Cardiac Physiology
These components are found in large amounts in the extracellular fluid and include sodium, chloride, bicarbonate ions, and nutrients such as oxygen, glucose, fatty acids, and amino acids
What are the ESSENTIAL COMPONENTS OF EXTRACELLULAR FLUID?
Conditions that may increase myocardial oxygen demand or decrease myocardial oxygen delivery, potentially exacerbating previous stable angina.
What are (1) FEVER; (2) COCAINE USE; (3) TACHYCARDIA; (4) ANEMIA; (5) THYROTOXICOSIS, AND; (6) HEART FAILURE?
Nerve that innervates the larynx.
What are (1) EMERGENCY SURGERY WITH A FULL STOMACH; (2) BOWEL OBSTRUCTION; (3) PREGNANCY; (4) ACUTE TRAUMA?
Dominant cerebral hemisphere in majority of population.
LEFT?
Significant cognitive decline from the baseline level of performance in one or more cognitive domains, interferes with the activities of daily living, does not occur exclusively in the context of a delirium, not better explained by any other medical or psychiatric condition.
What are CRITERIA FOR DEMENTIA?
Excess levels of this electrolyte in the extracellular fluids can cause the heart to become dilated and flaccid, slow the heart rate, decrease the resting membrane potential in cardiac muscle fibers, and block conduction of the cardiac impulse from the atria to the ventricles.
What is POTASSIUM?
Most important factor that negatively affect myocardial oxygen consumption.
What is HEART RATE?
Responsible for the majority of oxygen transportation.
What is HEMOGLOBIN?
Effect of OSA on FRC and apneic oxygen reserve.
What are DECREASED FRC AND DECREASED APNEIC OXYGEN RESERVE?
Three key components of a neuron.
What are the (1) SOMA; (2) AXON, and; (3) DENDRITES?
Sudden change in mental state, develops over days – weeks & fluctuates and develops over days to weeks.
What is DELIRIUM?
Excess levels of this ion cause the heart to move toward spastic contraction, while a deficiency causes cardiac weakness.
What is CALCIUM?
Patients with active heart failure have a significantly higher risk of postoperative death than do patients with coronary artery disease but no heart failure.
What is DECOMPENSATED HEART FAILURE?
Atmospheric concentration of oxygen.
21%?
Most common causes of cor pulmonale.
What are PULMONARY EMBOLISM AND COPD?
Pathway of sensory transmission with a high degree of localization.
What is the DORSAL COLUMN-MEDIAL LEMNISCAL SYSTEM?
Immediately to 1-3 days after anesthesia, fluctuating consciousness, inattention, memory impairment, & perceptual abnormalities.
What is POST-OPERATIVE DELIRIUM?
This node, located along the epicardial surface at the junction of the superior vena cava and right atrium, has an intrinsic rate of 60 to 100 beats per minute and consists of P cells and transitional cells.
What is the SINOATRIAL NODE?
Angina causing a marked limitation of ordinary physical activity at a normal pace or angina so severe as to prevent any physical activity without discomfort.
What is SEVERE OR UNSTABLE ANGINA?
Divisions of the pharynx.
What are the (1) NASOPHARYNX; (2) OROPHARYNX, AND; (3) LARYNGOPHARYNX (HYPOPHARYNX)?
Pulmonary function test that is used to assess the severity of COPD.
What is FEV1?
Primary pathway that transmits motor signals.
What is the CORTICOSPINAL TRACT?
Widespread atrophy of the cortex, neuritic plaques composed of extracellular amyloid beta protein deposition, neurofibrillary tangles composed of hyperphosphorylated tau proteins, common to see signs of vascular ischemic damage and hippocampal sclerosis.
What is ALZHEIMER'S DISEASE?
This node, located on the posterior aspect of the right atrium behind the tricuspid valve near the opening of the coronary sinus, has an intrinsic rate of 40 to 60 beats per minute and a conduction velocity of 2 m/sec.
What is the ATRIOVENTRICULAR NODE?
Primary risk factor in the development of coronary artery disease, congestive heart failure, and cardiomyopathy. Increases the risk for atherosclerotic coronary artery disease by at least two-fold
What is HYPERTENSION?
Blood vessel that supplies oxygenated blood to the lungs.
What is the THORACIC AORTA?
Modalities used in diagnosis of aspiration pneumonitis.
What are ABG AND CHEST X-RAY?
The divisions of the Anterolateral System.
What are the NEOSPINOTHALAMIC TRACT AND PALEOSPINOTHALAMIC TRACT?
