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physiology Flashcards

1
Q

how do hypoxia, hypercapnia, and acidosis effect pulmonary vasculature

A

pulm vasocontriction

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2
Q

urine to plasma osmolar ratio > 1.5 indicates what

A

oliguria 2/2 prerenal hypovolemia

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3
Q

how does sodium bicarb administration effect LV contractility, preload, intracranial, lactate

A
  1. bicarb increases calcium so increases LV contractility
  2. its hypertonic so increases preload due to increase intravascular volume
  3. increases lactate
  4. can cause intracranai hemmorhage (due to number 2 )
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4
Q

what properties of gas determine flow rate through annular space at low fresh gas flow vs high

A

at low –> viscosity
high –> density

think low cost
high demand

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5
Q

what type of cells are have the most insulin dependent transporter for glucose uptake

A

cardiac myocytes

think u have to give insulin with hyper K to stabilize that shit or whatever

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6
Q

when is pulmonary vascular resistance at its lowest

A

at FRC

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7
Q

how does uremia interefere w platlet activation and aggregation (4 places)

A
  1. vWF
  2. gp IIb-IIIa
  3. increases prostacylcin
  4. increased NO
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8
Q

how does hetastarch inhibit platelet aggregation

A

will cause decreases in gp IIa-bIII

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9
Q

how do u interpret increased platuea pressure vs increased peak pressure

A

increased platuea pressure = decreased pulm compliance (TRALI, pulm edema etc.)

increased peak pressure = increased airway resistance (kinked tube, asthma, bronchospasm etc)

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10
Q

define lithotripsy and. how the pressure volume loop would change for increased lithotripsy

A

increased compliance

will have a rightward downward shift of end diastolic pressure volume curve to show more volume at decreased LV pressure

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11
Q

large volumes of licorice will create more of what hormone

A

aldosterone so you will have HTN, metabolic alk, hypo K, hypernatremia

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12
Q

how can u diagnose abdominal compartment sydrome w bladder and what effect does it have on ICP

A

the pressure will be greater > 20 ish

increased ICP

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13
Q

patients with 3 or more risk factors for CAD are recommended to take what medication perioperatively?

what is the risk factors

A

beta blocker

risk factors: hx of ischemic heart dz, stroke, DM, CHF, CKD

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14
Q

which nerve carries afferent signals from carotid bodies

A

CN 9 or glossopharyngeal nerve

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15
Q

3 ways in which volatile anesthetics potentiate NMBA

A
  1. decreasing sensitivity of the post junctional membrane to depolarization
  2. increasing skeletal muscle blood flow which augments NMBA
  3. depression of upper motor neurons
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16
Q

when minute ventilation exceeds fresh gas flow how will that affect fio2

A

fio2 will be lower because u are rebreathing exhaled gases and therefore less O2

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17
Q

normal umbilical artery blood gas sample?

A

pH 7.2-7.3
pco2. 50s
pao2 20s
bicarb 22 ish

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18
Q

how do you trouble shoot o2 pipeline failure

A

disconnect o2 pipeline from wall
open emergency oxygen cylinder
ventilate by hand

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19
Q

what would u see etco2 do with co2 embolism

A

etco2 will usually decrease with CV collapse but may increase as well

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20
Q

if you decrease paco2 by 1 how much does that decreased CBF

A

decreases 1-2 cc

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21
Q

what 2 lab tests are low in DIC

A

factor 8
fibrinogen

d dimer is high af

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22
Q

whats the benefit of stopping smoking the day before surgery

A

shifts hemeglobin O2 dissociation curve to the right

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23
Q

whats the primary cause of low serum bicarb in patients w high AG metabolic acidosis

A

low bicarb is bc they are used to buffer H+ ions

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24
Q

if you have paraplegic patient how will the TOF differ between hand and foot nerve stims (if the foot is paralyzed)

A

the foot will have a increased TOF ratio due to ach receptor build up in the muscle of the paralyzed limb

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25
Q

during forced exhalaiton where does emptying occur first and where does airway closure occur first

A

emptying of the apex first

forced airway closure of the base of the lungs first

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26
Q

when ABG are corrected for colder temperatures how does that affecr pao2 paco2 and pH

A

paco2 and pao2 will be lower, pH will be higher

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27
Q

why do barbituates have higher concentrations of of free active moleculres in renal failure

A

less barbituate bound to protein

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28
Q

how long is the half life of albumin

A

half life is 2-3 weeks

which is why PT is a better measure of liver synthetic function as factor 7 has a short half life.

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29
Q

during fasting what organ uses ketone for energy

A

brain uses ketones

other parts of the body uses fatty acids

30
Q

switching from spontaneous ventilation to mechanical ventilation does what in obese patients

A

reduces oxygen consumption

31
Q

bezoid- jarisch reflex is what

A

essentially bradyardia, hypotention, apnea

32
Q

why do you have hypocalcemia in esrd

A

kidney cant convert to active form of vitamin D so u have low calcium

33
Q

hematologic effects of hyperthyroidism

A

thrombocytopenis and anemia

think CHF is possible and so u have dilution

34
Q

what acid base derrangement will u see with cyanide poisoning

A

AG acidosis

35
Q

why is the mivacurium dose only slightly increased in burn patients

A

burn patients usually require higher dose of paralytis because have upregulaton of acH receptors

but mivacurium is metabolized by pseudocholinesterase which is decreased in burn patients

