Primary 1 Flashcards

Question

Hepatic BF

Answer 1

30% CO 75% portal vein 50% DO2 by each HABR (semireciprical interrelationship) - decreased PV flow-->increased HA flow (x2) - decreased PVF-->increased adenosine-->HA VD HA - autoreg of HA - F=P/R P=Hep Art- Hep Venous hence in CCF-->hep flow increased VO2-->increased OER ******P+K decreased PV-->adenosine increase-->hep vasoDILATES (THIS IS THE OPPOSITE TO RENAL TG FEEDBACK WHERE ADENOSINE CAUSES VC)-BLOODY RIDICULOUS

Answer 2

maximally dilated hence cant dilate more no autoreg | volatile -->decreased MAP-->decreased PP (F=P/R)

Answer 3

``` Midaz Phase I -1-Hydroxymidazolam Phase II -1-hydroxymidazolam glucoronide ``` Morph - predom phase II - Morphine 3 glucorinide or M6G Paracetamol - Phase I-->NAPQI - Phase II (not a flow on of phase one products)-->glucoridine conjugates and sulfate conjugates Phase I - alter to expose or add charge or reactive group - oxidation, reduction, hydrolysis - eg cytp450 hydroxylation (OH- addition) MAO in mitochondria - more water sol Phase II - conjugation: add a large polar group eg glutathion by S-glutathionase - so cant cross membrane so can be actively transported Both make it more polar so more water soluble for urine and bile excretion (P+H p20) LF-->phase I effected most

Answer 4

pek and hill VD at low and VC at high

Answer 5

PC PD PK different linkage between lipophilic aromatic ring and hydrophilic group Esters - comparatively unstable - high allergy due to met para-aminobenzoate - rapidly hydrolysed by butrylcholinesterase - mid PrB-->smaller Vd amides - have a shelf life of 2 years - met in liver

Answer 6

bup 3 lig 7

Answer 7

Increased tissue protein binding-->remain at axon longer Increased acidity locally eg seziure -->increased unbound-->increased risk of toxicity bind A1acid glycoproteint-->saturated at clinical doses -->albumin

Answer 8

bases ionise below hence acid decrease unionised. low pKa increases unionized. primary determinant of onset Lig pKa 7.9 bupiv pkA 8.1

Answer 9

temporary blockade of neurotransmission when applied to a nerve fibre Block VGSC from inside axon in ionized form (crossed unionized) Higher affinity to open and inactive vs resting state

Answer 10

pH=pka +log A-/AH pH=pka +log B/BH+ proton acceptor ie base on top in both equations

Answer 11

Wests p 118 At FRC base is ideal compliance and fills most. at RV bases is at very bottom of PV compliance curve and apex is on steep rise-->most compliant-->fill first Hence the took in deed space volume high in N2 and low in O2 hence CC flick when dependant alveoli close and higher Nitrogen percentage open Note N2 vs Volume to calculate volume (not time)

Answer 12

=R.C | basal are bigger and more compliant s apex

Answer 13

Dead space and MV (note DS not a sig Cx)

Answer 14

Voltage dependant ligand gated transmembrane cation channel. A delta or C fibers stim glutamate release C fibres are polymodal and with wind up non-nociceptive stimuli-->pain initially glut stim AMPA slower is NK1 buy substance P eventually Mg plug removed-->excitation of post gang nerve ketamine bind PCP rec

Answer 15

#sydney course desk top additionally less intermedia CO2-->VC in lungs

Answer 16

decreased calibre due to loss of elastin with less radial traction

Answer 17

``` #50ml:50ml 500ml/day 15mmHg SPIDER sucks it up Rb Na:KATP ``` active secretion + ultrafiltrate produced in choroid plexus of ventricles and SAS tight junction of choroid epithelium ATPase pumps Na in and takes K out water and anions follow passively glucose actively transported (60% glucose level of plasma) 60+60ml total brain and CSF replace 4x per day (500ml) absorbed in arachnoid villi Pressure 11mmHg due to production-->drive Mg and Cl increased Na normal everything else decreased (K, glucose, protein etc) Power and Kam - REAB INCREASES IN RAISED ICP - SECRETION constant until CPP is less than 70mmHg

Answer 18

In normal airways, the flow is mainly laminar (turbulent flow is localised to the upper airways) "derranged phys #INERTIA is key viscoisty maintains flat sliding sheets inertia ripples them into turbulent waves hence reynolds number =2r.inertia/viscosity =2r. density X velocity / viscosity more inertia -->more tubulent large radius-->space for eddies etc lamina flow-->hagen poisel F=P/R turbulent not the same! R=8nl/pi.r2 note n=viscosity Derranged phys viscosity increase lamina R to slow! density increase likelyhood of turbulent therefore-->slow! density of turbulent flow-->decreased flow -Oxygen pushes bobbin higher than less dense He density of lamina flow-->do change -eg low flow rotameter same viscosity O2 and He -->same flow pushing bobbin Turbulent flow Flow is proportional to the square root of driving pressure. For turbulent flow, resistance is relatively large. That is, compared with laminar flow, a much larger driving pressure would be required to produce the same flow rate. Because the pressure-flow relationship ceases to be linear during turbulent flow, no neat equation exists to compute its resistance. , and cannot be described using the traditional Hagen-Poiseuille equation. Pressure = K.(flow)^n where K is an empirical constant which, for the human respiratory tract, appears to be 0.24 ( when the pressure gradient is expressed in kPa), and n=1.3 Density is the most important determinant of whether or not flow will be turbulent, all other things being equal. This is where helium becomes useful, i.e. by decreasing the density of the inspired gas mixture helium improves the likelihood of laminar flow occurring in narrowed airways, and this decreases the resistance to flow.

Answer 19

starts not at zero Alv O2 is 100mmHg hence 60% of inspired RA

Answer 20

``` Central * Clonidine * Methyldopa Cardiac * Beta blockers Vasc * Alpha blocker * Acei ARB * CCB * Direct * CCB * N * K ch Renal * Diuretics * Renin inhib ```

Answer 21

Q1- - 2 OH—>COMT met AND increase POTENCY - OH group position ie any B2 activity. (The ones that can be boluses routinely are not potent and last longer eg metaramino, phenylephrine and ephedrine) Q2 -beta chain size—>lipid insol and potent Q3 -alpha chain alteration—>MAOi hence longer and can have an indirect action Q4 - small—>alpha (note even a methyl in my understanding increases beta eg Norad has nothing but Adrenaline and a methyl group—>more beta. Same with metaraminol vs ephedrine-noting that ephedrine also has no benzyl hydroxyl groups) - bigger—>beta and MAOi

Answer 22

substituted Hydrocarbons(methyl (2C) ethyl (1C) ethers (O connecting to alkanes) except Halo-->alkane 5 changes 1) low MW, and polarity-->lower BP and higher Vapour pressure (as less bonds to hold together in my mind) 2) Flouride - decrease flam - decrease sol in blood and lipid - decrease potency 3) Br or CL - retain or increase potency 4) CHF2 - react with soda lime to liberate CO 5) chain length - max potency above and below

Answer 23

think boiling water with temp constant Constant temp: decreased volume-->increased pressure

Answer 24

Think Charles Charted a Hot air balloon of Chitwan National Park at a fixed pressure: Increased temp-->increased volume

Answer 25

Think Gays need to blow of steam partying on a gay train at a constant Volume: increased temp-->increased pressure

Answer 26

Henry scuba diving at a constant temp and at equilibrium: PP is proportional to ammount dissolved

Answer 27

In a mixture of non-reactive gases the PP exerted is equal to the sum of the PP of the individual gases #doesnt apply to volatiles just gases

Answer 28

men 130 women 12O g/L target >75 TRICC

Answer 29

``` acidotic hyperkalaemic low Ca high glucose (added) CO2, O2 lactate ```

Answer 30

44mg/L HME - condense due to cooling air - ->Latent heat of condensation warms water - evaporates on insp due to heating - ->Latent heat of vapourisation-->cool 70% efficient at 30C Coiling heat wire in water bath-->maitain temp

Answer 31

O2 PP at which oxidative phosphorylation ceases 1mmHg

Answer 32

naturally exist in RBC binds more avidly to deoxy to shift OHDC down ie right to release O2 in tissues increased in Altitiude and CCF as acidosis and hypoxaemia inhibit the enzyme that break it down and stim those that make it. Increased in Preg to offload oxygen to fetus decreased sens in fetus to take up mums oxygen Stored blood has DECREASED DPG-->poor offloading of oxygen for 24 hours

Answer 33

spont breathing awake - dependant becomes base with increased perfusion and increased ventilation - fat-->worsen VQ GA - decreased volume - ->changed position on compliance curve-->upper like apical becomes most compliant (worsen V:Q)

Answer 34

1) copper sink-high specific heat capacity 2) metal with high thermal conductivity conducts heat: enviro to bottle (no insulation) 3) splitting ratio altered eg Bimetalic strip Pressure 1) baffles 2) one way valves 3) long serpantine

Answer 35

SVP=1/3 atmp | for 3.3% inhaled need 10% to vapouriser and 90% bipass

Answer 36

MAINLY EXCRETED UNCHANGED in bile and to a lesser extent in urine. a little bit of de-acetylated metabolites prolonged in liver and renal failure

Answer 37

"BOTH ARE INDEP OF LIVER AND RENAL FUNCTION" P+H Cisatrac UNIQUE - Hoffman elimination (enzyme indep degen) - no direct hydrolysis by non specific esterase as per P+H - -but ester hydrolysis of metabolite laudenosine-->harmless Atrac UNIQUE - Hoffman - spontaneous BD at normal pH and temp -->laudenosine - hydrolysis by non-spec plasma esterase-->laudenosine Laudenosine-->seizure in doses above what is ever seen clinically

Answer 38

O2=CO2/0.8 ie for each O2 0.8 CO2s (less CO2 than O2) | 1:1 for car met

Answer 39

Aagradient/AVgradient Berggren equation CcO2-CaO2/CcO2-CvO2 Above is per L for each unit therefore ratio is end result. CcO2 is presumed to be maximal (100*Hb*1.34) If Aa is zero then no shunt If AV is massive then no shunt NOT CO2!!! CAPILLARY OXYGEN ``` Gold standard Role vs PaO2 -factors in low mixed venous O2 Role vs PaO2/FiO2 -Partial pressure isn’t as meaningful as content ```

Answer 40

Calculated amount of venous blood that would be needed to be added to pulmonary end capillary blood to give the PaO2 seen. issues: don't know the exact volume or PO2 of all the venous blood. Hence it's an estimate

Answer 41

Positive penetration Roc is excreted in liver and to a lesser degree kidney UNCHANGED

Answer 42

GDP-->GTP with activation then breaks down to GDP HENCE name GPCR

Answer 43

thio decreases SVR as per OCHB update hand notes and decreased resp to hypercarbia and BC no uterine change decreased renal BF

Answer 44

Physiological DS - anatomical - alveolar Apparatus DS

Answer 45

``` Anatomical -thesbian, bronchioli, coronary veins -cardiovasc fistulas/malformations Alveoli -V:Q mm ``` No CO2 Rise due to increased MV in response

Answer 46

Anatomical -fowelers N2 VS Vol curve Alv - bohrs eqn for physiological DS (all DS) Minus Fowler's anatomical = alv DS BOHR eqn -all CO2 is from alveoli. More DS more diluted capno like in an arrest! Vd/Vt= PACO2-PmixedCO2/PACO2 alv CO2 (assume PaCO2) - mixed end tidal CO2 / alv CO2 Presume alv CO2 = PaCO2 #DEAD SPACE DEAD MAN CPR ETCO2

Answer 47

Beta predome at low dose alpha predominantly at high dose 0.01-0.1mcg/kg/min-->beta >0.1mcg/kg/min-->alpha ``` #MAP can be unchanged! #NSWhealth ```

Answer 48

``` A-decrease oedema B-BD, small increase TV *increase Pulm VR C- HR, rhythm Vaso and veno changes ino work, VO2 AL D *increase MAC E -alpha decreases insulin release, -stims glucagon, Glycolysis, GNG, lipolysis -K+ driven intracell B2 # salbutamol *increased lactate F -RAAS -direct Na reab -decreased RBF G -BSL ```

Answer 49

stretch of aorta to buffer SBP and DBP to smooth

Answer 50

* Infrared absorbed by molecules that have 2 or more different atom types (not O2) * CO2, N2O, iso * Beer * Amount absorbed proportional to conc of infrared absorbing substance * Analyser * Infrared source, chamber, analyser * Different gases absorb different wavelengths * Hence to measure CO2 emit infrared at 4.25micrometer wavelength (doesn’t cross over with N20 absorption) * Must be a narrow band to avoid absorption by other gases * Chamber * Fixed size * No infrared absorption * Detector * Low CO2—>high IR detected—>low visual display of CO2 on capnograph * Collision broadening * Collision of different gases—>broader IR absorption pattern—>potential error source—>measure O2 and N2O to compensate * Mainstream vs sidestream * sidestream * compirse * suction * Recycle * comparison * Transit time * Minimal weight at patient end non bulky * In Paeds 150ml/min suction may be significant * Block and kink * Condensation—>error—>water trap * delay * Response time= transit time +rise time * Transit time for Co2 to arrive at detector * Rise time=time for display value to rise from baseline to max eg 0.2s * Quicker with smaller chamber

Answer 51

tension=p.r in a cylinder | note AL=tension/wall stress so p.r/thickness

Answer 52

SVR INITIALLY DECREASED!!!! due to parallel vasculature #adipokines Leptin (KEY ON ALL FRONTS except coag) - VC - cardiac remodel-->LVH - myocyte impaired contractility - leptin resistance-->DM Plasminogen activator inhibitor (NOT PLATELET) Angiotensinogen Resistin (think of a fat resistance army being strong) -Myoctye impaired contractility-->hypertrophy adipokines impaired neural control of resp system in sleep-->OSA (and fatty pharnyx)

Answer 53

``` BP=COxSVR #work #ECG #REFLEXES!!!!!! #AL=valves #coagulopathy #exercise ```

Answer 54

>30kg/m2 morbid obesity >35 with comorb or >40 #hyperdynamic ciculation #distributive change(decreased %to brain-absolute maintained) HR generally unchanged increased preload (50ml/kg vs 70ml/kg non obese) -due to RAAS and polycythemia -MAP unchanged wide pulse pressure due to to increased SV -AL initially decreased due to parrallele and concentric hypertrophy DILATED NOT REALLY A THING ITS HYPERTROPHY

Answer 55

``` Consumption req and Work of breathing Trigger Mech-Flow=P/R #resistance #CW and LC VQ-->Aa Diff Pulm VR Carriage ``` Dx Measurement clinical imp 9Cs 1. consumption 2. control 3. compliance 4. comparison 5. capillaries 6. carriage 7. Crisis 8. Calculation 9. Clinical implications

Answer 56

fatty pharynx leptin resistance-->impaired CO2 resp drive sensitivty OHS -awake hypovent

Answer 57

``` CO decrease 1% per year over 30 years HR 220-AGE impaired contractility->increased reliance on frank starling curve two maintain CO HR not sig changed #hypertrophy-->increased demand #atrial kick (30%vs 5%) ```

Answer 58

#restrictive picture - abdo fat - CW fat - increased pulm BV Airway resistance "↓Lung volumes → ↓radial traction → ↓airway diameter" ↓Lung compliance ↑Pulmonary blood volume → stiffer lungs ↓Lung volumes → operating on flatter part of compliance curve ↓Chest wall compliance ↑Weight of adipose tissue surrounding thoracic cage supply demand -decreased TV, increased RR net increase MV to meet demand decreased 1% FRC for every unit BMI >30 BMI 40 FRC =1L (normal is 2.5L) ↓FEV1 and FVC FEV1/FVC remains normal

Answer 59

WHO 60-75y.o old=75-90 ``` #GRAPES AND RAISENS BV decreased-->decrease loading ```

Answer 60

central compartment (effectively plasma)

Answer 61

15% decrease CO 15% decreased SV 15% decrease SVR -due to reduced SNS-->decreased Ca in, increased K out, NO stim

Answer 62

``` sux 1 roc 0.6 (this is 6x less potent faster acting derive of Vec!) atrac 0.5 cisatrac 0.15-0.2 (3x more potent) vec 0.1 panc 0.1 tube at 2 min for 45min ``` Note Roc and Vec and tubocurarine are Monoquaternary rest and Bisquaternary Mono is less potent and faster acting (hence why we use roc while cisatrac is so slow)

Answer 63

glucose-->pyruvate-->LA or Acetyl CoA (oxygen path) 1. Glycolysis (ADD) - ADP-->ATP NAD-->NADH 2. NAD recycle (Subtract)

Answer 64

Bendenoili effect

Answer 65

proportion to prod/AV | normal produ=200ml/min

Answer 66

This is not the conc required to have an effect of 50% in 95% of the pop. It is in fact then ED50 for a 95% reduction in twitch height TOFC MENTAL!

Answer 67

SeXy DARL Six hundred ie red deox absorbs CO same ab as oxygenated Hb in red light and no light absorbed at 900 nm ISOBESTIC point ab equal deox and ox

Answer 68

diluted ETCO2 vs PaCO2 all CO2 from alv

Answer 69

high PP diluted with low PP-->some dexocygenated HB get loaded up. Hence why platue is useful that a decrease PP can still have fair sats before the drop

Answer 70

stim of Ab ascending touch fibers increase inhbitory interneruons-->along with desc inhib pathway stop ascending pain fibre Ad and C

Answer 71

mechanothermal | mechanothermal +polymodal

Answer 72

Lissauer's tract up or down 2 levels

Answer 73

Polymodal C fibers transmit non noxious stim as painful (allodynia) glial inflam-->substance P neutrophils Nitric oxide-->alter Ca homeostasis 3 key features - decreased threshold - increased magnitutude (hyperalgesia) - increased zone

Answer 74

1 met is BMR ie VO2 of 3.5ml/kg/min

Answer 75

Cut-like a jigsaw high current low volt continuous Clot-like a rotating fan heater high volt low current interupted

Answer 76

quaternary ammonium compounds, are structurally related to acetylcholine. synthetic alkaloids Stoelting and P+H don't go beyond aminosteroid-steroid structure rigid and big BQ-long flexible chain

Answer 77

Light AMPLIFIFICATION by Stimulated Emmission Radiation 1. spontaneous emission excited-->base 2. stimulated emission when excited struck-->2 photons in phase, direction, wavelength-->chain reaction Ho:yag-->mild IR-->lithotripsy (Hodoor was built like a stone) CO2-->deep IR-->Cut Coag aRgon-->Retinal Risk 1) ETT Dx 2) fire in O2 and N2O 3) eyes and tissues

Answer 78

Light AMPLIFIFICATION by Stimulated Emmission Radiation 1. spontaneous emission excited-->base 2. stimulated emission when excited struck-->2 photons in phase, direction, wavelength-->chain reaction #monochromatic, coherent, collimated Ho:yag-->mild IR-->lithotripsy (Hodoor was built like a stone) CO2-->deep IR-->Cut Coag aRgon-->Retinal Risk 1) ETT Dx 2) fire in O2 and N2O 3) eyes and tissues

Answer 79

a conductor in motion in an EM field-->current | ->transform and generator

Answer 80

though body 100mA-->VF

Answer 81

through PICC or pacing wire to heart 0.1mA-->VF due to current density! Prevented with EES +/-more (CHECK!)

Answer 82

Shock req 1) potential diff 2) closed circuit Cx 1) fault-->expose a connection to active circuit 2) leak-->(present in all equipment even without fault) - -casing of other conductive component of equip - --due to capacitive coupling-->*****stray capacitance***** active-->resistor-->neutral with a neutral to earth touch active wire-->shock person as path of least resistance is through you and not the resistor touch neutral wire is fine as path of least resistance is through neutral wire

Answer 83

Capacitor -2 electrical conductors separated by an insulator Capacitance - the ability of a capacitor to store electrical charge - DC - -voltage pushes electrons from negative end to capacitor and build up on this negative side (cant cross due to insulator) on the other side electrons are release -->current flows until voltage on other side is equal to voltage of battery (then current=zero) - AC - -flick back and forth on one side-->back and forth on other (sustained current) Capacitive coupling -transfer of ALTERNATING SIGNAL on one site causing alternating signal on the other Stray capacitance -unintentional unavoidable capacitive coupling due to proximity of 2 conductors with an insulator and an AC current

Answer 84

not volts #Red! Residual Current Devices -an active and a neutral wire pass through a toroidal (coil of wire) detector -compare current difference in each to identify leak (due to a parralel path not through neutral wire) --if >5-10mA detected-->disruct power in 40ms ``` Short falls If 1st fault... 1) for 40ms risk of shock 2) power gets cut off Not ok for anaesthetic machine or bipass therefore need Isolated Power Systemie floating circuit ```

Answer 85

``` #blue plug for IPS #green and orange gauge for LIMD ``` Isolated Power System ie Floating circuit - no connection to earth - ->first fault doesnt connect to earth to create a circuit - can touch the line line and not get shocked! primary circuit-->isolation transformer-->secondary circuit isolation transformer is required to create a floating circuit (primary circuit is earthed while secondary is not) to shock need -2 faults or connections Line Isolation Monitor -monitors secondary circuit to confirm that it remains isolated from ground -->ALARM if the PROSPECTIVE HAZARD CURRENT >5mA --actually doesn't measure current but resistance Flow=V/R R=V/I -attempts to inject 5mA into pre and then post socket line of secondary circuit - if resistance reduced (due to parallels circuit) then flows -doesn't actually determine if current flowing just if it had potential to flow if 1 fault occurred

Answer 86

#green test button Equipotential Earthing System earthing wires at different powerpoints have different electrical potentials due to different resistance in wires EES-->large diameter Cu wire to connect all earthing wires prevents microshock

Answer 87

1-earthing wire due to metal casing eg fridge 2-double insulated so no earth eg hair drier 3-low voltage or battery eg mobile phone no earth as no risk of macroshock

Answer 88

``` B body unprotected -no additional protection #man BF Body floating - F #maninbox eg NIBP lead --macro CF cardiac Floating #heartinbox -eg ECG leads --micro ```

Answer 89

Body protection area -RCD or floating with LIM Cardiac protected area - RCD or Floating with LIMD and EES (RCH and ANZCA power point confirm RCD is acceptable-this confuses me as 40ms to switch off is a risk of shock but ok) (it appears mane role for floating then is for uninteruptable supply eg Bipass or anaesthetic machine

Answer 90

to protect supply if struck by lightening has an alternative path to flow. eg Class I device eg kettle. Fault-->shock you-->ground-->blow fuse. if no earthing wire ie IPS can touch active wire without shock as no circuit

Answer 91

time constant=sol.vol/filling as filling is flipping slow don't even come close to equilibrium especially with newer insol agents

Answer 92

=vol.sol/filling increased MV-->increased filling increased CO-->effective increase vol (insufficient time to hit equillibrium before ripped away)

Answer 93

0.693.Vd/Cl =vol.sol/filling VRG has smaller Vd and more filling so shorter halftime

Answer 94

methoxyflurane so lipid soluble impossible to knock out without N2O hence safe for ambos! lipid sol-->accumulate-->long DoA for analgesia

Answer 95

group 7 periodic table-->unfilled outer ring-->reactive-->strong bond-->inflammable, low volatility (unchangable), high boiling point Br and Cl increase potenecy Fl decreases potency but increases stability

Answer 96

not a gas-->no gas laws | no pressure change simply more in liquid form

Answer 97

ED50 dose required for 50% of pop eg roc #quantal DR curve | EC50 conc required for an individual to experience 50% of max effect #graded DR curve

Answer 98

Ag vs antag equilibrium equation | Ag conc with antag/Ag conc if along minus 1=antag conc/dissocation constant #derrangedpharm

Answer 99

decrease Emax without affecting affinity at rec hence EC50 remains same

Answer 100

Kd=dissociation constant=point at which 50% rec occupied. old theory 100% occupied-->100% respon yet spare rec shows max resp and lower % eg NMJ 75% full-->full response at 75% occupancy of AcH

Answer 101

GiPCR M2A2D2 2s MAD 2s GqPCR HAVE 1 M and M H1A1V1e M1 M3 GsPCR The rest

Answer 102

slow-->perineural trapping

Answer 103

beer lambet unreliable due to scatter-->patient calibration pulation therefore CHANGE in ab measured

Answer 104

No connection Neutral to earth in isolated system. shock cannot cross transformer either Hence neither way can a circuit be closed

Answer 105

VOLT SFO IN HYPOTHAL! P+K normal osmolarity 280-300 if Blood loss then increased osmolarity-->>280-->increased ADH 280=R.M.O give too much hypertonic solution

Answer 106

overview-->compensation Early autoreg of RBF--> preserve GFR then fail Sensors 1. osmorec #280 2. low pressure baro-->ADH and decreased ANP 3. high presure baro-->RAAS 4. renal Baro JGA-->R ``` Effector hormones ADH ->increase water, sodium and urea reab Renin -due to SNS, intrarenal baro of the JGA (not MD!), MD due to Na conc! , ATII, baro AT -->VC-->decrease peritubular capillary pressure-->increased reab increased SNS-->MAP -->VC afferent and efferent and reduce filtration coeff-->decreased GFR Ald in CD SNS-->Renin and VC afferent and efferent ANP -normally-->diuresis --block Renin and ADH --block Na reab in CD --increase GFR by VD aff and VC eff and increasing filtration coeff ```

Answer 107

Renin | -due to SNS, intrarenal baro of the JGA (not MD! Just pressure), MD due to Na conc! , ATII, baro

Answer 108

7.33 due to CO2

Answer 109

Fentanyl diffuses away rapidly primarily due to higher lipid sol (600x) -->rapid ab into perineural tissue, ED veins etc D=Sol.A.P/MW.T pH 7.33 in CSF-->both are more ionized-->trapping not sure how legit this is

Answer 110

vital capacity breath

Answer 111

nitrogen washout curve | time constant for washout reduced with increased MV hence 3x VC breath

Answer 112

``` 1 time constant-->63% complete 3 time constant to be 95% complete T=0.693xsol.vol/flow T=1/k T=R.C for alveoli ```

Answer 113

nitrogen washout as lung is only decent potential O2 reservoir safe apnoic period ie time to SaO2 < 88% 21% FiO2 2.5L FRC-->450ml O2--> <2min 100% sig higher O2 optimal ETO2 is 90% airway occlusion-->atelectasis and shunt LITFL 3 minutes of tidal breathes or 8 VC breaths half-time for exponential change in FAO2with a step change in FIO2is 0.693 × VFRC/V̇A for a non-rebreathing system With VFRC equal to 2.5 l, the half-time is 26s and 13s when V̇A= 4.0 and 8.0 l/min, respectively Thus, most of the oxygen that can be stored in the alveolar and arterial spaces can be brought in by hyperventilation with FIO2= 1.0 for a short period of time this is the basis for the 4-deep-breath-within-30-seconds method of preoxygenation However the4DB/30 sec method still submaximally preoxygenates and leads to more rapid desaturation because: it does not allow enough time to maximally oxygenate tissue and venous compartments, and FiO2 may be decreased if the oxygen flow rate is insufficient for the rate of alveolar ventilation (due to entrained air)

Answer 114

butryl cholinesterase hetro -->double homo A-->4-8 home F-->several hours

Answer 115

``` aabgd dystophy burns demylination-stroke GBS, prolonged immob, paraplegic -->lethal ```

Answer 116

anaphylaxis 1:10K fo GA with 1/3 due to MR even on first exposure 60% cross reac DMR and NDMR

Answer 117

small and offset by benefit of not tubing paralysed patient | offset by NDMR

Answer 118

due to abdo m not gastric m contraction--><30cmH20

Answer 119

CO-->normal sats dye-->false low like nail polish too small-->compress or not full finger

Answer 120

1. eg morphine to Normorphine 2. ADDITION OF LARGE POLAR MOL eg morph-->M3G (70%) and M6G 10% (active and 3x potent) #SX-->trouble but adding glucorinide by glucorinde transferase

Answer 121

methylated

Answer 122

Clearance is constant but elimination decreases with decreasing conc. Conc=IMD/Cl (conc=x/Vd so conc=change x over change Vd is IMD over Cl!!!!) AUC=dose/Cl

Answer 123

p is -log10 Ka=equilib constant acid:base Ka= Proton acceptor [H][A-]/proton donator [AH] at equilib

Answer 124

Not at all simply liquid-->vapour instead of evaporation from surface from liquid to vapour. boiling point is when SVP is as great as the external pressure on the liquid. hence bubbles can form in rather than just at the surface (as just as much pressure to fight against either way!) - vapour pressure > or equal to enviro pressure - so on everest this boiling point is lower! so in a closed system liquid and vapour form an equilibrium adding heat above boiling point-->no increase in temp but change in equillibrium with higher vapour pressure until critical temp reached (above which no compression to liquid so no equilibrium)-->gas boiling point is pressure dependant (low P-->low boiling point) crit temp vapour-->gas

Answer 125

handy features 1. insulated 2. pressure gauge - decreased use-->no LHV-->increased temp-->increased P-->let off-->cool and decrease pressure 3. evaporator (extenal pipeline) No power supply req -use-->vapour drawn off-->more liquid to vapour-->LHV-->cool Critical temp of O2 -116C Boiling point (liq-->vapour -183C) system -180C--160C -liquid:vapour in euquilibrium Pros - cheap on mass vs gas - no power req Cons - set up cost and waste - back up - fire and explosion

Answer 126

critical illness myopathy met liver-->active met-->renally cleared -->accum biliary clearance

Answer 127

vec derivative with decreased potency-->increased SoO mild vagolytic anaphylaxis NO METS (<5%) biliary clearance unchanged mild renal clearance #suggamadex

Answer 128

vagolytic due to SA MAch stim +/- SNS stim met in liver to active mets-->biliary excretion unchanged elim in kidney

