Basic exam content Flashcards

Question

Cardiovascular effects due to laparoscopic surgery

Answer 1

Increased cardiac filling due to increased intrathoracic pressure Arrhythmias Decreased venous return due to vena cava compression Decreased EF Decreased renal blood flow (results in decreased UOP 2/2 increased ADH secretion) Decreased splanchnic perfusion

Answer 2

Decreases arterial pressure by decreasing afterload Increases HR, especially after quick concentration change Dose-dependent depression of myocardial fxn **Maintains CO**

Answer 3

Direct myocardial depressant and smooth muscle relaxant. HOWEVER, also decreases neuronal reuptake of circulating catecholamines. Therefore, net result is: * elevated BP * elevated HR * elevated CO * increased myocardial oxygen consumption

Answer 4

Propofol decreases sympathetic activity, therefore... * Decreased SBP and DBP w/o increase in HR (CO, SV and SVR all decrease lowering BP while propofol inhibits baroreceptor response, therefore no reflexive increase in HR occurs) * Myocardium depression (due to altered intracellular Ca²⁺ balance/influx) * Both arterial and venous vasodilation

Answer 5

Cardiovascular collapse (decreased CO) VAE PE Kinked/dislodged ETT Esophageal intubation Sample line disconnect

Answer 6

* Intrinsic pulmonary dz * Ascites * Insufflation * Tension PTX * Trendelenburg positioning

Answer 7

* Increased oxygen consumption (fever, shivering) * Decreased CO (cardiogenic shock) * Decreased [Hgb] (anemia) * Decreased arterial oxygen saturation (methemoglobinemia) Fick Equation: SvO₂ = SaO₂ - [VO₂/(CO x Hgb x 1.36)]

Answer 8

* Bronchospasm * Kinked ETT * Airway secretions * Mucous plug Peak inspiratory pressures directly proportional to changes in airflow resistance, while plateau pressure changes vary with change in lung compliance/elastic changes.

Answer 9

* Inadequate regional blood flow (PVD) * Decreased VO₂ (sepsis, CN toxicity, hypothermia) * Increased SaO₂ (L to R intracardiac shunt, AV fistula) * Increased [Hgb] (polycythemia) Fick Equation: SvO2 = SaO2 - [VO2/(CO x Hgb x 1.36)]

Answer 10

**FUSEDCARS:** * Fistula * Ureteral diversion * Saline administration * Endocrine dfxn * Diarrhea * Carbonic anhydrase inhibitors (acetazolamide) * Ammonium chloride (TPN component) * RTA * Spironolactone

Answer 11

1. Pseudocholinesterase deficiency 2. Liver dz (why? pseudocholinesterase produced by liver) 3. Pregnancy 4. Malnutrition 5. Malignancy 6. Hypothyroidism

Answer 12

Depleted CO2 absorbent Dysfunctional circuit valve Low FGF Improper calibration of bellows

Answer 13

* Activate descending inhibitory pain pathway via inhibition of GABA receptors in the brainstem * Provide analgesia via mu1 receptors in periaqueductal gray matter, locus ceruleus and nucleus raphe magnus

Answer 14

1. No fade in response to repetitive stimuli 2. No amplification in force of subsequent muscle contractions after period of high-frequency stimulus (tetany)

Answer 15

1. Progressive decrease (fade) in response to repetitive stimuli 2. Potentiation of evoked responses with high-frequency stimulation (tetany) = increased amplitude and decreased fade of response

Answer 16

Acute refractory bradycardia Severe metabolic acidosis Cardiovascular collapse Rhabdomyolysis Hyperlipidemia/hypertriglyceridemia Renal failure Hepatomegaly

Answer 17

Shows effect of change in V or T when pressure remains constant V1 / T1 = V2/ T2

Answer 18

* increases CMRO2 * increases CBF (therefore, increases CBV) * elevates ICP

Answer 19

Tremors Muscle twitches Seizures Meperidine is a synthetic opioid, acts on mu-receptors, metabolized in liver to normeperidine- t1/2 15-30 hrs, no mu-receptor activity but is a CNS STIMULANT.

Answer 20

* reduce MAC of inhaled anesthetics * normeperidine-induced seizures * reduce cerebral metabolic oxygen requirement * reduce CBF * reduce ICP (except in TBI!) * opioid induced respiratory depression and associated mydriasis * stimulate area postrema in brainstem leading to N/V * interfere with serotonin uptake causing serotonin syndrome

Answer 21

* hypnosis via agonism at beta subunit of GABA-A receptor and inhibition of glutamate binding site on NMDA receptors * decreases IOP * decreases CMRO2 and CBF, leading to decrease ICP

Answer 22

MUDPILES Methanol (formic acid) Uremia DKA Paraldehyde Iron, Isoniazid Lactic acidosis Ethanol Salicylates

Answer 23

* Levodopa, Carbidopa-levodopa * SSRI (citalopram, fluoxetine, sertraline) * SNRI (duloxetine, venlafaxine) * Dopamine-NE reuptake inhibitor (bupropion) * Trazodone * TCAs (amitriptyline, clomipramine) * Valproate, Carbamezepine * St. John's Wort * Dextromethorphan

Answer 24

* #1 = hemorrhage * Abnl cardiac pump fxn (myocardial contusion, tamponade, coronary artery dissection, valve injury) * PTX * Hemothorax * **Spinal cord injury**

Answer 25

1. bradycardia, asystole (esp. in children) 2. fasciculations, myalgias 3. elevated IOP 4. elevated ICP 5. elevated serum K+ 6. rhabdomyolysis/fatal hyperkalemia in children with muslce dystrophies 7. malignant hyperthermia (associated with concomittant IA use) 8. masseter muscle spasm

Answer 26

Hypotension Bradycardia Postdural puncture HA Epidural hematoma (reqs emergent evacuation) Infx- epidural abscess, meningitis **Urinary retention** Transient neurologic sx- spinal only, occurs 24hrs after block wears off, causes severe buttock pain but no sensory or motor deficits **LAST**

Answer 27

* Left shift of oxygen dissociation curve due to increasing pH, leading to tissue hypoxia, subsequent anaerobic metabolism and worsening lactic acidosis * Depression of LV contractility, as sodium bicarbonate will transiently decreased serum ionized [calcium]; LV contractility is proportional to serum ionized [calcium] * Increased preload, as sodium bicarbonate is a hypertonic solution (~1,800 mOsm/L), leading to increased intravascular volume * Risk of elevated ICP and ICH, especially in infants, due to volume expansion in setting of sodium bicarbonate conversion to PCO2 leading to cerebral vasodilation

Answer 28

Spina bifida Urogenital syndromes Frequent exposure to latex foley catheters and surgical equipment with latex

Answer 29

AVOID NITROUS OXIDE FOR 4 WEEKS! N2O can raise IOP by expanding air bubble. SF6 used as intraocular gas during retinal detachment surgery.

Answer 30

Active vomiting Unstable cervical spine

Answer 31

Increased ICP Increased IOP or open eye injury ICM lesion Ischemic heart disease Vascular aneurysm Psych hx, including PTSD, Schizophrenia

Answer 32

Unknown PO status (pt can aspirate around LMA) Restrictive pulmonary dz (decreased chest wall compliance, LMA not intended for positive pressure ventilation) Non-supine positioning, ie: lithotomy Obesity Pregnancy Intra-abdominal procedures Prolonged surgical time

Answer 33

Severe coagulopathy High-dose systemic anticoagulation Nasal pathologies or mass lesions Infection of paranasal sinuses Basilar skull fracture TBI with CSF leak

Answer 34

* pulseless electrical activity (PEA) * asystole * VT with pulse and perfusable rhythm (once unstable, should receive cardioversion; only defibrillate once pulseless) * wet environment

Answer 35

Pts with allergy to cyclodextrins Pediatric pts ESRD Reversal of agents other than rocuronium/vecuronium

Answer 36

Allergy to amides (lidocaine, prilocaine) Use of class III antiarrhythmics (amiodarone, sotalol, dofetilide) Hx of congenital methemoglobinemia

Answer 37

Venous/arterial air embolism PTX Intestinal obstruction with bowel distention Pneumocephalus Pulmonary blebs Intraocular procedures Tympanic membrane procedures

Answer 38

LAD, diagonals: * medial aspect anterior wall * anterior 2/3 septum * apex Left circumflex, marginals: * anterior/posterior aspect of lateral wall RCA: * medial posterior wall * posterior 1/3 septum

Answer 39

Pulmonary edema

Answer 40

Produced in lateral ventricles ---\> third ventricle via intraventricular foramina ---\> fourth ventricle via cerebral aqueduct ---\> subarachnoid space to surround brain and spinal cord

Answer 41

HTN Bradycardia Respiratory changes \*sign of elevated ICP and impending uncal herniation.

Answer 42

* Phenytoin * Warfarin * Ibuprofen

Answer 43

* Beta blockers * Amiodarone * Codeine * Tramadol, Fentanyl, Oxycodone

Answer 44

Hoarseness

Answer 45

1. Right ventricular hypertrophy 2. Posterior wall MI 3. WPW 4. Muscular dystrophy 5. Right atrial enlargement

Answer 46

The pressure required to liquefy a gas at its critical temperature. Remember, critical temperature is the temperature above which no amount of pressure can convert a gas to liquid.

Answer 47

Critical velocity is the velocity at which flow turns from laminar to turbulent flow. Critical velocity is dependent on: * radius of the tube (r) * viscosity (Π) * density (þ) * Reynolds number (k) Critical velocity = kΠ ÷ þr

Answer 48

Measure of peripheral tissue perfusion signified by %O₂ bound to Hgb in blood returning to right atrium (blood captured from SVC, IVC, coronary sinus)

Answer 49

Highest temperature at which a gas can exist in liquid form

Answer 50

Maximum effect produced by a drug. **Efficacy does not depend on dose**.

Answer 51

Hypotension and bradycardia caused by the loss of vasomotor tone and sympathetic innervation of the heart as a result of functional depression of the descending sympathetic pathways of the spinal cord. It is usually present after high thoracic and cervical spine injuries and improves within 3 to 5 days.

Answer 52

Dose required to produce a given effect. **Related to receptor affinity.** S maller dose needed for given effect, the higher the potency.

