True Learn Flashcards

Question

Nerves for sensory innervation of these parts of the leg: Medial thigh Posterior thigh Posterior calf Lateral foot Heel

Answer 1

Posterior thigh- Posterior cutaneous nerve of thigh Medial thigh- obturator Posterior calf- sural n Lateral foot- sural n Heel- tibial Adductor canal block for saphenous block, pure sensory, common for total knee

Answer 2

Mixed sensory and motor Foot dorsiflexion Cutaneous innervation to skin between 1st and 2nd toes Lateral knee injury can cause deep peroneal n damage and result in foot drop

Answer 3

Motor: foot eversion Sensory: lateral lower leg and most dorsum of foot

Answer 4

Starvation 24-48 hr: glycogenolysis, lipolysis, proteolysis Insulin: glycolysis and glycogen synthesis, lipogenesis, protein synthesis Glucagon: glycogenolysis, gluconeogenesis Catecholamine: beta stimulation > lipolysis (TGs turn into glycerol and FFAs) Substrates for gluconeogenesis include glycerol, lactate, and some amino acids FFA undergo hepatic conversion into ketone bodies in setting of low Insulin or lack of glycogenolysis Brain does not use amino acids only ketone and glucose

Answer 5

Depends on purposeful movements to specific stimuli, NOT airway Minimal- normal response to verbal stimulation Moderate- Purposeful response to verbal or tactile stimulation Deep- response to repeated painful stimulation General- no response to repeated painful stimulation

Answer 6

High aspiration risk: delayed gastric emptying, hiatal hernia, gerd, full stomach, intestinal obstruction Low Lung conpliance: restrictive lung disease, glottic or subglottic airway obstruction, limited mouth opening

Answer 7

Painful vaginally bleeding, uterine tenderness, nonreassuring fetal heart rate pattern Rfs: materal/paternal smoking, trauma, hypertension, advanced material age, parity

Answer 8

154mmeq/L of Na and Cl No potassium Isotonic Excess chloride causes impaired bicarbonate reabsorption, causing decreased serum bicarbonate. This creates electroneutrality resulting in non-ion gap metabolic acidosis with hyperchloremia In terms of strong ion difference, sharp increase of chloride as compared to sodium increase will decrease the strong ion difference. Smaller SID will create an acidosis.

Answer 9

Phosphodiesterase 3 inhibitor Positive inotrope and causes peripheral vasodilation (Good for right heart failure but need to add vasoconstrictor to support peripheral bloodpressure/perfusion ie vasopressin to prevent pulmonary constriction)

Answer 10

Phase 1: cessation of gen anes, antagonism of NMB, increased CO2, spontaneous respiration returns Phase 2: recovery of airway tone and pharygeal muscles, ETT becomes noxious stimulus, defensive posture, gagging, coughing, salivation, tachy, HTN Phase 3: responds to verbal command, return of cortical function, eye opening

Answer 11

Carotid body chemoreceptor > aortic arch chemoreceptor for inducing ventilatory response to hypoxia Central chemoreceptors more sensitive to hypercapnia Carotid sinus has baroreceptors ro manage blood pressure

Answer 12

Competitive aldosterone antagonist, potassium sparing, wastes Na Aldosterone usually upregukstes ENACs at the distal tubule with pumps in Na and in return potassium is usually dumped

Answer 13

(1.36 mL O2/g hb x hgb value x oxygen saturation) + (0.003 mL O2/dL/mm Hg × partial pressure of oxygen)

Answer 14

Adductor pollicis muscle is supplied by ulnar nerve and lags behind diaphragm recovery Flexor hallucis is innervated by posterior tibial n on Medial side posterior to Medial maleolus, similar to adductor pollicis Corrugated supercilii innervated by facial nerve and resembles laryngeal adductor but not reliable for diaphragm recovery

Answer 15

Describes the standard deviation and measures the precision with which a sample mean represents a population SEM = standard deviation / Sq root of (n) As the sample size increases the standard error decreases Compared to standard deviation which is a description of sample data compared to sample mean and quantifies the variation or dispersion of the data

Answer 16

Decreases by 6% per decade of life starting after age 40

Answer 17

sodium channel blockade which causes QRS prolongation (>100ms) along with inhibition of potassium efflux during repolarization which flattens the T wave, QT is also prolonged but patients are often sinus tachycardic during TCA overdose.

Answer 18

damage to carotid body can lead to low hypoxic induced ventilatory drive damage to the carotid sinus can lead to hypertension or hypotension risk of thromboembolism, cerebral hypoperfusion, and neck hematomas

Answer 19

cholinergic receptors are a part of the parasympathetic system nicotinic receptors are excitatory and are located in between the pre and post ganglionic neurons muscarinic receptor activation depends on subtype. M1-3. M1 and M3 are excitatory, M2 is inhibitory and works on the heart.

Answer 20

inhibitory role when activated and located in presynaptic terminal betwee neurons of the sympathetic nervous system often in the CNS and peripheral blood vessels, act as a negative feedback system. ie. clonidine is alpha-2 agonist and is used for both lowering blood pressure both peripherally and centrally which helps with migraines.

Answer 21

risk is increased in low mobility, nerve damage, or neuromuscular disorders burn (1 day up to 1-2 yrs), stroke, spinal cord injury (worse after 16 days), muscular dystrophy, GBS, ALS, MS MG is auto antibodies targeting nicotinic acetylcholine receptors vs. GBS is autoimmune destruction of myelin sheath of neuronal axons

Answer 22

both are excreted by kidneys and will be prolonged in patients with CKD. extended duration of neostigmine provides a safety margin for the prolonged NMB. No dose changes are indicated in CKD for neostigmine, glycopyrrolate, or rocuronium.

Answer 23

aimed at blocking ventral rami of C5-7 which covers the shoulder and proximal arm, but spares the distal arm and hand since C8-T1 is often not blocked Common risks include almost 100% hemidiaphragm due to involvement of C5 that contributes to phrenic nerve, hoarseness if recurrent laryngeal n is blocked, and horner syndrome from sympathetic blockade

Answer 24

increased cardiac output and increased blood volume leads to GFR and renal plasma flow increases by about 50% along with decreased tubular reabsorption leading to glycosuria BUN and Cr are decreased and usually lower than pre-pregnancy levels

Answer 25

Above T1 vertebrae (C1-8) is quadriplegia Below T1 vertebrae (T1-L5) is paraplegia

Answer 26

mental status respiratory function cardiovascular function temperature pain hydration status

Answer 27

blood volume increases by 45% by sodium retention through RAA system Hemoglobin only increases by 30% but usually hgb will be above 11. CO increases in order to increases oxygen delivery to tissues. oxygen dissociation curve shifts to the right in order to help facilitate offloading to the fetus

Answer 28

accel or decel lasting more than 10 minutes dictates a change in baseline FHRT normal range is 110-160bpm

Answer 29

irregular fluctuations in peak/ trough of heart rate absent minimal <5bmp moderate 6-25 marked >25 sinusoidal pattern is undulating fluctuations that occur 3-5 times per minute and last more than 20 minutes and is an ominous sign of placental abruption

Answer 30

V = cord compression E = head compression Accel = ok Late = placental insufficiency

Answer 31

Containing high amounts of strong bases like NaOH or KOH Baralyme (discontinued) and sodalime both have higher amounts of strong bases Desflurane breaks down into CO and sevoflurane breaks down into Compound A when ran thru carbon dioxide absorbents

Answer 32

HR < 50 place ECG/cardiac monitoring, IV access check for HD stability and signs of shock including angina, AMS, dizziness 1. atropine IV 1mg q3-5min for maximum 3 doses 2. transcutaneous pacing or dopamine gtt @5-20mcg/kg/min or epinephrine gtt @ 2-10mcg/min 3. transvenous pacing/expert consult

Answer 33

partial pressure decreases as elevation increases sea level atmospheric pressure is 760mm hg (1 atm)

Answer 34

Desflurane has high vapor pressure and will boil at temp above 22C therefore must be pressurized and delivered via dual-gas blender which is calibrated at a certain elevation and will deliver anesthetic based on the change in elevation that it is currently at compared to storage All other gases can be delivered through variable bypass vaporizer which delivers similar MAC at higher and lower elevations

Answer 35

medially are the femoral artery and vein nerve lies deep to the fascia lata and fascia iliaca with the sartorius muscle more lateral nerve sits on top of the iliopsoas muscle

Answer 36

anterior left ventricle = Lateral anterior descending a. AV node = AV nodal a. lateral right ventricle = Right marginal a. posteromedial papillary = Posterior descending a. interventricular septum (thirds) = - anterior 2/3 = LAD - posterior 1/3 = PDA SA node = SA nodal a. bundle of HIS = AV nodal a. cardiac apex = RMA + LAD posteroinferior wall = PDA

Answer 37

beta blocker or CCB avoid beta blocker in patients with reactive airway diseases. Esmolol/metoprolol is cardioselective for B1 anatagonism, esmolol would be more indicated in rapid correction of dysrhythmias ie HD instability diltiazem better for HD stable patients. inhibits influx of Ca in cardiac and smooth muscle cells causing negative inotropy and vasodilation of cerebral, periphery, and coronaries digoxin has low therapeutic window

Answer 38

bind to GabaA receptors and increase the duration of opening of the chloride ion channels. They provide anesthesia by increasing inhibitory transmission and decreasing excitatory transmission (CNS depression). They do not produce analgesia. Depresses the ventilatory center of the brain stem which blunts ventilatory response to hypoxia and hypercarbia.

