Input: [1] What are some examples of moist heat [2]

Output: boiling, autoclave

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] in order to heat water above 100 degrees C at sea level, what must you do? [2]

Output: use pressure

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] The higher the pressure... [2]

Output: the higher the boiling point

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are some things you should not autoclave? [2]

Output: heat sensitive, flour, milk powder, vitamins, antibiotics, water insoluble substnaces

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What will a larger volume mean for autoclaving? [2]

Output: longer to penetrate

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the protein that causes mad cow disease [2]

Output: prion

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What degrees is boiling [2]

Output: 100 degrees

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Can you use boiling for sterilization [2]

Output: no, cannot kill endospores

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Does boiling kill vegetative cells [2]

Output: yes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Does boiling kill viruses [2]

Output: some

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Does boiling kill endospores [2]

Output: no

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Does boiling kill mold spores [2]

Output: probably

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is a mild heat treatment used to reduce spoilage organisms and pathogens [2]

Output: pasteurization

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are some things that are pasteurized [2]

Output: milk, OJ, cheese, sauerkraut

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are the types of pasteurization [2]

Output: low temp holding, high temp short time, ultra high temp

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] what is low temp holding? [2]

Output: use a low temp about 63 degrees celsius for 30 minutes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is high temp short time [2]

Output: 72 degrees C for 15 seconds

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is ultra high temp? [2]

Output: 140 degrees celsius for less than one second

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What can destroy milk over time [2]

Output: enzymes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What organisms survive pasteurization [2]

Output: thermoduric

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is special about ultra high temperature [2]

Output: can be shelf stored because it kills spoilage pathogens

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] How does dry heat kill [2]

Output: oxidation

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Does dry heat penetrate [2]

Output: no

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What requires a higher temp and longer exposure due to slow penetration [2]

Output: dry heat

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are some examples of dry heat? [2]

Output: flaming, incineration, hot air sterilization

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the oven equivalent to dry heat [2]

Output: hot air oven 170 degrees C for 2 hours

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the autoclave equivalent of dry heat [2]

Output: 121 degrees C for 15 minutes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] low temperature [2]

Output: cannot control microbial growth but cannot be used to destroy mos and preserves microbial culture

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Most what wont grow during refrigeration [2]

Output: mesophiles

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What grow slowly in refrigeration [2]

Output: psychrophiles

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What occurs at a lower temp [2]

Output: slower growth rate

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What occurs if the temp is really low [2]

Output: wont grow

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Can mos grow w/o water [2]

Output: no

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Why can cells not grow if frozen [2]

Output: if the water in the cell is frozen, it won't have water for growth

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is slow freezing [2]

Output: -20 degrees C for several hours

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is fast freezing [2]

Output: -70 degrees C within 20 minutes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is freeze drying [2]

Output: freezes instantly and then dries

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is used to preserve stuff? [2]

Output: fast freezing

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is freezing? [2]

Output: below 0 degrees: not pure H20

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is freezing material rapidly first and then dry under the vacuum [2]

Output: freeze drying

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is freeze drying? [2]

Output: gently used to preserve bacterial cultures

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Is low temperature used to kill mos? [2]

Output: no

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What type of mos will grow at refrigeration temperatures? [2]

Output: psychrotrophs

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Will mos grow at freezing temperatures? [2]

Output: no

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Which of the following types of freezing is more harmful to microbes? [2]

Output: slow freezing

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is removing water to stop microbial growth? [2]

Output: drying

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does dessication do? [2]

Output: prevents metabolism

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is drying used for? [2]

Output: food preservation

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What survives drying? [2]

Output: most mos but not all: spores survive well

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What causes plasmolysis? [2]

Output: high osmotic pressure

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is plasmolysis? [2]

Output: cell shriking

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Why do we use salt and sugar to preserve food? [2]

Output: create a high osmotic pressure (hypertonic env't) in which mos lose H20 and can't grow

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What grows in a high salty env't? [2]

Output: halophiles

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does radiation do? [2]

Output: damage DNA

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are types of ionizing radiation [2]

Output: x rays, gamma rays, electron beams

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is non ionizing radiation? [2]

Output: UV

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] How do microwaves kills mos? [2]

Output: by heat, not by radiation

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] How does a microwave generate heat? [2]

Output: by friction

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does UV radiation do? [2]

Output: make T-T dimers

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What can become sterile without heat [2]

Output: gamma rays

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the only type of radiation that kills microbes [2]

Output: ionizing

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does ionizing radiation do [2]

Output: break DNA, irradiated H2O generates free radicals to damage cells

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Can you use ion radiation to cause sterilization? [2]

Output: yes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the most effect wavelength to kill mos? [2]

Output: 260 nm

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are bacteriocidal wavelengths? [2]

Output: 200-280 nm

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is stronger bacteriocidal? [2]

Output: shorter wavelength

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is only effective on the surface [2]

Output: UV light

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is UV light [2]

Output: 136-400 nm

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the most effective wavelength [2]

Output: 260 nm

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is UV absorbed by [2]

Output: cellular DNA and form thymine dimers that distort DNA strands

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the major disadvantage of using UV? [2]

Output: poor penetration power

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does filtration do [2]

Output: removes microbes (particles) from liquid or air

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What stays on the filter in membrane filtration? [2]

Output: anything larger than spores

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is an example of membrane filtration? [2]

Output: hood

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What should you use a hood for? [2]

Output: mycobacterium/ TB

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What could pass through the pore size of 0.22 micrometers? [2]

Output: small viruses, pliable bacteria and prions

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What could pass through the pore size of 0.45 micrometers? [2]

Output: viruses, small bacteria and prions

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does HEPA stand for? [2]

Output: high efficiency particulate air

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does high pressure do? [2]

Output: denatures proteins and damages cell structures

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What can be pasteurized [2]

Output: OJ

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the advantage of high pressure [2]

Output: doesn't use heat, heat can destroy flavor

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are factors that influence chemical controls? [2]

Output: concentration of disinfectant, organic matter (protect mos), pH, temperature, time

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] WHat does an acidic pH do? [2]

Output: may decrease resistance or usually an increase in temperature, you get a better result

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are the only chemicals that can kill endospores? [2]

Output: chemosterilants

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are some chemosterilants? [2]

Output: ethylene oxide, glutaraldehyde, heated hydrogen peroxide, peracetic acid

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What can treat surgical instruments? [2]

Output: glutaraldehyde

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the BP of ethylene oxide? [2]

Output: 10.2 degrees C- toxic

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the disadvantage to using ozone? [2]

Output: no toxic residuals because it must travel in pipes and recontaminate

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does peracetic acid do? [2]

Output: kills endospores within 30 minutes, kills vegetative cells within 5 minutes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] How is peracetic used? [2]

Output: on food processing and medical equipment

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are the advantages of using peracetic acid? [2]

Output: no toxic residuals, not affected by organic matters

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the application of hydrogen peroxide? [2]

Output: aseptic food packaging materials are sterilized with hot solution of hydrogen peroxide

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is hydrogen peroxide? [2]

Output: 35% H2O2 and 40-80 degrees C

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the advantage of hydrogen peroxide [2]

Output: no toxic residual, vaporized H2O2, high penetration

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is hydrogen peroxide used at home for [2]

Output: generate O2 bubbles to lift dirt

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does hydrogen peroxide break down into [2]

Output: water and O2

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is a phenol coefficient of 1 [2]

Output: same as phenol

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is a phenol coefficient over 1 [2]

Output: better than phenol

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What a phenol coefficient below 1 [2]

Output: not as good as phenol

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is phenol [2]

Output: toxic and irritating

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are derivatives of phenol that are less irritating [2]

Output: phenolics

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is used nowadays? [2]

Output: phenolics

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the very 1st disinfectant ever used? [2]

Output: phenol

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What will most likely not kill endospores [2]

Output: phenol/phenolics

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] PAGE 280 [2]

Output: TABLE 9.5

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is effective against all bacteria, many endospores, fungi and viruses? [2]

Output: iodine

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is iodine in alcohol solution [2]

Output: tincture of iodine

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is iodine plus an organic carrier [2]

Output: iodophore

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What slowly releases iodine and is less irritating but doesn't stain? [2]

Output: iodophore

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is not very pleasant; burns [2]

Output: tincture of iodines

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are some oxidizing agents that inactive enzymes [2]

Output: halogens, iodine, chlorine

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is used to treat water effective concentration of 0.5-1.0 ppm [2]

Output: chlorine

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is HOCl [2]

Output: hypochlorous acid

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] How does pH influence the effectiveness of chlorine [2]

Output: in an acidic env't a lot of hypochlorous acid is made

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is bleach? [2]

Output: sodium hypochloride (NaOCL)

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is an active antimicrobial ingredient? [2]

Output: hypochlorous acid

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What inactivates proteins by cross linking with functional groups? [2]

Output: aldehydes

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] How can aldehyde kill spores [2]

Output: probably for a high concentration for a long time

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is used for disinfection of medical equipment? [2]

Output: glutaraldehyde

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is used for fumigation? [2]

Output: formaldehyde gas

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is used to disinfect a whole room? [2]

Output: formaldehyde

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is formalin? [2]

Output: 37% aqueous soluntion of formaldehyde that is used to preserve corpse, tissue, inactive viruses to prepare vaccines

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What denatures proteins and dissolves lipids and can kill vegetative cells but not endospores [2]

