Vivas July

Question 1

ideal breathing system

Answer 1

1. Simple and safe to use.
2. Delivers the intended inspired gas mixture.
3. Permits spontaneous, manual and controlled ventilation in all age groups.
4. Efficient, requiring low FGF rates.
5. Protects the patient from barotrauma.
6. Sturdy, compact, portable and lightweight in design.
7. Permits the easy removal of waste exhaled gases.
8. Ability to conserve heat and moisture.
9. Easy to maintain with minimal running costs.

simple
safe-o2 in CO2 out, accurate
save-cheap system, low flow, efficeint
spont
strong
small
baro
heat

Question 2

N20 bottle

Answer 2

For a cylinder that contains liquid and vapour, e.g. nitrous oxide, initially the pressure remains constant as more vapour is produced to replace that which was used. Once all the liquid has been used, the pressure in the cylinder starts to decreases. The temperature in such a cylinder can decrease because of the loss of the latent heat of vaporization leading to the formation of ice on the outside of the cylinder.

Question 3

test bottle manufacturere

Answer 3

look
bend
pressurise
strip

Question 4

mark bottle

Answer 4

chemical
test date
test p
tare weight (of empty bottle)

Question 5

cylinder valve system

Answer 5

yoke (whole) with its pins
bodok washer
valve to turn on and off

Question 6

PIping system

Answer 6

Cu-non rusting antibacterial

colour and hape matched
flexible hoses
pulltest
risk of fire frome warn hose and connection

Question 7

cylinder manifold

Answer 7

series of cylinders

As nitrous oxide is only available in cylinders (in contrast to liquid oxygen), its manifold is larger than that of oxygen.

In either group, all the cylinders’ valves are opened. This allows them to empty simultaneously.

2. The supply is automatically changed to the secondary group when the primary group is nearly empty. The changeover is achieved through a pressure-sensitive device that detects when the cylinders are nearly empty.
3. The changeover activates an electrical signalling system to alert staff to the need to change the cylinders.

Question 8

VIE

Answer 8

#cu coil
#superheater
#-160C ie less than -118C crit temp
1000x vol at room temp
nil active cooling #LHV

Question 9

entenox

Answer 9

pseudocritical temp -5C
therefore at -5.1C can be compressed to liquid–>poynting effect
N20 with 20% O2 on bottome with high O2 above

so >10C for 24hours before use, invert and shake, dip to take bottom before becomes hypoxic

only flows when sucked on (2 stage Pressure:demand regulator

Question 10

renal feedback

Answer 10

macular densar are sensars of Na and release Adenosine
gRanular cells generate Renin
mesangial cells contract

Question 11

N20 CBF

Answer 11

increased CMRO2

Question 12

N20 production

Answer 12

NH4NO3–>H20 +N2O with impurities of NO and NO2

Question 13

N20 SE resp

Answer 13

nil Change in MV despite small decrease in TV

Question 14

N2O toxicitiy

Answer 14

oxidises the cobalt in B12 which means B12 can’t be a cofactor for methionine synthitase which makes methionine to produce activated folate and DNA

• ->BM suppression–>agranulocytosis
• ->subacute combined degreneration of spinal cord

Question 15

N20 causing PTx

Answer 15

1) N2 is highly insoluble therefore TRAPPED IN THESE SPACES
2) N20 while insoluble vs other agents is more soluble in blood than N2
3) N20 out of blood into gas filled spaces (down conc gradient) much quicker than N2 exiting that space into blood

Question 16

N20 lungs

Answer 16

PHTN-increased SNS

Question 17

apheresis

Answer 17

Apheresis is a medical technology in which the blood of a person is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation

Question 18

diasterioisomers

Answer 18

> 1 chiral centre

Question 19

CO reduced Vd

Answer 19

V1 smaller i believe

Question 20

t/2=

Answer 20

In2/k

k is rate constant for elimination

Question 21

isomers definitions

Answer 21

structural=different bonds

stereoisomer=same bonds, different 3D arrangement

Question 22

strucutural isomers

Answer 22

positional: butane vs isobutane

chain-iso vs enflurane

Question 23

iso vs enflurane

all agent draw

Answer 23

chloride on diff carbon

similar O:G yet ENFLURANE has higher mac

Iso strong

Flouride stable, impotent increase VP less flammable decreased sol

• halo 3 and old school Br (potent)
• iso/en 5 and CHF2—>CO
• sevo 6 and nil CHF2, has CF3, but compound A
• des 7 and fuck it CHF2 but no compound A

Non polar and small—>high VP

Question 24

geometric isomer

Answer 24

differ from each other in the arrangement of groups with respect to a double bond, ring, or other rigid structure.

Question 25

S vs R structure

Answer 25

chiral centre, lowest behind, then flat plane on pace ascending clokwise is Right Rectus vs Serious

Question 26

high first pass

Answer 26

GTN, morphine, midaz,

Question 27

prodrug

Answer 27

codeine, clopidogrel

Question 28

midaz elim

Answer 28

pee out inactive met so CKD no biggy as per oxford

Question 29

fat

Answer 29

increased alpha1 acid GP

Question 30

roc offset factors

Answer 30

Rb elderly and femal due to decreased m mass rememeber Li Amingoglyco and frusemide-->decreased AcH aminolgycocyde also CCB fenytoin speeds up recovery by increasing PrB to alpha 1 A GP and upreg of rec Rb volatile inhibits NaCHR

Question 31

clondine PK

Answer 31

99% OBA 50% hep 50% renal elimunchanged MoA presynaptic a2 stim-->decreased Nad B stem-->decreased SNS out DH-->opiate release and moduclate descening pain

Question 32

role BBB | core

Answer 32

1) chemical #kenicturus 2) immune # MS 3) ph 4) ion and glucose #manitol not effective in stroke 5) nt #ice abuse

Question 33

BBB structure

Answer 33

tight junction of endo cells BM foot processesses podocytes enyzmes MAO AchE

Question 34

Preg cvs

Answer 34

Oestrogen RAAS (all women are tense) Progesterone ->prostaglandin->vd->improve perfusion

Question 35

SSx

Answer 35

most common is - hyperreflexia - clonus

Question 36

OHBD shift right | CORE AS FUCK

Answer 36

23dpg is PRODUCED IN hypoxia-->to release O2 23dpg is produced in pregancy increase-->right shift (release O2) 23DPG is produced in alternative pathway for one of the steps of glycolysis (less efficient-consumes 1ATP inseatd of producing it) decreased glycolysis in storage-->decreased 23DPG

Question 37

deadspace preg

Answer 37

The lack of gradient is attributed to the reduction in alveolar dead space (increased blood perfusion from an increase in maternal CO).

