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Openanesthesia Flashcards

1
Q

The brain doesn’t need to herniate for diagnosis of

A

Brain death

In brain death usually have vasogenic and cytotoxic edema

Need
COMA
Apnea
No brain stem reflexes

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2
Q

TCA overdose

A

Check ECG

Give sodium bicarbonate if QRS duration > 100 ms

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3
Q

Carbon monoxide poisoning mainly due to

A

Cyanide

Give high flow oxygen

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4
Q

Needlestick injury

A

Mainly due to hepatitis B

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5
Q

Central line infection risk lowered with

A

Single linen catheter
Using chlorhexidine daily
Use of single lumen catheters

Routine dressing changes does not lower the risk

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6
Q

Clonidine

A

Alpha 2 agonist

Prolongs sensory block when added to local anesthetics

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7
Q

Liocaine vs lidocaine with epi

Duration to onset

A

Delayed when you give epi bc it lowers the pH and thus more ionized molecules

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8
Q

Lumbar plexus comes from

A

Ventral primary rami of L1-L4 with contribution from T12-L5

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9
Q

Nitroglycerin more of a

A

Venodilator than arterial dilation

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10
Q

Sodium nitroprusside leads to cyanide toxicity leading to

A

Metabolic acidosis

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11
Q

Desflurane less at higher altitude because

A

Partial pressure goes down of desflurane so have to give more

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12
Q

Patent duct is arteriosus

A

Post procedure closure can injure recurrent laryngeal nerve leading to hoarseness

From pulmonary artery to aorta

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13
Q

Minimize ventilator associated pneumonia by putting patient

A

Supine and head up

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14
Q

ANOVA vs T test

A

2 or more means vs just 2 means. Paired T test looks at the same group

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15
Q

Sensory above vocal cords which does tounge and epiglottis

A

Superior branch of internal laryngeal nerve

Glossopharyngeal nerve innervates the pharynx

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16
Q

Autonomic reflexives most likely if lesion is above which dermatome

A

T7

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17
Q

Headache dizzy nausea at what percent of carboxyhemoglobin concentration

A

Above 15%

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18
Q

HIT

A

Igg to heparin platelet factor 4 complex

Don’t give Coumadin as it can cause necrosis

Can give fondaparinux

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19
Q

LMWH vs UFH

A

LMWH is more efficious with less side effects

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20
Q

Amiodarone works by prolonging

A

Repolarization

Made side effects are Bradycardia and hypotension

Blocks calcium and potassium channels

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21
Q

Tirofiban

A

Glycoprotein 2b/3a inhibition

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22
Q

Hctz works in the

A

Distal convoluted tubule and blocks sodium chloride transporter and causes increased calcium

