Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th Year > Acute and Critical Care > Flashcards

Acute and Critical Care Flashcards

1
Q

What is the threshold for immediate treatment of hyperkalaemia (with and without ECG changes)?

A

Serum potassium
- Greater than 6mmol/L with ECG changes
Greater than 6.5mmol/L without ECG changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cardiogenic causes of pulmonary oedema

A 
Heart failure
Myocarditis
Tamponade
Pulmonary embolism
Valve disease
NSAIDs, ACEi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Non-Cardiogenic causes of pulmonary oedema

A 
AKI
Renal artery stenosis
Sepsis
Altitude
Liver failure
Acute respiratory distress syndrome
Head Injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of acute pulmonary oedema

A 
SOB ± orthopnoea
S3 sound
Gallop rhythm
Wheeze
Pink frothy sputum
Fine crackles
Sweaty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Common infective organisms in COPD exacerbations

A 
H. influenzae
Strep pneumoniae
Staph aureus
Rhinovirus
Influenzae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ECG findings in PE

A 
Right Axis Deviation
RBBB
Tachycardia
S1Q3T3
- Large S Wave in Lead 1
- Q wave in Lead 3
- Inverted T wave in Lead 3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PE Management (normal)

A

LMW Heparin or Fondaparinux
Aim for INR >2
Continue warfarin or NOAC for 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Thrombolysis in PE

A

10mg IV Alteplase then 90mg infusion over 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PE Management in renal impairment

A

Unfractionated heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What score on the Two-Level Well’s Score suggests a PE is likely?

A

4 or more

less than 4 is PE unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management if PE likely on Two-Level Well’s Score

A

Offer CTPA, or immediate AC if CTPA not available immediately

V/Q SPECT scan if CTPA not suitable/ allergy to contrast media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management if PE unlikely on Two-Level Well’s Score

A

Offer a D-Dimer

If positive, investigate as PE likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Antibiotic management of mild Community acquired pneumonia

A

Amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antibiotic management of moderate CAP

A

Amoxicillin + Clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Antibiotic management of severe CAP

A

Co-Amoxiclav/ Cephalosporin + Clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Antibiotic management of HAP

A

Aminoglycoside IV + Antipseudomonal penicillin/ cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Common CAP organisms

A

Strep pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common organisms in HAP

A 
Gram negative enterobacteria
S. aureus
Pseudomonas aureginosa
Klebsiella
Clostridium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptoms of a silent MI

A 
Syncope
Pulmonary oedema/ SOB
Epigastric pain
Vomiting
Acute confusion
Feeling of impending doom
Common in Elderly and diabetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ECG changes in NSTEMI

A

ST depression
T wave inversion
No changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hyperacute changes in a STEMI

A

Tall T waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Changes seen in a STEMI after hours (and the criteria for pPCI)?

A 
ST elevation in 2 consanguineous leads
- 2mm in chest leads
- 1mm in limb leads
New LBBB
No evidence of a pathological Q wave
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Latent ECG changes in a STEMI

A

T wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Contraindications to fibrinolysis

A 
Previous intracranial haemorrhage
Ischaemic stroke in last 6 months
Cerebral malignancy
Recent trauma or surgery in 3 weeks
GI bleed in previous month
Bleeding disorder
Aortic dissection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Classification of Aortic Dissection

A

Type A- Affects the ascending aorta

Type B- affects other portion of aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Signs and symptoms of aortic dissection

A

Central retrosternal chest pain

  • ‘Ripping’
  • Radiates to back
  • Worst at onset then gradually improves

Hemiplegia/ diplegia if carotid involvement
Limb ischaemia
Angina
Pulse deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Best imaging type for Aortic dissection

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Management of aortic dissection

A

BP aim for 100-120 mmHg
Cross match 10 units of blood

Surgical (stents, grafts, arch replacement)
TEVAR for type B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Irregular features/ unstable in tachycardia warranting 3x DC shock followed by Amiodarone?

A 
Hypotension/ shock
Syncope
HR >200BPM
MI
Heart failure
Impaired consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Examples of focal Narrow complex tachycardias

A

Sinus Tachycardia (underlying cause)
Atrial tachycardia
Junctional tachycardia
Multifocal atrial tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Condition in which Multifocal atrial tachycardias are common?

