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1
Q

aASA Levels of Sedation
Minimal Sedation:
Moderate Sedation:
Deep Sedation:
General Anesthesia:

A

Minimal Sedation: normal response to VERBAL stimulation. AIRWAY unaffected. SPONTANEOUS ventilation. CV unaffected

Moderate Sedation: purposeful response to VERBAL or TACTILE stimulation. AIRWAY unaffected. SPONTANEOUS ventilation. CV usually unaffected.

Deep Sedation: purposeful response to repeated or painful stimulation. AIRWAY may be required. SPONTANEOUS ventilation may be inadequate. CV usually maintained.

General Anesthesia: unarousable even with painful stimulation. AIRWAY often needed. SPONTANEOUS ventilation inadequate. CV may be impaired

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2
Q

PONV Medications Simple MOA

Droperidol:
Diphenhydramine/Promethazine:
Aprepitant:
Scopolamine:
Amisulpride
Ondansetron:
Dexamethasone:

A

Droperidol (or haldol): Dopamine antagonist

Diphenhydramine/Promethazine: histamine antagonist

Aprepitant: neurokinin antagonist

Scopolamine: muscarinic antagonist

Amisulpride: dopamine antagonist

Ondansetron: serotonin antagonist

Dexamethasone: corticosteroid (nucleus tractus soltarii)

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3
Q

Dexmedetomidine

MOA:
CNS: CBF, CMRO2
Pulmonary: TV, MV, RR, response to Co2

A

MOA: alpha-2 receptor agonist at locus coeruleus and spinal cord

CNS: decreased CBF, decreased CMRO2

Pulmonary: decreased TV, decreased minute ventilation, RR unchanged, response to CO2 unchanged

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4
Q

Liver Disease Coagulation Factors:

Elevated

Decreased

A

Elevated: VIII, vWF

Decreased: II(Thrombin), V, VII, IX, X, XI, Protein C

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5
Q

Infective Endocarditis Antibiotic Prophylaxis

Conditions:

Surgeries:

A

Conditions: prosthetic cardiac valves, prior IE, valvular heart disease after transplant, unrepaired congenital, repaired CHD, Melody valve or Contegra conduit

Surgeries: no ear piercing, dental procedures, bronchoscopy, GI/GU with active infections, I&Ds skin/MSK, intravascular/intracardiac surgeries

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6
Q

Elective Surgery after BMS vs DES

A

BMS: >30 days
DES: >6 months

*depends on time it takes to endothelialize. BMS must faster due to antirestenotic drug in DES which reduces local neointimal hyperplasia

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7
Q

Rapid normal saline administration

HCO3
CL
Strong Ion
Anion Gap

A

Nonanion gap hyperchloremic metabolic acidosis

HCO3: decreased
Cl: increased
Strong ion: decreased
Anion gap: normal

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8
Q

What nerve mediates the afferent pathway of laryngospasm?

A

Internal branch of superior laryngeal nerve

*sensation to epiglottis, Aryepiglottic folds, Laryngeal mucosa above the vocal cords, and Glands of the larynx

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9
Q

What nerve is primarily responsible for the cough reflex?

A

Internal branch of superior laryngeal nerve

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10
Q

What nerve mediates the efferent pathway for laryngospasm?

A

Recurrent laryngeal nerve.

*The lateral cricoarytenoids, transverse, and oblique arytenoids adduct the vocal cords and close the glottic opening. The vocalis muscles are considered part of the thyroarytenoids, and they tense the vocal cords.

*Unilateral damage = hoarseness
*Bilateral damage = stridor, possible airway emergency

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11
Q

What nerve innervates the cricothyroid muscle?

A

External branch of superior laryngeal nerve

*plays crucial role in voice production

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12
Q

What nerve provides sensory innervation to nasopharynx?

A

trigeminal nerve V

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13
Q

What nerve provides sensory innervation to oropharynx?

A

glossopharyngeal nerve IX

*afferent gag reflex

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14
Q

What nerve provides sensory innervation to larynx above vocal cords?

A

internal branch of superior laryngeal nerve

*afferent cough reflex

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15
Q

What nerve provides sensory innervation to larynx below vocal cords?

A

recurrent laryngeal nerve

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16
Q

Motor innervation to pharynx is mediated via Vagus nerve except what muscle?

A

stylopharyngeus muscle - innervated by glossopharyngeal nerve IX

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17
Q

Which coagulation factor is increased in severe liver dysfunction?

A

VIII (and vWF)

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18
Q

Malignant hyperthermia is inherited in what pattern?

A. Autosomal dominant
B. Autosomal recessive
C. Mitochondrial
D. X-linked recessive

A

A - autosomal dominant with variable penetrance

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19
Q

Hypermagnesemia Symptoms with levels:
1.5-2.5
5-7
7-12
12-15
>15

A

1.5-2.5: normal
5-7: nausea,headache,lethargy,diminished DTR
7-12: ECG changes (prolonged PR, QRS, and QT) absent DTR
12-15: muscle paralysis, respiratory failure, complete heart block
>15: cardiac arrest

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20
Q

Which drugs have synergistic effects with non-depolarizing neuromuscular blockers?

A

lidocaine, volatile anesthetics, antibiotics (aminoglycosides,clindamycin,polymyxin,tetracyclines)

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21
Q

neuromuscular junction action potential influx and efflux:

presynaptic:
postsynaptic:

A

presynaptic: influx calcium, efflux potassium

postsynaptic: influx sodium, efflux potassium

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22
Q

What paraneoplastic syndromes is highly associated with small-cell lung cancer?

A

lambert-eaton
SIADH
ectopic cushing syndrome
PEM/SN (encephalomyelitis/sensory neuronopathy)

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23
Q

what oscillometric measurement is least accurate and overestimated?

A. MAP
B. SBP
C. DBP

A

SBP

*DBP is underestimated

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24
Q

Rightward shift oxyhemoglobin dissociation curve:

“CADET face right”

A

C - carbon dioxide increase
A - acidosis
D - 2,3-Diphosphoglyceric acid (chronic anemia, CHF)
E - exercise
T - temperature increase