Answer 129

``` Histamine-->BS and VD critical illness myopathy uniqu met -hoff -non spec plasma esterases-->laudenosine ```

Answer 130

BENZYLISOQUINOLINIUM butryl cholinesterase histamine release

Answer 131

high capacitance-->high storage -hence increase SA by coiling 1. build up on either side of capacitor to charge 2. connect alternative circuit to defib - 4 switches for biphasic shock (two paths-->forward then back with transition time inbetween to avoid short circuit - truncation (cut off) occurs to avoid low current-->arrhythmia - achieve by intensional short circuit-->dissipated energy as heat - twitches for above dictated by computer based on oscilloscope reading ``` #transformer-->12V-->2000V -since high voltage-->increase capacitance storage=capacitancexVoltage squared/2 #AC-->DC in machine ```

Answer 132

high capacitance-->high storage -hence increase SA by coiling 1. build up on either side of capacitor to charge 2. connect alternative circuit to defib - 4 switches for biphasic shock (two paths-->forward then back with transition time inbetween to avoid short circuit - truncation (cut off) occurs to avoid low current-->arrhythmia - achieve by intensional short circuit-->dissipated energy as heat - twitches for above dictated by computer based on oscilloscope reading ``` #transformer-->12V-->2000V -since high voltage-->increase capacitance storage=capacitancexVoltage squared/2 #AC-->DC in machine ```

Answer 133

Both bind ATIII ATIII CONNECTED TO II AND X II has binding site requiring binding achieved by Heparin not LMWH X DOESN'T HENCE SHORT LMWH ACHIEVES EFFECT

Answer 134

HIT JUST LOW NUMBER HITTS 1% mortality ``` <100 3-14 days 50% drop Clot ?sepsis and dic ```

Answer 135

tertiary vs quarternary amine

Answer 136

oxytocin rec GqPCR -->PLC-->IP3 and DAG-->Ca increase amp and freq with normal relaxation between ``` CVS = vasodilatation ! ↓MAP ! reflex ↑HR; ↓coronary perfusion RENAL = mild ADH effect ! fluid retention ± volume overload MATERNAL = ↑uterine contraction (esp. in multigravid) ! possible uterine rupture FETAL = ↓uterine blood flow ! possible fetal distress ```

Answer 137

ergot alkaloid 500 IU IM agonist at A1, DA, 5HT increase basal tone and force of contraction A1-->VC and decreased coronary perf DA-->CTZ and CNS-->N+V headache seizure

Answer 138

misoprostol PGE2 -coordinated contraction, increased basal tone and cervical relaxation -induction, PPH, abortion decrease MAP, increase HR BS, increased RR Given PO, SL, PV, PR - i have seen it given PR 4x200mg tabs (up2date) - onset gastro inhib of secretion in 30 min and DoA 3 Hr also given to Mx NSAID induced GI ulcers

Answer 139

1. NSAID (prost) 2. Salbutamol or terbutaline (b2) 3. Mg 4. nifedipine 5. GTN 6. volatile (not N2O) 7. atosiban (oxytocin antag)

Answer 140

oxytocin rec GqPCR -->PLC-->IP3 and DAG-->Ca increase amp and freq with normal relaxation between ``` CVS = vasodilatation ! ↓MAP ! reflex ↑HR; ↓coronary perfusion RENAL = mild ADH effect ! fluid retention ± volume overload MATERNAL = ↑uterine contraction (esp. in multigravid) ! possible uterine rupture FETAL = ↓uterine blood flow ! possible fetal distress ```

Answer 141

ergot alkaloid 500 IU IM agonist at A1, DA, 5HT increase basal tone and force of contraction A1-->VC and decreased coronary perf DA-->CTZ and CNS-->N+V headache seizure

Answer 142

PG rec misoprostol PGE2 -coordinated contraction, increased basal tone and cervical relaxation -induction, PPH, abortion decrease MAP, increase HR BS, increased RR

Answer 143

1. NSAID (prost) 2. Salbutamol or terbutaline (b2)-tachy 3. Mg--limp baby and resp distress for baby 4. nifedipine 5. GTN 6. volatile (not N2O) 7. atosiban (oxytocin antag)-->yes hypotension and nausea

Answer 144

b2 ag for tocolytics

Answer 145

both stop post synaptic NaCh

Answer 146

block presynaptic Ca Ch

Answer 147

block Ach vescicle release disrupts docking protien SNARE

Answer 148

block choline channel for reab

Answer 149

stop post synaptic NaCh

Answer 150

block presynaptic Ca Ch

Answer 151

block presynaptic NACh-->reduce positive feedback

Answer 152

cold acidotic Mg K (NDRM yet shortens sux)

Answer 153

increased mobilization, production of Ach and increased Ca

Answer 154

tetany= 50Hz x for 5s Single twitch=1Hz PTC= tetany then 1Hz 3s later (many twitches #PTC twitch of 9=TOFC of 1) -effect of tetany-->mobilization lasts 6min-->TOFC falsely raised -post tetanic fascilitation -useful for deep block req eg retinal surgery "A Post-Tetanic Count (PTC) of 2 by palpation suggests no twitch response for about 20-30 minutes, PTC of 5 about 10-15 minutes" TOFC=2Hz x 0.1ms x4 DBS=(50Hz x 0.2ms x 3 20ms appart)x2 separated by 75 ms "the second burst is lost as the third twich of TO4 is lost; the first burst is lost a little after you lose all response to TO4" DBS of 2 is reversible DBS less useful to assess depth of block but has a potential roll in confirming lack of residual block post reversal Summary: burst and tetany intense PTC chilled TOFC chilled Tetany 50Hz x1 PTC 1 Hz x many (5-->10-15min TOFC1) TOFC 2Hz x 4 DB 50Hz x3x2

Answer 155

role: qualitatively say if 1=2 then no clinically sig residual block (less sensitive when quantified manually)

Answer 156

picture -preganant donut with breast CA vomiting after taking ABx with a bogan heart tatoo and a strange rash PONV >1% OCP progesterone ineffective hypersens reaction severe brady rare may have slower action with IV fusidic acid (Abx) and ERModulator-->release the wrapped up roc. negatively charge hydrophilic center binds charge Quaternary amine (a modified gamma cyclodextrine)

Answer 157

uterine artery - O2 100mmhg - CO2 30mmHg Uterine Vein - 40mmHg - CO2 45mmHg umbi artery - O2 15mmHg - CO2 55mmhg Umbi Vein - O2 30mmHg - CO2 40mmhg

Answer 158

end capillary 40mmHg venouns 60mmhg mitochonidria 4-22mmHg

Answer 159

FEV1 decreased more than VC is decreased but both are decreased restrictive normal FEV1 and markedly decreased FVC

Answer 160

-ve on left and +ve on right which is bloody different to every other lung PV curve! makes no sense if you get this wrong

Answer 161

right lean systole-->early ventricular LENGTHENING (bulging of ischaemic muscle) DIASTOLE-->postsystolic shortening ie elastic recoil in severe ischameia

Answer 162

normal 80-matey 70-sats drop due to increased extraction 40->fucked

Answer 163

3ml/100g 1.5kg not 3.5ml/kg is total body so close to 10x normal body req 20% of bodies o2

Answer 164

is PC | Prod CO2/Consumed O2

Answer 165

Qt.CaO2= Qs.Contentmixedvenous +(Qt-Qt).Contentendcap several steps--> Qs/Qt=CcapO2-CaO2/CcapO2-CmixedvenousO2

Answer 166

wide AR narrow AS

Answer 167

Twave end is MV open (end of isovol relaxation)!!!!!

Answer 168

5mm=0.2s cycle is 1s for 60bpm PR 0.2s QTinterval <540ms

Answer 169

1 AV close 2 Aortic and pulm close 3 Filling in diastole 4 filling of stiff ventricle post atrial contraction before S1

Answer 170

ARP of 250ms vs 1ms due to platue due to L-type CaCh | higher RMP for myocyes -70mv vs -90mv

Answer 171

PWP is literally occluding the PA and letting pressure drop then pressure wave transfused from LEFT atrium to PV to PA hence looks like CVP trace but with pressure 6-10mmHg CVP 0-5 RV due to valve 25/0 PA due to valve 25/10 PAWP looks like CVP at 6-12mmHg

Answer 172

baro rec defect in Autonomic neuropathy or quad - excessive BP drop in p2 - no overshoot or brady in phase 4 CCF -increased blood vol-->increased venous pressure-->maintain venous return then ITP translated to ITP -->raised MAP -SQUARE WAVEFORM! (ELEVATED NOTE DROPPED) -think of how PEEP-->improved frank starling in CCF (not exactly the same but close (or maybe the exact same?)

Answer 173

arterial elastance line

Answer 174

EDVP relationship (elasatance line (not compliance))

Answer 175

ESDVP relationship

Answer 176

increased HR-->increased Ca-->increased force of contraction

Answer 177

increased afterload-->increased wall tension-->increased contractility

Answer 178

increase one the other drops

Answer 179

Bainbridge | Atrial stretch—>baro—>decreased HR

Answer 180

1. SNS 2. catechol 3. drugs +ve or neg 4. pH, oxygen, CO2 5. electrolytes 6. MI 7. reflexes - Anrep increased AL-->increased Contract - Force frequency Contraction

Answer 181

at RAP of zero | frank starling curve starts at RAP -2 ish

Answer 182

MSFP-RAP/Restistance to filling resistance to filling is note venous tone! - increased venous tone with SNS improves venous return - ->shift MSFP - resistance to filling is dictated by organ autoreg - ->in exercise decreased resistance-->increased VR - ---->pivot gradient

Answer 183

1. delay 2. wider PP-less compliant 3. narrower- less compliant 4. decreaed MAP 5% 5. distorted shape - reflection - resonance - damping - various pressure waves at different velocities 6. loss of incisur due to damping 7. diastolic hump due to reflection and resonance Changes with age -narrower PP and less distortion in non compliant arteries

Answer 184

the freq at which the system would oscillate at if stimulated then left undisturbed eg for BV 1Hz eg for artline system >24Hz (8th harmonic of 3Hz) Nat freq=square root of r squared.stiffness/density.length

Answer 185

the complex wave (ie 1Hz pulse) that is being broken down into 8 by fouriers analysis harmonic eg 2Hz, 3Hz, 4Hz 8 harmonics to appreciate dicrotic notch

Answer 186

amplification of sine wave when natural frequency of measuring system is close to fundamental freq of that being measured not if it overlaps with the 8th harmonic-->resonance but 8th harmonic is high freq LOW AMP-->minimal impact

Answer 187

the absorption of energy of oscilations req to damp resonance

Answer 188

(flat range) range of frequencies for which minimal change in amplitude due to resonance ie the range of frequencies for which natural frequency of the artline system does not cause significant resonance frequency: response ie freq:resonance ie how much can i increase freq before i get resonance Damping Coef of 0.7 -index of the system to resist oscillation Flat range influenced by natural frequency of the artline - if the artline system has a low nat frequency eg 7Hz then very high chance of resonance with 7th Harmonic and no amount of damping could fix this - if artline system was 70Hz this is well above the 8th harmonic and resonance very minimal hence no damping even required - the flat range would be a over a large number of frequencies before resonance amplified the signal damping reduces the amplitude-->increased the flat range a bit damping also slightly increases the nat freq of the system! #derranged phys. sine wave squeeze down alot and pushed to the right a little.

Answer 189

narrowing 1/r^3

Answer 190

reverb-->amplify

Answer 191

most 10-25 Hz ideal NOT SIMPLY >24 Hz BUT A FLAT RANGE>24HZ simplistically people say 24Hz how to measure Fast flush test -freq of once per 30ms-->33Hz-->flat range >24 Hz-->set to go

Answer 192

HR. SV-area from upstroke to incisura Preload contract SVR sup- area below diast Diastolic Pressure time index demand-area below systole Tension Time index art compliance Swing-PEEP-->decreased systolic

Answer 193

Last part of ventricle to depolarise → epicardial surface of LV wall at base of heart RV depols first as thinner

Answer 194

perkinji fibers

Answer 195

25mm/sec 1mc/cm

Answer 196

peaked T waves P wave flat PR prolonged -harder to pushout K-->less neg-->excitable muscle but suppresses conducting tissue

Answer 197

positive electrode-->upstroke RA-->LA LA +ve LA-->LL LA is -ve etc

Answer 198

prolonged Qtc hence increased risk in brady

Answer 199

start of p to start of QRS not R!

Answer 200

CV phys says Na influx | wiki says K and Na influx

Answer 201

Pulmonary opens first as PA pressurePaP | Splitting AP greater on insp as pulm VR decreased-->even later close of Pulm

Answer 202

Consumed=CO.Ca-CO.Cv | Consumed/AV diff=CO !!!!!!!!!

Answer 203

-->NTS-->inhibitory GABA interneurons to vasomotor center in ventrolateral medulla

Answer 204

phase ii M3G-potentially a mu antag M6G 13x more potent! -Six is Strong! both excreted in urine

Answer 205

1 RBC and brain 2 panc liver and kidney 4 fat and skeletal four fatties flexxed while eating glucose

Answer 206

can increase MV 15x theory unknown 1) not CO2, O2 or pH 2) muscle spindle play a role 3) oscillating CO2 and O2 may play a role 4) central chemorec threshold may change 5) temp may have a role

Answer 207

y axis % of normal x CPP 50-165mmHg Co2 20-80 O2 flick up at 50

Answer 208

normal 10mmHg comp to 20 focal 20-45 general >45

Answer 209

minimal platue-->RAF possible as decrease ARP

Answer 210

phase 2 is 1-4 hrs | temp change is from -1.5->-2.5

Answer 211

umbi vein - 1/3-->DV-->bipass liver straight to IVC - 2/3-->liver-->portal vein-->IVC

Answer 212

``` definitely! flow 3/4 from IVC 2/3 RV-->90%DA 10% lungs 1/3 LV-->2/3 head 1/3 lower ``` sats umbi and DV 80% (call it 3/4) IVC 2/3% SVC 1/3% ascending aorta 2/3% as from IVC (small water down) PA essential from SVC with some extra O2-->50%

Answer 213

IPP and ITP are the same!!!!!! IPP: pressure in pleura TPP: Alv-IPP TPP is the same as TMP intra inside the pleura trans is outside to insude

Answer 214

x axis is plasma glucose mmol/L y axis is glucose flux mg/min at 11mmol max reab of 300mg/min

Answer 215

machine to patient 1. electronic issue 2. sampling line 3. ETT lumen 4. ETT placement in eosophagus 5. resp obstruction 6. resp arrest 7. cardiac arrest

Answer 216

partial obstruction patient or tube

Answer 217

1. CO2 level (and site) 2. RR 3. patency/obstruction 4. curare sign 5. rebreathing (not same as breath stacking)

Answer 218

Artline saline collumn-->move diaphragm-->change resistance-->measured with WBC must see wiki image 2 sets of parallel resistors left side known and variable right side known and an unknown gauge between left and right ABCD clockwise NULL DEFLECTION:when galvanometer is zero the bridge is balance with no flow. This is because the ratio of the bottom sides is equal to the top sides on both sides resistance electronically converted into SBP, MAP , DBP and displayed

Answer 219

sinus has baro rec hence a sinus for pressure | body has chemo rec

Answer 220

arterial elastance line ESP to EDV P/SV not perfect representation but is indep of preload and afterload so used as a surregate

Answer 221

ESPVR line

Answer 222

mmHg/ml/sec of dynes/sec/cm^5

Answer 223

minimal more than left ESV right 50-70ml still!

Answer 224

bezold jarish

Answer 225

most are RIGHT ie right -->PDA-->inferior IVS

Answer 226

pulmonary artery

Answer 227

vasoactive intestinal peptide-->VD

Answer 228

KD | -conc at which 50% of available rec occupied

Answer 229

both can be drawn as either a sigmoid log or a non log (kinda inverse exponential function) EC is for individual graded ED is for pop quantal log conc x axis non lg y axis

Answer 230

acid with a pKa of 7.6 -obviously because acidosis goes to huge change in vial is basic to make ionized to dissolve-->necrosis if extravesates

Answer 231

alften 6.5-->90% UI fent 8.4-->10% UI lig 7.9%-->25% UI bup 8.1%-->17% UI

Answer 232

y=e^kx y=e^-kx (negative to zero) y=1-e^-kx (washin with asymptote at 1)

Answer 233

0.58 halo 2.4

Answer 234

VRG muscle fat

Answer 235

log conc y axis and normal x axis ie a semi-log plot my initial understanding was wrong!!!!!!!.. NOT: first is V1-V2 THEN second is V1-V3 THEN third is elimination balance against redistribution back into V1 P+H uses 2 exponential: distribution and elim clinical aneasthesia uses 2 exponentials millers says nothing derrange phys uses 3 1. distrib 2. elim 3. terminal elim (rate that it is eliminated in the final phase as redistribution flattens gradient) https://derangedphysiology.com/main/cicm-primary-exam/required-reading/pharmacokinetics/Chapter%202.0.1/single-and-multiple-compartment-models-drug-distribution

Answer 236

onset 3-5 min peak 5-10 DoA <3mcg/kg is 30-60min Doa at 50mcg/kg is 5 hours

Answer 237

1) ZERO ORDER KINETICS at infusion 2) active met 3) hang over

Answer 238

ph=-logH 7.4=40nmol.L 7=100nmol 8=10 (not 1/10th of ph of 7)

Answer 239

HA-->H+A- (k1) backwards is K2 K1/K2=K high Ka means stronger acid-->LOWER PKA (a negative log!!!!! like pH)

Answer 240

HA-->H+A- (k1) backwards is K2 K1/K2=K high Ka means stronger acid-->LOWER PKA (a negative log!!!!! like pH)

Answer 241

pKA 6.1 (good for acids) | note H+-->shift left-->resp center-->out

Answer 242

rbc lung renal tubule | eyes and gastric mucosa

Answer 243

1. buffer (instant) 2. comp (slower) eg resp and renal CO2/HCO3 changes 3. Correction

Answer 244

1. buffer (instant) 2. comp (slower) eg blowing off Co2 ???? 3. Correction of underlying problem eg COPD, haemorrhagic shock, sepsis. #P+K

Answer 245

Carboxyl group pKa 2-->little effect ECF but more effect for ICF amino group pka 9

Answer 246

max net loss 300mmol H+ secretion per day 70mmol of fixed acid produced per day 4321mmol per day for recapture of HCO3 renal comp 1) H secretion to recapture HCO3 -secrete H-->H2CO3-->CO2-->into cell-->HCO3-->system -90% PCT -against conc gradient -5% in DCT intercalated cells secrete H+ and can increase H conc 900 fold 2) secretion of tritratable acids H++HPO4-->H2PO3 also includes sulfate once HCO3 reabsorbed any further H+-->H2PO3 3) excretion of ammonia (75% of daily metabolic acid secreted this way) PCT: glutamine-->2NH4+ +2HCO3 -->HCO3 reab DCT NH3 secreted (lipid sol)-->H++NH4+ charged and not reab

Answer 247

BE: amount of acid need to be added to 1L of blood to restor pH to 7.4 with normal CO2 and temp Standard BE: if Hb 50

Answer 248

amount of acid need to be added to 1L of blood to restor pH to 7.4 with normal CO2 and temp

Answer 249

CO2 is MEASURED (ITS EASY TO MEASURE) HCO3 is CALCULATED -actual HCO3 calculated from HHE -standard caclulate is HHE had a normal CO2 ----if standard HCO3 is normal then shift in pH is due to changed CO2 and not any metabolic process

Answer 250

SID in body is 42 140+4-102 giving non albumin product with dilute albumin down so HCO3 increase (in general-it is a balance of dilution vs SID number) to avoid ALKALOSIS SID needs to be reduced to 27 to have neutral effect on pH note hyperchloaemia facted in to this SID of 27 (shit tone of Cl--->decreased SID-->decreased HCO3 hyperchloraemic MA Plasma has osmolarity of 296mosmol/L Na 140 Cl 102 NaCl 150-150=SID of ZERO-->hyperchloaraemic acidosis -osmol 300 CSL 131+5+2-112=SID 28-->neutral -osmol 276 -has lactate-->HCO3-->further alk i believe Plasmalyte (no colloid) 140+5+1.5-98=SID 50-->alkylosis 4% albumin is iso-oncotic with same alb conc as blood and SID of 42-->no change in pH

Answer 251

increased temp--> increased energy so more sol (picture hot water absorbing more salt increased temp-->increased dissociation of H20-->H and OH-->increased acidity

Answer 252

temp not corrected assumed 37C - fine for adults - -1) ICF pH unchanged by temp due to imadozole temp dependant intracellular buffering system

Answer 253

20,000mmol/day

Answer 254

cant secrete H to reab bicarb | -->NAG MA!

Answer 255

acute circulatory failure with inadequate perfusion to meet tissue metabolic demand resulting in generalised tissue hypoxia (BMJ)

Answer 256

summation of inhibitory and excitatory action potentials of cortical pyrimidal cells ***UNPROCESSED ALPHA THEN BETA THEN DELTA FROM AWAKE TO ASLEEP AND FROM HIGH FREQ TO LOW*** awake- high freq low amplitude asynchronous - alpha predom when awake with increased amp when eyes closed ALPHA >8 HZ - sedation Beta predome >13Hz - anaesthetised delta shift <4Hz (4 looks like a d) low freq high amp SPINDLE WAVES - deep anaesthesia burst sup-->isolectric line ``` PROCESSED BIS or entropy -3 point, frontotemperal -fouviers analysis -detect interference and compensate -proprietery algorythms -for hypnotics NOT OPIOIDS ``` BIS (FFFFFFF) ***BFF***read's my mind. Bi is single - Freq and phase analysis - single number Entropy (FT) (this world and it's entropy is ***F't*** ENtropy is 2 - RE - SE - Freq and Time analyse -->entropy (degree of disorder)

Answer 257

``` # evernote #contrasting SI units #eg of specific heat capacity ``` heat is energy measured in joules (both KINETIC AND POTENTIAL) Temp is measured in Kelvin and related to how fast the molecules of a substance are moving ie their kinetic energy but does not factor in their potential energy heat can be added to a substance and either increase temp or change state (potential energy added) as in LHoV an equal amount of heat energy can be add to two different substance of differing SHC-->different change in temp - SHC of water 4200J - SHC of Hg is 140J SHC is the amount of energy to increase 1kg 1K J/kg/K

Answer 258

non electric - mercury/ETOH-->delay - bimet coild - volatile-->Boudan (BOW DOWN) gauge thermometer electric - Resistance thermometers eg old ventilators! - -platenum-->Galvonometer in Wheatstone bridge - -INCREASED RESITANCE LINEARLY WITH TEMP - --->bulky - Thermisters (therma resistors) - -ceramic or metal oxides beads in series with a circuit - -increased temp-->EXPONENTIALLY increase in resistance - --->small-->swanganz catheters - --->overheat-->messed callibration eg in sterilization - IR - -IR-->pyroelectric sensors (yes pyro not piso)(crystals that become electrically polarised by EMR eg IR radiation)-->charge-->changed capacitance-->measured-->displayed

Answer 259

https://www.wfsahq.org/components/com_virtual_library/media/ 324d4c30cd8e5bc6473f988dec984d25-7-Paediatric-anatomy---physiology-and-the-basics-of-paediatric-anaesthesia.pdf airway forgettables - mandible - funnel - narrowest at cricoid vs vocal cords - nasal Dx easy. oedema is big consequence - larynx is both ant and high - epiglottis is large and stiff yet flops Breathing forgettables 1) consumption 2) drive-apnoea, RR 40, 3) mech #CC #diaphram #CW compliance-->decreased FRC

Answer 260

``` #insp-->increased Pulm BF-->increased LAP #decreased hpvc -->decreased RAP ``` #cord clamp-->increased SVR -->increased LAP YES P+K small fry - high O2 constricts DA - increasing O2 and decreasing CO2 decrease pulm VR A then Ovale then V seconds minutes hours Duo weeks Forament 5 weeks Vino hour seconds: DA-narrow with first breath phys close 14 hours anatomical closure 14 days minutes FO-functional close minutes perm at 5 weeks hours DV-hours

Answer 261

stim-->Reticular formation-->resp centre stim vaginal birth 35ml squeeze from thorax to pulm cap-->reab O2 falls 30--15mmHg CO2 rises 55--60mmHg centeral and peripheral chemo rec become more sensitive (likely due to increased BF to them) FRC 20ml/kg at birth -->30ml/kg at 1 hours -80cmH20 first insp

Answer 262

2.2ml/kg=150ml

Answer 263

increased ECF and TBW TBW 75% vs 60% ECF 40% vs 20% ICF 35% vs 40% adult 70kg-->42L 28L ICF 14L ECF 11 IF 3 plasma (2L of RBC)=5L of blood

Answer 264

F:M 0.16 | sux is zero

Answer 265

``` Rb Mg (apparently not on new evidence #anzca course- yet royal womens has diagram with i...) Rb CCB ```

Answer 266

met by oxytocinase | VD-->reflex tachy

Answer 267

ergot alkaloid from fungus DIRECT Sm stim-yet no VD as blocks vasomotor component onset 40s for 2-3H little known about PK note also VC uterine artery increases SVR and CVP and BP CORONARY ARTERY SPASM, MI STROKES, PULMONARY OEDEMA

Answer 268

prostaglandin rec-->increased SR release of Ca bronchoconstriction NV+D severe VC uterine rupture

Answer 269

1st line for preterm

Answer 270

DO NOT USE FOR ACUTE - close PDA - renal - gut

Answer 271

IN 400mcg or 100mcg IV

Answer 272

hypoxia and acidosis

Answer 273

decreased glycogen stores increased req glucose main source then fat once insufficenet N BSL is 3 at term

Answer 274

decreased conjugation for first 70 days decreased albumin initially volatiles - increased resp rate and decreased FRC - increased CO and ECF-->increased uptake (slower onset) and decreased % to brain ``` A -RR and FRC -slow gastric emptying -imature biliary secretion-->decreased AB lipid sol -less acidic stomache-->change ionization -less GI enzymes -percutaneous ab increased D -alb -ECF -less body fat 10 vs 20% vs 1 year old -low Prbinding alpha 1 and alb -->increased free Phenytoin -BBB immature M -liver phase 1 and 2 normal at 2 years -non linear mcg/kg morphine req peak at 3yo E -renal GFR decreased up to 2 years-non liner -Tubular secretion and reab also reduced for 2 years ```

Answer 275

Uptake=Q˙×𝜆b/g×(Palv−PMV)

Answer 276

#evernote Rb labyrinth -->Vest-->CNVII-->CRTZ VC ach rec GI 5HT-->NTS CRTZ has 2 names and 2 feed ins Victoria Cross has 4 points steroids at 5HT GI

Answer 277

Rb pyruvate oxidation-->CO2 and NADH not ATP kerb prod only 2 ATP and CO2 ETC 32 ATP glycolysis-->2ATP+NADH pyuvate oxidation-->acetyl CoA (CO2 +NADH) kreb cycle: acetyl coa cycles with prod of CO2, ATP, NADH, FADH2 Oxidative phosphorylation. electrons carried to electron transfer chain by NADH. with O2 as electron acceptor. electrons taken from high potential to lower. and ADP-->ATP glycolysis in cytosol pyruvate oxidation and kreb cycle exclusively in mitochondira electron transfer chain -the membrane of the mitochondira glycolysis occurs without oxygen everything else requires oxygen (definitely!)

Answer 278

Gold Cats K high IC-->negative Nernst 150conc vs 5conc Cl low IC-->negative nernst 10 vs 125 Na low IC-->positve nernst 15 vs 150 calc E=58log(o/i) Goldman-Hodgkin-Katz E=58log Ko+Nao+Cli/Ki+Nai+Clo 0 is Over I is Inferior bellow

Answer 279

O2 is severity | CO2 is DDx of ventilatory failure vs shunting

Answer 280

on room air - small store of O2 so decreased AV-->half time of 30s - large store of CO2 so decreased AV-->half time 16 min practically we can preoxygenate and desat much quicker than building up CO2 with hypovent hence accutely desat is earlier warning of vent failure than CO2 (could erroniously mislead practitioner to believe it is a shunt as CO2 not yet risen)

Answer 281

barbituate with sulfur added at C2 hence "thio" at C5 substitution of central pyridimine ring-->"pentone" --phenyl at C5-->anticonvulsant --Methal at C1-->excitation TAUTOMERISM KETO-LIPID SOL ENOL-WATER SOL contains sodium (hence STP) salt N2 and NaCO3 -->basic-->enol 80% PrB pka 7.6

Answer 282

not enol, keto but closing of ring above ph of 4

Answer 283

substituted HCs all methyl ethyl ethers except halothane which is an ethane sub and sevo-->propyl methyl ether forgetables - CF3-->stable (3=tripod=stable) - CHF2-->react with sodalime-->CO (2=two soda and lime) - C next to O without halogen-->metabolised eg sevo! (no halo=no angel=no protection)

Answer 284

benzyl hydroxyl groups - 2 for max affinity eg Adr and Na but also BD by COMT and now too polar to cross BBB - just site 4-->alpha selective - -note metaraminol and ephedrine just have 4 (weak and long lasting-->good as bolus) beta chain - DECREASES LIPID SOL and increases potency - eg NA and A alpha chain -addition-->MAOi eg metaraminol and ephedrine. phenylepherine doesnt have addition-->direct action only with no indirect action amine - methyl-->alpa and MAOi - large-->Beta eg dobutamine

Answer 285

same formular different structure A)structural with diff bonds A1 static iso vs en ethyl group arrangment of Cl vs F A2 is dynamic B)stereo same bonds diff 3D space B1 optic ie enantiomer (mirror) B2 diastereoisomer (non mirror) B2x is configurational (can't be converted by rotation around a single bond) B2y geometric eg cis and trans around double bond

Answer 286

NATURETIC=DIURETIC VD affenent VC efferent and increase filtration coefficient blocks ADH, ATII, Ald

Answer 287

less Na-->increased renin less Na-->NO more Na-->adenosine

Answer 288

Key role in cellular stability due to osmotic forces and albumin having astronger oncotic effect in plasma (RMB contribution small) describes the fact that uneven distribution of charged particles near a semipermeable membrane will form in the presence of impermeant charged particles Kerry brandis-->until chem and electrical gradient equal BUT THEN osmotic pressure-->distort things double gibbs donnan 1) large colloids Pr and PO4 IC pull H20 in -Cl pushes out to offset negativity and join Na outside 2) Na impermeant (would rush in if it could)--> EC Na high pulls H2O out -->balance ####if Na:K also pumps Na out and if this was blocked the cell would fill with h20 and burst # brandis note therefore high NaCl outside and high PO4 and Pr inside small Role 1) cell stability 2) increased plasma effective oncotic pressure 3) small contribution to RMB - vast vast majority comes from K+ permeability-->changed potassium conc (not exactly the same process) derranged phsyiology - DOES NOT CONTRIBUTE significantly RMB - "if the Gibbs Donnan equillibrium was unnopposed RMB would be -20mv (goldman-Hodgekin-Katz" - COMPLETELY PASSIVE is the effect (it is compensated for with active N:K ATPase to ensure not too osmotic inside-->burst) - in contrast RMB is set up because if because of different perm of potassium vs Na GOLDISH So, we are now at the Gibbs-Donnan equilibrium: the products of diffusible ion concentrations must be the same on both sides, and on each side of the membrane electrical neutrality is preserved. However, the presence of non-diffusible protein makes the total concentration of intracellular molecules much higher than the concentration of extracellular molecules:

Answer 289

dep on particle conc. BP FP SVP osmotic pressure

Answer 290

4.2Kj/Kg/C 2.2Kj/kg 44mg/L 47mmHg

Answer 291

key is that for X match you mix patient plasma with what could cause a big reaction (the donor RBC) -name is IDAT step 1 is forward and back 1. ABO (what Antigens are present on RBC) (including Rhesus which in on the RBC no in the plasma) 1. Forward test 1. Recipient RBC vs control 2. Backward test (confirm forward) 1. Recipient plasma vs control RBC 2. Screen for non ABO antigens (these are not on RBC! So patients serum is tested for antigens!!!!!) 1. Recipient plasma vs control RBC 3. Xmatch 1. Is screen and Hx negative for ABs then 2 options 1. Algorithm based on data—>choice 2. Immediate saline spin (check screen really right with real donor sample) 1. Recipient plasma vs donor RBC 2. Screen positive or sig hx 1. Indirecirect Antiglobulin test (IDAT) to see if ABO and other antigens present 1. Incubation of recipient plasma and donor RBC 2. Wash this combo to remove any plasma Ig not bound to RBC (this would react with the anti-human immunoglobulin about to be added 3. Glutination-add anti-human-IG to bind the Ig that is bound to antigens—>little clumps—>positive result

Answer 292

AB FFP because no antigens

Answer 293

PRBC PL-ABO preferable but can give incompat (as ABO antigen-->minor reaction) FFP- i presume same as cryo... -all factors eg DIC, liver Dx warfarin but not if a more specifc therapy available. Cryo ABO preferable but can give incompat -high in fibrinogen, 8, vWF

Answer 294

