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SUM '20 Final Exams Prep > APP II Exams > Flashcards

APP II Exams Flashcards

1
Q

EMG to the lateral rectus monitors what nerves?

A

Abducens

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2
Q

insert brain pic The area with the blue color is supplied by? The area with the green color is supplied by?

A

blue: Anterior cerebral artery Green: Posterior cerebral artery

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3
Q

Calculate CPP: BP = 100/70, HR = 65, RAP = 10, ICP = 15? SHORT ANSWER

A

CPP = MAP - ICP; CPP = 80 - 15; CPP = 65

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4
Q

SSEP assesses the integrity of ________ spinal cord.

A

Posterior

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5
Q

How is cerebral blood flow autoregulated?

A

SHORT ANSWER

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6
Q

Name structures pierced during lumbar puncture.

A

SHORT ANSWER Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, subdural space*, arachnoid mater, subarachnoid space

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7
Q

Patient with increased ICP that suddenly rises to 30 mmHg will exhibit? SELECT 3

A

Irregular respirations, bradycardia, Hypertension

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8
Q

Which potential is MOST RESISTANT to anesthesia?

A

BAEP- Auditory

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9
Q

insert image of epideral verterbra Which number represents the subarachnoid space?

A

10

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10
Q

Describe Horner’s Syndrome?

A

SHORT ANSWER

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11
Q

Which nerve can be blocked to decrease pain from tourniquet inflation during IV regional anesthesia?

A

Intercostalbrachial nerve

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12
Q

Aqueduct of Sylvius supplies?

A

Third and fourth ventricle

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13
Q

insert vertebra picture Which number represent the lamina?

A

8

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14
Q

insert paco2/po2 image graph What does “X” represent:

A

x = PaCO2

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15
Q

Insert image of hand/nerves innervation what nerve is represented by blue?

A

blue = ulnar

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16
Q

Which evoked potential is measured during pituitary surgery

A

Visual evoked potential

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17
Q

Describe falx cerebri

A

Short answer

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18
Q

Differentiate between cerebral steal and inverse steal.

A

short answer

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19
Q

Differentiate between supraspinal and spinal anesthesia.

A

short answer

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20
Q

Brain controls the activity of interneuron in substantia gelatinosa?

A

Periventricular and periaqueductal gray matter

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21
Q

Gray Ramus contain_____fibers?

A

Postganglionic sympathetic

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22
Q

Patient has eyelid drooping, pupil fixed and dilated, not reactive to light. What nerve is damaged?

A

Oculomotor

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23
Q

Which would decrease cerebral blood flow?

A

Fentanyl-Droperidol

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24
Q

A 55-year-old is undergoing an intracranial tumor resection under GA. Preoperatively, the patient is alert & oriented and has no focal neurological deficit. Within what range should the PaCO2be maintained during surgery?

A

25-30 SHORT ANSWER

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25
Q

Which bone supports the pituitary gland / location of sella turcica:

A

Sphenoid bone

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26
Q

insert graph diagram Which agent describes ketamine? Which agent would be best to use in head trauma?

A
  1. ketamine = 5 2. head trauma= 1
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27
Q

Masseter muscle and temporalis muscle responses are monitored using which nerve?

A

Trigeminal CN (V)

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28
Q

insert electrode diagram Electrode position diagram – where would you place the electrode for tibial stimulation?

A

a. Z

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29
Q

In the case of venous air embolism, aspiration with a SINGLE-orificed catheter is done by placing the tip ________ the SVC-atrial junction.

A

3 cm ABOVE

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30
Q

In the case of venous air embolism, aspiration with a MULTI-orificed catheter is done by placing the tip ________ the SVC-atrial junction.

A

2 cm below

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31
Q

Picture of a man only smiling with half of his face. Which nerve is injured?

A

Facial (VII)

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32
Q

30 y/o jumped and pool and injured C3-C4. Neurological damage showed bilateral blindness. Describe injury -

A

SHORT ANSWER

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33
Q

Pain afferent nerve fibers dorsal horn ascend 1-3 seg ____ in before entering synapse dorsal horn?