*cadets like to unload their guns - more oxygen unloading

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25
Sulfhemoglobinemia (green black blood) causes a _____ shift in the oxyhemoglobin dissociation curve
rightward *carboxyhemoglobin (bright red blood) and methemoglobin (chocolate brown blood) cause a leftward shift
26
Type I Protamine reaction is mediated by ______ or _____ administration
histamine release; rapid *isolated hypotension; normal airway pressures; normal filling pressures
27
Type II Protamine reaction is mediated by ____, ___ antibodies and _____ activation
IgE, IgG; complement *features of anaphylactic or anaphylactoid reactions
28
Type III protamine reaction is mediated by ______
thromboxane A2 *large heparin-protamine complexes lodge in pulmonary circulation causing high pulmonary artery pressures, right ventricular failure
29
____ is a independent risk factor for a protamine reaction
NPH insulin use
30
All of the following are indications for RSII EXCEPT A. GA >20 weeks B. Ascites C. Morbid Obesity (BMI>40) D. well controlled GERD
D. GERD - indication only with active reflux, hiatal hernia, or endoscopic evidence *also esophageal cancer, stricture, SBO, gastroparesis, trauma
31
TCAs and SNRIs ____ analgesic effects of morphine and ____ morphine tolerance
Increase; decrease
32
Intercristal line is used to identify which vertebrae?
L4/5 Inter laminar space
33
I cells in the _____ secrete hydrogen or bicarbonate ions
Collecting tubule *play role in acid base in body *aldosterone acts on cortical collecting tubule
34
P cells in the collecting tubule reabsorb ___ and secrete _____
Sodium; potassium
35
The half life of labetalol is approximately ______ while the duration is _________
6 hours; 16-18 hours
36
Beta blockers: Non selective: B1 selective: Mixed a,b:
non selective: propranolol, nadolol B1 selective: metoprolol, atenolol, nebivolol, bextaxolol, acebutolol, bisoprolol, esmolol Mixed: carvedilol, labetalol
37
What ion enters the neuron when GABAa receptors are activated?
chloride *glycine is also an inhibitory neurotransmitter resulting in influx of chloride to hyperpolarize action potential
38
RAAS Pathway 1. Renin 2. Angiotensinogen 3. Angiotensin 1 4. Angiotensin 2 5. Aldosterone
When blood pressure drops, the kidneys release renin into the bloodstream. 1. Renin released from juxtaglomerular cells (stimulated via B1 receptors) 2. cleavage of angiotensinogen (produced by liver) into angiotensin 1 3. Angiotensin I is split into angiotensin II by the angiotensin-converting enzyme (ACE) in the lungs and kidneys. 4. Angiotensin II constricts arterioles, which increases blood pressure. Angiotensin II also triggers the release of aldosterone from the adrenal cortex, directly acts on PCT for sodium retention, and vasopressin from the posterior pituitary gland. 5. Aldosterone and vasopressin cause the kidneys to retain sodium and water, which increases blood pressure
39
The only oral direct thrombin inhibitor is _____
Dabigatran *argatroban and bivalirudin are IV
40
Unfractionated heparin MOA is indirect inhibition of ___ and ___
factor Xa and thrombin *LMWH (lovenox, dalteparin) indirectly inhibit factor Xa
41
Which antiemetic may nduce hypertensive crisis in patients with pheochromocytoma by releasing catecholamines from the tumor?
metoclopramide *also contraindicated in intestinal obstruction, parkinsons, GI bleed
42
oxidative metabolism of which volatile anesthetic results in hexafluoroisopropanol? A. Halothane B. Isoflurane C. Desflurane D. Sevoflurane
Sevoflurane *halothane, isoflurane, desflurane result in triflurosoacetic acid. Halothane also has free radical liver damage.
43
which volatile anesthestic has the greatest impact on NMB? (assuming same MAC)
Desflurane > sevoflurane> isoflurane> nitrous oxide (little to no effect)
44
Vecuronium and Rocuronium are additive or synergistic?
Additive (same aminosteroid class)
45
Rocuronium and Cis-atracurium are additive or synergistic?
synergistic (aminosteroid + benzylisoquinolinium)
46
Chronic anticonvulsant therapy causes ____ to NMB
resistance
47
Acute anticonvulsant therapy causes ____ to NMB
potentiation
48
NDNMB vs Succinylcholine A. ALS, Guillan-Barre B. Muscular Dystrophy C. Burn D. Lambert-Eaton E. MS F. Myasthenia Gravis G. Spinal Cord Injury H. Stroke I. Myotonic Dystrophy J. Hypothermia K. Primary Hyperparathyroidism
A: ALS, Guillan-Barr: Sensitive vs risk hyperkalemia B. Muscular Dystrophy Normal vs risk hyperkalemia C. Burn Resistance vs risk hyperkalemia D. Lambert-Eaton Sensitive vs Sensitive E. MS Sensitive vs risk hyperkalemia F. Myasthenia Gravis Sensitive vs resistance G. Spinal Cord Injury Normal vs hyperkalemia H. Stroke Resistance on affected side vs risk hyperkalemia I. Myotonic Dystrophy Sensitive vs risk hyperkalemia J. Hypothermia Prolonged duration vs normal K. Resistance to NBNMB
49
Plasma butyrylcholinesterase is also known as ______ and breaks down ____
pseudocholinesterase; succinylcholine
50
the ED95 of rocuronium is A. 0.6 B. 0.31 C. 1.2 D. 0.2
B. 0.31 (about half of the intuating dose)
51
in the average adult, normal vd/vt ratio is ___
33% *anatomic deadspace + alveolar deadspace is approximately 2ml/kg. -deadspace increases in upright position, PPV, anesthesia circuit (distal to Y piece where there is bidirectional flow), neck extension, emphysema, age, anticholinergic drugs
52
Oxytocin is released from the anterior/posterior pituitaryy
posterior *travels via neuroendocrine cells to posterior pituitary *anterior pituitary hormones travel via hypothalamic-hypophyseal portal vessels
53
Citrate acts as a _____ in stored RBCS
anticoagulant
54
Phosphate acts as a ____ in stored RBCs
buffer
55
____ is largely denitrogenated during preoxygenation
FRC
56
____ (opioid) has the lowest octanol/H20 partition coefficient (least lipophylicity)
Hydromorphone *persist longer in CSF or epidural space; higher risk of respiratory depression; morphine also hydrophobic
57
Spironolactone acts on the ____ and ___ of the nephron
DCT; collecting ducts *other examples: eplerenone (aldosterone receptor antagonist), triamterne, amiloride (epithelial sodium channel blockers)
58
smoking cessation shifts the oxygen dissociation curve to the ____
right *improved oxygen delivery to tissues, even a day before surgery
59
incorrectly rejecting the null hypothesis is a _____ error
type I (false positive) *type II is incorrectly accepting the null hypothesis
60
___ is buffer for LR and Hartmann's Solution
Lactate *metabolized to bicarbonate in the liver/kidney and acts as buffer
61
___ is buffer for Plasma-Lyte
Acetate and Gluconate; *also contains magnesium
62
high magenesium concentrations leads to muscle weakness by blockade of ___ channels A. Sodium B. Potassium C. Calcium D. SNARE inhibition
Calcium
63
Renarcotization are more likely to occur with which opioids after using naloxone?
morphine, hydromorphone *half life of narcan is 30-60 minutes
64
Propofol effect on cardiovascular system A. SVR decrease independent of dosing B. Myocardial depression independent of dosing C. Enhances baroreceptor response to hypotension D. Arterial and vasodilation
D - arterial and vasodilation *vasodilation mediated by intracellular smooth muscle calcium mobilization, inhibition of prostacyclin syntehesis, reduction in angiotenin II, stimulation of nitric oxide *reset or reduced baroreceptor reflex is reason for no tachycardic response to hypotension
65
Coronary perfusion pressure equation
CPP= diastolic pressure - LVEDP diastolic pressure: pressure in the aorta during relaxation LVEDP: pressure inside the left ventricle at end of diastole
66
Normal PAP values: Systolic Diastolic MAP
Systolid: 15-28 Diastolic: 5-16 MPAP: 10-14
67
Jugular Venous Waveform a wave: c wave: x descent: v wave: y descent:
a wave: right atrial contraction c wave: bulging of tricuspid into right atrium during ventricular contraction x descent: atrial relaxation v wave: atrial venous filling during closed tricuspid valve y descent: opening of tricuspid valve for ventricular filling
68
SVR equation
SVR = (MAP-CVP/CO) x 80 Example: BP: 120/90 CVP: 5 CO: 5 (100-5)/5 x 80 = 1520 dyns*sec/cm^2
69
Poiseuille's Law: variables R=8nl/pir^4 Q= P(Pi*r^4)/8*viscosity*length)
R=resistance (SVR) n=viscosity l=length r=radius
70
Baroreceptors respond to change in ____ and are located in the ____ and ______
blood pressure; carotid SINUS (within arterial wall itself) and aortic arch *carotid sinus reflex: glossopharyngeal nerve aortic arch reflex: vagus nerve
71
Chemoreceptors are located in the ___ and ___ and detect changes in ____
carotid BODY and aortic bodies; pH, pO2, pCO2
72
aortic bodies transmit afferent nerve impulses via the ____
vagus nerve (X)
73
carotid bodies transmit afferent nerve impulses via the ____
glossopharyngeal nerve (IX)
74
Skeletal muscle action potential ions
influx: sodium effelux: potassium
75
nerve action potential
influx: sodium efflux: potassium
76
phases of cardiac muscle action potential
Phase 0: Na+ influx Phase 1: K+ passive efflux Phase 2(plateau): L-type Ca2+ influx Phase 3: K+ efflux
77
cardiac pacemaker cell action potential:
slow influx (funny channel): sodium influx: L-type calcium efflux: potassium
78
the first heart sound refers to closure of what valve?
mitral (tricuspid) valve
79
the second heart sound referes to closure of what valve?
aortic (pulmonic) valve
80
Labetalol is/is not lipid soluble and can/cannot cross the placenta
Is not lipid soluble; cannot cross the placenta *useful in pregnancy induced hypertension
81
As portal vein blood flow decreases, the liver releases _____ which vasodilates the hepatic artery/vein
adenosine; vasodilates the hepatic artery
82
medial thigh nerve innervation
obturator nerve
83
medial calf sensory nerve innervation
saphenous *adductor canal block
84
heel and plantar sensory innervation
tibial nerve *also webspace between toes 1,2
85
lateral posterior leg sensory innervation
sural nerve *popliteal block
86
anterior and lateral leg, dorsum foot sensory innervation
common peroneal nerve
87
what are the strong cations in SID?
Na+, K+, Ca2+, Mg2+
88
What are the strong anions in SID?
chloride, lactate
89
vomiting causes increased/decreased SID?
increased due to loss of chloride ions
90
large bolus of NS causes increased/decreased SID?
decreased due to increase of chloride ions
91
lactic acidosis causes increased/decreased SID?
decreased due to increased lactate
92
dehydration causes increased/decreased SID?
increased due to
93
percent body water in females in approximately ____
50% elderly 40%, males 60%, children 70%, neonates 80%
94
Acute hemolytic transfusion reactions are caused by ____
ABO or non-ABO incompatibility (usually humar error) *Complement system is activated *usually within 24 hrs flank pain, dyspnea, fever, hypotension, oozing from sites, dark urine; usually within 24 hrs
95
Delayed hemolytic transfusion reactions are causes by ______
antibodies against non-ABO or minor RBC antigens (Duffy or Kidd antigens) *antibodies developed through prior transfusions or pregnancy jaundice, dark urine, back pain, fever; usually days to weeks after transfusion
96
febrile nonhemolytic transfusion reaction is caused by ____
