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Anesthesia > Questions > Flashcards

Questions Flashcards

1
Q

Which anesthetic are least favorable with Beta-Adrenergic Receptor Blockers? (Start from least favorable to favored)

A
  • Ketamine
  • Enflurane
  • Halathane
  • Opiods
  • Isoflurane
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2
Q

What is the use of Yohimbine?

A

-Impotence

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3
Q

Physostigmine is nonionized and is ________, not a quaternary ammonium compound.

A

tertiary

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4
Q

What drug reactivates acetylcholinesterase?

A

Pralidoxime

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5
Q

Miosis is the _____ of the eye and mydriases is the _____ of the eye.

A
  • Constriction

- Dilatation

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6
Q

Phentolamine is used in the acute treatment of what emergency and is used in the treatment of sympathomimetic extra vasculature?

A

-Phentolamine

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7
Q

What is the drug of choice in the treatment of pheochromocytoma and the dose when used.

A
  • Phenoxybenzamine

- 0.5 to 1 mg/kg

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8
Q

How is norepinephrine metabolized in the varicosity?

A
  • MAO in the synaptic cleft
  • COMT in the plasma
  • Reuptake occurs in the presynaptic cleft (80%)
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9
Q

Describe the synthesis of Noriepinephrine?

A
  1. Tyrosin
  2. L-Dopa
  3. Dopamine
  4. Norepinephrine
  5. Epinephrine
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10
Q

What would a massive parasympathetic response do to the organism?

A
  • Organism would be prostrate
  • helpless
  • salivating
  • wheezing
  • weeping
  • vomiting
  • urinating
  • deficating
  • seizing
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11
Q

What drug is used to treat myasthenia gravis?

A

-Pyridostigmine

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12
Q

The cranial sacral nerve III arises from the:

A

Midbrain

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13
Q

Cranial sacral nerve IX and X arise from the:

A

medulla

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14
Q

Cranial Sacral nerve VII arises from the:

A

Pons

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15
Q

List the cranial sacral nerves that carry parasympathetic activity?

A
  • III
  • VII
  • IX
  • X
  • S2
  • S3
  • S4
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16
Q

What is used to treat Hypercalcemia?

A
  • Pamidronate

- Zolendronic

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17
Q

What is the spinal anesthesia dose of fentanyl?

A

10 to 25 mcg

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18
Q

What is the spinal anesthesia dose of morphine?

A

250mcg

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19
Q

What is the spinal anesthesia dose of clonidine?

A

150mcg

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20
Q

What is the equation to convert Celsius to Fahrenheit?

A

9/5 x C + 32 = Fahenheit

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21
Q

What is the equation to convert Fahrenheit to Celsius?

A

(F - 32) x 5/9 = Celsius

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22
Q

List the affects of Fenoldapam administration?

A

INCREASE

  • Renal blood flow
  • urinary SODIUM excretion
  • Creatine clearance
  • Heart Rate
  • IOP

DECREASE
- Arterial pressure

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23
Q

What is the receptor in the treatment of anti cholesterol and the appropriate serum levels with drug.

A
  • HMG-CoA
  • Adequate is LDL below 130 mg/dL
  • Optimal is LDL below 100 mg/dL
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24
Q

Give the equation for anion gap.

A
  • (Na+) - ([CL-] + [HCO3-]) = Anion Gap

- Appropriate level is 8 to 12 meq/L

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25
Q

What does an increase anion gap indicate?

A
  • Renal failure
  • Ketoacidosis
  • Lactic acidosis
  • hyperosmolar
  • nonketotic coma
  • ETOH toxicity
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26
Q

List the ace inhibitor and the duration of each.

A
  • Captapril (6-10 hours)
  • Lisinopril and Enalapril (18 to 30 hours)
  • Ramipril (24-60 hours)
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27
Q

What is the dose of Stadol.

A

1 to 2 mg (IV or IM)

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28
Q

What is the normal serum osmolarity?

A

280 to 290 mosm/L

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29
Q

What is the osmolarity of D5 1/4, 1/2 NS,

D5NS, D5W.

A
  • D5 1/4 is 355
  • 1/2 NS is 154
  • D5NS is 586
  • D5W is 253
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30
Q

What is the equation for creatine clearance?

A

(Urinary creatinine x Urinary Flow Rate)/Plasma creatinine

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31
Q

Why are esters more prone to allergic reaction?

A

-Paraaminobenzoic acid preservative (PABA)

Found in lotion, sunscreen, cosmetics, sulfonamides,, foods

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32
Q

What arteries consist of the celiac trunk?

A
  • Common Hepaic Artery
  • Left Gastic Artery
  • Splenic Artery
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33
Q

Stimulation of the __ receptor causes _______ by histamine and stimulation of the ___ receptor causes _______.

A
  • H1
  • bronchoconstriction
  • H2
  • Bronchodilatation
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34
Q

List from greatest to least the most common anaphylaxis agents.

A
  • Intra op drugs (Rocuronium) 60%
  • Latex 15%
  • Antibiotic 10 to 5 %
  • Opiods 5 %
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35
Q

Anaphylactoid does not involve Ig__ and is mediated by ____ and ____ activation.

A
  • E
  • Mast
  • Basophil
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36
Q

What class of drug could be used to make the respiratory system more sensitive to CO2.

A

-Xanthines

Drug: Aminophylline

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37
Q

Describe the Sorsal-Lamniscal Sensory System.

A
  • Sensation is pressure, touch, and vibration
  • Cuneatus (lateral) and Gracilis (medial)
  • Ascend ipsilateral side of the spinal cord, CROSSES over the to the contralateral side of the thalamus and primary sensory cortex
  • Considered the “direct route”.
  • Monitors the somatosensory evoked potential (SSEP)
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38
Q

What is the reticular Activating System?

A
  • “Indirect route”

- Maintain the alert/awake state

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39
Q

How does general anesthesia work?

A

-Depressing the reticular activating system. (sedation and hypnosis)

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40
Q

List the sensitivity of Somatosensory Evoked Potential(SSEP), Brainstem Auditory Evoke Potential(BAEP), and Visual Evoked Potential (VEP).

A
  • VEP is very sensitive (V = Very)
  • SSEP is Somewhat sensitive (S = Somewhat)
  • BAEP is Barely sensitive (B =Barely)
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41
Q

Describe the pain pathway.

