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Truelearn Flashcards

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1
Q

Carcinoid tumor

A

1 cause of death is cardiac failure with carcinoid

Mainly in gi tract
High 5 hiaa in urine
Excess of serotonin in systemic circulation
Flushing diarrhea abdominal pain hypotension right heart lesions

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2
Q

Ulnar neuropathy

A

Thin males

Don’t put pressure on condylar groove of humerus

Most common perioperative neuropathy is ulnar

Nerve conduction studies look at both motor and sensory

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3
Q

Decrease smoking for two days

A

Less carboxyhemoglobin and oxyhemoglobin curve shifts to the right

Takes two months to see reduced sputum increased ciliary function improved closing volume

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4
Q

Causes of failed neuraxial block during c-section

A

Maternal obesity
Late labor epidural placement
Rapid conversion from labor to C section

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5
Q

Hyperparathyroidism main cause

A

Single adenoma

Leads to hypercalcemia with abdominal pain nephrolothiasis

Parathyroid stimulates osteoclast activity

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6
Q

Familial hypocalcemic hypocalciuria is due to

A

Decreased excretion of calcium and magnesium

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7
Q

Normal creatinine and BUN I’m pregnant patient

A
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8
Q

In pregnancy

GFR

Blood clotting factors increase/decrease

Hemoglobin

A

Increases

Increase

Decrease -physiologic anemia

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9
Q

Sitting pain =

A

Discogenic

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10
Q

Morning stiffness back pain

A

Anklyosing spondylitis

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11
Q

Primary hyperthyroidism

A

High serum and urinary calcium

Low phosphorus

Causes non anion gap acidosis

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12
Q

Non parathyroid causes of hypercalcemia

A

Multiple myeloma, vitamin d intoxicating

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13
Q

Renal failure

A

Secondary hyperthyroidism

Caliciun low phosphorus hugh

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14
Q

Gas score verbal

A

5 normal
4 confused
3 inappropriate words
2 incomprehensible words

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15
Q

GCS score

Movement

A 
6 normal
5 localize to pain
4 withdraw to pain
3 flex ion
2 extension
1 nothing
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16
Q

