Chapter 1 Flashcards
1
Q
Intrascalene block doesn’t block what nerve
What dermatome
A
Ulnar nerve
C8-T1
2
Q
Neuraxial block level of blockade
Which is first second third from bottom up
Sensory motor sympathetic
A
Motor is lowest
1 dermattome above sensory
1 more dermatome above is sympathetic
3
Q
Intercostobrachial nerve innervates what dermatome
A
T2
4
Q
Dorsal respiratory center initiates
Ventral respiratory center initiates
A
Inspiration is dorsal
Passive exhalation is ventral
5
Q
Apnustic center in pons sends signals to dorsal respiratory center in medulla to
A
Sustain inspiration.
6
Q
Reticular activating system does what?
Where is it found
A
Increases ventilators rate and volume of inspiration
Found in midbrain
7
Q
Bezold jarish reflex
A
Parasympathetic leading to bradycardia vasodilation and hypotension when stimulating cardiac myocytes
8
Q
Carotid body chemoceptors interact with respiratory centers via which nerve
A
Glossopharyngeal
9
Q
Aortic arch chemocepters deliver signal via what nerve
A
Vagus
10
Q
Infarct of the hypothalamus would involve which artery
A
Anterior cerebral artery
11
Q
Which artery supplies broca and wernickes area
A
Middle cerebral artery
12
Q
Gray matter of spinal cord
A
Consists of neurons andneuroglia
Butterfly shaped
Gray to white matter ratio is highest at cervical and lumbar regions
13
Q
Dorsal column tract
A
Ascending signal pathway
First order neurons are in dorsal root ganglion
Second order in dorsal horn
Third order in hypothalamus
For fine touch, proprioception, vibration
14
Q
Reticulospinal tract
A
Descending for voluntary movement and reflexes
15
Q
Corticospinal tract
Descending or ascending
A
Descending that innervates skeletal muscle
16
Q
Descending pathways generally how many neuron system?
First order is in what cortex
A
3
Cerebral cortex
17
Q
Spinothalamic tract
A
Pain and temperature
18
Q
Meningies main function
A
Protect brain and spinal cord from injury
Blood supply to skull and hemispheres
Space for CSF
They do not produce CSF
This is formed by the lateral cerebral ventricles of the choroid plexus
19
Q
Which layer of meningies is pain sensitive
A
Dura mater
20
Q
Between arachnoid and pia is the
A
Subarachnoid space
21
Q
CPP is primarily determined by the
Normal CPP range
A
MAP
80-100 mm/hg
22
Q
CBF increases 1-2 ml/100g per minute for a
A
Increase in co2
23
Q
H+ does not cross blood brain barrier thus
A
Does not affect cerebral blood flow
24
Q
Auto regulation is constant at maps of
Higher blood pressure causes autoregulation curve of CBF to shift
A
60-160 map
Right
25
Volatile anesthetics
Dilated cerebral vessels
Impair autoregulatoon
Increase CBF
26
Circulatory steal
Giving blood to normal areas of brain instead of ischemic areas
27
Volatile anesthetivs increase CBF when above
Ketamine increases
Nitrous oxide increases
1 MAC
ICP
CBF
28
Nitrous oxide increase
CBF and CMR02
Volatile anesthetivs decrease CMRO2
Halothane causes the most increase in cerebral blood flow, Sevoflurane the least
29
Which volatile anesthetivs facilitates CSF absorption
Isoflurane
30
To prevent neuronal damage you don’t need
Tight glucose control
Makes patient hypoglycemic leading to more issues
31
Arachnoid villi absorb
How much CSF volume is maintained
CSF
100-150 ml
32
Production of CSF is by
Lateral cerebral ventricles of choroid plexus
33
Furosemide, acetazolamide, thiopental decrease CSF production
Ketamine increases
CSF production
34
Halothane impedes CSF
Absorption
35
Barbiturates can help in the brain with
Focal, not global ischemia
Etomidate increases cmrO2
36
In neurosurgery cases high PEEP
Should be avoided! Increses I tear Horacio pressure and may impede cerebral venous drainage worsening icp
37
Fentanyl has minimal affect on
Elevating head of bed can decrease
ICP and CBF
ICP
38
Fev1/FVC ratio
Can provide indication of degree of airway obstruction
| Normal subjects can expire 75-85% of FVC in one sec
39
FVC
Volume of gas expired forcefully after maximal inspiration
Usually equal to VC