A

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Examples of Re-entrant Narrow Complex Tachycardias

A

Atrial Flutter
Atrial Fibrillation
AV Node re-entry tachycardia
Atrio-Ventricular Re-entrant tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Management of Narrow complex tachycardia with IRREGULAR Rhythm

A

(Treat as Atrial Fibrillation)

Rate control with beta blocker or Diltiazem
± Digoxin or amiodarone if heart failure

LMW Heparin until full assessment of emboli risk ahs been made

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Management of Narrow complex tachycardia with REGULAR rhythm

A

Vagal manoeuvres e.g. Valsalva, Carotid sinus massage

Adenosine 6mg rapid IV bolus
Followed by 2x12mg IV boluses if unsuccessful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Types of Broad complex tachycardia

A 
Monomorphic (most common)
Fascicular tachycardia
RV outflow tract tachycardia
Polymorphic tachycardia
Torsade de pointes tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Management of Broad complex tachycardia with REGULAR rhythm

A

Amiodarone 300mg IV then 900mg/24h infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of Broad complex tachycardia with IRREGULAR rhythm

A

Depends on cause

- Torsade de pointes –> MgSO4 infusion 2g over 10 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Causes of bradyarrythmia/ complete heart block

A

Drugs (CCBs, Beta blockers, Digoxin)
Lenegre’s/ Lev’s disease
Severe hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of bradyarrythmia with adverse features

A

Atropine 500mcg infusion every 3-5 minutes up to a maximum of 3mg

Percutaneous pacing/ pacemaker more definitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Causes of VF

A 
MI
Cardiomyopathy
aortic stenosis/ dissection
myocarditis
tamponade
trauma
Brudaga syndrome
Tension pneumothorax
PE
Primary pulmonary hypertension
QT Prolonging drugs
Seizures
Stroke
Hyperkalaemia
Sepsis
Drowning
Electrical shocks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Management of Ventricular Fibrillation

A

NON-Synchronised DC shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Infective causes of pericarditis

A

Viral (Coxsackie virus, Echovirus, EBV, influenza, HIV)

Bacterial (staph, H. influenzae, TB, meningococcus, Rheumatic fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Other causes of pericarditis

A 
Sarcoidosis
SLE
RA
Vasculitis
Myxoedema
Uraemia
Dressler's syndrome
Radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ECG findings of pericarditis

A 
ST elevation (saddle-shaped)
T wave inversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Management of pericarditis

A

Ibuprofen or Naproxen 250mg QDS
Colchicine if symptoms persist for 14 days

Treat underlying cause ± steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

AAA criteria for diagnosis

A

Dilation of the aorta of over 50% (usually 3cm original size)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Risk factors for AAA

A 
Male (3x)
Over 65
Smoking
Hypertension
COPD
Alcohol
Infective (Brucellosis, Salmonellosis, TB, HIV)
Behcet's Disease
Takayasu's Disease
Marfan's Syndrome
Ehlers-Danlos Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Criteria for surgical repair of AAA

A

Over 5.5cm in size

May be an open repair or endovascular (EVAR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What percentage of appendicitis have perforated at presentation?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is Rovsing’s Sign in Appendicitis?

A

Pain is greater in the RIF when pressing the LIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the Cope Sign in appendicitis?

A

Indicates a low appendix

Pain on flexion and internal rotation of the right hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What indicates a retroperitoneal appendix?

A

Tenderness on the right on PR

RUQ and flank pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Choice of antibiotics for Appendicitis?

A

Cefuroxime and Metronidazole pre-operatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Biliary Colic presentation

A

RUQ pain radiating interscapularly

Nausea and vomiting
Intermittent jaundice
Lasts 15 mins to 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Biliary colic investigations

A

USS scan
Bloods unremarkable
ERCP/ CT/ MRI scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Acute Cholecystitis presentation

A 
RUQ pain radiating interscapularly
Fever
Local Peritonism (Murphy's Sign- pain when pressing right costal margin)

Nausea and vomiting
Intermittent jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Acute cholecystitis investigation findings

A

USS scan
Bloods- mildly deranged LFTs, raised WCC/CRP
ERCP/ CT/ MRI scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Cholangitis presentation

A

CHARCOT’S TRIAD
RUQ pain radiating interscapularly
Fever
Jaundice

Local Peritonism (Murphy’s Sign- pain when pressing right costal margin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Cholangitis investigations findings

A

USS scan
Bloods- Raised WCC, CRP, ALP, GGT, Bilirubin
ERCP/ CT/ MRI scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Risk factors for paralytic ileus

A 
Surgery
Pancreatitis
Spinal injury
Hypokalaemia
Hyponatraemia
Uraemia
Peritoneal sepsis
Drugs (TCAs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

AXR findings in small bowel obstruction

A

Distended loops of small bowel

Valvukae conniventes completely cross the lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

AXR findings in large bowel obstruction

A

Haustra do not cross the bowel lumen

Coffee bean sign in sigmoid volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Most common location of a diverticulum in adults

A

Sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Presentation of diverticulitis

A

LLQ colicky pain relieved on defaecation
Tenderness and peritonism
Fever
Sudden painless bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Cullen’s sign in pancreatitis

A

Periumbilical bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Grey-Turner’s Sign in pancreatitis

A

Flank bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Serum enzyme measurements in pancreatitis

A

Amylase (usually increases 3x/ 1000u/mL; but may be normal even in severe disease)

Lipase (more sensitive and specific)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

GET SMASHED acronym for causes of Pancreatitis

A

Gallstones
ETOH
Trauma

Steroids
Mumps
Auto-immune
Scorpion Venom
Hyperlipidaemia, Hypothermia, hypocalcaemia
ERCP and emboli
Drugs

And pregnancy or cancer!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Glasgow Prognostic Score for pancreatitis

A

A score of 3 or more (1 point for each) would prompt immediate ITU/ HDU referral

PaO2: <8KPa
Age 55+
Neutrophilia (WCC >15x10^9/L)
Calcium (<2mmol/L)
Renal function (Urea 16mmol/L +)
Enzymes (raised AST, LDH)
Albumin ( <32g/L)
Sugar (BM 10+)
70
Q

Where are most peptic ulcers located?

