NCE/SEE exam

where should monitors be placed for a mediastinoscopy

right upper extremity pulse ox or aline (due to compression of innominate artery)

left upper extremity NIBP

What age is cricothyroidotomy contraindicated?

6 years old

what psi is required to ventilate through a percutaneous cricothyroidotomy?

50psi

what does each intrinsic muscle do?

Posterior cricoarytenoid

Thyroarytenoid arytenoid

Aryepiglottic

Cricothyroid

Posterior cricoarytenoid - Abducts vocal cords

Thyroarytenoid arytenoid - Adducts vocal cords

Aryepiglottic - Closes glottic opening

Cricothyroid - Lengthens vocal cordsAor

CO2 production is how many ML

200ml/min

what are variables that are directly proportional to drug clearance

-extraction ratio & drug dose

-blood flow to clearing organ

what are histamine releasing NMB

SAM

Succs

atracurium

mivacurium

What are the three most common used pharmacological agents for treating ischemic heart disease?

Nitrates

Beta-blockers

CCB

A patient with mitral stenosis is asymptomatic with occasional mild symptoms with exertion. Which mitral valve area is associated with these symptoms?

Patients with valve areas between 1.5 and 2.0 cm2 are usually asymptomatic or have only mild symptoms with exertion. Critical mitral stenosis is associated with valve are 0.5-1.0 cm2 or less. Mitral stenosis is usually diagnosed when the valve area is 1.5 cm2 or less.

What is the onset of analgesia following administration of epidural morphine 5 mg?

The onset of epidural morphine is 30 to 60 minutes. The duration of analgesia is 12 to 24 hours. Larger doses of epidural morphine are needed for analgesia. However, delayed respiratory depression may result.

Which variable increases Minimum Alveolar Concentration (MAC)?

Hypernatremia increases MAC

You administered meperidine IV. Immediately following administration the patient developed profound hypotension, hyperpyrexia and respiratory arrest. You expect an interaction with:

Patients receiving MAO inhibitors should not receive meperidine. In addition to hypotension, hypertension, hyperpyrexia, and respiratory arrest, coma may result. Interaction of alfentanil and erythromycin may lead to respiratory depression and prolonged somnolence. Meperidine and other narcotics combined with central nervous system depressants foster synergism that affects the respiratory and cardiac systems.

Which agent results in an increased heart rate during inhalational anesthesia?

Heart rate increases linearly with dose. There is a minimal increase in heart rate with desflurane when using less than 1 MAC. The heart rate increases with Sevoflurane at 1.5 MAC or greater.

Which local anesthetic is metabolized by 0-toluidine?

Prilocaine

Prilocaine is the only amide local anesthetic not metabolized by P-450 microsomal enzymes. Ester local anesthetics nesacaine is metabolized by pseudocholinesterase whereas N-methylation and ester hydrolysis is responsible for cocaine metabolism. Mepivacaine is metabolized by P-450 microsomal enzymes.

Which local anesthetic is linked to methemoglobinemia?

Methemoglobinemia is caused by prilocaine's metabolic pathway that includes o-toluidine

what is the dose range for cocaine?

1.5-3mg/kg

Which risk factor contributes to myocardial ischemia in a patient with aortic regurgitation?

One anesthetic goal of managing a patient with aortic regurgitation is to maintain the heart rate toward the upper limits of normal (i.e., c. 80 to 100 beats/minute). A heart rate that is too slow or an increase in systemic vascular resistance will increase the regurgitant volume (A and B). Tachycardia, on the other hand, will contribute to myocardial ischemia in a patient with aortic regurgitation.

Where is the primary location of hepatic microsomal enzymes?

The primary location =hepatic smooth endoplasmic reticulum.

Microsomal enzymes are also located in the kidneys and gastrointestinal system to a lesser extent.

The majority of reactions in the small intestine involve P450 enzymes

In which valvular disease is the pulmonary capillary wedge pressure (PCWP) an overestimation of the left ventricular end-diastolic pressure (LVEDP)?

Mitral stenosis

Because of the abnormal transvalvular gradient in mitral stenosis, the PCWP overestimates the LVEDP.

Which hemodynamic event will decrease coronary perfusion pressure the most?

Coronary perfusion pressure = arterial diastolic pressure minus the LVEDP. Any decreases in aortic pressure or increases in ventricular end-diastolic pressure will reduce coronary perfusion pressure. Since PCWP is an indirect measure of LVEDP, an increase in PCWP will decrease coronary perfusion pressure.

What is the maximum allowable current leakage in the operating room?

10 uA.