``` Bohr eqn is all DS Fowler is Anat DS (CC is not alv DS) Alv DS is Bohr-fowler Bohr eqn =PACo2-PexpiredCO2/PACO2 (PA is changed to Pa as minimal difference) ```

Answer 295

vol of conducting airways from insp to arrival at Alv ducts (respiratory zone)

Answer 296

Massive shunt or a shunt in a GA'd patient can look like DS as PaCO2 builds up and

Answer 297

dead space 5mmHg normal

Answer 298

spinal and epidural -decrease HBF due to MAP and PV Volatiles decrease HBF (ER at anaesthetic conc AR maintianed for sevo...Hm) - halo has severly impair HABR-->dropped HA and PV - newer agents have better maintianed HABR-->increased HA for decreased PV-->net decrease yet enough with increased OER to maintain oxygenation GA - decreased CO-->decreased map and venous congestion - impaired HABR

Answer 299

``` synth met Rb protein cat and anabolism (AA to build or release for KG) Rb FFA for KG and prod of LDL from FFA exc ab immune reservoir rb ADEK, glycogen excretes and regulated hormones ammonia-->urea-->urine ```

Answer 300

liver converts biliverdin to bili and then conj that bili total increased if excess BD, inefficient conj or obstruction - increase conj if obst - increased unconj if cant conj fast enough

Answer 301

AST>2xALT-->SLab of beers S>L AST in hep and mitchondria so increased in Dx muscle of heart or skel (System) ALT in liver alone (L) ALP-bile duct bones GI renal CA GGT-bili duct ALP and GGT>AST and ALT then obstructive

Answer 302

PDreams and BJA suggest INR and PT (INR is derived for PT!-not aPTT) -all coag factors except 8 produced in liver so i think aPTT also relevant-some reasearch articles entertain this. coags in liver failure DO NOT CORRELATE WITH BLEEDING RISK as decreased coags yes but decreased anticoags too!

Answer 303

Na rushes in and K out

Answer 304

1. Diffuse spread of NMJ 2. Visceral sm—>1 nerve actives multiunit sm connected by gap junctions 3. Tiny SR vs skeletal 4. Slower contraction as no troponin instead Ca:Calmodulin—>Myosin LC kinase—>phosphorylate ie activate myosin to bind 5. Plagued action potential for this 6. Kinase req to end contraction 7. Slow onset sustained powerful 8. Trigger: nerve, stretch hormone eg VC

Answer 305

In my memory 1. NACHR 2. Na in 3. Local depol 4. Ttubule (cardiac and Sk-more important for cardiac as has less developed SR vs Sk) 5. L-type VGCC (for cardiac most critical, and skeletal #guyton) ie DHPR-dihydropyridine 6. DHPR:Ryanodine rec interaction (for cardiac and skeletal #guyton) 7. SR Ca release(most dev in sk. less in cardiac, tiny in SM) 8. Trop change—>tropmysin change 9. Myosin binding site on actin exposed—>cross bridge—>shortening of myofibril unit

Answer 306

necessary state associated with decreased reactivity to surroundings or level of consciousness, easily reversible with sensory stim progression to deep sleep awake-alpha dyssynch low freq high voltage 1. alpha from awake-->theta 2. spindles 3. delta 4. delta synchronous high voltage low freq sync non rem - restful - inhib midbrain - decreased BMR, decrease ANS REM 15min Q90min - retic and sleep centre - high freq, low amp, dysynch like awake - BMR increased 20% - dream, move, necrease muscle tone - GCorticoid prod increased - increased HR and BP - decreased pharyngeal tone-->OSA no sleep -impaired cog, mood, changed BP, BMR ``` CNS CVS RESP ENDO note core temp Renal-ADH ```

Answer 307

glucose and ketones no fat

Answer 308

glucose mainstay for brain, neural, RBC, renal maintain 3.5-6 glucose store plasma and IF 2 hours glycogen store 4: sk m vs hep 12 hours fluid req 30ml/kg/day <6 - ADH, Adr, decreased insulin - very minor role of GNG >6 - increased glucagon, adren, ADH, cortisol - GNG source is AA, glycerol, lactate, pyruvate (cori cycle) - ketogen DONT FORGET - acid effect of hypovol and KB - vol resp - electrolyes - glucagon

Answer 309

both use fat and muscle!! GNG from AA and TG ketone is most classically from FFA from fat - trying to take away protein catabolism from GNG path - some AA still go to ketogen ``` KG FFA-->(betaoxidation) -->acetyl CoA-->if Acetyle CoA in excess what kreb cycle can use (oxaloacetate is depleted in fasting state) then Acetyl coA diverted to KG via acetoacetyl CoA enzyme and BMG-CoA--> acetone B-hydrybutyrate acetoacitate ``` used in brain, cardiac and sk m.

Answer 310

lactic acid cycle | glucose-->p-->lactate

Answer 311

the single ant posted two posts and got a radical response descending from level of foramen magnem 1. Single Ant (2 vert arteries supply) - ->ant 2/3 2. dual post (Post inf cerebellar Art) - ->post grey and white tracts single anterior is Supplimented with radicular arteries that enter through the intervertebral foramen and follow ventral and dorsal nerve root these radicular arteries are from the spinal branches of the cervical, intercoastal, lumbar and sacral arteries. Nil ANASTOMOSES

Answer 312

MAP-ISP or CVP dura is indistensible so injury-->swell-->monroe kelly doctrine req is SCPP of >90 vs CPP >75 Rx with raised MAP vent and manitol doesn't work on SC

Answer 313

``` Glut 1 brain and rbc Glut 2 -liver for GNG glycolysis control -panc beta cells -gut for absorp Glut 3 neural glut 4 fat and muscle ``` Two trigger Four Fat

Answer 314

indirect calorimetry - heat indrectly related to O2 consumption and CO2 producution - wait until CO2 and ET at steady state then crunch then numbers ``` Resting energy exp related to (Fio2-VeO2) plus VeCO2 with a few other constants #weir eqn ```

Answer 315

affected by: Age BMR decreases as age increases. Neonates have a BMR twice that of an adult Children have an increased BMR relative to that of an adult BMR declines by 2% for each decade of life Body Composition Lean muscle has a greater energy requirement than fat. Higher body fat percentage results in a lower BMR Females have a lower BMR for this reason - when adjusted for lean mass there is no difference Diet Digestion increases BMR by ~10% due to the energy required to assimilate nutrients This is known as the specific dynamic action of food. Protein > carbohydrate > fat Note that the Specific Dynamic Action for each macromolecule is not related to the respiratory quotient for that food type. Starvation decreases the BMR Exercise Skeletal muscle is the largest and most variable source of energy consumption Environment Cooler environments increase BMR Temperate environments decrease BMR up to 10% Physiological states Pregnancy increases BMR up to 20% in 2nd and 3rd trimester Lactation increases BMR Catecholamines increase BMR Corticosteroids increase BMR Disease states Malignancy increases BMR Sepsis increases BMR Hyperthyroidism increases BMR

Answer 316

triple point of water is 273K - ice, liquid, vapour all present at equilibrium - this is zero degrees!!!!!! =O degrees celcius! - boiling point of water (conveniently not by design) is 100C - -SVP=atm p-->bubble

Answer 317

atoms in 12g of C12

Answer 318

meter-related to speed of light second-related to period of a specific atom oscilating kg (only one with a physical prototype) candela-about the light from a standard candel Current=amp=based on force of attraction between parralell wires Kelvin=triple point of water (frozen, liquid, vapour in equilibrium at same time) =273K 0K is absolute zero no movmenet mole=about in 12g of C12 #SMMACKK ``` Derived Newton=kg/m/s2 pressure= Pa=N/m2 energy=J=n.m power=J/s ``` Non SI units

Answer 319

O2 has a strong magnetic susceptability EMField present-->attract O2-->pressure-->move flow meter-->callibrated to O2 content Oxygen, nitric oxide, and nitrogen dioxide alone among the common gases exhibit paramagnetic proper- Nitrogen as reference gas

Answer 320

triple point equal part liquid, solid, vapour liquid to solid=0 degrees with water at atm pressure

Answer 321

Fundamental freq=n (Hz) Harmonics 2nHz 3nHz 4nHz etc (multiples of fundamental freq)

Answer 322

optimal damping coefficient of a system therefore depends on the natural frequency one overshoot and one undershoot Damping coeff 0.64 over damp high number eg 1.5-->alot of damping underdamped 0.03-->hardly any damping

Answer 323

acetate and choline choline gets recycled cholineacetyl transferase AcetylCoA+Choline-->Ach

Answer 324

Neo reversible covalent bond to esteratic site -->carbamylated (NH2-CO-) complex --->slowly hydrolysed Organophosphate - broard group with PO4 in industry and insect - irreversible covalent binding of esteratic site Edrophonium - weak reversible electrostatic bond - QuAternary end binds Anionic site - OH-binds esteratic site (Ammino acidand OH is the esteratic site)

Answer 325

mono is faster and less potent

Answer 326

ENANTIOMERS -TRAMADOL —+ (S) 5HT RUI (S for seretonin S for SUM) — - NA RUI (R for reduce) ``` Ketamine S (+) -potent -faster off -less neg ino -less psych severity (not freq) R(-) -BD ``` ``` # sinister (left) # rectus (right) ```

Answer 327

AS - Vec-->CIM. hep met to active-->renal - roc-->mild Vagolytic anpahyl-->95% unchanged 5% liver-->biliary and renal exc - Panc-->vagolytic-->hep met to active-->bili and renal exc ``` BIQ -histamine Atrac -->CIM. met hoff and NSE laudenosine Cistatrac-->hoff and mets-->NSE Mivac-->Butyrlcholinesteras!!!! ```

Answer 328

Equipment book: utilise Fick's Principle CO=uptake/Ca-Cv -FICKs prinicple-->dose/AUC ``` CO=Clearance (clears the cooled blood) AUC=dose/Cl Cl=dose/AUC dose=density.Vol.SHC.difference in temp density and SHC assumed same as blood CO=Vol of injection.difference in temp/ Integration of temp vs time ie AUC ``` constant.thermal capacity of injectate. / constnat.AUC

Answer 329

HPO4+H pkA 6.8

Answer 330

CO2-->H2O+CO2-->H2CO3-->HCO3+H (HCO3 pushed in to plasma) | H+ KHbO2-->HHb +K+O2 (O2 released)

Answer 331

refers to amount of H bound to buffers in urine. | the amount of base needed to be added to equal pH 7.4

Answer 332

PCT Na/H pump Na from Na:Katpase active H+ produced by CA from CO2+H2O DCT H+ secreted alone by intercalated cells and also by HATPase

Answer 333

1. H+HPO4-->H2PO4 and 1 HCO3 added to peritubular capillary #P+K (is this production) 2. glutamine-->2NH4+2HCO3 in PCT

Answer 334

counter current - simultaneous movement of 2 substances in different dirrection across a membrane - in context of vasarecta 1 current down the other current back up Goal: concentrated hyperosmolar medulla to reabsorb from CD if ADH present only small amount of H20 reab itself note dilute 100mosmol/kg exit LoH (NOT CONCENTRATED) 1. Thick ascending loop active reab Na (imperm to H20) (exit LoH dilute water osmol 200-->100 with repeat) 2. creates hyperosmolar IF 400-->magnified to 1400 at hairpin with repeat 3. hence H20 reab into IF in desc loop (impermeable to NaCL #P+K)(causing hyperosmolar tubular fluid osmol 400-->500 with repeat) this reabsorbs water in LoH but more importantly creates gradient for CD NOTE medullary gradient 50% due to CC and 50% due to urea trapping. LoH, DCT, CD imperm to urea

Answer 335

role:minimise medullarly conc washout perm to NaCL and H20 the whole way slow flow H20 sucked out on descent and Nacl drawn in. then highly osmolar tubuleare solution draws H20 back in on ascent and Nacl leaks out.

Answer 336

Pa>Pi>Pv low lung vol-->increase Pi as less radial traction. also increased in pulmonary oedema. occurs at bases Pa:Pv steady and irrelevant and Pa:Pi governs flow

Answer 337

Arterial 5% dissolved 5% carboamine 90% HCO3 Venous STC #Vascular STEAK!!!!! 10% dissolved 30% carboamine 60% HCO3

Answer 338

Hypoxia O2flux eqn 1. Hypoxaemia 2. Cardiac output 3. Hb-anaemia or CO poisoning 4. Histotoxic (eg cyanide-stop OP process Rx nitrate) (also diffusion) ``` Hypoxaemia Normal Aa -PiO2 -MV -increased req Abnormal Aa -diff -V/Q-->shunt ```

Answer 339

water vapour in a gas Absolute Mg/M3 relative=VP /SVP ie absolute/max Measure 1. Hair hygrometer (relative) - hair wrapped around spool that turns dial. - humid-->lenthen-->turn 2. Wet and dry bulb hygrometer (relative) - wet thermometer vs dry thermometer - wet is constantly kept in a wet surrounding-->evaporation. - increased humidity-->less evaporation-->less temp change between them 3. Regnauld Relative and ab - shiny metal plate temp dropped until precip 4. electrical - metal with changed capacitance or resistance with humidiity

Answer 340

ITR 36.9-7.1 (Millers) ie normal is 37 core temp - millers GA drops threshold 2-3C widens a fraction above - miller "This range is bounded by the sweating threshold (P+K says VD) at its upper end and by vasoconstriction at the lower end. " - poikilothermic in the ITR TNZ 27-31 naked P+K ambient lower limit is critical temp

Answer 341

20C-->20mmHg-->20mg/L

Answer 342

note evap platues at crit temp (horse shit but whatever) | others have a brief platue at crit temp (no logic but sure)

Answer 343

Rb methyldopa central dexmedatom Rb monoxidil K chan openiner yes (physioten) Rb prazosin ALPHA BLOCKER Rb phentolamine alpha blocker betablockers work at a) heart b) block b1 rec in JGA-->block renin stim

Answer 344

old school non selective B1 and B2 negative ino and blocked renal B1 rec main action also VD B1 SE brady HB B2 asthma, ischaemia in PVD, Diabetic BSL*** rebound on WD #katzung ``` --------------------- P+H High lipid sol -T/2 4H -hep met-->ACTIVE MET -membrane stablilers ``` indic: T4

Answer 345

selectiv B1 ++ (not complete) | hypertension MORE?????

Answer 346

``` 4 isomers 1 alpha blocker 1 beta blocker IV PO 3:1 B:A ``` great for phaemochromocytoma and emergency hypertensive (alpha with stopped reflex tachy)

Answer 347

isomers with alpha beta | indic: heart failure with HTN

Answer 348

B1 selective rapid met by hydrolysis by RBC esterase half life 10min load 1mg/kg then 100mcg/kg/min and titrae indic: hypertensive crisis with tachy or periop indic: risk of tox of other bb in heart failure

Answer 349

``` HTN angina peri MI phaechromocytoma T4 HOCM anxiety migraine glaucoma suppress tachy on laryngospasm ``` Head down - brain and psych - eyes - thyroid - heart - -HTN, IHD, HOCM - adrenal

Answer 350

selectivity - BD generally unwanted-->BC and VD - Met, aten, esmolol (AME like AIM=selective) intrinsice Sympathomimetic activity ie partial ag - good for mild HF-->reduce severe brady - CI in severe as any neg inotrope bad membrane stabilizers -little clinical sig

Answer 351

Cardiac and vasc Chrono automaticity-class ii antiarrhythmic ino B2 block-->VC!!!!! and BC-->cold hands brady-->increased supply and reduced demand -outways the harm of B2 blockade-->VC of CorArt Resp -all will eventually cause BC Metabolic - BSL complex alpha and beta rec and many hormones - B2 block-->unable to raise BSL in hypoglycaemia but baseline increased in DM - B mask Sx - increased TG lipids CNS -lipid sol-->CNS Sx (Metop and propran) #fat PM -->hallucination, depression, nightmare, fatigue Occular -decreased prod of AH GI -dry mouth and GI disturb (like PSNS override)

Answer 352

lipid sol-main low - atenolol - ->poor GI ab, little hep met, excreted unchanged in urine - ->T/2 7 H - sotalol - ->half life 15 hours and renal exc ``` High -well ab -extensive hep met -short T/2-->freq dosing -Cross BBB-->CNS SE #labetalol is highly lipid sol yet used in maternity ``` High cont - Labetalol - ->short T/2 5H and hep met - Metop - ->T/2 3-6H hep - Esmolol - ->T/2 10 min - ->RBC esterase - Propanolol - T/2 4H hep - TImolol - -T/2 4H Hep and renal PrB is variable for high and low

Answer 353

``` P+H p235 # evernote ```

Answer 354

moxonidine physioten VD

Answer 355

EFFERENT VC to maintain glomerular perfusion in hypotension in shocked patient ACEi-->

Answer 356

``` HTN MI CCF DM atherosclerotic CVDx CKD ``` ``` Prevents cardaic remodelling improve supply (CorVD) and reduc demand (HR,Pre, contract, AL) minimise endothelial Dx ```

Answer 357

CKDx -usually improves renal blood flow (RBF) and sodium excretion rates in CHF and reduces the rate of progressive renal injury in chronic renal disease AKI risk ARF is most likely to occur when renal perfusion pressure cannot be sustained because of substantial decreases in mean arterial pressure (MAP) or when glomerular filtration rate (GFR) is highly angiotensin II (Ang II) dependent. -ATII normal VD efferent to MAINTAIN GLOM PERFUSIONPRESSURE so ellimination of efferent VD +hypotension -->ischaemia

Answer 358

C-inorganic cation U -A-attentuate SNS response to laryngoscopy -B-BD. attenuate (reduce HPVC) -C-VD (Cor, periph, cerebral, pulm), prolong SA, PR, AV conduction, torsade, peri MI -D-CNS dep-->anticonvulsant. solumn increased effect of hypnotics. CCB-->weak and increased DoA of Muscel relaxants (give 1/3 muscle relaxant) analgesia-blocks NMDA. inhibit release of Adr. decreases (Mx phaemochromocytoma) AcH release at NMJ worsen MGx minimise BBB disruption in TBI-->decreased cerebral Oedema -E electrolyte-CCB. modulate Na, K flow at NACHR and ion pumps, enzyme cofactor for 300+ and ATP, DNA, Pr -F renal VD-->diuresis -GI osmotic laxative -H-CCB-->increased clotting time -Interaction MR and CNS. deduce K release with Sux and reduce fasciculation and myalgia after. -M. cramp Rx -Uterine relaxant for preterm labour and PETx P -10ml of 20mmol CCS Dose 4g ie 8ml of 0.5mg/ml neat solution then diluted down R-IV or IM D 99% ICF A ileum passive ab M E-renal (95% reab -mostly LoH) Hypomagnesaemia vomiting, weakness, convulsions, tetany, fasciculations, as well as electrocardiogram (ECG) abnormalities (prolonged PR and QT intervals, diminished T-wave morphology, torsades de pointes, and others) and accompanying hypokalemia and hypocalcemia.

Answer 359

note: breath 1,2,3 all create a volume greater than the normal TV peak. i guess the negative pressure overcomes and overshoots

Answer 360

``` A B C D E -hypothermia F G H -less Vik K ddep clotting I -poor immunity ```

Answer 361

air trapping and atelectasis-->VQ mm narrow-->Alv hypovent Dx-->impaired gas transfer

Answer 362

binds to Pr- !!!!!!!

Answer 363

1 P.S Naaaaaa a) prolong refract (Procainamide) b) shorten (lignocaine and phenytoin) c) no change (flecanide) 2. BB 3. K CH eg amiod 4. CCB Verap and Dilt

Answer 364

VT -especially reentry of MI reduce rate of rise 0 and threshold and reduce ARP #evernote

Answer 365

``` #evernote note phlebitis note interaction ctyp450 inhibitor PrB QTc (TCA) AV block BB CCB A -variable OBA 20-80% D large Vd 98% PrB M-CYP450 metabises to active mets E-1% renal 99% all biliary ET/2=days ``` Dose adjust not req in renal (OxCHB) Interaction - PrB—>bump plus CYP450 inhibition—>effects - digoxin, warfarin, BB

Answer 366

``` amiodarone erythromycin clarithyromyc fluconazole Diltiazem and verap grape fruit imatinib cimetidine ```

Answer 367

``` Phenytoin, barbituates Carbemazepine st johns wart rifampicin ETOH ```

Answer 368

#evernote Phase 1 hepatic met (MUCH BETTER FROM COURSE warfarin is a substrate metoprolol CYP2C9 amiodarone/flucon/bactrim-->inhibit-->decreased met of NSAIDs and ARB and carvidelol-->hypotension, renal injury and bradycardia phenytoin/carbemazepine/phenobarbital/rifampicin induces-->ineffective analgesia, HTN and tachycardia NOTE THAT PHENYTOIN IS AN INDUCER (and also a substrate) like a terrorist destroying himself and others

Answer 369

phenytoin just above theraeputic range STP infusion ETOH

Answer 370

1. Thermodilution dose/auc - gold standard but dangerous 2. USS - AoCSA.Veloc=flow - errors wrong angle. technically difficult 3. Pulse contour analysis -computer algorythm -requires calibration with a TD test on that patient first hence PiCCO (Pulse Contour Cardiac Output) -->CVC cold flush -->artiline with thermister calibrated then CO=K (constant from thermodilution). integration of factors such as...P, SVR, compliance, change in P/time 4. throracic electrical impedence - outdated - size changes with diastole vs systole relative to SV NOTE THAT swing alone is hypovol not cardiac output

Answer 371

both increase hypotension dex is worse if given as a bolus or high dose dex is the only one to cause sig brady dex reduces sig tachy and sig HTN

Answer 372

turbulent in all devices except roatmeter at low flow ``` turbulent Re: r.inertia/viscosity F proportional to square of pressure change increased flow-->increased Res Increase Density-->decreased flow ``` Method 1. a) Orifice with U shaped manometer around (no flow through manometer at all (filled with water) THINK OF THE ORIFACE AS A THIN PIPE Pressure is less of other side vs where blast has come from change pressure is proportional to Q2 constant orifice-->change pressure causing changed flow b) same principle with rotameter but constant p-->variable orifice ie variable flow Method 2 Bernoilli principle venturi draw in=lamina so linear so more accurate upstream mean veloicty need to be continued through narrowing kinetic energy increased at expense of potential energy. reopen-->low pressure --entrail

Answer 373

In normal airways, the flow is mainly laminar (turbulent flow is localised to the upper airways) "derranged phys #INERTIA is key viscoisty maintains flat sliding sheets inertia ripples them into turbulent waves hence reynolds number =2r.inertia/viscosity =2r. density X velocity / viscosity more inertia -->more tubulent large radius-->space for eddies etc lamina flow-->hagen poisel F=P/R turbulent not the same! R=8nl/pi.r2 note n=viscosity Derranged phys viscosity increase lamina R to slow! density increase likelyhood of turbulent therefore-->slow! density of turbulent flow-->decreased flow -Oxygen pushes bobbin higher than less dense He density of lamina flow-->do change -eg low flow rotameter (decreased radius and decreased velocity) same viscosity O2 and He -->same flow pushing bobbin Turbulent flow Flow is proportional to the square root of driving pressure. Resistance increases in proportion to flow rate, and cannot be described using the traditional Hagen-Poiseuille equation. Pressure = K.(flow)^n where K is an empirical constant which, for the human respiratory tract, appears to be 0.24 ( when the pressure gradient is expressed in kPa), and n=1.3 Density is the most important determinant of whether or not flow will be turbulent, all other things being equal. This is where helium becomes useful, i.e. by decreasing the density of the inspired gas mixture helium improves the likelihood of laminar flow occurring in narrowed airways, and this decreases the resistance to flow.

Answer 374

fixed volume flow -->mean upstream velocity this velcoity must be maintained so increased flow through narrowing increased kinetic energy with decreased potential energy open up-->decreased Pressure bernoulli equn for hydrollics changed P=V^4

Answer 375

venturi smaller appetur-->less oxygen #mari

Answer 376

Pt=P1+P2 | the partial pressure exerterted by each gas would be the same if it were the only gas in the volume

Answer 377

relatively linear over measured range # eqbookyes semiconductor

Answer 378

thermocoupling -diff temp-->electrolytic cell-->voltage and current-->non-lineraly proportional to diff in temp between the ends (not temp diff between metals)

Answer 379

spirometry | not VC or hence TLC

Answer 380

anemometry - cooling of wire related to SHC and gas flow - wheatstone bridge change temp-->change res due to changed flow (in ICU vents)

Answer 381

dopper | -send and receive (lower freq if running away)

Answer 382

He dilution (funny and simple and only disolved ventilated RV not collapse air trapped) bag and tube=C1V1 end of normal tidal breath then inspire. equilibrate with lung with several Tidal breaths now whole system C2.(V1+v2) V2=FRC

Answer 383

body plethysmograph (not fun but covers everything including trapped gas) try breathe in after normal exhalation against obstructed tube V1.P1=P2.(V1-changed V) in telephone box V3.P3=P4(V3+change in V) in lungs first equation determines change in V second equation uses this to solve V3=FRC

Answer 384

refers to both the O2 trace and to volume change in body plethsmograph study of FRC

Answer 385

all block DA in BG and limbic and CRTZ also block alpha and hist Typical D2 Drop, halo and chlorpromazine (NOT PROCHLORPERAZINE=STEMETIL) Atypical D2 and 5HT-->less EPSE, less prolactin, dissociate before tardives can dev olanzapine 1st line less sedation, minor hypotension, no QTc change.