An acute drop in ventilation during a single lung case is to

A

Ventilate with both lungs

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17
Q

Dependent lung is the

A

Ventilated lung

Can give peep if hypoxemic

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18
Q

Septic shock

A

More glucose formation with insulin resistance

Sepsis leads to hyper metabolism which increases protein catabolism

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19
Q

SVT with WPW syndrome slanted R wave

A

ProcainAmide

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20
Q

Paroxysmal SVT first line

A

Adenosine

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21
Q

Elimination half life of labetolol

A

5.5 hrs

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22
Q

Diltiazem increases

A

AV nodal conduction

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23
Q

Anyicholingeric

A

Tachycardia

Mydriasis

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24
Q

Carbamazepine side effects

A

Widened qrs
Hypotension
Seizures
Anti-cholinergic symptoms

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25
Antiphospholipid syndrome
Recurrent pregnancy loss Leads to arterial/venous thrombosis Increase in PTT but no change to PT time
26
Bowel obstruction of my tubes
Decrease viscosity of feeds | Flush them through
27
Refeeding syndrome
All electrolytes are down mainly hypophasphatemia
28
ASIA scoring system for spine injury
A = complete cord transection E = normal
29
PCNS = p alveoli = p blood
At equilibrium
30
LAD supplies
Left anterior wall of left ventricle Lateral wall of LV is by the circumflex
31
IVRA
Tourniquet on its own provides distal ischemia without local anesthetic Provides motor and sensory anesthesia Bier block provides extremity anesthesia by diffusion of local anesthetic from veins to capillaries to vasa vasorum
32
C section when compared to vaginal delivery
Lower risk of maternal hemorrhage or uterine rupture if u do a c section C section will increase uterine rupture risks in further pregnancies Infection risk is higher in c section
33
Phosgene chemical warefare agent
Severe pulmonary damage
34
Can’t give hydroxyethyl starch to a patient with
Renal failure
35
Acute systolic reaction from dopamine antagonism from which drugs
Metochlopramide and procholrperazine Anticholinergic such as diphenhydramine or benztropine can be used for treatment
36
Sarcoplasmic reticulum calcium goes into the
Cytoplasm Calcium binds troponin c and displaced tropomyosin to allow actin-myosin binding
37
Lactate
Can not replenish ATP in muscle fiber
38
Binding of what molecule to myosin head allows for detachment from actin
ATP
39
Kappa opioid receptor provides relief from opioid induced
Itching
40
NMDA receptor antagonism
Methadone Ketamine Memantine
41
The substance seen most in the epidural space is
Fat
42
Dopamine
Increases Cardiac output and svr and doesn’t help with renal function
43
First line pressor for septic shock is
Norepinephrine
44
First line therapy In all forms of shock is
Intravascular volume replacement
45
Midazolam/diazepam method of bio transformation
Oxidation
46
Lorazepam/oxazepam method of bio transformation
Glucoronidation
47
Latex allergy
Tropical fruits Banana, mango, kiwi, pineapple, mango Also more with spina bifida, healthcare workers
48
How many category 1 credits are needed per cycle by MOCA
250 Fellowship gives 50
49
Quadraplegia occurs if lesion is above
T1 if not it is paraplegia Above C4 they will need ventilator support
50
During forced exhalation
The apices of the lungs are emptied first
51
Unilateral intrascalene block causes
Unilateral phrenic nerve blockade
52
ERV with atelectasis
Is less. The ERV difference between expiring with and without atelectasis is closing volume. Closing volume plus RV = closing capacity
53
Closing capacity is the volume remaining in the lungs
When alveoli begin to close
54
FRC =
ERV plus RR
55
Most safe volatile anesthetic with renal failure
Desflurane Sevoflurane produces compound A which could be determinate in kidneys
56
Methemoglobin
Ferrous form of heme is oxidized to the ferric form Prilocaine and benzocaine can cause it Treat with methylene blue 1-2 mg/kg If patient has G6PD defieciency treat methemoglobinemja with ascorbic acid(vitamin c)
57
Dibucaine number of 20 is homozygous for pseudo holiness erase deficiency 40-70 is heterozygous Phase 2 block with succ is after multiple doses and resembles neuromuscular block
Yes
58
Higher dibucaine =
More psuedocholinesterase
59
Pneumothorax
Sudden hypoxemia and high peak pressures
60
Post obstructive pulmonary edema
Young males after Extubation Treat with positive pressure ventilation
61
Hyperesthesia allodynia autonomic changes with previous fracture and damage to nerve
CPRS type 2! Cprs occurs in the abscence of apparent nerve injury
62
Palpable taut band, pain when nodule pressed on band
Myofascial pain syndrome
63
Treatment cprs
Physical therapy Memantine gabapentin Sympathetic nerve blocks
64
Jaw thrust to relieve upper airway obstruction affects what muscle
Genioglossus
65
General anesthesia can do what to uterine musculature Vagina and perineum is what dermatome
Relax it S2-S4
66
Registries are good bc they can tell us about
Rare events
67
Closed claims project was made to help with
Patient safety
68
Bumenorphine is a _____ my agonist
Partial Meaning it only get to a partial point if it’s full potential
69
In procurement give PRBCs to achieve hematocrit of
30% Try to have procurement as soon as possible Always perform echocardiogram on heart before doing a heart transplant
70
ACT
Used to evaluate intrinsic and final common pathway of coagulation system Normal ACT is 107 ACT 400-480 in order to go on cardiopulmonary bypass Hypothermia, thrombocytopenia, hemodilution prong the AcT
71
Common pathway of coagulation
Factors 10, 5, 2 7 extrinsic Intrinsic 12 11 9 8
72
Liver produces all vitamin k dependent factors
2, 7 9 10 protein c and s Factor 7 has shortest half life of vitamin k dependent factors
73
Second degree AV block type 2 requires a
Pacemaker Also third degree Refractory SVT Symptomatic bradycardia with sinus node dysfunction
74
Hypocalcemia
Distal paresthesia Tetany Hypokalemia = U waves
75
Emphysema = hyperinflation With pulmonary bleh on child want to avoid use of
Nitrous oxide
76
Child vs adult airway
Child has larger tounge cephalad larynx, slanted vocal cords floppy epiglottis Infant larynx is at c3-c4 adult is at c5-c6
77
On TEE cephalad structures
Are on the right side
78
Hardest valve to visualize via TEE
Pulmonic valve - easier to see with TTE as it is more anterior
79
Precedex is mainly metabolized in the
Liver Precedex causes inhibition of presynaptic norepinephrine release Elimination half life is 2-3 hours
80
Pregnancy related mortality number one cause is
Cardiovascular disease
81
Transient neurologic syndrome is not affected by the
Baricity of the local anesthetic Back pain with radiation to buttocks thighs and calves occurring 24 hours after spinal and gets better within 1-3 days TNS is associated with liocaine spinal anesthesia, lithotomy position, same day surgery, and early ambulation after surgery
82
Sensory level of spinal anesthetic affected by
Baricity of solution Dosage of local anesthetic Patient position
83
Motor evoked potentials
Procedures involving anterior spinal cord blood supply and anterior spinal artery
84
Artery of adamkowitz
Thoracolumbar spinal cord is supplied by it
85
Brainstein evoked potentials start in the ____ and end in the _______
Cochlea/auditory cortex
86
The first step if someone hyperkalemic with ecg changes and mental status change
Stabilize myocardium with calcium and give insulin other measures, can’t do dialysis first even though it’s the definitive treatment Furosemide takes 30 minutes to start working
87
Thermal neutral zone for new newborn
32-35 degrees C The range of ambient temperature where metabolic rate is at a minimum
88
Supfhemoglobin and acidosis shift oxyhemoglobin curve to the
Right Methemoglobin shifts it to the left
89
FRC is described as
Volume of air left in the lungs at the end of breathing, during normal tidal volume breathing
90
Below closing capacity
The lungs start to collapse
91
Musculochtaneous nerve is not within the
Axillary sheath That’s why it often doesn’t get blocked
92
Peak and plateau pressures both increase from
``` C02 insufflation Ascites Obesity pulmonary edema Tension pneumothorax ```
93
Best opioid for chronic neuropathic pain
Methadone Has nmda activity and serotonin reuptake
94
Hypophosphatemia
Dysfunction of skeletal muscle Hypophosphatemia decreases 2 3 DPG which causes left shift of oxyhemoglobin curve
95
Replacing phosphate can lead to what electrolyte abnormality
Hypocalcemia
96
DLCO looks at
Diffusion capacity of lung It is decreased by pulmonary embolism Higher cardiac output or bigger lung volumes increases it as well such as with exercise will increase dlco and so will asthma
97
Vasopressin doesn’t directly affect
Potassium concentration
98
What ventricle is continually perfused during cardiac cycle
Right Ventricle Resting coronary blood flow is 250 ml/min Coronary perfusion pressure is difference between aortic and ventricular pressures LV is primarily perfused during diastole
99
Alveolar dead space decreases during pregnancy due to increase in
Cardiac output
100
Spinal anesthesia leads to
Decreased hearing, hypothermia due to redistribution of heat from core to periphery,
101
PVR is highest at
Extremes of lung volumes. Lowest at normal tidal volumes As alveoli close get resistance of blood vessels due to decreased flow Pulmonary vascular resistance is lowest at FRC*****
102
Fluid flow pousielle law determined by
Viscosity, length of tubing, pressure exerted on tubing
103
Coffee with creamer and soy milk how long yo fast
6 hours
104
Phase 1 metabolism
Oxidation, reduction, hydrolysis
105
Elimination of drug is proportional to
Serum drug concentration
106
Constant fraction per unit time is lost in
First order kinetics Most drugs are eliminated by zero order kinetics
107
Aging lung tissue has decreased elasticity and thus increased
Compliance
108
FRC and Closing Capacity _________ in the elderly
Increase
109
Bohr effect describes
Hemoglobins affinity for oxygen at varying conditions
110
Absolute indications one lung ventilation
Protective isolation Uniteral lung lavage Vats Relative indications are pneumonectomy, love tiny, thoracic aneurysm
111
Hepatic artery supplies and Portal vein supplies how much of blood supply to liver
20/80 Synthetic function of liver is based off PT
112
Half life of albumin is
20 days
113
Which clotting factor has the shortest half life
7 - half life 3-6 hours
114
Midesophageal two chamber view shows
Anterior and inferior walls of LV Anterior supplies by LAd and inferior by RCA Can also see left atrial appendage
115
Hypercarbia causes
Rightward shirt of oxyhemoglobin dissociation curve
116
Long acting non selective alpha blocker
Phenoxybenzamine
117
Catecholamine resistant vasoplegic shock give
Methylene blue which is contraindicated relative to fluoxetine
118
At rest CMR02 is 3.5ml/100g/min Brain gets how much cardiac output
10-15%
119
If CBF higher than CMR get
Luxury perfusion If CBF is lower than CMR you get ischemia
120
Leukocyte reduction means
Depleting donor blood products of leukocytes Leads to decreased Febrile reaction s, decreased CMV transmission, reduced inflammatory mediators
121
In patients with high anion gap metabolic acidosis the reason bicarbonate is low as due to
Binding the excessive H+ ions
122
Approximately 85% of bicarbonate is reabsorbed in the
Proximal tubule
123
4T to diagnose HIT
Thrombocytopenia Timing of reduced platelets- 5 to 11 days Presence of thrombosis Exclusion of other causes of thrombocytopenia- other cause not apparent
124
Tetanus
Inhibiting neurotransmitter release from inhibitory neurons of the CNS Treat with tetanus immunoglobulin
125
Botulism
Inhibition of acetylcholine release from the nerves at the neuromuscular junction
126
Inhibition of elongation factor 2
Diptheria
127
Maternal ACEI use is associated with
Oligohydraminos not polyhydraminos
128
Polyhydraminos treatment of choice is
Indomethacin Usually due to fetal structural abnormalities like TEF or duodenal atresia
129
Method of treatment that could alone worsen thyrotoxicosis Thyrotoxicosis due to over abundance of thyroid hormone
Radioactive iodine- don’t give alone bc can lead to more hyperthyroid the first few days after bc it releases thyroid hormone in the bloodstream
130
PTU and methimazole act to lower
T4
131
Can’t do radioactive idodine in patients who are
Pregnant or breastfeeding
132
Ace inhibitor causes
Decreased cardiomyocyte proliferation
133
Left ij and carotid artery overlap more on the
Left side
134
Most common complication with central line is
Infection
135
Best and first way to diagnose c dif
C dif toxin enzyme immunoassay First cause is clindamycin and quinolone
136
Fenoldopam MOA
Dopamine 1 agonist Causes sodium and free water excretion Renal vasodilator
137
Non coronary cusp is on the
Right on mid esophageal aortic short axis view RCC is posterior
138
Causes of needing postop mechanical ventilation in patients with myasthenia gravis
``` Duration of disease>6 years Presence of pulmonary disease like copd Vital capacity<2.9L NIF<20cm H20 Daily pyridostigmine dose>750mg ``` Many patient with MG have thymoma Patients with MG are resistant to succinylcholine Sensitive to NMBlockers because less receptors available
139
Hypovemia leads to
Decreased venous return and cardiac output Leads to decreased 02 delivery and can lead to postop afib Occurs commonly after cardiothoracic surgery
140
Sotalol
Beta blocker | Potassium blocker-leads to less potassium
141
Apgar score
``` Heart rate Muscle tone Skin color Reflex irratibility- grimace and/or small cry is a 1 Breathing ```
142
Code dose epinephrine
0.01mg/kg 50-100 mcg iv I typical dose Give epi 1 mcg/kg after anaphylaxis
143
If you suspect latex allergy with anaphylaxis
Mast cell tryptase should be drawn Epi Fluid bolus Remove latex materials Cessation of anesthetic agents
144
Amiodarone can not be
Dialyzed
145
What hemodynamic parameter does not change during pregnancy
Central venous pressure SVR decreases in pregnancy
146
Cardiac output is highest right after
Delivery
147
Hemodialysis requires large fluid shifts and may not be tolerated in ppl with
Aortic stenosis, unstable angina and other cardiac conditions
148
Hypercalcemia symptoms
Polyuria, polydypsia, weakness, psychic disturbance, kidney stone, constipation, shortened qt, prolonged pr, heart block
149
Neostigmine side effect that isn’t reversed by anti-cholinergics
Paradoxical muscle weakness Neostigmine causes decreased LES tone and can lead to BRONCHOSPASM
150
Seperation anxiety starts
After 6 to 8 months
151
Spirometers can’t tell u
Residual volume
152
Negative pressure pulmonary edema
Hypoxia, pink frothy fluid, and bilateral patchy infiltrates on cxr Treat with Ppv or cpap Leads to increased preload and afterload
153
Trendelenberg does not increase
Dead space Can cause endobronchial intubation/total lung capacity can go down/trendelenberg leads to rise in shunt
154
ARDS
Non-cardiogenic pulmonary edema with hypoxemia
155
Increase PEEP to help patients with
ARDS High peep lowers cardiac output due to decreased venous return to right heart
156
Sodium nitroprusside causes
Cerebral vasodilation
157
Spinal cord stimulator affects
Dorsal horn of spinal cord
158
After mi without coronary intervention should wait
2 months before elective surgery
159
Emergency procedure is those defined as needing to take place within Urgent procedure is described as those needing to take place
6 hours | 6 to 24 hours
160
After MI
14 days for balloon angioplasty 30 days after BMS 60 days after no intervention 180 days for DES
161
CAM ICU first look at
Inattention to diagnose delirium
162
Sinusitis is a complication of
NG tube feeding for prolonged times Need CT Max face
163
Carbohydrates generate more ______ than lipids
C02
164
Headache with focal neurologic symptoms do
MRI
165
Storage of RBCs shifts oxygen dissociation curve to the
Left
166
Fever, nuchal rigidity, and altered mental status =
Meningitis
167
Epidural hematoma
Lower extremity neurologic signs, such as decreased motor function
168
Botulism
Blocks intracelluar fusion acetylcholine vesicles to the nerve terminal membrane
169
Botulism toxin works at the
Neuromuscular junction
170
Amniotic fluid embolus
Cardiovascular collapse and then consumptive coagulopathy
171
Pain in an area that lacks sensation
Anesthesia dolorosa
172
Hypalgisia
Decreased response to noxious stimuli
173
Mannitol May cause cerebral vasodilation
If given too quickly. Give over 10 to 15 minutes
174
Valproic acid doesn’t help In treatment of
CRPS type 2
175
First line for CRPS
Physical therapy- cornerstone TCA Gabapentin Sympathetic block
176
Terbutaline can cause
Hyperglycemia
177
Preterm labor
Before 37 weeks
178
Terbutaline side effects
Tachycardia Hypokalemia Hyperglycemia
179
Indomethacin side effect
Renal and platelet dysfunction
180
Fetal fibronectin can be used to screen for
Preterm labor
181
Absolute indicators for TPN
Short bowel syndrome Small bowel obstruction Active GI bleed Enteric fistula
182
Use lower glucose in tpn solution to prevent
Hypoglycemia | Leads to less insulin secretion
183
High dose oxytocin leads to
Hyponatremia and hypotension
184
High dose oxytocin leads to
Hyponatremia
185
Hyperchloremic metabolic acidosis lowers
SID | Lactate levels stay normal
186
Elderly patients have increased
Resting sympathetic tone and a decrease in parasympathetic tone
187
TPN metabolic changes
Hypercarbia/hyperglycemia/hypophosphatemia | Hepatic steatosis is common with TPN
188
TPN can lead to
Hepatic steatosis- AST/ALT will increase
189
RQ of 1 = RQ of 0.7 equals
Carbohydrate Oxidation Lipid oxidation
190
If patient has been getting any form of heparin for over 5 days
Need to check platelet count prior to neuraxial placement or epidural catheter removal
191
If patient is getting 5000 subq heparin BID or TID
Need to wait 6 hours until neuraxial placement
192
Most sensitive for detecting venous air embolus
TEE than precordial Doppler
193
Nicardipine is extensively metabolized by
The Liver
194
Nicardipine side effect
Flushing Headache Peripheral Edema Renal insufficiency has no affect on nicardipine
195
Diabetes inspidus with.m hypernatremia and seizures first line is
Free water slowly and then if needed desmopressin
196
Acute respiratory acidosis what helps first
Plasma protein buffers Renal retention of bicarbonate happens later
197
Bladder distention during surgery leads to
HTN
198
Anterior wall of left ventricle =
LAD
199
Drowning
Breath holding then laryngospasmtgen involuntary efforts then desat inhalationof water then cardiac arrest
200
With no leak on icu patient with good respiratory parameters you want to extubate
Give methylprednisolone prior to Extubation
201
Sensory below vocal cords
Recurrent laryngeal nerve which is a branch of the vagus
202
Infants risk for apnea increase with
Anemia General anesthesia Regional anesthesia with IV sedation
203
Volatile anesthetics above 1 MAC
Increase CBF and decrease CMR02
204
CMR02 decreases with
Hypothermia and sleep
205
Nitrous oxide increases
CMR02 and CBF
206
IV anesthetics all
Lower CBF and CMR02
207
Adult poly cystic kidney disease Before doing surgery need to get
CT angiogram of head to check for cerebral aneurysm Specifically Berry/Saccular aneurysms
208
Steep trendelenberg
Less blood to legs, reduced cardiac output, more central blood volume Steep trendelenberg increases risk of rupture Increased ICP and IOP Reduced FRC/vital capacity
209
Mar fans
Mutation in fibrillin1 | Get echo and CT angiogram prior bc they have high risk for aneurysm and heart issues
210
Loop and thiazides cause a
Hypochloremic metabolic alkalosis
211
Volatile anesthetics increase CBF only at
1.5-2.0 MAC
212
Pressure within alveolus =
2T/R
213
Surfactant concentration increases when
Alveoli become smaller
214
In pregnancy minute ventilation is FRC below closing capacity leads to
Increased Atelectasis
215
Urticaria angioedema dyspnea after blood transfusion usually due to
IgA deficiency
216
Continued use of opioids even after adverse consequences =
Addiction
217
Delay in latent phase of labor mainly due to
Unripe cervix 20 hours for first 14 if multigravida
218
Gradient between pac02 and Etc02 =
Dead Space
219
Stellate ganglion block complications
``` Vasovagal reaction Ptosis Miosis Spinal injection Horners syndrome ```
220
Duration of action of neuromuscular blockers in elderly is
Less Thus can give less
221
If patients intrinsic HR is above pacemaker HR and on asynchronous mode(DOO) can lead to
R on T phenomenon leading to V Tach or V fib
222
Can change to DOO
Periop to prevent electromagnetic interference Need DDD for complete heart block
223
Don’t give propofol to patients suspected of having
Pancreatitis
224
PRISyndrome
Metabolic acidosis, rhabdomyolysis, CHF, bradycardia and affects mitochondrial and fatty acid metabolism Related to high dose propofol infusions
225
In awake patient, first line medication to cause uterine relaxation is
Nitroglycerin-usually happens during cases of retained placenta
226
Glycine toxicity causes
Hyper ammonia and can cause transient blindness
227
Number one risk factor for placenta accreta
Former C section
228
If leak pressure of uncuffed endotracheal tube is high replace with
SMALLER endotracheal tube Too much pressure can lead to tracheal ischemia
229
Optimal cuff pressure is
20 cm H20
230
Opioid addiction is more likely in
Non cancer pain
231
Highest risk for AKI
Aortic aneurysms
232
Total hepatic blood flow preservation is least with
Halothane
233
Moderate to severe cancer pain can use
Morphine
234
Morphine 6 glucoronide also provides
Analgesic effect Morphine 3 glucoronide provides adverse affects
235
PONV
Female Non smoker Previous PONV Use of postop opioids
236
Ambulatory surgery shouldn’t require
Overnight stay Main reason for delay in discharge is pain or PONV
237
Type 1HRS
Happens fast. Usually due to some problem with spontaneous bacterial peritonitis
238
First fluid for severe dehydration in Peds patient
20 mg/kg of isotonic fluid like NS
239
Risk factors for placenta accreta
``` Multiparity Smoking Advanced maternal age Placenta previa Prior uterine surgery ```
240
Fibrinogen half life is
4 days
241
Only drugs that must be continued are
Beta blockers and statins
242
Nicardipine
Arteriolar vasodilator and decreases left ventricular afterload with minimal affect on preload
243
Fenoldopam
Vasodilator that causes reductions in preload and afterload
244
Nitroglycerin
Vasodilator via cGMP. Reduces preload and causes greater venous dilation
245
Neseritide
Vasodilation, naturesis, diuresis
246
A delta are the
Fastest conducting nociceptive fibers Immediate transmission of painful stimuli and are myelinated
247
Small unmyelinated fibers
C fibers
248
A alpha fibers
Proprioceptive and motor
249
Reuptake of serotonin and norepinephrine
Tramadol
250
Herpes zoster treat with
Antiepileptics TCA SNRIs Tramadol
251
Phantom limb pain is a type of
Neuropathic pain
252
Hypoplastic left heart is associated with
ASDs
253
Hyoplastic left heart
Systemic blood flow is dependent on retrograde flow from PDA | Severe stenosis of mitral or aortic valves
254
The greatest metabolism of anesthetivs gases
Sevoflurane>isoflurane>desflurane Desflurane is least metabolized
255
Celiac plexus block most common complication
Orthostatic hypotension and diarrhea
256
Infragluteal sciatic nerve block anatomical landmarks
Greater trochanter of the femur Ischial tuberosity Sciatic groove
257
Any form of carotid sinus manipulation such as carotid stent deployment stimulates carotid baroceptors and leads to
Bradycardia!
258
Chemoceptors
Ventilation in response to hypoxia
259
Intense vasoconstriction during
Autonomic hyperreflexia(causes skin pallor not flushing below level of lesion You get vasodilaton above lesion Nitroprusside nicardipine for treatment
260
Glucagon causes
Increased hepatic artery blood flow
261
Major disadvantage of paracervical nerve block is
Fetal bradycardia
262
Diabetes insipidus
Hyponatremia and hypovolemia Give fluids to pending organ donor to maintain intravascular volume
263
Oral midazolam is better than parental prescence to prevent
Preop anxiety
264
Early onset adult ventilator pneumonia associated with
MSSA Strep pneumoniae H influenzae
265
Mannitol is not a good treatment for
Carcinogenic pulmonary edema
266
PEEP helps oxygenation by
Increasing FRC and decreasing airway resistance and increasing lung compliance
267
High Fa/Fi =
Lower solubility
268
Lower extremity CRPS is treated with
Serial lumbar plexus sympathetic blocks Can mess up ejaculation
269
Memantine is an
NMDA antagonist which can be used for CRPS
270
Elevated ICP is an absolute contraindication to
Neuraxial anesthesia
271
Permanent pacemaker
Should be checked prior to surgery No need to convert a pacemaker to asynchronous mode if not pacemaker dependent
272
Alfentanyl acts faster than fentanyl because of its low
PkA
273
Going too deep on intrascalene block leads to
Intrathecal placement
274
Most specific sign of fat embolus is
Petechial rash on body
275
Fenoldopam causes a decrease in
Arterial blood pressure
276
Triiodothyronine is higher with
Graves’ disease
277
Thyrotoxic heart failure
Decreased SVR and increased PVR
278
Precedex effect
Hypotension Bradycardia Sedation Analgesia
279
What step starts coagulation cascade
Tissue factor converts factor 7 to factor 7a
280
Intraoperative anaphylaxis most likely cause
NMBDs
281
Carotid bodies respond to
PA02
282
Central chemoceptors in medulla respond to
pH
283
Which nerve travels posterior to lateral malleolus
Sural
284
What innervates toes
Deep perineal Sural Superficial peroneal Saphenous does medial ankle and median foot but not the toes
285
Femoral nerve terminates to form the
Saphenous nerve
286
Paravertebral space is continuous with
Epidural and intercostal space Not intrapleural
287
Thyroid storm start treatment with
IV propranolol
288
GA decreases FRC by
5-10%
289
What drugs are metabolized the fastest
High clearance | Low volume of distribution
290
Vasopressin doesn’t affect pulmonary hypertension bc
It has no alpha affect
291
Unfractionated heparin best monitored by Unfractionated heparin binds LMWH binds factor
PTT AT3 10a
292
Reversal of LMWH is not as predictable and good as it is with
Unfractionated heparin
293
HIT shows up at
5-10 days
294
HIT2 is mediated by
IgG antibodies binding to heparin pf 4 complex on surface of platelets
295
Argatroban is metabolized by the liver Drug affect of direct thrombin inhibitors is via
PTT or ACT
296
Dabigatran
Renally excreted Stop 24 hr before minor surgery Stop 48 hours before major surgery
297
Trans ex’s mic acid
Inhibits binding site of plasminogen so cant break down fibrin so cant anti colt TXA is renally excreted
298
PCC
Has a faster correction than FFP
299
Fondaparinux acts on
Factor 10a Can be used for prophylaxis and treatment of DVT
300
Aspirin is a non competitive inhibitor of
COX1 and COX2 COX2 is responsible for pain and inflammation Can only fix its affects with platelet transfusion
301
If at high risk for cardiac events continue
Aspirin perioperatively
302
Plavix
Inhibition of GP 2b/3a
303
Integrillin is an inhibitor of
G2b/3a
304
Intraoperative salvage
Withdraw blood from field with suction and goes through machine to anti-coagulate and then will centrifuge and wash before giving red cells back to patient
305
Problem with autologous blood transfusion
Dilutional coagulopathy
306
Use periop blood salvage if expected blood loss is
>1000 mL
307
EPOs levels to start release are if hematocrit falls below
30%
308
Neuraxial anesthesia platelet threshold
>50000
309
PRBC store at
1-6 degrees
310
Blood donors in the US need a minimum hemoglobin of
12.5
311
FFP contains all the factors for
Hemostasis
312
Cryopreciptate has more ________ than fibrinogen
Fibrinogen
313
Delayed hemolytic reactions occur at day
3-10
314
Acute hemolytic reaction need to do a
Direct Coombs test
315
Best way to avoid IgA transfusion reaction is to use
Washed cells
316
Prevent graft vs host disease by doing what to blood
Irradiate
317
Anaphylactoid reactions are commonly seen in
IgA deficient patients Hypotension Bronchospasm Hemodynamic instability
318
Citrate chelates
Calcium
319
Most likely blood component to get passed is
CMV and thenHepatitis B
320
Platelet transfusion has
Highest rate of infection
321
Septic shock
Need vasopressor to maintain MAP>65 | Lactate>2
322
Temporary reversal of magnesium toxicity with hypotension is to give
Calcium gluconate
323
Magnesium affects
Normal is 1.4-2.1 Acts at NMDA receptor so has analgesic properties Acts at nicotinic Ach receptor and thus prolongs neuromuscular blockade
324
Methanol affects
Anion gap metabolic acidosis Hemodialysis Iv ethanol Sodium bicarbonate for treatment
325
After HBV exposure give
Hep B immunoglobulin and offer Hep B vaccine
326
Lusitropy is
Myocardial relaxation Inodilator therapy increases lusitropy and inotropy
327
Infant breathing work is much higher than adults bc their lungs are
More compliant. Thus it isn’t supported by the ribs or surrounding structures and the airway closes easily
328
Pousielle law
8nl/pi x r to the fourth
329
What is not affected by aging
Ejection fraction
330
Efferent branch of laryngospasm
Recurrent laryngeal nerve
331
Adduction of vocal cords
Lateral cricoarytenoid
332
Afferent Limb of laryngospasm
Superior laryngeal nerve
333
Pulmonary hypertension worsened by
Acidosis Hypoxia Hypercarbia
334
First step in total spinal in infant is
Intubation due to apnea First sign is usually dyspnea for high spinal
335
T1-T4are cardiac accelerator fibers if blocked lead to
Bradycardia
336
Tumuscent lidocaine Max dosage
55 mg/kg
337
Conns syndrome
Too much aldosterone Hypokalemic metabolic alkalosis Plasma renin is reduced secondary to feedback by aldosterone Treat with spirnolactone and potassium supplementation
338
Hypokalemic periodic paralysis due to
Calcium channel defect
339
One benefit of MLT tube over standard tube is
Increased length
340
MLT tube is not safe for use with
Lasers
341
Airway obstruction 24 hours post thyroidectomy can be due to
Hypocalcemia Hematoma will show up within first 24 hours of thyroidectomy!
342
Acute mountain sickness prophylaxis is with
Acetazolamide
343
High altitude decreases partial pressures of both Activates
P02 and PC02 Peripheral chemoceptors to stimulate increased respiration
344
Acute epiglottis is
Extrathoracic obstruction Just do inhalational induction with Sevoflurane. No nitrous
345
Carotid bodies respond to
Arterial partial pressure of oxygen
346
Causes of post cardiac renal failure
Preop creatinine grater than 1.2 Combined valve and bypass procedure Preop intraaortic balloon pump Emergency procedures
347
Full E cylinder of oxygen
2200 psig 660L
348
Nitrous oxide
1590 L | 745 psig
349
With nitrous oxide the psig stays at 750 until
Less than 400L | 25% is left
350
Only inhalational agent that doesn’t cause uterine relaxation is
Nitrous oxide
351
Exocytosis of AcH does not occur in patients with
Botulism Treatment is equine serum antitoxin
352
Hypercarbia can lead to
Arrhythmia like atrial fibrillation post op
353
Systolic function doesn’t change in normal
Healthy heart
354
Carob Prost better known as prostaglandin F 2 alpha can’t be used on patients with
Asthma
355
MAC vs moderate sedation
MAC requires a qualified anesthesia provider able to convert to GA
356
Elevated hemidiaphragm on ipisateral side
Ruptured diaphragm
357
If ruptured diaphragm not fixed it leads to
Bowel ischemia as all the abdominal organs shift up
358
Loos ECG
Leads to wandering baselines
359
Left leg and right arm
Lead 2
360
Alternating current on ECG
Will make it go up and down multiple times a second
361
Exanatide
GLP1 analogue
362
After giving iodine therapy for thyroid elevation can get first
More hyperthyroid symptoms bc the mediators go out into bloodstream Treat first with ptu or methimazole
363
Octreotide MOA
Inhibit release of GH and IGF-1
364
Bromocriptine
Dopamine agonist
365
Neurohypophysis = posterior pituitary
Release ADH and oxytocin
366
Treatment of SIADH may include
Demeocycline
367
SIADH type of hyponatremia
Euvolemic For chronic hyponatremia from SIADH treatment of choice is fluid restriction
368
Microadenomas
Tend to present as hypersecretion syndromes such as galactorrhea from prolactin excess, Cushing disease from ACTH excess
369
Prolactinoma
Amenorrhea, impotence
370
Sub clinical hypothyroidism
High TSH and normal free T4 Should still treat if TSH too high
371
Secondary hypothyroidism
Both TSH and T4 are low
372
Thyroid storm mortality is greater than
20% Criteria for thyroid storm Hyperthermia Tachycardia Cerebral dysfunction
373
What is most likely to be seen in hypothyroidism patient under GA
Bradycardia Thyroid doesn’t affect neuromuscular blockade
374
Post thyroid hypocalcemia shows up after
24-48 hours Can manifest as stridor or laryngospasm
375
Graves’ disease
Radioactive iodine studies show diffusely increased uptake,
376
PTH
Activates osteoclasts to promote bone resorption PTH increases renal calcium reabsorption PTH increases 1alpha hydroxylase which makes vitamin D active PTH increases excretion of phosphate, bicarbonate, potassium, sodium
377
Calcitonin MOA
Excreted by parafollicular cells | Inhibits osteoclast activity to lower calcium levels
378
Hypercalcemia
NS is first choice | Use calcitonin if tachyphylaxis
379
Plasma calcium levels are higher in states of
Hypoalbuminemia
380
Phenoxybenzomaine half life Main side effect
12 hr Orthostatic hypotension
381
Which corticosteroid lacks mineralocorticoid activity
Dexamethasone
382
Give stress dose steroids to
Patients at risk for HPA axis suppression bc of chronic steroid administration Should be done if getting greater than 20mg of prednisone for more then 3 weeks Patients undergoing more than superficial procedures
383
Glucocorticoids increase
Protein catabolism Explaining muscle wearing seen during Cushings Decrease eosinophils and basophils
384
Nonketotic hyperosmolar coma
Type 2 diabetics Profound hyperglycemia Dehydration Symptoms of hyperosmolarity
385
Long term diabetes type 1 is an indicator of
Difficult airway
386
Surgery affects on sympathetic tone and glucose
Leads to more sympathetic tone and hyperglycemia via glucagon, ACTH and GH Alpha receptors inhibit insulin release Beta receptors stimulate insulin release and thus lower glucose
387
Metformin inhibits
Hepatic gluconeogenesis andglycogenolysis Metfirmin can be taken the night before surgery but not on the day of surgery
388
What is shown to decrease MI risk in diabetics
Aspirin
389
Calcium activates
Pyruvate dehydrogenase and accelerates the Krebs cycle
390
Final acceptor of electrons in electron transport chain
Oxygen
391
Gluconeogenesis mainly occurs in the
Liver To a lesser extent the kidneys and small intestine
392
Lipids can not be absorbed CCK
Directly Slows gastric emptying
393
Pancreatic exocrine insufficiency are at risk for
Fat soluble vitamin deficiencies such as A, D, E, or K
394
Glucagon activates
Beta oxidation of fatty acids
395
In times of starvation without glucose
Most tissues in human body can use fatty acids for energy except for the brain which uses ketone bodies
396
Liver converts cholesterol into
Bile salts
397
Ezetimibe
Inhibits intestinal absorption of TAGs
398
Gemfibrozil
Stimulate beta oxidation of fatty acids in peroxisomes and mitochondria
399
cGMP activates
cGMP protein kinase G to produce vascular relaxation
400
PDE5 inhibitors act by
Increasing levels of cGMP leading to vasodilation which is therapeutic to patients with pulmonary hypertension
401
Activating beta 1 receptor
Activates Adenylate Cyclase converting ATP to cAMP
402
As you get older closing capacity
increases thus collapse of small airways occurs even after normal tidal volume exhalation Aging increases RV, CC, FRC and loss of lung elasticity
403
Proper positioning of thoracic aortic aneurysm stent When to take care of elective aneurysm
hypotension helps, transient asystole, If greater increase than 1 cm in one day Or greater than 5.5 cm
404
Be careful using adenosine in asthma patients bc it can cause
Bronchoconstriction
405
Cricothyroid muscle innervated by
External laryngeal of superior laryngeal nerve
406
Succinylcholine is dosed off
Total body weight
407
Fentanyl Remifentanyl Propofol dose by
Lean body weight
408
Before doing elective surgery on infant, you must have
6 month period without apnea or bradycardia
409
Need endocarditis prophylaxis for these procedures
Dental procedures messing with gingival tissue Respiratory tract procedures such as a bronchoscopy Patients with infected skin Don’t need prophylaxis for GI or GU procedures
410
Buprenorphine
U receptor partial agonist | Most effective at helping with opioid withdrawal
411
Clonidine is good for symptomatic treatment with
Opiate withdrawal | Does not directly agonize u receptors
412
Sunglottic stenosis
Heliox can help with gas delivery to lungs
413
Manual in line stabilization of cervical spine
Operator 1 stabilizes head and neck in neutral position Operator 2 stabilizes the shoulders No sniffing position in suspected spinal injury as this can hurt the neck
414
Hypoalbumin will increase free fraction of
Benzodiazepines
415
During burns get a proliferation of acetylcholine receptors and
Neuromuscular blockade resistance
416
Aspirin irreversibly blocks platelet function by blocking
Thromboxane A2 Only get about 10% of platelets back each day
417
Apixaban =
Elaquis and blocks factor 10a levels
418
JG apparatus in glomeruli senses hypotension
And increases angiotensin 2 levels in roughly 20 minutes
419
Plasma concentrations increase most
