1
Q
what muscle abducts vocal cords
A
posterior cricoarytenoid muscles
2
Q
what nerve innervates the intrinsic muscles
A
recurrent laryngeal nerve
3
Q
what nerve innervates the circothyroid muscle
A
SLN
4
Q
what nerve innervates the vocal cords?
A
trick question…they are ligaments = not innervated.
5
Q
what does the aryepiglottic do?
A
closes the laryngeal vestibule
6
Q
what does the interarrytenoid transverse and oblique muscle do?
A
closes posterior commissure of glottis
7
Q
what muscles elevate the larynx
A
digastric anterior and posterior
mylohyoid
stylohyoid
thyrohyoid
8
Q
how does the cricothyroid muscle assist with swallowing
A
contraction -> anterior region of the cricoid cartilage towards the lower border of the thyroid cartilage
9
Q
what muscles depress the larynx
A
omoyoid
sternohyoid
sternothyroid
10
Q
what does the anterior ethmoidal nerve innervate
A
Branch of V1 of trigeminal nerve (opthalmic branch)
nares and anterior 1/3rd of the nasal septum
11
Q
what does the sphenopalatine nerve innervate
A
maxillary nerve V2 of trigeminal nerve
terminates and post 2/3rd of nasal septum
12
Q
what does the lingual nerve innervate
A
branch of V3 mandibular nerve of trigeminal nerve
anterior 2/3rd of tongue
13
Q
glossopharyngeal nerve innervation
A
CN 9
soft palate
oropharynx
tonsils
posterior 1/3 of tongue
vallecula
anterior side of epiglottis
14
Q
what is the gag reflex
A
cn 9 ( glossopharngeal nerve) - afferent limb
cn 10 - efferent limb
15
Q
what muscles to the SLN internal branch innervate
A
trick question - no motor innervation
sensory; posterior side of the epiglottis to the level of the vocal cords
16
Q
what does the SLN external branch provide sensory for
A
0 sensory innervation - only motor to the cricothyroid muscle
17
Q
what nerve provides motor for mastication
A
manidublar (linguial) nerve of V3 from the trigeminal nerve
18
Q
what nerve provides motor for phonation
A
glossopharyngeal (CN 9 )
19
Q
what does the RLN innervate
A
sensory; below the vocal cords/ tracheal
motor; all intrinsic except cricothyroid
20
Q
where does the SLN begin to branch
A
branches off the vagus nerve just beyond the jugular foramen at the skull base
21
Q
when does the sln branch between the internal and external branches
A
at the level of the hyoid
22
Q
where do the RLN makes the turn
A
right loops under the subclavian artery
left loops under the aortic arch
23
Q
how does an SLN injury present
A
hoarsness
affected side = wavy
24
Q
which RLN is more susceptible to injury?
A
left due to its position in the larynx- goes around the aortic arch
25
how does the unilateral RLN injury present
ipsilateral - abducted (midline) during inspiration
26
how does the Bilateral RLN injury present
acute -> airway obstruction . both cords are midline during inspiration
stridor/ resp distress
27
SLN landmarks for blockade
greater cornu of hyoid bone
inject local below (inferior border) of the corner of the greater cornu of the hyoid bone
1 ml outside the thyrohyoid membrane
2 ml beneath the thyroid membrane
air = too deep
28
what are the 3 airway blocks
glossopharyngeal
SLN
RLN
29
landmark for Glossopharyngeal nerve block
insert the needle at the base of palatoglossal arch; anterior tonsillar pillar, to a depth of 0.25-0.5 cm- inject 1-2 ml of LA on each side.
aspiration air; too deep
blood; carotid artery -> sz
30
RLN landmarks for blockade
puncture cricothyroid membrane an advance caudal (transtracheal)
take deep breath -> ijnect 3-5 ml on inspiration -> pt will cough
31
where is the larynx in relation to the spine in adults
C3-C6
32
laryngospasm efferent and afferent pathways
internal branch of SLN = afferent
External SLN + RLN = efferent
33
Larsons maneuver landmarks
pressure for 3-5 seconds and released for 5-10 seconds and repeat
skull base
ramus of the mandible
mastoid process
34
what is the valsalva maneuver
exhalation against a closed glottis (or obstruction)
ie coughing, bucking, bearing down
35
what is a mullers maneuver
inhalation against a closed glottis
ie biting down on ett / laryngospasm
36
nmbd that can be given IM
Succ
Rocc
37
what consideration needs to be had if giving succ to a peds pt
succ in children < 5 yo, co-administer atropine 0.02 mg/kg to prevent bradycardia
38
where can the upper airway obstruction occur
soft palate; relaxes the tensor palatine muscle
tongue; relaxes the genioglossus muscle
epiglottis; relaxation of the hyoid muscle
in the awake state = the upper airway is held open by these dilator muscles
39
where do the turbinates project from
lateral walls of the nasal septum
40
what is the correct bevel orientation for nasal instrumentation
bevel (the hole) should face the turbinates (lateral walls) so the sharp edge travels along the septum = less likely to get stuck on / cause trauma to the turbinates
41
tracheal has how many cartilagenous rings and is how many cm long?
16-20 rings
10-13 cm long
42
carina anatomical location
T4-T5
angle of lois
43
left and right bronchi angles from carina and length
right - 25 degrees + 2.5 cm long
left - 45 degrees + 5 cm long
peds = 50/50
44
what kind of cells are in the trachea and carina
ciliated columnar epithelium
45
what kind of cells are in the alveoli
squamos epithelium
46
what kind of cells are in the mainstem bronchi
cuboidal epithelium
47
describe type 1 pneumocytes
surface for gas exchange
flat squamos cells
80% of alveolar surface
tight junctions
48
describe type 2 pneumocytes
produce surfactant
resistant to oxygen toxicity
capable of cell division
can produce type 1 cells
49
describe type 3 pneumocytes
macrophages
fight lung infection
produce inflammatory response
50
distance between the incisiors to the carina
26 cm
13 from incisors to larynx and 13 from larynx to carina
51
how many generations does the trachea eventually bifurcate into
23 generations
52
what structures permit air movement between alveoli
pores of Kohn
53
what increases with airway bifurcation
muscle layers
cross- sectional area
number of airways
54
where does anatomical dead space begin and end
begins in the mouth and ends in the terminal bronchioles
55
what are the muscles of inspiration
scm
ant, middle, post scalene
external intercostals
diaphragm
56
muscles of expiration
internal intercoastals- secondary
rectus abdominus
external oblique
internal oblique
transversus abdominis
"tires"
57
physiology of exhalation
exhalation is passive
driven by the recoil of the chest wall
58
what vital capacity of what is required for an effective cough
15 ml/kg
59
what is the last structures perfused by the bronchial circulation
terminal pronchioles
60
what is transpulmonary pressure and what does it mean
alveolar pressure - intrapleural pressure
+ value = airway stays open
- value = airway collapses
61
alveolar ventilation equation
(tidal volume - dead space) x RR
62
normal tidal volume
6-8 ml/kg
63
normal dead space
2 ml/kg or 150 ml
64
what does atropine do to the airways
atropine is a bronchodilator (anticholinergic)-> increase dead space by increasing the volume of the conducting zones
decreases the effect of ach on muscarinic 3 receptor (parasympathetic) -> bronchodilation
65
normal dead space to tidal volume ratio (vd/vt)
150/450 = 0.33
66
what does mechanical ventilation do to the vd/vt ratio
increases ventilation relative to perfusion
increases the ratio to 0.50 / 50%
increases places that are ventilated but not perfused = increased Vd (dead space/ zone 1)
67
what increases dead space?