40
FRC =
Volume remaining in lung after passive expiration
41
TLC =
VC + RV
42
IRV plus tidal volume =
IC
43
MVV largest volume that can be breathed in 1 minute with voluntary effort
MVV usually normal in restrictive lung disease
44
FRC decreases when you
Lay down
45
Laplace law = 2T/R
Net pressure for inflation of the alveolus
46
Type 2 alveolar cells produce
Surfactant
47
Type 3 alveolar cells are
Macrophages
48
On flow volume loop
COPD has concave expiratory portion which is the effort independent portion of expiration
49
Flow volume loop tracheal stenosis
Both inspiratory and expiratory curves are decreased compared with baseline
50
Lung parenchyma
Respiratory bronchioles, alveolar ducts, alveoli,
51
More negative intraeural pressure at the
Apex of the lung
Most tidal volume reaches the gravity dependent portion of the lung
52
Blood flow into lungs is
Gravity dependent
West zone 1 gets ventilation in absence of perfusion
53
Ideal V/Q ratio is 1:1 occurs at what rib space
3rd
54
No perfusion =
Dead space
55
Direct inhibitors of HPV
Infection
Vasodilator drugs
Hypocarbia
56
Pa02 of 20-40
Saturation goes to 25%
57
Hyperoxia
Lowers ICP
58
Respiratory center
Located in the brainstem(pons and medulla)
59
Peripheral chemoceptors made up of
Carotid and aortic bodies
Stimulated by decrease in pa02
60
Central chemoreceptors are primarily sensitive to
Hydrogen ion concentration
Carbon dioxides effect is indirect
61
Ventilator rhythmicity controlled by
Dorsal medullary reticular formation
Dorsal respiratory group contains inspiratory centers
62
Above what pa02 do you not influence carbon dioxide response curve
100
63
Beta 2 on bronchial smooth muscle leads to formation of
cAMP
64
Leukotrienes
Arachodonic acid metabolites
They antagonize the leukotriene receptor
65
Dexametbasone has more anti inflammatory than
Hydrocortisone
66
Most energy used in cardiac cycle is during
Isovolumetric contraction
67
Frank starling relationship
Relationship between preload and contractile performance
68
Early indicator of MI are increased LVEDV and decreased compliance
ECG wall motion abnormalities are later findings
69
Sv02 is oxygen utilization in body
Mixed venous is measured in
Pulmonary artery
Increased hemoglobin, increased cardiac output will increase sv02
If you use more oxygen such as in hyperthermia will lower sv02
70
Diastolic dysfunction
Impaired relaxation of LV
E to A ratio is less than 1
71
Pressure baroceptors r located in the carotid sinus and aortic arch
SA and AV node decrease heart rate and vascular tone to decrease blood pressure
72
SBP is higher in femoral artery than in the
Aorta
73
Diaphragm goes down it drops
Intrathoracic pressure
74
Most blood lies in the
Venous system
75
Compliance of venous system
Much higher to that of arteries
76
Capillary blood flow
Determined by
Transmural pressure and tone of precapillary and postcapillary sphincters
77
Tissue with greatest capillary density
Are tissues with high metabolic rate such as heart and skeletal muscle
78
How much of cardiac output goes to liver
25%
79
CPR should continue for
At least 2 minutes after return of spontaneous circulation after defibrillation
80
Asystole
First medication after starting CPR is epinephrine 1mg
81
Symptomatic bradycardia
12 lead
Atropine 0.5 mg every 5 minutes
Then do transcutaneous pacing, epinephrine 2-10 ug/min or dopamine
82
Dilute drugs with 10ml saline when administered via
Endotracheal tube
83
Narrow complex tachycardia
Initial is
vagal manuever
Adenosine 6mg is next then 12mg
84
STEMI management
Door to balloon time of 90 minutes
Door to needle time 30 minutes fibrinolysis
Emergency room of 10 minute or less
85
With an mi with papillary muscle the one most likely to rupture is the
Posteromedial papillary muscle
86
Posterior interventricular artery is located in the
Inferior interventricular groove
87
Mitral valve has two leaflets
Anterolateral and posteromedial
88
What structure is responsible for conduction of impulses from right to left atrium