Question 38

preg resp

Answer 38

Cx 3 1) mech 2) humeral 3) MRO2 60% ``` Consumption Drive-progesterone Airway #BD due to progesterone Compliance and work Vol FRC decreased 20% #IC mild increase in preg VQ-shunt, DECREASED DS OHDC measurement ```

Question 39

fetal maternal CO2 levels

Answer 39

``` arterial gap of 15 venous gap of 5 essentially mum takes 5 off baby mum artery 37 (MEMORABLE alkalotic)-->42 fetal arter 52 (memorable acidodic)-->47 ``` REMEMBER MOTHER IS ON BOTTOM (more O2)

Question 40

haldane effect wiki

Answer 40

deoxyHB binds H+ | shift H2CO3 eqn to right with more CO2 soaked up

Question 41

bohr wiki

Answer 41

H+ stabilizes Hb in Tense state-->release O2 | essentially higher CO2-->more H+-->bump O2 off Hb

Question 42

CVS changes in preg | core

Answer 42

1) humeral 2) mech 3) MRO2 HR.SV.SVR plus clotting and albumin and HCT plus regional plus transport OHDC

Question 43

Hysteresis

Answer 43

1) surfactant -on expiration as volume decreases surfactant more concentrated to remaining volume—>reduced surface tension—>remains open for longer (less compliant) 2) visicoelastic properties 3) recruitement 4) dynamic compliance effected by airway resistance

Question 44

deadspace effects

Answer 44

decreased AV -increased CO2, decreased O2 hypoxia easily reversible with Fio2 vs if shunt a cause.

Question 45

resistance airway generation

Answer 45

moderate, high, +++low 17 division conductive including terminal bronchioles 17-23 respiratory including respiratory brioles

Question 46

alv ventilation/min

Answer 46

5000ml/min =5L of BF=VQ=1

Question 47

CO2 vs AV eqn CORE AF

Answer 47

PACO2=CO2 prod/AV.k

Question 48

DS eqn | CORE AF

Answer 48

cardiac arrest PACO2-PECO2/PACo2 #expired Co2 in douglas bag diluted

Question 49

Shunt eqn | CORE AF

Answer 49

Content o2 not Partial pressure ContentAlv o2-Content arterial/(Content Alv-mixed venous)

Question 50

Diffusion capacity measurement

Answer 50

Flow=P.Diffusioncapictyoflung Diffusion cap=P/flow measure the uptake of something that is diffusion not perfusion limited ie CO D of CO=sol/MW.A.P/T CO uptake=diffusion capacity.Palv PAlv=CO uptake/diffusion capacity of lung SINGLE BREATH METHOD measure insp with IR hold for 10s then measure exp with IR increases with exercise due to recruitment-->increased area

Question 51

diffusion limitation axis

Answer 51

Partial pressure not diffusion % things that are sol or sucked up by Hb-->dont build up an opposing partial P and keep sucking more and more in.

Question 52

O2 flux eqn

Answer 52

flux is delivery!!!!! Hb per L is 120 sol per L= 0.03 Hb per 100ml is 12 sol per 100ml is 0.003

Question 53

diffusion limitation 2 components

Answer 53

diffusion to RBC O2 and CO2 reaction in RBC both contribute 50%

Question 54

diffusion capacity error

Answer 54

VQ mm will fuck with things yet not a diffusion problem

Question 55

Fick principle

Answer 55

Uptake=Qt(CaO2-CvO2)

Question 56

measure PBF

Answer 56

fick prinicple uptake measure by measuring conc of expired O2 or indicator dillution method

Question 57

why shunt cant be compensated

Answer 57

well oxygenated alveoli even with +++PAO2 can't carry much more O2 due to Hb maxed out #plateu of OHDC

Question 58

asthma

Answer 58

airway obstruction-->shunt-->hyperventilate-->decreased PaCO2-->EXHAUSTED-->increased PaCO2 BC-->autopeep

Question 59

copd

Answer 59

shunt+deadspace-->hypoxia and HYPERCAPNIA treat with PEEP to reduce shunt

Question 60

hufners constant

Answer 60

each GRAM of Hb takes 1.34 ml of O2

Question 61

OHDC figures

Answer 61

100: 100 90: 60 p50: 28 75: 40 venous Myoglobin 50point is 2.8mmHg

Question 62

central venous vs mixed venous #teach

Answer 62

yes confirmed central is from atria normal is 70-80% mixed venous is from Pulm artery Central is RA Mixed is pulmonary arter Coronary sinus drains into RV so mixed is more hypoxic myocardial oxygen consumption (given that the source of the discrepancy is probably blood washing out of the coronary sinus can derive - OER to guide diag and Mx - CO from ficks prinicple - shunt eqn

Question 63

respiratory compliance curve

Answer 63

recoil P on x axis

Question 64

wheatstone bridge

Answer 64

#galvinometer

Question 65

aorta vs radius

Answer 65

Aortic incisura | Radius diastolic hump

Question 66

glucose handling graph

Answer 66

glucose flux vs plasma glucose (x)

Question 67

Warfarin met

Answer 67

Cyp450 CYP3A4 Met induced by STP And carbemazepine Met inhibited by amiodarone and cimetidine

Question 68

Warfarin reversal

Answer 68

Remember prothonvinex

Question 69

Hb BD

Answer 69

haem +globin haem-->fe and biliverdin-->bilirubin bili-->urobilinogen-->stercobilin

Question 70

Conj vs uncong

Answer 70

uncong=prehepatic or hepatic eg cirrhosis conj=hepatocellular or post hepatic if any bili in urine=hyperconj

Question 71

tryptase

Answer 71

1,4,24 peaks, dropping, baseline. baseline will factor into interp

Question 72

anaphylaxis

Answer 72

``` Hist leukotreine-chemotractic-->delayed effect PG bradykinin TNFa 5HT NO Tryptase-->activate comp system, coag-->thombus and DIC ```

Question 73

serum vs plasma

Answer 73

serum is what is left after blood has clotted ie plasma without coag factors

Question 74

role of plasma proteints

Answer 74

``` clings to... water pH drugs cations clots invaders enzyme function energy reserve ```

Question 75

reticulocytes

Answer 75

new production of RBC | still have RNA fracgments

Question 76

dibucaine number

Answer 76

is an amide LA that inhibits Butylcholinesterase % of butylcholinesterase uneefected after challenge gives number normal is 80% genetic dx-->only 20% remain %effective butylcholinesterase effective

Question 77

