Term
| What is an anaphylactoid reaction? |
|
Definition
| Bascially its the same as an anaphylactic, but there is no IgE involvement. The drug triggers the mast cell to empty without IgE |
|
|
Term
| What two cells are endogenous sources of histamine and heparin? |
|
Definition
|
|
Term
| What are the top 5 causes of anaphylaxis during anesthesia? |
|
Definition
| NMBA's, latex, Abx, colloids, hypnotics |
|
|
Term
| What are the top 3 NMBAs causing anaphylaxis? Top 3 Abx? |
|
Definition
NMBAs--Roc, Sux, Atracurium
Abx--PCN, cephalosporin, vanc |
|
|
Term
| What triggers erythropoietin production? |
|
Definition
|
|
Term
| What is the life span of an RBC? |
|
Definition
|
|
Term
| Where does hemoglobin breakdown occurr and what are the byproducts? |
|
Definition
| In the liver....iron and porphyrin |
|
|
Term
| Which clotting factors are not made in the liver? |
|
Definition
|
|
Term
| What is the function of protein C? |
|
Definition
| anticoagulant that triggers the release of tPA |
|
|
Term
| At what Hg are symptoms of anemia likely to be seen? |
|
Definition
|
|
Term
| What does a glucose-6-phosphate dehydrogenase deficiency cause? What two drugs should be avoided in these individuals? |
|
Definition
| Chronic hemolytic anemia---avoid prilocaine and SNP (vulnerable to cyanide toxicity) |
|
|
Term
| Which factors does FFP have the most of? |
|
Definition
|
|
Term
| What is the 2nd most common inherited bleeding disorder? |
|
Definition
|
|
Term
| Hemophilia A is a deficiency of what factor? |
|
Definition
|
|
Term
| What is the reversal dose of Vitamin K for Coumadin therapy? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is normal bleeding time? |
|
Definition
|
|
Term
| At what platelet level will spontaneous bleeding occurr? |
|
Definition
|
|
Term
| What enzyme synthesizes Ach? |
|
Definition
| choline acetyltransferase |
|
|
Term
| What protein is found in skeletal muscle thats not in smooth muscle? |
|
Definition
|
|
Term
| How should HTN from clonidine withdrawl be treated? |
|
Definition
| Hydralazine, SNP, or reinstitution of clonidine |
|
|
Term
| What drugs can exacerbate clonidine withdrawl? |
|
Definition
|
|
Term
| Which receptors does Atenolol work on? How is it eliminated? How are most beta blockers eliminated? |
|
Definition
| B-1. It renally eliminated, while most are hepatically cleared |
|
|
Term
| What is guanethidine, where/how does it work, and what is the major side effect? |
|
Definition
| Old antiHTN, it works peripherally by displacing norepi from the nerve terminal, thus depleting it......it causes orthostatic HoTN |
|
|
Term
| What does reserpine do, where/how does it work? |
|
Definition
| Reserpine is an anti-HTN that works centrally and peripherally....it binds to vesicles of nerve terminals and prevents them from releasing catecholamines |
|
|
Term
| How does methyldopa work, and where is its primary sight of action? |
|
Definition
| Its an anti-HTN prodrug...its converted to an alpha-2 agonist and decreases sympathetic outflow in the brain |
|
|
Term
| What receptors does Trimethaphan block and where? |
|
Definition
| Nicotonic receptors at the autonomic ganglia |
|
|
Term
| How is trimethaphan eliminated? |
|
Definition
|
|
Term
| What two muscle blockers have ganglionic blocking effects? |
|
Definition
| d-tubocurarine and metocurine |
|
|
Term
| What does MAOI-A do? What does MAOI-B do? |
|
Definition
A--metabolizes norepi, epi, serotonin, and dopamine
B--metabolized tyrosine |
|
|
Term
| What does St. John's Wort do? What does it do to dosing requirements? |
|
Definition
| It inhibits the reuptake of serotonin, NE, and dopamine.....dosages must be increases because P450 is induced |
|
|
Term
| What is Sux metabolized to? |
|
Definition
First stage--succinylmonocholine plus choline
2nd stage--SMC to succinic acid and choline |
|
|
Term
| Which two NDMBA's have active metabolites? |
|
Definition
|
|
Term
| Why do aminoglycosides potentiate NDMBAs? |
|
Definition
| They inhibit Ach release presynaptically |
|
|
Term
| Which abx are the most potent NMBA potentiators? |
|
Definition
|
|
Term
| What does Lasix do to NDMBlockade? |
|
Definition
| High doses antagonize block, low doses potentiate it |
|
|
Term
| What does cAMP do in the nerve junction? |
|
Definition
| Decreased cAMP means decreased calcium entry into the nerve synapse, meaning less Ach release |
|
|
Term
