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M5 BOARD REVIEW

Comprehensive Anesthesiology Question Bank

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Respiratory

 Alveolar Gas Equation PA O 2 = FI O 2 ( P ATM – P H 2 O ) – Pa CO 2 / RQ PA O 2 = Alveolar partial pressure of oxygen = Arterial partial pressure of CO2 Pa CO 2 FI O 2 = Inspired O2 P ATM = Atmospheric pressure P H 2 O = Saturated vapor pressure RQ = Respiratory Quotient Q’s Respiratory Physiology: Q14 Basic Pulmonary Physiology: Q7
 Shunt Equation Q shunt (Cc’ O 2 - Ca O 2 ) Q total = (Cc’ O 2 - C mv O 2 ) Cc’ O 2 = Post-capillary blood oxygen content (typically assumed to be the Saturation of haemoglobin utilizing the PAO2 • haemoglobin concentration • 1.34) Ca O 2 = Arterial Hbsat • Hb • 1.34 C mv O 2 = Mixed venous Hbsat • Hb • 1.34 Q’s Basic Pulmonary Physiology: Q17

Equations

 Dead Space (Bohr Equation) V D P a CO 2 – P E CO 2 = V T P a CO 2 P a CO 2 = Arterial partial pressure of oxygen P E CO 2 = Partial pressure of CO2 from all expired gases Q’s Basic Pulmonary Physiology: Q14

Ventilation/Perfusion Index (ratio)

VQI =

(1 Arterial Hbsat)

(1 Mixed Venous Hbsat )

Qs

Basic Pulmonary Physiology: Q17

 Ohm’s Law Pressure Gradient = Air Flow Airway Resistance Q’s Basic Pulmonary Physiology: Q17

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Equations

Respiratory

 Airway Resistance for Laminar Flow (Poiseuille’s Law) Laminar Flow Resistance = (8 Length • Viscosity of gas) Radius ( 4 ) Q’s Respiratory Physiology: Q7 Basic Pulmonary Physiology: Q5
 Reynold’s Number R = (Velocity Density Diameter ) Viscosity >2000 consistent with turbulent flow Q’s Respiratory Physiology: Q7 Respiratory Physiology: Q8 Basic Pulmonary Physiology: Q4

Law of LaPlace

Pressure =

2 • Wall Tension

Note:

Wall thickness is typically not considered for alveoli

Qs

Basic Pulmonary Physiology: Q5

 Time Constant TC = Compliance Resistance Q’s Basic Pulmonary Physiology: Q5

Static Compliance

Static compliance = Volume Pressure

Tidal volume delivered

=

(Plateau pressure – PEEP)

Qs

Basic Pulmonary Physiology: Q33

Dynamic Compliance

Dynamic compliance = Volume Pressure

Tidal volume delivered

=

(Peak pressure – PEEP)

Qs

Basic Pulmonary Physiology: Q33

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Respiratory

Equations

 Transpulmonary Pressure Transpulmonary pressure = Alveolar pressure – Pleural pressure Q’s ICU: Advanced Cardiopulmonary: Q1
 Transthoracic Pressure Transthoracic pressure = Pleural pressure – Atmospheric pressure Q’s ICU: Advanced Cardiopulmonary: Q1
 Predicted PaO2 by Age Predicted PaO2 = 110-(age • 0.4) Q’s Special Situations: Q12 Respiratory Physiology: Q6
 Boyle’s Law Pressure1 • Volume1 = Pressure2 • Volume2 Q’s Basic Cardiac Physiology: Q12

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Respiratory

Equations

Henry’s Law

Partial Pressure = k • C

k = Henry’s Law Constant C = Concentration of dissolved gas

 Ohm’s Law Pressure = Cardiac Output • Resistance Q’s Cardiac Physiology: Q14

Henderson-Hasselbach

pH = pK + log[HCO3-/ (0.03 • PaCO2)]

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Cardiac

Equations

 Myocardial Perfusion Pressure MPP = Aortic diastolic pressure – LVEDP Q’s Cardiac Physiology: Q23
 LaPlace Law Tension = (Pressure • Radius)/(2 • Wall Thickness) Note: Notice that as opposed to the equation in the Respiratory Section, the equation is solved for wall tension Q’s Basic Cardiac Physiology: Q12
 Poiseuille’s Law Flow Rate = (π • Pressure • radius4)/(8 • viscosity • length) Note: Notice that as opposed to the equation in the Respiratory Section, the equation is solved for flow. Q’s Basic Cardiac Physiology: Q12

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Cardiac

Equations

 Fick Principle CO = VO2/(CaO2 – CmvO2) CO = Cardiac Output VO2 = Oxygen consumption CaO2 = Arterial content of oxygen CmvO2 = Mixed venous content of oxygen Q’s ICU Principles: Q1
 Consumption of Oxygen (not including O2 dissolved in blood for simplicity) VO2 = Hb • (Sata - Satmv) X 1.34 • CO Rearranged: Satmv = Sata – [VO2/ (Hb • 1.34 • CO)] CO = Cardiac Output VO2 = Oxygen consumption Sata = Arterial saturation of haemoglobin Satmv = Mixed venous saturation of haemoglobin Hb = Haemoglobin Q’s ICU Principles: Q1 ICU Principles: Q2 ICU Principles: Q19