Answer 53

Resistance to flow. Also, internal friction between adjacent fluid layers sliding past each other. Increases based on opportunity for hydrogen bonding, components of fluid and molecular size.

Answer 54

\>3 attempts or \>10 minutes

Answer 55

Inability of unassisted anesthesiologist to maintain SpO2 \>92% or prevent/reverse signs of inadequate ventilation.

Answer 56

GA occurs when pt loses consciousness and ability to respond purposefully, whether or not airway instrumentation occurs

Answer 57

MAC = varying levels of sedation, analgesia, anxiolysis; provider must be prepared to convert to general anesthesia when necessary

Answer 58

A-a gradient measures pulmonary shunt to determine the efficacy of pulmonary oxygenation of arterial blood. **A-a gradient in healthy pt \< 10mmHg** Normal gradient exist due to physiologic shunting through bronchial and coronary veins that drain deoxygenated blood directly into left heart.

Answer 59

It is the ratio of the concentrations of a compound in one solvent to the concentration in another solvent at equilibrium. The blood/gas partition coefficient describes how the gas will partition itself between the two phases (blood/alveoli) after equilibrium has been reached. High solubility = more anesthetic needs to be dissolved = slower onset MAC decreases as blood gas partition coefficient increases, generally speaking

Answer 60

Boiling point is reached when vapor pressure is in equilibrium with external ambient pressure exerted on liquid surface.

Answer 61

Isoflurane has been shown to **dilate coronary arteries** that can lead to coronary steal syndrome. Coronary steal refers to narrowed coronary arteries with collateral microvasculature that becomes bypassed leading to myocardial ischemia in that distribution.

Answer 62

Dampening refers to the decrease of signal amplitude that accompanies a reduction of energy in an oscillating system. Signs of increased dampening include: * decrease in SBP * increase in DBP In a pressure transducer system, most dampening arises from **factors that decrease energy in the system**: * friction between tubing and fluid within the tubing * 3-way stopcock * bubbles * clots * arterial vasospasm * large catheter size * narrow, long or compliant tubing

Answer 63

During defibrillation, a RANDOMLY timed high-voltage electric current is discharged across two electrodes in attempt to SIMULTANEOUSLY DEPOLARIZE a large critical mass of myocardium. This would cause nearly all ventricular myocytes to enter their absolute refractory periods where no action potentials can be generated. At this point, the pacemaker with the highest automaticity (SA or AV node) will take control of ventricular pacing and contraction.

Answer 64

* Examines pt serum in those with suspected genetic mutations in pseudocholinesterase (homozygous, heterozygous) * Dibucaine is a local anesthetic that inhibits pseudocholinesterase by 80% (Dib # = 80) * If pseudocholinesterase is atypical due to homozygous mutation, dibucaine will inhibit it by only 20% (Dib # =20) * If pseudocholinesterase is atypical due to heterozygous mutation, dibucaine will inhibit it by 40-60% (Dib # = 40-60) * Pts with homozygous mutation, Dib # 20, will have an extremely prolonged block with phase II characteristics. Heterozygous pts will have a moderately prolonged block.

Answer 65

First used for its anticholinergic activity, as it has a structure similar to atropine. Side-effect is **tachycardia**.

Answer 66

Promotes vasodilation by increasing production of arachidonic acid metabolites and nitric oxide. Increases natriuresis (sodium excretion) via direct tubular effects. Usually degraded by ACE

Answer 67

Cell membrane must be depolarized Mg2+ removed by depolarization Glutamate (+/- glycine) bind to ligand-gated channel Sodium and **CALCIUM influx** (Ca2+ responsible for 2nd messenger signaling cascade) Potassium efflux

Answer 68

Related to hepatic metabolism of IA and production of fluoride ions causing direct toxicity to collecting ducts leading to high-output renal failure that is **unresponsive to vasopressin**.

Answer 69

Chemoreceptors that respond to **reductions in arterial partial pressure of oxygen** (PaO₂), "hypoxic drive". Associated with **afferent glossopharyngeal n**. that are stimulated when PaO₂ \< 60-65mmHg, leading to increased MV.

Answer 70

States that for a **constant temperature**, the amount of a given gas that dissolves in a given type and volume of liquid is **directly proportional** to the partial pressure of that gas in equilibrium with that liquid. Therefore, **at equilibrium**, there will be the **same number of molecules existing in the gaseous phase** and in the **dissolved (liquid) phase**, both exerting the same kinetic energy. Common application = solubility of gases * As temperature drops, gas solubility increases

Answer 71

Mediated by adenosine, used to maintain total hepatic blood flow when reciprocal changes occur in portal vein ie: portal vein blood flow increases --\> hepatic artery will vasoconstrict

Answer 72

Particles flow in one direction, parallel to tube/wall and down a pressure gradient. Flow is fastest in the center and decreases parabolically due to friction. **Resistance directly related to flow rate.** Poisseuille's law follows laminar flow.

Answer 73

Bony structures = ASIS (lateral), pubic tubercle (medial) Inguinal ligament Femoral vein --\> Femoral artery --\> Femoral nerve (medial --\> lateral) Femoral nerve lies superficial to psoas muscle, fascia iliaca draps its anterior

Answer 74

Dipyridamole inhibits both PDE and adenosine reuptake. Normally, PDE breaks down cAMP. When cAMP levels are high, PLT unable to aggregate due to cAMP inhibition of thromboxane A2.

Answer 75

Originate at T1-T4, traveling to the heart through cervical (stellate) ganglia.

Answer 76

* Selective peripheral **dopamine-1 receptor agonist** * Causes systemic arteriolar vasodilation leading to **reduced afterload** * Improves renal blood flow, diuresis, natriuresis * Short duration of action and elimination half-time * Indicated for short-term management of HTN emergency * Side-effects include HA, flushing, reflex tachycardia, elevated IOP (related to arteriole dilation) * Contraindicated in pts with allergy to sulfa due to preservative, sodium metabisulfite

Answer 77

* Produced in the **lateral ventricles** by choroid plexus * 20 mL/h (500 mL/d) * Total CSF volume 100-150 mL, maintained via **absorption at arachnoid villi** in cerebral venous sinuses

Answer 78

[tissue]=[plasma] causes redistribution in which drugs return from tissues back into plasma, therefore, slowing the rate of decline in [plasma drug]. Redistribution generally delays emergence as tissue reservoirs continue to feed [plasma drug]

Answer 79

Inverse relationship: Large VOD = lower [drug plasma]

Answer 80

**Every system has a frequency at which it oscillates, called the natural frequency**. If a force with similar frequency to the natural frequency of a system is applied, the system will oscillate at maximum amplitude. This is resonance. Resonance produces excessive amplification that distorts the electrical signal. In an invasive arterial BP monitoring system, this results in greater SBP, lower DBP and increased pulse pressure. Factors that minimize resonance: 1. Reduce tubing length 2. Reduce compliance of tubing 3. Reduce density of fluid in tubing 4. Increase diameter of tubing

Answer 81

Produced by type II alveolar epithelial cells, surfactant plays many roles outside of decrease surface tension within alveoli: * increases bacterial cell wall permeability * stimulates macrophage migration * stimulates synthesis of IgX and cytokines

Answer 82

* Basal ganglia is part of the extrapyramidal system important for **control of movement and posture** * Basal ganglia are made up of the **caudate nucleus, putamen, globus pallidus and substantia nigra** * Site of **input** is via the striatum made up of the **caudate nucleus and putamen** * Site of **output** is via the **globus pallidus and substantia nigra** * Globus pallidus sends inhibitory outputs to the thalamus * Degeneration of the pars compacta substantia nigra alters basal ganglia neurotransmission causing **Parkinson's disease** (dfxn dopaminergic pathway) * Degeneration of the caudate and putamen causes **Huntington's disease**

Answer 83

Parasympathetic-mediated reflex occurs when stretch receptors located in the **LV** respond to an acute decrease in LV preload, resulting in **bradycardia and reduced contractility.**

Answer 84

* Descending pathway involved in limb and axial motor movement **Precentral gyrus**---\> corona radiata and internal capsule---\> pons---\> **85% decussate** to form **pyramids** and descend as the **lateral corticospinal tract**---\> synapse in anterior/ventral horn onto lower motor neurons---\> **limb** motor movement ...pons---\>15% don't decussate in brainstem but rather continue to **descend ipsilaterally as the anterior corticospinal tract**---\> decussate at the anterior white commissure and synapse in anterior/ventral horn onto lower motor neurons---\> **axial** motor movement

Answer 85

* Ascending pathway carries fibers that control fine touch and proprioception * 3 neuron system (DRG, cunate/gracile nucleus, VPL) Peripheral receptors (Meissner's and Pacinian corpuscles, muscle stretch receptors, golgi tendon organs)---\> **cell body located in DRG**---\> fibers travel up dorsal column (cunate or gracile fasciculus)---\> terminate at cell body in medulla oblongata **(nucleus of cunate or gracile)**---\> decussate to become the medial lemniscus---\> synapse on the **ventral posterior lateral (VPL)** nucleus in thalamus---\> travel through internal capsule---\> terminate in **postcentral gyrus**

Answer 86

Fewer AcH receptors demonstrates a sensitivity to depolarizing agents (sux, fewer receptors to depolarize) and increased sensitivity to non-depolarizing agents (fewer receptors to impose conformational change on)

Answer 87

Describes CO₂transport from tissues to lungs Based on fact that deoxyhgb has 3.5x more capacity for CO₂ than oxyhgb * Once CO₂ enters RBC (Hgb), it combines with H₂0 to form carbonic acid via carbonic anhydrase * Carbonic acid rapidly releases H⁺ protons, forming bicarbonate, which diffuses from the RBC into plasma; H⁺ protons bind to histidine residue of Hgb * Chloride ions replace bicarbonate to maintain neutrality * Once RBC reaches lungs, Hgb is met with high [O₂], which decreases Hgb affinity for H⁺ ions * H⁺ then binds with bicarbonate to form CO₂ + H₂0, CO₂ is exhaled

Answer 88

* Ascending pathway carries fibers involved in pain and temperature * 3 neuron system (DRG, substantia gelatinosa, VPL) Peripheral receptors--\> **cell body in DRG**---\> ascend spinal cord through **Lissauer's fasciculus** (white matter) 1-2 levels---\> synapse onto cell body in dorsal horn = **substantia gelatinosa (rex lamina II)**---\> **axons decussate to the lateral spinothalamic tract**---\> synapse on the ventral posterior lateral **(VPL)** nucleus of the thalamus---\> internal capsule---\> **postcentral gyrus**

Answer 89

Granule size - Smaller granules have greater surface area for absorption but increased resistance to air flow. Ideal granule size is 4-8 mesh

Answer 90

Reflex that results in bradycardia, possible cardiac arrest secondary to traction on the EOM or pressure on the eyeball. Stimuli at the eye --\> ciliary ganglion --\> ophthalmic division of trigeminal n --\> gasserian ganglion --\> trigeminal nucleus --\> vagus n --\> bradycardia

Answer 91

Perioral and tongue numbness \> tinnitus \> lightheadedness, dizziness \> muscle twitching \> seizures \> coma \> respiratory depression \> cardiovascular collapse

Answer 92

Origin = L4-S3, lumbosacral nerve, travels down posterior thigh into popliteal fossa Branches = Tibial nerve and Common Peroneal nerve

Answer 93

The range of a drug between the concentration associated with desired therapeutic effect and the concentration associated with a toxic drug response.