facemask
hme
PPV
anticholinergics
old age
neck extension
decreased CO
COPD
PE
sitting- pooling of blood = increase vt relative to bf
68
what decreased dead space
ETT
LMA
trach
neck flexion
supine
trendelenburg
69
where does dead space begin in the circle system
y - piece
70
Bohr equation
vd/vt = (PaCO2 - PeCO2) / PaCO2
determines physiologic dead space
71
what is physiologic dead space
anatomic Vd + alveolar Vd
72
Normal V/Q ratio
ventilation ; 4 L/min
Perfusion 5 L/min
4/5 = 0.8
73
compliance formula
change in volume/ change in pressure
74
in the lung, where is ventilation and perfusion the greatest?
Ventilation is greatest in the base due to higher compliance
perfusion is greatest in the base due to gravity
75
what is the labels for the axis on the compliance curve
alveolar volume - y axis
transpulmonary pressure - x axis
76
describe the alveoli on the fullness/ compliance
at frc the alveoli are fuller and stay full making them less compliant
77
where is ventilation the highest
base
78
where is perfusion the greatest
base
79
where is compliance the greatest
base
80
where is the V/Q ratio the greatest and why
greatest at the apex because the AMOUNT of ventilation relative to the perfusion is greatest in the apex
81
Where is Co2 the greatest
in the base because the V/Q ratio is the less than that of the apex
82
Where is O2 the greatest
apex because the V/Q ratio is more than that of the base
83
dead space vs shunt
dead space = ventilation but not perfused = V/Q = infinity
shunt = perfused but not ventilated = V/Q = 0
84
what is the most common cause of hypoxemia in the PACU
V/Q mismatch (atelectasis)
85
whats the relationship between Co2 and oxygen diffusion
CO2 diffuses 20 times faster than oxygen
86
how does the body compensate for zone 1 and zone 3 development
to combat dead space -> bronchioles constrict to minimize ventilation of poorly perfused alveoli
to combat shunt -> HPV reduces blood flow to poorly ventilated alveoli
87
Law of Laplace equation
Pressure = 2 x tension / radius
88
What happens in over ventilated alveoli
Blood will give off excessive CO2 that cannot take up a proportionate amount of O2- consider oxyhbg dissocation curve
89
explain the physiology of surfactant
surfactant sits in between water molecules to decrease surface tension that promotes collapse
90
how much more surfactant do large alveoli have compared to small alveoli
trick question
each alveolus has the same amount of surfactant
large alveoli = smaller concentration of surfactant
small alveoli = higher concentration
91
what and when produces surfactant
type 2 pneumocytes produce surfactant between 22-26 weeks with peak production at 35-36 weeks.
92
what causes an anatomical shunt
venous blood that empties form L side of the heart (bypass the lungs)
thesbian veins (L heart)
Bronchiolar veins (drains bronchial circ)
Pleural veins (drain bronchial circ)
93
alveolar oxygen concentration equation
Alvolar oxygen = FiO2 x (Pb -PH2O) - (PaCO2 / RQ)
94
explain the RQ from the alveolar oxygen concentration equation and what it means
Normal = CO2 production / oxygen consumption = 200ml/min/250ml/min = 0.8
RQ > 1 = lipogenesis (overfeeding)
RQ - 0.7 = lipolysis (starvation)
95
what is the A-a gradient and whats the normal value
difference between alveolar oxygen (PAO2) and arterial oxygen (PaO2)
15 mmhg (d/t bronchial, pleural and thesbian veins)- when breathing RA
96
what is needed to calculate the A-a gradient
Alveolar gas PAO2 (from the alveolar gas equation )
PaO2 (form the ABG)
97
what does a large A-a gradient indicate
shunt, VQ mismatch or diffusion impairment
98
what increases the A-a gradient
Aging - closing capacity increases
vasodilators- dec HPV
R-L shunt - atelectasis, pne, bronch intubation, intracardiac defect
diffusion limitations- alveolarcapillary thickening hinders O2 diffusion
99
Vital capacity volume
65-75 ml/kg
or
4.8 L male
3.7 L female
100
FRC volume
35 ml/kg
101
lung volumes are based on what weight?