Bachman bundle
89
Best vasoactive agent for aortic stenosis
Phenylephrine
90
Conduction velocity is fastest through the
His-purkinjee system
91
C wave
Isovolumetric Ventricular contraction
92
Don’t give neostigmine to
Heart transplant patients
93
A wave
Atrial contraction
94
Diastolic dysfunction
Increased stiffness of ventricle, higher pressure
95
V5 lead best for
Lateral wall ischemia
96
Rhythm and conduction disturbance
Lead 2
97
Tachycardia helps with
Mitral regurgitation
98
WPW has an
Accessory pathway avoid AV nodal blocking agents like metoprolol and verapamil
99
Complications of trans catheter aortic valve replacement
Embolus stroke, hematoma, MI, LBBB or complete heart block
100
S3 is for and is
S4 is for and is
CHF/transient
Non compliant ventricle and is permanent
101
Severe tachycardia ca lead to
MI - hypokalemia can not
102
Acetylcholine acts on M2
Receptors to slow heart rate
103
Reverse T puts blood in the legs leading to a decrease in
Venous return
104
Diastolic dysfunction patients rely on the
Atrial kick
105
Midline fold on dura can lead to
Unilateral epidural
106
Renin release is increased in
Cirrhotic patients
107
Cirrhotic patients
Vasodilation decrease SVR and increases cardiac output
108
Retrograde intubation contraindications
Coagulopathy
Faint identify landmarks
Thyroid goiter
109
Systolic filling of atrium =
V wave
110
Atrial relaxation =
X descent
111
CRRT is ideal hemodialysis for
Unstable patients in the ICU
112
If you change pac02 what changes the most is
Cerebral blood flow
1-2 ml100g change for each 1mm change in pac02
113
First line treatment for cyanide toxicity is
Hydroxocobalamin
Cyanide inactivates cytochrome oxidase
114
Plasma creatinine x urine sodium/urine creatinine x plasma sodium =
FenA
115
Myotonic dystrophy
Muscle disorders with prolonged contraction and muscle relaxation.
Type1 due to CTG repeats
116
Propofol can lead to direct
Mitochondrial toxicity, leading to respiratory system dysfunction and impaired fatty acid metabolism
117
Central cord syndrome
Cervical spinal cord injury, resulting in loss of sensation and motor function in upper extremities
118
LR is metabolized to
Bicarbonate via mitochondria. Don’t give LR to patients with mitochondrial disease as it leads to elevated serum lactate and metabolic acidosis
119
Alcoholism and obesity increase
Psuedocholinesterase activity
They decrease in pregnancy
120
Dichotomous variable =
Nominal =
Continuous
2 categories available
2 or more categories with no order
Can take on infinite number of values
Ordinal are in groups such as small medium or large
121
Paired T test
Only one group of individuals
122
Chi square is used to evaluate
Two categorical variables
Like comparing PONV and red hair
123
Compare means of more than 2 groups with
ANOVA
124
Odds of something occurring =
Probability it occurs/(1-probability)
125
Positive skew
The tail is to the right
126
Sensitivity
Measures populations of individuals with the disease who are correctly identified as having the disease by the test
127
PPV
A test that is positive indicates the true prescence of the disease
128
Cohort study
Observational study are subjects chosen and followed over period to observe outcome of interest
129
Cross sectional
Survey
130
Type 1 error
Reject the true null hypothesis
131
Increased SD
Increased variability
132
NNT
Number of patients who need to be treated to prevent one adverse outcome
133
Best NNT is
1- because for each you treat don’t need control. The higher the NNT the less effective the treatment
134
Survival analysis between two comparable treatments is looked at with
Hazard ratios
135
Crossover in statistics means
Patients who receive a sequence of different treatments during the trial
136
Single blinded means you are blinding only to the
Subjects
137
P value
Obtaining test statistic value equal to or more extreme than actual test statistics given the null hypothesis is true
138
R time on TEG is prolonged. What do you give to treat?