Answer 386

``` Neuroleptic Malig Sx -RF=dehydration and illness 1. hyperthermia 2. hypertonic m. 3. Unstable ANS (arrhythmia, changing BP and HR) 4. Changing LoC -30% mortality -Cx not known (DA ag—>Rx hence likely related) -Rx supportive —Dantrolene—>m relax —DA agonist amantadine -DDx -MHx (NDMR DONT RELAX IN MH but do in NMSx), antichol Sx ``` ``` Prolactin increase (disinhibited)—>gynaecomastia Weight gain Amenorrhoea Decreased CrH Some impair insulin ``` Sedation -due to alpha blocker, antichol, and hist Poikilothermic Decreased seizure thresh Interaction -decreased response drive interact with anaesthetic drugs Halo—>longer vs drop and doesn’t block alpha to cause hypotension ``` SE “Resemble the others above” -The outwardly calming effect of droperidol may mask an overwhelming fear of surgery. -CI in PDx -rare laryngospasm ``` Decreased CBF but CMR nil change—>risk ischaemia No reticular activating system depression No amnesia Mild pull and systemic SVR drop “A cardiac antidysryhtmic—>protect against Nad induced arrhythmia” Large doses >0.2mg/kg—>decreased conduction—>reentry tacky in WPW Prolong QTc -delayed vent repol (slow K efflux) -Droperidol is capable of prolonging the QTc interval on the ECG.[70],[71],[72],[73] Although the QTc prolongation effect peaks 2 to 3 minutes following IV administration of droperidol, the effects may persist for several hours Furthermore, droperidol should be administered with caution to patients who may be at risk for development of prolonged QTc syndrome (congestive heart failure, bradycardia, hypokalemia, elderly, concomitant administration of other drugs known to prolong the QTc interval). Resting ventilation and the ventilatory response to carbon dioxide are not altered by droperidol.[78] Furthermore, droperidol administered IV augments the ventilatory response evoked by arterial hypoxemia, presumably by blocking the action of the inhibitory neurotransmitter dopamine at the carotid body A D 2L/kg M Liver: High HER so Cl=hep BF E ET/2 2H

Answer 387

lamina F=P/R Turbulent F proportional to square root of pressure so big drop in pressure due to turbulence misinterpretted as high flows. ie overestimation

Answer 388

all are lipid sol and cross BBB and placenta all are completely met in liver and excreted in urine all have long half life for OD dosing

Answer 389

Pneumotachogram 1) laminia F=Pressure grad/res errors 1) changed resistance R=8nl/piR2 - different viscosity requires diff calibration 2) temp-->cold-->condense-->increase res hot-->altered res 3) NONLAMINA FLOW 4) extremes of flow - too low reistance - too high (too small pressure diff to appreciate Types 1) fleisch (pipes) 2) lilly (gauze) 3) pitot

Answer 390

ROTAMETER peak expiratory flow meter (in anaesthetic machines) blow-->spin a rotating door reistened by coild spring with annular orifice to exit

Answer 391

1) static or dirt-->stick 2) crack 3) non verticle safety 1) rotameters in series and mixes with other gases(from other rotameters last to avoid hypoxic mix #14.11

Answer 392

IR SPECTROMETERY errors 1) collision braodening hence measure O2 and N20 to compensate 2) WATER VAPOUR-->WATER TRAP

Answer 393

Ab=e.L.C e= extinction coefficient SUPPLIMENT FORM EQUIPMENT BOOK P226 Chopper wheel—>intermittent IR Reference tube separated from testing tube with diaphragm—>different pressure from heating (with oscillation from intermittent IR—>change electrical conductance—>display (Some modern use photocells instead) Errors 1 CO2 CO and N2O all very close together in wavelength absorbed 2. Collision broadening 3. ethanol 4. acetone 5. Can’t detect different volatiles unless informed 6. BASE ON NUMBER OF MOLECULE IE partial pressure not conc! 1. PSV, narrow bore sampling or altitude —>increased pressure. Hence re calibration 7. Water condense (absorbs IR -can be measured) and blocks line) water trap

Answer 394

mass and charge any gas if known to be in mix errors unexpected gas eg acetone or propellant from BD pump vacuum failure loose two electrons instead of one (appear to have mass halve as much) 1) sampling inflow 2) vaccum ionization chamber (lose electgron-->positive charge) 3) accelerated into final chamber by negatively charge plate with slit 4) now all charge wih one ion lost and attracted to magnetic field (negative) hence Charge:mass now just mass-->heavy--->less deviation--> detected by ion detecting plate 5) for same mass eg N20 and CO2-->fragmented by ionization-->measure consituent parts.

Answer 395

Propofol dreams forgot 1) max conc 2) antispil mech 3) vol of bipass=vapouriser so increased temp causes equal change in pressure to avoid back flow 4) state different volatilies-->diff SVP 5) flow compensation 6) removable eg in MH 7) low pressure leak test

Answer 396

toroidal 40ms 5-10mA

Answer 397

0.1mA and 100mA

Answer 398

prospective hazard current>5mA

Answer 399

1 earthing wire 2 no earthin as double insulated 3 no earthing as small voltage

Answer 400

NOT AUTOREG AS AUTOREG IS INTRINSIC VC Aff and Eff-->decrease RBF alot and GFR just a little

Answer 401

AUC=x/Cl INDEP OF Vd!!!!!!!!!!!!!!!!!!!!!!!! Elimination=Cl/Vd so AUC=x/(Elim.Vd) but as Vd changes Elim changes the same so actually indep of Vd!!!

Answer 402

1) extrapolate from terminal elim on Logconc vs time -->small estimate of conc at time zero-->overestimate volume (vd=x/conc at time zero based on term elim) 2) Varea -Elimination=Cl/Vd so Vd=Cl/elimination (P+H p 65) -AUC-->calc clearance -Beta rate constant from term ellimination -assume rate constant for terminal elimination is average of all (which it isn't-->underestimate elim-->overestimate volume) 3) Vss Vss=Cl.MRT conc.time vs time-->First moment curve AUMC/AUC=MRT

Answer 403

low MW uncharged lipid sol tissue binding | CCF, renal, hep Dx, fat, dehyd, aging

Answer 404

x=conc.Vd if Vd single compartment then assumes instant equal mixing if Vdss then in my mind also assumes instant mixing

Answer 405

ITS DYNAMIC!!! | smallest at bolus then bigger at Vss and platues at final max at terminal elim

Answer 406

must same that Vd can be bigger than body weight and use the term APPARENT Vd marks for drugs eg and reasons marks for pathology

Answer 407

importance of stable CBF (high MRO2 nil anaerobic option) P+K 50-150 MAP linear increase 3%/mmHg CO2 due to H+-->VD-->steal Sx O2-->double flow at 30mmHg due to hypoxia and LAcid 10% CMRO2 per degree temp-->parralel CBF drop

Answer 408

reversible covalent bond at esteratic site of acetylcholinesterase

Answer 409

stim TK rec

Answer 410

no ATIII | yes vWF

Answer 411

glucose primary but can use a bit of ketones

Answer 412

light reflects with a tiny proprotion losing energy and changing wavelength determined by the reflecting material. laser with mirrors bounces back and forth light reflected changes wavelength this change in frequency is proportional to conc of that gas cons -lots of power, noisy pros no alteration to gas-->return to circuit

Answer 413

M1 is brain (1 tracked mind) | M3 is lungs and lung and BV VD 3 for the tree

Answer 414

1. adhere (Gp1a=collagen of GP1b with collagen:vwF 2. activate (by collagen, TXA, 5HT, Adren, IIa-->Phospholipase a-->PKC-->Ca and sphere to disc 3. aggregate (bind by Gp2b3a and Fibrinogen) 4. PL plug stabilization by fibrin from fibrinogne

Answer 415

fractional distillation of atm | (can also be done by hydrolysis of 2H2O-->4H and 2O2

Answer 416

additional note - outside - caged - cylinders in reserve - weighing scales MORE DEMAND-->pull liquid from bottom-->heat-->vapour store -160C (below cirt temp of -118C) at 100Bar ie 1000kpa

Answer 417

P+H is ++ brief on it glucose-->LA in m-->liver-->GNG-->glucose with production of HCO3 that is matched by H+ in this closed system but giving lactate in CSL-->addition of HCO3

Answer 418

nonselective COXi

Answer 419

Tachy is not much of a thing | Dex it is especially if given as a bolus due to a1 stim prior to alpha 2 onset

Answer 420

Post-Pooo (Oxytocin)

Answer 421

Post-Pooo (Oxytocin)

Answer 422

GABAB gamma alpha beta alpha beta (sounds like kebab) GABA rec at AB junction x2 BNZ at GA junction

Answer 423

GABAB gamma alpha beta alpha beta (sounds like kebab) GABA rec at AB junction x2 BNZ at GA junction

Answer 424

EN. AUTOREG PRESERVED at 1 mac of sevo low mac decrease CMR-->DECREASED CBF! high MAC-->uncouple MILLERS - if MAP controlled with vasopressor then yes as above - if MAP allowed to drop then CBF drops at 1 MAC 40%=same drop in CMR so OK

Answer 425

EN. AUTOREG PRESERVED at 1 mac of sevo low mac decrease CMR-->DECREASED CBF! high MAC-->uncouple

Answer 426

CO2 response is depressed by up to 70% during the administration of volatile anesthetics. slope is depressed.

Answer 427

tertiary amine yes

Answer 428

central M and H antag

Answer 429

THE 1 DRUG I TAKE 1st gen Phenergen-->cross BBB - antihist, anticholinergic - AE, sed, antihist - SE from antichol and sed from hist 2nd gen Fexofenadine-->no BBBB - anti hist and antichol - no AE or sed

Answer 430

Cimetidine-->inhibit p450 and has antiandrogen effects Rinitidine-->no inhibition of P450 and more powerful and no antiandrogen-->preffered both can cause brady due to H1 rec -->AV slow conduction-->arrhythmia

Answer 431

Gcell-->gastrin-->ECL-->histamine-->H2 rec GPCR at parietal-->acid parietal and G also stim by Ach from vagus and inhibited by Prostaglandin rec eg misoprostol vs NSAID

Answer 432

Omeprazole - prodrug in capsule to avoid stomach acid-->BD - activated in parietal cell - blocks final common pathway SE - inhibit P450-->decreased activation of clopidogrel (a prodrug)-->clots! - change stomache pH-->changed ab of things

Answer 433

al and mg salts-->diarrhoea and constipation-->complex things-->change ab sodium citrate and NaHCO3 water sol-->systemic ab rapid onset (10min prior) and HCO3-->CO2-->belch

Answer 434

ionization-->ab thicker epidermis on back vs chest BF-->ab hence thorax and abdo more than limbs Pros NO FIRST PASS MET!!!!!! P+H eg GTN NBM relatively constant ``` CONS slow offset variability dermatitis not possible for most drugs ```

Answer 435

eutectic - mix-->one set of physical features - decreased melting point-->liquid instead of crystal 2. 5+2.5 prilocaine and lig

Answer 436

MoA Measurement Effect -on, off, depth, SE Patient - phys Rb CO and m mass and Alkylosis - path Rb burns Drug - type, conc - interaction - -Phenytoin up reg hep met - -nil volatile

Answer 437

overall similar offset HR and contractility reduced in prop!!!! HR and contractility maintianed in sevo (mild decrease ino Miller) (no change in HR P+H vs des and ison increased to responde to hyotnesion) QTc prolonged by sevo! CNS propofol - increased res, decreased CBF decreased ICP hence NSx - rb excitation

Answer 438

C next to O without halogen-->met

Answer 439

SNS, Ca, K, NO # millers

Answer 440

blunted barorec in sevo (des and iso presserved) minor neg ino VD-VGCaCH (not mentioned in millers) maybe less SNS too- (P+H direct sm relax) preserved CO

Answer 441

P+H tachy is rare due to reflex blunted and decreased SNS-->BRADY

Answer 442

in Vitro -->VD ``` in Vivo decreased CMRO2 decreased MAP decreased CBF decreased ICP "autoregulation maintained" CO2 cerebral vascular response unchanged ``` good for NSx -controversial if protective or not (as supplyvs demand not really changed)

Answer 443

blunt reflexes blunt CO2 and O2 response (and decrease CO2 prod from met) Bronchodilator

Answer 444

millers "Thus, global myocardial oxygen supply-to-demand ratio is likely preserved." CorBF decreased

Answer 445

both supply decreased and demand decreased without a change in ratio

Answer 446

The exact mechanism of the action of general anaesthetics has not been delineated.[7] Sevoflurane acts as a positive allosteric modulator of the GABAA receptor in electrophysiology studies of neurons and recombinant receptors.[8][9][10][11] However, it also acts as an NMDA receptor antagonist,[12] potentiates glycine receptor currents,[11] and inhibits nAChR[13] and 5-HT3 receptor currents.[14][15][16] Myer Overton Protein rec target

Answer 447

SNS, Ca, K, NO # millers

Answer 448

blunted barorec in sevo (des and iso presserved) minor neg ino VD-VGCaCH (not mentioned in millers) maybe less SNS too- preserved CO

Answer 449

P+H tachy is rare due to reflex blunted and decreased SNS-->BRADY

Answer 450

in Vitro -->VD ``` in Vivo decreased CMRO2 decreased MAP decreased CBF decreased ICP "autoregulation maintained" CO2 cerebral vascular response unchanged ``` good for NSx -controversial if protective or not (as supplyvs demand not really changed)

Answer 451

blunt reflexes blunt CO2 and O2 response (and decrease CO2 prod from met) Bronchodilator

Answer 452

millers "Thus, global myocardial oxygen supply-to-demand ratio is likely preserved." CorBF decreased

Answer 453

both supply decreased and demand decreased without a change in ratio

Answer 454

The exact mechanism of the action of general anaesthetics has not been delineated.[7] Sevoflurane acts as a positive allosteric modulator of the GABAA receptor in electrophysiology studies of neurons and recombinant receptors.[8][9][10][11] However, it also acts as an NMDA receptor antagonist,[12] potentiates glycine receptor currents,[11] and inhibits nAChR[13] and 5-HT3 receptor currents.[14][15][16] Myer Overton Protein rec target

Answer 455

``` find mean mean minus every result square all of these so they are positive now square root them now divide by degree of freedom ie number of observations-1 ``` variation=sum of (mean-indidiual)squared/n-1 standard deviation= square root of variation within 1 STD of mean=68% within 2 is 95 3 is 99

Answer 456

for continuous data ,2 groups that are parameteric use either paired or unpaired difference in mean/SEM SEM=SD/squareroot of (n-1) t score translate to p value with table

Answer 457

Acceleromyography was developed as a more convenient method of monitoring evoked responses in the operating theatre. The principle is similar to MMG; however, instead of measuring force of contraction directly, acceleration of the contracting muscle is measured. Force can then be calculated using Newton's second law of motion: force = mass × acceleration. Acceleration is measured by a piezoelectric ceramic wafer that is strapped to the thumb. When the adductor pollicis is stimulated, the thumb will move and the attached transducer will produce a voltage, which is proportional to its acceleration. The voltage can then be converted into an electrical signal and displayed as a twitch response. For accurate measurement, the accelerating digit must be free to move.

Answer 458

BJA at least 3

Answer 459

larynx high BF so acts as central m.-->rapid paralysis and rapdi reversal (blocked and reversed quicker than adductor pollicus)

Answer 460

orbicularis oculi - eyebrow from temporal nerve reflects diaphragm blockade more accurately as both resistant to blockade but can directly stimulate muscle-->false impression of reversal

Answer 461

#evernote Phase 1 hepatic met (MUCH BETTER FROM COURSE picture is cardiac transplant with cylclospirin and tacrolymus immunosup on CCB(VD) and amiodarone and fluconazole and statin and antidepressent (fluoxetine) has a seizure 1) PrB of pheny and carb 2) inducers pheny and carb 3) inhibitors amiodarone, CCB, fluconazole 4) competition for cyp450-->statin-->decreased met of both

Answer 462

``` 1-beta beta is FN rate so power of 1=nil FNs 0.8 is the standard 20% FN is acceptable pv p value of 0.05 5% FP is standard ```

Answer 463

H1 GqPCR-->variable effects -increased Ca in bronchi-->BC -VD due to increased NO H2GsPCR-->increased cAMP H1 first gen-promethazine (phenergen) Rb -AE effect mild -BD and decrease secretions

Answer 464

Conclusion simplification (rounded ++) - prop at 30min -5 4H-10 Vss-20 - sevo/des 5,8,8 - iso 10, 20, +++ - propofol 5 in short 9 in long - sevo 5 in short 8 in long to clinically relevant pseudo awake point propofol 10min -->5min 180min-->9min Vdss-->20min STP 10min-->4min 180min-->85min Fentanyl 10min-12min 180min-->70min Remifent 10min-->3min 180min-->3min Sevo 90% decrement time MILLERS*** below time to MAC awake from MAC 1.2 (approx 75% decrement 1.2-0.3) Iso NOTE SEVO -30min-->9min -4hrs-->20min Des - 30min-->5min - 4hrs-->6min Note difference between sevo and des is clinically very small SEVO FIGURES NOT AVAILABLE IN MILLERS STOELTING **** "For example, the 80% decrement times of desflurane and sevoflurane are <8 minutes and do not increase!!!!!!!!!!! significantly with the duration of anesthesia, whereas 80% decrement times for enflurane and isoflurane increase significantly after about 60 minutes, reaching plateaus of approximately 30 to 35 minutes." "The major differences in the rates at which desflurane, sevoflurane, isoflurane, and enflurane are eliminated occur in the final 20% of the elimination process." (WHICH IS CLINICALLY NOT Very RELEVANT!!!!!!)

Answer 465

Quartad to consider 2 vessels 2 nerves 1) IJV-in carotid sheath 2) Carotid-internal then common-in carotid sheath 3) vagus nerve (BETWEEN IJ and CA)-in sheath 4) cervical sympathetic chain POST 5) Cervical chain lymph node-in sheath CLOSE to IJ - ->htoracic duct on right 6) pleural dome 2.5cm above medial 1/3 of clavicle Path 1) jugular foramen from sigmoid sinus - at first superficial in anterior triange. superficial to pulsating external carotid 2) vertically down neck 3) joined by external JV 4) dive deep to SCM 5) descends through groove of two SCM heads 6) join Subclavian to become brachiochepalic post to junction of clavicle and sternum CVC technique aim ipsilateral nipple head down aspirating 1) high-midpoint of SCM between mastoid join and sternal join 2) low-middle of triangle formed by 2 heads of SCM (sternum and clavicle) and clavicle

Answer 466

remember sweat glands ******* -SNS Ach-->M rec Fibers from parasympathetic ganglia release, VIP (Vasodilate), nitric oxide (NO) and the neurotransmitter acetylcholine (ACh). Fibers from sympathetic ganglia release neuropeptide Y (vasoconstrict) (NPY), and the neurotransmitters noradrenaline (NA) and adenosine triphosphate Note that ion channels has faster response for shorter duration note exicte or inhib Note onset time of gene transcription change (PKA from cAMP!!!!)

Answer 467

GDP-->GTP amplication 1) 1rec-->multiple Gproteins 2) cell signalling amplication due to Gprotien stimulating multiple second messengers-->stim more messengers

Answer 468

interact with AC or PLC OR ION CHANNEL eg opiates (GiPCR)-->block VGCaCh "The cAMP so formed acts by stimulating protein kinase A, which has two regulatory (R) and two catalytic (C) units. cAMP binds to the R unit, revealing the active C unit, which is responsible for the biochemical effect, and it may cause either protein synthesis, gene activation or changes in ionic permeability."

Answer 469

phosphorlyation of GTP:alpha-->allows arrestin to bind | agonist-->phsoporylation-->>tachyphylaxis

Answer 470

remember sweat glands ******* -SNS Ach-->M rec Fibers from parasympathetic ganglia release, VIP (Vasodilate), nitric oxide (NO) and the neurotransmitter acetylcholine (ACh). Fibers from sympathetic ganglia release neuropeptide Y (vasoconstrict) (NPY), and the neurotransmitters noradrenaline (NA) and adenosine triphosphate Note that ion channels has faster response for shorter duration note exicte or inhib Note onset time of gene transcription change (PKA from cAMP!!!!)

Answer 471

GDP-->GTP amplication 1) 1rec-->multiple Gproteins 2) cell signalling amplication due to Gprotien stimulating multiple second messengers-->stim more messengers

Answer 472

interact with AC or PLC OR ION CHANNEL eg opiates (GiPCR)-->block VGCaCh "The cAMP so formed acts by stimulating protein kinase A, which has two regulatory (R) and two catalytic (C) units. cAMP binds to the R unit, revealing the active C unit, which is responsible for the biochemical effect, and it may cause either protein synthesis, gene activation or changes in ionic permeability."

Answer 473

phosphorlyation of GTP:alpha-->allows arrestin to bind | agonist-->phsoporylation-->>tachyphylaxis

Answer 474

wiki endogenous chemical messenger that allows transmittion of a chemical message across a synaps from a nerve to a target nerve, mucle gland etc

Answer 475

7 4 3 There is a decrease in the duration of action potential and refractory period Bupivocaine has highest affinity for NaCh-->most toxic

Answer 476

extremes of age hypovol and elderly decreased vd preg-->increased sens-->increased risk (but also increased Vd renal Dx-->longer conductive and IHD Dx-->myocardium more sens CCF-->long half life "Reduced hepatic blood flow or hepatic dysfunction can decrease amide metabolism." P+H liver Dx-->long half life BB CCB-->increased risk of arrhytmia/conduction

Answer 477

eg epidural vol-->increased SA

Answer 478

Rb S enantiomers safer eg of bup Drug Interactions 1. Competition for protein binding AAG → ↑free fraction → ↑risk toxicity - Opioids 2. Inhibition enzyme systems → ↓metabolism → ↑duration of action - Phenytoin

Answer 479

changed Vd | increased sens of mycocytes

Answer 480

hypovol and elderly decreased vd preg-->increased sens-->increased risk (but also increased Vd renal Dx-->longer conductive and IHD Dx-->myocardium more sens CCF-->long half life "Reduced hepatic blood flow or hepatic dysfunction can decrease amide metabolism." P+H liver Dx-->long half life BB CCB-->increased risk of arrhytmia/conduction

Answer 481

"This question requires an understanding that systemic toxicity is due to an excess in the plasma concentration of local anaesthetic, which is dependent on the rate of absorption into the systemic circulation, drug distribution and clearance."

Answer 482

Binding to plasma proteins alters drug distribution, affinity for receptor proteins affects dwell time and binding to tissue proteins affects release of drug into the systemic circulation P+H e amides are more extensively bound (bupivacaine > ropivacaine > lidocaine > prilocaine) in the plasma. α1-Acid glycoprotein binds local anaesthetic with high affinity although albumin binds a greater quantity due to its relative abundance. When protein binding is increased.

Answer 483

90% of mets-->urine excretion 10% unchanged in urine

Answer 484

plasma cholinesterases and other esterases Para-aminobenzoate is one of the main metabolites and has been associated with hypersensitivity reactions especially in the atopic patient. This rapid hydrolysis results in a short elimination half-life. Cocaine is the exception, undergoing hepatic hydrolysis to water-soluble metabolites that are excreted in the urine

Answer 485

TRICKY BUGGERS-want discussion of effects of GA and also head down

Answer 486

"The effects of propofol (2,6-diisopropylphenol) on CBF and CMR are similar to those of barbiturates." Because blood flow and metabolism coupling are preserved, CBF is decreased. MILLERS In general, autoregulation and CO 2 responsiveness are preserved during the administration of intravenous anesthetic drugs.! ceiling of 50-60% decrease in CMRO2 for bar and prop as baseline met req During deep pentobarbital anesthesia, autoregulation is maintained at mean arterial pressures as low as 60 mm Hg. CO 2 responsiveness also persists.

Answer 487

increased CMRO2 and CBF | N2O increased CBF

Answer 488

Inconsistencies can be found in the available information, but narcotics likely have relatively little effect on CBF and CMR in the normal, unstimulated nervous system. When changes do occur, the general pattern is one of modest reductions in both CBF and CMR.

Answer 489

Benzodiazepines cause parallel reductions in CBF and CMR in humans.

Answer 490

CO 2 responsiveness is well maintained during anesthesia with all volatile anesthetics. MILLER As with all vasodilators, CBF is preserved up to lower MAP values during the administration of volatile anesthetics with no evidence of differences among the various anesthetics. Direct comparisons of CBF with isoflurane, desflurane, and sevoflurane anesthesia during hypotension are not available. By contrast, autoregulation of CBF in response to increasing arterial blood pressure is impaired, which is most apparent with the anesthetics that cause the most cerebral vasodilation and are dose related. Sevoflurane may cause less impairment of autoregulation than other volatile anesthetics.

Answer 491

aabgd | adult is aabge

Answer 492

Na in POTASSIUM OUT!!!--HYPERKALAEMIA central neuro is different NaCHR strucutre 2alphas3betas vs nα3mβ4 (n+m=5) vs 2abge NMJ SO GANGLION BLOCKERS dont cause NMJ blockade

Answer 493

synergy dose x and y req

Answer 494

20ppm but required 150ppm

Answer 495

stoelting It is likely that the more common self-limited form of hepatic dysfunction following halothane is a nonspecific drug effect due to changes in hepatic blood flow that impair hepatic oxygenation. -reactive metabolites (trifluroacetylated adduct-->Dx Conversely, the rarer, life-threatening form of hepatic dysfunction characterized as halothane hepatitis is most likely an immune-mediated hepatotoxicity -Ig in 70% found #reexposure

Answer 496

airways diving measure

Answer 497

speed 1.5km/s in soft tissue V=wave.freq doppler change=2costheta. change in velocity. original freq/USS velocity

Answer 498

resistors yes capacitors - increased freq-->decreased impedence (as flow) - ideally zero Inductors - increased freq-->increased impedence - ideally zero

Answer 499

85% sats | -strongly absorbs both 660 and 990nm wavelength

Answer 500

O2 volatile and N2O detector on insp limb just before Y piece O2, volatile agents, and N2O monitoring, with samples taken from the patient end of the system, is obligatory Fuel cell. It reads either the inspiratory or expiratory oxygen concentration. It is usually positioned at the common gas outlet of the anaesthetic machine (inspiratory). FGF supply downstream of the CO2 absorber,

Answer 501

6s ear | 24s hand

Answer 502

Fetal haemoglobin and bilirubin introduce no significant error,

Answer 503

4e+O2+H2O-->4OH Pb+2HO- -->PbO+H20+2e- gold cathode (neg charge terminal) lead anode (positive charge) (silver looks like lead) KCl electrolyte fill O2permeable membrane -->current proprotional to O2 100% and 21% O2 as references no power supply life of 1 year until exhausted delay20s accurate +/-3% will a cumulate nitrogen in the presence of N2O Results in an under-reading of PO2 Diffusion is linearly dependent on the partial pressure gradient, but is also temperature dependent, and the current rises about two to three percent per kelvin rise in temperature. A negative temperature coefficient resistor is used to compensate, and for this to be effective it must be at the same temperature as the cell.

Answer 504

O2 volatile and N2O detector on insp limb just before Y piece As FGF is reduced, it becomes a significantly smaller part of the gas being delivered to the patient, the majority of which is recirculated gas. With low FGF, the gas concentrations received by the patient bear considerably less resemblance to those delivered by the anaesthetic machine.7 Measured concentrations depend on the rate of uptake and excretion of any gas at a given moment. There is a dynamically changing relationship between what the patient inspires and expires, what is measured, and what is delivered in the FGF. This degree of uncertainty means that O2, volatile agents, and N2O monitoring, with samples taken from the patient end of the system, is obligatory FGF supply downstream of the CO2 absorber,

Answer 505

Two breathing tubes carry gases to and from the patient. Each tube connects to a port on the absorber at one end and the Y-piece at the other. The dead space in the system extends from the Y-piece to the patient. The length of the tubes does not affect the amount of dead space or rebreathing because the gas flow is unidirectional. A Y-piece with a septum will decrease the dead space. When exhalation or inhalation starts, the gases in the breathing tubes move in the opposite direction from their usual flow until stopped by a closed unidirectional valve.

Answer 506

I presumre just distal the Y piece in exp limb?????or is The sampling chamber can either be positioned within the patienťs gas stream (main-stream version, Fig. 10.16 ) or connected to the distal end of the breathing system via a sampling tube (side-stream version, Fig. 10.17 ).

Answer 507

#oxidation reduction reaction LEAD ME TO GOLD Pb+2HO- -->PbO+H20+2e- gold cathode (neg charge terminal) Pb anode (positive charge) KCl electrolyte fill O2permeable membrane -->current proprotional to O2 100% and 21% O2 as references no power supply life of 1 year until exhausted delay20s accurate +/-3% insp limb

Answer 508

PS i love u Plat-->silver ``` platenum anode silver cathode electolytes teflon O2 perm memb potential difference created by power source O2 -->cathode donating 4e to anode CURRENT at constant voltage is proprotional to PP 600mV (linear voltage-->O2) ``` ``` lasts 3 years temp compensation (increased diffusion with increased temp-measure and correct for ``` "Many candidates omitted a description of methods of calibration and factors affecting accuracy and limitations. These included the effects of temperature, consumption of oxygen by the electrode, problems with the membrane (e.g. holes, proteins), non-linearity of voltage and current."

Answer 509

1. Regular calibration of the analysers is vital. 2. Paramagnetic analysers are affected by water vapour therefore a water trap is incorporated in their design. 3. The galvanic and the polarographic cells have limited lifespans and need regular service. 4. The fuel cell and the polarographic electrode have slow response times of about 20–30 seconds with an accuracy of ± 3%. 5. The positioning of the oxygen analyser is debatable. It has been recommended that slow responding analysers are positioned on the inspiratory limb of the breathing system and fast responding analysers are positioned as close as possible to the patient.

Answer 510

Heart failure is a condition in which the heart is unable to generate a cardiac output sufficient to meet the demands of the body without increasing diastolic pressure. systolic diastolic mixed The term 'congestive heart failure' (CHF) is reserved for patients with breathlessness and abnormal sodium and water retention resulting in oedema.

Answer 511

yes nitrates and hydralazine PO

Answer 512

alpha blocker with phentolamine

Answer 513

sounds like clonidine | alpha agonist

Answer 514

``` def heart failure syst and diast ``` comp-->worsen preload #frankstarlin!!!! contractility afterload digoxin too

Answer 515

Thiazide blocks Na/Cl in DCT | K sparing eg amiloride blocks Na reab DCT and CD

Answer 516

polarographic (blood or gas sample) fuel cell parmagnetic

Answer 517

``` def MAC and MAC awake goal -immob, aware, SE Patient -phys --Rb, low O2, Na, temp, bp -path Drugs Procedure-surgical and regional block ``` Insp>exp and gap changes with low FGF MONITOR WITH BIS and titrate

Answer 518

``` Simple analgesics, including nonsteroidal anti-inflammatory drugs and paracetamol are usually not effective, unless a component of the pain is due to nociceptive stimulation. ```

Answer 519

CCB not NaCH!!!!!!--> prevent subsequent release of excitatory neurotransmitters NMDA antag central and presynaptic Shane warn at the GABA eating Shells (Ca) ->seizure and Erectile dysfunction gabapentin - first order-->zero order - slow ab with less absorbed at higher % - non linear plasma conc to dose - TDS dose Pregabalin - reliable fast absorption - linear increase in plasma with intake - 1 order kinetics - OD or BD Both drugs are met in liver then excreted renally, with elimination half-lives of approximately 6 hours Gabapentin TDS pregabalin OD or BD

Answer 520

SNRI block H1, Ach, alpha 1 #alpha dog NASH until put on 3 antidpressents

Answer 521

remember Lignocaine and carbemazepine

Answer 522

rb salivation

Answer 523

Clonidine hyperpolarizes nerve cell membranes, blocks the conduction of nerve induce enkephalin-like substance release at peripheral sites. Clonidine primarily activates presynaptic autoreceptors in the locus coeruleus (midbrain) and reduces norepinephrine release and turnover. give epidurally

Answer 524

GLYCINE!!! BINDING SITE found at most excitatory synapses -DH, central

Answer 525

1Hz-->uniform lower amplitude in NDMR and DMR (see evernote) use - define supramaximal - flat-->intubate Neg - need a control - return to normal is not safe for extubation - cant distinguish NDMR from DMR - It can be used (in conjunction with a tetanic stimulus) to monitor deep levels of NMB [the posttetanic count (PTC), discussed below]. Twitch: a short duration (0.1–0.2 ms) square wave stimulus of a frequency of 0.1–1 Hz (one stimulus every 10 seconds to one stimulus every 1 second) is applied to a peripheral nerve. When used on its own, it is of limited use. It is the least precise method of assessing partial neuromuscular block. Tetanic stimulation: a tetanus of 50–100 Hz is used to detect any residual neuromuscular block. Fade will be apparent even with normal response to a twitch. Tetanus is usually applied to anaesthetized patients because of the discomfort caused.