A
  • Tract is called the tract of Lissauer
  • A delta nerve is the fast pain
  • C nerve is the slow pain
  • Impulse enter through the dorsal root ganglion and ascends/descend 1 to 3 segments.
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42
Q

Describe the pathway for fast sharp pain (A delta fibers)?

A
  • Leave the tract of lissauer
  • Enter the dorsal horn and terminates in Rexed’s Lamina 1 and 5
  • Second order of neurons cross to the contralateral lateral spinothalamic tract and ascend to the brain
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43
Q

Describe the pathway for slow chronic Pain (C fibers)?

A
  • C fiber terminate in rexed’s lamina 2 and 3.
  • interneurons transmit pain to lamina 5
  • Neuron leaving immediately from lamina 5 cross immediately to the contralateral lateral spinothalamic tract and ascend to the brain.
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44
Q

What is the major neurotransmitter released from A delta fibers to bind with AMPA and NMDA receptors?

A
  • GLUTAMATE
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45
Q

What is the major neurotransmitter released from C fibers to bind with NK-1 receptors?

A

-Substance P

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46
Q

What is the tract name for the pain sensory?

A

Anterolateral system

  • Lateral Spinothalamic Tract
  • Ventral Spinothalamic Tract
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47
Q

What is the function of the Dorsolateral Tract?

A

Modulates Pain.

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48
Q

What ligand inhibits “Substance P” in the releasing nerve terminal?

A

Enkephalin (E)
(((Gate )))
(Another one may be Endorphins)

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49
Q

Name one Hydrophilic and three lipophilic opiods.

A

HYDROPHILIC:
-morphine

LIPOPHILIC:

  • alfentanil
  • fentanyl
  • sufentanil
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50
Q

Spinal Anesthesia works at receptor sites, but primarily at this receptor. (Bonus: What is the zone of rexed’s lamina?)

A
  • Mu1, Mu2, Kappa, Delta

- Zone 2 (Substantia Gelatinosa)

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51
Q

Supraspinal analgesia occurs when the opiod works on the brain in what areas and at what receptors. Which receptor is dominant in this function?

A
  • Limbic, Hypothalamus, thalamus
  • Mu1, Kappa, Delta
  • Mu1 is dominant
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52
Q

What type of pain is felt in Supraspinal analgesia?

A

Pain would be still felt, but the patient would not care.

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53
Q

Name all the opiods:

A
  • morphine
  • codeine
  • hydromorphone
  • meperidine
  • Fentanyl
  • Sufentanil
  • alfentanil
  • remifentanil
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54
Q

Name a opiod that is ultra short acting, metabolized by nonspecific plasma esterases, potent mu recptor agoinist and appears to lack delta and kappa agonist activity.

A

Remifentanil

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55
Q

Nam competitive opiod antagonist.

A

Naloxone
naltrexone
Nalmefene

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56
Q

Name the opiod agonist/antagonist.

A
  • Nalorphine
  • nalbuphine
  • Dezocine
  • butorphanol (stadol)
  • Buprenorphine
  • Pentazocine
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57
Q

Name the cranial nerves.

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. trochlear
  5. Trigeminal
  6. Abducen
  7. Facial
  8. Acoustic
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
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58
Q

Name from start to finish the route of CSF?

A
  1. Choroid Plexus
  2. Lateral Ventricles
  3. Foramina Munro
  4. Third Ventricle
  5. Aqueduct of Sylvius
  6. Fourth Ventricle
  7. Foramina of Lushka/Foramen of Magendie
  8. Subarachnoid Spaceof the spinal Cord
  9. Brain
  10. Arachnoid Villi
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59
Q

What is Cushing Triad?

A
  • Reflex increase in mean arterial blood pressure
  • Reflex decrease in heart rate
  • irregular respirations
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60
Q

Where should a central venous catheter with single orifice lumen be place and where should a multiple orifice lumen be place for a craniotomy?

A
  • The single central venous catheter should be place 3 cm above the junction of the right atrium and superior vena cava junction.
  • The multilumen ventral venous catheter should be place 2 cm below the junction of the right atrium and superior vena cava.
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61
Q

From time of birth, how long does it take for the anterior, posterior, Anterolateral, and posterolateral fontanelles to close.

A
  • Anterior is 18 months
  • posterior is 2 months
  • anterior lateral is 2 months
  • posterolateral is 2 years.
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62
Q

In relation to mechanical and electrical events of the heart the P wave represents.

A

-Atrial Depolarization

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63
Q

In relation to mechanical and electrical events of the heart the QRS complex represents.

A
  • ventricular depolarization (and atrial repolarization)
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64
Q

In relation to the mechanical and electrical events of the heart the PR interval represents.

A
  • atrial systole and AV nodal delay
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65
Q

In relation to the mechanical and electrical events of the heart the QT interval represents.

A

-Ventricular systole

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66
Q

In relation to the mechanical and electrical events of the heart the T wave represents.

A
  • ventricular repolarization
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67
Q

In relation to the mechanical and electrical events of the heart the U wave (not always present) represents.

A
  • precise activity unknown.
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68
Q

What are the leads and the coronary artery supply to the posterior inferior wall.

A

Leads are 2, 3, and AVF

Blood supply is Right coronary artery

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69
Q

What are the leads and the coronary artery supply to the septum and anterior wall.

A

Leads are V2, V3, V4, V5

Blood supply is left anterior descending (LAD)

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70
Q

What are the leads and the coronary artery supply to the lateral wall.

A

Leads are 1, AVL, V4, V5, V6

Blood supply is the Left circumflex

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71
Q

What is the equation for MAP.

A

MAP = (Cardiac output x SVR) / 80 + CVP

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72
Q

What is the equation for flow.

A

Flow = (pressure 1 - pressure 2)/ resistance

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73
Q

What is the equation for Ejection Fraction,

A

EF = Stroke volume / End Diastolic Pressure

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74
Q

What is the Frank Starling Law of the heart.

A

The greater the ventricular filling, the greater the preload. (When preload increases, stroke volume increases.)

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75
Q

What determines the contractility of the heart?

A

-Chemical environment of the cardiac cell.

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76
Q

T/F: Compared with the normal heart, the sized of the left ventricular chamber is not changed in the concentrically hypertrophied heart.

A

TRUE

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77
Q

What law is it when the volume overload causes the ventricular hypertrophy (eccentric).