Answer 94

Associated with lidocaine spinal anesthesia, causing LBP, buttocks and LE pain/sensory changes. Risk factors include lidocaine anesthetic, lithotomy, ambulatory anesthesia.

Answer 95

Particles move in all directions, flow rate is the same across the diameter of the tube. Pressure difference will increase to maintain flow and in turn increases resistance. **Gas density more important than viscosity.**

Answer 96

Long and variable CSHT: Highly lipophilic (hydrophobic) --\> large VOD --\> rapid redistribution--\> requires metabolism by liver enzymes--\> slower decrease in plasma drug concentration

Answer 97

Desflurane Tec 6 vaporizer is a dual-gas blender that will deliver anesthetic directly proportional to the atmospheric pressure change. In other words, MAC delivered will be inversely proportional to altitude change (6% des (1 MAC) at 1 atm = 3% des (0.5 MAC) at 0.5 atm)

Answer 98

Concentration effect of N20

Answer 99

Carotid sinus is a mechanoreceptor, responding to changes in pressure. Carotid body is a chemoreceptor, responding to changes in oxygen/CO2 levels in blood.

Answer 100

Physiologic dead space ventilation applies to areas of the lung that are ventilated but poorly perfused, physiologic shunt occurs in lung that is perfused but poorly ventilated. The physiologic shunt is that portion of the total cardiac output that returns to the left heart and systemic circulation without receiving oxygen in the lung.

Answer 101

Desflurane 670 \>\>\> Isoflurane 240 \> Sevoflurane 160

Answer 102

Pulmonary embolism Obstructive lung dz (asthma) Mucuos plugging Intrapulmonary shunt Methemoglobinemia

Answer 103

Downregulation causes decreased number of AcH receptors at NMJ due to sustained/chronic receptor agonism (chronic neostigmine use, organophosphate poisoning) * Decreased sensitivity/increased resistance to AcH/Suxx * Extreme sensitivity to NDNMBA

Answer 104

Meperidine | (Demerol)

Answer 105

Physostigmine

Answer 106

THE PAW Theophylline Heparin Ethanol Phenytoin Aspirin Warfarin

Answer 107

Decrease CSF production: * acetazolamide * furosemide * thiopental Increase CSF production: * desflurane * halothane * ketamine

Answer 108

Oxygen: Green Nitrous oxide: Blue Carbon dioxide: Gray Air: Yellow Helium: Brown Nitrogen: Black

Answer 109

Effects septal and/or anterior left ventricle V1-V4, often V5-V6

Answer 110

Effects lateral left ventricle. I, aVL, V5-V6

Answer 111

Involves territory of LAD and LCx I, aVL, V1-V6

Answer 112

Inferior territory II, III, aVF

Answer 113

Acute administration --\> **potentiates** blockade Chronic administration --\> **decreases duration of action** of aminosteroid NDNMBA

Answer 114

Potentiates effect of ketamine. Mg2+ blocks NMDA receptor channel at rest, therefore, will assist in "antagonizing" the receptor.

Answer 115

Aphonia Airway obstruction **\*Partial injury to nerve** = leads to bilateral adduction of vocal cords Complete transection = paralyzed cords in paramedian position but act as "curtains" so still able to pass ETT **\*partial nerve injury is worse**

Answer 116

Prolongs duration of action of NMBA blockade by inhibiting Ca²⁺ channels both pre and post-synaptically

Answer 117

Hypokalemia potentiates blockade and decreases effectiveness of anticholinesterase antagonism of nondepolarizing blocks.

Answer 118

Positive ionotropes increase contractility, augment cardiac output and thereby enhance end-organ perfusion.

Answer 119

Vaporizers are IA agent specific based on differences in vapor pressure * if a vaporizer calibrated for high vapor pressure (ie: iso) is filled with an agent with low vapor pressure (ie: sevo), less output/lower agent concentration will be delivered * if a vaporizer calibrated for low vapor pressure (ie: sevo) is filled with an agent with high vapor pressure (ie: isoflurane), increased output/higher agent concentration will be delivered

Answer 120

High affinity for beta-1 receptors, also acts on alpha-1 and beta-2 receptors but with equal affinity thereby resulting in no net effect on vascular tone Increases conductance through the SA node

Answer 121

1. prolongs duration of block 2. increases intensity of block 3. decreases systemic absorption of LA How? Epinephrine causes vasoconstriction that counteracts the vasodilatory effects inherent to LA. Therefore, epinephrine causes decreased systemic absorption, decreases intraneural clearance of LA and may have direct analgesic effects vvia alpha 2 receptors in brain and spinal cord.

Answer 122

Also known as Endothelium-derived relaxing factor (EDRF) ## Footnote Vasodilation Antiaggregation of PLTs Stimulates insulin release in pancreas Modulates pain response When bound to Hgb, causes pulm vasodilation

Answer 123

1) increase inotropy thereby improving cardiac output 2) improved lusitropy (myocardial relaxation) 3) decrease pulmonary vascular resistance thereby improve right ventricular outflow 4) vasodilation and reduced afterload

Answer 124

Large R wave in lead V1

Answer 125

Hyponatremia Hypokalemia Hypomagnesia Hypercalcemia Hyperglycemia Hypercholesterolemia Hyperuricemia

Answer 126

Feces All other barbiturates are renally excreted

Answer 127

50% renal excretion, therefore, duration of action is likely to be prolonged in renal failure pts.

Answer 128

Suppresses FSH, LSH, ACTH, TSH, GH Elevates prolactin

Answer 129

CPPLV = ADP - LVEDP (Aortic diastolic pressure - LV end-diastolic pressure)

Answer 130

CO= HR x SV ## Footnote How to measure CO? PA catheter TEE Esophageal doppler

Answer 131

Time remaining (t)= Remaining cylinder pressure (PSi)/ (200 x Flow rate L/min) (t) is measured in hours Ex: 1000PSi remaining at Flow rate 5 L/min means you have 1 hr left to use that E-cylinder

Answer 132

MAP= SVR x CO

Answer 133

SVR= 80 x (MAP - CVP) / CO

Answer 134

Difficult endotracheal intubation- AS as/w atlantoaxial instability and decreased ROM in cervical spine. Difficult mask ventilation- TMJ hypomobility leads to ill-sealing facemasks. AS as/w pulmonary fibrosis. Epidural hematoma- lumbar spine fusion leads to increased attempts. Many AS pts rely on NSAIDs for pain relief, resulting in plt dfxn and increased bleeding risk.

Answer 135

Total body sodium caused by increase/decrease in ECV/plasma; involves aldosterone, ANP Sodium concentration disorders due to excess/deficit of free water; involves ADH **\*think: hyperaldosteronism as/w hypervolemia (increased ECV) resulting in HTN but is NOT as/w abnormal [Na⁺]**

Answer 136

Facial nerve innervates orbicularis oculi (moves eyelid) and corrugator supercili (moves eyebrow). Neuromuscular blockade recovery time at the eyelid is similar to that of the adductor pollicis muscle (peripheral muscle), whereas recovery time at the eyebrow is similar to that of laryngeal muscles and diaphragm (central muscles).

Answer 137

_Low success:_ * time spent in dysrhythmia (longer time = worse outcome) * non-ischemic causes of cardiac arrest (tamponade, Tptx, PE, etc) _Higher success:_ * ischemic causes of cardiac arrest (MI) * applying firm pressure on paddles (~25 lbs) * using proper paddle size, conductive gel * defibrillating on end-expiration * stacked shock strengths

Answer 138

Based on Fick's Law of Diffusion **Vgas = A x D X (P1-P2) ÷ T** * A = surface area of barrier * D = diffusion cofficient (directly proportional to solubility and inversely proportional to sq root of molecular wt) * P1-P2 = partial pressure difference across the barrier * T = barrier thickness Factors that increase diffusion: * low molecular weight * increased solubility * increased partial pressure gradient * increased barrier surface area * decreased thickness of barrier

Answer 139

Lipophilicity and protein binding Lipophilic drugs and high tissue protein binding drugs have higher VoD Increased plasma protein binding has smaller VoD

Answer 140

IV anesthetics **Acute** EtOH intoxication **Chronic** amphetamine use Lithium Advanced age **Hypo**natremia Anemia Hypercarbia Hypoxemia **Hypo**thermia

Answer 141

Gas viscosity and radius of the airway

Answer 142

Gas density and increasing flow rate

Answer 143

Low blood solubility, decreased cardiac output, increased ventilation

Answer 144

Enteral feeds beta-adrenergic stimulation alpha-adrenergic blockade Nitric oxide

Answer 145

* increased velocity * increased tube diameter * increased fluid density * decreased fluid viscosity Reynolds number describes turbulent vs laminar flow Reynolds number = (**velocity** x **density** x **diameter**) / **viscosity** * Reynolds number **\<2000 = laminar flow** * Reynolds number **\>4000 = turbulent flow**

Answer 146

Amphetamines Cocaine Ephedrine **Chronic** EtOH use **Hyper**natremia **Hyper**thermia

