Basics Comprehensive Exam Flashcards
1
Q
When does smoking cessation lead to improvement of pulm. mechanics?
A
> 8 weeks
1
Q
When does smoking cessation not decrease risk of resp. complications?
A
<4 weeks
2
Q
Mallampati score acronym
A
PUSH
3
Q
Delay surgery for how long post MI?
A
60 days
4
Q
Delay surgery for how long post DES?
A
6 months
5
Q
Delay surgery for how long post BMS?
A
30 days
6
Q
OSA screening
A
STOPBANG
Snoring
Tired
Observed
high Pressure
BMI
Age>50
Neck circ
Gender (Male)
7
Q
Liver failure screening and what does it consist of
A
Child-Turcotte-Pugh
Ascites
Bili
Albumin
PT
Encephalopathy
8
Q
What vessels supply blood to nasal mucosa
A
maxillary
ophthalmic
facial arteries
9
Q
What innervates the nose
A
maxillary and ophthalmic branches of trigeminal nerve (sensory)
PNS- CN VII (facial)
SNS- superior cervical ganglion
10
Q
What does the nasopharynx lie anterior to
A
C1
11
Q
What does the oropharynx lie anterior to
A
C2-C3
12
Q
Where is the hypopharynx
A
C5-C6
13
Q
Where is the larynx
A
C3-C6
14
Q
What innervates the pharynx, larynx, and soft palate
A
glossopharyngeal
vagus
spinal accessory
15
Q
What does the SLN internal do
A
sensory ABOVE vocal cords
16
Q
What does the SLN external do
A
motor to cricothyroid muscle
17
Q
Where is the R. RLN
A
loops around brachocephalic artery
18
Q
Where is the L. RLN
A
loops around aortic arch
19
Q
What does the RLN do
A
provides sensory to subglottic area and trachea
motor to ALL except cricothyroid
20
Q
What nerve provides cough reflex
A
vagus
21
Q
3 single cartilages
A
cricoid
thyroid
epiglottis
22
Q
3 paired cartilages
A
arytenoids
corniculate
cuneiform
23
Q
intrinsic muscles do what
A
control tension of VC and opening/closing of the glottis
24
extrinsic muscles do what
connect the larynx, hyoid bone, and neighboring anatomic structures and adjust the position of the larynx during phonation, breathing, and swallowing
25
Which muscles depress the larynx
omohyoid, sternohyoid, sternothyroid
26
SNS innervation of trachea
1-5 thoracic ganglia
27
PNS innervation of trachea
vagus
28
Difficult BMV
BONES- beard, obesity, no teeth, elderly, snoring
29
Difficult intubation
LEMONS- look, eval 3-3-2, Mallampati, obstruction, neck mobilization, scaring
3-3-2 rule- interincisor, hyoidmental distance, thyrohyoid distance
30
Difficult cric
SHORT- surgery, hematoma, obesity, radiation, tumors
31
LMA intracuff pressure not to exceed
60 cmH2O
32
Muscles that ADDuct VC
lateral cricoarytenoids, thyroarytenoid, cricothyroid
33
Muscles that ABDuct VC
posterior cricoarytenoids
34
What does the Genioglossus muscle do?
opens nasopharynx: relaxation causes OSA obstruction
35
Narrowest region of larynx for adult
glottic opening
36
Narrowest region of larynx for child (fixed and dynamic)
fixed- cricoid ring
dynamic- VC
37
Where is the trachea
C6-T4
38
What innervates the diaphragm and where does it arise
phrenic innervation (arises from C3-5)
39
What muscles are used for inspiration
diaphragm, external intercostals, accessory muscles
40
What muscles are used for normal expiration
passive recoil and internal intercostals
41
What muscles are used for forced expiration
I let the air out of my TIRES (transverse abdominis, internal oblique, rectus abdominis, external oblique)
42
What is the intrapleural pressure at end exp
-4
43
What does the intrapleural pressure do during inspiration
becomes more negative
44
What does the intrapleural pressure do during forced expiration
more positive
45
What does a Mapleson D- Bain system contain
pop off valve only
46
What L and psi is the O2 flush valve
50 psi
35-75L
47
What type of valve is the O2 flush valve
type 3
48
In event of double hanger yolk, one tank is empty, other has 2200 psi, floating check valve prevents what
transfilling of the tanks
49
What type of valve is the first stage regulator
diaphragm style
50
How is O2 produced
fractional distillation of liquefied air
51
How is N2O produced
thermal decompensation of ammonium nitrate
52
Soda lime reaction
Water + Co2=
Carbonic acid breaks down into ions
End product: sodium and calcium carbonate and water
53
How much water do the sodalime molecules need to contain
11-19%
54
Steel cylinder abbrev
AA
54
Most complex part of gas scavenging system
interface
55
Aluminum cylinder abbrev
AL or ALM
56
What does the GE pressure sensor shut off do
shuts off N2O and doesn’t proportionally restrict
57
PISS for air, O2, N2O
Air 1,5
O2 2,5
NO2 3,5
58
Who regulates purity?
