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TruLearn Exam Flashcards > TL 5.5 > Flashcards

TL 5.5 Flashcards

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1
Q

What factors can decrease evoked potential amplitude in neuromonitoring?

A

Volatile anesthetics, nitrous oxide, anemia, ischemia, hypoxia

These factors can impair the monitoring of neural pathways during surgery.

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2
Q

Which agents have minimal effect on SSEP amplitude?

A

Propofol, opioids, benzodiazepines, lidocaine, dexmedetomidine

Ketamine and etomidate can augment SSEP amplitude at low doses.

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3
Q

What is obstructive sleep apnea defined as?

A

Complete apnea for 10 seconds, five times per hour, with a 4% decrease in SaO2

This condition occurs while sleeping.

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4
Q

What is the composition of the postjunctional nicotinic acetylcholine receptor?

A

2 alpha-1 subunits, 1 beta-1 subunit, 1 delta-7 subunit, 1 epsilon subunit

The fetal receptor has a gamma subunit instead of the epsilon.

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5
Q

What does SVR stand for and how is it calculated?

A

SVR = (MAP - CVP) / CO x 80

MAP is mean arterial pressure and CVP is central venous pressure.

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6
Q

What are the two primary sites for neuromuscular monitoring?

A

Facial nerve (corrugator supercilii), ulnar nerve (adductor pollicis)

The facial nerve response is a better reflection of laryngeal muscle blockade.

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7
Q

What is the gold standard for perioperative neuromuscular monitoring?

A

Quantitative acceleromyography

This method provides precise measurements of neuromuscular function.

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8
Q

What is the role of corticosteroids in treating brain tumors?

A

Useful for vasogenic edema

Corticosteroids help reduce swelling and pressure in the brain.

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9
Q

What is the effect of SNRIs compared to SSRIs?

A

SNRIs have less sexual side effects than SSRIs

This makes SNRIs a preferred option for some patients.

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10
Q

Which benzodiazepine is metabolized exclusively through hepatic glucuronidation?

A

Lorazepam

This reduces its susceptibility to drug-drug interactions.

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11
Q

What are CYP-3A4 inducers that may affect benzodiazepine efficacy?

A

Carbamazepine, phenytoin, phenobarbital, St. John’s wort, dexamethasone, topiramate, oxcarbazepine

Chronic use of these medications can lessen the effectiveness of midazolam and diazepam.

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12
Q

What can happen to a pneumothorax when exposed to a gas mixture of 75% N2O?

A

It can expand to double its size in 10 minutes and to three times its size in 30 minutes

This poses a risk for patients with pneumothorax.

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13
Q

Which local anesthetics are more likely to cause allergic reactions?

A

Amino ester local anesthetics, such as tetracaine

They are derivatives of para-amino benzoic acid (PABA), which is allergenic.

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14
Q

What is the unique feature of succinylcholine administration post-burn injury?

A

Can be administered safely more than one to two years after a significant burn injury

This is due to upregulation of nAChRs and changes in response to NMBDs.

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15
Q

What is the half-life of labetalol when administered intravenously?

A

Six hours

Its effect on blood pressure lasts approximately 16 to 18 hours.

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16
Q

What is esmolol and what is its half-life?

A

A selective β1 antagonist with a half-life of 9 minutes

It is useful for treating acute tachycardia.

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17
Q

What type of antagonist is buprenorphine?

A

Partial μ-agonist and κ-antagonist

It has a potency of 25-40 times that of morphine.

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18
Q

What is the primary metabolism route for dexmedetomidine?

A

Extensively metabolized in the liver before being excreted

Excretion occurs via urine and feces.

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19
Q

What are the risk factors for transient neurologic symptoms after spinal anesthesia?

A

Lidocaine, ambulatory anesthesia, lithotomy position

Lidocaine has the highest incidence of these symptoms.

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20
Q

What is the effect of ketamine on somatosensory evoked potentials?

A

Increases the amplitude of somatosensory evoked potentials

It decreases auditory and visual evoked responses.

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21
Q

What is the primary mechanism of action of vecuronium in renal failure?