``` Esterases #amanda diaz ```

Answer 77

hydrolyse esteres (BD by reaction with H2O) non spec-remi and emsolol and atrac and cisatrac butylesterease sux and miv and ester LA cocaine and heroine achetylcholinesterase-Ach RBC esterases esmolol and remi (small for remi)

Question 78

hoffman

Answer 78

spont degen in pH and temp | cleave of quarternary nitrogen link to central chain

Question 79

local anaesthetic structure function | GOLD

Answer 79

COO is ester NHCO is amide #amine aromatic lipophilic group hydrophilic group Mepivacaine, bupivacaine, and ropivacaine are characterized as pipecoloxylidides (see Fig. 10-2). Mepivacaine has a methyl group on the piperidine nitrogen atom (amine end) of the molecule. Addition of a butyl group to the piperidine nitrogen of mepivacaine results in bupivacaine, which is 35 times more lipid soluble and has a potency and duration of action 3 to 4 times that of mepivacaine. Ropivacaine structurally resembles bupivacaine and mepivacaine, with a propyl group on the piperidine nitrogen atom of the molecule. changing length and C attachments-->changed lipid sol DoA metabolism etc piperadine nitrogen: 1) Methyl->4)butl-->bupivocaine ++lipid sol and doa Butyl-->3)propyl-->ropivocaine methyl ethyl propoyl butyl

Question 80

LA pH

Answer 80

Local anesthetics are poorly soluble in water and therefore are marketed most often as water-soluble hydrochloride salts. These hydrochloride salt solutions are acidic (pH 6), contributing to the stability of the local anesthetic. An acidic pH is also important if epinephrine is present in the local anesthetic solution, because this catecholamine is unstable at an alkaline pH.

Question 81

remifentanil vs fent potency

Answer 81

can simplistically be thought of as equipotent | classically remi called 2x more potent

Question 82

pethidine

Answer 82

high sol low potency renal and fetal accum with active metabolite reacts with MAOi action and SE antichol and SSRI and morphine not reversed with naloxone

Question 83

methadone

Answer 83

C-full opioid agonist, NMDA antag, SSRI U-pain addition good for neuropathic pain P-PO A-opiate and NMDA D-1/4 morphine (more potent) O-relatively fast 2.5hrs (lipid sol) offset long due to large Vd R-PO/IV S - less sedation, euphoria, addiction - Qt prolongation in high dose ``` D -PrB 90% highly lipid sol A -good OBA 75% due to low first pass met M -hep met (has large reserve) with inactive met E inactive peed out T/2 24 hours ``` Low cost Individual unpredictable PK and PD so slow titration

Question 84

naloxone naltrexone

Answer 84

naloxone crosses BBB, low OBA and fast and short effect-->IV reversal (yet also with targin as low OBA means it stops GI Sx without blocking neuro Sx) Naltrexone -good OBA nil BBB crossing

Question 85

Opiate classification

Answer 85

``` Endogenous -encephalin, endorphine Natural -morphine -codeine -thebaine Semi syth -codiene changed to oxycodone -morphine changed to heroine Synthetic -phenylpiperidine -morphine deriv -thebaine change-->naloxone and naltrexone ```

Question 86

lafent offset

Answer 86

small Vd due to less lipid sol-->more rapid elimination despite less clearance

Question 87

opiate change

Answer 87

incomplete cross tolerance

Question 88

fent CSHT

Answer 88

better than alfent until2 hr infusion

Question 89

quantal vs

Answer 89

graded

Question 90

opiate rec

Answer 90

NOP is supraspinal Cortex, Thal, BG, PAG, Resp centre, SC, periph

Question 91

white vs grey matter

Answer 91

white is fat so middle of brain and outter tracts of SC

Question 92

ANS

Answer 92

sympathetic spinal colum grey matter and peripheral ganglio PSNS CN nuclei Sacral Rami

Question 93

content O2 of blood Normal

Answer 93

200ml/L

Question 94

bohr reason

Answer 94

H stab Hb binding ttttttoo boooooohring

Question 95

``` Hamburger effect RV RV RV GOLDEN ```

Answer 95

venous blood lower Cl vs arterial. CO2 into RBC-->HCO3-->swapped from Chloride Effect: mittigation of acidity in venous increased CO2 carry cap in venous increased offloading of O2 as Cl causes T state stabilization #allosteric change

Question 96

henderson

Answer 96

ph=pka +log HCO/CO2x0.003 pka+log A-/HA

Question 97

HCO3 in resp acidosis

Answer 97

INCREASES in acute and chronic 3x more in chronic

Question 98

Predicted CO2

Answer 98

HCO3x1.5+8

Question 99

Bicarb types

Answer 99

standard with real CO2 actual if CO2 normal BE if real CO2 BExxx if normal Hb

Question 100

NAG

Answer 100

10-16

Question 101

CATMUDPILES

Answer 101

Cyanide, CO, aminoglycosides

Question 102

measure osmolarity

Answer 102

2xNa +urea+glucose

Question 103

Blood gas interp steps

Answer 103

met or resp or mixed HAG or NAG osmol gap delta gap for HAG+other

Question 104

HAG NAG renal

Answer 104

RTA is HCO3 loss hence NAG | ureamia is HAG

Question 105

La Place | CORE

Answer 105

P=2T/r

Question 106

surfactant and hysteresis

Answer 106

collapsing-->surfactant pressed together-->resist further collapse

Question 107

Resp compliance

Answer 107

1/RC=1/L+1/Thoracic cage =1/100

Question 108

surfactant

Answer 108

Prevention of fluid transudation. As the surface tension forces are generally reduced by surfactant, less interstitial fluid is sucked into the alveolus.

