ECHO
Where is crista terminalis located in the heart?
Right Atrium
Name the 2 factors that affect drug elimination from subarachnoid space and spinal cord
1)Regional blood flow
2)Vascular reabsorption
Which organ has the principal of acid excretion in the body?
Lungs
Name the only Ca channel blocking agent that is used to treat vasospasm following SAH?
Nimodipine
Anterior hip dislocation affects what nerve?
Obturator
What is the most common cardiac side effects of sugammadex if given at higher doses? 16 mg/kg
Bradycardia and asystole.
Name the largest valve in the heart?
Tricuspid Valve 7-9 cm2
What is the most significant patient related physiologic parameter that determines block height during spinal anesthesia
The volume of CSF in the lumbosacral region.
In healthy young people what is the normal closing volume?
Closing volume is 10 % of the VC. 400-500 ml
Which cranial nerve has the 75% of parasympathetic nervous system action?
Vagus nerve cranial nerve X
The most important extrahepatic site of propofol metabolism is
By kidneys.
When performing ESP (erector spinae) block where does the local anesthetic spread? Which level will you choose for breast and thoracic surgery.
Through paravertebral space.
Breast T4-5
Thoracic surgery T 7-8
Moderator band is located in which structure?
Right Ventricle
When administering local anesthetic to the thoracic region why is the dose reduced compared to the lumbar area.
Greater spread is thought to be caused by decreased volume and the compliance of the thoracic epidural. The dose should be reduced 30-50 %
What is the PaO2 and PaCO2 in the apices of the lungs?
PaO2 132 mmHg
PaCO2 28 mmHg
Name the tertiary amine anticholinesterase agent that is used in central anticholinergic syndrome?
Physostigmine 1 mg.
Name the 3 shunts in fetal circulation.
Ductus venosus
Ductus arteriosus
Foramen Ovale
How does sugammadex work?
Sugammadex is a modified gamma cyclodextrin that irreversibly form a complex with rocuronium and vecuronium preventing aminosteroid NM. blockers from acting at the nicotinic receptors.
Which papillary muscle has dual supply?
Anterolateral papillary muscle
OM and diagonal
Name the Beta 1 receptor antagonist that has been showed to decrease intraop and postop opioid requirements.
Esmolol.
How long most adults with normal lungs and gas exchange can hold their breath when breathing room air without hyperventilating?
What will be the PaO2 and PaCO2?
1 minute
After 1 min. of breath holding, PaO2 decreases to 65-70 mmHg and PaCO2 increases 12 mmHg.
Name the preservative that is used in propofol which is responsible from bronchospasm especiailly patients with asthma?
Sodium Metabisulfite
Name the ultra short acting L-type Calcium channel blocker who is rapidly metabolized by esterases and extravascular tissues.
Clevidipine is a direct arterial vasodilator. Dose 1-2 mg/hr max. 16 mg/hr
Name the only oral direct thrombin inhibitor on the market.
Dabigatran (Pradaxa)
Name the 3 leaflets of Tricuspid Valve
Posterior, Septal and Anterior(largest)
Which opioid is not approved for spinal and epidural use.
Remifentanil has added glycine as a preservative
How about if you breath 100 oxygen?
How about if you hyperventilate and breathe 100 % oxygen
If someone breathes 100 % Oxygen they can hold their breath 2-3 minutes or until PaCO2 rises to 60 mmHg.
Hyperventilation and 100% oxygen prior to breath holding can extend the apneic period to 6-10 minutes
Name the polypeptide hormone that stimulates cAMP by causing inotropic and chronotropic effect that can be used to reverse hypotension, bradycardia, conduction impairment caused by B-blocker intoxication.
Glucagon
Name the neurotransmitter that doesn't change with aging.
Glutamate.
Dopamine, AcH, NE and Seratonin will decrease.
Name the most common cardiac issues in myotonic dystrophy patients.
Cardiac conduction defects, 1degree AV block, bundle branch block, high incidence of septal defects and MVP.