A

Most prolonged duration of action due to partial clearance by the kidneys

Cisatracurium is preferred in renal failure as it is cleared by Hofmann elimination.

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22
Q

What is the impact of dexmedetomidine on evoked potential monitoring?

A

Minimal to no direct impact on latency or amplitude

It decreases cerebral metabolic rate of oxygen and cerebral blood flow.

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23
Q

What effect do PPIs have on clopidogrel?

A

Decrease clopidogrel efficiency

This interaction can lead to increased cardiovascular events.

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24
Q

What is the mechanism of action of scopolamine for antiemetic effects?

A

Apply at least 4 hours prior to action

It has a high incidence of visual disturbances.

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25
What causes minor urticarial reactions during blood transfusions?
Soluble antigens in transfused blood ## Footnote These reactions are usually benign.
26
What is the cause of febrile transfusion reactions?
Nonhemolytic reaction caused by cytokines and release of intracellular leukocyte content ## Footnote Prevention includes using leukoreduced blood.
27
What does transpulmonary pressure measure?
Transpulmonary pressure = alveolar pressure - pleural (esophageal) pressure ## Footnote It indicates stress to the lungs during mechanical ventilation.
28
What is the treatment for bronchospasm?
Increase FiO2, begin hand ventilation, deepen anesthetic ## Footnote Albuterol inhaler and epinephrine are used for persistent or severe cases.
29
What is the primary source of radiation during fluoroscopy?
Scattered radiation reflected off the patient ## Footnote Intensity decreases with distance from the radiation source.
30
What are independent risk factors for difficult mask ventilation?
Age > 55, beard, history of snoring, BMI > 26, lack of teeth ## Footnote These factors increase the difficulty of maintaining oxygen saturation.
31
How is succinylcholine dosed?
Based on total body weight (TBW) ## Footnote Rocuronium is dosed based on ideal body weight (IBW).
32
What is the Aldrete Score used for?
Assessing recovery in PACU based on circulation, breathing, activity, consciousness, saturation ## Footnote It helps determine when a patient can move from PACU.
33
What causes decreased functional residual capacity (FRC) in obese patients?
Decreased expiratory reserve volume (ERV) ## Footnote Other factors include small airway collapse and V/Q mismatch.
34
What is the hepatic arterial buffer response?
Increased hepatic artery blood flow due to decreased portal vein flow ## Footnote This is mediated by increased local adenosine concentration.
35
What does parathyroid hormone do to serum calcium levels?
Increases serum calcium by stimulating osteoclasts and resorption ## Footnote It also promotes distal tubule calcium reabsorption and vitamin D conversion.
36
What is the normal arterial oxygen content range?
16–20 mL/dL with 12–15 mg/dL hemoglobin ## Footnote This indicates sufficient oxygen transport in the blood.
37
What is the effect of smoking on hemoglobin P50?
Causes a leftward shift of hemoglobin P50 ## Footnote A rightward shift can occur within a day after smoking cessation.
38
What is the result of inhibiting cytochrome C oxidase?
Histotoxic hypoxia and profound lactic acidosis ## Footnote This occurs due to impaired aerobic respiration.
39
What can prolonged nitroprusside administration lead to?
Cyanide toxicity ## Footnote This is due to inhibition of cytochrome C oxidase in the electron transport chain.
40
When is PVR greatest in relation to lung volume?
At extremes of lung volume ## Footnote PVR is lowest at functional residual capacity (FRC).
41
What effect does high oxygen concentration have on pulmonary shunt?
Increases pulmonary shunt ## Footnote This blunts hypoxic pulmonary vasoconstriction and can lead to microatelectasis.
42
What laboratory abnormalities are associated with corticosteroid use?
Leukocytosis, polycythemia, hyperglycemia, hypokalemia ## Footnote These can lead to conditions such as nephrolithiasis and osteoporosis.
43
What are classic lab findings for Cushing syndrome?
Hypokalemic metabolic alkalosis, glucose intolerance, elevated leukocyte count, elevated 24-hour urinary cortisol ## Footnote Excess cortisol mimics aldosterone effects.
