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Miller's Anesthesia > Exam 2023 > Flashcards

Exam 2023 Flashcards

Israeli board exam

1
Q

Locus cereleus and sleep

A

Secretes noradrenalin
Highest activity during waking up
Lowest during Non REM

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2
Q

CaO2 formula

A

1.34xHbxSa + 0.003xPO2

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3
Q

DO2 formula

A

CaO2x Q (cardiac output)

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4
Q

Lung apex vs base. Pressure and compliance

A

Apex. Less compliance (expands less) Pleural pressure lower
Trans pulmonary pressure higher

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5
Q

Laplace law

A

Pressure x radius / 2x wall thickness

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6
Q

What happens when there is an increase in heart wall thickness

A

Decrease radius, O2 consumption, Surface tension
Increase ventricular pressure

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7
Q

TLC
RV
FRC
VC
in restrictive and obstructive

A

Obs. Decrease VC Increase the rest
Rest. Everything decreases

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8
Q

Effect on motility of drugs

A

No effect midazolam
Increase Morphine
Decrease Propofol, Sevo Isoflurane

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9
Q

Absolute CI liver transplant

A

Active uncontrolled sepsis
Severe Cardiopulmonary disease
Alcohol abuse
lack of compliance
Cancer outside of liver
AIDS

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10
Q

Vasodilator systems in kidney. Type and effects

A

Prostaglandins, Kinins, ANP
Increase GFR / Urine o. / RBF / Na excretion

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11
Q

Therapeutic index

A

TI = Ld50 / Ed50

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12
Q

Effects of 75% N2O in Thorax and GI

A

X2 pneumothorax in 10 min
x3 pneumothorax in 30 min
x2 Gi volume in 120 min

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13
Q

Palv definition

A

Estimation of % of gas in CNS and other highly perfused organs

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14
Q

Isoflurane vs desflurane. Context sensitivity recovery

A

Larger in Iso compared to Desf

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15
Q

What to check always before use of anesthetic machine

A

Suction
Monitors
CO2 absorbent
Leak
Gas flow

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16
Q

Morphine in women

A

Greater potency
slower speed of onset

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17
Q

Why hyperalgesia after opiates

A

Stimulation of NMDA

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18
Q

COX 1 vs COX 2

A

COX 1 Gastro / platelets / kidney
COX 2. Inflammation / pain / fever / cardiac

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19
Q

When to expect hyperkalemia after Scoline

A

Hypovolemia
Met acidosis
Intra abdominal infection
Physical trauma

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20
Q

Sugammadex characteristics

A

Safe in Neuromuscular D.
Interact with contraceptive pills (decrease efficacy of sugammadex)
No difference in renal failure
No effect on fetus

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21
Q

Tranlendemburg and CO

A

CO increase 9% in a minute

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22
Q

Malignant hyperthermia treatment

A

Dantralone 2.5 mg/kg
HCO3-
Control fever
Urine output 1-2 ml/kg/h

23
Q

Ejection Fraction severity

A

50- 70 norm
41 -50 Mild
31 - 40 Mod
< 30 Severe
EF = (ED - ES ) / ED

24
Q

Drugs that cause burst supression

A

Vapors MAC > 1.5
Barb , Propofol, Etomidate at higher doses
No burst. NO , BZP, Opiates, Ketamine, Dexm

25
Transmitral pulsed wave doppler
Measure Diastolic function A - Atrial contraction E - Peak early filling
26
What to do in case of rebreathing CO2
Leads to increase CO2, to solve it, increase flow (hyperventilate)
27
Nephroprotective drugs
Dexmedetomidine, Propofol
28
Most reliable test for neuromuscular recovery after surgery
Handgrip/leg up/ head up > 5sc Maximum inspiration support Tongue depressor test
29
TOF PTC
TOF 0 - 4 and fade (from 0.1 - 1) In fade, TOF = 4 PTC 0 - 15 In PTC, TOF = 0
30
Arm innervation
C5 Upper forearm C6 finger 1 C7 2/3 finger C8 4/5 finger T1 lower forearm
31
Feet innervation
Superior peroneal - 2/3 toe Sural - Lateral feet Tibial - Talus
32
TBWater according to age Neonate, 6m, 1y, 5y, young adult, elderly
Neonate 80% 6m 70% 1y 60% 5y 65% Y.A. male 60% female 50% Elderly 50%
33
Correction of hyponatremia
Mod. 3% NaCl 1ml/Kg/h. 3-4 mEq/l Severe. 100 ml 3% (increase 2-3 mEq/l) Maximum 10 mEq/24h
34
Magnesium. normal range and effect in hyperMg hypoMg
Norm 1.7 -2.3 mg/dl HyperMg N+V, decrease QRS, can lead to bradycardia if >24 Decrease tendon reflexes if > 20 > 48 Coma HypoMg Vertigo, Trausseau + Chovstek. Prolong PR
35
PCO2 in met alk/ac formulas
Met Alk. HCO3x 0.7 + 20 Met ac. HCO3 x 1.5 + 8
36
Cryoprecipitate content
Factors 8, 13, vW, fibrinogen, fibronectin
37
More effective predictor of complications of surgery on the side in one lung ventilation
paO2 on the side in two lungs ventilation
38
Induction in patient with aortic regurgitation. What's important
To maintain preload high
39
Acute liver failure
Encephalopathy + INR > 1.5 without previous disease Usually acetaminophen toxicity
40
Cardio in pregnant woman
1 sound accentuated, 4 sound present ST depression (1mm) increase heart size, EF, HR TR/PR, sometimes MR
41
Prevention of Bezold jarisch reflex
Produces bradicardia and hypotension. Beta blockers and fluids
42
Age and changes in CV system
Increase: Afterload, Myocardial consumption, Wall stress, Incidence of VTe, Aortic stenosis Decrease: Sympathetic tone
43
Liver function and age
Decrease size and function, Blood flow, number of hepatocytes Most relevant blood flow
44
Kidney function and age
Decrease in size, GFR, Na
45
Lung function and age
Diaphragms weakens Chest wall stiffens Increase compliance Decrease Elastin production, VC Increase CC at the expense of FRC
46
Late resuscitation goals
Syst > 110 Coagulation Electrolyte balance Normal Temp Normal urine output
47
Initial TBI treatment
ABC PCO2 > 35 PO2 > 75 Sat > 94% Normothermia Normal ICP
48
Most common injury in aorta blunt trauma
Distal to the left subclavian artery
49
Epiglottitis induction in kids
Careful No RSI, No awake (no crying) Light anesthesia with spontaneous breathing
50
Ambulatory surgery in toddler
Post conceptual age > 60
51
Cardiovascular changes after birth in order
Decrease portal blood pressure --- Closure of DA --- increase PBF --- Closure of foramen ovale
52
Breathing in infants
Decrease the diameter, increase the resistance Increase O2 consumption Type 1 fibers at 2 years, increase the work of breathing Increase compliance
53
Predictors of urinary retention
> 50 Fluids > 750 ml Urine bladder > 270 ml
54
IVC changes
< 2.1 cm Hypovolemia Distended Cardiogenic, distributive, obstructive. CO low except of distributive

Miller's Anesthesia (43 decks)

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