Question 109

dynamic airway compression relevance

Answer 109

more apparent in lung Dx to restrict exp flow rate due to loss of lung elastic recoil and radial traction. equal pressure point moves deeper into lungs on exp as airways get smaller in collapsing lung determined by AlvP-Pleural pressure not mouth pressure

Question 110

spiro dx

Answer 110

FEV1 decrease to GREATER EXTENT in COPD FEV1 decreased to LESSER extent west says in both FRC is decreased i believe can be increased hence barrel chest copd

Question 111

RR and TV and WoB in Dx

Answer 111

trap=elastic curve=frictional (80% airway and 20% tissue) in PF elastic work big and frictional work low so breath small TV with high RR in COPD elastic work reduced and airway res increased-->take big breathes and low RR

Question 112

static compliance

Answer 112

oeophageal pressure measure

Question 113

adding to alpha cardbon

Answer 113

BLOCKS MAO

Question 114

classification of sympathomimetics

Answer 114

evernote gold

Question 115

COMT mech

Answer 115

add a methyl group

Question 116

MAO

Answer 116

oxidative deamination ie uses O2 to cleave amine

Question 117

Sotalol

Answer 117

``` add salt to everything class I,II, III ```

Question 118

low lipid bblocker

Answer 118

poor ab but minimal first pass met-->good OBA and long halflife as minimal met

Question 119

adenosine

Answer 119

``` C-nat purine nucleoside U-SVT reentry and diag P 3mg/ml clear A- 1)adenonsine sense K ch open -->hyperpol 2) inhibit cAMP excitation in ventricles 3)infusion-->drop SVR D O 10-20s doA S -CI in 2nd or 3rd degree heart block or SSSx -can cx VF/VT as brady increases excitabiliy -can Cx AF of Aflutter as decreased atrial refractory period -can cx brady requiring pacing Met-RBC and vasc endo to AMP no dose change in renal or hep ```

Question 120

why ohms law imperfect for lungs

Answer 120

elastic, non lamina, non-newtonian fluid F=P/R yet increase increase P-->decreased resistance

Question 121

admix

Answer 121

"venous admixture is the amount of mixed venous blood required to mix with pulmonary capillary blood to produce the observed alveolar–arterial Po2 difference." (includes true shunt AND VQ scatter) mixed venous blood is the venous blood drained from bronchi (via bronchial veins) and LV (via thesbian veins) to LA AND VQ SCATTER AND CARDIAC DEFECT R-->LSHUNT Sources of venous admixture include: "True" intrapulmonary shunt, blood which passes through lung regions where V/Q = 0 V/Q scatter, blood which passes through lung regions where V/Q < 1.0 Thebesian veins, which contribute myocardial venous blood with low oxygen content Bronchial veins, which drain the bronchial walls Intracardiac right-to-left shunts Normal shunt fraction in healthy adults is 4-10% !!!!SO TRUE SHUNT IS ZERO OXYGENATION yet decreased VQ contributes to admix!!!!

Question 122

shunt

Answer 122

Shunt is the blood which enters the systemic arterial circulation without participating in gas exchange

Question 123

anatomical shunt CORE

Answer 123

just 2! P+K and derranged phys thesbian which go to coronary sinus -->LA bronchial Veins-->LA

Question 124

OLV CPAP

Answer 124

if blood going through may as well try add some O2 to it.

Question 125

Pulm HTN Mx

Answer 125

1) O2 2) NO donor (sodium nitropruside or GTN) 3) CCB 4) PDEi - PDE3i cGMP inhibited BD Silden - PDE35i CAMP inhibited BD milrinone 5) Prostaglandins-->VD

Question 126

silden | milrinone

Answer 126

S=5 M=3 visually looks that way 3->cAMP-->contractility

Question 127

peripheral chemo rec

Answer 127

CO2 and O2 CB and AoA | pH only in CB

Question 128

rotem | GOLD

Answer 128

clotting-->fibrin blocks-->platelet strength | CT-->CFT-->MCF-->plasmin

Question 129

vasopressin

Answer 129

VwF

Question 130

hypoplasmin

Answer 130

leukaemia, thrombolysis, bradykinin, ESLD due to impaired clearance of plasminogen activator Trauma, DIC, thombolytic therapy, placenta acreta-->plasminogen activator from placeta-->lots of lysis

Question 131

resp centre | CORE

Answer 131

Medullar resp centre Di Ve Be pons - pneumotaxic-taxes slow - apneustic centre-aps speed up efficientcy

Question 132

HYperbaric Rx

Answer 132

CO poisoning decompression gas gangreen

Question 133

pendeluf and RR

Answer 133

worse with high RR as need prolonged exp oause to balance

Question 134

daltons law clinic sig

Answer 134

P=P1 +p2 so at everest less PP of O2

Question 135

avagadros law

Answer 135

at equal temp, vol and pressure different gases contain the same number of molecules dilution of O2 in trachea-->decreased PP of O2

Question 136

henry's law

Answer 136

conc proportional to pressure of gas in a liquid.

Question 137

gibbs donnan

Answer 137

KPr intracell KCL out | CL comes in K comes in water comes in

Question 138

osmotic p

Answer 138

the pressure that would have to be applied to a pure solvent to prevent it from passing into a given solution by osmosis,

Question 139

oncotic

Answer 139

osmotic p exerted by colloids ie protein

Question 140

albumin tonicity and effect

Answer 140

I agree albumin 20% (and 4%) are hypotonic and hyposmolar which as a fluid would mean they wouldn't effectively expand much volume. But 1) albumin remains much more intravascular without spreading interestitial fluid as fast as IVF 2) album 20% is 200g/l vs 45g/l in healthy patient, 4% is 40g/l so if giving it to someone will low albumin then it will increase the oncotic pressure despite the decreased osmotic pressure (colloid + electrolyte contribution). This will mean the starling forces (defined by oncotic pressures not osmotic) will pull fluid into blood and prevent peeing out at kidney 3) Gibbs donnan effect-->albumin pulls more water into IV space that would be expected

Question 141

albumin 20% tonicity

Answer 141

Alb 130mmol/L Na 130mmol -->260mmol-->hypotonic

Question 142

normal plasma osmolarity

Answer 142

280mols/L

Question 143

TWB splitts

Answer 143

60% TBW 1/3 EC 1/4 IV 5% of weight is plasma vol =3.5L then add cells

Question 144

Stewart theory

Answer 144

!!!!Strong, weak nonvolatile, weak volatile!!!! ``` Stewart theory from Melbourne course H+/HCO3 are dependant on 3 variables 1. SID #electrical neutrality 1. Na + K-Cl =42 2. Other Strong ions Ca Mg, lactate, ketones, 3. Weak ion HCO3, Albumin 2. Weak inorganic acids 1. Alb 1. IVF—>dilute albumin (an acid)—>increased HCO3 2. (Note in SID decreased Alb—>increased HCO3 2. Phosphate 3. CO2 ``` ``` benefit Acknowledges - hydration status effects -Albumin conc effects -identifies SID as MOST IMPORTANT FACTOR ```