A

Law of LaPlace

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78
Q

What is the equation to obtain Stroke Volume and what is the normal value.

A
  • Stroke Volume = Cardiac Output / Heart Rate

- 60 to 90 mL

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79
Q

What is the equation to obtain Stroke index and what is the normal value.

A
  • Stroke index = Stroke Volume / Body Surface Area

- 40 to 60 mL/m^2

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80
Q

What is the equation to obtain Systemic vascular resistance and what is the normal value?

A
  • Systemic Vascular Resistance = (80) (Mean arterial pressure - central venous pressure) / Cardiac output
  • 900 to 1500 dynes.sec.cm ^-5
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81
Q

What is the equation to obtain Pulmonary Vascular Resistance and what is the normal value?

A
  • Pulmonary Vascular Resistance = (80) (Pulmonary Artery Pressure - PCWP) / Cardiac Output
  • 50 to 150 dynes.sec.cm^-5
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82
Q

What nerve carries the afferent action potential to the brain from the BARORECEPTORS in the aortic arch?

A
  • Vagus nerve
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83
Q

What nerve carries the afferent action potential to the brain from the BARORECEPTORS in the carotid sinus?

A

-Glossopharyngeal nerve (hering’s nerve)

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84
Q

T/F: The carotid baroreceptors are physiologically more important than the aortic arch baroreceptors and are primarily responsible for minimizing acute blood pressure alteration.

A

TRUE

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85
Q

What does nitric oxide synthase converts the amino acid arginine to.

A

Nitric oxide

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86
Q

Where is Nitric oxide produced?

A

vascular endothelial cell

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87
Q

What enzyme does Nitric oxide activate?

A

Solubel guanylyl cyclase (sGC)

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88
Q

What is the second messanger when nitric oxide is used?

A

cGMP

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89
Q

What two drugs are used to produce Nitric Oxide action for smooth muscle relaxation?

A
  • Nitroprusside

- Nitroglycerine

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90
Q

Inamrinone (Inocor) and milrinone (Primacor) block the breakdown of this enzyme and cause an increase in ___ of the heart and a decrease in what hemodynamics. What is the muscle affected.

A
  • cAMP
  • Contractility
  • SVR
  • Smooth muscle
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91
Q

In mitral valve anterior Leaf motion in hypertrophic Cardiomyopathy (IHHS) the venture effect draws leaflet out as blood rushes by. Whose law is this?

A

Bernoulli’s Law

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92
Q

What would cause acute aortic regurgitation?

A
  • Trauma
  • endocarditis
  • aortic dissection
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93
Q

What is the normal aortic valve area?

A

2.5 to 3.5 cm ^2

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94
Q

What is considered sever aortic valve stenosis?

A

0.8 to 1 cm^2

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95
Q

What is considered critical aortic valve stenosis?

A

0.5 to 0.8 cm ^2

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96
Q

What is considered moderate aortic valve stenosis?

A

-1 to 1.5 cm^2

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97
Q

What is a considered a normal mitral valve opening?

A

4 to 6 cm^2

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98
Q

A patient has von willabrand disease and requires a dessmopressin for treatment. What is the dose?

A

0.3 mcg/kg IV over 10 to 20 minutes.

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99
Q

If given Dessmopressin what patient with von willebrand could develop thrombocytopenia.

A

type 2b von willebrand disease.

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100
Q

What type of blood would be given to correct von willebrand disease and what factor are in it.

A
  • Cryoprecipitate
  • Factor 1 (fibrinogen)
  • Factor 8
  • Factor 13
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101
Q

What factor aggregates platelets?

A

Factor 1 (Fibrinogen)

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102
Q

What is the most common inherited bleeding disorder?

A

Von Willebrand Disease

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103
Q

What is the second most common inherited bleeding disorder?

A

Hemophilia A (Factor VIII)

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104
Q

What is the treatment for Hemaphilia A

A
  • Fresh Frozen Plasma

- Cryoprecipitate

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105
Q

All the procoagulant except platelets are found in what blood source?

A

Fresh frozen plasma

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106
Q

How much will 1 unit of Packed Red Blood cells raise the hematocrit?

A
  • 3 to 4 %

- 1 gram/dL

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107
Q

How much will 1 cc/kg of RBC increase the Hemocrit?

A

1 %.

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108
Q

How much will one unit of platelet raise the count?

A

5000 to 10000 mm^3

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109
Q

What constitutes as a massive transfusion?

A

1 complete blood volume transfused in a 24 hour period.

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110
Q

Anti thrombin binds what factors?

A
  • 2
  • 10
  • 9
  • 11
  • 12
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111
Q

Would heparin be affective in a person with anti thrombin deficiency?

A

NO

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112
Q

The most common cause of an isolated high PT is.

A

Liver Disease

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113
Q

Cryoprecipitate contains what factors?

A

-VIII
- I
-XIII
(Remember cryoprecipitate is harvested from platelets thawing.)

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114
Q

What causes a rightward shift on the oxyhemoglobin dissociation curve.

A

Remember (Maternal RIGHTS)

  • (M)aternal Hb
  • (R)ight shift
  • (I)ncreased PCO2
  • Increased 2,3 DP(G)
  • Hydrogen ions
  • Temperature
  • (S)ickle cell
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115
Q

What causes a leftward shift on the oxyhemoglobin dissociation curve.

A
  • Fetal Hemoglobin (HbF)
  • Left Shift
  • Decrease in PCO2
  • Decrease in 2,3 DPG
  • Decrease in hydrogen ions
  • Decrease Temperature
  • Carboxyhemoglobin
  • Methemoglobin
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116
Q

Whose law permits the amount of dissolved oxygen in the blood to be calculated?

A

Henry’s Law

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117
Q

What is Bohr’s effect.

A

-It is the shift of the oxyhemoglobin Dissociation Curve to the right or left with the increase/decrease of CO2

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118
Q

How is most of the CO2 transported in the blood?

A

-Much of it DISSOVLES in the blood in the form of HCO3 (Bicarbonate) (90%)

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119
Q

What principle is used in the breakdown of CO2 in the red blood cells so the HCO2 (BiCarb) can be dissolved in the blood?

A

-Lachatelier Principle

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120
Q

What is Hamburger’s Shift?

A

-The exchange of Cl- for a HCO3- in the transportation in blood for CO2.

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121
Q

What is the (respiratory) inspiratory pacemaker called and where is it located?