Most prevalent demyelinating disorder.
What is MULTIPLE SCLEROSIS?
This system, consisting of the bundle branch and terminal branches, extends outward under the endocardium, has pacemaker cells capable of firing at 20 to 40 beats per minute, and a conduction velocity of 4 m/sec.
What is the PURKINJE SYSTEM?
Disease caused by the pathological conditions such as pheochromocytoma, primary aldosteronism, and Cushing disease.
What is SECONDARY HYPERTENSION?
Effect of surfactant on the tendency of alveoli to collapse.
What is a DECREASED TENDENCY TO COLLAPSE?
Pulmonary function test that may indicate an acute asthma exacerbation.
What is FEF25-75%?
Arteries that form the Circle of Willis.
What are the CAROTID ARTERIES AND VERTEBRAL ARTERIES?
Symptoms start to appear in patients, trouble in the daily life, loss of concentration and memory, disorientation of place and time, change in the mood, development of depression.
What is EARLY PHASE OF ALZHEIMER'S DISEASE?
Efferent autonomic tone to the heart is initiated in the anterior (PNS) and posterior (SNS) hypothalamus and is modulated by these centers in the medulla prior to distribution.
What are the CARDIAC ACCELERATION AND CARDIAC SLOWING CENTERS?
Plays a major role in ischemic heart disease, left ventricular hypertrophy, congestive heart failure, cerebrovascular disease & stroke, peripheral vascular disease, aortic aneurysm, and nephropathy.
What is DISSEMINATED VASCULOPATHY?
Law that describes diffusion of gases across the alveolar-capillary membrane.
What is FICK'S LAW OF DIFFUSION?
Monitors used to assess ventilation and oxygenation.
What are SpO2 (OXYGENATION) AND ETCO2 (VENTILATION)?
The ability of the brain to control cerebral blood flow.
What is CEREBRAL AUTOREGULATION?
Neurodegenerative disorder is a spectrum of clinical syndromes characterized by neuronal degeneration involving the frontal and anterior temporal lobes of the brain.
What is FRONTOTEMPORAL DEMENTIA?
These fibers originate from cells in the intermediolateral columns of the higher thoracic segment of the spinal cord (T1-T4), synapse at the 1st to 5th thoracic vertebral ganglia, and increase heart rate, myocardial contraction, and the rate of AV node discharge.
What are the SYMPATHETIC NERVOUS SYSTEM'S CARDIOACCELERATOR FIBERS?
General rule in the perioperative care of hypertensive patients.
What is MAINTENANCE OF BLOOD PRESSURE WITHIN 20% OF BASELINE?
Describe Hypoxic Pulmonary Vasoconstriction.
What is PULMONARY VASOCONSTRICTION THAT OCCURS IN RESPONSE TO HYPOXIA, HYPERCARBIA, OR ACIDOSIS?
Modalities used in diagnosis of pulmonary hypertension.
What are DOPPLER ECHOCARDIOGRAPHY AND CARDIAC CATHETERIZATION?
Primary mechanism of acetylcholine removal from synaptic cleft.
What is ACETYLCHOLINESTERASE?
Neurodegenerative disease exhibiting a distinct pattern of neuropathological changes associated with repetitive head trauma leading to increased risk of long-term memory and cognition issue.
What is CHRONIC TRAUMATIC ENCEPHALOPATHY?
This neurotransmitter of the parasympathetic nervous system binds to muscarinic receptors, decreases SA node discharge, and slows conduction velocity through the AV node
What is ACETYLCHOLINE?
Risk of reinfarctions for a patient who had a myocardial infarction 3 to 6 months prior to undergoing anesthesia.
6%?
Responsible for the majority of carbon dioxide transportation.
What is BICARBONATE IONS?
Three classes of medications that may promote bronchodilation in patients with COPD.
What are (1) B2-AGONISTS; (2) ANTICHOLINERGICS, AND; (3) CORTICOSTEROIDS?
Key factors that influence cerebral blood flow.
What are (1) CARBON DIOXIDE CONCENTRATION; (2) HYDROGEN ION CONCENTRATION, AND; (3) OXYGEN CONCENTRATION?
Leading cause morbidity & mortality with SAH after aneurysm rupture.
What is VASOSPASM?
Stimulation of this nerve releases acetylcholine, decreases the rate of the sinus node, can slow the heart rate to one-half with weak to moderate stimulation, and can completely stop rhythmical excitation and block transmission from the atria to the ventricles with strong stimulation.