Question 145

G+S+Xmatch

Answer 145

1. ABO (what Antigens are present on RBC) 1. Forward test 1. Recipient RBC vs control 2. Backward test (confirm forward) 1. Recipient plasma vs control RBC 2. Screen for non ABO antigens (these are not on RBC! So patients serum is tested for antigens!!!!!) 1. Recipient plasma vs control RBC 3. Xmatch (Will the recipient reject this offering) 1. Is screen and Hx negative for ABs then 2 options 1. Algorithm based on data—>choice 2. Immediate saline spin (check screen really right with real donor sample) 1. Recipient plasma vs donor RBC 2. Screen positive or sig hx 1. Indirecirect Antiglobulin test (IDAT) to see if ABO and other antigens present 1. Incubation of recipient plasma and donor RBC 2. Wash this combo to remove any plasma Ig not bound to RBC (this would react with the anti-human immunoglobulin about to be added 3. Glutination-add anti-human-IG to bind the Ig that is bound to antigens—>little clumps—>positive result (bad thing: means recipient has antibodies against donor RBC that then clump when bound by antihuman Ig)

Question 146

immunoglob

Answer 146

Role of immunoglobulins 1. Labelled for NK to destroy 2. Labelled for phagocytosis #opsinization of viruses 3. Compliment activation 4. Bound to Bcell wall—>make a befell an Antigen presenting cell Immunoglobulins tip is variable so specific to antigens

Question 147

immune system pneumonic

Answer 147

Innate PGN Cs | Addaptive immune BAT

Question 148

complement cascade

Answer 148

Complement - proinflamatory proteins activated by classic: Ig:Antigen or alternative or proteolytic enzymes—>inflammation, lysis - reaction in ABO incompatability - inhibited by C1 esterase

Question 149

collegiate

Answer 149

increase BP, osmotic P | decreased freezing point and SVP

Question 150

actual and standard HCO3

Answer 150

pCO2 – Measured directly  Actual HCO3 – Measures pH and pCO2 from blood sample and then calculates HCO3 from the H‐H Equation  Standard HCO3 – Calculated parameter when the blood sample is equilibrated with a gas mixture with PCO2 level of 40mmHg – attempt to represent the True metabolic component in patients with dual Acid – Base AbN.

Question 151

BE and standard base excess

Answer 151

Hb 50 (anaemic-->standardized)

Question 152

Mannitol

Answer 152

RV adme and PD

Question 153

Des PD

Answer 153

Decreased TV Increased RR | Nil neg into more VD more hypotensive more tachy

Question 154

Frusemide

Answer 154

Pulm and systemic VD | Cl channel block can't conc medulla

Question 155

SNP met

Answer 155

OHb-->met-->cyanomet Rhodanase adds sulfur group B12-->cyanocobalamine Bicobolt chelates

Question 156

Heparin

Answer 156

mucopoly ACS REVERSIBLE BINDING TO ATIII 9,10,11,12,13 PL 8000 SC TDS/BD T/2 1.5hrs bleeds, HITS, osteoporosis, ald inhib ``` Vd 100ml/L Ab same SC M hep and liver and ER system-->de polymerated -slowed in hypothermia E-renal fine ``` target APTT 2x normal

Question 157

HITTS RX

Answer 157

direct thrombin inhibitor

Question 158

4Ts

Answer 158

timing 5-10days oTher Cx thombosis thrombocytopenia

Question 159

CYP450 types

Answer 159

3A4 midaz warfarin, clopid | 2D6 tramadol

Question 160

Naturalf freq stiffness eleasticity

Answer 160

on top

Question 161

damping effect

Answer 161

yes does decreased freq a little and increase freq response window (ie the range of frequency of before resonance occurs)

Question 162

damping anzca text

Answer 162

2. To determine the optimum damping of the system, a square wave test (fast flush test) is used ( Fig. 11.9 ). The system is flushed by applying a pressure of 300 mmHg (compress and release the flush button or pull the lever located near the transducer). This results in a square waveform, followed by oscillations: a. in an optimally damped system, there will be two or three oscillations before settling to zero b. an overdamped system settles to zero without any oscillations c. an underdamped system oscillates for more than three to four cycles before settling to zero.

Question 163

resonant freq

Answer 163

The lowest resonant frequency of a vibrating object is called its fundamental frequency. Most vibrating objects have more than one resonant frequency and those used in musical instruments typically vibrate at harmonics of the fundamental. Resonant Frequency is the Oscillation of a system at its natural or unforced resonance.

Question 164

damping coeff

Answer 164

reflection of freq response of system actual damping/critical damping zero damping=o optimal damping=0.64 critical damping =the point at which there is just no overshhoot =1 overdampe=no overshoot and takes more time than critical damping to get there >1

Question 165

HM

Answer 165

HM6G is INACTIVE but neuroexcitatory and accum in renal more lipid sol vs moprhine-->faster onset vs morph smaller Vd vs fent-->longer DoA vs fent

Question 166

Morphine met

Answer 166

CYP450 demethylation and glucornidation M3G-->neuroexcitatory M6G-->13x more potent

Question 167

octenol:water coeff

Answer 167

morph=1 | fent=600

Question 168

oxcodone met

Answer 168

noroxycodone inactive and oxymorpphone-->WEAKLY active 3A4 → inactive noroxycodone 2D6 → active oxymorphone Naloxone is an “Nalkyl derivative of oxymorphone”

Question 169

buprenorphine

Answer 169

partial ag slow dissocaition from rec-->long action and unpredictable reversal and low dependancy -resp dep not completely reversed by naloxone biliary excretion 25x potency of morphine SL BA=50% PO is well ab but high FPM Vd 4l?kg CYP450-->bile severe resp dep with high midaz elim T/2 5hrs

Question 170

Mannitol

Answer 170

decreased CSF produ cross glom and not reab-->wash out medulla-->no reab nil met small Vd HTN transiently target osmol 300-320 hypokalaemia