| What does dantrolene do to muscle blockade? |
|
Definition
|
|
Term
| Which anticholinesterase acts pre and post synaptically? |
|
Definition
|
|
Term
| Are sweat glands innervated by nicotinic or muscarinic receptors? |
|
Definition
|
|
Term
| Where is the center for regulating temperature found in the brain? |
|
Definition
|
|
Term
| What's responsible for the increased SNS stimulation during an episode of MH? |
|
Definition
|
|
Term
| What is often the first sign of MH in kids? |
|
Definition
|
|
Term
| What is the gold standard diagnostic test for MH? |
|
Definition
|
|
Term
| What is the initial and max dose of dantrolene? |
|
Definition
Initial is 2.5 mg/kg
Max is 10 mg/kg (20 in some books) |
|
|
Term
| How does dantrolene come packaged, and how must it be mixed? |
|
Definition
| Each vial has 20 mg, and each vial must be mixed with 60 mL of sterile water |
|
|
Term
| Which patients are susceptible to Neuroleptic Malignant syndrome? |
|
Definition
| Those being treated with Haldol, thorazine, or other anti-psychotics |
|
|
Term
| What does an S3 heart sound usually indicate? |
|
Definition
|
|
Term
| When in the cardiac cycle is an S3 heard? |
|
Definition
|
|
Term
| What is the problem is the newborn has a systolic and diastolic murmur? |
|
Definition
|
|
Term
| What dysrhythmia is most common with mitral stenosis? Mitral regurg? |
|
Definition
Mitral stenosis = Afib
Mitral regurg = PVC's |
|
|
Term
| What is a normal stroke volume? What is a normal stroke volume index? |
|
Definition
|
|
Term
| Where does bronchial circulation arise from? How much of left heart output does it recieve? |
|
Definition
| Bronchial circulation arise from the thoracic aorta and intercostals; 1-2% of C.O. |
|
|
Term
| Nerve signals from the atrial stretch receptors are carried by what nerve? |
|
Definition
Vagus--afferent
Sympathetic nerves--efferent |
|
|
Term
| What is the colloidal oncotic pressure in mmHg? |
|
Definition
|
|
Term
| What does hypercarbia do to cerebral vessels? Systemic vessels? Pulmonary vessels? |
|
Definition
| Cerebral and systemic vessels dilate, while pulmonary vessels will constrict |
|
|
Term
| Coronary blood flow as a percent of CO and in mL/min |
|
Definition
| 4-5% of CO, about 250 mL/min |
|
|
Term
| What is the SvO2 of coronary blood? |
|
Definition
|
|
Term
| What is the normal coronary perfusion pressure? |
|
Definition
| 60-160 (these are also the autoregulation limits) |
|
|
Term
| How is coronary perfusion pressure calculated? |
|
Definition
|
|
Term
| What is the most potent vasodilator released by cardiac cells? |
|
Definition
|
|
Term
| What is the oxygen consumption rate of the heart? |
|
Definition
|
|
Term
| Besides Ca, what other ion is a membrane stabilizer? |
|
Definition
|
|
Term
| How is WPW afib treated? What drugs are avoided? |
|
Definition
| Treat with procainamide; avoid CCBs |
|
|
Term
| What PCWP is indicative of CHF? |
|
Definition
|
|
Term
| What is left ventricular diastolic dysfunction usually associated with? |
|
Definition
| Decreased left ventricular compliance |
|
|
Term
| Which valvular problem may have both a systolic and diastolic murmur? |
|
Definition
| Aortic stenosis (because it often has mild AI with it) |
|
|
Term
| What potential side effect can inamrinone, but not milrinone, have? |
|
Definition
| Thrombocytopenia may occur with inamrinone, but not milrinone |
|
|
Term
| Besides CHF, what is digoxin used for? |
|
Definition
| To control atrial tachycardia/fib/flutter |
|
|
Term
| How does Dig increase contractility? |
|
Definition
| Dig poisons the Na/K pump. Na starts to build up in the cell, so it is pumped out in exchange for Ca. Increased Ca in the cell means increased contractility. |
|
|
Term
| What are 3 signs of dig toxicity? |
|
Definition
| Dysrhythmias, prolonged PR, and GI disturbances |
|
|
Term
| What 3 e-lyte disturbances will worsen dig toxicity? |
|
Definition
| Hypokalemia, hypercalcemia, and hypoMag |
|
|
Term
| Is diltiazem a better coronary or peripheral vasodilator? |
|
Definition
|
|
Term
| What drug might be used to treat intra-op myocardial ischemia when hemodynamics are normal? |
|
Definition
|
|
Term
| What are 4 contraindications to SNP use? |
|
Definition
| Liver disease, kidney disease, hypothyroidism, and B12 deficiency |
|
|
Term
| What are 4 hallmark signs of cyanide toxicity? |
|
Definition