cytokines released from recipient/donor leukocytes *incidence decreased with pre-storage leukoreduction fever within 4 hours of transfusion
97
allergic reactions to transfusions are caused by ____ and most often due to which blood products?
IgE-mediated reaction leading to histamine release; FFP and platelets are most common *washing products can reduce risk; IgA deficiency at higher risk
98
TRALI is caused by _____ and ____ is a major risk factor
activation of recipient neutrophils by anti-HLA or antineutrophil antibodies; multiparous female donor *acute lung injury (ARDS) and noncardiogenic pulmonary edema within 6 hours of transfusion
99
TACO is caused by _____
excessive volume or rapid transfusion *cardiogenic pulmonary edema within 12 hours of transfusion; responds to diuretics
100
What test is best to monitor enoxaparin (LMWH)? A. anti-xa assay B. PTT C. PT D. bleeding time
A. Anti-xa assay *no clinically significant affect on PTT
101
Difficult Bag Mask Ventilation "OBESE MMT"
O - obese >26 BMI B- beard E - edentulous S - Snoring (OSA) E - elderly M - malampati III or IV; male gender M - mouth opening <3 cm; micrognathia T - thyromental distance <6 cm
102
Cryoprecipitate contains _____
FIBRINOGEN factor VIII vWF Factor XIIII Platelet microparticles *used to treat specific clotting factor deficiences (FFP also contains these factors but is used for bleeding or coagulopathies)
103
FFP contains _____
clotting factors (not platelets) fibrinogen albumin
104
what blood type is used for whole blood transfusion?
LTOWB (low-titer o+ whole blood) *except for pregnant (or child-bearing age) females, O negative is needed due to Rh antigen. Only 3% of donors are O negative
105
transfusion of what blood product are most likely implicated in bacterial contamination?
platelets (stored at room temp) *platelets: most commonly staph epidermidis or aureus (skin flora) PRBCs: most likely gram - bacteria yersinia, pseudomonas, or serratia which proliferate at colder temps
106
leukoreduction reduces the risk of ____ transmission
CMV (specifically for immunocompromised patients) also EBV, T-lymphotropic virus,
107
calcium ___ is given through central access
chloride *gluconate can be given peripheral
108
washed PRBCs can be used for ___ deficient patients
IgA
109
The Bohr effect refers to A. oxygen consumption as it relates to cardiac output B. Hbg's ability to carry increased amounts of CO2 in deoxygenated state C. shift in the oxygen dissociation curve caused by changes in Co2 or pH
C. Bohr effect refers to the shift in oxygen dissociation curve caused by changes in the concentration of Co2 or pH; example is capillaries, PCo2 is higher and pH is lower, causing a R shift which leads to more oxygen offloading
110
Haldane effect describes ____
hemoglobins ability to carry increased amounts of CO2 in the deoxygenated state as compared to the oxygenated state. *left shift of curve with low Po2
111
Fick principle allows calculation of ____ by measuring ____
cardiac output by measuring myocardial oxygen consumption *CO= total o2 consumption/o2 pulm vein-02 pulm artery
112
High peak pressure and normal plateau pressure indicates ____
issue with elevated resistance examples: circuit problem (kink, fluid, biting) high TV laryngospasm, bronchospasm mucous plugging foreign body
113
High peak airway pressure and high plateau pressure indicates ____
issue with compliance Examples: pneumonia pulmonary edema auto PEEP Rt Mainstem pneumothorax atelectasis
114
driving pressure = _____ - _____
pleteau pressure - PEEP
115
Which antiplatelet is a prodrug (requires metabolism to active metabolite to exert effect)
Clopidogrel *also prasugrel, ticlopidine
116
Ticagrelor MOA
direct ADP receptor inhibitor
117
Abciximab MOA
glycoprotein IIB/IIIA inhibitor *also eptifibatide, tirofiban
118
Aspirin MOA
irreversible cyclooxygenase inhibitor which decreases production of thromboxane A2
119
Acute dystonic reactions occur when the ____ balance is disturbed
cholinergic-dopaminergic balance *usually with antidopamine drugs (droperidol, metoclopramide, prochlorperazine)
120
Treatment for EPS or acute dystonic reactions include
diphenhydramine (anticholinergic and antihistamine) benztropine, trihexyphenidyl benzos beta blockers antihistamines alpha agonists
121
____ bronchi are the sites with the greatest resistance in the airway
medium sized
122
Lung Volumes: Inspiratory Capacity: Functional Residual Capacity: Vital Capacity: Total Lung Capacity:
IC: Vt+IRV FRC: RV+ERV VC: Vt+IRV+ERV TLC: Vt+IRV+ERV+RV
123
Increasing age results in ____ RV and FRC and _____ IC and VC
increased; decreased
124
Obesity decreases which lung volumes the most?
ERV and FRC
125
Which lung volume cannot be measured with spirometry?
RV (and FRC, TLC)
126
closing volume =
closing capacity - RV
127
closing capacity definition
volume of air that remains in the lungs when the small airways begin to close
128
CC ______ with age at a greater rate than ____
increases; FRC *CC typically exceeds FRC at age 44 in supine position and 75 in seated position.
129
Which lung volumes are increased in obstructive lung disease?
TLC, RV, FRC *also FEV1/FVC ratio (compared to restrictive)
130
Which lung volumes are decreased in restrictive lung disease?
TLC, RV, FRC *FEV1/FVC usually normal to elevated
131
A reynolds number <1000 predicts ____ flow in the airway
laminar *reynolds number >1500 predicts turbulent flow Reynold number = (linear velocity x diameter x gas density)/gas velocity
132
Pulsus alternans is seen with
severe left ventricular dysfunction
133
Pulsus parvus et tardus is most commonly seen with
aortic stenosis
134
Pulsus paradoxus is most often seen with what 3 conditions
cardiac tamponade, constrictive pericarditis, severe asthma/COPD exacerbations
135
Pulsus bisferiens is seen with what two conditions
aortic insufficiency, HOCM
136
Block of the MSK nerve during axillary block provides coverage to the _____
lateral forearm
137
Block of the intercostobrachial nerve provides coverage to the
medial upper arm
138
Critical temperature of nitrous oxide carbon dioxide oxygen
nitrous oxide: 36.5C carbon dioxide: 31.1C oxygen: -118C *temperature above which a gas cannot be liquified no matter the pressure applied *air,helium,nitrogen,oxygen are dry gases because they only exist in gaseous phase when pressurized and stored
139
why is the boiling point of desflurane important?
it is close to room temp so it would readily vaporize without specialized heated vaporizer
140
the landmark for deep cervical plexus block is between _____ and _____
Chassaignac's tubercle (C6 transverse process); mastoid process
141
the landmark for interscalene block is between ___ and ____
anterior scalene and middle scalene
142
the landmark for supraclavicular block is ____ and ____ to the subclavian artery
superficial; lateral
143
the landmark for the infraclavicular block is ___ and ___ to the coracoid process
2 cm medial and caudad
144
the landmark for femoral nerve block is line between the ____ and _____ (inguinal ligament)
ASIS; pubic tubercle
145
the landmarks for sciatic nerve block are ____ and _____
PSIS; ischial tuberosity
146
the landmark for posterior tibial nerve ankle block is ______
posterior to medial malleolus
147
the landmark for sural nerve block is _____
lateral malleolus
148
the landmark for lumbar plexus block is _____ and _____
superior posteior iliac crest; PSIS
149
the landmarks for obturator nerve block are ____ and _____ to pubic tubercle
2cm lateral and inferior to pubic tubercle
150
the landmarks for fascia iliaca block are ___ and ____
ASIS; pubic tubercle
151
superficial peroneal nerve block is located between ____ and _____
peroneus brevis; extensor digitorum longus *inject local anesthetic from the anterior border of tibia to lateral malleolus
152
the landmarks for saphenous nerve block are ____ and _____
saphenous vein; medial malleolus *inject local anesthetic from tibial to medial malleolous
153
blood levels after injection of local anesthetic highest to lowest
intercostal>caudal>epidural>brachial plexus>sciatic/femoral>subQ
154
which nerve block is effective for first stage of labor?
paracervical block *first stage is cervix begins to dilate to 10cm
155
which nerve block is effective for 2nd stage of labor?
pudendal block *second stage is 10cm dilated to delivery
156
epidural anesthesia is effective for which stage of labor?
1st and 2nd (if supplementation is used)
157
which nerve block can be used in the treatment of CPRS I,II, migraines, postherpetic neuralgia?
stellate ganglion block *C6 vertebrae landmark (C7 can be dangerous)
158
celiac plexus block can be used for treatment of which conditions
intractable abdominal pain secondary to abdominal malignances, especially pancreatic cancer *stomach, esophagus, colorectal, liver, GB, bile duct
159
lumbar sympathetic nerve block is performed at what level
L2 *used for CPRS, vascular insufficiency, cystitis, GYN pain
160
Which of the following is an NOT an NMDA antagonist? Ketamine Mag Nitrous Oxide Methadone Tramadol
They all are
161
Insulin stimulates/inhibits glycolysis
stimulates *glycolysis is breaking down glucose
162
Insulin inhibits/stimulates glycogenolysis
inhibits
163
insulin stimulates/inhibits gluconeogenesis
inhibits
164
Which of the following of dexmedetomidine is NOT true A. increases minute ventilation B. does not alter arterial oxygenation C. Does not alter pH D. ventilatory response to hypercarbia is still present (slope of CO2 response curve unchanged)
A. dexmedetomidine REDUCES minute ventilation
165
clearance of dexmedetomidine is decreased with hepatic/renal dysfunction and dose reduction is recommended
hepatic *no dose alteration is required for renal insufficiency
166
analgesic effect of dexmedetomidine is seen in the _____ of the spinal cord which reduces the release of ____ and _____
dorsal horn; substance P and glutamate
167
the mechanism of negative pressure pulmonary edema is which of the following? (2 correct) A. increased pulmonary capillary permeability B. increased pulmonary hydrostatic pressure gradient C. cytokine-induced increase in capillary permeability D. decreased preload and afterload
A and B *NPPE causes INCREASED preload, INCREASED afterload with DECREASED cardiac output
168
oxytocin and vasopressin are synthesized in the ____
hypothalamus
169
Diffusion capacity equation includes what 5 variables
PMS ST partial PRESSURE gradient MOLECULAR weight SURFACE area SOLUBILITY of gas THICKNESS of membrane
170
____ can improve perioperative platelet dysfunction in uremic patients
desmopressin
171
Daltons law of partial pressures =
PTotal=P1+P2+P3 etc...
172
Aortic stenosis murmur will _____ with squatting
increase
173
HOCM murmur will ____ with standing
increase; also increases with valsalva *midsystolic murmur at apex or left lower sternal border
174
Mitral stenosis murmur will ____ with standing
decrease
175
mitral regurgitation murmur will ___ with squatting
increase
176
Aging results in: A: increased/decreased sympathetic nervous activity B: increased/decreased beta-receptor responsiveness C: increased/decreased ventricular compliance
A: increased B: decreased C: decreased
177