A
  • Dorsal Respiratory Group

- Found in the medulla

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122
Q

Where does the Dorsal Respiratory Group send it action potential?

A
  • Diaphram

- external intercostal muscles

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123
Q

The ventral respiratory group (VRG) can influence both ______ and _____ (internal intercostals)

A
  • inspiration

- expiration

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124
Q

Where is the pneumotaxic center located.

A

High in the pons

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125
Q

Where is the apneustic Center located.

A

Low in the pons

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126
Q

What shuts off inspiration?

A

-Pneumotaxic center

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127
Q

What is the pontine respiratory group?

A

Pneumotxic center

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128
Q

The central chemoreceptors are stimulated by increased __: an increase in cerebral spinal fluid __ automatically leads to an increase in __.

A
  • H+
  • CO2
  • H+
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129
Q

What chemical normal drives respiration?

A

CO2

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130
Q

The glossopharyngeal nerve carries sensory impulses from the ____ bodies, and the vagus nerve carries sensory impulses from the _____ bodies and also from the stretch receptors found in the lung ________.

A
  • Carotid
  • aortic
  • parenchyma
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131
Q

When are the peripheral chemoreceptors most responsive to the decreases in arterial blood O2 when PaO2 falls below ___ mmHg.

A

60

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132
Q

What chemical are the central chemoreceptors stimulated by.

A

Hydrogen Ions

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133
Q

The Peripheral chemoreceptor are stimulated by.

A

PCO2

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134
Q

When the partial pressure of carbon dioxide in the cerebral spinal fluid increases the hydrogen and bicarbonate ion concentrations increase immediately–what principle or law applies?

A

LeChatelier’s principle (Mass action)

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135
Q

1 atm = _____ mmHg = ____ cm H2o

A
  • 760

- 1033

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136
Q

What is normal minute ventilation.

A

4 liter/minute

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137
Q

What is normal cardiac output.

A

5 liter/minute

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138
Q

What is the normal V/Q mismatch.

A

0.8

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139
Q

What is an absolute shunt equal to?

A

zero ventilation

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140
Q

What is an absolute deadspace?

A

Zero perfusion..

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141
Q

What is the normal PAO2 - PaO2 gradient?

A

-5 to 15 mmHg

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142
Q

What is the normal PACO2 -PaCO2 gradient?

A

-2 to 10 mmHg

143
Q

What is the Equation for finding if there is a V/Q mismatch?

A

PAO2 - PaO2 = 0.21 x (age -2.5)

144
Q

You will have a V/Q mismatch if the PAO2 - PaO2 gradient is above or below the normal gradient average?

A

-Above

145
Q

WHat is the normal PaO2/PAO2 ratio.

A

0.75 if less then possible shunt is occurring.

146
Q

A fully denitrogenated lung has oxygen reserve for up to.

A

10 minutes.

147
Q

What is the oxygen consumption (VO2)…

A

250 mL/min

148
Q

What is not measured by spirometry in lung volumes.

A
  • Functional Residual Volumes
  • Residual Volumes
  • Total Lung Capacity
149
Q

What is measured in spirometry in lung volumes?

A
  • Vital Capacity
  • inspitory reserve volumes
  • tidal volumes
  • inspiratory capacity
  • Expiratory reserve volume
150
Q

How do you measure Functional residual Capacity?

A
  • Helium Dilution
  • Nitrogen washout
  • Body plethysmography (Boyle’s Law)
151
Q

What value of a spirometry test shows if there is an obstruction vs. a restrictive issue?

A

-FEV1/FVC

152
Q

What spirometry test is best for assessing small airway disease.

A

-midmaximal expiratory flow (MMEF) or known as FEF 25% to 75%

153
Q

Name the obstructive Pulmonary Disease. (Airway Obstruction)

A
  • Asthmas

- COPD

154
Q

Name the restrictive pulmonary disease.

A
  • Pulmonary fibrosis
  • pneumothorax
  • Chest wall disease
  • Neuromuscular disease
155
Q

When is Functional residual capacity equal to Closing capacity in a older healthy UPRIGHT patient.

A

66 years ols

156
Q

When is functional residual capacity equal to closing coapacity in a SUPINE healthy middle age patient.

A

44 years old

157
Q

What is the percent and volume of blood received to the kidney from the heart.

A
  • 25%

- 1.25 L/min

158
Q

Which part of the kidney (medulla) is most vulnerable to ischemia

A

Inner stripe

159
Q

What part of the nephron is permeable to glucose.

A

-only the proximal tubule

160
Q

What is the most powerful stimulus for triggering the release of Antidiuritic hormone (ADH) or Vasopressin

A

Increase in extracellular osmolality.

161
Q

When extracellular osmolality is high is Antidiuritic Hormone or vasopressin increased or decreased, what does it do the urine osmolality, and the urine volume?

A
  • Increase ADH
  • 1200 to 1500 mOsm
  • 0.5 mL/kg/hour
162
Q

When extracellular osmolality is low is antidiuretic Hormone or vasopressin increased or decreased, what does it do the urine osmolality, and the urine volume.

A
  • Decrease in ADH
  • 50 to 100 mOsm
  • 2 to 25 mL/kg/hour
163
Q

T/F: Aldosterone is the most important hormone for regulating the extracellular fluid volume

A

TRUE

164
Q

Name the area and the percent of sodium absorption and excretion in the nephron. And what effect aldosterone has in the nephron.

A

Proximal Tubule absorbs 67 %
Ascending Loop of Henle absorbs 25 %
Distal tubule and common tubule can excrete or absorb 7% of Sodium if aldosterone is present.

165
Q

What three factors determine sodium excretion?

A
  • Glomural Filtration Rate (GFR)
  • renin release decreases
  • output of atrial natriuretic peptides
166
Q

How many molecules are reabsorbed in the Na+,K+, Cl- symporter in the ascending Loop of Henle.

A

Na+ is 1
K+ is 1
Cl- is 2

167
Q

What is the Na+, K+, Cl- symporter responsible for the _____________ in the medulla of the kidney.

A
  • osmotic gradient
168
Q

What diuretic inhibits the Na+, K+, Cl- symporter protein channel in the medulla of the kidney?

A

Loop diurectic (Furosemide).

169
Q

Where do Thiazides exert their influence in the nephron of the kidney and how?

A
  • Distal Tubule

- Inhibit the reabsorption of Sodium

170
Q

Where is Spirlactone exert its influence in the nephron and how.