What is the VAGAL NERVE?
Primary substance responsible for coronary vasodilation.
What is ADENOSINE?
Name of the system used to describe the view of the larynx during laryngoscopy.
Medication that may reduce neutrophil chemotaxis.
What is LIDOCAINE (1.5 MG/KG)?
Three physiologic functions of sleep.
What are (1) COGNITION; (2) NEURAL MATURATION; (3) FACILITATION OF LEARNING AND MEMORY; (4) TARGETED ERASURE OF SYNAPSES; (5) CONSERVATION OF METABOLIC ENERGY, AND; (6) CLEARANCE OF METABOLIC WASTE PRODUCTS?
Widespread degeneration of the portion of the substantia nigra that sends dopamine secreting nerve fibers to the caudate nucleus and putamen.
What is PARKINSON DISEASE?
Increased sympathetic stimulation increases this, while increased parasympathetic stimulation decreases it, due to changes in heart rate and contractile strength.
What is CARDIAC OUTPUT?
Defined as angina at rest, angina of new onset, or an increase in the severity or frequency of previously stable angina without an increase in levels of cardiac biomarkers.
What is UNSTABLE ANGINA?
What are:
1. DECREASED H+ (INCREASED PH)
2. DECREASED CO2
3. DECREASED TEMPERATURE
4. DECREASED 2,3-BPG
5. METHEMOGLOBIN
6. CARBON MONOXIDE
?
Four principal changes involved in pathogenesis of asthma.
Nerve fibers with the highest conduction velocity, according to the general classification.
What are A-ALPHA NERVE FIBERS?
Sudden vascular-related focal neurologic deficit that resolves within 24 hours without intervention.
What is a TRANSIENT ISCHEMIC ATTACK?
These reflexes are initiated by stretch receptors in the walls of large systemic arteries, with receptors in the carotid sinus and aortic arch, and help regulate arterial pressure by sending signals to the nucleus tractus solitarius in the medulla.
What are BARORECEPTOR REFLEXES?
Exacerbated by chest wall movement and is associated with tenderness over the involved area, which is often a costochondral junction.
What is NON-CARDIAC CHEST PAIN?
Relationships between laminar flow and factors described in Poiseuille's Law.
What are:
(1) DIRECTLY PROPORTIONAL TO THE PRESSURE GRADIENT
(2) DIRECTLY PROPORTIONAL TO THE RADIUS OF THE TUBE
(3) DIRECTLY PROPORTIONAL TO THE VISCOSITY
(4) INVERSELY PROPORTIONAL TO THE LENGTH OF THE TUBE
?
Differentiate between chronic bronchitis and emphysema.
What is OBSTRUCTION OF EXPIRATORY AIRFLOW BY EXCESS MUCOUS SECRETION (CHRONIC BRONCHITIS) COMPARED TO PERMANENT ABNORMAL ENLARGEMENT OF AIR SPACES DISTAL TO THE TERMINAL BRONCHIOLES ACCOMPANIED BY IRREVERSIBLE DESTRUCTION OF ALVEOLAR WALLS (EMPHYSEMA)?
Ions that maintain resting membrane potential of neurons.
What are a HIGH EXTRACELLULAR CONCENTRATION OF SODIUM, HIGH EXTRACELLULAR CONCENTRATION OF CHLORIDE, AND HIGH INTRACELLULAR CONCENTRATION OF POTASSIUM?
Goal of therapy associated with the treatment of Parkinson’s disease.
What is INCREASING CONCENTRATIONS OF DOPAMINE IN THE BASAL GANGLIA AND DECREASING EFFECTS OF ACETYLCHOLINE?
These cells are sensitive to low oxygen or elevated carbon dioxide and hydrogen ion levels, and they stimulate nerve fibers that pass through Hering’s nerves and the vagus nerve into the vasomotor center of the brain stem to elevate arterial pressure.
What are CHEMORECEPTOR CELLS?
Cardiac muscle requires ______________of muscle tissue/min just to remain alive?
What is ~1.3 mL oxygen / 100 g?
Describe the Bohr effect.
What is the DECREASED AFFINITY FOR O2 BY HEMOGLOBIN IN THE PRESENCE OF ACIDOSIS AND HYPERCARBIA?
Principles that should guide an anesthetic prescription for a patient with pulmonary hypertension or cor pulmonale.
