Term
| The stellate ganglion is made up of what two ganglia? |
|
Definition
| Inferior cervical and superior thoracic |
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Term
| All sympathetic nerve fibers pass through which rami communicans? |
|
Definition
|
|
Term
| From the white rami communicans, what are the 3 possible routes sympathetic fibers can take? |
|
Definition
1. Go through the gray rami into the paravertebral ganglion
2. Ascend/descend into the paravertebral ganglia
3. Pass through the PVG without synapsing |
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Term
| Sequence of norepi synthesis (precursors) |
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Definition
| Tyrosine-->L-Dopa-->Dopamine-->Norepi-->Epi |
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Term
| How is norepi's action terminated? |
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Definition
1. Reuptake (majority)
2. Metabolized by MAO in cleft
3. Metabolized by COMT away from cleft
in bloodstream |
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Term
| What are two drugs to avoid with patients taking MAOI's? |
|
Definition
| Demerol and Ephedrine (Demerol especially) |
|
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Term
| What does stimulation of presynaptic Alpha-2 receptors do? Is this is the central or peripheral nervous system? |
|
Definition
| Decreases the synthesis/release of norepi. This is found in the peripheral nervous system |
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Term
| Where are post-synaptic Alpha-2 receptors found? What do they do? |
|
Definition
| In the CNS, when stimulated they decrease sympathetic outflow |
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Term
| Where does Precedex (dexmedetomidine) work? |
|
Definition
| Pre-synaptic alpha-2 receptors in the PNS |
|
|
Term
| Where is renin released from? |
|
Definition
| Juxtaglomerular cells of the afferent arteriole |
|
|
Term
| What pathway does SSEP's monitor? |
|
Definition
| The dorsal lemniscal system, which includes the cuneatis and gracilis |
|
|
Term
| What sensations do SSEP's monitor? |
|
Definition
| Pressure, Touch, and Vibration |
|
|
Term
| SSEP-monitored pathways: are they ipsilateral or contralateral? (if contra, when do they cross?) |
|
Definition
| The pathways measured by SSEP's (cuneatis and gracilis) monitor Pressure, Touch, and Vibration. They are ipsilateral until crossing at the brain stem |
|
|
Term
| Which nerve is usually monitored when measuring SSEP's? Where is the electrode placed? |
|
Definition
| Tibial nerve; electrode on the midline scalp |
|
|
Term
| What does the Lateral Spinothalmic tract serve (senses and side) |
|
Definition
| Pain and Temp; contralateral |
|
|
Term
| What does the Dorsolateral Fasciculus serve? (sense and tract) |
|
Definition
| Modulates pain; descending tract |
|
|
Term
| What is the excitatory neurotransmitter in the Substantia Gelatinosa? |
|
Definition
|
|
Term
| What is the inhibitory transmitter in the Substantia Gelatinosa? |
|
Definition
|
|
Term
| Which lamina make up the Substantia Gelatinosa? |
|
Definition
| Rexed's Lamina II (some say III also) |
|
|
Term
| What are the effects of Mu-1 receptors? |
|
Definition
Supraspinal analgesia
Euphora
Itching |
|
|
Term
| What are the effects of Mu-2 receptors? |
|
Definition
Spinal analgesia
Respiratory Depression
Dependence |
|
|
Term
| Describe platelet plug formation |
|
Definition
1. Adhesion (vW binds platelets to endothelium
2. Activation (platelets are activated by thrombin, which causes release of ADP and Thromboxane A2)
3. Aggregation (ADP and A2 uncover GPIIa/IIIb fibrinogen receptors, allowing fibrinogen to link platelets
4. Fibrin production (Factor 13 cross links the fibrin) |
|
|
Term
| Which clotting factors are not made in the liver? |
|
Definition
--III (tissue factor/thromboplastin)
--IV (calcium)
--VIII (vW) |
|
|
Term
| Which factors are contained in cryoprecipitate? |
|
Definition
|
|
Term
|
Definition
| Potentiates Anti-thrombin 3 (which then binds thrombin and factor Xa) |
|
|
Term
| Where is anti-thrombin 3 made? |
|
Definition
|
|
Term
