the vertebrae has she most likely hit?
vertebral lamina
46
which components of brachial plexus pass through scalene muscles
roots
47
max concentrations of lidocaine, mepivacaine, and bupivacaine for PNB infusion
lidocaine or mepivacaine = max 1-1.5%
bupivacaine = max 0.125-0.5%
48
measured by transcranial doppler
regional cerebral blood flow velocity
49
what is measured by jugular oximetry
global oxygenation in the brain (invasive)
50
monitors local oxygenation in the brain
NIRS (Cerebral ox)
51
absolute contraindications to low flow anesthesia
* smoke inhalation
* conditions assoc with increased O2 consumption (MH, thyroid storm)
## Footnote
relative - mask ventilation, uncuffed ETT, rigid bronch
52
key benefit of low flow anesthesia & what population is it used in
heat conservation
neonates
53
monitoring of which spinal pathway is affected by NMBs
corticospinal tract
54
what is an ataxic resp rate
what does it suggest?
irregular rate and Vt
suggests injury of medulla
55
what is an apneustic resp rate
what does it suggest?
prolonged pause at the top of inspiration
suggests injury of pons
56
a Hct above what is a threat to life
60%
57
how is dabigatran's anticoagulant effect reversed
idarucizumab
## Footnote
binds with dabigatran and its metabolites with a higher affinity than dabigatran has for thrombin
58
TXA produces antifibrinolytic effect by blocking:
plasminogen to plasmin
59
absolute contraindications for ESWL
* pregnancy
* bleeding disorder
* anticoagulation
## Footnote
relative - pacemaker/ICD, calcified aneurysm of aorta/renal a., untreated UTI, obstruction beyond stone, morbid obesity
60
best treatment for chronic orthostatic hypotension 2/2 hypoaldosteronism
fludrocortisone
61
Hypocalcemia secondary to inadvertent removal of the parathyroid glands during total thyroidectomy is MOST likely to present how many hours after surgery?
24-48 h
62
sensitive clinical indicator of restrictive lung disease
increased resting RR
63
2 primary determinants of ESV
- outflow impedance (afterload)
- ventricular contractility
64
MOA of local anesthetics
selectively bind to alpha subunit of Na+ channel in inactivated-closed state and active-open state
65
nerve fiber types that regulate vascular tone
B & C fibers
66
risk factors for hypoxemia if transferred to PACU on RA
age > 60
weight > 100 kg
67
where are peripheral chemoreceptors located
* carotid bodies (bifurcation & common carotid)
* aortic bodies (scattered throughout aortic arch)
68
During quiet breathing, the portion of the respiratory system that offers the greatest resistance to airflow is the:
mid-sized bronchi
69
What is the anatomic border between the oropharynx and the laryngopharynx (hypopharynx)?
epiglottis
70
how does mu agonism decrease neural transmission
* Increased K+ exit from the post-synaptic membrane
* Decreased Ca+2 permeability in the pre-synaptic terminal
71
which mapelson system is missing a reservoir bag
E
72
conditions that increase risk of LAST
* hyperkalemia (alters RMP)
* hypercarbia (cerebral vasodilation)
* resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
conditions that increase risk of LAST
* hyperkalemia (alters RMP)
* hypercarbia (cerebral vasodilation)
* resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
conditions that increase risk of LAST
* hyperkalemia (alters RMP)
* hypercarbia (cerebral vasodilation)
* resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
conditions that increase risk of LAST
* hyperkalemia (alters RMP)
* hypercarbia (cerebral vasodilation)
* resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
conditions that increase risk of LAST
* hyperkalemia (alters RMP)
* hypercarbia (cerebral vasodilation)
* resp & metabolic acidosis (dec sz threshold, altered protein binding)
73
conditions that increase risk of LAST
* hyperkalemia (alters RMP)
* hypercarbia (cerebral vasodilation)
* resp & metabolic acidosis (dec sz threshold, altered protein binding)
74
conditions that increase risk of LAST
* hyperkalemia (alters RMP)
* hypercarbia (cerebral vasodilation)
* resp & metabolic acidosis (dec sz threshold, altered protein binding)
75
common presentation of transient neurologic symptoms
radiating buttock pain
76
common presentation of cauda equina syndrome
sensory deficit with incontinence
77
common presentation with epidural hematoma
prolonged motor block, sensory loss, GU dysfunction
78
promoting forward flow with VSD
increase PVR
decrease SVR
79
s/s glutocorticoid excess in Cushing's
osteoporosis
muscle weakness
hyperglycemia
weight gain
mood changes
increased infection risk
80
most likely complications of each brachial plexus block
* interscalene = phrenic n. paralysis
* supraclavicular = PTX
* infraclavicular = subclavian a. puncture
* axillary = hematoma
81
mechanical events that occur between S1 and S2
isovolumetric contraction
ejection
82
Which effect of muscarinic antagonism has equal efficacy among atropine, glycopyrrolate, and scopolamine?
decreased gastric acid secretion
83
Which effect of muscarinic antagonism has equal efficacy among atropine, glycopyrrolate, and scopolamine?
decreased gastric acid secretion
84
CN that arise from brainstem
* Pons = 5, 6, 7, 8
* Medulla = 9, 10, 11, 12
## Footnote
Midbrain = 3, 4
85
CN that arise from brainstem
* Pons = 5, 6, 7, 8
* Medulla = 9, 10, 11, 12
## Footnote
Midbrain = 3, 4
86
CN that arise from brainstem
* Pons = 5, 6, 7, 8
* Medulla = 9, 10, 11, 12
## Footnote
Midbrain = 3, 4
87
CN that arise from brainstem
* Pons = 5, 6, 7, 8
* Medulla = 9, 10, 11, 12
## Footnote
Midbrain = 3, 4
87
CN that arise from brainstem
* Pons = 5, 6, 7, 8
* Medulla = 9, 10, 11, 12
## Footnote
Midbrain = 3, 4
88
CN that arise from brainstem
* Pons = 5, 6, 7, 8
* Medulla = 9, 10, 11, 12
## Footnote
Midbrain = 3, 4
88
CN that arise from brainstem
* Pons = 5, 6, 7, 8
* Medulla = 9, 10, 11, 12
## Footnote
Midbrain = 3, 4
89
structures in carotid sheath
* Common carotid artery
* Internal carotid artery
* Internal jugular vein
* Vagus nerve
90
what data are needed to determine if a drug is at steady state
infusion rate
rate of elimination
91
Local anesthetics bind to which part and configuration of the sodium channel?
Alpha subunit of an inactivated-closed channel
## Footnote
Local anesthetics selectively bind to the alpha subunit of the sodium channel in the inactivated-closed state and the active-open state.
92
route of admin with lowest bioavailability
intrathecal
93
NMDA receptor AGONIST