What are (1) MAINTAIN ADEQUATE OXYGENATION; (2) AVOID ACIDOSIS; (3) AVOID STIMULI THAT INCREASE SYMPATHETIC TONE; (4) AVOID HYPOTHERMIA, AND; (5) AVOID ADMINISTRATION OF CATECHOLAMINES?
Dermatome that corresponds to appropriate level of surgical anesthesia for cesarean delivery.
What is the T4 DERMATOME?
Common demyelinating diseases that affect your peripheral nervous system.
What are (1) GUILLAIN-BARRE SYNDROME; (2) CHARCOT-MARIE-TOOTH DISEASE, AND; (3) CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY?
These factors, including circulating catecholamines, influence heart rate independent of the SNS and PNS, and can cause tachycardia in a denervated heart following orthotopic heart transplantation.
What are HUMORAL FACTORS?
A common cause of death during the early period following Acute Myocardial Infarction.
What is VENTRICULAR DYSRHYTHMIAS?
Describe the Haldane effect.
What is the DECREASED AFFINITY FOR CO2 BY OXYHEMOGLOBIN, THUS FACILITATING OFFLOADING OF CO2 AT THE ALVEOLI?
Factors of the STOP-BANG Score.
What are:
SNORING
TIREDNESS
OBSERVED APNEA
HIGH BLOOD PRESSURE
BMI > 35 KG/M2
AGE >50 YEARS
NECK CIRCUMFERENCE >40 CM
MALE GENDER
?
Differentiate between anterograde and retrograde amnesia.
What is THE LOSS OF ABILITY TO FORM NEW DECLARATIVE MEMORIES (ANTEROGRADE AMNESIA) COMPARED TO THE DIFFICULTY OR INABILITY TO RECALL PREVIOUS DECLARATIVE MEMORIES (RETROGRADE AMNESIA)?
Risk factors associated with Alzheimer's disease.
What are (1) INCREASING AGE; (2) GENETIC FACTORS; (3) HEAD INJURIES; (4) VASCULAR DISEASE; (5) INFECTION, AND; (6) ENVIRONMENTAL FACTORS?
Cardiovascular effects can result from the suppression or blockade of sympathetic ganglia by local anesthetics during regional anesthesia.
What is BRADYCARDIA AND HYPOTENSION?
Determinants of Myocardial Consumption (Demand).
What are (1) HEART RATE; (2) PRELOAD; (3) MYOCARDIAL OXYGEN CONSUMPTION; (4) CONTRACTILITY; (5) AFTERLOAD; (6) COST OF ELECTRICAL CONDUCTION, AND; (7) BASAL CARDIAC METABOLISM?
Describe the innervation of the larynx.
What is
(1) VAGUS NERVE GIVES RISE TO SUPERIOR AND INFERIOR LARYNGEAL NERVES
(2) EXTERNAL BRANCH OF THE SUPERIOR LARYNGEAL NERVE - INFERIOR CONSTRICTOR MUSCLE OF THE PHARYNX, CRICOTHYROID MUSCLES
(3) INTERNAL BRANCH OF THE SUPERIOR LARYNGEAL NERVE - INTERARYTENOID MUSCLES, SENSORY INNERVATION BETWEEN INFERIOR ASPECT OF EPIGLOTTIS AND TRUE VOCAL CORDS
(4) INFERIOR LARYNGEAL NERVE/RECURRENT LARYNGEAL NERVE - ALL INTRINSIC LARYNGEAL MUSCLES EXCEPT CRICOTHYROID MUSCLES, SENSORY INNERVATION BETWEEN TRUE VOCAL CORDS AND TRACHEA
?
In rank order, which intravenous anesthetic agents may be preferred in patients with asthma?
What are (1) KETAMINE; (2) PROPOFOL, AND; (3) ETOMIDATE/BARBITURATES.
The four types of brain waves, expected frequencies, and when they occur.
What are:
(1) Beta waves - >14 Hz - periods of increased mental activity & REM sleep
(2) Alpha waves - 8-13 Hz - periods of limited mental activity
(3) Theta waves - 4-7 Hz - Stage 2-3 sleep
(4) Delta waves - <3.5 Hz - Stage 4 sleep
?
Criteria for decision-making capacity.
What are (1) UNDERSTANDING TREATMENT OPTIONS; (2) APPRECIATING AND ACKNOWLEDGING MEDICAL CONDITION AND OUTCOMES; (3) EXHIBITING REASONING AND ENGAGING IN RATIONAL DISCUSSION OF SURGICAL TREATMENT OPTIONS, AND; (4) CLEARLY CHOOSING A PREFERRED TREATMENT OPTION?