ideal body weight
102
spirometry cannot measure _____ volume
residual volume or closing capacity/ volumes
so it cant measure FRC or TLC
103
Lung Volumes
Residual volumes; 1,200 mls
expiratory reserve volume; 1,100 mls
tidal volume; 500 mls
inspiratory reserve volume; 3,000 mls
TLC; 5,800 mls
Vital Capacity; 4,500 mls
FRC; 2,300 mls
inspiratory capacity; 3,500 mls
104
what tests can measure FRC
nitrogen washout
helium wash-in
Body plethysmography
105
equation for time until patient desaturates
FRC/oxygen consumption (Vo2) - if breathing 100% oxygen
if breathing - multiply FRC x 0.21 then divide that by VO2
106
what increases FRC
advanced age
prone, Sitting, Lateral
Obstructive lung dz
PEEP
sigh breaths
107
what increases closing volume
(CLOSE-P)
COPD
LV failure
Obesity
Surgery
Extremes of age
Pregnancy
108
how does increased closing capacity relative to FRC affect oxygenation
anything that decreases FRC relative to CC or anything that increases CC relative to FRC will convert volume of VQ units to low VQ units or shunt units
109
Whats the relationship between age and FRC/CC relationship
by age 30, CC = FRC under GA
By age 44, CC = FRC when supine
By age 66, CC = FRC when standing
110
how is Closing capacity/ volume measured
washout of xenon or nitrogen. the gas is inhaled at RV and the measurement is stake as the patient exhanles from TLC
111
arterial oxygen content formula
caO2 = (1.34 x hbg x SaO2) + (PaO2 x 0.003)
112
delivery Oxygen formula
DO2 = CaO2 x CO x 10
113
Formula for oxygen bound to hbg
1.34 x HBg x SaO2
114
Formula for dissolved Oxygen in plasma
PaO2 x 0.003
115
Oxygen consumption formula
VO2 = CO x (CaO2 - CVO2) x 10
3.5 ml/kg/min
usually about 250ml/min
116
what is P50
PaO2 when hbg is 50% saturated
adults = 26.5 mmhg
fetal hbg = 19mmhg
117
describe left shift on oxyhbg curve
Left = lock
stronger hold on O2
occurs in the lungs
causes; hbg F, hyocarbia, carboxyhbg, met hbg, inc pH, dec temp, 2,3 dpg, co2, H+
118
describe right shift on oxyghbg curve
right = release
hbg willing to release O2
occurs in metabolic tissue
causes; acidosis, hyperthermia, increased 2,3 DPG, temp, Co2, H+
119
describe the Bohr effect
Co2 and hydrogen ions cause conformational change in the hbg molecule -> facilitates Oxygen release
ie ; increase partial pressure of CO2 and decrease pH cause hbg to release oxygen (right shift)
120
What is 2,3 DPG, what increases its release? banked blood? Fetal blood?
2,3-bisphosphoglycerate (2,3-BPG)
2,3 DPG is produced during RBC glycolysis
hypoxia -> increases DPG production d/t increased O2 offloading
compensation mechanism during anemia
decreased in banked blood
HBG F doesnt respond to 2,3DPG and is the reason why HBG F has a P50 of 19mmhg
121
rapoport-luebering pathway
BPG shunt, is a metabolic pathway in red blood cells (erythrocytes) that generates 2,3-bisphosphoglycerate (2,3-BPG). This pathway is a side branch of glycolysis and plays a crucial role in regulating oxygen delivery to tissues by influencing hemoglobin's affinity for oxygen
122
what are the three processess involved in aerobic glucose metabolism
glycolysis, krebs cycle and Electron transport chain
123
describe glycolysis
1 glucose -> 2 pyruvic acid molecules -> mitochondria -> 2 molecules of acetyl coenzyme A = 2 ATP
124
describe Krebs cycle
pyruvic acid to the mitochondria matrix -> oxaloacetic acid + acetyl coa -> citric acid-> CO2, NADH, oxaloacetic acid = 2 atp
125
describe the Electron transport chain
NADH split into NAD, H and 2 electrons. the electrons are fed into chemiosmotic mechanism. protein gradient across membrane = drives atp synthesis with help of atp synthase
O2 is the final electron acceptor
= 34 ATP
126
Describe the lactic acid pathway
no oxygen?
glycolysis -> pyruvic acid -> 2 atp and pyruvic acid gets backed up and the lactic acid pathway produces lactic acid -> anion gap acidosis
127
where is lactate cleared by
the liver
128
How is Co2 transported in the blood
1. carbonate (70%)
2. Bound to hbg as carbamino compounds (23%)
3. dissolved in plasma (7%)
129
What is arterial pH vs venous pH
arterial pH 7.40
venous pH 7.36
130
Haldane effect
oxygen causes the RBC to release Co2 or at a given PaCO2, deoxygenated HBG can carry more CO2. this allows hbg to load more co2 at the tissue level and release more co2 in the lungs.
deoxy hbg causes the co2 dissociation curve to shift to the left
131
describe how CO2 is buffered by HCO3-
H2O + CO2 <-> H2CO3 <-> H+ + HCO3-
H2CO3 = carbonic acid
132
is carbonic anhydrase in the RBCs or plasma
H2CO3 is present in the RBCs but not in the plasma
carbonic anhydrase is an enzyme that facilitates the formation of H2CO3- form H2O and CO2
133
describe the hamburger shift
CL- shifts into the RBCs to maintain electroneutrality in exchange for the HCO3-
water follows isosmotically, causing the erythrocyte to swell -> inc Hct by 3% d/t cell volume increasing relative to plasma volume
in the lungs the chloride shift operates in reverse as CO2 is excreted from the body
134
describe the Carbamino compoud buffer of CO2
CO2 binds with amino groups on hbg as well as other plasma proteins
135
how is CO2 dissolved in plasma
CO2 has a solbuility coefficient of 0.065 ml/dl/mmhg. vs oxygen, CO2 is 20 x more soluble in the blood (0.003)
136
where in the body is the CO2 dissociation curve right- shifted
the lungs (facilitates CO2 elimination)
137
how does hypercarbia affect blood pH
acute resp acidosis - for every 10 mmhg inc above 40 mmhg - pH decreases by 0.08
chronic resp acidsoso - for every 10 mmhg inc above 40 mmhg - pH decreases by 0.03 (kidneys retain HCO3)
138
Where is the primary and secondary monitor for PaCO2
The central chemorecetpor in the medulla= primary
secondary= peripheral chemoreceptors in the carotid bodies and transverse aortic arch
139
when does CO2 become a respiratory depressant
80-100 mmhg
140
what is the MAC of CO2
200 mmhg
141
what is the pacemaker for normal breathing
dorsal respiratory center, pre-Botzinger complex (VRG)
142
what is primarily responsible for triggering expiration
ventral respiratory center
143
What does the pneumotaxic center do
inhibits the Dorsal respiratory center (inhibits the pacemaker)
144
what does the apneustic center do
stimulates the dorsal respiratory center (pacemaker)
145
describe the neural coordination of respiration and the locations
pons; pneumotaxic center (upper pons) + apneustic center (lower pons)
medulla; Dorsal respiratory group (NTS), central chemoreceptors, ventral respiratory group (nucleaus ambiguous + retroambiguus)
146
where are central chemoreceptors located
ventral surface of the medulla
147
what do central chemoreceptors respond to
responds to PaCo2 (crosses BBB) and is the primary stimulus is the pH of the CSF d/t to increase H+ from the CO2. H+ doesnt x BBB
148
describe the peripheral chemoreceptors location
located in the adventitia of the carotid bodies at the bifurcation of the common carotid artery and the transverse aortic arch
149
what do the carotid bodies respond to
chief responsibilities of the carotid body is to monitor hypoxemia (PaO2 < 60 mmhg)
they do not respond to saO2 or CaO2.