What monitor alarms when a high current flow to the ground exists?

The line isolation monitor affords protection from electrical shocks in the operating room. The isolation transformer affords isolation between the power supply in the operating room and the ground. High efficiency particulate (HEPA) filters are used to maintain air quality in the operating room

What humidity levels are appropriate for the operating room?

Humidity levels between 50-55% foster infection control in the operating room. Sterile drapes may be affected by high humidity causing dampness, whereas low humidity may accelerate movement of particulate matter.

What is the capacity of nitrous oxide in an E-cylinder? (in liters)

Nitrous oxide in an E-cylinder is 1,590 L

H-cylinder (15,900 L).

The capacity of oxygen, air, and nitrogen in an E-cylinder is 625-700 L.

How does soda lime differ from barium hydroxide lime?

Soda lime is hardened with silica. Barium hydroxide lime's hardness is due to its water of crystallization.

Barium hydroxide contains barium hydroxide and calcium hydroxide, but no potassium hydroxide.

Absorptive capacity of barium hydroxide is 9-18 L of CO2/100 g granules and 14-23 L of CO2/100 g granules for soda lime.

Which of the following safety devices does not sense oxygen pressure?

Mechanical Link proportion system is a proportioning chain between the nitrous oxide flow control and the oxygen flow control, which limits the oxygen concentration without detecting pressures. Oxygen failure protection device is a diaphragm device dependent upon minimum oxygen pressure to remain open. Supply failure alarm operates above a minimum pressure threshold. Bourdon gauge is a pressure gauge.

when does the oxygen pressure failure device activate?

when 02 pressure falls below 20psi

when 02 tank is depleted

what does the hypoxia prevention device do?

limits the nitrous flow to three times oxygen flow

equation for fio2

(air liter x 21) +(oxygen liter x 100)/ total flow

FiO2 for nasal cannula

4% for every L starting at 20

-1L = 24%

-2L = 28%

24-44%

how does elevation affect desflurane output

higher elevation = less output due to lower atmospheric pressure

Does a descending bellow fill during a circuit disconnet?

yes it can be entrained with room air

which nerve is most likely to be injured during AC IV placement?

median nerve

how does a median nerve injury present?

-unable to oppose thumb

-reduced sensation over palmar surface of the thumb, index finger, middle finger, and lateral aspect of ring finger

which nerve can be injured by an iv pole that presses against the dosolateral aspect of humemrus

radial nerve

how does a long thoracic nerve injury present as?

scapular winging

How does common peroneal injury occur and present?

foot drop

happens when legs are in stirrups

obturator injury

caused by flexion of thigh toward groin

difficult forceps delivery'

excession traction during lower abdominal surgery

-presents as inability to adduct leg[ YHT5GR432

which nerve injury presents as foot drop?

common peroneal nerve

sciatic

which nerves are injured when legs are crossed?

top leg --> sural injury

bottom leg --> superficial peroneal injury

what happens during transduction of pain?

Transduction occurs when a chemical, mechanical, or thermal stimulus is sensed by a nociceptor and is converted into a action potential

opioid receptor stimulation

-adenylate cyclase activity is decreased

-cAMP production is decreased

-calcium conductance is decreased (reduced neurotransmitter release)

-Potassium conductance is increased

opiods cause a ____ shift on the carbon dioxide curve

rightward shift

what receptor is responsible for shiverring

kappa

what is the most important site for pain modulation?

dorsal horn of spinal cord

what is the afferent limb of the occulocardiac reflex

trigeminal nerve

long and short ciliary nerves

gasserian ganglion

Think five and dime

what is the efferent limb of the occulocardiac reflex

vagus nerve

what beta blocker increases splanchnic vascular resistance/hepatic artery constriction?

propranalol

it is a useful drug in the patient with hepatitis and elevated portal pressure

hepatocytes produce

-thrombopoietin

-alpha-1-acid glycoprotein

-factor VII

the liver does not produce which factors

von willebrand factor

factor 3 tissue factor (produced by vascular endothelial cells)

factor 4 (calcium comes from diet)

(3,4,)

what are synthetic liver function tests

PT (most sensitive for acute injury, short half life)

Albumin

hepatocellular injury lab test

AST

ALT

Hepatic clearance lab test

Bilirubin

Biliary duct obstruction lab test

alkaline phosphotase

y glutamyl transpeptidase

5'nucleotidase

what are the intrinsic clotting factors

8,9,11,12

if you cant buy the intrinsic pathway for 12 dollars you can for 11.98

what are the extrinsic clotting factors

3,7

for 37 cents you can buy the extrinsic pathway

factor 7 has shortest halflife of all factors (4-6) hours

a clot can form in 15 seconds

what measures the intrinsic pathway

PTT and ACT

what measures the extrinsic pathway

PT/INR

what are the final common pathway factors?