A

Track of lissauer

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34
Q

Berry aneurysm picture? Damage is to where?.

A

Anterior communicating artery

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35
Q

Picture of drop hand, image 3? what nerve is associated with injury?

A

Radial nerve damage

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36
Q

Picture of baby with Erb-Duchenne Palsy. Short answer

A

Excessive stretch of neck during delivery, damage to superior trunk of C5, C6. Can occur in falls, traumas. Pronated forearm, arm turned medially

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37
Q

Posterior spinal artery occlusion with loss of dorsal column tract, which will you lose? Choose 2

A

Fine touch Vibration

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38
Q

Venous Air Embolism all the following EXCEPT

A

Lateral 15 degrees, head up Use of PEEP

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39
Q

Extrinsic mechanism, ____ increase for each mmHg PCO2

A

2%

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40
Q

____ nerve monitored through vocal cords in major tumor resection

A

Vagus

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41
Q

insert image of tract of lis What is X?

A

C-fibers

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42
Q

Picture of hand injuries, image 1: Claw hand

A

Ulnar nerve injury

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43
Q

Picture of hand injuries, image 2: Ape Hand

A

Median Nerve injury

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44
Q

escribe structure and function of BBB

A

short answer

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45
Q

MOA of morphine in the substantia gelatinosa.

A

Short answer

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46
Q

Brachial plexus diagram- nerve 1 recognition

A

Musculocutaneous Nerve

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47
Q

Warfarin is part of

A

Extrinsic pathway

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48
Q

Vitamin k dependant factors

A

II, VII, IX, X (2, 7, 9,10) and protein c & s

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49
Q

Pt is getting ready for heart surgery and is being heparinized. Pt ACT is not getting past 250, what do you do?

A

Give FFP

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50
Q

Erythroblastosis fetalis:

A

Mother is Rh- having a fetus Rh+

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51
Q

Pt on heparin starts bleeding. What do you give?

A

Protamine

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52
Q

MOA of Dipyridamole -

A

Increases cAMP

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53
Q

MOA of Ticlopidine -

A

inhibit ADP

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54
Q

Inhibition by NSAID lasts:

A

24-48 hrs

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55
Q

COX inhibition by Aspirin lasts

A

7-12days

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56
Q

abciximab

A

GP iib/IIIa inhibitor

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57
Q

Reversal for coumadin

A

vitamin K

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58
Q

What is the best test for platelet function:

A

bleeding time

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59
Q

What is the factor deficiency in Hemophilia B?

A

Factor IX (9)

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60
Q

Most common hereditary bleeding disorder:

A

Von Willedbrand’s disease

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61
Q

Tests used to monitor Warfarin (choose 2):

A

PT INR

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62
Q

Heparin is part of what pathway?

A

intrinsic

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63
Q

Treatment for vWD

A

dDAVP

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64
Q

Fibrin stabilizing factor:

A

Factor XIII (13)

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65
Q

After tissue injury, Thromboplastin activates:

A

Factor VII (7)

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66
Q

Patient with priapism

A

sickle cell anemia

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67
Q

Which of the following would not be associated with a patient with sickle cell anemia:

A

splenomegaly

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68
Q

Reticulocytes are responsible for:

A

RBC’s

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69
Q

Male patient that has a high TIBC, low iron what diagnositc study would be done next?

A

occult stool colonscopy - all men with anemia r/o colon ca (they have it until it’s ruled out)

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70
Q

Patient complains of weakness, lightheadedness after menstruation. Tx -

A

Ferrous Sulfate

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71
Q

Pt living in high altitude polycythemia Treatment:

A

no treatment

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72
Q

A patient that had stomach resection … they would most likely have:

A

B12 deficiency

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73
Q

Male Pt(baby) cannot stop bleeding after a heel stick. History of prolonged bleeding time after circumcision. Bruises on elbows Which of the coag test represents this patient?

A

Hemophilia

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74
Q

Pregnant woman comes into the hospital. She is Rh(+), husband is Rh(-) and it’s there second child. What do you do.