Question 171

Hypertonic saline

Answer 171

``` ICP rhabdo preserve renal function start diuresis in renal transplant bowel prep glaucoma ``` ``` titrate to target Na 155 benefit nil osmolar testing cheap available antioxidant less likely to cause hypovolaemia 10min on for 1 hr ``` ``` Disad hypernatraemia hyperchlo acid hypokalaemia central pontine demiolosis renal failure phlebitis, necrosis hypervolaemia seizure encephalopathy rebound raised ICP ```

Question 172

porphyrin

Answer 172

porphyrin ring of Hb precurser of Hb req p450 to change forms genetic or acquired dysrufption-->accum-->toxic skin and nervous system - tachy, HTN - fever - confusion - seizure, paralysis - death - abdo, chest pain, - blisters

Question 173

parietal cell stim and inhibition

Answer 173

Highly specialised Mitochondria ++ Proton pump (apical H+/K+-ATPase) moves H out of cell againstsignificant gradient 3 agonists: Gastrin ACh Histamine ``` Inhibited by: Somatostatin B-adrenergic activity High acidity PGE2 ```

Question 174

filling ratio N2O

Answer 174

0.75 or 0.66 in tropics

Question 175

yoke pins etc

Answer 175

yoke is the outside c grip with pins as 1 componenet and fresh gas flow outlet washer valve is part of cylinder

Question 176

Heat vs temp

Answer 176

Heat is potential and kinetic energy that is transferred from a substance of higher temp to lower temp. J or Cal Temperature is not energy but a measure of the hotness or coldness of a substance (measure of average kinetic energy of a single particle in a system per degree of freedom) K or C heat can be added to increased the temp OR change the state.

Question 177

SHC

Answer 177

The amount of heat energy required to increase one Kg of a substance by one Degree Centigrade/Kelvin

Question 178

Renal BF reg

Answer 178

Autoreg ``` SNS Renin ATII ANP PGs ```

Question 179

Tubulorglomerular balance

Answer 179

glucose | increased oncotic P in pertubular cap-->increased reab

Question 180

oliguria mech

Answer 180

``` osmorec HP baro LP baro renal Baro renal autoreg ```

Question 181

cardiovascular centre

Answer 181

HTN-->... NTS stims Nambig stims PSNS NTS inhibits RVLM hence decreased SNS

Question 182

how is medulla gradient created

Answer 182

LoH ACSENDING pulls NaCL into interstium (reab) H20 impermeable. DESCENDING pulls allows H20 to be pulled out by NaCl 300 osmole-->400 in desc and 200 in ascending play over until 1400 in loop pin

Question 183

Vasa recta

Answer 183

water out as descending replaced as ascending

Question 184

potassium Ch blocker antiarrhythmic

Answer 184

rb sotalol

Question 185

digoxin tox

Answer 185

phenytoin

Question 186

SVT and VT options

Answer 186

amiod, flacainide, sotalol

Question 187

sotalol

Answer 187

class 1,2,3 Rx VT prevent SVT

Question 188

adensoisne rec

Answer 188

Where are the adenosine receptors? A1: Gi, in SA/AV node, cause decrease in HR. 
A2A: Gs, coronary arteries (vasodilatation) A2B: Gs, bronchiole smooth muscle (bronchospasm) A3: Gi, cardioprotective in ischaemia, inhibits neutrophils degranulation

Question 189

Cardiac SE adenonsine

Answer 189

decreased atrial refractory-->AF or flutter

Question 190

adenosine met

Answer 190

plasma and RBC esterase

Question 191

digoxin

Answer 191

``` 25% PrB-->large Vd minimal hep met largely excreted unchanged in urine narrow TI level 1-2mcg/L OBA 70% ``` increase Ach releaseat M rec ECG - PR prologn - ST dep reverse tick - t wave flatterening - Short Q T anorexia,N/V/D

Question 192

Rx digoxin tox

Answer 192

``` ABC electrolytes brady Rx Phenytoin Dig ABs if >20mcg/L 2 weeks to steady state post PO half line alph 1 day beta 3 weeks ```

Question 193

Ester vs amide structure

Answer 193

COOR vs NHCO

Question 194

nerve block onset types

Answer 194

B>Ad>Ab>C | ANS>sens>motor

Question 195

neuro tox common LA

Answer 195

CIRCUMORAL TINGLING

Question 196

thiopentone vial

Answer 196

500mg in 20ml 25mg/ml NaCO3 NOT HCO3

Question 197

thio vs prop CVS

Answer 197

Sodium thiopental generally produces less hypotension than an equivalent dose of propofol when used for induction of anaesthesia. This is partly because both drugs decrease systemic vascular resistance, but thiopentone (as opposed to propofol) tends to preserve the reflex tachycardia seen in states of acute hypotension, which can restore cardiac output.

Question 198

Adx

Answer 198

Htn brady-->pulmonary oedema seizure Nil betablcoeker

Question 199

Muscle relaxants class SE

Answer 199

Aminosteroids anaphylaxis Benzylisoquinoliniums histamine release

Question 200

Hoffman

Answer 200

Cleave nh4 from central structure Laudenosine Temp and oh dep

Question 201

Butylecholinesterase prod

Answer 201

Liver

Question 202

Leg block monitor

Answer 202

Post tibial nerve | Plantaflexion of big toe

Question 203

Onset muscle

Answer 203

See Evernote

Question 204

FRC as o2 buffer

Answer 204

constant o2 supply. stops swing of insp O2 with none on exp

Question 205

full body plethysomgraphy

Answer 205

V1.P1=(V1-changeV).P2 of box V2.P3=(V2+changeV).P4 of lung gauge pressure =alv pressure when zero flow

Question 206

estimate pao2 by age

Answer 206

100-a/3

Question 207

po2 tissue

Answer 207

5 | mitochondria 1

Question 208

Hep BF and volatiles

Answer 208

It is generally accepted that all the inhalational anesthetics alter hepatic blood flow and oxygenation that may lead to changes in hepatocellular functions [22-24]. The decrease in total hepatic blood flow (THBF) is primarily because of decreased cardiac output and imposes various compromising effects on hepatic oxygen supply [22]. Sevoflurane, like isoflurane, preserved THBF at up to 1 MAC, but THBF was reduced in tandem with increased MAC [23]. However, desflurane is shown to better preserve THBF than halothane or isoflurane in animal studies

Question 209

hepatic unit

Answer 209

acina central hepatic venules peripheral bile duct, heaptic arterioles and portal venules - portal triad - ->sinusoids 3 zones 1) periportal-high O2 protein synth 2) mediolobular 3) Centrilobular-CYP450 low O2.