Who regulates purity- FDA and pharmacopeia
59
Full tank of O2
660L, 2000psi
60
How long does a 500g soda lime canister last
10 hr
61
100g soda lime absorbs how much CO2
26L
62
International O2 color
white
63
How often to check cylinder
q5yr unless special permission for q10 years
64
Features of des vaporizer
heated to 39, pressurized to 2 atm, CPU chip, dual circuit design, back pressure, diaphragm
65
Retaining screw and there’s a cylinder on hanger yolk, crank it down but its hissing
washer issue-one time use
66
Full N2O canister
745 psi
1590 L
67
intraalveolar/intrapulm pressure in absence of air movement
atm
68
intraalveolar/intrapulm pressure during insp
decreases
69
intraalveolar/intrapulm pressure during exp
increases
70
transpulm pressure define
net pressure that distends lungs during insp or PPV
Difference b/w intraalveolar and intrapleural pressure
measure of lung compliance
71
transpulm pressure pneumo
0
72
transpulm higher pressure =
more distended lungs
73
What can dynamic compliance detect
obstruction
74
what can static compliance detect
lung elasticity
75
Closing volume define
volume above residual vol where small airways close
76
Airways close during tidal breathing if
closing vol>FRC
77
FRC can oxygenate healthy person for how long
8 min
78
normal anatomic dead space
2ml/kg
79
alveolar ventilation equation
VA= RR x (Vt-Vd)
80
where is alveolar ventilation greater
in areas of higher compliance (dependent areas)
81
Alveolar gas equation define
calculated maximal partial pressure of O2 in alveolus for given FiO2
82
PAO2=
FiO2 x (Patm-PH2O)- (PaCO2/RQ)
83
Where is the tip of the PA catheter placed
Zone 3
84
FRC supine, sitting, Tburg
sitting>supine>Tburg
85
How is CO2 stored
Bicarb ions in RBCs (80-90%)
86
Hamburger shift
bicarb leaves RBC and chloride enters to maintain neutrality
87
Haldane Effect
CO2 transport and exchange in lungs
88
Bohr effect
O2 transport and exchange in lungs (opposite of Haldane)
89
Respiratory pacemaker
dorsal respiratory group
90
what ramps up action potentials to the inspiratory muscles
inspiratory ramp signal
91
what is responsible for expiration
ventral respiratory group
92
Na content in NS
154
93
pH of NS
5.5
94
pH of LR
6.5
95
pH of plasmalyte
7.4
96
Na content in LR
130
97
Na content in plasmalyte
140
98
K content in LR
4
99
K content in plasmalyte
5
100
what fine tunes resp pattern by sending impulses to switch off insp ramp, limiting time in filling phase of insp cycle
pneumotaxic center
101
what turns off the insp off switch from pneumotaxic center
apneustic center
102
What is the Hering-Breuer reflex
increase in exp time and slows RR and switches off insp ramp to provect against overinflation
103
What is the Hering-Breuer deflation reflex
increases ventilation when lungs deflate abnormally (pneumo) or periodic deep breaths that prevent atelectasis
104
How much does ventilation increase for every 1mmHg increase in PaCO2
2-3L/min
105
Define hypoxic ventilatory response
PaO2<60 triggers response
Action potential along Hering's nerve stimulates central controller to increase min. ventilation
106
When is Hering's nerve impaired
it is cut during carotid endarterectomy
107
Lung protective ventilation Vt
5-7 mL/kg IBW
108
Lung protective ventilation PIP
<35
109
Lung protective ventilation PP
<28
110
Lung protective ventilation PEEP
<16
111
Controlled mandatory ventilation
predetermined settings. No compensation for patient-initiated breaths. Ideal for apneic patients
112
Assist control/ continuous mandatory ventilation
predetermined settings. Patient breaths receive predetermined settings. Can hyperventilate
113
SIMV
intermittent mandatory breaths delivered in synchrony with patient's spontaneous breaths. Patient efforts above settings are unassisted
114
CPAP
PSV with PEEP