| What is plasminogen and what does it do? |
|
Definition
| Its a factor incorporated in to clots as they're formed. If activated, it becomes plasmin and breaks down clots |
|
|
Term
| Describe the chloride shift |
|
Definition
| when CO2 enters the RBC, it reacts with H20 and is converted to carbonic acid (H2CO3), which is then broken down into HCO3 and H. HCO3 then diffuses out of the cell; as the HCO3 diffuses out, Cl- diffuses inside in order to keep neutrality |
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|
Term
| What nerve innervates the carotid bodies? |
|
Definition
|
|
Term
| What innervates aortic bodies and lung stretch receptors? |
|
Definition
|
|
Term
| What is the primary inspiratory pacemaker? |
|
Definition
|
|
Term
| What is the major control center for expiration? |
|
Definition
| Ventral respiratory group |
|
|
Term
| What does the pneumotaxic center do? |
|
Definition
| Shuts off inspiration (antagonizes the apneustic center) |
|
|
Term
| What does the apneustic center do? |
|
Definition
| Promotes deep/prolonged inspiration |
|
|
Term
|
Definition
|
|
Term
| What is the best pulmonary test for assessing small airway disease? |
|
Definition
|
|
Term
| What FEV1 and FEV1/FVC should postpone elective surgeries? |
|
Definition
|
|
Term
| What is normal serum osmolality? |
|
Definition
|
|
Term
| What are some endocrine functions of the kidney? |
|
Definition
RAAS system
Vitamin D production
Erythropoeitin |
|
|
Term
| Where in the kidney are proteins reabsorbed? |
|
Definition
| Proximal tubule via pinocytosis |
|
|
Term
| What are the most common 2nd messengers? |
|
Definition
| cAMP, cGMP, IP3, calcium, and calmodulin |
|
|
Term
| What is the most common inherited bleeding disorder? |
|
Definition
|
|
Term
| Hemophilia A is a deficiency of what factor? |
|
Definition
|
|
Term
| How does ASA inhibit clotting? |
|
Definition
| ASA inhibits COX, which converts arachidonic acid into prostaglandins, which eventually become thromboxane A2 |
|
|
Term
| What are some characteristics of DIC? |
|
Definition
| Oozing from sites and increased fibrin split products (d-dimer) |
|
|
Term
| What are the common anti-cholinesterases? |
|
Definition
| Neostigmine, edrophonium, pyridostigmine, and physostigmine |
|
|
Term
| Which anti-cholinesterases inhibit both true and pseudo (plasma) cholinesterase? |
|
Definition
| Neostigmine and Pyridostigmine (Edrophonium does not inhibit pseudo) |
|
|
Term
| What effects can echothiopate drops have? |
|
Definition
| Lowers cholinesterase activity levels, taking longer to metabolize Sux |
|
|
Term
| What are the common antimuscarinics (anti-cholinergics)and where do they work? |
|
Definition
| Atropine, Scopolamine, glycopyrrolate---they work at post-ganglionic, parasympathetic nerves |
|
|
Term
| What 2nd messengers promote bronchodilation? |
|
Definition
|
|
Term
| What 2nd messengers promote bronchoconstriction? |
|
Definition
|
|
Term
| What do PDE inhibitors do in the lungs? What is an example? |
|
Definition
| They prevent the breakdown of cGMP and cAMP by PDE, allowing more to build up and leading to bronchodilation. Milrinone is an example |
|
|
Term
| What do xanthines do? Example? |
|
Definition
| Inhibit all PDE's, leading to bronchodilation. Ex: aminophyline |
|
|
Term
| What do mast cell inhibitors do? Example? |
|
Definition
| Prevents the release of histamine from mast cells, preventing bronchoconstriction. Ex: cromolyn |
|
|
Term
| Describe the motor/sensory innervation of the larynx |
|
Definition
| All motor is provided by the RLN, except the cricothryoids (external SLN). All sensory above the cords is the internal SLN, while all sensory below the cords is RLN |
|
|
Term
| What happens with unilateral RLN damage? BIlateral? |
|
Definition
| Unilateral RLN damage causes one cord to me intermediately placed and hoarseness. Bilateral RLN damage will cause both cords to be intermediate and will cause aphonia and airway obstruction |
|
|
Term
| What happens with external SLN damage? |
|
Definition
| Cords are floppy and a weak/husky voice ensues |
|
|
Term
| What PO2 correlates with an SpO2 of 50%? |
|
Definition
|
|
Term