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23
Q

Severe sepsis

A

MAP<70

Systolic<90

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24
Q

SIRS

A

Temp heart rate respiratory rate WBC count

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25
LMWH heparin preferentially inhibits
Factor 10a
26
Vitamin K epoxside inhibition is done by
Warfarin
27
Only abductor of vocal cords
Posterior cricoarytenoid innervated by recurrent laryngeal nerve
28
Salicylate toxicity
Metabolic acidosis with respiratory compensation
29
Causes of postherpetic neuralgia
Age > 60 Severe acute pain Female
30
Post ganglionic sympathetic which receptor
Norepinephrine. Pre ganglionic is acetylcholine release as neurotransmitter
31
Fat embolism
``` Hypoxia Increased a a gradient Tachycardia Hypotension Petechial rash on upper body ```
32
HOCM basics
Avoid tachycardia increases contractolity Decrease after load/preload Keep left ventricle with blood to avoid outlet obstruction
33
As temp of blood decreases
Solubility increases and partial pressure of gases decrease
34
Contraindication of intraaortic balloon pump
Aortic regurgitation Peripheral vascular disease Aortic dissection Balloon inflates during diastole
35
Largest branch of lumbar plexus =
Femoral nerve
36
Lumbar plexus block usually spares which nerve
Sciatic
37
In central diabetes inspidus
Maintain euvolemia and check serial sodium levels
38
Phenobarbital acts on hepatic enzymes by
Increasing their action
39
Cerebral venous sinus thrombosis
Heparin first line If that doesn’t work go to endovascular therapy
40
Neurohypophysis
Sure of damage leading to central diabetes insipidus
41
Compression hematoma can be seen 24 hours after
Thyroidectomy
42
Treatment for organophosphate poisoning
Pralidoxime and atropine which crosses BBB
43
Narrowest part of pediatric airway is the
Glottis opening
44
Larynx position in adults is at
C4-C5 C3-C4 in infants
45
Protein kinase G decreases release of which ion?
Intercellular calcium
46
Blood volume of child over 12 months old
70-75 ml/kg 65-70 ml/kg for an adult male
47
Phrenic nerve stimulators improve
Atelectasis
48
Initial precedex first three minutes affect on hr, cardiac output, blood pressure
Bp increases, cardiac output and hr decrease Precedex is much more alpha2 than clonidine
49
Acute herpes zoster most affects
Thoracic spinal nerve roots first than ophthalmic division of V1 distribution around eye
50
Carbon dioxide cylinder color Nitrogen cylinder color
Gray Black
51
Epiglottis induction
Maintain spontaneous ventilation and do mask induction with Sevoflurane
52
New onset a fib with uncontrolled heart rate is an
Active cardiac condition leading to delay of surgery
53
Neuromuscular blockade in the icu
Polyneuropathy and myopathy increase, might help with severe ARDS
54
Garlic causes
Inhibition of platelet aggregation So does ginseng Should stop 7 days before surgery
55
Cyanide toxicity from nitroprusside is due to
Inactivation of cytochrome oxidase
56
During inspiration with tamponade there is increased right sided filling
Causing intraventricular septum to shift to left side of heart
57
During pregnancy
FRC decreases | Vital capacity stays the same
58
In pregnancy before induction
Preoxygenate for 3 minutes Decreased MAC More tissue edema so will likely use smaller endotracheal tube. Also more difficult mask ventilation
59
High magnesium makes you have more sensitivity to
Nondepolarizing and depolarizing muscle relaxants
60
Chest compressions
Depth of 2 inches Rotate every 2 minutes, 100 compressions per minute
61
MRSA rates are decreased by
Daily chlorohexidine usage
62
FENa of 3% of greater leads to
Acute tubular necrosis BUN: creatine is a ratio of 15:1 or less
63
SID if less than 40 =
Acidosis
64
Phase 2 block with succ
>4mg/kg is given
65
Hypercalcemia =
Short QT interval
66
PEEP affect on afterload and preload
Decrease RV preload and increase RV afterload
67
LV collapse is specific
For pericardial tamponade
68
Do t give succinylcholine to patient with guillemots barre because it can lead to
Life threatening hyperkalemiA
69
In pregnancy minute ventilation goes up
50% in first trimester
70
Patients with mylomeningocele are most likely to have
Chiari malformations
71
Treatment of HIT
Direct coagulation inhibitor
72
HIT usually seen at
5-10 days. Before this the drop in platelet count likely multifacyitial and not due to HIT
73
Intraortic balloon pump inflates at
Diastole | T wave
74
For A fib DC cardioversion and SVT
Synchronized biphasic at 100J
75
Chloroprocaine is broken down by
Plasma Esterase
76
MEP most affected by
Volatile anesthetics
77
St Johns Wart
MAO inhibitor
78
Supraclabicular block affects which dermatome
C5-T1 The block occurs at the origin of the divisions
79
Etomidate inhibits
11 beta hydroxylase
80
Patient who smokes may have a carboxyhemoglobin
8-10% Normal is 1-3%
81
MRSA pneumonia is treated with
Vancomycin
82
Window to be in A fib is
48 hours. After you need to either cardiovert or TEE
83
C wave due to
Tricuspid bulging
84
A wave in CVP is during
Diastole
85
Light anesthesia
More oxygen is consumed so mixed venous goes Down
86
Portal triad
Hepatic artery, portal vein, biliary duct
87
Blood flow In liver is not the same as oxygen delivery Percentage of oxygen delivery to liver via hepatic artery
50% Portal blood is deoxygenated so need more to flow to match oxygen of hepatic artery
88
02 content equation
1.39 x hgb x sat 02 + pressure 02 x 0.003
89
Hepatomegaly is seen with
CHF Leukemia Renal failure Not in hypovemic shock
90
Liver can store blood in
High volume states
91
Liver cirrhosis causes dysfunctional cells to
Acquire vasoconstrictor phenotype this increase endothelin, thrombocytes, norepinephrine Nitric oxide is most important vasodilator and is decreased
92
Liver failure see decrease in
Factor 7, decrease in albumin, are Increase in Ammonia levels
93
In fasting state liver breaks down glycogen stored in hepatocytes
Broken to form glucose
94
Creatinine is used in the
MELD score but not child pugh
95
GGT is elevated in
Biliary tract disease
96
ALT is a marker of hepatocellat injury in the
Liver
97
PT/INR
Synthetic function of the liver
98
Liver failure is associated with
Hypoglycemia bc liver metabolizes insulin so now you have too much
99
Liver has no effect
On factor 8 levels
100
PBC and primary sclerosing cholangitis increase
Direct bilirubin
101
Wilson’s disease = too much copper
Treat with penicillamine
102
In normal liver ammonia is converted to
Urea and then excreted from urine Lactulose increases the acidity of the colon If acidified ammonia turns into ammonium ion which cant go into the blood and is excreted through the stool
103
Sepsis increases morphine clearance due to
Elevated cardiac output
104
Benzodiazepines are metabolized by liver without need for
Blood flow
105
Macrolides like erythromycin are inducers of p450 3a4 which also biotransforms
Midazolam
106
P450 2D6 metabolizes
Codeine
107
GFR =
RBF x filtration fraction 125 ml/min normal GFR
108
Normal oxygen extraction in the body is highest at the
Renal medulla at 79%
109
Sodium reabsorption in distal nephron is Mediated directly by
Aldosterone
110
Renin converts
Angiotensinogen to angiotensin 1 Low perfusion to afferent arteriole drives it
111
Vasopressin acts in the
Collecting duct
112
Stage 3 renal failure
Commencement of renal replacement therapy Stage 2 if creatinine doubles
113
RBF represents
25% of cardiac output
114
Cimetidine decreases tubular secretion of
Creatinine
115
How many of the kidneys nephrons need to be affected to see rise in creatinine
50%
116
Angiotensinogen is produced in the
Liver
117
50-70% of renal vasodilation is from
Nitric oxide
118
Angiotensinogen 2 causes both afferebt and efferent
Vasoconstriction and decreased blood flow. GFR is largely preserved
119
ANP is released by
Atrial myocytes in response to atrial distension and Dilates afferent arteriole, constricts efferent arteriole and increases RBF and GFR
120
Kidneys can Control amount of
Bicarbonate reabsorbed and eliminate hydrogen ions, | In respiratory alkalosis excrete more bicarbonate bc you are alkalotic
121
Cause of non anion gap acidosis
Diarrhea, renal tubular acidosis, acetazolamide, spirnolactone
122
Prolonged vomiting or suction on gastric tube =
Metabolic alkalosis
123
Normal SID =
40-44
124
Non anion gap metabolic acidosis
Aspirin ingestion
125
Salicylate toxicity
Metabolic acidosis and respiratory alkalosis
126
Propofol is made into inactive metabolites in the liver and
Unchanged in the kidneys
127
Normeperidine is an active metabolite of
Meperidine and can accumulate in renal failure leading to seizures
128
H2 receptor antagonists are excreted by the
Kidneys
129
Vecuronium
Primarily eliminated by biliary clearance
130
Cisatacurium
Degraded by Hoffman elimination
131
Atracurium breakdown
Degradation by non specific esterases
132
Which morohine metabolite responsible for delayed respiratory depression
Morphine 6 glucoronide
133
Mannitol is renal protective
In cadaveric kidney transplant recipient
134
Eplerenon
Aldosterone antagonist
135
NSAIDs lead to
Prerenal azotemia
136
Fenoldopam is a selective D1 agonist
10 times more potent than dopamine
137
Loop diuretics work at
Thick ascending limb
138
Acetazolamide inhibits
Carbonic anhydrase
139
Thiazides work at
distal convoluted tubule
140
With uremia
See hyperphosphatemia, hyperkalemia, hypermagnesium
141
Uremia means
Urine in the blood See asterixis and hiccups BUN above 70 Treat with dialysis
142
Max amplitude on TEG looks at
Clot strength which is a product of platelets and fibrinogen
143
Venous embolus leads to large increase in
Dead space
144
TAP block inferior border of triangle of petit
Iliac crest Anterior is the external oblique muscle
145
T5 spinous process
Is right next to the T6 transverse process
146
Posterior approach to sciatic nerve block
PSIS, sacral hiatus, and greater trochanter
147
One anterior and two
Posterior spinal arteries Anterior 2/3 of spinal cord done by artery of adamkewitz Distal aortic cross clamp can lead to spinal cord ischemia and paraplegia
148
Highest sensitivity to detect a pheochromovytoma
Plasma metanephrines
149
Decrease catacholamines in peripheral nerves using
Metyrosine Stops conversion of tyrosine to dips by blocking tyrosine hydroxylase
150
Max desirable cuff pressure of tracheostomy cuff is
25 mm Hg Too high causes mucosal edema too low causes aspiration
151
Chang in pulmonary with aging
Decreased elastic recoil thus higher residual volumes
152
Post tonsillectomy hemorrhages usually occur within first
6 hours
153
Ach binds to which subunit of the nicotinic AcH receptor on the skeletal muscle
Alpha
154
Motor nerve depolarization to voltage gated calcium channel to release of Ach to ligand gated sodium channels to
Muscle depolarization
155
Most ACHR are at
Neuromuscular junction StrOke, burns, prolonged icu stay increases leads to upregulayion of receptors Renal failure does not increase number of Ach receptors
156
Ach at the neuromuscular junction is terminated by
Break down by acetylcholinesterase
157
NACH receptors have 5 subunits. Two molecules of Ach bind to two alpha subunits
This leads to a conformational change that allows sodium influx and potassium efflux It will not open if only one Ach binds the receptor
158
Atropine inhibits
Muscarinic acetylcholine receptors
159
Which structure of skeletal muscle does not change in length as muscle contracts
A band
160
Which subunit is found in endplate nmj but not extrajunctional receptors
E
161
Resting potential of skeletal muscle cell
-90 mV Neurons is usually -70mV Cardiac pacemaker cells is -50
162
Tetanus leads to
Botulism toxin acts peripherally to induce flaccid paralysis secondary to inhibition of Ach release at the NMJ
163
Ach is synthesized from
Acetyl coA and choline in motor neurons by Avril of choline acetyl transverse
164
Ach binds to
Presynaptic nAchRs NMDBs block both presynaptic and postsynaptic receptors
165
Succinylcholine side effects
Myalgia Increased IOP Anaphylaxis
166
Less potent neuromuscular blockers like rocirlnium act
Faster duration of action
167
Benzylisoquinolinium NMB =
Cisatracurium, atracurium, mivacurium
168
Atracurium causes
Histamine release
169
When drugs with different duration of actions are used for maintenance of neuromuscular blockade
Recovery will follow the pattern of the drug that was initially administered If you give rocuronium then pancuronium, it will only go the length of roc bc you gave it first
170
Phase 2 blocks of succ acts like NMDBs
Causes post tetanic potentiation
171
Fasiculations with succinylcholine
Binds to presynaptic AchRs stimulating repetitive during and Ach release from motor nerve terminals, fasiculations
172
TOF does not require a
Baseline measurement
173
TOF ratio 0.7
75% of Achrs are still blocked
174
DBS is better than TOF
Because it is easier to detect fade
175
Giving intubation dose of succinylcholine to patient with dibucaine of 20 how long will they stay paralyzed
4 hours
176
Dibucaine is a
Local anesthetic
177
Lambert Eaton
Anti body against presynaptic voltage gated calcium channels, normal number of Ach receptors, proximal muscle weakness that gets better with exercise, sensitive to succ and NMDBs
178
In patients with myasthenia gravis
Avoid magnesium, calcium channel blockers or aminoglycosides
179
Myasthenia crisis will improve when you give
Edrophonium
180
Duchenne muscular dystrophy
X linked recessive,
181
Mannitol decreases Time to peak effect
Water content of brain 45-60 minutes
182
Most sensitive indicator of uterine rupture
Fetal Bradycardia
183
Methotrexate is very
Teratogenic
184
Neuraxial anesthesia can be done on
Patients taking ASA or NSAIDS
185
Tumor lysis syndrome
At beginning of treatment can cause electrolyte shifts
186
Dorsal part of foot
Superficial peroneal nerve Web space of 1st and 2nd space is done with deep peroneal
187
Obturator nerve is far
From fascia Iliaca injection point
188
ASIS and pubic tubercle are landmarks for
Fascia iliaca block
189
Anaphylaxis
High peak pressure Hypotension Blotchy marks on body
190
Nitroglycerin increases myocardial oxygen demand by
Lowering BP and increasing HR
191
Complication of removal of aicd lead or pacemaker leads is
Pericardial collapse and hypotension Treat with thoractomy and drain pericardial effusion
192
1:1000 =
1 mg/ml 1:200000 = 1/1000/200000 = 0.005 mg/ml
193
Radius is most important to fluid flow according to
Pousielle s law
194
Radius is most important to fluid flow according to
Pousielle s law
195
Most common cause of bleeding in critically ill pts is
Peptic ulcer
196
1% lidocaine is
Concentration of 1000 mg/100 ml
197
TAP block
Sensory block of T10-L1
198
Propofol infusion syndrome
Acute bradycardia and metabolic acidosis with
199
All pleural punctures do not turn into
Pneumothorax
200
Opioid side effects
Biliary tract spasm Nausea Urinary retention dose dependent bradycardia
201
Opioid side effects
Biliary tract spasm Nausea Urinary retention dose dependent bradycardia
202
Morphine codeine meperidine
Histamine release
203
Methtlnaltrexone
Peripheral opioid receptor antagonist For opioid induced constipation
204
Opioid side effects
Biliary tract spasm Nausea Urinary retention dose dependent bradycardia
205
Methtlnaltrexone
Peripheral opioid receptor antagonist
206
Context sensitive half time
Time required for a 50% reduction in the plasma concentration of a drug after constant infusion
207
Onset of Fentanyl Morphine Dilaudid
1-3 5-10 5-10 Minutes
208
Hydromorphone and meperidine can lead to
Seizures
209
Coedine is metabolized by
Cytochrome p4502D6 and undergoes demethylation to morphine
210
Methadone
U agonist NMDA antagonist Methadone may prolong QT
211
Tramadol
Reuptaje of norepinephrine/serotonin Lower incidence of respiratory depression compared to U agonists
212
Don’t give meperidine to patients on
MaoIs
213
If you give neuraxial morphine ASA recommends monitoring for
24 hrs
214
Termination of effects of iv anesthetics is through
Redistribution
215
Termination of effects of iv anesthetics is through
Redistribution
216
Benzos enhance binding of
GABA to its receptor
217
Flumszinil works by
Competive inhibition
218
Flumazinil works with slower half life than midazolam
Might need to give flumazjnil again if resedated
219
Ach binds to the
Alpha subunits of the Ach receptor
220
Ach is released from storage vesicles after action potential and bind receptors on
Post junctional membrane Muscle action potential after enough Ach is bound
221
Sch alsobinfs to
Alpha subunit of Ach receptor
222
Succ side effects
Myalgias | Increases intraoccular pressure
223
Psuedocholinesterase is produced in the
Liver
224
Rocironium and vecuronium mainly removes by
Biliary excretion
225
Mivacurium breakdown Atracurium breakdown
Plasma esterases Hoffman elimination
226
Pancuronium side effect
Tachycardia
227
Hypermagnesium Hypercalcemia Hypothermia
Prolong neuromuscular blockade
228
Ulnar nerve
Adductor pollicus
229
Facial nerve muscular twitch
Orbicularis ovuli
230
Esters are broken down by
Psuedocholinesterase found in plasma Amides undergo bio transformation mainly in the liver
231
Esters are more likely to produce allergic reactions than slides bc of
PABA group
232
Higher the solubility or local anesthetic the greater the
Potency
233
More protein binding of local anesthetic =
Greater duration of action
234
Local anesthetic are
Weak bases Most are unionized at pH 7.4
235
Most systemic absorption
Intercostal/caudal/epidural
236
First signs of local anesthetic toxicity
CNS like light headed tinnitus prrioral numbness
237
Don’t use concentrations of bupivicaine above
0.5%
238
Seizures from local anesthetic toxicity
Give diazepam 0.1 mg/kg Give intralipid
239
Benzocaine/prilocaine
Methemoglobinemia
240
Prilocaine
O touludine
241
Preload helps contractility
Frank starling curve
242
Initropic activity
Increase cardiac output by increasing contractility
243
Amrinone infusion aead to
Thrombocytopenia
244
PDE inhibitors lead to
Inotropy and lusitropy
245
High epinephrine dosage is mainly
Alpha
246
Isoproterenol
Potent beta 1 | Beta 2 agonist
247
Digitalis has very narrow
Therapeutic window
248