Answer 39

aka antidiuretic hormone released from the hypothalamus and transported into the posterior pituitary release is triggered by hypovolemia or hyperosmolality will activate V2 receptors in the collecting ducts of the kidney which increases free water reuptake via aquaporins and will activate V1 receptors of peripheral vessels which causes vasoconstriction

Answer 40

ester = plasma cholinesterase amide = hepatic metabolism

Answer 41

- prevent spontaneous bleeding = >10k - minor procedure = 20-30k - major procedure = 50k - neurosurgery/neuraxial procedure = 100k **take into account clinical context, platelet dysfunction can occur in times of acidosis or hypothermia (ie trauma/cardiac arrest)

Answer 42

cushing = hypercortisolism moonfacies, hyperglycemia/diabetes, osteoporosis, central obesity, easy brusing addison's = hypocortisolism weight loss, fatigue, hypercalcemia, hyponatremia, hyperkalemia (via hypoaldosteronism)

Answer 43

hydrophilic (morphine, dilaudid) slower onset, longer duration, greater CSF bioavailability and CSF spread, delayed respiratory depression lipophilic (fentanyl) faster onset, shorter duration, fat redistribution > systemic, less CSF spread/bioavailability

Answer 44

density, velocity, and size of tube are all directly associated with Re (reynolds number) and inverse with viscosity Re <2000 = laminar RE >4000 = turbulent

Answer 45

chronic HTN is elevated BP prior and up to 20 weeks of gestation gestational HTN is elevated BP after 20 weeks gestation without severe features Pre-clampsia is HTN after 20 weeks accompanied by proteinuria or severe features (think HELLP syndrome stuff, headache, migraine, RUQ pain, elevated liver enzyme, kidney dysfunction, thrombocytopenia, pulm edema) control BP to prevent maternal stroke, Mg sulfate for neuroprotection from seizures

Answer 46

L3 = medial knee L4 = medial malleolus and anterior knee L5 = dorsum of foot and 2nd/3rd digit S1 = lateral foot and lateral malleolus FYI C1 does not have dermatome C2 covers posterior scalp and anterior neck under chin

Answer 47

posterior tibial nerve (1cm posterior to medial malleolus and posterior tibial artery) branches from tibial n and provides motor and sensory to plantar aspect of foot Saphenous n (1cm anterior to medial malleolus) is a terminal branch of the femoral nerve and provides sensory to the medial ankle Sural n (lies 1 cm distal to lateral malleolus) branches from both peroneal and tibial and provides sensory to the lateral foot and 4th and 5th digits Deep peroneal n is medial of the dorsum of the foot while superficial peroneal n is more lateral on dorsum of the foot Alternatively, sciatic (popliteal fossa) and saphenous n blocks will coverall the nerves in an ankle block as well

Answer 48

woods x80 = dynes normal SVR 800-1200 dyne normal PVR 30-180 dyne

Answer 49

Ca O2 = (1.39 x SaO2 x Hgb) + (0.003 x PaO2)

Answer 50

- reversible inhibition of Na/K pump in cardiac muscle producing high intracellular Na - there is a Na/Ca exchanger which will retain Ca as Na leaves the cell - this causes increased contractility and decreased conduction via AV and SA nodes, which helps in heart failure and for SVTs eliminated mostly by kidneys, must be dose adjusted for renal function toxicity is from slowing heart too much ie bradycardia, AV block, and PVCs and delirium and visual changes and is promoted by electrolyte abnormalities like hypoK, hypoMg, hyperCa Tx is digoxin specific antibodies

Answer 51

initiating treatment with clonidine or betablockers prior to non-cardiac surgery had increased risk of clinically relevant hypotension and nonfatal cardiac arrest compared to placebo ok to continue if patient is chronically on betablocker or clonidine

Answer 52

NMDA r antagonist in thalamus and indirectly affects reticular activating system All other sedatives or anesthetics directly affects RAS including gas, etomidate, opioids

Answer 53

Fasle positive is type 1 or alpha error (incorrectly reject null) False negative is type 2 or beta error (incorrectly accept null)

Answer 54

Sedative hypnotic effect via alpha2 receptor agonist in the locus ceruleum and also can cause hypotension

Answer 55

Absolute: measure of gaseous water in gas and is reported as mass of water per unit area of gas, temp directly associated with maximum absolute humidity Relative humidity is amount if water vapor in gas relative to temperature of the gas itself and is reported as a percentage of the maximum absolute humidity at a given temp Lower ambient relative humidity results in more rapid water evaporation from skin Recommended humidity in OR is 20-60% (lower limit for electrical equipment and upper limit for sterile barrier integrity)

Answer 56

Embryonic tumor of kidneys can often metastasized thru IVC into right atrium and high risk of PE Usually present with hypertension but volume down Often have hematuria and chronic kidney dysfunction, excess renin release from mass compression of renal artery Present with severe anemia and thrombocytopenia and acquired vWB disease but may be asymptomatic Preoperative chemo therapy

Answer 57

21% O2 78% nitrogen

Answer 58

- Holding breath while submerged - water in hypopharynx causes laryngospasm - hypercarbia from lack of ventilation - release of laryngospasm from hypoxia - aspiration of water causes washout of surfactant, decrease lung compliance, VQ mismatch - multiorgan failure from global hypoxemia

Answer 59

Sensory: recurrent laryngeal is sensory to larynx from vocal cords and downward while superior laryngeal supplies above vocal cords Motor is from recurrent laryngeal which supplies al intrinsic laryngeal muscles except the cricothyroid muscle Circothyroid M is innervated motor by superior laryngeal n which tenses the vocal cords for pronation but has minimal disruption

Answer 60

Increase in stroke volume by 10-15% after 500cc bolus IV Often volume depleted causes low preload and low CO. Positive pressure Vent causes increases intrathoracic pressure and decreases venous return/preload of right ventricle. If LV stroke volume changes with cyclic vent then then ventricles are preload dependent Stroke volume variation can be calculated from arterial pressure waveform when arterial compliance and SVR are known or can be determined by doppler Must be paralyzed, Supine, ventilated with larger tidal volume >8cc/kg and in NSR with closed thorax and normal lung compliance

Answer 61

Wide spread Coagulation cascade activation thrombo-hemorrhagic disorder Lab findings will commonly show thrombocytopenia Presents with diffuse thrombosis leading to multi organ failure, consumption coagulopathy, and bleeding

Answer 62

Loss of fetal station due to loss of uterine tone Pain uncontrolled by epidural analgesia Vaginal bleeding Abnormal change in fetal heart rate Acute shoulder or abdominal pain

Answer 63

Iliac crest inferior Latissimus dorsi posteriorly External oblique anterior

Answer 64

Mostly thru biliary system, but partially thru kidneys Has active metabolite which has 80% potency and is also eliminated via kidneys Prolonged duration in kidney failure and elderly

Answer 65

HIV 0.3% HEPC 0.5% HEPB 30%

Answer 66

Gr1 epiglottis, entire vocal cords, arytenoids Gr2a epiglottis, partial posterior aspect of VCs, arytenoids Gr2b epiglottis and aryteboids, no VCs visualized Gr3 only epiglottis no arytenoids Gr4 only soft tissue no epiglottis

Answer 67

Propagation speed and density of mediums

Answer 68

Need 2/3: Altered mental status SBP < 100 RR > 22/min

Answer 69

Sepsis with persistent hypotension Requiring pressors to maintain map >65 Lactate > 2 despite adequate volume resuscitation

Answer 70

Increases Fibrinogen levels double to limit postpartum hemorrhage Increase in factors Dilution if platelets, often <150k Dilutions anemia, plasma vol increases by 40-50%