Aging results in: A: increased/decreased inspiratory capacity/vital capacity B: increased/decreased FRC C: increased/decreased closing capacity D: increased/decreased residual volume E. increased/decreased lung compliance
A: decreased VC B: increased FRC C: increased CC D: increased RV E: increased lung compliance
178
Alveolar gas equation=
PAO2= FiO2(Pb-47)-(PaCO2/R) R=vco2/vo2 (usually 0.8 in normal diet, higher with carb diet 1)
179
Acute altitude exposure results in: -increased/decreased HR? -peripheral vasodilation/vasoconstriction -increased/decreased hematocrit -oxygen dissociation curve shift to left/right -cerebral vasodilation/vasoconstriction -increased/decreased RAAS -increased/decreased cortisol -increased/decreased catecholamines
Increased HR Vasodilation Increased hematocrit Left shift Cerebral vasodilation Decreased RAAS Increased cortisol Increased catecholamines
180
Chronic hypoxia -lowers/raises HR -peripheral vasodilation/vasoconstriction -o2 dissociation curve to left/right -weight loss/weight gain -SV increased/decreased -hypertrophy/wasting adrenal glands
Lowers Vasoconstriction Right shift (inc 2,3 DPG) Weight loss (inc metabolic rate) Stroke volume decreased Hypertrophy of adrenal glands
181
Acute high altitude shifts oxygen dissociation curve to the
left *chronic shifts it back to the right (Inc 2,3 DPG)
182
which drug reduces the efficacy of epidural morphine?
2-chloroprocaine
183
Controlled ventilator modes CMV: IMV: SIMV: AC:
CMV: set number of breaths; set volume/pressure; set I:E ratio; SPONTANEOUS BREATHING NOT ALLOWED IMV: same as above; SPONTANEOUS BREATHING ALLOWED BUT NOT SUPPORTED SIMV: same as above; SPONTANEOUS BREATHING ALLOWED AND SUPPORTED Ex: RR set to 10; patient attempts to breathe 20 times per minute, half breaths will be controlled, other half pressure-supported AC: same as SIMV except ALL BREATHS INITIATED BY PATIENT ARE SUPPORTED AS CONTROLLED BREATHS. Ex: RR set to 10; patient attempts to breathe 20 times per minute, all breaths will be fully suppored; POSSIBLE HYPERVENTILATION
184
Controlled breaths vs pressure-supported breaths
controlled: machine takes complete control of breath to set volume regardless of patient effort Pressure-supported: machine assists to patients own breathing efforts delivering set pressure until patient initiates exhalation so patient has some control over size of breath
185
what is the ratio of intravascular volume effects of bolus administration of crystalloids compared to colloids?
1.5:1 *previously taught at 3:1, but studies show that only 1.5 times the volume of isotonic crystalloid is required to expand the plasma volume compared to isotonic colloid and do not permeate into the interstitium to the extent that was previously thought
186
Pseudocholinesterase is produced where and found where?
produced by liver; found in blood stream *up to 90% is hydrolyzed by circulating pseudocholinesterase before drug reaches NMJ
187
How are the effects of succinylcholine terminated at the NMJ?
passive diffusion away from NMJ back into the bloodstream for pseudocholinesterase to degrade
188
how are cisatracirum and atracurium metabolized?
hoffman elimination; nonenzymatic reactions in the bloodstream *hypothermia, acidemia slow hoffman elimination
189
Alveolar ventilation equation
Va=RR x VT-VD
190
Intrapulmonary shunting results in a ___ V/Q ratio
low *too much blood flow or too little ventilation and blood returns to heart unoxygenated; atelectasis and pneumonia are causes
191
physiologic dead space results in ____ V/Q ratio
high *inadequate blood flow to ventilated alveoli; common causes PE and emphysema
192
P50 is higher/lower in neonates
lower *fetal hemoglobin has P50 of 18-19 due to high affinity for oxygen *P50 is value at which 50% of hemoglobin is saturated with oxygen
193
chronic anemia shifts oxygenation dissociation curve to the ___
right *chronic anemia --> increased 2,3 DPG
194
Oxygen content of arterial blood equation
CaO2 = (Hb x SaO2 x 1.31) + PaO2 x 0.003) Ex: Hb: 10, artrial partial pressure oxygen 100, O2 saturation 100 10 x 1.31 x 1 + .3 = 13.3
195
Oxygen delivery to tissues equation
DO2 = CaO2 x CO *normal = 1000ml O2/min
196
Fick Equation
VO2 = CO (CaO2 - CvO2)
197
Modified Fick Equation
SvO2 = SaO2 - ((VO2 / (Hb x 1.31 x CO)) *accurate measurement from Swan-Ganz catheter; normal = 65-70%
198
PNS -Location: -Preganglionic neuron length: -Postganglionic neuron length: -Preganglionic synapse receptor type: -post ganglioninc receptor type:
-III,VII,IX,X; S2-S4 -pre: long -post: short -pre receptor: nicotinic -post receptor: muscarinic *nicotinic receptor also in NMJ and brain
199
SNS: -Location: -Preganglionic neuron length: -Postganglionic neuron length: -Preganglionic synapse receptor type: -post ganglioninc receptor type:
-T1-L2 -pre: long -post: short -pre receptor: nicotinic -post receptor: A,B EXCEPT sweat glands are muscarinic *adrenal medulla is directly innervated by pre-ganglionic axon releasing adrenaline and noradrenaline
200
gabapentin/pregabalin MOA
inhibit the action of α2δ-1 subunits, thus decreasing the density of pre-synaptic voltage-gated CALCIUM channels and subsequent release of excitatory neurotransmitters
201
Volatile anesthetics ____ slope of CO2 response curve and shift to the ____
decrease slope; rightward shift *less ventilatory response with hypoventilation despite progressive hypercapnia
202
Benzos/Propofol ____ slope of CO2 response curve
decrease slope
203
Metabolic acidosis ___ slope of CO2 response curve and shifts to the ___
increases slope; leftward shift *hyperventilate to increase pH; hypoxia also shifts left with increased slope
204
Pituitary gland hormones are peptide/steroid hormones
peptide *water-soluable so they need to bind receptors with second-messenger signaling
205
steroid hormones are hydrophillic/hydrophobic
hydrophobic (lipophillic) *cross lipid bilayer of cells and directly exert clinical effect, however they need carrier proteins in serum (testoserone, aldosterone, estradiol, cortisol, thyroid hormones)
206
catecholamines,dopamine,norephinephrine,epinephrine all derive from the amino acid ____
tyrosine
207
Which of the following is NOT part of the RCRI score A. CAD B. CHF C. CVA D. DM (not insulin dependent) E. Renal dysfunction with Cr. 2.1
D. DM with insulin dependence
208
Hanger-yoke assembly is
how cylinders attach to anesthesia machine
209
pin-index safety system vs diameter-index safety system
pin-index: each medical gas has a unique pin configuration on the anesthesia machines yoke diameter-index: prevents incorrect hose attachment with specific fittings
210
International color codes Co2: He-O2: Air: Nitrogen: Nitrous Oxide: Ox-He: Oxygen: Vacuum: Evac:
Co2: grey (SAME as US) He-O2: brown/white (vs BROWN/GREEN in US) Air: black/white (vs YELLOW in US) Nitrogen: Black (SAME as US) Nitrous Oxide: Blue (SAME as US) Oxygen: White (vs GREEN in US) Vacuum: Yellow (vs WHITE in US) Evac: Purple (SAME as US)
211
When does it become a low pressure system on anesthesia machine?
after the flowmeters/regulator (about 45 PSI); downstream of yoke
212
PaCO2 rises ______ during the first minute of apnea time and _____ each minute thereafter
8-16 mmHg first minute; 3 mmHg thereafter
213
Corneal reflex afferent/efferent
afferent: opthalmic nerve (V) efferent: facial nerve (VII)
214
oculocardiac reflex afferent/efferent
afferent: opthalmic nerve (V) efferent: vagus nerve (X) *retrobulbar block
215
gag reflex afferent/efferent
afferent: glossopharyngeal (IX) efferent: vagus nerve (X)
216
cough reflex afferent/efferent
afferent: vagus (internal branch of superior laryngeal nerve) efferent: vagus
217
carotid sinus reflex afferent/efferent
afferent: glossopharyngeal (IX) efferent: vagus (X)
218
jaw jerk reflex afferent/efferen
afferent: mandibular nerve (V) efferent: mandibular nerve (V)
219
glottic closure reflex (laryngospasm) afferent/efferent
afferent: vagus nerve (internal branch of superior laryngeal nerve) efferent: vagus nerve (recurrent laryngeal nerve or inferior laryngeal nerve)
220
Motor/Sensory Mneumonic
some say marry money but my brother say big boobs matter more
221
pupillary reflex afferent/efferent
afferent: optic nerve (II) efferent: oculomotor nerve (III)
222
nitroprusside moa
inc cGMP which releases nitric oxide to cause arterial and veno dilation
223
NMDA receptor mediates its effects through increasing _____
intracellular calcium
224
what does PCC contain?
Factors II, VII, IX, X (vitamin K dependent); Proteins C,S
225
Nitrous Oxide: -MOA -Analgesia -Secondary MOA
-NMDA glutamate antagonist -activates opioidergic in PERIDUCTAL GREY MATTER and nonadrenergic neurons in LOCUS CERULEUS -hyperpolarization through potassium channels
226
Heat loss during anesthesia has what phases?
1. peripheral cold blood to core (prevented with preop warming) 2. RADIANT heat loss (core-->skin surface-->radiates away) 3. Convection 3. thermoregulatory vasoconstriction
227
Hypercalcemia _____ the effects on non-depolarizing neuromuscular blockers
antagonized (increased dose required)
228
onset of action vecuronium is ____
3-5 minutes ( 0.12 mg/kg dose)
229
onset of action of cisatricurium is ____
2-3 minutes (0.2mg/kg dose)
230
onset of action of rocuronium is ____
1-2 minutes (0.6mg/kg dose)
231
which of the following congenital syndromes IS NOT associated with MS? A. Central core disease B. Centronuclear myopathy C. King-Denborough syndrome D. Duchenne muscular dystrophy
D. Duchenne muscular dystrophy (and Becker, mitochondrial disease) are not associated with MS)
232
Initial dose of dantrolene is ____
2.5mg/kg
233
Diagnosis of MH includes ______ and ______
molecular genetic testing (negative test doesn't definitively r/o) and halothane and caffeine induced contracture or CHCT (negative test definitively rules out MH)
234
sensory innervation to the infraglottic airway is by ____
recurrent laryngeal nerve
235
superior laryngeal nerve can be blocked by injecting local anesthetic at the _____
horn of the hyoid
236
Which of the following is NOT used in the MELD score? A. Bilirubin B. INR/PT C. Sodium D. Ascites/Encephalopathy E. Creatinine
D. Ascites/Encephalopathy *Child-Pugh-Turcotte uses total bilirubin, albumin, PT, ascites/hepatic encephalopathy "Pour Another Beer At Eleven" *MELD uses bilirubin, creatinine, INR, sodium - more predictive of short term mortality "I Crush Several Beers Daily"
237
Shock with multiorgan dysfunction would be ASA __
5 *ruptured AAA, massive trauma, ischemia bowel with multiorgan dysfunction, intracranial bled with mass effect
238
Patient with current cardiac ischemia would be ASA __
4 *MI,CVA,CAD <3 months, valvular dysfunction, reduced EF, shock/sepsis, ARDS, ESRD not on dialysis
239
A patient with ESRD on dialysis would be ASA __
3 *POORLY controlled HTN, DM, COPD, BMI>40, hepatitis, alcohol use disorder, MI,CVA,TIA,CAD >3 months
240
Which of the following is metabolized by plasma/RBC esterases? A. Clevidipine B. Succinylcholine C. Mivacurium D. Ester local anesthetics
A. Clevidipine *also esmolol, remifentanil
241
What drugs are metabolized by pseudocholinesterase?
Succinylcholine, mivacurium, ester local anethetics
242
LaPlaces Law:
T=Pr/2h T=tension of LV wall P=pressure r=radius h=wall thickness *dilated LV = increased wall stress *hypertrophied LV = less wall stress
243
Thiazide diuretics MOA