they also monitor PaCO2, H+ and perfusion pressure
150
Hering-breuer inflation reflex
lung inflation is > 1.5 L above FRC (3x normal vt) -> CN 10 -> turns off the DRC -> Inhibits the phrenic nerve
not active during inspiration
151
Describe the hypoxic ventilatory response
PaO2 < 60 mmhg closes the Oxygen sensitive K+ channels in the type 1 glomus cells -> raises RMP/ opens Ca channels and increases NT release (ach and atp) -> action potential propagation along herings nerve -> CN 9 -> afferent pathway terminates in the inspiratory center in the medulla -> MV increases to restore PaO2
152
hering - breeuer deflation reflex
lung volume is too small -> CN 10 -> stimulates DRC
153
What causes J receptors
J receptor stimulation cause tachypnea. the J receptors are activated by things that jam traffic in the pulmonary vasculature; such as PE or CHF
154
Paradoxical reflex of Head
causes newborn baby to take her first breath
155
Hypoxic pulmonary vasoconstriction vs hypoxic ventilatory response
vasoconstriction vs increased RR
156
Hypoxic pulmonary vasoconstriction
increases pulm vascular resistance in poorly ventilated areas to minimize shunt flow to the regions
Low PA (alveolar) not PaO2 controls this
response begins within seconds and achieve its full effect in 15 minutes
157
Other term for shunt
venous admixture
158
kg units to grams
1 milligram = 0.001 gram
1 centigram = 0.01 gram
1 decigram = 0.1 gram
1 gram = 1 gram
1 decagram = 10 grams
1 hectogram = 100 grams
1 kilogram = 1000 grams
1 gram = 1000 mg
159
Dive reflex
causes apnea, bradycardia and vasoconstriction when the face is submerged in cold water
160
Albuerol, metapropterenol, salmeterol are what types of drugs?
Beta 2 agonists -> inc camp -> bronchodilation
also increase the Na/K pump -> hypokalemia
161
Ipatropium is what type of medication?
anticholinergic -> anatgonise M3 -> dec IP3 -> bronchodilation
162
Cromolyn is what type of medication
mast cell stabilizer
163
Theophylline is what kind of medication
methylxanthines; inhibit PDE -> inc CAMP -> bronchodilation
164
which pulmonary function test is the most sensitive indicator of small airway dz
forced expiratory flow 25-75%
165
Normal FEV1
> 80% predicted value (takes age into account)
volume of air that is exhaled after a max inhale in 1 second
166
Normal FEV1/FVC ratio
75-80% predicted value
167
a FEV1/FVC ratio less that ____ suggest ____ disease
< 70% = obstructive dz
normal in restrictive dz
168
what is MMEF and the normal value
Mid maximal expiratory flow rate or Forced expiratory flow at 25% - 75% vital capacity
normal; 100 +/-o 25% predicted value
169
How is the MMEF affected in obstructive and restrictive dz
reduced in obstructive
normal in restrictive
170
what is MMV and the normal value
maximum voluntary ventilation
max volme of air that can be inhaled and exhaled for 1 min. tests endurance
male 140-180 L
female 80-120 L
171
What is DLCO and the normal value
Diffusion capacity. volume of CO that can traverse the alveolarcapillary membrane/ alveolar partial pressure of cabon monoxide. based on ficks law of diffusion
nomal; 17-25 ml/min/mmhg
172
Ficks law of diffusion
Diffusion = (change in pressure x diffusivity x surface area)/ thickness
173
Positive predictors of postoperative pulmonary complications
pts; > 60, chf, copd, smoking
Procedure; surgcal site, >2 hrs, GA
Dx; albumin < 3.5 g/dl
174
what is CO T1/2
4-6 hrs
175
when does the P50 return to normal after someone stops smoking
P50 returns to normal near 12 hrs post cessation
176
What and when do the pulmonary effects change after smoking cessation
Return to pulmonary function takes 6 weeks; airway function, mucocilary clearance, sputum production, pulmonary immune function, hepatic enzyme induction
177
Describe an Alveolar recruitment maneuver
reverses anesthesia induced atelectasis
PIP to 40 cmH2O for 8 seconds + Peep
178
what is the peak airway pressure required for initial reopening of atelectatic regions
30 mmhg
179
what tests would be normal in restrictive dz that is decreased in obstructive dz
FEV1/FVC ratio + FEF 25-27%
180
Tracheal stenosis is an example of what type of airway disease?
"fixed" lesion- both inspiration and expiration are flat on a flow volume loop
181
what would be seen with a variable extrathoracic obstruction
inhale = airway collapse (negative pressure worsens obstruction) -> reduced flow
exhale = pushes the obstruction open - flow is normal
182
What would be seen with a variable intrathoracic obstruction
inhale = pulls open the obstruction -> normal flow
exhale = collapses the airways -> reduced flow
183
what is atopy
a condition of being hyper-allergic = greatest risk factor for developing asthma
184
What drugs should be avoided in asthmatics
Aspirin, nsaids, beta antagonists, sulfites, histamine releasing drugs (sux, atricurium, morphine, meperitine), H2 recetpor antaonists (ranitidine + famotidine), Hemabate (carboprost), anticholinersteraces (given independently)
185
Common abg finding in asthmatics
resp alkalosis
increased CO2 -> airtrapping d/t rep fatigue/ impening failure
186
What happens to FEV1, FEV1/FVC and FEF 25-75% in athmatics
these values are usually reduced but improve after bronchodilator therapy
187
what does a chest x ray for an asthmatic look like?