Answer 71

Hemorrhage - avoid hypertension Ischemia from vasc steal- avoid hypotension Normal perfusion pressure breakthru - inability to vasoconstrict after AVM removal Occlusion hyperemia Seizures Avoid hypertension by mix of 0.5 Mac gas and opioid anesthesia especially on induction

Answer 72

Male: 65-70cc/kg Female: 60-65cc/kg

Answer 73

tamponade showing pericardial effusion on echo esophageal thermal injury , detectable with temp probe MI can be detected on ECG, often in right coronary distribution phrenic nerve damage, can detect with fluoro while stimulating phrenic nerve

Answer 74

somatosensory evoked potential provide information on the integrity of ascending neurons during stimulation of peripheral or cranial nerves and measuring resulting cortical impulse on EEG SSPE quantifiable by amplitude and latency of signal (aka delay between stim and signal) decrease in amplitude or increased latency can indicate direct damage to nerve or ischemic insult (significant is 50% lower amp or 10%inc latency) signal is worsened by inhaled volatile gases (keep mac below 0.5 and use multimodal anesthetic i.e. propofol) other types of SSPE are brainstem auditory evoked potential and visual evoked potential often used during spine surgery

Answer 75

evaluate integrity of descending motor neuron pathways. Generate motor impulse by stimulating motor cortex and receiving signal from distal muscle groups Require that NMB not be used to receive motor signals inhaled volatile gases can reduce signal but not as sensitive as SSPE

Answer 76

anterior to C7 transverse process but safer to block at C6 (below is risk of unprotected vertebral artery) part of the sympathetic chain receiving T1-4 outflow and can be used for CRPS in the upper extremities

Answer 77

fat is metabolically active and therefore requires increase in total blood volume excess blood volume leads tto increase cardiac output with inc SV and ventricular dilation resulting in deleterious hypertrophy of ventricles also eventually develop hypertension due to increased sympathetic NS leading to increased SVR which contributes to cardiac hypertrophy and eventual failure

Answer 78

in fetus, immobilized, burns, or motor neuron injury, sepsis associated with larger efflux of potassium from depolarizing paralytics they contain gamma subunit instead of mature epsilon one

Answer 79

anticonvulsant and for neuropathic pain (DM, TGN, phantom limb) inhibits alpha2 voltage gated calcium channel by decreasing release of glutamate SFX: sedation, dizziness, ataxia, nystagmus, edema, weight gain

Answer 80

decreased risk of perioperative MI but increased risk of stroke and increased mortality recommended to start BB atleast week prior to surgery and continue taking chronically

Answer 81

CPP = AoDP - LVEDP diastolic fillingtime/HR also contributes

Answer 82

High risk = intrathoracic, intraperitoneal, suprainguinal vascular procedure, aortic/major vessel vasc surgery Moderate risk = head neck, carotid, orthopedic, urological, gynecologinal, EVAR low risk = superficial, outpatient, breast, endoscopic, eye, thyroid consider per-op ECG for cardiac/CVA risk factors and for moderate to high risk procedures

Answer 83

all plasma factors involved in hemostasis can be used to urgently reverse warfarin, in DIC, liver dysfunction recommended dose is typically 10-15ml/kg which obtains level of 30-40% factor activity which is about INR 1.4-1.7 (INR1.0 is 100% factor function) can calculate by equation: Amt FFP needed (mL) = (target functional percent - present percent) * Kg stored frozen and warmed prior to use single unit is about 200-250 mL usualy to reach INR 1.5 INR 2.5 needs 4u INR 2.0 needs 3u INR 1.8 needs 2u

Answer 84

arm: 50 above systolic leg: 100 above systolic up to 2 hours at a time before compression injury changes after deflation: metabolic acidosis increased CO2 drop in systemic BP

Answer 85

left shift means at a given pO2 there is more Hgb saturation which means higher affinity and less unloading right shift means less saturation at a given pO2 which means less affinity and more off loading

Answer 86

less CO2 or H+ lower temp less DPG alkalinity (higher pH) met-Hgb CO-Hgb fetal-Hgb

Answer 87

increased pCO2 increased temp increased DPG acidosis (lower pH)

Answer 88

first letter: chamber paced (A,V, Dual) second letter chamber sensed (O none, A, V, Dual) third letter response to sensing (O none, I inhibit, T trigger, Dual) *inhibits pacemaker not actual heart asynchronous modes are DOO,VOO,AOO and often used in perioperative setting where electro cautery is being used and patient is pacemaker dependent such as complete heart block, often set between 80-100bpm Danger is posed with patient's intrinsic HR is greater than pacemaker rate and has chance of R on T phenomenon and can lead to VT or VF safe if intrinsic heart rate is less than mode set DDD is most commonly used since it can pace both chambers and also inhibit itself if detecting increase intrinsic hr

Answer 89

Zone 1: all freely accessible public areas outside MR environment Zone 2: interface between uncontrolled zone1 and strictly controlled zone 3, acts as holding area for unscreened patients Zone 3: strict access to screened patients and equipment includes control room outside the scanner Zone 4: MR magnet scanner room, restricted access to screened patients under constant supervision of MR personnel and MRI compatible equipment

Answer 90

Total mass is about 60% water intracellular fluid 2/3 Extracellular fluid 1/3 (mostly interstitial about 3/4 and rest is CSF and intravascular fluid about 1/4) neonates have higher total body water than adults about 3x (particularly ECF) obesity has lower TBW, adipose tissue contains much less water compared to other tissues

Answer 91

when oxygen tension is low: peripheral resistance decreases/vasodilates pulmonary resistance increases (hypoxic pulmonary vasoconstriction) often in focal lung diseases to shunt blood to better oxygenated alveoli, diffuse constriction can lead to pulmonary hypertension

Answer 92

age >3 duration of surgery >30min type of surgery (eye, tonsil) PMH and FHX of PONV adequate hydration and reduce opioids, consider regional where able

Answer 93

enlarged internal organs Heart failure macroglossia sleep apnea epiglottis enlargement HTN DM CAD peripheral neuropathy

Answer 94

increased mortality in GCS<13 patients with TBI who received albumin 4% compared to normal saline

Answer 95

Risk: UOP < 0.5cc/kg over 6 hours Injury: UOP <0.5cc/kg over 12 hours or GFR decrease by 50% or rise of Cr x2 Failure: UOP < 0.3cc/kg for 24hr, dec GFR by 75%, rise Cr by3x, or 12hr anuria Loss: persistent renal failure lasting 4 weeks End stage: needs renal replacement therapy

Answer 96

transplanted hearts are dennervated and there is minimal baroreceptor reflex to counterbalance need to use direct adrenergic agents (beta 1) such as isoproterenol which is nonselective beta agonist, can also use epi, norepi, dobutamine, and glucagon but save epi/norepi for reserve since baroreceptor reflex is severed and can have unopposed tachycardia reinnervation of vagus nerve of the donor heart can take up to 24months to be re-established

Answer 97

chi square evaluates multiple categorical data sets while ANOVA analyzes the variance between multiple nominal or ordinal data

Answer 98

Prop gtt, succ: total BW thiopental, fentanyl, prop push: lean BW roc/vec: ideal BW

Answer 99

premature infant: 90-105cc/kg fullterm infant: 80-90 cc/kg infant 1-12 months: 70-80cc/kg child 1yo-12yo: 70-75cc/kg adult male: 65-70 adult female: 60-65

Answer 100

ABL = EBV x (HCTi - HCTf)/HACTavg means maximum blood loss prior to transfusion

Answer 101

TLV = total lung volume TV = tidal volume VC = vital capacity (IC + ERV) what you can maximally inhale and exhale RV = what is remaining after forced exhale ERV = forced exhalation volume after tidal exhale IC = tidal volume with forced inhale FRC = remaining volume after exhaled tidal volume

Answer 102

Hepatic artery buffer response is the increase or decrease in Adenosine that will contract or dilate hepatic arterioles when portal blood flow changes

Answer 103

1mg Intrathecal = 10mg epidural = 100mg IV = 300mg oral Very hydrophilic drug which means if given intrathecal, it will stay for long duration It will occur to smaller extent if given epidural Lipophilic drugs like fentanyl will redistribute back into fat, so shorter duration

Answer 104

shortened QT interval Normal qtc is 350-450ms

Answer 105

CaO2 = [(SaO2 * Hgb * 1.34 ml O2/gm Hgb, O2 carrying capacity of Hgb) + ( 0.003, O2 solub in plasma * PaO2) SaO2 is fraction of Hgb saturated with O2 PaO2 is partial pressure of O2