115
Airway pressure release ventilation (APRV)
BIVENT but patients can overbreathe
116
Inverse ratio ventilation (IRV)
BIVENT- requires muscle relaxant
117
High-frequency ventilation
high RR, low Vt
118
plasma osmo
280-290
119
NS osmo
310
120
LR osmo
275
121
plasmalyte osmo
295
122
use LR cautiously in what population
diabetics
123
contraindication for using LR
TBI- cerebral edema
124
SE of albumin
pulm. edema with endothelial injury
125
which lytes are found in ECF
Na
K
126
which lytes are found in ICF
Mag
Phos
127
how to replace sodium
1-2 mEq/hr
128
treating hyponatremia too quickly can cause
central pontine myelinolysis
129
treating hypernatremia too quickly can cause
cerebral edema
130
fully soaked sponge can hold
10 ml
131
fully soaked lap can hold
100-150 ml
132
replace _:_ with crystalloids
3:1
133
replace _:_ with colloids
1:1
134
How fast to replace NPO deficit
1/2 first hour
1/4 second hour
1/4 third hour
135
NPO deficit calculation
maintenance rate x hours fasted
136
4:2:1 rule for fluid replacement
4cc/kg/hr for first 10kg
2cc/kg/hr for next 10kg
1cc/kg/hr after 20kg
(just add 40 if over 20kg)
137
fluid challenge amount for adults and peds
2L adults
20ml/kg peds
over 15 mins
138
hyperventilation does what to calcium
hypocalcemia
139
if SVV is > than what %, a 250 bolus is indicated
10-15%
140
intrinsic coag pathway
12, 11, 9, 10
141
extrinsic coag pathway
3+7=10
142
common coag pathway
1x2x5=10
143
thrombotic teg wide or narrow
wide and fat
144
hemorrhagic teg wide or narrow
narrow
145
k time in a TEG means what
fibrinogen and platelet number
146
alpha angle in a TEG means what
fibrinogen and platelet number
147
MA in a TEG means what
platelet number and function
148
G value in a TEG means what
entire coag cascade
149
LY 30 in TEG means what
fibrinolysis
150
Estimated blood volume for a female
65ml/kg
151
Estimated blood volume for a male
70ml/kg
152
ABL=
EBVx [(initial hgb-accepted hgb)/initial hgb]
153
cryo contains which factors
1, 8, 13, vWF
154
how much cryo to give to increase by 50-100
1 unit/10kg
155
Lateral EKG leads
I, aVL, V5, V6
156
Inferior EKG leads
II, III, aVF
157
Anterior/Septal EKG leads
V1-V4
158
Which EKG lead is recommended to monitor for assessment of narrow QRS complex rhythms and P-waves
II
159
Which EKG lead is recommended if no preop EKG
V3, V4, V5, III, aVF
160
Distance from subclav to RA
10
161
Distance from R IJ to RA
15
162
Distance from L IJ to RA
20
163
Distance from fem to RA
40
164
Distance from R IJ to RV
25-35
165
Distance from R IJ to PA
35-45
166
Distance from R IJ to PAOP
40-50
167
CVP A-wave means
contraction of RA
168
CVP C wave means
closure of tricuspid valve
169
CVP V-wave means
passive filling of RA (RV systole)
170
PVRI calculation
(MPAP-PAOP)/CI * 80
171
SVRI calculation
(MAP-RAP)/CI*80
172
CI calculation
CO/BSA
173
heat and warmth receptors travel which fiber
unmyelinated C fibers
174
cold receptors travel along which fiber
a delta
175
Change in BP _mmHg per inch of height change
2
176
chronic cubital nerve injury presents as
claw hand
177
5 risk factors for ischemia optic neuropathy
crystalloids instead of colloid
longer operative time >5hrs
Lg blood loss <1L
cardiac surgery
spinal fusion
178
what causes central retinal artery occlusion
external compression of the eye from improper positioning
179
what is the most common cause of airway obstruction in immediate post op phase
loss of pharyngeal muscle tone
180
what is the most common cause of airway obstruction in PACU
tongue
181
what is the most common cause of postop hypoxemia
atelectasis
182
what is the most severe type of aspiration
gastric contents-chemical pneumonitis
183
7 things that prolong NMBDs
hypoK
hypermag
hypothermia
resp. acidosis
aminoglycoside abx (clinda, gent, neomycin)
Mag
Lithium