Answer 147

Adults \> pediatrics Womyn \> men Larger doses with rapid administration

Answer 148

Hx of motion sickness Block above T5 (sympathectomy) Hypotension Opioid use

Answer 149

* Pelvic/GU/rectal surgery * Hernia repairs * Periop urinary catheterization * Hx of urinary retention * Neuraxial anesthesia (increased risk with hydrophilic opioids, ie: morphine)

Answer 150

Overinflation of cuff Prolonged operative times Lidocaine lubrication Difficult insertion Use of nitrous oxide (displaces air within cuff and can increase cuff pressure by 30 mm Hg) Cervical joint dz

Answer 151

* Volatile anesthetics * Local anesthetics * CCB * Beta blockers * Antibiotics (aminoglycosides) * Magnesium * Chronic steroid use * Dantrolene * Respiratory acidosis * Metabolic alkalosis * Hypothermia * Hypokalemia * Hypercalcemia * Hypermagnesemia

Answer 152

Drug concentration and volume

Answer 153

Clear liquids, 2H Breast milk, 4H Infant formula, 6H Cows milk, 6H Solids, 6H Fried food, 8H

Answer 154

* induction stage, ends with LOC * respiration is slow but regular * **eyelid reflex INTACT**

Answer 155

* "excitement" phase- disinhibition, delirium, **spastic movements** * **loss of eyelash reflex** * divergent gaze * reflex pupillary dilatation * airway irritability- risk of cough, vomiting, laryngospasm, bronchospasm * irregular respirations and breath holding

Answer 156

* period when target level of surgical anesthesia is reached * cessation of eye movement * skeletal muscle relaxation * respiratory depression

Answer 157

The rapid redistribution of fentanyl back to plasma prevents the plasma concentration from quickly falling after the infusion is stopped, even though fentanyl is rapidly cleared (1530 mL/min).

Answer 158

CO = O2 uptake by lungs (ml/min) / (O2 artery - O2 vein) \*arterial oxygen is from left heart, venous oxygen is from right heart

Answer 159

SvO₂ = SaO₂ - [VO₂ / (CO x Hgb x 1.36)]

Answer 160

Oxygen- 625 L, 2200 Psi Air- 625 L, 2200 Psi Nitrous- 1,590 L, 745 Psi

Answer 161

Vomiting (NG suctioning) Diuretic use

Answer 162

**Increased intra-gastric pressure** and **increased LES tone** (LES tone effect \> gastric pressure, therefore, as long as LES is competent, there is no increased risk of aspiration)

Answer 163

Pathology = **Viable lymphocytes in DONOR** blood attack recipient tissues. Recipient is IMMUNOSUPPRESSED so can't mount response S/Sx = fever, rash, cytopenia, liver dfxn, **diarrhea** Timing = 3-4 wks post-transplant Ppx = irradiated blood to reduce donor WBCs or leukoreduction filter use

Answer 164

**Zone 1**, hepatocytes closest to hepatic arterioles and therefore, first zone to come in contact with blood toxins

Answer 165

Prevents overinflation of the lungs

Answer 166

Lower atmospheric pressure will lower boiling point. Boiling point is reached when vapor pressure of liquid is equal to the external pressure exerted on its surface. Therefore, if external pressure is lower, vapor pressure is lower.

Answer 167

Higher CO \> greater volume of blood perfuses the lungs \> removes more inhalation anesthetic from alveoli \> decreases concentration of anesthetic in lungs \> lowers alveolar, arterial and therefore brain partial pressures of inhaled agent \> delay in anesthetic induction

Answer 168

Slows induction. First, anesthetic gas leaving pulmonary arteries are diluted by deoxygenated blood from the right heart. Second, FA/FI is not effected much. Even though there is a higher gradient between mixed venous partial pressure and alveolar partial pressure (favoring uptake), less lung is perfused to participate in gas exchange, so overall there is decreased uptake.

Answer 169

Alkalinization increases the percentage of molecules in their unionized form, therefore, molecules that can cross lipid bilayers and act on voltage-gated sodium channels

Answer 170

Half-life to clearance= inverse relationship, faster clearance= shorter half-life Half-life to VOD= proportional relationship, larger VOD, longer half-life

Answer 171

Either tachycardia or bradycardia can cause hypotension if CO is decreased. Bradycardia--\> enhanced ventricular filling, increased SV but based on CO equation (CO= HR x SV), severely slow HR can lead to decreased CO Tachycardia--\> insufficient time for left ventricular filling resulting in low CO

Answer 172

High plasma clearance = faster/shorter context-sensitive half-time (think Remifentanil)

Answer 173

* stimulates osteoclastic bone resorption * activates distal tubule calcium reabsorption * conversion of vitamin D to calcitriol, which increases gut absorption of calcium

Answer 174

Slower redistribution = faster/shorter context-sensitive half-time Drug is being cleared from plasma faster than drug returning to plasma from tissue compartments.

Answer 175

Fentanyl is much more lipophilic than morphine, and will cross out of the epidural space resulting in a more restrictive segmental spread! Since morphine is more hydrophilic, it does not cross out but rather remains within the epidural space with greater chance of rostral spread. This is why we worry about **delayed respiratory depression with neuraxial morphine!**

Answer 176

Therapeutic doses- 24 hrs Prophylactic doses- 12 hrs

Answer 177

23-26L of CO2 per 100g of absorbent

Answer 178

Acute = 24 - 0.2 x (40 - P_aCO²) Chronic = 24 - 0.5 x (40 - P_aCO²)

Answer 179

Acute = 24 + 0.1 x (P_aCO² - 40) Chronic = 24 + 0.4 x (P_aCO² - 40)

Answer 180

Metabolic **acidosis: Winter's Formula** P_aCO² = (1.5 x HCO3^-) + 8 Metabolic **alkalosis: Summer's Formula** P_aCO² = 40 + 0.6 x (HCO3^- - 24)

Answer 181

Excessive CO2 production is occuring

Answer 182

Surgery requiring deliberate HoTN, HTN- vascular, intracranial, trauma Pts with severe valvular dz CAD CHF who can't tolerate alterations in BP Need to monitor ABG- pHTN, ARDS **Expected large volume shifts**

Answer 183

1) intermediate or high risk elective surgery 2) poor functional status (\<4 METS) or unknown functional status 3) pt would agree to angiography if test were positive 4) care team agrees it would change pts overall care/outcome

Answer 184

Used in high-risk patients undergoing high-risk operations _High-risk factors:_ * prosthetic heart valves * prior hx of IE * unrepaired congenital cyanotic heart dz * repaired congenital heart dz (within first 6 mo of repair) * repaired congenital heart dz with residual defect * valvular dz in transplanted heart _High-risk operations:_ * dental work EXCEPT routine cleanings * respiratory tract biopsy * skin, MSK procedures

Answer 185

Desflurane \> sevoflurane \> isoflurane \> halothane \> nitrous oxide

Answer 186

Nitrous oxide (3,800 mmHg)

Answer 187

1) increased venous return --\> increased RV preload 2) increased pulmonary venous capacitance --\> decreased LV preload 3) increased intrathoracic pressure means LV has more pressure to overcome when contracting --\> increased afterload 4) decreased LV preload + slight increase LV afterload --\> slight decreased arterial BP 5) more RV preload delays pulmonic valve closure causing physiologic split of S2 (pulm and aortic valve closure) 6) increased HR due to inhibited vagal tone

Answer 188

HoTN Tachycardia Decreased chest wall movement Hyperresonance to percussion Arterial hypoxemia Decreased/absent breath sounds Elevated inspiratory pressures

Answer 189

Tachycardia Refractory HoTN Decreased pulmonary compliance Arrhythmia Urticaria Periorbital/perioral edema

Answer 190

1. voltage-gated sodium channels inactivated preventing further sodium influx 2. voltage-gated potassium channels open and allow potassium efflux

Answer 191

Propofol Etomidate Diazepam Methohexital Rocuronium

Answer 192

* Methylene blue absorbs wavelengths at 668nm, close to red light absorption at 660nm seen with deoxyHgb. Therefore, methylene blue generates a higher R value leading to a **FALSELY LOW SpO₂.** * Indigo carmine and indocyanine green also cause falsely reduced SpO₂readings but not to the same extent as MB.

Answer 193

Leukocytosis Elevated hemoglobin Hyperglycemia Hypokalemia Mild hypernatremia Alkalosis Increased urinary uric acid Increased urinary calcium

Answer 194

aPTT ## Footnote Unfractionated heparin enhances the affects of antithrombin 3, which inactivates multiple coagulation factors in the intrinsic pathway- thrombin (II) and factor Xa- which are measured by aPTT

Answer 195

* +direct coombs test * elevated indirect and direct bilirubin * decreased haptoglobin * elevated LDH * elevated BUN * gross hematuria * elevated urinary urobilinogen

Answer 196

**SENSITIVE** to BOTH NDNMBA and SUXX

Answer 197

Methoxyflurane \>\>\> sevoflurane \>\> enflurane \> isoflurane \> desflurane

Answer 198

Red light, emitted at 660nm, is absorbed by deoxyHgb Infrared light, emitted at 940nm, is absorbed by oxyHgb \*this is why arterial blood appears more red than venous blood- oxyHgb absorbs IR light and scatters or reflects red light, making arterial blood appear more red!

Answer 199

**Core-to-peripheral redistribution** of body heat due to VA induced vasodilation and inhibition of tonic thermoregulatory vasoconstriction.

Answer 200

* Clark electrode **requires a battery source** to polarize electrodes, allowing rxn to run faster than galvanic analysis * Exposing galvanic electrodes to air prolongs lifespan of analyzer (lower [oxygen] in air decreases consumption of electrodes by "slowing down" rxn)

Answer 201

Histamine release

Answer 202

Continuous activation of AcH receptors leads to ongoing shifts in sodium influx/potassium efflux. However, increased activity of the Na-K ATPase pump moves the post-junctional membrane potential towards normal, resulting in a faded response to stimulation, a nondepolarizing blockade occurs.