Answer 106

benzocaine, dapsone, inhaled nitric ozide

Answer 107

no evidence to show anesthesia affects long term course of MS higher chance of relapse in the few months following pregnancy

Answer 108

converts grounded power supply from electrical company into ungrounded isolated power for OR use

Answer 109

checks integrity of the isolated (ungrounded) power supply and measures current flow from isolated power to the ground

Answer 110

GCFI prevents shocks from occurring in a grounded power system by detecting differences in current between the hot and neutral wires to immediately interrupt the power supply

Answer 111

macroshock is electrical shocks that traverse the skin and can cause muscle contractions or even Vfib at higher currents microshock is electrical shocks that are applied directly to the heart (ie from indwelling catheters, pacing wires, or from leakage current)

Answer 112

alpha 1 and 2 blocker causes vasodilation but also increase in catecholamine release from alpha 2 block (unihibits release of norepi)

Answer 113

nonselective vasodilator working on veins and arteries causing decrease preload and SVR

Answer 114

alpha 2 agonist which activates negative feedback that decreases sympathetic outflow in CNS and causes vasodilation in periphery

Answer 115

nonselective beta and alpha 1 blocker through competitive inhibition, with more beta than alpha about 4:1 onset of 10minutes and lasts 2-6hours

Answer 116

venodilator which functions when it is turned into nitric oxide first line therapy for MI since it also causes dilation of epicardial coronary arteries immediate onset of action and lasts up to 5 minutes

Answer 117

medial side includes median nerve, brachial artery, and basilic vein (brachial artery will split into the ulnar and radial arteries distal to the antecubital fossa and runs lateral to median nerve) lateral side is the cephalic vein and the radial nerve midline of the fossa deep to the biceps tendon is the musculocutaneous nerve posterior/medial is the ulnar nerve near the olecranon (funny bone)

Answer 118

maintains own nervous function separate from recipients but will not receive parasympathetic innervation direct beta agonists and blockers will work on the denervated heart parasympathetic-blocking meds such as glyco and atropine will not affect the HR resting HR of a transplanted denervated heart is usually between 90-110

Answer 119

Rocuronium: 30% renal, mostly biliary Vecuronium: 10-50% renal Cisatracurium: hoffman elimination and ester hydrolysis Succinylcholine: plasma cholinesterases

Answer 120

normally 35-65% is normal fetal O2 saturation Below 30% is considered to cause metabolic acidosis This can be measured with fetal pulse oximetry but Fetal heart rate monitor is more often used where decreases in heart rate are thought to be due to fetal hypoxia and correlates with fetal distress

Answer 121

fascia lata is most superficial layer that encases all musculature fascia iliaca is second layer that encases the femoral nerve femoral nerve is lateral to the femoral artery and femoral vein (most medial) lateral muscle structure us the sartorius with the iliopsoas being deep to the femoral nerve

Answer 122

pantoprazole/omeprazole: directly inhibit H+ atpase channels in gastric parietal cells which ceases acid release, takes about 1hr for onset famotidine/cimetidine: histamine-2 receptor blockers which partially prevents parietal cells from release acid (but other mechanisms are still unblocked), requires about 30min for onset sodium citrate immediately increases pH of gastric fluid but also increases amount of fluid in the stomach

Answer 123

originates from S2-4 sensation to clitoris/head of penis, labia, external anal sphincter

Answer 124

stage 1 is divided into latent and active phases latent is variable in time and includes onset of contractions and persistent dilation active phase is when contractions are regular at 2-3 minutes and lasting about a minute and ends at complete dilation of 10cm (can use paracervical block) Pain comes from inferior hypogastric plexus to the uterus and cervix (T10-L1) stage 2 starts with complete cervical dilation and ends with delivery of fetus (can use pudendal block) Pain comes from S2-4 and T12-L1 to the vaginal wall stage 3 is delivery of the placenta

Answer 125

lasts 90 minutes IV adult dose is 0.4mg to 2mg can repeat q2-3minutes until reversal of respiratory depression

Answer 126

10 min to double and 30min to triple this occurs because N2O has MAC 105% and very insoluble in blood (ie has a low blood:gas coefficient) and thus will come out of solution

Answer 127

1/radius^2 ie if exposure is 8mrem/s, and if you move 2 feet away, then it reduces exposure by 1/4 resulting in 2mrem/s

Answer 128

divide number of apnea episodes with hypoxia that last at least 10 seconds by the number of hours slept normal is 0-4 mild is 5-14 moderate 15-29 Severe is 30+

Answer 129

increased levels of progesterone will relax the lower esophageal sphincter can give antacid (non particulate), H2 blocker, and metoclopramide (reglan) for patients >16weeks gestation

Answer 130

30-35cm from incisors which will reach about level T5-6, this is where esophagus and descending thoracic aorta are in close proximity you can also see the mid-esophageal 4 chamber view here with views of the thoracic aorta when you rotate left

Answer 131

exenatide semaglutide (wegovy/ozempic) liraglutide administered as injectables while DPP4 inhibitors (sitagliptin/januvia) and SGLT2 inhibitors (empagliflozin/jardiance) are oral

Answer 132

hepatic arterial buffer system adenosine is a byproduct of the liver and causes vasodilation blood flow through the portal vein will determine how much adenosine is washed out from the liver, if blood flow is low then high amounts of adenosine will dilate hepatic artery to increase blood flow and the opposite will occur if high portal blood flow resulting in adenosine washout and less arterial dilation

Answer 133

repercussion syndrome: acidosis from influx of hydrogen ion, can give 25 meq of bicarb preemptive influx of potassium can result in peaked t waves and arrhythmia - preemptive CaCl (500mg-1gm) administration can stabilize myocyte membranes increase preload and right heart strain hypothermia due to organ being cooled to prevent organ ischemia coagulopathy due to wash out of TPA when organ is reperfused

Answer 134

uncuffed is age/4 + 4 cuffed is age/4 +3.5 ie for a 2yo use a size 4.5mm uncuffed or 4mm cuffed

Answer 135

sinus tach has p waves present and rate is typically less than 150 for adults SVT has either absent or abnormal pwave emorphology with rates usually >160 For SVT attempt vagal maneuver or adenosine then try cardioversion sinus tach: treat underlying cause

Answer 136

presence of beard BMI >30 edentulous age > 55 hx of snoring (occlusion present) also, male and mallampati 3-4

Answer 137

aspirin only needs to be held prior to operations that involve increased risk of bleed in to confined spaces ie intraocular, middle ear, intramedullary hold for 7 days P2Y12 inhibitors ie ticagrelor or clopidogrel are stronger antiplatelets and generally are held 5-7 days prior to surgerys with high bleed risk usually DAPT is given 6-12onths after PCI stent and then recommended to wait 3-6mo after stent placement for elective surgery resume anticoagulants immediately after surgery

Answer 138

pulmonary artery systolic pressure >35, or mean PA pressure >25 at rest or >30 during exercise

Answer 139

keep tidal volumes low (6-8cc/kg) avoid excess PEEP which can increase vascular resistance, increase RV afterload from inc intrathroacic pressure avoid permissive hypercapnia which will result in increase pulmonary vascular resistance and possible right heart failure

Answer 140

Group 1: primary pulmonary artery hypertension (ie collagen disease, portal HTN, drugs/toxins) Group 2: left side heart disease Group 3: lung disease (ie COPD, OSA) Group 4: chronic thromboembolic disease (PE or sickle cell) Group 5: other (ie sarcoidosis, henolytic anemia)

Answer 141

prominent incisor length large overbite poor prognath ability <3 cm interincisor distance mallampati 3 or 4 narrow or high arched palate stiff mandible <3 finger breaths thyromental distance short neck thick neck limited neck flexion or extension

Answer 142

paravertebral block or thoracic epidural PCA with IV opioid has higher risk profile and less analgeisa efficacy

Answer 143

6-7% per each degree celsius deep hypothermic cardiac arrest, temp target is around <25C

Answer 144

central venous pressure 0-7 right atrial pressure 0-7 RV sys pressure 15-25 (systolic presence) RV end-dia pres 3-12 Pulm A systolic pres 15-25 Pulm A end-dia pres 8-15 (dia step up) mean pulm A pres 10-22 pulm cap wedge pres 6-15

Answer 145

Hgb > 7 PT/PTT <1.5 (give FFP) Fibrinogen >300 (give cryo) Platelets >50,000

Answer 146

PaO2 = FiO2(Patm-Ph2o) - (PaCo2/R) patm sealevel = 760 Ph2o = 47 R quotient - 0.8

Answer 147

febrile nonhemolytic transfusion reaction Mechanism is cytokine build up in stored blood