44
What is the risk associated with assist control mode in ventilation?
Higher tendency to cause hyperinflation ## Footnote This can lead to complications during mechanical ventilation.
45
What is the treatment for hypochloremic metabolic alkalosis?
Correct underlying etiology, volume repletion ## Footnote Normal saline is usually preferred for repletion.
46
What is the relationship between hyperparathyroidism and neuromuscular blocking agents?
Results in hypercalcemia and resistance to nondepolarizing neuromuscular blocking agents ## Footnote This can complicate anesthetic management.
47
How much gas is in a full tank of N2O?
1590 L at a pressure of ~745 psig ## Footnote The pressure remains until about 250 L (16%) is left.
48
How can dynamic pulmonary hyperinflation be improved?
By lower minute ventilation and longer expiratory time ## Footnote This decreases end-inspiratory lung volume and intrinsic PEEP.
49
What happens in a suspected pipeline crossover with oxygen supply?
No oxygen flows from the cylinder due to high-pressure gas regulator ## Footnote The pipeline supply must be disconnected for the cylinder to be used.
50
What governs velocity measurement in Doppler ultrasound?
The Doppler equation and the cosine of the angle between blood flow and ultrasound probe ## Footnote Angles > 20 degrees significantly decrease accuracy.
51
What flow type is favored by gases with lower density?
Laminar flow ## Footnote Reynolds number > 2100 indicates turbulent flow; lower indicates laminar.
52
What is the ignition risk of standard polyvinyl chloride tubes?
Very vulnerable to ignition when exposed to carbon dioxide laser ## Footnote Silicon tubes are less combustible.
53
What does pulse oximetry measure?
Relative absorbance of infrared and red light to reflect arterial oxygen saturation ## Footnote Inaccuracy can occur in the presence of various factors such as dyes and movement.
54
What is the first step when the line isolation monitor alarm sounds?
Unplug the most recent electronic device that was plugged in ## Footnote This helps identify the source of the issue.
55
What is the pressure of pipeline oxygen delivery?
50-55 psi ## Footnote O2 tanks deliver at 40-45 psi, allowing for preferential delivery from pipelines.
56
What type of ultrasound probes are used for superficial vs deep structures?
Higher frequency probes (linear) for superficial, lower frequency probes (curvilinear) for deep structures ## Footnote This distinction is important for effective imaging.
57
What is the effect of vasopressin on platelet count and aggregation?
Increase in platelet aggregation but decrease in platelet count ## Footnote This can affect coagulation status.
58
What do epinephrine and vasopressin do to cerebral vasculature?
Cause cerebral vascular dilation ## Footnote This can influence cerebral perfusion and oxygenation.
59
What is the primary function of the first stage O2 regulator?
Allows for O2 delivery to anesthesia machines from the pipeline source
60
What type of ultrasound probe is often used to visualize superficial structures?
Linear probe
61
What type of ultrasound probe is used for deeper structures?
Curvilinear probe
62
What is the effect of vasopressin on platelet aggregation and count?
Increase in platelet aggregation but decrease in platelet count
63
What is the effect of epinephrine and vasopressin on cerebral vascular dilation?
Both cause cerebral vascular dilation
64
How does epinephrine's B2 effect influence cardiac output compared to vasopressin?
Epinephrine prevents decrease in CO while vasopressin increases SVR and afterload, potentially reducing CO
65
What can vasopressin cause in the splanchnic circulation?
Contraction, potentially leading to gut ischemia
66
In what condition is vasopressin commonly used?
Vasodilatory shock
67
What physiological process is stimulated by beta-adrenergic receptor activation?
Lipolysis
68
Where are A1 adrenergic receptors located?
Postsynaptic membranes
69
Where are A2 adrenergic receptors located and what is their function?
Pre/postsynaptic membranes; inhibit NE release and reduce sympathetic flow
70
Where are B1 adrenergic receptors located?
Postsynaptic
71
Where are B2 adrenergic receptors located and what is their function?
Pre/post synaptic; augment NE release
72
Where are D1 receptors located and what is their effect?