Answer 203

Used to minimize the decrement in FiO2. The system decreases the flow or halts gas administration (besides oxygen) when a decline in O2 pressure is sensed. **Prevents hypoxic mixture delivery.**

Answer 204

Prevents delivery of hypoxic fresh gas mixture if provider attempts to deliver disproportionate ratio of oxygen to nitrous, ie- 1 L/min O2: 4 L/min N2O, delivers \<20% FiO2

Answer 205

ACEi, ARBs Potassium-sparing diuretics (spironolactone, amiloride) Non-selective beta antagonist NSAIDs Sux Heparin Mannitol Trimethoprim

Answer 206

Cyanide and thiocyanate

Answer 207

Acute: [HCO₃^-] decreases 2 mEq/L per 10 mmHg decrease in PaCO₂ Chronic: [HCO₃^-] decreases 5-6 mEq/L per 10 mmHg decrease in PaCO₂

Answer 208

Hepatic metabolism, eliminated via bile and feces. c/i in hepatic disease states.

Answer 209

MOA= dopamine antagonist that works in the chemoreceptor trigger zone of CNS and also acts as a peripheral cholinergic agonist that enhances GI tissue response to AcH. Uses= gastroparesis, N/V Effects= accelerates gastric emptying, increases LES tone, decreases gastric fluid volume and relaxes pyloric sphincter c/i= parkinson's disease due to anti-dopaminergic effects

Answer 210

Inhibits influx of calcium through L-type channels and reduces the slope of uprise of phase 4 and reduces conduction through AV node.

Answer 211

Depress the **reticular activating system of the brainste**m that controls consciousness, primarily through binding GABA a receptor.

Answer 212

Alpha-2 agonism in **locus ceruleous**

Answer 213

Blocks **Na+/Cl- co-transporter** channels in **distal convoluted tubule**s.

Answer 214

Acetylcholinesterase inhibitor \> increases amount of acetylcholine available at motor end plate

Answer 215

Vasopressin= ADH= Arginine vasopressin (AVP) AVP has two primary functions: First, it increases the amount of solute-free water reabsorbed back into the circulation from the filtrate in the kidney tubules of the nephrons. Second, AVP constricts arterioles, which increases peripheral vascular resistance and raises arterial blood pressure.

Answer 216

Anti-PLT: Blocks **glycoprotein IIa/IIIb** receptors that bind fibrinogen

Answer 217

Direct factor Xa inhibition

Answer 218

Anti-PLT: Inhibits thromboxane A₂ synthesis

Answer 219

mu agonist-antagonist with partial agonism at the kappa-opioid receptor. Relieves biliary colic b/c it does not cause sphincter of Oddi contraction in the CBD leading to biliary spasm, like other opioids tend to do.

Answer 220

Anti-PLT: **Inhibits** **ADP receptor activation** on PLT membrane, inhibiting the expression of glycoprotein IIa/IIIb that binds fibrinogen

Answer 221

Anticholinergic drug used topically during ocular surgery to cause mydriasis. Systemic absorption leads to CNS toxicity, ie: dysarthria, AMS, tachycardia, seizures

Answer 222

Direct thrombin inhibition

Answer 223

Anticholinesterase drug used to treat refractory glaucoma by causing miosis. Systemic absorption leads to inhibition of plasma butyrylcholinesterase (pseudocholinesterase) and can cause prolonged duration of action with succ administration.

Answer 224

Glucagon is synthesized and secreted by alpha cells of the pancreas --\> activates G-coupled protein receptors --\> stimulates adenylyl cyclase --\> increased cAMP levels --\> glycogenolysis, gluconeogenesis, inhibition of glycogen synthesis \*b/c glucagon increases cAMP, it also increases intracellular Ca2+ levels, leading to increased ionotropy and chronotropy and increasing MAP resembling epinephrine, NE

Answer 225

Block Na/Cl co-transporter in the distal convoluted tubule causing decrease in Na (and water) reabsorption.

Answer 226

Bind serine protease inhibitor AT III causing a conformational change that increases its activity leading to inhibition of activated factor X and thrombin.

Answer 227

#1: Cardiovascular: HoTN, HTN, arrhythmia Respiratory: hypoxemia, laryngospasm, bronchospasm Pain PONV

Answer 228

Sevoflurane

Answer 229

Bleeding intercostal vessels

Answer 230

Laryngospasm

Answer 231

Respiratory depression due to over-sedation

Answer 232

Paresthesias in perianal, genitals (incidence not decreased with use of LA, NSAIDS, etc)

Answer 233

Ondansetron

Answer 234

Abdominal muscles

Answer 235

Bradycardia. Pediatric pts. have high vagal tone due to acetylcholine receptors at the SA junction. Succinylcholine mimics action of Ach leading to bradycardia.

Answer 236

Posterior cricoarytenoid (attached between posterior cricoid and arytenoid cartilage bilaterally)

Answer 237

Lateral cricoarytenoid and transverse arytenoid muscle, both cause adduction of vocal cords

Answer 238

SENSITIVE to NDNMBA RESISTANT to SUXX

Answer 239

Blue, green, black and opaque acrylic nail polish lead to FALSELY LOW SpO₂ readings.

Answer 240

Formaldehyde, phosphate

Answer 241

* High-dose ketamine * Fentanyl

Answer 242

* repeat dosing (especially within 5 minutes)\* * young age \*succinylcholine metabolic products- succinylmonocholine and choline- sensitive the myocardium to parasympathetic effects of a second dose of succinylcholine

Answer 243

Spironolactone Amiloride Triamterene Eplerenone

Answer 244

1) Hypovolemia (hemorrhage, fluid losses, NPO status) 2) Venodilation (GA, neuraxial anesthesia) 3) PTX (prevent ventricular filling due to increased pressure around the heart) 4) Pericardial tamponade (same mechanism as PTX) 5) Pulmonary embolism (effects right heart ability to pump sufficient blood to left heart for CO)

Answer 245

* Preload * Afterload * Myocardial contractility * HR * Rhythm

Answer 246

Ketamine Methadone Tramadol Nitrous oxide Dextromethorphan Memantine Magnesium

Answer 247

Thiopental infusion --\> desulfurization --\> Pentobarbital CNS depression.

Answer 248

_Left shift_: increased Hgb affinity for O₂, less unloading * decrease pCO₂ * decrease [H⁺] = increase pH * decrease 2,3-DPG * hypothermia * HbF _Right shift_: decreased Hgb affinity for O₂, more unloading * increase pCO₂ * increase [H⁺] = decrease pH * increase 2,3-DPG * hyperthermia

Answer 249

Stroke Spinal cord injury Burns Prolonged immobilization Prolonged exposure to NMBA Myopathies (Duchennes MD) Denervation d/o (MS, GBS, ALS)

Answer 250

Echothiophate (glaucoma drug) Neostigmine, pyridostigmine Phenelzine (MAOI) Cyclophosphamide Metoclopramide Esmolol OCP

Answer 251

Thiopental, propofol, **fentanyl**, methohexital. ## Footnote **Lipophilicity**

Answer 252

* smoking * dry gas inspiration * extreme temperature exposure * dehydration * inhaled anesthetics * opioids * atropine * alcohol

Answer 253

Older age **Acute** alcohol intoxication Anemia PaCO2 \>95mmHg Hypotension (MAP \<40mmHg) **Hypo**natremia Hypercalcemia Pregnancy

Answer 254

Young age **Chronic** alcohol use Hypernatremia Cocaine Ephedrine T \>42C (hyperthermia) MAOI, Levodopa use

Answer 255

Elimination of rebreathing High fresh gas flows Low anesthetic-circuit volume Low absorption by anesthesia circuit Decreased solubility of IA High CBF Increased ventilation

Answer 256

1. Thalamus: * made up of nuclei, acts as a relay station for motor, sensory, limbic, auditory and visual systems * involved with arousal 2. Hypothalamus: * controls ANS * endocrine fxn via pituitary * **thermoregulation** * circadian rhythm 3. Epithalamus: * pineal gland (produces melatonin) 4. Basal ganglia: * **movement** 5. Hippocampus: * memory and learning 6. Amygdala: * **"fight-or-flight" response** * fear, emotions

Answer 257

Internal branch of superior laryngeal nerve

Answer 258

Factor VIII and XIII FIBRINOGEN Von Willebrand Factor Fibronectin

Answer 259

Factor VII

Answer 260

* acute onset hypoxemia **within 6 hrs of tranfusion** * bilateral pulmonary infiltrates on CXR * NO cardiogenic cause of pulmonary edema (therefore, **PCWP \< 18 mmHg**) * NO pre-existing lung injury

Answer 261

Morphine = morphine-6-glucoronide Meperidine = normeperidine \*both are active metabolites that require renal elimination, therefore, dose adjustment in pts with renal failure

Answer 262

Flumazenil

Answer 263

Bone, ligament, cartilage

Answer 264

Brain, heart, lungs, liver, kidney, endocrine glands These tissues approach equilibration with the [plasma] more rapidly due to blood flow

Answer 265

Blood solubility Alveolar blood flow (cardiac output) Difference in **partial pressure** between alveolar gas and venous blood

Answer 266

1) Complete heart block (atropine works on SA node) 2) Transplanted heart (lacks innervation)

Answer 267

Increase diameter of circuit tubing Minimize sharp bends Decrease circuit length

Answer 268

Long thoracic (C5-6-7) and dorsal scapular (C5) nerves

Answer 269

Anterior cutaneous nerves (anterior thigh) Infrapatellar branch of Saphenous nerve (below knee cap) Saphenous nerve - medial lower extremity

Answer 270

Veno-arterial vasodilation (venodilation \>\> arteriodilation) with decreased preload and SV T1-T4, cardiac sympathetic fibers, bradycardia Biphasic CO: initially, increased SVR with increased CO; eventually, increased venodilation with decreased preload and CO

Answer 271

Supraspinous ligament \> interspinous ligament \> ligamentum flavum \> epidural space (LOR) \> dura mater "pop" \> subarachnoid space with cauda equina and CSF

Answer 272

Most sensitive, blocked first= preganglionic sympathetic fibers Sensory, C fibers= temp. (cold) Sensory, A delta= pinprick, sharp Sensory, A beta= touch Least sensitive, blocked last= Motor A alpha

Answer 273

States there is NO difference between the variables tested

Answer 274

Measure of **association between exposure and an outcome**. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.