8-10 hours after infusion of tumescent lidocaine
420
Tumescent lidocaine complications if using
More than 5L Doing other procedures at same time Giving sedation as well - usually doesn’t require sedation to be given
421
Cerebral salt wasting
Hyponatremia and hypovolemia due to low intravascular volume
422
Conns syndrome definitive treatment
Excision of adrenal adenoma tumor
423
Spirnolactone
Competitive aldosterone receptor antagonist and potassium sparing diuretic
424
Midodrine
Alpha 1 receptor agonist
425
Treat acromegaly with
Octreotide
426
Permanent nerve injury usually due to
Improper positioning
427
Critical temperature
Temperature above which a gas can’t be converted to liquid with increasing pressure alone At standard temp and pressure nitrous oxide is a gas
428
Laryngeal papillomatosis can do
jet ventilation
429
Patients with long QT and history of cardiac arrest require
AICD
430
Mainstay of treatment with long QT
Beta blockers and possible pacing
431
Alpha stat
Add c02 to oxygenation and leads to embolus phenomenon
432
Volatile anesthetics increase duration of NMBDs
Volatile anesthetics decrease sensitivity of the postjunctional skeletal muscle cell membrane to depolarization
433
ARDS
Tidal volume of 6 ml/kg | Plateau pressure<30 cm H20
434
Coronary artery disease and cerebrovascular disease are need for
Preop ECG
435
Loose filler cap most common source of
Vaporizer leak
436
Will have overdose of volatile anesthetic if sevoflurame vaporizer is filled with
Isoflurane due to its higher vapor pressure and higher potency
437
If you tip a vaporizer
Clinically don’t use for 20 to 30 minutes and set fresh gas flow high rate with high volatile concentration to fix
438
Children with stribasmis 4 times more likely to get what when given succinylcholine
Massager muscle rigidity
439
Strabismus surgery commonly leads to
Bradycardia and PONV in pediatric population
440
Reason succinylcholine isn’t given to Peds patients
Hyperkalemic response with undiagnosed myopathies
441
If you fail initial SBT
Good strategy is to continue SBTs with pressure support
442
Down syndrome
Atlantoaxial insyability Hypothyroidism Macroglossia OSA
443
Full term baby in first minute if cyanotic and HR<100
Positive pressure ventilation Do PPV before chest compressions 3 compressions to 1 ventilation
444
FHR normal values
110-160
445
Acceleration is defined as
Higher than 15 bpm for at least 15 seconds
446
Decrease in RBF leads to decrease in GFR which causes decrease in chloride concentration and JGA is activated
Causes efferent arteriole constriction JGA senses the decrease in chloride concentration
447
Decrease in GFR leads to
Afferent after dilation and efferent arteriole constriction
448
Epinephrine added to local anesthetic does not affect the
Onset time Local anesthetics are weak bases
449
Local anesthetic
Lipid soluble is faster Higher concentration is faster Lower pKa and higher environment pH is faster
450
Clevidipine
Short acting calcium channel blocker leading to arteriolar vasodilation Broken down by plasma esterases
451
Ester local anesthetics, succinylcholine, mivacurium breakdown is by
Psuedocholinesterase
452
Renal medulla
Has a high O2 extraction ratio Compared to renal cortex which does not Kidney gets 20% of cardiac output
453
Need to have good blood flow
To renal medulla
454
Diarrhea
Metabolic acidosis
455
CHF
Cold extremities Poor urine output Delirium
456
Contraindications to epidural
Increased ICP Patient refusal Uncorrected hypovolemia
457
Etomidate inhibits
11 beta hydroxylase and 17 alpha hydroxylase in a reversal dose dependent fashion
458
Secondary adrenal insuffiency
ACTH is down
459
Adults without adrenal insufficiency secrete
20 mg cortisol and 0.1mg aldosterone daily
460
Acute adrenal insufficiency management Hydrocortisone 25mg should be given as stress dose in surgery
Hydrocortisone 100mg bolus IV and then q6
461
Weakness with adduction of the thumb
Ulnar nerve
462
Reduce risk of ulnar neuropathy by
Keeping hands supinated | Proper padding of all pressure points
463
During mass causality situation
Need a system to implement to identify patient injuries
464
Lethal triad
Coagulopathy acidosis hypothermia
465
Can have tracheal deviation with
Tension pneumo Mediastinal Mass- see widened mediastinum Difficult to lay supine
466
If data are not normally distributed best measure of central tendency is the
Median
467
Mean is best to use for central tendency if data is
Normally distributed
468
Peripheral TPN is most associated with
Infection and thrombophlebitis Give TPN for Short bowel Bowel obstruction Active GI bleeding Give TPN through central catheter if possible
469
Meperidine
Can reduce oxygen demand in hypothermic patients Goal temp is 32-36 for 12-24 hours and then you do rewarming Most patients die during the rewarming phase
470
Shorter QT and widening of QRS seen with
Hyperkalemia
471
Lithium toxicity
Hypermagnesium
472
Potassium sparing
Spirnolactone triamterene amiloride
473
Opioids are best dosed by
Lean body weight
474
OSA is a risk factor for
Postop hypoxemia
475
Chronic hypoxemia can cause
Polycythemia and this increase in total blood volume
476
Hypercarbia
Decreases the alveolar partial pressure of oxygen
477
Cystic fibrosis
Autosomal recessive Chronic pulmonary infections Hepatobiliary tract disease Diabetes Pancreatic insuffiency
478
When defibrillating use electrode pads size
8-12 cm You can apply electrode gel and biphasic defibrillator is preferred
479
After placing endobronchial left sided double lumen tube When you inflate both tracheal and bronchial cuffs
You will only get breath sounds on the right hand side
480
Bronchial cuff is herniated at carina
If you have resistance ventilating the side your trying to ventilate
481
Tobacco use causes carbon monoxide levels to increase thus
Shift of oxyhemoglobin curve to the left Cyanide increases so less mitochondrial oxidation and you get acidosis Causes vasoconstriction
482
Carbon monoxide from c02 absorbent is increased with
Low fresh gas flow Dessicated absorbent Increased temperature
483
What absorbent are the best
Calcium hydroxide Soda lime Worse is barium hydroxide
484
Hypocalcemia leads to
Prolonged QT
485
Critical temp above room temp
Why nitrous oxide is both liquid and gas at room temp Critical temp is temp where a gas can’t be turned into liquid no matter how much pressure is applied
486
Epidural 2 chloroprocaine has an onset of action of
6-12 minutes as a result of the high concentration used
487
Chloroprocaine duration of action
45-60 minutes plain | 60-90 minutes when used with epi
488
MG, Lambert Eaton and chronic renal failure
Do not upregulate the number of AcH receptors
489
Scopolamine somnolence can be counteracted with
Physostigmine
490
Stimulation of central nicotinic Ach receptors can lead to
Seizures
491
For main stem obstruction in child
Prefer inhalational induction because PPV can potentially move the object down further
492
Increased intensity of motor block seen when adding epi to
Epidural local anesthetic Epi also increases onset time and duration by vasoconstricting the blood vessels in the epidural space that take up the local anesthetic
493
Morphine given through epidural space causes pruritis best treatment is with
Nalbuphine Give in small dose of 3 mg
494
Ketamine is best induction medication for
Cardiac tamponade Want quick heart rate, maximize preload, and forward(avoid cardiac depressants) Ketamine also helps maintain spontaneous ventilation
495
Pulses paradoxus
During inspiration, drop in systolic of 10 or more
496
Botulism
Prevent vesicular release of Ach at the neuromuscular junction
497
C Tetani
Travels through retrograde transport up the motor neurin
498
Upward shift in frank starling curve due to an increase in
Contractility
499
Ratio of potency intrathecal, epidural, iv fentanyl
0.01, 0.1, 1 Thus intrathecal is the most potent Same ratios with morphine Iv morphine is more potent than oral morphine by a ratio of 3:1
500
Three anesthesia time units are equal to
45 minutes
501
Pudendal nerve
S2-S4
502
Single shot spinal lasts 1 to 2 hours so great to give right when close to
Delivery
503
SA node
Increase sympathetic activation increases the slope of phase 4 of the action potential
504
Factors that increase the SA node firing rate include
Sympathetic stimulation, muscarinic receptor antagonism, beta receptor agonism, catecholamines, hypokalemia
505
Multifocal atrial tachycardia is associated with
Severe lung disease COPD exacerbation is most common cause Sinus tachycardia with 3 different morphologies of the P waves
506
In settings of poor oxygen extraction like methemoglobinemia
Mixed venous will be normal or elevated
507
Normal Sv02 is
75%
508
Higher mixed venous means you
Extract less oxygen
509
Klippfel feil syndrome associated with
Fusion of cervical spine
510
Larger extra cellular volume seen in
Infants than adults
511
How much of lean body mass is total body water
55-60%
512
TBW =
Extracellular plus intracellular volume
513
Amiodarone class 3 antiarrhythmic that blocks
Potassium channels
514
Myasthenic syndrome is also known as
Lambert-Eaton syndrome
515
Landmark for lateral femoral cutaneous nerve block
ASIS Femoral nerve L2-L4
516
Best sites to measure core temperature
Pulmonary artery Distal esophagus Nasopharynx Tympanic membrane
517
Goal level of neuraxial block for C Section is
T4-S4 is what should be covered
518
Acetazolamide can lead to
Metabolic acidosis
519
Psuedotumor cerebri high ICP treat with
LP
520
For precurarization
Use 10% of the ED95 Stops muscle fasiculations which can increase intraabdominal pressure leading to aspiration
521
ED95
Median effective dose in 95% of population Dose that causes 95% twitch suppression in 50% of population.
522
Metochlopromide affect on LES tone
Increases LES tone
523
Most anesthetics such as propofol, anticholinergics and fentanyl affect on LES tone
Decrease
524
CPAP
Keeps airways and alveoli option Decreases depletion of surfactant Increases FRC Increases minute ventilation
525
What is an absolute contraindication to shock wave lithotripsy
Pregnancy
526
Hypoxia and hypercarbia are found during
Pulmonary embolus
527
Which patients won’t tolerate awake crani
Children, psych patients, claustrophobic
528
Corneal reflex afferent and motor reflex
Trigeminal, facial
529
Airway exchange catheters better than bougie
Can do jetventilation | Monitor ETC02
530
Prefer for elective surgery to commence hemoglobinA1C should be under
8%
531
Give 2/3 insulin the night before
And 1/2 the day of
532
Most evaporative heat loss is via
Tissue exposure from the surgical incision
533
What is responsible for most heat loss in OR
Radiation
534
Pre warm heat blanket to blunt
Affect of redistribution on temperature
535
Citrate can be metabolized to
Sodium bicarbonate leading to metabolic alkalosis
536
What coagulation factors decrease in pregnancy
13, 9, antithrombin 3 and tPA
537
Dose of oral midazolam for Peds patients
0.5 mg/kg Onset of action is 15-30 minutes IV form is 0.05-0.1 mg/kg
538
Hyperparathyroidism
Normal anion gap metabolic acidosis With hyperchloremia
539
Most the claims in the ASA closed claims database are
Non respiratory events
540
If mother comes in for elective C Section and she and baby are fine. You induce with prop and succ and have three difficult intubation attempts and mom and baby are good and you can bag mask what should you do?
Since it is elective you should wake the mother up. Baby is also ok so more reason to do so
541
Don’t try to intubate any more after how many unsuccessful attempts
3
542
cDH
More common on left side Do not bag mask! Leads to more insufflation and possible contralatral pneumothorax
543
ASA 4 is a severe illness Unstable angina falls in this
Which is a constant threat to life
544
ASA looks at
Not to predict operative risk Used to look at patients commorbisitues and overall physical state
545
ASA 2
Smoker Pregnant Controlled diabetes
546
ASA 3
Morbid obesity | Regular dialysis
547
ASA 5
Won’t survive without the operation
548
Angiotensin 2 will
Construct efferent arteriole and increase GFR | Also increases intravascular volume through sodium
549
MAC of nitrous oxide =
105%
550
Side effect of terbutaline is
Hypokalemia Hyperglycemia Hypotension Pulmonary edema
551
Platelets can lead to
RH sensitization
552
Infants usually require larger doses of succinylcholine due to their
Higher volumes of distribution
553
In Peds succinylcholine first dose can cause
Sinus arrest | Bradycardia
554
Premature closure of cranial sutures is seen In
Crouzon syndrome Due to mutation in fibroblast growth factor
555
Donepezil
Increases Ach levels thus making you more resistant to NMDBs and sensitive to succinylcholine
556
MH vs thyroid storm
Muscle rigidity Higher rate of temp rise Higher ETC02 rise Hyperkalemia Elevated CK Lactic Acidosis All these are seen mainly in MH
557
Drug you shouldn’t give to children after tonsillectomy
Codeine
558
Acetaminophen dose if under 12 75 mg/kg
Based on ideal body weight
559
Above 10L 02 pt is breathing
Cold dry oxygen leading to discomfort for the patient
560
High flow NC
Contributes PEEP Can get rid of co2 Provides oxygen
561
NO
Dilates pulmonary vasculature when administered by inhalation Half life of 15-30 sec Too much NO leads to NO2 which can lead to pulmonary edema/alveolar hemorrhage
562
Cannon A waves are seen with
Complete heart block
563
Wedge pressure reflects
Left atrial pressure Best time to look at it is at end of diastole when blood goes from atrium to ventricles
564
CVP c wave
Isovolumetric contraction of right ventricle A wave is first rise building up blood in ventricle C wave is small rise Then descent during systole
565
X descent
Blood into atria
566
Papillary muscle rupture leads to
Mitral regurgitation and large v waves
567
MAP
The cuff pressure where the highest pulse amplitude is detected
568
Square wave test
Pull flush valve If 1 or 2 oscillations your good 3 or more is dampened
569
In children slower heat loss from core to periphery
Due to greater proportion of body mass in core
570
Thermogenesis in infant occurs by metabolism of
Brown fat
571
Hypothermia
Reduces the MAC of an agent and can lead to anesthetic overdose
572
Hypothermia leads to
Norepinephrine release
573
Shivering increases
Oxygen consumption
574
Don’t give succ or volatile anesthetic to patient with pseudohypertrophic muscular dystrophy
Risk of rhabdomyolysis and hyperkalemia
575
Mixed venous
Percentage of oxygen bound to hgb in blood returning to right side of heart It’s what’s left after body extracts what it needs Increased Fi02 or hgb will increase mixed venous
576
Hypothermia affect on mixed venous
Increases even with increased shivering
577
Neostigmine crosses placenta leading to bradycardia
Use atropine to reverse Glycopyrolate does not cross placenta
578
Muscarinic receptors are found at the
SA node
579
Neostigmine dose for reversal is
0.07 mg/kg Giving too much leads to prolonged weakness. Leads to presynaptic nicotinic receptor desensitization
580
Cardiogenic shock
Systolic<90 Pcwp>18 Cardiac index<2.2
581
Spinal cord injury is a type of
Distributive shock
582
Desflurane can augment neuromuscular blockade by as much as
60% | Relax skeletal muscle and act indirectly at NMJ
583
Sodium bicarbonate deficit to treat pH
0.2 x patient weight kg x base excess = MeQ of sodium bicarbonate needed to correct acidosis
584
Acidosis causes
Reduced cardiac contractility, decreased SVR and QT abnormalities
585
Only give sodium bicarbonate if
Patient is ventilated bc if not can lead to respiratory depression
586
Norepinephrine does not cause
Significant bronchodilation
587
M3 receptor stimulation leads to
Bronchial constriction
588
Rightward shift of hemoglobin P50 shifts
Immediately when you stop smoking
589
Normal P50 of hemoglobin is
27 mmHg
590
Hypophosphatemia shifts hemoglobin dissociation curve to the
Left
591
A pneumothorax will double in size when breathing 75% nitrous oxide In
10 minutes
592
Arterial pressure variation is an accurate measure for
SVV>13% will be responsive to fluids
593
Chronic dantrolene therapy
Need to check LFTs
594
Malignant hyperthermia
Autosomal dominant with variable penetrance
595
TIVA costs
10 to 100 times more than inhaled anesthetic
596
End point of root cause analysis does not involve knowing
Who is causing the event
597
Increased latency or decreased amplitude on SSEPs can indicate
Cortex ischemia
598
Rapidly giving sodium bicarbonate
Increases affinity of C02 for oxygen shifting curve to left Can actually worsen hypoxia and increase lactate Increases preload Decreased contractility Increases cerebral hemorrhage
599
Treatment for organophosphate poisoning
Pralidoxime and atropine Take off all clothes Don’t use succ
600
Tylenol overdose
N-Acetylcysteine
601
Placental abruption
Painful vaginal bleeding Uterine tenderness ``` Risk factors Maternal HTN Maternal cocaine Tobacco use Trauma ```
602
Caution should be taken before giving vasopressin to a patient with
Coronary artery disease. Can lead to vasoconstriction and ischemia
603
Desmopressin is preferred over vasopressin bc it doesn’t cause
HTN
604
Vasopressin increases
VwF and factor 8
605
One anterior and two posterior spinal arteries
Supply spinal cord Anterior spinal cord provides 75%
606
If nuclear explosion give
Sodium iodine
607
Large R wave in lead V1 due to
``` Right ventricular hypertrophy Posterior wall MI WPW syndrome Muscular dystrophy Right atrial enlargement ```
608
Subnormal corticosteroid production is called
Functional adrenal insuffiency | Most common adrenal insufficiency in the ICU
609
Mineralocorticoid is produced by
Zona glomerulosa
610
Increased flow rate =
Turbulent flow
611
Decrease radius
Increases laminar flow
612
Severe sepsis
30 ml/kg iv crystalloud in first 3 hours
613
Hydroxyethyk starch don’t give with
Sepsis
614
High Stenotic lesion along the PDA leads to
AV Nodal Blockade
615
Valsalva Maneuver
Increased intrathoracic pressire by forced expiration against closed glottis. Increased intrathoracic pressure will force blood out the heart, to the svc to the IJ
616
Improvement of how much with bronchodilator therapy in FEV1 is an indication for chronic bronchodilator therapy
15%
617
PRIS
``` Heart failure Metabolic acidosis 4 mg/kg/hr is max dose of propofol Rhabdomyolysis Lactic acidosis ``` Does not lead to pulmonary edema
618
Alfentanil acts quick
Low pKA leads to high unionized fraction
619
Given small dose of neuromuscular blocker before succ does not decrease the rise In
IOP | Myalgia
620
Giving pre roc dose 3-5 minutes before succ
To prevent fasiculations Rise in intragastric pressure Rise in ICP can also be blunted
621
In patient with unknown status of hiv and needlestick injury
No postexposure prophylaxis is necessary
622
If someone had HIV with viral load and symptomatic need to give
Triple drug therapy Give two drug if HIV unknown but high risk of infection
623
Head down position
More likely endobronchial intubation Increases cardiac index increases venous return back to heart Decreases FRC Decrease TLC
624
If a nerve in a paralyzed extremity is tested, the TOF will be
Higher
625
Premature closure of PDA
Associated with maternal NSAID usage
626
Acidosis can lead to reversion to
Fetal circulation as well as hypoxemia and hypothermia
627
Preventing post op nausea or vomiting best medication in peds
Ondansetron
628
Causes of nausea vomiting Peds
Age>3 Procedure>30 min Type of procedure Family history of PONV
629
First stage in correction of pulmonary atresia
Blalock Taussing shunt is first stage. It moves subclavian to pulmonary artery blood flow
630
Hypermagnesium
Theophylline does not help Can cause bradycardia and hypotension Loop diuretics with D5 help remove magnesium Prolongs local anesthetics and NMDBs and succ
631
Gastroschsis
Has no enclosing membrane | More heat loss, dehydration, and infection
632
Patients with normal body mass index have higher rate of tourniquet than those who are
Obese
633
Upper extremity nerve injuries are more common with tourniquet than
Lower
634
Metochlpramide
Increases LES tone
635
Iv metochlopramide
acts within 1-3 minutes
636
Preterm infants have problems with
Decreased surfactant
637
Respiratory distress syndrome in infants mainly due to
Surfactant deficiency
638
Fetal lung maturity with L/S ratio
>2
639
Increases A-a gradient with
Atelectasis | V/q mismatch or diffusion problem, shunting or dead space with increased A-a gradient
640
Pediatric endotracheal tube size
(Age/4) + 4
641
Hal Dane effect
Increased ability for hemoglobin to carry carbon dioxide from tissues to lungs for exhalation
642
Bohr effect relates to
H+ | High H+ lower affinity of hemoglobin for O2
643
Alpha stat management
Leftward shift of oxyhemoglobin PaC02 is maintained on 40 C02 is not added so it stays down and get a left shift
644
Multi drug resistant organisms
More than 5 days in hospital Prior abx Recent hospitalization
645
Ventilator associated or hospital acquired pneumonia treatment
Lineziolid/vancomycin And floroquinolone/aminoglycoside And zosyn/cefepine/cephalosporins
646
High blood solubility from high cardiac output mainly affects
Isoflurane bc more is taken up by the blood Reduce cardiac output makes isoflurane much faster
647
Intrinsic INR of FFP is
1.6-1.8
648
Reverse Coumadin with
Vitamin K
649
If can wait 24 hours reverse Coumadin with
Vitamin K
650
Mannitol can have deleterious effects on patient with
CHF bc it increases intravascular volume
651
ICP management
Keep ICP 20-25 | CPP > 60
652
Guillan barre drug contraindicated | Ascending motor paralysis w/wo sensory
Succinylcholine It is autoimmune demyelination treat with plasmapharesis or ivig
653
Adductor similar analgesia
To femoral nerve for knee surgery Adductor has a lower risk of falls
654
Saphenous nerve is purely
Sensory
655
Cross clamping of aorta hemodynamic changes
``` CVP higher More catecolamines Decrease in oxygen extraction Increased coronary artery blood flow Decreased arterial pressure below clamp Decreased cardiac output Decreased in renal blood flow ```
656
First thing to do if malfunctioning inspiratory valve
Increase fresh gas flow will help decrease exhaled gas going retrograde Inspiratory valve opens letting fresh gas go into patient If it doesn’t close fully some of the exhaled gas will go into it Increased plateau on capnography and more slope on downstroke
657
Causes of preop anxiety
``` Higher cognitive Multiple personnel Anxious mothers Shy children Younger children ```
658
LMWH better than UFH
Bc better at blocking factor 10a
659
Acute normovolemic hemodilution
Good for ppl who can’t get allogenic blood, or if they have rare antibodies Can’t do it if active infection, cardiac disease, preop anemia
660
What ion contributes most to serum osmolality
Sodium
661
Hyponatremia
Check extracellular free water level Plasma osmolality Urine sodium
662
PDPH definitive therapy
Epidural blood patch Usually use autologous blood If they are a cancer patient or have bad active infection use allogenic blood
663
Celiac plexus
``` Pancreas Liver Spleen Gall bladder Biliary tract Ascending and transverse colon ```
664
Celiac plexus block most common complication
Orthostatic hypotension
665
Pheno is
Painless on injection Used for neurolytic block
666
Step 2 of pain ladder
Weak opioid including Codeine, oxycodone, tramadol hydrocodone
667
WHO ladder
Should give oral administration whenever it’s possible
668
In type 2 CRPS
Clear preceding nerve injury
669
Greatest risk factor for development of posthrrpetic neuralgia
Older age
670
Phantom limb pain Risk factors
Pain before amputation Proximal amputation Psychological problems
671
Facet joint pain, spinal stenosis pain is
Radiating | Usually t ipsilateral posteroir thigh
672
Facet joint innervation
Medial branch of the dorsal ramus of spinal nerves
673
Pain that radiates into ipsilateral buttocks
SI joint pain
674
Numbness of anterolateral thigh
Meralgia parenthetica
675
Piroformis and sciatic nerve
Whole sciatic nerve passes below the piriformis muscle
676
Trigeminal neuralgia
V2 and V3 distribution
677
Spinal anesthesia failure most common cause
Displacement of the top of the needle
678
Pudendal nerve
S2-S4
679
Superficial cervical plexus contains nerves that arise from
C1-C4 Causes 100% chance of ipsilateral diaphragmatic palsy
680
TENS
Has not been shown to help with chronic pain
681
Impact of warming IV fluids in neonate on thermal homeostasis is
Minimal Fix radiant heat loss by heating the room
682
Midazolam rapid onset
Due to ability to convert to lipophilic form at high pH
683
Midazolam
Younger children need a higher dose. Highest bioavailability is when given rectal Time to peak concentration after giving is 50 minutes orally
684
Mapleleson circuit
Type A has the fresh gas flow inlet at the end of the resevior tubing distal from t piece that connects to patients mask or endotracheal tube
685
Mapleson D has distal pop off valve
Allows for excess expired gas to be released during expiration prevent revreathing
686
Desflurane isn’t given too children
Leads to airway irritability Don’t give for mask induction as can lead to laryngospasm
687
Ketamine IM dose for induction
2-4 mg/kg
688
Formula NPO time =
6 hours
689
Rapid sequence succ in children
2 mg/kg bc children have higher volume of distribution Intramuscular succ dose is 4 mg/kg
690
Preschool age 3-5 best blade is
MAC-2
691
Age/4 plus 4 =
Pediatric endotracheal tube uncuffed Lower by .5 to get cuffed tube size
692
Sevoflurane in Peds leads to
Emergence delirium
693
What helps with emergence delirium
Propofol Precedex Fentanyl
694
For each 1 degree decrease in body temp
MAC decreases 5%
695
I Mac of isoflurane in adults
1. 2% end tidal isoflurane | 1. 6% in Peds
696
Which group of population requires highest level of NMDB
Children require the most Next is adults Finally neonates
697
Full term neonate EBV
80-90 ml/kg
698
Leukoreduction
Useful to prevent CMV, HLA, non hemolytic febrile transfusion Doesn’t help with graft vs host
699
Cefepime causes hypotension by
Lipopolysacharide release
700
Vancomycin release leads to hypotension via
Histamine release
701
Stellate ganglion is between
C6-C7
702
Cerebral auto regulation of blood flow is
Maintained in elderly
703
SIRS leads to more
Cortisol and thus hyperglycemia
704
Ischemic optic neuropathy
Painless vision loss
705
Dual chamber pacemakers
Right atrial and ventricular septum P wave followed by left bundle branch
706
Persistent vegetative state
Can open eyes unconsciously It is seen in comas
707
CO x svr
MAP
708
Hypokalemia leads to
ST and T wave depression
709
Terbutaline leads to
Hypokalemia
710
RCA supplies
Inferior wall of left ventricle
711
LAd
Supplies apex of right ventricle
712
Increase CK and myoglobinuria
Rhabdomyolysis
713
On intubated patients in regard to feeds
Continue enteral and parenteral
714
Neonates need to evaluated overnight until
60 weeks Risk of apnea and bradycardia
715
Succ is safe in ppl with
Myasthenia gravis Lambert Eaton Renal failure with normal potassium
716
Don’t use succ on patients immobilized for longer than
24 hrs
717
Full tank of N20
1590 L O2 745 psig
718
MAP =
2/3 diastolic plus 1/3 systolic
719
Coiling cables is
Bad in MRI
720
IV calcium chloride is needed when giving lots of
Blood
721
Citrate toxicity electrolyte problems
Hypocalcemia | Hypomagnesium
722
Femoral nerve block with parenthesia in sartorius
Deeper and more lateral
723
Plasma elimination half time of flumazinil is the shortest of all benzos at about
1 hr Plasma elimination half life of midazolam is 2 hrs
724
Absolute contraindication to ECT
Intracranial mass lesion Pheo Recent MI
725
Bow ditch reflex
Increase in HR by increase in myocardial tension
726
Hyperchloremic metabolic acidosis
Excessive fluid SID down Decreased bicarbonate
727
ACE inhibitors will increase
Bradykinin leading to vasodilation Decreases effefent arteriole contriction leading to lower GFR
728
Treat neuraxial nausea with
Atropine Next choice is glycopyrolate
729
Aspiration suspected what to do
Place in head down or left lateral Do bronch if possible to suction out as much aspirate as possible
730
Tocolytic agents like beta 2 agents like midodrine
Relax uterine contractions Increase uterine blood flow Uterine vasoconstriction with severe hypocapnea
731
Early post partum hemorrhage
Uterine stony
732
NG tubes can lead
To more sinusitis and otitis media
733
Lidocaine decreases
Seizure duration do not good to use if getting ECT
734
First sign of good normalization for surgery
Cl- coming close to normal
735
Pyloric stenosis
Hypokalemic, hypochloremic, metabolic alkalosis
736
AV node supplied by the
RCA
737
Anterior 2/3 of septum supplied by the
LAD
738
Phase 2 block with succinylcholine apnea best way to reverse is with
0.03 mg/kg
739
First compensatory state in anemia
Rightward shift of oxyhemoglobin dissociation curve
740
ERAS protocol
Start orals an soon as possible
741
Giving ritodrune to mother
Increases her glucose levels Causes hypoglycemia in infant as more insulin is released
742
MH
High end tidal co2 Tachycardia Acidosis
743
At high altitude you get
Increased minute ventilation as a result of hypoxia stimulation of peripheral chemoceptors
744
At high altitude
Lower partial pressure of 02 so you increase respiratory rate Increased hemoglobin
745
Give 20-40 ml/kg of lactated ringers
For replacement in surgery for infants
746
Which drug is Sch 3
Ketamine
747
Cochin morphine oxycodone
Sch 2
748
Salicylate toxicity- aspirin
Mixed respiratory alkalosis and metabolic acidosis
749
Carbohydrate load increases chance for
Hypokalemic periodic paralysis
750
Keep neurosurgical patients euvolemic or hypervolemic to maintain
Cerebral perfusion pressure
751
Discovery
Exchanging documents
752
Depositions
Statements made under oath about the case
753
Sunmons
Beginning of case notify the defendant there is a law suit against him
754
First step after aspiration
Suction endotracheal tube
755
Gram negative and anaerobic coverage should start if aspiration of
Fecal material
756
Hypercalcemia
Iv fluids and lasix
757
Hypetcalcemia
Stones bones abdominal pain psych issues
758
Excessive diresis
Don’t get respiratory alkalosis
759
Metabolic constriction alkalosis
When giving lasix
760
Garlic neuraxial anesthesia
Can just do it without more tests | Same with factor 10a inhibitors
761
For warfarin pts and neuraxial anesthesia
Wait 4-5 days and check inr prior to doing it to make sure it’s normalized
762
Myotonic dystrophy
Avoid neostigmine, succinylcholine, potassium Myopathy leads to you being in hyperkalemic state Neostigmine leads to more Ach leading to more contractions of muscles which isn’t what u want
763
Cryoanalgesia
Nerve regeneration in 1-3 months Takes about 90 sec to do Intercostal nerve analgesia post thoracotomy
764
In esld what do you look for
Factor 8 is great to look for coagulation disorder bc it is high Factor 8 is low in DIC
765
Down syndrome goes with
Pyloric stenosis
766
Infants pulling knees to chest and currant jelly stool
Intussception
767
Duodenal atresia
Double bubble sign
768
In down syndrome on inhalational induction the common response is
Bradycardia
769
Infants desaturate faster than adults due to
Their lower FRC
770
Low FRC means
The lungs really collapse due to force of chest wall so harder to reopen
771
Incidence of PONV is related to
Age Lower age has lower risk of PONV
772
Epiglottis induction
Inhalational direct laryngoscopy with rigid bronch, surgical personnel present
773
Coarctatuon repair use pulse of on
RUE
774
Central core disease at risk for
Malignant hyperthermia
775
Morphine dose for pediatric patient
.05-.2 mg/kg
776
Connie medularris at infants lies at
L3 End of spinal cord
777
Caudal block landmark
At the corpus of the sacral hiatus Where the crease of buttocks begins
778
In cardiac transplant
HR generation is dependent on donor atrium Frank starling stays intact Less HR variability
779
First step in treating dka
Iv hydration Need hourly glucose
780
Don’t use CPAP of non ventilated lung in
VATS case bc leads to less surgical exposure Instead add be to the dependent(ventilated lung)
781
Carotid duplex us
Easy in ppl with lots of commorbidities
782
Retrobulbar block
Posterior glove rupture | Ocular pain wo increase in IOP
783
Leading cause of periop morbidity I’m obese patients
DVT
784
Obturator nerve block
Weakness of thigh adductor muscles Combined sensory/motor block
785
Persistent headache after 20 weeks gestation goes with
Preeclampsia
786
No spinal anesthesia on someone with
Neural tube defect
787
Jehovah’s Witness won’t get
Allogenic autolougois platelets
788
Epidural anesthesia is safe in patient with
MS
789
Hyperthermia leads to
MS exacerbation
790
Local anesthetic absorption
Intercostal then causal then epidural
791
Patients with mild of severe PFTs show the
Least response to bronchodilator therapy
792
If PFTs show pneumonectomy might not be tolerated next test is
Split function tests
793
When placing Caudal block you pass which ligament before epidural space
Sacrococcygeal ligament
794
Adenosine blocks the
AV node
795
Adenosine doesn’t help with tachycardia in
Atrial glitter bc AV node is not involved
796
Acetazolamide inhibitor of
Carbonic anhydrase Waste sodium in bicarbonate in proximal tubule leading to Hyperchloremic metabolic acidosis
797
Meds not ok with history of malignant hyperthermia
Succinylcholine | Inhalational anesthetics like Sevoflurane
798
Pituitary does not have an affect on
Parathyroid hormone and hypercalcemia
799
GH secreting tumor
Consider patient a difficult airway
800
What has shown to help pre-delivery
Corticosteroids either betametgasone or dexamethasone
801
Frank starling curve
Y axis - cardiac output X axis- end diastolic volume
802
Loop diuretics
Lower filling pressures but don’t help with iontropy or cardiac output
803
Furosemide acts at
Ascending limb of loop of Henle Increases venous capacitance and increases venous volume Decreased stroke volume leadin to increase in contractility Lowers diastolic blood volume and pressure Reduces svr and increases venous capacitance to allow fluid to move
804
What drug is not associated with pain on injection
Ketamine
805
ASA criteria for discharge home from pacu
Take care of Nausea Return to baseline consciousness Pain control Stable bp and hr Voiding is not a part of the criteria
806
Beckeith-weidsman
Macrosomia, perinatal hypoglycemia, omphalocele
807
Hurler syndrkme
Most difficult airway management
808
ARDS of newborn if born early
Diffuse ground glass opacities and reduced lung volumes
809
Dose of ketorolac in children
0.5 mg/kg
810
Adult hemoglobin p50 Infant hemoglobin p50
27 Infant is 20
811
Oxygenated blood from placenta travels from the umbilical vein to the
IVC - this is where oxygenated blood is highest in the fetus. Everywhere else the blood is mixed
812
Give blood to children even if the family are
Jehovahs witnesses
813
Propofol clearance rates are similar to
Adults But children have higher Vd Child have higher redistribution from vessel rich organs
814
Precedex loading dose can lead to
Bradycardia Don’t use precedex for induction in children
815
Moderate sedation
Airway patent | Children respond to verbal or touch
816
Which parameter increases with pregnancy
LVEDV CVP and pulmonary artery diastolic pressure don’t change
817
Supine hypotensive syndrome of pregnancy due to
Compression of IVC
818
Pregnant women have more neural sensitivity to local andsthetics
Faster onset and prolonged duration in pregnant vs non pregnant patients
819
In pregnancy
Decreased FRC and decreased MAC
820
Pregnancy you see increase in
Tidal volume Pac02 degrees to about 30 at 12 weeks gestation
821
Renal changes in pregnancy
``` GFR increase RBF increase Creating clearance increase More protein excretion Bicarb excretion increase to compensate for respiratory alkalosis Glucose excretion increases ```
822
Pregnancy leads to
Biliary stasis and changes in bile composition Estrogen increases cholesterol production
823
Pregnancy
Decreased LES tone Same fasting guidelines in pregnant patients Intestinal transit and pariestalsis are slowed Fibrinolytic activity is increased WBC don’t work as well in pregnancy leading to more infections Platelet consumption is higher in pregnancy
824
Oxytocin can lead to
Hyponatremia | Misoprostol is commonly associated with fever
825
CVS and amniocentesis
Look at fetal karyotype CVS is safer if performed 9-14 weeks
826
Oligohydramonos
Most common cause is fetal anomalies
827
Hydros fetalis
Fluid in two or more compartments
828
Elective C Section May be warranted if
>4500 g in diabetic or 5000 g in non diabetic
829
Can do neuraxial anesthesia for
Preeclampsia | Placenta previa
830
My second stage of labor oxygen consumption has increased
70%
831
Tidal volume in pregnancy
Increase So does minute ventilation but respiratory rate stays the same
832
Best way to help patient with atrial fibrillation increase cardiac output
Convert to normal sinus rhythm
833
PPV increases intrathoracic pressure and thus IVC pressure which can lead to
Decreased renal perfusion and oliguria Oliguria= <0.5 ml/kg/hr Causes decreased preload and increased afterload
834
Midazolam bioavailability
IV>intramuscular>intrascalar>rectal>oral
835
RA is not sssociated with
Bronchospastic disease
836
RA most commonly leads to
Pleural effusions
837
Detecting pericardial fluid is best with
TEE
838
Eclampsia is a preeclampsia patient with
Grand mal seizures
839
Increased cardiac output
Decreases speed of inhalational induction
840
At above what level does autonomic dusteflexia start
T6
841
Best way to treat intraoperative hypothermia in Peds patient
Forced air blanket
842
Obese patients have
Higher lean body weight | Higher cardiac output
843
Lithium increases blockafage of
Neuromuscular and depolarizing agents
844
Fastest way to restore cerebral perfusion pressure
Drain CSF from evd
845
Hypertonic
Draws fluid from intracellular space as osmotic Head up increases venous drainage and is helpful
846