FFP
Normal R time is 6-8 minutes
139
Decreased F time is treated with anti-fibrinolytic such as
Transexamic acid
140
Alpha angle is a reflection of clotting kinetics. If decreased it’s due to low fibrinogen and treat with
Cryoprecipitate
141
What nerve is in close proximity to brachial artery
Median nerve within antecubital fossa
142
A line
Pressure transducer converts to electric signal
143
Flush test on A line system to look if dampened
Should get 1 large and 1 small oscillation before return to baseline
144
Overdampened systems
Attenuate true arterial pressure waveform leading to low pressures and low pulse pressure
Overdampening causes are kink in line and bubbles in fluid tubing
Underdampening makes systolic look higher and thus can be due to excessive length of tubing
145
As arterial pressure moves away from aorta the systolic portion becomes peaked/narrowed with increased amplitude
This dorsalis pedis has about 20 mmHg higher systolic shown that at aorta
146
A wave of CVP
Atrial contraction at end of diastole called atrial kick
C wave isovolumetric contraction against a closed tricuspid valve resulting in back pressure through atrium to CVP catheter
X descent- midsystole due to atrial relaxation
This is not found in junctional rhythm
In junctional rhythm contraction of right atrium occurs against closed tricuspid resulting in exaggerated A wave called a canon A wave
147
Tall C wave with
Tricuspid regurgitation
148
Right IJ is typically
Lateral and anterior to carotid artery
149
Peripheral insertion of central catheter
Best is basilic which runs medial
150
Catheter induced pulmonary artery rupture is
Hypoxia secondary to lung spillage of contents
151
Compliance =
Change in volume/ change in pressure
152
Static compliance =
Tidal volume /(ppleateau- peep)
153
Pressure control
Pleateau is horizontal
Volume control pleateau is concave down
154
PEEP
Recruits collapsed alveoli and thus increases pulmonary compliance
Causes FRC to increase
155
Positive pressure Ventilation
Decreases preload, afterload, and increases cardiac output
Increased intrathoracic pressure lowers venous return
PPV leads to peak systolic transmural wall pressure to be decreased and afterload is decreased
156
Oxygen face mask Fi02 from 5-10 liters is
.4-.6
157
NC Fi02
2 liters is .24-.28
| 3 liters .28-.32 and then goes up by 4
158
Nonrebreather can hit anFi02 of
1, partial rebreather hits an Fi02 of 0.75
Both have a bag for expired gas to go out of
159
Venturi mask
A fixed Fi02 is given based on entrainment port of mask, independent on patients minute ventilation
160
A Paced if pacer spike is before
P wave
161
Different morphologies of P waves are seen in what rhythm
MAT
Get heart rate control with beta blockers
Don’t need cardiac consult
162
D Shaped left ventricle on mid papillary view seen in
Pulmonary embolisms bc of shift of interventricular septum toward left ventricle
RV is above LV usually I this view
163
VOO mode can lead to
Under sensing of cardiac activity and can lead to pacer spike before T wave leading to R on T phenomenon
Leading to V fib
Treat by switching pacing mode to DDD
164
MAP =
Cardiac output x SVR
165
Pericardial tamponade
Looks black. Inside the pericardium but outside the ventricles
166
Mid esophageal bicaval view to look for
Venous air embolus
167
M mode of IVC subcostal view looks at
Volume status
Low pressure = hypovolemia
168
High PPV
Give fluid bolus/ should have lots of variation on arterial pressure tracing
169
Awake vs general anesthesia EEG
Awake: high frequency low amplitude
GA: low frequency and high amplitude
170
Increased ICP decreases
Cerebral perfusion pressure and thus TCD is lower
171
SSEP most affected by in order
Isoflurane> propofol> opiodiis> etomidate
Etomidate and ketamine enhance quality of signal with SSEPs
172
Which is commonly least affected by inhalational anesthetics
Brainstem auditory EP
173
Etidocaine
Longest motor block is very long on epidural at 600 minutes
174
Diphenhydramine
Doesn’t help with epidural itching
175
You can bill for
Total anesthesia and lines. What you give to maintain anesthesia is bundled in overall payment so knowing what meds you gave doesn’t matter
176
Hemodynamically unstable SVT
Synchronized cardioversion
177
For stable SVT
First do vagal maneuvers
| Next give adenosine 6mg than 12mg
178
Carotid sinus is controlled by
Glossopharyngeal nerve, senses high pressure and activates parasympathetic to lower BP and HR
179
Hetastarch
Decreases glycoprotein 2b/3a
Messes up platelet aggregation
Reduces factor 8/vWF levels
180
Myotonic dystrophy leads to
Gastric atony not spasticity
181
In supine patient most secretions can be found
In the posterior segment of the right lower lobe
182
Difficult laryngoscopy
```
Inter incisor distance less than 4 cm
Higher mallampati
Can’t protrude lower over upper teeth
Thyromemtal distance less than 6 cm
Neck circumference > 43 cm
Sternomental distance less than 13 cm
```
183
Line isolation monitor
Monitors ungrounded power source in the operating room
Primary circuit is attached to the ground but the secondary circuit is not
It signals when leakage current > 5 mAMP
