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1week before Flashcards

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1
Q

tripple point of water

STP

A

triple point: 273.16 K – 0.01°C, 611.2 Pa (0.06atm)

STP : 273.15K (0°C), 101.3 kPa (760 mmHg)

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2
Q

what is a resistance wire, thermocouple, thermistor?

A

resistance wire - metal. linear graph, positive gradient (temp =x , resistance =y). very accurate, slow response, fragile

thermistor = metal oxide. non linear - negative expontial graph (can be positive). cheap, fast, small. calibration error, deteriorates overtime.

thermocouple = temp vs potential difference. seebeck effect. very small, cheap, tough. needs amplificationw

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3
Q

where are thermistors found

A

Used in PA catheter and oesophageal stethoscope

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4
Q

which temperatures is mercury and alcohol liquid expansion thermometers suitable for?

A

Mercury is more suitable for high temperatures, between -39°C and 250°C (alcohol boils at 78.5°C)

Alcohol is more suitable for low temperatures, between -117°C and 78°C (mercury solidifies at -39)

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5
Q

how do infrared thermometers work?

A

pyoelectric sensor and thermopile

detect infrared radiation

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6
Q

how do chemical thermometers worK?

A

liquid crystals
change colour with temp

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7
Q

what can affect accuracy of bladder and rectal temp?

A

bladder - flow rates
rectal - few degrees higher due to bacterial fermentation

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8
Q

which temp sensor is best for hypothalamic?

A

tympanic

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9
Q

when should a forced air warmer and fluid warmer be used?

A

forced air warmer surgery >30mins

IV fluid warmer - fluids >500ml

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10
Q

what does hypothermia do to MAC?

A

drop

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11
Q

% of different forms of heat loss

A

40-50% of heat loss is via radiation, 30% by convection, 20% by evaporation and 3% by conduction.

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12
Q

what is found in a dial thermometer that is responsible for detecting temp change?

A

bimettalic strip

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13
Q

define relative humidity

A

Absolute humidity/the SVP of water at that temp, or,

The ratio of the mass of water vapour in a given volume of air compared with the mass that would be required to saturate that given volume of air at the same temp.

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14
Q

what is due point?

A

temp at which relative humidity exceeds 100% and water condenses out

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15
Q

what is hygroscopic material?

A

Material that attracts moisture from the atmosphere

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16
Q

how does a wet and dry bulb hygrometer work?

A

2 thermometers
one reads ambient temp.
one sits in a container of water which cools as water evaporates due to loss of heat of vapourisation
rate of evaporation varies with humidity of surrounding

difference between 2 = relative humidity

requires good air movement to be accurate

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17
Q

how does the regnaults hygrometer work?

A

silver tube containing ether
air bubbled through to cool it

when condensation occurs on the tube (dew point) this will be the temp at which ambient air is fully saturated
use table for comparison

more accurate the wet and dry bulb and hair hygrometer

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18
Q

methods to measure humidity?

A

hair hygrometer
wet and dry bulb
regnaults

mass spec
UV light absorption
transducers

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19
Q

what does regnaults hygrometer measure?

A

relative humidity

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20
Q

at what humidities is hair hygrometers most accurate

A

between relative humidity 30-90%

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21
Q

what are Pitot tubes in measurement?

A

improve accuracy of pneumatochograph

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22
Q

how does efficiency of HME vary with volume?

A

more efficient at lower TV

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23
Q

what principle do gas driven nebulisers rely on?

A

bernoulli / venturi

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24
Q

what does clonidine do to gastric motility? and cerebral blood flow

A

drops both

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25
Q

what ion is a cofactor for adenylate cyclase?

A

Mg

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26
Q

how do cAMP and cGMP lead to smooth muscle dilation?

A

cAMP –> PKA
cGMP –> PKG

MLCK = normally phosphorylates myosin for muscle contraction.

PKA - inhibits MLCK
PKG - promotes MLC phosphatase

cGMP also reduces Ca into cell

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27
Q

name 3 a2 agonists

A

clonidine,
methyldopa
dexmedetomidine - more selective

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28
Q

how is methyldopa normally given?

A

oral
rarely IV

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29
Q

what does clonidine do to hormones?

A

inhibits ADH
inhibits insulin release

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30
Q

which antihypertensives act as ganglionic blocking agents

A

rarely used
Trimetaphan
block nACHr at ganglia of ANS
less sympathetic output and vasodilation

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31
Q

what is Guanethidine ?