Lusitropy is different from preload how?
In preload volume goes up but pressure stays the same In lusitropy volume goes up and pressure goes down
847
ASA physical status classification was originally used for
Anesthetic data comparison
848
Intravesical pressure =
Bladder pressure If high can signify compartment syndrome correlated with increase in ICP
849
Mild dehydration of newborn
< 2 ml/kg/hr urine output
850
Prolonged second stage of anesthesia
2 hours without neuraxial in first pregnancy and 3 hours if neuraxial
851
Prior c section with pfannenstiel incision. Can have a
TOLAC attempted the next time
852
In multiple sclerosis patients
Epidural and spinal anesthesia are safe
853
Best method to look for ectopic pregnancy
Transvaginal US
854
VwF normally aids in
Platelet binding
855
Most common valvular disease in pregnancy
Mitral valve stenosis
856
Diagnosis of umbilical cord prolapse
Deliver fetus as soon as possible
857
Zofran does not help against
Aspiration pneumonia
858
Nitroglycerin can help take out
Retained placenta
859
For breech delivery
C section preferred Anesthesia helps with a version Give nitroglycerin for fetal head entrapment during Vaginal delivery of breech infant
860
Umbilical artery pH less than 7.0 associates with
Neonatal morbidity
861
Hemodynamic instability is a contraindication to
NIPPV as is recent vomiting or copious secretions
862
After intubation in COPD patients especially can get auto-peep
First step is to disconnect from ambu bag HR will go down as will BP
863
In ARDS want plateau pressure below
30
864
Ability to follow commands is not required for
Extubation Want RSBI<100 Cuff leak Minimal secretions Successful SBT at inspiratory pressure of 5
865
RSBI =
RR/tidal volume
866
PPV
Decreases preload and LV afterload Increases RV afterload
867
Increasing inspiratory flows helps in COPD patients bc it
Allows a longer time for expiration
868
In volume control ventilation tidal volume is determined by
Set inspiratory flow
869
Ventilator associated pneumonia
Best way to prevent vap is reduce duration of mechanical ventilation Use NIPPV Daily sbt Chlorhrxjdjbd Head of bed up
870
Catheter related blood stream infection
Diagnosis- positive blood culture from catheter site and another site Don’t routinely replace CVC Avoid femoral line placement Avoid subclavian in renal disease patients Chlorhrxidine is best
871
Use guidewire on cvc if
Lack of blood return
872
According to the CDC reasons for indwelling urinary catheter includes
Acute urinary retention Close monitoring of urine output in Ill patient Comfort care
873
Fick equation calculates
Oxygen consumption
874
Metochlopramide affect on les tone
Increases Increases gastric ph Dopamine receptor antagonist Antiemetic
875
Nonshivering theogenesis In adults
Brown fat/skeletal muscle
876
Imminent acute renal failure is best seen with
Creatinine clearance
877
FenA checks for the cause of
Renal failure
878
Pregnancy
Unchanged vital capacity
879
Biggest predictor of difficult intubation in morbidly obese
Neck circumference
880
Neuraxial anesthesia causes
Vasodilation and decrease in core temp
881
Ventilation and perfusion are lower in
Apical alveoli
882
In adults and elderly what stays the same
Total lung capacity Closing capacity is higher in elderly
883
Gold standard for pain
Continuous labor epidural
884
Treatment of choice for lung abscess
Broad spectrum abx
885
Formation of atelectasis does not increase with
Increasing age
886
Causes of atelectasis
High Fi02 Obesity General anesthesia
887
Oral H2 blockers have an onset time of
One hour
888
Strongest predictor of perioperative outcome in patient on TPN
Albumin
889
Fetal academia
pH 7.2 or lower | Lactate greater than 4.8
890
Claims made insurance policy
Covers claims made that calendar year
891
Vertebral arteries originate from
Subclavian arteries
892
Oropharynx
Soft palate to epiglottis =
893
Epiglottis to crocoid cartlidge
Larynx
894
TCD ultrasound monitoring
Measures blood flow velocity in large arteries in head | Detects number of atherosclerotic plaques in the vessels
895
Active humidificatijn vs passive humidification
Active is more effective at humidification of gases
896
ARDS you want vcv bc
Can set tidal volume perfectly
897
Tidal volume in vcv determined by
Inspiratory flow
898
Do not replace indwelling catheters regularly only take them out when
No longer needed
899
C diff is transmitted by
Spores
900
If you suspect c diff
Only chlorine containing products such as bleach should be used for cleaning Give oral vancomycin for severe cases PPIs are associated with c diff
901
Endotracheal intubation/bronchoscopy
Need face shield to protect for mucous membranes
902
Mycobacterium tuberculosus
Transmitted through respiratory droplets Start airborne precautions Start 4drug regimen if you think they have it
903
If needlestick injury to patient with hepatitis B
Get anti HBs titers If low give HBV vaccine and immunoglobulin If normal give nothing
904
CA pneumonia
Ceftriaxone is great for pneumococcal Macrolide or flouroquinolone for atypical Vancomycin plus cefepime for HA pneumonia
905
Parasternal short axis
RV on top LV to the right Left third to fifth intercostal and facing left shoulder Distributive shock underfilled ventricles and hyper dynamic In PE RV dilated and almost same size as LV
906
Contraindications to systemic fibrinolysis
Active bleeding Intracranial lesion Recent ischemic cva These ppl need embolectomy
907
Subcostal view
Can show pericardial effusion Elevated SVR, HR, CVP If tamponade post CABG Need redo sternotomy if tamponade post CABG to figure out source of bleeding
908
Lactate is a marker for
Organ hypoperfusion
909
Dobutsmine has beta1 and beta2 and is preferred in
Cardiogenic shock- inotrope and chronotrope Can cause decrease in svr and hypotension
910
PAC can be used to get
Stroke volume SV02 SVR Oxygen consumption Not ejection fraction
911
Look out for urosepsis
After taking out stones
912
Sepsis is considered a
Medical emergency
913
Septic shock
Lactate greater than 2 and hypotension despite fluid resuscitation Next step is start norepinephrine Start with 30 cc/kg Straight leg test and look at IVC
914
Spinal cord injury below C4 still have diaphragm but
Lose accessory muscles which are crucial for adequate cough and deep breathing
915
If high risk for DVT
Use LMWH instead of subq heparin High risk is spinal cord injury, major trauma, leg trauma
916
ASPEN guidelines
Early enteral feeding in ICU 24-48 hours of admission advocated
917
Elevate head of bed to reduce
Aspiration risk
918
Brain death
Abscence of spontaneous respiration’s at pac02 of 60 or greater Absent brainstem reflexes Normotension Etiology of coma Complete absence of motor function not needed
919
Gold standard ancillary test for brain death
Abscence of cerebral vessel filling on cerebral angiography
920
Brain death is defined as
Irreversible loss of brain function and need 2 brain death exams 6 hours apart
921
First step I hyponatremia
Check serum osmolality Mannitol draws water into extracellular fluid leading to hyponatremia Normal serum osmolality 280-290
922
SIADH treatment remove sources of excess free water
Fluid restrict!
923
Pleautaeud expiratory flow
Mediastinal mass
924
Jet ventilator
Maximum of 35 psi Seldinger technique 12 to 16 gauge catheter Minimum pressure to ventilate patient is 15 psi
925
Thoracic epidural allows for deep breathing
Without pain
926
Ethosuximide
Blockage of T type calcium channels
927
Air in the sample syringe for blood gas artificially increases the
Pa02
928
20 minute delay of reading blood gas sample leads to
Lowering of Pa02
929
Communication between doctor and lawyer is always
Privledged information
930
AcH binds to
Alpha 1 subunit of the postjunctional nicotinic receptor at the nmj
931
Airway resistance affects the
Ppeak | Endotracheal tube obstruction, bronghosoasn ashthma attack
932
Pulmonary edema, ARDS affects
Pleateau pressure
933
Chronic high flow AVM getting embolized
Cerebral dysautoregulation post avm can lead to profound cerebral edema often requiring decompressive craniotomy
934
Hypothermia decreases
CMR02 and ICP
935
QT prolongation
Erythromycin | Hypocalcemia
936
In refeeding treatment includes
Stop tube feeds and replace electrolytes
937
In drowning patient
Don’t do the heimlich as can lead to pulmonary aspiration
938
Hypothermic drowning patients tend to do better
Reduced cerebral oxygen consumption
939
Antidotes
Methanol/ethylene glycol poisoning - fomepizole Organophosphate- glycopyrolate/atropine Diltiazem- insulin
940
Cyanide poisoning and carbon monoxide poisoning is seen in
Burn victims Can see lactic acidosis Hydroxycobalamin is first line against cyanide poisoning. Also administer 100% oxygen
941
Sarin gas =
Organophosphate poisoning
942
Intimal flap in aorta
Descending aortic dissection Type B dissections are distal to subclavian Type A involve ascending aorta with or without descending Need to increase preload, decrease afterload,
943
Midesopageal short axis
Aorta Mercedes Benz sign
944
AI
Increase preload Decrease afterload to maximize forward stroke volume High normal HR Maintain sinus rhythm
945
Bicuspid aortic valve see
Aortic root dilation
946
Aortic stenosis hemodynamics
Preload- full | Afterload- don’t decrease. Maintain it to sustain coronary perfusion
947
Electromagnetic interference to pacemakers
Inhibition of pacemaker Loss of capture Inappropriate icd firing Myocardial burns
948
Pacemaker code
Position 1 designates chamber being paced Position 2 chamber being sensed Position 3 is response to sensing
949
Atrial fibrillation initiates in
Pulmonary vein
950
Phrenic nerve injury
Elevated hemidiaphragm
951
RICI score to assesss
Periop major cardiac events If emergency procedure like perforated bowel just go to or! U use this for intermediate procedures with multiple risk factors
952
3 RICI risk factors
Recommend starting a beta blocker prior to procedure
953
Intraoperative MI is seen best with which lead
V5
954
Type 2 MI due to
Increased myocardial demand or decrease oxygen supply
955
VAD device
Close to stomach so leads to delayed gastric emptying thus do rapid sequences
956
CBP vs ECMO
CBP uses lower flow rates thus requires more anti coagulation A line will lack pulsatility
957
Prior exposure to Protamine
Puts you at greater risk for anaphylaxis when you get protamine again
958
Fixed upper obstruction
Foreign body Tracheal stenosis Large airway tumor
959
Extra thoracic airway obstruction
Goiter
960
Lumbar nerve roots exit
Below the numbered Pedicle
961
Benzos and opioids may cause marked
Synergistic vasodilation
962
Pons injury
Respiratory dysfunction
963
NIF > -20 such as -15 is associated with a
Difficult wean
964
BUN with uremia
Give lower dose of versed
965
Cyp 2D6
Coeidine
966
Lactate ringers is made up of sodium and lactate and has a little glucose
The lactate is converted to bicarbonate leading to an alkalosis
967
Chi square doesn’t work for
Continuous variables Works well for categorical variables
968
Best for DVT prophylaxis and prevention of post-op bleeding
LMWH
969
Do not give midazolam to
Pregnant patient
970
Dexamethasone anti-emetic site
Nucleus tractus solatarii
971
Increased epinephrine
Increased blood glucose levels
972
Serum osmolality is high in HHS but low in
DKA <320 in dka and above 350 with HHS
973
Give IV ketamine if worried about patients
Respiratory status
974
100% of intrascalene blocks get
Phrenic nerve blockade
975
Ketamine can induce
Seizures
976
Rigid laryngoscopy/bronchoscopy
Foreign body
977
Don’t give glucose containing fluid to
Burn patients
978
Hypocalcemia Hypokalemic Hypo magnesium all cause
Prolonged QT
979
During fasting on liver it
Increases glycogenolysis and does gluconeogenesis
980
Which anti muscarinic increases HR the most
Atropine
981
Zone fasiculata makes
Glucocorticoids Glucocorticoids are made in adrenal cortex
982
Water moves freely acriiss
BBB Lipophilic substances move freely as well
983
Pa02 above 100 can have
Deleterious affects on patients
984
Prolonged exposure to high levels of oxygen can lead to
Tracheobronchitis/pulmonary edema/eventual respiratory failure
985
Volatile anesthetics
Increase RR | Decreased TV
986
Fa/Fi increases most with higher minute ventilation
In highly soluble agents like isoflurane
987
Which evoked potential is mode sensitive to volatile anesthetics
Visual evoked. Brainstem auditory most resistant
988
Left ventricular diastolic dysfunction goes with
LV hypertrophy
989
Patients with diastolic dysfunction and normal ejection fraction
Have normal volume but high diastolic pressures
990
Myofascial pain
Multiple taut bands with radiating pain
991
Esophageal monometry
It is used to calculate transpleural pressure gradient
992
1 mg of protamine per
1 mg of heparin(100 units)
993
What is made in liver?
Angiotensinogen
994
BNP is released from heart
Response to myocardial stretch receptors
995
Vascular rings are due to failure of
Embryonic structures to regress Occur with right sided aortic arches
996
Video laryngoscopy helps with
Glottis visualization
997
Where do you sample to get mixed venous saturation
Proximal pulmonary artery
998
Keeping OR humidity 50-55% helps with
Mitigating increased risk of static discharge
999
Cryotherapy delays
Nerve conduction
1000
Neostigmine causes
Fetal bradycardia
1001
Increasing gain increases
Black white and gray on screen
1002
Addiction
Significant physical or emotional dependence on drug and craving despite negative or even harmful consequences
1003
Chylothorax
Left IJ you can injure thoracic duct
1004
Phospholipoprotein surfactant made by
Type 2 alveolar cells
1005
Pulmonary surfactant is also called
Phospholipoprotein
1006
Posterior pituitary also called
Neurohypophysis
1007
Beta stimulation and pain or emotional stress increase
ADH secretion
1008
In SIADH
Urine must be inappropriately concentrated plasma osmolality <280 and urine osmolality >100
1009
Primary therapy for SIADH is
Fluid restriction. Chronic SIADH may require demeocycline
1010
Severe risk for acid aspiration give
Metochlopramide/ranitidine- better than cimetidine with fewer side effects
1011
IABP is out
Put into descending aorta Should end up above renal arteries and 2cm distal to origin of left subclavian artery IABP increases DBP and coronary perfusion During systole increase output and decrease afterload
1012
Hyperkalemic periodic paralysis patient
Potassium free dextrose solutions help More glucose leads to more insulin formed to decrease potassium level
1013
Diffusion hypoxia
Due to high amounts of nitrous oxide coming out on emergence displaces 02 and c02
1014
Cyp2D6
Converts codeine to morphine
1015
Waste gas scavenging
Vaccum rate must exceed the rate of waste gas flow
1016
Airway procedures such as blank are at higher risk for adverse events with pediatric sedation
Bronchoscopy | Also ASA 3 or greater and obesity
1017
Etomidate
Enhance affinity of GABA binding to Gabaa receptor Does not directly activate GABA
1018
Biggest adverse risk with midazolam is
Respiratory depression
1019
Alanine is a substrate for
Glucose synthesis
1020
Max amplitude on TEG is low give
Platelets Want R time 6 minutes Alpha angle 60 degrees Max amplitude 6 mm Prolongation of R value requires FFP
1021
CBP with bypass flow of how much replicates normal cardiac output
4.5 L/min
1022
Physician have the highest blank of any profession
Suicide
1023
First leading cause of death in residents
Cancer second is suicide
1024
Hypotonia of neonate can be caused by administration of what to the mother
Magnesium
1025
Diltiazem good for
Hemodynamically stable A fib Non-dihydropyridine calcium channel blocker
1026
Labetalol
Alpha1/beta1 antagonist don’t use beta blockers for a fib if patient has bad COPD
1027
When a patient is anemic
Blood viscosity is deceased helping improve blood flow aiding in oxygen delivery Blood flow goes more to vital organs and not to kidneys skin and muscle
1028
Propofol decreases amplitude of
SSEPs
1029
Coagulatiopathy happens in 1/3 of bleeding patients
J
1030
Burst suppression helps mortality in patients with
Status epilepticus
1031
Help prevent medication errors with
Prefilled syringes
1032
TR will affect
Thermodilution Check temp in pulmonary artery to get cardiac output
1033
Postop myalgia after succinylcholine
Do not correlate with fasiculations
1034
LY30 elevates is a sign of
Coagulopathy
1035
Protamine MOA
Direct binding of large negatively charged molecules in serum. Heparin is negatively charged
1036
Gabapentin blocks
Calcium channels
1037
Change in portal venous flow will result in
Compensatory flow changes in hepatic artery
1038
Adenosine produces
Hepatic arterial dilation
1039
Inhalational induction is most slower by
Right to left shunt
1040
What muscle contracts during forced exhalation.
External obliques and internal obliques
1041
Diaphragm and external intercostal swirl during
Inspiration
1042
Acute anemia lowers
SV02
1043
Dexamethasone
Is the most potent glucocorticoid Can lead to adrenal suppression
1044
Fludocortsone
Potent mineralocorticoid
1045
Dermatome spread if local anesthetic injection is based on
Baricity of medication
1046
Propofol acts through
Posysynaptic GabaA receptors increasing chloride conductance
1047
APRV can lead to
Hypercarbia In paralyzed patients due to inverse 2:1 I to E ratio
1048
Polyvinyl chloride endotracheal tube most likely to undergo
Ignition when exposed to c02 laser
1049
Concentration calibrated bypass vaporizer uses blank to achieve desired percentage of volatile anesthetic
Splitting ratio
1050
Cornual placenta predisposes to
Breech delivery As well as multiple gestation and macrosomia
1051
Opioid with highest side effects in epidural space
Morphine Very hydrophilic and produces longer duration of action Cephalad movement of opioids in CSF principally depends on lipid solubility
1052
In MRI suite after starting
CPR Remove patient from scanner immediately
1053
DBS electrodes for refractory Parkinson’s avoid
Midazolam
1054
Need to stop on day of surgery
Diuretics
1055
Selective beta 2 agonist
Terbutaline
1056
Treacherous Collins
About 50% have hearing loss
1057
Hyperparathyroidism leads to
Skeletal muscle weakness And hypophosphatemia
1058
If looking at facial nerve can’t use
Neuromuscular blocking agents NMBD work at postsynaptic receptors
1059
Mediastinal mass
Don’t use nmbd can lead to tracheal collapse
1060
Acetylcholine synthesis is catalyze by choline acetyltransferase at
Presynaptic neuron
1061
Psuedochilineeease is found in
Plasma- not the neuromuscular junction
1062
For Ach release
Need ca2+ influx
1063
Feverfew has additive effect with
Warfarin
1064
DIC is associated with
Elevated PT time
1065
Alvimopan
U receptor antagonist which does not cross BBB.
1066
BAEP
Most resistant evoked potentials to volatile anesthetics
1067
Only need meds for malignant hyperthermia if
Triggering agents are used - succ or inhalational agents
1068
Fade on train of four is associated with
Progressively decreased Ach release on successive twitches
1069
Beta agonist leads to increased
cAMP
1070
Hydralaxine mainly dilates arteriole
Duration of action 1-4 hrs
1071
Inability to extend neck and create sternomental distance >12.5 leads to
Difficult intubation Mallampati 3 or 4 Interincisor distance < 3 cm Thyromental distance < 6.5 cm
1072
Febrile Rxn to platelets caused by
Cytokines released by donor leukocytes
1073
Third and fourth generation cephalosporins have very little cross reactivity with
Penicillins
1074
Secondary Adrenal Insuffiency
Direct result of inadequate ACTH production by the anterior pituitary CRH from hypothalamus is first
1075
Sanz electrode for
PH Clark for P02 Severinghouse for C02
1076
Median aperture drains CSF into
Cisterna magma
1077
Epinephrine leads to
Vasodilation
1078
Transpulmonary pressures are high in patients with
Restrictive lung disease
1079
Distal to subclavian descending thoracic aortic aneurysms treat with
Endovascular repair
1080
More magnesium leads to decreased calcium leading to less Ach release which results in
Muscle weakness
1081
Endotracheal cuff pressures based on
Boyle’s law
1082
Bedside percutaneous tracheostomy what type of tracheostomy tube
Cuffed low pressure tracheostomy tube
1083
Gum elastic boogie vs airway exchange catheter
Anterior angulation at distal end
1084
Nitroglycerin calcium channel blocks can cause
Direct cerebral vasodilation
1085
Infants and patients with sickle cell do poorly when getting blood
With defective hemoglobins
1086
Surgical manipulation of carotid sinus may lead to
Sudden Bradycardia and hypotension
1087
Atropine crosses the
BBB
1088
High volume low pressure
ETT cuff is the standard Polyurethane cuffs are used which are ultra thin
1089
Desmopressin leads to rease of
VwF from endothelial cells
1090
In VWF patients check
VwF legend, factor 8 levels, VwF ristocetin cofactors
1091
Three phases of liver transplant
Dissection anhepatuc repercussion Anhepatic clamp portal vein/hepatic artery remove liver and anastomosis to IVC and portal vein Reperfusion Anastomosis hepatic artery and biliary systems
1092
Regional is better than neuraxial in
Bad liver patients General is the worst messes up hepatic blood flow
1093
Neuraxial anesthesia
Reduces rate of perioperative vte Decrease stress response as well as improves venous blood flow
1094
Post op after retroperitoneal carcinoma resection continue LMWH for
28 days
1095
PE
Increased dead space
1096
Most common acid base disturbance in acute PE is
Respiratory alkalosis Most sensitive ECG change is sinus tachycardia
1097
Most common cause of HTN is
Essential HTN
1098
AceI and Arbs block
RAS which releases vasopressin. Cause vasopressin depleted state but treat with vasopressin
1099
CSF drainage is recommended as spinal cord protective strategy in
Open and endivascular thoracic aortic repair
1100
Aortic cross clamp release
Venous return decreases as blood goes to distal tissues | Cardiac output is thus decreased
1101
Clopidogrel should be held how long for epidural
7 days
1102
Acute lung injury is a risk in patients
With acute alcohol intoxication
1103
Preop spirometry for delineating risk in thoracic surgery
FEV1<800 FEV1<30% of normal RV/TLC>50% are all associated with increased postop risk for lung resection procedures
1104
Theophylline toxicity
Low therapeutic window and used in COPD patients Can lead to tachyarhythmias
1105
V02 max greater than 20 ml/kg/min has
Low risk of postop complications
1106
Surgery on which lung is more likely to lead to desaturation
Right Significant lunch parenchyma disease is evident with a low Pa02/fi02!ratio
1107
25 vs 5% albumin
25% has much higher osmotic pressure so moves fluid into intravascular space better
1108
Hydroxyetgyl starch is
Renally excreted | Increases PTT
1109
Normal serum osmolality
285-305
1110
Diltiazem is unique why?
Can act on both smooth muscle and cardiac muscle Vasodilator and cardiac depressant thus dilating corinarues and decreaseing PVR
1111
Dihydroperidines end in dine
Amlodipine Acts as vasodilator but has no cardiac depressant effect
1112
Best way to avoid upper extremity injury during spine case
Use somatosensory evoked potentials
1113
Can’t measure oxygen level with
Infrared absorption spectrophotometer
1114
Treat high spinal quickly with
Epinephrine
1115
Pacemaker leads go through subclavian axillary veins to svc ra rv or both . The end of the lead is placed in the
Endocardium
1116
Ventricular arrhythmias are common as you float PAC into
Right ventricle
1117
Awake fiber optic is best for
Clinically stable pt
1118
In general the higher the pH of solution the more will exist in
Unionized form
1119
Atrial fibrillation
Loss of A wave
1120
Serotonin syndrome
Clonus Tachycardia Hyperpyrexia Diaphoresis
1121
As gas flow through rotamer increases so does
Cross sectional area of orifice Density and viscosity of gases aren’t affected by flow
1122
Periodic recruitment maneuvers are known as
Sighs
1123
Flail chest
Conservative treatment is standard of care. Not surgical. Thoracic epidural not intubation unless required
1124
CPAp provides continuous pressure throughout inspiration and expiration and is analogous to
PEEP Prevents collapse of airways
1125
Bipap adds pressure support to
Cpap
1126
Don’t do Bipap if
Severe agitation | Vomiting
1127
Gold standard analysis of platelet function is
Optical aggregometry
1128
First step in work up of anemia
Peripheral smear and reticulocyte
1129
Hexamethonium
Neuronal type nicotinic antagonist
1130
Blood transfusion from first degree relative can lead to
Graft vs host disease
1131
Intrinsic peep goes down with
Lower minute ventilation and longer expiratory time
1132
Myofascial pain best treated by trigger point injection and
TENS Myofascial pain is at a particular point in the muscle
1133
Lateral cricoarytenoid and transverse arytenoid result in
Adduction of vocal cords
1134
Increase bradykinin with ace inhibitor use can lead to
Facial edema
1135
Pipeline pressure of oxygen nitrous and air ranges at
50 psig
1136
Mapleson D is the most
Efficient and requires the least gas flow
1137
General contraindication to MRI include
Pacemaker or CID
1138
Bronchiectasis is an
Obstructive pulmonary disease
1139
FEV1/FVC is down in
Obstructive lung disease
1140
Pneumonia and ARDS are
Restrictive lung disease
1141
Gray rami carry postganglionic sympathetic fibers
From the sympathetic ganglia to the spinal nerves
1142
White rami carry
Preganglionic sympathetic fibers from spinal nerves to paravertebral ganglia
1143
Hunt Hess 1
No blood detected Hunt Hess 2 diffuse thin layer of blood < 1 mm
1144
Risk of airway fire is higher in MAC cases bc they are never intubated and thus don’t have a secure airway
In Mac must be ready to convert to general. Purposeful to painful stimuli and usually maintain cardiac function Biggest risk is respirator depression
1145
Thoracic duct drains into
Subclavian vein You should suspect injury if unilateral pleural effusion or ipsilateral supraclavicular swelling Pneumothorax presents as sudden onset chest pain and immediate dyspnea
1146
Temperature regulation by
Hypothalamic nuclei This is where most of it occurs centrally
1147
For airways with limited neck extension should use
Flexible laryngoscopy Video Laryngoscopy requires some neck flexibility
1148
With three twitches in TOF approximate blockade of
75% of receptors
1149
Gold standard TOF ratio is
0.9 for reversal
1150
1 twitch on TOF
90% of nicotinic Ach receptors are blocked
1151
Inhibits breakdown of midazolam
Fluoxetine
1152
When performing a circuit leak test the APL valve should be
Closed Closed means 30-70 cm H20
1153
If you leave APL closed on spontaneous ventilation can lead to
Barotrauma
1154
Epinephrine and dopamine both
Decrease renal blood flow Angiotensin 2 effects efferent vasculature thius increasing renal blood flow
1155
Morphine 3 glucoronide contains
No analgesic activity in humans May cause hyperalgesia M6G more likely to cause nausea/pruritis/respiratory depression
1156
The larynx is located at the
C3-4 interspace In adult it’s at C4-C5
1157
What reflex stays intact after inducing general anesthesia
Pupillary response to light Corneal reflex/gag reflex/
1158
Gel warming mattresses are
Ideal for transport and don’t need a power supply
1159
Hypernatremia increases
MAC Delay elective cases if serum sodium > 150
1160
Lower potassium
Beta agonists Insulin Alkalosis
1161
Barbiturate coma
Construction of cerebral vasculature leading to decreased ICP Duration of action dependent on redistribution to peripheral compartments
1162
Skin surface warning before induction of anesthesia
Increase body heat content
1163
Parasympathetic pre and post ganglionic receptors are both
Ach
1164
Single most important risk factor for developing postoperative cognitive dysfunction is
Increasing age
1165
In trauma give
1:1:1 prbc, FFP, plts to maintain coagulation pathways
1166
Increasing abdominal distention from small bowel obstruction can lead to
Ischemia or perforation Smart to put NG tube if lots of vomiting to decompress prior to starting case Certain drugs such as nitrous oxide and metochlopramide can lead to higher risk of bowel perforation so don’t use Metochlopramide is a promotility agent and causes increases gastric emptying
1167
Warfarin half life
38 hours
1168
Precedex is highly selective for
Alpha2 Much more than clonidine
1169
Naloxone has greatest affinity for which receptor
Mu
1170
Hydromorphone and morphine intrathecal can lead to formation of
Granulomas intrathecally
1171
All Duran sinuses drain into the
Internal jugular vein. The veins of the brain drain into the Dural venous sinuses
1172
Invasive arterial blood pressure monitoring involves
Electromechanical pressure transducer
1173
When can you do an SBT
GCS>13 Pa02 150-200 on fi02 50% or less peep of 8 or less No sepsis or electrolyte issues HR<140 beats per minute
1174
Post op in Peds for fluid replacement use the
2-1-.5 rule
1175
Propofol is Safe to use in patients high risk for
Hepatic encephalopathy
1176
Precedex is mainly based on
Liver metabolism
1177
Succinylcholine increases
Tracheal tone
1178
Which nerve most attenuated hypoxia ventilatory drive
Peripheral response to acute hypoxia Glossopharyngeal nerve Carotid and aortic bodies detect decrease in arterial partial pressures of oxygen
1179
Large left atrium will show as bigger RA on CXR
RA at bottom of heart on cxr can’t see RV Can see LV at bottom
1180
Nicotinic Ach receptors increase in
Skeletal muscle with Guilin barre and burns
1181
Severe metabolic acidosis in hypovolemia can lead to
Severe hyperkalemia due to GI tract - not skeletal muscle
1182
Warfarin has
Narrow therapeutic window Tylenol can make you supratheraputic
1183
Termination of local anesthetic drug effect when used in neuraxial anesthesia
Vascular absorption and redistribution is primarily responsible for termination of effect
1184
No local anesthetic
Gets metabolized in CSF
1185
Dobutamine acts on
Beta1 receptor
1186
Hyperkalemia with potassium above 6 should be corrected before
Elective cases
1187
Sodium bicarbonate insulin beta agonists can lower
Potassium
1188
Body excretion of potassium takes time
Diuretics kayexelate dialysis
1189
95% of mag is
Renally absorbed
1190
High normal saline leads to
Hyperchloremic metabolic acidosis
1191
Platelets are stored at highest temp with highest risk for
Bacterial infection of all blood components
1192
Febrile rxn to blood due to
Leukocyte antibodies
1193
Trali
Non cardiogenic pulmonary edema Hypoxia SOB fever
1194
Urticaria rxn to blood
Don’t stop transfusion!
1195
TRALI criteria
Within 2 to 6 hours of transfusion PA occlusion pressure low Bilateral infiltrates No acute lung injury prior to transfusion Diuretics and steroids are contraindicated in Trali
1196
AB universal for giving
Plasma bc they have no antibodies
1197
In cross match a small amount of donors blood is mixed to see if
Compatible
1198
Type and screen
Add blood from donor to specially made red cells with all the antigens to see what antibodies are on the donor blood
1199
Hypothermia increases blood loss by
20%
1200
First step in blood transfusion rxn
Stop the transfusion
1201
Coagulation cascade always involves
Conversion of fibrinogen to fibrin
1202
When clot is formed
Plasminogen is concerted to plasmin by tPa to break down clot
1203
Spontaneous bleeding occurs at plt count less than
20,000 Minimum recommended plt count before surgery is 75,000
1204
Thrombocytopenia
Dilution after massive transfusion | Uremia cirrhosis and aspirin can also cause it
1205
ASA stops platelet aggregation by inhibiting platelet
Cyclooxygenase
1206
Factor with shortest half life
Factor 7
1207
Warfarin competes with vitamin K for binding sites on the
Hepatocyte
1208
Heparin activates
Antithrombin 3
1209
Normal PTT
40-100 seconds
1210
Normal PT time
10-12 seconds
1211
Cryoprecipitate is thawed
FFP
1212
Less thick TEG
Severe plt dysfunction R time increase in coagulation factor deficiency Hypercoagulable state will be more thick
1213
Glossopharyngeal nerve
Provides sensory innervation to base of tounge and vallecula
1214
Jet ventilation
Can’t expire and can lead to barotrauma or decrease in cardiac output
1215
Negative inspiratory force should exceed blank for Extubation
1216
Risk of pressure injury is higher with
Mask ventilation
1217
LMA can affect the lingual
Nerve
1218
Prolonged heparin use leads to
Hypoaldosteronism
1219
Warfarin
Vitamin K antagonist
1220
Near infrared uses
Longer wavelengths than visible light spectroscopy
1221
IgA deficiency
Recurrent infections of respiratory and GI tract
1222
Lvads can be
Long term RVADs and bivad can not
1223
Bupivicaine induced cardiac arrest
T wave amplitude increases
1224
Onset of action of IV fentanyl
3 to 5 minutes Onset of action with hydromorphone is 8 minutes
1225
Midazolam benzos will Lower
Seizure duration so don’t use in ECT
1226
Most resistance to gas flow
Occurs in large airways including the upper bronchi
1227
Adrenergic agonists like
Norepinephrine Phenylephrine Dopamine Can’t cross BBB
1228
Adolescents are more likely to get opioid
Addiction
1229
Recombinant hemoglobins does not require
Typing or crossmatch
1230
C tetani
Exotoxin binds peripheral nerves Blocks GABA leading to spasticity
1231
Isoproterenol
Beta agonist
1232
During labor most common causes of fever are
Chorionionitis and epidural catheter placement Chorio you get foul smelling amniotic fluid
1233
Stellate ganglion
Increased blood flow to arm you place it on
1234
Alcohol leads to
Afonso demyelination
1235
Medial branch innervates
Multifidus, facet joint, interspinous
1236
Before injection of epidural steroid injection hold xarelto for
Three days
1237
C6 nerve exits from
C5-C6 foramen
1238
Tension headache
First line are NSAIDs If NSAIDs don’t work can do anti-depressants
1239
Stellate ganglion block occurs at level of
C6
1240
Spinal cord stimulator should be placed at
Posterior epidural space
1241
Opioid withdrawal
Diarrhea
1242
Central chemoceptors detect
PH and pac02
1243
Renal blood flow is controlllrd by
Endotheliin 1 and nitric oxide
1244
PPV greater than
15% means you will be responsive to fluid bolus
1245
Increased aortic clamp times(ischemic time) leads to
Renal injury
1246
Hemodilution promotes
Anemia
1247
Muddy brown casts go with diagnosis of
ATN
1248
Liver transplant pts do poorly with
Hyponatremia
1249
Sodium hypochlorite for disinfecting
C diff
1250
Meperidine
Synthetic opioid agonist
1251
If aspiration want head
Lateral and down
1252
No change in RR during
Pregnancy
1253
Etomidate is associated with
General myoclonus
1254
Congenital diaphragmatic hernia can lead to
Pulmonary HTN
1255
Decreased total lung capacity in
Obese patients- makes them restricted
1256
Dexmetodimine
Total body weight
1257
Heparin stops conversion of
Prothrombin to thrombin
1258
In utero Pa02 of fetus is
20 mm Hg
1259
Haldol
D2 receptor antagonist
1260
FEV1 greater than 12% increase is good response to
Bronchodilator
1261
Emphysema doesn’t get better after
Bronchodilator therapy
1262
Abscence of breath sounds and high peak pressures post intubation think
Bronchospasm Give 5-10 mcg epinephrine
1263
Which nerve supplies trachea
Vagus
1264
In hypoxia respiratory failure you usually use
Venovenous ECMO
1265
Hypoxia and hypocarbia are classic for
Pulmonary embolus
1266
Spinal stenosis
Relief when bending forward
1267
Fibrinogen and vwf are normal inpatients with
Liver disease
1268
Acidosis messes up
Clotting factors from working correctly
1269
Longer storage of blood leads to more co2 and
Metabolic acidosis
1270
Look at calcium on blood gas by looking at
Ionized calcium
1271
Enlarged cardiac sillhoute on patients with
Hypothyroidism
1272
Vasogrnic edema messes up BBB by
Moving fluid from intravascular to extravascular compartment
1273
Canulas of LVAD placement
Left ventricular apex for inflow | Outflow to ascending aorta
1274
PTU acts on thyroperoxidsse
Thus inhibiting new thyroid hormone from forming Also stops conversion of T4 to T3
1275
In ARDS
Tital volume is based on ideal body weight
1276
Barotrauma
Overdistension of alveoli
1277
Side effects of PEEP
Barotrauma Cardiac output decrease Increase in ICP and fluid retention
1278
Red on pulse of Infrared
660 940 nm
1279
Methemoglobin converts oxygen dissociation ratio to the
Left
1280
Co oximeter blood gas analysis is test to look for
Methemoglobin
1281
Pulse of only tells you about
Oxygenation not ventilation Thus might be hypocapnic but pulse ox is fine
1282
Et c02 less than
10 after 20 minutes cpr is 100% sign of death
1283
Causes of rebreathinh
``` Exhausted C02 absorber Incompetent expiratory or inspiratory valve Accidental administration of c02 Giving bicarbonate Tourniquet release Inadequate fresh gas flow ```
1284
Sudden loss of capnographic waveform
``` Esophageal intubation Ventilator disconnect Capnigeaph doscinnect Obstructed ETT Cardiac arrest ```
1285
Cause of increased ETC02
``` Hypoventilation Increased body temp Airway obstruction Revreatginh Bronchial intubationi adequate fresh gas flow ```
1286
Don’t give what during thyroid storm
Aspirin
1287
Compensation for metabolic acidosis in humans that acts quickly
Hyperventilation
1288
Dilation of ascending aorta seen in patients with
Bicuspid aortic valve
1289
Decelerating flow is seen in
Pressure control ventilation This is why it’s better than volume in morbidly obese undergoing laparoscopic surgery
1290
Brain death leads to decrease in
Temperature
1291
Brain dead patients still have spinal reflexes so need to give
Muscle relaxant
1292
Pa02>200 is needed before doing
Apnea test
1293
Vagal blockade during glossopharyngeal nerve block leads to
Tachycardia
1294
Acute chest syndrome
New pulmonary infiltrate involving at least one lung segment not due to atelectasis Treat with exchange transfusion
1295
In VSD give
Preload up
1296
CPP=
MAp-ICP
1297
Complete heart block is known complication of
TAVR Below level of aortic annulus caused by the prosthesis Treat complete heart block with transvenous pacing
1298
Tizanidine