Question 210

hepatic failure first effected

Answer 210

synthetic function | enzyme function ++late

Question 211

coags made by liver

Answer 211

fibringoen, ATIII, prothrombin,2,7,9,10

Question 212

osmolarit of blood and NACL tonicity of NACL

Answer 212

290 vs 308 (close enough) blood is not a perfect fluid so NaCL doesn't completely dissociate so 308 x osmotic coef of 0.93=286

Question 213

tonicity define

Answer 213

effective osmotic pressure

Question 214

normal osmolar gap

Answer 214

10 due to normal unmeasured osmoles

Question 215

osmolar gap cx

Answer 215

mannitol, ethanol, methanol

Question 216

colligiate properties

Answer 216

osmotic pressure, depressed freezing point

Question 217

solute vs solvent

Answer 217

U--->V

Question 218

how to measure (not calc) osmolarity

Answer 218

osmometer: HP vs osmotic vapour pressure depression FP depression with platue pressure using thermister

Question 219

pendulum chest

Answer 219

Seen in flail chest when several ribs are fractured at multiple sites so that a portion of the Chest wall moves independently • The negative intrathoracic pressure during inspiration causes the fractured ribs to be sucked in, thereby preventing expansion of the lung and during expiration, this segment moves outwards. • When the injury is unilateral, air from the affected lung passes into the opposite healthy lung during inspiration and air moves back from the normal lung into the affected lung during expiration = "Pendulum breathing".

Question 220

why PTx resolves

Answer 220

O2 absorbed down conc gradient N2 absorbed down conc gradient - 593 in atm - 573 in blood as alv air is humidifed and then equillibrates with blood second gas effect as O2 absorption-->conc further

Question 221

slow vs fast twitch

Answer 221

slow is Type I

Question 222

RAP normal

Answer 222

0-5

Question 223

fluid bolus starling curve

Answer 223

increased RAP and MSFP

Question 224

cefazolin allergy or MRSA Abx

Answer 224

clina/ticoplanin vanc for MRSA

Question 225

GI absorption

Answer 225

mor lipid sol-->more absorption Most drugs are weak organic acids or bases, existing in un-ionized and ionized forms in an aqueous environment. The un-ionized form is usually lipid soluble (lipophilic) and diffuses readily across cell membranes. The ionized form has low lipid solubility (but high water solubility—ie, hydrophilic) and high electrical resistance and thus cannot penetrate cell membranes easily.

Question 226

bacterial wall

Answer 226

g+ve thick PG wall (peptidoglycan) | g ive thin PG wall with lipopolyysacharide layer

Question 227

ABx moa anaesthetics

Answer 227

evernote | all renal clearance except metronidazole which has an active met-->renal Cl

Question 228

contamination class and ABx

Answer 228

clean elective (nil ABx) clean contam emergency anything or elective hernia contam NONPURULENT penetrating <4 dirty PURULENT penetrating >4. or bowel p give <24 hours

Question 229

nerve block

Answer 229

Supraclav: commet with subclavian artery interscalene: between scalenes infraclavicular: surrounds axillary artery cephalad axillary: surrounds axillar

Question 230

metabolic alkalosis

Answer 230

https://litfl.com/metabolic-alkalosis/ H loss 1) GI 2) renal - diuretics HCO3 gain -Antacid HCO3 iatrogenic So easy to piss away HCO3 so something has to maintain the HCO3 reab issue 1) low Cl -diuretics -HCL vomit 2) dehyd aldosterone-->reab Na. nut not as much chloride saved. 3) low K due to high minercorticoids -->minerocorticoids-->aldosterone-->reab Na and spit out K and H+ ``` Sx resp -cling to O2 -resp comp-->hypovent impaired contractility decreased CBF confusion, obtunded ```