Answer 275

Some opioids have 5-HT_1A agonism that augments serotonin release and weakly inhibits reuptake, therefore, increasing synaptic serotonin levels * fentanyl * tramadol * methadone * meperidine

Answer 276

Desflurane \> Sevoflurane \> Isoflurane \> Halothane

Answer 277

200 - 300 mmHg

Answer 278

Acute glottic closure (laryngospasm)--\> pt continues to inspire against closed glottis --\> generates sudden increase in negative intrathoracic pressure --\> increased venous return to right heart and pulmonary arteries --\> increased volume expansion causes high arteriole/capillary fluid pressure that favors transudation into alveolar space

Answer 279

Lateral spinothalamic tract \*also responsible for temp and touch

Answer 280

IV \> tracheal \> intercostal \> caudal/paracervical \> epidural \> brachial plexus \> sciatic/femoral \> spinal \> subcutaneous

Answer 281

Acts to suppress Substance P in dorsal horn, substantia gelatinosa

Answer 282

Increased analgesia Red hair

Answer 283

Decreased efficacy of morphine

Answer 284

Extrapyramidal symptoms (EPS)- acute dystonia, akathisia, tardive dyskinesia Tx = anticholinergic medication, ie: diphenhydramine, benztropine, atropine

Answer 285

Beta-blocker ACE inhibitor HI statin ASA **\*if EF \<35%, add spironolactone**

Answer 286

Liver failure (requires routine LFT monitoring)

Answer 287

R(R)ODS Restricted mouth opening Resistance of airway (restrictive airway dz) Obstruction Distorted anatomy Short TM distance

Answer 288

Pt must be able to remain motionless and, if necessary, actively cooperate throughout the procedure \*exclusion = cognitive dfxn, CHRONIC COUGHING, Tourettes

Answer 289

10 cmH₂0 : 7.4 mmHg

Answer 290

beta-1: exclusively in cardiac muscle, ionotropy, chronotropy beta-2: vascular smooth muscle, vasodilation alpha-1: vascular smooth muscle, vasoconstriction dopamine 1 and 2: renal, splanchnic vasculature, vasodilation

Answer 291

HR (ventricular contraction rate per minute)

Answer 292

LA dose LA baricity Pt positioning

Answer 293

* ventricular fibrillation * pulseless ventricular tachycardia

Answer 294

* The principle that the electrical resistance of a wire increases as it extends. * Strain gauges are incorporated into pressure transducers used for invasive arterial BP monitoring. The constant variation of BP through an arterial catheter is connected to a column of saline, which transmits pulse pressure through this pressurized column onto a flexible diaphragm, causing the shape of the diaphragm to change. The displacement of the diaphragm is measured by a strain gauge. * Used to convert mechanical energy (pulsatile BP) into electrical energy.

Answer 295

Sniffing position= **neck flexed** 35 degrees with **head extended** 15 degrees brings oral-pharyngeal axis to 125 degrees (with displacement of the tongue during DL, provides 180 degrees and view of glottis)

Answer 296

Propofol is not contraindicated in pts with egg allergy, why? Egg lecithin used in propofol emulsion is derived from egg yolk. Most egg allergies are due to egg albumin found in egg whites.

Answer 297

* Remember: CPP = MAP - ICP * Propofol causes both venodilation and arterodilation leading to decreased MAP \> ICP. Ultimately, propofol results in reduced CPP.

Answer 298

* located between the vaporizers and common gas outlet * permit only unidirectional flow of gases * **prevent retrograde flow of gases** from the anesthesia machine or the transfer of gas from a compressed-gas cylinder at high pressure into a container at a lower pressure

Answer 299

Discontinue the flow of N2O (or proportionally reduce it) if the O2 pressure within the anesthesia machine falls below 30 psi

Answer 300

PaCO₂ decreases 1.2 mmHg per 1 mEq/L of [HCO₃^-] to minimum of 10-15 mmHg

Answer 301

* PaCO₂ increases 0.5 mmHg per 1 mEq/L increase in [HCO₃^-] * Last 2 digits of pH should approximate [HCO₃^-] + 15

Answer 302

Decreased lung compliance Increased V/Q mismatch Increased inspiratory pressure Increased PaCO2 and decreased blood pH

Answer 303

* profound respiratory depression leading to apnea * blunts medullary respiratory center response to PaCO₂(therefore, need a higher PaCO₂ before spontaneous ventilation will resume) * decreases TV * bronchodilation * minimal effect on hypoxic pulmonary vasoconstriction

Answer 304

Reynolds number = (velocity x density x diameter ) / viscosity RN \< 2000 = laminar flow RN \> 4000 = turbulent flow

Answer 305

IgA deficiency

Answer 306

Smoking DM Age High LDL Low HDL

Answer 307

**#1= LA POTENCY (lipophilicity)** 2. decrease in protein binding 3. systemic acidosis 4. hypercapnia 5. hypercarbia

Answer 308

Neck hyperflexion Elevated diaphragm, ie: pneumoperitoneum Head down position **"ETT tip follows the chin"**

Answer 309

Light plane of anesthesia Extubation during phase II Oropharyngeal secretions Recent URI Pediatric pts Hx of reactive airway dz Second-hand smoke exposure

Answer 310

Emergency surgery Trauma Bowel obstruction Morbid obesity AMS Age \>60 yo Pregnancy DM Severe GERD

Answer 311

Advanced age Lower educational level Hx of CVA

Answer 312

Womyn **Hx of PONV and/or motion sickness** Non-smokers Age \<50 GETA IA, esp nitrous oxide Post-op opioids Surgical type- laparoscopy, gyn, breast, eye surgery

Answer 313

FHx of substance use Use of major opioid, ie: fentanyl Presence of co-existing psychiatric d/o

Answer 314

* chronic meperidine therapy * large doses meperidine over short period of time * renal failure

Answer 315

Acute Porphyria Crisis, presenting with severe abdominal pain, nausea and discolored urine.

Answer 316

Hypovolemia leading to systemic HoTN Acute mannitol toxicity * hyponatremia * elevated serum osmolality Exacerbation of edema

Answer 317

Post-op myocardial ischemia Poor wound healing and infection

Answer 318

DISS, PISS Flowmeter sequence (oxygen outlet located in downstream position) Fail-safe system Proportioning system **Oxygen analyzer (last safety mechanism in line before gas delivered to patient**; measures oxygen concentration beyond fresh gas outlet)

Answer 319

Treatment of beta-blocker overdose Treatment of anaphylaxis in pts taking beta blockers Glucagon acts on G-coupled protein receptors and increases cAMP levels and Ca2+ levels by bypassing the second messenger system providing ionotropy and chronotropy and increasing MAP.

Answer 320

TP/ TP + FN "Rules Out" disease **Screening test should be highly sensitive**

Answer 321

Saphenous nerve, a branch of the femoral n.

Answer 322

Impaired thermoregulation

Answer 323

Bradycardia HoTN Dry mouth Nausea

Answer 324

Yellow-green color vision d/o

Answer 325

Hypokalemic- hypochloremic metabolic **alkalosis**

Answer 326

Class III antiarrhythmic that blocks potassium channels * Bradycardia, HoTN (risk factors include age \>60 yo and higher dose therapy) * AV nodal block * Prolonged QT interval, torsades de pointes * Acute pulmonary toxicity (risk remains present for duration of amiodarone t1/2 of 45 days) * Hypothyroidism * Hyperthyroidism storm resulting in high output CHF * Skin hyperpigmentation causing blue-grey appearance * Optic neuritis and corneal deposits * Statin-induced myalgias * Elevated LFTs

Answer 327

Activation of parasympathetic NS: * bradycardia * hypotension * bronchospasm * increased secretions * miosis * decreased IOP

Answer 328

Hypocalcemia Hypokalemia HoTN

Answer 329

Hyperkalemia Hyponatremia Gynecomastia Impotence

Answer 330

#1: anaphylaxis/hypersensitivity rxn #2: severe bradycardia Increased risk of unintentional pregnancy if on OCPs Prolonged PT/INR and aPTT Arrhythmias HoTN

Answer 331

1) increased excretion chloride \> hypochloremic metabolic alkalosis 2) increased excretion sodium \> hyponatremia 3) increased excretion potassium \> hypokalemia 4) directly inhibit calcium excretion \> hypercalcemia

Answer 332

Abdominal pain, shoulder pain, nausea

Answer 333

Collapse of reservoir bag after NGT placed to suction

Answer 334

Hypoxemia is then secondary to: * V/Q mismatch * pulmonary shunt (perfused lung that receives no ventilation) * diffusion barrier/restriction

Answer 335

Hypoxemia is then secondary to either **hypoventilation** or **decreased inspired oxygen concentration**.

Answer 336

Tachycardia HoTN Bronchospasm Hives Hemoglobinuria

Answer 337

Partial spinal cord transection resulting in: * ipsilateral motor deficit below injury (weakness, due to transection of corticospinal tract) * ipsilateral loss of vibratory and joint positioning (due to transection of dorsal column) * contralateral loss of pain and temp 1-2 levels below lesion (due to transection of spinothalamic tract)

Answer 338

Hypovolemia Polyuria Elevated BUN, Cr Hypernatremia Serum hyperosmolality

Answer 339

Fever, chills Nausea, vomiting Diarrhea Chest and back pain Acute renal failure DIC

Answer 340

Injury to peripheral neuron after its synapsed in the anterior horn, resulting in: * flaccid paralysis * diminished or absent DTR * muscle atrophy * +/- fasciculations

Answer 341

Agitation, tremor Tachycardia, HTN Diarrhea Mydriasis Hyperthermia Symmetric hyperreflexia Myoclonus, rigidity Autonomic instability DIC, rhabdomyolysis Seizure, coma

Answer 342

* Cyanosis * Tachypnea * HoTN * \*Distended neck veins * tracheal deviation * absent breath sounds on affected side \*JVD may be absent in hypovolemic pts

Answer 343

Injury to cerebral cortex or descending pathway in spinal cord resulting in: * spastic paralysis * hyperactive DTR (ie: + babinski)

Answer 344

Signs of volume overload are specific to TACO: * increased JVD * peripheral edema * HTN

Answer 345

Delirium/AMS Decreased secretions- dry mucous membranes Mydriasis Hyperthermia Decreased GI/GU activity

Answer 346

Becks triad: HoTN Distended neck veins Muffled heart sounds **Narrow pulse pressures**

Answer 347

Battle sign (mastoid ecchymosis) Raccoon eyes Bleeding from ears or nose

Answer 348

Decrease oxygen saturation Increase in peak airway pressure Increase in plateau airway pressure

Answer 349

Incomplete injury s/f sacral sparing: * voluntary contraction of the anus * sensory preservation over sacral distribtution

Answer 350

* Flaccid areflexia * Loss of rectal sphincter tone * Paradoxic respiration * Bradycardia in hypovolemic pt

Answer 351

* Cutaneous vasodilation * Anhidrosis * Hyperthermia * Mydriasis * AMS * Urinary retention * +/- respiratory depression "**Red** as a beet, **Dry** as a bone, **Hot** as a hare, **Blind** as a bat, **Mad** as a hatter, **Full** as a flask"

Answer 352

Anterior spinal artery syndrome, due to interruption of blood flow to anterior spinal artery: ## Footnote Bilateral LE paraplegia Bowel/bladder dfxn Loss of pain and temp Proprioception and vibration are preserved as posterior portion of spinal cord is supplied by PSA.