Hyperinflated lungs with diaphgramatic flattening
188
vent settings for asthmatics
limit inspiratory time, prolongexpiratory time and moderate permissive hypercapnia
189
Samters Triad
Nasal polyps
Asa/ NSAID sensitivity
Asthma
these can lead to respiratory distress
190
why avoid dropping PaCo2 in COPD pts
chronic resp acidosis leads to elevated PaCo2. Kidneys reaborb HCo3- to try to compensate. if we drop the CO2 the HCo3 in the blood can cause alkalosis -> left shift of oxyhbg dissociation curve/ apnea
191
Describe Alpha - 1 antitrypsine deficiency
produced in the liver; if hepatocytes cant secrete it then aleveolar elastase will go unregulated. alveolar elastase breaks down pulmonary connective tissue, if left unchecked or deficient of A1A -> panlobular emphysema
192
What PFT is diagnostic of COPD
FEV1/FVC ration < 70% after bronchidilator thereapy = COPD
pts will have inc RV, FRC and TLC
Decreased; FEV1 and FEF 25-75%
193
How does O2 affect COPD pts
1. oxygen inhibits the HPV -> inc shunt and dead space = decreased CO2 excretion and worsening hypercapnia
2. Haldane effect; when O2 is added, H+ is kicked off the hbg worening hypercapnia
194
Vent settings for COPD
6-8 ml/kg vt
slow inspiratory flows (allows for distribution to low compliance areas)
Peep
inc expiratory time
195
Other term for auto-peep
dynamic hyperinflation
196
What PFTs are diagnostic of restrictive lung diseases
FEV1 and FVC < 70%
normal FEV1/FVC ratio
197
Aspiration, flail chest, Pleural effusion, pneumothorax, pulmonary edema, mediastinal mass are all restrictive or obstructive dz
restrictive dz
198
Vent settings for restrictive dz
FRC is dec -> anticipate rapid desaturation
smaller VT; 6ml/kg + inc RR (14-18)
PIP < 30 cmH20
prolong Inspiratory time
199
Why dont PPIs decrease VAP
PPI increase gastric pH, provides environment where bacterial pathogens can flourish. microaspiration introduces these pathogens into the lungs
200
Mendelsons syndrome
aspiration pneumonitis
risk factors
gastric pH <2.5
Gastric volume > 25 ml (0.4 ml/kg)
201
Treatment for aspiration
head down
suction upper and lower
secure airway
PEEP
bronchodilation
IV lidocaine
ABX
202
Mortaility rate post aspiration
5% die
60 % asymyomatic
20 % supportive care
15% require ventilation > 6 hr
203
Treatment for tension pneumothorax
inertion of 14g angiocath in 2nd ICS mid clavicular or 4th/5th intercostal space at the anterior axillary line
204
Blood gas partition coefficient for nitrous vs nitrogen
0.47 vs 0.014
nitrous is 34 x more soluble in blood than nitrogen is.
205
indication for thoracotomy with hemothorax
initial drainage > 1,000 ml, continued bleeding > 200 ml/hr with white lung on CXR and Large air leak
hemodynamically stable with bleeding < 150 ml/hr -> managed with VATS
206
Flail chest rib movement with inhalation and expiration
inspiration; injured ribs move inward
expiration; injured ribs move outward
think of the + and - pressures
207
What is them most sensitive indication for a venous air embolism
most; TEE
then Precordial doppler, then ETCO2, then CVP/CO
208
what is the durant maneuver
a pt with VAE should be placed in the left lat decubitus position to cuase theair to rise in the R heart and miminize entry to pulmonary circulation
209
Define pulmonary htn
PAP > 25 mmhg
210
PVR formula
PVR = ((Mean PAP - PAOP)/ CO) x 80
211
Normal PVR
150-250 dynes/sec/cm-5
212
Vent settings for pulm htn
keep spontaneous if possible
cut peep
inceased RR to dec CO2/ acidosis
inhaled NO
213
CO vs oxygen hbg binding
CO binds to the hbg on the O2 binding site with an affinity 200 x that of oxygen
214
carbon monoxide poisoning and pulse ox
pulse ox doesnt measure CoHBG; give fasely elevated result.
must use CO- oximiter
215
Treatment for carboxyhemoglobin
T1/2 = 4-6 hrs breathing RA
Tx; 100% oxygen reduces the T1/2; 60-90 min. continue until COhbg < 5% or for 6 hrs
hyperbaric oxygen for COhbg > 25% or symtomatic
216
What is soda lime hydrated to
13-15%
217
which VAA are more likely to form CO
Des > iso >>> sevo
218
What drugs can be given down the ETT
NAVEL
narcan
atropine
vasopressin
Epi
Lidocaine
219
normal inspiratory force
75-100 cmH2O
220
Indications for mechanical ventilation
VC < 15 ml/kg
inspiratory force < 25 cmH2O
PaO2 < 55 on RA
A-a gradient > 55 on RA or > 450 on 100%
PaO2 < 200 on 100%
PaCO2 > 60
RR > 40 or < 6
221
Pulmonary tests that are the best predictors of pulmonary complications for pts undergoing pulmonary sugery
DLCO <40% predicted
FEV1< 40 % predicted
VO2 max < 15 ml/kg/min
222
Normal VO2 max for male and female
35-40 ml/kg/min-male
27-31 ml/kg/min- female
223
Tracheal cuff vs bronchial cuff volumes and types
tracheal cuff- 5-10 ml; high volume, low-pressure cuff
Bronchial cuff- 1-2 ml; low volume, high pressure cuff = inc risk for mucosal injury
224
How to size a DLT
<8yo = bronchial blocker or mainstem with ETT
children 8-9 yo = 26 french
Cildren 10+ = 28/32 Frech
Female; < 160 cm = 35 french, > 160 cm = 37 french
male; < 170 cm = 39 french, >170 cm = 41 French
225
Insertion depth for DLT
female; 27 cm
male 29 cm
226
Management of OLV hypoxia
1. 100% O2
2. Verify position/ R/O other problems
3. CPAP to non dependent lung (start at 2 cmh20, can increase to 10). apply peep to dependent lung
4. insufflate o2 to non dependent through suction catheter
5. intermittent reinflation
6. clamping of Pulmonary artery
227
Describe what happens when the DLT is not positioned correctly
Too far -> upper lob isnt ventilated
Too shallow -> cant achieve lung separation
Wrong bronchus -> wrong lung collapses
228
Most serious complication with a. mediastinoscopy
1 = hemorrrhage
2 = pneumothorax (usually right sided
229
Absolute C/I for mediastinoscopy
previous mediasinoscopy
230
Pathophysiology of ARDS
stage 1; exudative
stage 2; proliferative
stage 3; fibrotic
231
vent settings for ARDS
Low VT 4-6ml/kg
Peep
PCV
Plateau pressure < 30
RR 6-35 to maintain pH of 7.3-7.45
pao2- 50-80%
saO2 88-95%
232
what is the max FiO2 for a regular nasal canula
21-40%
233
What FiO2 range and flow rate can a HFNC achieve
21-100% and rates up to 60 L/min
234
Most common pulmonary etiology for ARDS
pne
235
Most common extrapulmonary etiology for ards
sepsis
236
normal inter-incisor gap
2-3 finger breadths or 4 cm
237
Acronym for malampati
PUSH
pillars
uvula
soft palate
hard palate
238
Normal Thyromental distance