Nitroglycerin acts on NO increasing cGMP
Improves coronary perfusion with a reduction in myocardial oxygen consumption
249
Hydralazine relaxes
Smooth muscle Takes 15 minutes to act Affects arteriole more than veins
250
Low dose dopamine is NOT
Protective for the gut or acute kidney injury
251
Protein and lipid catabolism seen in
Burn patients
252
If von wildebrands and still have bleeding after giving DDAVP then give
Cryoprecipitate
253
Need to watch preterm infants for 24 hr after anesthesia due to risk of
Apnea Give caffeine and it helps
254
Intermittent p waves with no change in or length
Mobitz type 2 Cancel surgery
255
Tibial nerve
Plantar flexion at ankle and foot inversion
256
Guillan Barre
TLC is lower | Restrictive lung disease
257
Fascia iliaca block for
Postop analgesia anterior and lateral thigh
258
In lambert Eaton you are more sensitive to depolarizing and
NMDBs
259
Pulmonary blood flow can improve by
Maintaining spontaneous ventilation this lowering intrathoracic pressure
260
Lidocaine spinal acts fast bc the pH is very close to the
Maternal pH
261
Dypiridamole is a
PDE inhibitor
262
IV fentanyl compared to morphine iv ratio
Fentanyl is a 100 times more potent
263
Lumbar facet arthropathy is diagnosed with medial branch blocks
Blocks
264
Give lidocaine 1.5 mg/kg
If more than 6 pvcs per minute start to show up
265
Biventricular pacing recommended if EF
Less than 35%
266
Most important factor determining Fa/Fi ratio is
Blood gas partition coefficient Not alveolar ventilation
267
Cardioplegia during bypass electrolyte abnormality
Hyperkalemia
268
Therapeutic range of magnesium is
5-9 Respiratory paralysis at 15 Loss of deep tendon reflexes at 12
269
If you give too much mag give
Calcium gluconate
270
Clearance increases | Vd decrease with
Burns
271
Metabolic CMR02 decreases
50% with burst suppression
272
Etomidate
Increases seizure duration
273
Brain dead patients
Thyroxine, corticosteroids, vasopressin
274
Put anesthetic equipment passed the
5 gauss line
275
Peripheral alpha 2 from precedex causes
Transient increase in BP
276
Increased NO seen in
Septic shock
277
Lowering heart rate is best to decrease
Myocardial oxygen demand
278
Insensible fluid losses can occur with use of
Radiant heat warmers
279
Most anesthesiologists get radiation on the
Head
280
As low as reasonably achievable for
Radiation exposure
281
Radiation exposure
1/Distance ^ 2
282
Contraindications to MRI
``` ICD Pacemaker Cocear implant Ferrous implant Metal/bullet fragments ```
283
Pressure control ventilation leads to higher
Oxygenation especially in the morbidly obese
284
Anaphylaxis happens from reexposure to an
Antigen which causes immune mediated IgE receptor aggregation
285
Treatment of thyroid storm
Propranolol
286
Sensation to base of tounge
Internal branch of superior laryngeal nerve
287
10% of maternal cardiac output is given to
Uterus at term
288
PTU
Stops conversion of T4 to T3
289
Ketorolac analgesic effect from
Inhibition of cyclooxygenase
290
Cox2
Pain Inflammation Fever
291
What nerve block will block gag reflex
Lingual nerve
292
Magnesium inhibits release of
Ach at neuromuscular junction
293
In stellate ganglion block
Get sympathetic response to temp of arm goes up
294
IV regular insulin acts at peak effect within 10-15 minutes and has a duration of action
Of 45 minutes
295
For carotid endarterectomy need
Deep and superficial cervical plexus blocked
296
Deflation of tourniquet leads to decrease in
MAP and CVP
297
Most ICDs turn off with
Magnet If getting asystolic with mono polar cautery switch to bipolar
298
Reduced total lung capacity seen with
Myasthenia gravis
299
Dypiridamole
PDE inhibitor
300
pPV see increase in
SVR
301
Cryoprecipitate contains
Fibrinogen Factor 8 Factorv13 VwF
302
Quadricuspid aortic valve
Most common murmur is AI with mitral regurg
303
Cell salvage blood
No heparin plts etc Hematocrit 50-80% Can use the blood within 6 hrs
304
After someone gets 2 units whole blood uncrossmatched O-
Keep giving this blood due to risk of intravascular hemolysis frim
305
Donor RBCs mixed with recipient serum =
Crossmatch
306
Decreased volume of distribution increases
Plasma concentration of medications Thus you need less drug as seen in cardiomyopathy
307
Inferior angle of scapula
T7
308
Mitral regurgitation gets better through use of
LVAD
309
Midesopheagal bicaval view
TEE
310
First step in drowned apnic patient
Jaw thrust with initiation of rescue breaths
311
First physiologic response to drowning is
Breath holding
312
Guillan Barre don’t use
Succinylcholine
313
Descending bellow ventilators have a disadvantage in that
You can’t tell if there is a leak bc they always descend
314
Neostigmine blocks
Plasma cholinesterase
315
Peripheral cholinergic agonist
Metochlopramide
316
Metochlopramide
Dopamine receptor antagonist
317
At what time of pregnancy does airway get worse
12 weeks
318
Increases in PVR are seen with
Hypoxia
319
Increased tidal volumes | Normal DLCO with
Morbid obesity
320
Reduction in intravascular volume seen in
Preeclampsia
321
Want to maintain SVR in tamponade to keep it
Tight
322
C section is a risk factor for
Amniotic fluid embolus
323
TURP syndrome occurs after
Rapid large volume absorption of hypotonic bladder irrigation Leading to hyperglycemia hyponatremia hypoosmolality
324
Stopping gabapentin aprubtly can lead to
Seizures
325
Less resistance in
Non circle system than in circle system bc the circle system uses valves
326
Can reduce rates of postoperative cognitive decline by using a
BIS monitor
327
Beta agonist causes shift
Intracellular of potassium ions
328
Hypokalemia can lead to loss of
T waves
329
Mild hypoxia in patients undergoing one lung ventilation
Give PEEP to dependent lung
330
Infants
Lower FRC than adults | Quicker inhalation induction due to higher cardiac output
331
Left mainstem bronchus is much longer than the
Right- making it easier to put in
332
Ascending below expiration occurs as it goes
Up!! | Descending bellow is opposite
333
Alfentanyl acts fast bc of high
Unionized fraction
334
Carisoprodol is
SOMA | Has high abuse potential and is a skeletal muscle relaxant
335
Botox for
Chronic migraines
336
Botulism toxin blocks
Presynaptic release of Ach
337
YAG laser associated with
Venous air embolus
338
Capacity
Patient informed enough to make medical decisions
339
Posterior tibial nerve branches
Medial and lateral plantar nerves, medial calcaneal nerve. Does the heel of the foot
340
Femoral nerve is a branch of the
Lumbar plexus
341
Normal aortic valve area is
2.5-3.5 cm
342
UFH 10000 units SC q12 is for
Therapeutic anticoagilation of pregnant female post DVT
343
Femoral nerve =
Knee extension
344
Dorsum of foot
Superficial fibular nerve
345
Sciatic nerve block does not get the
Saphenous
346
Popliteal triangle
Semibranosuse Biceps femoris Popliteal crease are the landmarks
347
The popliteal nerve is more superficial than distal
Femur bone
348
Leviphed incrsss bp
And cardiac output
349
Vertebral arteries arise from the
Subclavians
350
If someone is taking oxycodone regularly you expect to see
Oxycodone and oxymorphone in the UDS
351
Tet spell
Right to left shiny deoxygenated
352
Halothane is
Soluble
353
Tip of tounge pain after LMA due to damage to
Lingual nerve
354
IJ venous cannulation can mess up
Vertebra artery
355
More likely reaction to blood from
Multiparous and those who have been exposed to getting blood before
356
Y wave
Tricuspid valve opens
357
A wave
Right atrial contraction
358
LVEDV biggest right after
QRS. Then systole begins after QRS
359
Hold antiepileptics prior to
Awake craniotomy
360
ARDS reduced compliance due to
Alveoli de-recruitment and collapse
361
Overtime stored levels of 2-3 dpg go down
And oxygen affinity for hgb goes up
362
SI joint dysfunction
Patrick’s test
363
Ideal point to measure CVP is at
Tricuspid valve
364
Central venous catheter Pulmonary artery catheter
Right side of heart Left side of heart
365
Check valves
Allow for unidirectional flow of gas
366
How much 02 required for N20 to flow
Need at least 30 psi
367
Max N20
25 ppm
368
Suction to the
Tip of the endotracheal tube
369
Highest volatile anesthetic trace concentration with N20 is
0.5 ppm
370
If lose tooth during intubation
Get radiographs
371
C02 laser can damage
Cornea Can use regular plastic glasses
372
Pressure drop across a obstruction to find peak pressure is
4V squared
373
Chamber paced
First letter
374
Use if high gas flows
Will not take away trace volatile anesthetic
375
NdYAG laser
Penetrates tissue the most
376
Max Fi02 with NC
0.45
377
Deoxygenated hgb 660 nm
Worst is blue nail polish
378
Minimum macroshock to elicit v fib
100 mA
379
Line isolation monitor does not cause
Micro or macro shock Alarms when grounding occurs in the OR
380
Too narrow or loose BP cuff will be
Falsely elevated
381
625 L 2000 psi
02 cylinder
382
If vaporizer tipped over
Can use after 30 min with dial turned on
383
Microshock is
Close to heart Macroshock around body
384
Lowering the I to E ratio gives more
Inspiratory time and lowers peak pressures
385
Laminar flow is dependent on
Viscosity
386
High pressure anestgesia workstation
From oxygen cylinder to oxygen pressure regulator
387
V5 lead placement
Anterior axillary line midclavicular space
388
Pipeline source to anesthesia machine
Diameter index safety system
389
Calcium hydroxide is better than
Soda lime Compound A not formed CO is not formed
390
Widened pulse pressure seen with
Underdamped on a line
391
Plantar surface of medial forefoot
Posterior tibial nerve
392
Spontaneous type A
APL mask closer to mask In type D fresh gas inlet closest to mask
393
Absolute criteria machine is obsolete
Abscence of vaporizer interlock system Abscence of fail safe device Abscence pin index safety system
394
Atracurium or mivacurium can cause
Histamine induced hypotension
395
Use of topical beta blockers can result in
Exacerbated hypotension Defasiculatimg dose does not help
396
Polyuria polydypsia seen in
Hypercalcemia
397
Radiation is biggest cause of intraop hypothermia
Uniate skin surface rewarming is best
398
Don’t give hemabate to patient with
Pulmonary hypertension
399
Uptake of local anesthetic
``` Intercostal Caudal Lumbar Brachial plexus Peripheral nerve ```
400
Dobutamine
Inotrope and vasodilator
401
Supraclavicular block
Needle insertion 1cm superior to midpoint of clavicle Causes phrenic Horner syndrome
402
High frequency ventilation
Don’t set tidal volume Set Fi02 Frequency Amplitude Inspiratory time
403
Iv labetalol 1 to 7 alpha to beta
First line for HTN in preeclampsia along with hydralazine
404
Median nerve is more superior to
Ulnar nerve
405
Midhumeral fracture
Radial nerve
406
Pudendal nerve
Distal two thirds of vagina and anus
407
Biggest factor for PDPH is
Younger age
408
Initiate chest compressions on neonate is HR<50
When born
409
Lowest hgb in neonate st 8-12 weeks lowest value is
8
410
Increased preload increases MAP due to more intravascular volume from
Mannitol
411
Isoflurane maintains
Hepatic blood flow
412
V wave in CVP
Right atrium filling
413
Y descent is
Tricuspid valve opening and filling right ventricle
414
V wave
Right ventricle fillling Large V wave resembles tricuspid regurgitation
415
Thoracoabdinal aneurysm requires aorta crossclamp
Can’t move lower extremities due to anterior spinal artery syndrome
416
Umbilical artery pH
7.26 is normal Pc02 50 P02 20 BE -3
417
Anterior ischemic optic neuropathy involves
Optic disk PION normal fundiscopuc exam and usually happens right after waking up
418
Left side double lumen tube
Bronchial lumen in left mainstem and tracheal above Carina
419
Proximal left upper lobe bronchus should not be seen after
Left side double lumen tube is put in
420
Right to left leading Shunt from tricuspid atresia slows
Inhalational induction
421
Closing capacity
Volume of air at which alveoli collapse increases with age Compliance increases with age as well
422
Lambert Eaton syndrome
Proximal limb weakness Don’t use neuromuscular blockers
423
HOCM
Slow HR Adequate SVR Maintain preload Maintain myocardial contractility
424
Max amplitude on TEG represents clot strength
Strength
425
Transient neurological syndrome
Dose and concentration of lidocaine don’t matter NSAIDs are best treatment
426
Lower pKa =
Faster onset of local anesthetic block
427
Baclofen
GABAb agonist Benzos work at GABAa receptors
428
Crps type 2
Traumatic nerve lesion present
429
Ventricular wall thickness affects
Myocardial wall tension from LaPlace law
430
Decrease in uteroplacental blood flow due to
Uterine contractions
431
Can use caudal block for
Circumcision
432
Crps type 2
Get swearing in distribution Known injury Motor manifestations can occur over time
433
Parkinson’s
Tremor Rigidity Bradykinesia
434
Tidal volume increases in
Pregnancy Total lung capacity and vital capacity stay the same Closing capacity remains unchanged
435
Stable monomorphic VTach can give
IV amiodarone
436
Give one defibrillation shock for
V fib
437
Compare association of two categorical variables with
Chi square test
438
Neurogenic pulmonary edema from closed head injury increases both
Systemic and pulmonary circulations
439
Give octreotide during surgery in patient with
Carcinoid syndrome
440
Haldol is the agent of choice to treat
Delirium
441
Carbamazepine
Sodium channel blocker
442
Before doing long term ablative procedure do a
Local anesthetic gasserion ganglion block
443
For anterograde cardioplegia need a good
Aortic valve Can’t do anterograde with aortic insuffiency must be retrograde
444
TRALI
Leukopenia and fever are seen
445
Interrogate pacemaker within 12 months of
Surgery
446
Nerve injured in lithotomy position
Common peroneal
447
Contraindications to MRI
Cochleae implant Spinal cord stimulator Aneurysm clip Mechanical heart valve is not
448
LVEDP increases with
Age
449
Ginseng can lead to
Hypoglycemia
450
Sensory nerve injuries
Resolve in 4 wks
451
How long after subq heparin to put epidural
4 hrs
452
West zone 1
Alveolar Arterial Venous In order
453
Don’t give topimax to patient with
Closed angle glaucoma It increases IOP
454
Epidural hematoma treatment and symptoms
Decompressive laminevtomy Symptoms are motor sensory deficits and bowel/bladder dysfunction
455
Aspiration first step
Put bed head down(trendelenberg)
456
Muscle relaxants do not cross
Placenta
457
Potency of benzos in order
Lorazepam Midazolam Diazepam
458
Refraction artifact =
Acoustic shadowing
459
Cervical spinal cord injuries mainly due to
Seated position
460
Tibial nerve
L4-S3
461
Etomidate lowers
Cortisol and aldosterone
462
Mixed venous would be elevated with
Cyanide toxicity
463
PVR = PAPmean-PAOP/CO x 80
PVR
464
Most likely to have another MI on post operative day
3
465
Normal FEV1/FVC ratio is
0.8
466
Direct current cardio version can’t be used on
Multifocal atrial tachycardia
467
Hyperchloremic metabolic acidosis seen with
TPN Don’t get ketoacidosis with TPN
468
02 requirement for an adult is
3 to 4 ml/kg/min
469
More dead space will lead to higher
PaC02
470
Oxygen content =
1.39 x hgb x sa02 + 0.003x Pa02
471
Transpulmonary pressure x tidal volume =
Work of breathing
472
Normal VC
60 to 70 ml/kg
473
Carotid bodies respond to
Pa02
474
Pac02 increase by 10
PH down by 0.08
475
0.01 to 0.04 units/min is starting
Vasopressin dose
476
P50 shifts to right with
Sickle cell
477
Diffusion coefficient of a gas directly proportional to square root of gas solubility and
Inversely proportional to molecular weight of gas
478
With aging
FRC Closing volume Residual volume Increase
479
Pa02 is higher at
Apex of lung
480
Metabolic alkalosis
Hardest to compensate for
481
FEF 25% to 75% is least dependent on
Patient effort
482
Carbon monoxide poisoning doesn’t include
Cyanosis
483
Alveoli at the base of lungs are better ventilated than those at the
Apex
484
Absolute contraindication to TEE
``` Esophageal obstruction Active upper gi hemorrhage Recent esophageal Perforated viscous Full stomach with unprotected airway ```
485
Esophageal Doppler
Monitor cardiac output continuously
486
Sustained HTN leads to
Concentric hypertrophy Impaired ventricular relaxation leading to diastolic dysfunction
487
Labetalol 5-20 mg onset
1-2 min
488
Hydralazine time to onset
5-10 min
489
Joint cement leads to
Hypotension
490
An atomic dead space 2 cc/kg
2
491
Most important buffering system in human body is bicarbonate
Bicarbonate
492
Decreased Pa02 shifts oxyhemoglobin curve to the left
Less oxygen is released when you have less
493
Carboxyhemoglobin half life in someone breathing 100% oxygen is
1 hr
494
CDC guidelines don’t recommend changing
Central catheters
495
Best way to prevent air embolus
Mechanical ventilate with head down so air doesn’t go into venous system
496
Pregnancy shifts oxyhemoglobin curve to the
Right
497
Hypotension I’m setting of severe acidemia
Best choice vasopressin
498
With shunt there is a gradient between
Alveolar and arterial oxygen partial pressures
499
The two bradhiocephalic veins form the
SVC
500
30:2 ratio for single person doing
CPR
501
Amiodarone does decrease mortality after
MI
502
Milrinone not good for
Cirrhotic
503
NIPPV not good for patients with
ARDS
504
Cycle between high and low pressure release ventilation
APRV
505
STOPBANG score of 5 or more
Think pt is OSA Don’t do in ambulatory surgery center if requirement of lots of opioids
506
If surgery is below umbilicus nothing needs to be done
To ICD or pacemaker Turn ICD off of above ulbilicus and reprogram pacemaker
507
Sign of renal injury
Giving lasix with minimal Irvine output
508
Decreased risk of barotrauma
When patient is paralyzed
509
Cannabinol receptors usually located at
Immune system
510
Risk factor for cauda equina with spinal anesthesia
Lithotomy position | History spinal stenosis
511
Reduced insulin resistance by carbohydrate loading
Drink Gatorade two hours before procedure
512
What drug decreases POCD in cardiac surgery
Ketamine
513
Chronic alcohol use increases metabolism of
Midazolam
514
Don’t need to give as much propofol to older patients due to small
Compartment volume
515
Propofol causes bronchodilation by
Attenuating Vagal induced brinchocinstriction
516
Full fast and tight for
Pericardial tamponade
517
Succinylcholine
