RANDOM/ PRODIGY TRIVIA/VALLEY BOOK Flashcards
Parasympathetic does not include fibers of
CN8
What is the opioids with the highest protein binding?
Sufentanil
NDNMB are what kind of compounds?
Quaternary compounds
What type of diuretics can cause hyperKalemia?
Spironolactone (Potassium sparing diuretics)
What amount of hepatic blood flow comes from the portal vein?
70%
70% of hepatic blood flow comes from the
PORTAL VEIN
What % of calcium is in the ionized form?
50%
Serotonin act as a _________in all tissues, except
Vasodilator ; HEART and skeletal muscles
All of the following should be avoided in carcinoid syndrome
Morphine
Atracurium
fentanyl
Apneic oxygenation during bronchoscopy can lead to
HYPERCARBIA
Fenoldopam on BP
Decreases arterial BP
ARDS is defined as
Acute respiratory failure due to pulmonary injury.
Most suitable for inductin controlled hypotension agent
sodium nitroprusside
CHF is usually caused by
Systolic dysfunction
High cardiac output heart failure is associated with
Sepsis
How does midazolam depresses ventilation?
By decreasing the Hypoxic drive.
Butyrephenones drugs classes are
droperinol and haloperidol
Pt taking MAOIs should avoid
Avocado
The most common manifestation of folic acid deficiency of
Megaloblastic anemia
Carbamezepine helps prevent seizures by primarily
blocking Na+ Channels.
Folic acid antagonists
methotrexate
Acetazolamide is used in treatment of
Altitude sickness
Glaucoma.
Clonidine 0.3mg will not decrease plasma catecholamine in patient w/
Pheochromocytoma.
Dopexamine is similar to Dopamine except that it is devoid
alpha-1
Other name for German measles
Rubella
Prions are responsible for what type of encephalopathy?
SPONGIFORM
Pacemaker of the respiratory system
Dorsal Respiratory Group
Bronchospam with what level of Ca2+
Hypocalcemia
Most common blood transfusion is transmitted via
Hep C
Desflurane differs from isoflurane is chemical structure by how many atoms
1
Condition also known as acute idiopathic polyneuritis
GBS
Drug that increases Lower esophagus sphincter tone and lower aspiration risk ? reversal
Edrophonium
ABG associated with asthma is
Respiratory alkalosis
Platelets half life is
1-2 weeks
In the presence of Ca2+ activated factor XI, will activate factor
IX
What is the most significant risk factor for an acute ischemia stroke?
HTN
The most common complication associated with this procedure is stroke caused by
thromboembolism
Cheyne-Stokes respiration
Bilateral dysfunction of cerebral hemispheres
Midbrain and upper pons
Central neurogenic hyperventilation
Low midbrain and upper pons
Increased intracranial pressure with head trauma
Deep, rapid, and regular pattern of breathing
Central neurogenic hyperventilation
Describe Cheyne-Stokes respiration
Regular increase in the rate and depth of breathing that
peaks and is followed by a decreasing rate and depth
of breathing, which progresses to apnea; then
the cycle repeats itself
Apneusis breathing
A pause at full inspiration occurs; may see prolonged
inspiratory pause alternating with prolonged expiratory pause
Ataxic breathing Location of Injury and Other Causes
Medulla
Irregular breathing with shallow, deep respirations
and irregular apneic episodes; usually slow
Ataxic breathing
Acute ischemic stroke BP range for thrombolysis / no thrombolysis
Keep < 180/110 mm Hg if thrombolysis
Treat only BP > 220/120 if no thrombolysis
Intracerebral hemorrhage BP range
Keep SBP < 180 and MAP < 130 mm Hg
ideal SBP < 160 and MAP < 110 mm Hg
Subarachnoid hemorrhage BR range.
Keep SBP < 160 mm Hg before aneurysm treated
Do not lower BP after aneurysm treated
Traumatic brain injury
Keep MAP to maintain CPP > 60 mm Hg
In cell-mediated immunity, the antigen is presented to the
T lymphocyte by infected cells or by antigen-presenting cells such as dendritic cells, macrophages, or B lymphocytes.