Alpha 2 agonist
1299
Primary metabolite of oxycodone is
Oxymorphone
1300
Bivalirudin
Thrombin inhibitor that blocks thrombin mediated cleavage of fibrinogen to fibrin
1301
Steroids cause
Decreased wound healing
1302
Best way to see if facets are cause of back pain is
Medial branch block
1303
Postop period following craniotomy patients who have a seizure should be investigated with
Head CT
1304
1 amp 50% dextrose solution first line for hypoglycemia in
Teen patient
1305
Tranexamic acid
Decreases risk of bleeding or blood transfusions
1306
PO to IV hydromorphone conversion is
5:1
1307
Meconium inactivated surfactant making
Ventilation perfusion mismatch
1308
Head to body ratio of infants is higher so need to raise
Shoulders to get into sniffing position
1309
Lingual nerve is a branch of the
Trigeminal
1310
Laryngeal manipulation can lead to
Bradycardia
1311
For jet ventilation
Avoid breath stacking Hard to measure exact Fi02 so pulse ox important TIVA is required Pressure monitoring distal tip of jet ventilation catheter
1312
During microlaryngoscopy patient need to be
Immobile
1313
Increased airway pressure Wheezing Hypotension
Anaphylaxis | Give epinephrine 50-100 ug
1314
Begin low dose epinephrine infusion
For anaphylaxis if refractory to medication and blood pressures stay decreased
1315
Tryptase is a marker for
Mast cell activation and degranulation Need to keep anaphylactic patient in icu for minimum 24 hrs
1316
Thumbprint sign shows
Epiglottis Mostly associated with h influenza
1317
For aspiration in child
Want to keep patient spontaneous as long as possible flexible bronchoscope is placed
1318
Can pass a flexible bronchoscope through an
LMA
1319
Malpositioned trach
If trach falls out within first 24 hours there is a risk for false passage so don’t just stick it back in
1320
Sign of difficult intubation
Inability to bring mandibular incisors anterior to maxillary incisors
1321
Class 3 mallampati
Soft palate only season
1322
Lambert Eaton gets better with
Exercise
1323
Mechanical pump to circulate blood from machine to patient either
Centrifugal or roller pump
1324
Diffusion constant of a gas is proportional to
Solubility and inversely proportional to the square root of the molecular weight
1325
PEEP
Decreases afterload
1326
Anterior wall on rigt side of
Left ventricle Inferior wall on further left side
1327
Complete heart block due to
Inferior wall
1328
Difference between end diastolic and end systolic =
Stroke volume
1329
Don’t give positive pressure to side of lung with
Bronchopleural fistula Can lead to pneumothorax
1330
Alk phos is increased in
Pregnancy
1331
If blood is found in subarachnoid lumbar catheter
Stop draining CSF Need to look for spinal hematoma or intracerebral hemorrhage
1332
Leading cause of death worldwide is
Maternal hemorrhage
1333
Increased FRC when placed in
Reverse trendelenberg vs supine
1334
Decrease SVR to compensate for
Anemia
1335
Gastric pH increases in
Pregnancy
1336
HR no change BP will increase when giving phenylephrine
To pt s/p heart transplant
1337
Tranexamic acid
Inhibits activation of plasmin
1338
Desired magnesium range is
4-8
1339
Hypermagnesium
More sensitive to depolarizing/nondepolarizing neuromuscular blockers
1340
In acute tubular necrosis FenA >
3% BUN:Creatinine<15
1341
Prosthetic valve and cardiac transplant pts should get
Endocarditis prophylaxis
1342
Least sensitive evoked potential
Brainstem auditory evoked potentials
1343
Deep peroneal Superficial peroneal Sural
Innervate foot
1344
Nitroglycerin not good with aortic stenosis
Leads to decrease in BP and increase in HR thus increasing myocardial oxygen demand
1345
18% for front of torso
18% for back of torso 9% for each leg
1346
Homozygous atypical dibucaine 20
Bad in psuedocholinesterase deficiency
1347
Fa/Fi ratio most important factor is
Blood gas partition coefficient
1348
T10-L1 visceral sympathetic
Pain transmission for first stage of labor
1349
Thoracic epidural
Lower FEV1 Lower FVC V/Q ratio doesn’t change
1350
SAH ecg
QT prolongation
1351
70 ml/kg for
Children blood volume
1352
Phenelzine | Tranylcypromine
Are MAOi inhibitors along with selegeline Be careful giving to patients with meperidine
1353
SOMA
Highly addictive
1354
Email between medical record must be
Encrypted
1355
PaO2 is higher and PaC02 is lower without
Air bubble
1356
Retrobulbar block biggest complication
Hematoma
1357
Least cerebral vasodilation is seen when giving
Sevoflurane
1358
Medullary thyroid cancer comes from
Parafollicular cells Best to check preop for pheochromocytoma because part of the MEN family of syndromes
1359
Bronchospasm leads to decreased breath sounds
Bilaterally
1360
Induction of ECT use
Methohexital
1361
Anterior ischemic optic neuropathy
Optic disk edema
1362
Stroke volume decrease in
Aortic stenosis due to increase afterload
1363
Mapleson circuit has less
Airway resistance than circle system
1364
PKa
Where 50% are unionized
1365
Right laryngeal nerve off of
Right subclavian Left laryngeal comes off aortic arch
1366
Total thyroidectomy respiratory distress in day 1 mainly due to
Hypocalcemia
1367
Prolonged oxytocin can lead to
Hyponatremia
1368
5% albumin has as much sodium as
Normal saline
1369
Decrease in
Protein S with pregnancy Become resistant to protein C
1370
Biggest limitation to using peripheral iv for giving TPN is
Can’t give high osmolality Thus have to give a lot of volume that can’t be tolerated by critically ill patients
1371
PRESS
MRI findings vasogenic edema localized to posterior cerebral hemispheres Reversible If pre eclamptic do delivery
1372
C02 crosses
BBB. It affects pH by combining with bicarbonate
1373
CBF changes 5-7% per 1 degreee change in
Temperature
1374
Biggest maximal depression in CMR with
Isoflurane
1375
Most vasodilator increase
ICP Use labetalol or esmolol
1376
Compromise blood flow increases
Latency of SSEPs
1377
Precedex activates
EEG
1378
Awake crani
Must be able to rapidly control ventilation and general anesthesia LMA is good option
1379
Precedex for placement of
Deep brain stimulator placement
1380
Cerebral vasospasm after ansurysmal SAH
3-14 days
1381
Hunt Hess grade
0 is best
1382
Grade 1 fisher scale for SAH
No SAH blood Grade 2 thin SAH Grade 4 is intraventricular
1383
Nimodipine
For ruptured aneurysm BP management
1384
SAH hypertensive due to
Catecholamine release Can cause cardiomyopathy
1385
Decreased MAP reduces
Transmural pressure on aneurysm
1386
Treat ruptured SAH
And treat BP Give nimodipine as soon as aneurysmal SAH diagnosis made
1387
DI
Urine specific gravity < 1.005 is confirmatory Don’t do elective if above 150
1388
Neurogenic pulmonary edema
CNS injury occurring usually after a few hours to days after injury
1389
Draining CSF
Quickest way to decrease ICP Better than phenobarbital coma, hypothermia, nimbex
1390
Siting position crani
A line for cardiac issues, closely monitor SBP and CPP, repeated gases CVL for better venous access to remove air
1391
Right side better to
Aspirate venous air Right subclavian best so don’t need to put head down even though risk for pneumothorax
1392
Increased PaC02 and decreased EtC02 with
Thrombotic pulmonary embolus
1393
IABP
Increase Ejection fraction Cardiac output MAP Coronary blood flow Decrease Aortic systolic pressure Heart rate Left atrial pressure
1394
Mitral valve stenosis
Beta blockade helps
1395
Codeine is inactive and must undergo O demethylation CYP2D6 to create
Morphine Ultra rapid metabolized are at increased risk to develop respiratory depression
1396
Ascending bellow ventilator is
Safer Fail safe valve can reduce risk of delivery of hypoxia gas mixture to patient
1397
Low pressure curcuit includes
Flow control tubes and vaporizers
1398
Minimize anticholinergic drugs in ppl with
Alzheimer’s All opioids except remifentanyl gave anticholinergic properties
1399
Transdermal buprenorphine for
Moderate to severe chronic pain in adults Very high u opioid receptor binding affinity Partial agonist
1400
Histamine antagonists decrease gastric acid secretion but do not altar gastric emptying
Dopamine D2 antagonists increase gastric emptying
1401
Dopamine antagonists like metochlopramide increase
Gastric emptying
1402
Cyclosporine toxicity affects
The kidneys
1403
Incretins
Delay gastric emptying
1404
Bier block
Lidocaine causes more toxicity than prilocaine
1405
Use manual pads for
Newborn defibrillation
1406
Beta 2 agonists like ritodrine
Hypokakemia | Hyperglycemia
1407
Milrinone PDE3 inhibitor that
Increases cAMP and decreases SVR
1408
Way to treat TET spell
More preload Increase SVR Shift blood from left to right
1409
Opioids tramadol gabapentin for
Phantom limb pain
1410
Hypersensitivity to contrast dye due to
Complement activity
1411
Lusitropy
Ability of myocardium to relax
1412
Myotonic dystrophy need to look for
Cardiac conduction abnormalities
1413
RA on bottom of
Modesophageal bicabal view LA is above SVCcomes into right atrium from the left
1414
Collecting duct
Produces ammonia
1415
With hypoxia
Immediate increase in ventilation within 5 minutes Hypoxia detected in carotid bodies
1416
Hepatic extraction ratio
Hepatic clearance/hepatic blood flow
1417
Therapeutic hypothermia for ppl who have experienced
V fib or v tach cardiac arrest Intracranial hemorrhage pregnancy refractory hypotension are reasons not to do therapeutic hypothermia
1418
Verapamil is a negative inotrope and not good for patients with
Heart failure
1419
Hypotension due to
Air trapping and breath stacking with asthma exacerbation
1420
4-5 days of Coumadin for
Epidural catheter
1421
T test in normally distributed populations to look at the
Mean
1422
Permeability of dura mater increased in
Elderly
1423
Laryngeal edema common after
Surgery of the neck
1424
Unilateral recurrent laryngeal nerve transectionyou get
Hoarseness but not stridor Hypocalcemia hypoxia seen after 24 hrs
1425
Fascia iliaca does not block
Obturator nerve
1426
5HT 1 and 2 inhibition by
Cyproheptadine
1427
Succinylcholine binds to
Nicotinic Ach receptors at neuromuscular junction
1428
Post carotid endarterectomy headache give
Labetalol to lower BP
1429
QRS length increased
In bundle branch blocks
1430
Transplanted heart
Isoproterenol dobutamine epinephrine still act the same No tone so don’t get reflex tachy
1431
Almost all of the carbamino carriage of c02 is my
Hemoglobin
1432
Zero order kinetics
Fixed amount of drug eliminated per unit time not percentage Decreases linearly Occurs when all the pathways for drug elimination are saturated
1433
Vapor pressure decreases proportional to
Temperature
1434
Meconium stained amniotic fluid
Higher with maternal cocaine usage Iugr Chorio
1435
Elimination half life of neostigmine is
77 min
1436
Magnesium
Potentiates NMDBs
1437
Intravascular injection signs
HR>10 SBP>15 Bradycardia T wave amplitude Not ventricular ectopy
1438
More likely uterine rupture if
Classical incision Age>30 yes 1 previous c section History of chorio with prior c section
1439
Musculaocutaneous my injecting local into
Coracobrachialis muscle
1440
Alveolar gas equation to get alveolar oxygen pressure
PA02 = 760 x fi02 - PaC02/.8
1441
E size and smaller cylinders have
PISS
1442
Most common side effect of intrathecal opioids is
Pruritis Both epidural and spinal decrease gastric motility
1443
Methadone
NMDA antagonist | Inhibits serotonin and norepinephrine reuptake
1444
Ultrasound guided stellate ganglioni block
You see longus colli muscle
1445
70% of innervation to shoulder joint is from
Suprascapular nerve
1446
Dorsal foot and toes innervated by
Superficial peroneal
1447
Predicted postop FEV1 and postop diffusing capacity of lung for carbon Dioxide
Postop respiratory complications after lung resection best tests
1448
Within 24 hours of acetaminophen toxicity you get
Nausea/vomiting, abdominal pain, anorexia Pallor/fatigue
1449
Oil gas partition coefficient
Most closely associated with MAC of local Anesthetic Inverse to MAC
1450
Bronchiectasis
Hemoptysis Decreased FEV1 Dilated bronchi
1451
Which gas shortest period of time followining injection to vitreous
Air
1452
Sulfhemoglobin
Right shift in curve Measure by gas chromatography Remains until red blood cell until destroyed Doesn’t respond to methylene blue
1453
Vasopressin better for severe AS then dobutamine or milrinone
Bc doesn’t decrease SVR and doesn’t affect PVR
1454
Hypertrophy
Increase wall stress and higher myocardial oxygen demand
1455
Refeeding
Hypophosphatemia | Hyperglycemia
1456
Etomidate
Increases epileptiform activitybinduced by ECT Enhanced amplitude of SSEPs Maintains CPP
1457
Prednisone doesn’t cause
Renal dysfunction | Cyclosporine does
1458
Treat brain dead with
Steroids NMDBs Volatile anesthetics No benzos
1459
In ascites you compensate with increase in
Respiratory rate Due to restrictive lung disease DLCO decreases in ascites
1460
Cross reactivity of penicillin allergy is highest with
First generation cephalosporins
1461
SSEP latency increase with
Hypotension Decrease cardiac output Hypothermia Hypoxemia decrease amplitude increases in latency
1462
Dexamethasone increases metabolism of codeine to its
Active form
1463
Remifentanyl won’t change with
Lower dibucaine number
1464
Gentamicin
Increases neuromuscular blockade
1465
Profound bradycardia and hypotension with
Manipulation carotid sinus
1466
Prior to neuraxial block if plt count less than 100000 get
Coagulation studies
1467
Desflurane leads to transient increase in
HR and BP
1468
N20 leads to transient increase in
Cardiac output
1469
Isoflurane maintains
Cardiac output
1470
Use expired concentrations when calculating for
MAC
1471
Brain Heart Kidney Are part of
Vessel rich group Lungs are not
1472
Recovery from inhaled anesthesia from
Blood/gas solubility
1473
After long N20 you cancause
Anemia seen in bone marrow
1474
Oxygen and nitrous
Nitrous will cause oxygen to be taken up by second gas effect
1475
Halothane
Only gas that has a preservative
1476
Isoflurane has solubility in
Rubber and plastic
1477
Sevoflurane forms
Compound A
1478
Sevoflurane undergoes 2% metabolism
Which is the most of the gases
1479
Washing of circuit equals priming circuit includes
Anesthesia bag Hoses Absorbent component
1480
Prolonged PT can be helped by
Vitamin K Cryoprecipitate FFP
1481
For platelets only need
RH matching | Platelets don’t contain RBCs
1482
VwD
Most inherited coagulopathy
1483
Can store erythrocytes for
Ten years frozen
1484
Leukocyte reduction doesn’t help with
TRALI Occurs within 6 hrs Non cardiogenic pulmonary edema
1485
TRALI more likely with
Female donor Longer blood cells more than 14 days Pooled plts
1486
Infant blood volume
80 ml/kg
1487
Hep B
Most common infection
1488
Hemophilia A
X linked recesssive
1489
Hematocrit
40% Plasma volume 60%
1490
During stress of surgery ADH
Increases Causes decrease in urine output
1491
Plts are most stored at
Higher temps to optimize function
1492
Citrate toxicity
Decrease in ionized calcium Leads to prolonged QT arterial hypotension
1493
Calculate dose of sodium needed to raise by
Body weight kg x 0.6 x desired Na - Current Na
1494
Intravascular half life of crystallography is
20 to 30 minutes Colloid is 3-6 hrs
1495
Abrupt discontinuation can lead to bad
Hypoglycemia which can show up as severe tachycardia
1496
Heyastarch agfects
Factor 8 and vWf
1497
Leftward shift due to less 2 3 DPG in
Stored blood Stored blood hyperkalemia acidosis
1498
Liver does not produce
Factor 8 Liver produces protein c s and antithrombin 3
1499
LMWH acts on factor 10a best monitored by factor 10 assay Unfractionated heparin activates antithrombin best seen with
PTT
1500
Reduction of leukocytes prevents
CMV
1501
Regular insulin
Peak effect 2 to 3 hours after subq administration and lasts 8 hrs Cholpropramide is a sulfonurea that lasts 3 days
1502
Normal Pv02 in mixed venous is
40 If higher due to increase in cardiac output etc
1503
25 to 30
Normal tracheal capillary pressure
1504
Coedine must be metabolized to morphine in order to
Work via the CYP2D6 enzyme
1505
Balloon angioplasty without a stent
2 wks
1506
Retinal artery thrombosis higher in
Glaucoma patients because already have high ICP
1507
Naloxone
Competitive inhibitor at all opioid u receptors acts for 1 hour Naltrexone is long acting only oral and lasts half life 8-12 hrs
1508
Airway problems from hypocalcemia show at
24-72 hours post op
1509
Bronchiectasis
Main cause is air pollution Permanently dilated bronchi that often contain secretions
1510
Extravasation of drugs in anyecubital fossa affects
Median nerve
1511
Delirium tremens shows up
2 to 4 days since last drink
1512
Relative contraindication to tracheal surgery if
Post op mechanical ventilation needed bc can lead to wound dehiscence
1513
Green eye drops
Miosis
1514
CBF reserve is substantial
First signs of cerebral ischemia aren’t seen until cbf has fallen to 22 ml/100g/min
1515
Closest to Mac value
Oil/gas partition coefficient
1516
High oil/gas=
Low MAC
1517
Central diabetes insipidus will
Pee a lot
1518
Anticholinesterases used to reverse neuromuscular blockade also act on
Psuedocholinesterase thus if you give succ after reversing it will last longer
1519
Trendelenberg causes pooling of
Fluid in dome of bladder
1520
Decrease in blood volume =
Decrease in DLCO
1521
Increased end expiratory C02 one of the first signs in
MH
1522
If you don’t get MH it is still likely you can get it the
Next time you get an anesthetic
1523
Trismus
Rigidity of jaw muscles Indicates MH in less than 50% of patients
1524
Prevent pulmonary fibrosis from bleomycin by using lower
Fi02 levels
1525
Can use N20 10 days after
Intravtreal injection of air and SF6
1526
Volume overload can be seen with
TURP procedure
1527
Trigeminal does muscles of mastication including
Clenching the teeth
1528
02 carrying capacity goes up when you give
Hemoglobin
1529
Huntington chorea
Decreased psuedocholinesterase
1530
PaC02 going up out of normal range will increase
IOP
1531
Apnea hypopnea index
AHI greater than 30 is severe osa Shows number of incidences in 1 hr
1532
Bad pulmonary function tests
Residual volume/TLC > 50%
1533
Pa02 is actually lower than abg
I’d pt is cold
1534
Supfhemoglobin and methemoglobin both cause low Sa02 with good Pa02
Sulfasalazine can cause sulfhemoglobin
1535
LMWH
Only partially reversed by protamine Longer half life than unfractionated heparin
1536
Scopolamine
Anticholinergic so can lead to mydriasis
1537
NMS and MH both causes
Hyperthermia Generalized muscular rigidity Effectively treated with dantrolene
1538
Most common reason outpatient gets admitted post surgery is due to
Nausea vomiting
1539
Don’t give tramadol to
Depressed/suicidal patients High nausea/vomiting
1540
Urine sodium less than 20=
Prerenal disease
1541
N20 MAC
104%
1542
Fenoldopam can be used besides
Nitroprusside
1543
Prolonged insulin in pts with
Renal disease
1544
Gabapentin is similar to
Carbamazepine
1545
Stuck inspiratory valve will lead to
Old gases and C02 coming through inspiratory valve leading to increased inspired C02
1546
After transphenoidal hypophysectomy
CPAP is contraindicated
1547
Malignant hyperthermia
Mixed venous is low
1548
Most hemodynamic instability in liver transplant during
Reperfusion phase | Need epi atropine calcium and sodium bicarbonate
1549
Female is the strongest predictor of
PONV
1550
Ketorolac has affects on
Bone healing
1551
X syndrome
Insulin resistance
1552
Pulses are last to go in
Compartment syndrome
1553
Anterior spinal artery syndrome affects
Motor but not SSEPs
1554
Botulism prevents release of
AcH
1555
Most common injury with lithotomy
Common peroneal
1556
Fetal hemoglobin for first
6 mo
1557
Glottis of feel newborn is at
C4
1558
Water content 75% in
Term newborns
1559
ROP In fetus not affected by giving mother
Oxygen
1560
Much less unlikely to get ROP in
Term infant
1561
Spontaneous breathing easier in
Uncuffed tube bc it’s bigger Usually cuffed tubes are a little smaller
1562
Want a leak at 15 to 25 cm h20
Allows for adequate ventilation and reduces incidence of postintubation croup
1563
Age/2 plus 12
Tube length inserted in cm Or tube length x 3
1564
Normal saline
Hyperchloremic metabolic acidosis Best maintenance fluid in Peds is LR
1565
High Vd in children means
You need more of drugs
1566
Less than 60 wks gestational age watch patient overnight looking for
Apnea
1567
Spinal cord of infant ends at
L2-L3
1568
Wait 4-6 weeks if child
Has cough and sore throat
1569
Healthy full term neonate blood volume
80-90 ml/kg
1570
Parkland formula for first 24 hrs
4 x weight kg x percent burned
1571
Epiglottis induction
Transfer to or inhalation induction tracheal intubation
1572
Rapid sequence can be done in infants
With GERD
1573
First expand fluids in child
With dehydration
1574
Infants younger than 3 months produce heat by
Metabolism of brown fat
1575
Normal RR for 6 mo old
Is 25-35
1576
Don’t use loss of air in child bc of risk of
Air embolus
1577
Anemia nephropathy hemolytic anemia in child
Hemolytic uremic syndrome
1578
Terbutaline does not cause
HTN
1579
Organogenesis at
3-8 weeks
1580
Pregnancy
Minute ventilation | Tidal volume increase
1581
Placing central pine give IV abx prior to
Immunosuppressed patients or neonates
1582
Moderate sedation
Check verbal response each 5 minutes Need pulse ox and bp every 5 minutes Don’t need ecg unless cardiovascular risks Capnography is preferred
1583
Reynolds number for turbulent flow
Velocity x radius x density/ viscosity
1584
SEM =
SD/square of sample size
1585
Paired t test
Same subjects
1586
Selectivity bias
Who responds to survey
1587
P value
Probability of obtaining certain data set if the NULl hypothesis is true and correct Not alternative hypothesis
1588
Type 1
Accepting alternative when null is true Alpha value
1589
Power =
1-beta Ability of study to detect a true difference
1590
Incidence
Number of new events in period of time/number at risk
1591
Relative risk
Indidence In exposed/incidence in unexposed 1 = no difference
1592
Difficult mask ventilation
Age>65 Edebturloss Mallalptaei 3 4 Beard Obesity I’m
1593
Difficult airway
Mallampati 3-4 Thyromenral distance small Inter incisor distance < 3cm
1594
Supine position
Decreases FRC
1595
PaC02 drops in
Pregnant patient
1596
In pregnant
EF increases, CVP pcwp unchanged
1597
Need
Left uterine displacement in pregnancy
1598
Hypercoaguable In
Pregnancy More plasminogen leads to enhanced fibrinolysis Most coagulation factors go up including fibrinogen
1599
Pregnancy
WBC Count goes up mainly postpartum Risk of infection actually higher bc less ability of neutrophils to function
1600
Npo except
Clears during labor
1601
Creatinine clearance increases
Pregnancy
1602
Pregnancy decrease
MAC
1603
Psuedocholinesterase
Decrease in pregnancy More sensitive to roc and vecuronium
1604
Neuraxial
Further decreases in FRC
1605
UBF increase
100 to 700-900 ml min at term Uteroplacental low resistance circuit based on pressure and can auto regulate
1606
Fetal hemoglobin
Lower Pa02
1607
Insulin requirement
Decreases postpartum
1608
Depomedrol contains
Methylpresnisolone
1609
Cannabidiol for
Pediatric seizures
1610
Warm sensation from
C fibers
1611
Neostigmine causes
PONV
1612
PONV
0 risk just zofran 1 risk zofran dexamethasone 2 is zofran dexamethasone and prop infusion 3 or more get scopolamine patch as well ``` APFEL score Female History PONV No smoker Post op opioids ```
1613
Dexamethasone mainly
Glucocorticoid activity | Minimal mineralocorticoid
1614
Promethazine
Dopamine antagonist as is metochlopramide(increase LES fine and gut motility, don’t give to patient with bowel obstruction)
1615
Droperidol black box warning against
QT interval prolongation
1616
Aprepitabt
Nk1 antagonist Ephedrine is also an antiemetic
1617
BMI
Kg/meters squared
1618
PONV
Avoid hypervolemia
1619
Median nerve is
Above axillary artery
1620
Naloxone start with 0.04 and can give every
2 minutes
1621
Flumazinil start with
0.2mg
1622
What nerve mediates laryngospasm
Superior laryngeal
1623
Laryngospasm
Just thrustbhead lift | Oral/nasal airway succ more prop
1624
Failsafe prevents
Hypoxia mixture
1625
Stop nitrous if ppm<30
02
1626
Sodium binds
Alpha intracellular receptors
1627
Lower pKa of local anesthetic =
Unionized
1628
The ionized form! It changes once it goes in the membrane is what binds
Sodium channel
1629
In infected environment pH of environment is lowered so
More ionized and slower onset
1630
Lidocaine pKa
7.9
1631
Local anesthetic decrease MAC requirement by
40% Inhibit inflammation
1632
Max dose of bupi
2.5 mg/kg
1633
Local anesthetic systemic absorption
Iv>tracheal>intercostal etc
1634
Systemic absorption depends on the
Dose of local anesthetic It’s pharmacokinetic propertied Addition of vasoactive agent like epi
1635
Local anesthetics regularly cross
BBB
1636
Malignant hyperthermia
Autosomal dominant with variable penetrate and expression
1637
C02 production and metabolic acidosis =
Malignant hyperthermia
1638
Malignant hyperthermia not cause by
Nitrous Masseter muscle rigidity trismus due to increased calcium
1639
Increase o2 consumption with
Malignant hyperthermia See rhabdomyolysis Usually first sign is hypercarbia
1640
Immediate actions MH
Call for help my cart Stop anesthetics Call MH hotline Get ABG Ck coags Give 2.5 mg/kg dantrolene
1641
Dantrolene has
Mannitol in it
1642
MH leads to
Hyperkalemia due to acidosis Watch patient for 24 hours look for DIC ortenal failure
1643
Gold standard to rule out MH
Caffeine halothane contracture test
1644
Give abx within
60 minutes prior to surgical excision All the antibiotic should be in before tourniquet is inflated!
1645
Give cipro
Slowly over 60 minutes
1646
History of anaphylactic to penicillins is absolute contraindication to giving
Cephalosporins
1647
Anaphylactoid reaction Is
Dose dependent Anaphylactic reaction is not
1648
HOCM/MVP does need
Bacterial endocarditis prophylaxis
1649
Radial nerve below | Median nerve above!
Axillary artery
1650
Curare cleft
Muscle strength coming back
1651
Large molecules like albumin or prealbumin don’t get
Hemolysis
1652
St segment depression
Subendocardial ischemia
1653
Acute normovolemuc hemodilution
Compensate with higher cardiac output and lower PVR Blood viscosity goes down
1654
PSV only on
Spontaneously breathing pt
1655
Brachial artery cannulatoo big complication is
Thrombosis
1656
Lose first stage regulator could
Depleted oxygen tank
1657
Cardiac output is
Maintained with desflurane usage
1658
Mivacurium broken down by
Psuedocholinesterase
1659
Psuedocholinesterase levels are lower in
Burn patients
1660
Metochlopramide contraindicated in patients with
Bowel obstruction
1661
Antibodies formed against donor
Leukocytes after massive transfusion Cause febrile reaction To Hla leukocytes
1662
Palatoglossal fold
Glossopharyngeal nerve
1663
Fully compensated means the pH is in
Normal range
1664
A delta most sensitive to local
Anesthetics C fibers least sensitive
1665
Atropine works best with
Edrophonium
1666
Insulin causes
Active transport of glucose and potassium into the cell
1667
Citrate intoxication leads to
Hypomagnesium
1668
Separation anxiety starts at
6 months
1669
Worsening hypoxemia whole standing with
Hepatopulmknary syndrome PVR is lower in this syndrome Standing up blood goes lower into areas of no ventilation
1670
mean PAP above 50 is
Absolute contraindication to liver transplant
1671
Sodium potassium pumps require
ATP so fucked up during ischemia
1672
Zofran main side effect
Headache
1673
Preeclampsia
Intravascular volume depletion High SVR Decreased uterine or placental blood flow
1674
Greater Cornu of hyoid bone gets
Internal branch of superior laryngeal
1675
Don’t give hydrocortisone if septic shock is responsive to fluid or
Vasopressors
1676
Prerenal oliguria
Urine to plasma osmolar ratio >1.5
1677
Non shivering thermogenesis trigger in infants
Norepinephrine thyroxine
1678
PDPH gold standard
EEG
1679
MAOi use
Increase MAC
1680
Carboprost
Uterine contraction not relaxation Don’t use it pulmknary HTN or reactive airway disease
1681
Logistic regression analysis use
Adjusted odds ratio
1682
Cohort use
Relative risk
1683
Warfarin
Teratogenic Use heparin first to get inr within range bc it is usually thrombotic
1684
HBOxygen for
Air embolism CO poisoning Chronic ischemic ulcers
1685
Excessive growth hormone patients have
Normal lung volumes IGF1 looks for acromegaly
1686
Most cardiac myxomas are found in
Left atrium
1687
Infant blood volume
70-80 ml/kg
1688
Closing of mitral valve occurs at
R wave of QRS
1689
Ectothiphate blocks
Psuedocholinesterase
1690
Posteromedial papillary muscle is supplied by the
RCA
1691
Polyhydraminos risk factor for
Placenta accreta
1692
Discoverable info includes
Conversations with friends, charting about patient, emails
1693
L5 =
Big toe
1694
Lambert Eaton
More sensitive to NMDB and succ
1695
Lambert Eaton
More sensitive to NMDB and succ
1696
MS exacerbation likely
Post partum Most common is relapsing remitting Beta interferon treatment
1697
Mid humerus
Radial nerve damage
1698
Extension of elbow
Median nerve injury
1699
Synchronize shocks in ecg during shock wave lithotripsy to
R waves
1700
Vasospasm most likely at
2-14 days
1701
MCA and ICA tested in
Transcranial doppler
1702
<1mm of blood in
Hunt Hess for SAH
1703
Hematoma absorption or lots of blood given
Increase bilirubin Not hepatic enzymes
1704
Coracobrachialis
Musculocutaneois nerve
1705
Increase FRC
Increased age increase height
1706
Pangos=
Low FRC
1707
Coma A scene of brain stem reflexes Apnea in
Brain death
1708
Don’t give what med intramuscular
Norepinephrine Can lead to tissue necrosis
1709
Normal dibucaine number =
80
1710
Phenotoyin increases
Neuromuscular blockade
1711
OSA hypoxemia can lead to
Polycythemia Preop anemia is independent risk factor for morbidity/mortality
1712
Septic shock
Decrease end tidal c02 | Cortisol release leads to hyperglycemia
1713
Uterine relaxation doesn’t happen with
Neuraxial blockade
1714
Uterine rupture
Fetal bradycardia
1715
AST is not a good indicator of just
Liver disease
1716
Diaphragm moves more
Cephalad in pregnant patient leading to reduced FRC
1717
Down syndrome
Cervical instability | 45% have CV deficits-endocardial cushion deficits most common
1718
PVR is highest at
Extremes of lung volumes
1719
Familial hypocalcemic hypocalciuria
Autosomal dominant
1720
PDPH is
Positional
1721
Fever nuchal rigidity altered mental status
Meningitis
1722
Ace inhibitor use
Maternal oligohydraminos
1723
Acidosis
Decrease SVR increase PVR
1724
Botulism moa
Inhibition of intracellular fusion Ach containing vesicles
1725
Fena
Plasma creatinine x urine sodium/urine creatinine x plasma sodium
1726
Continue dantrolene for
24 hour after acute mh resolved Initial dose 2.5 mg/kg
1727
Paresthesia/cant void think
Cauda equina
1728
More renin
Cirrhotic pts
1729
Spread of local anesthetic in epidural space mainly effected by
Volume of anesthetic
1730
DLCO is higher in
Asthma exercise left to right shunt(more blood to lungs)
1731
Chi square
Acts on one discrete variable T test is one continuous variable like BP
1732
Central diabetes insipidus start with
Free water
1733
Periop hyperglycemia associated with
Sympathy adrenergic activity and not bradycardia
1734
Hyperglycemia
``` More immunosuppressive Infections Sympatho adrenergic activity Increase catabolism Delayed gastric emptying ```
1735
Need endocarditis prophylaxis
Hearty transplant with cardiac valvular disease
1736
Only beta blocker metabolized by kidneys
Atenolol
1737
Peritoneal dialysis has less hemodynamic changes than
Hemodialysis
1738
Duration of action of nmdb and onset is delayed in
Elderly
1739
Want a leak of
20-30 cm
1740
4-6 hrs before epidural with
Subq heparin
1741
Desflurane
Prolongs neuromuscular blockade the most
1742
If patients intrinsic hr higher than pacemaker on asynchronous can lead to
R on T
1743
Inferior wall on transgastric short acix on top
Anterior wall on bottom
1744
NMDA receptor
Increases serum calcium
1745
Organophosphate poisoning
Atropine | Pralidoxime
1746
Dobutamine best for cardiogenic shock if BP good
Increase CI / decrease afterload
1747
CBF changes with
C02
1748
Separation anxiety starts at
6-8 mo in age
1749
Don’t give potassium or dextrose in infant solutions
Until initial bolus given
1750
Glucagon released from
Alpha cells and increases hepatic artery blood flow
1751
Trigeminal neuralgia
Anesthesia dolorosa
1752
Hypalgisua
Decreased response to noxious stimulus
1753
Neostigmine for reversal than giving succ
Increases phase 1 block
1754
If pacemaker dependent convert to
Asynchronous
1755
Unripe and false labor
Delay in latent stage of labor
1756
Increase CBF only after
1.5 MAC
1757
Etc02 doesn’t change with
Tourniquet release
1758
Metochlopramide inhibits
Plasma cholinesterase
1759
Hepatic steatosis common with
TPN
1760
Type 1 hepatirebal syndrome
Acute onset | Type 2 is gradual
1761
Aminoester allergy think
PABA Aminoamide think methylparaben
1762
Bronchospasm | Kinked tube think
High peak pressure
1763
Abdominal insufflation and obesity
Increased plateau and peak
1764
A alpha divers
Propioception
1765
Decreased SID =
Decreased pH
1766
Norepinephrine broken down in
Lungs
1767
Milrinone
Pde3 inhibitor
1768
Higher length of tubing
Underdampening
1769
Beta blocker affects the numbers on the
BIS
1770
Transducer on us
Goes through bone the most
1771
Increase in temp to platelets due to
Cytokines
1772
Inhalational anesthetics act at
Amphilic cavities of proteins
1773
Quinolone sulfa can lead to
G6PD hemolysis
1774
Non shivering thermogenesis in adults
Skeletal muscle Infants at brown fat
1775
Boiling point of desflurane
Lower than Sevoflurane so needs a heated vaporizer to keep at constant temp so stays as liquid so you have predictable concentration
1776
Precedex and opioids lower
BIS
1777
Give first blood taken
Last Has the most RBCs
1778
Moonlight clinical activity at home patient educational activity
Counts as part of 80 hr workweek
1779
Catecholamines are higher at rest and during stress in
Elderly This is why they can’t mount a good response
1780
Hypoplastic left heart
ASDs associated | Left ventricle is nonfunctional
1781
Muscarinic activation
Decreased cAMP which opposes sympathetic activation
1782
Ketamine
NMDA receptor antagonist Also increases myocardial oxygen demand therefore not indicated with ischemic heart disease
1783
Botulism treat with
Antitoxin
1784
Airway reflexes and respiratory drive is preserved with
Ketamine
1785
St. John’s wart promotes
Cytyrome p450 Stop 5 days before surgery and don’t continue it
1786
Autonomic hyperreflexis
Vasoconstriction below | Vasodilation above lesion and flushing
1787
Lidocaine reduces duration of seizures so don’t use during
ECT
1788
Hypothermia increasss
Alveolar partial pressure | Decrease arterial partial pressure
1789
As you age decrease
Arterial and venous vasculature compliance
1790
Palatoglosal fold
Glossopharyngeal nerve
1791
CPAP reduces
Surfactant depletion | Respiratory rate is typically decreased
1792
Oropharynx
Soft palate to epiglottis
1793
Nasopharynx
Base of skull to soft palate
1794
Opioids are best dosed by
Lean body weight
1795
Febrile rxn due to
HLA antibodies
1796
Resting tachycardia seen with
Diabetic autonomic neuropathy Don’t see sweating
1797
Kleppil feil
Cervical spine fusion
1798
Large blood volumes containing sodium citrate lead to
Metabolic alkalosis
1799
Cystic fibrosis
Autosomal recessive Mutation on chromosome 7 defective chloride channel in epithelium Greater bronchial reactivity Keep Fi02 up want to avoid pulmonary vasoconstriction and HTN Pancreatic insufficiency
1800
Buprenorphine for opioid
Withdrawal
1801
LV mainly perfused during
Diastole
1802
Anterior spinal artery
75% of spinal blood supply
1803
Pulmonary surfactant increases when
Alveoli shrink
1804
Donepizol increaeed
Succ
1805
TPN associated with
Thrombophlebitis and infection
1806
When placed under pressure nitrous oxidebis in
Liquid form
1807
Ulnar nerve for adduction of
Thumb
1808
Catecholamines are higher at rest and during stress in
Elderly This is why they can’t mount a good response
1809
White rain communicates
Preganglionic neuron
1810
Parasympathetic CN 3
Ciliary ganglion
1811
Halothane
Most likely to cause arrhythmia Slows conduction through SA node leading to bradycardia Decreases MAP and CO Unchanged HR due to blunting of baroceptor reflex
1812
Isoflurane maintains cardiac output due to
Preserved carotid baroceotor reflex which responds to decreased SVR with increase in HR to maintain cardiac output
1813
Compound A accumulation associated with
Long duration anesthetic, low fresh gas flow, higher inhaled concentration Sevoflurane and absorbent dessication
1814
Desflurane
Increased CBF DECREASED CMR02 decrease MAP and SVR increase HR maintain CO Increased RR Decreased TV
1815
Speed of induction based on
Rate of rise of Fa/Fi Desflurane has lowest blood gas partition coefficient and is the least soluble and will result in quickest induction
1816
Nitrous oxide should be discontinued how many minutes prior to the placement of gas bubble in the eye
15 minutes
1817
Wait ten days to use nitrous oxide after
Bubble formed from SF6 For air causing intraocular bubble can wait 5 days
1818
SSEPS act on peripheral nerves
Increase in latency and decrease in amplitude of the response
1819
SSEP most common nerves
Posterior tibial, median, ulnar nerve Increase in latency OR decrease in amplitude from BASELINE indicate neurologic decline
1820
Gas exchange worsens with higher anesthetic concentrations and PaC02 rises
Dead space ventilation increases compared to alveolar ventilation due to decrease in tidal volume Gas blunts hypoxic/hypercarbic respiratory drive
1821
Desflurane vapor pressure of 660 very close to atmospheric pressure of 760 so minimal changes
Can have large effect on vaporizer output Desflurane is close to boiling even at room temp
1822
Higher altitudes Partial pressure of inhaled agent will be decreased
Desflurane vaporizer dial must be set HIGHER at higher elevation to ensure same anesthetic effect due to decrease in partial pressure Partial pressure is what’s important not the concentration