inhibit sodium-chloride cotransporter in DCT *metolazone is thiazide; increase calcium
244
C7 nerve root is found between __ and ___
C6 and C7 *C8 is found below C7 Cervical nerve roots are ABOVE corresponding vertebrae
245
T1 nerve root is found between __ and ___
T1 and T2 Thoracic nerve roots are BELOW corresponding vertebrae
246
The Fi/Fa ratio increase seen with increased MV of which inhaled anesthetic will have the greatest effect?
Isoflurane (due to high blood solubility to begin with)
247
CBF autoregulatory range for: PaO2: MAP:
PaO2: >50, no changes to CBF MAP: 50-150mmhg no changes to CBF
248
What nerve is often missed in axillary nerve block?
Musculocutaneous nerve *elbow flexion (musculo); lateral forearm sensation (cutaneous); found in the corachobrachialis muscle
249
SA and AV nodes are most likely supplied by the ___
RCA (in 90% of the population)
250
the posterior one-third of interventricular septum is supplied by
the RCA (posterior descending artery)
251
The anterior two-thirds of the interventriclar septum is supplied by
left anterior descending artery
252
anterolateral papillary muscle is supplied by the
left circumflex artery (or LAD)
253
cardiac apex is supplied by the
LAD
254
Midbrain nerves, blood supply
3,4; PCA
255
Pons nerves, blood supply
6,7,8,9; AICA (lateral) Basilar (medial)
256
Medulla nerves, blood supply
12, 9,10,11; PICA (lateral) ASA (medial)
257
Aldrete Scoring system uses what 5 parameters
Activity (moves extremities) Respiration Circulation Consciousness Oxygen Saturation
258
Hypoxia causes systemic _____ and pulmonary _____
systemic vasodilation; pulmonary vasoconstriction
259
Hypocapnia causes systemic ____ and pulmonary ____
systemic vasoconstriction; pulmonary vasodilation *severe acidemia (<7.2)may lead to catecolamine-refractory vasoplegia
260
Acute mannitol administration can lead to: A. Decreased CO B. Increased ICP C. Increased PCWP D. Decreased PCWP
C. Increased PCWP due to increase initial increase in plasma volume *careful with anuric or CHF patients
261
A phase 1 blockade results in: A. Twitch Height: B. TOF Fade: C. TOF ratio: D. Response to tetanus: E. Post-tetanic fade: F. Administration of Neostigmine: G. Administration of Rocuronium:
A phase 1 blockade results in: A. Twitch Height: decreased B. TOF Fade: no fade C. TOF ratio: >0.7 D. Response to tetanus: sustained E. Post-tetanic fade: none F. Administration of Neostigmine: augments G. Administration of Rocuronium: antagonize
262
Type I allergic reactions are mediated by
IgE - anaphylactic reactions
263
Type II allergic reactions are mediated by
IgG - ex: hemolytic anemia
264
Type III reaction is mediated by
IgG - serum sickness immune complexes
265
Type IV Hypersensitivity reaction is mediated by
delayed T cell mediated
266
Percentage of nicotinic receptors occupied by rocuronium 0 twitches 1 twitch 2 twitches 3 twitches 4 twitches
0 twitches: 100% 1 twitch: 90% 2 twitches: 80% 3 twitches: 75% 4 twitches: <65%
267
Helium has a higher/lower Reynolds number compared to oxygen
Lower - favors laminar flow Re<2300 laminar flow Re>4000 turbulent flow
268
Botulism toxin MOA
Cleavage of SNARE proteins at presynaptic terminal inhibiting the release of acetylcholine by preventing vesicle fusion
269
Clostridium Tetani MOA
Cleavage of synaptobrevin in inhibitory neurons (retrograde at neuromuscular junction)
270
Static Lung Compliance
Vt/Pplat-PEEP
271
PVR is lowest at what lung volume
FRC *PVR increases at extreme lung volumes, so TLC and ERV
272
Which anesthetic agents inhibit HPV (hypoxic pulmonary vasoconstriction) at higher levels?
volatile anesthetics, nitrous oxide
273
hoffman elimination (cisatricirium metabolism) is increased with ____ temperature and ____ pH
increased
274
Phase I Reactions in metabolism involve glucoranidation or oxidation and reduction?
oxidation and reduction
275
Phase II reactions in metabolism involve glucoranitation or oxidation and reduction?
glucoranidation
276
Immature acetylcholine receptors contain a unique ___ receptor subtype
gamma Y *mature have epsilon
277
Allodynia definition
painful response to non painful stimulus
278
Aldosterone function: A. increases Na+K+ ATPase B. decreases H+ATPase C. increases Na+H+ ATPase D. increases aquaporins
A. increases Na+K+ ATPase in the DCT *also increases H+ATPase; ATII increases Na+H+ ATPase Vasopressin increases aquaporins
279
Adrenal medulla secretes:
catecholamines
280
Adrenal cortex layers and hormones:
G: glomerulosa - mineralcorticoids F: fasciculata - corticosteroids R: reticularis - sex hormones
281
a1 receptor activates ___ which ____
Gq - increases IP3, DAG *vasoconstriction, pupillary dilation
282
a2 receptor activates ___ which ___
Gi; decreases cAMP *decreases adrenergic outflow, insulin release, and lipolysis
283
B1/B2 activates __ which ___
Gs; increase cAMP *B1: increase pulse and contractility B2: vasodilation, bronchodilation, lipolysis, and glycogenolysis B3: thermogenesis, lipolysis, bladder smooth muscle relaxation
284
D1 activates ___ which ___
Gs; increases cAMP *renal vasodilation, activates direct striatum pathway
285
D2 activates ___ which ___
Gi: decreases cAMP *decreases direct striatum pathway
286
H1 activates ___ which ___
Gq; increases IP3, DAG *increases vascular permeability, bronchoconstriction, pruritis
287
H2 activates __ which __
Gs; increases cAMP *increases gastric acid secretion
288
M1, M3 receptors activate __ which ___
Gq; increases IP3/DAG *M1: increases gastric motility M3: smooth muscle contraction and increases secretions/intestinal motility
289
M2 receptors activate ___ which ___
Gi; decreases cAMP *decreases HR
290
V1 receptors activate ___ which ___
Gq; increases IP3/DAG *increases vascular tone (vasocontriction)
291
V2 receptors activate ___ which ___
Gs; increases cAMP *increases water permeability in renal collecting tubules and promote release of vWF *EFFERENT arteriole vasoconstriction which leads to increases GFR
292
Effect of hypoxic pulmonary vasoconstriction with nitroglycerin, nitroprusside, nicardipine?
all inhibit HPV *same with volatile anesthetics at higher concentrations
293
Monoamine oxidate breaks down ____
norepinephrine and serotonin
294
_____ enzyme breaks down acetylcholine
acetylcholinesterase *neostigmine inhibits
295
____ synthesizes acetylcholine
choline acetyltransferase
296
____ breaks down norepinephrine and dopamine
catechol-O-methyltransferase
297
Pathophysiology of GVHD?
attack of recipient tissues by donor lymphocytes *4-21 days after transfusion of RBCs or platelets; PANCYTOPENIA, jaundice, abdonimal pain
298
Hypocarbia leads hypercalcemia/hypocalemia?
hypocalcemia due to increased protein binding of calcium -> perioral numbness, peripheral neuropathy, muscle spasms
299
Hemolytic Reactions: Haptoglobin: LDH: Bilirubin:
Haptoglobin: decreased LDH: increased Bilirubin: increased
300
Which local anesthetic increases risk for methemoglobinemia in a dose dependent manner?
Prilocaine *Benzocaine is NOT dose dependent
301
Low dose SQ Heparin: Before neuraxial placement: After neuraxial placement: Before neuraxial catheter removal: After neuraxial catheter removal:
Before neuraxial placement: 4-6 hrs or normal coagulation studies After neuraxial placement: Immediately Before neuraxial catheter removal: 4-6 hrs After neuraxial catheter removal: immediately
302
High dose SQ Heparin: Before neuraxial placement: After neuraxial placement: Before neuraxial catheter removal: After neuraxial catheter removal:
Before neuraxial placement: 12 hrs and normal coags After neuraxial placement: avoid Before neuraxial catheter removal: avoid After neuraxial catheter removal: immediately
303
Therapeutic SQ Heparin: Before neuraxial placement: After neuraxial placement: Before neuraxial catheter removal: After neuraxial catheter removal:
Before neuraxial placement: 24 hours and normal coags After neuraxial placement: avoid Before neuraxial catheter removal: avoid After neuraxial catheter removal: immediately
304
IV Heparin Before neuraxial placement: After neuraxial placement: Before neuraxial catheter removal: After neuraxial catheter removal:
Before neuraxial placement: 4-6 hrs and normal coags After neuraxial placement: 1 hr Before neuraxial catheter removal: 1 hr After neuraxial catheter removal: 4-6 hrs and normal coags
305
Prophylactic LMWH Before neuraxial placement: After neuraxial placement: Before neuraxial catheter removal: After neuraxial catheter removal:
Before neuraxial placement: 12 hrs After neuraxial placement: 12 hrs Before neuraxial catheter removal: 12 hrs After neuraxial catheter removal: 4 hrs
306
Therapeutic LMWH Before neuraxial placement: After neuraxial placement: Before neuraxial catheter removal: After neuraxial catheter removal:
Before neuraxial placement: 24 hrs After neuraxial placement: avoid Before neuraxial catheter removal: avoid After neuraxial catheter removal: 4 hrs
307
Maximal Allowable Blood Loss Equation
EBV*(starting Hct-allowable Hct/starting Hct)
308
Antibiotics that potentiate NMB (CLAP iT)
Clindamycin Lincomycin Aminoglycosides Polymyxins Tetracycline
309
HypoDAAM (potentiates NMB)
Hypothermia, hypocalcemia diuretics antiarrythmics (CCBs), antibiotics, anticonvulsants (lithium,phenytoin) Magnesium
310
Acetylcholine is synthesized in the ____
laterodoral tegmentum and pendnculopontine tegementum
311
Norepinephrine is synthesized in the ____
locus coeruleus in pons
312
Dopamine is synthesized in the _____
substantia nigra and ventral tegmental area
313
serotonin is synthesized in the ____
raphe nuclei
314
histamine is synthesized in the ____
tuberomammillary nucleus of the posterior hypothalamus
315
Which nerves are targeted in a TAP block?
subcostal, ilioinguinal, iliohypogastric nerves
316
Sugammadex binds steroidal/benzolisoquinolone NMBs?
steroidal in a 1:1 binding
317
Layers for Spinal block:
Skin->subq->supraspinous ligament->interspinous ligament->Ligamentum Flavum->epidural space->dura mater->arachnoid mater->subarachnoid space
318
Layers for Epidural block:
Skin->subq->supraspinous ligament->interspinous ligament->Ligamentum Flavum->epidural space
319
Power =
1-B
320
As power increases in a study, the ____ decreases
False negatives
321
Which CYP enzyme alters pharmacokinetics of warfarin?
CYP2C9
322
Posterior ischemic optic neuropathy has what findings on clinical exam?
afferent pupillary defects but no optic disc edema ; bilateral more commonly than AION
323
Anterior ischemic optic neuropathy has what findings on physical exam?
unilateral painless vision loss, optic disc edema/pallor, afferent pupillary defects
324
Volatile anesthetic after 1,2,3,4 time constants respectively:
63%, 86%, 95%, 98% If time constant is 3L (6L circuit with FGF at 2L/min), then after 6 minutes the concentration of volatile anesthetic in the circuit would be 86%. -
325
Increasing FGF at the end of a case ____ time constant
decreases
326
The bland-altman plot is used to assess which type of variables?
two quantitative variables
327
Why does supplemental oxygen cause worsened hypercapnia in COPD patients?
impairment of hypoxic pulmonary vasocontriction *NOT due to blunting the central respiratory drive like is taught
328
What are the 4 ways O2 is analyzed?