2 AcH molecules Succ causes higher levels of hyperkalemia in septic patients
518
Storing blood
Increases potassium | Decresss 2-3 DPG causing left shift
519
E cylinder is considered part of the
High pressure anesthesia circuit
520
Higher partial pressure does not affect
Vapor pressure or partial pressure of the gas But other gases partial pressure gets lower so the volume concentration of anesthetic gas goes up Anesthetic depth only based on partial pressure of gas so it is not affected by altitude
521
Stage 2 anesthesia
Increased HR/BP
522
Most respiratory claims are due to inadequate
Ventilation
523
Vaporizers can compensate for change in
Altitude Isoflurane MAC is 1%
524
Do not do bronchoscopy with lavage after
Aspiration event
525
Chronic renal failure
Anion gap metabolic acidosis
526
Maternal ephedrine administration is linked to
Fetal acidosis
527
Shivering increases
IOP and ICP
528
HPV does what to PA02-Pa02 gradient
Decreases it
529
Aspartate
Excitatory neurotransmitter Serotonin is an inhibitory neurotransmitter
530
Pneumbra can be salvaged with
More perfusion
531
Diastolic murmur
Not good
532
Volatile anesthetics
Increases atelectasis
533
For mediastinoscopy need a
Right hand pulse ox
534
Heart transplant patients are
Preload dependent, they can’t increase HR to improve cardiac output Need to use direct acting drugs such as epinephrine or isoproterenol. Indirect drugs like ephedrine won’t work
535
Methylene blue MOA
Inhibition of nitric oxide synthesis
536
At 3 months much better
Pain control if block was performed
537
Apnea-hyponea index
>10 is a sign of OSA
538
Intercostal nerve block for rib fractures should be done
Inferior to the rib
539
Bleomycin for
Testicular cancer Can cause pulmonary fibrosis/pneumonitis
540
Carotid endarterectomy
Central chemoreceptors gone for ten months so Pac02 resting increases by about 6 mmHg
541
Paravertebral nerve block can lead to
Pneumothorax
542
CVP
Can’t do if tricuspid vegetation | Put in SVC right atrial junction and measure post expiration
543
Entacapone prevents
Decarboxylation of levodopa
544
Ergotamine is contraindicated during
Pregnancy
545
Impulse generation at
atria and ventricles are due to sodium channels
546
Procainamide blocks
Sodium channels
547
Pancreatic cancer patients pain best managed with
Celiac plexus block
548
Rheumatic fever think
Mitral stenosis
549
More total body water in infants so require higher
Succinylcholine dosage
550
Respiratory alkalosis in
Pregnancy
551
What lung parameter stays the Same in pregnant vs non pregnant
Inspiratory reserve volume TV increases by about 45%
552
What factor is decreased in liver disease
Protein C
553
Impulse at SA and AV node driven by
Calcium
554
C7 mediates
Triceps reflex C5 is biceps reflex C6 brachioradialus reflex
555
Drug that can cross placenta
Atropine
556
Anterior wall of LV
LAD
557
Pregnancy is an absolute contraindication to
Shock wave lithotripsy
558
GRH release decreases with stress of
Surgery
559
How does dexamethasone help with nausea
Inhibition of prostaglandin synthesis
560
Lipolysis glycogenolysis gluconeogenesis and increased insulin secretion by
Beta 2 receptors
561
Irradiation helps with
Graft vs host disease
562
Duchenne muscular dystrophy goes with
Rhabdomyolysis
563
Fontan has single ventricle anatomy but not
Physiology Mixing pulmonic and systolic blood
564
Increase in FRC
When seated
565
Can measure LVEDV just after
QRS
566
Cerebral salt wasting
Hyponatremia High urine sodium Dry mucous membranes
567
Angel of petit
External oblique Iliac crest Latismus Dorsi
568
Elective surgery on kids should wait until at least
60 weeks post conceptual age
569
Pulmonary capillary wedge pressure high
With abdominal compartment syndrome
570
Propofol dosing
Maintenance on total body weight | Induction on Lean body weight
571
CRAO
Cherry red macula
572
Pulmonary HTN
mPAP>25
573
Beta agonist
Calcium mediated binding of action myosin to troponin c
574
Methohexital is safe for
ECT
575
Red wine and cheese
MAOi syndrome
576
Washed product
IgA deficiency
577
If positive mixture with RH antibody you are
Positive
578
Paramedian and midline approach both use
Ligamentum flavum
579
ICE-BS for systemic absorption local anesthetic
Intercostal Caudal Epidural Brachial plexus
580
Pediatric local anesthetic toxicity give
1.5 mg/kg inttalipid
581
Prostaglandin e1 for
Hypoplastic left heart
582
CRAO is usually
Unilateral Cherry red spot on macula
583
Student T test
Compare means of two groups normally distributed
584
More airway resistance seen in
Neonates than adults
585
Body pink extremities blue is 1 point on
Apgar scale
586
Most uncrossmatched blood u can give without moving to crossmatched is
1 unit
587
What has can be stored in bulk in liquid form
Nitrous oxide
588
Placenta accreta invaded up to the
Myometrium
589
Neonates require lower dosing of blank that adults
Opioids But they require more propofol due to higher Vd
590
Oral tingling think
Hypoparathyroidism
591
AVNRT is suppressed by general anesthesia so do the ablation under
Conscious sedation
592
To see size of bronchopleiral fistula measure
Inhaled vs exhaled tidal volume
593
ST segment elevation V1-V6
LAD
594
TEE probe can affect and damage
Hypopharynx
595
Peds patient endotracheal tube size
Age/4 + 4
596
Distal Lomb of Y connector and endotracheal tube make up
Dead space
597
Pierre robin
Micrognathia glossoptitus airway obstruction
598
Hetastarch has high
Viscosity
599
IO big risk is
Oateomyelitis Good for tibia in kids
600
TRALI most common after giving
FFP
601
Regional for carotid endarterectomy
C2-c4
602
Diploidia on puridostigmine think
Myasthenia gravis
603
Tarazosin and prazosin are good drugs for
Autonomic hyperteflexia
604
Infraclavicular block
Great for below the elbow Doesn’t block phrenic nerve often Frequently misses ulnar nerve
605
Suprarenal cross clamp
Decreased cardiac output
606
Dabigatran does not affect
Platelet function
607
Phenylephrine vasopressor of choice in patients with
Aortic stenosis Up to 40% of blood flow from atrial kick
608
Face mask 6 liters Fi02
0.50
609
Partial rebreather 6 liters
Fi02 .6 Total rebreather at 8 L = 0.8
610
Laryngospasm
Extubation with light anesthesia Secretions falling back into vocal cords Little air movement if complete Stridor if partial Jaw thrust Positive pressure at 100% Succ 10 to 20 mg If continues to be bad give 100mg succ and reintubate
611
Negative pressure pulmonary edema
Supportive treatment Usually better in 24-48 hrs No diuresus usually
612
Surgeries associated with PONV
``` Laparoscopic Middle ear Eye Shoulder Craniotomy ```
613
Everyone needs a ride home after
Anestgesia
614
Atropine delirium treat with
Physostigmine Neostigmine pyridostigmine and edrophonium do not cross BBB
615
Magnets
No affect on pacemaker Turns off ICD Needs to be reprogrammed to asynchronous mode
616
Naloxone oral is poorly
Absorbed
617
Local anesthetics cause
Increased permeability to membrane to sodium blocked by local anesthetics
618
Cystic fibrosis
Dysfunctional transmembrane chloride channel in epithelial cells
619
Pulmonary HTN
Maintain preload Maintain afterload to reduce hypotension Avoid hypoxemia, hypercarbia, and acidosis
620
Guillan Barre can lead to
Hypotension
621
Endobronchial hemorrhage
Mitral stenosis | Pulmonary HTN
622
Lithotomy position
Damage common peroneal nerve
623
Inferior epiglottis to vocal cords innervation
Superior laryngeal nerve
624
Go through cricothyroid to get
Recurrent laryngeal nerve
625
Sevoflurane produces the most
Fluoride
626
Methylene blue selective inhibitor of
cGMP
627
Absolute contraindication of sitting craniotomy
Right to left shunt
628
Older ppl have age related
Decrease in beta cell responsiveness
629
Acetazolamide
Non anion gap metabolic acidosis Decrease in serum bicarbonate
630
Ester local anesthetic metabolized by
Psuedocholinesterase PABA derivative causes rxn
631
Each unit of FFP increases coagulation factors by
3 to 6% Thawed FFP should be used within 5 days Citrate toxicity much higher In FFP vs pRBCs
632
DLCO
Shows transfer of inhaled gas to erythrocytes in pulmonary capillaries Polycythemia increases RBC mass and increases DLCO
633
Neurofibromatosis
Autosomal dominant
634
For zenker diverticulum
Have patient regurgitate contents prior to induction
635
Septal wall is more to the left on
Four chamber view
636
Xrays are
Teratogenic to pregnant patients
637
Quench
Sudden shutdown of magnet During emergency Helium will go into atmosphere taking away the oxygen Give patient oxygen
638
Recommended treatment for factor 8 deficiency
Give recombinant factor 8 Repeat factor administration every 12 hours
639
Patients with preop FEV1 >40%
Low risk for periop complications Also DLCO>40% V02 Max is best to look for post thoracotomy outcome
640
Shivering is not seen in the
Elderly
641
Hypercalcemia can lead to
Hypotension
642
Chi square test
Looks at means of categorical variables
643
Pierre robin to relieve airway obstruction put patient in
Prone position
644
Levofloxacin can cause
Myasthenia crisis
645
Bowel perforation abx use
Zosyn Give antifungal if immunocompromised
646
Esopgacetomy need
Rapid sequence induction
647
Metabolic syndrome =
Increased waist circumference
648
Even if overdampened the mean pressure is
Normal Due to blood clots and air bubbles can cause overdampening
649
MAC increase
Hyperthermia | Chronic alcohol intoxication
650
Sevoflurane plus soda lime produces hydrogen
Which can be easily ignited and lead to fire
651
Leptin
Protein that decreases appetite and increases ventilation Obesity hypoventilation syndrome compensated for respiratory acidosis
652
Flumazinil competitive antagonist at
GABAa receptors If on chronic benzos and given it can lead to seizures
653
Neurolytic celiac plexus block causes
Diarrhea hypotension Less common is paraplegia
654
In hyperthyroidism
SVR is decreased Cardiac output is increased
655
Abdominal compartment syndrome
Compression of kidneys so urine output/renal blood flow/GFR drop Lower venous return so cardiac output down, LVEDV down, stroke volume down, svr up Intrathoracic pressure up Leads to hypoexemia higher airway pressure lower compliance higher PA pressures and CVP readings
656
Musculocuraneous nerve
Lateral forearm
657
Patients with brain death get diabetes insipidus and present with high levels of
Sodium
658
Saphenous nerve
L2-L4 nerve group
659
Chronic anti epilepsy drug usage
More rapid clearance and resistance to neuromuscular blockers
660
SSEP monitor integrity of
Dorsal spinal columns
661
QT interval above what number is bad
> 500
662
RQ of 1 is due to pure
Carbohydrates metabolism RQ of 0.7 goes with pure fat metabolism
663
Intercostobrachial nerve can lead to
Tourniquet pain
664
Sex has no affect on
MAC values Clonidine and precedex decrease MAC value
665
Medullary segments of nephron get much less blood flow than the
Cortex
666
Fa/Fi ratio of halothane goes up
The least Desflurane the fastest bc of low solubility
667
PE
D shaped interventrivular septum
668
Motor evoked potentials
Most sensitive to somatosensory evoked potentials
669
12 hour before epidural with LMWH prophylactic For enoxaparin 1 mg/kg every 12 hours need to wait
24 hours
670
LR contains
Potassium Hypotonic Does not cause lactic acidosis pH of 6.5
671
Therapeutic blood concentrations of fentanyl are achieved after 13 hours with a
Patch
672
Epidural hematoma
Severe back pain Neurological deficits Use CT to diagnose or MRI
673
Bicarbonate lost in urine with
Acetazolamide leading to hyperchloremic metabolic acidosis
674
High FGF increases predictability of concentration delivered to pt but also increases
Waste gas and contributes to contamination of atmosphere
675
Dopamine causes release of
Norepinephrine
676
Migraine with aura
Reversible focal neurological symptoms Transient neurological symptoms usually precede a headache
677
SIADH treatment
Fluid restriction
678
Autonomic hyperteflexia
Bradycardia Headache Hypertension
679
Sacral nerves do
Bladder and urethra
680
Tibial for
Foot inversion
681
NSAIDs
Renal afferent arteriole constriction can lead to HTN
682
NSAIDs
Cause hyperkalemia/hyponatremia
683
Neurogenic =
Central diabetes insipidus
684
Absolute contraindication to ECT
Pheochromocytoma Pregnancy/AICD is not
685
Hypotension from spinal anesthesia due to
Deactivation of preganglionic sympathetic fibers
686
Increased atrial stretch
Increases heart rate
687
Peak levels of tumescent lidocaine at
Twelve to fourteen hours 35 to 55 mg/kg is max
688
Tracheal intubation for pts
With congenital diaphragmatic hernia
689
Cyclosporine leads to
Increased serum creatinine
690
Obesity hypoventilation syndrome vs OSA
Daytime awake hypercapnia and hypoxia
691
Dexemetetomidine does not produce
Burst suppression Volatile anesthetics do lead to burst suppression
692
Sentinel events include
Retained foreign body post surgery | Patient committing suicide within 72 hr hospital admission
693
Chronotropy =
Heart rate
694
Chronic meth use
Depletion of neurotransmitters, mainly epinephrine and norepinephrine
695
Less painful injection of lidocaine when what is added to it
Sodium bicarbonate
696
Mandibular teeth
Inferior alveolar nerve
697
Patients are not ventilated while on
Cardiopulmonary bypass Ventilation changes need to be made based on oxygenater flow If PaC02 is high oxygenater flows need to be increased
698
Dexamethasone helps decrease flow of blood from intravascular to
Extravascular space
699
Methohexital increases
Seizure duration.
700
Critically hypotension is class4 when blood loss greater than
40%
701
Lingual nerve block abolishes
Gag reflex
702
Artery of Adamkowitz
T9-T12
703
Fibrinogen Factor 8 VwF is found in
Cryoprecipitate
704
Intrascalene block
100% ipsilateral phrenic nerve block
705
TXA
Blocks plasminogen to plasmin conversion Can cause seizures
706
Most common TEF
Blind esophageal pouch with distal tracheo-esophageal fistula
707
Calibrate oxygen sensor
Once daily!
708
Gold standard spot for getting cute temperature
Pulmonary artery
709
Post bronchoscopy should watch patient for
4 hrs
710
During hypothermia
Solubility of C02 increases, thus lowering the partial pressure of C02 and raising the pH
711
Interferon B 1
For MS | Causes flu like symptoms and elevation in ALT
712
Need increased dose of neuromuscular blockade to achieve same effect on
Burn patients
713
Small for gestational age can lead to
Hypoglycemia
714
Usual newborn weight is
3-3.5 kg Below this you are small for gestational age
715
Use small doses of D5 or D10 for
Hypoglycemia in small children
716
Want endotracheal tube past the level of the
Fistula if patient has a TEF
717
RVAD inflow and outflow cannula placed
Inflow is in right atrium Outflow within pulmonary artery GOAL is to bypass right ventricle
718
Pregabalin can cause
Fluid retention and weight gain
719
First line drugs for fibromyalgia
Pregabilin Duloxetine TCAs
720
Best nerve block for pelvic pain
Superior hypogastric
721
Less like hypotension in
Neonatal spirals. They also require a higher dose due to more CSF volume than adults
722
High block level and asymmetric block is seen with
Subdural injection
723
Plasma volume
Increases in pregnancy | Red cell volume goes up less leading to a decrease in hematocrit
724
Max safe dose of lidocaine without epi
5 mg/kg
725
Flumazinil
GABA antagonist
726
Precentral gyrus =
Primary motor cortex
727
V fib and tachycardia during cardiac arrest preferred drug is
Amiodarone
728
BMI>50 shouldn’t be done at
Ambulatory surgery center
729
First step in V fib secondary to LAST is
Airway management
730
Carcinoid mainly found in
GI tract Made up of neuroendocrine cells
731
Anhydrosis, impotence, early satiety all go with
Autonomic neuropathy in diabetic patients
732
Hepatic stellate cells regenerate after
Injury They are derived from neural crest cells
733
80 * (MAP-CVP)/CO
SVR
734
Blocking brachial plexus often blocks
Phrenic nerve (C3-C5)
735
Gentle passive rewarming with hypothermic patient with
TBI
736
In TBI patients corticosteroid can lead to increase in
Mortality
737
Adenosine is increased if portal vein thrombosis in order to
Increase hepatic arterial flow
738
Morphine metabolites are excreted by the
Kidneys
739
Low Fi02 lowers risk of free radical injury in patient on
Bleomycin
740
Bleomycin is associated with pulmonary
Fibrosis
741
Pringle maneuver to reduce blood flow to
Liver
742
Seplenic sequestration due to portal HTN in ppl with ESLD leads to
Thrombocytopenia
743
Factor 7 half life is very low at
4-6 hours
744
Variable intrathoracic airway obstruction
Anterior mediastinal mass or tracheomalacia Expiratory curve is flattened
745
Cerebral aneurysm rupture or SAH complication after =
Vasospasm Happens after 3-10 days look out for new neurological complications
746
Fascia iliaca nerve block blocks the
Femoral nerve
747
Multiple sclerosis avoid which medication
Succinylcholine
748
1 avl V5 V6 =
Left circumflex artery
749
Vasospasm first line
IV normal saline
750
Main cause of liver transplantation
Hep C
751
Calcium gluconaye contains less calcium than calcium
Chloride. Need to give calcium chloride through central access
752
Hyperkalemia is common with
Compartment syndrome
753
At 1 Mac anesthesia you see
Theta waves
754
Hunter syndrome associated with
Coronary artery ischemia
755
Gestational age
Number of weeks until baby born Postnatal is time since birth Postconceotual age = gestational plus postnatal
756
Neonate with
High pulse pressure Tachycardia Respiratory distress Tachypnea systolic murmur This is a PDA
757
Post splenectomy higher chance of infection with
Hemophilus influenza type B
758
ANP is released after stimulus from
Atrial diatension such as after a fluid bolus
759
Decreased physiologic dead space with higher
I:e ratio | Like 1:1
760
Diseases with high likelihood MH
Central cord | King dunborough syndrome
761
Velocity of gas increases
Pressure decrease = Bernoulli equation
762
End tidal c02 not possible with
Jet ventilation but need to look out for hypercarbia High velocity low pressure system
763
BIPAP tidal volume =
Peep high- Peep low
764
Fondapariunax inhibits factor
10a Can restart 6 hr after epidural removed
765
MAC requirement decreased in older ppl
Isoflurane MAC in 40 yo 1.2% In 80 yo 0.9%