A

Nothing

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75
Q

Patient with Polycythemia Vera -

A

Increased Blood Viscosity

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76
Q

All of the following are chemical accelerators of clot formation except -

A

PGI2

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77
Q

vWF is responsible for stabilizing:

A

VIII (8)

78
Q

Patient receiving multiple blood infusions will be deficient in:

A

Platelets

79
Q

ICU patient has oozing from line sites (was this the patient with bacteremia, leading to paint the picture of thrombocytopenia secondary to DIC? I was thinking DIC)

A

Decreased PLT, Increased BT, PT, PTT

80
Q

Hemolytic Anemia will more than likely cause increased circulation of:

A

Free Bilirubin

81
Q

Describing a patient with B12 deficiency:

A

Give B12 and Folic Acid

82
Q

How to treat the patient with anemia due to renal failure:

A

Erythropoietin

83
Q

A pt is treated for DVT with heparin, he comes back a week later and has a decrease in PLT…. What is the treatment?

A

DC Heparin

84
Q

Which factor activates prothrombin for conversion to thrombin?

A

Factor X

85
Q
A

sickle cell

86
Q
A

megoloblastic anemia

87
Q
A

microcytic hypochromic cells

88
Q

patient presented with pain in abdomen, (I think it said pink tinged urine too?), accumulation of aminolevulinic acid (ALA) and uroporphyrins

A

. Acute intermittent porphyria

89
Q

Female pt with heavy periods last 8-9 days and difficult to stop bleeding after cut.

A

Platelets Normal, bleeding time increased, pt normal, ptt increased (von Willebrand’s disease)

90
Q

Asprin inhibits:

A

Cycloxygenase 1

91
Q

Which of the following is not true about platelet aggregation?

A

A. Aspirin inhibits COX, leading to increased formation of thromboxane A2

92
Q

Life of a RBC?

A

4 mos

93
Q

66 yr old woman comes to ER 30 mins after the onset of chest pain that radiates to neck and left arm. She is diaphoretic and hypotensive; the serum troponin-I is elevated. Thrombolytic therapy is begun. Which of the following drugs is most likely to be administered?

A

tPA

94
Q

All of the following promote platelet aggregation EXCEPT:

A

Prostacyclin (PG12)

95
Q

What is the major cause of diffuse bleeding after 25 pints of whole blood transfusion?

A

Thrombocytopenia

96
Q

What area is known as countercurrent multiplier? Labeling picture

A

a. Loop of Henle

97
Q

Insert Renal 1 picture Site of Secretion? Site of Reabsorption?

A

secretion - #3 reabsorption - # 2

98
Q

What is used to measure GFR?

A

creatinine clearance

99
Q

dilating efferent arterioles causes?

A

Decreased GFR

100
Q

All are causes of hyperkalemia except for? a. Acidosis b. Tissue trauma c. Extreme exercise d. Hyperventilation

A

hyperventilation

101
Q

Calcium gluconate is used for hyperkalemia for what reason?

A

cardiac stabilization

102
Q

Most important renal buffers? (choose 2)

A

phosphate ammonia

103
Q

Anion gap equation for calculation:

A

Na+ - (Cl- + HCO3 -)

104
Q

Patient who has been vomiting will likely have what condition?

A

Metabolic alkalosis

105
Q

Possible acid base disorder after anesthesia?

A

respiratory acidosis

106
Q

Salicylate overdose acid base disorder?

A

respiratory alkalosis

107
Q

wife who urinates when husband squeezes her; what is the treatment?

A

kegels Alpha Agonist

108
Q

treatment for incomplete emptying :Choose 2

A

Cholinergic Intermittent catheterization

109
Q

Tx for BPH?

A

Alpha adrenergic blocker

110
Q

Acetazolamide works where?

A

Proximal tubule

111
Q

Furosemide works where?

A

thick ascending limb of loop of Henle

112
Q

All cause decrease calcium except for?

A

loop diuretics

113
Q

Which diuretic is an aldosterone antagonist/ spares potassium?

A

spironolactone

114
Q

Which lab is used to determine rena (intrinsic) or pre-renall failure?

