101 Flashcards
GCS
Eye opening (possible score of E1-4) Verbal response (possible score of V1-5) Motor response (possible score of M1-6)
Best Eye-opening (E):
No response To pain To speech Spontaneously Best verbal response (V):
None Incomprehensible sounds Inappropriate words Confused Orientated Best motor response (M):
None Extensor response to a painful stimulus Flexion to a painful stimulus Withdraws from pain Localises to a painful stimulus Obeys commands
What are the black deposits seen in most normal lung specimens in the anatomy laboratory?
The black deposits seen in otherwise healthy lung tissue are known as anthracosis.
This refers to carbon (anthrac-) and condition (-osis). This is a benign phenomenon seen in populations with exposure to carbon - such as large cities.
A pathology where there’s excess deposition of carbon in the lungs that leads to a black lung
Coal Workers pneumoconiosis
This pathology is serious and confers a restrictive respiratory pattern on the patient.
At what vertebral level do the following pierce the diaphragm
Aorta
Oesophagus
inf Vena Cava
T8: caval foramen - for the inferior vena cava - remember that vena cava has 8 letters and that this is the thoracic level T8;
T10: oesophageal hiatus - for the oesophagus - oesophagus has 10 letters, for thoracic vertebral level T10; and
T12: aortic hiatus - for the aorta - aortic hiatus has 12 letters in it, for vertebral level T12.
There are more structures that pass through these foramen and hiatuses…
The inferior vena cava usually passes through on its own;
The left and right vagus nerves pass through T10 with the oesophagus; and
Azygous vein and the thoracic duct pass through T12 with the aorta.
What is the somatic innervation of the
Coastal parietal pleura
Parietal diaphragmatic and mediastinal pleurae
cervical parietal pleura
Intercostal nerve
phrenic nerve
intercostal nerve
A 24-year-old medical student has just returned from his elective in Ghana. In the last few days, he has developed severe diarrhoea and has now presented to A&E. On assessment, he is very dehydrated and tachypnoeic. An ABG is performed on air showing the following:
PaO2: 14.6 kPa (109 mmHg) pH: 7.32 PaCO2: 3.8 kPa (30 mmHg) HCO3-: 13 mmol/L BE: -4 What does the ABG show?
Metabolic acidosis with partial respiratory compensation
How does hyperventilation lead to perioral and peripheral paresthesia?
As blood plasma becomes more alkalotic, the concentration of freely ionised calcium, the biologically active component of blood calcium, decreases (hypocalcaemia).
A 17-year-old male presents to A&E complaining of a tight feeling in their chest in addition to shortness of breath and some tingling in their fingers. They have no significant past medical history and are not on any regular medication. An ABG is performed on the patient whilst they’re breathing room air and the results are shown below:
PaO2: 14 kPa (105 mmHg) pH: 7.49 PaCO2: 3.2 kPa (24 mmHg) HCO3-: 22 mmol/L BE: +2 What does the ABG show?
Respiratory alkalosis
A 22-year-old female is brought into A&E by ambulance with a 5-day history of vomiting and lethargy. She has no past medical history and takes no regular medication.
Her observations are as follows:
Respiratory rate: 21 Oxygen saturation: 97% on air Blood pressure: 96/50 Pulse: 105 bpm Temperature: 36.6 degrees GCS 14 (E4 / V4 / M6) - confused speech On assessment you note:
Cool peripheries with prolonged capillary refill time
Dry mucous membranes
Confusion
No other abnormalities
You perform an ABG with the results shown below (patient not on oxygen):
PaO2: 13 kPa (98 mmHg) pH: 7.25 PaCO2: 3.5 kPa (26 mmHg) HCO3-: 13 mmol/L BE: – 4 What does the ABG show?
Metabolic acidosis with partial respiratory compensation
You’re asked to review a 59-year-old female who has been admitted the acute medical ward of your hospital. The nurse tells you that she appears short of breath despite currently receiving 3 litres of oxygen via nasal cannulae. You take an arterial blood gas with the patient on oxygen and the results are shown below:
PaO2: 9.1 kPa (68 mmHg) pH: 7.36 PaCO2: 8.4 kPa (63 mmHg) HCO3-: 29 mmol/L BE: +4 Does this blood gas suggest an acute or chronic derangement in CO2?
Acute derangement in CO2
Chronic derangement in CO2
Chronic derangement in CO2
A 64-year-old man is admitted to A&E with central crushing chest pain. As the nurse is taking his observations he has a cardiac arrest. Thankfully CPR was started immediately and after 6 minutes he regained spontaneous circulation.
An ABG (on 15L O2) immediately following this sequence of events revealed the following:
PaO2: 9.5 kPa (71 mmHg) pH: 7.14 PaCO2: 8.1 kPa (60 mmHg) HCO3-: 15.2 mmol/L BE: – 9.7 What does the ABG show?
Mixed respiratory and metabolic acidosis76 Respiratory alkalosis1 Metabolic alkalosis1 Normal ABG1 Metabolic acidosis8 Respiratory acidosis
Mixed respiratory and metabolic acidosis
Wells score
Active cancer Treatment or palliation within 6 months No0 Yes+1 Bedridden recently >3 days or major surgery within 12 weeks No0 Yes+1 Calf swelling >3 cm compared to the other leg Measured 10 cm below tibial tuberosity No0 Yes+1 Collateral (nonvaricose) superficial veins present No0 Yes+1 Entire leg swollen No0 Yes+1 Localized tenderness along the deep venous system No0 Yes+1 Pitting edema, confined to symptomatic leg No0 Yes+1 Paralysis, paresis, or recent plaster immobilization of the lower extremity No0 Yes+1 Previously documented DVT No0 Yes+1 Alternative diagnosis to DVT as likely or more likely No0 Yes-2
D-dimer reference ranges
Reference range Age (Years) D-dimer (ng/ml) <60 <500 61-70 <600 71-80 <700 81-90 <800 >90 <900
Pregnancy and anticoagulants
offer LMWH not aspirin
Reversal of Warfarin anticoagulant effect
Platelets
Protamine
Vit K or Vit K dependant coagulation factors