Virchow’s triad includes
hypercoagulability, venous stasis, and vessel wall abnormalities.
Virchow’s triad is a set of three factors that predict a
high risk for pulmonary embolism.
Pericardial sac approximately
10 to 25 mL of serous fluid,
Venous drainage ==> What are the 3 major systems?
coronary sinus
the anterior cardiac veins
Thebesian veins
Three major internodal tracts exist:.
the anterior, middle, and posterior
internodal tracts
The anterior internodal tract, or Bachmann bundle,
extends into the LA and then travels downward through the atrial septum to the AV node.
The middle internodal tract, or Wenckebach tract, curves behind the
superior vena cava before descending to
the AV node.
The posterior internodal tract, or Thorel’s pathway,
continues along the terminal crest to enter the
atrial septum and then passes to the AV node.
From anterior to posterior tract
BWT
Proposed mechanism whereby the inhaled anesthetic agents cause depression of myocardial contractilityInhibition of calcium
Influx into cardiac muscle cells is the proposed mechanism whereby the inhaled anesthetic agents cause depression of myocardial contractility
Pericardial tamponade affect what?
Restricts filling of the cardiac chambers during diastole and produces a fixed low cardiac output
Pericardial tamponade IV anesthetic of choice
Ketamine
Connective disease associated with corneal disturbances
Scleroderma
Trisomy 13 aka
Patau’s disease
Ludgwig’s angina is characterized by
Rapidly expanding cellulitis of the mouth, infection of trismus.
Relative contraindication in hypertrophic cardiomyopathy
VASODILATORS
WPW may present as
Paroxysmal SVT
Cocaine effects on HR mainly through
Blockade of Na+ Channels
Bleomycin leads to what kind of toxicity
Pulmonary
Paget’s disease is a disorder that affects
Bone
Largest parenchymal organ is
LIVER
AKI most frequently
ATN
Herbal associated with prolonged sedation
Kava Kava
Decrease pain transmission signal
Enkephalin
Cisatracurium class
Benzoisoquinolinium
Beta Blocker with the highest degree of protein binding
PROPRANOLOL
% of CO goes to the Kidney
25% of CO every minute
3 types of FLOW
Laminar
Turbulent
Transitional
Bernoulli’s principle relates the effect of flow a tube that contains
Constriction
Theoretical temp of absolute zero
0 degree Kelvin
Vapor pressure of liquid solely dependent on
Temperature
Reynold > 2000
Turbulent flow
Reynolds < 2000
Laminar
Nebulizers rely on this effect to deliver medication
Venturi effect
Whose equation corrects the universal gas law
Van der waal
Cell splits into 2 new cells
Mitosis
How many pair of chromosomes
23
Chemical substance that can cause cellular mutation
Carcinogens
Dark areas crossing cardiac muscle fibers
Intercalated discs
Calcium release channels are known as
Ryanodine receptors
Nitroprusside generates
Nitric oxide–> cGMP
Antiarrythmic drugs inhibiting K+ ions
Amiodarone/sotalol
Digitalis toxicity treated with
Phenytoin
Synthetic NONcatecholamine medication
Ephedrine
ALpha adrenergic antagonist used for BPH/HTN
Prazosin
Carbonic anhydrase inhibitor example? What is it used for
Acetazolamide, glaucoma
Upon what receptors does nalbuphine act? (select two)
Mu and Kappa
After intravenous administration of fentanyl, there is an initial rapid increase in plasma concentration of the drug
followed by a rapid decline in plasma administration. This initial, rapid decline is due primarily to
redistribution to highly-perfused organs
Which calcium channel blockers inhibit CYP450? (select two):
Diltiazem &Verapamil
Propofol metabolized by
Partially 3A4 BUT CYP 2B6 main one
Which class of CCBs is verapamil?