Output: alcohols (ethanol, isopropanol)

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is an effective form of alcohol? [2]

Output: 60-95%

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] The lower the alcohol conc...? [2]

Output: the higher the exposure time needed

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is needed for alcohol effectivness? [2]

Output: water

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is the action of heavy metals? [2]

Output: oligodynamic action

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What do heavy metals do? [2]

Output: denature proteins

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are some heavy metals? [2]

Output: AgNO3, CuSO4, Mercurochrome

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is a skin antiseptic [2]

Output: mercurochrome

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What are the functions of surface active agents or surfactants [2]

Output: as a wetting agent to help remove dirt and fats that protect mos, and remove mos from surface

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does soap do? [2]

Output: degermine

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does acid-anionic detergents do? [2]

Output: sanitizing

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What can soaps do? [2]

Output: bind oil and water and can wash away bacteria under the oil

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] Can antimicrobial soap sterilize [2]

Output: no

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What can quaternary ammonium compounds do? [2]

Output: bactericidal and disrupt the plasma membrane

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is quaternary ammonium compounds effective against? [2]

Output: enveloped viruses, G+, fungi but not effective against G- and endospores, some bacteria can grow IN them

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What do organic acids do? [2]

Output: inhibit metabolism (fungi), sorbic acid, benzoic acid, calcium propionate, control molds and bacteria in foods and cosmetics

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What does nitrite do? [2]

Output: prevents endospore germination (botulism/ clostridium botulina and carcinogens)

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What do antibiotics do? [2]

Output: nisin and natamycin prevent spoilage of cheese

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What do all meats that show a pink color have? [2]

Output: nitrite

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is benzoine used for? [2]

Output: soda/inhibits yeeast

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] What is calcium propionate for? [2]

Output: on bread to inhibit mold growth

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [1] REVIEW CHARTS [2]

Output: Graph in notes pg 20

BIOL 221 Chapter 9 Flashcards - Cram.com


Input: [colloid] secretion of thyroid hormones is controled by

Output: TSH (pit) controlled by secretion of TR (HT)

eoinophilic proteinaceous material in thyroid


Input: [colloid] thyroid hormone secretion operates via

Output: negative feedback loop

eoinophilic proteinaceous material in thyroid


Input: [colloid] thyroid hormones are active

Output: when not bound they stimulate metabolism in general

eoinophilic proteinaceous material in thyroid


Input: [colloid] most congenital abnormalities of thyroid develop secondary to

Output: migration problems during embryogensis

eoinophilic proteinaceous material in thyroid


Input: [colloid] lingual thyroid

Output: thyroid material left at base of tongue

eoinophilic proteinaceous material in thyroid


Input: [colloid] if thyroid tissue left between gland and tongue it become

Output: cystic, thyroid duct cyst

eoinophilic proteinaceous material in thyroid


Input: [colloid] complete absence of thyroid gland

Output: hypothyroidism and leads to developmental problems and retardation

eoinophilic proteinaceous material in thyroid


Input: [colloid] hyperthyroidism

Output: excess thyroid hormone hypermetabolic state tachycardia sweating weight loss oligomenorrhea fine hair EXOPHTHALMOS

eoinophilic proteinaceous material in thyroid


Input: [colloid] hyperthyroidism is almost always caused by

Output: abnormal thyroid stimulater (graves disease) or neoplasm

eoinophilic proteinaceous material in thyroid


Input: [colloid] most frequent cause of hyperthyroidism

Output: graves disease IgG ab agonisits to TSH receptor

eoinophilic proteinaceous material in thyroid


Input: [colloid] hypothyroidism is characterized by

Output: myxedema, boggy appearing sking bloated depression lethargy sensory dfects

eoinophilic proteinaceous material in thyroid


Input: [colloid] most common form of thyroiditis

Output: autoimmune or Hashimoto secondary to stim of cytotoxic t cells and b cells

eoinophilic proteinaceous material in thyroid


Input: [colloid] most common neoplasm of thyroid

Output: follicular adenoma benign F:M 7:1 no vascular invasion or extra capsular extension

eoinophilic proteinaceous material in thyroid


Input: [colloid] most common malignancy of thyroid gland

Output: papillary carcinoma pt rarely die even with mets

eoinophilic proteinaceous material in thyroid


Input: [colloid] psammoma bodies

Output: papillary carcinoma

eoinophilic proteinaceous material in thyroid


Input: [colloid] nuclear enlargement, overlap, orphan annie eyes, nuclear pseoinclusions

Output: dx features of papillary carcinoma

eoinophilic proteinaceous material in thyroid


Input: [colloid] fllicular carcinoma

Output: thyroid malignancy hematogenous spread, no lymph node involvement behave poorly

eoinophilic proteinaceous material in thyroid


Input: [colloid] anaplastic carcinoma

Output: 10% thyroid malignancy, rare, aggressive, invasive, UNVERSALLY FATAL

eoinophilic proteinaceous material in thyroid


Input: [colloid] universally fatal thyroid malignancy

Output: anaplastic carcinoma

eoinophilic proteinaceous material in thyroid


Input: [colloid] tumor of thyroid that secretes hormone

Output: meduallry carcinoma

eoinophilic proteinaceous material in thyroid


Input: [colloid] three major classes of antidotes

Output: removers consequence treaters true antidotes

eoinophilic proteinaceous material in thyroid


Input: [colloid] activated charcoal

Output: removal antidote

eoinophilic proteinaceous material in thyroid


Input: [colloid] thiamine

Output: treats consequence of alcohol abuse malnutrition

eoinophilic proteinaceous material in thyroid


Input: [colloid] glucagon

Output: reverses dysrythmias and hypotension if fail to respond to atropine, epii, after beta blocker or ca cha blocker od

eoinophilic proteinaceous material in thyroid


Input: [colloid] methylene blue

Output: clears methemoglobin after NO or lidocain od

eoinophilic proteinaceous material in thyroid


Input: [colloid] NaBicarb

Output: reverse acidosis

eoinophilic proteinaceous material in thyroid


Input: [colloid] Clonidine

Output: alpha2 aonist relieve opiod withdrawal symptoms

eoinophilic proteinaceous material in thyroid


Input: [colloid] Folic acid/leucovorin

Output: reverses malnutrition associate with methanol intox

eoinophilic proteinaceous material in thyroid


Input: [colloid] hyperbaric oxygen

Output: CO poisoning

eoinophilic proteinaceous material in thyroid


Input: [colloid] heavy metal chelator

Output: true antidote

eoinophilic proteinaceous material in thyroid


Input: [colloid] anti digoxin antibody

Output: binds digoxin, inhibits associate with cardia receptors

eoinophilic proteinaceous material in thyroid


Input: [colloid] reverses efects of opiates

Output: naloxone

eoinophilic proteinaceous material in thyroid


Input: [colloid] acetominohen antidote

Output: N acetylcystein

eoinophilic proteinaceous material in thyroid


Input: [colloid] methanol or ethylene glycol

Output: ethanol

eoinophilic proteinaceous material in thyroid


Input: [colloid] alcohol dehydrogenase inhibitor

Output: 4 methylpyraole

eoinophilic proteinaceous material in thyroid


Input: [colloid] organophosphate pesticeide

Output: pralidoxime

eoinophilic proteinaceous material in thyroid


Input: [colloid] benzodiazapine OD

Output: flumazenil

eoinophilic proteinaceous material in thyroid


Input: time- repeates stimulation from ONE presynaptic neuron occuring within a breif period of time [synapse]

Output: temporal summation

physio test 2 Foreign Language Flashcards - Cram.com


Input: cummulative effect upon a postsynaptic neuron of SIMULTANEAUS STIMULATIO FROM SEVERAL presynaptic neurons [synapse]

Output: spatial summation

physio test 2 Foreign Language Flashcards - Cram.com


Input: frog experiment led to finding that synaptic transmissons are chemical [synapse]

Output: loewi found that...

physio test 2 Foreign Language Flashcards - Cram.com


Input: chemicals which relese from presynaptic neuron that diffuse across the synapse [synapse]

Output: neurotrasmitters

physio test 2 Foreign Language Flashcards - Cram.com


Input: graded dpolarization of a neuron that occurs when the active sodium gates open for a brief period of time. Sodium ions rush into the neuron and a positive charge moves across the neural membrane via electronic flow toward the axon hillock [synapse]

Output: Excitatory Postsynaptic Potential (EPSP)

physio test 2 Foreign Language Flashcards - Cram.com


Input: loosing strength as it travels-flow is electronic [synapse]

Output: Decromental

physio test 2 Foreign Language Flashcards - Cram.com


Input: stronger stim=stonger sxcitation weaker stim= weaker excitation [synapse]

Output: graded

physio test 2 Foreign Language Flashcards - Cram.com


Input: graded hyperpolarization of neuron happens when active potassium or chlorine gates to open for a breif period of time. potassium leaves. leads to a negative charge moving across the neural membrane [synapse]

Output: Inhibitory Postsynaptic Potential (IPSP)

physio test 2 Foreign Language Flashcards - Cram.com


Input: the ability of a neuron to produce an action potential without synaptic input. In this case, EPSPs ans IPSPs increase or decrease the spontaneous firing of the neuron [synapse]

Output: spontaneus firing rate

physio test 2 Foreign Language Flashcards - Cram.com


Input: spherical shped packet where neurotransmtters are stored on the axon terminal [synapse]