A

adrenergic blocking agent
(can be used for chronic pain)

this is uptaken by adrenergic neurons and blocks release of NA

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32
Q

how does hydralazine work?

A

arteriole dilator
acts via cGMP / guanyl cyclase pathway

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33
Q

what is the effect of hydralazine affected by?

A

acetylator activity
variable BO

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34
Q

what vessels do nitrates work on?

A

low doses - veins
high doses - arterioles

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35
Q

how does sodium nitroprusside work?

A

arteriolar and venous dilator
rapid on and offset

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36
Q

how does magnesium cause vasodilation?

A

co-factor for adenylate cyclase - more PKA , more MLCK inactivated

blocks catecholamine receptors

blocks L type Ca channels

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37
Q

how do Ca channel blockers work?

A

L type Ca channels
vasodilation
reduced contractility
reduced propagation of cardiac depolarization

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38
Q

what are the subgroups of Ca channel blockers?

A

Phenylalkylamines – Verapamil - antiarrhythmics
Dihydropyridines – Nifedipine, Amlodipine - arteriolar vasodilation

Benzothiazepines – Diltiazem - both cardiac and peripheral

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39
Q

which ACEi is a prodrug? which is secreted unchanged?

A

lisinopril - excreted unchanged

prodrug - ramipril, enalopril

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40
Q

guidelines for antiHTN management primary care

A

<55 years:
1st line: ACEI or Angiotensin II inhibitor
2nd line: Calcium channel blocker or Thiazide diuretic

> 55 years or black:
1st line: Calcium channel blocker or Thiazide diuretic
2nd line: ACEI or Angiotensin II inhibitor

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41
Q

what antiHTN used in preganncy ?

A

oral methyldopa, labetalol, nifedipine

if severe IV labetolol/ Mg/ hydralazine

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42
Q

side effects of clonidine

A

dry mouth, sedation, depression, reduced gastric motility and reduced cerebral perfusion

hypotension
rebound hypertension

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43
Q

how does sodium nitroprusside effect shunt?

A

It can increase shunt by impairing hypoxic pulmonary vasoconstriction.

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44
Q

how many cyanide ions does sodium nitroprusside make?

A

5

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45
Q

how does nifedipine affect MAC?

A

CaCB acting on arterioles - can reduce MAC

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46
Q

what is the anion gap in CKD like?

A

normal

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47
Q

how does low albumin affect the anion gap?

A

reduces it
unmeasured anion

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48
Q

where is HCO3 mostly reabsorbed?

A

PCT

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49
Q

which part of kidney determines final urine pH?

A

distal convoluted tubule

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50
Q

how does affinity for O2 compare in COHb and MetHb

A

increased in COhb
less in metHb - unable to bind O2

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51
Q

how much more soluble is CO2 than O2

A

x25

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52
Q

what is the CO2 content of venous blood?

A

500ml/L

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53
Q

how does O2 consumption, MV, CO and oxygen extraction change in vigorous exercise?

A

Maximum O2 consumption = 10 fold
cardiac output of 5 times,
minute ventilation 10 times

doubling of the oxygen extraction ratio to 0.5.

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54
Q

how does O2 dissociation curve shift in stored blood?

A

to the left
less 2,3 DPG

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55
Q

what is the minimum storage capacity for VIE oxygen?

A

14 days

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56
Q

how many more times its volume does liquid O2 in VIE provide O2 gas?

A

842x

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57
Q

what is the pressure inside VIE?

A

10.5 Bar / 1000kpa

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58
Q

what are modern gas cylinders made of?

A

Molybdenum steel,
high-carbon manganese steel

light-weigh steel aluminium composite.

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59
Q

what are pipelines for gases made of?

A

copper

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60
Q

what is the presure in pipeline for medical air?

A

It is 4 Bar for Medical Air and 7 Bar fo Surgical Air

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61
Q

what flow rate is required for suction?

A

25L/min

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62
Q

how much pressure should suctioning be able to generate?

A

more than 500 mmHg in 10 seconds

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63
Q

how is the resistance and compliance of suction tubing?

A

low resistance
low compliance - prevents colapsing of tubing

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64
Q

in a plenum vapouriser is the output dependant/independant on gas flow?

A

dependant - as it is only calibrated from 0.5-15L/min flow

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65
Q

how much CO2 does 1Kg soda lime absorb?

A

250 litres of CO2

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66
Q

standard size reservoir bag ?

A

2 L

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67
Q

what pressure do reservoir bags limit the system to?