766
Third degreee Burns are painless and dry
Second degree burns are moist and painful
767
Head and neck in rule of 9s for burn
Total altogether is 9% both the head plus neck
768
Rivaroxabin
Factor 10a inhibitor
769
Dabigatran
Oral thrombin inhibitor
770
Rivorpoxaban reversal is
PCC
771
Bolus dosing of bupivicaine is 2 mg/kg and 0.2 mg/kg for epidural
Infusion
772
Weak pulse and altered mental status =
Low perfusion to brain Can be seen in patient with SVT Cold pack is best for children then do cardio version .5-1 J/kg
773
TCAs
Sedation urinary retention Nortriptyline is least sedating one
774
Vancomycin for
Penicillin resistant gram positives
775
For resistant psuedomonas give
Zosyn/ aminoglycoside or flouroquinolone
776
Air embolus
First give Fi02 of 100%
777
Laryngospasm occurs during
Inspiration
778
Higher risk of laryngospasm for how long after URI
2 wks
779
Posteromedial papillary muscle rupture MI
Large V waves due to quick atrial filling from incompetent mitral valve
780
Y wave on PAC
Passive filling of LV
781
A wave
Atrial comtraction X descent is atrial relaxation V wave ventricle contraction Y descent is passive filling of left ventricle
782
More arterial C02 when sodium
Bicarbonate is given
783
Glipizide
Increase insulin secretion from pancreatic beta cells
784
Nitroprusside
Both venous and arteriolar vasodilation Nitroglycerin is much more venous than arterial
785
Decrease in calcium leads to
Smooth muscle relaxation
786
Promethazine
Histamine antagonist
787
Aprepirant
NK1 receptor antagonist
788
Chlorhexidine alcohol is best to use before
CVC placement
789
Stop tirofiban 8 hours prior to placing
Epidural
790
Methohexital is gold standard for ECT bc it lowers
Seizure threshold Etomidate increases the seizure duration
791
Obese patients have
Increased gastric volume and decreased gastric pH
792
Giving sodium bicarbonate lowers
Ionized calcium Increase ph Increase arterial C02 Increases lactate temporarily
793
Ace inhibitors can lead to
Angioedema
794
Diastole phases
Isovolumetric relaxation Rapid filling Diastasis Atrial Systole Diastolic can’t fill correctly heart Systolic can’t eject properly
795
75-80% of filling is during
Rapid filling phase
796
Bradycardia Hypotension Coronary artery dilation In response to MI or reperfusion
Behold Jarish Reflex
797
Bainbridge stretch leads to increase in
HR
798
Clindamycin increase
Neuromuscular blockade
799
Ectothiophate increases
Succinylcholine blockade
800
Right arm Left arm Left leg
3 lead ECG
801
3 lead ECG great for detecting
V fib
802
Fluoxetine can lead to no inhibition of
Cytochrome P450
803
Cocaine use chronically can lead to
Thrombocytopenia
804
Stopping smoking decreases surgical site
Infections
805
For CDH in newborn
Spontaneous ventilation Fentanyl to blunt pulmonary HTN No paralysis
806
Last to be blocked by local anesthetics
A alpha fibers Large and myelinated
807
Iron isn’t safe in
MRI
808
Xenon acts via
inhibition of NMDA receptors
809
Decreased GI ulceration with
COX-2
810
Sevoflurane can prolong
QT interval
811
All inhaled anesthetics prolong
QT interval Same with all pressors except phenylephrine
812
During ECT get a parasympathetic surge at beginning which shows up as
Bradycardia
813
Medial clavicle =
C4
814
Highest risk of hyperkalemia after burn injury is after
2 weeks
815
After suprarenal aortic clamp what decreases
Cardiac output
816
NMS
Related to antipsychotic medications Will have high CPK level
817
Decrease which drug dose with cirrhosis
Thiopental
818
Give fluids for
Suction events in LVAD Usually bc patient is hypovolemic
819
Pyloric stenosis electrolytes
Hypocholemic hypokalemic metabolic alkalosis
820
Increased preload and cardiac output in
Pregnancy
821
Mitral valve repair can injure
Circumflex artery
822
Fascia iliaca block blocks
Femoral nerve and lateral femoral cutaneous
823
IABP increases
Coronary perfusion pressure
824
Acute intermittent porphyria
Diffuse abdominal pain Proximal muscle weakness Urinary retention or dark urine Don’t give barbiturates like thiopental to pt with AIP
825
100 uA leads to
Mucroshock if applied to heart and can lead to v fib
826
Forceps delivery more likely
Intracranial hemorrhage
827
Precedex
No amnestic effects
828
Meet Extubation criteria faster with
Desflurane than Sevoflurane
829
NASH is associated with
Insulin resistance
830
Residual volume increases with
Age Vital capacity decreases with aging
831
Epinephrine to check for
Intravascular placement
832
Samarium 153 is a radio pharmaceutical good for
Bone metastasis from prostate cancer
833
Subcutaneous emphysema can lead to hypercapnia but not
Hypoxia
834
Normal saline contains no
Potassium
835
High thoracic spinal lowers
Vital capacity
836
Hyperthermia increases
MAC
837
PEA use
Epinephrine not defibrillation
838
Dorsum of foot sensation
Superficial peroneal
839
Static ultrasound is located in
Internal jugular vein
840
Fetal scalp pH less than 7.2 is indication for
Emergency delivery of baby
841
Intrapartum asphyxia
PH < 7.0 | Base deficit of 12 or more = intrapartum asphyxia
842
HIT can lead to
Thrombosis
843
Best to look at myocardial bloody supply of all 3 major coronary arteries
Transgastric midpapillary short axis
844
Celiac plexus block for
Pancreatic cancer
845
Celiac plexus block
Inferior aspect of anterolateral T12 vertebral body
846
Leukocyte reduction helps against
Nonhemolytic febrile transfusion reaction
847
Risk of vasospasm after SAH peaks at
5-7 days
848
Atelectasis
In more than 90% of people getting GA Occurs during spontaneous/PPV Nitrous oxide doesn’t increase it More atelectasis = more intrapupmonary shunt
849
Carbamazepine autoinduction of
Cytochrome system enzymes Leads to agranulocytosis
850
TIPS procedure good for patient with
Refractory ascites
851
Most North America liver failure is
Drug induced
852
High risk of ICP elevation in
Liver transplant patients
853
Fentanyl patch can lead to acute
Respiratory depression Forced air blankets increase transdermal fentanyl uptake
854
RSBI<105 is a good indicator for successful
Extubation
855
LIM prevents against
Macroshock, but not microshock
856
Oculocardiac reflex afferent is
CN 5
857
Do not give 100% oxygen to neonates even for an instant
Can lead to problems Correct hypothermia want above 36 Celsius Give IV dextrose if glucose below 45 Chest compressions if HR below 60
858
Infants higher risk for local anesthetic toxicity compared to adults due to
Low levels of plasma binding proteins such as alpha 1 acid glycoprotein
859
Sevoflurane
Emergence delirium Precedex opioids help in children Haloperidol does not help
860
Carbohydrate RQ is
1 Fat is 0.7 Protein is 0.8
861
Decreased cardiac output in neonates both to mothers on
Cocaine
862
Creatinine clearance
Most accurate for renal function Urine creatinine x urine flow rate/serum creatinine
863
If under 50 weeks post conceptual age monitor for how long after surgery
12 hours
864
Post op apnea and Bradycardia risk in preterm newborn highest at
0-6 hours post surgery
865
Metyrosine
Inhibits release of catecholamines
866
Critical illness neuropathy
More lower limbs
867
Desmopressin for
Von wildebrands disease
868
Management of cardiac tamponade want to maintain preload
No vasodilation Used levophed to keep the pressure up
869
CRPS type 2 has an identifiable
Nerve injury Intermittent edema/sweating in hand
870
D shaped intraventricular septum =
PE
871
Ferrous to ferric state in
Methemoglobinemia
872
Sodium nitrate for
Cyanide poisoning
873
Aortic stenosis radiates to
Neck and apex
874
Mitral stenosis is best heard when
Patient exhales
875
Normal mitral valve area is
4 to 6 cm Lower than this will lead to sob Critical if less than 1 cm
876
Mitral stenosis
Need to maintain preload No sinus tachycardia Maintain SVR when cardiac output is limited Need adequate contractility Reduce PVR
877
Level C personal protection after mass casualty
Respirator! | Chemical resistant boots/gown/outer gloves
878
WPW can lead to
SVT WPW you see delta waves on ECG
879
Lower PONV with
Carbohydrate loading Also helps with insulin resistance
880
Capacity
Ability to understand nature and consequences of a decision
881
VSD
Left to right shunting of blood Increased contractility increases resistance to right ventricular outflow thus you don’t want this for VSD On the same line keep preload up so doesn’t get hypovolemic
882
Greatest decrease in myocardial contractility is seen with
Halothane
883
Mean of a sample representing actual population mean is shown through
Standard error
884
Peak of T wave is at
Ventricular systole
885
Full term neonate blood volume
85 ml/kg Premature neonate is 95 ml/kg
886
Lowest mineralocorticoid activity
Dexamethasone Dexamethasone has highest glucocorticoid activity
887
Increased hematocrit can be associated with higher EPO
Levels Pa02 less than 60 leads to more EPO release and higher red cell mass
888
As you get older
Higher lung compliance Lower chest wall compliance
889
Highest bioavailability of midazolam
Intramuscular
890
Atrial systole big part of filling with
Aortic stenosis
891
Relationship between two categorical variables
Chi square test
892
Barbiturate coma
Lower cerebral metabolic rate and ICP by 50%
893
Tumescent high dose is
55 mg/kg
894
Hydroxyethal starch lowers
Factor 8 levels
895
TBI causes hypernatremia due to
Diabetes insipidus
896
Major buffering in blood is from
Hemoglobin
897
Bain ridge
Tachycardia after increase in intravascular volume Bezold jarisch- vasodilation and bradycardia
898
EMG is markedly reduced with use of
Neuromuscular blockade
899
SSEP
Stimulates a peripheral nerve
900
MEP
Very fast response corticospinal tract SSEPs need to be averaged and are not fast
901
Modern ICDs have
Cardioverter defibrillator and a pacemaker
902
Most common cause of jaundice and hepatic dysfunction during pregnancy is due to
Viral hepatitis
903
High pressure leads to
Concentric hypertrophy
904
Carbamazepine two black box warnings
Agranulocytosis | Skin rxn like Stevens Johnson
905
90% of acetaminophen goes through
Liver to sulfate and glucoronide conjugated and excreted from kidneys
906
Lithium
Causes prolongation of neuromuscular blockade Causes increased sensitivity to volatile anesthetics so your MAC is lowered
907
Peripartum cardiomyopathy occurs
During end of pregnancy or months after delivery
908
Acromegaly
Too much growth hormone Leads to diastolic heart dysfunction
909
Mitral stenosis can lead to
Atrial fibrillation
910
SVR decreases during
Pregnancy
911
Elevated progesterone during pregnancy reduces
Smooth muscle tone Decrease SVR Ultimately decreases MAP
912
Put pulse ox on right hand during
Mediastinoscopy
913
Separation anxiety in children behind ya about age
10 months
914
Hypothyroidism
Postop ileus Hyponatremia Hypotension
915
ANOVA for finding means
Of more than two groups
916
Propofol
Context sensitive half life o 8 hour propofol infusion is 40 min Hepatic metabolism 60% of total propofol clearance GABA agonist
917
Fentanyl has very high
Context sensitive half life
918
First apply PEEP to operative lung
Before CPAp to non ventilated lung
919
In extreme measure you can clamp
Pulmonary artery to non ventilated lung to only give blood flow where needs
920
Hypophysectomy
To remove pituitary adenomas
921
Remifenanyl primarily metabolized by
Liver
922
TBI fluid of choice
Normal saline
923
Give reduced opiates post op to children with
OSA
924
ASD leads to
Pulmonary HTN
925
Retrograde cardioplegia best
In AI bc doesn’t distend LV
926
Cardioplegia is
High potassium solution that causes diastolic arrest of the heart
927
No ace inhibitor in
Pregnancy
928
Cos atracurium
Hoffman elimination
929
Distal tube of endotracheal tube In TEF position
In between fistula and carina
930
Late decelerations occur after
Peak of uterine contractions
931
Glycopyrolate
Does not cross BBB
932
Tirofiban
Glycoprotein 2b/3a inhibitor
933
Single shot spinal with MORPHINE
Need to monitor every hour for first 12 hours then every 2 hours for the next 12 hrs
934
Hypoxia pulmonary vasoconstriction
Increased intracellular calcium
935
Claudication can be
Vascular or neurogenic
936
Dantrolene
Inhibits ryanodine receptors Lessing to less release of intracellular calcium
937
Each leg=
16% in Parkland formula
938
Neostigmine crosses the
Placenta
939
Choanal atresia first 4-6 wks by blocking nares
Associated with CHARGE and deafness
940
Botulism toxin blocks
Presynaptic Ach release
941
Cricothyroid innervated by
Vagus
942
PVR is lowest at
FRC
943
Achondroplasia =
Atlantoaxial instability Awake fiber optic is a good choice
944
Remifentanyl volume of distribution and clearance are decreased in elderly
Patients
945
ED95 of rocuronium
The dose of rocuronium that gives a 95% reduction of twitch height
946
Stellate ganglion block helps with
Ramsay Hunt
947
Doubling catheter diameter increases
Fluid flow by 16 times
948
Factor 3/8 is not made by
Liver
949
Duchennes
Reduced EF is seen X linked recessive disorder
950
5-10 cm proximal to popliteal crease is where
Sciatic splits Sciatic is derived from L4-S3
951
For pulseless electrical activity
Continue chest compressions | Epinephrine
952
ASA developed to
Facilitate comparison of anesthetic data
953
Bioavailability of oral midazolam is the
Lowest
954
Pneumotaxic area helps move inspiration to
Expiration
955
Alveolar concentration and mixed venous concentration of blood determines uptake of
Volatile anesthetics
956
Hypokalemic periodic paralysis stimulated by
Hyperglycemia
957
Total spinal more likely and difficult intubation with
Ankylosising spondylitis
958
If all leaflets are open likely not
Aortic stenosis
959
I’m patient with severe AI want to increase BP
Use epinephrine
960
Law of Laplace
Wall tension= Pressure x radius/2 x thickness
961
Dopamine leads to release of
Endogenous norepinephrine
962
Compartment syndrome
Lower cardiac output
963
What contributes to complications after tumescent liposuction
Large volume liposuction Multiple procedures in addition to liposuction Replacement of volume of aspirate with iv saline
964
Large grounding pad to lower
Current density
965
Haldane affect
Property of hemoglobin where deoxygenation increases its ability to carry C02
966
Fentanyl patch
50% gone in 16 hrs
967
Intrascalene block
Phrenic nerve block
968
Number needed to treat
1/ARR
969
Caudal anestgesia at
S4-S5
970
Local anesthetic into intrathecal space first sigh in neonate
Apnea
971
ST elevation
Need cardiac catheterizatoon
972
ED50
Dose required to achieve a drugs effect in 50% of exposed patients
973
Most frequent in SLE
Asymptomatic pericarditis
974
Reversible cause of A fib
Hypokalemia | Hypomagnesium
975
Sartorial movement in femoral nerve block
Go deeper/more lateral
976
High spinal leads to decrease in
Expiratory reserve volume
977
If giving office based anesthetic need to have a
Backup energy source
978
Bradycardia during induction
Typically occurs in patients with trisomy 21
979
PEEP can impede
Venous return
980
Williams syndrome is associated with
Hypercalcemia
981
Popliteal block doesn’t block
Saphenous nerve
982
BUN/plasma creatinine decrease in
Pregnancy Renal blood flow/GFR increase by about 50%
983
Being of female age increases risk of
Myalgias In female patients given succinylcholine
984
Infants have increased
Volume of distribution for most drugs
985
Milrinone
PDE3 inhibitor Decreases SVR and PVR Decrease afterload Increases cAMP Can lead to atrial fibrillation after cardiac surgery
986
Febrile non hemolytic transfusion reactions are the most common
Transfusion reactions and due to donor leukocytes
987
Down syndrome patient more likely to have
Hypothyroidism Subglottic stenosis and airway obstruction More likely to have congenital heart defects
988
Pregnant patient
Elective surgery should be postponed until after delivery | If need to be done perform surgeries in 2nd trimester
989
NPO guidelines are for all forms of
Anesthesia including regional
990
Spina bifida occulta
Can still do epidural just away from site of lesion
991
In MH
Dabtrolene dose 2.5 mg/kg If emergent surgery continue with IV agents Treat hyperkalemia with calcium
992
Rocuronium
Classified as an intermediate acting neuromuscular blocker
993
Most important determinant of cerebral vasospasm is
Volume of hemorrhage
994
After MI
Troponin I and T stay elevated for 7-10 days LDH 6 days CKMB and total CK for 2 days
995
Orbicularis oculi of facial nerve for blinking
Peribulbar block covers this | Retrobulbar does not
996
Withdrawal from painful stimulus is
General anesthesia it is not purposeful
997
Air bubble in blood gas line
Increases in Pa02 decrease in PaC02
998
Sustained IAP above 20 is
Abdominal compartment syndrome
999
Pulsos paradoxes also seem with
Tamponade Asthma Obesity PE
1000
Most important single determinant of postop apnea is
Post conceptual age
1001
Aspiration
Still need positive pressure ventilation
1002
Hashimoto thyroiditid
Hypothyroid Increased SVR because beta activity goes down
1003
Thoracic epidural
Paramedics approach is easier Decreases mortality in patients with multiple rig fractures
1004
Atropine
Smooth muscle relaxation Increase SA node conduction increasing HR Increases body temp
1005
Decrease in cardiac output won’t affect
Isoflurane The most of it already goes in blood
1006
Bipap and CPAP for
Mixed hypoxemic/hypercarbia girls of respiratory failure ``` Bipap contraindication include AMS Aspirationrisk Pneumothorax Hemodynamic instability ```
1007
Critical illness myopathy
Higher levels of CPK
1008
Platelets much more likely to cause TRALI then
PRBCs
1009
Increased risk of trali getting blood from mothers
Multiparous
1010
Deficiency of C1 esterases inhibitor
Angioedema
1011
Spinal leading to bradycardia hypotension
Bezold Jarisch reflex
1012
Baroceptor reflex
Bradycardia in response to increase in mean arterial pressure Seen when given bolus dose of phenylephrine Mediated by carotid sinus and aortic bodies
1013
Best place to get temp measurement
Nasopharynx Tympanic membrane Distal esophagus Pulmonary artery
1014
Penicillin allergic
Use clindamycin or vancomycin
1015
Most eyewear is protective for
C02 lasers Burns cornea
1016
Mitral regurgitation