1823
Nitrous oxide 34 times more soluble than
Nitrogen in blood
1824
Contraindications to nitrous oxide use
``` Venous air embolus Pneumothorax Pneumocepahlus COPD with blebs Acute intestinal obstruction Tympanic membrane grafting ```
1825
MAC to describe
Potency or volatile anesthetics Alveolar concentration that will stop movement in 50% of patients response to standard surgical stimulation MAC decreases 6% per decade
1826
Things not affecting MAC
Thyroid state Gender Duration of anesthetic PH alterations
1827
Emergence coincides with
Decreasing inhalation anesthetic BRAIN CONCENTRATION Emergence is faster than induction Continues to be absorbed by adipose tissue during emergence
1828
Which is not part of the vital organs that gets 75% of cardiac output
Lungs
1829
Vessel rich organs get
75% of cardiac output | Small volume, moderate solubility, rapid saturation
1830
Slowest metabolism is seen with
Desflurane
1831
Enflurane can produce
Fluoride ions which can lead to high output renal failure
1832
Nitrous oxide cylinder will stay at constant pressure 750 psi until about
400 liters is left in the cylinder
1833
Nitrous oxide
Macrocytic anemia
1834
Hepatic necrosis seen with
Halothane
1835
CMR02 increases with
Nitrous oxide administration
1836
0.5 MAC of volatile anesthetic
For maternal amnesia | Fetal presentation of anesthetic overdose includes cardiopulmonary depression and hypotonia
1837
Neuraxial opioids act on
Mu receptors substantiatia gelatinosa
1838
Less soluble opioids remain in CSF
Transfer to more cephalad locations
1839
Binding of alpha 2 delta subunit calcium
Mechanism of gabapentin
1840
Uremia lower dose of
Midazolam
1841
Esmolol broken down by
Red blood cell esterases
1842
Desmopressin
Improves perioperative platelet dysfunction in uremic patients
1843
Propofol causes dose dependent decrease in amplitude of
SSEPs and increases SSEP latency
1844
Synthesis and release of angiotensinogen
Liver
1845
Most resistant evoked potential
BAEP
1846
Most sensitive to volatile anesthetics
VEPs
1847
Atrial fibrillation can see loss of
A wave
1848
Pneumothorax
No lung sliding and no B lines
1849
Most selective for alpha 2 receptors
Precedex is much more selective than Clonidine
1850
Alpha 2
Found presynaptic ally and inhibit norepinephrine release
1851
Dobutamine acts on Beta 1 more than
Beta 2
1852
Terbutaline
Beta 2 selective
1853
Nicardipine causes
Direct cerebral vasodilation
1854
MAP 60 to 160
Cerebral auto regulation
1855
Muscarinic receptor activation leads to
Diaphoresis | Bradycardia bronchospasm
1856
Muscarinic receptors round mainly at
Parasympathetic postganionic innervating target organs
1857
Preganglionic neurons of sympathetic nervous system
Ach
1858
Eccrine sweat glands
AcH
1859
Pulse pressure equal to SBP-DBP
As bp cuff moves more distally sbp increases and dbp thus decreases
1860
MAP
Cuff pressure at which the amplitude or the magnitude of the oscillations is greatest
1861
Lumbar nerve roots exit
Same pedicle
1862
Clevidipine broken down by
Plasma esterases
1863
Most common complication of retrobulbar block
Retrobulbar hemorrhage
1864
Phospholipoprotein surfactant
Type 2 alveolar cells
1865
Muscle weakness with high doses of magnesium
Blockade of calcium channels
1866
Sudden polymorphic V tach in patient undergoing asynchronous ventricular pacing think
R on T phenomenon
1867
Postop elevated liver enzymes due to
Surgical procedure
1868
ACTH stimulates release of steroid hormones from adrenal
Cortex
1869
Secondary adrenal insufficiency
Decreased ACTH production in the anterior pituitary
1870
Intrascalene nerve block for shoulder injection of local anesthetic in what vessel leads to seizure
Vertebral artery
1871
CYP2D6
Coedine
1872
Fixed airway obstruction
Tracheal stenosis
1873
Treat high spinal quickly with
Epinephrine
1874
Decreased filling pressure leads to bradycardia
Bezold Jarisxh reflex
1875
Neonates are less sensitive to codeine compared to school age children due to less
CYP2D6 activity
1876
Tonsillectomy and adenoidectomy don’t use
Coeidine
1877
Epinephrine
Increase in plasma free fatty acid levels
1878
Beta 1 leads to
Lipolysis Beta 2 increases glycogenolysis
1879
First line for status epilepticus
Benzodiazepines
1880
Cornual placenta
Predisposes to breech fetal presentation | So does macrosomia, multiparty, multiple gestations
1881
Diltiazem
Acts on both smooth muscle and cardiac muscle Vasodilator and cardiac depressant
1882
Hydrogen ion concentration no affect
On cerebral blood flow
1883
Fluoxetine prolongs effect of
Midazolam
1884
Phase 1 rxn
Oxidation reduction hydrolysis
1885
LIM
Monitors integrity of ungrounded power source Alarms when leakage current greater than 5 mAMps A first fault is not a shock hazard, a second fault is a hazard to operating room personnel
1886
Etomidate
Increases amplitude of SSEPs Decrease cerebral blood flow
1887
SNS from
T1-L2
1888
Water moves
Freely across BBB
1889
For new a fib without hemodynamic instability
Beta blocker or calcium channel blocker Don’t give beta blocker if COPD or diabetes
1890
Best for platelet dysfunction
Optical aggregometry
1891
Mixed venous from
Proximal pulmonary artery
1892
Chest wall rigidity due to
Opioids
1893
Succ can increase
Tracheal tone
1894
Most likely to cause fire
Polyvinyl chloride
1895
Bupivicaine intravascular
Increase in PR interval QRS duration increase T wave amplitude goes up
1896
Caudal block
Surgery below umbilicus
1897
Hypocarbia from hyperventilation during
Venipuncture
1898
Motor innervation from tounge is entirely from
Hypoglossal nerve
1899
Blockade of T type channels is MOA of
Ethosuximide
1900
Isoflurane has higher vapor pressure than Sevoflurane thus can cause
Anesthetic overdose
1901
Most common slice of vaporizer leak
Loose filler cap
1902
If vaporizer tips go at high flow 20 minutes with vaporizer dial set at high
Concentration
1903
LV diastolic dysfunction goes with LV
Hypertrophy
1904
ACC/AHA guidelines
Good cardiac guidelines
1905
RCRI risk
Type of surgery | Creatinine etc
1906
Life threatening surgery
You just do it
1907
Don’t do stress echo
If st elevations Call cardiology and do a cath You don’t want to stress patient with echo
1908
Age does not affect
ECG getting it
1909
In Stent
Thrombosis 6 months for DES
1910
Know
Lbbb vs rbbb
1911
Only do beta blocker if patient already on it in
OR don’t just give can lead to stroke
1912
Troponin can last
7 days
1913
Cirrhosis doesn’t affect
Troponins
1914
First line is benzos for
Cocaine Not calcium channel blocker bc doesn’t get to coronaries
1915
ANP released in
A fib - atrial dilation
1916
Septal
V1, V2
1917
Lateral
1, aVl
1918
Least pruritis
Meperidine is the least
1919
Oculocardiac Bainbridgre Gag reflex
Affyerent ovculocardiac goes through gasserian ganglion- efferent through vagus
1920
Ca absorption the most
Thiazides
1921
Loop diuretics
Hyponatremia
1922
Cyanide CO toxicity treated with
Hyperbaric oxygen
1923
Benzocaine prilocaine
Methemoglobinrkia
1924
Minimum effect on PVR
Vasopressin
1925
What causes release of intrinsic vasopressin
Hypertonicity!
1926
Vasopressin goes down with
Chronic septic shock
1927
Racemic epi
To treat strider
1928
Near drowning pathophysiology
Shunt First get reflex laryngospasm
1929
CSF pH regulation
By C02
1930
Know respiratory changes in pregnancy
Pregnancy
1931
Know fetal heart tracing
In pregnant
1932
Desflurane
At high altitude
1933
Descending bellow
Tells you if circuit disconnect
1934
Hyperparathyroidism
Increased dose due to Ach
1935
MSK
Innervayre which part of arm
1936
Big toe
L1
1937
Big toe
Tibial nerve
1938
Back of knee
Sciatic
1939
Saohenous blocked in
Adductor canal block
1940
Know visual anatomy
Of airway
1941
First sign of liver failure
Factor 7
1942
Oxygen determines
Hepatic artery flow
1943
Shortest ischemia time
Heart/lungs
1944
Know what drugs work
Post transplant
1945
Post heart transplant patient can
Have two P waves and be normal
1946
Know vascular of
Spinal cord
1947
Know ECT
What drugs prolong
1948
Know latex allergy
Foods
1949
4-5
ECHO questions
1950
2.5 mg/kg
Ryanoidine
1951
Know AIONvs PION
AION usually with cardiac | Pion with spine
1952
Can still use succ if full stomach with retinal detachment
Increased eye preesure better than getting aspiration
1953
Lung physiology
Based on groups
1954
Know when PCA is
Contraindicated and conversions of opioids
1955
CVL biggest risk of
Infection
1956
Pediatric vs adult
PONV
1957
Duchennes vs
Myotonic dystrophy
1958
Difference
Hypo/hyperkalemia
1959
OR positioning
Affect
1960
Third highest opioid abuse in
Physician
1961
PDA
Pulmonary edema, hemorrhage, Ductos arterisos stays open causing left to right shunt IVH/left heart volume afterload
1962
PDA targets prostaglabdin
Synthetase Use ibuprofen or indimethacin affects COX
1963
Transcatheter
PDA closure Stops flow across PDA Thoractomy longer hospital stay vs transcatheter Higher opioid use increased opioid need
1964
Venous air embolus
Increase PA RV pressure | VQ mismatch
1965
Y tubing for blood with extension
80 ml
1966
Learn to prime
Hot line tubing
1967
Higher concentration of nitrous oxide needed for anesthesia contributes to
Diffusion hypoxia
1968
Desflurane more potent than nitrous so use
Lower concentration
1969
TRALI causes increase In
Plateau pressure
1970
Bronchospasm from acute asthma exacerbation
Increases Peak pressure but not plateau
1971
Esophageal monometry
Measures transpleural pressure
1972
PAOP =
LAP
1973
Expiratory phase of ventilation
Ventral respirartory group in medulla
1974
Absolute contraindication to BIPAP
GCS<8
1975
Bipap adds pressure support to
CPAP
1976
BPAP contraindication
``` Cardiac or Respiratory arrest Severe agitation Hemodynamic instability Facial trauma Can’t protect airway Lots of secretions vomiting or gi bleed ```
1977
Mastectomy with pacemaker
Best is to reprogram into asynchronous mode prior
1978
Magnet can also program pacemaker to
Asynchronous mode
1979
Transtentorial or uncal herniation
Ipsilateral hemoparesis | Oculomoter nerve palsy
1980
Subfalcine herniation
Midline shift
1981
Addition if humidifier can significantly increase
Dead space in Peds patients
1982
Overdistenson of lungs in zone 1 leads to
High Vd/Vt
1983
Apparatus like a humidifier added to patient side on the y piece
Can add to dead space
1984
Neostigmine crosses
Placenta Can cause fetal bradycardia
1985
During hemorrhagic shock first line
Volume before pressors if not increased mortality Hgb often normal even with acute blood loss
1986
Class 4 blood loss
More than 40%
1987
Ketamine
Can use even in unstable patients with worry of intracranial pressure increase
1988
Sternamental distance less than 12.5 cm
= difficult intubation Interincisor less than 3 cm predicative or difficult intubation
1989
Skin surface warming helps prevent redistribution of heat
Increase body heat content
1990
Heat redistributed
From core to periphery
1991
Delta oscillations are those with lower frequency than
Theta
1992
Beta wave
Awake
1993
Corneal reflex
Affereht trigeminal | Efferent facial nerve
1994
What reflex stays intact in patients under general anesthesia
Pupillary response to light
1995
Awake pattern of low amplitude beta gamma oscillations to high amplitude slow delta with high levels of
Propofol
1996
Active humidifiers are much more effective at humidification of gases than
Passive devices Active includes vaporizers/nebulizers
1997
Burns tend to increase
Insulin resistance Give mainly crystalloid no albumin bc oncoticbpressure already high from protein peaking into instertitial space Never bolus fluid in burn patients give hourly
1998
Microelectrode recording with deep brain stimulator can get broken by using
Midazolam
1999
Gray Rami carry postganglionic sympathetic divers from sympathetic ganglia to
Spinal nerves
2000
Only sympathetic nervous system contains
Gray rami
2001
Gray rami contain
Unmyelinated postganglionic axons
2002
Ketamine acts indirectly on
RAS Most drugs affect RAS directly
2003
Pacemaker/ICD is a contraindication to an
MRI
2004
Rivoroxaban/Apixaban
Andexant
2005
Awake fiber optic good jd
Clinically stable patient with multiple risk factors for difficult intubation and mask ventilation
2006
Physicians have highest suicide rate of
Any profession
2007
Acute hemodilution of patients blood from large volume of crystalloid solution
Hypotension following initiation of CPB
2008
Most T3 is formed by
Partial drip donation of T4
2009
Air bubble in sample syringe
Leads to increased Pa02
2010
Delaying abg sample analysis lowers Pa02 due to
Ongoing metabolism of red and white blood cells
2011
Mitochondrial myopathy
Variable penetrance Keep normpthermic Don’t give propofol infusion as high risk for Propofol infusion syndrome
2012
Absence of electrical activity greater than 2 uV/mm indicates
Electrocerebral silence
2013
EEG monitoring not part of standard criteria for diagnosing
Brain death
2014
Fetal bradycardia can happen from
Aortocaval positioning and putting patient in supine position
2015
Technique to most reduce heat loss during phase 1 of hypothermia
Forced air warning blanket
2016
Desflurane forms the most
Carbon monoxide
2017
Baralyme increases compound A more than
Soda lime
2018
Doppler us
Echocardiography to determine both direction and speed of blood flow
2019
Blood towards transducer higher frequency than
Transmitted signal
2020
With imperfect alignment of US
Underestimate velocity or flow
2021
Muscular dystrophy avoid which drugs
Succinylcholine | Volatile anesthetics
2022
Muscular dystrophy
Need EKG and ECHO prior due to risk of cardiovascular issues
2023
Hypermagnesium causes muscle weakness which can lead to
Blurred vision
2024
Treat hypermagnesium with
Iv calcium
2025
The higher the pH of the solution the more a weak base will stay in
Unionized form
2026
Acids are
Weak bases Lower pKa means weak base will be neutralized leading to unionized
2027
Dexamethasone anti emetic effect is at
Nucleus tractus solitarii
2028
Airway fire risk much higher in
MAC vs GA
2029
Cardiovascular function is usually maintained even with deep
Sedation
2030
Neonates should be monitored overnight until 60 wks postconceptual age to
Avoid episodes of apnea/bradycardia
2031
LFCN landmark is the
ASIS
2032
LFCN branches from
L2-L3 nerve roots Block by going medial and inferior to ASIS
2033
PVR is minimal at
FRC
2034
TCA toxicity treatment
Sodium bicarbonate
2035
Amiodarone
Blocks potassium channels Can’t give if heart block or preexisting bradycardia Can cause blue grey discoloration Hypotension Prolong Qt Pulmonary toxicity
2036
Perform surgery if 6 months free of apnea or bradycardia in
Neonate
2037
After pneumonectomy Maximum voluntary ventilation greater than 50% of predicted value associated with good prognosis post
Pneumectomy
2038
Increase periop mortality if spiromatory values
``` FVC<50% FEV1<2 L FEV1/FVC ratio less than 50% MVV<50% DLCO<50% PaC02>45 Pa02<50 ```
2039
Expiratory obstruction
Unilateral vocal cord obstruction
2040
Renal medulla
High oxygen extraction ratio Renal cortex gets most the blood flow
2041
Vascular rings are associated with
Right sided aortic arches Vascular rings due to embryonic structures not regressing
2042
Mirror branching
Right side aortic arch giving rise to left braciocephalic ehh gives rise to left subclavian and carotid artery
2043
Giving too much neostigmine leads to
Prolonged weakness
2044
Acetylcholinesterase inhibitors like neostigmine also inhibit plasma butyrylcholinesterase
Prolongs effect of succ
2045
Fibrinogen
Doubles in pregnancy Protein S levels go down Resistance to protein C
2046
Hexamethonium
Neuronal type nicotinic antagonist
2047
Hypoventilation
A-a gradient normal but hypoxemic
2048
Metochlopramide
Increases LES tone
2049
Hyperkalemic periodic paralysis
Give dextrose
2050
Bronchiectasis
Obstructive pulmonary disease
2051
Patients don’t need to void in order to meet criteria for
Discharge
2052
Urine alkalinization does not help
Renal function
2053
Chronic dantrolene get
Liver function tests
2054
Both types 1 and 2 of diabetes are
Increasing in children
2055
Treacher Collins
Approximately 50% of children have hearing loss These patients can get ketamine
2056
Isoflurane much cheaper than
Sevoflurane/desflurane
2057
Alfentabyl fast acting opioid due to
High unionized fraction from low pKa
2058
Don’t use which medication during ECT
Midazolam Decreases seizure threshold
2059
Incompetent inspiratiry valve fix with
Higher fresh gas flow
2060
MH
Autosomal dominant with variable penetrance Mainly RYR and calcium channel defect Gold standard is halothane contracture test
2061
Amilioride associated with
Hyperkalemia
2062
With sepsis maintain MAP of
65
2063
Concentration calibrated variable bypass vaporizer to get right percentage
Adjust splitting ratio
2064
Paralyzed extremity train of four is
Exaggerated
2065
Children with strabismus four times more likely to demonstrate massater muscle rigidity after getting succ
Than normal population
2066
Rebreath more gas if fresh gas flow goes
Down
2067
Thoracic aortic aneurysm stent
Helped by transient cardiac asystole Avoid shear force by doing it
2068
Adenosine can cause
Bronchoconstriction
2069
Acute normovolemic hemodilution can be used on Jehovah’s Witness but can’t do if
Preoperative anemia
2070
Clopidogrel
Stop seven days before spinal anesthetic
2071
Phenelzine and meperidine can cause
Serotonin syndrome Don’t give both together
2072
Febrile reactions to platelets due to
Pyrogenic cytokines and intracellular contents released by donor leukocytes
2073
Jet ventilation
Psi 15-35 Allow time for passive expiration Seldinger technique requires large bore 16 g or bigger
2074
Sign of difficult intubation
Can’t protrude lower jaw beyond the upper teeth
2075
Elevated ICP is a contraindication to
Controlled hypotension.
2076
Normal LY30 on TEG is
6%
2077
Prolonged exposure to corticosteroids can result in
Myopathy and lead to muscle weakness
2078
Angioedema due to
High bradykinin
2079
Head down associated with
Increase in cardiac index
2080
FRC =
ERV +. RV
2081
Thermodilution graph
Temperature change y axis | Time on x axis
2082
Most claims in Asa closed claims project for death or brain damage
Non respiratory events
2083
Lateral cricoarytenoid
Adduction
2084
Thyroid cardiledge forms atoms apple and is inferior to
Hyoid bone
2085
Median nerve does
Lateral palm of hand and motor to wrist flexors Can block medial to brachial artery in AC fossa
2086
Most common adrenal insufficiency in icu
Functional adrenal insufficiency did
2087
Cardiogenic shock similar to
Obstructive shock in numbers Need to look at cause
2088
Emergence delirium usually lasts
10 to 30 minutes More likely with less soluble anesthetics
2089
If patient is taking preop steroids
Continue those steroids in the perioperative period
2090
Dexamethasone
Most potent glucocorticoid | No mineralocorticoid
2091
Endocarditis prophylaxis not needed for cardiac transplant unless
Valvulopathy present
2092
SSEPs are good for checking nerve injury in
Spinal cord cases
2093
Closing capacity increases as you age
Exceeds FRC RV goes up as does FRC IC goes down
2094
Epidural 2 chloroprocaine has an onset of approximately
6-12 minutes
2095
Transpulmonary pressures are highest in patients with
Restrictive lung disease such as idiopathic pulmonary fibrosis
2096
CI less than 2.2 is
Bad
2097
Synthesis of catecholamines starts with
Tyrosine
2098
Must stop plavix for
7 days prior to neuraxial Scoliosis is not a contraindication to neuraxial
2099
Single most important risk factor for POCD is
Increasing age
2100
Tumescent lidocaine
No more than 5 liters | Using GA can increase complication rate
2101
Moving vaporizer to higher altitude will increase
Output
2102
Midazolam to pregnant patient leads to
Fetal hypotonia or floppy baby
2103
Ketamine does not affect
APGAR score
2104
CSF is pulsatile and produce
500 ml per day
2105
CSF
500 ml made per day It is pulsatile Made by choroid plexus and lateral ventricles
2106
As flow through Rotameter increases
Cross sectional area increases
2107
Hyperbaric local anesthetics movement mainly based on
Baricity
2108
Advanced age
Less CSF volume
2109
Block onset time not affected by addition of
Epinephrine
2110
Local anesthetic
Higher concentration lipid solubility faster Lower pKa faster Higher environment pH faster
2111
Graft vs host disease higher if
Direct blood relative is used for blood donation Irradiation helps by eliminating donor lymphocytes
2112
TCD us monitiring
Measures blood flow velocity in major arteries usually the MCA And atherosclerosis plaques in same vessel
2113
Most sensitive to volatile anesthetics
Visual evoked potentials BAEPS MOST RESISTANT
2114
Hypermagnesium
Treatment includes calcium, dialysis, furosemide
2115
Lack of randomized control trials for treating
Phantom limb pain
2116
ASA 4
Severe systemic disease that is a constant threat to life such as chest pain at rest
2117
Necrotic small bowel
ASA 5 cant live without procedure
2118
Continue enteral feeds in
Intubated pts going into surgery
2119
In mass casualty must identify
Severity of injuries
2120
Albumin worsens outcomes after
SAH
2121
Caution giving vasopressin to patients with
CAD as can lead to ischemia
2122
Muscular stimulation leads to
Bronchial constriction
2123
Open waste scavenging system has no
Positive or negative relief valves Vacuum must exceed waste gas flow
2124
Most ppl believe hemoglobin A1c should be below
8% before elective surgery
2125
2/3 of subq insulin the night before
One half the day of surgery
2126
C8 nerve root between
C7 and T1 vertebrae
2127
C1 lacks a vertebral body
And spinous process
2128
Nerve regeneration after cryoanalgesia occurs after
1-3 months
2129
Low max amplitude on TEG what should you give
Platelets
2130
In deep sedation
Intervention may be required of the airway Usually cardiovascular function is maintained
2131
Premature closure if cranial sutures is seen in
Crouzon syndrome
2132
IABP decreases
Afterload
2133
Stop diuretics in
Preop period such as furosemide
2134
Terbutaline leads to
Hypokalemia More selective for beta 2
2135
Beta 2 stimulation leads to
Hyperglycemia
2136
If sartorius contracts during femoral nerve block
Advance and direct needle laterally
2137
Femoral nerve
L2-L4
2138
Absolute indicators for one lung ventilation
Protective isolation VATS Unilateral lung lavage Bronchopleural fistula
2139
APL valve should be closed for
Circuit leak test
2140
Open APL valve is at
0
2141
In the setting of poor oxygen extraction such as methemoglobinemia mixed oxygen
Normal or elevated
2142
RCA does
Inferior wall of LV
2143
Surgery during pregnancy higher risk of
``` Miscarriage Abortion Low birth weight Pre-term labor Aspiration ```
2144
If patient is stable after aspiration next step is to
Suction endotracheal tube
2145
Don’t give abx if
Aspiration Suction Immediate intubation Then after suctioning can do PPV
2146
Cooling cables increases the risk of
Thermal injury
2147
In mri
Place pulse ox is furthest as possible from patient and cables right down the center of patient
2148
Bigger paddle size for doing defibrillation is
Better Electrode size 8-12 cm is good Biphasic defibrillator is better Ok to apply force Ok to put gel on pads
2149
Anemia first step
Obtain peripheral smear and reticulocyte count
2150
After aortic cross clamp
CVP increases due to increased catecholamines Increased vasoconstriction distal to clamp drives CVP higher Decrease oxygen extraction due to less blood to distal regions Increases in arterial pressure above clamp Decreased CO is seen
2151
Ischemic optic neuropathy
PAINLESS SUDDEN VISION LOSS
2152
Type 1=
Alpha error
2153
Reducing population variability(SD)
Increase statistical power
2154
Child Pugh score does not include
Creatinine
2155
Electromechanical pressure transducer
Invasive arterial pressure monitoring
2156
Haldane effect
Increased ability for hemoglobin to carry carbon dioxide from tissues to the lungs for exhalation
2157
Blood reflects
The least
2158
Intrathoracic airway obstruction
Mediastinal Mass
2159
Plateau wave =
Sharp increase in intracranial pressure
2160
Modern endotracheal tubes
High volume low pressure cuff | PVC made
2161
Ach synthesized in presynaptic terminal
Via choline acetyltransferase in the cytoplasm No reuptake of Ach
2162
Atelectasis associated with increased
A-a gradient
2163
Normal Aa gradient in
Hypoventilation
2164
Pediatric endotracheal tube size
Age/4 + 4
2165
LMWH more selectively inhibits
Factor X when compared to unfractionated heparin
2166
Epidural anesthesia leads to
Increased peristalsis
2167
Neuraxial nausea treat with
Atropine
2168
TR affects thermodilution measurement of cardiac output
All cardiac output goes through pulmonary artery
2169
Mannitol
Increases intravascular volume and may have deleterious effect on patients with CHF
2170
Oligohydraminos not associated with
Placental abruption
2171
Lowering humidity lowers risk of
Static discharge
2172
PEEP decreases atelectasis and increases
FRC
2173
Alanine is part of
Glucose synthesis pathway
2174
Glycogen storage occurs in
Fed state Glycogenolysis and gluconeogenesus during stress
2175
Claims made policy is malpractice that works for
That year
2176
Intrascalene block
Affects phrenic and not good for patients with COPD or asthma
2177
Hair color has never been identified as a cause of
Intraoperative recall High dose opioid use increases risk of recall
2178
Angiotensin 2 is a potent vasoconstrictor but mainly effects
Efferent arteriole thus maintain renal blood flow
2179
Myocardial oxygen demand most effected by
Heart rate
2180
Weakness of thigh adductor muscles with
Obturator block Never just sensory
2181
Recommended postop management of patient with double lumen endotracheal tube is to exchange with
Single lumen endotracheal tube
2182
Generally cardio version is used for patients with a pulse and defibrillation for patients without a
Pulse
2183
Lidocaine decreases seizure duration making it undesirable for
ECT
2184
Metabolic alkalosis can worsen
Hypokalemia periodic paralysis
2185
Hyperglycemia with lower
Potassium levels
2186
Presynaptic calcium channels
Destroyed in lambert Eaton myasthenic syndrome
2187
Myasthenia gravis autoimmune disorder involving antibodies that attack
Postsynaptic Ach receptor in neuromuscular junction MG improves with rest
2188
Post op respiratory failure post op in MG patients
Disease duration > 6 years Daily pyridostigmine dose> 750 mg FVC<2.9 liters Other chronic lung diseases not related to MG
2189
NIF greater than -20 in ICU is a sign of
Unsuccessful wean Max pressure against occluded airway
2190
RR/TV =
RSBI | Less than 105 is good
2191
Management of aspiration put patient in
Head down or lateral position and initiate supplemental oxygen
2192
Increased flow rate promotes
Turbulent flow
2193
Increasing radius promotes
Turbulent flow
2194
Hyperglycemia happens secondary to
SIRS
2195
Low cardiac output mostly affects
Isoflurane
2196
Heparin is not effective in
Fat embolus syndrome
2197
Rigid fiber optic scope
For foreign body aspiration
2198
Type 2 pneumocytes produce surfactant which helps to prevent
Atelectasis
2199
Do not give Succ in guillan Barre disease
Guillan
2200
Sevoflurane is safe in renal
Disease patients
2201
Compensation for anemia
Rightward shift of oxygen hemoglobin dissociation curve Also get increase in cardiac output
2202
Rotation of patients head to contralateral side during ivj cannulation leads to
Greater overlap of ijv and cca if past 45 degrees
2203
Nitroglycerin
Systemic venodilation that decreases preload
2204
Hydralazine
Slow onset of action and lasts for multiple hours- not the best during surgery
2205
Child at higher cognitive level will have
Higher preoperative anxiety
2206
Use FFP if INR is above 1.5 in urgent/emergent
Cases Also for heparin resistance For microvascular bleeding and one above 2
2207
If inr high and surgery in 24 hours and need to reverse give
Vitamin K Not FFP
2208
Post exposure prophylaxis for Hep B exposure includes
Hey B virus immune globulin
2209
Excessive diuresis does not lead to
Respiratory alkalosis Excessive diuresis leads to metabolic alkalosis
2210
Respiratory alkalosis due to
``` Aspirin overdose Stroke Anxiety Pain Progesterone ```
2211
PE leads to
Respiratory alkalosis
2212
Resuscitation of drowning patient starts with
Rescue breaths
2213
AV node supplied in majority of population by
RCA
2214
Dual chamber pacemaker usually see
P wave followed by left bundle branch pattern
2215
Severinghouse for
C02 Sanz for 02
2216
Bronchodilator therapy shows change in
FEV1
2217
Hyponatremia get
Plasma osmolality | Urine sodium
2218
Fade is due to
Blockage of pre junctional receptors
2219
At high altitudes compensate by increase in
Minute ventilation Hypoxia stimulation of peripheral chemoceptors Increase in PVR due to hypoxia
2220
Leftward shift due to
Hypocarbia
2221
Discovery
Exchange of documents and sworn statements by the defendant witnesses to event or expert witnesses
2222
Depositions
Statements made under oath about the case
2223
Grade 2b
Can only see posterior arytenoids
2224
Grade 3
Only epiglottis Grade 4 can’t see anything
2225
Any malpractice payment made by insurer on behalf of individual physician must be
Reported to NPDB Insurance payments on behalf of corporations are not reported
2226
Contraindication to ECT
Increased ICP
2227
Main cause of guillan barre
C jejuni Ascending motor paralysis Elevated CSF protein
2228
Before caudal epidural you hit
Saccroxoygeal ligament Between S4-S5
2229
End of Dural sac in infants ends at
S3
2230
PRIS
Acute kidney injury Heart failure Metabolic acidosis
2231
Max dose of propofol infusion
4 mg/kg/hr
2232
Cefepime
Worsening hypotension through lipopolysacharide release Histamine release is associated with vancomycin use
2233
Pouiselle law
Length of tubing Pressure exerted on fluid Viscosity of fluid Density of fluid not important! Most important if radius of tubing
2234
Reducing density leads to more
Laminar flow
2235
Hyperglycemia lowers
Potassium levels
2236
Spirnolactone competitively inhibits
Aldosterone
2237
Persistent expiratory flow at end expiration suggests
auto-PEEP | Longer expiratory time. And lower MV improves peak airway pressure and intrinsic PEEP
2238
Bag inlet valve allows bag valve mask to
Reinflate
2239
Ambu bag =
Mapleson C circuit
2240
Best for pain management after rotator cuff repair
Continuous intrascalene block
2241
Zofran plus metochlopramide doesn’t help with
PONV
2242
Cortisol made from
Zona fasiculata
2243
All catecholamines are derived from the amino acid
Tyrosine
2244
ECG signs of hypokalemia includes
ST segment and T wave depression
2245
Ketamine is a sch
3 drug
2246
Cannibis LSD
Sch 1
2247
Benzos
Sch 4
2248
Morphine oxycodone
Sch 2
2249
Persistent vegetative state patients can
Open eyes
2250
Lactated ringers did not cause
Metabolic alkalosis Potassium of 4
2251
20 to 40 ml/kg lactated ringer
During anesthetic in infants and children
2252
Hyperkalemia
Widening of QRS and peaking of T waves
2253
Malignant hyperthermia
Tachycardia Elevated end tidal c02 Acidosis
2254
Malignant hyperthermia
Autosomal dominant variable penetrance
2255
Xenon primarily works by
Inhibition of NMDA receptors
2256
Carboprost can lead to
Bronchospasm
2257
Heart rate generation in cardiac transplant is dependent on
Donor atrium
2258
PPV
Decrease preload Increase right ventricular afterload Increase intrathoracic pressure increases ivc pressure
2259
ANP
Sodium and water excretion
2260
RAAS activation by low cardiac output
Efferent is constricted more to preserve glomerular filtration
2261
TNF alpha and complement increase in
Sepsis
2262
Bedside tracheostomy
Use cuffed low pressure tracheostomy tube For airway protecting should be cuffed Cuffed helps avoid aspiration
2263
Can’t use nitrous with
Malignant hyperthermia
2264
Bad dehydration in newborn
Weight loss 15% Fontalle sunken Urine flow 1.030
2265
Factor 8 levels normal or elevated in
Liver disease Down in DIC
2266
Thrombocytopenia is found in both
DIC and ESLD
2267
Elemental diets do not decrease
Mortality
2268
Most pregnancy related deaths in United States due to
Cardiovascular disease
2269
Cstatic =
Tidal volume/ Pplat-PEEP
2270
End of pacemaker leads go into
Endocardium
2271
Sympathetic block for
Chronic angina
2272
PVR =
PA mean- PCWP / CO x 80
2273
Most evaporative hear loss under general anesthesia is from
Tissue exposure
2274
Pre warming patient externally with forced air warming blanket prevents
Initial fire temperature change caused by redistribution
2275
Left atrial enlargement see double density sign spreads into the space of the
Right atrium
2276
Pressure gradient aortic valve
4 x velocity squared
2277
Fick
Gold standard for cardiac output measurement
2278
Fat embolus don’t see
Tachycardia Petechiae, hypoxemia, neurologic problems like seizures
2279
Cushing reflex
High ICP | Decrease HR increase BP
2280
Bowditch reflex
Increase in HR
2281
Faster inhalation induction
Increased minute ventilation - most important Increase blood flow to vessel rich organs Decrease blood gas partition coefficient Decrease tissue blood partition coefficient
2282
Ace inhibitors
More bradykinin thus more arachadonic acid
2283
Placenta previa
Higher risk of bleeding need two large bore ivs
2284
Salicylate poisoning
Mixed respiratory alkalosis and metabolic acidosis
2285
Contraindication to ECT
Intracranial mass lesion
2286
Parathyroid gland is not controlled by
Pituitary
2287
Acromegaly =
Difficult airway
2288
Anterior mediastinal mass
Inability to lie flat as mass causes tracheal/cardiac compression Tracheal deviation without pneumothorax Widened mediastinum
2289
MH
Flush with 10L of oxygen for 60 minutes
2290
MH don’t give
Inhaled general anesthetics Succinylcholine CAN GIVE NITROUS OXIDE
2291
Methemoglobin
Fe2+ to Fe3+
2292
AHI > 30 in adult =
Severe COPD Mild is 5-15
2293
Least important in heat loss in or
Conduction
2294
Enteral less infections/maintain gut integrity compared to
Parenteral feeding
2295
VACTERL infant with TEF look for neural tube defect
Neural tube
2296
Myasthenia gravis patient can get
Succinylcholine
2297
Can’t give succ to
Multiple sclerosis patient
2298
Cyanide toxicity treatment
Hydroxycobalamin
2299
No basal rate for
Opioid naive patients
2300
Beta 2 agonists like terbutaline
Relax uterine contractions and increase uterine blood flow
2301
Methyelgonavine augments uterine contractions and will
Decrease uterine blood flow
2302
Lithium prolongs
Blockade of both nondepolarizing and depolarizing muscle relaxants
2303
Most effective to treat intraop hypothermia in pediatrics patient
Forced warm air blanket
2304
Excess normal saline
Non anion gap hyperchloremic metabolic acidosis with decrease bicarbonate and decreased SID
2305
Most attenuating on EMG signal
Neuromuscular blocking agents
2306
Leftward shift of oxyhemoglobin dissociation curve is a feature of
Alpha stat ABG Adding CO2 = pH stat
2307
Strongest marker for perioperative outcome in patient on TPN
Albumin
2308
Delayed transfusion reactions
Result of donor red blood cell antigens
2309
Hyperparathyroidism
Skeletal muscle weakness
2310
Propofol acts on
GAbAa receptor Allows Cl- to hyperpolarize cells
2311
Precedex much more selective for alpha 2 than
Clonidine
2312
Baclofen
GAbAb
2313
Oxygen pipeline pressure for oxygen nitrous oxide and air
Ranges between 50-55 psig
2314
Visible spec vs infrared
Visible looks at less tissue with longer wavelengths of light
2315
Increased FRC in patient who is
Prone Larger ERV as well
2316
Morbidly obese
Increase in lean body weight
2317
Transfusion related immunomodulation can be stopped by
Leukocyte reduction
2318
Morphine 3 G
No analgesic activity May actually lead to hyperalgesia
2319
Nausea Pruritis Respiratory depression due to
M6 G
2320
MELD greater than 14
Usually can’t go in for surgical intervention
2321
Liver transplant
Dissection Anhepatic Reperfusion
2322
Most hemodynamic instability during
Reperfusion phase
2323
Pace atria and ventricle
In ddd
2324
Normal Pa02 in
Methemoglobinemia You have oxygen but RBCs can’t take it Giving oxygen won’t help
2325
6 months for
DES
2326
SIADH
Euvolemic or hypervolemic so CVP will be high
2327
Ethacrynaic acid no reaction to
Sulfonamides
2328
Nerve problems
Then need nerve block like with change in temp or pinprick
2329
Both ventilation and perfusion are lower in
Apical alveoli
2330
Anuria
Urine output less than 50 ml per day
2331
Thin layer of blood<1mm
Fisher grade 2
2332
Bioteansformation of lorazepam by
Glucoronidation
2333
Rate of postop pulmonary complications drastically declines in smokers after stopping for
8 weeks
2334
Heart failure at bottom of
Frank starling curve
2335
Patient analgesia best in order
Continuous epidural > patient controlled epidural > patient controlled analgesia > prn
2336
In event of emergency move patient out of MRI scanner
ASAP
2337
Saphenous block
L2-L4 Adductor canal block similar pain help to femoral but lower risk of fall
2338
Adenosine does not help with
A flutter
2339
Adenosine blocks
AV node
2340
Recurrent laryngeal nerve is a branch of the
Vagus nerve
2341
Neuraxial causes
Decrease temperature where shivering will begin Epidural increases incidence of shivering in women undergoing vaginal delivery
2342
Furosemide
Increased venous capacitance
2343
Periop mortality in obese main cause is
DVT
2344
Best way to increase CO in someone with a fib is to convert to
NSR
2345
Inhalational induction slowed by
Right to left shunt and more insoluble anesthetic
2346
If failed intubation with fetal distress in pregnancy and difficult intubation
Mask them or lma before video til patient comes out
2347
Rheumatoid arthritis not associated with
Bronchospastic disease
2348
Midazolam bioavailability greatest to least
iV> Intramuscular > intranasal > rectal > oral
2349
Epidural anesthesia ok for
Multiple sclerosis
2350
Fetal academia requiring delivery
pH of 7.2 or lactate greater than 4.8 mmol/L
2351
Ketamine/precedex
No pain on injection
2352
Duchenne muscular dystrophy
Lead to hyperkalemia/rhabdomyolysis Not MH