Phenylakalanine
Onset of heparin SQ
1-2h
Describe relationship of between LVEDV/SV
Frank Starling.
Coronary Perfusion Pressure formula
Diastolic BP - LVEDP
Most common congenital cardiac abnormality in infants and children
VSD
Most common CYANOTIC congenital heart abnormality
Tetralogy of Fallow
Ebstein anomaly involves what valve
Tricuspid
Normal venous O2 sat
75%
Equation can be used to estimated physiologic-dead space ventilation
Bohr
Vital capacity in elderly
Increased
2 lungs parameters increase with pneumoperitoneum
PIP, Intrathoracic pressure.
First line of defense against unfavorable changes in pH
Buffers
Physiologic dead space =
Anatomic + functional dead space
The administration of epidural steroids can produce an antiinflammatory effect primarily by the inhibition of
Cytokines & Phospholipase A2
sacroiliac joint with radiation to the groin, medial buttocks, and posterior thigh with occasional
radiation below the level of the knee is consistent with what syndrome?
Pyriformis syndrome
How long after a single epidural injection of methylprednisolone 80 mg would you expect the patient’s ability to secrete cortisol to be impaired?
3 weeks
Remifentanil have lower _____and _____clearance when compared to fentanyl
Vd; clearance
What is the most important buffering system in the body
HCO3 (bicarboate system)
What is the enzyme necessary for Prostaglandins synthesis?
Cyclooxygenase
NSAIS on cyclooxygenase
inhibits
Avoid this drugs with porphyria
DILANTIN
Alveolar gas equation is used to estimated
PaO2
Cyclosporine is most likely to cause toxicity to the
kidneys
Drugs with little to no effect on systemic circulation
N2O
H2 receptor antagonists will cause an
Increase in gastric fluid pH
Drugs must likely beneficial to patient with WPW
Droperinol (dopamine antagonist)
Most common cause of Mitral stenosis
Rheumatic fever
Not an ACYNOTIC but a CYANOTIC heart defect
TOF
What medication antagonize the action of ADENOSINE
THEOPHYLLINE
WPW avoid this drug
VERAPAMIL or cardizem
Commotio cordis is
Blunt chest wall impact
Commotio cordis affects what organ
Heart
20% of athletic injury
commotio cordis
Stimulus for the release of arginine vasopressin arises from
osmoreceptors in the hypothalamus that sense an increase in plasma osmolality.
Not an indirect lung injury
Near drowning
Ependymoma can most commonly be found in the floor of what ventrile
Fourth
Normal pressure hydrocephalus TRIAD (DUG)
DEMENTIA
Urinary incontinence.
Gait changes
Obstructive hydrocephalus is when
CSF outflow is blocked at the LEVEL OF THE AQUEDUCT OF SILVIUS in the 4th ventricle
Tuberous sclerosis aka
Bournovilles disease
Erwing’s sarcoma is a malignancy that affects
bone
2 most common symptoms of SLE
Polyarthritis AND Dermatitis
MALAR RASH 1/3 patients
Gitelman’s disease is an inherited
Renal salt wasting disorder
What is the most common neoplasm in infants
NEUROBLASTOMA
Laryngeal Papillomatosis is caused by
HPV types 6 and 11
Crouson’s syndrome is a
Cranial dysostosis
Atrial systole increase CO by
20-30%
Left coronary artery division
LAD and Circumflex
What creates Lead II (NRAPLL)
What creates Lead III (NLAPLL)
Negative Right Arm Positive Left Leg
Negative lead on L arm and positive lead on L leg.
Junction between S wave and ST segment
J-point
Where is lead V2 placed
Left sternal border @ 4th intercostal space
Unipolar limb leads
avF
BLood type with neither A or B Agglutinogen
Type O
Where in AV node located
Right Atrium
What is Stokes-Adams syndrome?
Fainting spells associated with periodic cessation of A-V conduction
Angiotensin II on sodium
Sodium retention
Filtration fraction =
GFR/ RBF
Visual signals terminate in what lobe of the brain?