Postsynaptic; cause vasodilation
73
What is the function of D2 receptors?
Presynaptic: inhibit NE; Postsynaptic: vasoconstriction
74
When does acute respiratory distress syndrome typically appear after smoke inhalation injury?
Two to three days after the injury
75
What is the risk of using corticosteroids in inhalational injury?
Increases risk of infection
76
What are high-risk conditions for infective endocarditis?
* Prosthetic cardiac valves * History of infective endocarditis * Unrepaired cyanotic CHD * Completely repaired congenital heart defect during the first 6 months after the procedure * Repaired CHD with residual defects at or adjacent to the site of prosthetic material * Cardiac transplantation recipients with cardiac valvular disease
77
What procedures require prophylaxis for infective endocarditis?
* Gingival manipulation * Perforation of oral mucosa * Invasive respiratory tract procedure * Infected skin * Musculoskeletal tissues
78
What is the annual limit of occupational exposure to ionizing radiation?
5 rem
79
What is the annual exposure limit for pregnant women to ionizing radiation?
0.5 rem
80
In which situations may bronchial blockers be preferred over a dual-lumen endotracheal tube?
* Anticipated difficult airway * Requirement for nasal intubation * Presence of tracheostomy * Distortion of tracheobronchial anatomy * Requirement for selective lobar blockade * Expected prolonged intubation
81
What acid-base disturbances can thiazide and loop diuretics cause?
Alkalosis
82
What acid-base disturbances can acetazolamide and potassium-sparing diuretics cause?
Metabolic acidosis
83
What condition does pseudocholinesterase deficiency cause?
Prolonged neuromuscular blockade and apnea with succinylcholine and mivacurium
84
What effect does succinylcholine have on lower esophageal sphincter tone and intragastric pressure?
Increases both, but the increase in LES tone is greater
85
What is the onset of action after an intubation dose of rocuronium (0.6mg/kg)?
Approximately one to two minutes
86
What is argatroban and what is its mechanism of action?
A direct IV thrombin (factor IIa) inhibitor that does not require regular monitoring
87
What neurotransmitters are suspected to be the primary sites of action of volatile anesthetics?
* γ-aminobutyric acid * Glycine * Potassium channels
88
What is the immobilizing effect of volatile anesthetics attributed to?
Inhibitory effect on the spinal cord
89
What is the gold standard for neuromuscular blockade monitoring?
Quantitative acceleromyography ## Footnote This method provides precise measurements of muscle response to nerve stimulation.
90
Which sites are commonly used for monitoring neuromuscular blockade?
Facial nerve (corrugator supercilii) and ulnar nerve (adductor pollicis) ## Footnote These sites are selected for their accessibility and reliability in assessing muscle function.
91
What techniques can refine the Train-of-Four (TOF) monitoring?
Double burst and tetanic stimulation ## Footnote These techniques enhance detection of neuromuscular blockade levels.
92
Which anesthetics decrease evoked potentials?
Volatile anesthetics, nitrous oxide, anemia, ischemia, hypoxia ## Footnote These factors negatively impact the sensitivity of neuromonitoring.
93
Which agents have minimal effect on evoked potential?
Propofol, opioids, benzodiazepines, lidocaine, dexmedetomidine ## Footnote These medications are generally safer in terms of preserving neuromonitoring signals.
94
Which anesthetics increase evoked potentials at low doses?
Ketamine and etomidate ## Footnote These drugs can enhance certain neural signals when administered at low doses.
95
Define Obstructive Sleep Apnea (OSA).
10-second apnea, five times/hour with >4% SaO2 drop during sleep ## Footnote This condition is characterized by repeated episodes of apnea during sleep.
96
What is the difference between intrathoracic and extrathoracic obstruction?
Intrathoracic affects expiratory curve; extrathoracic affects inspiratory curve ## Footnote Understanding these distinctions is crucial for diagnosing respiratory issues.
97
How do high oxygen concentrations affect pulmonary shunt and FRC?
Increase shunt and decrease FRC ## Footnote This relationship is important for managing patients with respiratory conditions.
98
When is pulmonary vascular resistance (PVR) highest and lowest?