paramagnetic oximetry: pressure changes in sample line (most common) galvanic cell: current through permeable membrane into electrode (blood gas measurment) clark cell: similar to galvanic. battery required (blood gas measurement) polarographic: oxygen passes permeable membrane for reaction.
329
popliteal fossa medial to lateral
popliteal ARTERY, popliteal VEIN, TIBIAL nerve, COMMON PERONEAL nerve
330
cyanide blocks what enzyme?
cytochrome c oxidase
331
Reduced activity in the locus ceruleus results in
decreased conciousness
332
reduced activity in the ventrolateral preoptic nucleus results in
alertness
333
intralipid dosing for LAST
20% lipid emulsion 1.5mg/kg over 2-3 minutes
334
dantrolene dosing protocol
2.5mg/kg
335
___ is the most important factor for intrathecal spread of local anesthetic in a hyperbaric solution (intrathecal = spinal, NOT epidural)
baricity *epidural most important factor is VOLUME
336
____ is the most important factor for local anesthetic spread in a iso/hypobaric solution
volume
337
Which of the following is a circulatory effect of cirrhosis? A. Decreased CO B. Increased SVR C. Increased AV shunting D. increased blood viscoscity
C. increased AV shunting
338
what is the normal P50 value on the oxygen-hemoglobin dissociation curve?
27mmHg
339
What is lost with anterior spinal cord syndrome?
Motor function, pain, temperature *posterior spinal cord syndrome spares motor function but affects proprioception and sensation
340
at what PO2 value does cerebral blood flow increase?
below 60mmHg, CBF increases exponentially (remains unchanged from 60-200mmHg)
341
at what MAP does cerebral blood flow increase?
above 150mmHg (60-150mmHg remains unchanged)
342
PCO2 increases cerebral blood flow in a linear fashion between what values?
25-75mmHg (decreasing PCO2 increases CBF)
343
blood gas particial coeffcient Nitrous Oxide: Isoflurane: Desflurane: Sevoflurane:
0.46 1.5 0.42 0.65
344
Vapor pressure: Nitrous Oxide: Isoflurane: Desflurane: Sevoflurane:
243 248 669 157
345
If Isoflurane is set to 1% and FGF are 3L/min, what is the splitting ratio?
44:1 (bypass flow: vaporizing flow) *need 30ml/min of isoflurane in the 3L/min FGF; vapor pressure is 248, so 248/760 =.31 --> 30/.31 = 97ml/min must leave vaporizer champer. 97-30ml = 67ml/min of FGF flows into vaporizer champer. 3000-67 = 2933 flows into the bypass champer; 2933/'67 = 44:1 splitting ration
346
what EKG changes are seen in digoxin toxicity?
downsloping ST segmenets, shorted QT interval, increases PR interval, T-wave flattening
347
what CYP enzyme helps metabolize codeine into morphine?
CYP2D6
348
what can decrease SSEPS?
volatile anesthetics nitrous oxide anemia ischemia hypoxia
349
Stage 1 of Anesthesia
conscious but sedated
350
Stage 2 of Anesthesia
hyperexcitability, loss of eyelash reflex, laryngeal reflexes in tact
351
Stage 3 of Anesthesia (surgical anesthesia)
Plane 1: loss of swallow and conjuctival reflex Plane 2: loss of laryngeal reflex, increased lacrimation Plane 3: loss of pupillary light reflex, intercostal muscle paralysis Plane 4; apnea from diaphragm paralysis
352
Stage 4 of Anesthesia
cardiovascular and respiratory depression fixed, dilated pupils flaccid skeletal muscles
353
reflex bronchoconstriction occurs during stimulation of what nerve?
vagus nerve
354
complete injury to unilateral recurrent laryngeal nerve results in what position of vocal cords?
paramedian position
355
partial injury to unilateral recurrent laryngeal nerve results in what position of vocal cords?
midline positoin
356
which of the following has a larger osmotic gradient? A. Interstitial to intravascular B. Intravascular to intercellular C. Interstitial to intercellular
B. Large osmotic gradient between intravascular and intercellular
357
TBW makes up what percentage in healthy individuals?
60% *could be less in obese individuals
358
Of TBW, what percentage is intracellular vs extracellular?
Intracellular 55% Extracellular 45%
359
Of the extracellular fluid, what percent is bone, dense tissue (not involved in rapid redistribution?
2/5 (or 17% of TBW)
360
of the 3/5 extracellular fluid, what percentage is interstitial vs intravascular?
2/5 interstitial (20% TBW) 1/5 intravascular (8% TBW) *interstitial is 2-2.5 times the size of interstitial
361
nitric oxide works by increasing _____
cyclic GMP
362
Adelta nerve fibers transmit ____
pain (fasted, myelinated)
363
C fibers transmit ___
pain (burning, slow unmyelinated)
364
Aa nerve fibers are responsible for ___
proprioception (muscle spindles, golgi, ruffini endings)
365
Abeta nerve fibers are responsible for ___
pressure, touch, vibration (merkel disc, pacsinian corpusles)
366
Prerenal kidney injury findings: Fractional Excretion Sodium: Serum Osm: Fractional Excretion Urea: Urine Sodium:
Fractional Excretion Sodium: <1% Urine Osm: <400mOsm/kg Fractional Excretion Urea: <35% Urine Sodium: <20Meq/L
367
Intrinsic kidney injury findings: Fractional Excretion Sodium: Serum Osm: Fractional Excretion Urea: Urine Sodium:
Fractional Excretion Sodium: >2% Serum Osm: <350 Fractional Excretion Urea: >40% Urine Sodium: >40mEq/L
368
where is norepinephrine mainly metabolized?
pulmonary tissues (serotonin, bradykinin, angiotensin-1)
369
Succinylcholine increased upper/lower espohageal sphincter tone
lower
370
sevoflurane effect on amplitude and latency in neuromonitoring?
decreased amplitude and increased latency
371
chronic corticosteroid therapy results in all of the following except A. hyponatremia B. hypokalemia C. increased urinary calcium D. hyperglycemia E. Leukocytosis
hyponatremia
372
what is the universal RBC donor type?
O rh-
373
What is the universal plasma donor type?
AB+
374
Dextran colloids can ___ blood flow and ____ thrombus formation
improve, reduce *reduce blood viscocity, platelet aggregation, and rbc aggregation, and vWF )
375
hydroxy ethlyl starches disadvantages
coagulation (impaired platelets, reduced VII, vWF, increased PT, PTT, bleeding time) renal impairment increased amylase (no clinical significance)
376
risk factors for postoperative cognitive dysfunction include
lower educational level advanced age prior CVA
377
HCTZ acts on the ____ tubule
distal
378
loops diuretics act where?
thick ascending loop of henle
379
acetazolamide and mannitol act on the ___ tubule
proximal
380
how is a blood type and screen occur? (3 parts)
1, mixing recipient RBCs with anti-A, anti-B, and anti-AB antibodies 2. mixing recipient RBCs with anti-D antibodies for Rh status 3. mixing recipient serum with commercial type O RBCs
381
how is a type and cross done?
all components of type and screen plus mixing patients serum with donor RBCs
382
which anticholinesterase crosses the BBB?
physostigmine
383
glucagon causes hepatic arterial _____
vasodilation
384
angiotensin II causes _____ of hepatic arterial and venous systems
vasoconstriction
385
milirone MOA
PDE III inhibitor
386
milirone causes systemic ____ and pulmonary ____ but ____ cardiac index
vasodilation, increases cardiac index
387
Which amino acid synthesizes catecholamines?
tyrosine -->DOPA --> catecholamines
388
what can cause an increase between PaCO2 and EtCO2?
PE Reduced CO High V/Q ratio Increased Dead Space
389
The Meyer and Overton correlation describes
relationship between potency and lipid solubility
390
St Johns Wort (hypericum perforatum) can decrease what three things?
Cyclosporine levels (lead to transplant rejection) Warfarin levels Digoxin levels *also inhibits reuptake of serotonin and can lead to serotonin syndrome. also delayed emergence
391
St Johns Wort should be stopped ___ days before surgery
5
392
Echinacea can cause
immunosuppression (activation of cell mediated immunity)
393
Garlic can cause
increase risk of bleeding (antiplatelet)
394
Ginger can cause
increase risk of bleeding (antiplatelet)
395
Ginkgo can cause
increase risk of bleeding
396
Ginseng can cause
Hypoglycemia Increase bleeding Decrease Warfarin levels
397
Green tea can cause
increase risk of bleeding
398
Saw palmetto can cause
bleeding (inhibits 5a-reductase and cyclooxygenase)
399
Valerian and Kava cause
sedation
400
ephedra can cause
sympathometic response (MI, stroke)
401
Metoclopramide causes ___ LES pressure, ___ speed of gastric emptying, and ___ pyloric pressure
Increase LES pressure Increased gastric emptying Decreased pyloric pressure
402
sodium polystyrene (potassium binder) has been shown to lead to ___
bowel necrosis
403
What neurotransmitter is released from postganglionic neurons on vascular smooth muscle?
ATP
404
What enzyme converts norepinephrine to epinephrine?
PNMT
405
what is the most accurate coagulation test for Dabigatran?
TT (thrombin time)
406
Administration of mannitol can initially present with hyper/hypokalemia?
translocational hyperkalemia due to efflux of water from cells including K+
407
Intrapulmonary shunt (right to left) will ____ inhalational induction time
decrease *more notable for nitrous>desflurane>sevoflurane>isoflurane>halothane
408
Intrapulmonary shunt will ___ IV induction
have no effect
409
Intracardiac shunt (right to left) will ____ inhalational induction
decrease
410
intracardiac shunt (right to left) will ___ IV induction
increase (lungs are bypassed)
411
Intracardiac shunt (left to right) will ___ inhalational induction
have no effect
412
Intracardiac shunt (left to right) will ___ IV Induction
have no effect
413
PaCO2 is inversely related to: A. Alveolar Ventilation B. Minute Ventilation C. Tidal Volume D. RR
A. Alveolar Ventilation *30% of MV is dead space ventilation. In healthy individuals, 150ml tidal is close to 0 alveolar ventilation Ex: MV of 5L/min with 500ml TV and 10RR is better than MV of 5L/min with 150ml TV and 33 RR
414
LAD occlusion results in ischemia to what part of the heart?
anterior, anteroseptal, and inferoseptal walls
415
NIOSH maximum volatile anesthetic in ambient air recommendation
2 parts per millino
416
meperidine mainly acts on what opioid receptor?
kappa
417
what circumstances will you see an upregulation of immature acetylcholine receptors?
times of decreased stimulation (burns, sepsis, immobilization, CVA) - 48 hours to 2 years after insult *increased sensitivity to succinylcholine and resistance to NDNMB
418
under what circumstances is there a downregulation of mature acetylcholine receptors?
chronic pyridostigmine use, organophosphate poisoning, exercise conditioning *decreased sensitivty to succinylcholine, increased sensitivity to NDNMB
419
which area of the brain is responsible for inspiration?
dorsal medulla
420
which area of the brain is responsible for expiration?
ventral medulla
421
the lower pontine center (apneustic) in the brain ___ respirations
increases
422
the upper pontine center (pneumotaxic) in the brain ___ respirations
decreases
423
branches of the aortic arch (right to left) ABC's
Ascending Aorta Brachiocephalic Artery (innominate artery) Common Carotid (left) Subclavian (left) *right subclavian and right common carotid come off the brachiocephalic trunk - this is also where tracheoinnominate fistulas occur after tracheostomies (3-6 weeks post op)
424
Albuterol is associated with all of the following except: A. Tachycardia B. Hyperetnsion C. Hypokalemia D. Diastolic Hypotension
B. Hypertension is not associated with albuterol use