OCCIPITAL
Syndrome when only ONE site of the SPINAL CORD is TRANSECTED (incomplete)
Brown Sequard syndrome
Concentration of dissolved gas/solubility coefficient equals
Partial pressure.
Mapleson circuits requires the lowest low FGF
Mapleson D
Most commonly used laser for laryngeal surgery
CO2
Blepharospasm (involunteray movement of eyelid) is a
tonic spasm of orbicularis oculi
Sympathetic innervation and insulin
causes a decrease in insulin secretion via ALPHA-2
Which agent causes no change in the LATENCY or amplitude of SEEP waveform
Dexdemetomidine
Larynx levels
C3-C6
How many segments in the RLL
5
Difficulty swallowing would reveal dysfunction of what CN
IX
Diencephalon 2 parts
Thalamus
Hypothalamus
SA Node aka
Keith Flack node
Batman whacked THOR (AMP)
Batman - Bachmann bundle–> anterior tract
Whacked - Wenckebach tract –> middle tract
Thor - Thorel –> posterior tract
Digitalis (digoxin) is a
Cardiac glycosides
Inotropic effect of digitalis is achieved by
Binding to the alpha subunit of the sodium potassium ATPase in cardiac cells.
S/s of digitalis toxicity
Diarreha, n/v, headache, fatigue, colored vision
What is contraindicated in patient taking digitalis
Calcium (may lead to cardiac arrest)
Larynx begins at the ______and extends to the _____-
Epiglottis; Cricoid cartilage
Most common electrolyte abnormality in hospitalized patients?
Hyponatremia
Changes in banked blood : Factors missing
LaCk Factor V and VIII
Resting cardiac cell membrane is relatively permeable to what electrolytes
POTASSIUM
SLE : medications that can be exacerbate SLE are PHID-ME
Procainamide Hydralazine Isoniazid D-Penicilllamine Methyldopa
Heart issues with SLE
Diffuse SEROSITIS leads to PERICARDIAL effusion
Drugs to treat SLE
Antimalarials
Corticosteroids
Immunosuppresants (reduce corticosteroids requirements)
Condition able to precipitate SLE (PIS)
Pregnancy
Infection
Surgical stresses
SLE : on pulmonary : restrictive vs obstructive
Restrictive
SLE prone to
pleural effusion, pneumonitis, alveolar damage, pulmonary HTN.
Cyclophosphamide consideration
inhibits plasma cholinesterase so may prolong ESTER LA and SUCCINYLCHOLINE
Equation of H2O + CO2 –>
H2CO3 –>
Sensory nerve supply to nasal mucosa comes from
Trigeminal nerve
Stimulation of the atrial stretch receptors will produce
Diuresis
Hemodynamic management of Cardiac tamponade
Increased PRELOAD
The ratio of effective beta: alpha-blockade is approximately (BA)
7:1.
Clonidine alpha 2 to alpha 1 ratio
200 : 1
Dexmedetomidine alpha 2 to alpha 1 ratio
1600:1. (about 7 times more than clonidine)
Should clonidine be continued during the perioperative period?
yes, because ABRUPT discontinuation can lead to HTN and tachycardia
What is the hallmark of ASPIRATION PNEUMONITIS?
Arterial Hypoxemia
Beta-2 receptor stimulation on fat cells
lipolysis
CN supplies PNS innervation to the parotid Gland
CN IX
Metabolite of Norepinephrine
Vanillylmandelic acid
Gas with the highest VP
Desflurane
Primary action on clonidine to reduce BP
Primarily on CENTRAL (not peripheral) ALPHA-2 receptors.