First fault is not a hazard but the second fault is a hazard
184
Ranitidine will increase gastric pH within
One hour of administration
Increases gastric pH before induction helps with aspiration pneumonitis
185
H2 receptor antagonists increases
Gastric PH
186
Increased power of study
Increase sample size
Increasing alpha p value
Reducing population variability(standard deviation)
Alpha = type 1 error
Power = 1- beta
187
Power =
1- beta
188
Alpha =
Type 1 error
189
Difficult mask
```
OSA or history of snoring
Age>55
Male
Bmi>30
Mallampati
No teeth
Beard
Limited mandibular protrusion
```
190
Glycopyrilate isn’t transferred across
Placenta
Blocks peripheral muscarinic receptors
191
Assist control is just like VCV if
Patient is not breathing
If they are breathing spontaneously it gives patient enough pressure or volume to get them to the tidal volume you want
SIMV is similar but gives to the pressure you assign
192
Neck flex ion or extension can highly affect
Depth of endotracheal tube in Peds patients
193
4 factor PCC contains
2, 7, 9, and 10
194
Vasopressin
Good choice for improvement of SVR
| Doesn’t affect PVR
195
Vasopressin binds to
V1a receptors of vascular smooth muscle
196
Most common cause of neurologic deficit during carotid endarterectomy
Dislodged empiric plaque leading to thromboembolism
197
Norepinephrine
Does not block beta 2
198
Dopamine and doubtamine aren’t used in cardiac surgery much bc they can cause
Arrhythmia
199
Amiodarone bolus leads to decrease in
SVR
Blocks potassium channels and prolongs repolarization
200
Potent independent risk factor for postop apnea
Anemia
201
Milrinone
Increases cardiac output
PDE 5 inhibitor
Stops breakdown of cAMP
202
In amiodarone you get hypothyroidism through low levels of
T3
203
Clebidipine
Dihydroperidine calcium channel blocker broken down by plasma esterases
204
Morphine
Very hydrophilic. Onset of respiratory depression is 6-12 hours after injection.
205
More lipophilic opioids will spend more time in the
Epidural space
206
Good way to check epidural if patient is pain
Bolus lidocaine and recheck 10-15 minutes late
207
What drug is avoided for PCA
Meperidine bc of it’s toxic metabolite normeperidine
208
Morphine 6 glucoronide leads
To hypotension and respiratory depression
209
Don’t give morphine to
Renal failure patient
210
Dilaudid PCA
Don’t use background infusion if opioid naive
Hourly lockout of 1-2 hours in adults
Set lockout each 10 min
211
5 HT3 antagonist =
Zofran
212
Acetaminophen moa
Analgesic and antipyretic
| Centrally acts and inhibits COX
213
Can use dilaudid in patient with
CKD
Be careful giving tizanidine to patient on cipro
214
Good low dose ketamine infusion
5-10 ug/kg/min
215
Nitrous oxide and ketamine both block the
NMDA receptor
216
SCStimulator creates parenthesia in painful area
To mask the pain
217
SCS leads target
Dorsal columns
218
Opioid induced hyperalgesia
Causes diffuse pain instead of localized. Don’t give more opioids! NMDA receptors involved
219
If suboxone is continued
Patients are likely to have increased opioid needs postop
220
Opioid withdrawal
Restless legs, nausea, diarrhea, mydriasis
Withdrawal can occur when you give suboxone to someone actively using heroin
221
If alpha is decreased
Chance of type 1 error decreases but chance of type 2 increases
222
Grade 2b if you only see
Posterior arytenoids
223
Ability to void is not a criteria for
Discharge from ambulatory surgery center
224
Misuse of opioids can include
Taking more pills than you should
| Giving opioids to someone else
225
Chronic pain in cancer patients mainly due to
Bone metastasis
Radiation therapy is first like therapy
226
Continuous epidural vs PCA
Much faster return of bowel function, better pain control, reduced nausea
227
IABP fills
Right after dicrotic notch
Indicating closure of aortic valve augments aortic diastolic pressure
228
Moderate AS patient
TTE every 1-2 years
If max>4.0 every 6-12 months
229
Low flow state is bad for
Aortic stenosis
Aortic valve area < 1.0 cm^2 is bad
230
Infective endocarditis prophylaxis
Manipulation of gingival tissue
Periapical region of teeth
Perforation oral mucosa
Root canal needs IE prophylaxis
231
Patients with AS have increased myocardial oxygen demand bc of concentric hypertrophy
Diastolic filling pressure also increases so need to keep HR low to fill heart
Lesion is fixed at the valve so strike volume doesn’t depend on afterload
232
In MR stroke volume represents
Volume ejected into systemic circulation
That regurgitated back into LA
Very important to reduce SVR to push blood forward
Full, fast forward
233
In Hocm want high afterload to stent open
Lvot obstruction
Phenylephrine is a good drug
234
Onset of pulmonary edema with HTN that is acute most likely diagnosis is
Flash pulmonary edema
235
Negative pressure pulmonary edema
When the tube comes out
236
Chronic tamponade you see
Edema
237
Pulsus patadoxus inspiratory fall in SBP greater than 10
In tamponade pericardial fluid pressure exceeds cvp so passive filling doesn’t occur without variations in intrathoracic pressure
238
Beta1 stimulation causes
Lipolysis In fat cells
239
Dopamine 2