36
Q

how does FRC change with heigh and age

A

greater the high greater the FRC

older patients have greater FRC due to loss of elasticity

37
Q

fastest uptake IO sites of insertion

A

manubrium > humerus > tibia

38
Q

benefits of acute normovolemic hemodilution

A
  1. decreased blood viscosity —> 2. decreased vasicular resistance
  2. increased CO
  3. increased regional blood flow
39
Q

what electrolyte abnormalities does hyperventilation cause

A

tink ur blowing shit off

hypocalcemia
hypokalemia
hypophosphatemia

40
Q

what explains why NO has a more rapid onset than desflurane despite NO being more soluble

A

the concentration affect of NO

41
Q

what is the hering nerve

A

branch of glossopharyngeal nerve that transmits info from carotid body (chemoreceptors) and carotid sinus (baroreceptors)

**carotid body baroreceptors increase ventilation when paO2 is low, this reflex is impaired with opioids, benzos, volatile anesthetics + b/l carotid endardectomy

42
Q

what are the 3 ways co2 is transported in the blood

A

dissolved co2
bicarb
carbonic compounds

43
Q

in lumbar / low thoracic epidurals what 2 respiratory factors are DECREASED

A

peak expiratory pressure

cough strength

44
Q

how is roc excreted

A

30% renally excreted and then the rest is through hepatic uptake

45
Q

fresh frozen plasma does NOT have what two factors

A

factor VII

factor II

46
Q

if patient with hemophilia A has antibodies formed against factor 8 how do u treat hemorrheage or surgery

A

porcine factor VIII
Factor VII
or Factor II

47
Q

which drug has the lowest pka and highest fraction of nonionized drug at physiologic pH

A

alfentanil

48
Q

what phase of diastole delivers the highest volume of blood

A

early rapid filling

49
Q

most common complication following autologous blood transfusion

A

infection from improper storage

50
Q

why will FFP help with heparin resistance

A

heparin binds to anti thrombin 3, people that have a deficiency will have resistance to heparin
FFP contains antithrombin 3

51
Q

why NOT use ffp for hemophilia A

A

ffp does contain factor 8 but very little levels, other blood products have a a greater concentration of factor 8

52
Q

most common complication of jet ventilation

A

hypercarbia because u ont have controlled exhalation?

other complications include: hypoxia, loss of airway, impaired cilliary function –> necrotizing tracheobronchitis

53
Q

how does solubility of gases and partial pressure of gases differ between warmed and cooled blood

A

partial pressure of paO2 and paco2 is higher I warmed blood, so that means that dissolved gas is lower in warm blood because its more soluble in cold blood

54
Q

how does low flow anesthesia increase risk of PONV

A

rebreathing of CO and acetone aka noxious gases

55
Q

how does burn injury cause increased platelet aggregation

A

increased fibrinogen which is an acute phase reactant

56
Q

eccrine vs apocrine sweat glands pathway

A

eccrine glands
symthatetic pre ganglioninc > nicotinic receptor > sympaththetic post gang > muscarinic receptor

apocrine is found I perineal area and armpits:
symthatetic pre ganglioninc > nicotinic receptor > sympaththetic post gang > adrenal gland

57
Q

how can can hypothermia lead to metabolic acidosis in neonates

A

they have hella brown fat, non shivering thermoregulation leads to metabolism of brown fat and metabolic acidosis

58
Q

decribe how bicarb changes in aucte vs crhonic respiratoy acidosis

A

assuming norma paco2 is 40 and normal bicarb is 24

in acute every 10 paco2 causes a change of bicarb by 2

in chronic bicarb changes by 4

59
Q

what is the most reliable sign of uterine rupture

A

non reassuring fetal heart rate patterns

60
Q

mechanism by which tetany leads to twitches

A

accumulation of calcium in the presynaptic membrane that will lead to a slightly higher acH release

61
Q

what class of drugs can cause increase gastric pH withn an hour

A

H2 blockers
ranitidine has shortest onset, and longer duration of action
famotidine has the longest half life

H2 blockers increase gastric pH and decrease gastric volume

62
Q

what leads are the best for monitoring atra

A
  1. lead II

2. lead V1

63
Q

what substances will reflect US beams the least

A

substances with most water content will be blakcer and reflect the beams the least

64
Q

is thyroid hormone binding ratio increased or decreased in primary hyperthyroidism

A

increased

only TSH is decreaed in primary hyperthyroid

65
Q

wandering baseline artifact on EKG is due to waht

A

moving patient, lose electrodes, poor skin contact

66
Q

what class of drugs is most commonly associated wtih PERIOPERATIVE anaphylaxsis

A

neuromuscular blocking agents

67
Q

how and why do u adjust dose of benzos and opioid in severe burn patients

A

severe burn patients will have hypoalbumin

whihc increases the free fraction of benzos and opioids so u should reduce the dose

68
Q

what is the pathiophysiology behind delayed hemolytic transfusion reaction

A

recipient antibodies to donor minor RBC antigens like rhesus, kidd, or kell

69
Q

Bayes theorum

A

helps determine preop testing algoriths ike people who have ___ need TTE beforehand type of thing

conditional probability

70
Q

what will cause a larger degree of overlap between IJ and carotid when placing central line

A

over rotation of patient heads beyond 45 degrees

basic (8 decks)

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