Want HR high using dobutamine or epi Will look like a high EF but that’s bc some of blood goes into left atrium Norepinephrine mainly alpha and increases SVR which u don’t want
1017
Succinylcholine
Low placental transfer
1018
Desflurane decreases uterine tone less than
Sevoflurane
1019
TLC is higher in
Adult vs neonate
1020
Static compliance =
Tidal volume/pplateau-peep
1021
Myotonic dystrophy must avoid
Succinylcholine
1022
VAE risk increased if
Head is 15 degree above level of right atrium
1023
Routine testing of blood is for
HIV htlv and west Nile Not CMV as most ppl have it so it is normal flora
1024
Preeclampsia with high BP and rales think
Pulmonary HTN and start with IV nitroglycerin
1025
Midazolam
Doesn’t affect thermoregulatory control
1026
Place ancillary roll
Caudal to axilla
1027
Doppler probe to detect venous air embolus should be in
Right atrium
1028
Mitral valve diastolic dysfunction look at with
Four chamber midesophageal Also best for looking at wall motion abnormalities
1029
Which view shows all three coronary distributions
Midesopageal four chamber view
1030
Peds patients PONV
Length of surgery greater than 30 min Patient age > 3 Stribusmis surgery Hx of PONV
1031
Peak effect of dilaudid is ten
Minutes
1032
Apnea hypopnea greater than 10 bad in
Peds
1033
Fentanyl
Long context sensitive half life due to high volume of distribution
1034
Sufentanil has shorter context sensitive half life than
Alfrntanyl
1035
Effect size of logistic regression
Odds ratio
1036
Kidney disease problems come giving dilaudid due to accumulation of
Hydromorphone 3 gluconronide
1037
If tracheal cuff overinflated can lead to
Vocal cord paralysis Common trachealcuff high volume low pressure
1038
Increase respiratory rate increases
Airway resistance
1039
Large sudden decrease in CSF will lower ICP but will increase
Transmural pressure which can rupture aneurysm
1040
LAD and RCA seen in
Midesopaggeal two chamber view
1041
First thing after taking out drowning patient is
Rescue breaths
1042
During embolization of AvM can
Induce hypotension
1043
Succ lidocaine and roc can be used to break
Laryngospasm Epinephrine does not help
1044
Thumb and middle finger is
C6 C7 is middle and index finger
1045
Indication for intubation and ventilation
Vital capacity less than 15 ml/kg
1046
Cyanide toxicity
Sodium thiosulfate Undergoes renal elimination
1047
CPB
High pressure in arterial cannula should be treated as aortic dissection
1048
Medical error
Unintended health care outcome caused by a defect in delivery of care to patient
1049
Which of the following is blocked with intrascalene block
Roots trunks Usually spares ulnar nerve
1050
Intrascalene nerve block blocks phrenic
100%
1051
Intrascalene what is not blocked
C8-T1
1052
Supraclavicular block
Spinal of the arm
1053
Arm elbow hand forearm
Infraclabicular block
1054
Axillary nerve block
Low risk of pneumothorax
1055
Esterases metabolized by
Plasma esterases
1056
Max dose bupivicaine
3 mg/kg max
1057
Amides broken down by
Liver
1058
Most to least local anesthetic absorption
IV Intercostal Caudal Epidural
1059
Local anesthetic
Blocks fast sodium channels in purkinje fibers
1060
Local anesthetic toxicity
Give lower dose of epi
1061
In acillary nerve block if ulnar is twitching redirect more
Superiorly
1062
Musculocutandous
Lateral forearm
1063
Adverse event
Undesirable experience to patient with use of medical product
1064
Absolute contraindication to TEE
``` Perforated viscous Esophageal stricture Esophageal tumor Esophageal perforation/esophageal diverticulum Acute gi bleed Previous esophagectomy ```
1065
LMA higher likelihood of
Aspiration
1066
Baclofen withdrawal syndrome
Fevers Seizures Blood pressure variability Rhabdomyolysis with bloody urine
1067
Pelvic pain need to block
Superior hypogastric block Not pudendal
1068
CABG can’t take penicillin give
Vancomycin
1069
Don’t give aspirin to patient with
Thyroid storm
1070
Sucralfate lowers risk of
Ventilator associated pneumonia
1071
Increase LVAD speed for higher
Cardiac output with LVAD
1072
To prevent CLASBI recommended if putting an emergent central line to
Put a central line in another site within 24 hours
1073
Lorazepam is not affected by
Age
1074
Initial pacemaker placement start with
VOO mode
1075
Amiodarone and cpr help with local anesthetic toxicity
Yes they do
1076
Hypercapnia following giving oxygen to COPD patients is due to
Ventilation perfusion mismatch You take away hypoxia pulmonary vasoconstriction
1077
Streptokinase increases the
PTT Helps activate plasminogento make plasmin breaking up clots
1078
Synchronized cardio version in infant
1 J/kg is starting shock dose
1079
Intercostobrachial does
Medial aspect of forearm
1080
If on subq heparin need to check
Platelet count before removal
1081
Rocephin
Can cause drug induced hemolytic anemia
1082
ETC02 monitor should have an
Audible alarm
1083
Valsalva
Intrathoracic pressure and central venous pressure increases and venous return decreases
1084
Succinylcholine has very little
Placenta transfer
1085
Tramadol is broken down by CYP2D6 into
More potent opiate
1086
Hyperoxia can lead to
Retinopathy of prematurity
1087
Micrognapthia | Retrognathia
Treacher Collins | can be potential difficult airway
1088
Max nitrous oxide concentration in or is
25 ppm
1089
RSBI less than 105 is predictive of
Weaning success
1090
Terminal branch of femoral nerve is
Saphenous and does sensory to medial calf
1091
Interop TXA
Can lead to postop seizures
1092
Peds spinal cord goes to same level of adult at
2 years old Ends at L1-L2 Dural sac ends in S2
1093
H2 blocker
Decrease gastric volume and increase gastric pH
1094
Large Vd of fentanyl leads to long
Context sensitive half life
1095
Emergence after single dose of propofol is due to
Distribution of propofol from the brain to the skeletal muscle
1096
Transtracheal lidocaine blocks
Recurrent laryngeal nerve
1097
Bupivicaine cardiac toxicity due to
Delay in ventricular repolarization
1098
Low volume of distribution means it goes all over like
Morphine
1099
Recurrent laryngeal and superior laryngeal help block
Cough reflex
1100
Cryoprecipitate
Factor 8, fibronectin, fibrinogen No factor 5
1101
Most sensitive to gas is
MEPs
1102
During sternotomy which rib is fractured most often
1st Affects C8-T1 nerve roots
1103
Kidney has best
Cold ischemia time It can be the longest
1104
Balloon of intraaortic balloon pump filled with
Helium
1105
After giving roc
Diaphgram is the most resistant It is the last to go and first to come back
1106
SIADH characterized by
Hyponatremia High urinary sodium Low serum URIC acid
1107
Suggamadex messes up
Oral contraceptives
1108
Decreased sensitivy to depolarization why
Volatile anesthetics increase paralytics
1109
Prolong NMDB
Hypothermia
1110
Loss of elastic recoil of lung as you
Age
1111
Epinephrine tends to decrease level of
Potassium
1112
Conversion of angiotensin 1 to 2 occurs in the
Lungs
1113
Even with cardiovascular commorbidity if case is emergent
You have to do it without further cardiac testing
1114
T3
Helps with BP and improved survival of transplanted organs
1115
Absolute contraindication to TEE
Esophageal diverticulum
1116
Most common complication following SAH
Recurrent hemorrhage
1117
Starting periop beta blockade increases risk of
Stroke
1118
Mannitol is safe to use during
Pregnancy
1119
Drug of choice to treat hypotension in pregnant patient with compromised placental circulation
Phenylephrine
1120
Usually get tachycardia with
Fat embolus
1121
Dobutamine/milrinone can help with RV dysfunction
From fat embolus
1122
In severe septic shock
Initiate empiric antibiotic therapy within first hour even if cultures haven’t been obtained
1123
Mild preeclampsia after 20 wk gestation
Proteinuria greater than 300 mg in 24 hours | BP > 140/90
1124
Fever anemia pain from
Vasopculsive crisis in patient with sickle cell
1125
AIN
Abdominal and neurologic problems not anemia
1126
Very common in patients with sickle cell
Cholelithiasis
1127
Spina bifida
More likely latex anaphylaxis
1128
Rivoroxaban
Inhibits factor 10a
1129
Cilostazol inhibits
PDE3
1130
Contraindications to shock wave lithotripsy
Systemic anticoagulation Pregnancy Bleeding disorder An AICD is not a contraindication
1131
What drug decreases lithium level
Mannitol
1132
High fi02 leads to
Atelectasis Fi02 denitrogenation leads to atelectasis PEEP prevents atelectasis
1133
Decrease in SVR and no change in CVP in
Pregnant patient
1134
C Section decreases rate of
Vertical transmission of HIV
1135
Rapid administration of desmopressin for vWF leads to
Hypotension and flushing
1136
After pediatric tonsillectomy black box warning not to give
Codeine
1137
Cisplatin causes
Renal toxicity
1138
Acute normovolemic hemodilution
Replace whole blood with fluids Due to less viscosity it increases cardiac output
1139
Left atrial appendage
2 view mid esophageal Between LA and LV
1140
For atrial flutter best is
Amiodarone
1141
To estimate GFR need to know patients
Sex
1142
Omphalocele more likely to have
Congenital anomalies than gastroschisis
1143
Allodynia is causing pain from a source that normally doesn’t cause
Pain
1144
More plasma cholinesterase in
Obese patients
1145
Heparin insulin NDMB
Do not cross placenta
1146
Preop celecoxib reduces
Opioid consumption
1147
Most volatile anesthetic in air is
2 PPM
1148
Bioavailability of midazolam most from
Intramuscular
1149
Lithium increases length of time of
Rocuronium
1150
GLP1
Exenatide most common complication is vomiting
1151
Carcinoid syndrome associated with
TR
1152
Respiratory depression in patients on chronic opioids due to
Narrow therapeutic window
1153
Gabapentin/TCAs don’t help with
Shingles These have a role in postherpetic neuralgia
1154
Compliance is increased in
Obstructive lung disease
1155
Sciatic least absorption of
Local anesthetic
1156
Closing capacity doesn’t change in
Pregnant patient- same with vital capacity FRC decreases Inspiratory capacity increases
1157
Don’t give mannitol to patient with
ESRD
1158
Tidal volume based off
Ideal body weight
1159
Remifentanyl is clearer faster in children than
Adults
1160
Post obstructive pulmonary edema
Post laryngospasm Don’t give diuretics
1161
Fondapariunx is excreted by the
Kidney
1162
Microshock stopped by
Equipment ground wires
1163
Acute intermittent porphyria
Don’t give ketamine
1164
TAP block for
C section
1165
Supraclavicular block can miss
Ulnar nerve distribution
1166
Most extrahepatic metabolism of propofol done by the
Kidney
1167
C02 regularly crosses BBB
Ions do not
1168
Neck over flexion In seated position leads to
Quadriplegia
1169
Activation of carotid baroceptors during endarterectomy leads to
Bradycardia which stops after surgeon stops manipulation
1170
Restructivelung disease
Decreased lung compliance
1171
Multi level spine surgery at risk for
Venous air embolus
1172
Sciatic nerve is not a branch of the
Lumbar plexus
1173
Lumbar plexus made up of
T12-L4 nerve roots
1174
Fascia iliaca block involves
Femoral and lateral femoral cutaneous nerves Alternative to femoral or lumbar plexus block
1175
Test doses usually show
Sinus tach if intravascular but if on beta blocker you will see systemic HTN
1176
C2-C4 for regional anesthesia for
Carotid endarterectomy
1177
Fetus has more
Hemoglobin to adapt to maternal hypoxia
1178
Risk factors for PPH
Age>40 Hypertension Obesity
1179
Greatest risk of substance abuse in physicians is from
Family history of drug or alcohol dependence
1180
Myelomininhocele
Goes with Chiari type 2 malformation
1181
Premature blood volume
90-100 ml/kg
1182
Post tonsillectomy secondary bleeding happens at
5-10 days
1183
Modifiable risk factors for delirium
Benzodiazepine usage and blood transfusion!
1184
French gauge system is 1/3 of a mm so
Higher French gauge equals a bigger device
1185
Subclavian is preferred over IJ central line to prevent
CLABSI
1186
RSBI<105 is correlated with
Weaning success
1187
TKA protocol
Much less quad weakness with adductor vs femoral nerve block
1188
Fetal hemoglobin will give accurate readying for
Pulse ox Carboxyhemoglobin Methoglobin Methylene blue will not
1189
Tran’s pulmonary pressure x tidal volume =
Work of breathing
1190
Normal vital capacity
60 to 70 ml/kg
1191
Acute increase in PaC02 by 10 will result in decrease in pH of
0.08 pH unit
1192
PEEP means
Capnography curve will be a little up
1193
Thalassemia or sickle cell move hemoglobin dissociation curve to the
Left!
1194
As you get older closing volume stays the
Same!
1195
Work of breathing total let 02 consumption
2%
1196
Decreased Pa02
Shifts hemoglobin curve to left You don’t have it so can’t release it
1197
Half life of carboxyhemoglobin if breathing 100% 02 is
1 hr
1198
Acidosis does not cause
Vasoconstriction
1199
Aniodarone decreases mortality after
MI It prolongs QTc
1200
Beta adrenergic receptor antagonists don’t cause
Orthostatic hypotension
1201
Atropine
Decreased secretions | Mydriasis
1202
Physostigmine crosses
BBB
1203
Meperidine has some
Anti cholinergic properties
1204
Norketamine is not as potent as
Ketamine
1205
Prolonged elimination time of benzos on patients getting
Protease inhibitors
1206
Aprepitant has
Anti nausea Anti depressant Anxiolytic effect Not analgesic
1207
Ectothiophatevinhibits
Psuedocholinesterase
1208
If only one twitch on TOF
More than 85% depression
1209
Postganglionic sympathetic nerve fibers
Release norepinephrine
1210
Calcium does not enhance
Neuromuscular blockade
1211
Erythromycin
Does not augment neuromuscular blockade
1212
Most common side effect of flumazinil is
Nausea/vomiting
1213
Ketorolac
Nonselective inhibitir of both cox-1 and Cox-2 Exhibits a dose cieling effect o analgesia
1214
AIP
Etomidate is contraindicated
1215
Remifentanyl reaches steady state in
1 hr
1216
Rocuronium has the
Fastest onset of the NMDBs
1217
Acute decrease in serum potassium causes
Hyperpolarization of cell membranes. This causes resistance to depolarizing NMDBs and resistance to NMDBs
1218
50% of neuromuscular blockade could take place and still have
5 second head lift
1219
MAC if sevo highest at 0-1 months
Others are highest at 1-6 months
1220
Volatile anesthetics
Decrease TV and increases RR
1221
Low flow techniques rebreathing leads to
More rapid depletion of C02 absorbent
1222
Sevoflurane vapor pressure
160
1223
N20 tends to increase
Cardiac output
1224
Isoflurane maintains
Cardiac output Decreases MAP May attenuate bronchosoasm
1225
Hip pain on internal rotation
Give local anesthetic into hip joint
1226
Best invasive treatment for trigeminal neuralgia
Microvascular decompression of facial nerve
1227
L2
Genitofemoral nerve
1228
After 2 yrs most ppl with CRPS
Resolve
1229
Uterine cancer pain
Superior hypogastric
1230
A beta
Large myelinated Fastest speed
1231
C fibers
Unmyelinated Diffuse burning or aching sensation Seen more in visceral pain
1232
Hyperalcesja
More pain than it should cause Dysthesia abnormal sensation that isn’t pleasant
1233
Stellate ganglion
Base of transverse process of C6 Horner syndrome seen if successful
1234
Celiac plexus block for
Upper gi malignancy Chronic or acute pancreatitis Big side effect orthostatic hypotension Next is diarrhea
1235
Superior hypogastric
For pelvic pain
1236
Myofascial pain syndrome
Active trigger point Palpable taut band Treatment is physical therapy Next is trigeer point injection
1237
Fibromyalgia
Trigger points in 11 of 18 sites at body SNRIs are approved for this including cymbalta
1238
Herpes zoster mainly seen in
Thoracic distribution
1239
Carbamazepine
Sodium and calcium channel blocker Can lead to skin disease like Steven johnson
1240
Parenthesias not seen in
Disc herniatiion
1241
Nalbuphine
Mixed opioid agonist antagonist Benadryl helps with spinal itching
1242
Morphine intrathecal can last
12 to 24 hrs 5 mg epidural morphine is equal to 0.3 mg intrathecal morphine
1243
Intrascalene block doesn’t get
Ulnar nerve
1244
Intrascalene blocks phrenic nerve
100%
1245
Regional blocks
Cardiovascular adrenergic and metabolic response
1246
Cauda equinA
Low back pain Bilateral lower extremity weakness Saddle anesthesia Loss of bowel bladder control Due to polling of local anesthetic in depehdeht areas of spine within subarachnoid space
1247
No psuedocholinesterase in CSF so
Ester local anesthetics leave by getting absorbed in systemic circulation
1248
Cardiac toxicity
Bupi highest than ropi then lidocaine
1249
With high spinal
Decrease in venous dilation is predominant cause of hypotension
1250
Nerve blocks may decrease incidence
Phantom limb pain
1251
Phenylephrine and epi
Will prolong spinal
1252
Largest vertebral interspace
L5-S1
1253
Epidural abscess is more
Radicular pain Epidural hematoma has severe back pain
1254
Artery of Adamkowitz comes from
T9-T12 Anterior spinal artery comes off vertebral
1255
Ester local anesthetics have
Shorter half life
1256
Retrobulbar block acts on CN
3-6
1257
Vertebral artery lies near
Stellate ganglion
1258
Median nerve most medial in
ANTECUBITAK FOSSA
1259
If you get a parenthesia that is sustained when putting in epidural you are in nerve root so
Pull out and redo don’t inject
1260
Plantar surface of foot innervation
Posterior tibial nerve
1261
No meperidine to patient on
MAOis
1262
If both recurrent laryngeal nerves transected it causes cords to be in
Intermediate position bc it affects both abductors and adductors
1263
Intercostal structures from cephalad to caudad is
Vein artery nerve
1264
If coughing or SOB during supraclavicular block placement think
Pneumothorax
1265
Femoral nerve lateral to
Artery and vein | Proper placement makes patella elevate and quad muscle contraction
1266
Most common complication of supraclavicular block is
Phrenic nerve block
1267
Shoulder is not done by
Brachial plexus
1268
Supraclavicular block is at level of
Divisions Instrascalebe block occurs at the roots/trunks
1269
Pelvic organs are supplied by
Hypogastric plexus not celiac
1270
Sural only does
Lateral side of foot
1271
TENS works by
Activation of inhibitory neurons
1272
Thumb corresponds to
C6
1273
Increasing the dose best for
More depth of local Anesthtic
1274
Nerve blocks with alcohol or phenol are never
Permanent
1275
Vagus nerve does not have
Pain fibers
1276
Most visceral pain is from
C fibers
1277
Major nerve blocks like axillary last
A long time Like 6-12 hrs