| Metabolic acidosis, cardiac arrythmias, increased SVO2, and tachyphylaxis |
|
|
Term
| What drug is used to treat cyanide toxicity? |
|
Definition
|
|
Term
| What can happen in 10-20% of patients who receieve hydralazine? |
|
Definition
| A lupus like syndrome--these patients are fast acetylators |
|
|
Term
| What 3 vasodilators can cause angina and why? |
|
Definition
| NTG, SNP, and hydralazine....they all lower BP, which can cause a reflex tachycardia......SNP can also cause coronary steal |
|
|
Term
| What is the max dose of mepivicaine? |
|
Definition
|
|
Term
| What is the max dose of chloroprocaine? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where does beta-oxidation occurr? |
|
Definition
|
|
Term
| What local is not used for infiltrations? |
|
Definition
|
|
Term
| What is the most toxic ester local? |
|
Definition
|
|
Term
| What is the least potent local? |
|
Definition
|
|
Term
| What is the least toxic local? |
|
Definition
| 2-chloroprocaine due to fast elimination |
|
|
Term
| Which is the least toxic amide? |
|
Definition
|
|
Term
| What are class I anti-dysryhtmics? |
|
Definition
| Membrane stabilizers--they block Na channels |
|
|
Term
| Which drugs are Class I-A anti-dysrhythmics? |
|
Definition
| Quinidine and procainamide |
|
|
Term
| Which drugs are class I-B anti-dysrhythmics? |
|
Definition
|
|
Term
| Which drugs are Class I-C antidysrhythmics? |
|
Definition
|
|
Term
| What kind of drugs are Type II anti-dysrhythmics? |
|
Definition
|
|
Term
| What drugs are Class III anti-dysrhythmics? What do they do? |
|
Definition
| Bretyllium, Amio, and Ibutilide are Class III. They prolong APs in the atria, ventricles, and Purkinje's |
|
|
Term
| What drugs are the Class IV anti-dysrhythimcs? What do they treat? |
|
Definition
| CCBs--they treat reentrant SVT's |
|
|
Term
| In what phase of the myocyte AP does lidocaine work? |
|
Definition
| Phase IV--slows spontaneous depolarization |
|
|
Term
| What two drugs are well-suited for treating dig toxicity? |
|
Definition
|
|
Term
| What drug should be avoided in Dig toxicity? |
|
Definition
|
|
Term
| Where does COMT work? Where does MAO work? |
|
Definition
| COMT works mostly in the liver, while MAO works within nerve terminals |
|
|
Term
| What is the principle inhibitory transmitter in the spinal cord? In the CNS? |
|
Definition
| The major inhibitory transmitter in the spinal cord is GLYCINE, while in the CNS in general its GABA |
|
|
Term
| Which cranial nerve provides sensory innervation to the face? |
|
Definition
| Trigeminal (5 feels the face) |
|
|
Term
| What nerve stimulates the sneeze reflex? |
|
Definition
|
|
Term
|
Definition
Beta--stimulation
Alpha--awake
Theta--sleep, general anesthesia
Delta--deep sleep/deep anesthesia |
|
|
Term
| What is cerebral blood flow in ml/min and % |
|
Definition
|
|
Term
| At what ICP does focal ischemia start? Global? |
|
Definition
| Focal starts at 25...global at 55 |
|
|
Term
| What does acidosis do to seizure threshold? Alkalosis? |
|
Definition
| Acidosis increases seizure threshold (less likely to have one) while alkalosis decreases it (more likely to have one) |
|
|
Term
| What are the top 3 most common complications with mediastinoscopy (in order) |
|
Definition
1st--hemorrhage
2nd--pneumo
3rd--RLN damage |
|
|
Term
| What worsens brain injury: hypo or hyperglycemia? |
|
Definition
|
|
Term
| What are the 1st and 2nd most common causes of mortality and morbidity in CEA patients? |
|
Definition
|
|
Term
| What is reactive hyperemia? |
|
Definition
| Its the rapid increase in blood flow to tissues that have been ischemic for some time (like after aortic cross clamp) |
|
|
Term
| Which CCB is usually used to treat cerebral vasospasm? |
|
Definition
|
|
Term
| Describe the pathway for the oculocardiac reflex |
|
Definition
| Afferent sensations are carried by the trigeminal nerve, while efferent is carried by the vagus |
|
|
Term
| Which eye muscle is most likely to cause the oculocardiac reflex when pulled? |
|
Definition
|
|
Term
| What is the upper limit for intraocular pressure? |
|
Definition
|
|
Term
| What 5 values must be checked prior to a pneumonectomy? Limits? |
|
Definition
FEV1 < 2L
CO2 > 45
VO2 <10
FEV1/FVC < 50%
Max breathing capacity < 50% |
|
|
Term
| Respiratory obstruction after thyroid surgery is most likely due to what? |
|
Definition
| Tracheomalacia (weakness/collapse of the tracheal rings) |
|
|
Term