Question 231

LA tox

Answer 231

``` circum oral tingling and numbness tinitus vertigo NOT TASTE or VISION EXCITABLE TWITCHING seziure coma ``` HTN tachy VD prolonged QRS and PR and brady

Question 232

semiopen

Answer 232

mapelson ``` T extended freq disabled A for efficeincy Bain for BRAIN MRI ```

Question 233

closed benefit and loss

Answer 233

slow onset | warm

Question 234

how does afterload affect contractility

Answer 234

The increased afterload causes an increased end-systolic volume. This increases the sarcomere stretch. That leads to an increase in the force of contraction.

Question 235

withdraw reflex

Answer 235

afferent-->several interneuron-->alpha motor neuron -->flexor stim extensor relax. - interneurons from pathway that cross the spinal cord can stimulate the extensor motor neurons on the opposite side of the body to produce the cross-extensor reflex

Question 236

SNS cell bodies and structure

Answer 236

lateral grey col (since cell body has no myelin) and in peripheral ganglion preganglionic is myelinated yes-->NaCHR paravertebral ganglia exit from grey collum (unmyelin)-->white rami COMMUNICANS -->synapse with paravertebral ganglion OR -->up or down to other paravertebral ganglia # cervical sympathetic ganglia OR -->skip and create more distal ganglia So... blocking on white rami communicante-->effects at multiple levels

Question 237

ANS structure

Answer 237

SNS and PSNS - efferent: visceral and somatic - afferent (just visceral): organ sens, reflex loop, refered pain

Question 238

A delta vs C fibre lamin

Answer 238

A delta lamina 1,5 #15As rugby team pain C is lamina 1 2 3 as per ANZCA talk and a model answer

Question 239

pain fibre rec modulation

Answer 239

evernote pain pathway goldne

Question 240

once NMDA stim

Answer 240

cations in changed gene transcription activate kinases central sensitization

Question 241

peripheral sensitation

Answer 241

at nociceptor | central is at DH and brain

Question 242

central sens

Answer 242

1) wind up - increased no of action potentials per noxious stim 2) Long term potentiation - C fibres activated to transmit pain 3) altered gene transcription - persistant neural inflam 4) abnormal connection between cells in DH

Question 243

spinoreticular tract

Answer 243

spine to reticular formation then thalamus and hypothal-->emotion

Question 244

neuropathic pain mech

Answer 244

dysfunction of nervous system 1) changed NaCH-->spont depol 2) changed K -->less breaks 3) changed Ca -->more NT due to changed gene transciption and phsphorylation of ion ch

Question 245

paracetamol meta

Answer 245

phase I (cyp450)-->NAPQI-->neutralized by glutathione (replenished by NAC) phase II (simultneous) non toxic

Question 246

NSAID in IHD risk

Answer 246

both selective and nonselective CI

Question 247

paracoxib benefit

Answer 247

less asthma less PLi (PL is cox1) less GI

Question 248

pain Mx options

Answer 248

* Simple * Opiate * Neuropathic #ducktape * Duloxetine * Clonidine * Ketamine * Tramadol/talent * Amitriptyline * Pregabalin * Adduvent ie psych immobilize enviro * Regional ``` decrease ascedending -nsaid, paracetamol -opiate -LA NaCH -gabapentinoids CCB -ketamine -clonidine -regional increased descending -SNRIs -tramadol ```

Question 249

gabapentinoids soa and SE

Answer 249

VGCCB at DH Gabapentinoids prevent VGCC getting to presynaptic membrane in dorsal horn. inhibit alpha2delta subunit (the tugboat that pulls VGCC to membrane) drowsy and fat Other SoA -NMDA rec antag #neuropathic

Question 250

Gabapentin vs pregabalin

Answer 250

Gabapentin A -active uptake, changes with dose-->unreliable -non linear dose response curve M-neither is metabolised!!!!!! E -elimination zero order for gabapentin at high doses

Question 251

tramadol met path

Answer 251

o desmethyltramadol-->opioid rec | CYP2d6 (genetic variability)

Question 252

ketamine routes

Answer 252

Rb oral 40min | nasal 15min

Question 253

clonidine vs dex

Answer 253

DH and locus ceruleus and SNS peripheral nerves and reticular n. GiPCR-->changed Na and K ch conductance dex is full agonist (higher ceiling vs clonidine) peak at 10min similar t/2 2 vs 15hrs hence doa 1 vs 6 hrs severe brady hi Pr Bound no renal clearance ok in CKD! decrease in hep failure

Question 254

pain pathway

Answer 254

Tissue damage/Nociception/Pain Experience

Question 255

Buprenorphine

Answer 255

C: partial Mu agonis. Kappa antag. 25xpotency vs morphine hence 200-400microg SL dose (OBA 70%) U: acute with poor oral, chronic, opiate replacement/wean P: SL, patch, iv A: D Onset: peak after IV is 80min: due to slow distribution to effect site and other sites Give doses Q8H for pain IV or SL Offset: terminal elim 24 hrs, elimination half life 5 hours due to high affinity to rec. binds and doesn’t let go R S -less resp dec as kappa blocked -less euphoria ?as slow? -less tolerance And depressiondependance as slow on and off -antagonise full -unpredictbale reversal with naloxone E T D-large 3.2L/kg due to high PrB A-good ab but large first pass met hence SL not PO M-liver phase I and II—>bile E-70% in bile with some renal Elim T/2 is 5 hours No dosage adjustment is required in patients with renal impairment or mild to moderate hepatic impairment. Patients with severe hepatic impairment may accumulate buprenorphine and Bupredermal patch should be used with caution, if at all, in such patients. (MIMS)

Question 256

fentanly clearance and effect site term

Answer 256

10% renal excretion unchanged 90% is inactive met clearance rate and Vd is similar to morphine t/2Keo 4.5 min vs 4.5 hrs morphine

Question 257

codeine met

Answer 257

15%-->morphine hence give 6xdose ``` Poor -2 shitty allells Intermediate -1 shitty allel Extensive (normal -2 normal Ultrameta -multiple repeats of funcitoning allel ``` aftricans-->ultrafast poor white man-->poor

Question 258

nociception

Answer 258

def

Question 259

substantia geletanosa

Answer 259

The apex of the posterior grey column, one of the three grey columns of the spinal cord, is capped by a V-shaped or crescentic mass of translucent, gelatinous neuroglia, termed the substantia gelatinosa of Rolando (or SGR) (or gelatinous substance of posterior horn of spinal cord). C fibres from primary afferents terminate here with some fibres projected to deeper layers of spinal grey matter, from which arises the spinoreticular tract to the ascending reticular activating system. However, some A delta fibers (carrying fast, localized pain sensation) also terminate in the substantia gelatinosa, mostly via axons passing through this area to the nucleus proprius. Thus, there is cross talk between the two pain pathways.

Question 260

wind up

Answer 260

Wind-up = repeated stimulus with no change in strength causes an increase in response from dorsal horn neurons mediated by the release of excitatory neuromediators. Wind-up is dependent on activation of NMDA receptor

Question 261

Ca to NT release

Answer 261

Ca binds calmodulin-- calmodulin dep kinases-->doc and release

Question 262

Ca in second order afferent neuron pain

Answer 262

Ca in due to NMDA, AMPA, NK1 Ca:calmodulin-->changed gene transcription altered K perm second messangers-->NO-->neurotoxic

Question 263

silent nociceptor

Answer 263

unmyelinated primary afferents, normally do not respond, but in presence of inflammation or chemical sensitization may become responsive and discharge vigorously

Question 264

blood supply to kidney in shock

Answer 264

reduced! ATII and SNS-->VC afferent and efferent PG-->VD afferent and effent normally ANP-->VC efferent and VD afferent-->increase filtration

Question 265

ADH trigger

Answer 265

high osmol (VOLT etc in Hypothal) >280 low pressure baro rec >5-10% blood vol -but bumps threshold left and steepens above 20% BV ADH has caused maximal renal reab and continues to rise and now is its VC effect becomes apparent.

Question 266

ADH

Answer 266

see evernote

Question 267

WOB diagram

Answer 267

trapezium=ELASTIC (TISSue and alv ST) | curve=RESTRICTIVE: 80% airway 20% tissue (increased in interesitial Dx)

Question 268

static vs dynamic

Answer 268

Dynamic compliance=vol/(Pmax-PEEP) -hence no eosoph Static Compliance=vol/PlateuP-PEEP) -hence eosoph

Question 269

potassium channels cardia AP

Answer 269

K1 RMP Kto special transient at peak of 1 Kr rectifying

Question 270

excitatory and inhib NTs

Answer 270

glut, NAd ach, 5HT inhib GABA glycine

Question 271

time constnat

Answer 271

time to complete if rate cont t=C.R t=0.63of completion (loner than half life) t/2= 0.5 completion t/2=t.0.63

Question 272

oxycodone met

Answer 272

CYP450 noroxycodone active 15% of parent renally elliminated so imperfect but a fair option for PO renal Dx

Question 273

pethidine

Answer 273

Mu, SSRI, VGSC, SE Ach met to norpethadine 50% as potent but renally accumulates ``` accumulates in renal delerium anticholinergic addictive seziures due to ```

Question 274

Na Ch types

Answer 274

resting (closed) -->active-->inactive ARP due to NaCh in inactive stage (need time and repol to reset both gates)

Question 275

Botulin etc

Answer 275

botuline stops release of Ach | hemicolinium inhibits Choline recycling

Question 276

T tubule

Answer 276

invagination of sarcolemna

Question 277

MEPP

Answer 277

small small small big

Question 278

cardiac vs smooth vs cardiac

Answer 278

evernote

Question 279

midaz met

Answer 279

a little bit of active met yet renal excretion no problem

Question 280

MG vs GBS

Answer 280

GBS succhy syndrome -->K so use NDMR | MG->muscles weak ACHR Dx--> more sens to 10% of NDMR dose or use sux (less sensitive to sux as less agonist rec).