| What factors cause a leftward shift of the O2 curve (p50 less than 26, sats higher than normal) |
|
Definition
Decreased Temp
Increased pH (low CO2)
Decreased 2-3 DPG
Fetal/Carboxy/Met Hemoglobin |
|
|
Term
| What factors cause a rightward shift of the O2 curve? (p50 >26, sats lower than normal) |
|
Definition
Increased Temp
Decreased pH (increased CO2)
Increased 2-3 DPG
Sicle Cell |
|
|
Term
| What happens with methemoglobin? |
|
Definition
| Methemoglobin causes Ferric (Fe3+) instead of the usual Ferrous (Fe2+) iron |
|
|
Term
| How is CO2 transported in the body? (breakdown) |
|
Definition
90% as HCO3 (70% in plasma, 20% in RBCs)
5% protein bound
5% dissolved |
|
|
Term
| Where are most peripheral chemoreceptors found and what do they respond to? |
|
Definition
| Mostly in the carotid bodies (glossopharyngeal nerve); they respond to low PO2 |
|
|
Term
| What do central chemoreceptors mostly respond to? |
|
Definition
| Hydrogen ions; however H ion concentration is dependent on pH |
|
|
Term
|
Definition
|
|
Term
| During normal inspiration, when does intrapleural pressure become positive? |
|
Definition
|
|
Term
| What is the normal PAO2-PaO2 gradient? |
|
Definition
|
|
Term
| What is the normal PaCO2-PACO2 gradient? |
|
Definition
|
|
Term
| What value is the average of PACO2? |
|
Definition
|
|
Term
| What is the normal PaO2/PAO2 ratio? |
|
Definition
|
|
Term
| What are the 3 possible reasons for hypoxemia? |
|
Definition
| Low FiO2, hypoventilation, and V/Q mismatch |
|
|
Term
| During one-lung ventilation, which is more effective: CPAP of the non-dependent lung or PEEP of the dependent lung? |
|
Definition
| CPAP of the non-dependent lung is more effective during OLV |
|
|
Term
| What is more affected in a patient in whom V/Q mismatch suddenly develops (O2 or CO2)? |
|
Definition
|
|
Term
| Describe the blood flow in each of the 4 zones of the lung |
|
Definition
Zone 1 = no blood flow
Zone 2 = flow during systole
Zone 3 = flow during systole/diastole
Zone 4 = flow during systole (intersitial pressure becomes greater than venous) |
|
|
Term
| In which zone should the tip of a PA catheter be placed? |
|
Definition
|
|
Term
|
Definition
| Breathing 100% O2 for a few minutes replaces all of the Nitrogen in the FRC with O2, effectively increasing the amount of O2 in the FRC 5-6 times |
|
|
Term
| In theory, how long can the average adult who is adequately pre-oxygenated be apneic without desaturation? |
|
Definition
| About 9 minutes (FRC of 2500 mL full of O2, using 250 mL/min) |
|
|
Term
| What are some drugs that can inhibit hypoxic vasoconstriction? |
|
Definition
| HPV can be inhibited by direct acting vasodilators (SNP, hydralazine, etc) and volatiles at > 1 MAC |
|
|
Term
| What are the main types of obstructive disease? |
|
Definition
| Asthma and COPD (chronic bronchitis and emphysema) |
|
|
Term
| What spirometry results require split lung function tests prior to pneumonectomy? |
|
Definition
| FEV1/FVC < 50% and FEV1 < 2L |
|
|
Term
| If a patient has a V:Q ratio of zero, are they: deadspacing, having R-->L shunt, normal, or having L--R shunt? |
|
Definition
| They would be having R-->L shunt |
|
|
Term
| Is PAO2 higher in the dependent or non-dependent lung? Why? |
|
Definition
| PAO2 is higher in the non-dependent lung because the blood flow is lower and therefore less blood is carried away from the alveoli |
|
|
Term
| When a patient is given narcotics, what happens to the O2 curve? CO2 curve? |
|
Definition
| O2 curve shifts right (low sats), while CO2 curve shifts left |
|
|
Term
| What is the best test for assessing small airway disease? |
|
Definition
|
|
Term
| When should split lung function tests be ordered? |
|
Definition
| If the FEV1 < 2L and FEV1/FVC < 50% |
|
|
Term
| Expiration/inspiration is impaired with variable extrathoracic/intrathoracic obstruction |
|
Definition
Expiration is impaired with an intrathoracic
Inspiration is impaired with an extrathoracic |
|
|
Term
| what % of the normal healthy adult vital capacity is closing volume? geriatric? |
|
Definition
young healthy = 10% of VC
geriatric = 40% of VC |
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