Inhibits norepinephrine release
240
Dopamine norepinephrine epinephrine
Naturally occurring catecholamines
241
MAO breaks down
Norepinephrine
242
AcH made up of
Acetyl coenzyme A and choline by choline acetyltransfersse
243
Repeated doses of ephedrine demonstrate diminishing response is what concept
Tachyphylaxis
Possibly from exhaustion of norepinephrine supply
244
What beta blocker has been shown to reduce death after MI
Atenolol
245
Beta 1 blockers inhibit
Lipolysis
| Renin secretion
246
Beta 2 blockade inhibits
Insulin release
247
Prazosin
Selective alpha 1 blocker
248
Muscarinic antagonists
Anticholinergics
Mydriasis
Bronchodilation
Increase HR
Inhibition secretions
249
Glycopyrolate can’t cross
BBB
250
Pheo is made of
Chrommafin tissue most are intraadrenal
251
One pheo is removed
Give lots of fluid and phenylephrine
252
Residual volume
Volume left in lung after max expiration
253
Vital capacity is different from TLC bc of
Residual volume not added
254
Normal FRC
1.7-3.5 Liters
Increase with age, height, lung disease like COPD
FRC greatest when standing
255
Closing capacity
Point at expiration when small airways start to close
Increase with age intraabdominal pressure
256
Increased closing capacity
Is bad! Airways close faster more likely to become hypoxia on induction
257
Resistance to gas flow in tube mainly affected by
Radius
258
Compliance
Change in volume of lung when pressure applied
When lung is inflated and held at a volume the pressure peaks and then goes down to plateau pressure
259
ARDS leads to
Elevated resistance and decreased compliance
260
Laplace law for alveoli
2 x tension /radius = pressure
261
Alveolar gas equation
Pa02 = fi02(760-47) - paco2/.8
262
Endotracheal intubation decreases
An atomic dead space
263
Arterial oxygen content
1.34 x hgb x sa02 + (pa02 x 0.003
264
C02 is mainly transferred in blood as
Bicarbonate ions
265
Dorsal respiratory center mainly involved with
Inspiration
The ventral center is involved with inspiration and expiration
266
High pac02 =
Respiratory acidosis due to
Drugs
Asthma
Emphysema
Neuromuscular disorders
267
Major organ involved in rapid acid base regulation.
Lungs
268
HC03- on blood gas is
Calculated whereas c02 is measured
269
Common cause metabolic alkalosis
Vomiting/diuretics
270
DLCO is a measure of
Functioning alveolar capillary units
271
Flow volume loops show
An atomic location of airway obstruction
272
MAC
Concentration at 1 atmosphere that blocks motor response to a painful stimulus in 50% of patients
273
Gender
Thyroid
Hyperkalemia
Don’t affect
MAc
274
MAC of
Isoflurane
Sevoflurane
Desflurane
1.2
1.8
6
275
Factors that decrease alveolar concentration slow onset of volatile induction
Increase in cardiac output
Decrease in minute ventilation
High anesthetic lipid solubility
Low flow within breathing circuit
276
Administering 100% oxygen can mitigate
Diffusion hypoxia
277
Volatile anesthetics
Decrease in tv
| Increase in RR
278
MAC decreased by
```
Old age
Hyponatremia
Hypothermia
Opioids
Clonidune
```
279
Volatile anesthetics increase
CBF
280
Methoxyflurane
Fluoride toxicity
281
KOH containing absorpents like baralyme cause the most
CO production
282
Into right side of bronchus if
Double linen tube inflate bronchi and get right side breath sounds only
283
Posterior femoral cutaneous nerve is blocked by
Sciatic nerve
284
Nicardipine is a selective
Arterial vasodilator and doesn’t increase ICP
285
Paravertebral and epidural block are
Similar
286
Increased aortic diastolic pressure with higher
SVR
287
Popliteal block is
Deep and medial
In relation to tibial to peroneal
288
Percent trach vs open trach
Similar rates of complications
289
Central anticholinergic syndrome
Delirium from scopolamine
| Give physostigmine which crosses BBB to treat
290
E stands for in ASA classification
Any unplanned or emergent procedure
291
Bronchociliary finction improves within
2 days of stopping smoking
292
TEG measures combined function of
Plts and coagulation factors
293
Warfarin half life
Heparin half life
2. 5 days
| 1. 5 hrs
294
Full e cylinder 02
2000 psig
| 625 L
295
Air and 02 cannot be compressed to liquid at room temp
Passed critical temp do exist as gases
296
02 in anesthesia machine
```
Contribute to fresh gas flow
02 flush
Provides low 02 alarm
Controls flow of N20
Powers fail safe valve
Driving gas of vent
```
297
Diameter index safety system is to the
Wall
298
02 flow meter must always be on the
Right
299
Fail safe valve
Cuts off all flow of gases except 02 when the 02 value falls below a set value about 25 psig
300
Need heat for vaporization of liquid to
Gases
High thermal heat conductivity helps restore the heat
301
Partial pressure of the vapor not the concentration in volume percent
Is the important factor in depth of anesthesia
Actual output is higher at higher pressure places
302
Desflurane has high vapor pressure
Boiling point is at room temp
303
Desflurane vaporizer is not
Altitude compensated thus need to give higher percentage of desflurane to achieve MAC at 7000 feet
304
Scavenger system also presents
Excess suction or an occlusion from affecting the patient breathing circuit.