A

Distal tubule and collecting tube

-Inhibiting aldosterone

171
Q

What type of acid/base balance would you see with carbonic anhydrase inhibitor. (Diamox or acetazolamide)

A

Hyperchloremic metabolic acidosis

172
Q

How do you know if acute kidney injury is prerenal failure or renal failure?

A

Fractional excretion of Sodium

- FEna 0.03 (renal failure)

173
Q

What controls threshold potential?

A

Calcium

174
Q

What controls resting membrane potential?

A

Potassium

175
Q

What variables and equation determine the pH.

A
  • PaCO2 and HCO3-

- Henderson-Hasselbach equation

176
Q

The incidence and secerity of aspiration pneumonitis are reduced if.

A

Gastric pH is above 2.5

gastric volume is below 25 mL (0.4 mL/kg)

177
Q

What drugs should be avoided with Parkingson Disease and why.

A

DRUGS:
reglan
droperidol
prochlorperazine

REASON:
These drugs are dopamine receptor antagonist activity (Competitive dopamine antagonists)

178
Q

What drug works on ht e peripheral 5 HT receptors.

A

Zofran

179
Q

Histamine 2 antagonist (________________) reduce gastric hydrochloric acid secretion, and this action increases gastric pH and decreases gastric volume.

A

cimetidine
ranitidine
famotidine

180
Q

T/F: Metoclopramide decreases gastric volume without altering pH.

A

True

181
Q

Zero Order Kinetics eliminates how much drug over.

A

Constant amount of drug overtime

182
Q

What few drugs use the zero order kinetics.

A

Alcohol
phenytoin
aspirin

183
Q

T/F: Most drugs are eliminated by first order kinetics.

A

TRUE

184
Q

What drug would be an example of first order kinetics in one compartment.

A

Albumin

185
Q

What drug would be an example of first order kinetics in two compartment.

A

All other drugs

186
Q

What is a equation for calculating volume of distribution.

A

Volume of distribution = (Quantity of the Drug) / (Estimated Concentration)

187
Q

What are the types of phase 1 reaction in the hepatic metabolism.

A

oxidation
reduction
methylation
hydrolysis

188
Q

What are the types of phase 2 reaction in the hepatic metabolism.

A

glucuronidation
glutathione conjugation
sulfation
acetylation

189
Q

What are the types of phase 3 reaction in the hepatic metabolism.

A

ATP binding cassete (ABC) transport

190
Q

Will mixing a weak acid with a low pH solution lead to the formation of a precipitate.

A

Yes

191
Q

Which is more important when considering duration. Protein or Lipid solubility?

A

Protein.

192
Q

List in order from greatest to least the local anesthetic loss from blood flow.

A
  1. Intravenous
  2. tracheal
  3. intercostal
  4. Caudal
  5. Paracervical
  6. Epidural
  7. Brachial plexus
  8. Subarachnoid, Sciatic, Femoral
  9. Subcutaneous

Mnemonic: I Think I Can Push Each Bolus SSlowly For Safety.

193
Q

Voltage gated sodium channels are found only in the ______.

A

Nerve’s Axon

194
Q

WHat is the treatment for local toxicity.

A

20% intralipid of 1.5 mL/kg followed with a 0.25mL/kg/min.

(If first round does not work!!!Rebolus with 1.5 mg/kg with a infusion of 0.5 mg/kg/min.

195
Q

List the plasma concentration with the order of toxic manifestation of lidocaine.

A

1 to 5 mcg/mL = Analgesia, Therapeutic

5 to 10 mcg/mL = Light headedness, tinnitus, visual disturbances, numbness of tongue, muscle twitching

10 to 15 mcg/mL = Seizure, Convulsions

15 to 25 mcg/mL = unconsciousness, Coma, Respiratory arrest

> 25 mcg/mL = Cardiovascular depression

196
Q

What is the normal Dibucaine number and the range.

A

Normal is 80

Range is 70 to 85

197
Q

If the dibucaine number is 20, the individual is a ______ for the abnormal (atypical) pseudocholinesterase.

A

Homozygote

198
Q

If the dibucain numb is 30 to 70, the individual is a _______ for the abnormal (atypical) pseudocholinesterase.

A

Heterozygote

199
Q

Prilocaine may induce the development of methemoglobinemia. It is said that ____ a metabolite of procaine is responsible

A

O-toluidine

200
Q

What is the molecule for methemoglobinemia (met-Hb)

A

F+++

201
Q

What is the treatment of methemoglobinemia.

A

Methelene Blue 1 to 2 mg/kg

202
Q

What law explains more inhalational agent will dissolve in blood if the patient is hypothermic: conversely less inhalational agent will dissolve in blood if the patient is hyperthermic.

A

LeChateliers Law

203
Q

List the vapor pressures of Desflurane, sevoflurane, isoflurane, enflurane, halothane.

A 
Desfurane = 669
Sevoflurane = 170
isoflurane = 240
Enflurane = 172
Halothane = 244 mmHG
204
Q

List the Oil:Gas Partition of Nitrous Oxide, Desflurane, Sevoflurane, isoflurane, Enflurane, Halothane.

A 
Nitrous Oxide = 1.4 (MAC 104%)
Desflurane     = 19 (MAC 6.6%)
Sevoflurane    = 1.8 (MAC 1.8%)
Isoflurane       = 91   (MAC 1.17%)
Enflurane        = 97  (MAC 1.63 %)
Halothane       = 224 (MAC 0.75 %)
205
Q

What is the Blood:GAS coefficient and % Equilibrium and 30 minutes.

A 
Nitrous Oxide = 0.46 (99%)
Desflurane      = 0.42 (91 %)
sevoflurane     =0.65 (85 %)
isoflurane        = 1.46 (73 %)
enflurane        = 1.9 (65%)
halothane       = 2.5 (58%)
206
Q

What is 1 mm Hg = ______ cm H20

A

1.36

207
Q

What is 1 atm = ______ mmHg = _____ psi = ___kPa = __bar

A
  • 760
  • 14.7
  • 101
  • 1
208
Q

1 psi = ___ mmHg

A

54

209
Q

The equation for Laplace is

A

Tension = Pressure x radius

210
Q

The equation for Laplace in the left ventricle:

A

Tension = (pressure x radius) / Thickness

211
Q

The equation for Laplace in a sphere:

A

Tension = (pressure x radius) / 2

212
Q

What law explains Laminar Flow?