| What organs are most susceptible to damage during ESWL? |
|
Definition
| Lungs (filled with air, different impedance) |
|
|
Term
| Why might QT interval during a radical neck dissection develop? |
|
Definition
| If its a right sided surgery, there may be trauma to the right stellate ganglion |
|
|
Term
| What is the biggest post-op concern of the patient who just had an ACDF? |
|
Definition
|
|
Term
| What are the autonomic s/s of ECT? |
|
Definition
| Immediately, there will be a parasympathetic response, with a sympathetic response after a minute or two |
|
|
Term
| Which laryngeal muscle closes the laryngeal vestibule? |
|
Definition
|
|
Term
| What percentage of normal inspiration is contributed by the diaphragm? |
|
Definition
|
|
Term
| How much of total blood volume is found in the pulmonary circulation? |
|
Definition
|
|
Term
| Is it easier for an anemic or polycythemic patient to become cyanotic? Why? |
|
Definition
| Polycythemic. Cyanosis isn't seen until there is 5 gm/dL of deoxygenated blood...so if anemic this is unlikely to be the case |
|
|
Term
| What is the production rate of CO2 per minute? |
|
Definition
|
|
Term
| Is tracheal stenosis considered obstructive or restrictive? |
|
Definition
|
|
Term
| What is normal FEF 25-75? |
|
Definition
|
|
Term
| What pressure do hospital pipelines have? |
|
Definition
|
|
Term
| What is the most common contaminant of medical gas lines? |
|
Definition
|
|
Term
| What makes up Wood's metal? |
|
Definition
| Bismuth, lead, tin, cadmium |
|
|
Term
| In a circle system, where is the dead space located? |
|
Definition
| Between the y-piece and the patient |
|
|
Term
| What 3 forms of sterilization kill all spores and viruses? |
|
Definition
| Steam autoclave, ethylene oxide, and radiation |
|
|
Term
| What method of sterilizing kills everything (virus, bacteria, spores)? |
|
Definition
|
|
Term
| Will mitral valve stenosis lead to a falsely high/low or accurate PCWP? |
|
Definition
| MV stenosis PCWP will overestimate LVEDP |
|
|
Term
| Will mitral valve insufficiency PCWP over/under estimate LVEDP, or will it be accurate |
|
Definition
| PCWP is an accurate estimate of LVEDP in the patient with MV insufficiency |
|
|
Term
| What does nitrous do to SSEP's? |
|
Definition
| Decreases amplitude but does nothing to latency |
|
|
Term
| Which laser is best for not damaging underlying tissue? |
|
Definition
|
|
Term
| What are 5 groups with a higher incidence of latex allergies? |
|
Definition
| Spina bifida, health care workers, pts with multiple surgeries, atopic individuals with hx of multiple allergies, thoese with specific food allergies |
|
|
Term
| How long should most herbals be d/c'd before surgery? What is a notable exception to this rule? |
|
Definition
| 2 weeks. Ephedra should only be d/c'd 24-36 hours prior to surgery |
|
|
Term
| What two herbals may cause hypoglycemia? |
|
Definition
|
|
Term
| What is the max dose of hetastarch per day? |
|
Definition
|
|
Term
| Which blood substitute can alter serum amylase levels? |
|
Definition
|
|
Term
| What is the use of Dextran 40 compared to Dextran 70? |
|
Definition
| 40 is used to maintain perfusion (prevents thromboembolism), while Dextran 70 is used a volume expander |
|
|
Term
| How much will one unit of platelets increase the patients platelet count? |
|
Definition
|
|
Term
| What are the max spinal doses of the following drugs: lidocaine, bupivicaine, ropivicaine, and tetracaine |
|
Definition
Lido: 60
Bupiv: 10-15
Ropiv: 15-20
Tetra: 10-15 |
|
|
Term
| What epidural agent will give the most profound motor block? |
|
Definition
|
|
Term
| What epidural agent will give the most profound sensory blockade? |
|
Definition
|
|
Term
| What nerve levels form the brachial plexus? |
|
Definition
|
|
Term
| What nerve passes through the medial humeral epicondyle/olecranan ulnar groove? |
|
Definition
|
|
Term
| The median nerve generally innervates what kind of muscles in the forearm? |
|
Definition
|
|
Term
| What nerve innervates the web space between the thumb and first finger? |
|
Definition
|
|
Term
| The radial nerve generally innervates what kind of muscles in the arm/forearm? |
|
Definition
|
|
Term
| Which nerve is damaged by a needle in the AC? |
|
Definition
|
|
Term
| Which nerve provides sensory innervation to the lateral aspect of the forearm? |
|
Definition
|
|
Term
| Which nerve is often missed with an interscalene block? |