425
nitric oxide is also known as
endothelium-derived relaxing factor
426
nitric oxide functions in the body
-vasodilatory effects in smooth muscle -antiplatelet -immune system -stimulates insulin release in pancreas
427
the amount of air remaining in the lungs at peak inspiration of a vital capacity breath
total lung capacity
428
the amount of air remaining in the lungs at end-exhalation of a vital capacity breath
reserve volume
429
the amount of air remaining in the lungs after a tidal volume breath
functional residual capacity
430
catecholamines effect on renal blood flow and GFR
decrease renal blood flow and decrease GFR (afferent constriction)
431
angiotensin II effect on renal blood flow and GFR
decrease renal blood flow and increase GFR (efferent constriction)
432
inhaled anesthetics effect on renal blood flow and GFR
both are decreased
433
a patient with an MI without coronary intervention must wait ____ before elective noncardiac surgery
60 days
434
a patient with acute MI with balloon angioplasty must wait ___ days before noncardiac elective surgery
14 days
435
which AV blocks are considered high risk and noncardiac elective surgery should be delayed?
mobitz type II and third degree AV block
436
what is the mean pressure gradient cutoffs for severe aortic stenosis?
>40mmHg and <1cm^2
437
layers for caudal block in infant
skin, subq fat, sacrococcygeal ligament
438
Phase 1 reactions in liver metabolism include
oxidation, reduction, hydrolysisE
439
Enzymes that catalyze phase 1 reactions include
cytochrome P450, alcohol dehydrogenase, monoamine oxidase, esterases, amidases
440
Phase 2 reactions in liver metabolism are ___ _reactions
conjugation
441
Enzymes catalyzing phase 2 reactions include
glucuronyl transferase and sulfotransferase
442
in myasthenia gravis and lambert eaton, what reversal should be used?
sugammadex MG - chronic pyridostigmine decreases acetylcholinesterase levels lambert eaton - neostigmine is ineffective
443
basal ganglia striatum disorder
huntington disease
444
basal ganglia subthalamic nucleus disorder
hemiballismus
445
basal ganglia lentiform nucleus disorder
wilson disease
446
basal ganglia substantia nigra disorder
parkinson disease
447
standard error of the mean
SE = SD / square root of N *SD 4, sample size is 100 what is SE? SE= 0.4
448
thiamine is involed in which metaolic pathway
citric acid cycle
449
local anesthetics with a higher protein binding have a longer/shorter duration of action
longer
450
components of RCRI score
high risk surgery ischemic heart disease history of CHF history of CVA DM requiring insulin Cr >2
451
dexamethasone inhibits ___ which produces anti-inflammatory effects
NR3C1
452
what nerve may be injured after PDA ligation?
left recurrent laryngeal nerve
453
Parkland formula
4ml x TBW x percentage of body burned *100kg man with 63% of body burned 4 * 100 * 63 = 25200ml (25.2L) First 8 hours: 12.6L Next 16 hours: 12.6L
454
ACLS medications for ETT
epinephrine, naloxone, atropine, lidocaine
455
higher FiO2 prior to lung surgery can blunt the ____ response
HPV (individuals on oxygen have increased shunt fraction)
456
pulmonary shunt defintion
area of lung that is perfused but not ventilated
457
pulmonary dead space dfinition
area of lung that is ventilated but not perfused
458
law of LaPlace
T = P * r / 2h T= wall tension P = pressure r = radius h = wall thickness
459
hypothermia causes ____ PaCO2 levels
decreased
460
pH stat vs alpha stat
pH stat: dont warm blood sample to 37C so the sample will show higher pH and lower PaCO2 - correction with CO2 carries higher embolic risk but preserves cerebral blood flow alpha stat: warm blood sample to 37C so it shows "normal" pH and PaCO2 and lets body do the buffering
461
V1 receptors are found ___ and lead to ____
vascular smooth muscle in systemic, renal, coronary, and splanchnic; vasoconstriction
462
V2 receptors are found ____ and lead to ____
distal and collecting tubules in kidney; free water uptake
463
V3 receptors are found ___ and lead to ____
pituitary; increased ACTH release
464
vasopressin acts on _____ receptors in the myometrium, vascular smooth muscle, and vascular endothelial cells leading to ____
oxytocin-type; increased nitric oxide synthase and vasodilation
465
which drugs inhinit clopidogrel?
fluoxetine citalpram clozapine olanzepine diazepam omeprazole konazoles
466
vapor pressures of gases:
nitrous oxide> desflurane >isoflurane > sevoflurane
467
what conducts cardiac impulses from right atria to left atria?
bachman bundle SA node --> bachman bundle --> AV node -- bundle of His --> purkinje fibers
468
how does insulin decrease potassium levels?
increased Na+K+ATPase in skeletal muscles.. (not H+, K+ transport)
469
maximal allowable dose chloroprocaine?
12mg/kg
470
max allowable dose : lidocaine plain: lidocaine w/ epi:
lidocaine plain: 5mg/kg lidocaine w/ epi: 7mg/kg
471
normal PvO2 and SvO2
40mmHg 65%-75%
472
increasing the Pa-Pv ratio will _____ the Fa/Fi ratio and ____ induction times
slow rise of the Fa/Fi ratio and slow q
473
which of the following patients should have perioperative beta blocker therapy? A. individual already on beta blocker B. individual with 2 cardiac risk factors and having same day vascular surgery C. individual with 2 cardiac risk factors having intermediate risk surgery in 2 days
A and C. Should never start day of surgery. *cardiac risk factors: HTN, CAD, CHF, diabetes, CKD, CVA, PVD
474
double burst tetanic stimulation
two bursts of three rapid stimulations *if the clinician doesn't feel a second twitch, it can be assumed the TOF is <0.3
475
____ muscles have spindle fibers which when stretched, result in cessation of breathing
intercostal muscles
476
flow airway loop: fixed airway obstruction
plateaued top and bottom of the curve (tracheal stenosis, foreign body, large airway tumor)
477
flow airway loop: variable extrathoracic obstruction
plataeu bottom curve (inspiration portion) *vocal cord dysfunction, upper airway mass
478
flow airway loop: variable intrathoracic obstruction
plataeu top curve (expiration portion) *mediastinal mass, distal airway obstruction
479
osmolality units: osmolarity units:
osmolality: Osm/Kg osmolarity: mOsm/L
480
closing capacity is ____ in supine position
unchanged; however FRC is decreased so CC becomes higher than FRC resulting in hypoxemia
481
factors that increased closing capacity?
age, COPD, CHF, smoking, surgery
482
what coronary artery supplies the bundle brances and purkinje system?
LAD
483
Ketamine CNS effects
lateral gaze nystagmus increased CMRO2, CBF, ICP hallucinations
484
Dermatomes T4: T6: T7: T10: T12:
T4: nipple T6: xyphoid T7: inferior angle of scapula T10: umbilicus T12: pubis
485
treatment for neuraxial opioid pruritis?
nalbuphine (partial opioid antagonist) *more efficacious than diphenhydramine
486
minutes until hypoxemia equation
FRC (ml) / O2 Consumption (ml/min) * %O2 *FRC = 30ml/kg O2 Consumption = 3ml/kg/min Example: 70kg man at 100% FiO2 for 10 minutes - 2100ml / 210ml/min *1 = 10 minutes
487
PRIS symptoms
initial lipemia (check triglycerides) profound bradycardia hypotension metabolic acidosis rhabdomyalysis, hyperkalemia
488
Bayes theorem
preoperative testing algorithms using conditional probability
489
atropine duration of action vs glycopyrolate
atropine 15-30 minutes glyco 4-6 hours
490
landmark for superior laryngeal nerve block
either side of hyoid bone
491
glossopharyngeal nerve block landmark
posterior tonsillar pillar or posterior to the styloid process
492
posterior superior iliac spien is found at what spinal level
S2
493
tuffier's line refers to what spinal level
L4
494
Horners syndrome symptoms
ptosis, anhidrosis, miosis (constricted pupil)
495
wrist lateral to medial
radial Nerve, radial Artery, median Nerve, ulnar Artery, ulnar Nerve
496
anterior 2/3 of spinal cord receives blood supply from
single anterior spinal artery (most important branch is the artery of Adamkiewicz) *T9-T12 originates
497
posterior 1/3 of the apinal cord receives blood from
two posterior spinal arteries
498
tip of IJ venous catheter if: at carina: below carina:
at carina = SVC below carina = RA
499
_____ block is an alternative to epidural blood patch for treatment of postdural puncture headache
sphenopalantine ganglion block
500
Sevoflurane dial set to 2% at 2L/min mistakenly filled with isoflurane, what is the flow of isoflurane to patient?
step 1 (sevo output): .02 * 2000ml = 40 mL step 2: (gas flow sevo): 40 = (160 * Gas flow) - 760-160) --> 154 mL step 3: (iso output): X = (238 * 154) - (760-238) = 70 mL *vapor pressure sevo = 160 *vapor pressure iso = 238
501
acetazolamide can cause ____ by ____
metabolic acidosis ; inhibiting carbonic anhydrase and reducing bicarbonate levels
502
BUN levels are ___ in liver disease and ___ in kidney dysfunction
low; high
503
Hypertonic solutions ___ cerebral perfusion pressure
increase *CPP = MAP - ICP (ICP is decreased with hypertonic solutions)
504
Half Life for synthetic liver function: Factor VII (PT): Albumin: Fibrinogen:
Factor VII (PT): 4 hours Albumin: 20 days Fibrinogen: 4 days
505
____ potentiates NMB the most compared to other anesthetics
desflurane
506
buprenorphine moa
partial mu agonist , antagnosti at kappa receptor (slow dissociation from mu receptor)
507
nalbuphine moa
partial mu antagonist partial kappa agonist
508
butorphanol moa
partial mu agonist/antagonist full kappa agonist
509
Oxygen PSI: Volume:
PSI: 2000 PSI Volume: 660L
510
Air PSI: Volume:
PSI: 1800 Volume 625L
511
N20 PSI: Volume:
PSI: 745 Volume 1590L
512
Critical temperature of N20 (cannot be liquified above this)
36.5 C
513
Critical Temperature of Oxygen (cannot be liquified above this)
-118 C
514
denser tissue will have ____ echogenicity
higher (brighter)
515
high frequency ultrasound waves results in ____ resolution
increased
516
lower frequency ultrasound waves results in ____ depth of penetration
increased
517
nerve stimulator should have the cathode (positive end) on ____ and anode (negative end) _____
positive (skin) negative (needle)
518
inadvertent endotracheal tube advancement can occur with what things?
abdominal insufflation trendelenberg position head and neck flexion
519
deep peroneal nerve innervates
2nd webspace between 1st and 2nd toes
520
superficial peroneal nerve innervates
dorsum of foot and first through fourth digits
521
sural nerve innervates
achilles, ankle joint, lateral malleolus, lateral foot, fifth digitsa
522
saphenous nerve innervates
medial malleolus *branch of femoral nerve while the rest of the foot is branch of sciatic
523
posterior tibial nerve innervates
heel, plantar surface of foot
524
what lung conditions result in INCREASED DLCO?
asthma, obesity, high altitude
525
What factors with blood exposed to ventilated air increase DLCO?
Polycythemia, heart failure, left to right shunt, pulmonary hemorrhage
526
GCS Score: EVM-456
Eyes - 4 points Verbal - 5 points Motor - 6 points
527
when hydralazine is metabolized it releases ____
nitric oxide
528
which SSRI can inhibit the metabolism of midazolam?
fluoxetine
529
Phenytoin, rifampin, carbamazepime, steroids, St Johns Wort, tamoxifen, phenobarbital all ___ CYP450
induce (can reduce efficacy of drugs)
530
Grapefruit juice, conazoles, SSRIs, cimetidine, quinidine, clarithromycin all ____ CYP450