A

40 cmH20

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68
Q

what part of cylinders are colour coded?

A

shoulder
not bodies

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69
Q

what pressure does the blow off valve of a VIE open?

A

1500kpa

70
Q

is soda lime always essential in circle system?

A

no
can use high flows instead

71
Q

should you disconnect a vapouriser before filling it up?

A

no

72
Q

how is oxygen failure alarm checked?

A

disconnection of the oxygen hose
checked weekly

73
Q

as part of AABGI anaesthetic machine check, does scavenging system need checking?

A

yes

74
Q

how do inhalation agents affect NMBA?

A

potentiate action
because have effects to reduce muscle tone - reduce NT release at NMJ

75
Q

what is the blood gas partition coeficient of xenon? how does this compare to N20 and desflurane?

A

xenon = 0.14
N20 = 0.47
des = 0.42

76
Q

what happens to metabolism of atracurium in hypothermia?

A

reduced

77
Q

how much plasma protein binding of atracurium?

A

15%

78
Q

describe alcohol metabolism…

A

Alcohol is metabolised in cytoplasm by alcohol dehydrogenase to acetaldehyde, then by acetaldehyde dehydrogenase to acetate.

79
Q

why does alcohol cause ataxia in acute intoxication

A

cerebellar toxin

80
Q

what gives hangover effect of diazepam?

A

active metabolite - tenazepam
tenazepam has 8 hours half life.
removed via glucuronidation

81
Q

what do class 1b drugs do to AVN conduction? e.g. phenytoin

A

enhance

82
Q

elimination half life of digoxin?

A

35 hours, which is increased by renal impairment

83
Q

excretion of digoxin?

A

Less than 10% undergoes metabolism in the liver. Digoxin is excreted primarily unchanged via the kidney by glomerular filtration and tubular secretion, hence the necessity for dose adjustment in renal impairment.

84
Q

which receptors does dobutamine mainly act on

A

agonist
B1

85
Q

in null deflection O2 paramagnetic analyser, what opposes the dumb bells?

A

opposing magnetic field

86
Q

what does PEEP do to deadspace?

A

increases it

87
Q

wavelength of O2 in pulse ox

A

oxy - 940
deoxy 660

88
Q

in terms of korakoff sounds, how does systolic BP relate to them?

A

Systolic pressure corresponds to the onset of Korotkoff sounds, not the loudest sound

89
Q

how is CO calculated via Ficks principle?

A

dividing oxygen consumption, in ml per minute (250 normally) by A-V oxygen difference, in ml per litre of blood (5ml.100mL-1 or 50ml.L-1 normally).

d/dt VO2 = (CaO2 - CvO2). Q

d/dt VO2 = uptake
Q= CO

90
Q

what increases damping in arterial system?

A

bubbles,
poor functioning flushing system
very long tubing
less compliant tubing
many connections.

91
Q

what direction is the T wave in aVR?

A

negative deflection

92
Q

which lead is a Q wave normal in ?

A

V 6

93
Q

whats the equation for energy/ work and pressure and volume ?

A

energy/work = pressure x volume

94
Q

what is the equation for power, force and velocity?

A

power = force x velocity

95
Q

does Vd depend on lipid solubility only?

A

no
also can depend on metabolism e.g. remifent is very lipid soluble but low Vd because rapid metabolism.

96
Q

why is propofols Vd so large?

A

v lipid soluble
mostly unionised at physiological pH

97
Q

metabolites of atracurium?

A

laudanosine
monoquarternary alcohol derivative

98
Q

CYP enzymes with genetic variability?

A

2D6
2C9 - warfarin

99
Q

how does rate of elimination related to clearance?

A

rate of elimination = clearance multiplied by plasma drug concentration

100
Q

type of curve for wash in

A

described as negative exponential
1- Ae-kt

101
Q

how is oral bioavailability calculated?

A

AUC(oral)/AUC(IV)

102
Q

Vd for atropine - small or big?

A

big
v lipid soluble

103
Q

what is the problem with using filters in ecg to reduce noise?

A

can also reduce signals in ecg that can be used for diagnosis

104
Q

what frequency does diathermy work in?

A

1-5MHz

105
Q

how does coagulation mode and cutting mode in diathermy differ?

A

Coagulation mode uses short burst sine waves and cutting mode uses continuous sine waves.

106
Q

equation for energy in electricity

A

I^2 x R
or
V^2/ R

107
Q

reynaulds number calculation…

A

Re = density x velocity x diameter/viscosity

108
Q

what type of receptor is a2?