Answer 353

Specific: * act on beta 1 receptors in cardiac myocardium and on SA node * slow SA node conduction * metoprolol * atenolol Non-specific: * act on beta 1 and beta 2 receptors * beta 2 receptors found on vascular smooth muscle and bronchioles * slows SA node conduction * decreases SVR * labetalol * propranolol * carvedilol

Answer 354

TN/ TN + FP "Rules In" disease **Confirmatory test** should be highly specific

Answer 355

Apply pressure to retromandibular notch Apply 15-20 cm CPAP, 100% oxygen Administer 1mg/kg propofol Administer 0.5mg/kg sux (add 0.01mg/kg atropine in peds due to risk of severe bradycardia with sux)

Answer 356

Partial glottis: Epiglottis Posterior features of true vocal cords Arytenoids

Answer 357

**Epiglottis only**

Answer 358

Glottis structures are not visualized

Answer 359

Hard palate Soft palate Uvula

Answer 360

Hard palate Soft palate

Answer 361

**Hard palate only**

Answer 362

Tryptase levels, drawn within 1-2 hrs of rxn. Tryptase is released from mast cells when activated by IgE, the immune cells involved in type I hypersensitivity rxn, anaphylaxis.

Answer 363

Diaphoresis ## Footnote Sweat glands are innervated by sympathetic nervous system using acetylcholine neurotransmitter onto muscarinic receptors, therefore, beta blockade will not prevent sweating due to hypoglycemia

Answer 364

Fever, back pain and progressive neurological symptoms. Staph Aureus from skin flora.

Answer 365

General: Flushing, N/V Neuro: Sedation, dizziness, muscle weakness, loss of DTR Cardiac: HoTN, bradycardia, PR prolongation, widened QRS, complete heart block Increased sensitivity to NDNMBA, therefore, use smaller doses in pts with hypermagnesemia IV Mg2+ is a calcium channel antagonist that affects the presynaptic Ca channels and decreases release of AcH while also decreasing the motor end plates sensitivity to AcH.

Answer 366

**R time**= time to start clot formation; problem with coag factors; **tx = FFP** **K time**= time until clot reaches full strength; problem with fibrinogen; **tx= cryoprecipitate** **alpha angle**= speed of fibrin accumulation; problem with fibrinogen; **tx= cryoprecipitate** **MA**= problem with platelets; **tx= PLT and/or DDAVP** **LY30**= lysis of clot at 30 minutes; problem with excess fibrinolysis; **tx = TXA and/or aminocaproic acid**

Answer 367

* \<24 hrs: right shift of oxygen dissociation curve * 48-72 hrs: increased secretions and reactive airways * 2-4 weeks: decreased secretions and reactive airways * 4-6 weeks: normalized immune system and metabolism * 8-12 weeks: improved mucociliary transport and small airway function

Answer 368

Adults- dural sac, S1; CM, L1 Infants- dural sac, S3, CM, L3

Answer 369

**MV** and **inspired concentration** Other important factors that determine uptake in blood of agent are: * solubility * CO * difference between partial pressure of anesthetic agent in alveolus vs mixed venous blood

Answer 370

1. Inhalation injury 2. Burn size \>40% TBSA 3. Age \> 60 yo.

Answer 371

Underlying etiology not definitely known; 2 hypothesis: * donor blood contains anti-HLA or HNA antibodies that activate complement cascade, resulting in neutrophil recruitment to pulmonary vasculature resulting in endothelial damage and capillary leakage leading to pulmonary edema * Two-hit model: stress (surgery, trauma, infxn) causes neutrophil sequestration in the lungs; transfusion contains donor antibodies against HLA or HNA substypes resulting in neutrophil activation and lung injury Tx: * supportive- supplemental oxygen, PPV, IVF, vasopressors * steroids (to reduce inflammatory response) * **_DIURESIS NOT INDICATED_** AND MAY CAUSE FURTHER DAMAGE!!!!

Answer 372

Pathology = antibodies in the DONOR blood react with the recipient's WBCs, activating the inflammatory cascade, causing fever and chills. S/Sx = Temp increase 1-2 ºC, chills, rigors, **anxiety**, and headache Timing = within 4 hrs of initiating transfx Risk factor = hx of chronic transfusions; why? antibodies increase with a greater number of tranfusion exposures Ppx tx = NSAIDS, acetaminophen Tx = STOP transfusion

Answer 373

Pathology = ABO incompatibility due to IgM ab-antigen complexes activating complement system resulting in intravascular and extravascular RBC hemolysis S/Sx = The release of bradykinin causes fever, hypotension, and hemodynamic instability, while histamine release from mast cells leads to bronchospasm and urticaria, as well as symptoms of dyspnea, flushing, and **severe anxiety**; hemoglobinuria, DIC Timing = immediate Tx = **STOP TRANSFUSION**, resuscitation

Answer 374

Pathology = **RECIPIENT** blood contains **minor antigens** (Rh, Kell, Kidd, Duffy) from _prior transfusion, pregnancy_ that react to **DONOR RBC antibodies** S/Sx = mild fever, +/- rash, jaundice (^ direct bili), hemoglobinuria, +/- anemia, **+ direct coomb's test** Timing = 3-10 days post-transfusion Tx = supportive **\*note: sx \>mild than AHTR b/c hemolysis of RBC occur extravascular in reticuloendothelial system - spleen and liver**

Answer 375

Anticholinergic drugs (atropine, glycopyrollate) Sympathectomy due to spinal anesthesia leads to unopposed parasympathetic (vagal) activity, causing increased peristalsis, leading to nausea.

Answer 376

Elevated mixed venous oxygen Tachyphylaxis Metabolic acidosis

Answer 377

* Morphine * Atracurium Histamine release can induce bronchospasm

Answer 378

* drug size * electric charge ## Footnote **\*small, nonpolar drugs have increased VoD**

Answer 379

Baricity and patient position

Answer 380

Alpha, False positive Accepted alternative hypothesis (Ha) but null hypothesis (Ho) is true (can't be rejected)

Answer 381

Beta, False negative Accepted null hypothesis (Ho) but alternative hypothesis (Ha) was true

Answer 382

Increasing frequency of sound waves emitted increases image resolution but decreases the ability of the wave to penetrate deeper tissue.

Answer 383

Determined by density of tissue and propagation speed of sound wave

Answer 384

Sound waves pass through low attenuation tissue- CSF, blood- allowing energy returning to probe from deeper structures that appear bright

Answer 385

Structures deep to tissues with high attenuation- bone, tendons- appear black because the reflection from more superficial structure blocks signal from deeper structures

Answer 386

Wave form bounces back and forth between two parallel interfaces causing multiple delayed signals to return to probe

Answer 387

Curved array probe maximizes returning ultrasound waves, allowing better visualization of deeper structures. Linear array probes have higher frequency, better resolution but with less penetration and therefore, unable to better visualize deeper structures.

Answer 388

Based on acoustic impedance (sound wave transmission vs sound wave reflection). ## Footnote **Echolucent/anechoic**- increased transmission/conduction, appears **BLACK** due to high water content, ie: **CSF, blood** **Hyperechoic**- increased reflection, appears **bright/white**, ie: **bone, tendons, fascial planes** **Hypoechoic**- both absorption and reflection, appears **gray**, ie: **fat and muscle**

Answer 389

Increasing sound wave frequency increases resolution but decreases depth (penetration) of image. Higher frequency wave forms scatter more easily, depth increases scatter further.

Answer 390

Circuit \> brain = alveoli \> muscle \> fat

Answer 391

Temperature

Answer 392

Decreased EtCO2 Desaturation in pulse ox No change in airway pressure HoTN

Answer 393

Increased EtCO2 Desaturation in pulse ox Increased airway pressures Hyper-resonance

Answer 394

Desaturation in pulse ox Increased airway pressures Unilateral decreased breath sounds **\*EtCO₂ is least sensitive indicator- may increase, decrease or have no change!**

Answer 395

Decreased EtCO2 Desaturation in pulse ox Increased airway pressures

Answer 396

Increased EtCO2 No change in pulse ox No change in airway pressure +/- crepitus

Answer 397

Absorption, distribution, biotransformation, excretion

Answer 398

Stylopharyngeus muscle (dilates pharynx during swallowing) Parotid gland Glands of posterior tongue

Answer 399

Sensation to pharynx, middle ear, posterior 1/3 of tongue (taste buds), carotid body and sinus.

Answer 400

Potency, efficacy, therapeutic window. It's all about how the drug affects the body.

Answer 401

Adult: 1500 mL Child: 500 mL Infant: 250 mL

Answer 402

Methylparaben (preservative ingredient)

Answer 403

Lidocaine can destabilize the lipid emulsion of propofol and precipitate lipid droplets that, when \>5 mcm can lead to embolism.

Answer 404

N₂O irreversibly oxidizes cobalt atoms in vitamin B₁₂, thereby rendering enzymes that are B₁₂ dependent dysfunctional, including methionine synthetase necessary for myelin formation and thymidylate synthetase, responsible for DNA synthesis. This is related to bone marrow suppression, megaloblastic anemia and peripheral neuropathy.

Answer 405

Pneumotachometer is a type of **fixed-orifice flowmeter.** In this type of flowmeter, gas is channeled through a narrowed conduit, the narrowing increases resistance to flow dropping the pressure of gas as it exits. This pressure drop across resistance is proportional to the flow rate. Limitation: only accurate when flow is laminar.