inhibit (can prolong action of drugs)
531
L4/L5 disc herniation affects ___ nerve root
L4 *cervical is the nerve root below
532
increased velocity, increased gas density, increased flow length, and decreased velocity will all ____ turbulent flow
increase *reynolds number
533
activation of B2 receptors ___ insulin release
promotes
534
activation of a2 receptors ___ insulin release
inhibits
535
bainbridge reflex
increased heart rate due to atrial strech
536
borders of adductor canal block
lateral - vastus medialis medial - adductor mangus superior - adductor longus anterior - sartorius
537
the annual limit for ionizing radiation is ____ rem
5
538
halogenated gases exposure limit (during 10-hour shift)
2ppm
539
nitrous oxide exposure limit during 10 hour shift
25 ppm (50ppm at dental office)
540
nitrous oxide + halogentaed exposure limit during 10 hour shift
0.5ppm
541
what is contraction alkalosis with loop diuretics?
decrease in extracellular volume with constant HCO3- (also with urinary loss of H+)
542
which local anesthetic has the highest incidence of TNS?
lidocaine
543
auditory and visual evoked potentials are ___ _by ketamine
decreased
544
glucagon ____ hepatic blood flow
increases *also D1 and B2 receptors
545
parathyroid hormone increases ____ which increases calcium levels
osteoclast activity
546
posterior cricothyroid muscle is the only to ____ the vocal cords and is innervated by the ___
abduct; RLN
547
angiotensinogen is synthesized in the ___
liver
548
renin is released from the JXA in response to ___, ____, and ____
B1 activation decreased renal perfusion decrease NaCl at the macula densa
549
angiotensin 1 is cleaved to angiotensin 2 by ____ in the ____
ACE, lungs
550
desmopression MOA
binds V2 receptors in kidneys --> urine retention increases levels of vwF and factor vIII for coagulopathic diseases (hemophilia A, vwB disease, diabetes insipidus)
551
cushing syndrome results in metabolic ____ with hypo/hyperkalemia
alkalosis, hypokalemia
552
peripheral chemoreceptors account for what percent of response to Co2? (carotid bodies)
20-40% (peripheral is more reponse to hypoxemia) 60-80% in central chemoreceptors to hypercarbia
553
factors affecting MAC: chronic amphetamine: acute alcohol: acute amphetamine: chronic alcohol: hypercarbia: lithium: verapamil: hypernatremia:
chronic amphetamine: decreased acute alcohol: decreased acute amphetamine: increased chronic alcohol: increased hypercarbia: decreased lithium: decreased verapamil: decreased hypernatremia: increased
554
hypocalcemia may ___ the effects of NMB
prolong (decreased acetylcholine release due to low calcium) *same with hypermagnesemia
555
aminoglycosides, tetracyclins, clidnamycin all may ____ NMB
prolong
556
compared to propofol, methohexital ____ HR which ___ MAP
increases; maintains
557
If altitude increases, the cuff on an ETT should ____ according to _____ law.
increase; Boyles (inverse relationship between pressure and volume)
558
Avagadro Law
equal volumes of gases at same pressure and temperature contain the same number of molecules
559
Charles law
V1/T1=V2/T2
560
Gay-Lussac Law
P1/T1=P2/T2
561
anticholinergic effects
tachycardia mydriasis bronchial smooth muscle relaxation decreased respiratory tract secretions
562
Difficult intubation risk factors LEMON
L- look E - evaluate -inter-incisor distance <4cm, thyromental distance <6cm, neck circumference >43cm, sternomental distance <12.5cm M - malampati III/IV O - obstruction - obesity, foreign object, trauma N - neck mobility <80 degrees
563
doubing Fi02 will ____ PiO2 (partial pressure of oxygen)
double
564
how quickly will IV vitamin K reverse warfarin?
6-8 hours *if INR>5, hold 1-2 doses of warfarin *if INR>8, oral vitamin K can be given first *if emergent or actively bleeding, 4 factor PCC can reverse within 4 hours
565
Transfusion related immunomodulation (TRIM) is associated with ____
renal allograft survival rate
566
10 cm H20 = ____ mmHg
7.4 *1kPa, 9.7mbar, 0.147 psi, 0.01 atm
567
An anesthetic is being delivered in NYC (760mmHg). If partial pressure of sevoflurane in the alveolus is 13mmHg, what is the concentration of sevoflurane?
13/760 - 1.7%
568
After the initial redistribution of heat loss, what two ways is heat linearly lost during general anesthesia?
Convection and radiation Convection: transfer of heat from body to surrounding air Radiation: loss of heat from patients body through infrared waves
569
In a left skewed (negative skewed) graph, where do the mean, median, mode lie?
Mode, median, mean
570
In a right skewed (positive skewed) graph, where do the mean, median, mode lie?
Mean>median>mode
571
Local Anesthetic systemic absorption into circulation
IV > Tracheal > Intercostal > Paracervical > Caudal > Epidural > Brachial Plexus > Sciatic > Subcutaneous
572
Lipid emulsion therapy dosing
1.5 mg/kg bolus 0.25mg/kg/min infusion
573
What test is used after anaphylaxis event?
Tryptase *half life of 3 hours
574
Methemoglobinemia SpO2 and PaO2
SpO2: 85% PaO2: normal
575
Carboxyhemoglobinemia SpO2 and PaO2
SpO2: normal PaO2: normal SaO2: 50% **
576
Cyanide toxicity SpO2 and PaO2:
SpO2: normal PaO2: normal
577
Post op cognitive dysfunction risk factors
Age, duration of anesthesia, second operation, respiratory complications, level of patient education
578
Monophasic defibrillator -rrect energy for v fib shock:
360J
579
-Biphasic defibrillator correct energy for v fib shock;
120-200J
580
Parkinson’s Disease Considerations: - antidopaminergic medications (reglan, haloperidol): -Sympathomimetics (ephedrine, ketamine) -Anticholinesterase medications (rivastigmine, dozepezil, galantamine) -Selegiline -Propofol: -Opioids:
- antidopaminergic medications (reglan, haloperidol): avoid due to potential for exacerbation of Parkinson’s -Sympathomimetics (ephedrine, ketamine): severe hypertension -Anticholinesterase medications (rivastigmine, dozepezil, galantamine): prolonged succinylcholine, resistance to NDNMB -Selegiline: avoid meperidine due to risk of serotonin syndrome -Propofol: dyskinesias -Opioids: rigidity
581
____ is the most important factor for spread of epidural
Volume
582
Risk factors for post dural puncture headache
Young Age Pregnancy Low BMI Cutting needle (Quincke, Sprotte) or larger Touhy Prior headaches? Female
583
Contraindications to Neuraxial anesthesia
Increased ICP Infection at site Allergy Coagulopathy (INR >1.5, Plt <70) Sepsis
584
Uptake of LA depends on ____ and ___ nerve roots have more
Surface area; smaller
585
___ fibers are blocked first and remain blocked the longest with spinal anesthesia
B fibers B fibers (preganglionic sympathetic) > C fibers (sensation to cold, post-ganglionic sympathetic) > A-delta (pinprick) > A-alpha (motor)
586
Spinal anesthesia elimination occurs entirely by
Vascular absorption
587
Stored RBCs results in ___pH, ___ ,2,3 DPG, and ___ K+
Decreased pH Decreased 2,3 DPG Increased K+
588
nACHR, 5-HT2, glycine, GABA, NMDA, AMPA, kainate are all examples of ____ receptors
Ligand-gated ion channels
589
HbSS shifts the oxygen dissociation curve ot the ____
right
590
sulf-Hb shifts the oxygen dissociation curve to the ___
right
591
anemia shifts the oxygen dissociation curve to the ___
right
592
met-Hb and CO-Hb shift the oxygen dissociatio curve to the ___
left
593
myasthenia gravis and graves disease are examples of type ___ allergic reactions caused by Ig__
II; IgG
594
Alpha waves EEG
8-13 Hz; sedated adult with eyes closed
595
Beta waves EEG
13-30 Hz; wakeful (also alpha waves in awake adult)
596
Delta waves EEG
0.5-4 Hz; brain injury, deep sleep, anesthesia
597
Theta waves EEG
4-7 Hz; sleeping individuals and during anesthesia
598
BIS >85 BIS 65-85 BIS 40-65: BIS <40:
BIS >85: awake adult BIS 65-85: sleeping adult BIS 40-65: surgical anesthesia BIS <40: deeply anesthesia
599
Preoperative steroid supplementation is indicated for oral use > ____ mg, topical use > ____g, and >____mcg inhaled for > _____ in the last year
20mg oral 2g topical 800 mcg inhaled For > 3 weeks in the last year *very minor surgery: take usual dose Minor surgery: usual dose +25mg hydrocortisone *moderate surgery: 50-75mg hydrocortisone Major surgery: 100-150mg hydrocortisone
600
Endoneurium covers _____
Each individual axon (innermost layer)
601
Perineurium covers _____
Nerve fascicle *intrafasicular injection, pressure monitoring
602
Epineurium covers _____
Entire peripheral nerve
603
Reflex bronchoconstriction occurs via the ____ nerve
vagus; efferent nerves sent to nucleus soltarius tract; afferent parasympathetic activate M2,M3 receptors in airway leading to bronchoconstriciton
604
in adults the dural sac ends at ___ and the conus medularis ends at ___
S2; L1-L2
605
In newborns, the dural sac ends at ___ and the conus medularis ends at ___
S3; L3
606
postsynaptic a2 receptors ____ platelet aggregation, _____ insulin release, and ____ lipolysis
inhibits all
607
b1 receptors ____ lipolysis
increase
608
b2 receptors causes ____ of bronchial and smooth muscle, ____ lipolysis, ____ insulin release
relaxation, increase lipolysis, increase insulin release
609
the c wave on central venous waveform corresponds to ____ on ECG, ____ closure, and ____ opening
QRS mitral valve aortic valve
610
the y descent on CVP waveform is associated what heart sound?
third heart sound; ventricular filling
611
the v wave on CVP waveform corresponds to ___ valve opening, and passive filling of the ventricle
mitral valve
612
calcitonin ____ levels of calcium
decreases
613
Apfel score components
female - 1 Non smoker - 1 history of PONV/motion sickness - 1 Opioids - 1 Total 0-4
614
Each unit of cryoprecipitate contains ____ mg fibrinogen
200mg
615
TENS provides pain relief by stimulating ______
A-beta mechanoreceptors
616
water moves across the BBB through _____
aquaporin 4; channel-mediated transport *electrolytes via specialized channels *gases through simple diffusion
617
what locations do not have a BBB in the brain?
area postrema (vomiting center) lamina terminalis (electrolytes and thirst) neurohypophysis (oxytocin and ADH)
618
Whittacre and Sprotte needles are _____ spinal needles
conical pencil-point
619
Pinkin and Quinke needles are _____ spinal needes
cutting point
620
Hustead, Crawford and Touhy needles are ____
non cutting point needles
621
Cushing reflex
Hypertension Bradycardia Irregular respirations In response to cerebral ischemia/ increased ICP and occurs in the lower brainstem motor center
622
Type A alpha fibers
proprioception, motor
623
Type A beta fibers
touch, pressure
624
Type A gamma fibers
muscle spindles/tone
625
Type A delta fibers
pain, temp, touch
626
Type B fibers
preganglionic
627
Type C fibers dorsal root
dull pain, temp touch
628
Type C sympathetic fibers
post ganglionic
629
the efficacy of a partial agonist ____ be higher than a full agonist
cannot
630
the potency of a partial agonist ____ be higher than a full agonist
can
631
arytenoid cartilage serves as ____ attachment of the vocal coreds
posterior
632
bronchi has ____ circular rings of cartilage
complete
633
the trachea contains ____ c-shaped rings opposing the esophagus and ends at __ vertebrae
16-20; 5th thoracic
634

CA1 Basic Exam (1 decks)

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