Output: vesicles

physio test 2 Foreign Language Flashcards - Cram.com


Input: transporter of nerotransmitters from cell body to axon terminal [synapse]

Output: microtubules

physio test 2 Foreign Language Flashcards - Cram.com


Input: out of the cell, during this the vesicles move to the neural membrane and rupture spilling the neurotransmitters intos the synaptic gap/cleft [synapse]

Output: exocytosis

physio test 2 Foreign Language Flashcards - Cram.com


Input: nuerotransmitter binds to a receptor causing the immediate opening of an ion gate super fast directly effects ion [synapse]

Output: ionotrophic effects

physio test 2 Foreign Language Flashcards - Cram.com


Input: effects metabolism most prevalent type of effect neurotasmitter binds to a receptor and alters the configuration of the rest of the receptor protein; enabling a portion of the protein inside the neuron to reac with other molecules slower longer lasting often depend on the actions of seconf messangers [synapse]

Output: metabotrophic effects

physio test 2 Foreign Language Flashcards - Cram.com


Input: ["What are your rates?"] “What are your rates?” (2)

Output: (Merchant’s name), a low rate is not going to guarantee you any savings, allow me to explain why. Most fake low rates are offset by high backend processing fees that are not explained on your statement. That’s why many merchants don’t question anything on the statement but the rates. 9 out of 10 times we find that merchants are paying hundreds of dollars every month in hidden charges. Could you meet with us this Monday or Tuesday? (Wait for response).

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] What is your rate? (3)

Output: (Merchant’s name), is having a lower rate a big concern for you? (Wait for response). If you’re currently getting any rate below 2% I’d say, you have a good rate. But let me just say this, regardless of the rate you are currently paying, chances are we may be able to lower your backend processing costs by a few hundred dollars per month. And this is without even touching the rate. We point out all of the hidden charges on your statement to give you an accurate figure. We analyze hundreds of statements per day and have saved merchants substantial amounts. We have a lot clients do business with us just because our statement is easy to read so you can get a clear picture of what you are getting. Could you fax me your statement so I can make this happen for you or would you prefer we made an appointment with you to come by and see you?

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “I already have a great rate and no body can beat my rate”

Output: (Merchant’s name), did you know that most rates that appear low are in fact, offset by high backend processing expenses usually with no explanation on your statement? This means that the higher the backend processing fees the lower the rate. It’s a great smoke screen- and we have been able to clear it up for a lot of merchants by providing useful information and creating awareness that other options are available with lower credit card processing costs. I’d love to show you in writing how much money we can put back in your pocket, are you available this Monday or Tuesday?

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “We are all set”

Output: That’s great! My other clients thought the same thing until they found out they were actually “set” with higher processing costs, after I provided a free rate and fee comparison they are now happy that they talked with me. Can I ask you a couple of questions to see if you can use more information on how you can lower these costs that you have been “set” up with?

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “We just switched”

Output: Did you switch your processing service or did you switch terminals? (The answer to this will determine which direction the call will take, will you turn this call into an equipment sale, gift card sale, check verification services sales, etc.?).

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] "I’m locked into a 3 year contract"

Output: You don’t sound too happy about that. (Wait for reaction). So even if the possibility existed that I could save a substantial amount every month, you are still bound to this lengthy contract are you not? (Wait for response). I hope they provide you free equipment replacement in case of malfunction, which can cause inaccurate readings leaving you open for non-qualified transactions and added fees. By the way what type of equipment do you have? (Wait for response so you can sell the equipment).

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] "I’m not interested"

Output: I don’t blame you for reacting this way. I understand, a lot of my clients were not interested at first also, until they found that we actually save them hundreds of dollars every month by lowering their credit card processing cost. You see we are a wholesale processor this means you don’t get slammed with hidden fees. Many merchants are under the impression that a low rate means they are saving all they can but this is not true. Are you doing anything to lower these costs? (Wait for response). Can I ask you a couple of questions to see if you can use more information?

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “We are happy with our current processor" (1)

Output: Can I ask you a terrible question? When was the last time your current processor called and said: “Because you are such a great customer we are going to lower your credit card processing costs?” I’m assuming never, and chances are your current processor doesn’t want to either. We can help you find out if you are being slammed with hidden over charges. Let me just explain that we are a direct credit card processor that’s why we are able to provide you with wholesale pricing, due to the fact that we have a strict policy of meeting or beating anyone’s pricing. So chances are you will get substantial savings. . We analyze hundreds of statements per day and have saved merchants substantial amounts. Could you fax me your statement so I can make this happen for you or would you prefer we made an appointment with you to come by and see you?

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “We are very happy with our current processor” (2).

Output: I see, well (Merchant’s name) let’s talk about that. What type of services are you currently getting from your current processor?

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “We are very happy with Wells Fargo, Bank of America, etc.” (3).

Output: (Merchant’s name), Did you know that banks do not do their own credit card processing? They outsource these services to a third party, and charge the usual 15 to 35% more in fees. (Merchant’s name), I’m not suggesting that you change banks, all I’m suggesting is that you consider other options that can possibly save you thousands of dollars every year.

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “We don’t accept credit cards”

Output: Have you tried getting a merchant account before? (Wait for response). If no- what’s stopping you? (Wait for response). If yes- what happened, are you still having trouble implementing it? (Wait for response).

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] "I’m not looking to change right now"

Output: I don’t blame you one bit and I understand change can be scary sometimes. But if you were looking to change what’s the best way to submit a proposal that shows you in writing how much you are going to save every month? By the way, are you doing anything to lower these costs? (Wait for response).

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] "I’m busy right now"

Output: Yes you do sound awfully busy and this is extremely important and that’s why we need to talk for a few minutes, when’s a good time to discuss lowering your credit card processing costs, would you prefer I call you again later today or tomorrow morning?

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: ["What are your rates?"] “I don’t feel comfortable showing anyone my statement”

Output: (Merchant’s name), I agree you should never show anyone your statement without verifying credentials. We receive hundreds of statements daily and what I recommend for my future clients is to blackout the merchant account number. That way I only see the numbers so I can do the math for you. (Merchant’s name), I can assure you everything you share with us is in strict confidence, we’ve been in business for 15 years, we process transactions for thousands of merchants like yourself. I know your time is extremely valuable, so at your convenience of course, I can have my partner spend time with you and go over your statement. Would Monday or Tuesday work for you? (Wait for response).

(Merchant’s name), are you interested in a rate reduction only or would you prefer to eliminate back end processing fees also? (Wait for response). We have a strict policy on meeting or beating anybody’s pricing. This possibly could mean to you substantial savings of a few hundred dollars every month. Would you be open to learn more on how to eliminate these hidden over charges? (Wait for response). Would you available this Monday or Tuesday to set an appointment to see you?


Input: a theory starting that language shapes how people think and perceive [speech community]

Output: Sapir-Whorf hypothesis


Input: the direct explicit meaning of a word found in a dictionary [speech community]

Output: denotation,


Input: the feeling or evaluations we personally associate with a word [speech community]

Output: connotation


Input: theory explain how people come to agree on the rules of meaning in an interaction [speech community]

Output: coordinated management of meaning


Input: culture in which messages are expected to be direct specific and detailed [speech community]

Output: low-context


Input: culture in which messages are indirect general and ambiguous [speech community]

Output: high-context


Input: culture in which power is distributed unequally [speech community]

Output: high power-distance culture


Input: culture in which power is distributed equally [speech community]

Output: low power-distance cultures


Input: theory explaining how people adjust their language patterns to accommodate their partners during communication [speech community]

Output: communication accommodation theory


Input: adapting to the language style of our partner [speech community]

Output: convergence


Input: consciously speaking in a lanuage style diff. from that of our partner [speech community]

Output: divergence.


Input: the system of belifes values and attitudes shared by a particular segment of a population [speech community]

Output: culture


Input: psychological discomfort of adjusting to a new cultural situation [speech community]

Output: culture shock


Input: interactions that occur between people whose cultures are so diff. that the communication between them is altered [speech community]

Output: intercultural communication


Input: the extent to which people in a culture are integrated into groups [speech community]

Output: individualistic culture


Input: a culture that emphasizes community collaborations shared interests harmony the public good and avoiding embarrassment [speech community]

Output: collectivist culture.