Primary indication for dexdemetomidine is
Short sedation in critically ill patients
2 main side effects of dexdemetodimidine
Hypotension , bradycardia
Intended drug effects of dexmedetomidine
SAAS
Sedation
Anxiolysis
Analgesia
Sympatholysis
Clonidine causes analgesia via
SUPRASPINAL and SPINAL adrenergic receptors and DIRECT INHIBITORY effects on PERIPHERAL nerve conduction (A and C nerve fibers)
Gas with low molecular weight
N2O
Is Nitrous flammable
NO
Another name for scopolamine
Hyoscine
Highest pKA among opiods
MEPERIDINE
What is the only corticosteroid amount other administered orally
Prednisone
What are the 3 methyxanthines
Caffeine
Theophylline
Theobromide
Tricuspid stenosis on CVP waveform
Large A wave
Nitrogen mustards drugs
Mechloretamine, CYCLOPHOSPHAMIDE
Pts on MAOIs should avoid
LIVER, AGED CHEESE, FAVA beans.
Blockade of what receptor causes neuroleptic malignant syndrome
DOPAMINE
Amrinone produces dose dependent
decrease in LVEDP
Edinger-westphat nucleus is located in CN
III
Sympathetic NS neurons arise from
T1 to L2
Substituting a butyl group for an amine group of procaine’s benzene ring creates
TETRACAINE
Procaine to tetracaine
Substitute a butyl group for an amine group
Is Glutamate a biogenic amine?
NO
What is the drug with the lowest hepatic Extraction ratio?
DIAZEPAM
Could cause serotonin syndrome in patients taking MAOIs,
Meperidine
What structures are found in transitional airways?
Alveolar ducts
What is the VP of Sevoflurane at ___C
157 mmHg, 20 degrees C
Fentanyl potency relative to morphine
100x
Fournier gangrene affects what parts
Genitalia
Which factor would increase the reabsorption of NA by the renal tubule
Angiotensin II.
Where are the CENTRAL CHEMORECEPTORS LOCAED
MEDULLA
Diuretics exerts its effects on the Proximal tubule
MANNITOL
CREST syndrome presence is used in the diagnosis of what
Scleroderma
CREST Mnemonic stands for
Carcinosis
Raynaud’s phenomenon: spasm of blood vessels in
response to stress
Esophageal dysfunction- Acid reflux, decrease motility in
esophagus
Sclerodactyly- Thickening or tightening
Telangiectasias _dilation of capillaries causing red marks.
A patient is experiencing pruritus from the administration of an opioid for surgical pain. What is the most appropriate treatment for the itching?
Nalbuphine
Which opioid receptor produces diuresis when stimulated?
Kappa
2 opioids that cause the release of histamine from mast cells when administered in high doses
MORPHINE
CODEINE
Which agent has the ability to reverse opioid induced respiratory depression, yet maintain analgesia?
Nalaxone (Narcan)
Which agent is a pure opioid antagonist that reverses opioid induced respiratory depression and analgesia?
Nalbuphine
Which of the following statements is true concerning the effect of opioids on the CO2 response curve?
They shift the curve to the right, which represents a decrease in responsiveness to CO2
Which agent is administered to patients undergoing treatment for substance abuse to prevent the euphoric effect of opioids?
Naltrexone
Repeat stimulation caused by nerve damage or chronic inflammation can cause a condition known as :
Windup
The muscle relaxant cyclobenzaprine is structurally most similar to :
amitriptyline
What is the most common serious complication associated with opioid intrathecal and epidural administration?
RESPIRATORY DEPRESSION
Select two excitatory neurotransmitters
Glutamate & substance P
Anesthetic malpractice claims have decreased over the past two decades in which area of practice?
Obstetric anesthesia.
When is the optimal time to perform an epidural block for the treatment of post-herpetic neuralgia?
Within 2 weeks of the appearance of the rash
Which of the following substances is the principal neurotransmitter in the activation of dorsal horn neurons following painful stimuli?
Glutamate
The dorsal horn of the spinal cord includes
laminae I to VI
The chief danger in performing a cervical transforaminal steroid injection is
vascular injury
Isotonic fluids 2
Plasmalyte
0.9% NS
VA that potentiate NMB the most
Desflurane
Cushing’s syndrome
Trunchal obesity
Osteopenia
HTN
Acidosis is associated with (calcium)
Increased ionized calcium
What substance is physiologically inhibit platelet activation?