|
Definition
|
|
Term
| What is thoracic outlet syndrome, and what position is of special concern? What should be done |
|
Definition
| TOS is when the brachial plexus/subclavian artery are compressed between the first rib/clavicle. Prone position is a worry; if the patient reports any parasthesia after working with arms overhead, they arms should be tucked at the sides |
|
|
Term
| Which 3 nerves of the ankle block are most superficial? |
|
Definition
| The 3 "s"s. Superficial peroneal, saphenous, and sural |
|
|
Term
| Which nerve flexes the foot? Which nerve extends the foot? |
|
Definition
Extension: peroneal
Flexion: tibial |
|
|
Term
| Describe sural nerve block |
|
Definition
| Fan infiltration between the Achilles and lateral malleolus |
|
|
Term
| Describe saphenous/superficial peroneal block |
|
Definition
| SubQ infiltration from the medial malleolus to the big toe tendon |
|
|
Term
| What type/concentration/amount of local is usually used for Bier blocks? |
|
Definition
| 40-50 mL of 0.5% Lido or Prilocaine |
|
|
Term
| Which nerves are blocked with a cervical plexus block? |
|
Definition
| C1-C4 (although C1 is purely motor) |
|
|
Term
| What is the max dose for an epidural blood patch? |
|
Definition
|
|
Term
| What is the cause of apnea after spinal? |
|
Definition
| ISCHEMIA of the brain stem respiratory centers due to hypotension |
|
|
Term
| What nerve block must be avoided in the patient who is being positive pressure ventilated? |
|
Definition
|
|
Term
| What vessels might be compressed when the head is extended for thyroidectomy? |
|
Definition
|
|
Term
| what nerves may be damaged during mask ventilation? |
|
Definition
| Buccal nerve (facial) and supraorbital of the trigeminal |
|
|
Term
| Which nerve is responsible for dorsiflexion of the foot? |
|
Definition
|
|
Term
| What drug combo would you want to give to a patient with known allergies who is having a procedure involving injection of IV contrast dye? |
|
Definition
|
|
Term
| What happens to red blood cells and hematocrit in the first 24 hours in the burn patient? |
|
Definition
| RBC's are destroyed, but Hct goes up due to the massive loss of fluid |
|
|
Term
| What determines the position of the dicrotic notch on an Aline tracing? |
|
Definition
| Preload (high preload = high CO = high notch) |
|
|
Term
| What stimulates the release of ACTH from the anterior pituitary? |
|
Definition
| Corticotropin (released by the hypothalamus) |
|
|
Term
| What cranial gland is under sole control of neural impulses? |
|
Definition
| The posterior pituitary (neurohypophysis) |
|
|
Term
| Does the thyroid release more T4 (thyroxine) or T3 (tri-iodothryonine)? |
|
Definition
| More T4, which is converted peripherally to T3 |
|
|
Term
| Where is calcitonin released from? |
|
Definition
|
|
Term
| Where in the pancreas in insulin secreted from? Glucagon? Is this considered exocrine or endocrine? |
|
Definition
| Insulin is made in Beta cells, while glucagon is made from alpha cells. Its endocrine (there is no duct) |
|
|
Term
| What do pancreatic delta cells release? What does this do? |
|
Definition
| Pancreatic delta cells release somatostatin, which inhibits GI motility |
|
|
Term
| Where is aldosterone secreted from? |
|
Definition
| Zona glomerulosa of the adrenals secrete aldosterone |
|
|
Term
| What are the two most powerful stimuli for aldosterone release? |
|
Definition
| High K and Angiotensin II |
|
|
Term
| Where is cortisol released from? |
|
Definition
| The zona fasciculata of the adrenals |
|
|
Term
| What is the final product of catecholamine metabolism? |
|
Definition
| VMA (vanillylmendelic acid) |
|
|
Term
| Which synthetic corticosteroids have NO mineralocorticoid activity? |
|
Definition
| Dexamethasone, betamethasone, and triamcinolone |
|
|
Term
|
Definition
| Primary hyperaldosteronism |
|
|
Term
| What are the 4 main symptoms of Addison's disease (hypoadrenocorticism)? |
|
Definition
| Hypotension, hyponatremia, hyperkalemia, hyperglycemia |
|
|
Term
| What two veins make up the portal vein? |
|
Definition
| The splenic and superior mesenteric |
|
|
Term
| What receptors are found on the hepatic arteries? What receptors are found on the hepatic veins? |
|
Definition
| Hepatic arteries have a-1, b-2, d-1 (d-1 causes vasodilation), and cholinergic receptors. Hepatic veins have a-1 and d-1 |
|
|
Term