Input: a cluture characterized as being accepting and having a low need to control unpredictable people telationships or events [speech community]

Output: low uncertainty-avoidance culture


Input: a culture characterized as having a low tolerance for and high need to control [speech community]

Output: high uncertainty-avoidance culture


Input: a culture in which people expacted to adhere to traditional sex roles [speech community]

Output: masculine culture


Input: people regardless of sex are expected to assume a variety of roles based on the circumstances and their own choices [speech community]

Output: feminine culture


Input: selfish interests in ones own needs to the exclusion of everything else [speech community]

Output: egocentricity


Input: imaginartively placing yourself in another persons cultural world to attempt to experience what he or she is experiencing [speech community]

Output: intercultural empathy


Input: receiving constructing meaning form and responing to spoken and or nonverbal messages [speech community]

Output: listening process


Input: appreciative discriminative comprehensive critical evaluative empathic [speech community]

Output: types of listening


Input: tension between sharing personal info and keeping personal info confidential [speech community]

Output: disclosure-privacy dialectic


Input: thory that provides a frame work for understanding the decisions making processes people use to manage disclosure and privacy [speech community]

Output: communication management theory


Input: it is the mutual exchange of informations....so helps build trust [speech community]

Output: Why is reciprocity important for developing relationships


Input: warmth and affection trust self disclosure commitment shared symbols and rituals [speech community]

Output: characteristics of intimate relationships


Input: they are meaningful . [speech community]

Output: female-male


Input: couples who maintain a traditional ideology about their long term relationships are interdependent and engage in conflict [speech community]

Output: traditional


Input: couples who share and ideology whose values differ from traditional ones are interdependent and engage in conflict [speech community]

Output: independent


Input: couples who share traditional ideology but are independent and avoid conflict [speech community]

Output: separate


Input: that focuses on the enjoyment of what is being said [speech community]

Output: appreciative listening


Input: listening that focuses on gaining and accurate understand of the message [speech community]

Output: discriminative listening


Input: focuses on learning and remembering info [speech community]

Output: comprehensive listening


Input: focuses on being able to judge or evaluate the inf heard [speech community]

Output: critical evaluative listening


Input: focses on understand the feelings of the others [speech community]

Output: empathic listening


Input: attending understanding remembering critically evaluation responding [speech community]

Output: What are the five areas that make up the listening process


Input: the amount producers plan to produce at each given price [supply]

Output: planned supply

Chapter 3 Supply in a Market Flashcards - Cram.com


Input: the amount that producers in fact produce. This may differ from planned supply for a variety of reasons such as breakdowns in production, staff absences, etc. [supply]

Output: actual supply

Chapter 3 Supply in a Market Flashcards - Cram.com


Input: the sum of all individual firm's supply curves at each given price [supply]

Output: market supply

Chapter 3 Supply in a Market Flashcards - Cram.com


Input: when there is an increase in supply because the market price has risen [supply]

Output: extension in supply

Chapter 3 Supply in a Market Flashcards - Cram.com


Input: when the amount offered for sale is reduced because the price level has fallen [supply]

Output: contraction in supply

Chapter 3 Supply in a Market Flashcards - Cram.com


Input: when the production of one good also results in the production of another [supply]

Output: joint supply

Chapter 3 Supply in a Market Flashcards - Cram.com


Input: [..] • The brain, kidney, liver, lungs, heart, digestive tract and endocrine tissues are organs of the vessel rich group (VRG). These are the well perfused organs. • % of the cardiac output › 4-5% heart › 15% brain › 20% kidneys › 25 % liver › 100% lungs [1]

Output: Name the organs in the vessel rich group. What percent of cardiac output goes to each of these organs?


Input: [..] • Approximately 75% of resting cardiac output is delivered to the vessel rich organs, although they constitute only 10% of total body mass. [1]

Output: What percentage of cardiac output is delivered to the highly-perfused organs (heart, lungs, brain, kidneys, and liver)?


Input: [..] • Isovolumetric relaxation occurs from closure of the aortic valve to opening of the mitral valve on the left ventricular pressure-volume loop. [1]

Output: In words, describe where isovolumetric relaxation occurs on the left ventricular pressure-volume loop.


Input: [..] • Isovolumetric contraction occurs from closure of the mitral valve to opening of the aortic valve on the left ventricular pressure-volume loop. [1]

Output: In words, describe where isovolumetric contraction occurs on the left ventricular pressure-volume loop.


Input: [..] • When the great veins and right atrium are stretched by increased vascular volume, stretch receptors send afferent signals to the medulla via the vagus nerve. The medulla then transmits efferent signals via the sympathetic nerves to increase heart rate (by as much as 75%) and myocardial contractility. The Bainbridge reflex helps prevent damming up of blood in veins, the atria, and the pulmonary circulation. [1]

Output: What nerves carry the afferent and efferent signals of the Bainbridge reflex? What does the Bainbridge reflex help prevent?


Input: [..] • Myocardial preconditioning is a short-term rapid adaptation to brief ischemia such that during a subsequent, more severe ischemic insult, myocardial necrosis is delayed. The infarct-delaying properties of ischemic preconditioning have been observed in all species studied. • Five minutes of ischemia is sufficient to initiate preconditioning, and the protective period lasts for 1 to 2 hours. [1]

Output: Describe myocardial preconditioning.


Input: [..] • Pharmacological activation of adenosine receptors (particularly a1 and a2 subtypes) initiates preconditioning via intracellular signal transduction mechanisms involving protein kinase C and adenosine triphosphate (ATP)-dependent potassium channels (KATP). Other factors involved include including the sodium: hydrogen exchanger, inhibitory G proteins, and tyrosine kinase. [1]

Output: Describe the cellular mechanisms mediating myocardial preconditioning.


Input: [..] • The volatile anesthetics mimic ischemic preconditioning and trigger a similar cascade of intracellular events resulting in myocardial protection that lasts beyond the elimination of the anesthetic. Adenosine or opioid agonists delivered into the coronary circulation may also mimic preconditioning. • Ketamine antagonizes the protective effect of preconditioning and thus should be used with caution in the patient at risk for myocardial infarction in the perioperative period. [1]

Output: What anesthetic agents can trigger or modulate the myocardial preconditioning response?


Input: [..] • The use of invasive monitoring such as central venous pressure (CVP) or pulmonary artery catheter (PAC) may be indicated in managing the patient with a history of congestive heart failure secondary to diastolic dysfunction. [1]

Output: What monitoring is indicated for managing the patient with a history of congestive heart Failure secondary to diastolic dysfunction?


Input: [..] • Four major compensatory mechanisms participating in the response to cardiac failure are › (1) increased left ventricular preload › (2) increased sympathetic tone › (3) activation of the renin-angiotensin-aldosterone system › (4) release of AVP (arginine vasopressin, antidiuretic hormone) › (5) ventricular hypertrophy • These mechanisms initially compensate for cardiac failure, but with increasing severity of the disease, they may actually contribute to the cardiac impairment. • The RAA and sympathetic nervous system contribute to the progressive structural changes in the peripheral vasculature and in the remodeling of the left ventricle. [1]

Output: List five (5) compensatory responses in the patient with cardiac failure.


Input: [..] • The principal hemodynamic feature of cardiac tamponade is a decrease in cardiac output due to a reduced stroke volume, secondary to an increased central venous pressure and thus reduced venous return to the heart. • The diagnosis of postoperative cardiac tamponade should be considered whenever hemodynamic deterioration is encountered, particularly when reductions in CO or BP or both are not readily resolved by conventional management. [1]

Output: What is the principal hemodynamic alteration with cardiac tamponade?


Input: [..] • Becks triad is the constellation of: › (1) Hypotension › (2) Jugular Venous Distension › (3) Distant, muffled heart sounds [1]

Output: What is Becks Triad?


Input: [..] • In the awake subject, the cricopharyngeus muscle is the primary muscular barrier to regurgitation. [1]

Output: What muscle acts as a barrier to regurgitation in the conscious subject?


Input: [..] • Stimulation of the superior laryngeal nerves may cause laryngospasm. • Note: external branch of SLN innervates the crycothyroid muscle. [1]

Output: Laryngospasm is caused by stimulation of which nerve?


Input: [..] • West zone 2 shows the greatest increase in blood flow over the distance of the zone; blood flow is zero at the nondependent start of zone 2 and increases with dependency over the distance of zone 2. • Reminder: zone 2 is the "waterfall zone" of intermittent blood flow, where Ppa > PA > Ppv [1]

Output: West's zones of the lung describe alveolar perfusion based on the relationship of three pressures: alveolar pressure (PA), arterial pressure (Ppa) and venous pressure (Ppv). Which region shows the greatest increase in blood flow over the distance of the zone?


Input: [..] • West zone 3 possesses the maximal pulmonary blood flow of any zone (region). • Reminder: zone 3 is the "distension zone" with continuous blood flow, where Ppa > Ppv > PA. [1]

Output: West's zones of the lung describe alveolar perfusion based on the relationship of three pressures: alveolar pressure (PA), arterial pressure (Ppa) and venous pressure (Ppv). Which region maximal blood flow of any zone?


Input: [..] • Marked right-to-left intrapulmonary shunting (shunt flow >15%) is associated with radiographically discernable findings such as pulmonary atelectasis, parenchymal infiltrates, or a large pneumothorax. [1]

Output: How does marked right-to-left intrapulmonary shunting manifest on radiographs?


Input: [..] • Lung regions where Ppa>PISP>Ppv>PA are termed zone 4 regions. • Blood flow in zone 4 is reduced by gravitational compression of the lung parenchyma or by interstitial edema formation. [1]

Output: What happens to pulmonary blood flow in zone 4 of the lung?


Input: [..] • Juxtapulmonary-capillary receptors (J receptors) are located in the walls of the pulmonary capillaries or in the interstitium, hence the name. J receptors appear to be stimulated by pulmonary vascular congestion or an increase in pulmonary interstitial fluid volume, leading to tachypnea. The J receptors may also be responsible for the dyspnea encountered during pulmonary vascular congestion and edema secondary to left ventricular failure. [1]

Output: What are pulmonary J-receptors?


Input: [..] • C-fibers lie in close relationship to the pulmonary microcirculation and appear to innervate the pulmonary J receptors. • The afferent pathway from the J receptors is the slow-conducting nonmyelinated (C) fibers in the vagal nerves. [1]

Output: Which nerve fiber type innervates pulmonary J receptors?