Answer 406

Any negative deflection that precedes an R wave. Bad= \>40 ms/ 1 mm wide \>2 mm deep \>25% depth of QRS Observed in leads V1-V3

Answer 407

CAS is caused by anticholinergic medications that cross the BBB (scopolamine and atropine, due to tertiary amine structure). It is similar to post-op delirium with symptoms including agitation, hallucinations, seizure, coma. Tx= physostigmine, why? It is the only cholinesterase inhibitor that also has a tertiary amine structure and therefore crosses the BBB.

Answer 408

Diminished enzyme reduction of methemoglobin back to hemoglobin because iron (Fe2+) has been oxidized to iron (Fe3+) and can't carry oxygen. Avoid prilocaine (EMLA cream), benzocaine, quinine, metoclopramide, sulfa drugs, dapsone.

Answer 409

Tenses and ADDUCTS the vocal cords. Innervated by the external branch of the superior laryngeal nerve.

Answer 410

Internal branch of the superior laryngeal nerve

Answer 411

Reduces ventricle wall tension.

Answer 412

* Descending pathway, originates in the precentral gyrus, descends through corona radiata and genu of the internal capsule before terminating onto motor nuclei = cranial nerves * CN III, IV, V, VI, VII, IX, X, XI, XII

Answer 413

AVP secretion is normal in CSWS

Answer 414

4% per Liter. Max FiO2 obtainable with nasal cannula is 44% at 6L.

Answer 415

TRALI **FFP** \> PRBC

Answer 416

Vocal cords are no longer visualized with grade IIb view

Answer 417

FiO2 90%. Why not 100%? Pt inspires a small amount of room air, otherwise if the oxygen supply was depleted, the patient would suffocate.

Answer 418

Score used to predict mortality in pts with end-stage liver disease. Used to prioritize patients for liver transplantion. **Components= INR, creatinine, sodium, bilirubin, dialysis (I Crush Several Beers Daily)**

Answer 419

An observation that inhaled anesthetic potency correlates directly with their lipid solubility.

Answer 420

Neuromuscular blocking agents

Answer 421

**Urticarial allergic reaction** (1-3% of all transfusions delivered) Sx = urticaria and pruritus, airway is not typically involved Tx = diphenhydramine + cont tranfusion exception = if rxn affiliated with cardiovascular or pulmonary instability, STOP transfusion, provide supportive care

Answer 422

Type I hypersensitivity rxn, requires prior sensitization IgE binds antigen --\> Fc receptor of Ige then binds to mast cells --\> degranulation of histamine. leukotrienes, prostaglandins

Answer 423

Hemoglobin Hgb takes up H⁺ ions when pH becomes acidotic and releases H⁺ ions when pH increases.

Answer 424

Lipophilicity

Answer 425

Worsening hypercapnia 2/2 V/Q mismatch (O2 decreases HPV in areas of lung that should be constricted b/c they are not ventilated well)

Answer 426

Erythromycin

Answer 427

Aminoglycosides (Gentamicin, Neomycin) Tetracylcins Clindamycin

Answer 428

Clopidogrel Ticlopidine

Answer 429

Abciximab Eptifibatide Tirofiban

Answer 430

#1: administer via antecubital vein #2: modified Bier block (occlude vein 30-120 sec \> administer lidocaine \> then give propofol)

Answer 431

Medial thigh **Obturator nerve (ventral rami of L2-L4)**, whereas Femoral nerve originates from the anterior rami of L2-L4

Answer 432

Anterior compartment of lower extremity and dorsum of foot

Answer 433

Diazepam (Valium) because a primary metabolite -- desmethyldiazepam and 3- hydroxydiazepam -- are physiologically active and prolong sedative effects.

Answer 434

External branch of superior laryngeal n.

Answer 435

Internal branch of superior laryngeal n.

Answer 436

Recurrent laryngeal n.

Answer 437

Cardiac myocytes

Answer 438

PNS- Schwann cells CNS- Oligodendrocytes

Answer 439

Esters- metabolized to PABA (para-aminobenzoic acid).

Answer 440

Amides- metabolized by liver enzymes, whereas esters are broken down by esterases in plasma, therefore, have less time in systemic circulation to cause toxicity than amides.

Answer 441

XIII --\> XIII_a X --\> X_a Prothrombin --\> thrombin

Answer 442

CN IX, glossopharyngeal

Answer 443

CN V, trigeminal- nose, nasopharynx CN IX, glossopharyngeal- tongue --\> upper epiglottis CN X, vagus- larynx --\> below epiglottis (trachea)

Answer 444

ACE inhibitors Block conversion of AT I to ATII, therefore, block production of aldosterone, effectively reducing afterload and **prevent ventricular remodeling**.

Answer 445

Cholinesterase inhibitors. These inhibitors block enzyme degradation of AcH, thereby increasing [AcH] at synaptic cleft that further potentiates action of depolarizing agents. By inhibiting cholinesterase activity, increased [AcH] is available to compete with NDNMBA action at AcH receptors thereby overcoming their blockade effects.

Answer 446

* Norepinephrine * Propofol * Serotonin * Atrial natriuretic peptide * Endothelins * Adenosine * Bradykinin

Answer 447

* Epinephrine * Histamine * Dopamine * Isoproteronol

Answer 448

* Hyponatremia * Hypokalemia * Hypomagnesemia * Hyperuricemia * Respiratory alkalosis

Answer 449

Hyponatremia Hypochloremia (metabolic alkalosis) Hypokalemia Hypercalcemia

Answer 450

Hypokalemia Hypocalcemia (increased calcium binding to negatively charged plasma proteins-albumin- as proteins release hydrogen ions to restore physiologic pH Hypophosphatemia

Answer 451

**CYP3A4** (amiodarone, aprepitant, cyclosporine, diltiazem, verapamil, voriconazole, grapefruit juice, protease inhibitors- indinavir)

Answer 452

11-beta hydroxylase

Answer 453

Pseudocholinesterase

Answer 454

Drug volume

Answer 455

Equipment ground wire ## Footnote How? It is a low impedance wire that allows current leakage to pass through to prevent buildup of leakage current.

Answer 456

**Oxygen and Xenon** They are both non-polar molecules

Answer 457

Cyclosporine

Answer 458

Sevoflurane

Answer 459

N20, Xenon

Answer 460

Sodium, calcium influx and potassium efflux

Answer 461

PT/INR PT test extrinsic pathway, specifically factor VII, which has the shortest t1/2 of all clotting factors.

Answer 462

Limbic lobe, containing the hippocampus and amygdala

Answer 463

Tetracaine, procaine

Answer 464

Bupivacaine

Answer 465

Corrugator supercilli muscle, innervated by facial nerve, causes movement of the eyebrow.

Answer 466

Recurrent laryngeal n. branch of CN X, vagus n. and posterior cricoarytenoid muscle.

Answer 467

Recurrent laryngeal n. branch of CN X, vagus n. and lateral cricoarytenoid muscle.

Answer 468

Nerve: * superior laryngeal nerve (CN X, vagus n.) Muscle: * cricothyroid (causes vocal cord adduction) \*other muscles involved= cricoarytenoids, thyroarytenoids

Answer 469

Musculocutaneous n.

Answer 470

Median nerve

Answer 471

Pancuronium 80% renal elimination

Answer 472

mu-2, mu-1, sigma (respectively)

Answer 473

Meperidine, Tramadol, Methadone They are considered weak serotonin reuptake inhibitors.

Answer 474

1. Isthmus of the descending aorta (area of the arch between the left subclavian artery and ligamentous arteriosum) * arch is freely mobile but ligament anchors descending aorta, making it vulnerable to traction and tearing 2. Aortic root * fixed by the diaphragm, therefore vulnerable to velocity changes

Answer 475

Norepinephrine

Answer 476

Constipation and myosis

Answer 477

Mydriasis and sedation. Glycopyrrolate is a quaternary molecule that is too big to cross the BBB, therefore, does not cause CNS side effects.

Answer 478

Stratum corneum

Answer 479

R + isomer

Answer 480

Intracranial surgery Middle ear surgery Posterior eye surgery Intramedullary spine surgery (vertebrae) Prostate surgery

Answer 481

Dose and plasma concentration

Answer 482

Check valve

Answer 483

Choroid plexus of the lateral and third ventricles

Answer 484

Arterioles

Answer 485

NMBA are divalent molecules and can cross-link IgE with resultant mast cell degranulation even without forming hapten-macromolecule complexes.

Answer 486

Underlying pulmonary contusion with increased elastic recoil of the lung, in setting of increased work of breathing.

Answer 487

It has a relatively **high concentration (3%)**. pKa is just one factor in onset of action for local anesthetics (lipid solubility and injection site are other variables that contribute to onset).

Answer 488

Variable bypass vaporizers used for sevo and iso are constructed for their unique vapor pressures, and rely on **ambient temperature** to continually vaporize liquid anesthetic. Boiling point for sevo/iso is greater than room temperature, allowing ambient temp to act as energy source for vaporization. **Desfluranes boiling point is close to room temperature**

Answer 489

Dex acts on centrally located alpha-2 receptors, activating presynaptic receptors in the locus ceruleus. Alpha-2 receptors active inhibitory neurons, causing decrease in NT release. When this effects sympathetic neurons, catecholamine release is reduced resulting in decreased HR and BP.

Answer 490

pKa is the pH at which the fraction of ionized (acidic) and unionized (basic) drug is equal to each other. When pKa is closer to physiologic pH (7.4), more drug is in the unionized (basic) form, which is the only form that penetrates the nerves cell membrane to create effect.

Answer 491

Acidosis Hypothermia Dilutional coagulopathy

Answer 492

EMLA cream contains lidocaine and prilocaine. Prilocaine is biotransformed into aminophenols which oxidize hemoglobin into methemoglobin.

Answer 493

Risk of hyperkalemia. Normal muscle releases enough potassium during sux induced depolarization to raise serum potassium by 0.5 mEq/L.

Answer 494

Zero-order= a constant amount of medication is removed per unit time First-order= a constant proportion/percentage of medication is removed per unit time; dependent on liver blood flow for elimination Note: any drug can follow zero-order kinetics

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