3 finger breadths 6-9 cm
239
Mandibular protrusion classes
class 1 = can bit upper lip
class 2= can move upper and lower inline
class 3 = cannot move lower beyond upper
240
Normal atlando-occipital flexsion and extension
90-165 degrees
difficult if < 23 degrees extension
241
what is the 332 rule
3 finger inter-incisor gap
3 finger thyromental distance
2 finger thyrohyoid
less than these values - difficult airway
242
risk factors for difficult mask
BONES- in this order!! greatest risk to least risk
beard
obese
no teeth
elderly
snoring
243
NPO guidlines
2 hrs = clear liquids
4 hrs= breast milk
6 hrs = nonhuman milk, infant formula, solid food
8 hrs = fried or fatty foods
244
Cricoid pressure before and after loc
before LOC = 20 newtons ~ 2 kg
After LOC = 40 newtons ~ 4 kg
245
treatment for anaphlyxis angioedema
EPI, antihistamines, steroids
246
hereditary angioedema treatment
C1 inhibitor concetrate (danazol), ffp (contains enzymes that metabolize bradykinin), ecallantide(plasma kallikrein inhibitor), icatibant (brakykinin receptor antagonist)
247
which congenital dx have large tonge
"big tongue"
Beckwith syndrome
Trisomy 21
248
Which congenital dz have small/ underdeveloped manibles
"please Get that chin"
pierre robin
goldenhar
trachear collins
cri du chat
249
what congenital dx have cervical spine anomalies
"kids Try gold"
klippel-Feil
trisomy 21
goldenhaur
250
what airway management technique is contraindicated in pts with ludwigs angina
retrograde intubation
best options; awake trach or awake intubation
251
how does the head position affect the ETT position
nose to chest = pushes ett towards the carina ~ 2 cm
nose away from chest = pulls tip away from carina ~ 2 cm
lateral rotation most tip away from carina ~0.7 cm
252
risks for cirbiform plate injury
lefort 2 or 3 fracture
basilar skill fracture
CSF rhinorrhea
racoon eyes
periorbital edema
253
C/I for nasal airways
Cirbiform plate injury
coagulopahy
preveious transphenoidal hypophysectomy
precious caldwell-luc procedure
nasal fracture
254
where is the cribriform plate
boney struture that separates the nasal cavity from the anterior cranial fossa
255
ETT cuff pressure should be less than ____
25 cmH2O
256
what tubes have low volume- high pressure cuffs
red rubber tube
silicone tube for LMA fasttrack
bronchial balloon on the double lumen ETT
257
Can internal pressure be monitored on a low volume high pressure cuff
no
258
what is the purpose of the murphy eye
alternative passage of air movement in case the tip of the ett becomes occluded or abuts the tracheal wall
259
formula for Peds ett size and depth
uncuff: age / 4 + 4
cuff: age / 4 + 3.5
depth: ID x 3
260
LMA touches the border of what anatomical structures
proximal end- base of the tongue
distal end - upper esophageal sphincter (cricopharyngeus muscle)
sides- pyriform sinuses
261
Max PPV through LMA
20 cm h20
262
Max cuff pressure for LMA
60 cmH2O
target; 40-60 cmH2O
263
LMA table ; pt size, cuff inflation, ett, flexible endoscope
1- < 5 kg - 4 ml - 3.5 - 2.7
1.5- 5-10 kg - 7 ml - 4 - 3.0
2-10-20 kg- 10 ml - 4.5 - 3.5
2.5 - 20-30 kg- 14 ml - 5 - 4.0
3 - 30-50 kg - 20ml - 6 - 5.0
4 - 50-70 kg- 30 ml- 6 - 5.0
5- 70-100 kg- 40 ml - 7 -5.5
264
Other name for LMA Proseal
Supreme (disposable version)
265
Purpose of LMA proseal
Gastric drain, large mask, bite block
max pressure = 30 cmh2O
266
name of intubating LMA
LMA fast track
267
what is the name of an LMA fast track with a camera
LMA c- track
268
LMA flexible features
wire - reinforced
longer than LMA clasic
Narrower than LMA classic
used for head and neck surgery
269
how to use and LMA for laprascopic procedures
has a gastric drain
normal BMI
avoid light anesthesia
less than 15 degree tilt, less than 15 cmh20
less than 15 min of insufflation
270
LMA C/I
Risk of regurg; gastroparesis, hiatal hernia
airway obstruction
risk of tracheal collapse
poor lung compliance
high airway resistance
271
sizing of combitube and baloon volume
height 4-6 ft = size 37; 40-85 mls
Height > 6 ft = size 41; 40-100mls
no options for < 4 ft
272
how to place a combitube
insert blindly
inflate proximal tube; oorophargneal secured
inflate distal cuff; esophageal secured
273
Max cuff pressure of combitube
60 cmh2O
274
king laryngeal tube
like a combitube but only one lumen
child size (minimum 10 kg)
275
C/I for combitube and king laryngeal tube
intact gag reflex
prolonged use
zenkers diverticulum
ingestion of caustic substances
276
what is a bullard scope
rigid fiberoptic device
minimum mouth opening = 7 mm
pull straight up on handle
277
C/I for bullard scope
There are none
278
When is the best time to use intubating stylet
Class 3 view, next best is class 2 B. worst time = class 4
279
how far should the eschman be advanced into the trachea
23-25 cm
280
When using the trach light in the adult the tip should be bent ____ and in children the angle should be _____ and ____ to better accomidate for the more ____ glottic opening
When using the trach light in the adult the tip should be bent 90 degrees and in children the angle should be 60-80 degrees and more acute to better accomidate for the more cephalad glottic opening
281
contraindications for retrograde intubation
tracheal mass, layngotracheal dz, coagulopathy, infection, cant intubate/ cant ventilate
282
C/I for percutaneous cricothyroidotomy with TTJV
upper airway obstruction (because exiration if passive)
laryngeal injury
283
inspiratory pressure Jet ventilation psi
50 psi
the hand held ventilator is connected to a 50 psi oxygen source and the pressure is set to 15- 30 psi
284
C/I for surgical cicothyroidotomy
children
laryngeal fracture/ neoplasm
285
I:E ratio for jet ventilation
10-20 b pm
1-1.5 seconds for insufflation and 4-5 seconds for full exhalation
286
what is the minimum pressure to power a hand held jet ventilator
15 PSI
287
what is the recommended position for a patient undergoing video larygoscopy
supine, neutral
288
what is the emergency airway for peds pts < 6 yo
percutaneous cricothyroidotomy (needle cric)
289
How deep should the airway exchange catheter be placed
25-26 cm at the lip
290
how long can the airway exchange catheter be left in place
72 hrs
291
what can be done with an airway exchange catheter
monitor etco2
insuflate O2
jet ventilation
it cant suction
292
The glidescop has what degree of anterior bend?