Input: [..] • The detection of basilar crackles on auscultation is the traditional hallmark of early pulmonary edema. • A "butterfly" appearance or "whitedout" areas on chest radiographs support the diagnosis of pulmonary edema. [1]

Output: Lung auscultation reveals basilar crackles and chest radiographs exhibit "whited-out" areas; what is your diagnosis?


Input: [..] • The primary mechanism of hypoxemia in obstructive pulmonary disease is regional mismatch of ventilation and perfusion (VIQ mismatch). • COPD → V/Q mismatch → hypoxemia [1]

Output: What is the primary mechanism of hypoxemia in the patient with chronic obstructive pulmonary disease COPD)?


Input: [..] • Glutamate is the most common excitatory neurotransmitter in the central nervous system (CNS). • Glutamate is an excitatory amino acid neurotransmitter. [1]

Output: Which neurotransmitter is the most common excitatory neurotransmitter in the central nervous system (CNS)?


Input: [..] • The three ligand-gated ionotropic glutamate receptors of the CNS are: › (1) N-methyl-D-aspartate = NMDA › (2) AMPA › (3) kainate • When the ligand glutamate binds to these ionotropic receptors, a transmembrane, cation-selective channel opens, permitting influx of Na+ and Ca2+ and efflux of K+. • Sodium is the main ion permeating the channel, leading to membrane depolarization. [1]

Output: List three (3) common ionotropic glutamate receptors in the central nervous system (CNS). Which electrolytes (ions) pass through these receptors upon activation?


Input: [..] • The necessary actor in causing both depolarization and repolarization of the nerve membrane during the action potential is the voltage-gated sodium channel. A voltage-gated potassium channel also plays an important role in increasing the rapidity of repolarization of the membrane. • Repolarization begins with the closing of the voltage-gated sodium channels, followed by opening of the voltage-gated potassium channels. During early repolarization, the sodium channels are in the closed, inactive conformation causing the cell to be absolutely refractory to stimulus. During the latter stages of repolarization, the voltage-gated sodium channels have returned to the closed, resting conformation, and the cell is relatively refractory to stimulus. [1]

Output: What membrane ion channels play a role in cell repolarization?


Input: [..] • The conus medullaris is the blunt, tapering tip of the spinal cord. The pia alone continues from the conus medullaris and after piercing the dural sac, continues with a covering of dura to the coccyx, forming the filum terminalis. • The filum terminalis is comprised of the pia and dura mater. [1]

Output: What is the conus medullaris? What is the filum terminale?


Input: [..] • The pelvic viscera in men and women -- the urogenital organs, the colon, and the rectum -- are supplied by afferent fibers from the lumbar sympathetic chain. • The superior hypogastric plexus is a retroperitoneal structure that is formed by confluence of the bilateral lumbar sympathetic chains; it is situated between the bodies of the L5 and S1 vertebrae. The pelvic pain caused by either inflammatory diseases or cancer can be relieved by interruption of bilateral sympathetic pathways, which can be achieved with a superior hypogastric plexus block. [1]

Output: Describe the anatomy of the hypogastric plexus.


Input: [..] • Preganglionic parasympathetic nerves arise from › nuclei of cranial nerves III, VII, IX and X (CN 2, 7, 9, 10) in the brainstem › sacral segments 2-4 (S2-S4) of the spinal cord. • Owing to these origins, the parasympathetic system is also known as the craniosacral division. [1]

Output: Where do preganglionic parasympathetic nerves originate?


Input: [..] • When intracranial pressure (ICP) exceeds 30 mmHg, cerebral blood flow progressively decreases and a vicious cycle is established: ischemia produces cerebral edema, which in turn increases ICP, and further precipitates ischemia. If this cycle remains unchecked, progressive neurologic damage or catastrophic herniation may result. • ICP > 30mmHg →decreased CBF → ischemia → cerebral edema → increase ICP [1]

Output: Intracranial hypertension occurs with a sustained increase in intracranial pressure (ICP) above 15 to 20 mm-Hg. Above what ICP will a 'vicious cycle' of ischemia and edema ensue?


Input: [..] • All volatile (potent) inhalational agents and succinylcholine are absolutely contraindicated in patients with malignant hyperthermia [1]

Output: Identify the anesthetic agents that are absolutely contraindicated in the patient with a family history of malignant hyperthermia.


Input: [..] • The prophylactic blood level for dantrolene is 2.5 mcg/ml. [1]

Output: What is the prophylactic blood level for dantrolene?


Input: [..] • 2.5 mg/kg over 5 minutes until episode is terminated • Max 10-20 mg/kg [1]

Output: What is the dosage for dantrolene?


Input: [..] • Each vial of dantrolene contains 20 mg with 3 g of mannitol; the vial should be mixed with 50 mL of warmed, bacteriostatic sterile distilled water (not saline solution). • It is important to store sterile water in clearly labeled containers of a different size from that used for routine intravenous solutions. • Mixture: 20 mg Dantrolene + 50 mL sterile H2O [1]

Output: How much dantrolene is found in each vial of dantrolene? How must each vial of dantrolene be prepared?


Input: [..] • The half-life of dantrolene is approximately 10 hours, therefore dantrolene should be re-administered at least every 10 to 15 hours for at least one and possibly several doses. • Barash and Stoelting say dantrolene should be supplemented every 6 hours for at least 24 hours following the clinical episode. • Summary: › Half-life: 10 hrs › re-administer every: 10-15 [1]

Output: You have successfully treated an acute episode of malignant hyperthermia with dantrolene sodium. Dantrolene should be re-administered at what intervals for how often?


Input: [..] • (1) Anesthesia and premedication should be designed to produce a low normal heart rate. Standard premedicant drugs such as opioids, benzodiazepines, ataractics, barbiturates, antihistamines, and anticholinergics do not cause problems in MH-susceptible patients when administered in appropriate doses, • (2) the anesthesia machine is prepared by draining, removing, or disabling anesthetic vaporizers, and changing tubing and CO2 absorbent and flowing oxygen at 10 L/min for 10 minutes or longer, • (3) measure end-tidal CO2, • (4) body core temperature should be monitored by nasopharyngeal, rectal, or esophageal routes in all patients for all surgical procedures, • (5) If possible, a regional, local, or major conduction anesthetic should be used. If not possible, intravenous induction of anesthesia followed by nitrous oxide, oxygen, and a nondepolarizing relaxant with opioid supplementation is recommended. Agents that have not been implicated in MH are midazolam, dexmedetomidine, diazepam, droperidol, and propofol, • (5) arterial and central venous monitoring is recommended for MH-susceptible patients, only as dictated by the surgical procedure and • (6) observe patient closely in the postoperative period. [1]

Output: During the preoperative assessment of the patient, you discover a positive family history for malignant hyperthermia. What six steps need to be taken to manage this patient? Are nondepolarizing muscle relaxants safe in this patient?


Input: [..] • Neuroleptic malignant syndrome (NMS) has many features in common with malignant hyperthermia but the mode of onset and recovery are quite different. • MS typically develops over 24 to 72 hours, whereas malignant hyperthermia develops acutely. • NMS presents as a hypermetabolic episode consisting of hyperthermia, autonomic nervous system instability, pronounced muscle rigidity, and rhabdomyolysis. [1]

Output: What syndrome can mimic malignant hyperthermia?


Input: [..] Superior rectus -Supraduction of orbit -("look up") -CN III (oculomotor) Inferior rectus -Infraduction of orbit -("look down") -CN III (oculomotor) Medial rectus -Adduction of orbit -(“look inward”) -CN III (oculomotor) Lateral rectus -Abduction of orbit -“look outward” -CN VI (abducens) Superior oblique Intorsion depression of orbit -“look in and down” -CN IV (trochlear) Inferior oblique Extorsion elevation of orbit -("look out and up") -CN III (oculomotor) [1]

Output: List the six (6) orbital muscles, their function, and their motor innervation.


Input: [..] • Neuroleptic malignant syndrome (NMS) results from treatment with a variety of antipsychotic agents, including phenothiazines, haloperidol and other potent antipsychotics. • NMS following antipsychotic drug therapy presumably reflects dopamine depletion in the CNS. [1]

Output: Patients treated with what drugs are susceptible to neuroleptic malignant syndrome (NMS)?


Input: [..] • Myotonia dystrophy (Steinert's disease, myotonic atrophica) is a multisystem disease that usually manifests as facial weakness (expressionless facies), wasting and weakness of the sternocleidomastoid muscles, ptosis, dysarthria, dysphagia, and inability to relax the handgrip (myotonia). • Frontal balding, cataracts, and testicular atrophy in males form a frequently recognized triad of characteristics. [1]

Output: What are the clinical manifestations of myotonic dystrophy (Steinert's disease)?


Input: [..] • Myotonic dystrophy (MD) is inherited as an autosomal dominant trait and usually manifests in the second or third decade of life. Myotonic dystrophies are characterized by persistent contracture (myotonia) after voluntary contracture of skeletal muscle or following electrical stimulation. • Electromyographic findings are diagnostic and are characterized by prolonged discharges or repetitive action potentials. Skeletal muscle resting membrane potentials are also lowered (less polarized) in patients with MD. • The inability of the skeletal muscle to relax after voluntary contraction or stimulation results from abnormal calcium metabolism -- ATP-driven pumps fail to return calcium to the sarcoplasmic reticulum (SR) thus the unsequestered calcium remains available to produced sustained skeletal muscle contraction. [1]

Output: Identify the genetic pattern of inheritance for myotonic dystrophy and describe the pathophysiology of this group of degenerative diseases.