A

FEF na

115
Q

All labs are indicative of renal failure except for?

A

hypercalcemia

116
Q

All labs are indicative of renal failure except for?

A

hypernatremia Acute RF you would see HYPOnatremia (and hypocalcemia d/t decreased vit D3)

117
Q

First line of defense?

A

buffer system

118
Q

Calculation for renal clearance. 4320 ml in a 24 hour urine collection (180 ml/hr or 3 ml/minute), urine concentration of sodium (or whatever it was) is 40, and plasma concentration of 3.

A

a. 40 ml/min

119
Q

ABG interpretation → pH 7.24, PCO2 60, HCO3 26, O2 80

A

Acute respiratory acidosis

120
Q

ABG interpretation → pH 7.52, PCO2 30, PO2 110, HCO3 24

A

Acute respiratory alkalosis

121
Q

Clearance calculation urine NA was 100, urine flow rate of 2 ml/min, and plasma Na was 20?

A

10 ml/min

122
Q

What is the most common cause of death in chronic renal failure

A

Infections

123
Q

Tetany is seen with a decreased level of?

A

Calcium

124
Q

What does ACEI’s do to GFR?

A

Decreases GFR

125
Q

Vitamin ______ is activated in the kidney?

A

D

126
Q

All of the following stimulate ADH secretion except?

A

Decreased serum osmolarity (this will decrease secretion of ADH)

127
Q

What is seen with acetazolamide administration?

A

Metabolic acidosis with a normal anion gap

128
Q

The source of progesterone and estrogen in second trimester is

A

Placenta

129
Q

The source of progesterone and estrogen in first trimester is:

A

Corpus luteum

130
Q

What letter indicates HCG?

A

X

131
Q

How the reproductive hormones change in postmenopausal woman?

A

Estrogen decreases, FSH, LH, and GnRH are increased

132
Q

(insert the picture) What letter indicates LH? Progesterone?

A

D (the highest peak) - LH B - progesterone

133
Q

Increase urinary excretion rate of VMA dx for:

A

Pheochromocytoma

134
Q

Which set of labs indicates parathyroid adenoma?

A

Increased PTH, Ca and low Phos

135
Q

During normal menstrual cycle, LH surge predicts

A

Ovulation

136
Q

Guy has chronic diarrhea, lack of appetite, colicky abd pain…. Exam revels wheezing and bronchospasm, and flushing. Dx?

A

5-HIAA (urinary 5-hydroxyindoleacetic acid

137
Q

Deficiency of ___ causes decreased level of cortisol and androgen, increased aldosterone

A

17 alpha hydroxylase

138
Q

Incorrect statement about anesthetic management of pt with Grave’s disease;

A

Require increase MAC

139
Q

35 yr old DM 1 with difficulty managing morning hyperglycemia b/c of somogyi effect, what do you do?

A

Decrease evening dose of insulin

140
Q

Pt came in with fall, is on all kinds of medications for a million other things. I think Na 4.5, serum osm 254, urine 180 ish, … ct normal

A

SIADH

141
Q

During throidectomy of medullary carcinoma, pts BP suddenly rises. Assuming preexisting pheochromocytoma, what is the most probable dx?

A

MEN Type IIa MEN type III (IIB)

142
Q

Bipolar guy on lithium gets polyuria. Urine osm 90 and not responsive to nasal dDAVP

A

Nephrogenic DI

143
Q

Increases prolactin secretion?

A

Haloperidol

144
Q

Source of ADH

A

-Post. pituitary -Hypothalamic supra optic nuclei

145
Q

Pt presents with HTN, buffalo hump, puffy face. Likely cause?

A

Prolonged steroid use

146
Q

Rathke’s pouch develops

A

Anterior pituitary

147
Q

Angiotension II acts on this to release aldosterone:

A

Zona glumerulosa

148
Q

What hormone is stimulated by EC vol expansion

A

ANP

149
Q

Conversion of 25-OH (inactive vitamin d) to 1.25-OH (active)

A

Kidneys

150
Q

ost sensitive test for thyroid function

A

TSH

151
Q

Which of the following would be expected in a patient with Conn’s Syndrome?