60
293
Double lumen tube placement sequence
remove stylet
rotate 90 degrees
advance the DLT into the bronchus
confirm placements
294
airway fire sequence of events
remove ett
stop flow of all airway gasses
pour saline into the airway
re-establish ventilation
295
what family of enzymes catalyze the addition of phosphate group on a molecule to their substrate
kinase catalyze the addition of aphsphate group to their substrate
296
Dopamine, epi, NE and iodothyroninies are derived from what amino acid?
Tyrosine
297
gaba can be interconverted to what molecule
glutamate
298
neurotransmitter signaling is a specific form of which type of cell communication method?
paracrine
299
GQ pathway
PLC ->PIP 2-> IP3 + DAG
DAG -> PKC -> dec ca+ on MLCP
IP3 -> SR -> inc ca+ on MLCK
300
what is the bond order from weakest to strongest
van der waals < hydrophobic < hydrogetgh < ionic < covalent
301
GS pathway
PKA = tissue specific
AC -> atm/ camp -> PKA
302
Gi pathway
inhibits AC -> dec CAMP
303
what is the rate limiting factor of Ach production
availablility of choline and acetyl coa
304
AchE effect on ach
AchE hydrolyzes ach to acetate + choline
305
where are nnAchRs found
nicotinic neuronal; autonomic ganglia, on chromaffin cells in the adrenal medulla and the cns
306
Which muscarinic recetpr are GQ and which are Gi
M 1,3,5 = Gq
M2 & 4 = Gi
307
what is the primary excitatory nt in the brain
glutamate
308
are presynaptic auto receptors to suppress ach realease muscarinic or nicotinic
muscarinic achR
309
what is the primary inhibitory nt in the brain
Gaba
310
Primary inhibitory nt in the spinal cord and lower brain stem
glycine
311
What converts gaba to glutamate and vice versa
Krebs cycle (TCA cycle)
312
Rate limiting step of glutamate synthesis
glutaminase activity - converts glutamine into glutamate on the mitochondrial membrane
313
NMDA receptor activation requirements
2 glutamates, 2 glycine molecules and a depolarizing voltage change - each must happen for full activation - full activation -> magnesium blockade is relieved
314
What is the GABA B receptor
metabatropic GPCR that generates inhibitory response
315
what is seratonin sythesized from
tryptophan
316
what is histamine synthesized from
histidine
317
dopamine, epi, ne production pathway
Pheylalanin -> tyrosine via phylalanin hydoxylase
tyrosine -> L-Dopa via tyrsoine hydroxylase
L dopa -> Dopamine via aromatic L amino acid decarobyxlase
Dopamine -> NE via dopamine hydroxylase
NE to Epi via Phenylethanolamine - methytransverase (PNMT)
318
Rate limiting step in catecholamine synthesis
Tyrosine hydroxylase
319
How are NE and Epi metabolised and what are they metabolized into?
Monoamine oxidase (A = da, epi, 5ht3) (B= ne and 5hts) and catechol- o- methystransferase
Vanillymandelic Acid is the end product (kidneys eiliminate)
320
How is dopamine metabolized and what is it metabolized to
MAO and COMT metabolize and the major metaoblite is Homovanillic acid (HVA)
321
what is seratonin metabolized to
5 hydroxyindoleacetic acid (5-HIAA)
322
High levels of 5-HIAA in the urine are consistent with what?
carcinoid tumor
323
where is the largest concentration of dopainergic neurons in the brain
substantia nigra
324
which dopamine receptors are Gq/ GS and whcih are Gi
D 1& D5 = Gq/Gs
D2,D3,D4 = Gi
325
Low dose epi vs high dose epi has a propensity for which receptors
low dose = beta
high dose = epi
326
Which seratonin receptors are Gi, Gq and Gs and which is ionotropic
5ht 1 = Gi
5ht 2 = Gq
5 ht 4 = Gs
ionotropic = 5 ht3
327
where is the highest density of histamine containing neurons
tuberomammilary region of the hypothalamus
328
The receptor for insulin is ___
receptor tyrosine kinase
329
how does the sns affect the eye
nsn -> alpha 1 -> radial muscle contraction -> mydriasis
330
how to the parasympathetic nervous system effect the eye
pns -> muscarinic stimulation -> sphincter muscle contraction -> miosis
331
What is the rate limiting step of ach synthesis
availabity of acetyl- CoA and choline
332
How is an sns signal sent
short preganglionic via the ventral horn-> white ramus -> sns ganglia -> gray ramus -> post ganglionic fiber
333
horners syndrome
ipsilateral ptosis, miosis, anihydrosis, flushed skin, nasal congestion, enopthalamost
"very homely PAM (vasodilation Horner Ptosis anihydrosis MIosis)
334
SNS innervation
Thoracolumbar
T1- L2-L4
335
PSNS innervation
craniosacral
CN 3,7,9,10
S3,4
336
What makes up the stallate ganlgion
cervicothoracic (stallate) ganglion is confluence of the inferior cervical ganglion and the T1 ganglion
337
What does the stallate ganglion innervate
sns innervation to the ipsilateral head, neck and upper extremity
338
Describe the autonomic nerve to the adrenal medulla
Preganglionic B fibers from T5-T9 pass uninterrupted form the spinal cord to the adrenal medulla; ach is release onto the chromaffin cells in the medulla binds to Nicotinic neuronal receptor
339
What does the adrenal medulla secrete
epi = 0.2 mcg/kg/min (80%)
ne = (0.05 mmcg/kg/min) 20%
340
classic symptom triad for pheochromocytomas
headache, diaphoresis, tachycardia
will have elevated VMA in urine
341
Name non selective alpha blockers
pheoxybenzamine and phenolamine
342
name alpha 1 selective blockers
doxazosin and prazosin
343
Other name for adrenal gland
suprarenal glands
344
barroreceptor activation with increased map
inc map -> stretch of baroreceptors in aortic arch and carotid bifurcation -> NTS in the medulla for interpretation -> HR slows and vasculature dilates -> decreased map
345
Where are the high pressure baroreceptors located
carotid sinus and aortic arch
346
Spinal cord origin for the carioaccelerator fibers
T1-T4
347
how do vasodilators affect the baroreceptor reflex
hydralazine, snp and nitro preserve (remain intact) the baroreceptor reflex
PDE inhibitors and CCB impair the baroreceptor reflex
348
Describe the bezold-Jarisch reflex
bradycardia, hypotension, coronary vasodilation
slows the heart in the setting of profound hypovolemia (allows itself adequate time to fill)
349
Describe the bainbridge reflex
increased blood volume -> inc atrial stretch -> NTs in medulla -> inc HR (prevents damming up/ sluding of the blood in vasculature)
350
what is the low pressure cardiopulmonary baroreceptor reflex
bainbridge reflex
351
What kind of heat loss occurs by sweating
Evaporation
352
CNS ischemic reflex
dec bf to medullary vasomotor center -> ischemia -> sns activation -> vasoconstriction -> inc BP
353
Cushing reflex and triad
inc ICP -> dec CBF -> HTN, Bradycardia, Irregular respirations (dt brainstem compression)
354
Thermogenesis reflex
preoptic area in the hypothalamus -> thermal afferent signals -> efferent output; cutaneous vessels, brown fat and skm, sweat glands,
355
Valsalva reflex
forced expiration against closed glottis -> increased intrathoracic pressure -> dec cardiac filling and bp (dec CO) -> inc hr and inc inotropy -> glottic opening -> psns decrease in HR
356
Mass reflex
autonomic hyperreflex or massive sns output
357
Horners syndrome muscles/ nerves paralyzed
drooping eyelid- levator palpebrae superior muscle
miosis - dilator pupillae
vasodilation - dec sns tone
358
Muscle and nerve for chewing
masseter muscle innervated by cn 5
359
Oculocardiac reflex
traction on globe -> V1CN5-> NTS -> CN10
360
norepinephrine can stimulate its own release by agonising the _____
presynaptic beta - 2 receptor
361
shy drager syndrome
autonomic dysfunction / degeneration of locus coeruleus
362
how is phenylephrine metabolized
mao
363
How is ephedrine metabolized
liver
most is excreted renally unchanged
364
low dose vs high dose epi
low dose = beta stimulation; inc hr, co, pulse pressure and decreased svr
high dose = alpha; increased SVR and decreased CO
365
which anitmuscarinics are tertiary amines?