A

Gi
inhibits NA release - vasodilation of arterioles
also causes smooth muscle contraction of veins and coronary
platelet aggregation too

109
Q

other than vasoconstiriction what does a1 receptors do?

A

glycogenolysis
increase insulin and glucacon
mydriasis

110
Q

functions of B1, B2, B3

A

B1 - heart, renin, lipolyisis
B2 - lungs, glycogenolysis, insulin and glucagon release
B3 - lipolysis and thermogenesis

111
Q

name the selective a1 antagonists…
uses..

A

Prazosin
doxazocin
terazosin

Used for essential hypertension, phaeochromocytoma and congestive cardiac failure.
also for BPH

112
Q

non selective alpha 1 antagonists include..

A

Phentolamine - IV , given to block sympathetic driven HTN

Phenoxybenzamine - oral or IV, longer acting. makes covalent bonds with alpha receptors so long duration of action.

113
Q

side effects of phentolamine

A

nasal congestion
bronchospasm from sulphite metabolites
hypoglycaemia due to insulin release

114
Q

side effects of B blockers?

A

bronchospasm

poor peripheral perfusion

hallucinations, nightmares, depression

increased urine tone and retension

115
Q

are B blockers used in heart failure?

A

sometimes
early stages NYHA 1 and 2
but not decompensated stage 4

116
Q

when is labetolol and esmolol used?

A

labetolol = non cardioselective , reduces BP and HR. has alpha and beta affects

Esmolol cardioselective - only reduces HR. given as infusion. can cause bronchospasm sometimes

117
Q

how does labetolols selective alter with route of administration

A

more selective to B receptors over alpha receptors when given IV

118
Q

in pheochromocytoma, do alpha or beta blockers need to be given first and why?

A

alpha blocker
then B blocker

because if b blockers first it can worsen HTN by removing vasodilation from B receptors

119
Q

what type of antagonism does phenoxybenzamine have?

A

Phenoxybenzamine is an irreversible α-adrenergic receptor antagonist

half life 24 hrs

120
Q

treatment for bradycardia in ALS?

A

Atropine 500mcg
next
- atropine up to 3mg
- isophrenaline
- adrenaline
- pacing

121
Q

is atropine racemic?

A

Yes (only L is active, D inactive)

122
Q

can atropine cause bradycardia?

A

At low dose can initially produce bradycardia (Bezold-Jarisch reflex)

123
Q

2 unusual side effects of atropine

A

local anaesthetic properties
reduces ADH release

124
Q

does glycopyrolate cross placenta?

A

yes
but not BBB

125
Q

what is more potent at reducing secretions glycopyrolate or atropine?

A

glycopyrolate

126
Q

how does isophrenaline work?

A

B1 and B2 agonist

127
Q

is atropine given in PEA arrest?

A

no

128
Q

what effects on heart does amiodarone have?

A

blocks K+ channels
slows repolarisation
increases refractory
prolongs phase 3
slows AVN automaticity and conduction.
No effect on conduction through bundle of His and ventricles

129
Q

is amiodarone protein bound?

A

yes high PB
can diplace digoxin, anticoags, CaCB and Bblockers

130
Q

name a cardiac glycoside

A

digoxin

131
Q

how is digoxin excreted?

A

mostly unchanged in urine
hence adjustments in renal failure
narrow therpeutic index

132
Q

what increases risk of digoxin toxicity?

A

low K, low Mg
high Na, high Ca
hypoxia
amiodarone, verapamil, diltiazam

133
Q

what drug class does flecanide belong too?

A

amide local anaesthetic

134
Q

effects of digoxin toxicity

A

headache
abdo pain
convulsions
gynaecomastia
colour vision change
muscle weakness
heart block

135
Q

which cytokine is anti inflammatory?

A

IL 10

136
Q

what part of spinal needle stops wrong route of administration?

A

NRFit system
ywllow in colour

137
Q

equation for heat generated by diathermy?

A

heat generated = current²/area.

138
Q

gold standard for sterilisation?

A

steam via autoclave

139
Q

4 parameters for autoclaving?

A

steam, pressure, temp, time

140
Q

what antiemetics antagonise dopamine?

A

domperidone
droperidol
promethazine
chlorperizine
prochlorperizine

141
Q

great toe extension myotome?

A

L5

142
Q

at what level is the stellate ganglion blocked?

A

C6 - anterior tubercle

143
Q

how long should the heparins and warfarin be stopped for before spinal?

