Misunderstood/Diff Topic Flashcards by Franz Biehl

True/False

Neuronal pathway for reflex withdrawal of a limb in response to a painful stimulus is mediated by the cerebral cortex.

False

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_____ toxicity can develop in patients with renal failure who receive nitroprusside infusion.

Thiocyanate

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Risk factors for development of persistent postoperative pain include
_______

psychosocial issues,

preoperative pain severity and postoperative pain severity.

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During non-depolarizing neuromuscular blockade, fade with train-of-four stimulation is the result of ______

ion channel blockade at the neuromuscular junction.

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Hepatopulmonary syndrome triad

Liver dysfunction
Hypoxia
Intrapulmonary vascular dilation

*Unique positional change: worsening hypoxemia when standing, improved when supine

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Portopulmonary HTN

Pulmonary HTN that exists in pt that has Portal HTN

- mean PAOP >25 mmHg at rest

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How does magnesium prolong NMB?

Prejunction effects
- Inhibits Calcium channels at presynaptic junction -> prevent release of ACh

Post junctional effects
- decreases muscle fiber membrane excitability

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Insulin exerts an (anabolic/catabolic) effect on the body

anabolic

Increases glucose uptake
Increases aa uptake
Increases fatty acid storage/synthesis

*insulin inibits catabolic processes (glycogenolysis, lypolysis, proteolysis), opposes glucagon and cortisol

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Ideal time period to quit smoking is ___ weeks. Why?

4-8 weeks

decrease airway reactivity
increase bronchial ciliary motility -> enhance mucous clearance
decrease carbon monoxide lvls -> increase oxygen carrying capacity of hgb

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Broken down Henderson-hasselbalach equation

pH = HCO3-/PaCO2 (kidneys/lungs)

*describes interrelated PaCO2, pH, and HCO3-

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When does “anion gap” occur?

What is normal?

When metabolic acidosis occurs and the body has an excess of anions.
- The acid dissociates into H+ and an unmeasured anion. H+ is buffered by bicarb, and the unmeasured anion accumulates in the serum

Normal is 10 +/- 2

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What is PaO2?

measurement of the oxygen tension in plasma
aka
Dissolved oxygen in plasma

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Which analyzer is affected by water vapor, paramagnetic or galvanic?

Paramagnetic analyzers (ie: desflurane)

bc water vaper is diamagnetic, and will oppose the paramagnetic effect of O2
Paramagnetic devices are incorporated with a water trap from the sampled gas

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Response to succinylcholine

Upregulation of extrajunctional ACh receptors
and
increased hyperkalemic response to succs

*do not give

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Response to succinylcholine

- Myasthenia gravis

Increased resistance to succinylcholine

*can be given

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Response to succinylcholine

- Lambert-Eaton Myasthenic syndrome

Extremely sensitive to succs

*can be given

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Guillan barre syndrome

- Autonomic dysfunction seen

Labile BP
Orthostatic Hypotension
Arrhythmias
Circulatory collapse

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Every pt that receives anesthesia must have (4)

Pre anesthesia eval
w/in 48 hr to procedure, some elements no more than 30 d prior
Review medical/surgical hx, meds, allergies, devel plan
Post anesthesia eval w/in 48 h post surg

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The _____ is the only organ that receives a dual blood supply. What happens if there is a reduction in blood flow?

liver
- hepatic a (25%) and portal v (75%)

Increase in adenosine in liver -> local arteriole dilation and increase in blood flow from hepatic a.

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Desflurane has an extremely (High/Low) vapor pressure and is significantly vaporized at RT. How is this adjusted for?

High - 669 mmHg

Desflurane requires a heated vaporizer to maintain constant vaporizer output [ ], to account for evaporative cooling of des

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3 major mechanisms for nitroprusside toxicity

Cyanide ions bind to cytochrome C oxidase and inhibit cellular aerobic respiration
Formation of cyanmethemoglobin (unable to carry O2)
Thiocynate production (CNS related fx)

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Local anesthetic systemic toxicity (LAST) usually occurs __ hours after the procedure

10-16h when plasma [ ] of local anes typically peaks

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Prior to an awake intubation, percutaneous nerve blocks can be used to anesthetize the airway
- Transtracheal injection of local anesthetic will block ________, which provides _________

Recurrent laryngeal n., branch of vagus n.

- Sensory innervation to vocal folds and trachea

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Most common risk of NSAID use in elderly

dyspepsia (20%)

*more than renal toxicity

Dexmedetomidine (alpha 2 agonist) is metabolized ________.

in the liver, Cyt P450 | - minimal changes noted with renal disease

______ is the main mechanism for pt heat loss in the OR following initial redistribution of heat to the periphery

Radiation - 67%

Bronchopulmonary dysplasia in preterm infants - What is it - Characterized by (4)

chronic disease of lung parenchyma, a sequelae of respiratory distress syndrome Characterized by: - peribronchiolar fibrosis - disorganized pulmonary vasculature - airway smooth muscle hyperplasia - enlarged alveoli

During electroconvulsive therapy, there is a brief initial ______ surge followed by a ______ response. How is this manifested in their monitor?