atropine and scopalamine = x BBB
glycop = quaternary amine = wont x bbb
366
antimuscarinic od s/s
hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter
367
how can atropine cause bradycardia
< 0.1 mg -> worsing bradycardia by blocking M1 on preganglionic parasymathetic fibers
M1 = GQ, if blocked = decreased sns output
368
treatment for antimuscarinic OD
pysostigmine 1-2 mg IV
369
what meds are dihydropyridines
nefedipine, nimodipine, nicardipine, clevidpine
mostly affect afterial more than venous vascular tone
370
what meds are benzothiazepines
diltiazem
mostly reduce hr
371
what meds are phenylalkylamines
verapamil
mostly reduces hr
372
rank ccb based on highest to lowest on their impariment of contractility
verapamil, nefedipine, diltiazem, nicardipine
373
half life of clevidipine
2 minutes
374
does hydralazine dilate venous capactiance?
no it dilates cardiac, cerebral, splanchnic and renal vasculature leading to decreased SVR but preserved preload
tachycardia is d/t baroreceptor reflex
375
explain which pde inhibitors antagonize which molecules
PDE 3 = camps and CGMP
PDE 4 = camp selective
PDE 5 = cGMP selective
376
why is snp not used for MIs
can produce coronary steal + produces reflex tachycardia d/t its arterial dilation
377
what ans reflex is preserved in a denervated heart
bainbridge reflex because the SA node stretch directly increases the sa nodes firing rate
378
cardiac myocyte oxygen consumption and extraction ratio
8-10mlO2/100g/min
70% extraction
379
the amount of o2 dissolved in blood (PaO2) follows what law
Henrys
380
what is ohms law
Q = P/R
381
what is the conversion factor between L/min to dynesxsecxcm5
80
382
formula for calculating map from CO and svr
Map = ((CO x SVR) / 80)) + cvp
383
poiseuilles law
Q = pi x R4 x P / 8 x viscosity x length
384
reynolds numbers meaning
<2000 = laminar
>4000 = turbulent
2000-4000= transitional
385
how is viscosity related to temp
inversely proportional
386
frank starling relates ____ to _____
ventricular volume to ventricular output
387
law of laplace
wall stress = intraventricular pressure x radius / 2 x ventricular thickness
388
name the cardiac veins and what they drain
Great cardiac vein - LAD
middle cardiac vein - PDA
anterior cardiac vein - RCA
coronary sinus - blood returns to here
389
what are the thesbian veins
small blood that empties directly into all 4 chambers = anatomical shunt
390
formula for coronary perfusion pressure
CPP = ADBP - LVEDP
391
normal coronary sinus o2 sat
30%
392
what is wall stress equivalent to?
preload
LVESV
consider coronary perfusion pressure
393
what is the mean transvalvular pressure gradient (lv to aorta) is dx of AS
> 40 mmhg
394
normal coagulopathic dz found in pts with AS
acquired von willebrand dz d/t damage when passing through stenotic valve
395
normal wave form abnormality for as
pulsus parvus
slower upstroke with delayed peak + narrow pulse pressure / small amplitude wave folrm
396
how should cardioplegia be injected in those with AR
retrograde or directly into coronary ostia
397
genetric conditions associated with AI
marfan syndrome
ehler-Danlos syndrome
Aklosing spondylityis
398
aline waveform morphology associated with AR
Bisferiens pulse
wide pulse pressure
399
most common cause of AR and MS
endocarditis
400
transvalvular pressure and PASBP that suggest MS
Transvavular pressure over 10mmhg and PASBP > 50mmhg
401
sapian valve features
rapid venriculoplasty -> cardiac standstill
mao >75 prior to RVP
if misplaced -> valve in valve procedure
402
corevalve features
no need for valvuloplasty or RVP
403
primary goal of MV prolapse
keep the ventricle full
404
pericarditis acute vs constrictive
constrictive = chronic
acute = inflammation
central symptoms for acute; friction rub, st elevation, cp with positioning
peripheral symptoms with constrictive; jvd, pulsus paradoxus, hepatomegaly ascites, pericardial knock
405
becks triad
hypotension
JVD
muffled heart tones
406
alpha stat vs ph stat
alpha stat; no temp correction
ph stat; temp correction - done for peds
407
Clinical prep
flashcards
Decks in class (22)
# Cards
-
Clinical prep291
-
Symposium pimping questions29
-
meds; benzos31
-
meds; opioids78
-
meds; induction agents56
-
meds; inhalation agents63
-
meds; muscle relaxants98
-
meds; regional medications65
-
meds; CSE labor analgesia17
-
meds; antiemetics69
-
meds; non opioid analgesics26
-
labs56
-
Fluid management23
-
vitals/ hemodynamics39
-
respiratory/ airway assessment46
-
complications and treatment21
-
meds; cardiac57
-
meds; abx35
-
PEDS134
-
Peds pt 2197
-
OB230
-
Board Prep407