Positive/negative relief valves
If doesn’t work patients lungs can blow up like a balloon
305
Pop off valve is located on
Expiratory limb in semi closed circle system
306
Closed system goal
For fresh gas flow to match patients 02 consumption and anesthetic agent uptake
307
Controlled efficiency
D BC A
| A is the worst
308
PH sensitive dye is what changes color
In soda line canister
309
Closing pop off means the values are
Going up on valve
310
Bellows failing to rise think
Leak
Disconnect
Patient extubated
311
Supine positioning causes
Decreases FRC and TLC secondary to abdominal content on diaphragm
312
Femoral nerve in lithotomy can be avoided by
Preventing hip flexion greater than 90 degrees
313
Trendelenberg
Increases blood to central compartment
Intracranial and intraocular pressure increase
314
VAE
Bc surgical site is above level of heart
Air entrainment into venous circulation is a risk
315
Most common nerve injury
Ulnar
316
Most eye injuries are seen in
Cardiac injury
Ischemic optic neuropathy posterior is more common
317
Hypoplastic leftbheart
Only have one working ventricle so need to decrease blood flow thus don’t overventulate
318
Acidosis increases
PVR but SVR is decreased
319
Visceral sympathetic T10-L1
Pain during first stage of labor
320
Lack of Vagal input to transplanted heart means
Resting HR 100-120
321
Dabigatran directly inhibits
Thrombin
322
With big burns
See decreased cardiac output and pulmonary function. Less fluid
323
Increased drug effect depending on how long it’s being infused
Context sensitivity
324
Thiopental increases latency of
SSEPs
325
Male sex of fetus leads to increased risk of placenta
Previa
326
Interaction with IgE antibodies are usually seen in
Anaphylaxis
327
Cerebral salt wasting
Hypooolar hyponatremic hyponatremia
328
Epidural to dura to
Subarachnoid space
329
Acute alcohol intoxication more risk
For lung injury
330
Higher residual volume is not a good
Sign
331
Theophylline toxicity can lead to
Tachyarhythmia and has a narrow therautic window
332
Use right sided double lumen tube for surgery involving
Left mainstrm
333
Best place to measure CVP
Tricuspid valve
334
In aortic stenosis don’t want
Tachycardia or bradycardia
335
Left dominant with ST elevations in 2,3, or aVf think
Left circumflex
Not right coronary
336
Conus medularis
L1-L2
337
CSE
Same risk of postural puncture headache
338
T10-L1 for
First stage of labor
339
ETT size
Age/4 + 4
Measure internal diameter
340
Venous return is highest when
RAP is 0
341
Sufentanil on EEG
Increase in amplitude and decrease in frequency of EEG
342
Nitrous oxide goes into bloodstream and binds hgb to
Get degraded
343
Regional block wears off at
8-10 hrs
Femoral TAP adductor sciatic popliteal ankle
344
IVRA
Prilocaine better than lidocaine
345
Metochlopramide
Block dopaminergic D2 receptors and enhances gastric emptying
346
ION after spine surgery risk factors
```
Male
Obese
Wilson drake
Duration
Blood loss
```
347
Midazolam
No anticholinergic properties
348
Baroceptor activity increased with more
Stretching
349
If you initiate the breath in AC mode you will get
Full volume
In simv extra breaths just get whatever pressure is added
350
Nitroprusside can lead to
Methemoglobinemia after a few days
351
PVR
Papmean-paop/co x 80
352
BMI
Kg/height squared in meters
353
Most likely to have MI
Third day play surgery
354
MAT doesn’t work on
Direct cardipversion
355
TPN does not cause
Ketoavidosis
356
02 requirement for adult is 3-4 ml/kg
3-4
357
Droperidol can help with
Wolf Parkinson’s white
358
Psuedocholinesterase breaks down
Succ
Mivacurium
Ester type local anesthetics
Half life is 12 hpsuedocholinesterase lower in pts with liver disease
359
COX2 inhibitors
Higher risk for thrombotic state or stroke