Input: [..] • Preoperative evaluation and management of anesthesia in patients with myotonic dystrophy must consider the likelihood of › (1) cardiomyopathy › (2) respiratory muscle weakness and sensitivity to respiratory depressants › (3) vulnerability to aspiration of gastric contents › (4) potential for abnormal responses to anesthetic drugs. [1]

Output: What four anesthetic concerns should you have for the patient with myotonic dystrophy?


Input: [..] • Succinylcholine should not be used in the patient with myotonic dystrophy because succinylcholine can produce intense generalized myotonic contracture that makes ventilation or intubation difficult or impossible. [1]

Output: Should succinylcholine be used in the anesthetic management of the patient with myotonic dystrophy?


Input: [..] • Treatment of myotonic dystrophy is symptomatic and may include the use of phenytoin, quinine, and procainamide. These agents delay the return of membrane excitation by blocking rapid sodium (Na') influx into muscles. Quinine and procainamide should be used with caution as they may worsen cardiac conduction abnormalities (prolonged P-R interval). [1]

Output: What is the medical management of the patient with myotonic dystrophy?


Input: [..] • Myasthenia gravis is characterized by weakness and easy fatigability of skeletal muscles. • The weakness can be asymmetric, confined to one group of muscles, or generalized. • Easy fatigability of skeletal muscle in myasthenia gravis is caused by autoimmune destruction of nicotinic acetylcholine receptors at the neuromuscular junction. [1]

Output: Myasthenia gravis is characterized by what symptoms? What is the cause of these symptoms?


Input: [..] • The most common onset of myasthenia gravis is ocular. Ptosis and diplopia result. • If the disease remains localized to the eyes for 2 years, the likelihood of progression to generalized MG is low. [1]

Output: Onset of myasthenia gravis (MG) is slow and insidious and any skeletal muscle group may be involved. Onset is most common in which muscles?


Input: [..] • In ambulatory individuals, serum TSH is currently the best initial screen for thyroid function. [1]

Output: What is the best initial test of thyroid function in ambulatory individuals?


Input: [..] • Calcitonin is a polypeptide hormone secreted from the parafollicular cells (C cells) of the thyroid gland. • Calcitonin has a quantitatively weak role in calcium homeostasis in the adult. [1]

Output: Calcitonin is released from what organ? Is calcitonin a weak or a strong regulator of calcium?


Input: [..] • Calcitonin tends to decrease plasma concentration of calcium ions, due to a decreased activity of osteoclasts (bone breakdown) and an increased activity of osteoblasts (bone deposition). • In general, calcitonin has opposite effects to those of parathyroid hormone (PTH). [1]

Output: What is the major physiologic action of calcitonin?


Input: [..] • Insulin is produced in the beta cells of the pancreatic islets (of Langerhans), as you know. • Venous blood from the pancreatic islets drains into the hepatic portal vein, via the pancreatic vein, and then into the general circulation. [1]

Output: In what vessels would you find the highest concentration of insulin?


Input: [..] • Aldosterone is synthesized in the zona glomerulosa alone because this zona is the only one to contain aldosterone synthase. [1]

Output: Which zona of the adrenal cortex is the only one capable of synthesizing aldosterone? Why is this true?


Input: [..] • The zona fasciculata and zona reticularis can synthesize the corticosteroids, cortisol and corticosterone, because they contain the necessary enzyme, 17-a-hydroxylase for synthesis. [1]

Output: Which two zonae of the adrenal cortex can synthesize cortisol and corticosterone? Why?


Input: [..] • The normal adrenal gland can secrete 20 mg/day of cortisol and may secrete up to 200-500 mg/day during stress. NB: Both the Barash 2009 Handbook and textbook incorrectly state daily cortisol = 200 mg. • Normal daily 20mg /day cortisol • Stress 200-500 mg/day cortisol [1]

Output: How much daily cortisol is normally secreted from the adrenal glands? How much during stress?


Input: [..] • Low-dose (physiologic) supplemental steroid coverage: cortisol 25 mg IV before induction of anesthesia followed by continuous infusion, 100 mg IV over 24 hr. • Supraphysiologic coverage: cortisol 200-300 mg IV in divided doses on the day of surgery [1]

Output: Perioperative supplemental steroid coverage regimens are either low-dose (physiologic) or high-dose (supraphysiologic). Describe each regimen.


Input: [..] • Hallmarks of acute porphyria attacks are abdominal pain, nausea & vomiting, autonomic disturbances with sweating, tachycardia, sustained hypertension, and neurological manifestations including seizures and neuromuscular weakness. Attacks can be life-threatening and neurological manifestations may be permanent. [1]

Output: Identify the hallmarks of an acute porphyria attack.


Input: [..] • Renal auto regulation is the mechanism by which the kidney maintains renal blood flow (RBF) and glomerular filtration rate (GFR) thus preserving solute and water regulation independently of wide fluctuations in blood pressure. • Renal auto regulation typically operates over mean arterial pressures ranging from 60 mm-Hg to 180 mm-Hg (some texts state 80- 180 mm-Hg, and others 60-160 mm-Hg). • Renal vascular resistance appears to be mediated by the variable resistance of the preglomerular afferent arteriole. [1]

Output: Describe renal auto regulation. Which renal structure appears to mediate auto regulation?


Input: [..] • The most plausible explanations for renal auto regulations are › (1) a myogenic response in which the arterioles constrict in response to increased arterial pressure and vice versa, and › (2) tubuloglomerular feedback by way of the juxtaglomerular apparatus. • The myogenic response theory states that increased wall tension in the afferent arterioles, due to an increase in perfusion pressure, causes automatic contraction of the smooth muscle fibers in the vessel wall, thereby increasing resistance to flow, and keeping flow constant despite the increase in perfusion pressure. • The tubuloglomerular feedback mechanism proposes that increased perfusion pressure will increase filtration, increasing the tubular fluid delivery to the macula densa, which then releases a factor or factors that cause vasoconstriction of the afferent arteriole. [1]

Output: State and briefly describe two proposed mechanism for renal auto regulation.


Input: [..] • The three major renal tubular functions are filtration, reabsorption, and secretion. Of these, reabsorption and secretion are active transport (ATP) processes that require energy from ATP hydrolysis. The major energy source for reabsorption of sodium, the key link to most renal transport processes, is activity of the Na+--K+ ATPase (pump). • Remember that "pump" implies an active process, costing ATP-derived energy to move a substance against its concentration gradient. [1]

Output: Identify the 3 major renal processes. Which of these functions require(s) energy (ATP)?


Input: [..] • Approximately two-thirds of all reabsorption and secretory processes in renal tubules takes place in proximal tubules. [1]

Output: Which nephron tubular segment is responsible for approximately two-thirds of all reabsorption and secretory processes?


Input: [..] • A series of four similar peptides with natriuretic actions have been identified in the human. › (1) ANP (atrial or A- type) is released from atrial muscle in response to local wall stretch and increased atrial volume. › (2) BNP (brain or B-type) is released from ventricular muscle when distended. › (3) CNP (C-type) is released from endothelial walls of major vessels. › (4) Urodilatin is produced in the lower urinary tract. [1]

Output: Identify four (4) natriuretic peptides and their sites of synthesis and release in the body.


Input: [..] • All natriuretic peptides › induce arterial and venous dilation › increase renal blood flow (RBF) and glomerular filtration rate (GFR) › suppress the actions of norepinephrine, angiotensin, and endothelin. › inhibit renin secretion and decrease angiotensin II-stimulated aldosterone release. › inhibit sodium reabsorption at the collecting duct. [1]

Output: Describe the common actions of all natriuretic peptides (ANP, BNP, CNP, urodilatin).


Input: [..] • Cyclic guanosine monophosphate (cGMP) mediates the cellular actions of natriuretic peptides. [1]

Output: Identify the cyclic nucleotide second messenger that mediates the cellular actions of natriuretic peptides.


Input: [..] • The sensitivity and specificity of fractional excretion of sodium of <1% in differentiating prerenal azotemia from acute tubular necrosis are 96% and 95%, respectively. • Sodium < 1% distinguish prerenal azotemia from ATN › Sensitivity 96% › Specificity 95% [1]

Output: State the specificity and sensitivity of the fraction excretion of sodium in distinguishing between prerenal azotemia and acute tubular necrosis (renal azotemia).


Input: [..] • The most important determinant of blood viscosity is the hematocrit. • A decrease in hematocrit decreases viscosity and can improve blood flow. • However, there is a concomitant decrease in oxygen-carrying capacity with decreased hematocrit and eventually impaired oxygen delivery. [1]

Output: What is the most important determinant of blood viscosity?


Input: [..] • GPIIb/IIIa is platelet glycoprotein IIb/IIIa, otherwise known as platelet fibrinogen receptor. • Upon activation, GPIIb/IIIa binds circulating fibrinogen and promotes platelet aggregation, leading to a primary platelet plug, or white thrombus. [1]

Output: What is GPIIb/IIIa?


Input: [..] • Transfusions of fresh frozen plasma (FFP) are indicated for: › (1) isolated coagulation factor deficiencies › (2) reversal of warfarin therapy › (3) correction of coagulopathies associated with liver disease › (4) after massive transfusions with continued bleeding even after platelet transfusions. [1]

Output: Identify 4 general indications to administer fresh frozen plasma (FFP).