| What does a portal triad include? |
|
Definition
| A portal triad includes a portal vein, hepatic artery, and bile duct |
|
|
Term
| What do Kupferr cells do and where are they found? |
|
Definition
| Kupferr cells are found lining the sinusoids of the liver and clear the blood of bacteria and other contaminants |
|
|
Term
| What type of elimination reactions are not fully developed in the newborn? |
|
Definition
| Conjugation reactions (phase 2 reactions) |
|
|
Term
| Name the 3 main countercurrent mechanisms found in the body? |
|
Definition
| The vasa recta, loop of henle, and testes |
|
|
Term
| What local mediators are released in response to reanl hypoxia/ischemia? |
|
Definition
| Prostaglandins and bradykinin are released in response to renal hypoxia/ischemia |
|
|
Term
| Name 3 stimuli for the release of renin |
|
Definition
1. Decreased renal perfusion
2. Stress
3. Hyponatremia |
|
|
Term
| Which electrolyte controls blood flow through the juxtaglomerular apparatus? |
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Definition
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|
Term
| How much renal function must be lost before symptoms appear? |
|
Definition
| Renal symptoms will not appear until 60% of function has been lost (40% remaining) |
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Term
| How is PT, PTT, and platelet levels in the chronic renal failure patient? |
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Definition
| PT, PTT, and platelet levels are all normal in the chronic renal failure patient (however, bleeding time is extended) |
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|
Term
| Why do chronic renal patients have increased bleeding times if platelet levels are normal? |
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Definition
| They produce defective vW factor, so while platelet AMOUNT is normal, FUNCTION is abnormal |
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Term
| What is the best overall test of renal function? |
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Definition
| creatinine clearance is the best overall test of renal dysfunction |
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|
Term
| What is normal creatinine clearance? |
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Definition
| >100 is normal creatinine clearance |
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|
Term
| What does an increase in alk. phosphatase usually indicate? |
|
Definition
| A biliary tract obstruction |
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|
Term
| Is the esophagus striated or smooth muscle or both? |
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Definition
| The upper 1/3 is striated muscle, while the lower 2/3 are smooth muscle |
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|
Term
| What is gastric pH range in the fasted patient? |
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Definition
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|
Term
| What does cholecystokinin (CCK) do? |
|
Definition
| It promotes the optimum environment for digesting fats. It mildly slows the GI motility and causes release of pancreatic enzymes to break down the fats |
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Term
| Which H2 blocker has no effect on P450? Which has the most? Which has little effect? |
|
Definition
Famotidine (Pepcid) has no effect
Ranitidine has little effect
Cimetidine has the most effect |
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|
Term
| What type of problems are associated with a high anion gap acidosis? |
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Definition
| Too much acid, whether it be increased exogenous production (ketoacidosis, lactic acidosis), increased acid intake, or lack of acid excretion |
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|
Term
| What is the first sign of hypocalcemia? |
|
Definition
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|
Term
| Which local might precipitate if used with bicarb? |
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Definition
| Bupivicaine may precipitate when used with bicarb |
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|
Term
| What 3 LA's are effective topically? |
|
Definition
| Cocaine, lidocaine, and tetracaine |
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|