A

Poiseuille’s law

213
Q

The equation of Poiseulle’s Law

A

Flow (Q) = ( (PIE) radius ^4 (gradient pressure)) / 8 (viscosity) (Length)

214
Q

What is the equation for resistance:

A

Resistance = (pressure gradient) / Flow

215
Q

What is the equation for laminar flow:

A

Resistance = (8 (viscosity)(length)) / (PIE) (Radius)^4

216
Q

At what angle does laminar flow begin to become turbulent.

A

25 Degrees

217
Q

What is the equation for Reynolds number:

A

Reynolds Number = ((velocity) (density)(diameter)) / Viscosity

218
Q

What is Reynolds number when laminar flow turn to turbulent flow?

A

1500 to 2000

219
Q

What law is being discussed when you squeeze ambu bag?

A

Boyle’s Law

220
Q

What law is being discussed when a laryngeal mask airway expands when placed into an autoclave for sterilization.

A

Charle’s law

221
Q

What law explains whey a cylinder when taken from a cold environment and place in a warm environment causes the pressure to increase?

A

GayLussac’s

222
Q

What is the equation for the generalized ideal (universal) gas law?

A

pressure x volume = (moles of gas) (universal gas constant) (temperature)

223
Q

What is one mole?

A

Molecular Weight of a substance

224
Q

What is van der Waal’s equation.

A

(Pressure + (finite volume)/v^2) (Volume - molecules attract) = nRT

225
Q

What is the equation for Dalton’s Law:

A

P Total = P1 + P2 + P3 + P….

226
Q

What is the make up of atmosphere at sea level using Dalton’s law.

A 
O2 = 160 mmHg = 21%
N2 = 600 mmHg = 79 %
227
Q

What is Avogadro’s Number

A

6.022 x 10^23

228
Q

What is Avogadro’s Hypothisis?

A

One mole of a gas at satandard temperature (0 C) and standard pressure (1 atm) occupies a volume of 22.4 liters.

229
Q

What is the major determinate of intravascular volume?

A

Albumin.

230
Q

What is the partial pressure of saturated water vapor at 37 C

A

47 mmHg

231
Q

Where is the widest opening in the epidural space?

A

L2 (5 to 6 cm)

232
Q

Where is the narrowest at the epidural space?

A

C5 (1 to 1.5 cm)

233
Q

How long in the spinal cord?

A

42 to 45 cm

Extends from the foramen magnum to lumbar level L1 in adults) (PEDS is L3

234
Q

What is the baracity of water.

A

1

235
Q

What is the specific gravity of CSF.

A

1.004 to 1.009

236
Q

Rate of elimination determines the ____ of spinal anesthesia

A

duration

237
Q

At what level is a neuroaxial block considered a high spinal.

A

> T4

238
Q

When should a neuroaxial catheter be place OR removed when patient is on Warfarin.

A

INR

239
Q

What is the most accurate assessment of overall sensory block in a neuraxial block.

A

Pinprick

240
Q

What is the most sensitive indicator of initial onset of sensory block dealing with temperature.

A

Alcohol Swab

241
Q

What is the medication, concentration, and volume for a caudal epidural block in a child.

A

Bupivacaine 0.125 % to 0.25 % at 0.5 to 1 cc/kg

242
Q

What is the medication, concentration, and volume ofr a caudal epidural block in a premature Infant.

A

Chloroprocaine ?% at 1 mL/kg INTIAL then 0.3 mL/kg until desired level is achieved.

243
Q

Cervical plexus block requires how much volume.

A

4 cc.

244
Q

Interscalen Block require how much volume.

A

40 cc

245
Q

What is the volume of suprclavicular block

A

40 cc

246
Q

Name that arm block in which the arm can be in any position and pneumothorax is the greatest risk.

A

Supraclavicular block

247
Q

The Infraclavicular brachial plexus block will the musculocutaneous.

A

Yes

248
Q

For a median, ulna, or radius block at the elbow the volume would be.

A

4 cc

249
Q

What would be the volume for a block at the wrist for ulnar or median.

A

3 cc

250
Q

What would be the volume for a block at the wrist for a radial nerve.

A

6 cc

251
Q

What is the volume for a block on the finger.

A

2 cc

252
Q

What nerve roots consist of the femerol nerve.

A

L1 to L4

253
Q

What nerve roots consist of the sciatic nerve.

A

L4 to S3

254
Q

The volume of a intercostal nerve block.

A

3 cc

255
Q

Functional residual capacity will have been reduced by 20 % due to what being displaced by how much. (Page 388 of Valley Anesthesia)

A

Diaphragm is displace by 4 cm

256
Q

What value do not change in breathing during pregnancy

A

Total lung capacity, vital capacity, inspiratory capacity

257
Q

Would a PaO2 be higher in a pregnant or non-pregnant state.

A

Pregnant

258
Q

Would a PaCo2 be higher in a pregnant or nonpregnant state.

A

Non pregnant

259
Q

The increase in oxygen consumption produces a __ increase in alveolar ventilation at term. The tidal volume will increase by ___ and the respiratory rate increases by up to __ reflecting the increase in alveolar ventilation. The increase in alveolar ventilation and decrease in the functional residual capacity enhance the maternal uptake of inhaled anesthetics.

A
  • 70%
  • 40%
  • 15%
260
Q

What is the increase in cardiac output in the latent phase, active phase, Second stage, Postpartum of a pregnant woman.

A

Latent - 15
active - 30
second - 45
postpartum - 80

261
Q

Blood volume increases ____ and red blood cells increase by ___ , and plasma increases ___.

A
  • 33 to 40 %
  • 30 ml/kg
  • 70 mL/kg
262
Q

How much blood is dedicated to the uterus during pregnancy.

A

700 to 800 cc/minute

263
Q

What must systolic pressure be kept at to maintain maternal perfusion pressure to the vasculature.

A

100 mmHg

264
Q

Proper hemoglobin and hematocrit for a pregnant woman.

A 
Hemoglobin = 11.6 grams/dL
-Hematocrit = 35.5 %
265
Q

What does giving narcotics, valium and ATROPINE do to the lower esophageal sphincter tone, does it increase or decrease gastric emptying, and what does it do to the fetus.