Nitric oxide
Perisinusoid space of DISSE can be found where
liver
Hepatocyte produce bile and secrete it into
biliary calculi via CANALS OF HERING
Metabolite of procaine associated with anaphylaxis reactions?
PABA
Conn’s aka
HYPERALDOSTERONISM
Sevoflurane is
FLUORINATED METHYL ISOPROPYL
Not a chiral compound
Propofol
what is the metabolite of Diazepam
Oxazepam.
Meperidine a.k.a
Pethidine
Toxicity of which drug is associated with PULSUS ALTERNANS
DIGOXIN
Triangle of Koch is located in what organ
HEART
What Corticosteroid with the longest duration?
Bethamethasone
Other name for this synthetic opioid is Diacetylmorphine
Heroin
Nerve fibers with the fastest conduction velocities
MOTOR NEURON
Minor Calyx part of the
Kidneys
Thin CT of the liver
Glisson’s capsule
Kuffer cells are
Specialized macrophages.
Majority of blood flow to liver provided by
Portal vein
Sensory deficit to the lateral thigh w.o motor deficit indicates what kind of injury –>
Lateral femoral cutaneous
Brainstem composed of
MMP
Medulla, Midbrain, pons.
Term use to related SV + elasticity of arteries to the arterial pressure waveform
Windkessel effect
Therapeutic index
LD50/ED50
Example of phase II enzyme
N-acetyltransferase
2 major calcium channels
L-type and T-type
Important channel is the role of cardiac pacemaker
Funny current
Type I hypersensitivy
IgE antibodies
ABO blood group reactions are classic examples of what type of hypersensitivy reactions
Type III
The key antigens triggering reaction in transplant recipient’s are the
HLA molecules.
Xenogenic transplants are between
different specied
Most common substance secreted by GLOMUS TUMOR
NE
What are glomus tumors?
Glomus tumors, or paragangliomas, are slow-growing, usually benign tumors in the carotid arteries (major blood vessels in your neck), the middle ear or the area below the middle ear (jugular bulb).
Drugs to be avoided in patient with a hx of Acute porphyric crisis
Pentazocine
Von Gierke’s disease has excess levels
of GLYCOGEN
Chemo agent with cardiotoxicity
Doxorubicin
Most common patter of Fetal HR changes in intrapartum period
Variable decels
Factors decrease the depolarization threshold of a cardiac PM
Hypokalemia
Kartagener’s syndrome consists of which TRIAD
Sinusitis
Sinus inversus
Bronchiectasis
ADministration of a decarboxylase inhibitor will prevent
conversion of levodopa to dopamine
Vitamin D can reveal
Thoracic kyphosis
Mandibulofacial dystosis
Trachear collins
ISOFLURANE is
HALOGENATED METHYL ETHYL ETHER
Propofol has antioxidants to
Vit D
Scopolamine is derived for what plant?
Bella donna
Prilocaine metabolite is
O-toluidine, which is capable of oxidizing hemoglobin to methemoglobin.
AV dissociation seen with
Cannon A waves
Used for Vtach
Fleicanamide
Class 1C
Fleicanamide
Class 1B
Lidocaine
Class 1A
Procainamide, Quinidine
Fast sodium channels blocker Antiarrythmic
Class 1
Class II antiarrythmic :
Beta Blockers
Class III antiarrythmic :
Amiodarone
Sotalol
Ibutilide
Dofetilide
Class IV antiarrythmic :
Calcium Channel Blockers
Verapamil
Diltiazem
Class V antiarrythmic
Adenosine
Digoxin
Magnesium Sulfate
Changes in Co2 Transport because O2 sat describe
Haldane effect (think Chaldane)
Protamine sulfate should be used cautiously with patient with
VASECTOMY
Macrolide ABT
Erythromycin
Origin of pathology of 2nd Degree Type I HB
Wenckebach AV node
High output cardiac failure
Sepsis
AV fistulas
Pregnancy
Anemia
In what position would a patient with Epiglotitis be placed for emergent intubation
SITTING
May exacerbate sx in patient with parkinson’s
Droperinol
Chlorpromazine
Metoclopramide
Electrolyte imbalance that may exacerbate s/s of Myasthenia gravis
HYPONATREMIA
Produce by parietal cells of stomach
INTRINSIC FACTOR
Target site of ADH
Collecting tubules
3am low BS, morning high
SOMGYI (SO MOCH insulin)
3am NORMAL , morning high
DAWN phenomenon
Too rapid administration of DDAVP IV can cause
hypotension.
