TL 6.5 Flashcards
(85 cards)
1
Q
What is Sugammadex used for?
A
Reversal agent for steroidal neuromuscular blocking medications rocuronium and vecuronium.
2
Q
What are the contraindications for Sugammadex?
A
Known hypersensitivity to Sugammadex or its components (e.g cyclodextrins).
3
Q
How long does reversal with Sugammadex take?
A
2-4 minutes.
4
Q
What is the effect of Propofol on systemic vascular resistance?
A
Dose-dependent decrease.
5
Q
What is the mechanism by which Propofol causes vasodilation?
A
Reducing sympathetic activity.
6
Q
What are the cardiovascular effects of Midazolam?
A
Increases HR, decreases blood pressure, decreases ventilation.
7
Q
What is Physostigmine used to treat?
A
Central anticholinergic syndrome.
8
Q
What should Physostigmine be avoided in?
A
Closed angle glaucoma.
9
Q
What is the function of Dexamethasone?
A
Agonizes the nuclear receptor subfamily 3, group C, member 1 receptor to upregulate anti-inflammatory proteins.
10
Q
What effect do steroids have on prostaglandin synthesis?
A
Inhibit synthesis at the beginning of the arachidonic acid pathway.
11
Q
What does Transcutaneous nerve stimulation (TENS) provide?
A
Pain relief.
12
Q
How does TENS achieve pain relief?
A
Stimulating A-beta mechanoreceptors, increasing B-endorphins, facilitating descending inhibitory pathways.
13
Q
What type of inhibitor is Milrinone?
A
PDE III inhibitor.
14
Q
What are the side effects of Milrinone?
A
Tachycardia and hypotension.
15
Q
How is Milrinone excreted?
A
Via the kidneys in its unconjugated form.
16
Q
What is the significance of Alfentanil’s pKa?
A
Lowest pKa and highest fraction of nonionized drugs at physiologic pH.
17
Q
What determines the duration of action of opioids?
A
Lipid solubility.
18
Q
True or False: Epinephrine prolongs the effect of ropivacaine and bupivacaine.
A
False.
19
Q
What increases the duration of action of Bupivacaine?
A
Clonidine and Dexamethasone.
20
Q
What does bicarbonate do to local anesthetics?
A
Alkalinizes and increases speed of onset.
21
Q
What is the time constant in anesthetic circuits?
A
Circuit volume divided by fresh gas flow.
22
Q
What is the mydriatic effect of Epinephrine?
A
It causes dilation of the pupils.
23
Q
What is the anatomical structure of the trachea?
A
Comprises 15 to 20 U-shaped hyaline cartilages.
24
Q
What type of cells line the trachea?
A
Ciliated pseudostratified columnar cells.
25
What is the function of the carotid sinus?
Baroreceptor reflex.
26
What is the role of Acetylcholine?
Degraded by cholinesterase into acetate and choline.
27
What channels transport water across the blood-brain barrier?
Aquaporin 4 channels.
28
What is the function of the ventrolateral preoptic nucleus?
Associated with reduced consciousness when activated.
29
What effect do hypertonic solutions have on cerebral perfusion pressure?
Increase it via reflexive vasoconstriction.
30
What is the classic presentation of a pontine infarct?
Crossed syndrome.
31
What is the effect of insulin on potassium?
Causes a temporary intracellular shift of potassium.
32
What is Con syndrome?
Excess of aldosterone.
33
What is added to red blood cells to prevent coagulation?
Citrate.
34
What does citrate in stored blood potentially cause?
Hypocalcemia or metabolic alkalosis.
35
What is P50 in relation to hemoglobin?
PO2 at which 50% of Hgb is saturated.
36
What is commonly used to diagnose HIT?
Detection of antiplatelet factor 4 antibodies.
37
What medications can be administered via the ETT route in ACLS?
Epinephrine, naloxone, atropine, and lidocaine.