360
8 of dexamethasone is like
50 of prednisone
361
Atracurium and cisatracuriuk are broken in plasma so
Not affected by aging
362
Succ cases
Neuromuscular blockade, but also stimulates all cholinergic receptors including the nicotinic receptors of the sympathetic and parasympathetic ganglia as well as muscarinic receptors of hearty leading to bradycardia in children
363
Neuromuscular blockade happens faster in
Larynx has diaphram and recovers quicker then in adductor of thumb
Adductor of thumb comes back it means your larynx and diaphragm are good
364
95% of drug is cleared after
3 half life’s
365
Meperidine and methadone can cause
Serotonin syndrome in patient taking MAOi
366
Most pts don’t like etomidate bc of the
Nausea and vomiting
367
Naltrexone duration of action is 24 hrs
24
368
When u inject NMDB into plasma it goes into
The neuromuscular junction
Intubation doses go back into plasma
369
Buprenorohine acts for
8 hrs and not reversed by naloxone
370
Naloxone has no affect on
NSAIDs
371
Psuedocholinesterase only found in blood
Not at neuromuscular junction
372
Miosis and constipation do not exhibit
Tolerance
373
Dopamine depletion leads to
NMS
374
Psuedocholinesterase inhibited by
Dibucaine
Number of 57 means succ will last up to 30 min since heterozygous
375
Naloxone does not help with
Shivering
376
Nitroprusside worry about cyanide toxicity when goes above
2 ug/kg/min
377
Amrinone
PDE3 inhibitor
378
G2b/3a antagonist
Tirofiban
379
Dantrolene causes
Diuresis
380
Opioid withdrawal dont get
Seizures
381
Phase 1 depolarizing block enhanced with use of
Anticholinesterase drugs
382
Lithium and opioids decrease
MAC
383
Gender does not affect
MAC
Severe hypoxia/anemia decreases MAC
384
Atropine has best blocking effect on
Muscarinic receptors of heart
385
Aprtocaval compression starts being important at
20 wks
386
CP occurs during
Development
387
Insulin does not regularly cross
Placenta
388
FDA does not mandate screening for
CMV
389
O- whole blood contains anti a and b antibodies so don’t give to someone with
Type A pRBCs
390
Sickle cell disease
Valine for glutamic acid
391
Newer blood banking techniques makes citrate toxicity
Less likely
392
Cryoprecipitate contains
Factor 8 13
VWF
Fibrinogen
393
Distance from Y piece to terminal bronchioles contributes to
Dead space
394
Dead space
Tidal volume not undergoing gas exchange
395
Mapleson circuit
For mapleson D best order is
Breathing bag, APL valve, breathing tube, fresh gas inlet, to mask
396
Hypotension can lead to
Hypoxia
Hypothermia can not
397
Macroshock
Current outside body
398
Microshock
Current inside the body
1 mA or below
399
Flow
Radius to fourth power
400
Flowmeters should be off when performing
Leak test
401
Tipping of vaporizer during a case actually leads to
Overdose of anesthetic
402
LIM
Tells you if grounded by alarming
You want it to stay ungrounded
Purely a monitor
403
Low pulse ox won’t be bc of
Severe anemia
404
Guidelines provide
Basic recommendations
405
Hole in bellow leads to
Hyperventilating or barotrauma
406
Bipolar cautery better if patient has
Aicd
407
Need to reprogram pacemaker prior to surgery if surgery above
Unbilivus to asynchronous mode
408
Transcutaneous pacing
Must sedate patient if awake it is very uncomfortable
Dial up amplitude until capture
Want trans venous pacing which is better
409
Recs for pacemaker aicd
```
Identify device
Review interrogation report
Battery life and lead function
Dependence
Magnet response
Consider needs fir reprogramming vs magnet
Always have magnet available
Consider need for transcutaneous pacing
```
410
Electrolyte abnormalities like hypocarbia can cause pacemaker to stop
Working
411
Standard for sickle cell hgb minimim is
10