Sympathetic detrusor and trigone muscles(DRTC)
Detrusor Relax
Trigone Contract
Sympathetic and penis
EJACULATION
Parasympathetic and penis
ERECTION
Parasympathetic on arterioles
NONE
Beta 2 responsilbe for
Glycogenolysis
Lipolysis
Bladder wall relaxation
Sympathetic on gallbladder and bile duct
Relaxation
Action of sympathetic on liver
Tell liver to release glucose.
Sympathetic on renal
Decrease urine output
Sympathetic on renin
INCREASE renin secretion
Sympathetic on skeletal muscle
Glycogenolysis
Parasympathetic on adrenal medulla
None
What is the most common spinal deformity?
SCOLIOSIS
Assess integrity of the unidirectional valve what test?
FLOW TEST
Arteriogram risks
Kidney and vessel damage, allergic reaction
ACidosis and catecholamines
Decreased responsiveness to catecholamines
Barbiturates on CMRO2
Reduce
Barbiturates on CBF
Reduce
What nerve provides motor innervation to the cricothyroid muscle?
The external branch of the superior laryngeal nerve
To determine the outer diameter of the French gauge system, the French gauge is
divided by 3, and the answer will be in millimeters.
Hunsaker tubes.
. They are used primarily for jet ventilation
They are double lumen tubes
Which endotracheal tube stylet allows the stylet angle to be adjusted during laryngoscopy?
Schroeder stylet
ETT LPHV
LPHV
Seward laryngoscope blade? (select two)
It should be used in patients under five years of age
C. It is useful for nasotracheal intubation
The LMA Fastrach will accommodate an
8.5 ID endotracheal tube.
Does barbiturate lower cerebrovascular resistance
NO
Preferred energy source of the brain
Glucose
Mother of Anesthesia
Alice Magaw (St mary’s hospital, Rochester minnesota)
Who first coined term Laughing gas for N2O
Humphry Davy
1st person to use chloroform for labor pain
James young Simpson
Who is credited with developing the first direct video laryngoscope?
ALFRED KIRSTEIN
Who is credited in the development of the cuffed ETT
Arthyr Guedel .
For POGO the clinician describe
The clinician describes the linear percentage of the glottis that is visible from the anterior commissure to the interarytenoid notch.
The retrograde technique is useful for situations where traditional intubation is
not possible, but ventilation is possible.
The retrograde technique is useful for situations where traditional intubation is
not possible, but ventilation is possible. So NOT IDEAL for cannot ventilate and cannot intubate situation
2 LMA contraindications
Intestinal obstruction
Poor lung compliance
Invented IV Regional anesthesia
August BIER
1st synthesize ether
Valerius Cordus
In the neonate, calcium delivery to the cardiac myocytes is primarily reliant upon
diffusion through the sarcolemma
An infant undergoing surgery for necrotizing enterocolitis is in the ICU but not yet intubated. Which induction method would you anticipate being the most appropriate in this patient?
Ketamine induction
Which topical anesthetic does not contain lidocaine?
Ametop
What area of the brain in the micro-preemie is most at risk for damage?
Periventricular white matter
The neonatal response to hypoxia is typically a short period of _____ followed by _____.
Hyperventilation, hypoventilation
Which inhalation agent should be avoided in micro-preemies?