Answer 526

Current, not voltage, is the determining factor in nerve stimulation. Because skin resistance may change, only a stimulator that automatically adjusts its output to maintain a constant current can ensure constant stimulation with changes in skin resistance.

Answer 527

A control is not necessary. The main disadvantage of TOF is its poor performance at both extremes of NMB, deep relaxation, or near complete recovery.

Answer 528

decreased amp for MR fade with NDMR but not Sux 5s 50Hz A significant disadvantage of tetanic stimulation is that it is very painful and should be avoided in the conscious patient.

Answer 529

Douuble-burst stimulation (DBS, minitetanus) consists of two short bursts of 50-Hz tetanic stimuli separated by 750 milliseconds. DBS DBS has been used mainly to detect residual NMB. Studies show that fade (response to the second burst weaker than that to the first) is more readily detected with DBS than with TOF using visual or tactile monitoring. It has also been used for intraoperative assessment of NMB Another use of DBS is to assess deep block, since the first twitch in double burst can be detected at deeper block levels than the first twitch in TOF.

Answer 530

Digoxin or calcium-channel blockers should not be used in pati

Answer 531

more rapid on offset similar hydromorph has no active mets hydromorph mets neuroexcitatory so caution in seizures hydromorph nephrotoxic mets accum in renal failure

Answer 532

1-2H vs 4-7H

Answer 533

Sodium thiopental 4 to 6 mg/kg intravenously is still used in many countries for induction of anesthesia and was previously the most commonly used drug for induction of anesthesia within the United States (see also Chapter 30 ) increased Vd but dcreased PrB

Answer 534

Propofol administration does not affect neonatal Apgar scores with typical intravenous induction doses (2.5 mg/kg),

Answer 535

onset 1 min for 45 min Rb oxytocin rec GqPCR Rb reflex tachy and decreased Cor P and increased Pulm VR-->pulmonary oedema

Answer 536

Rb alpha, 5HT and DA agonist Rb Pulmonary oedema, IHD DoA 45 min MIMS onset 1 min

Answer 537

PG rec agonist--> quicker onset vs misoprostol

Answer 538

Vss=Cl.MRT | MRT=AUMC/AUC

Answer 539

related to r squared. stiffness/density.length

Answer 540

inversely proprotional to radius cubed | bubble-->damping (will cusion oscillation)

Answer 541

1) V1-2 2) V1-3 3) terminal ellimination

Answer 542

the word clearance only related once 1) single comp C=x/Vd Vd=x/C 2) Extrap use terminal elim to back tract to determine conc at time zero then Vd=x/Cattimezero 3)Varea -T/2=0.693.Vd/Cl hence Vd= halfline. Cl=Cl.1/beta 4) Vss=dose.AUMC/AUC

Answer 543

Levobupivocaine less VD hence...!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! - dont need to add Adr -longer DoA -less systemic uptake -less CNS and CVS toxicity-->larger dose can be given 13% less potent hence slower onset !!!!!!!!!!!!!!

Answer 544

in=elim=cl.c not simply clearance as the infusion would need to be higher to maining a higher conc due to high elim while clearance stable

Answer 545

vaccum insulated evaporator - 160C - BELOW CRITICAL TEMP so can be condensed - above boiling point so vapour is forming effectively

Answer 546

dont forget isovol, e, l, atrial kick | relate to valves!

Answer 547

increased LVEDP-->decreased gradient to fill-->increased dep on atrial contraction

Answer 548

old and CCF | cant comp

Answer 549

TNZ is the ambient 27-31 for minimal ITR 36.9-37.1 of no ANS

Answer 550

Kd shifts right if low affinity

Answer 551

7. 4 40nmol/L 7. 1 80nmol 6. 4 400nmol

Answer 552

pH=6.1 + log HCO3/paCO2.0.003

Answer 553

6.8 hence very effective #histadine reisdue

Answer 554

intracell due to pKa of 2.8

Answer 555

prox CT and thick asc glutamine-->2NH4+2HCO3 CD NH3 secreted

Answer 556

direct B agonist and indirect NAd release met by MAO in liver slowly (MAOi) 40% renal excretion unchanged nil hyperglycaemia

Answer 557

uptake 1 via transporter protein at presynaptic nerve terminal - ->reuptake inhibitor of catechol - ->displace NAd vesciles - ->inhibit MAO-->decrease BD in cleft Uptake 2 occurs at postsynaptic and peripheral cells to prevent the neurotransmitter from diffusing laterally.

Answer 558

synthetic opioid deisgned initially as an anticholinergic -also SSRI mech. Use-labour onset- more rapid due to lipid sol offset-2H R-PO IV IM S -active metabolite with long ellimination half life (norpethidine)-->renal excretion-->accumulate -fetal accumulation as crossed placenta then metabolised to less lipid so norpeth -peak in fetus four hours post IM maternal dose -Seretonin reuptake inhibitor-->CI with MAOi-->seretonin syndrome small amount eliminated in urine unchanged T -NOT REVERSED WITH NALOXONE! (YES TRUE)

Answer 559

PLM via PLA2 AA-->Cycloperoxidase via COX which then produces TXA2, and prostaglandins AA-->5HPETE (via LOX)-->leukocytes that produce leukotreines

Answer 560

Naproxen has a stable biological antiplatelet effect similar to aspirin.

Answer 561

``` Peak effect 6-10min ET/2 10min DoA 20min extravesation-->necrosis irritates veins can precip CCF mostly inactive met (1 weak B antag)-->urinary excretion RBC esterase-->hydrolysis Vd 3.6L ``` CAUTION IN RENAL FAILURE DUE TO METS

Answer 562

1) V1-2 2) V1-3 3) terminal ellimination

Answer 563

the word clearance only related once 1) single comp C=x/Vd Vd=x/C 2) Extrap use terminal elim to back tract to determine conc at time zero then Vd=x/Cattimezero 3)Varea -T/2=0.693.Vd/Cl hence Vd= halfline. Cl=Cl.1/beta 4) Vss=dose.AUMC/AUC

Answer 564

Cl.c NOTE Vd

Answer 565

in=elim=cl.c not simply clearance as the infusion would need to be higher to maining a higher conc due to high elim while clearance stable

Answer 566

wide therapeutic range then.... 1st dose-->into TR a half life later 2nd dose-->TR if didn't dip below therapeutic range in t/2 then dose freq=elimination half life Simplified freq=T/2

Answer 567

``` #derranged phys first order kinetics-->increase by one half life as after once halflife it is the same as half the dose! ``` zero order double dose-->double duration

Answer 568

dose every T/2-->increasing dose BUT Elim is conc dep so increases by decreasing amount so rise is by half of prior ie after 1 T/2=50 after 2T/2=75, 87 92 etc

Answer 569

It may be irrelevant if the effect of the drug has little relationship with its plasma concentration It usually refers to β half-life, which has less relevance for widely and rapidly distributed drugs

Answer 570

``` 1% propfol 10% soya bean oil to disslove prop 1%purified egg phospholipid from yoke (nil albumin-->allergy) to emulsify soyabena oil glycerol for tonicity Na EDTA fo bacteria NaOH for base ```

Answer 571

fing and throne on heroin Phenanthrene Phenylpipperadine (Funnel pipe high) 1) endogenous 2) opiates -morph and codeine Phenanthrene derive 3) semi synth -smal change to morph-->oxycodone or heroine 4) synthetic (not a change but a construction) phenylpipperadine derive -fent, su, remi, alf

Answer 572

morphine-3 phenanthrene rings and tertiary amine ionized

Answer 573

immune cells VD cardioprotective

Answer 574

Decontamination renders an item or material safe to handle. The level of microbial contamination is reduced enough that it can be reasonably assumed free of risk of infection transmission. Sterilization, disinfection, and antisepsis are forms of decontamination. disinfection and antiseptic used interchangably in stoelting

Answer 575

In anaesthesia, the term ED95 is also used when referring to the pharmacology of neuromuscular blocking drugs. In this context, it is the dose which will cause 95% depression of the height of a single muscle twitch, in half of the population. Put another way, it is the ED50 for 95% reduction in twitch height.

Answer 576

max also Rb nasal septum

Answer 577

rb eustacian tube and decrease water loss

Answer 578

trachealis m. 10-12cm neanoate is 4cm ring only anteriorly

Answer 579

short straight wide divides

Answer 580

physiochem, enzyme inhib, rec

Answer 581

note if MAP maintained its simple as you know if map not compensated then 40% decrease CBF with 1MAC CO2 VD response unchanged (MILLERS)

Answer 582

apex most negative IPP due to gravity-->over distent (-10-->too high up curve) -2.5 at base-->ideal shift

Answer 583

articular facet

Answer 584

``` pH 3.5 tautomerism at 4 pka 6.5 mets as known then renal excretion <5% to active oxazepam T/2 1-4 Hrs met same p450 as alfent -->prolong 95% PrB ```

Answer 585

renin EPO vit D active also GNG (not strictly endo)

Answer 586

if freely absorbed and no secretion or reab then... amount filtered=amount in urine plasma c. GFR=urine c.v INULIN INULIN INULIN INULIN INULIN 5500 Daso is freely filtered. In addition it is not reab• sorbed, secreted, metabolised or synthesised in the kidney Creatinine is released at a steady state from skeletal muscle eel.ls. It is freely filtered and not reabsorbed. A smaU amount is secreted into the tubules; however, this only introduces a small error and ilie error is constant.

Answer 587

Paramino hippuric acid -freely filter and secreted-->all renal art content-->urine [p].RPF=[u].vol RBF=RPF/(1-HCT) so is piss all HCT then RPF=RBF

Answer 588

SID in body is 42 141+4-103 27=neutral IVF due to alb dilution

Answer 589

1) full body plethysmograph - can figure out TLV and then with boyles law p.v=p.v - F=P/R so flow measured and resistance calculated 2)eosophageal balloon-->estimate intrapleural pressure IPP is caused by recoil of lungs in vs spring of chest out AND resistance to air and tissue recoil can be calc from compliance curve the IPP less recoil-->resistance HENCE BALLOON DOESNT WORK IF COMPLIANCE INCONSISTENT eg with variable time constants in COPD -

Answer 590

LUNG VOL due to radial raction. smallers-->increased res Hist, PSNS SNS-->dilate density-->increased turbulence (medium size is site of most res)

Answer 591

lamina R=8nl/pir4 n is viscosity He is low DENSITY so won't help lamina flow (viscoisty s higher) but will decrease turbulent fraction via reynolds number the fact that He helps deep see divers is evidence than medium sized conductive airways are not purely laminia #wests

Answer 592

Rb - hagen poisel r and R and flow - impact of hypotension and hypoxia -->VD cerebrally -->raise ICP so hypervent can be protective against this rise.

Answer 593

30s OxCHB Rb PO PR IT ED note intrinsic neg ino

Answer 594

``` dissociative anaesthesia (break thalamolimbic connection) DO NOT FORGET RAISED ICP, CBF, CMRO2 CPP ```

Answer 595

PK including drug effects fill circ circ to al -----Rb MV, second gas, deadspace alv to blood----B:G, CO, compare washins blood to brain---O:G compare mac # myer overton PD septic old etc

Answer 596

``` #phospholipase A2 #cyclic endoperoxidases -PL, vasc endo, widespread ``` NOTE: ASPIRIN SELECTIVELY INHIBITS PL COX! without effecting COX of Prostaglandins or prostacyclin. IRREVERSIBLE (aspirin induced bronchoconstriction from leukotreins) NSAIDS - PGE2 PGF2alpha - -->inflam Renal perf PGE2 and PGI2 COX1 constitutive COX 2 inducible -COX2 PRODUCES PROSTACYLCIN: block-->PL clot and VC! but less GI ulcer Rb haemorrhage with aspirin ? with others? Hep Dx

Answer 597

COX2 lower risk celoxib paracoxib Nonselective -high risk=ketoralac, piroxicam -low risk=ibuprofen, diclofenac, naproxen

Answer 598

COX2>non selective but both MI yes Stroke not statistically sig yet listed by AMH NSAIDS can cause gastric ulcer-->bleed but don't otherwise cause bleeds

Answer 599

energy in Joules expended to insp and exp in one resp cycle 3% of MBR =area under PxV curve #dynamic PV curve!!! =Restistive +elastic elastic -surface tension (surfactant) + tissue (PF, empyema) remeber active expiration if ++ resistance eg emphysema

Answer 600

#evernote elastic vs frictional changes EN: parks for % contribution insp elastic: 70% surface tension and 30% tissue

Answer 601

-5-->-10 | 1L above FRC # wests

Answer 602

diffucult to measure unless paralysed in iron lung so... 1) measure O2 cost then assume efficiency to be 5-10% in healthy and plug formula efficiency (5%)=useful work/O2 cost.x100 to find useful work ie WoB effciency O2 cost is 5% of Baseline o2 req in COPD cost is up to 30% and limits exercise

Answer 603

Sensitivity -proportion of people with disease who have positive test Spec -The specificity of a test (also called the True Negative Rate) is the proportion of people without the disease who will have a negative result Sensitivity and specificity are independent of prevalence of outcome in population!!!!!!!!!! Spec= TN/TN+FP so rare will have high FP and high TN in proportion! PPV=TP/TP+FP so rare-->high FP and low TP-->marked drop in PPV!!!

Answer 604

1:1000 Outcomes with low prevalence ! reduce PPV and increase NPV of test ! more likely to have false positives (type I error) and less likely to have false negatives (type II error) potentially serious consequences if unpredicted note only useful if representative ie obstetrics not the gen pop

Answer 605

numerical or catagorical if numerical - cont or discrete - para vs non para - paired - group >2 if catagorical >2 or not expected >5 or not

Answer 606

numberical continuous parametric paired or unpaired difference in mean/SEM SEM=sample SD/square root of N so t test is increased if big diff in mean and small SEM (due to small SD and large study)

Answer 607

``` numerical continuous nonparametric PAIRED #WILCOX IS MEAN signed summed from mean and add up the negs ```

Answer 608

numerical continuos non parametric unpaired | left=right

Answer 609

numerical discrete 2 or less with expected >5 in each sum of all (O-E/E)^2

Answer 610

Rb anatomical

Answer 611

LBM = 1.1(weight)−1.28(weight/height)2

Answer 612

Ideal body weight (kg) = height (cm) - 100

Answer 613

everything! TLC, FRC, TV, ER, VC Cx -abdo chest and increased pulm blood FRC decrease 1% per unit BMI over 30 FRC>CC-->atelectasis

Answer 614

decreased lung comp due to decreased vol | decreased CW com due to fat

Answer 615

decreased vol-->increased res

Answer 616

OSA 5x10s/hr chronic hypercapnia-->decreased CO2 resp OHS leptin-->decreased resp CO2 resp

Answer 617

↓Time to desaturation during apnoea Hypoventilation during supine, spontaneous breathing Prone to getting atelectasis Low threshold for RSI, intubation, IPPV with PEEP

Answer 618

IPP and ITP are the same!!!!!! IPP: pressure in pleura TPP: Alv-IPP TPP is the same as TMP intra inside the pleura trans is outside to insude

Answer 619

PPV is air driven in in inspiration-->Positive ITP-->effect on heart lungs vessels

Answer 620

la place P=2T/r essentially the afterload eqn rewritten with AL=1

Answer 621

PD model answer spont-->neg IPP, ITP, TTP PPV-->positive TTP-->exert force on heart, lungs, great vessels insp 1) left vent early and late 2) right vent early and late Exp reversed note: laplaces afterload left preload up then down right preload decrease (++ with hypovol or high PPV or PEEP) right afterload increased-->raised RAP-->ventricular interdependance-->bulge-->impair diastole and systole splinting impair diastole in both ``` # frank starling in young-->decreased CO (EN) ```

Answer 622

spinal OR epidural ``` #vasomotor centre #renal #sacral ```

Answer 623

fixed CO so cant comp for drop in SVR! AS-->LVH-->diastolic failure-->reliance on atrial kick for 40% of preload slow N HR for long diastole sinus High, N AL adequate preload

Answer 624

P+K SUmmary: AR then everything else you can think off (afferent is RBF A:E is GFR) The main resistance vessels in the renal circulation are the afferent and efferent arterioles, and contraction of either reduces renal blood flow. !!!!This autoregulation of renal blood flow is produced by changes in the contraction of afferent arteriole smooth muscle in response to changes in perfusion pressure (the efferent arteriole is not involved).!!!! THIS OCCURS IN ISOLATED KIDNEY YES other things effect renal BF -SNS VC aff and eff-->reduced RBF and mild decrease GFR -RAAS --SNS-->direct stim a and b rec in JGA-->renin-->ATII --ATII-->VC aff and eff-->reduce RBG and moderate decrease GFR since also contracts mesangial cells-->decrease filtration coeff --PG Prostacyclin and prostaglandins PGI2 and PGE2 are locally active renal vasodilators produced by the kidneys in clinical states associated with high concentrations of circulating vasoconstrictors. In such clinical states, inhibition of prostaglandin production by the administration of cyclo-oxygenase inhibitors can reduce renal blood flow and impair kidney function -ANF increases glomerular hydrostatic pressure and GFR by dilating the afferent arteriole while constricting the efferent arteriole. 20% CO P+K OER 10% MENTION FUCKING GFR IS PARRALELLED regional (cortex more than medulla)

Answer 625

Low FGF—>expired air High FGF—>no dilution with expired air (1.5-2.5xMV achieves this) Hence 20kg TV= 140mlx RR20=2.8L 2.8Lx2.5=7L Hence any bigger than 20kg get less and less benefit Mapelson E-->longer reservoir Mapelson F has bag and is used in current practice

Answer 626

Summary Tots EF'D As! * T piece * E #ET make a longer reservoir tube * FGF close to mouth flushes exp out so high FGF 3xMV for no dilution * F ad a bag (Frequently used) * FGF close to mouth flushes exp out so high FGF 3xMV for no dilution * D changes bag to a exp valve (with scavanger) * FGF close to mouth flushes exp out so high FGF 3xMV for no dilution * A-a grade * FGF from distal fills bag then breathed in. Expiration of DS doesn’t spill out but after DS sufficient pressure to open exp valve close to mouth (with scavenger) * 0.7*MV req for no dilution * Lack * Modified A * B is Bannished * C is Crap

Answer 627

Summary Tots EF'D As! * T piece * E #ET make a longer reservoir tube * FGF close to mouth flushes exp out so high FGF 3xMV for no dilution * F ad a bag (Frequently used) * FGF close to mouth flushes exp out so high FGF 3xMV for no dilution * D changes bag to a exp valve (with scavanger) * FGF close to mouth flushes exp out so high FGF 3xMV for no dilution * A-a grade * FGF from distal fills bag then breathed in. Expiration of DS doesn’t spill out but after DS sufficient pressure to open exp valve close to mouth (with scavenger) * 0.7*MV req for no dilution * Lack * Modified A * B is Bannished * C is Crap

Answer 628

ionizated is charged | protonation is uncharged for an acid and charged for a base

Answer 629

plasma PrB separate from Rec affinity and dissociation rate | bup has highest for both-->long and toxic

Answer 630

myocardial depressent slows phase zero rise -->DECREASED action potention--> shorten refractory prolong QRS and PR -OXCHB AND P+H First, bupivacaine exhibits a much stronger binding affinity to resting and inactivated Naþ channels than lidocaine [72]. Second, local anesthetics bind to Naþ channels during systole and dissociate during diastole. Bupivacaine dissociates from Naþ channels during cardiac diastole much more slowly than lidocaine. Indeed, bupivacaine dissociates so slowly that the duration of diastole at physiologic heart rates (60–180 beats per minute) does not allow enough time for complete recovery of Naþ channels and bupivacaine conduction block accumulates (Fig. 36.4). In contrast, lidocaine fully dissociates from Naþ channels during diastole and little accumulation of conduction block occurs [73]. Thus, enhanced electrophysiological effects of more potent local anesthetics on the cardiac conduction system may explain their increased potential to produce sudden CVS collapse through cardiac dysrhythmias.

Answer 631

ANTICONVOLSANT no coma essentially CCB-->VD, brady, Bronchodilator, anticonvulsant, renal VD-->diuresis, prolong clotting small so crosses placenta so Rx CCB with Cagluconate! enhanced NMB and CNS dep

Answer 632

some indirect-->NA release and OXCH Adr | increases SVR due to arterial VC (OXCHB doesnt mention veno or preload)

Answer 633

orbicularis oculi | orbi eye

Answer 634

Increased - Tot Body water - ECF (as fat is mostly extracell water) - -early distribution, low peak con-->increase load - increased BV - increased RBF--increased renal clearance - increased LBW-->increased CO and increased clearance in muscle - -faster offset - decreased % CO to brain - -slower onset?????? (i think) - increased fat - ->Vd doesn't increase in proportion to % fat - --Propofol Vd obese is same per kg as non obese! -increased alphaacidglycoproteirn yet opiates decreased due to risks LBW - STP - prop load - LAs-decrease epidural as epidural veins compressed TBW - prop - sux due to increased butryl cholinesterase and LBW and CO

Answer 635

DoA 40min elim T/2 100min redistribution half life 2 min (uptodate) giving double the dose adds a half life but roc 1.2 doesn't feel 100min longer (i think this is because elimination half life is not the same as the half life)

Answer 636

``` Forgetables -QTc, AV, AP, refractory, CHB -decreased HR—>increased Cor BF Active met Biliary excretion ```

Answer 637

smile with 940 ab> 660 ab=same as deox

Answer 638

The term SpO2 means the SaO2 measurement determined by pulse oximetry.

Answer 639

T/2Keo 4.5 min vs 4.5hrs (CORRECT IN 2 sources) peak 4min vs 20min-->stacking of morph DoA 30-60min (Small dose-note large dose 3-4H OxCHB) vs 3-4H Morphine similar Vd 3.5-4L and clearance 20ml/kg/hr and terminal elim #fent fall asleep-->pain Thus, if a patient administered five doses of morphine to achieve an analgesic level (ignoring the potential contribution of the active metabolite, morphine-6-glucuronide, see below) that will allow him or her to fall asleep, the effect-site concentration would remain elevated for more than 3 hours after the last morphine dose Hydromorphone is associated with less nausea, one of the major opioid-related side effects that decreases patient satisfaction. In addition, plasma hydromorphine concentrations remain elevated for a long time, which may result in prolonged analgesia. However, without knowing hydromorphone PDs, it is difficult to predict the effects of a given PK profile on the effect of the drug accurately

Answer 640

onset 10-20min vs 20min of morph offset (Anesthetic Pharmacology says slower vs morph) -Potentially the ideal agent for quick onset-->decreased risk of stacking before peak. and long DoA so can sleep It is less hydrophilic than morphine, leading to faster onset of analgesia. This opioid produces somewhat more sedation and evokes less euphoria than morphine. Because of rapid elimination and redistribution, oral dosing every 4 hours is needed to maintain adequate plasma concentrations for analgesia. Hydromorphone is an effective alternative to morphine in the treatment of opioid-responsive moderate to severe pain.[170] The uses and side effects of hydromorphone are the same as those of morphine, although histamine release is less prominent with hydromorphone. Up2date - glucorination-->inactive mets-->renal excretion (decrease in hep failure - 7% excreted unchanged in urine so avoid in severe CKD

Answer 641

plasma conc of all drops by >50% in less than 5 min

Answer 642

Higher CO -->larger apparent Vd -->larger induction dose required "The effect of cardiac output on the apparent volume of distribution was poorly understood with most discussions being exclusively devoted to the effect on the duration of onset of action." Higher CO and CBF  faster onset and offset  may need larger induction dose "Total CBF was significantly higher in children compared with adults" A common misconception made was that alterations in clearance and metabolism affect induction doses. They do not. Many candidates asserted that an elderly patient would have a significantly reduced cardiac output. This is not the case in an elderly patient without co-morbidities.

Answer 643

slowly and titrated to effect due

Answer 644

articulate decreased PVR-->increased RAP and increased LAEDV-->LAP

Answer 645

lost of umbivein flow-->decreased flow-->functional close in minutes Functional closure occurs within minutes of birth. Structural closure in term babies occurs within 3 to 7 days. The ductus venosus is open at the time of birth and is the reason why umbilical vein catheterization works

Answer 646

#RAP change normal changes dont occur if... hypoxia, prostaglandins-->PDA high RAP-->PFO

Answer 647

* Calculate the delta gap (or delta ratio) to identify the possibility of a mixed disorder ie HAGMA +NAGMA (ANZCA MELBOURNE SAYS DO THIS IF Chloride is abnormal) * Delta gap = Delta AG – Delta HCO3 * Delta gap = (AG – 16) – (25 – [HCO3]) * -6 to 6 mmol/L = isolated RAGMA * < -6 mmol/L = excess HCO3 loss, therefore also a NAGMA present * > 6 mmol/L = excess HCO3 present, therefore also a respiratory acidosis or metabolic alkalosis present

Answer 648

``` #evernote C3HFP ``` R,A,K,MA

Answer 649

``` #evernote (great formulas for Elastic res etc) ```

Answer 650

CW at small volume really negative pressure due to spring out. CW at normal volume less spring. CW at overdistended actual recoils back in hence a positive pressure Lung. increased positive pressure-->increased vol

Answer 651

increased FRC and TLV

Answer 652

PACO2-PeCO2/PACO2

Answer 653

FRC doesn't decreased with age as per the classic graph of age FRC and CC! CC>FRC-->V:Q mm and shunt

Answer 654

extra alv are right outside alv. | capillaries are further away

Answer 655

Patient, Procedure, Anaesthetic, position ``` Decreased -patient: decreased CW or lung compliance eg restrictive lung Dx (TRUE), abdo pressure, atelectasis -procedure raised intraabdo pressure -Anaesthetic -GA -supine ``` Increased - patient: increased compliance eg emphysema - anaesthetic: PEEP emphysema, FRC is increased, because the lungs are more compliant and the equilibrium between the inward recoil of the lungs and outward recoil of the chest wall is disturbed.

