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General Medicine > APIC > Flashcards

APIC Flashcards

1
Q

What receptor are neuromuscular blockade drugs specific for?

A

nicotinic acetylcholine receptor

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2
Q

Where does the trachea begin?

A

At the level of the thyroid cartilgae C6

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3
Q

What level dose the trachea bifrucate

A

T5

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4
Q

When to suspect difficult bag mask ventilation

A 
BONES
Beard
Obesity/ Obstetrics 
No teeth
Elderly
Sleep Apnoea
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5
Q

Proper positioning for intubation

A

“sniffing position” : flexion of lower C spine (C5,6), i.e bow head forward and extension of upper C spine at atlanto (C1) - occipital joint, ie. nose in the air

aligns the 3 axes of mouth, pharynx and larynx to allow visualisation from the oral cavity to the glottis
proper position for laryngoscope tip to visualise cords is in the epiglottic vallecular
contraindicated in known/ suspected C spine fracture/ instability

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6
Q

Differential Diagnosis of Poor bilateral breath sounds after Intubation

A 
DOPE
Displaced ETT
Obstruciton
Pneumothorax
Esophageal intubation
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7
Q

ASA Classfication

A

1: Normally healthy
2: Mild systemic disease, but with no limitation of activity
3: Severe Systemic disease that limits activity; not incapacitating
4: Incapacitating systemic disease which poses a threat to life
5: Moribund. Not expected to survive 24 hour even with operation
6: Braindead patient whose organs are being removed for donor purposes

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8
Q

State which stage of anesthesia each of the following descriptions refers to? Delirium; violent behavior; increased blood pressure; increased respiratory rate; irregular breathing
rate and volume; amnesia; retching and vomiting with stimulation; disconjugate gaze

A

Stage II (excitement)

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9
Q

State which stage of anesthesia each of the following descriptions refers to? Depression of vasomotor center; depression of respiratory center; death may occur

A

Stage IV (medullary depression)

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10
Q

State which stage of anesthesia each of the following descriptions refers to? Eye movements cease; fixed pupils; regular respiration; relaxation of skeletal muscles

A

Stage III (surgical anaesthesia)

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11
Q

State which stage of anesthesia each of the following descriptions refers to? Loss of pain sensation; patient is conscious; no amnesia in early part of this stage

A

Stage I (analgesia)

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12
Q

Give Examples of inhaled anaesthetics

A

sevoflurane; desflurane; nitrous oxide;

isoflurane; enflurane; methoxyflurane Halothane;

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13
Q

With regard to inhaled anesthetics, what does MAC stand for?

A

minimum alveolar concentration

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14
Q

What is MAC in regard to inhaled anesthetics?

A

The concentration of inhaled anesthetic required to stop movement in 50% of patients following a surgical stimulus; a measure of potency for inhaled anesthetics

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15
Q

Which inhaled anaesthetic has the largest MAC?

A

Nitrous oxide

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16
Q

Which inhaled anaesthetic has the smallest MAC

A

Halothane

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17
Q

As lipid solubility of an inhaled anesthetic increases, what happens to the concentration of inhaled anesthetic needed to produce anesthesia, that is, does it increase or decrease?

A

Decreases

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18
Q

What is the blood/gas partition coefficient?

A

The ratio of the total amount of gas in the blood relative to the gas equilibrium phase. It refers to an inhaled anesthetic’s solubility in the blood.

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19
Q

Are MAC values higher or lower in elderly patients

A

Lower

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20
Q

Are MAC values higher or lower when opioid analgesics and/or sedative hypnotics are used concomitantly?

A

Lower

21
Q

What is the role of the periaqueductal gray matter?

A

Primary control centre for descending pain modulation

22
Q

enkephalin?

A

endogenous opiod neurotransmitter

23
Q

Substantia gelatinosa

A

where the first order neuron of the spinothalamic tract synapses n

24
Q

Do inhaled anesthetics increase or decrease the response to Pco2 levels?

A

Decrease

25
Q

what characterises malignant hyperthermia?

A

Hyperthermia; muscle rigidity; acidosis; hypertension; hyperkalemia

26
Q

Should a patient with a family history positive for malignant hyperthermia be concerned?

A

Yes, because a genetic defect in ryanodine receptors may be inherited.

27
Q

What inhaled anaesthetic can cause hepatotoxicity

A

Halothane

28
Q

What inhaled anaesthetic can cause nephrotoxicity?

A

Methoxyflurane

29
Q

Which inhaled anaesthetic can be a proconvulsant

A

Enflurane

30
Q

What inhaled anaesthetic can cause expansion of gas inside a closed body cavity

A

Nitrous oxide

31
Q

What does thiopental do to cerebral blood flow

A

Decreases it

32
Q

What does ketamine do to cerebral blood flow

A

Increases it

33
Q

Why is more local anaesthetic needed in infected tissue?

A

Infected tissue has low ph

Anaesthetics become charged and cannot cross the membrane effectively

34
Q

What is the order of sensory loss with local anaesthetics

A

Pain, temperature, touch, pressure

35
Q

Which local anaesthetic can cause severe cardio toxicity

A

Bupivacaine

36
Q

Which local anaesthetic can cause arrhythmias

A

Cocaine

37
Q

What do you use to treat malignant hyperthermia

A

Dantrolene

38
Q

Mechanism of succinylcholine

A

Strong Ach receptor agonist

39
Q

Mechanism of Dantrolene

A

Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle

40
Q

What is the mechanism of non depolarising neuromuscular blocking drugs

A

Competitive antagonist of AcH receptor

41
Q

Name the non depolarising neuromuscular blocking drugs

A

Rocuronium, mivacurium, vecuronium, tubocurarine, pancuromium

42
Q

Complications of succinylcholine

A

Hypercalcemia, hyperkalemia, malignant hyperthermia

43
Q

Describe the phases of succinylcholine in neuromuscular blockade

A

Phase 1: prolonged depolarisation

Phase 2: repolarised but desensitised

44
Q

Side effects of local anaesthetic

A

CNS excitation
Hypertension
Hypotension

45
Q

Describe how tertiary amine local anaesthetics act on sodium channels

A

Penetrate membrane in the uncharged form then bind to ion channel in charged form

46
Q

What is malignant hyperthermia?

A

hypermetabolic disorder of skeletal muscle
due to an uncontrolled increase in intracellular Ca2+ (because of an anomaly of the ryanodine receptor which regulates the Ca2+ channel in the sarcoplasmic reticulum of skeletal muscle)

47
Q

Inheritance of malignant hyperthermia

A

Autosomal dominant

48
Q

What drugs can trigger malignant hyperthermia?

A

All inhalational agents except NO

Muscle depolarising agents - Sch

49
Q

Signs of malignant hyperthermia

A 
unexplained rise in ETCO2
increase in minute ventilation
tachycardia
rigidity
hyperthermia (late sign)

General Medicine (15 decks)

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