Input: [..] • Virchow's triad is a group of three primary abnormalities in hemostasis that lead to thrombus formation. • Virchow's triad is › (1) endothelial injury › (2) stasis or turbulent blood flow › (3) hypercoagulability of the blood [1]

Output: Describe Virchow's triad.


Input: [..] • The pyloric sphincter is a short, relative poor barrier of smooth muscle between the stomach and the duodenum. [1]

Output: What type of muscle is the pyloric sphincter?


Input: [..] • The tunica muscularis of the gastrointestinal tract is comprised of two layers of smooth muscle: the inner layer is circular, the outer layer is longitudinal. • Specialized circular muscles are called sphincters. [1]

Output: What type of muscle is found in the gastrointestinal tract? Identify the arrangement of this muscle in the GI tract.


Input: [..] • Anorexia nervosa is characterized by hypokalemia, hyponatremia, hypochloremia, and metabolic alkalosis as a result of vomiting and laxative & diuretic abuse. [1]

Output: List the electrolyte disturbances associated with anorexia nervosa.


Input: [..] • Acquired immunity is the result of lymphocyte activity and is classified into › humoral › cell-mediated [1]

Output: Identify the two types of acquired immunity.


Input: [..] • Humoral immunity is mediated by B lymphocytes whereas T lymphocytes are responsible for cell-mediated immunity. • B lymphocytes get their name from the original discovery of these cells in the bursa of birds. • T lymphocytes are so-named due to their pre-processing and maturation in the thymus gland. [1]

Output: What specific lymphocyte class mediates humoral immunity? Cell-mediated immunity?


Input: [..] • Differentiated (mature) B lymphocytes may be either › memory cells or › plasma cells. • Mature T lymphocytes are either › T-helper (CD4), › T-suppressor (CD8), › T-cytotoxic/killer (CD8), or › T-memory cells. [1]

Output: List two types of mature B lymphocytes and 4 types of mature T lymphocytes.


Input: [..] • Mature B lymphocyte plasma cells are the source of the gamma globulins known as immunoglobulins. [1]

Output: Which lymphocytes are the source of immunoglobulins (Ig)?


Input: [..] • The 5 classes of immunoglobulins are IgG, IgA, IgM, IgD, and IgE, collectively accounting for approximately 20% of total serum proteins. • G-A-M-E-D [1]

Output: List the 5 types of immunoglobulins in the serum. Approximately what percentage of total serum proteins are immunoglobulins?


Input: [..] • Hypothermia prolongs the refractory period of excitable tissues. In the heart, a prolonged refractory period leads to sinus bradycardia and conduction deficits, which may progress to atrioventricular block and eventually ventricular fibrillation. [1]

Output: During an aorto-femoral bypass, the patient becomes hypothermic; what cardiac arrhythmia is likely?


Input: [..] • The main alterations in lung mechanics of the patient with end-stage scoliosis are reduced lung volumes (VC, TLC, FRC, and RV-all restrictive process features) and reduced chest wall compliance. • In the late stages of scoliosis, V/Q mismatching with hypoxia (due to alveolar hypoventilation), increased PAP, hypercapnia, abnormal ventilatory CO2 response curve, increased work of breathing, and cor pulmonale occur, eventually leading to cardiorespiratory failure. [1]

Output: Describe the pulmonary mechanics alterations that occur in the patient with end stage scoliosis.


Input: [..] • A "low risk" of postoperative disability following lung resection is predicted when: › (1) FEVI> 2 L › (2) MVV > 50% predicted › (3) predicted postoperative FEV1> 0.8 L and is 40% of predicted value › (4) RV/TLC <50% › (5) cardiac disease is absent [1]

Output: The patient is scheduled for lung resection. Identify five findings that would reflect "low risk" postoperative disability.


Input: [..] • A dose-response curve depicts the relationship between the dose of a drug administered (x-axis) and the resulting pharmacologic effect (y-axis). [1]

Output: What is a dose-response curve?


Input: [..] • Dose-response curves are characterized by differences in › (1) potency › (2) slope › (3) efficacy › (4) individual variability. • The potency of a drug is depicted by its location along the dose axis (usually the x-axis) of the dose-response curve. Increased affinity of a drug for its receptor shifts the curve to the left, whereas decreased affinity shifts the curve to the right. • Drug potency and receptor affinity are directly related--a more potent drug has a greater affinity for its receptor. Mnemonic: Left-shift = Less drug required = More potent. [1]

Output: List four (4) descriptive characteristics of a dose-response curve.


Input: [..] • The slope of the dose-response curve indicates the number of receptors that must be occupied (bound) before a drug effect occurs. • A steep dose response curve slope means that a majority of the receptors must be bound before a relevant effect occurs. • Neuromuscular blocking drugs and inhaled anesthetics dose-response curves have steep slopes. [1]

Output: What does the slope of a dose-response curve reveal about the drug?


Input: [..] • Efficacy is a measure of the intrinsic ability of a drug to produce a given physiologic or clinical effect. In other words, the maximal effect of a drug reflects its intrinsic activity, or efficacy. • A drug's efficacy is depicted by the plateau of the dose-response curve. A higher plateau correlates with a greater efficacy. [1]

Output: Define drug efficacy. Which feature of a dose-response curve indicates the efficacy of a drug?


Input: [..] The presence of a competitive antagonist (inhibitor) would shift the dose response curve to the right, with no change in the efficacy (plateau) or slope. The rightward shift is caused by competition for the same number of receptors. [1]

Output: Describe how the presence of a competitive antagonist would alter a dose-response curve of a drug.


Input: [..] • The presence of a noncompetitive antagonist (inhibitor) would shift the curve rightward and downward, with a decrease in the slope of the curve. The changes occur because a maximal effect cannot be achieved in the presence of a noncompetitive block. In other words, a noncompetitive block cannot be reversed by excess agonist. [1]

Output: Describe how the presence of a noncompetitive antagonist would alter the dose response curve of a drug.


Input: [..] • The Context-sensitive half-time describes the time necessary for the plasma drug concentration to decrease by 50% (or any other percent) after discontinuing a continuous infusion of a specific duration. • "Context" refers to the infusion duration. • Context-sensitive half-time, in contrast to elimination half-time, considers the combined effects of distribution and metabolism as well as duration of continuous IV administration on drug pharmacokinetics. [1]

Output: What is the "context-sensitive half-time" of a drug and how does it differ from elimination half-time?


Input: [..] • The context-sensitive half-time describes only the time to a 50% decrease in the central compartment concentration, which may not correlate with the time to achieve recovery (awaken, for example). [1]

Output: What is a substantial limitation to the context-sensitive half-time concept?


Input: [..] • Nitrous oxide: N20 • Halothane: C2HBrClF3 • Enflurane: C3H2C1F50 • Isoflurane: C3H2ClF50 • Desflurane: C3H2F60 • Sevoflurane: C4H3F70 [1]

Output: Give the chemical formula for each of the clinically useful inhaled anesthetic agents. For example nitrous oxide is N20.


Input: [..] • Nitrous oxide: N=N-0 • Halothane: CF3CHBrCI • Enflurane: -CHF2-0-CF2-CHCIF • Isoflurane: -CHF2-0-CHCl-CF3 • Desflurane: -CHF2-0-CHF-CF3 • Sevoflurane: -CH2F-O-CH-(CF3)2 [1]

Output: Write out the condensed structural formula for each of the clinically useful inhaled anesthetic agents. For example, nitrous oxide is N=N-0.


Input: [..] • Halothane is Fluothane • enflurane is Ethrane • isoflurane is Forane • desflurane is Suprane • sevoflurane is Ultane [1]

Output: State the trade names of each of the volatile inhaled agents.


Input: [..] • Nitrous oxide: dinitrogen monoxide. • Halothane: 2-bromo-2-chloro-1,1,1-trifluroethane • Enflurane: 2-chloro-1,1,2,-trifluoroethydli fluoromethyl ether • Isoflurane: 1-chloro-2,2,2-trifluoroethydli fluoromethyl ether • Desflurane: difluoromethyl-1-fluoro-2,2,2 trifluoroethyl ether • Sevoflurane: fluoromethyl-2,2,2-trifluoro-1 [trifluoromethyl] ethyl ether. [1]

Output: Give the IUPAC (International Union of Applied and Applied Chemistry) chemical names of each of the clinically useful inhaled names of each of the clinically useful inhaled names of each of the clinically useful inhaled anesthetic agents.


Input: [..] • The functional group C-0-C is called an ether bond. A functional group is a set of atoms bonded together in a specific way. • C-O-C = ETHER [1]

Output: Enflurane, isoflurane, desflurane and sevoflurane all have a "C-0-C" bond their structures. What is the name of the C-0-C functional group?


Input: [..] • All of the volatile agents except halothane are ethers • Halothane IS NOT an ether [1]

Output: Which of the clinically useful volatile inhaled agents are ethers?


Input: [..] • Halothane is a halogenated alkane derivative. An alkane is a hydrocarbon containing all carbon-carbon single bonds (no double or triple bonds between carbon atoms). • Halothane is HALOGENATED ALKANE [1]

Output: Halothane is not an ether; from what functional group is halothane derived?


Input: [..] • Enflurane, isoflurane, and desflurane are methyl ethyl ethers. [1]

Output: Which three modern volatile agents are methyl ethyl ethers?