2353
Drug volume affects
Epidural anesthesia but not spinal
2354
Spinal anesthesia affected by
Drug baricity Drug dosage Patient position
2355
Deadly triad
Coagulopathy Hypothermia Metabolic acidosis
2356
Acute stoppage of TPN can lead to
Hypoglycemia
2357
Old MI =
>30 days prior
2358
Intercostal blocks associated with
Highest blood levels of local anesthetic following completion of block
2359
Lower density =
Less turbulent flow
2360
Carbon monoxide poisoning with carboxyhemoglobin level> 25%
Hyperbaric oxygen therapy
2361
Unstable angina =
ASA 4
2362
Pa02 increases in
Pregnancy
2363
Increased cardiac output decreases speed of
Inhalation induction
2364
C botulism toxin works by
Impairment of Ach release from storage vesicles
2365
Cholestasis is a complication of
Parenteral nutrition
2366
Cyclosporine causes
Nephrotoxicity not pulmonary toxicity
2367
FEVERFEW PROLONGS THE ACTION OF
Warfarin
2368
Recombinant hgb
Does not require typing or crossmatching
2369
Terbutaline
Selective beta 2 agonist
2370
Terbutaline can lead to
Glucose intolerance
2371
Ritodrine side effect is
Neonatal hypoglycemia | Maternal hypokalemia
2372
Single blinded
Only patients are not aware
2373
Elevated CPK in heavy patient from prolonged immobilization leads to
Rhabdomyolysis
2374
Sacral spinal nerves simulates
Urethral sphincter relaxation
2375
In pelvis sacral spinal nerves include parasympathetic nerve fibers that promote
Sexual arousal, peristalsis, defecation, urination
2376
5 to 10 AHI per hour is
Normal
2377
Disadvantage of autotransfusion via intraoperative blood salvage
Platelet and clotting factor deficiency
2378
Autonomic dysreflexia starts with spinal lesions at
T6
2379
Avoid pre term delivery by delaying pregnant surgery until
Second trimester
2380
Myofascial pain syndrome treat with
Trigger point injection Physical therapy TENS
2381
Unchanged vital capacity in
Pregnancy Tidal volume increases FRC decreases
2382
Etomidate inhibits
11 beta hydroxylase
2383
Mapleson D most efficient for
Controlled/spontaneous ventilation
2384
Drainage of CSF fastest way to restore
Cerebral perfusion pressure
2385
Decrease > 10 mmHg of systemic BP during inspiration for
Pulpus paradoxus not expiration
2386
During inspiration increase in negative intrathoracic pressure increases
Venous return to right side of heart
2387
Most jevohahs witnesses will take
Albumin Refuse autologous blood transfusions
2388
When a patient is anemic
Blood viscosity is decreased. Helps to improve blood flow to specific tissues thus aiding in oxygen delivery
2389
Vital organs
Brain heart and lungs
2390
Polycythemia
Increased blood viscosity slows blood flow and decreaeses oxygen delivery
2391
For difficult airways due to limited neck extension do
Flexible laryngoscopy
2392
Three drug prophylaxis in severe exposure when the patient is known to have
HIV OR AIDS
2393
Predisposes to atelectasis
General anesthesia Fi02 high Obesity
2394
Hypothermia causes
Increased mixed venous
2395
Chronic heparin use leads to
Hypoaldosteronism and this hypokalemia
2396
Most injured nerve during thyroid/parathyroid surgery
Superior laryngeal Tensor of vocal cords without it the voice tires easily
2397
Eclampsia
Seizures in woman with preeclampsia
2398
Telling families adverse events =
Professionalism
2399
Giving magnesium to mother can cause
Hypotonia in neonate
2400
Lusitropy
Active myocardial relaxation Downward shift of EDPVR slope
2401
Bronchospasm affects
Dynamic compliance
2402
The AMA is not involved with
Operating room safety
2403
Hyperosmolar vs DKA
HHS has serum osmolality above 350 and BG>600
2404
High intravesical pressure is consistent with compartment syndrome which can lead to increased
ICP
2405
Carbamazepine overdose causes
Anticholinergic symptoms such as mydriasis
2406
Succ disadvantages
``` Increase intragastric pressure Increase iop Postop myalgia Hyperkalemia Increased LES tone ```
2407
6 hours npo
Tea and toast such as an English muffin
2408
Alpha is for
Type 1 error Alpha decreased decreases chance of type 1 error but increases type 2 error chance
2409
Beta error lower
Less chance for type 2- falsely accepting null hypothesis
2410
Most chylothorax post central line is on
Left side
2411
Transcutaneous pacemakers can lead to
Muscle injury Rhabdomyolysis Hyperkalemia
2412
Most direct cause if cv collapse during massive venous air embolism is
RV outflow tract obstruction from air lock phenomenon in RV
2413
SBO requiring surgery
Put NG tube in while awake
2414
Metochlopramide
Dopamine antagonist
2415
Chi square good for
Categorical data
2416
200 mcg =
0.2 mg
2417
1 mg intrathecal morphine = 10 mg epidural morphine
1 mg EPidural morphine = 10 mg iv I mg iv = 3 mg po morphine
2418
Creatinine clearance best to determine
Imminent acute kidney injury
2419
FenA determines cause of
Established kidney injury
2420
FENA is affected by
Diuretics
2421
Closing capacity increases as patients
Age
2422
SIMV with pressure support
Mandatory breaths and additional PS breaths all synchronized with patient effort
2423
Delayed hemolytic transfusion reaction
3 to 7 days post
2424
Anaphylactic or anaphylactoid transfusion rxn
First stop transfusion First give bolus of fluids then slow epinephrine pushes
2425
No premedication to prevent
Allergic or febrile non hemolytic transfusion rxn Stopping transfusion is ok
2426
Jehovah’s Witness ok with
Acute normovolemic hemodilution
2427
No acute normovolemic hemodilution on patient with
Cardiac abnormalities such as stable angina
2428
Vapor pressure depends on
Temperature and specific liquid
2429
PVC is ok with laser
Especially if aluminum covers it Avoid nitrous and volatiles bc can lead to airway problems
2430
First letter
Chamber paced
2431
Position 2
Chamber sensed
2432
Still pacing but not sensing in
Asynchronous mode with a magnet
2433
Soda lime especially with KOH form bad
Byproducts
2434
Intraop awareness
Higher with neuromuscular agents So does TIVA
2435
VATS pleurodesis for
Chronic pleural effusion
2436
Bain circuit conserves
Moisture better
2437
When oxygen falls below 20 to 30 psi
Fail safe valve decreases or ceases nitrous oxide delivery
2438
Most effective noninvasive oxygen delivery device
Nonrebreathing mask Venturi mask is not a good device
2439
Boyle’s law hyperbaric oxygen decreases
Emboli
2440
Max Fi02 NC
50%
2441
Des
Highest vapor pressure
2442
Ventilator disconnnect
Alarm
2443
Atracurium
Histamine release
2444
Pancuronium can worsen
Tachycardia Rocuronium can be used on patient with liver lac
2445
High spinal
Numbness and or tingling in hands and SOB
2446
Tounge points towards the lesion in
Stroke
2447
Beach chair position can lead to
Stroke
2448
In MH RYR I’m locked state so keep getting more and more intracytoplasmic
Calcium
2449
Sodium citrate works
Immediately to increase gastric pH
2450
Aspiration pneumonia has CXR findings while aspiration pneumonitise
Does not
2451
Anaphylactoid does not activate
Antigen mast cell activation
2452
Anaphylaxis treatment first give
Fluid bolus and epinephrine
2453
Pac02 30 to 35 for a
Crani to reduce blood flow
2454
Pac02 etC02 difference due to
Dead space
2455
Airway fire
Take out ETT
2456
Intraop awareness more likely in
Cardiac Obstetric Trauma
2457
Hypothermia can cause
Coagulopathy If vital signs stable not due to massive blood loss
2458
C02 insufflation could lead to
C02 embolus
2459
Best strategy for fat embolus
Low tidal volume similar to ARDS
2460
Treatment of TRALI is with
Ventilator support Use low tidal volume with high RR and peep
2461
Tourniquet release
Increase in HR Increase in potassium Slight increase in pac02 Transient metabolic acidosis
2462
Lumbar epidural prior to
Ex lap is ok
2463
Best predictor of postop renal injury
Preop creatinine clearance
2464
Give naloxone if you give too much
Dilaudid
2465
Intercostal to caudal
Intrascalene lower absorption as part of brachial plexus
2466
Neuraxial opioids procure analgesia via
Dorsal horn opioid receptors Morphine can go to stark when given intrathecal and can cause respiratory depression at 6 to 18 hours
2467
PDPH is not associated with
Fever
2468
1 liter of crystalloid or 1 pRBC lowers temp by
.25 degrees C
2469
Hypothermia is protective against
Cerebral ischemia and hypoxia
2470
Postop vision loss if
Prone position Long duration of surgery Prolonged hypotension Significant intraop blood loss
2471
Protect ulnar nerve with
Forearm supination
2472
Dantrolene decreases
Release of calcium from SR
2473
Mandibular central incisors most likely to be injured during
Intubation
2474
Cuff of LMA can cause
Hypoglossal or lingual nerve injury Hypoglossal goes to ipsilateral side
2475
Positive pressure leak test will not find leak in
Vaporizer
2476
IOP is not affected by
Etomidate
2477
Left IJ most likely to lead to
Chylothorax
2478
Anaphylaxis
Type 1 hypersensitivity antigen binding for IgE
2479
Atracurium
Histamine release
2480
Pancuronium can worsen
Tachycardia Rocuronium can be used on patient with liver lac
2481
High spinal
Numbness and or tingling in hands and SOB
2482
Tounge points towards the lesion in
Stroke
2483
Beach chair position can lead to
Stroke
2484
In MH RYR I’m locked state so keep getting more and more intracytoplasmic
Calcium
2485
Sodium citrate works
Immediately to increase gastric pH
2486
Aspiration pneumonia has CXR findings while aspiration pneumonitise
Does not
2487
Anaphylactoid does not activate
Antigen mast cell activation
2488
Anaphylaxis treatment first give
Fluid bolus and epinephrine
2489
Pac02 30 to 35 for a
Crani to reduce blood flow
2490
Pac02 etC02 difference due to
Dead space
2491
Airway fire
Take out ETT
2492
Intraop awareness more likely in
Cardiac Obstetric Trauma
2493
Hypothermia can cause
Coagulopathy If vital signs stable not due to massive blood loss
2494
C02 insufflation could lead to
C02 embolus
2495
Best strategy for fat embolus
Low tidal volume similar to ARDS
2496
Treatment of TRALI is with
Ventilator support Use low tidal volume with high RR and peep
2497
Tourniquet release
Increase in HR Increase in potassium Slight increase in pac02 Transient metabolic acidosis
2498
Lumbar epidural prior to
Ex lap is ok
2499
Best predictor of postop renal injury
Preop creatinine clearance
2500
Give naloxone if you give too much
Dilaudid
2501
Intercostal to caudal
Intrascalene lower absorption as part of brachial plexus
2502
Neuraxial opioids procure analgesia via
Dorsal horn opioid receptors Morphine can go to stark when given intrathecal and can cause respiratory depression at 6 to 18 hours
2503
PDPH is not associated with
Fever
2504
1 liter of crystalloid or 1 pRBC lowers temp by
.25 degrees C
2505
Hypothermia is protective against
Cerebral ischemia and hypoxia
2506
Postop vision loss if
Prone position Long duration of surgery Prolonged hypotension Significant intraop blood loss
2507
Protect ulnar nerve with
Forearm supination
2508
Dantrolene decreases
Release of calcium from SR
2509
Mandibular central incisors most likely to be injured during
Intubation
2510
Cuff of LMA can cause
Hypoglossal or lingual nerve injury Hypoglossal goes to ipsilateral side
2511
Positive pressure leak test will not find leak in
Vaporizer
2512
IOP is not affected by
Etomidate
2513
Left IJ most likely to lead to
Chylothorax
2514
Anaphylaxis
Type 1 hypersensitivity antigen binding for IgE
2515
Rodenticide
Super warfarin
2516
Amide local anesthetic breakdown
Plasma cholinesterase
2517
Onset and recovery of block works fastest at
Diaphragm
2518
Atracurium breakdown
Hoffman elimination
2519
Block recovery after single dose of NDMR is the result of
Redistribution
2520
Avoid which NDMB in patients with renal failure
Pancuronium
2521
High K above 5.5 don’t use
Succ
2522
Hypercalcemia does not enhance
Neuromuscular block
2523
Histamine release following administration of NBMAs is most apparent after giving
Succinylcholine
2524
Can give succ to a burn patients as long as they got it within
2 days of burn
2525
Succ is a partial agonist of the
AchR Binds the alpha subunit
2526
Succ onset Succ offset
<1 min 5 to 10 minutes
2527
Succ much higher risk of
Allergic reaction which is IgE mediated
2528
Succ can increase
ICP
2529
Heart transplant patients can get
Succinylcholine
2530
Succ binds
Alpha subunit of postsynaptic AcH receptor
2531
Phase 1 block
Cation channel stays open leading to Flaccid paralysis
2532
Phase 2
TOF<50% | At very high doses of succinylcholine
2533
Dantrolene elimination half life is
12 hours
2534
Dantrolene inhibits calcium release from the
Sarcoplasmic reticulum
2535
Continue dantrolene infusion in MH patients for at least
24 hours in the ICU
2536
Increase in biliary pressure due to
Opiates Least is from tramadol/buenorphine
2537
Antiemetics don’t act on
Opioid receptor
2538
TIVA = less
PONV
2539
Can’t use in pts with Parkinson’s disease
Droperidol
2540
Black box droperidol for
QT prolongation
2541
Can use propofol with
Acute intermittent porphyria
2542
Amnesia persists the longest with
Benzodiazepines
2543
Flumazinil lasts
45 to 90 min Give in doses of 0.2 mg up to 3 mg
2544
Clonidine
Hypotension and bradycardia
2545
Lorazepam
Lasts 32 hours
2546
Etomidate
PONV and thrombophlebitis Maintains Hypoxic pulmonary vasoconstriction
2547
No ketamine during
Pregnancy
2548
Reduction of methemoglobin to hemoglobin is action of
Methylene blue
2549
Mannitol can cause
Pulmonary edema
2550
Glucagon produced by
Pancreatic alpha cells
2551
Glucagon causes
Positive inotropy and increased heart rate Can treat hypoglycemia and beta blocker overdose (5 to 10mg iv)
2552
IV beta blockers for
HTN and tachyarrhyhmias Propranolol non selective beta blocker
2553
Labetalol is 7 times more
Beta than alpha
2554
Esmolol is much less
Potent than propranolol
2555
Want to discontinue TCA and MAOis
2 weeks before surgery
2556
Digoxin
Positive inotropy, negative chronotropy, reduced SVR Inhibits sodium/potassium ATPase
2557
Can give lidocaine for
V Tach
2558
High potassium can lead to
Digoxin toxicity
2559
Clindamycin prolongs
NDMBs
2560
Buprenorphine 50 times more potent than
Morphine
2561
Nalbuphine iv for
Intrathecal Itching Start with dose 4 mg iv
2562
Can’t give reglan to patients with
Epilepsy
2563
Reglan increases
LES tone
2564
Randomization no affect on
Power of study, does balance cofounders
2565
Type 1 error =
False positive
2566
Mann Whitney for
Unpaired groups
2567
Nominal variable has two or more categories such as
Gender
2568
Patients can refuse testing for
HIV
2569
Roe v Wade
Established women’s right to obtain a therapeutic abortion in early stages of pregnancy
2570
Four principles of malpractice
Preexisting duty of care Breach of duty Injury to patient Proximate cause
2571
Antithymocyte globulin side effects
Leukopenia Thrombocytopenia Serum sickness, anaphylactic rxn
2572
Orthodeoxia
Hepatopulmonary syndrome
2573
Parameter of TEG measuring clot strength is
Maximum amplitude
2574
Drug of choice for increasing heart rate in heart transplant patients
Isoproterenol
2575
ESRD
Nprmochromic, normocytic anemia
2576
Hyperventilation with lower tidal volumes with
Cirrhosis
2577
Vasopressin affects SVR without big effect on
PVR
2578
Diagnosis of rejection requires a
Liver biopsy
2579
Reperfusion syndrome occurs during
Neohepatic phase of liver transplant when portal vein, hepatic artery, and vena cava are unclamped
2580
Don’t use nimbex in
Rapid sequence induction
2581
Ok to use succ if preop potassium less than
5.5 in ESRD
2582
Usually two p waves on
Donated heart due to both donor and recipient AV nodes
2583
Usually plt count goes up 10000
Per donor unit
2584
Give FFP bc it gives back
All coagulation factors Cryoprecipitate for hypofibrinogen which shouldn’t be given for bleeding before FFP
2585
Citrate not metabolized without liver
During anhepatic phase need to watch calcium bc low amounts will lead to decreased cardia contractility
2586
Most common cause of ARDS is
Severe sepsis
2587
Same volume replete on overall whether using
CVP or PA cath
2588
Delirium leads to
Increased morbidity and mortality
2589
Expiratory wheezing not heard in
Severe asthma
2590
ARDS damage
Capillary endothelial Alveolar epithelial cells Impaired surfactant levels
2591
Pneumothorax can lead to
Impaired ventilation of unaffected lung
2592
Transient increase in atrial pressure produced by isovolumetric contraction =
C wave
2593
PEEP can decrease
LV afterload and thereby enhancing cardiac performance
2594
DKA has a high
Anion gap
2595
Sodium bicarbonate problems
No benefit in acidosis from cardiac arrest, shock, and sepsis. Can lead to venous hypercarbia, tissue hypoxia, hypernatremia, shift of 02 dissociation curve
2596
No ketonuria is seen with
HHS
2597
If u had a pneumonectomy
Don’t do central line on other side bc only lung u have
2598
Don’t do subclavian on side with
AV fistula
2599
Trunk is
18% in burn formula
2600
4 ml/cc/hr per
Parkland formula
2601
Cherry red pigmentation
Only during high CO concentrations
2602
In anaphylaxis intravascular fluid moves into tissue triggering acute tissue edema leading to rise in
Hematocrit in pts suffering from anaphylactic rxn
2603
Intraop urine output has not been shown to be a predictor of
Postop renal dysfunction
2604
If life threatening bleeding after giving tPA can reverse first line with
Cryoprecipitate
2605
Transfusion of pRBCs helps BP by increasing
Preload
2606
Most citrate toxicity would come from
FFP
2607
Sepsis you see a low
SVR
2608
Can you CPAP and biPAP for
Cardiogenic pulmonary edema
2609
Nitric oxide
Potent pulmonary vasodilator that can cause plt dysfunction
2610
Giving pRBCs shifts oxyhemoglobin curve to the
Left
2611
In management of acute aortic dissection
Morphine first then esmolol then sodium nitroprusside Want systolic 90-110
2612
First signs of cyanide toxicity in patients treated with nitroprusside is
Tachyphylaxis
2613
Tachycardia decreases
Diastole time
2614
Cryoprecipitate contains
``` Fibrinogen Fibronectun VwF Factor 8 Factor 13 ```
2615
MABL
``` EBV x (pt hct-minimum tolerated hct))/Pt hct Older children EBV 75 to 80 cc/kg ```
2616
Albuterol acts on
cAMP Relax bronchial smooth muscle Can be used in ppl with cardiovascular disorders
2617
Spinal cord stimulator does not treat
Pancreas related pain
2618
Tumescent lidocaine max dose
55 mg/kg during liposuction
2619
Neuraxial morphine has an association with
Reactivating heroes simplex virus
2620
Lidocaine speak plasma concentration occurs more than
6 hours after injection when given for tumescent lidocaine procedures
2621
Bainbridge reflex
Increase in HR due to an increase in CVP
2622
Stroke volume and arterial pulse pressure drop during
Expiration
2623
Guillan barre causes
Pain
2624
Brain dead pts more vasopressin release and most common electrolyte abnormality is
Hypernatremia
2625
PEEP increases
FRC Does not decrease extra vascular lung water
2626
No enteral nutrition if patient has ileus but ok for
Pancreatitis
2627
Do not use verapamil or other calcium channel blockers during
MH
2628
MAC
Concentration of vapor that prevents the reaction to a standard surgical stimulus of 50% of subjects
2629
To achieve same partial pressure at altitude need to increase
Concentration of anesthetic
2630
Primary polycythemia higher
Plt count than secondary polycythemia
2631
Epidural analgesia during first stage is
Fever
2632
Ordinal data
Wilcoxon rank sum test
2633
Milrinone
Inodilator and vasodilation
2634
Jet ventilation reduces risk of
Airway fire
2635
Two small groups comparing data use
Fisher exact test
2636
More likely to cause atlantoaxial instability
Neck flexion
2637
Dexamethasone no
Mineralocorticoid activity
2638
Celebrex raises
Lithium levels
2639
SD=
SE x square root of sample size
2640
Gi/Gu
No infective endocarditis prophylaxis
2641
Masseter muscle innervation
Trigeminal nerve
2642
Nitric oxide
cGMP
2643
Sensory innervation of tounge
Mandibular nerve CN V3
2644
Nitrous oxide
NMDA receptor antagonist
2645
Fraction of expired gases use
Infrared absorption spectrophotometry
2646
More airway resistance with
Hyperventilating
2647
Most common cause of normal anion gap in setting of lactic acidosis
Hypoalbuminemia
2648
Vocal cord paralysis may result from
Prolonged over inflation of an endotracheal tube
2649
Anaphylactoid are not
IgE mediated
2650
Esmolol breakdown
Red cell esterases
2651
Labetalol iv 7 to 1
Beta to alpha
2652
Intracranial aneurysm symptoms
Severe headache | Neck stiffness
2653
Cerebral vasospasm treatment includes
Nimodipine aka calcium channel blockers
2654
Hyperthermia can trigger
Myasthenia gravis
2655
In pregnancy plasma volume goes up causing albumin levels to go
Down
2656
Coagulation factors that go up most in pregnancy
Factors 7 and fibrinogen
2657
HFJV allows for
Passive expiration whereas HFOV does not
2658
Flumazinil half life 1 hr not long enough for most
Benzo agonists and causes resedation
2659
N20
1590 L and 745 psig
2660
Furosemide
Hypochloremic metabolic alkalosis
2661
Thiazides works at
Distal convoluted tubule
2662
Increase in renal bicarbonate with
Acetazolamide
2663
Acetazolamide
Hyperchloremic metabolic acidosis bc more bicarbonate in urine getting excreted
2664
Hemoglobin curve affected by carbon dioxide and pH due to
Bohr effect
2665
Mivacurium broken down by
Psuedocholinesterase
2666
Meperidine resembles atropine so May cause increase in
HR
2667
Most common cause of bradycardia in neonates is
Hypoxia
2668
PRIS
Cardiac failure Rhabdomyolysis Pancreatitis
2669
Drugs not crossing placenta
Heparin insulin glycopyrolate muscle relaxants and succ
2670
Tourniquet release can cause
PE through dislodgement of thrombus with acute decrease in Etc02 and sp02
2671
HTN Bradycardia Diaphoresis
Autonomic hyperteflexia
2672
After spinal cord injury extra junctional receptors are highest 3 days to
9 mo after
2673
Treat autonomic reflexia with
Short acting not long acting like phenoxybenzamine
2674
Autonomic hyperteflexia causes
Reflex bradycardia
2675
Ion trapping
Fetus has low pH | Gives hydrogen ion to basic drug like lidocaine trapping it by making it ionized
2676
Great auricular artery originates from the aorta between
T9-T12
2677
Circle of Willis is made up of
ACA, PCA, anterior communicating internal carotid MCA is not considered part of the circle of Willis
2678
Precedex is most selective for
Alpha 2
2679
Propofol decreases amplitude of
SSEPs
2680
Least resistant
BAEP
2681
Carcinoid associated with
Tachycardia not bradycardia
2682
Greater cornu of hyoid bone local anesthetic
Internal branch of superior laryngeal nerve
2683
External obliques muscles contract
During forced exhalation
2684
Cardiovascular collapse during massive venous air embolus
Air lock phenomenon in right ventricle
2685
NMDA is an
Excitatory neurotransmitter blocked by ketamine
2686
Double blinded is to both
Patient and investigator
2687
Isoflurane most improved with
High minute ventilation
2688
Expiration controls
Ventral respiratiry group in the medulla
2689
Heat loss through breathing circuit
Evaporation
2690
Phenelzine is an MAOi used for treatment can cause
Serotonin syndrome Clonus hyperreflexia tachycardia also seen No meperidine to patient on phenelzine
2691
Uremia causes platelet dysfunction including impaired aggregation
In dialysis patients Platelet count usually doesn’t go down
2692
Glycine
Metabolized to ammonia
2693
Myelingocele goes with
Hydrocephalus
2694
Non pitting edema
Myxadema coma
2695
Cuffed trach is necessary when
Positive pressure ventilation is required
2696
At least 10% of transfused blood is
Hemolyzed within 24 hours of blood transfusion Patients with Gilbert’s have a hard time dealing with increased unconjugated bilirubin load
2697
Supraclavicular block high risk for
Pneumothorax - near subclavian artery and pleura
2698
Intrascalene usually doesn’t affect
Ulnar where’s supraclavicular does
2699
Corneal reflex
5 and 7
2700
Sulfhemoglobinemia shifts oxyhemoglobin dissociation curve to the
Right
2701
Clevidipine breakdown is by
Plasma esterases
2702
Gabapentin binds
Alpha 2 receptors
2703
Most sensitive lab test for acromegaly
IGF-1
2704
Cryotherapy helps with postop pain by
Nociceptive sensitivity inhibition by slowing nerve conduction
2705
MG and chronic renal failure do not lead to
Upregulation of nicotinic Ach receptors
2706
Indications for hyperbaric oxygen therapy
Air embolus, carbon monoxide poisoning, ischemic ulcers
2707
Epi Norepinephrine Dopamine do not cross
BBB
2708
Mitral valve closes at the
R wave
2709
W/o first stage regulator
Can get depletion of oxygen tank
2710
Hyper magnesium
Iatrogenic | May result in reduced deep tendon reflexes and muscle weakness
2711
Cerebral vasospasm most likely to develop at 2-14 days post
Sub arachnoid hemorrhage
2712
Milrinone dose should be reduced in setting of
Renal failure PDE inhibitor Increases cAMP levels leading to more inotropy Increases cardiac index without increasing myocardial oxygen demand Reduces SVR and PVR
2713
Inferior wall of LV is done by
RCA it is on septal side
2714
MAOi use increases
MAC
2715
Hypermagnesium can cause
Muscle weakness which can lead to blurred vision
2716
Cardiac myxona most common benign cardiac tumor mainly found in
Left atrium
2717
Activating nicotinic Ach on motor end plate requires
Two Ach or one succ molecule
2718
Meperidine main effect is through
Kappa opioid receptors
2719
Aorta to pulmonary artery
PDA
2720
Urine to plasma osmolar ratio > 1.5 indicates
Prerenal oliguria
2721
PPV in neonate if HR under
100 Chest compressions if under 60
2722
Acute mountain sickness treat with
Acetazolamide | Dexamethasone
2723
NSAIDS have a ceiling affect to
Analgesia
2724
Cephalad movement of diaphragm is seen in
Pregnancy
2725
Progesterone
Causes relaxation of bronchiolar smooth muscle during pregnancy and mitigates upper airway edema
2726
Esmolol breakdown
Red cell esterases
2727
Labetalol iv 7 to 1
Beta to alpha
2728
Intracranial aneurysm symptoms
Severe headache | Neck stiffness
2729
Cerebral vasospasm treatment includes
Nimodipine aka calcium channel blockers
2730
Hyperthermia can trigger
Myasthenia gravis
2731
In pregnancy plasma volume goes up causing albumin levels to go
Down
2732
Coagulation factors that go up most in pregnancy
Factors 7 and fibrinogen
2733
HFJV allows for
Passive expiration whereas HFOV does not
2734
Flumazinil half life 1 hr not long enough for most
Benzo agonists and causes resedation
2735
N20
1590 L and 745 psig
2736
Furosemide
Hypochloremic metabolic alkalosis
2737
Thiazides works at
Distal convoluted tubule
2738
Increase in renal bicarbonate with
Acetazolamide
2739
Acetazolamide
Hyperchloremic metabolic acidosis bc more bicarbonate in urine getting excreted
2740
Hemoglobin curve affected by carbon dioxide and pH due to
Bohr effect
2741
Mivacurium broken down by
Psuedocholinesterase
2742
Meperidine resembles atropine so May cause increase in
HR
2743
Most common cause of bradycardia in neonates is
Hypoxia
2744
PRIS
Cardiac failure Rhabdomyolysis Pancreatitis
2745
Drugs not crossing placenta
Heparin insulin glycopyrolate muscle relaxants and succ
2746
Tourniquet release can cause
PE through dislodgement of thrombus with acute decrease in Etc02 and sp02
2747
HTN Bradycardia Diaphoresis
Autonomic hyperteflexia
2748
After spinal cord injury extra junctional receptors are highest 3 days to
9 mo after
2749
Treat autonomic reflexia with
Short acting not long acting like phenoxybenzamine
2750
Autonomic hyperteflexia causes
Reflex bradycardia
2751
Ion trapping
Fetus has low pH | Gives hydrogen ion to basic drug like lidocaine trapping it by making it ionized
2752
Great auricular artery originates from the aorta between
T9-T12
2753
Circle of Willis is made up of
ACA, PCA, anterior communicating internal carotid MCA is not considered part of the circle of Willis
2754
Precedex is most selective for
Alpha 2
2755
Propofol decreases amplitude of
SSEPs
2756
Least resistant
BAEP
2757
Carcinoid associated with
Tachycardia not bradycardia
2758
Greater cornu of hyoid bone local anesthetic
Internal branch of superior laryngeal nerve
2759
External obliques muscles contract
During forced exhalation
2760
Cardiovascular collapse during massive venous air embolus
Air lock phenomenon in right ventricle
2761
NMDA is an
Excitatory neurotransmitter blocked by ketamine
2762
Double blinded is to both
Patient and investigator
2763
Isoflurane most improved with
High minute ventilation
2764
Expiration controls
Ventral respiratiry group in the medulla
2765
Heat loss through breathing circuit
Evaporation
2766
Phenelzine is an MAOi used for treatment can cause
Serotonin syndrome Clonus hyperreflexia tachycardia also seen No meperidine to patient on phenelzine
2767
Uremia causes platelet dysfunction including impaired aggregation
In dialysis patients Platelet count usually doesn’t go down
2768
Glycine
Metabolized to ammonia
2769
Myelingocele goes with
Hydrocephalus
2770
Non pitting edema
Myxadema coma
2771
Cuffed trach is necessary when
Positive pressure ventilation is required
2772
At least 10% of transfused blood is
Hemolyzed within 24 hours of blood transfusion Patients with Gilbert’s have a hard time dealing with increased unconjugated bilirubin load
2773
Supraclavicular block high risk for
Pneumothorax - near subclavian artery and pleura
2774
Intrascalene usually doesn’t affect
Ulnar where’s supraclavicular does
2775
Corneal reflex
5 and 7
2776
Sulfhemoglobinemia shifts oxyhemoglobin dissociation curve to the
Right
2777
Clevidipine breakdown is by
Plasma esterases
2778
Gabapentin binds
Alpha 2 receptors
2779
Most sensitive lab test for acromegaly
IGF-1
2780
Cryotherapy helps with postop pain by
Nociceptive sensitivity inhibition by slowing nerve conduction
2781
MG and chronic renal failure do not lead to
Upregulation of nicotinic Ach receptors
2782
Indications for hyperbaric oxygen therapy
Air embolus, carbon monoxide poisoning, ischemic ulcers
2783
Epi Norepinephrine Dopamine do not cross
BBB
2784
Mitral valve closes at the
R wave
2785
W/o first stage regulator
Can get depletion of oxygen tank
2786
Hyper magnesium
Iatrogenic | May result in reduced deep tendon reflexes and muscle weakness
2787
Cerebral vasospasm most likely to develop at 2-14 days post
Sub arachnoid hemorrhage
2788
Milrinone dose should be reduced in setting of
Renal failure PDE inhibitor Increases cAMP levels leading to more inotropy Increases cardiac index without increasing myocardial oxygen demand Reduces SVR and PVR
2789
Inferior wall of LV is done by
RCA it is on septal side
2790
MAOi use increases
MAC
2791
Hypermagnesium can cause
Muscle weakness which can lead to blurred vision
2792
Cardiac myxona most common benign cardiac tumor mainly found in
Left atrium
2793
Activating nicotinic Ach on motor end plate requires
Two Ach or one succ molecule
2794
Meperidine main effect is through
Kappa opioid receptors
2795
Aorta to pulmonary artery
PDA
2796
Urine to plasma osmolar ratio > 1.5 indicates
Prerenal oliguria
2797
PPV in neonate if HR under
100 Chest compressions if under 60
2798
Acute mountain sickness treat with
Acetazolamide | Dexamethasone
2799
NSAIDS have a ceiling affect to
Analgesia
2800
Cephalad movement of diaphragm is seen in
Pregnancy
2801
Progesterone
Causes relaxation of bronchiolar smooth muscle during pregnancy and mitigates upper airway edema
2802
Nonshivering thermogenesis
Triggered by norepinephrine glucocorticoids thyroxine
2803
Alveolar dead space goes down during pregnancy
Due to increase in cardiac output
2804
Mid esophageal aortic long axis view see ascending aorta at
105 degrees
2805
To reduce PONV need metochlopramide dose
25-50 mg
2806
Trans cranial Doppler can see elbolization in
90% of occlusions
2807
Next to intrascalene block you have vertebral artery where if you inject local anesthetic you get immediate
Seizures
2808
Phrenic nerve stimulators improve
Atelectasis
2809
Vasoplegia causes bad
Vasodilation
2810
Dixogin inhibits myocyte Na K ATPase
Leads to increased intracellular calcium and positive inotropy Treatment of overdose is with immunotherapy
2811
Glucagon
Acts via G protein coupled receptor independent of beta 1 receptor to cause chronotropic and inotropic effects
2812
Milrinone
May be limited due to hypotension Due to its arterial and venous vasodilatory effects
2813
Sinus Brady and angina
Give amlodipine
2814
Increased bradykinin is due to
Ace inhibitors leading to angioedema
2815
V/Q ratio is 1 at the
Third rib in upright lungs
2816
TLC, RV FRC all increased with
COPD
2817
Chemoceptors sense higher pC02 and increase
Ventilation
2818
02 content of arterial blood
1.39 x hemoglobin x O2 sat + 0.003*PaO2
2819
Diastole is
Ventricles filling ``` Consists of Isovolumetric relaxation Rapid inflow Duastasis Atrial systole ```
2820
SVR =
80 x (MAP-CVP)/CO
2821
A failing ventricle leads to dilation and significantly increase
Afterload which lowers cardiac output
2822
Hypoxia acidosis ischemia and drugs like calcium channel blockers and beta blockers decrease
Contractility
2823
Coronary perfusion pressure
Aortic diastolic pressure - LVEDP
2824
Fourth power of radius
Reduction in flow due to coronary lumen getting smaller
2825
Coronary vasodilation by
Calcium channel blockers Nitrates Dipyridamole
2826
Left recurrent laryngeal wraps around the
Aorta
2827
Right recurrent laryngeal wraps around
Right subclavian artery
2828
Apex of heart is conducted by
Left posterior fasicle
2829
ICD for
Left bumble branch block | With QRS complex greater than 150
2830
Atrial arrhythmias can lead to
Inappropriate ICD firing
2831
IABP cycling is triggered by the
R wave of the ecg
2832
Contraindications to IABP
Platelet count<50000, active stroke, severe AI, active bleeding
2833
Amionester local anesthetic more likely allergy than
Aminoamide
2834
Sulfites are added to local anesthetics to stabilize
Vasoconstricting agents like epi
2835
Methylparaben preservative can lead to
Anaphylactoid rxn
2836
Cocaine is a local anesthetic reversibly blocks the flux
Of sodium ions Norepinephrine reuptake inhibitor
2837
Cocaine has led to
Ruptured aortic aneurysms Infective endocarditis Vascular thrombosis
2838
NSAIDs block
Cox which enhance prostaglandin production They have a ceiling effect for pain control
2839
Water freely moves across the
BBB
2840
Atropine doses cross
BBB and causes sedation | Glycopyrolate does not
2841
Can’t give which drug IM as it causes local ischemia and tissue necrosis
Norepinephrine
2842
Phenylephrine direct alpha 1 that causes more
Venoconstriction>arterial constriction
2843
Midazolam can interfere with placement of
Deep brain stimulator Propofol affects MERs as well but is rapidly titratable
2844
Lumbar plexus block spares the
Sciatic nerve which does muscles that do planterflexion at the ankle It does block femoral obturator and lateral femoral cutaneous nerves
2845
Newly diagnosed hyperthyroidism
See elevated thyroid hormone binding ratio
2846
Resting LV systolic function is not affected by
Aging in most studies Plasma catecholamines are significantly elevated
2847
Rocuronium
25-30% renally excreted | Not affected by renal failure
2848
Decrease in fresh gas flow
From semi closed to closed circuit As more fresh gas is injected into the system, it causes less vaporizer gas so u rebreather less Closed circuit causes more rebreathing of gas C02 levels still go down with scavenging
2849
Conus medullaris =
Terminal end of spinal cord Ends at L3 in newborns and sural sac at S3 In adults ends at L1 and Dural sac at S1
2850
TAP block
Intercostal, subcostal, ilioinguinal, iliohypogastric
2851
Succ in kids causes
Bradycardia Can give atropine before in patients<1
2852
Monoclonal anti Ige antibody
Omalizumab
2853
Most common periop neuropathy is
Ulnar Keep hand and forearm supinate to prevent injury
2854
Double peak is common in capnography who have received
Single lung transplant
2855
Capnogram does not return to 0 during inspiration
When expiratory valve is incompetent
2856
Discogenic low back pain
Pain increases with sitting
2857
Morning stiffness
Ankylosis spondylitis
2858
GBS is associated with SIADH which causes
Hyponatremia Ileus LP shows increased protein with normal cell count and glucose in CSF Associated with DVT as well
2859
Cornula placenta predisposes to
Breech fetal presentation
2860
First order kinetics is a
Constant fraction not a constant amount per unit time
2861
Administration of glucose containing crystalloid is not recommended in
Adult burn pts
2862
Coma No brainstem reflexes Apnea for
Brain death
2863
Static compliance is measured without
Gas flow Inspiratory gold is an example of static compliance Tidal volume/Pplat-PEEP
2864
No lung sliding and no B lines think
Pneumothorax
2865
TEE then precordial Doppler are best for looking at
Venous air embolus
2866
Inspiration less with
Poor patient effort
2867
Pregamglionic nerve fibers of upper extremity originate from
First four or five thoracic spinal segments
2868
Precurization with non depolarizing blocker clearly reduces
Fasiculations before giving succinylcholine
2869
First degree relative
Leads to more increase graft vs host disease
2870
Latex allergy
Avocado, banana, kiwi, pineapple, mango Tropical fruits
2871
Spinal block can fail if
Maternal obesity Late labor epidural placement Moving from epidural to spinal does not cause this but can lead to high spinal
2872
Beer measure of plt function
Optical aggretometry
2873
Medial arch of foot is
Saphenous nerve. Passes anterior to medial malleolus
2874
Hyperparathyroidism leads to
Skeletal muscle weakness due to hypercalcemia Hypercalcemia often leads to hypertension Shortens at interval
2875
Communication between physician and attorney are almost always
Privledged
2876
Phosgene leads to
Pulmonary damage
2877
Gel filled mattresses for
Hypothermia can be transferred easily
2878
Most heat loss is due to radiation and can be fixed by
Warming the room
2879
As flow through rotameter increases so does the
Cross sectional area of the orifice around the rotameter
2880
Neuromuscular blocking agents effect
EMG signals
2881
Ach can affect
Post synaptic receptors at motor end plate to obliterate emg signal
2882