Highest at extreme lung volumes; lowest at FRC ## Footnote This knowledge is key for understanding lung mechanics during anesthesia.
99
How is Lorazepam metabolized?
Via hepatic glucuronidation ## Footnote This metabolic pathway results in fewer drug interactions.
100
What effect does Ketamine have on SSEP amplitude and evoked potentials?
Increases SSEP amplitude but decreases auditory and visual evoked potentials ## Footnote This effect is significant in neuromonitoring during anesthesia.
101
What are the effects of Succinylcholine on lower esophageal sphincter (LES) tone?
Increases both LES tone and intragastric pressure ## Footnote This makes it important to consider when administering during certain procedures.
102
What is the pharmacological classification of Buprenorphine?
Partial μ-agonist, κ-antagonist; ceiling effects on respiratory depression ## Footnote This profile makes it a unique analgesic in clinical use.
103
What happens to Vecuronium and Pancuronium in renal failure?
Active metabolites accumulate ## Footnote This can lead to prolonged neuromuscular blockade.
104
What is the impact of Dexmedetomidine on evoked potential latency or amplitude?
Minimal impact; decreases CMRO and cerebral blood flow ## Footnote This drug is often used for its sedative properties with limited effects on neuromonitoring.
105
What can N2O do to a pneumothorax?
A 75% N2O mixture can double the size in 10 minutes ## Footnote This is critical information for managing patients with pneumothorax.
106
What are the risk factors for difficult mask ventilation?
Age >55, BMI >26, beard, snoring, lack of teeth ## Footnote These factors can complicate airway management during anesthesia.
107
What are the treatment steps for bronchospasm?
Increase FiO2, deepen anesthesia, use albuterol, epinephrine for refractory cases ## Footnote These steps are essential for managing acute bronchospasm during anesthesia.
108
What is the inverse square law in radiation protection?
Distance from the source reduces radiation exposure ## Footnote This principle is fundamental in minimizing radiation risks during procedures.
109
What causes a febrile transfusion reaction?
Due to cytokines (IL-1) and leukocyte breakdown ## Footnote Preventable with leukoreduced blood products.
110
What is a consequence of ABO incompatible blood transfusion?
Causes hemolytic reaction via cytokine release ## Footnote This is a serious complication that can occur during transfusions.
111
Which drugs are CYP-3A4 inducers?
Carbamazepine, phenytoin, phenobarbital ## Footnote These medications can reduce the effectiveness of benzodiazepines.
112
What effect do proton pump inhibitors have on clopidogrel?
Decrease the efficacy of clopidogrel ## Footnote This interaction is important for managing patients on both medications.
113
What is the half-life of Labetalol?
6 hours, effective for 16-18 hours ## Footnote This makes it a suitable option for managing hypertension.
114
What type of blocker is Propranolol?
Nonselective β-blocker ## Footnote Its pharmacological profile affects both β1 and β2 receptors.
115
What is the half-life of Esmolol?
9 minutes ## Footnote This very short half-life makes it ideal for acute situations.
116
What are the effects of corticosteroids?
Cause leukocytosis, polycythemia, hyperglycemia, nephrolithiasis ## Footnote These side effects necessitate careful monitoring in patients receiving corticosteroids.
117
What do thiazide and loop diuretics cause?
Metabolic alkalosis ## Footnote This is an important consideration during fluid and electrolyte management.
118
What is the normal arterial oxygen content?
16–20 mL/dL with 12–15 mg/dL hemoglobin ## Footnote This range is critical for assessing oxygen delivery in patients.
119
What happens to carboxyhemoglobin levels with smoking?
A leftward shift of hemoglobin P50 occurs ## Footnote This shift resolves within 24 hours of cessation and affects oxygen affinity.
120
What is a risk associated with Assist Control Mode in ventilation?
Higher risk for hyperinflation ## Footnote This mode can lead to complications if not monitored properly.
121
What occurs during pipeline crossover with oxygen supply?
If cylinder supply of O2 is opened, no flow due to high-pressure regulator ## Footnote Understanding this is essential for proper anesthesia delivery.

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