Term
| Which electrolyte disturbance will cause an increase in MAC? |
|
Definition
| Hypernatremia causes an increased MAC |
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|
Term
|
Definition
| N20 is metabolized by anaerobic bacteria in the intestine |
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|
Term
| Which volatiles most depress the baroreceptor reflex? |
|
Definition
| Halothane and sevo most depress the baroreceptor reflex |
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Term
| The use of barbituates is absolutely contraindicated in which two disease states? |
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Definition
| Barbituates are absolutely contraindicated in porphyria and status asthmaticus |
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|
Term
| What is the dosing for flumazenil? |
|
Definition
| 0.2 mg doses up to a total of 5 mg |
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|
Term
| Which IV induction agent is administered as a single isomer? |
|
Definition
| Etomidate is given as a single isomer |
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|
Term
| What drug can be used to relieve the extrapyramidal effects of dopamine antagonists? |
|
Definition
| Diphenhydramine can be used to treat extrapyramidal effects |
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|
Term
| What technique is not advised for patients with MS? |
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Definition
| Spinal anesthesia is not advised for those with MS as it can cause an exacerbation |
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|
Term
| Which enzyme is the best test for hepatocellular damage? |
|
Definition
| Debatable. Choose in this order: 5-NT, GST, ALT, AST |
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|
Term
| Is albumin a good indicator for acute hepatic dysfunction? Why or why not? |
|
Definition
| No, not for ACUTE. Albumin has a half life of 20 days, so it won't reflect recent changes. |
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|
Term
| What are the hallmarks of nephrotic syndrome? |
|
Definition
| Proteinuria and hypoalbuminemia are the hallmark signs of nephrotic syndrome |
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|
Term
| Where does most digoxin excretion take place? |
|
Definition
| Most dig is dependent on the kidneys for elimination |
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|
Term
| What is the first line treatment of HoTN in the patient with IHSS? 2nd? |
|
Definition
| Fluids first, neosynephrine 2nd |
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|
Term
| What drugs should be avoided in the patient with IHSS? |
|
Definition
| Patients with IHSS should not receive vasodilators, inotropes, beta agonists, or diuretics |
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|
Term
| What is the induction agent of choice in cardiac tamponade? |
|
Definition
| Ketamine is the induction agent of choice in cardiac tamponade |
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|
Term
| What is Takayasu's arteritis, what are some of the s/s, and how is it treated? |
|
Definition
| Takayasu's is an inflammation of the aorta and its major branches, which can lead to absent peripheral pulses. S/S include vertigo, visual problems, occlusions of peripheral vessels, etc. Treatment is with CORTICOSTEROIDS. |
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|
Term
| What is cretinism, and what is the most important aspect of it from an anesthesiology standpoint? |
|
Definition
| Cretinism is a congenital hypothryroidism. They tend to have large tongues making airway more difficult. |
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|
Term
| What substance is the hallmark product of a carcinoid tumor? |
|
Definition
| Serotonin is the hallmark of carcinoid tumors |
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|
Term
| What is the hallmark urine metabolite of serotonin used to diagnose carcinoid tumors? |
|
Definition
| 5-HIAA is the marker found in the urine indicative of serotonin production |
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|
Term
| In patients taking lithium, what other electrolyte level is important to know? |
|
Definition
| Na levels are important to know in the lithium patient. Low Na = high Li levels |
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|