Type 2 pneumocytes produce
Surfactant which helps reduce atelectasis
2883
Carbon dioxide cylinder is
Gray
2884
Nitrogen cylinder is
Black
2885
Treacher Collins
50% of these patients have hearing loss OSA common Hard to ventilate/intubate
2886
Oscillations in BP occur during
Deflation. Highest oscillation is the MAP
2887
Electromechanical pressure transducer is needed for
Invasive arterial monitoring
2888
National practitioner database reports
Any malpractice payment made by an insurer on behalf of an individual physician
2889
Path of motor evoked potential
Lower limb capsule to internal capsule to brainstem to corticospinal tract to peripheral nerve
2890
Prevent post op ileus with
Sympathetic activity inhibits bowel motility and the surgery itself interrupts normal basal activity, and opioids May also lead to postop Ileus Almovopan can help with postop ileus
2891
U2
Respiratory depression, miosis, reduced Gi motility
2892
Precedex as low as
.15 mcg per kilo has been shown to reduce postop delirium in children
2893
Postpartum period leads to exacerbation of
MS
2894
Avoid succ in MS can lead to
Hyperkalemia
2895
Pataloglossus is innervated by
Vagus nerve
2896
Most affected dermatome from herpes zoster
Thoracic
2897
Hypophosphatemia leads to
Dysfunction of the skeletal muscles Lack of atp
2898
Refeeding syndrome
All eclectrolytes are low but you get hyperglycemia
2899
Terbutaline can cause
Hyperglycemia Tachycardia Hypokalemia
2900
LV diastolic dysfunction usually goes with
LV hypertrophy
2901
Increase LES tone to block aspiration prophylaxis with
Metochlopramide - antidopaminergic agent Iv form usually acts within 1-3 min Helps with gastric emptying
2902
MLT tube leads to
Increased length of tube Mlt tube is not safe with lasers
2903
1.5 Mac and permissive hypercapnia leads to
Higher CBF to CMR ratio Volatile anesthetics increase CBF and decrease CMR
2904
Brain gets
15% of cardiac output with blood flow approx 50ml/100g/min
2905
N20 increases
CBF and CmR
2906
Propofol and hypothermia decrease
CMR
2907
When a patients intrinsic HR is higher and set pacemaker with lower HR and in asynchronous mode can lead to
R on T leading to V tach or V fib
2908
Morphine can have an analgesic duration of action of
4 hours
2909
Alfentanyl is unionized with
Low pka
2910
FRC and TLC you cant get from
Spirometry
2911
Fenoldopam causes increase in
Renal perfusion | Selective dopamine 1 agonist
2912
Obesity leads to big reduction in
Expiratory reserve volume
2913
Angiotensinogen is made in the
Liver
2914
ACE cleaves
Angiotensin 1 to 2 and is made in the lungs
2915
Platelets are released from megakaryocytes which are released from the
Bone marrow
2916
IgA blood to patient who is iga deficient
Leads to transfusion rxn
2917
CVP is the pressure in the right atrium and does not change much in
Pregnancy
2918
SVR decreases in a normal pregnancy by about
15%
2919
V wave
Increased venous return and systolic return to right atrium
2920
Normal CVP
2 to 8 mm Hg
2921
Total spinal in neonate first step is
Intubation | Usually leads to apnea/respiratory depression
2922
Thiazides increase reabsorption of calcium in distal convoluted tubule leading to
Worsening hypercalcemia
2923
Bladder distention can lead to
HTB intraop
2924
Activation of NMDA receptor increases intracellular calcium which acts as a
Signaling pathway
2925
Carotid body chemoceptors are primarily responsive to
Reductions in arterial partial pressure of oxygen
2926
Buffering of excess hydrogen ions is why bicarbonate is low in
High anion gap metabolic acidosis
2927
Renal failure causes metabolic acidosis bc kidney usually excretes hydrogen ions into extracellular fluid but this mechanism
Is messed up in renal failure
2928
If patient is stable after aspiration episode
Suction the endotracheal tube
2929
Vascular rings are a sign of
Right sided aortic arches
2930
Milrinone is a
PDE3 inhibitor that increases inotropy
2931
Milrinone causes venodilation which
Decreases preload
2932
Optimum rostrel level of sensory block for c section is at
T4-S4
2933
Second stage of labor need to cover
S2-S4
2934
Aspirin blocks formation of
Thromboxane A2
2935
About 10% of platelets come back each day after
Aspirin is stopped
2936
Eliquis
Direct factor 10a inhibition
2937
Inhaled nitric oxide
Pulmonary vasodilator
2938
Max recommended dose of tumescent lidocaine is
55mg/kg
2939
0.055 mg/kg is max dose of
Epinephrine
2940
Phantom limb pain is a type of
Neuropathic pain
2941
Don’t give carboprost if pt has
Asthma
2942
Increases in metabolic activity of fetus will use oxygen
And decrease amount of oxygen transferred to the fetus
2943
Fetal hgb is
Left shifted
2944
During acidic situations oxygen binds hemoglobin
Less tightly
2945
A side effect of PGE1 is
Apnea
2946
PGE1 can open a
Closed ductus arteriosus
2947
Maternal ace inhibitor usage is associated with
Oligohydraminos
2948
Carbon monoxide poisoning will show
Metabolic acidosis with a normal Pa02 and a falsely elevated Sa02
2949
Hyperchloremic non anion gap acidosis due to
Diarrhea
2950
Dobutamine is good if patient is
Hypotensive
2951
Cardiogenic shock failure of one or both ventricles
Leads to increased preload and inadequate ejection of end diastolic volume
2952
Dopamine can lead to
Tachyarhythmia
2953
Dobutamine increases cardiac output and decreases afterload with minimal increase in myocardial oxygen demand so it is good for
Cardiogenic shock
2954
Don’t use volatile anesthetics or succinylcholine in kids with
Psuedohypertrophic myscular dystrophy
2955
Avoid volatile anesthetics in muscular dystrophy
Can lead to rhabdomyolysis
2956
Codeine must be
Metabolized to exert its effects Metabolized to morphine with CYP2D6
2957
High bilirubin with normal AST goes with
Large hematoma absorption
2958
Elevations in AST Less than 2 times normal unlikely to cause
Postop hepatic dysfunction
2959
Pousielle law
To the fourth power Doubling radius will increase flow 16 fold
2960
High pressure/low viscosity and short tubing lead to
Slower flow rates
2961
Nicardipine has a prolonged half life in
Liver disease Nicardipine is a calcium channel blocker
2962
Nicardipine decreases
SVR and is a good coronary and peripheral dilator Increases cardiac contractility Renal insuffiency has no effect on nicardipine
2963
Lead 2 is in between
Red and white electrode Left leg and right arm
2964
Lead 3 is between left leg and left arm
Black and red
2965
Nitroglycerin first line in female not anesthesized for
Retained placenta
2966
Coiling cables very high risk for
Thermal injury
2967
Use of nonferrous cables and fiberoptic cables lowers risk of
Injury during mri
2968
Renin release is increased in
Cirrhotic patients
2969
Dyspnea while sitting
Platypnea
2970
Need to monitor patient for
4-5 hours post racemic epinephrine
2971
A sympathetic response is seen initially with
Hypoxemia followed by bradycardia
2972
Continued use of opioids despite adverse consequences is
Addiction
2973
Labetalol is much more beta to alpha
7 to 1 ratio
2974
Normal ly30 is 6%
If too high need to give txa which is an antifibrinolytic bonding plasmin effectively decreasing breakdown of fiber
2975
DHCA
Continue bypass for 20 minutes past to make sure neural tissues are cooled
2976
Forced elbow extension
Leads to median nerve injury
2977
Abduction of the arm too far leads to
Stretching of axillary neurovascular bundle
2978
Too much cycling of bp cuff leads to
Radial nerve injury
2979
Lidocaine is a weak base
Put in a basic solution will keep liocaine mainly unionized
2980
TPN causes
Hyperglycemia
2981
Decreasing glucose to lipid ratio of TPN leads to
Less incidence of steatosis and hypoglycemia after stopping TPN Need to monitor glucose levels when giving TPN
2982
Polycystic kidney disease first get
CT angiogram to screen for intracranial aneurysms
2983
Hypochloremic metabolic alkalosis from
Loop and thiazide diuretics
2984
Best for synthetic function of the liver is
Prothrombin time
2985
24 hours to giving
Intrathecal morphine
2986
AS patients like
Increased preload
2987
Bolus dosing for propofol
Lean body mass
2988
Baclofen pump is used to treat
Muscle spasm
2989
Rocuronium dosing should be based
On ideal body weight
2990
Hypokalemic periodic paralysis is caused by a
Calcium channel defect High glucose leads to it bc will release more insulin and lower the potassium
2991
Infants larynx is at
C3-C4 C4-c5 in adults
2992
Lower than expected
Fi02 if crack in o2 cylinder
2993
Lateral cricoarytenoid for
Adduction
2994
Thyroid cartidledge
Atoms Apple
2995
Increases in metabolic activity of fetus will use oxygen
And decrease amount of oxygen transferred to the fetus
2996
Fetal hgb is
Left shifted
2997
During acidic situations oxygen binds hemoglobin
Less tightly
2998
A side effect of PGE1 is
Apnea
2999
PGE1 can open a
Closed ductus arteriosus
3000
Maternal ace inhibitor usage is associated with
Oligohydraminos
3001
Carbon monoxide poisoning will show
Metabolic acidosis with a normal Pa02 and a falsely elevated Sa02
3002
Hyperchloremic non anion gap acidosis due to
Diarrhea
3003
Dobutamine is good if patient is
Hypotensive
3004
Cardiogenic shock failure of one or both ventricles
Leads to increased preload and inadequate ejection of end diastolic volume
3005
Dopamine can lead to
Tachyarhythmia
3006
Dobutamine increases cardiac output and decreases afterload with minimal increase in myocardial oxygen demand so it is good for
Cardiogenic shock
3007
Don’t use volatile anesthetics or succinylcholine in kids with
Psuedohypertrophic myscular dystrophy
3008
Avoid volatile anesthetics in muscular dystrophy
Can lead to rhabdomyolysis
3009
Codeine must be
Metabolized to exert its effects Metabolized to morphine with CYP2D6
3010
High bilirubin with normal AST goes with
Large hematoma absorption
3011
Elevations in AST Less than 2 times normal unlikely to cause
Postop hepatic dysfunction
3012
Pousielle law
To the fourth power Doubling radius will increase flow 16 fold
3013
High pressure/low viscosity and short tubing lead to
Slower flow rates
3014
Nicardipine has a prolonged half life in
Liver disease Nicardipine is a calcium channel blocker
3015
Nicardipine decreases
SVR and is a good coronary and peripheral dilator Increases cardiac contractility Renal insuffiency has no effect on nicardipine
3016
Lead 2 is in between
Red and white electrode Left leg and right arm
3017
Lead 3 is between left leg and left arm
Black and red
3018
Nitroglycerin first line in female not anesthesized for
Retained placenta
3019
Coiling cables very high risk for
Thermal injury
3020
Use of nonferrous cables and fiberoptic cables lowers risk of
Injury during mri
3021
Renin release is increased in
Cirrhotic patients
3022
Dyspnea while sitting
Platypnea
3023
Need to monitor patient for
4-5 hours post racemic epinephrine
3024
A sympathetic response is seen initially with
Hypoxemia followed by bradycardia
3025
Continued use of opioids despite adverse consequences is
Addiction
3026
Labetalol is much more beta to alpha
7 to 1 ratio
3027
Normal ly30 is 6%
If too high need to give txa which is an antifibrinolytic bonding plasmin effectively decreasing breakdown of fiber
3028
DHCA
Continue bypass for 20 minutes past to make sure neural tissues are cooled
3029
Forced elbow extension
Leads to median nerve injury
3030
Abduction of the arm too far leads to
Stretching of axillary neurovascular bundle
3031
Too much cycling of bp cuff leads to
Radial nerve injury
3032
Lidocaine is a weak base
Put in a basic solution will keep liocaine mainly unionized
3033
TPN causes
Hyperglycemia
3034
Decreasing glucose to lipid ratio of TPN leads to
Less incidence of steatosis and hypoglycemia after stopping TPN Need to monitor glucose levels when giving TPN
3035
Polycystic kidney disease first get
CT angiogram to screen for intracranial aneurysms
3036
Hypochloremic metabolic alkalosis from
Loop and thiazide diuretics
3037
Best for synthetic function of the liver is
Prothrombin time
3038
24 hours to giving
Intrathecal morphine
3039
AS patients like
Increased preload
3040
Bolus dosing for propofol
Lean body mass
3041
Baclofen pump is used to treat
Muscle spasm
3042
Rocuronium dosing should be based
On ideal body weight
3043
Hypokalemic periodic paralysis is caused by a
Calcium channel defect High glucose leads to it bc will release more insulin and lower the potassium
3044
Infants larynx is at
C3-C4 C4-c5 in adults
3045
Lower than expected
Fi02 if crack in o2 cylinder
3046
Lateral cricoarytenoid for
Adduction
3047
Thyroid cartidledge
Atoms Apple
3048
Sympathetic stimulation leads to sharper phase 4
Causing quicker depolarization
3049
Phase 0
Calcium channel opening
3050
Patients hypoxic ventilator drive is run by
Glossopharyngeal nerve
3051
Carotid bodies respond to
Afferent body of CN 9 for acute hypoxia
3052
Cerebral vascular dilation will occur when using
Sodium nitroprusside
3053
APRV can lead to
Hypercarbia if patient not spontaneous
3054
Variable intrathoracic airway obstruction such as mediastinal mass leads to
Plateaued expiratory flow
3055
Mediastinal mass
Intrathoracic airway obstruction
3056
Inspiration is
Going down on flow volume loop
3057
Goiter
Extrathoracic airway obstruction
3058
Cyclosporine prolongs
Neuromuscular blockade the most out of the immunosuppressants
3059
AKI following cardiac surgery
Preop creatinine greater than 1.2 Combined valve and bypass Emergency surgery Preop iabp
3060
Lumbar nerve roots exit the
Same numbered pedicle Cervical nerve roots exit above the last vertebra. Seven vertebrae and 8 nerves
3061
Esmolol is metabolized by
Red cell esterases
3062
Trans pulmonary pressures highest in
Restrictive lung disease
3063
Ester local think
Parabenzoic acid
3064
Low sodium in blood with
Cerebral salt wasting
3065
Lumbar sympathetic blocks for cprs
Lead to failure with ejacylation
3066
TPN common to see
Hyperglycemia hypercarbia hypophosphatemia
3067
Airway reflexes under ketamine are
Maintained
3068
ASIS is palpated for accurate placement of
Lateral femoral cutaneous Block
3069
Klippel Feil syndrome in newborn
Cervical spine fusion
3070
Endocardial cushion defects
Trisomy 21
3071
Glycine toxicity causes
Hyperammonia
3072
Two days of smoking cessation
Decreased carboxyhemoglobin Shifts oxyhemoglobin curve to the right
3073
Tracheobronchial fistula
Inhalational induction
3074
Volatile anesthetics
Decrease CMR even at 1 Mac
3075
Don’t use mannitol for
Cardiogenic pulmonary edema
3076
Cyanide toxicity give
Hydroxocobalamin
3077
Large quantities of blood products containing sodium citrate can lead to
Metabolic alkalosis
3078
Angiotensinogen 2 increases GFR by causing
Efferent arteriole constriction
3079
Renin hydrolyzes angiotensinogen into
Angiotensin 1
3080
90% stenotic lesion of PDA leads to
AV nodal blockade
3081
Preop vital capacity less than 2.9 L correlates with post op ventilation needs in those with
Myasthenia gravis
3082
MG
Non activating antibodies bind to post synaptic ACH receptors at the neuromuscular junction Very sensitive to NMDB but resistant to succ
3083
Pyloric stenosis
All electrolytes are down including Sodium
3084
Before pyloric stenosis case put in
Og tube and suction out stomach
3085
Bag inlet valve is a one way valve that allows
Air as well as fresh gas to flow into bag reservoir as it Reexpands
3086
Venous drainage provides most the blood to
Liver through portal vein 75% of Livers blood supply
3087
Hepatic artery is made up of
Lobules. Liver metabolizes nutrients. Bile produced and goes into bile duct and all form common bile duct
3088
Liver failure
Porto pulmonary hypertension Hepatipulmonary syndrome Coagulation abnormality Renal etc
3089
Liver sometimes doesn’t metabolize
Nitric oxide leading to pulmonary HTN
3090
Liver patients can be
Hypo or hypercoaguable
3091
More ammonia due to liver failure can lead to
Hepatic encephalopathy
3092
Dissection Anhepatic Reperfusion Neohepatic phases of
Liver transplant
3093
Dissection phase
Usually elevated INR, low Hgb, low plts, other issues. Lots of hemodynamic instability
3094
Anhepatic phase
Give steroids which increase glucose but gluconeogenesis stops
3095
Most hemodynamic instability during
Reperfusion phase
3096
Referring syndrome
Starting to feed after prolonged starvation
3097
HFJV causes
Passive expiration for very short period leading to Autopeep
3098
Need TIVA with HFJV because can’t use
Inhalational anesthetic
3099
Wind up phenomonen is due to repetitive stimulation of
Peripheral C fibers | Leads to increased action potentials in spinal synapse
3100
Allodynia
Painful response to nonpainful stimulus
3101
Sural nerve is a division of the
Tibial nerve
3102
Tibial divides into
Posterior tibial and the sural nerves
3103
Deep peroneal nerve is blocked at
Dorsum of food. Innervates between first and second toes
3104
Saphenous is a branch of the
Femoral nerve
3105
PEA
Start CPR and give epi as soon as possible
3106
Atropine is not indicated in
Cardiac arrest
3107
Hypocarbia from hyperventilation can lead to
Hypocalcemia
3108
Centrifugal pump flow varies depending on pump
Preload/Afterload
3109
Rheumatoid Arthritis goes with
Mitral regurgitation
3110
Primary hyperaldosterone
Hypokalemic metabolic alkalosis
3111
Aldosterone is made in the
Zona glomerulosa
3112
Etomidate is associated with
30-40% nausea and 70% incidence myoclonus
3113
Pain on injection is common with
Etomidate
3114
Volume control ventilation
Breath at a constant flow rate
3115
Latex causes
Type 1 ige mediated reaction Most significant is through mucosal exposure
3116
Latex allergy has delayed onset of
30 minutes
3117
Succ almost always causes
Bradycardia in pediatric patients. Pretreat with atropine
3118
Tense ascites leads to
Restrictive lung disease The FEV1 and FVC are both decreased both ratio is normal FEF25-75% will be normal
3119
Decreased beta receptor responsiveness with
Age
3120
Amionamides cause anesthetic rxn from more likely the
Preservative than the anesthetic itself
3121
Thiazide induced blockade of sodium entry entry enhances
Na Ca antiporter activity and increases overall resorption of calcium
3122
Thiazides work at the
Distal convoluted tubule
3123
Carbonic anhydrase acts on
Proximal Convoluted tubule
3124
Digoxin toxicity is caused by hypokalemia
Hypokalemia bc digoxin competes with potassium
3125
Stellate ganglion block seizure due to
Vertebral artery injection
3126
Bupivicaine
Potent lipid soluble agent that easily crosses BBB and can cause CNS toxicity
3127
SEM
SD/sqrt(n)
3128
Medial to lateral in ac fossa
Median nerve, brachial artery, radial nerve
3129
FFP if can’t get the
ACT high enough. Give two to three units FFP which has AT3
3130
COPD results in flow volume loop with expiratory phase with
Quick peak followed by a much lower plateau phase
3131
Acute MR due to
Posteromedial papillary muscle rupture
3132
AsMR progresses increases in HR will decrease
Left Atrial distension since they reduce regurgitant volume. Avoid bradycardia
3133
Magnesium most potentiates neuromuscular
Blockade
3134
Phenytoin acutely potentiates
Neuromuscular blockade
3135
No Coumadin to
Pregnant women
3136
Anyone taking steroids preop should continue them in
Perioperative period
3137
Spinal anesthesia has faster block onset in infants
Due to higher cardiac output and loose myelination
3138
Lambert Eaton
Proximal muscle weakness better with movement Antibodies to presynaptic calcium channel do less AcH release
3139
Aging see increased
Residual volume
3140
Doubling distance from radiation source decreases exposure to
1/4 the original
3141
Phenelzine and meperidine lead to
Serotonin syndrome
3142
Thyroid storm usually takes place
A few hours after surgery is done
3143
660L for 2200 psig for
Oxygen tank
3144
Nitrous inhibits
DNA synthesis
3145
Hepatic arterial vasodilation in response to
Reduced portal venous flow
3146
Liver gets
20-25% of cardiac output
3147
Nitric oxide has no role in the
Hepatic arterial buffer response
3148
Intercostobrachial nerve from
T2 nerve root and is not blocked by any of the brachial plexus nerve blocks Does sensation your upper medial arm
3149
Plasmin leads to
Removal of thrombus
3150
Aminocaproic acid is an antifibrinolytic
And prevent plasmin binding Prevents bleeding
3151
Argatroban inhibits
Thrombin
3152
In fontan venous circulation bypassed the heart to reach
The lungs
3153
Milrinone causes smooth muscle vasodilation by increasing
Intracellular cAMP levels
3154
Grade 3 view you see
Only epiglottis Grade 4 you can’t see eiglottis
3155
High protein binding of bupivicaine prevents
Placental transfer
3156
Ionized and more protein bound drugs go
Less into the placenta
3157
Hoffman elimination is a
PH and temp related process Proceeds more rapidly when pH and temp are higher
3158
Glycopyrolate causes
Pupillary dilation
3159
Loss of fetal heart rate variability is an early sign of
Fetal hypoxia
3160
Most cancer related pain due to
Tumor invasion and metastatic tumor formation
3161
Preeclampsia
Elevation in thromboxane A2 levels Decrease in prostacyclin leading to Primarily vasoconstricted state
3162
Full term newborn blood volume
80-90 ml/kg
3163
Lateral ankle covered with
Sciatic nerve block Sciatic covers posterior thigh sensation and all the leg below the knee Doesn’t do medial strip supplied by the saphenous
3164
Butorphanol
Mixed mu opioid receptor agonism and antagonist plus kappa receptor agonism
3165
Methadone
Mu opioid receptor agonist and NMDA antagonist
3166
Morphine improves coronary perfusion through
Reduction in preload and a reduction in end diastolic pressure in the ventricles
3167
Preload is ventricular volume at end of
Diastole
3168
Morphine reduces
Preload and afterload
3169
PDA blood will flow preferentially to the
Lungs
3170
Newborn experiences a mild and transient anemia at
8-12 weeks of life
3171
Opioids staying in epidural space mainly due to
Lipophilicity. More lipophilic will stay at the level of injection
3172
Forceps delivery a risk factor for
HIV vertical transmission
3173
Jaw thrust maneuver affects
Genioglossus muscle
3174
Amniotic fluid embolus leads to
Intense pulmonary vasospasm
3175
Manual replacement of bulging membranes prior to induction is not recommend as may increase risk of
Premature rupture
3176
Ischemia reperfusion injury during liver transplant surgery is due to
Alteration of the sodium potassium pumps to maintain ion gradients
3177
Termination of a bolus dose of thiopental mainly due to
Redistribution of the drug from the brain to the peripheral tissues
3178
CT scan during strike should get within
25 minutes and interpretation within 45 minutes
3179
Refractory v fib despite multiple rounds of CPR and rounds of epi and defibrillation next consider
Amiodarone
3180
Administration of anticholinergic medication such as
Benztropine or diphenhydramine quickly and reliably treats eps symptoms from antidopaminergics
3181
If refractory to vasopressors with septic shock can give
IV hydrocortisone 200mg daily
3182
Hydrocortisone inhibits nitric oxide
Synthesis
3183
Second order neuron for pain goes with
Spinothalamic tract
3184
Lumbar sympathetic block for
First stage of labor
3185
Mechanism of action of midazolam
Positive allosteric modulator of GABAA receptor
3186
Only hard palate is seen if
Mallampati 4
3187
Increased ICP can use
Etomidate to induce
3188
Never hyperventilate to PaC02 below
25, even with high ICP
3189
CPP =
CBF-ICP or CVP whichever is greater
3190
Amiodarone commonly causes
Bradycardia
3191
Lactic acidosis most likely seen in a
Hypovolemic trauma patient getting contrast
3192
Transfusion is for
Inadequate oxygen delivery
3193
Citrate is anticoagulant binding
Calcium in blood
3194
Blood stored at
1 to 6 degrees Celsius
3195
Definition of viability of RBCs is greater than
70% to survive and function after being transfused first >24 hours
3196
Most common blood type is
Group O
3197
Alloantibodies are antibodies to
Foreign antigens
3198
If you give two units o negative
Stay with O negative
3199
Platelets are activated
To start a clot
3200
Fibrinolysis
Remodels clot and removes thrombus
3201
Only factor not made by liver is
8
3202
ACT
90-120 seconds is normal
3203
Physiologic changes to anemia
Cardiac output increases with decreased SVR increased HR Oxygen availability increased at cellular level by increased DPG levels Shunting of blood to core organs
3204
Hgb mine portion of
Oxygen equation
3205
Can’t wash cells if
Infection, urine, amniotic fluid, malignancy
3206
10K to 50K platelets
Spontaneous bleeding likely
3207
VwF
Due to platelet dysfunction but platelet number is good
3208
MTP
1 plt 1 FFP 1 prbc
3209
Citrate intoxication
Hypocalcemia Treat with calcium
3210
TRALI
Most common acute transfusion rxn
3211
Most blood rxn due to
Giving wrong blood to wrong patient
3212
Contractility compromised by
Myocardial dysfunction or acidosis
3213
Afterload equals
Resistance against ventricular blood flow with each contraction
3214
Oxygen hemoglobin has
4 oxygens
3215
Tissue acidosis increases
Oxygen unloading Bohr effect
3216
Resistance to catecholamines after
Too much shock
3217
Hypocapnia with acidosis bc you have to
Breath more to drive off acid
3218
Hyper dynamic system
Hypotension due to decreased SVR
3219
Hypodynamic state due to
Decreased CO with compensation by increasing SVR
3220
3-7 days post LAD infarct can lead to
Papillary muscle rupture
3221
Isolated RV infarcts are
Rare Treat with fluid and inotropy rather than pressors
3222
Inhalation equals negative pressure and decreased intrathoracic pressure
More fluid in right heart
3223
RA collapse with
Tamponade during systole
3224
PE
``` Pleuritic chest pain Tachycardia Hypoxemia Respiratory alkalosis RV strain ```
3225
Best for treating hypotension in setting of severe acidemia
Vasopressin
3226
SV02 90% least appropriate is
Milrinone | Don’t want to decrease SVR more
3227
Myocardial 02 consumption most work for heart is in order
HR then afterload then Preload
3228
Secondary hyperaldosteronism
Increased renin
3229
Spirnolactone
Potassium goes up | Antigypertebsive by blocking aldosterone
3230
Intraop steroids needed if
Prednisone 20mg or more for greater then 3 weeks If minor surgery just take morning dose Major give morning dose plus 100mg hydrocortisone
3231
Ephedrine stimulates
Catecholamine release
3232
Carcinoid rumors release
Vasoactive substances such as serotonin/histamine
3233
Carcinoid tumors are mainly found in
GI tract
3234
Serotonin causes
Vasoconstriction and possible coronary artery spasm
3235
Serotonin metabolites in
Urine for carcinoid
3236
Pancreatic pituitary parathyroid =
MEN type 1
3237
Elevated fasting blood glucose >126 | A1C > 6.5%
Diabetes
3238
Tachypnea Abdominal pain Nausea vomiting with
DKA Due to low insulin and catabolism of free fatty acid
3239
DKA and HHS
Fluid resuscitation insulin and potassium to treat
3240
Carcinoid disease you should get an
ECHO
3241
RASS system blocked when chronically taking
Corticosteroids
3242
Fluid status and thus CVP generally stays normal
With adrenal suppression
3243
Septic patient induced with etomidate can get
Adrenal insufficiency
3244
Increased MAC at
High atmospheric pressure
3245
At higher atmosphere
Reduced ambient pressure Reduced partial pressure Reduced gas density
3246
High altitude PVR
Goes up
3247
Lead V5 best for detecting
Ischemia
3248
Arterial hypoxemia
Hypoventilation Diffusion impairment Shunting
3249
Major predictor of cardiac risk
Unstable coronary syndromes AcuteMI within last seven days or recent MI within 1 month with clinical symptoms Decompebsated heart failure Significant arrhythmias Severe valvular disease like <1 cm for severe aortic stenosis
3250
Three major determinants of myocardial oxygen demand are
Myocardial LV wall tension(preload/afterload) Cardiac contractility HR
3251
Meralgia paresthetica
Mono therapy of the lateral femoral cutaneous nerve
3252
TNS associated with
Spinal Bilateral or unilateral pain in the buttocks radiating to the legs and resolving within one week or less
3253
Deceased breath sounds on the right in Peds after aspirating foreign body
Aspiration
3254
Croup mainly caused by
Parainfluenza or RSV
3255
Congenital muscular dystrophy
Hypotonia, feeding difficulty, respiratory dysfunction
3256
In abscence of hemorrhage can wait up
To an hour for placenta to deliver
3257
Retained placenta is second most common cause of PPH
25% of cases Most common is uterine atony
3258
Mannitol containing priming solutions used in CB bypass is found to
Improve urine output
3259
Esophageal perforations need to be treated with
Medical or surgical intervention even if vitals are stable
3260
Hypercalcemia antagonizes NMDBS so need a
Higher dose
3261
Category data best for
Chi square test Shows goodness of fit if data from chance alone
3262
Most important predictor of desaturation on one lung is
Pa02 with two lung
3263
Laryngeal edema causes stridor
Post extubation Laryngeal edema from pressure of endotracheal tube on the mucosa
3264
Superior laryngeal nerve
Innervated the cricothyroid muscle
3265
Registry studies
Describe rare events
3266
Most likely cause of shivering during labor in a patient with a epidural is
Redistribution of core heat to the periphery
3267
Prejunctional is nerve related
Post junctional is muscle related
3268
More ACHrs in burn patients so need to give more
NMDBs
3269
Glaucoma due to increased
IOP Zofran is safe
3270
Open globe eye injury avoid increases in IOP so don’t use
Succinylcholine Unless difficult airway
3271
Hepatopulmonary triad
Liver dysfunction, otherwise unexplained hypoxia, and intrapulnknary vascular dilation
3272
Alpha 1 antitrypsin deficient affects
Lung and liver
3273
Ketamine enhances
Motor evokes potential amplitude the most
3274
Best indicator of liver transplant graft function is
INR
3275
Which anesthetic potentiates neuromuscular blockade the most
Desflurane
3276
Vital capacity
Unchanged in pregnant women
3277
Quick propagation of electrical signal in cardiac myocyte is due to
Gap junctions
3278
Stage one and two of labor pain can be relieved by
Caudal epidural
3279
Intercostal nerve blocks
One of the highest rates of systemic absorption due to vascularity Low risk of local anesthetic toxicity if blocking one level
3280
Every patient receiving any anesthesia must have
ECG
3281
Acute herpes zoster deratomal distribution is mainly
Thoracic
3282
DLCO looks at
Diffusion capacity of the lung Lowered by PE
3283
Best for cerebral vasospasm after SAH
Cerebral angiography
3284
Most aneurysms occur in the
ICA Small less than 12 mm is most
3285
If CT is negative use what to diagnose SAH
LP
3286
Risk of bleeding after ruptured aneurysm is highest
24 hours after
3287
Cooling of aneurysm big complications are
Hemorrhage or thrombosis
3288
If cool malposiyioned continue anticoagulation
While IR snares the coil
3289
Don’t premeditate before
Craniotomy
3290
Patient at risk of aspiration
Medications to decrease gastric acidity and volume are appropriate
3291
Must prevent rupture of aneurysm on
Induction while maintaining adequate CPP
3292
Done need a line for
Unruptured aneurysm that needs to be coiled
3293
MEPs for
Subcortical ischemia
3294
CPP =
Transmural pressure If too high aneurysm ruptured If too low you get ischemia
3295
Pa02 less than 60 increases
CBF
3296
After Dural opening one of the best ways to decrease ICP is with
Hyperventilation, also helps with surgeon exposure
3297
Trans pulmonary pressures are highest in patients with
Restrictive lung disease such as idiopathic pulmonary fibrosis
3298
Acute mountain sickness best prophylaxis is
Acetazolamide
3299
Preservation of laryngeal reflexes with
Ketamine
3300
Cerebrovascular disease is not associated with
Postop AKI
3301
TRALI within
6 hours | Non cardiogenic pulmonary edema
3302
Heparin acts on
AT3 ``` Heparin resistance if AT3<60% Plt count>300000 LMWH Preop heparin Age>65 ``` Treat again with heparin AT3 or FFP
3303
Improper canning leading to botulism
Equine serum antitoxin
3304
Activation of Nicotinic AcH receptor on motor end plate results in
Inward flow of sodium ions Calcium leads to release of Ach into synapse Calcium ions do not flow through nicotinic AcH
3305
Prolonged steroid leads to
Myopathy and can lead to muscle weakness
3306
Controlled ventilation is not recommended for
Congenital emphysema
3307
Etomidate given as a bolus can help identify
Seizure foci
3308
Etomidate inhibits
11 beta hydroxylase
3309
Albumin down in pregnancy as
Plasma volume goes up
3310
Smoking cessation in first week leads to more
Sputum production
3311
Smoking causes
Vasoconstriction leading to decreased blood flow to certain areas
3312
``` Sodium<= 155 Map 60-120 CVP 4-13 Pa02/Fi02>300 Glucose<150 Hgb>10 Ef>50% ```
Goal for organ procurement after brain death
3313
Succinylcholine induced hyperkalemia
Greater than 0.5 as a result of potassium reflux
3314
Myasthenia gravis
Antibodies against postsynaptic ach receptors
3315
MG usually
Thyroid issues Progressive weakness with activity
3316
MG postop mechanical ventilation
Duration longer than 6 hrs Chronic respiratory disease Pyridostigmine dose greater than or equal to 750 mg Vital capacity less than or equal to 2.9L
3317
Anestgesia dolorosa
Pain in a region that is deenervated with no sensation at all and is a pain referral
3318
Closing capacity is when small airways start to close at
Certain lung volume High CC means small airways close before FRC leading to atalectasis bc the small airways close before end exhalation
3319
Deceased FRC leads fo
Atelectasis
3320
Midazolam does not cause
Drug fever
3321
Exposure to Hep B blood or bodily fluids
Get HBV hyper immune globulin | Also offer vaccination
3322
Only 10% of acute HBV infections progress to
Chronic HBV carrier state
3323
Valproic acid not helping for
CPRS type 2
3324
Cprs type 2 is precipitated by a
Nerve injury Physical therapy is first lint treatment
3325
Hypocalcemia is expected in patients with
ESRD Kidney can’t reabsorb calcium as well
3326
CP patients increased incidence of GE reflux and
Esophagealdysmotility
3327
CP can give
Succ | No big hyperkalemic response
3328
Tachycardia is a universal funding in
Thyroid storm and malignant hyperthermia
3329
Urine sodium is high with
Acute tubular necrosis
3330
Albumin down in pregnancy as
Plasma volume goes up
3331
Smoking cessation in first week leads to more
Sputum production
3332
Smoking causes
Vasoconstriction leading to decreased blood flow to certain areas
3333
``` Sodium<= 155 Map 60-120 CVP 4-13 Pa02/Fi02>300 Glucose<150 Hgb>10 Ef>50% ```
Goal for organ procurement after brain death
3334
Succinylcholine induced hyperkalemia
Greater than 0.5 as a result of potassium reflux
3335
Myasthenia gravis
Antibodies against postsynaptic ach receptors
3336
MG usually
Thyroid issues Progressive weakness with activity
3337
MG postop mechanical ventilation
Duration longer than 6 hrs Chronic respiratory disease Pyridostigmine dose greater than or equal to 750 mg Vital capacity less than or equal to 2.9L
3338
Anestgesia dolorosa
Pain in a region that is deenervated with no sensation at all and is a pain referral
3339
Closing capacity is when small airways start to close at
Certain lung volume High CC means small airways close before FRC leading to atalectasis bc the small airways close before end exhalation
3340
Deceased FRC leads fo
Atelectasis
3341
Midazolam does not cause
Drug fever
3342
Exposure to Hep B blood or bodily fluids
Get HBV hyper immune globulin | Also offer vaccination
3343
Only 10% of acute HBV infections progress to
Chronic HBV carrier state
3344
Valproic acid not helping for
CPRS type 2
3345
Cprs type 2 is precipitated by a
Nerve injury Physical therapy is first lint treatment
3346
Hypocalcemia is expected in patients with
ESRD Kidney can’t reabsorb calcium as well
3347
CP patients increased incidence of GE reflux and
Esophagealdysmotility
3348
CP can give
Succ | No big hyperkalemic response
3349
Tachycardia is a universal funding in
Thyroid storm and malignant hyperthermia
3350
Urine sodium is high with
Acute tubular necrosis
3351
Propofol related infusion syndrome
No thrombocytopenia
3352
Be careful giving vasopressin to patients with CAD as may lead to
Vasoconstriction of coronary arteries
3353
Myssthenic syndrome patients are sensitive to
Succ
3354
Children with strabimus are 4 times more likely to
Demonstrate masseuse muscle rigidity
3355
P= 2T/R
For alveoli bubble
3356
Anatomic dead space is about
2 ml/kg
3357
Dorsal respiratory center mainly for
Inhalation Ventral is for both
3358
Elective case hold for
Sodium>150
3359
Oliguria
0.5 ml/Kg/hr
3360
Anuria
Urine output<50 ml per day
3361
Neural tube defect should be ruled out before placing
Caudal catheter
3362
Preeclampsia associated with an increase in
Thromboxane A2 levels
3363
Lactated ringers lactate can make metabolic alkalosis worse as it is converted to
Bicarbonate
3364
Tachycardia Is only a minor criteria for
Fat embolization syndrome
3365
For diagnosis of ARDS don’t need
Wedge pressure less then 18
3366
Phrenic nerve stimulators are utilized to improve, not worsen
Atelectasis
3367
A child greater then 1yo blood volume
70-75 ml/kg
3368
In line stabilization of cervical spine
One gets head and neck in neutral position | 2 stabilizes the shoulders
3369
Potassium iodide can help with
Radiation exposure
3370
Labetalol is
7 to 1 beta over alpha
3371
Anesthesia dolorosa
Pain in a region that is deenervated and should have no pain at all
3372
Fat embolus does not require
Heparin
3373
Half life of methadone
13 to 50 hours
3374
Methadone does not need to be adjusted with
Kidney disease
3375
Inhaled anesthetics and zofran increase
QT interval
3376
Don’t give hydrocortisone to patient with
Septic shock responsive to fluids and vasopressors
3377
Heparin anticoagulant effect is
90 min
3378
Normal ACT
90 to 120
3379
Tissue thromboplastin is added to patients plasma
PT
3380
Micro vascular bleeding andPT/PTT exceeds 1.5 the control value
FFP should be considered
3381
Cryo lacks factor
5
3382
Severe aspirin toxicity
Dialysis

Areviewbook (12 decks)

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