Answer 148

increases ICP by increasing CMR and cerebral blood flow

Answer 149

methohexital: no change propofol: decreases midazolam: decreases etomidate: increases remifentanil: no change

Answer 150

fentanil is metabolized by the liver and is better for ESRD dilaudid has metabolite and can cause seizures in ESRD

Answer 151

preganglionic parasympathetic > Ach >nicotinic R preganglionic sympathetic > Ach > nicotinic R postganglionic parasympathetic > Ach > muscarinic R postganglionic sympathetic > Norepi > adrenergic R motor neurons > Ach > nicotinic R

Answer 152

it is a intermediate in glycolytic pathway and increasing 2,3DPG will shift the curve to the left

Answer 153

Carbamazepine Phenytoin Rifampin Ethanol Barbiturates

Answer 154

Fluconazole Valproic acid Metronidazole Cirpofloxacin

Answer 155

Wide awake - beta Drowsy awake - alpha Stage 1 light sleep - theta Stage 2 deep sleep - sleep spindles k complex Stage 3 and 4 (deep non rem) - delta Rem sleep - beta Bis is simplified eeg Isoelectric = Bis < 40

Answer 156

Host antibodies against donor leukocytes Or accumulation of cytokines in donor blood during storage Most common transfusion reaction and incidence can be reduced by leuko reduction

Answer 157

Egfr < 15 (esrd)

Answer 158

gingko - inhibit platelet activating factor (inc risk bleed) ginseng - lowers glucose, antiplatelet (risk bleed, hypoglycemia) kava - sedation/anxiolysis (increases anes req) st john wort - used for depresison (induces Cytp450 ginger - anti-emetic/antiplatelet (inc risk of bleed)

Answer 159

Ab against alpha-subunit of the muscle-type nicotinic acetylcholine receptors symptoms include diplopia, ptosis, dysarthria, and proximal limb muscle weakness that worsens with activity

Answer 160

hold 4-6 hr before and can restart 1 hr after both insertion and pull

Answer 161

hold 12 hr before and resume 12 hour after insertion or 4 hr after removal

Answer 162

hold 4-6hr prior and can resume immediately after insertion and pull

Answer 163

bicarb increases about 4-5mEq per 10 mm Hg inc in PaCO2

Answer 164

transpulmonary pressure are highest in restrictive lung disease due to a decrease in lung compliance

Answer 165

S1 closure of mitral and tricuspid valves S2 closure of pulm and aortic valves S3 (after S2) early ventricle filling S4 (before S1) atrial contraction

Answer 166

glycopyrrolate heparin nondepolarize NMB succinylcholine phenylephrine sugammadex

Answer 167

0.5mEq/L in healthy and in renal failure patients (not in spinal cord, burn or neuromuscular disease)

Answer 168

kiwi, bananas, and avocados (many fruits)

Answer 169

increase in progesterone leads to increase in minute ventilation by increasing tidal volumes

Answer 170

activity level (0, 2, 4 extremities) respiration (deep breath, shallow breath, apneic) circulation (>20, >20-50, >50% pre-anes bp) consciousness (fully, arousable, unconscious) o2 sat (92% on RA, O2 supp for >90%, <90% on support

Answer 171

PADSS also incorporates nasua/vomiting, pain, and surgical bleeding also requires patient have a driver

Answer 172

myasthenia gravis is Ab against postsynaptic nicotinic Ach receptors LE is Ab against presynaptic Ca channels

Answer 173

initial bolus of 2.5mg/kg and maintenance of 1mg/kg q6hr for 1-2 days

Answer 174

3+ attempts and taking longer than 10 min

Answer 175

flumazenil has quick onset 1-3 min but only lasts 45min midazolam is shortest duration of all benzos and lasts 1-2hr patient must be continuously monitored for resedation when given flumazenil to reverse benzos due to half life discrepancy

Answer 176

decreased lung compliance increased inspiratory pressure increased VQ mismatch from atelectasis hypercarbia from CO2 insufflation and reduced ventilation

Answer 177

For low dose: 4-6hours from last dose OR normalization of PTT. Can dose while catheter is in place immediately after placement For high dose wait 12 hrs before insertion and avoid giving while catheter is in For both doses, can immediately resume next dose of subQ heparin ppx catheter removal

Answer 178

hold 4-6hrs AND normalization of PTT prior to catheter insertion and removal Can resume heparin IV dosing 1 hour after procedure/removal

Answer 179

BID dosing lovenox must wait 12 hours before insertion and wait 12 hours after to restart dosing. Can wait 4 hours after catheter removal but cannot be within 12 hours from insertion (ie catheter was inserted but removed within 12 hours) daily dosing must wait 12 hours before insertion. Avoid dosing daily while catheter is in. wait 12 hours after single shot and can similar wait 4 hours after catheter removal but no sooner than 12 hrs after insertion therapeutic dosing wait 24hrs (longest) after last dose prior to insertion. Avoid administering while catheter is in place. Can resume dosing after removal 4hrs after and must be atleast 24hrs since initial insertion.

Answer 180

wait 24hrs before insertion AND have normalization of PTT. Do not administer while catheter is in place. Can resume immediately after removal.

Answer 181

loss of chloride causes hypochloremic metabolic alkalosis hyponatremia hypokalemia hypercalcemia

Answer 182

mechanically ventilated, no PEEP, 6=8cc/kg TV, ECG = SR, supine PPV>13% is likely fluid responsive

Answer 183

correlates directly with lipid solubility of that gas (meyer overton study). higher potency means less drug is needed to attain therapeutic effect. high lipid solubility means a high oil:gas parition coeffecient which resutls in a lower MAC of that gas. (ie higher potency) This also gives reason that partial pressure of a gas describes its potency (ie MAC) and not percent of gas volume. given different atmospheric pressures, a given percent gas volume can be more or less potent than at sea level. higher elevation ie -0.5atm means half the number of gas molecules per volume in a similar percentage

Answer 184

MACamnesia = 0.25 MACunconscious = 0.5 MACbar = 1.3

Answer 185

transverse process: nose pedicle: eye ears: superior articular process inferior articular process: front legs pars interarticularis: neck opposite superior/inferior articular processes: tail/hindlegs spinous process/lamina: body fractured pars interarticularis from spondylolysis will show a white band on scotty dog neck

Answer 186

LE is antibodies against VG Ca channels at the terminal end of motor neurons which prevents vesicles from fusing and release acetylcholine (paraneoplastic syndrome sometimes seen when small cell lung cancer) MG is antibodies against acetylcholine receptors at the motor end plate rendering transmission less sensitive Dantrolene prevents the release of calcium from the sarcoplasmic reticulum in skeletal muscles, depressing the excitation-contraction coupling

Answer 187

MAP is most accurate as this is what is directly measured Systolic is the most inaccurate and is often overestimated especially in HTN

Answer 188

Stage 1: - cessation of anesthetics - reversal of NMB - transition of respirations from apnea to irregular to regular (reactivation of respiratory centers of medulla and pons) - increase in CO2 levels Stage 2: - Return of autonomic responsiveness (ie tachycardia, HTN iso recent surgical trauma and ETT stimulation), sensory and motor brainstem pathways recovery (ie reaching for tube) - tearing, grimacing, salivating (return of CN 7, 9, 10 in pons and upper medulla) - airway tone improves when pharyngeal muscles recover (risk of laryngospasm here) Stage 3 - following commands denotes recovery from general anesthesia (shows recovered integration of higher brain functions along with CN8) - however spontaneous eye opening is usually the last physiologic response to recover despite patient following verbal commands

Answer 189

metoclopramide is a dopamine antagonist (along with antipsychotic like haloperidol, and even antinausea/antiemetic promethazine (phenergan) which can result in tremors and dyskinesias caution sympathomimetics (ephedrine, ketamine) when patient is on levodopa therapy which can precipitate severe hypertension avoid meperidine if patient is on selegiline (MAOis) due to risk of serotonin syndrome (rigidity, hyperautonomic state) if patient is taking acetylcholinesterase inhibitor like rivastigmine or donepezil for parkinsons dementia, administration of succinylcholine can be prolonged and patient can be more resistant to nondepolarizing NMB prone to dyskinesias with propofol and rigidity with opioids (morphine/fentanyl)

Answer 190

- minor surgery: continue ASA thru surgery - noncardiac surgery: prescriber and surgeon must discuss bleed risk vs MI risk - elective CABG: continue ASA thru surgery - prior PCI with upcoming CEA: continue ASA thru surgery unless risk of bleed > risk of MI - periph vasc disease s/f pop art endovascularization: continue ASA thru surgery (better outcomes) **If holding ASA or P2Y12 blocker, must stop 5-7 days prior to the surgery