38
What should be continued in the perioperative period?
Anti-hypertensive therapy.
39
What do ERAS protocols encourage regarding preoperative fasting?
Clear liquids until two hours before surgery.
40
What is a rare side effect of IM ketamine sedation?
Laryngospasm.
41
What is the treatment for laryngospasm?
Remove offending stimulus, 100% O2 with CPAP.
42
What does improved glycemic control reduce the risk of?
Microvascular complications.
43
What is the cause of negative pressure pulmonary edema?
Increased afterload and RV preload.
44
What alarms are noted in the ASA standards for basic anesthetic monitoring?
Low oxygen concentration alarm, audible end-tidal carbon dioxide alarm, circuit disconnection alarm, pulse oximetry.
45
What vitamin K-dependent factor has the shortest half-life?
Factor VII.
46
What is the inheritance pattern of malignant hyperthermia?
Primarily autosomal dominant with variable penetrance
## Footnote
Malignant hyperthermia is a genetic condition that can lead to a severe reaction to certain anesthetics.
47
What combination of medications reduces the risk of aspiration injury?
An antacid with immediate onset and a histamine 2-antagonist
## Footnote
This combination is particularly important for patients at high risk for aspiration.
48
What cognitive functions are impaired by chronic fatigue and sleep deprivation?
Decision-making, critical evaluation, and abstract reasoning
## Footnote
These functions are governed by the prefrontal cortex.
49
What factors can improve defibrillation success?
Larger paddle size, biphasic waveform, conductive materials
## Footnote
These factors enhance the effectiveness of defibrillation in cardiac emergencies.
50
What is the most accurate blood pressure measurement in oscillometric noninvasive monitoring?
Mean arterial pressure
## Footnote
It occurs at the peak amplitude of arterial pulsations.
51
What causes a delayed hemolytic transfusion reaction?
Recipient antibodies targeting donor minor red blood cell antigens
## Footnote
This reaction can occur days to weeks after transfusion and is often linked to the Rhesus, Kidd, or Kell systems.
52
What is TRALI?
Donor antibodies activating recipient neutrophils leading to pulmonary edema
## Footnote
TRALI stands for Transfusion-Related Acute Lung Injury.
53
What does the transtracheal block anesthetize?
The recurrent laryngeal nerve
## Footnote
This nerve innervates the airway below the vocal cords.
54
What is the best statistical method to compare two different means?
t-test
## Footnote
ANOVA is used for comparing means of three or more groups.
55
Which enzymes require thiamine as a cofactor?
Pyruvate dehydrogenase and α-ketoglutarate dehydrogenase
## Footnote
These enzymes are essential in the citric acid cycle.
56
Fill in the blank: Concentration = Agent Output Volume / (Fresh Gas Flow Volume + _______).
Agent Output Volume
57
What is protamine?
A cationic protein that binds to heparin
## Footnote
It neutralizes heparin and is associated with specific allergic reactions.
58
What are potential reactions to protamine?
Isolated mild hypotension, mod-severe hypotension, anaphylactoid reaction
## Footnote
Severe reactions can lead to cardiovascular collapse.
59
What specific alarms are noted in the ASA’s Standards for Basic Anesthetic Monitoring?
Low oxygen concentration, audible end-tidal carbon dioxide, circuit disconnection, pulse oximetry alarms
## Footnote
These alarms are essential for patient safety during anesthesia.
60
What can lesions affecting the subthalamic nucleus lead to?
Hemiballismus
## Footnote
This condition results in involuntary, forceful movements of the contralateral extremities.
61
What condition is associated with the substantia nigra?
Parkinson's disease
## Footnote
This area of the brain is critical for motor control.
62
What disease is linked to the lentiform nucleus?
Wilson's disease
## Footnote
This condition is characterized by copper accumulation in the body.
63
What is the respiratory quotient (RQ)?
The ratio of carbon dioxide produced to oxygen consumed during metabolism
## Footnote
A normal whole-body RQ is approximately 0.8.