A
  • Decreases esophageal sphincter tone
  • Increases gastric emptying
  • depresses the fetus
266
Q

Renal plasma flow and glomerular filtration rate ______ 50 to 60 % _________ normal by the fourth month of gestation and slowly return to normal during the third trimester.

A
  • increase

- above

267
Q

Glomerular filtration rate increases ___ by 16th gestational week and remains elevated until delivery.

A

50

268
Q

24 hour creatinine clearance values are increased by ___ week until delivery.

A

8th

269
Q

Normal decreases in BUN and serum creatinine are due to increases in renal __________ and glomerular filtration rate.

A

blood flow

270
Q

What is the equation to know ETT size of a children.

A

(age in years/4)+4

271
Q

What is the ETT length in children.

A

Height (cm)/10 + 5

or

weight (kg)/5 +12

272
Q

How will an infant present for pulmonary aspiration?

A
  • Apneic

- Bradycardia

273
Q

Increased incidence of postoperative apnea in former preterm infants, born before __ weeks

A

37

274
Q

List the congenital anomalies with T-E fistula association of VACTERL.

A
  • Vertebral Defect
  • Anal Atresia
  • Cardiac Anomalies
  • Tracheoesophageal Fistula
  • Esophageal atresia
  • Renal Dysplasia
  • Limb anomalies
275
Q

Describe what the most common T-E fistula is and the diagram name.

A
  • Esophageal ends in a blind pouch and a lower esophagus that connects to the trachea. (85%)
  • Usually it C.
276
Q

What type of electrolyte imbalance would you have with pyloric stenosis.

A
  • Hypokalemia

- Hypocloremia metabolic alkalosis (primary) with secondary respiratory acidosis

277
Q

How do you prepare epinephrine to give via a nebulizer and when can you repeat the treatment?

A

A 2.25% Epie in 3 mL normal saline is given a 0.05 mL/Kg up to 0.5 mL/Kg every 1 to 4 hours.

278
Q

Hemophilus influenza, streptococcus, pneumococcus, and mycoplasma pneumonia are common casues of _____.

A

Otitis media

279
Q

APGAR scoring of one minute score correlates with _____ and the five minute score is related to ______.

A
  • Survival

- Neurologic outcome

280
Q

An APGAR score of 0 to 2 means _____, An APGAR score of 3 to 4 means ______, and an APGAR score of 5 to 7 means ______.

A
  • intubate and compression
  • temporary assisted ventilation
  • stimulation and blood oxygen across face.
281
Q

What is the decline in end organ function after age 30.

A

1 %

282
Q

What is Apoptosis..

A

Cell Death

283
Q

What is the reduction of blood volume in the geriatric patient.

A

20 to 30 %

284
Q

Younger patient shiver at __ C, patient over the age of 80 years shiver at __ C. Shivering increases oxygen consumption up to ____, which leads to________________compromise.

A
  • 36.1 C
  • 35 C
  • 400
  • Hypoxia, acidosis, cariopulmary
285
Q

What two drugs must be increased in the elderly.

A

Atropine

Isoproterinal

286
Q

How much does cardiac function decrease from age 20 to 80 years of age.

A

50 %

287
Q

What kind of heart sound may be heard in the elderly due to thickening of the aortic valve cusps, ventricle thickening, decrease in myocardial compliance.

A

Midsystolic ejection murmer

288
Q

The A to a gradient increases from__ mmHg in the 20 year old to __ mmHg in the 70 year old.

A

8

20

289
Q

At what age will you begin to see a PaO2 decrease and by how much.

A

20

0.5 mmHg

290
Q

WHat is the most common post operative problem in older adults?

A

-Delirium (15 to 20 %)

291
Q

What are the two most common older adult type of procedure that cause delirium.

A
  • Ortho (First) (28 - 60 %)

- Cardiac (Second) (32 - 47 %)

292
Q

What is the most common comorbidity in the elderly and what follows second?

A
  • Hypertension is first

- CAD is second.

293
Q

Epidural volume tends to result in more extensive cephalead spread of anesthetics, but accompanied by a shorter duration of analgesia and motor blockade.

A

True

294
Q

True/False: Plasma cholinesterase levels are reduced in elderly men.

A

TRUE

295
Q

Renal blood flow deceases by __ each year in the elderly.

A

10 %

296
Q

GFR decreases by _______ per DECADE in the elderly.

A

6 to 8 %

297
Q

Mac is decreased by how much over the age of 40.

A

4 to 6 %

298
Q

What is Broco’s index?

A

Ideal body weight

299
Q

What is the equation for ideal body?

A 
Females = height(cm) - 105
Males     = height(cm) - 100

or

BMI = body weight in kg / height (cm) ^2

300
Q

What is the equation for lean body weight?

A

Lean body weight = (idea body weight) + or - 20 to 40 %

301
Q

Waist circumference greater then ____ cm (40.2 cm) in men and greater than __ cm (34.6 inches) in women denotes an increased risk for certain diseases and conditions.

A
  • 102

- 58

302
Q

What lung values typically do not change in the obese patient.

A

Tidal volume
residual volume
Closing capacity

303
Q

What does FRC =

A

ERV + RV

304
Q

What does TLC =

A

FRC + IC

305
Q

What test is the definitive for OSA?

A

Pplysomnography in the sleep lab

306
Q

How is obesity hypoventilation syndrome (Pickwickian syndrome) defined.

A 
> 30 BMI
> PCO2 45
hypercapnea, 
Daytime hypersomnolence, 
arterial hypoxemia
cyanosis induced polycythemia
respoiratory acidosis
pulmonary hypertension
right sided heart failure
307
Q

What EKG changes will be seen wiith the obese patient.

A
  • low QRS voltage
  • LV hypertrophy
  • Left atrial enlargement
  • flattened T waves
  • leftwar shift of P wave, QRS, complex, T wave axis,
  • Prolonged QT interval
308
Q

What type of bioactive mediators does obesity produce in the body.

A

-cytokines
- chemokines
-hormones
(produce CAD, DM2, coagulopathies)

309
Q

WHat type of complaints in the obese patient may point to rhabdomyolysis.

A
  • Buttocks pain
  • shoulder pain
  • hip pain
310
Q

How much of the a B/P bladder should encircle the arm?

A

75%

311
Q

What is the only ventilator parameter to improve respiratory function in the obese patient?

A
  • PEEP
312
Q

What is the O2 and NO2 wall gas hose to anesthesia machine.