N2O
In pediatric patients, drugs whose termination of action depends upon redistribution into muscle tissue would most likely exhibit a _____ peak plasma concentration and _____ duration of action.
higher; longer
Earliest known nurse anesthetist
Sister Mary Bernard, St vincent’s hospital, ERIE PA, 1887
Who described the 5 stages of narcotism in repsonse to anesthesia using chloroform
John Snow
Adult brain weights
2-3 % body weight
SLE patients are at increased risk of
Dementia, stroke, seizure.
First to serve chief of the army nurse corps
Colonel Mildred Irene Clark
Founder of NANA (then AANA,now)
Agatha (AAnA 3 as) Hodgkins
Most common arrythmia with lithotripsy
PVC, supraventricular premature complexes
Why is quality ECG important during lithotripsy
Shock waves timed with R wave to prevent arrythmias
Anesthesia for lithotripsy what dermatomes level
T4-T6
Contraindications to lithotripsy
Pregnancy
Untreated bleeding disorders.
PM and lithotripsy
Shut off -reactivates after lithotripsy
Parasympathetic nerve fibers from CN IX innervate
Parotid gland
Where are parasympathetic nerve fibers exit?
3, 7,9,10 S2-S3
Where are CELL bodies of SYMPATHETIC PREGANGLIONIC NEURONE FOUND?
IntermedioLATERAL HORN of SC
Spinal cord segment originates from
T1 - L2
75% of all parasympathetic can be found in CN
X
Adrenergic receptors are
Alpha 1, Alpha 2
beta 1, beta 2, beta 3
What beta receptor is responsible for THERMOGENESIS?
Beta 3
Nerve fiber that terminate in ADRENAL MEDULLA are ________and therefore secrete
Preganglionic; ACH
Where are POST ganglionic neurons of parasympathetic
Within wall of effector organ
Majority of sympathetic post ganglionic neurons are
Adrenergic and secrete NE
Sympathetic post ganglionic neurons in ONLY 3 areas are
cholinergic
SWEAT GLANDS, PILOERECTOR MUSCLES OF HAIR< SMALL NUMBER OF BLOOD VESSELS>
Inhibition of neurotransmitter when stimulated which receptor
Alpha-2
What spinal cord tract modulates pain (DDT)
DESCENDING DORSALATERAL TRACT
Delayed respiratory depression occurs after neuraxial injection of which opioid?
MORPHINE
Pain afferent nerve fibers enters the dorsal cord and ____or _______ how many segmentts/ in what tract before entering and synapsing in the dorsal horn?
Ascend or descend 1-3 segments; TRACT of LISSAUER,
Early depression of ventilation after neuraxial opioids result from
Systemic absorption of opioid
Remember SAD
Sensory , Afferent , dorsal
DORSAL Leminiscal system include
Cuneatus and Gracilis tracts in spinal cord.
Effects of NE released from sympathetic postganglionic neurosn are terminated mainly by
REUPTAKE by the nerve terminal
Vasopressors devoid of beta 2 activity
NE
Low levels of epinephrine leads to ___why?
Decrease in SVR, beta dominates
Patient took propranolol preop , be cautious administering
Phenylephrine
Chronically beta Blocked , upregulation or downregulation?
Upregulation
Alpha adrenergic BLOCKADE (pay attention to agonist vs blocking)
Venodilation , and decrease in venous return.
Organophosphate insecticides treat with
Atropine
Pralidoxime
2nd messenger promotes bronchoconstriction
IP3
2 most important stimuli for aldosterone release
Angiotensin II
High Potassium
Why is dopamine a different kind of vasopressors?
It simultaneously increases contractility, GFR, RBF, sodium excretion and urine output.
Pheochromocytoma: Which one is IV which one is PO
Phenoxybenzamine IV 0.5-1 mg/kg
Phentolamine IV 50-70 mcg/Kg IV
Treatment of EXCESS beta blockade
Glucagon 1-10 mg IV f/b 5mg/hr
Atropine incremental doses 7mcg/kg IV