Answer 191

L1 - femoral crease L2 - anterior mid thigh L3 - medial KNEE (THREE) L4 medial maleolus L5 top of fore foot S1 lateral foot

Answer 192

COPD patient s/p single lung transplant healthy lung is initial peak and diseased lung is the second elongated peak

Answer 193

incompetent inspiratory valve which results in the inspiration of CO2. extended expiratory plateau due to the detection of CO2 during inspiration phase blunted and shortened inspiration wave ETCO2 may or may not return to 0 during inspiration

Answer 194

ETCO2 does not return to 0 due to incompetent expiratory valve which results in rebreathing expired air

Answer 195

via histamine release this will lower end diastolic volume and thus pressure in the ventricles this will assist in coronary perfusion

Answer 196

anterior: V3-4 Septal: V1-2 Lateral: I, aVL, V5-6 Inferior: II, III, aVF

Answer 197

pupillary light: II, III corneal: V1 (ophthalmic), VII jaw jerk: V3 (mandibular), V3 (masseter) gag: IX (GPN, tongue base, post. pharynx wall), X (contract post. pharyngeal musc.) oculocephalic: VIII, III/IV/VI

Answer 198

two acetylcholine bound together binds to the alpha subunit on nicotinic acetylcholine receptors

Answer 199

ulnar nerve injury numbness/pain in the 5th/4th digits of hand and weakness on wrist flexion and thumb abduction ensure adequate padding of medial epicondyle and supination of upper extremities

Answer 200

baricity hypobaric: sterile water hyperbaric: dextrose (volume will determine spread for EPIDURAL injection)

Answer 201

MAP 60-150

Answer 202

gases: potentiate blockade antibiotics: potentiate blockade except for penicillin and cephalosporins (ceftriaxone) antiepileptics: potentiate blockade electrolytes Ca: decreases blockade Mg and Li: potentiate blockade

Answer 203

initially due to veins supplying nearby organs such as jugular or inferior thyroid veins large bleed multiple months out is due to tracheoinnominate fistula bleed where there is a fistula between trachea and the brachiocephalic trunk coming off the aorta

Answer 204

dihydropyridine calcium channel blocker mainly causing arteriolar vasodilation with minimal effects on cardiac inotropy (this allows for easier control of BP as compared to medications that cause both venous and arterial vasodilation like nitroglycerin) short half life of about 3-14min

Answer 205

290 mOSM/kg

Answer 206

increased body plasma osmolality which triggers ADH release to retain more free water

Answer 207

TACO: transfusion associated cardiovascular overload is volume overload that appears several hours after large volume transfusion and presents with dyspnea, tachycardia, hypertension, with bilateral infiltrates but is afebrile TRALI: TR acute lung injury is an immune response where donor antibodies trigger recipient neutrophils to cause damage to pulmonary vascular capillaries leading pulmonary edema. Presents with fever, chills, hypotension, hypoxia, and frothy airway secretions

Answer 208

they increase the conductance of chloride across the channel while GABA is bound to the receptor, therefore benzos are allosteric positive modulators of the receptor and not direct agonists (flumazenil is the opposite and is considered a negative allosteric modulator)

Answer 209

TENS = transcutaneous nerve stimulation and provides analgesia by activating A-beta mechanoreceptors which will inhibit A-delta and C nociceptive fibers (pain fibers)

Answer 210

immature and mature nACHr upregulate starting 1-2 days after initial burn and becomes safe 1-2years after the initial injury

Answer 211

aminoamides have preservatives (ie methylparaben) that can sometimes cause allergies but rarely cause anaphylactic rxn themselves aminoesters break down into PABA which can induce anaphylaxis

Answer 212

atropine is a tertiary structure that is able to cross both BBB and placental barrier and can be used to prevent neonatal bradycardia from neostigmine for reversal of NMB glycopyrrolate (quaternary structure) does not cross the blood brain barrier and minimally crosses the placental barrier (often used during reversal of NMB to prevent the side effects of neostigmine (ie bradycardia) scopalamine can cross the blood brain barrier and placental barrier, allowing for CNS effects like antinausea along with the potential adverse effect of central anticholinergic toxicity (AMS)

Answer 213

physostigmine since it is a tertiary structure and is able to cross the BBB unlike neostigmine and pyridostigmine neostigmine can cross the placental barrier and has potential for neonatal bradycardia pyridostigmine is used to treat myasthenia gravis but does not cross BBB

Answer 214

0.2mAmp - 0.5mAmp less indicates risk of intraneural injection and too close proximity greater than 0.5 means needle may be too far for LA to provide adequate block after injection

Answer 215

glucocorticoids affect glucose metabolism, glycogen deposition mineralocorticoids are for sodium and water retention hydrocortisone is a naturally produced glucocorticoid that has a 1:1 ratio (standard equivalent benchmark) Prednisone, prednisolone, methylprednisolone are all glucocorticoids with very minimal mineralocorticoid function with ratio approx 4-5:0.5-0.8 dexamethasone only has glucocorticoid function and has a ratio of 30:0 and is long acting

Answer 216

hyperglycemia from increased gluconeogenesis muscle wasting used to feed gluconeogenesis fat metabolism and redistribution centrally anti-inflammatory by decreasing prostaglandins which takes away protective stomach lining leading to peptic ulcers immunosuppression leading to infections and oral thrush sodium and water retention causing edema and hypertension negative feedback on adrenal gland causing secondary adrenal insufficiency osteoporosis/fractures

Answer 217

>20mg prednisone for 3+ weeks, especially for moderate and major surgeries give 100-150mg hydrocortisone during induction

Answer 218

plasma: 291 NS: 308 LR: 280 Plasmalyte: 284

Answer 219

plasma: 4-5 NS: 0 LR: 4.5 Plasmalyte: 5

Answer 220

goal directed means to use IV fluids to improve prelaod and to utilize fluid responsiveness measurements to track response such as pulse pressure variation, cardiac output and oxygen perfusion then once adequately euvolemic, fluid is restricted zero balance is where euvolemic weight is minimized and IF fluids are used to replete 3rd space losses and avoid overhydration and weight gain no differences have been identified in terms of outcomes between the two methods

Answer 221

supplemental oxygen racemic inspired epinephrine non-invasive PPV (BiPAP, CPAP, or HFNC) humidified air Heliox (laminar flow 70%helium, 30% oxygen) Steroids

Answer 222

primary hemostasis involves a vasospasm to reduce bleeding area and the aggregation of platelets of exposed collagen at a damaged vascular endothelial site to form a platelet plug secondary hemostasis involves the coagulation cascade purposed to create activated fibrin polymers to form a fibrin mesh that will strengthen the platelet plug

Answer 223

the start of the common pathway is the activation of factor X. Xa along with Va will activate the prothrombin activator complex which activated prothrombin into thrombin which will activate fibrinogen into fibrin intrinsic and extrinsic pathways lead to the activation of factor X fun facts: - Ca is also known as Factor IV - tissue thromboplastin is part of the extrinsic pathway and is known as Factor III

Answer 224

tissue damage causes a release of tissue thromboplastin (aka factor III) which activates factor VII into VIIa which then activates X into Xa, starting the common pathway. this is very quick to activate (approx 30 secs) since there is a high amount of factor VII available.

Answer 225

tissue damage/inflammation leads to activation of Factor XII then factor XII which activates Factor IX then factor VIII which directly activates factor X of the common pathway this is a slower but more robust cascade that takes a few minutes but produces more fibrin than the extrinsic pathway

Answer 226

PT/INR measure extrinsic pathway by measuring Factor VII, X, V, II (prothrombin), and Factor I (fibrinofgen) INR is a standardized way of expressing PT across different countries Warfarin is monitored using INR aPTT measures intrinsic pathway and common pathway by measuring all factors excpet for VII Heparin is monitored using PTT (or ACT) (both drugs affect both pathways but each is more sensitive for a particular drug)

Answer 227

present in both primary and secondary hemostasis Primary hemostasis: in the creation of platelet plug, VWF is used for platelet adhesion to the exposed collagen of the damaged endothelium, without vWF platelets cannot adhere and therefore cannot activate and therefore cannot aggregate Secondary hemostasis: VWF acts as a carrier of Factor VIII and significantly extends the half-life of it, without VWF, you will have extended PTT DDAVP will increase the amount of VWF expressed by the subendothelial tissue

Answer 228

peripheral vasodilation decreased cardiac contractility coronary vasodilation (especially isoflurane) cardiac preconditioning (decrease loading of Ca into myocardial cells)