1,2,5,10,13,

"the final common pathway can be purchased at 5 and dime for 1 or 2 dollars on the 13th of the month

what law applies to the venturi mask?

bernouli or venturi effect

Where is plasminogen produced?

liver

what does plasminogen do?

What is a Durant's maneuver?

placing patient in left lateral decubitis to prevent air entrainement

which component of the sympathetic nervous system forms the right the right rami?

preganglionic neuron

what is the primary action of acetylcholine in the sympathetic ganglion?

increase sodium conductance

What is the Bainbridge reflex?

Adjusts heart rate in response to venous return

what is the celiac reflex?

-DT traction to the mesentery or other abdominal organs

-reflex mediated by vagus nerve= bradycardia and HoTN

How does nitroglycerin work?

alters the second messanger cyclic gmp --> protein kinase G --> smooth muscle relaxation

what factors can increase local anesthetic toxicity

What are the EKG signs of hyperkalemia?

1. Mild to Moderate: tall, peaked T waves

2. Moderate to severe, P waves decrease or disappear,: QRS widening

3. Very Severe: sine-wave pattern- asystole and v-fib

fio2 of nasal cannula

measure 20+4 for 1liter then +4% for each following liter

1L = 24%

2L = 28%

3l = 32%

4L = 36%

5L: = 40%

6L= 44% (MAX)

when halogenated agent are used alone, what is the highest acceptable level of exposure

2PPM

when halogenated agents are used with nitrous, what is the highest acceptable level of exposure

0.5PPM

25PPM when nitrous is used alone

which mapleson circuit is best for spontaneous ventilation?

A

APL valve next to mask

FGF near the bag

Which Mapleson circuit is best for controlled ventilation?

D

Only circuit with the APL away from patient

Which Mapleson circuit is best for spontaneous ventilation only?

E

No reservoir bag/APL

According to ASA pre-anethesia checkout procedures, what should be checked prior to each case?

check the vaporizer fill level

perform a high pressure check

Verify that gas flows through the circuit during inspiration and expiration

how do you measure fio2

Fio2 = (liter flow air x 21) / (liter 02 x 100)/ total flow

which spinal pathway is impacted by NMB.

corticospinal track. Goes from cortex to spine and is responsible for motor function.

which column is responsible for fine touch and proprioception

the dorsal column

Which tract is responsible for pain and temperature?

Spinothalamic tract

how does epidural anesthesia affect glucose metabolism?

Decreased gluconeogensis

improved glucose utilization

increased glucose sensitivity

improved post operative glucose tolerance

For acute respiratory acidosis, what does PH decrease by for every 10 mmHg rise in paco2?

PH decreases by 0.08 for every 10 mmhg rise in paco2

For chronic respiratory acidosis, what does PH decrease by for every 10 mmHg rise in paco2?

PH decreases by 0.03 for every 10 mmhg rise in paco2

what chemicals are responsible for bronchoconstriction?

inositrol triphosphate

phopholipase c

leukotrienes

what chemicals are responsible for bronchodilation?

Cathecholamines

VIP receptor

A vital capacity less than __ ml/kg is at high risk for respiratory failure

15ml/kg

The vessel rich group recieves __% of cardiac output and is __% of total body mass

75%

10%

Muscle group receives__% of cardiac output and is__% of total body mass

20%

50%

Fat group receives __% of cardiac output and is __% of total body mass

5%

20%

Vessel poor group receives. __% of cardiac output and is __% of total body mass

<1%

20%

A left to right cardiac shunt will increase or decrease IV induction?

Decrease rate of IV induction. Agent is recirculated in the lungs.

During ocular surgery an sf6 bubble is place, when should nitrous oxide be discontinued? how long should it be discontinued after placement?

Atleast 15 minutes before

7-10 days after

how long do you avoid perfluroropropane when administering nitrous?

30 days

3

how much % does MAC decrease each decade?

6%

Volatile anesthetics produce immobility in the _______

ventral horn of the spinal cord

what receptors does nitrous oxide work on?

blocking NMDA and stimulating potasium 2p channels

what happens to the qt interval at 1 MAC

it increases due to an increase in duration of myocardial repolarization by impairing outward k current

what do inhalational agents do to coronaries?

causes vasodilation. isoflurane causes them most vasodialtion

how do halogenated anesthetics affect respiratory status?

increase respiratory rate and decrease tidal volumes