1278
Must have popliteal and
Saphenous for surgery under foot
1279
Sensory innervation back of head from
C2 and C3 roots which are terminal branches of cervical plexus
1280
Phrenic nerve
C3-C5
1281
Central pain is the cause if someone has a good block but they are still in
Pain such as malingering
1282
Hyperventilation leads to respiratory alkalosis so higher pH leads to more
Unionized fraction of local anesthetic
1283
Peripheral nerves always enveloped in
Schwann cells
1284
Tidlodipine before epidural need to wait
14 days 7 days for plavix
1285
Must pass dura for
Subarachnoid block
1286
In epidural space bupi is four times more potent than
Lidocaine
1287
Stellate ganglion block does not
Increase HR
1288
Adduction of thumb is
Ulnar not abduction
1289
TAP block blocks
Subcostal ilioinguinal iliohypogastric
1290
If you hit phrenic nerve you activate diaphragm and should redirect your
Needle posteriorly
1291
Pure S form of local anesthetic
Decrease in potency and shorter duration of action
1292
Epidural hematoma treatment
Decompressive laminectomy
1293
Benzocaine is the only
Weak acid of the local anesthetic
1294
Myelin enhances ability of
Local anesthetic to block conduction
1295
Musculocutabeius is below and lateral to
Axillary artery
1296
Awake intubation block CN
5, 9, 10
1297
Gi gu procedures don’t need
Prophylaxis for endocarditis Nor do valvular disease unless in setting of heart transplant
1298
HIT
Antibodies to PF4
1299
If patient has HIT and needs emergent bypass
Wait until disappearance of antibodies and use heparin
1300
One MET equals
Energy expended during 1 minute of rest which is roughly 3.5 ml of oxygen per kg body weight
1301
Right to left flow
TOF, Eisenmeiger syndrome Left to right shunt is a PDA
1302
Starling curve
Left ventricular work on y axis Left ventricular pressure on x axis
1303
PA catheter often migrates into
PA Noted as an increase in the PA pressure
1304
Anticholinesterase drugs
SA and AV node slowing Bronchocpnstriction Peristalsis
1305
Fontan procedure
Anastomosis of RA to the PA Helps with high pressure congenital defects
1306
50% reduction in metabolic rate if
Temp lowered rib to 28 to 30 degrees C
1307
IABP inflates
In diastole Just after closure of aortic valve
1308
Myocardial oxygen consumption from most to least
Heart rate > afterload > preload
1309
Drugs that can be given via endotracheal tube
ALONE ``` Atropine Oxygen Lidocaine Naloxone Epi ```
1310
Tetralogy of fallot
VSD Overriding aorta RVH
1311
When shocking patient want leads to be located on
QRS Don’t shock during repolarization
1312
Normally pressure in pericardial sac is less than in
CVP
1313
Prolonged QT can use
Beta blockers
1314
LVAD
Blood taken from apex of heart and returned to circulation via aorta No blood exists in aortic valve during systole so can’t measure BP with NIBP
1315
In normal heart
20% of cardiac output is from atrial kick
1316
Bisfrrens pulse = two systolic peaks
Seen with significant AR on arterial waveform
1317
Want to maintain SVR in patient with
TOF so use ketamine
1318
MS looks like opposite of
Aortic stenosis on the flow volume chart
1319
150 mg IV aniodarone over ten minutes for stable
V tach
1320
Paced is first then
Sensed
1321
Normal myocardial oxygen consumption is
8 ml/100 g/min
1322
Phenylephrine has minimal direct affect on myocardial
Contractility
1323
High Peep can lead to
Barotrauma and this pneumothorax
1324
Hallmark of PA catheter rupture Is
Hemopytsis
1325
Regular insulin does not cause
Protamine rxn because it doesn’t contain protamine
1326
1 mg heparin =
100 units Give 1.3 mg per 1 mg of heparin to reverse
1327
Dipyridamole
Patients need reduced dose of adenosine
1328
Bladder and PA temp is measured which helps
Estimate rewarming
1329
Tran’s gastric mid papillary short axis view of LV best to look at
MI
1330
Giving bicarbonate can lead to
Hypercarbia | It lowers potassium levels
1331
Decrease in SVR exacerbates
Right to left shunt leading to TET spells
1332
Sildenifil in the same class of meds as
Milrinone Milrinone effects PDE3 Sildenifil PDE5
1333
No drug reverses effect of
Plavix
1334
Nitric oxide inhibits
HPV and not a good choice with OLV
1335
In DOO don’t want HR too high as can lead to
R on T
1336
Milrinone does not produce thrombocytopenia and increases level of
cAMP
1337
Milrinone lowers
PVR
1338
For elective surgery wait
1 month for bare metal stent and 12 months for DES for elective procedure If procedure must be done continue aspirin
1339
Get ECG if pt has
Cardiovascular or respiratory risk factors Don’t do routinely for preop no matter what age
1340
For airway case to prevent fire
No nitrous | Lower fi02
1341
Fire
Pull tube Stop flow of all gases Pour saline into patients airway
1342
If fire somewhere other than airway
Stop all gases first! Remove all drapes flammable and burning material from patient Extinguish fire
1343
If neuraxial infection suspected
Remove catheter and culture tip Blood tests and cultures Imaging studies I’d abscess start abx and get surgical consultation
1344
Supine patient don’t abduct arms greater than
90 degrees Try to avoid flexion of elbow
1345
Chloroprocaine not used in regional due to risk of
Thrombophlebitis
1346
Diaphragm
C3-C5
1347
Pain blockade onset
Sympathetic then pain then propioception Small unmyelinated Next is unmyelinated c Large myelinated blocked last
1348
Turbulence if Reynolds number greater than
2000
1349
Mapleson D
Fresh gas is right next to mask
1350
Volatile anesthetic
Increase rr | Decrease tv
1351
Make sure
Vaporizer cap closed
1352
Volatile gases
Increase cbf Decrease CMR02 Desflurane causes HTN and tachy temporarily
1353
Anesthetic potency marker
Oil: gas partition coefficient
1354
MACbar to blunt autonomic response is
1.6 MAC
1355
Neuromuscular blockade is more likely to less go
Awareness Same with chronic use of alcohol opioids Or in high risk like trauma when can’t keep to deep
1356
Hearing is the last sense to be lost in
Anesthesia
1357
Benzos have no
Analgesic activity
1358
Precedex has
Analgesic activity
1359
Analgesic from u
Receptor Periaquadictal gray in brain Spinal cord - substantia gelatinosa
1360
Dilaudid peak effect is at
15 minutes
1361
Less response to opioids after
Opioid induced hyperalgesia Usually from remifentanyl Bradycardia is common with remifentanyl
1362
Morphine 6 glucoronide is
Excreted from kidneys
1363
Meperidine
Anticholinergic symptoms
1364
Morphine/meperidine
Renally excreted
1365
CO equals
HR x SV
1366
Tourniquet deflation
MAP CVP go down Everything else like potassium lactate etc02 go up
1367
First step in aspiration
Head down and suction | Then positive pressure
1368
Most intracranial volume is
Intracellular content
1369
Most blood flow goes to
Liver
1370
Median nerve runs between
Flexor carpi radialis and palmaris longus
1371
Low albumin leads to
Hypocalcemia
1372
Hypermagnesium
Lasix calcitonin volume
1373
Alpha 1 hydroxylase in kidneynoncteweee vitamin d and higher
Calcium
1374
Identify carboxyhemoglobin with a
Cooximiter
1375
Hyperbaric oxygen if
Neurologic impairment Cohb>25% Cardiac abnormalities from carboxyhemoglobin
1376
EEG is gold standard for monitoring in
Carotid endarterectomy
1377
Dry mouth Bulbar paint Diplopia ptosis
Botulism
1378
C tetani
Reaches spinal cord via retrograde Axonal transport Blocks neurirransmission Increased muscle tone Painful spasms
1379
Cross clamp higher up
Has more pronounced effect Acute HTN above clamp Hypotension below clamp
1380
Microshock is around
Heart
1381
Macroshock is protected by
Isolated power supply
1382
Methohemoglobinemia from
EMLA made up of lidocaine and prilocaine
1383
Epiglottis due to
H influenza
1384
After SH6 in eye avoid nitrous for
10 days
1385
Extothiopate increases duration of
Succinylcholine
1386
Turbulent flow depends on the
Density
1387
Larger airways like upper bronchi are more
Turbulent
1388
Use leukoreduced blood in
Immunocompromised patients
1389
Hypothyroid Arrhythmia Seizure from
Lithium toxicity
1390
More allergies to
Ester local anesthetics
1391
Following spinal with lidocaine in lithotomy position leads to
Transient neurologic symptoms
1392
Cardiovascular effect of bupiv
Hypotension, AV block, arrhythmia
1393
Volatile anesthetics
Increase QT time
1394
For spontaneous ventilation
A>D
1395
Milrinone increases
cAMP
1396
MG goes with
Thymoma
1397
Respiratory or oropharyngeal weakness
IVIG and plasmapharesis
1398
Duchenne
X linked recessive Males exclusively High CK levels
1399
SCC of lungs with
Lambert Eaton Lower Ach release
1400
AV block you need to inhibit
Ventricle sensing on pacemaker
1401
Atrial bradycardia means
Atrium need to be paced on pacemaker
1402
Substance P
Excitatory neurotransmitter in dorsal horn leading to pain
1403
Equalization of diastolic pressures in
Tamponade
1404
Prominent y descent seen in
Tamponade
1405
Avoid succ ketamine droperidol in
Pheo patients Droperidol can lead to HTN
1406
Hypophosphatemia
Left shift of curve
1407
Rate limiting enzyme in porphyrias
Ala synthetase
1408
Greater risk in pneumonectomy
FEV1<50% predicted | RV/TLC>50%
1409
Uterine and umbilical arteries 2
Take deoxygenated blood to placenta 1 umbilical and uterine vein carry’s oxygenated blood away
1410
Psuedocholinesterase increased in
Obesity
1411
Low calcium high phosphate low albumin in
Renal failure
1412
Time constants
1 = 63% 2= 86% 3=95%
1413
Hypercarbia In
TPN
1414
LIM helps against
Macroshock only
1415
V fib threshold
100 uA
1416
Donor red blood cell antigens
Cause if delayed transfusion reaction
1417
More vaporizer output at
Decreased partial pressure
1418
2% lidocaine
2 g/100ml or 20mg/ml
1419
Vital capacity is area in between
Flow volume loop in flow volume loop
1420
Vital capacity is area in between
Flow volume loop in flow volume loop
1421
Dilutional anemia
Decreases oxygen delivery
1422
Cyanide toxicity
Good oxygen delivery it just doesn’t function correctly
1423
Right to left shunt affects
Desflurane more than isoflurane
1424
Anterior cardiac vein runs with the
RCA
1425
Regular insulin
Onset 15 minutes Peak at 1 hr
1426
Case control
Looks after intervention given Opposite of cohort
1427
Case series
One isolated event
1428
Serum albumin down in
Pregnancy
1429
Bohr effect
Right shift
1430
Hyperventilation
Hypocalcemia
1431
HFJV allows
Passive expiration Creates autopeep
1432
Serum albumin down in
Pregnancy
1433
Bohr effect
Right shift
1434
Hyperventilation
Hypocalcemia
1435
HFJV allows
Passive expiration Creates autopeep
1436
Posterior approach of lumbar plexus also gets
Obturator nerve
1437
PPV
Neonate HR<100
1438
Higher cardiac output means
Block onset in spinal is faster in infants than adults
1439
Spinal cords end at L3 if age less than
2 yo
1440
More secretions when Ach binds
Muscarinic receptor
1441
Benzos
Do cross BBB Causes neonate sedation hypotonia cyanosis
1442
Hypermagnesium
PotentiatesvNMDBs Respiratory arrest>15 Cardiac arrest>25 Treatment is calcium
1443
Women getting invasive procedure who are pregnant should get
Rhogam prior
1444
Gilbert due to decrease In
Hepatic gluconyktransferase Autosomal dominant
1445
Lidocaine crosses
BBB
1446
Nitrous oxide
Inhibits Dna synthesis
1447
Dp/dt looks at
Contractility of heart E/A for diastolic function
1448
Late decels occurs after
Contraction
1449
Mid esophageal two chamber view
LV on bottom LAD on right RCA in left side
1450
Reactive non stress test is good Can look for uteroplacental insufficiency Contraction stress test
Need 3 contractions in 10 minutes Positive CST fetus not getting enough blood flow
1451
Magnesium doesn’t stimulate
Nmda receptors Mag does cause sedation
1452
Ritodrine causes
Tachycardia
1453
Neostigmine does cross
BBB
1454
No fetal bradycardia from
Maternal smoking
1455
Great auricular artery also known as artery of adamkowitz originated from
T9-T12
1456
Single anterior spinal artery
First 2/3 of spinal cord
1457
Platelets can lead to
RH sensitization
1458
Platelets can’t be
Refrigerated
1459
Plasma highest risk for
Trali
1460
Post transplant kidney injury during transplant gets better with
Mannitol
1461
TAP block also gets
Intercostal
1462
Glycine leads to
Hyperammonia
1463
In sickle cell patient getting surgery avoid
Hypo, hyperthermia, hypoxemia, hypotension, hypovolemic acidosis
1464
Ventricle hypertrophy
Reduces wall tension
1465
Peribupbar block
Lower risk of retrobulbar hemorrhage or optic nerve damage
1466
Blunt oculocardiac reflex with
Peribupbar and retrobulbar block
1467
Need to watch 4-5 hours after giving
Racemic epi for dusk of rebound effect
1468
What helps against succ myalgia
Vitamin c Lidocaine Calcium
1469
Low ite scores and males more likely for
Substance abuse
1470
MS exacerbation
Post partum
1471
Can turn inaccurate monitor
Accurate. If it’s imprecise it’s useless
1472
Full term infant neutral zone
32 to 35 degreee
1473
If FRC is lower
Increase atelectasis
1474
Spinal
Unopposed parasympathetic effects | More GI secretions
1475
Guillan Barre associated with
SIADH which causes hyponatremia
1476
Larynx position in infant
C3-C4
1477
Infant vocal cords
Angled or slanted
1478
Arterial pressure variation good to look for
Volume status
1479
Diabetes insipidus need to
Expand intravascular volume in brain dead
1480
Hyperkalemic periodic paralysis due to defect in
Sodium channel
1481
Sympathetic blocks don’t help with
Postherpetuc neuralgia only acute
1482
Starting insulin with TPN high likelihood of
Hypoglycemia
1483
Deep sedation May have airway issues
Issues
1484
Always need postop care for
MAC cases
1485
Tetanus
Inhibit neurotransmitter release from inhibitory neurons of CNS Stops gaba/glycine release
1486
Botulism
Inhibits ACH release at neuromuscular junction
1487
Phantom limb pain is
Neuropathic
1488
Don’t use mannitol for
Cardiogenic pulmonary edema
1489
Peep increases
FRC
1490
Pneumothorax doubles in 10 minutes
With nitrous
1491
CPAP is good for child with
Epiglottis want to keep airways open
1492
Epiglottis
Extrathoracic airway obstruction
1493
Carotid bodies
No baroceptirs The carotid sinus does leads to bradycardia
1494
Early onset VAP
Methicillin sensitive staph
1495
Nitrous oxide
No uterine relaxation
1496
Methanol turns into toxic formaldehyde by what enzyme
Alcohol dehydrogenase
1497
Hypocalcemia | Hypomagnesium with
Citrate toxicity
1498
Want to keep Fi02 down with ARDS
ARDS
1499
Nitroglycerin
Decreases preload due to venous pooling
1500
Nicardipine reduces afterload no affect on
Preload
1501
Meperidine blunts shivering response and this
Reduces total body oxygen demand
1502
Endovascular cooling is fastest way to
Cool patient
1503
If critical temp of anesthetic is higher it exists as a
Gas
1504
If critical temp is below room temp it will always exist as a
Gas and can’t liquify
1505
Angiotensin 2 constructs efferent arteriole to maintain
GFR
1506
Renin turns
Angiotensinogen into angiotensin 1
1507
Child blood volume
70-75 ml/kg
1508
AV nodal blockade think
PDA
1509
To activate nicotinic receptor it’s
2 Ach molecules and 1 succ
1510
Atropine=
Helps with fetal Brady
1511
RAAS starts working after
20 minutes
1512
Heat loss through breathing circuit
Evaporation
1513
Right lower lobeposterior segment
Most secretions
1514
Hypoxic ventilator drive
CN 9
1515
MH has more muscle rigidity rise in etc02 and temp increase than
Thyroid storm
1516
Unstable SVT
Sunchronized cardiobersion
1517
Hyperparathyroidism
Normal anion gap acidosis
1518
NMDB does not stop succc
Increase in IOP
1519
PVR lowest at
FRC
1520
Surfactant decreases
Surface tension as alveoli shrink
1521
Transmural pressure
Atmospheric plus intrapleural pressure
1522
Surfactant
Type 2 alveolar cells
1523
In turbulent flow radius is to the
Fifth power Laminar flow is to the 4th power
1524
Expiratory flow
Goes upward on diagram
1525
Mid sized bronchi
Most resistance
1526
Pulmonary artery catheter measured best at
West zone lung 3 This spot airway pressure isn’t higher to mess it up
1527
Nitroprusside nitric oxide
Mess up HPV
1528
What organ gets most cardiac output at rest
Lungs
1529
Closure of AV valves
Isovolumetric contraction
1530
PR interval
Atrial depolarization and AV nodal conduction
1531
Slowest rate of conduction
AV node
1532
Frank starling
Cardiac output and LVEDV
1533
Decrease in contractility shifts frank starling to the
Right
1534
Isovolumetric contraction
Most myocardial oxygen consumption
1535
Most blood is in
Veins and venules
1536
CO x TPR
MAP
1537
More pulmonary blood volume leads to decrease in
PVR
1538
Tissue edema due to heart failure due to
Increased capillary hydrostatic pressure
1539
Renin secretin will be increased by
Norepinephrine
1540
More bradykinin with
Ace inhibitors
1541
Liver makes
Psuedocholinesterase
1542
Epinephrine increases
cAMP levels
1543
Angiotensin 2
Stimulation of thirst
1544
Don’t want lactated ringers when giving
Blood
1545
Store platelets at room te
Temp
1546
Best filter to prevent macro aggregate delivery during transfusion
170 microns
1547
Type and screen
ABO and RH type
1548
Antibody screen
Type and crossmatch
1549
Urticaria due to blood reaction give
Diphenhydramine
1550
Acute hemolytic transfusion rxn
Fever
1551
Citrate is metabolized by the liver into
Bicarbonate
1552
TACO
Diuretics helps Not in TRALI
1553
Central cord disease high risk of
MH so use TIVA
1554
Pyloric stenosis
Hypokalemic hypocholermic metabolic alkalosis
1555
Testicular torsion is a medical emergency so have to go in
Regardless
1556
FRC and tidal volume are unchanged throughout
Life
1557
Mandibular hypoplasia
Pierre robin
1558
Gastroschisis
Abdominal wall defect lateral to midline
1559
CDH usually
Left sided Maintain spontaneous ventilation
1560
Most common TEF
Esophageal atresia with distal fistula
1561
Inhalation induction best for
TEF
1562
Position tube below
Fistula in TEF
1563
Infants have higher
CSF volume than adults and require more volume of local
1564
Closure of ductus venosus not important for establishing
Fetal circulation
1565
Treat TET spell by increasing
SVR Don’t give epi bc will cause more contractility narrowing RVOT
1566
RVOT is narrowed in
TET spell | Don’t give epi
1567
Neonate blood volume
90 ml/kg
1568
Oculocardiac reflex from pressing on eye involves CN
5 and 10
1569
Necrotizing enterocolitis treatment includes