Term
| Whats the formula for estimating PaO2? |
|
Definition
|
|
Term
| What are the two leading causes of death in the elderly trauma patient? |
|
Definition
| Respiratory failure and sepsis are the top two causes of M+M in the elderly trauma patient |
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|
Term
| What is the number 1 and 2 cause of death with PIH? |
|
Definition
| #1 cause of death in PIH is cerebral hemorrhage, followed by pulmonary edema |
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|
Term
| Does ritodrine (Yutopar) cross the placenta and affect the fetus? |
|
Definition
| Yes, ritodrine (Yutopar) does cross the placenta |
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|
Term
| Severe HTN may occurr if the parturient is given a pure alpha agonist along with what drugs? |
|
Definition
| If the patient receives an alpha agonist such as phenylephrine along with the ergot derivatives (ergonovine and methylergonovine), severe HTN may occurr |
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|
Term
| What is the max dose of ketamine (mg/kg) that should be given to a pregnant woman during an RSI? |
|
Definition
| No more than 1 mg/kg should be given to pregnant women |
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|
Term
| What is the neonatal dose of epi for treatment of asystole? |
|
Definition
| Epi dose for neonates is 0.01-0.03 mg/kg |
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|
Term
| At what age does the Cytochrome P450 system reach full function? |
|
Definition
| 1 month--Cyt P450 becomes fully functional at 1 month |
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|
Term
| When is hemoglobin the lowest during childhood? |
|
Definition
| 3 months is the lowest Hg |
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|
Term
| When is basal metabolic rate the highest? |
|
Definition
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|
Term
| What factor is most responsible for closure of the PDA at birth? |
|
Definition
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|
Term
| What two arteries should not be used for arterial blood gases in the neonate? |
|
Definition
| The brachial or femoral (nerve damage/femoral necrosis) |
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|
Term
| What can cause a newborn to return to fetal circulation? |
|
Definition
| Anything that increases PVR (acidosis, hypothermia, hypoxia, pneumonia) |
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|
Term
| What are 3 abnormalities associated with prune-belly syndrome? |
|
Definition
| Cryptorchidism, club feet, and GU abnormalities |
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|
Term
| What group of patients has the highest incidence of latex allergy? |
|
Definition
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|
Term
| What is the average blood loss in mL/kg for tonsillectomy? |
|
Definition
|
|
Term
|
Definition
| Kernicterus is a bilirubin-induced encephalopathy caused by unconjugated bilirubin |
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|
Term
| Which local is not metabolized by neonates? |
|
Definition
|
|
Term
| What can hyperglycinemia from using glycine during a TURP cause? |
|
Definition
| Transient blindness and ammonia toxicity |
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|
Term
| Where is correct placement of the Doppler to detect a venous air embolism? |
|
Definition
| Over the right atrium (right sternal border, 3rd-6th intercostal space) |
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|
Term
| What is the rate of fluid absorption during a TURP? |
|
Definition
|
|
Term
| What is the intravascular half life of LR? |
|
Definition
|
|
Term
| Why are neurolytic blocks usually done? |
|
Definition
| For intractable cancer pain |
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|
Term
| With unstable angina, to what INR is coumadin titrated to?20 |
|
Definition
|
|
Term
| Which locals can cause methemoglobinuria? |
|
Definition
| Prilocaine, benzocaine, and EMLA |
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|
Term
| What is EMLA cream a combo of? |
|
Definition
|
|
Term
| At what temp does the brain go isoelectric? |
|
Definition
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|
Term
| What LA does not exist in a charged form? |
|
Definition
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