A

50 PSIG

313
Q

Explain what a check valve is and its function.

A
  • free floating valve
  • unidirectional gas flow
  • prevents E-cylinder gas flow to lower pressure system such as the wall gases.
314
Q

What kind of valve is used on the Hanger Yoke system (back of anesthesia machine).

A 
Check valve (Free floating) 
PISS (pins index safety system)
315
Q

What is the name of the gauge that shows the oxygen tank pressure.

A

Boudon

316
Q

You have a dual hanger yoke with two oxygen E cylinders. Both cylinders are turned on; which one will supply the gas machine.

A

-E cylinder with the highest pressure.

317
Q

In a dual hanger yoke system, what prevents one cylinder from emptying into the other?

A
  • the free floating valve
318
Q

What does a regulator do?

A

Only reduces pressure

319
Q

Where does the first stage regulator work and by how much does it reduce pressure.

A
  • Works at the hanger yoke, reduces E cylinder pressure to 45 psig (intermediate pressure)
  • Slightly less than wall psig to prevent depletion of Cylinder gas when attached to wall gas pressure
320
Q

Where does the second stage regulator work and by how much does it reduce pressure.

A

Receives the gas from the first stage regulator and decreases the pressure to 16 psig.

321
Q

What is the pressure of the oxygen flush valve and what is the L/min flow rate.

A
  • 40 to 50 psig

- 35 to 70 L/minute

322
Q

What is the pressure and volume of an O2, N20, and air tank.

A
  • O2 is 1900 psig with 660 Liters
  • N20 is 745 psig with 1590 Liters
  • air is 1900 psig with 625 Liters
323
Q

Where in the pressure Sensor shut off Valve does oxygen and nitrous oxide mix?

A
  • No missing of gases occurs. It senses the pressure of the O2 gas.
324
Q

What type of Pressure Sensor shut off valve does OHMEDA use.

A

-All or nothing

325
Q

What type of pressure sensor shut off valve does Drago use.

A
  • o2 failure device

- proportioned

326
Q

What is the pressure that a pressure sensor shut off valve must be at to cause flow of said N20 gas.

A

25 psig

327
Q

Where would you read the flow rate in a float ball in a Thorpe tube.

A

middle of ball

328
Q

Where would you read the flow rate in a arrow float.

A

Top of float

329
Q

What is annular space.

A

-Amount of O2 that can pass around a float in one minute.

330
Q

Tell me the characteristic of a O2 knob on a anesthesia machine.

A
  • Bigger
  • to the right of other knobs
  • fluted
  • green
  • sticks out more
331
Q

A check valve located between the vaporizer outlet and the machine common gas outlet is found on what brand of machine?

A

Ohmeda machine

332
Q

What direction will a check valve allow gas.

A

One way

333
Q

What would happen if the ispiratory valve sticks open?

A

Expiratory volume will exhaust through the inspiratory limb. The ETCO2 wave will become elevated

334
Q

What happens if the expiratory valve sticks open?

A

Due to the path of least resistance the inspired volume will not enter the endotracheal tube but instead will bypass and exhaust through the expiratory limb

335
Q

What does the APL valve do.

A

Increase the pressure limit in the patient circuit and rebreathing bag

336
Q

Where is the APL valve located.

A

Expiratory limb

337
Q

What occurs if the vaporizer is tipped..

A

It may allow liquid vapor to get into the vapor chamber and carry more agent to the patient.

338
Q

What consist of the high pressure system on the anesthesia machine.

A
  • E cylinder
  • Pins index safety system
  • Hanger yoke
  • Check valve
  • Bourdon gauge
  • First stage regulator of 1900 psig to 45 psig
339
Q

What consist of the intermediate pressure on the anesthesia machine.

A
  • Flush Valve
  • Oxygen pressure shut off valve (fail safe system)
  • Pressure gauges from wall gas outlet (Bourdon)
  • Diameter index safety system
  • Flow control valve of manifold
  • Second stage regulator from 50 to 16 psig
340
Q

What consist of the low pressure system on the anesthesia machine.

A
  • vaporizer,
  • common gas outlet,
  • manifold
  • check valve
341
Q

What type of Marking will all medical and anesthetic gases have on them.

A

ICC3S (Interstate Commerce Commission 3 Specification)

342
Q

What is the safety device on every e cylinder that will exhaust the gas in cylinder should excess of heat or fire happen.

A 
Safety plug (melts at 200 F)
-consist of (wood's metal) bismuth, lead, tin, and cadmium
343
Q

What is the most commonly used semi-open system used today.

A

-Bain circuit (7th circuit)

Modified Mapleson D circuit

344
Q

What solutions can be used to clean a LMA?

A
  • Sodium bicarbonate (8 to 10%)
  • Endozime
  • Steam Autoclave (Remove air from cuff
345
Q

What is the maximum use of one LMA.

A

40

346
Q

What are the Bispectral Index Monitoring Range Guidelines.

A 
100 = awake
90 to 70 = Light/moderate sedation
70 to 60 = Deep sedation (Low probability of recall)
60 to 40 = General Anesthesia
40 to 10 = Deep hypnotic state
10 to 0   = EEG flatline
347
Q

Pulse oximetry uses two wavelengths and those wavelength absorb what type of light.

A
  • 660 nm = red light for deoxyhemoglobin

- 940 nm = infrared light for oxyhemoglobin

348
Q

How will the blood pressure change from a noninvasive to a invasive form of monitoring?

A

20 mmHg in blood pressure.

349
Q

Karotkoff sounds identify the onset of?

A

Systole.

350
Q

What is the first and second most common complication of a meiastinoscopy.

A

1st is hemorrhage
2nd is pneumothorax
Usually on right side.

351
Q

What is the diagnostic triad for pheochromocytoma?

A
  • Diaphoresis
  • Tachycardia
  • Headaches
352
Q

Where is Pheochromocytoma usually found (95%) of the time.

A

Stomach

353
Q

Where is Pheochromocytoma usually originates 90% of the time in the?

A

Adrenal Medulla

354
Q

What is a carlens, White, and robertshaw tubes used for and describe each..

A

Used for ONE LUNG VENTILATION

  • Carlens is a left sided double lumen with carinal hook
  • White is a right sided Carlens tube
  • Robertshaw is a double lumen tube available in right or left clear plastic that does not have a carinal hook.

Anesthesia (1 decks)

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