Answer 229

Propofol works as an anesthetic by potentiating the GABAa receptor quick onset and termination are due to its lipid solubility allowing for quick re-distribution into other body compartments dose dependent associated decreases in tidal volume and eventual apnea bronchodilation increases sensitivity of hypoxic vasoconstriction

Answer 230

epinephrine increases the duration of the block by causing vasoconstriction and decreasing uptake of the LA sodium bicarb will decrease the pH and allow for more LA to be in the nonpolarized form which allows for faster onset via faster diffusion across cell membranes increased lipid solubility equates to more potent medication and denser block

Answer 231

5HT3 (serotonin) Histamine Dopamine muscarinic M1 Substance P/Neuokinin 1

Answer 232

ABL = [EBVx(starting Hct - minimum Hct)]/starting hematocrit minimum Hct is about 20-25 for healthy adults/kids and 30 for active cardiac comorbidities

Answer 233

occurs when there is not enough time for adequate exhalation of lung volumes before the start of next inspiration this is often due to inappropraite settings on the ventilator I:E time and frequency in patients with increased lung compliance suchas COPD where it takes longer for the chest to recoil and exhale to remove lung volumes this leads to progressive build up of end inspiration and expiration lung volumes auto/intrinsic PEEP is the notable by the presence of persistent end expiratory flow at the end of expiration and is due to hyperinflation of the lungs generating pressure moving outwards

Answer 234

consciousness activity (moves extremities) O2 saturation (>90%/supp req) respiration (quality of resp) circulation (BP)

Answer 235

superior laryngeal nerve originates from the vagus nerve (CN X) and divides into the external and internal branches External provides motor function to the cricothyroid muscle which tenses the vocal cords Internal branch provides sensory innervation to laryngeal/epiglottic structures above the vocal cords

Answer 236

almost entirely by the liver (even with liver function at 50%, can metabolize 100% of propofol) however this means propofol metabolism is also dependent on adequate hepatic blood flow about 30% of propofol is extrahepatic at the site of the kidneys

Answer 237

940nm (infrared) more absorbed by oxyhemoglobin 660nm (red) more absorbed by deoxyhemoglobin

Answer 238

opioid agonist, NMDA antagonist, and serotonin reuptake inhibitor metabolized by liver enzyme CYP3A4 can cause QT prolongation that can progress into torsades de pointes (normal QTc is 350-450ms)

Answer 239

epi does not increase duration of bupi or ropi for either peripheral nerve blocks or neuracial blocks dexamethasone and clonidine have both been shown to increase duration of block for both ropi/bupi dicarbonate is thought to increase speed of onset of local anesthetic block but it has the potential to cause LA precipitation at higher pH

Answer 240

occurs due to recipient antibodies targetting minor antigens on donor red blood cells (rhesus, kidd, kell) and hemolysis usually presents days to weeks after transfusion with mild or minimal symptoms (ie mild fever, jaudice or back pain)

Answer 241

-60 to -90 mV and is largely due to K why it is negative

Answer 242

Bohr effect pertains to the shift in the oxygen-hemoglobin dissociation curve due to changes in CO2 and pH Haldane effect pertains to hemoglobin's ability to carry more CO2 in the deoxygenated state

Answer 243

Air = yellow Oxygen = Green CO2 = grey NO = blue Nitrogen = black Helium = brown

Answer 244

2 x Na + Glucose/18 + BUN/2.8 normal gap is <10 increased gap can be due to solutes that are unmeasured such as ethanol, mannitol, sorbitol, lactate, ketones

Answer 245

temperature: directly related to cerebral blood flow and will decrease with decrease in temp (CMRO2 decreases by 6% with every drop in 1 degree) blood pressure is connected to blood flow thru the cerebral perfusion autoregulation curve that exists between maps of 50-150 PaO2: cerebral blood flow is inversely related t oPaO2 when < 50, does not change when PaO2 is > 50 PaCO2: increases in PaCO2 will result in increased cerebral blood flow

Answer 246

citrate = anticoagulant phosphate = pH buffer adenine = ATP source and maintains membrane integrity dextrose = sugar source

Answer 247

halothane = 2.5 (very soluble) iso = 1.4 sevo = 0.6 nitrous = 0.47 des = 0.42 (not soluble)

Answer 248

increase the most in highly soluble gases (ie halothane then second is isoflurane)

Answer 249

subcostal, ilioinguinal, and iliohypogastric nerves which provide sensation to lower abdominal walls

Answer 250

lowers cerebral metabolic rate, cerebral blood flow, and intracranial pressure

Answer 251

cricothyroid muscle adducts the vocal cords and is innervated by the external branch superior laryngeal nerve all other intrinsic muscles are innervated by the recurrent laryngeal nerve (along with sensation below the vocal cords, internal branch of SLN provides sensation above the vocal cords) both of these nerves provide efferent innervation of the laryngospasm

Answer 252

bilirubin, albumin, prothrombin time (PT or INR) fatigue, nausea/vomiting, jaundice, dark urine, biliary colic, ascites, encephalopathy

Answer 253

enzyme-independent reaction of breakdown that occurs in the plasma which allows for a relatively predictable offset time especially in liver failure patients (this can be affected by acidosis or hypothermia). cisatracurium and atracurium undergo this elimination route.

Answer 254

200mg of fibrinogen per unit of cryoprecipitate which will tend to raise the serum levels by about 70mg/Dl in addition to fibrinogen, cryo has high concentrations of Factor VIII and XIII and vWBF

Answer 255

relaxes airway tone,, depresses airway reflexes, and attenuates hyperconstrictive responses to bradykinin and acetylcholine

Answer 256

anticholinergics such as atropine or glycopyrrolate short acting beta agonist inhaler (albuterol) magnesium epinephrine glucocorticoids

Answer 257

factors that increase tendency for turbulent flow include velocity, density, and length of travel (tubing) while viscosity decreasing tendency of turbulent flow

Answer 258

both augment antithrombin III which inhibits factor Xa and thrombin however in order to inhibit thrombin, the heparin molecule must be long (ie unfractionated heparin) while LMWH will preferentially only inhibit factor Xa which allows for lower risks of HIT and platelet dysfunction due to the role of thrombin in inflammatory and immune pathways

Answer 259

sever hyponatremia is < 120 mmeq give hypertonic saline if severe or symptoms are present correct by 1-2mmeq per hour with maximum 12 per day due to risk of pons demyelination syndrome

Answer 260

it allows for the preferential use of the higher pressured pipeline oxygen source (50 psig) over the lower pressure oxygen tank (40psig) source using oxygen flush can allow high flow that lowers pipeline pressure below tank pressure second stage regulators reduce pressure to just above atmospheric and provide constant flow to downstream components

Answer 261

Prerenal: BUN:Cr >20 Urine Na <20 FENa <1% Renal: BUN:Cr <20 Urine Na >20 FENa>2%

Answer 262

centrally acting alpha2 agonist which decreases sympathetic activity in the medulla oblongata (vitals control) this reduces the production of renin and catecholamines in plasma withdrawal presents with rebound hypertension, tachycardia, flushing, agitation, palpitations

Answer 263

emergent = risk of life or limb if not operated within 6 hours urgent = within 24 hrs time sensitive is from 1 week to months elective = within a year

Answer 264

incompetent inspiratory valve will show an extended down stroke due to inappropriately allowing CO2 back into the inspiratory limb incompetent expiratory valve will show residual CO2 during inspiration phase, such that EtCO2 will not return to baseline of 0.