A

Hypokalemia

152
Q

SIADH caused by release of ADH. has the following features EXCEPT

A

Increased urinary flow

153
Q

Alcohol inhibits the release of

A

ADH

154
Q

Pt with HTN leg cramps, hypokalemia, …. Nodule on adrenal cortex…

A

Conn’s syndrome

155
Q

Pt with head injury from skiing. Became polydipsic, serum osm 300’s, urine osmolarity 70s. Treated with dDavp and urine osmolarity increased.

A

Central DI

156
Q

Man presented with changes in his appearance, hands and feet enlarged, hyperglycemic, mri revealed pituitary mass.

A

Acromegaly

157
Q

cGMP hormone

A

Nitric Oxiide

158
Q

Ambiguous genitalia… 9 month old? Baby picture. Testosterone levels are 4 x normal. Brother had similar problem

A

21 beta hydroxylase

159
Q

Pt had a seizure. Had thyroid surgery a year ago. CC fatigue, circumoral and foot numbness, hand fascculation, calf cramps. When her bp was check a wrist spasm was seen

A

Hypoparathyriodism (hypocalemic)

160
Q

6 mos Pregnant , fatigued, TSH is elevated, T3 and t4 are low

A

Hypothyroid

161
Q

Baby found to have elevated TSH. tx?

A

Levothyroxine

162
Q

Milk production in breast

A

Prolactin

163
Q

Milk ejection and let down reflex

A

Oxytocin

164
Q

Why does hypocalcemia cause musculare spasm and tetany?

A

Increases Na permeability across cell membrane

165
Q

Man complains of frequent urination urgency. Rectal exam = BPH. Proscar is prescribed. Proscar is:

A

Inhibits 5 alpha-reductase

166
Q

Destruction of posterior pituitary gland results in deficiency of

A

ADH Oxytocin

167
Q

Hormone to its source:

A

Growth hormone : anterior pituitary

168
Q

Lab values for cretinism

A

High TSH, low T3 and T4

169
Q

Picture of… Probable dx in this 23 yr old female with an untreated medical condition:

A

CAH - 21 beta hydroxylase

170
Q

Pregnant pt with high TBG, T3 and T4, normal TSH

A

No treatment required

171
Q

Which one of the following set of lab values is consistent in the following patient? (pic of hyperthyroid looking person)

A

Low TSH, high T3 and T4

172
Q

Hypercalcemia, thirst, lethargy, and fatigue. Ionized calcium =1.6 (high), phosphate = 0.8 , PTH= 10.3 (high). What is probable dx?

A

hyperparathyroid

173
Q

30 yr old woman, wt loss, amenorrhea for 2 yrs. Significant postpartum bleeding. Most probably diagnosis?

A

Sheehan’s Syndrome

174
Q

Hypotensive patient, Hypoglycemic, Hyperkalemia and Hyponatremia (from low aldosterone), metabolic acidosis; or results from increased ACTH.

A

Addison’s Disease

175
Q

Pars Recta is located:

A

Straight part of PCT

176
Q

67% of NA and K are reabsorbed in the

A

PCT

177
Q

Ace inhibitors impact on GFR

A

Decrease GFR (by dilating efferent arterioles)

178
Q

Acetazolamide works in the

A

(1) Proximal CT

179
Q

Furosemide / loop diuretics work in the

A

(3) ascending loop of henle

180
Q

Thiazides work in the

A

(4) Distal Convoluted tubule

181
Q

Spironolactone works in the

A

(5) collecting tubule and duct

182
Q
A
183
Q
A

addisons

184
Q
A

diarrhea

185
Q
A

lost in desert

excessive sweating

Diabetes insipidus

186
Q
A

isotonic vol expansion - isotonic infusion

Increased ECF

187
Q
A

high NaCl intake

ecf increases

icf descreases

osm of ECF increases

188
Q
A

hypotonic infusion (dextrose /water)

SIADH

ECF vol increases; osm decreases

ICF increases

189
Q
A
190
Q
A
191
Q
A

SUM '20 Final Exams Prep (7 decks)

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