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Cardiac

 Arterial Content of Oxygen CaO2 = [Hb • Sata • 1.34] + 0.003 • PaO2 Sata = Arterial saturation of haemoglobin Pa O2 = Partial pressure of oxygen in arterial blood Q’s ICU Principles: Q1
 Elimination of CO2 VCO2 = Hb X SatmvCO2 • CO SatmvCO2 = CO2 saturation in mixed venous blood Q’s ICU Principles: Q1
 Respiratory Quotient RQ = VCO2/VO2 VCO2 = Elimination of CO2 VO2 = Oxygen consumption Q’s ICU Principles: Q15

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Equations

 Oxygen Delivery DO2 = CaO2 • CO CaO2 = Arterial content of oxygen CO = Cardiac Output Q’s ICU Principles: Q1
 Oxygen Extraction Ratio ER = VO2/DO2 VO2 = Oxygen consumption DO2 = Delivery of oxygen Q’s ICU Principles: Q1 ICU Principles: Q3

Cardiac Output

CO = Stroke Volume • Heart Rate

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Cardiac

 Stroke Volume SV = End-diastolic volume – End-systolic volume Q’s Basic Cardiac Physiology: Q29
 Pulmonary Vascular Resistance PVR = [(PAP-Wedge)/CO] • 80 PAP = Pulmonary Arterial Mean Mressure CO = Cardiac Output Q’s ICU Principles: Q6
 Stroke Work SW = Stroke volume • mean arterial pressure Q’s Basic Cardiac Physiology: Q29

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Equations

Cardiac Index

CI = CO/BSA

CO = Cardiac Output BSA = Body Surface Area

 Systemic Vascular Resistance SVR = [(MAP-CVP)/CO] • 80 MAP = Mean Arterial Pressure CVP = Central Venous Pressure CO = Cardiac output Q’s Basic Cardiac Physiology: Q13

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Cardiac

 Starling Equation Q = kA X [(Pc – Pi) + σ(πi-πc)] Q = Net Fluid Filtration k = Capillary Filtration Coefficient (of water) A = Area of the Membrane σ = Reflection Coefficient (of albumin) Pc = Capillary Hydrostatic Pressure Pi = Interstitial Hydrostatic Pressure πi = Interstitial Colloid Osmotic Pressure πc = Capillary Colloid Osmotic Pressure. Q’s Basic Cardiac Physiology: Q30

Allowable Blood Loss

ABL = EBV X [(Hb – Minimum allowable Hb)/Hb]

EBV= Estimated Blood Volume

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Equations

Cerebral Perfusion Pressure

CPP = MAP – ICP

MAP = Mean arterial pressure

ICP = Intracranial pressure

Q’s

Clinical Neurophysiology: Q2 Clinical Neurophysiology: Q3

Perfusion Pressure

PP = MAP – Venous Presure

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Pharmacology

Equations

It is important to understand the concepts of pharmacokinetics, but few equations need to be memorized. Memorizing complex clearance and half-life equations, accounting for peripheral compartments are very low yield…just understand the concept.

Volume of Distribution

VD = Dose / Concentration

Q’s

Basic Pharmacology: Anesthesia Adjuncts Q1 Basic Pharmacology: Anesthesia Adjuncts Q2 Basic Pharmacology: Induction Agents Q12

Half Life

Half-life = Volume of distribution / Rate of clearance

Q’s

Basic Pharmacology: Anesthesia Adjuncts Q1 Basic Pharmacology: Anesthesia Adjuncts Q2 Basic Pharmacology: Induction Agents Q12

Clearance

Clearance = dose/ area under time concentration curve Clearance = (Urine concentration • Urine flow) / Plasma concentration

Q’s

Basic Pharmacology: Anesthesia Adjuncts Q1 Basic Pharmacology: Anesthesia Adjuncts Q2 Basic Pharmacology: Induction Agents Q12

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Pharmacology

Equations

 Opioid Conversions Drug IV Oral Morphine 10 mg 30 mg Hydromorphone 1.5 mg 7.5 mg Fentanyl 100 mcg N/A Codeine N/A 200 mg Hydrocodone N/A 30 mg Oxycodone N/A 20-30 mg

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Equipment

Endotracheal Size (for children)

Size = 4 + (Age/4)

Equations

 Endotracheal Depth Depth = 12 + (Age/2), or 3 • ETT size Q’s Pediatrics: Q4
 Gas Tanks (E) Gas Volume Pressure Oxygen 625 L (US) 2200 psig Nitrous Oxide 1590 L 745 psig Q’s Equipment: Q1 Equipment: Q2

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Statistics

Equations

Incidence & Prevalence

Incidence = Number of occurrences / Sum of person-time at risk Prevalence = Number of cases/ Number of individuals sampled

Measure of Effect

Absolute measure of effect = Rate Difference = Rate of risk exposed – Rate of risk not exposed Relative measure of effect = Rate Ratio = Rate of risk exposed /Rate of risk not exposed

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Statistics

Equations

 Disease Screening Has Disease No Disease Positive Test True Positive (TP) False Positive (FP) Negative Test False Negative (FN) True Negative (TN) Sensitivity = TP/ (TP + FN) Specificity = TN/ (TN + FP) Positive Predictive Value = TP/ (TP + FP) Negative Predictive Value = TN/ (TN + FN) Q’s Statistics: Q17 Statistics: Q18

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Statistics

Equations

 Disease Screening Has Disease No Disease Exposed A B Not Exposed C D Odds Ratio = AD/BC Relative Risk = [A/(A+B)] / [C/(C+D)] Q’s Statistics: Q16
 Number needed to Treat NNT = 1 / ARR ARR = Absolute Risk Reduction = Control event rate – Experimental event rate Q’s Statistics: Q19

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