Answer 265

ETCO2 will not return to 0 during inspiration phase it lies after the expiratory valve and APL valve and just before the inspiratory limb (exhausted absorbent will cause CO2 to spill over into the inspiratory limb)

Answer 266

primarily class 3 antiarrhythmic by blocking potassium channels also acts as blocks calcium, sodium channels and to lesser extent alpha and beta adrenergic receptors it can be used to treat ventricular arrhythmias and sustained SVT such as afib

Answer 267

adult: 3-5 ml/kg/min infant 7-8 ml/kg/min

Answer 268

desflurane 0.42 nitrous oxide 0.46 sevoflurane 0.65 isoflurane 1.46 (much more soluble) "DNSI = Desflurane Not Soluble In..blood"

Answer 269

thiazides = hypercalcemia loop = hypocalcemia

Answer 270

activates GCPRs to increase adenylyl cyclase and increases cAMP and causes increased inotropy and chronotropy in cardiac cells and which also leads to counter effects to insulin which increases blood sugar by increasing glycogenolysis and gluconeogenesis, and inhibiting glycogen synthesis in the liver

Answer 271

sevoflurane: 167 isoflurane: 238 desflurane: 669 nitrous oxide: 38000 vapor pressure increases and boiling point decreases "SID-NEE has lots of vapor from aquatics"

Answer 272

anterior = sartorius lateral = vastus medialis posteromedial = adductor longus (superior portion), adductor magnus (inferior portion) contents include saphenous nerve, femoral artery and vein ultrasound halfway between ASIS and patella

Answer 273

standard pressure is 2000 psig and volume is 625L convert the new remaining pressure in to a volume and divide it by the flow rate ex. 1500psig/2000psig = X/625L then divide the new volume by the flow rate to get time in minutes

Answer 274

nitrous oxide will be partially liquid and partially vapor when it reads pressure of 745psig. At this point only by weighing the tank will tell how much gas is left. Once <75% is remaining then the amount of nitrous oxide will parallel the decrease in pressure

Answer 275

intubation dose: 0.1-0.15mg/kg and lasts 30-60min with half life about 25min undergoes hoffman degradation dependent on temperature and pH (not kidney or liver)

Answer 276

MELD predicts mortality in mortality in End stage liver disease but is purely objective criteria and components compared to childs-pugh and can be used to prioritize patients for transplant MELD: "I crush several beers daily = INR, Cr, Sodium, bilirubin, dialysis Childs-pugh: "Pour Another Beer At Eleven" = prothrombin, ascites, bilirubin, albumin, encephalopathy

Answer 277

morbid obesity uncontrolled GERD recent GI surgery improper NPO > 14 weeks pregnant hiatal hernia delayed gastric emptying (opioids, diabetes)

Answer 278

if the following is present: 0 twitches = 95% blocked 1 twitch = 90% blocked 2 twitches = 80% blocked 3 twitches 75% blocked 4 twitches = 0-60% blocked

Answer 279

phase 1 is polarizing with the addition of polar side groups (uses CYP enzymes to undergo oxidation/reduction etc) phase 2 is addition of endogenous compounds to enlarge the molecule and uses transferase enzymes

Answer 280

PSNS is both cholinergic SNS is cholinergic for preganglionic (including the single synapse to the adrenal gland) and postganglionic is all adrenergic including organs and smooth muscle (except for sweat glands which is cholinergic)

Answer 281

increased inotropic and chronotropic effect by increasing adenylyl cyclase in cardiac muscle cells (similar to catecholamines) but bypasses any inhibition by beta blockers (which is why it is considered Betablocker reversal) dose is 1-5mg IV bolus followed by infusion

Answer 282

roc 0.6mg/kg, 1-2min vec 0.12mg/kg, 3-5min cis 0.2mg/kg, 2-3 min (hoffman degradation)

Answer 283

urine will be concentrated but Na content will be low due to the body attempting to reuptake Na to retain voume BUN:Cr ratio > 20:1 FENa <1% UrNa < 20meq Urine osm > 400

Answer 284

for recent MI, stroke, or TIA that occurs more than 3 months ago is considered ASA3 and within 3 months is considered ASA 4

Answer 285

D2-antagonist used for antiemetic can cause QT prolongation and is C/I in anyone with prolonged QT, patients with hypomagnesemia have higher risk of prolonged QT and developing torsades other potential sideeffects include anxiety, restlessness, dystonia

Answer 286

30% of total blood output 3/4 blood flow to liver is thru the portal vein, 1/4 is thru the hepatic artery (origin celiac trunk) 50/50%

Answer 287

sensitive = anti-platelet factor 4 antibody specific = serotonin release assay

Answer 288

when heparin binds to platelets and exposes platelet factor 4, then antibodies develop to PF4 10x more likely from UF hep compared to LMWH presents 4-10 days after initiating heparin and often has reduction of 50% of pre-heparin platelet levels other risk factors include surgical patient > medicine, UF heparin, appropriate timing, and thrombosis

Answer 289

hypokalemia will potentiate effects of digoxin MOA: digoxin binds to K spot on the Na/K ATPase and causes inhibition. this leads to higher levels of Na in the cardiac cells. Higher levels of intracellular Na will then be exchanged outward in return for Ca to increase in the cell. This causes increased contractility (inotropy) and slower electrical conduction (decreased HR) By decreasing K levels in the state of hypokalemia, there will be less competition for digoxin in the binding of ATPase

Answer 290

4ml x total body weight x %SA burn half of this should be given over the first 8 hrs then the second half over the next 16hrs

Answer 291

ventricle dilation leads to increased afterload (higher volume to push), wall stress and also increased O2 consumption. thick walled hypertrophy will develop a smaller ventricle chamber and will have lower wall stress wall thickness is inversely related to wall tension. as chamber radius increases along with wall pressure then wall tension increases (thin dilated walls have high tension). when the chamber radius is decreased and wall thickness is increased then wall tension decreases

Answer 292

1. give calcium gluconate and increase pH with bicarb to immediately cause intracellular shift of K into cells 2. insulin takes 15min, albuterol takes 30min to shift potassium intracellularly 3. dialysis/RRT can be ordered, lasix can be given but must be euvolemic, polystyrene helps with GI excretion but takes days

Answer 293

1. patient pathologies - morbid obesity - improper NPO or high aspiration risk - difficult airway/intubation - neck immobility, recent H/N radiation - inability to lay flat/lay still for duration of surgery (anxiety/tremors/coughing) 2.type of surgery -accessibility to airway (180 turn/prone) - high pain stimulation surgery - need for paralysis - fire risk

Answer 294

eyes (4), mouth (5), movement (6) Eyes: 4 = spontaneous eye movement 3 = opens to command 2 = opens to pain 1 = no response mouth/verbal: 5 = spontaneous conversation 4 = confused speech 3 = incongruent speech 2 = incoherent speech 1 = no response movement: 6: spontaneous movement 5: localizes painful stimuli 4: withdraws from pain 3: decorticate (flex) posture 2: decerebrate (extended) posture 1:no response

Answer 295

cerebral blood flow is 50ml/100g/min cerebral perfusion pressure is 80-100mmhg ICP is <10mmhg

Answer 296

anticonvulsants such as carbamazepine and phenytoin wil induce the CUP450 system which increases metabolism of NMBs, shortening the duration aminoglycosides prevent the release of acetylcholine in alpha neurons and potentiate NMB duration hypercalcemia antagonizes NMBs hypermagnesemia will prolong NMBs hypokalemia will prolong NMBs

Answer 297

1 point each: high risk surgery, hx of ischemic heart disease, congestive heart failure, cerebrovascular disease, DM2 requiring insulin, Cr >2 score equates to risk of major cardiac event 0 = 0.4% 1 = 1% 2 = 2.4% 3+ = 5%

Answer 298

initially causes both decrease in CBF and CMR, but above 1.1 MAC it will cause vasodilation that increases CBF while decreasing CMR

Answer 299

Paired t test is for when comparing outcomes from a single group who acts as their own control Unpaired t test is used to compare nonordinal outcomes of two groups

Answer 300

- lidocaine plain: 5 - lidocaine w epi: 7 - bupivicaine plain: 2.5 - bupi w epi: 3 ropivicaine: 3 - chloroprocaine: 12

Answer 301

low: outpatient, superficial, breast, eye, endocrine (thyroid) moderate: head and neck, orth, uro/gyn, endovascular (aneurysm), carotid endarterectomy high: intrathoracic, intraperitoneal, suprainguinal endovascular, large vessel (ie aorta)

Answer 302

Urine:serum > 1.5 , meaning the kidneys preserve the ability to concentrate the urine

Answer 303

"PEA": phenytoin, ethanol, aspirin

Answer 304

total volume is 1590L of N2O at a pressure of 745psig much of it contained in liquid form under high pressure (actual internal volume of the cylinder is 5L) pressure will continue to read the same until about 16% volume left or 250L, this is when all liquid N2O is used up

Answer 305

unpaired: cricoid, thyroid, epiglottis paired: arytenoid, cuneiform, corniculate

Answer 306

starts at the cricoid cartilage C6 and ends at the carina T5 has 15-20 U-shaped cartilage rings with the posterior wall consists of the posterior trachealis muscle that aids in expectoration lined with ciliated pseudostratified columnar cells

Answer 307

Oxygen consumption of myocardium factors: wall tension, heart rate, and contractility LaPlace Equation: Wall tension = (Pxr)/2H, where H is wall thickness from increased systemic pressure ie AS or HTN, wall tension increases from an increase in afterload pressure. The heart will hypertrophy the LV walls to increase thickness and subsequently decrease wall tension and thus decrease O2 consumption Deleterious effects of this change is that the ventricles become less compliant and can develop diastolic dysfunction and becoming more reliant on left atrium kick to maintain LV end diastolic volume for adequate CO.