Input: [..] • Sevoflurane is fluorinated methyl isopropyl ether. [1]

Output: If sevoflurane is not a methyl ethyl ether, what type of ether derivative is sevoflurane?


Input: [..] • Enflurane and isoflurane are isomers of each other (the "iso" in isoflurane is a tip-off) [1]

Output: Which two clinically useful volatile inhaled agents are isomers of each other? (Hint: recall that isomers have identical chemical formulas but different arrangements of the atoms...)


Input: [..] • Halothane is the only brominated modern volatile anesthetic agent [1]

Output: Which of the modern volatile anesthetic is the only one containing a bromine


Input: [..] • Desflurane and sevoflurane are halogenated exclusively with fluorine. • Volatile agents halogenated exclusively with fluorine are less soluble in blood. [1]

Output: Which two modern volatile agents have - only fluorine as the halogen substitutions?


Input: [..] • Desflurane differs from isoflurane only by the substitution of a fluorine atom for the chlorine atom. • This one change increases the vapor pressure dramatically (669 mm-Hg for desflurane compared to 240 mm-Hg for isoflurane). [1]

Output: Which modem volatile agent differs from isoflurane only in the replacement of the chlorine with fluorine?


Input: [..] • (1) Presence of a closed pneumothorax • (2) tympanoplasty or other middle ear surgery • (3) pneumocephalus • (4) venous air embolism [1]

Output: List four contraindications to the use of N2O.


Input: [..] • Halothane and sevoflurane most depress the baroreceptor reflex (there are no increases in heart rate despite decreases in blood pressure with these agents). Depression of the baroreceptor response by sevoflurane is comparable to halothane. • In contrast, isoflurane and desflurane least depress the baroreceptor reflex (heart rate tends to increase reflexively with the decreases in blood pressure produced by these agents). [1]

Output: Which volatile agents most depress the baroreceptor reflex, and which least depress it?


Input: rotary engine that extracts power from a fluid flow [reciprocating engine]

Output: turbine

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Input: shaft turbine engine in which the compressor and power section are mounted on a common driveshaft [reciprocating engine]

Output: direct-shaft turbine

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Input: a turboshaft engine with no physical connection between the compressor and power output shaft [reciprocating engine]

Output: free turbine

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Input: a warning device that alerts to abnormal wear in a transmission or engine. consists of a magnetic plug that attracts any ferrous metal particles that may have come loose [reciprocating engine]

Output: chip detector

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Input: a component of the transmission or power train that automatically disconnects the main rotor from the engine when the engine stops or slows below the equivalent rotor rpm [reciprocating engine]

Output: freewheeling unit

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Input: transmits control inputs from the collective and cyclic controls to the main rotor blades [reciprocating engine]

Output: swash plate

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Input: brings outside air into the engine, mixes it with fuel in the proper proportion, and delivers it to the combustion chamber [reciprocating engine]

Output: fuel control system

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Input: low space that collects an often-undesirable liquid e.g. oil ~ [reciprocating engine]

Output: sump

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Input: rpm gauge [reciprocating engine]

Output: tachometer

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Input: a mechanism for transmitting rotation, which can be engaged or disengaged [reciprocating engine]

Output: clutch

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Input: a one-way freewheel clutch [reciprocating engine]

Output: sprag

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Input: a device that restrains the motion of a mechanism or brings a mechanism to rest [reciprocating engine]

Output: damper

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Input: a device to permit constrained relative motion between two parts (typically rotation or linear movement) [reciprocating engine]

Output: bearing

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Input: measuring instrument used to measure the flow of electric current in a circuit [reciprocating engine]

Output: ammeter or loadmeter

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Input: type of overcurrent protection device (usu. w/ a metal wire or strip that melts) [reciprocating engine]

Output: fuse

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Input: device that blends air and fuel for internal combustion [reciprocating engine]

Output: carburetor

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Input: study of the mechanical properties of liquids [reciprocating engine]

Output: hydraulics

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Input: Stability Augmentation System [reciprocating engine]

Output: SAS

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Input: Ground-based navigation system consisting of very high frequency omnidirectional range stations which provide course guidance. [reciprocating engine]

Output: VOR

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Input: (Instrument Landing System) - A precision instrument approach system, which normally consists of the following electrical components and visual aids: localizer, glide slope, outer marker, and approach lights. [reciprocating engine]

Output: ILS

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Input: Global Positioning System - a satellite-based radio positioning, navigation, and time-transfer system [reciprocating engine]

Output: GPS

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Input: Instrument Flight Rules - Rules that govern the procedure for conducting flight in weather conditions below VFR weather minimums. The term is also used to define weather conditions and they type of flight plan under which an aircraft is operating. [reciprocating engine]

Output: IFR

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Input: the use of flowing air by a moving object for power [reciprocating engine]

Output: ram air

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Input: part of an engine that supplies fuel/air mixture to the cylinders [reciprocating engine]

Output: intake manifold

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Input: collects the exhaust gases from multiple cylinders into one pipe [reciprocating engine]

Output: exhaust manifold

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Input: How do valproic acids exert their pharmacological effect

Output: by suppressing sodium and calcium influx and by potentiating GABA

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Valporic Acids are used to treat

Output: generalized, partial, and abscence seizures Bipolar disorder and prophylaxis of migraine HA's

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Valporic Acid toxicity

Output: moderately hepatoxic

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Succinides pharmacological effect

Output: used to treat absence seizures by reducing the synaptic nerve response to low-frequency repetitive stimulation

generalized and partial seizures and bipolar disorder (mental disorder)


Input: What settings are Succinides used

Output: clinics only

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Anti-Seizure agents nursing considerations

Output: monitor seizure activity, watch for drowsiness when giving sedating agents, monitor therapeutic blood levels, monitor liver enzymes and assess weakness, fatigue and muscle pain

generalized and partial seizures and bipolar disorder (mental disorder)


Input: (Anti-Depressants) What is the basis of depression

Output: thought to be a depletion of the neurotransmitters serotonin, dopamine, and norepinephrine

generalized and partial seizures and bipolar disorder (mental disorder)


Input: How does depletion of neurotransmitters during Anti-Depressants occur

Output: due to excessive reuptake or by excessive breakdown by monoamine oxidase (MAO)

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Why do clients get discouraged when taking anti-depressants

Output: symptoms does not improve for about 4 weeks

generalized and partial seizures and bipolar disorder (mental disorder)


Input: What kind of response does anti-depressants have

Output: therapeutic responses vary

generalized and partial seizures and bipolar disorder (mental disorder)


Input: How does anti-seizure meds exert a therapertic effects

Output: Anti-seizure agents raise the seizure threshold by inhibiting excitatory activity in the motor cortex of the brain

generalized and partial seizures and bipolar disorder (mental disorder)


Input: (3) Mechanism Anti-seizure drugs exert a therapeutic effect

Output: 1) suppression of sodium influx, 2) suppression of calcium influx or 3) potentiation of gamma aminobutyric acid (GABA) in the brain

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Classificiations of Anti-Seizure Agents

Output: Hydantoins Iminostilbenes Barbituates Benzodiazepines Valporic Acids Succinides

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Barbituates agents exert their pharmacological effect by

Output: potentiating GABA and decreasing the conduction of impulses

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Barbituates are used for.....and are....

Output: seizures and are sedating

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Barbituates use with other drugs

Output: may be used in conjunction with other anti-convulsants

generalized and partial seizures and bipolar disorder (mental disorder)


Input: What Benzodiazepines will be used during coma or respiratory depression and how long does it take to work

Output: (Romazicon) may be given IV, will work within 2 min.

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Non-Benzodiazepine Somnifacients agents exert their pharmacological effect by

Output: potentiating GABA

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Non-Bonzodiazepines effects over Bonzodiazepines

Output: have less residual effect and are thought to cause less physiological and psychological dependence

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Non-Benzodiazepine Somnifacients effect on food

Output: decrease food bioavailability

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Effect on person if awakened while taking Non-Benzodiazepine Somnifacients

Output: short term anesia

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Pharmacological effect of NON-BENZODIAZEPINE ANXIOLYTIC: buspirone (BuSpar)

Output: Binds to serotonin and dopamine receptors in the CNS resulting in decreased transmission of these neurotransmitters

generalized and partial seizures and bipolar disorder (mental disorder)


Input: NON-BENZODIAZEPINE ANXIOLYTIC nursing considerations

Output: monitor for (EPS) extrapyramidal side effects abnormal movements, eg. Parkinson dystonia tardive dyskinesia

generalized and partial seizures and bipolar disorder (mental disorder)


Input: hormones: melatonin

Output: synthesized from serotonin and is secreted by the pineal gland

generalized and partial seizures and bipolar disorder (mental disorder)


Input: melantonin secretions is stimulated by

Output: darkness and suppressed by light received through the retina

generalized and partial seizures and bipolar disorder (mental disorder)


Input: hormones: melatonin nursing considerations

Output: act very rapidly decreases food bioavailability short-term amnesia i awakened alcohol increase action causing psycho-motor impairments

generalized and partial seizures and bipolar disorder (mental disorder)


Input: DRUGS USED FOR PAIN MANAGEMENT (Analgesics

Output: opiods

generalized and partial seizures and bipolar disorder (mental disorder)


Input: Opiods pharmacological effects

Output: bind with opiate receptors in the central nervous system altering the perception of and the emotional response to pain

generalized and partial seizures and bipolar disorder (mental disorder)