Medical management Stop enteral feeds
1570
Erythropoiesis
Suppressed after birth And less made leading to physiologic anemia
1571
Duchenne
Get ECHOto check for cardiomyopathy
1572
Vecuroium action prolonged in
Infants Higher ECF volume
1573
Umbilical vein
From placenta to fetus Normal umbilical vein PH 7.35 pC02 40 PO2 30
1574
Low fi02 maintains PVR in situations of
VSD
1575
Extrathoracic obstruction
Vocal cord paralysis or croup
1576
Isoflurane nitroprusside inhibit
HPV
1577
Highest blood levels local anesthetic
Intercostal
1578
Post thoracotomy outcome best seen with
VO2 Max
1579
FEV1<2L sign of
High risk for pneumonectomy
1580
Transplanted lung has lower
PVR
1581
Absolute one lung ventilation for
Bronchopleural fistula
1582
First step with desaturation in two lung is
Reinflate deflated lung
1583
Increase Pa02 with one lung ventilation
With CPAP to nondependent lung
1584
RR/TV =
RSBI best to plan for Extubation
1585
Decreased RV, VC Increased FEV1/FVC1 ratio
Restrictive lung disease
1586
Anterior spinal artery syndrome
Loss of motor function and pinprick sensation with urinary incontinence
1587
Artery of Adamkowitz
T9-T12
1588
Chylothorax
Thoracic duct injury Prolonged serosanguinous drainage
1589
Improved V/Q due to
Nitric oxide post lung transplant
1590
Harder to get off ventilators when on
SIMV
1591
Hypoxemia due to v/q mismatch
Emphysema
1592
Dead space decreased when supine
Supine
1593
Postop pulmonary dysfunction strongest risk factors
Location of surgery | History of dyspnea
1594
Epinephrine has low
Beta 2
1595
Beta 2 works on
cAMP
1596
Opioid receptors
G protein coupled receptors
1597
Opioid receptors are antagonized by
Naloxone and naltrexone
1598
M6G is more potent than
Morphine
1599
IV morphine dose opioid naive
2.5 to 10 mgs
1600
Spinal
1/10 epidural dose
1601
Neuraxial morphine
12 to 24 hrs
1602
Order or lipophilicity
Sufentanil to fentanyl to alfentanyl yo morphine
1603
Fentanyl has a long context sensitive
2 hours after 1 hour of infusion
1604
Remifentanyl equipotent with
Fentanyl
1605
Opioids
Histamine release Biliary colic Vasodilation Delayed gastric emptying
1606
Naloxone/naltrexone
Potent antagonists at mu opioid receptors Don’t use naltrexone for PONV
1607
Don’t form tolerance to
Miosis and constipation
1608
Treat cocaine overdose with a
Benzodiazepines
1609
Garlic inhibits platelet aggregation and should be discontinued
7 days prior to surgery
1610
St Johns Wart does affect
Coagulation status
1611
Reverse tirofiban by giving
Platelets
1612
1 mg of protamine per
100 units heparin
1613
Precedex IV loafing dose
1 ug/kg first 10 min Then 0.2 to 0.7 ug/kg/hr
1614
12 hour before neuraxial after giving
Subq lovenox
1615
Ketorolac has
Anti inflammatory, antipyretic, analgesic properties
1616
Elimination half life of acetaminophen is
2-4 hours
1617
Nitroglycerin predominately produces
Venodilation
1618
Dopamine is an endogenous precursor of
Norepinephrine
1619
At low doses dobutamine produces
Vasodilation At high doses vasoconstriction
1620
Phenylephrine
Pure alpha1 agonist
1621
Max dose of epinephrine when given with local anesthetic
40 ml of a solution with epinephrine 1:200000
1622
Volatile anesthetics have biggest effect on
MEPs
1623
Vertebral cause if
Seizure
1624
Mid diastolic murmer
Mitral stenosis
1625
Patients with mitral stenosis often present in
Atrial fibrillation
1626
Pulmonary artery pressure can show
Appropriate volume resuscitation
1627
Prior to coming off bypass
``` Temp greater than 36 C Confirm mechanical ventilation resumes Confirm enough in CPB reservoir to maintain map and ci as you come off Get ABG PH>7.3 K< 5.5 Hct >24 ```
1628
CPB can be hand cranked if
Electricity off
1629
Can do CAbG off bypass if one vessel like a single LAD with no hemodynamic instability or
High risk for stroke like calcified aorta
1630
Most thrombogenic component of bypass machine is
Oxygenater
1631
CPB most common complication
Short term memory loss
1632
Majority of intraventricular septum supplies by the
LAD
1633
Left current laryngeal nerve loops around whAt major vessel Of mediastinum
Aorta
1634
Right recurrent laryngeal loops around
Right subclavian
1635
Cardiac skeleton insulates
The atria from the ventricles
1636
Organ getting most cardiac output at rest
Lungs 100% of cardiac output goes through the lungs Brain gets 15% Kidneys 20%
1637
Sympathetic activation of the SA node leads to
Increased permeability of resting membrane to sodium and calcium ions
1638
LV diastolic dysfunction
Increased E wave on Doppler with reducer A wave
1639
Venous return is augmented by
Decreased venous resistance
1640
How much blood in veins and venules
60%
1641
Bronchospasm most likely during
Intubation
1642
First treatment in bronchospasm that works fastest
Deepen the anesthetic
1643
Need SSEP for
Elective spine cases
1644
Hypocarbia from hyperventilating can lead to
Hypocalcemia
1645
Bradycardia and hypotension think
Carotid sinus
1646
Normal ACT is about
107
1647
Factors that prolong act
Hypothermia Thrombocytopenia Hemodilution
1648
Muscarinic activation
Bradycardia Bronchoconstrict Miosis Gi hypermotility
1649
Precedex metabolism occurs in the
Liver
1650
Concentric hypertrophy helps by lowering
Wall tension
1651
Biracial artery goes with
Median nerve
1652
PVR is highest at
Extremes of lung volumes
1653
Dp/dt
Left ventricular contractility
1654
E/A ratio
Diastolic measurement
1655
Progressive distal muscle weakness in
Charcot Marie tooth disease
1656
Decrease these to lower auto peep
RR TV Gas flow rate
1657
Decrease plateau pressure with
Decrease peep and decrease tidal volume
1658
Sickle cell avoid
Hypo/hyperthermia Hypoxemia Hypotension
1659
Post transplant kidney injury lower when giving
Mannitol
1660
Etomidate
Higher risk of superficial thrombophlebitis compared to propofol
1661
Endovascular is better for
Descending aorta but not proximal aorta
1662
COPD goes with
MAT
1663
Base excess calculated in
ABG
1664
PC02
Severinghouse electrode
1665
SVR
MAP/CO x 80
1666
Nitrous oxide inhibits
DNA synthesis
1667
Eccrine sweat gland
Sympathetic preganglionic to nicotinic receptor to sympathetic postganglionic to muscarinic receptor
1668
Full term newborn
80-90 ml/kg
1669
Factors that result in variable clotting time include
Hemodilution, hypothermia, platelet count below 50k
1670
Pacemaker leads are put in the
Endocardium
1671
Axillary artery
Radial nerve lateral | Musculoskeletal nerve
1672
Pyloric stenosis
Chloride exchanges with bicarbonate in stomach Bicarbonate is absorbed and chloride lost
1673
Nicardipine causes
Direct cerebral vasodilation
1674
After starvation brain will obtain most its energy from
Ketone metabolism
1675
Most T3 is formed peripherally by
Partial deiodination of thyroxine
1676
More thyroid hormone causes increase in
Metabolic rate
1677
CDH ok for
Gentle ventilation with permissive hypercapnia using low tidal volume
1678
No spinal cord stimulator for
Soma to form patient | Coagulopathy sepsis
1679
Carboprost does not help with
Uterine relaxation
1680
1-beta =
Power
1681
CYP2D6 converts
Codeine to morphine
1682
Pulmonic valve better visualized on
TTE than TEE
1683
Hypnosis with blood pressure occurs faster than
Time to decrease of blood pressure
1684
Neonates have decreased
CYP2D6
1685
Don’t need preop ecg for
Renal insuffiency age diabetes
1686
Alpha 2 ligands
Gabapentin, pregabalin bind to alpha2 subunit of voltage gated calcium channel prevent release of nociceptive neurotransmitters
1687
Eye blocks are not used in cases
Lasting longer than 90 minutes Patients younger than 15 yo Or inability to follow commands or lie still
1688
Retrobulbar hemorrhage from eye block
Excellent motor block but also Closure of upper eyelid Propotosis Palpable increase in IOP
1689
Oculocardiac reflex
Bradycardia Arrhythmias Cardiac asystole
1690
If arrhythmia from oculocardiac reflex
Stop stimulating and give 0.007 mg/kg atropine
1691
High spinal but pt
In trendelenberg
1692
Contraindications to spinal
``` Coagulation abnormalities Severe hypovolemia Increased ICP Infection at site Severe valve disease ```
1693
Regional spots
``` C8 pinky finger Nipple T4 Inferior angle scapula T7 Umbilicus T10 Perineum S2-S4 ```
1694
Spinal cord ends at
L1 in adults
1695
More pruritis when giving opioids in
Intrathecal space
1696
Don’t do epidural if On heparin can lead to
Spinal hematoma and spinal cord injury
1697
Discontinue chronic warfarin 4-5 days before spinal procedure and
Evaluate INR
1698
No contraindication to epidural with
Aspirin or other NSAIDs Stop plavix 7 days before
1699
12 hours to epidural since last dose of
LMWH prophylactic For treatment LMWH weight 24 hours
1700
14 days for
Ticlodipine before doing epidural
1701
Spinal hematoma symptoms
Severe back pain Progression of numbness/weakness Bowel/Bladder dysfunction
1702
Intrascalene doesn’t get
Ulnar nerve and is good for shoulder procedures
1703
Supraclavicular for elbow forearm and hand
If on supraclavicular you hit subclavian artery go posterolateral
1704
Axillary doesn’t get
Musculocutaneous
1705
Radial is below and ulnar above in
Axillary nerve block
1706
Variables must be mutually exclusive to run a
Chi square test Looks if observed distribution is based on chance alone Participating in one category should not participate in another category
1707
A fib don’t give esmolol if patient
Has severe COPD or diabetes mellitus
1708
Digoxin has
Low therapeutic index
1709
Amiodarone takes about
7 hours to achieve rate control without preexcitation Amiodarone is considered a second line agent
1710
Ethosuximide blocks
T-type calcium channels
1711
Soft palate to epiglottis is the
Oropharynx
1712
High volume low pressure
ETT cuffs
1713
Carbon dioxide cylinder is
Gray
1714
Majority of intraventricular septum supplies by the
LAD
1715
Left current laryngeal nerve loops around whAt major vessel Of mediastinum
Aorta
1716
Right recurrent laryngeal loops around
Right subclavian
1717
Cardiac skeleton insulates
The atria from the ventricles
1718
Organ getting most cardiac output at rest
Lungs 100% of cardiac output goes through the lungs Brain gets 15% Kidneys 20%
1719
Sympathetic activation of the SA node leads to
Increased permeability of resting membrane to sodium and calcium ions
1720
LV diastolic dysfunction
Increased E wave on Doppler with reducer A wave
1721
Venous return is augmented by
Decreased venous resistance
1722
How much blood in veins and venules
60%
1723
Bronchospasm most likely during
Intubation
1724
First treatment in bronchospasm that works fastest
Deepen the anesthetic
1725
Need SSEP for
Elective spine cases
1726
Hypocarbia from hyperventilating can lead to
Hypocalcemia
1727
Bradycardia and hypotension think
Carotid sinus
1728
Normal ACT is about
107
1729
Factors that prolong act
Hypothermia Thrombocytopenia Hemodilution
1730
Muscarinic activation
Bradycardia Bronchoconstrict Miosis Gi hypermotility
1731
Precedex metabolism occurs in the
Liver
1732
Concentric hypertrophy helps by lowering
Wall tension
1733
Biracial artery goes with
Median nerve
1734
PVR is highest at
Extremes of lung volumes
1735
Dp/dt
Left ventricular contractility
1736
E/A ratio
Diastolic measurement
1737
Progressive distal muscle weakness in
Charcot Marie tooth disease
1738
Decrease these to lower auto peep
RR TV Gas flow rate
1739
Decrease plateau pressure with
Decrease peep and decrease tidal volume
1740
Sickle cell avoid
Hypo/hyperthermia Hypoxemia Hypotension
1741
Post transplant kidney injury lower when giving
Mannitol
1742
Etomidate
Higher risk of superficial thrombophlebitis compared to propofol
1743
Endovascular is better for
Descending aorta but not proximal aorta
1744
COPD goes with
MAT
1745
Base excess calculated in
ABG
1746
PC02
Severinghouse electrode
1747
SVR
MAP/CO x 80
1748
Nitrous oxide inhibits
DNA synthesis
1749
Eccrine sweat gland
Sympathetic preganglionic to nicotinic receptor to sympathetic postganglionic to muscarinic receptor
1750
Full term newborn
80-90 ml/kg
1751
Factors that result in variable clotting time include
Hemodilution, hypothermia, platelet count below 50k
1752
Pacemaker leads are put in the
Endocardium
1753
Axillary artery
Radial nerve lateral | Musculoskeletal nerve
1754
Pyloric stenosis
Chloride exchanges with bicarbonate in stomach Bicarbonate is absorbed and chloride lost
1755
Nicardipine causes
Direct cerebral vasodilation
1756
After starvation brain will obtain most its energy from
Ketone metabolism
1757
Most T3 is formed peripherally by
Partial deiodination of thyroxine
1758
More thyroid hormone causes increase in
Metabolic rate
1759
CDH ok for
Gentle ventilation with permissive hypercapnia using low tidal volume
1760
No spinal cord stimulator for
Soma to form patient | Coagulopathy sepsis
1761
Carboprost does not help with
Uterine relaxation
1762
1-beta =
Power
1763
CYP2D6 converts
Codeine to morphine
1764
Pulmonic valve better visualized on
TTE than TEE
1765
Hypnosis with blood pressure occurs faster than
Time to decrease of blood pressure
1766
Neonates have decreased
CYP2D6
1767
Don’t need preop ecg for
Renal insuffiency age diabetes
1768
Alpha 2 ligands
Gabapentin, pregabalin bind to alpha2 subunit of voltage gated calcium channel prevent release of nociceptive neurotransmitters
1769
Eye blocks are not used in cases
Lasting longer than 90 minutes Patients younger than 15 yo Or inability to follow commands or lie still
1770
Retrobulbar hemorrhage from eye block
Excellent motor block but also Closure of upper eyelid Propotosis Palpable increase in IOP
1771
Oculocardiac reflex
Bradycardia Arrhythmias Cardiac asystole
1772
If arrhythmia from oculocardiac reflex
Stop stimulating and give 0.007 mg/kg atropine
1773
High spinal but pt
In trendelenberg
1774
Contraindications to spinal
``` Coagulation abnormalities Severe hypovolemia Increased ICP Infection at site Severe valve disease ```
1775
Regional spots
``` C8 pinky finger Nipple T4 Inferior angle scapula T7 Umbilicus T10 Perineum S2-S4 ```
1776
Spinal cord ends at
L1 in adults
1777
More pruritis when giving opioids in
Intrathecal space
1778
Don’t do epidural if On heparin can lead to
Spinal hematoma and spinal cord injury
1779
Discontinue chronic warfarin 4-5 days before spinal procedure and
Evaluate INR
1780
No contraindication to epidural with
Aspirin or other NSAIDs Stop plavix 7 days before
1781
12 hours to epidural since last dose of
LMWH prophylactic For treatment LMWH weight 24 hours
1782
14 days for
Ticlodipine before doing epidural
1783
Spinal hematoma symptoms
Severe back pain Progression of numbness/weakness Bowel/Bladder dysfunction
1784
Intrascalene doesn’t get
Ulnar nerve and is good for shoulder procedures
1785
Supraclavicular for elbow forearm and hand
If on supraclavicular you hit subclavian artery go posterolateral
1786
Axillary doesn’t get
Musculocutaneous
1787
Radial is below and ulnar above in
Axillary nerve block
1788
Variables must be mutually exclusive to run a
Chi square test Looks if observed distribution is based on chance alone Participating in one category should not participate in another category
1789
A fib don’t give esmolol if patient
Has severe COPD or diabetes mellitus
1790
Digoxin has
Low therapeutic index
1791
Amiodarone takes about
7 hours to achieve rate control without preexcitation Amiodarone is considered a second line agent
1792
Ethosuximide blocks
T-type calcium channels
1793
Soft palate to epiglottis is the
Oropharynx
1794
High volume low pressure
ETT cuffs
1795
Carbon dioxide cylinder is
Gray
1796
Hypercarbia can lead to
Respiratory acidosis which is a known cardiac depressant which can lead to arrhythmias
1797
RV is perfused throughout
Cardiac cycle
1798
LV mainly during
Diastole
1799
Normal PCWP
6-12
1800
CI is increased to compensate for low
SVR in septic shock
1801
LFCN block need to identify
ASIS
1802
Pyloromyotomy need to intubate fast so
Give succ
1803
Succ activates muscarinic receptors in sinus node leading to
Bradycardia
1804
TEE best for detecting
Myocardial ischemia
1805
Acute stoppage of TPN leads to
Hypoglycemia
1806
CSF volume is higher in infants on a
Ml/kg basis than adults
1807
Bradycardia more likely in adults due to
Affecting cardiac accelerating fives T1-T4
1808
Termination of spinal cord occurs at
L3 in infants Dural sac ends at S3
1809
Enoxaparin monitored by measuring
Factor 10a levels
1810
Preeclampsia leads to
Abnormal myometrial spiral arteries with increased vascular tone Increases uterine vascular resistance and decreases uterine blood flow
1811
Fentanyl shorter duration of action is due to
Greater lipid solubility compared to morphine
1812
SIADH treatment is
Free water restriction Cerebral salt wasting treat both with free water and sodium Usually CSW patients are hypovolemic while SIADH are euvolemic
1813
Midazolam bioavailability
IV, subcutaneous, intramuscular, intranasal, rectal, oral
1814
Mivacurium is hydrolyzed by
Psuedocholinesterase
1815
Plasma administration most likely to lead to
TRALI
1816
Metoprolol contraindicated in
Acute heart failure bc it’s a negative inotropy
1817
PVR is highest at
Extremes of lung volumes
1818
If treating acute malignant hyperthermia don’t give another
Calcium channel blocker
1819
Functional closure of foramen ovale occurs
The day of birth
1820
Uremia will result in higher concentration of free fraction
Unbound midazolam
1821
Desmopressin May improve
Platelet dysfunction in uremic patients
1822
Decreased stroke volume and cardiac output when standing
Upright
1823
Water moves freely across
BBB
1824
Higher peak pressures after steep trendelenberg with desat think
Endobronchial intubation and pull the tube back a few cm
1825
Glucagon released by
Alpha cells and inhibits hepatic glycolysis
1826
Anterior mediastinal mass
Fear complete airway obstruction | Inability to maintain gas exchange and cardiovascular collapse from compression of vital structures
1827
Before patient comes off pump
Calcium to increase myocardial contractility and reverse potassium cardioplegia
1828
AV block leading to low heart rate need
Temporary epicardial pacemaker not atropine
1829
Ventricular pacing for
Complete AV block
1830
Sem
Standard deviation/square root sample size

Areviewbook (12 decks)

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