Test 10
1. Adenosine is a potent vasodilator that plays major role in determining hepatic blood flow by
regulating the hepatic arterial buffer response (HABR)
2. Early manifestations of aspirin toxicity include tinnitus, vertigo, N/V, diarrhea and resp alkalosis
(hyperventilation). Late symtoms include AMS, hyperthermia, noncardiogenic pulmonary
edema, anion gap metabolic acidosis
3. Acute aspirin overdoses causes harm by interfering the citric acid cycle and causing uncoupling
of oxidative phosp which leads to buildup of orgainic acids- ketones, lactate causing anion gap
acidosis. It also directly acts on the respirotaory center in the medulla to increase the resp drive
leading to resp alka
4. Mnemoni for vitamin K dependet factors: 1972,
5. X, IX, VII and II are synthesized in the liver and require vitamin K dependent gamma
carboxylation to become active
6. The superior hypogastric block is performed to treat cancer related pain involving the pelvic
organs (desending and sigmoid colon, prox rectum, uterus, ovaries, testes, seminal vesicales,
prostate and baldder) and chronic pelvic conditions ( endometriosis, inflame disease and
interstitial cystitis)
7. Splanchnic nerve block is perfomed to treat caner related pain in the upper abd and
retroperiotneum involving the lower 1/3 of esophagus, stomach, duodenu, pancreass and biliary
tract. It can be used as an alternative to celiac plexus block when there is a significant tumor
burden in the celiac plexus region
8. The desired spinal level during transurethral resection of prostate (TURP) is T10. Prostate
innervated by S2 to S3 while bladder T11 to L2. Spinal anesthesia allows to monitor for TURP
syndrome which arsies from endovascular translocation of the cystoscopic irrigant fluid used
during the procedure. If distilled water, the pt may become severly hyponatremic and
hypoososmolar. Hemolysis is common given lack of plasma osmolarity. If glycine containing
solution is used then glycine is biotranformed inot ammonium which can cause blindess. Other
irrigation solution like sorbitol, mannitol, glucose which all have potential side effects oif
excessive volumes are absorbed in circulation
9. Physiologic stress result in deranagemnts of carbohydrate utilization to include increased
glucose production and peripheral insulin resistance. Insulin resistance likely due to
postreceptor impairment of intracellular glucose transport and can reduce the efficacy of insulin
by 50-70%.
10.
11.
12. Waveform consistsing of frequenicies in the delta and alpha ranges is characteristic of surgical
depth of anesthesia achieved with volatile anesthetics
13. Changes to lung volumes in the geriactric population include greater closing capacity compared
to FRC, causing an alveolar arterial shunt, decreased vital capacity, and increased residual
volume and moderately decreased to unchanged total lung capacity
14. To prevent delayed cerebral ischemia caused by cerebral vasospasm, all pts with subarachnoid
hemorrhage should receive oral nimodipine within 48hrs after symptom onset for total
duration of 21 days
15. All volative agents augment NMBDs by directly cuasing skeletal muscle relaxation and acting
synergistically with NMBDs. Desflurane causes the most block potentiation.
16. Succinulcholine induced myalgias are not solely related to fasciculations and can occur in the
absence of fasciculations. Pre treamtnet with NSAIDs has been shown as the most effective
methoid ot prevent myaligias followed by lidocaine and “defasiculaitng” doses of rocuronium
(0.03mg/kg)
17. Bradycardia and hyptension during a carotid endarterectomy can be casued by stimulation of
receptors in the cartotid sinus NOT carotid body.
18. Carotid body contains chemorecpotrs that monior pH, PO2, pCO2
19. Measurement of platelet function is challenging due to the complex nature of platelet
aggregation and the myriad of physiologic processes required for appropritate aggregation. Gold
standard lab analysis of platelet tfuncion is optical aggregometry though biscoelastic monitoring
of coagulation is a resonalble surrogate. Other point of care measures of platelet function are
limited in their use to predict an increased risk of intraop bleeding
20. Acethlcholine synthesized in the nerve terminal from acetyl-coenzyme A and choline by the
enzyme choline acetyltransferase
21. Classic risk factors for the need for posop mechanical ventilation for thymectomy in a
myasthenia gravis pt include a vital capcity <2.9L, disase duration >6yrs, chronic respirat illness,
pyridostigmine doase >750mg/day.
22.
23. Musle weakness from high magnesium concetrations results from inhibition of calcium influx,
leading to reduced acetylcholine relase.
24.
25. TAP block is a fascial plane block in which local anesthetic is deposited btw internal oblique and
transverse abdominis muscles.
26. For anesthetic billing, one anesthesia time units is define by CMS as 15 units. So 80mins case
would be billed as 80/15= 5.3 TU
27. Presence of hand or foot malformations such as thumb aplasia or polydactyly may be the first
evidence of a neonate with VACTERL association. If a neonate with known hadn or foor
malformations if required surgery, essential to screen for congenital heart diasese with echo
prior anesthesia
28.
29. When emergencies occur in zone IV of the MRI suite the first step is to removed the pt from the
MRI suite for safety. ACLS measures should be enacted as soon as the pt is moved to an area
where resusciataion equipment can be safe
30.
31. No single test can predict the success or failure of a wean from ventilatory support. A maximum
inspirtatory pressure of >-20 cm H2O is a fairely sensitive predictor of wean failure but a vale of
<-20cmH2o is not necessarily predictive of successful wean.
32. Mean inspiratory pressure is the maximal pressure generated against an occluded airway.
33. Rapid shallow breathing index (RSBI) is another bedside measurement can give both negative
and positive predictive values for weaning. It is calculated when the pt is on NO ventilator
support (0 cmH2O pressure support, 0 PEEP) by divind the pts unsupported respiratory rate by
their tidal volumes in Liters. This generates units of “breaths/min/L”. RSBI<105 is reassuring.
34. Airway leak test, airway leak at <12-15cm H2O is patent airway
35. Severe burns lead to hypoalbuminemia which increases the free fraction of amny anesthetic
druges including benzo and opiods. Lower doses of benzo and higher sdoses of opiods are uslly
required due to the rapid development of tolerance. Insulin resistance is seen due to increase
catecholamine and corticosteroid levels. Proliferation of extrajunctional acetylcholine receptors
leads to exaggerated hyperkalemia with sux use and resistance ot NDMB
36. Fontan physiology requreies passive blood flow from the superior and inferior vana cava into
the pulmonary arterial system. So successful maintenance of the pressure differential btw CVP
and pulmonary arterial pressure requires minimizing elevation in pulmonary vascular resistance
and intrathoracic pressure while manining higher than normal CVP. Using low tidal volumes like
5ml/kg for Positive pressure ventilation is preferred in pts with Fontan circulation to keep
intrathoracic pressure as low as possible.