Answer 656

``` A)-decrease airway res B) Compliance-WoB (comp and res) B) reservoir B) gas exchange in exp B) vol>CC-->avoid V:Q mm C) optimise PulmVR-->decrease RV AL ```

Answer 657

alpha angle of capno plateu reflects V:Q status due to this! pendelluft. In pendelluft, distribution of inspired gas is dependent on respiratory rate As respiratory rate increases, the proportion of the tidal volume that is delivered to the region with a long time-constant decreases Fast alveoli are preferentially inflated, causing V/Q scatter or shunt in the unventilated slow alveoli. Dynamic compliance will decrease as respiratory rate rises and be markedly different from static compliance

Answer 658

vol of gas is directly proportion to the number of molecules of that gas

Answer 659

MAC50, MAC95 =1.3x MACBAR 1.7 MACAWAKE=0.3 | MACHours

Answer 660

volume percentage (45%) Hematocrit is usually lower in the smaller vessels in tissue than in the large veins or arteries from where the blood samples are withdrawn. The spleen is an exception; hematocrit in splenic blood is usually almost two times higher than in arterial blood. -i believe decreased in capillaries because RBC volume is reduced to squeeze through caps

Answer 661

Venous CO2 diffuses into RBC. CA HCO3+H. RBC allow HCO3 out for Cl in. reverse true in pulm cap. The chloride shift has signficant effects for the organism: It mitigates the change in pH which would otherwise occur in the peripheral circulation due to metabolic byproducts (mainly CO2) It increases the CO2-carrying capacity of the venous blood It increases the unloading of oxgyen, because of the allosteric modulation of the haemoglobin tetramer by chloride (it stabilises the deoxygenated T-state)

Answer 662

Estrogen->renin and Angiotensin Prostaglandin and progesterone-->VD BMR increased 20%

Answer 663

3 paired -arytenoid-pyramid -cuneform (isolated flake of cartilage within the margin of the aryepiglottic fold) -corniculate (Corn means horn-ontop of arytenoid) 3 unpairded -thyroid -cricoid-signaturi ring with signaturi post -epiglottis arytenoid at post, sup, lat aspect of cricoid corniculate is the horn on top

Answer 664

SET for CT (sup ext tensor Cricothroid) Cartilage 3 paired -arytenoid-pyramid -cuneform (isolated flake of cartilage within the margin of the aryepiglottic fold) -corniculate (Corn means horn-ontop of arytenoid) 3 unpairded -thyroid -cricoid-signaturi ring with signaturi post -epiglottis arytenoid at post, sup, lat aspect of cricoid corniculate is the horn on top Muscles The actions of the intrinsic laryngeal muscles can be summarized thus: 1 abductors of the cords: posterior cricoarytenoids; 2 adductors of the cords: lateral cricoarytenoids, interarytenoid; 3 sphincters to vestibule: aryepiglottics, thyro-epiglottics; 4 regulators of cord tension: cricothyroids (tensors), thyroarytenoids (relaxors), vocales (fine adjustment). Nerves Vagus (ipsilateral)—>sup laryngeal and recurrent laryngeal Sup laryngeal—>small external—>motor Critcothroid—>sole TENSOR—>Hoarse—>compensate -SLN close to sup thyroid art and vein—>dx in T4 surgery Sup laryngeal—>large internal branch—>sens to VC and above. Runs deep to piriform fossa (cavity lateral to cords—>easy to block with topical LA) Recurrent Laryngeal Nerve Right: loop under subclavian artery. Associated with inf thyroid art and vein—>Dx in surg or malignancy, cervical lymph malignancy, rarely in goitre Left: loop under AoA: associated with same in addition to Dx in lung, oesophagus malignancy, Aortic arch aneurism. Both—>sensation below VC Sx—>vocal cord paralysis—>midline and inf. If unilateral—>hoarse—>compensate Bilateral—>valve like obstruction worse on insp—>stridor —>wow

Answer 665

CO-->diffuses easily across alv into RBC-binds avidly to Hb. So soluble that no appreciable increase in PP established to create back pressure. so it is not flow but diffusion that determines amount t/f to blood. N2O (not nitrogen) rapidly crosses and as doesn't react with Hb rapidly establishes a PP that within 1/10 of transit equals alveoli so uptake ceases. hence perfusion is the only thing that will increase uptake.

Answer 666

AA+Glycerol-->GNG | AA+FFA-->Ketogen (less m. break down vs GNG)

Answer 667

The glucocorticoid effects relevant to this discussion are initiated by interaction of the drugs with specific intracellular glucocorticoid receptors nuclear receptor superfamily with action at nucleus-->changed gene transcription This suggested that in addition to controlling gene expression within the nucleus, the liganded receptor itself could initiate important signal transduction events while still in the cytosolic compartment (there may even be a subpopulation of receptors that reside there permanently). One such effect seems to be interaction of the receptor with the regulatory complex, NF-κB (see Fig. 34.6 and Ch. 3 ) and other important interactions may involve protein kinases/phosphatase signalling systems.

Answer 668

google CVP wave form atrial contraction-->tricuspid bulge X-relax and ventricle tugs down-->vacuum Venous filling followed by opening of TV-->drop—>atrial S3 increased blood vol in ventricule as in CCF or athlete S4 atrial contraction int stiff ventricle-->pathological eg CCF or AS LV -diastole 10mmHg RV - systole 15-25mmHg - Diastole 0-8mmHg CONTRACTILITY AND AFTERLOAD SHIFTS up and down evernote " vasoconstriction CO “ CO is independant and on X axis technically max CO when RAP sig neg mutation genetic mutation of skeletal isoform sarcomer is the muscle fibre util sarcolemna membrane AP travels Goldman-hodgkins, Katz calc E=58log(o/i) E=58/log150/5=K RMP Goldman-Hodgkin-Katz E=58log Ko+Nao+Cli/Ki+Nai+Clo Absolute 200ms due to NaCH inactive RRP 50ms as some Nach have transitioned to resting more Na perm-->unstable resting less Inward rect K cha-->further from Nerst potential-->high baseling membrane potential SA -65mv-->T-->L (phase 0 at -40mv)-->K (triggered by positive Memb pot Mycotye-90 ``` NO...FIRMTITS Please #heparin ``` Hb is a metabolloprotein with 4 polypeptide globin chains each with an associated haem (1Fe each) in its pocket As Hb acts as an oxygen carrier, the globin chains slide on each other. e α1 β 1 and α2 β 2 contacts stabilize the Hb molecule when oxygen reacts with Hb (in the Relaxed form). When O2 is unloaded, the β-chains are pulled apart so that 2,3-diphosphoglycerate (2,3-DPG) !enters! the molecule and decreases the affinity of the Hb molecule for oxygen MELBOURNE COURSE deox-->stabilized in Tense form oxy-->stabilized in Relaxed form Wiki Each heme group contains one iron atom, that can bind one oxygen molecule

Answer 669

Co2+H20-->H2CO3 H2CO3+NaOH-->Na2CO3+H20+heat Na2CO3+Ca(OH)2-->CaCO3+2NaOH strong base --> react-->CO des>iso CF2H (cant f 2 hard) strong base-->compound A for sevo Newer absorber is Amsor nil strong base CaOH and CaCl H20 and pH indicator and setting agents

Answer 670

acceleromyography

Answer 671

Double-Burst Stimulation Double-burst stimulation (DBS, minitetanus) consists of two short bursts of 50-Hz tetanic stimuli separated by 750 milliseconds. DBS P.506 should not be repeated at intervals of less than 12 seconds. Caution should be exercised when switching between double-burst and TOF stimulation. Up to 92 seconds may be required before these responses stabilize. DBS has been used mainly to detect residual NMB. Studies show that fade (response to the second burst weaker than that to the first) is more readily detected with DBS than with TOF using visual or tactile monitoring. It has also been used for intraoperative assessment of NMB. Another use of DBS is to assess deep block, since the first twitch in double burst can be detected at ###!deeper block levels than the first twitch in TOF.!#### DBS causes more discomfort than TOF stimulation but less than tetanic stimulation. It can be used at submaximal currents. This causes less discomfort and, in most cases, is more reliable than testing with supramaximal stimuli.

Answer 672

time dep phys process-->decreased cellular function and reserve

Answer 673

laplace A=p.r/t AS, SVR increase Pressure!!! dilated heart-->increased radius

Answer 674

V/D 25% normal 70% is max

Answer 675

DO NOT FORGET RAAS ``` goal why reservers 2 months 2H glucose 10H glycogen requirement -1ml/kg/hr fluid -2500kcal ``` REMEMBER decreased consumption with lethergy, hunger, thirst rb Cori

Answer 676

1) biguanide metformin Rb renal excreted unchanged LA in renal Dx inhibit GNG, GI uptake, increased sens 2) sulfonylurea - eg gliclazin!!!!!!!!!!!!!!!!!!! LICK - increased release and sens. renal excretion unchanged and hep met 3) DPP4i eg sitagliptin (SITTING DUCK FOR A fuck up) normal BD GLP-->less GLP-->more insulin ``` 4) gliflozins SODIUM GLUCOSE TRANSPORTER 2inhibitor in PCT UTI, osmotic diureses UKA high PRb ``` 5) acarbose INHIBIT ALPHA GLUCOSIDASE

Answer 677

C fibres are demylinated and synaps at 1,2, laminae A delta are myelinated an I,II, V laminae Desc Higher centers-->PAG-->DH Transduction-capsaisin transmission-LA, everything else Perception modulation Rb with NMDA anatag ad N2O and Mg with tapentadol add TCA

Answer 678

active met NorKet (demethylated) conj-->inactive renal exc

Answer 679

predom DH stoelting

Answer 680

IT doesnt do shit so it is a CCB centrally (stoelting) also reduces glutamate release at DH (stoelting)

Answer 681

FFA-->(betaoxidation) -->acetyl CoA-->if Acetyle CoA in excess what kreb cycle can use (oxaloacetate is depleted in fasting state) then Acetyl coA diverted to KG via acetoacetyl CoA enzyme and BMG-CoA--> acetone B-hydrybutyrate acetoacitate

Answer 682

FFA-->(betaoxidation) -->acetyl CoA-->if Acetyle CoA in excess what kreb cycle can use (oxaloacetate is depleted in fasting state) then Acetyl coA diverted to KG via acetoacetyl CoA enzyme and BMG-CoA--> acetone B-hydrybutyrate acetoacitate

Answer 683

adensosine 1 rec at SA and AV adensosine sensitive K channel open-->hyperpol-->neg chrono GiPCR-->decreased camp-->neg ino

Answer 684

deoxy As a result of the shift of chloride ions into the red cell and the buffering of hydrogen ions onto reduced haemoglobin, the intercellular osmolarity increases slightly and water enters causing the cell to swell. This can be measured as an increase in mean corpuscular volume (MCV).

Answer 685

The typical resting membrane potential of a cell arises from the separation of potassium ions from intracellular, relatively immobile anions across the membrane of the cell

Answer 686

Cp=60mmHg Gp=15mmHg Co=21-->33 average 27 59-15-27=19=180L/day

Answer 687

R is retardable so arithmatic | 2Na+glucose+urea

Answer 688

Tonicity is the measure of the osmotic pressure gradient between two solutions. (Derranged phys) Dextrose and urea are the main ineffective osmoles. In a diabetic patient, dextrose can still be an effective osmole. An iso-osmolar solution can be hypotonic if the solute is able to penetrate the cell membrane. For example, an iso-osmolar urea solution is hypotonic to red blood cells, causing their lysis. This is due to urea entering the cell down its concentration gradient, followed by water. The osmolarity of normal saline, 9 grams NaCl dissolved in water to a total volume of one liter, is a close approximation to the osmolarity of NaCl in blood (about 290 mOsm/L). Thus, normal saline is almost isotonic to blood plasma. Neither sodium nor chloride ions can freely pass through the plasma membrane, unlike urea. or 5% dex isoosmolar but hypotonic in plasma-->tissues

Answer 689

Osmolality is the same in the ICF and the ECF. 290mosmol/kh

Answer 690

neg - - - - - - - - - -

Answer 691

slightly neg due to active lymphatic pump ``` structure function control of lymph ```

Answer 692

Pulse pressure is the difference between systolic and diastolic blood pressure Pulse pressure depends on stroke volume, arterial compliance and run-off –is increased if: • Stroke volume increases –exercise, aortic regurgitation • Arterial compliance is reduced –elderly with stiff arteries • Run-off is increased –artero-venous shunt, aortic regurgitation • Compare this to hypovolaemia/cardiogenic shock: low SV/pulse pressure

Answer 693

res is arterioles | MSFP is based on venous tone

Answer 694

capacitor capacitance=storage

Answer 695

#PAH if Plasma flow=clearance as 100% cleared then [p].vol/time=[u].vol/time so clearance=[u].vol/[p] and RBF=Plasmaflow/(1-HCT)

Answer 696

Indocyanine green has a fixed HER of 0.74 and no clearance elsewhere Cl=x/auc HBF= Cl/HER

Answer 697

Consumed=CO.Ca-CO.Cv | Consumed/AV diff=CO !!!!!!!!!

Answer 698

USS CSA.VTI V=c/fo. fd/costheta c=USS velocity f0= emitted freq fd=doppler shift theta=angle https://link.springer.com/content/pdf/bbm%3A978-1-84882-336-5%2F1.pdf

Answer 699

``` Ficks prince N20 or xenon PET USS bulb So2 Once inserted blood can be sampled for p02 and oxygen saturation, lactate and other substances. These measurements can give an indication of the adequacy of CBF. Lower val-ues suggest a greater uptake by the brain and therefore decreased blood flow, providing there is no change in oxygen consumption and that it is uniform throughout the brain tissue. ```

Answer 700

thermodilution to calibrate then pulse contour analysis Other measures generated include: — preload: global end-diastolic blood volume (GEDV) and intrathoracic blood volume (ITBV) — extravascular lung water (EVLW) which is a sensitive indicator of pulmonary oedema. — arterial BP, HR, stroke volume (SV), systemic vascular resistance (SVR), and cardiac function index (CI). -ve severe AR -->inaccurate thermodilution can't use with Aortic balloon pump

Answer 701

frictional force between sliding layers of fluid apparent viscosity decreases with reduced radius and increased flow

Answer 702

Cvs barorec loop evernote

Answer 703

CORTICAL NEPHRONS are auto reg increased BF-->VC-->decreased renal BF juxtaMEDULLARY nephrons and vasa recta are not autoreg increased BF-->washout conc grad-->diuresis -->exponential curve RAAS alters this curve

Answer 704

sevo - uncouple above 1MAC - CO2 responsivness to VD preserved Propofol - CMRO:CBF maintained - CO2 responsiveness maintained

Answer 705

Prop every mech you can think of 15% decrease CO 15% decreased SV 15% decrease SVR no reflex tachy and can reset barorec and Brady -due to reduced SNS-->decreased Ca in, increased K out, NO stim Sevo VD due to direct sm relax blunts barorec reflex (no change in HR), minor neg ino (changed Ca sens and decreased ICC due to L type CCh, preserves CO, cardioprotective Cor VD

Answer 706

google heart, brain, liver, kidney regional blood flow normal values ml/100g

Answer 707

increased filtration-->increased sodium reab 1) increased Na filtered also means increased glucose and AA filtered-->reab together 2) increased GFR-->increased oncotic p in peritubular cap-->increased reab TBFB -high flow-->high Na-->Adenosine-->VC-->decreased GFR

Answer 708

flow decreases resistance (never reaches overdistention) | 1) recruit then distend (both decrease res)

Answer 709

IR analyzers are based on the principle that gases with two or more dissimilar atoms in the molecule (nitrous oxide, CO2, and the halogenated agents) have specific and unique IR absorption spectra. Oxygen and nitrogen cannot be measured. There is interference from other gases, such as oxygen in high concentrations, although this can be compensated for by most new monitors. Water vapor can absorb IR light.

Answer 710

O2 is attracted because of the fact that it has two electrons in unpaired orbits. When introduced into a magnetic field, some substances locate themselves in the strongest portion of that field. These substances are termed paramagnetic. Oxygen is the only paramagnetic gas that is important in anesthesia. When a gas that contains oxygen is passed through a switched magnetic field, the gas will expand and contract, causing a pressure wave that is proportional to the oxygen partial pressure. They are very accurate and highly sensitive. The analyser should function continuously

Answer 711

mimics Ach at M2-->brady at ganglionic NaCH-->tachy

Answer 712

glutamine NH4+HCO3

Answer 713

6.1 hence better for acid buffer but so big and open its good for both

Answer 714

Cortical CD principle cells and Type A intercalated cells increased Pr prod including NaKATPase pumps and Na and K ch. The release of the steroid hormone aldosterone from the zona glomerulosa of the adrenal cortex is stimulated by angiotensin II, increased plasma potassium concentration and adrenocorticotrophic hormone. Aldosterone acts in the renal cortical collecting duct where it stimulates sodium reabsorption and potassium secretion by the principal cells, and hydrogen secretion by the type A intercalated cells. Aldosterone is the main determinant of tubular sodium reabsorption and controls the reabsorption of over 500 mmol of sodium, which is more than the normal dietary intake. Aldosterone induces the production of proteins in the cortical collecting duct cells, including the basolateral membrane Na/K-ATPase pump and sodium and potassium channels in the luminal membrane. Aldosterone similarly increases sodium reabsorption from the gut, sweat and salivary glands.

Answer 715

1) met 2) antinflam - block PL-A - ->decreased PG, leukotriens 3) immune - inhibit T lymphocytes and macrophages - decreased antibody production and interleukin 4) fetal lung 5) mania, insomnia

Answer 716

PC - non reactive with sodalime - odourless PK -nil diff hypoxia PD - nil neg ino - MAC 71%-->decreased max FiO2 - raised CBF - PONV - dense and viscous - MV unchanged - nil MH

Answer 717

Diaphragm and laryngeal m. are resistant (req higher conc to block) BUT BF is higher so onset and offset are faster vs Add. P Upper airways are more sens vs Add.p so diaphragm -->breathes, Add.p appears normal but swallowing ineffective-->aspirate with normal TOFR<0.9 vs >0.9

Answer 718

Millers "When doses lower than those required to cause 100% neuromuscular block are administered, the time required to reach maximum effect is a function of the NMBD and blood flow to the muscles. It is independent of the dose administered. However, if the administered dose is high enough to cause 100% neuromuscular block, the time required for maximum block will depend on the dose of NMBD administered. Larger doses will, up to a certain point, produce a faster onset of effect. " "The maximal effect of either 0.25 or 0.5 mg/kg of rocuronium at the laryngeal muscles occurs after 1.5 minutes.:

Answer 719

Makes no sense The times to 95% blockade at the adductor pollicis after administration of the ED 95 dose of succinylcholine, rocuronium, vecuronium, atracurium, mivacurium, and cisatracurium are shown in Figure 34-10 . 114133135 The illustration shows that the most potent compound, cisatracurium, has the slowest onset, and the least potent compound, rocuronium, has the most rapid onset. 114133135 Bevan also proposed that rapid plasma clearance is associated with a rapid onset of action. 137 The fast onset of succinylcholine’s action is related to its rapid metabolism and plasma clearance.

Answer 720

The pattern of blockade (onset, depth, and speed of recovery) in the corrugator supercilii is similar to that in the larynx, 119 the diaphragm (eye brow) The onset of maximal blockade in the larynx also corresponds with the point at which the adductor pollicis begins to show palpable evidence of weakening.

Answer 721

Increasing the dosage of rocuronium from 0.6 mg/kg (twice the ED 95 ) to 1.2 mg/kg (four times the ED 95 ) shortens the onset time of complete neuromuscular block from 89 seconds to 55 seconds but essentially doubles the clinical duration of action of the compound (the recovery of the first twitch of TOF [T1] to 25% of baseline values) from 37 minutes to 73 minutes.

Answer 722

With larger doses, when administration is based on TBW, recovery occurs during the elimination phase when plasma concentration decreases more slowly than during the distribution phase. 312 The pharmacokinetics of rocuronium is not altered by obesity. In the same way, the duration of action of rocuronium is significantly prolonged when the dose is calculated according to TBW. In contrast, when rocuronium is dosed according to ideal body weight (IBW), the clinical duration is less than half.

Answer 723

They are therefore usually completely ionized at 7.4 pH and are poorly bound to plasma proteins.

Answer 724

Only atracurium, cisatracurium, and, to some extent, vecuronium are independent of renal function. Succinylcholine elimination is mainly independent of kidney function However, succinylcholine is metabolized by plasma cholinesterases, and concentrations may be slightly decreased in patients with severe renal failure ( Table 34-10 ). The decrease in plasma cholinesterase activity is always moderate (30%) and does not result in prolongation of succinylcholine-induced neuromuscular block. Succinylcholine induces a transient increase in plasma K + concentration (<0.5 mmol/L). Therefore, succinylcholine is not contraindicated in severe renal failure when plasma K + concentrations are within the normal range. Consequently, the duration of action of NMBDs may be prolonged in patients with renal failure.

Answer 725

In comparison with renal elimination, liver function is a modest determinant of the pharmacokinetics of nondepolarizing muscle relaxants (see also Chapter 73, Chapter 74 ). The influence of hepatobiliary disease on the pharmacokinetics of NMBDs can be complex because of the different types of liver failure ( Table 34-11 ). Cirrhosis is associated with an increased extracellular water compartment, edema, and often kidney dysfunction. Cholestasis induces decreased biliary excretion but is not associated with significant liver failure, contrary to acute hepatic failure.

Answer 726

ED5095=0.3 Ed9595=0.45 intub 0.6 (2xED5095) ED5050=0.15 stoelting left shift with volatile, Mg, hypothermia, aminoglycocides, LA right shift with chronic anticonvulsants -->upreg of Nicotinic achR, increased clearacnce and increased binding to A1aGP. increased Ca with hyperparathyroidism NOTE this is not the same as onset or offset but similar key points Diaphragm and laryngeal m take more but have higher BS (this would be a different y axis) IM probably has incomplete BA decreased dose req (defs is explicitly. non defs is unexplicit) 1) other NDMR (defs) 2) volatile (defs) 3) Mg, CCB (defs) 4) LA, low Ca, Tamoxifen, Lith, aminoglyco increased dose req 1) paeds No change in load -oldies-more ECF but less Ach release (increased DoA-->decreased maintainance DoA hypothermia (millers doesnt define onset) liver failure (complex) renal Dx Onset faster with NDMR, Volatiles, aminoglycosides, Ma, low ca, CCB, li, LA, Slower LF-->increase ECF

Answer 727

NONCOMPETETIVE | partial agonist

Answer 728

time to first twitch (T1) becoming 25% of control twitch | ie time for 25% of rec to become available again

Answer 729

I sux | II NDMR

Answer 730

2 +2 +32=36 from 1 glucose ``` Structure IC organelle outermembrane inner membran high H between membranes ribosomes for protein synth DNA tRNA cristae are inner membrane folds to increase SA and ATP prod Proton pump out ATPsynthase-->H flows back in ``` not present in RBC (Quora) - as needs to squueze through small space - not use up O2 just glycolysis - fit more Hb

Answer 731

C fibres are demylinated and synaps at 1,2, laminae A delta are myelinated an I,II, V laminae in lamina 5 polymodal C and Abeta (touch) fibers synapse with Wide Dynamic Range Neurons. WDRN sensitized by inflam--> transmit non-noxious as pain ``` Central Sens NMDA glutamate sub P NO-after NMDA stim-->increased NO-->nerve Dx-->hyperalgesia neurotrophins ``` silent nociceptors which can become active

Answer 732

1. Spinothalamic DH to thalamus to cortex. Sensory discriminative aspects of pain 2. Spinoreticular and spinomesencephalic (= Spinoparabrachial) To medulla and midbrain: arousal, homeostatic, autonomic To cortex: anterior cingulate cortex, insular and prefrontal cortex= affective and motivational components of pain

Answer 733

one or a series of neurons projecting down Periaqueductal Gray: Enkelpahin, GABA Locus Coeruleus: NorAdrenaline VRM: Nucleus Raphe Magnus: Serotonin

Answer 734

Convergence. Referred pain is felt in the cutaneous area corresponding to the DH neurons on which visceral affernts converge. This is accompnied by allodynia and hyperalgesia in the skin area. Peripheral visceral afferents branch with considerable overlap in the territory of individual roots Viseral hyperalgesia

Answer 735

Sites of ectopic discharge in the damaged primary afferent nerve Spont firing neuroma Demyelination and production of ectopic impulses Sensitivity of DRG: Increased sensitivity to nordrenaline Upregulation of NGF and BDNF (Brain derived neurothrophic factor): peripheral and central effects

Answer 736

Tissue Dx, SNS, inflam--> soup-->sensitize the PRIMARY AFFERENT REC PERIPHERAL H+, K, histamine, NAd, PG, leukotreines, -sensitize rec, VD and increased perm-->more inflam mediators sensitizing HENCE NO GLUTAMATE or sub P INVOLVED! central sensitaztion is at dorsal horn 1) glut and sub P-->NMDA -->ca in-->second mesengers-->rec upreg and gene transcription --> NO-->effect 2) Wide dynamic range neurons Abeta and polymodal C in context of inflam and central sensitization 3) neurotrophins and glial inflam CENTRAL SENSITAZTION-->allodynia, hyperalgesia, windup (resolves rapidly), long term potentiation (persists up to months)

Answer 737

This requirement could indicate that either hydrophobic sites on proteins (the interior of soluble proteins or the membrane-spanning regions of membrane proteins) or lipid membranes could be the target sites of anesthetic action. The absence of apparent structure–activity relationships for anesthetics coupled with the Meyer–Overton relationship, led to the “unitary theory of anesthesia,” which posited that all anesthetic agents act by a common molecular mechanism Indeed, the changes in membrane biophysical properties produced by clinical concentrations of anesthetics are similar to those produced by a 1 C change in temperature There are a number of volatile compounds that deviate from the Meyer–Overton correlation. These include compounds, referred to as “transitional compounds,” that are less potent than predicted by their oil/gas partition coefficients, as well as “nonimmobilizers,” compounds that do not produce immobility despite being highly soluble in olive oil (and lipid) Photoaffinity labeling experiments have identified specific protein binding sites for a few anesthetics ( Site-directed mutagenesis has shown that anesthetic actions on specific target proteins can be eliminated with single amino acid changes in protein sequence; subsequent generation of transgenic animals has confirmed that these specific target protein modifications can dramatically and selectively alter anesthetic potency

Answer 738

A more useful definition of anesthesia is as a collection of component behaviors including: (1) sedation (2) immobilization in response to a noxious stimulus (3) amnesia (4) attenuation of autonomic responses to noxious stimulation (5) analgesia

Answer 739

add hydrophobic side chain-->sedation make that chain longer-->more lipid sol and more potents swap position 2 O2 for sulfur-->more potent

Answer 740

R/V ``` KETO-->ENOL how it is kept alkaline minimal neg ino (VD-->decrease preload) induces CYP450 #dynamic equiplib #porphyria crisis -inducible and non-inducible genetic condition -block enzyme that converts haem precurer into haem -->Sx ```

Answer 741

Meyer overtone-->amount in lipiphilipd membrane-->expand-->block poor BUT temp-->same expansion enantiomers and o:gxMAC not a constant gene mutation of protein-->change effect lipid potency alone inadequate variable effects of different agents at different sites

Answer 742

bind to ATP sens K ch-->depol, ca, insulin

Answer 743

active AMP sens protein kinase

Answer 744

``` rosiglitazone PARR gamma inhibit -->increase glucose ut -->decrease hep glucose prod -->increased sens ```

Answer 745

inhbit alpha glucosidase

Answer 746

sitagliptin inhibit BD of GLP1 less hypos

Answer 747

TV increased VC normal all else decreased

Answer 748

``` bombay gp (nil H antigen) Minor RBC antigens Kell-->sensitize for next time # minimal plasma in PRBC ```

Answer 749

Serum is solo without coags | Plasma eg FFP has coags

Answer 750

adhere, activ, agg initiation, amplification, propogation of coag cascade PL plug with fibrinogen is stabilized by coag cascade that converts fibrinogen to fibrin and then cross bridge with XIII. TXA VC and act 5HT VC and act ADP activate only

Answer 751

``` P+H Morphine Vdss 4L Cl 15ml/L/min Elimination half life =3 hours ``` FENT IS ESSENTIALLY THE SAME - so at ss both equal - after bolus very different 1hr vs 3-4 hours DoA

Answer 752

onset of fent and doa of morph! Onset 5-8min Doa 4 hours Met CYP2D6-->active oxymorphone (n-alk of this is naloxone!) -->variable oxycodone -CYP2D6 is the genetic polymorph --Poor 10 --intermed 10 --Extensive 70 --Ultrafast 10 -codeine prodrug-->variable met to morphine -Tramadol prodrug-->desmethyltramadol 10% don't get it CYP3A4-->inactive Noroxycodone

Answer 753

onset of fent and doa of morph! Onset 5-8min Doa 4 hours Met CYP2D6-->active oxymorphone (n-alk of this is naloxone!) -->variable oxycodone -CYP2D6 is the genetic polymorph --Poor 10 --intermed 10 --Extensive 70 --Ultrafast 10 -codeine prodrug-->variable met to morphine -Tramadol prodrug-->desmethyltramadol 10% don't get it CYP3A4-->inactive Noroxycodone

Answer 754

P+H synthetic phenylpiperadinee anitcholinergic-->SE SSRI--> Seretonin Sx with MAOi opiate-->SE more lipid sol vs morph-->rapid onset DoA 2Hrs met to inactive me plus 50% active Nor-pethidine (via N demethylation) NP is less lipid sol and has longer half life and eliminated renally it accumulates in the fetus where it is eliminated even slower not reversible with naloxone

Answer 755

NAG is a Neg quality Delta gap = (AG – 16) – (25 – [HCO3]) * -6 to 6 mmol/L = isolated RAGMA * < -6 mmol/L = excess HCO3 loss, therefore also a NAGMA present * > 6 mmol/L = excess HCO3 present, therefore also a respiratory acidosis or metabolic alkalosis present

Answer 756

as CO2 goes up H2CO3 buffer system response is increased HCO3 then with time more HCO3 created Met acidosis HCO3 drops and CO2 drops in response (move in PARALLEL)

Answer 757

#evernote "Abg presentation anion gap Aa alveolar gas eqn" the "actual ie what it is" HCO3 as calculated by the HH eqn will alter with change in CO2. "standard ie standardise condition" with normal CO2 because if the CO2 was normal is there a metabolic process that was masked. BE is similar to standard HCO3 but factors in Hb into its complex eqn as this buffers CO2 Standard BE is with Hb of 50

Answer 758

#evernote "Abg presentation anion gap Aa alveolar gas eqn" the "actual ie what it is" HCO3 as calculated by the HH eqn will alter with change in CO2. "standard ie standardise condition" with normal CO2 because if the CO2 was normal is there a metabolic process that was masked. (dual process) BE is similar to standard HCO3 but factors in Hb into its complex eqn as this buffers CO2 Standard BE is with Hb of 50

Answer 759

evernote siggaard anderson GOLDEN

Answer 760

Intraventricular pressure so AS or raised SVR-->raised intraventricular P to overcome this PPV reduces afterload as the transmural pressure is less and the gradient from ventricle to aorta is less.

Answer 761

Intraventricular pressure so AS or raised SVR-->raised intraventricular P to overcome this PPV reduces afterload as the transmural pressure is less and the gradient from ventricle to aorta is less.

Answer 762

derranged phys is perfect! Css in=out mg/hr in=target conc.clearance Conc of infusion. rate of infusion= Conc of plasma.Clearance so rate of infusion=target conc.cl/conc of infusion

Answer 763

isomers A)structural with diff bonds A1 static iso vs en ethyl group arrangment of Cl vs F A2 is dynamic B)stereo same bonds diff 3D space B1 optic ie enantiomer (mirror) B2 diastereoisomer (non mirror) B2x is configurational (can't be converted by rotation around a single bond) B2y geometric eg cis and trans around double bond

Answer 764

CYP450 | CYP3A4-->compete with midaz

Answer 765

NH4 greater capacity | (think of it as 2 mechanisms>1

Answer 766

APL just distal to reservoir bag to titrate bag filling. | APL on ex limb so spill weak shit not strong shit.

Answer 767

``` ChF2 not present on sevo or halo sevo has lots of F too so weak halo small (just alkyl) Des is covered in F so very weak Iso and En have Cl and a CHF2 ``` #CHF2 is CO risk

Answer 768

Overall: CO2 + Ca(OH)2 -->CaCO3 + H2O

Answer 769

as only 1 hydroxyl on benzyn ring-->nil COMT but as nothing at alph MAO does break down metaraminol lasts longer as nil COMT or MAO

Answer 770

potentiate action of glycine and GABA may reduce NaCh opening time ``` 26dipp 1% 10%soya bean oil (proteins removed so safe) 1% egg Phosphatide (not protein so safe) glycerol-tonicity OH-alk ``` propofl infusion syndrome - met acid, rhabdo, MOF - quinol met-->green urine and hair distribution T/2=4 min (note CSHT at 10 min is 5min) inactive mets via glucorination or met to a quinol no effect in renal or hep Dx

Answer 771

Conclusion simplification (rounded ++) - prop at 30min -5 4H-10 Vss-20 - sevo/des 5,8,8 - iso 10, 20, +++ - propofol 5 in short 9 in long - sevo 5 in short 8 in long to clinically relevant pseudo awake point propofol 10min -->5min 180min-->9min Vdss-->20min STP 10min-->4min 180min-->85min Fentanyl 10min-12min 180min-->70min Remifent 10min-->3min 180min-->3min Sevo 90% decrement time MILLERS*** below time to MAC awake from MAC 1.2 (approx 75% decrement 1.2-0.3) Iso NOT SEVO -30min-->9min -4hrs-->20min Des - 30min-->5min - 4hrs-->6min Note difference between sevo and des is clinically very small SEVO FIGURES NOT AVAILABLE IN MILLERS STOELTING **** "For example, the 80% decrement times of desflurane and sevoflurane are <8 minutes and do not increase!!!!!!!!!!! significantly with the duration of anesthesia, whereas 80% decrement times for enflurane and isoflurane increase significantly after about 60 minutes, reaching plateaus of approximately 30 to 35 minutes." "The major differences in the rates at which desflurane, sevoflurane, isoflurane, and enflurane are eliminated occur in the final 20% of the elimination process." (WHICH IS CLINICALLY NOT Very RELEVANT!!!!!!)