A

Unfractionated heparin (IV) – 4 hours (check APTT).

LMWH (prophylactic dose) – 12 hours.

LMWH (treatment dose) – 24 hours.

Warfarin – INR < 1.5.

144
Q

describe method of pasteurisation…

A

low temp steam

145
Q

mechanism of azoles

A

inhibit formation of ergosterol

146
Q

mechanism of polyenes

A

antifungal
bind ergosterol and create pores in membrane

amphotericin, nystatin

147
Q

mechanism of echinocandins

A

inhibit B1 -3 glucan synthase

capsofungin etc

148
Q

what is dobutamine an isomer of?

A

structural isomer of dihydrocodeine

149
Q

what does sodium nitroprusside do to V:Q

A

reduces hypoxic vasoconstricition
worsens V:Q
can cause shunt
must use additional O2 to reduce this.

150
Q

how is sodium nitroprusside metabolised?

A

hydrolysis in RBC to produce nitric acid, cyanide ions and methamoglobin

151
Q

how does cyanide toxicity present?

A

hyperventilation
met acidosis
increased venous sats

152
Q

what is a HMEF filter?

A

filters microbes as well as HME

153
Q

equation for ventricular ejection fraction?

A

stroke volume/ end diastolic volume

154
Q

name the parasympathetic ganglia in H&N…

A

ciliary, pterygopalatine, submandibular and otic.

155
Q

what is the hepatic artery buffer response?

A

vasodilation of hepatic artery in response to reduced portal venous blood flow.

adenosine is secreted into the space of mall via O2 independant mechanism. reduced portal flow, less clearance of adenosine, builds up and causes vasodilation of hepatic artery.

156
Q

describe tautomorism of midazolam?

A

pH <4 - open ring - water soluble

157
Q

name structures…

A

A = fem nerve
B femoral canal
C= great saphenous vein
D = femoral sheath

158
Q

causes of increased transfer factor and decreased?

A

increase = polycytheamia, alveolar haemorrhage

decrease = pulmonary fibrosis, P.E , emyphysema, pulmonary HTN

159
Q

how does cisatracurium compare to atracurium in terms of potency and side effects?

A

less histamine release
more potent

160
Q

which form of warfarin is more protein bound?

A

S warfarin
s is sticky

161
Q

entonox is what ratio mixture?

A

50:50
by volume (not by weight)

162
Q

what filter is used in cell salvage?

A

150 micro meters

163
Q

what is represented by the area inside the hysteresis curve?

A

energy lost as heat

164
Q

how are epidural catheters marked?

A

Epidural catheters have one single mark at the tip so that it may be identified on removal.

They have 5 single markings at 1 cm intervals from 5-9 cm,

a double marking at 10cm, 1cm intervals from 10-14cm,

a triple marking at 15cm and then quadruple markings at 20cm.

165
Q

pka. PB and solubility of lidocaine, prilocaine and bupivacaine

A

Lidocaine has a pKa of 7.9, is 70% protein bound, and its relative lipid solubility is 150.

Prilocaine has a pKa of 7.7, is 55% protein bound, and its relative lipid solubility is 50.

Bupivacaine has pKa of 8.1, is 95% protein bound, and its relative lipid solubility is 1000.

166
Q

normal urine output per hour

A

30-80ml/hr

167
Q

how often is a diabetics BMs monitored intra op

A

1 hourly

168
Q

mechanism of hyoscine?

A

Both hyoscine and atropine primarily work by antagonising muscarinic receptors at the chemoreceptor trigger zone.

169
Q

describe the bundles in fibre optic endoscope?

A

It consists of two main bundles of optical fibres, a coherent bundle (to transmit image) and a non-coherent/illumination bundle (to transmit light), and a working channel surrounded by a flexible steel braid, angulation wires and a protective sheath.

Whilst the coherent channel consists of 10’000 individual fibres of diameter 10 μm, it constitutes only a very small portion of the diameter of a flexible fibre optic endoscope. The size of the working channel is the major determinant of size.

170
Q

how often is a fuel cell calibrated?

A

daily
2 points - 21% and 100%

171
Q

how does methylene blue work? some ADRs

A

nhibiting nitric oxide induced cGMP activity

causes pulmonary vasoconstriction
methamoglobinaemia
sats 85% (falsely)

172
Q

what is the british standard for level of performance of a filter?

A

The British Standard is N95. At this level of performance, less than 5% of particles pass through the filter.

royal college questions (4 decks)

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