Parasympathetic followed by sympathetic Brief bradycardia followed by significant tachycardia and HTN - manage w/ esmolol, labetalol, nicardipine, clevidipine, nitroprusside

With the hepatic arterial buffer response, hepatic arterial tone is modulated by ________ via _____ in order to maintain hepatic perfusion

portal venous flow via adenosine

Effects on Hepatic arterial flow - Glucagon - Angiotensin II - Vasopressin

- Glucagon: vasodilation | - Angiotensin II: vasoconstriction

Treatment of tracheoesophageal fistula (can't pass OG tube, excessive oral secretions) is ________

Kasai procesure - jejunal roux-en-y plus portoenterostomy

VACTERL

``` Vertebral abnl imperforate Anus Congenital heart disease TracheoEsophageal fistula Renal abnl Limb abl ```

How to prevent ECG burns in the MRI scanner | - Which law does this follow?

prevent any coiling or loops | - Faraday's law: current in wire is directly proportional to the number of turns (coils) present

Autonomic dysreflexia - Signs under GA - Signs awake/light anesthesia

- Signs under GA: HTN, bradycardia | - Signs awake/light anesthesia: profuse sweating, facial erythema, piloerection, feeling of doom

GCS mneumonic

Eyes (4) Vocal (5) Motors (6) *# of letters in each category

Partial compression of the aorta/IVC will cause _____ BP in the upper extremities and _____ in the lower extremities

increased decreased *ie: aortocaval compression > 20 weeks pregnancy

____________ should be first line tx of bronchospasm during ETGA

increasing O2 [ ] to 100% (FIO2)

What is unique in transplanted lungs?

Denervated and cough reflex and mucociliary function impaired Lymphatic drainage absent

Scopolamine, antimuscarinic can cause paradoxical ______ when given in low doses (0.1 mg)

paradoxical bradycardia

PT/INR is typically increased in cirrhosis d/t ______

decreased production of coagulation factors in the liver

Crawford classification of aortic aneurysms - I - II - III - IV

- I: descending thoracic and upper abdominal - II: all or most of the descending thoracic and abd - III: inferior portion of the descending thoracic and most of the abd - IV: all or most of the abdominal aorta

Crawford type __ aortic aneurysm has the greatest risk of spinal and renal ischemia

Type II | - mortality of 20%

Spinal cord perfusion pressure =

MAP - CSFP *cerebral spinal fluid pressure

Spinal cord and kidneys are at risk for ischemic injury during open thoracoabdominal aneurysm repair. Protective techniques for spinal cord include __ (4)

1. Shunts 2. Bypass 3. Hypothermia 4. Spinal drain placement

Why do obese pts rapidly desaturate with periods of apnea?

They have markedly reduced FRC, which narrows the gap btwn closing capacity and TV *closing capacity: volume at which the respiratory bronchioles begin to collapse. residual volume + closing volume

Treatment for postherpetic neuralgia

1. TCA 2. Opioids (tramadol - opioid + SNRI) 3. Gabapentin/pregab *NSAIDS are useless

Glucagon (raises/lowers) blood glucose levels. How? Glucagon (stimulates/impairs) lypolysis and (stimulates/impairs) glycolysis

raises by stimulating glycogenolysis and gluconeogenesis Stimulates lipolysis Impairs glycolysis

__________ blocks provide fast, reliable, surgical anesthesia of the upper extremity, and are ideal for surgical procedures performed at or below the elbow

Supraclavicular block

_______ blocks are best for shoulder and upper arm surgeries

Interscalene block | - proximal portion of the brachial plexus

______ is a second messenger that causes smooth muscle relaxation, bronchodilation, vasodilation, and tocolytic effects.

cAMP *also increases cardiac contractility

Malignant hyperthermia is inherited in which fashion?

Autosomal dominant with incomplete penetrance

What should you avoid in pts with sickle cell in the OR?

``` Prolonged tourniquet time Hypoxia Dehydration Cold Acidosis ```

Vasopressin's structure is similar to _____ oxytocin. Differ by 2 amino acids

oxytocin Exhibit cross reactivity at high plasma [ ]. Is: vaso can cause uterine contractions Oxytocin can inhibit diuresis

___ stimulates vasopressin secretion, while ___ inhibits secretion

AT2 (angiotensin II from RAAS) ANP

What type of info is seen on the National Practitioner Data Bank (NPDB)

1. Medical malpractice payments 2. Certain adverse licensure actions by state boards 3. Certain adverse clinical privileges actions 4. Certain adverse professional society membership actions 5. DEA controlled-substance registration actions 6. Exclusions from medicare, medicaid, and other federal healthcare programs

On pressure support, a breath is triggered when a pt produces a _____ above a preset _____

flow rate flow trigger

What is the Time Constant?

The volume or capacity of the circuit (Vc) divided by the fresh gas flow (FGF) Vc / FGF

What accounts for the the most heat loss during GA?

Radiation - heat loss from infrared heat

Dyspnea shortly after tumescent liposuction is most commonly caused by _______

Fluid overload and pulmonary edema | - injection of very large volumes of saline