Answer 772

Rb R vs S ischaemic precond NDMA antag NaCHB NAchB opioid rec onset not in one arm brain 90s P+H doa 10min IM onset 5 min for 20 min 5-10mg procedural 0.2mg/kg active met--.conj-->inactive no change to SVR

Answer 773

all luminal have H-ATPase PCT and thick asc H:Na Type A IC in DC have K/H ATPase

Answer 774

B:G 0.69 VRG 2 min VPG 70 min fat 30 hours due to diff BS and sol patient facotr circuit anaesthetic -depth, duration, conc, second gas fat is short case-->speed up awakening due to distribution

Answer 775

art and venous VD

Answer 776

venous VD >>>art-->decreased preload decreased wll tension-->increased cor BF to subendocardial regions GTN-->nitrate-->NO Elim T/2 1 min OCH onset SL 3min and last for 30-60min

Answer 777

``` 1mg onset 1min for 10min alpa 1 block-->decreased SVR alpha 2 blockade presynaptically-->increased NAd release-->positive inotrope, chronotrope increase Cor BF increased insulin-->hypoglycaemia ```

Answer 778

active GC->increase cGMP-->decrease Ca -->VD art>venous onset 10min for 5 hrs

Answer 779

alpha 2 ag physioten sounds like clonidine

Answer 780

K ch opener katzung #mink seksy KKK

Answer 781

FOR LAMINA Pressure + potential energy (graivty.dens.height) + density.Vsquared dive by 2=a constant so increase P-->decrease V increase V-->decrease P-->draw air in

Answer 782

The pressure difference between the ports is proportional to the square of the flow rate.

Answer 783

Efficacy (Emax) is the maximum effect which can be expected from this drug (i.e. when this magnitude of effect is reached, increasing the dose will not produce a greater magnitude of effect) Intrinsic activity is the drug's maximal efficacy as a fraction of the maximal efficacy produced by a full agonist of the same type acting through the same receptors under the same conditions

Answer 784

"A pharmacological system has spare receptors if a full agonist can cause a maximum response when occupying only a fraction of the total receptor population

Answer 785

This maximal efficacy thing is related to several possible mechanisms. Perhaps the partial agonist occupies all the receptors (i.e. achieved full receptor occupancy), and interacts with them in a manner identical to the full agonist, but for some of the receptors it inexplicably fails to activate the ligand binding site or secondary messenger system. The obvious extension of this is where the drug, while binding avidly to the receptors, somehow fails to activate any of them - in which case it is said to be an antagonist. Alternatively, a drug may be a partial agonist because it produces a different distinct structural change in the receptor - for example, an ion channel might open incompletely with a partial agonist, with ionic conductance reduced thereby. The latter effect is observed in the effect of different partial agonists on the acetylcholine receptor

Answer 786

5 to ionize and dissolve

Answer 787

decrease O2 tension - ->glomus cell in preriph CR - ->decreased ATP - ->block ATP sens K ch - ->depol - ->Ca in - ->NT release - ->AP - ->medullar resp centre stimulated Raised Pco2 also stimulates glomus cell neurotransmitter release, perhaps by raising intracellular hydrogen ion concentration

Answer 788

``` CO2 vs O2 (High and low!) O2 vs CO2 glomus cells CNs reflex ```

Answer 789

is is the change in volume of the lung produced by a unit pressure change, the ow of gas having ceased. For example, a subject can inspire a known volume of gas and then relax against a closed airway for as long as possible, while intrapleural pressure is measured (usually by observing oesophageal pressure). Lungs with a high compliance have a steep slope in their pressure–volume curves. us, a small change in distending pressure will cause a large change in lung volume. Compliance is the inverse of elasticity or elastic recoil. Dynamic compliance is a measure of the volume and pressure changes that occur during normal breathing, without any breath holding. e calculation of dynamic compliance is made from the volume and pressure values at times of no gas ow at the mouth at the end-expiratory and end-inspiratory points.

Answer 790

``` insp at rest -diaphragm-phrenic C3,4,5 -EIC -angelled down and forward #AP LAT (spinal nerves at that level) -scale-oppose -ve ITP pulling ribs in accessory -sternomastoid lift ribs 1,2, sternum AP LAT -traps etc -nares ``` Exp forceful -IIC pull closed -Ab rect, EO,IO, TA

Answer 791

increased RR-->exaggerate-->overdistend and underdistend -->VQ mm worsend dynamic compliance as change in pressure -->flow between alveoli and not in and out-->decreased TV for same pressure widen gap between static and dynamic compliance pendelluft. In pendelluft, distribution of inspired gas is dependent on respiratory rate As respiratory rate increases, the proportion of the tidal volume that is delivered to the region with a long time-constant decreases Fast alveoli are preferentially inflated, causing V/Q scatter or shunt in the unventilated slow alveoli. Dynamic compliance will decrease as respiratory rate rises and be markedly different from static compliance

Answer 792

airway pressure = flow x resistance + alveolar pressure so zero flow simple alv pressure alveolar pressure = (volume/ compliance) + PEEP so High alveolar pressures can be due to excessive tidal volume, gas trapping, PEEP or low compliance as shown by this relationship: Static compliance is measured in the absence of gas flow, and is based on plateau pressure: Cstat = Vt/(Pplat – PEEP) Dynamic compliance is measure in the presence of gas flow, and is based on peak pressure: Cdyn = Vt/(Ppeak – PEEP) Remember these three scenarios to understand how compliance curves will change: Pulmonary emboli do not change resistance or compliance, so both compliance curves are unchanged. Plugging or bronchospasm increases airway resistance (Raw) and peak pressure, so dynamic compliance curve shifts to the right and flattens. Plateau pressure and static compliance are unchanged. Tension pneumothorax, atelectasis, pulmonary edema, pneumonia, bronchial intubation cause reduced lung compliance which increases both peak pressure and plateau pressure, so both static and dynamic compliance fall.

Answer 793

yes turb changes res!

Answer 794

flow proportional to. square root of Pressure increased flow -->increased res ie more P req for same flow

Answer 795

airway pressure = flow x resistance + alveolar pressure so zero flow simple alv pressure alveolar pressure = (volume/ compliance) + PEEP so High alveolar pressures can be due to excessive tidal volume, gas trapping, PEEP or low compliance as shown by this relationship: Static compliance is measured in the absence of gas flow, and is based on plateau pressure: Cstat = Vt/(Pplat – PEEP) Dynamic compliance is measure in the presence of gas flow, and is based on peak pressure: Cdyn = Vt/(Ppeak – PEEP) Remember these three scenarios to understand how compliance curves will change: Pulmonary emboli do not change resistance or compliance, so both compliance curves are unchanged. Plugging or bronchospasm increases airway resistance (Raw) and peak pressure, so dynamic compliance curve shifts to the right and flattens. Plateau pressure and static compliance are unchanged. Tension pneumothorax, atelectasis, pulmonary edema, pneumonia, bronchial intubation cause reduced lung compliance which increases both peak pressure and plateau pressure, so both static and dynamic compliance fall.

Answer 796

yes turb changes res!

Answer 797

bohr - CO2-->push O2 out and Cl in - more CO2-->increase T stabilization-->more effective CO2 buffer haldane deoxy more effective buffer more O2-->drive the following to the right->CO2 release H+ +HbO-->HbH +O (this eqn also represents the bohr effect

Answer 798

4e+O2+H2O-->4OH Pb+2HO- -->PbO+H20+2e-

Answer 799

CO2 on capnograph * Collision broadening * Collision of different gases—>broader IR absorption pattern—>potential error source—>measure O2 and N2O to compensate

Answer 800

bohr - CO2-->push O2 out and Cl in - more CO2-->increase T stabilization-->more effective CO2 buffer haldane deoxy more effective buffer more O2-->drive the following to the right->CO2 release H+ +HbO-->HbH +O (this eqn also represents the bohr effect

Answer 801

Bohr Hydrogen ions bind to the α-amino and imidazole groups of haemoglobin and alter the allosteric conformation of haemoglobin, which reduces the anity of oxygen to haem. Carbon dioxide binds to the N-terminal amino acid residues, and this reduces the accessibility of the haem groups to oxygen and causes the oxyhaemoglobin curve to shi to the right. 2,3-Diphosphoglycerate binds to the β chains of one tetramer of deoxyhaemoglobin, causing a conformational change in the haemoglobin molecule, which reduces oxygen anity. Haldane e attachment of oxygen to haem reduces the capacity of haemoglobin to carry carbon dioxide. Oxygen increases the ionization of nitrogen groups, reducing the capacity of the globin chain to carry carbon dioxide as carbamino compounds. erefore, deoxyhaemoglobin can carry more carbon dioxide in the form of carbamino compounds, which account for about one-third of the arterial venous dierence of carbon dioxide carried in blood. In addition, deoxyhaemoglobin is more basic and therefore has an increased buering capacity for carbon dioxide.

Answer 802

1mg 1min 10min BC due to reaction increased insulin release-->hypoglycaemia

Answer 803

NaCO3-->NaCO3 +H20-->Na + OH +NaHCO3

Answer 804

enol in vile | keto in body

Answer 805

1mg 1min 10min

Answer 806

neg ino, hypotension brady | anaphylaxis

Answer 807

live, renal CCF, hyperthyroidism, preg | neostigmine

Answer 808

inhibit PL reuptake of adenosine to increase conc in plasma to keep stimulating receptors PDEi to decrease BD of camp-->PKA-->block activation, aggregation and also-->VD

Answer 809

up2date | 3-5hrs for 12 hrs

Answer 810

Fondaparinux

Answer 811

non-immune - PL recover without ceasing heparin - day 1-4

Answer 812

shift OHDC far left (can't release O2) Wiki: Because of the increased affinity between hemoglobin and oxygen during carbon monoxide poisoning, little oxygen will actually be released in the tissues. The affinity between hemoglobin and carbon monoxide is approximately 230 times stronger than the affinity between hemoglobin and oxygen so hemoglobin binds to carbon monoxide in preference to oxygen The traditional understanding is that carbon monoxide toxicity arises from the formation of carboxyhemoglobin, which decreases the oxygen-carrying capacity of the blood and inhibits the transport, delivery, and utilization of oxygen by the body.

Answer 813

Both oxygen and carbon dioxide exchange is perfusion-limited. Diffusion of gases reaches equilibrium one-third of the way through the capillary/alveolar interface diagram google: is co2 diffusion or perfusion limited mak95

Answer 814

Elite Athlete |  ↑↑CO → ↓red cell transit time (<0.25s) preventing equilibration b/n PAO2

Answer 815

1) ficks law decreased P change-->decreased diffusion rate-->slower-->diffusion limited 2) deoxygenated patient lower on OHDC so O2 in alv taken into Hb avidly so Partial pressure doesn't increase as fast vs a well oxygenated patient whose Hb are quickly filled and pressure spills over into plasma - ->longer to equilibrate

Answer 816

awake -dep gets more vent and Q-->10% better VQ than supine anaesthetised -dep gets less vent one lung - surgical lung up - bottom lung has even worse compliance as IPP that was holding mediastinum up is lost - ->sig decrease vent and - ->increased Q due to HPVC of surgical upper lung ?????is this right (as per melbourne it is)

Answer 817

decontaminate - clensing to remove micro - include sterilization and disinfection Sterilization -kill all forms including spores-heat radiation, pressure etc Disinfection -apply to surface to kill (doesnt kill spores) Decontamination renders an item or material safe to handle. The level of microbial contamination is reduced enough that it can be reasonably assumed free of risk of infection transmission. Sterilization, disinfection, and antisepsis are forms of decontamination. disinfection and antiseptic used interchangably in stoelting

Answer 818

anitinflam high PrB aplastic anaemia so just for severe arthritis

Answer 819

PG analgoe at EP3 rec parietal cel inhibit H+ sec surface cell-->increase mucous secretion

Answer 820

cimetidine (only one to inhibit cyp450) ranitidine famotidine

Answer 821

less neonatal resp dep

Answer 822

less commonly used can measure O2, CO2, N2O, volatiles 1. Raman spectroscopy: the anaesthetic gas sample is illuminated by an intense argon laser. Some light energy is simply reflected but some energy stimulates the sample molecules, causing them to scatter light of a different wavelength from that of the incident light energy (Raman scattering). This scattered light is detected at right angles to the laser beam and the difference in energy level between the incident and reflected light is measured. All molecules in the gas/volatile phase can be identified by their characteristic spectrum of (Raman) scattering.

Answer 823

sulfonulyruea-renal excretion unchanged

Answer 824

>6000daltons dont cross increase t/f later in preg as less Alb to bind PrB drugs

Answer 825

D2 antag for N+V doesnt cross BBB so no tardives | does cause prolactinaemia

Answer 826

This is traditionally converted to a semi-logarithmic plot because:  The doses from smallest measureable response to maximum response usually spans several orders of magnitude (Evers and Maze) The hyperbola can be transformed into a sigmoid which:  Expands the scale at the low concentrations where effect is rapidly changing and compresses it at high concentrations where the effect is changing slowly  usually linearizes the the dose-response range of interest  20% - 80%.

Answer 827

1st desens: Phosphorlation of GPCR-->functional uncoupling of rec and effector systme 2nd internalisation phosphorlyation of GPCR-->arrestin 3rd down reg with rec degradation slower AC upreg NMDA rec activation !!!!!!! VGCCH and K chan sens change

Answer 828

D + R-->DR DR--D+R Kd=D+R/DR

Answer 829

how avidly it binds eg high affinity antagonist

Answer 830

1. phsyiochem 2. rec 3. enzyme 4. ion Ch eg LA 5. other

Answer 831

Structural: In structural isomers, the atoms in each isomer are connected, or bonded, in different ways Stereo: In stereoisomers, the atoms in each isomer are connected in the same way but differ in how they are oriented in space. Enantiomers are stereoisomers that are non-superimposable mirror images of each other with chiral centre Diastereomers are any stereoisomers that are not enantiomers.

Answer 832

fucking hell man

Answer 833

https://www.cvphysiology.com/Heart%20Failure/HF005

Answer 834

``` delay systolic hump wider as diff waves at diff speeds PP greater as less compliant decreased MAP 5% ``` #more compliance radial looks like aortic as faster and less distortion from stretch

Answer 835

``` HR and rhytm SV area under curve from contraction to incisur Contractility is up AL is down angle and incisure higher up if high SVR swing is preload index of supply is area under dias index of demand is area under syst MAP etc ```

Answer 836

depol-->Kch open-->hyperpolarisation (4)– closing of K channel-->funny current

Answer 837

nil CCh so no plateu

Answer 838

https://academic.oup.com/bjaed/article/7/4/122/466759 #evernote

Answer 839

at a set P, T equal volumes contain same number of moles

Answer 840

cyclizine motion sickness, RT, PONV block H1 and Ach -->antichol Sx

Answer 841

brady, flush, HA, constipation OBA 70% hydroxylation-->conj-->inactive decrease in hep Dx

Answer 842

Critical temp of O2 -116C . 120 Boiling point (liq-->vapour -183C) . 180 system -180C--160C 160 -liquid:vapour in euquilibrium

Answer 843

Rb labarynth-->Vestibular n.-->CN 8 Ach and H1 CRTZ 5HT and DA EC Ach

Answer 844

#propofl dreams

Answer 845

Critical temp of O2 -116C . 120 Boiling point (liq-->vapour -183C) . 180 system -180C--160C 160 -liquid:vapour in euquilibrium

Answer 846

150 vs 200mg/kg both have active mets salycilate--> resp acidosis renal K and H dump ETC block-->MA NAPQI-->oxidative Dx ``` Mx PK A D M E ``` PD electrolyes salycilate Liver synth paracetamol Psych Charcoal salicylate-->NaCO3-->increased urine ion trapping both can be taken off with dialysis

Answer 847

bronchial tree

Answer 848

Rb theophyline PDEi and adrenlaine

Answer 849

``` onset 10-20min (uptdate) NOT A SALLY so is highly lipid sol so 1) extensive absorption 2) large Vd 3) cross BBB ``` Exc-90% in urineunchanged (this is the exception to the rule that high lipid sol-->hep met like bisoprolol) DoA dose dependant t/2 20mg 6hrs atenolol - Lowlipid sol-->poor GI ab--> - No IV formular - onset 1hr peak 3 DuO 24hrs - met

Answer 850

Critical illness myopathy (OXCH) incompatable with fent, midaz, propofol ``` 1 of 10 stereoisomers 2mg/ml 2.5mg onset ED5095 is 0.05 tube at 2min 905 Twitch height reduction at 2.6min peak at 3.5min ```

Answer 851

benzyl group with 2 hydroxyl groups attached, alpha, beta and amine SO PHENYLEPHERINE metarminol, ephedrine ARE NOT CATECHOLAMINES

Answer 852

iso will be longer in obese x y z short case can be quicker vs long-->longer MELBOURNE COURSE Note: OHS-->resistance to leptin and letin involved in resp drive so decreased resp to high CO2. accentuated with GA Increased sens to CNS dep drugs -->resp dep

Answer 853

Sterilization, disinfection, and antisepsis are forms of decontamination. disinfect-disrupt nonpor sterilise-kill all asepsis prevent contam

Answer 854

light amplified Stimulated emmision of radiation stim by light or electricity Spont decay stim emmision amplification

Answer 855

cut like a saw

Answer 856

Both fat and lean body mass increase in the obese individual, although there is a relative decrease in lean body mass; water content and blood flow per gram of fat tissue are reduced in obese patients compared with non-obese subjects.4–7 For these reasons, obesity is likely to increase the degree of importance of partition coefficients (λblood/gas, λoil/gas) of inhaled drugs as total body weight and duration of anaesthesia increase.

Answer 857

Ideal body weight = 22 × H squared (m).

Answer 858

iso will be longer in obese x y z short case can be quicker vs long-->longer MELBOURNE COURSE Note: OHS-->resistance to leptin and letin involved in resp drive so decreased resp to high CO2. accentuated with GA Increased sens to CNS dep drugs -->resp dep

Answer 859

lipton iced tea - ->VC - ->heart remodels and gets weak - ->IT DOESN'T MAKE YOU RETAIN WATER

Answer 860

the resistance are just contracts-->decrease contractility and remodel

Answer 861

1. Brachiocephalic 2. Left CC 3. left SC

Answer 862

Quartad to consider 2 vessels 2 nerves 1) IJV-in carotid sheath 2) Carotid-internal then common-in carotid sheath 3) vagus nerve (BETWEEN IJ and CA)-in sheath 4) cervical sympathetic chain POST 5) Cervical chain lymph node-in sheath CLOSE to IJ - ->htoracic duct on right 6) pleural dome 2.5cm above medial 1/3 of clavicle Path 1) jugular foramen from sigmoid sinus - at first superficial in anterior triange. superficial to pulsating external carotid 2) vertically down neck 3) joined by external JV 4) dive deep to SCM 5) descends through groove of two SCM heads 6) join Subclavian to become brachiochepalic post to junction of clavicle and sternum CVC technique aim ipsilateral nipple head down aspirating 1) high-midpoint of SCM between mastoid join and sternal join 2) low-middle of triangle formed by 2 heads of SCM (sternum and clavicle) and clavicle

Answer 863

rb supraspinous interspinous lig flav

Answer 864

trachealis m

Answer 865

Pec M Lat Dorsi 5th ICS (nipple) axillar apex note vascular nerve bundle under rib

Answer 866

F-flex E-easy and ebate eating is complex prostaglandins evernote

Answer 867

1. Brachiocephalic 2. Left CC 3. left SC

Answer 868

Prop dream (better than text-misc zone)

Answer 869

Afferent -CNX Control Medulla: POns and Brainstem Efferent CNX phrenic spinal

Answer 870

PG and TXA and leukotreins icosanoids are signaling molecules made by the enzymatic or non-enzymatic oxidation of arachidonic acid

Answer 871

Katsung prostaglandins evernote

Answer 872

RBF=P/R!!!!!!!!!!!!! Decreased RBF-->decreased Na-->renin from MD VC afferent and efferent - ->decrease RBF and GFR - ->mesangial contraction decrease filtration coef ATII rec in SFO and VOLT-->thirst VC eff>aff-->decreased RBF deu to afferent VC yet preserve GFR in hypotension due to efferent VC (and mesangial contraction SNS aff and eff -->decrease RBF but as Pressure hydrostatic increased GFR minimally dropped

Answer 873

(MR) = amount of energy liberated by catabolic processes in the body

Answer 874

sens, channel, gate pot diff-->conf change imperm if not open -->selective perm various arrangements of subunits around central poor Resting active inactive NaCH CCh -rianodine, NT release KCh changes with drugs

Answer 875

superior aspect of the illiac crest

Answer 876

angina, HTN, T4, phaemo NOT FOR AF. weakly active met CYP2D6

Answer 877

weakly active met renally excrete

Answer 878

remeber fick law diffusion vs perfusion limited

Answer 879

load distributed through ECF in 15min. peed out by 6hrs sepsis-->leak even less IV vol. 1) osmo 276 but water into cells and electrolytes out -->no change 2) Na net 0.3mmol/L rise CL 1.5mmp;/L rise 3) SID, 4) lactate-->met to CO2 and H20 and consumes a H 5) 1:4 IV to EC and 9:1 ECF: ICC-->225ml IV-->outside A 5%–10% change in blood volume is required before ADH secretion is stimulated.threshold for bar rec change (derranged phys) -->increase Preload-->increa CO and BP 6) TG balance -diluted alb-->decreased reab-->urine (i believe insufficient to alter other renal system-probs some pressure diureses and medulla RBF not autoreg)

Answer 880

RBF=P/R!!!!!!!!!!!!! Decreased RBF-->decreased Na-->renin from MD VC afferent and efferent - ->decrease RBF and GFR - ->mesangial contraction decrease filtration coef SNS aff and eff -->decrease RBF but as Pressure hydrostatic increased GFR minimally dropped

Answer 881

``` osmo tone vol ONSET and OFFset oncotic UEC and BSL SID baro renal ```

Answer 882

dromotropy peledrome drome=speed

Answer 883

visualise - max dial - mount - interlock - pressure check - size of 2 chambers

Answer 884

Baroreceptors are less sensitive (but more potent) than the osmoreceptors. The threshold of the volume receptors for causing changes in ADH secretion is an 8 to 10% change in blood volume

Answer 885

increase AA and glucose increase pertibular ONCOTIC PRESSURE -->more reab A constant fraction of filtered sodium and water is reabsorbed from the proximal tubule despite changes in GFR; this is called glomerulotubular balance

Answer 886

The lactate in Hartmanns is a conjugate base, the anionic part of lactic acid, in which the role of the hydrogen ion is played by sodium. However. The lactate anion is what the ABG machine measures

Answer 887

load distributed through ECF in 15min. peed out by 6hrs sepsis-->leak even less IV vol. 1) osmo 276 but water into cells and electrolytes out -->no change 2) Na net 0.3mmol/L rise CL 1.5mmp;/L rise 3) SID, 4) lactate-->met to CO2 and H20 and consumes a H 5) 1:4 IV to EC and 9:1 ECF: ICC-->225ml IV-->outside 8% threshold for bar rec change (derranged phys) -->increase Preload-->increa CO and BP 6) TG balance -diluted alb-->decreased reab-->urine (i believe insufficient to alter other renal system-probs some pressure diureses and medulla RBF not autoreg)

Answer 888

280-295mosmol

Answer 889

``` vol osmo oncotic UEC SID baro renal ```

Answer 890

This one time, Lobo et al infused some healthy volunteers with 2 litres of dextrose over 1 hour. The average BSL at the end of this hour was around 15. At the end of the second hour, it had already dropped to normal (actually, on average it was slightly low).

Answer 891

3.3% sevo peaking in term neonate-->2.5% at older than 6month require deep plane narrower margin of safety immature CVS system -->risk

Answer 892

CORE >2yo-->Increased CO with increased % to kidney and liver that are heavier per Kg-->more rapid met and elim vs adult! <2yo-->immature hep and renal In general, most medications will have a prolonged elimination half-life in preterm and term infants, a shortened half-life in children older than 2 years of age up to the early teenage years, and a lengthening of half-life in those approaching adulthood. The response of infants and children (particularly neonates) to medications is modified by many factors: body composition, protein binding, body temperature, distribution of cardiac output, functional organ (heart, liver, kidneys) maturity, maturation of the blood-brain barrier, the relative size of the liver and kidneys, and the presence or absence of elevated intraabdominal pressure (gastroschisis or omphalocele closure) or congenital malformations because the neonate has less fat, a drug that depends on the redistribution into fat for the termination of its action will have a long clinical effect; and (3) a drug that redistributes into muscle may have a long clinical effect (e.g., fentanyl, for which, however, saturation of muscle tissue has not been demonstrated).

Answer 893

Tots EF'DA T E F D add pressure valve Mapelson A a grade

Answer 894

spont - exp: DS into tubing the FGF pushes Alv gas out - insp nice conc gas Controlled 1) expiration is low pressure APL doesnt open DS and Alv fill tubing 2) insp: PPV-->Alv rebreathed shit goes back into patient with some blasted out with FGF-->++ wasteful.

Answer 895

Perhaps the most important factor influencing the potential for anesthetic overdose in neonates is the number of MAC multiples that can be delivered by the vaporizer; for example, a halothane vaporizer can deliver up to 5.75 MAC multiples versus 2.42 MAC multiples for a sevoflurane vaporizer

Answer 896

sevo better in everything except excitation on awakening

Answer 897

It should be avoided in children with anaphylactic reactions to eggs. dose larger in infants than kids

Answer 898

Contraindications to the use of ketamine in children include the presence of an active upper respiratory infection (URI), increased intracranial pressure, open-globe injury, and a psychiatric or seizure disorder. Ketamine does not preserve the gag reflex and thus should not be used as the sole anesthetic for children with a full stomach or a hiatal hernia.

Answer 899

Rb smaller Vd-->increased Elim despite smaller Cl Rb CYP3A3/4-->compete with madaz

Answer 900

Succinylcholine is highly water soluble and rapidly redistributes into the extracellular fluid volume. For this reason, the dose required for intravenous administration of this depolarizing muscle relaxant in infants (2.0 mg/kg) is approximately twice that for older children (1.0 mg/kg). IM -->double the dose

Answer 901

Sugammadex is a cyclodextrin whose endoskeleton forms a water-soluble complex with the exoskeleton of rocuronium; because sugammadex is made of sugars, the potential for adverse side effects would appear to be minimal. can be given in paeds yes

Answer 902

CYP450 CYP3A3/4 | met inhib by CCB grapefruit juice erythromycin

Answer 903

decrease SVR-->reflax tachy-->decrease MAP 5% TV decreased, RR increased MV stable decreased response to CO2 -my patients desat: atelectasis? decrease CO2 resp?

Answer 904

alpha 2 GiPCR PARTIAL agonist-->less potent with ceiling - Lat reticular n.-->decreased SNS - SNS presynaptic neg feedback - DH-->opiate release - Loceus ceruleous-->analagesia 100% OBA nil sig resp dep P+H nil change in CO nil sig neg ino 50% EXCRETED UNCHANGED IN URINE

Answer 905

1600:1 extensive hep met-->fine in CKD unpredictable OBA severe brady decrease MAC 90% 94% PrB

Answer 906

P+K 1) Proteases C (5,8), S, Antithrombin (2,10), plasmin C cuts S Supports C C is stimulated by thrombomodulin when thrombin binds to endothelial surface proteases inhib by antitrypsin and antiplasmin virchows triad

Answer 907

Endothelium release tPA Plasminogen always circulating (prod in liver) - bind to clot or endothelial tPA or urokinase or XIIa or XIa - ->activated to plasmin-->BD fibrin and fibrinogen to D-dimer products

Answer 908

Haemaccel causes direct histamine release from mast cells without complement activation or IgE production

Answer 909

IgM in milk-primary immune response vs bacteria #milk IgG crosses placenta-secondary immune # igG rhesus antibody crosses #goes IgE mast cell

Answer 910

The mechanism of this opiate response has remained unclear, although it is known to be non-immunological in nature. Immunoglobulin E antibodymediated immediate hypersensitivity reactions to the drugs are not often encountered.

Answer 911

1)cori cycle lactate-->pyruvate-->GNG-->glucose-->pyruvate-->lactate 2) conjugate Base of lactic acid - met to CO2 and H20 consuming 1 H - effectively 1HCO3 produced

Answer 912

acetate 27 | vs CSL lactate 28

Answer 913

However, in large randomized studies, colloids have no superiority over crystalloids in terms of major outcome measures such as mortality. 5556 They are more expensive than crystalloids and can have unfavorable side effects. gelofusine-hydolysed end product of collagen 80% IV vol expansion (more leak vs albumin) T/2 in IV 6Hrs vs Alb 24hrs anaphylaxis nil renal issues not a sig procoagulant

Answer 914

Albumin is transported back to the circulation system via the lymphatic system. Albumin 5% expands plasma volume by 80% of the infused volume In critically ill patients, there is increased leakage of albumin and supplementation of more albumin only contributes to peripheral edema (i.e., “albumin trapping”). Despite excellent volume-expanding efficacy of albumin, randomized clinical trials have found no superiority over crystalloids.

Answer 915

Dextran molecules are excreted by the kidneys or metabolized by endogenous hydrolase (dextranase) to carbon dioxide and water. Dextrans have been associated with anaphylactic reactions.

Answer 916

Hetastarches are synthetic colloids consisting of polysaccharides prepared from either grain or corn. The older hetastarch solutions and pentastarches have been associated with considerable side effects such as renal and coagulation problems.

Answer 917

Definition. Goal directed therapy (GDT) is a term used to describe the use of cardiac output measurement to guide intravenous and inotropic therapy, to ensure adequate tissue perfusion and cellular oxygenation

Answer 918

A reduction in renal perfusion normally results in dilatation of the afferent glomerular arteriole and constriction of the efferent arteriole so that the GFR is kept constant. However, if mean arterial pressure falls below 70 mm Hg (the kidney autoregulatory threshold), renal perfusion pressure and GFR fall, leading to oliguria.