64
What medications induce CYP-3A4?
Carbamazepine, phenytoin, phenobarbital, St. John’s wort, dexamethasone, topiramate, oxcarbazepine
## Footnote
Chronic use of these medications can reduce the effectiveness of benzodiazepines.
65
What factors protect against succinylcholine-induced myalgias?
Sex (men), pregnant state, extremes of age (children or elderly), high muscular fitness
## Footnote
These factors can mitigate the risk of developing myalgias after succinylcholine administration.
66
When should preoperative coagulation studies be performed?
In patients with bleeding disorders, excessive surgical bleeding, liver disease, poor nutritional status, or anticoagulant use
## Footnote
These studies are important for assessing bleeding risk.
67
What acid-base disturbance is associated with large infusions of normal saline?
Hyperchloremic acidosis and hyperkalemia
## Footnote
This is especially concerning in patients with baseline organ dysfunction.
68
What does chronic alcohol use do to cytochrome metabolism?
Increases risk of intraoperative awareness
## Footnote
It enhances the metabolism of anesthetics, potentially leading to awareness during surgery.
69
What effect does diazepam have on the carbon dioxide response curve?
Decreases the slope, dampening the ventilatory response
## Footnote
This occurs despite higher arterial partial pressures of carbon dioxide.
70
What is the classic presentation of a pontine infarct?
Crossed syndrome: ipsilateral cranial nerve palsy, contralateral hemiparesis, contralateral hemisensory loss
## Footnote
This syndrome is characterized by specific neurological deficits.
71
What are the presynaptic effects of A2 receptors?
Inhibition of norepinephrine release and CNS activity, MAC reduction
## Footnote
These receptors play a role in modulating anesthetic requirements.
72
What do V1, V2, and V3 vasopressin receptors do?
V1: vasoconstriction, V2: aquaporin channel placement, V3: ACTH release
## Footnote
These receptors have distinct roles in fluid balance and endocrine function.
73
What is the result of excessive carbohydrate intake in relation to RQ?
Can trigger lipogenesis and cause RQs exceeding 1
## Footnote
This is significant in monitoring the nutritional status of critically ill patients.
74
What effect do central causes like ICP and catecholamines have on the CO2 curve?
Cause a left shift
## Footnote
This can impact respiratory responses in various clinical situations.
75
What effect does glucagon have on hepatic blood flow?
Increases hepatic blood flow via vasodilation of the hepatic artery
## Footnote
This effect is important for metabolic regulation.
76
What is methemoglobinemia?
A condition where hemoglobin is altered so it cannot effectively carry oxygen.
77
Name a common cause of methemoglobinemia.
Benzocaine
78
Which medication is associated with methemoglobinemia and is also an antibiotic?
Dapsone
79
What type of compounds can cause methemoglobinemia?
Nitrates
80
Fill in the blank: Sodium _______ is an example of a nitrate associated with methemoglobinemia.
nitroprusside
81
Which gas can lead to methemoglobinemia?
Nitric oxide
82
What local anesthetic is known to cause methemoglobinemia?
Prilocaine
83
Where are the cell bodies of the parasympathetic nervous system located?
In the brainstem (CN III, VII, IX, and X) and sacral segments (S2-4) of the spinal cord
## Footnote
CN stands for cranial nerves, which are important components of the nervous system.
84
What postoperative DLCO percentage is associated with increased respiratory complications after lung resection surgery?
Post-op DLCO < 40%
## Footnote
DLCO stands for diffusing capacity of the lungs for carbon monoxide, which is a measure of gas exchange efficiency.
85
What arterial blood gas values indicate adequacy of gas exchange?
PaO2 > 60 mm Hg and PaCO2 < 45 mm Hg
## Footnote
PaO2 is the partial pressure of oxygen, and PaCO2 is the partial pressure of carbon dioxide in arterial blood.