Answer 919

Response to Fluid Challenge An important concept for guiding rational fluid administration is the use of the Frank-Starling curve for cardiac performance ( Fig. 41.5 ). In most clinical circumstances, a basic assumption is that the patient is on the ascending part of the Starling curve and has a submaximal cardiac output. When the subject reaches the flat part of the curve, more fluid administration has little effect on cardiac output/stroke volume and will only increase tissue edema. Although this concept applies to healthy volume-depleted patients, less than half of critically ill patients might respond to a fluid challenge.

Answer 920

CVP is influenced by many factors unrelated to actual fluid balance, such as venous tone, intrathoracic pressure, and left and right ventricular compliance. Consequently, there is poor correlation between CVP and the right ventricular end-diastolic volume,

Answer 921

Pulmonary Artery Occlusion Pressure The pulmonary artery catheter (PAC) is used to measure pulmonary artery occlusion pressure or pulmonary capillary wedge pressure, which is intended to reflect left ventricular preload. 69 However, pulmonary artery occlusion pressure is not a good indicator of preload. 7071 The catheter measures pressure and not volume, the relationship is not direct but curvilinear, and clinical benefit is highly doubtful. 7273 Left ventricular compliance is dependent on filling of the right ventricle, which means that the PAC has the same limitations as the central venous catheter.

Answer 922

Transesophageal Echocardiography Widely used in cardiothoracic surgery, transesophageal echocardiography has not proved a reliable predictor of fluid responsiveness in critically ill patients. There are conflicting results for use of the left ventricular end-diastolic area as a good predictor because it is a static measurement. 7475 Continuous measurements, such as positive-pressure ventilation, induced changes in vena cava diameter, and aortic flow velocity/stroke volume assessed by echocardiography, all have limitations.

Answer 923

Transpulmonary thermodilution is a method that uses a cold bolus as a single indicator for determination of the assessment of the largest volume of blood contained in the four heart chambers, called the global end-diastolic volume. It requires the use of a specific thermodilution arterial catheter (pulse contour cardiac output monitoring) that measures temperature changes after the injection of the bolus through a central vein catheter (normally the central vein catheter is placed in the neck, the arterial line in the femoral artery). It does not appear to be a good predictor of fluid responsiveness according to available studies.

Answer 924

Changes in RV and LV stroke volume are greater when the ventricles work on the steep part of the Starling curve Thus change in LV stroke volume is an indicator of biventricular preload dependence. According to a large systematic review, pulse pressure variation (PPV) and stroke volume variation (SVV) predict with a high degree of accuracy (receiver operating curve 0.94 and 0.84, respectively) patients who are likely to respond to a fluid challenge limited by arrhythmias and the requirement for mechanical ventilation. They are less reliable in critically ill patients receiving ventilatory support. Furthermore, PPV is a direct measurement, whereas SVV is an indirect calculation from pulse contour analysis. PPV can be affected by the tidal volume, with the recommendation that tidal volume should be at least 8 mL/kg.

Answer 925

Pulse pressure = stroke volume / arterial compliance

Answer 926

Passive Leg Raising Test Passive leg raising (PLR) represents an endogenous volume challenge that can be used to predict fluid responsiveness. This procedure rapidly returns 150 to 200 mL of blood from peripheral veins in the lower extremities to the central circulation. When ventricular preload is increased, cardiac output is augmented according to the degree of preload reserve. 86 A PLR test can be used in patients with spontaneous or assisted breathing and irregular cardiac rhythm; therefore it can be a more useful test of fluid responsiveness in critically ill patients. 87 PLR is a simple test in which the legs are elevated by 45 degrees above the bed, but to be reliable it must be accompanied by cardiac output monitoring. Because of the ease of use, simplicity, and high diagnostic accuracy, PLR is the preferred method to assess fluid responsiveness.

Answer 927

TBW.(Na-140/140) TBW 50% male Current sodium x Current (unknown water)=ideal sodiumxideal water ie 0.5*wt—>derivation of above formula

Answer 928

2Na +g +U makes perfect sense

Answer 929

Freezing-point depression osmometry is the most commonly used method for measuring the changes in colligative properties of a solution. It is based on the principle that the addition of solute molecules lowers the temperature at which a solution freezes.

Answer 930

Freezing-point depression osmometry is the most commonly used method for measuring the changes in colligative properties of a solution. It is based on the principle that the addition of solute molecules lowers the temperature at which a solution freezes. membrane osmometers not used much (not referenced in text) only wiki

Answer 931

does more to interstitial fluid! 20% alb =20g in 100ml 100mmol/L Na T/2 in vasc=24 hrs-->interstital fluid then degraded after 2 days From this we can extrapolate that in our healthy cylinder model, the 20g of albumin will attract about 220ml of water into the intravascular space (increased onc pressure) with the expansion maximal at 30 minutes post infusion, and petering out rapidly afterwards (suggesting that in septic ICU patients the transcapillary escape rate is increased by as much as 200%, to 10% per hour).

Answer 932

EPV = [0.065 X wt(kg)] X [1-Hct]. since BVE and 65 mL/kg RBC volume, mL = total blood volume, mL × hematocrit / 100 Plasma volume, mL = total blood volume, mL × ( 1 – hematocrit / 100 ) Example: adult male, height = 180 cm, weight = 70 kg, Hct = 25% ``` Total blood volume, L = [ 0.3669 × (height, m)3 + 0.03219 × (weight, kg) + 0.6041 ] = [ 0.3669 × (180 / 100)3 + 0.03219 × (70) + 0.6041 ] = 2.1398 + 2.2533 + 0.6041 = 5.0 L (4,997 mL) Red blood cell volume, mL = (4,997 mL) × (25% / 100) = 4,997 mL × 0.25 = 1,249 mL Plasma volume, mL = 4,997 mL × [1 - (25% / 100)] = 4,997 mL × 0.75 = 3,748 mL ```

Answer 933

same dose as IV 10mg for seizure

Answer 934

12x more potent than fent as more affinity (IA same obviously) highly lipid sol-->fast onset and offset after bolus ET/2 between fent and alfent high PrB-->smallish Vd CSHTweakly active desmethyl sufentanil (n-dealkylation)

Answer 935

evernote diagram To ensure good flow, the maximum vacuum and the shortest possible length of tubing should be used, the internal diameter of tubings, connectors, and the suction catheter should be as large as possible, and the vacuum system should not leak. The outlet from the vacuum system is on a roof Filter for bacteria, liquid, solid, condensation and smoke ``` Additionally note Nozzle-soft with multi openings Tubing is flex but strong Receiver is not too big or small Vacuum source is electric pump with pneumatic pumps—>neg pressure 500mmHg—>generate flow of 25L/min pithing 10s of switch ``` Test before use Titrate suction req to effect High P low flow (vs scavenger system)

Answer 936

Vacuum is usually stated in gauge pressure, the difference between the measured pressure and ambient atmospheric pressure (which is zero on the gauge).

Answer 937

evernote ``` A #cough and laryngospasm and Dx B C D Exposure to infection ``` Inadequate tip to wall 1. tip 2. Tubing-intra luminal or extra 3. receiver 4. Filter 5. Pressure

Answer 938

http://www.partone.lifeinthefastlane.com/inhalational-anaesthetics.html Pka Rat LaM O:G sevo 50:1 SVP of iso 33kpa

Answer 939

BGPC 15 vs 0.69—>slow—>can’t knock self out with N20 OG 950 vs 50—>to fat—>prolonged effect above analgesic level 70% hepatic met—>Fl ions—>high output renal failure Neg ino, catechol sensitisation Raised ICP if PP sustained Same Resp SE vs others Nil tocolytic—>good for labour

Answer 940

Zone 1 conditions are generally said to be absent from the normal lung under physiological conditions.

Answer 941

Finally, the addition of PEEP to the ventilated lung during OLV seems like a logical response to its reduced lung volume and propensity to develop atelectasis, but PEEP will also increase the pulmonary vascular resistance of the dependent lung and potentially worsen the shunt The suggested ‘protective ventilation’ strategy requires pressure-controlled ventilation, low tidal volume (6 ml.kg −1 predicted body weight) and low levels of PEEP (5 cmH 2 O). This strategy has been shown to improve oxygenation during OLV, reduce the systemic inflammatory response associated with OLV 56 and improve postoperative lung function. Non vent lung CPAP5-10 Fio2 100% recruite or clamp or squeeze if needed Vent lung 0.7%Fio2 PCV

Answer 942

picture what is darker in brain outside is grey in SC inside is grey

Answer 943

Nerve systems 1. Cerebrospinal brain, SC, peripheral nerves 2. ANS (contort of nonskeletal to reg internal enviro) Higher centres influence ANS ANS - SNS-efferent cell bodies in lateral grey column and in peripheral ganglion of T1-L2 - PSNS-efferent Brainstem CNs 3,7,9,10 and sacral primary rami—>pelvic splanchnic nerves Exit as myelinated the ganglia then unmyelinated Ganglia 2.5cm from midline for SNS and very close to organ for PSNS SNS-mass effect - exit lat grey column—>white rami communicans 3 options in the Sympathetic trunk 1. Synapse at that ganglion in white rami communicans 2. Travel upon down trunk to ganglions above # cervical ganglion 3. Pass through and synapse with a more distal ganglion - therefore blocking or stimulating one white rami communicans segment—>wide effect on many organs at many levels above and below SNS 2 segments -somatic—>skin—>VD, sweat, piloerector -visceral—>organs (from ganglia to organ) —enteric: ganglia more distal and stimulated by splanchnic nerves (autonomic nerves) —adrenals —>preganglionic—>chromaffinc cells of medulla

Answer 944

corniculate corn is horn on top of arytenoid posterior is aryepiglottic fold attaches to epiglotis VC-->vestibular (Channel) fold-->false VC nares have vestibule (Channel) too

Answer 945

catagorical vs numerical catagorical-->binary, nominal, ordinal numerical-->cont vs discrete cont-->interval (zero is just a number celcius) or ratio (kelvin)

Answer 946

vs Metabolic rate | MnM

Answer 947

colligative properties are those properties of solutions that depend on the ratio of the number of solute particles to the number of solvent molecules in a solution, and not on the nature of the chemical species present

Answer 948

CO2prod=AV.PaCO2 .k | AV=CO2 prod/PaCO2 .k

Answer 949

CO2prod=AV.PaCO2 .k | AV=CO2 prod/PaCO2 .k

Answer 950

Anatomical+alv

Answer 951

Anatomical+alv

Answer 952

PACO2-PETCO2/PACO2 | NOT CONTENT

Answer 953

Qs/Qt = (CcO2 - CaO2) / (CcO2 + CvO2) Aa/AV

Answer 954

finger ann on throne while doing heroin

Answer 955

pre and post synaptic GABA binding at AB AB a gamma is for benzo aaaaayyyyyy B-barb-allosteric volatile and prop also act at B at sep site to Barb ``` If a benzodiazepine increases the frequency of channel opening by 300%, and a barbiturate increases the duration of their opening by 300%, then the combined effects of the drugs increase the channels overall function by 900%, not 600%) #BarbD BenF ```

Answer 956

In biochemistry, allosteric regulation is the regulation of an enzyme by binding an effector molecule at a site other than the enzyme's active site. #conformational change

Answer 957

non mech Lipolysis -->glycerol and FFA FFA-->acetylcoa-->recycled back to FFA with release of Heat and consumption of ATP increase BMR x2

Answer 958

Cold: BoK in dermis fires over wide range (max 40C) with peak at 25C Adelta mylin BoR 30-46 peaking at 44 C unmyelin both LSTT-->RAS and medulla and HT ``` increased firing from cold-->stimulate Post Thal-->VC and shiver #poles are cold ``` increased firing from hot and local warm blod -->ant pit increased firing-->sweat and VD Shiver increase BMR x1 shunt -artioventous shunt cap venous plexu1.5L -VD-->decreased SVR-->increased CO-->flood plexus and heat loss BFincrease x30

Answer 959

Cold: BoK in dermis fires over wide range (max 40C) with peak at 25C Adelta mylin BoR 30-46 peaking at 44 C unmyelin both LSTT-->RAS and medulla and HT ``` increased firing from cold-->stimulate Post Thal-->VC and shiver #poles are cold ``` increased firing from hot and local warm blod -->ant pit increased firing-->sweat and VD Shiver increase BMR x1 shunt -artioventous shunt cap venous plexu1.5L -VD-->decreased SVR-->increased CO-->flood plexus and heat loss BFincrease x30

Answer 960

trifluroacetic acid , Br and Cl

Answer 961

5% hepatic met CYP450-->inorganic F- additionally reacts with sodalime-->compound A -more when dry, low flow, (only with strong base) additionally if not enough water in storage tank-->lewis acid -->hence 300ppm water

Answer 962

#bulk exchange process time constant for circuit equilib Vol/FGF -conc of FGF will not change the time constant but set a higher equilib point V circ = 6 L and FGF = 6 L/min, the exponential time constant will be 1 minute with delta p/t= FGF/Vol.chang in circ P - Uptake into lung time constant for alveoli equilib (if no uptake) FRC/Alv vent with delta P/t= Alv vent/FRCxPressure grad circ to alv time for alv to blood uptake=Sol.Vol/blood flow tim constant is the same time constant from for tissue equilib Vol.sol/flow -brain has high flow ans small vol so short fast time constant ``` VARIABLES ARE circ vol.sol, FGF, conc vol of alv, Alv vent (Deadspace i.e., ventilated but not perfused pulmonary regions, reduces effective alveolar ventilation thus slows anesthetic uptake), CO (and shunt) Sol of drug irritant drug ```

Answer 963

However, the relative size of the ventilation effect is greater for soluble agents ``` Low MV for Low lipid sol low problem as will saturate quickly anyhow #sevo you can just chill. ```

Answer 964

shunt-->50% cant participate in exhcange-->slower rise of arterial PP-->slower onset effect lipid sol more (same logic)

Answer 965

in order to maintain a constant flow, a fluid must increase its velocity as it flows through a constriction This is achieved despite the patienťs respiratory pattern by providing a higher gas flow than the peak inspiratory flow rate. P+12𝜌𝑣2=𝜅 P is pressure p is density Because of the high fresh gas flow rate, the exhaled gases are rapidly flushed from the mask, via its holes. Therefore there is no rebreathing and no increase in dead space. calibrate For example, a 24% oxygen Venturi mask has an air : oxygen entrainment ratio of 25 : 1. This means an oxygen flow of 2 L/min delivers a total flow of 50 L/min, well above the peak inspiratory flow rate. These masks are recommended when a fixed oxygen concentration is desired in patients whose ventilation is dependent on their hypoxic drive, such as those with chronic obstructive pulmonary disease. However, caution should be exercised as it has been shown that the average FiO 2 delivered in such masks is up to 5% above the expected value. 2. The Venturi mask with its Venturi device and the oxygen delivery tubing is often not well tolerated by patients because it is noisy and bulky. Anaesthetic breathing systems are other examples of the fixed performance devices. The reservoir bag acts to deliver a fresh gas flow that is greater than the patienťs peak inspiratory flow rate.

Answer 966

"fixed performance device" PEEP of 5 " It is thought that it produces a reduction of anatomical dead space" The above can lead to reduced work of breathing, improved oxygenation and ventilatory efficiency. 4. Such systems enhance patient comfort and tolerance compared with other oxygen delivery systems Contraindicated in recent nasal surgery and severe epistaxis. 2. Base of skull fracture and/or cerebrospinal fluid (CSF) leak.

Answer 967

"fixed performance device" PEEP of 5 " It is thought that it produces a reduction of anatomical dead space"-as nasopharynx and traceha and conducting airways-->reservoir?? The above can lead to reduced work of breathing, improved oxygenation and ventilatory efficiency. 4. Such systems enhance patient comfort and tolerance compared with other oxygen delivery systems Contraindicated in recent nasal surgery and severe epistaxis. 2. Base of skull fracture and/or cerebrospinal fluid (CSF) leak.

Answer 968

its tiny effective reservoir is air in front of face. expired air pushout out faster resp rate -->breathing in expired ie rebreath High FiO 2 delivered Low FiO 2 delivered Low peak inspiratory flow rate High peak inspiratory flow rate Slow respiratory rate Fast respiratory rate High fresh oxygen flow rate Low fresh oxygen flow rate Tightly fitting face mask Less tightly fitting face mask

Answer 969

The nasopharynx acts as a reservoir!! Mouth breathing causes inspiratory air flow. This produces a Venturi effect in the posterior pharynx entraining oxygen from the nose.

Answer 970

short int long | <12 <24 >24 half life

Answer 971

 Reflux & Regurgitation:passive processes  Reflux:relaxation of lower oesophageal sphincter and passage of gastric contents into oesophagus  Regurgitation: relaxation of upper oesophageal sphincter and passage of gastric contents into pharynx  Aspiration:gastric contents reach tracheobronchialtree when airway reflexes are obtunded and protective gag and cough reflexes don’t occur

Answer 972

irreversible covalent bond most potent CYP450 inhibitors some benzimidazole derivative

Answer 973

Sucralfate

Answer 974

ACE amox clarythm esomeprazole

Answer 975

GiPCR-->decrease camp-->decreased H secretion parietal at mucosal cell-->HCO3 and mucous

Answer 976

DA antag in GI stim Ach rec ``` SE extrapyramid Prolactin porphyria inhibit bytylcholinesterae NEUROLEPTIC MALIGNANT SYNDROME ``` Met conj and excretion with sig amount unchanged

Answer 977

gut coating | decreased ab of some drugs warf and phenytoin etc

Answer 978

1c amide LA slows Na rise, increase pacing threshold, slow AV conduction good for AF, VF, WPW neg ino junctional arrhytmia dizzy headache active met renal excretion of unchanged

Answer 979

1,2,3 nil Ca so SVT AF and VT -->prolong Qt-->torsades low lipid sol (so nil met but defies rule and good absorption) nonselective

Answer 980

``` class I antiarrhytmic depresses pacemaker activity but allow good conduction so Rx digoxin toxicity (slowed conduction) ```

Answer 981

1b slow rate of rise raise pacing threshold REDUCE AP and ARP SE AV block neg ino met amidase

Answer 982

nondihydro CCB slow AP and conduction neg ino cor VD Rx SVT precip by WPW risk of VT due to accessory pathway instead risk brady in other AV blockers in CCF will cause decreased CO

Answer 983

active met

Answer 984

If the anaesthetic machine incorporates a gas flowmeter bank, oxygen must be the last gas to enter the common gas manifold at the top of the flowmeter tubes. The oxygen flow knob must be the first from the left on the rotameter, relative to other flow knobs. Vaporisers with mechanical adjustment dials, when used in high pressure circuits, must increase the delivered anaesthetic vapour concentration when the dial is rotated in an anti-clockwise direction.

Answer 985

active and passive positive and negative relief valves on either side of a reservoir bag-->protect if it collapses with neg pressure risk of rebreath A receiving system (reservoir bag) can be used. Two spring-loaded valves guard against excessive positive (1000 Pa) in case of a distal obstruction or negative (–50 Pa) pressures in case of increased demand in the scavenging system. 1. passive model - when pressure exceeds APL-->out and driven by patietn expiration of PPV - ->out to atmosphere (not recylced) problems Connecting the scavenging system to the exit grille of the theatre ventilation is possible. Recirculation or reversing of the flow is a problem in this situation. 2. Excess positive or negative pressures caused by the wind at the outlet might affect the performance and even reverse the flow. 3. The outlet should be fitted with a wire mesh to protect against insects. 4. Compressing or occluding the passive hose may lead to the escape of gases/vapours into the operating theatre and thereby polluting it. The disposal hose should be made of non-compressible materials and not placed on the floor. Active A bacterial filter situated downstream and a visual flow indicator positioned between the receiving and disposal systems can be used. A reservoir bag with two spring-loaded safety valves can also be used as a receiving system The active disposal system consists of a fan or a pump used to generate a vacuum The reservoir is designed to prevent excessive negative or positive pressures being applied to the patient. Excessive negative pressure leads to the collapse of the reservoir bag of the breathing system and the risk of rebreathing. Excessive positive pressure increases the risk of barotrauma should an obstruction occur beyond the receiving system.

Answer 986

Barylime, which consists of barium hydroxide (80%) and calcium hydroxide (20%), is widely used in the United States. Another absorber is Amsorb that consists of CaCl 2 and Ca(OH) 2 .

Answer 987

base neutralizing an acid!!!!! The acid is carbonic acid formed by the reaction of carbon dioxide with water. The end products are water and a carbonate. Heat is liberated in the reaction NaOH and KOH-->(if dry)-->carbon monoxide (exothermic) Absorbents no longer contain potassium hydroxide Compound A, formaldehyde, and methanol can be formed with sevoflurane Their capacity to absorb carbon dioxide is decreased by decreased moisture, and they adsorb anesthetic agents more when dry Newer types of soda lime have a low concentration of a zeolite added. This helps to maintain the pH at a high level for longer and retains moisture so improving carbon dioxide absorption and reducing the formation of carbon monoxide and compound A. Disintegrated granules increase resistance to breathing. Because of this, silica (0.2%) is added to harden the absorbents and reduce powder formation. Colour changes can be from white to violet/purple (ethyl violet dye), from pink to white (titan yellow dye) or from green to violet 7. The size of soda lime granules is 4–8 mesh. Strainers with 4–8 mesh have four and eight openings/in, respectively. Therefore, the higher the mesh number, the smaller the particles are. Recently produced soda lime made to a uniform shape of 3–4-mm spheres allows a more even flow of gases and a reduction in channelling. This results in a longer life with lower dust content and lower resistance to flow: 1 kg can absorb more than 120 L of CO 2 .

Answer 988

CaOH!!!!!!!!!!!!! Alkali-free absorbents consist mainly of calcium hydroxide, with small amounts of other agents added to accelerate carbon dioxide absorption and bind water. With these absorbents, there is no evidence of carbon monoxide formation with any anesthetic agent, even if the absorbent becomes desiccated. There is little or no compound A or formaldehyde formation with sevoflurane even with low fresh gas flows and desiccated absorbent. The indicator in these absorbents changes color on drying. Once exhausted, these absorbents do not revert to their original color. The carbon dioxide absorption capacity of these absorbents is less than that of absorbents containing strong alkali but does not deteriorate when moisture is lost.

Answer 989

antenatal Concentrations of morphine in the colostrum of parturients receiving patient-controlled analgesia with morphine are low and it is unlikely that significant amounts of drug will be transferred to the breast-fed neonate Systemic opioids including those used in patient-controlled intravenous analgesia cross the placenta and may reduce fetal heart rate variability. However, there is no evidence that this is detrimental to the fetus.

Answer 990

Electroencephalographic studies of subjects treated with fentanyl, alfentanil, sufentanil, and remifentanil support a 50% dose reduction for elderly patients. Creatinine clearance is reduced with advancing ag

Answer 991

Fentanyl is a phenylpiperidine-derivative synthetic opioid agonist that is structurally related to meperidine

Answer 992

phase I | eg Adr-->norad

Answer 993

Despite the clinical impression that fentanyl has a short duration of action, its elimination half-time is longer than that for morphine A prolonged elimination half-time for fentanyl in elderly patients is due to decreased clearance of the opioid because Vd is not changed in comparison with younger adults.[87] This change may reflect age-related decreases in hepatic blood flow, microsomal enzyme activity, or albumin production, as fentanyl is highly bound (79% to 87%) to protein. For these reasons, it is likely that a given dose of fentanyl will be effective for a longer period of time in elderly patients than in younger patients Vd not changed in elderly for fent!

Answer 994

#unpredictable theoretical Body composition Dec lean body mass and TBW, contracted blood volume Inc body fat (relative) Inc serum conc and dec Vol distribution of water soluble drugs Inc duration of action lipid soluble drugs Vd not changed in elderly for fent! (MILLER)

Answer 995

active phase metabolite then renal excretiondecrease dose as per AMH if CrCl<10

Answer 996

The underlying mechanism is believed to involve the buildup of ammonia i

Answer 997

butyrl cholinesterase | decreased in LF, RF, CCF, thyrothoxicosis, preg

Answer 998

In general, severe liver disease predictably alters the metabolism of drugs with large extraction ratios, such as lidocaine and meperidine, in which clearance primarily depends on hepatic blood flow or portosystemic shunting. Conversely, the metabolism of low-extraction drugs, such as the benzodiazepines, is influenced mainly by protein binding, in which unbound drug is available for elimination, and by intrinsic hepatic clearance and metabolism, which are reduced in accordance with the severity of hepatocellular dysfunction.

Answer 999

T T T Leuk

Answer 1000

pressure to liquify at exactly the critcal temp

Answer 1001

black body white shoulders

Answer 1002

blue and blue and white

Answer 1003

blue and blue THE ONLY USED VAPOUR (CO2 ALSO BUT RARE)

Answer 1004

black body and Back+W

Answer 1005

1) non corrosive 2) strong 3) melting valve block attachement 4) pin index (yoke vs cylinder) 5) colour coding 6) N2O Filling ration 3/4 or 2/3 (weight vs if water) - crit temp 36C - verticle 7) thermostat reg for N2O 8) washer (bodok seal) 9) 5 year check 10) entenox - ->horizontal >5C as at -6C poynting effect - ->dipper - ->multiple to share cooling of LHV

Answer 1006

O2 RaF 2 5 N2O at TaFe 3 5 RA is SaFe 1 5 CO2 if SiC 1 6

Answer 1007

brown and brown

Answer 1008

vapor exerts 4.4Kpa pressure will only drop once all liquid used therefor wiegh it! s the liquid is less compressible than a gas, the cylinder should be only partially filled.

Answer 1009

poynitng-->O2 gas N2O liquid-->under dose early then hypoxic late

Answer 1010

thin-walled seamless molybdenum steel. Internally endoscopic examination is carried out to look for cracks and defects in the inner surface. Each cylinder is then subjected to high pressures, much higher than their normal working pressure, of normally approximately 22 000 kPa. This pressure is then stencilled on the valve block. One out of every 100 cylinders undergoes tensile testing, where it is cut into strips and it is stretched to assess the yield point. Bending, flattening and impact tests are also performed on 1 in every 100 cylinders

Answer 1011

reg pressures The pipelines are made of special high quality alloyed carbon which prevents the break-down of the gases it carries and also has bacteriostatic properties. Outlet sockets are found throughout the hospital and the gas supplied is identified by name, shape and colour-coding. Colour-coded hoses connect the outlet socket to the anaesthetic machine; these hoses have a quick connect/release Schrader valve, with an indexing collar for each gas. A singie hose and tug test should be performed to check for misconnection or cross-connection. The hoses should be permanently attached to the anaesthetic machine with a non-interchangeable screw thread.

Answer 1012

E cylinder is 10L 144Bar-->1440L

Answer 1013

100mcg/ml 1ml bolus (i believe)

Answer 1014

30 vs 60 of glyco ish

Answer 1015

DOES CROSS BB SO ANTICHOLSYNDROME +++ AND CONFUSOIN AND SEDATION AND URINARY RETENTION

Answer 1016

quarternary not teritary

Answer 1017

methiothione

Answer 1018

DOSE NOT CAUSE CO WITH SODALIME! increase CBF>1mac

Answer 1019

INCREASED CBF DESPITE DECREASED CMRO2

Answer 1020

sevo des and iso | K+ Ch.

Answer 1021

The exact mechanism of the action of general anaesthetics has not been delineated.[7] Sevoflurane acts as a positive allosteric modulator of the GABAA receptor in electrophysiology studies of neurons and recombinant receptors.[8][9][10][11] However, it also acts as an NMDA receptor antagonist,[12] potentiates glycine receptor currents,[11] and inhibits nAChR[13] and 5-HT3 receptor currents.[14][15][16] Myer Overton Protein rec target

Answer 1022

Ischemic preconditioning occurs in two phases – the first takes place 1-2 hours after the conditioning episode, the second takes place 24-72 hours later and is dependent on ATP-sensitive mitochondrial K+ channels – this second mechanism is fundamental to anesthetic agents’ ability to enhance ischemic preconditioning and/or provide myocardial protection decreased infarct size attenuated in anyone that needs it ha (old, DM, cardiomeg, fat) improve supply (open KATPase) and decrease demand improved NO release in isolated ischaemic hearts reduce excess Ca influx on reperfusion protect against neutrophil action on ischaemic tissue bitemporal protection

Answer 1023

Sevo VD due to direct sm relax blunts barorec reflex (no change in HR), minor neg ino (changed Ca sens and decreased ICC due to L type CCh, preserves CO, cardioprotective Cor VD All inhaled anesthetics prolong the QT interval (clinical significance unclear), but sevoflurane should be avoided in patients with long QT syndrome [Miller].

Answer 1024

Prop every mech you can think of 15% decrease CO 15% decreased SV 15% decrease SVR no reflex tachy and can reset barorec and Brady -due to reduced SNS-->decreased Ca in, increased K out, NO stim Sevo VD due to direct sm relax blunts barorec reflex (no change in HR), minor neg ino (changed Ca sens and decreased ICC due to L type CCh, preserves CO, cardioprotective Cor VD All inhaled anesthetics prolong the QT interval (clinical significance unclear), but sevoflurane should be avoided in patients with long QT syndrome [Miller].

Answer 1025

4 for MOOOOR-fat | 2- trigger

Answer 1026

glucose in. increased ATP-->close K channel-->depol-->ca

Answer 1027

binds to insulin rec (transcellular)-->internalisation-->beta subunit activation-->TK activation-->second messenger -->GLUT4 internalisation, and gene transcriptioin and other effects complex with Zn or protamine or crystalise-->less lipid sol-->less ab-->longer

Answer 1028

Whereas the phase I reaction involving CYP enzymes may be impaired in liver disease, the phase II reaction (glucuronidation) seems to be affected to a lesser extent, although both phase I and phase II reactions in drug metabolism are substantially impaired in patients with advanced cirrhosis

Answer 1029

1MV is height of QRS

Answer 1030

BB CC digitalis Adenosine (very transient) hypokalamia LITFL Hyperkalaemia LITFL Hypermagnesaemia essentially CCB Fibrosis, MI Vagal or acetylcholinesterase inhibitor—>increased Ach #neostigmine! Role: in my mind - max rate of ventricular contraction in AF - atria contract pause for atrial dump and only when that is complete does ventricle contract

Answer 1031

post pit for post partum

Answer 1032

instant effects