A

Duodenal (80%)

71
Q

ALARMS symptoms in dyspepsia- indications for an Upper GI endoscopy

A

Over 55 and new dyspepsia fro 4-6 weeks, with:

  • Anaemia
  • Loss of weight
  • Anorexia
  • Recent onset/ progressive symptoms
  • Melaena/ haematemesis
  • Swallowing difficulties
72
Q

Use of the Rockall score in Upper GI bleeding

A

Aims to identify patients at risk of adverse events following acute upper GI bleeding. Should be interpreted with a NEWS score
Under 3: Good prognosis
8+: High risk of mortality

73
Q

Domains of the Rockall score

A 
Age
Shock
Co-Morbidities
Diagnosis
Stigmata of haemorrhage on endoscopy
74
Q

Presentations of Renal colic

A

Typical: Loin to groin spasms and inability to lie still; nausea and vomiting

Upper obstruction- pain between rib 12 and lateral lumbar muscles
Mid Ureteric obstruction- mimics appendicitis/ diverticulitis
Lower ureteric obstruction- bladder irritability, genital pain

75
Q

Treatment of an uncomplicated lower UTI

A

Nitrofurantoin 50mg/6h PO or Trimethoprim 200mg/12h PO

3 day course for women
7 day course for men

76
Q

Treatment of Pyelonephritis

A
  • Oral Ciprofloxacin 7-10 days IV followed by oral switch

- Cefalexin, Co-Amoxiclav are alternatives

77
Q

Indications for inpatient treatment for Pyelonephritis

A

Dehydrated/ unable to tolerate oral fluids
Pregnant
High risk of complication development e.g. patients with structural renal disease
Diabetes or immunosuppression

78
Q

Indications for early brain imaging in stroke

A 
Indications for thrombolysis/ early anticoagulation
Patient on anticoagulation treatment
Known bleeding tendency
Reduced GCS (<13)
Unexplained progressive or fluctuating symptoms
Papilloedema
Neck stiffness
Fever
Severe headache at stroke onset
79
Q

Contra-Indications for Thrombolysis in stroke

A 
U18
recent stroke/trauma/surgery/MI/GI bleed
INR>1.7 on Warfarin
Pregnancy
Diabetes
liver disease
cancer
80
Q

Bamford stroke classification of a LACS

A

One of:

Pure sensory stroke
Pure motor stroke
Senori-motor stroke
Ataxic hemiparesis

81
Q

Bamford stroke classification of a POCS

A

Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia

82
Q

Bamford Stroke classification of a TACS/ PACS

A 
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

All 3 for TACS
2/3 for PACS

83
Q

Blood sugar control target in acute stroke

A

4-11mmol/L

84
Q

What percentage of strokes are preceded by TIAs?

A

15%

85
Q

Management of a TIA with an ABCD2 score of 4+

A

Immediate Aspirin 300mg OD
± Clopidogrel or Dipyridamole

24 Hour referral for TIA clinic (MRI, Carotid USS)
Don’t drive for 1 month

86
Q

Management of a TIA with an ABCD2 score of less than 3

A

Immediate Aspirin 300mg OD

Specialist referral within 1 week

87
Q

Symptoms that may precede a Vasovagal Syncope

A

Nausea
Pallor
Sweating
Closing of visual fields

88
Q

Rule of 15s for Syncope

A 
Pulmonary Embolism
Aortic Dissection
ACS
Ectopic Pregnancy
Subarachnoid Haemorrhage
Ruptured AAA
89
Q

Prevention of syncope

A

Lying down/ squatting if warning symptoms
Tilt training
Isometric counterpressure manoeuvres (leg crossing or arm tensing)
Cardiac pacing
Avoid alcohol and stop drugs
Increase oral fluid intake

90
Q

Empirical antibiotic treatment of meningitis in 3 months - 50 years

A

IV Cefotaxime/ Ceftriaxone

91
Q

Empirical antibiotic treatment of meningitis in 50+ years

A

IV Cefotaxime/ Ceftriaxone + Amoxicillin

92
Q

Whipple’s Triad of Hypoglycaemia

A
  1. Plasma Hypoglycaemia (< 3 mmol/L; or 4mmol/L in hospital patients)
  2. Symptoms attributable to low blood sugar
  3. Resolution of symptoms with correction of hypoglycaemia
93
Q

Most common site of an intracranial venous thrombosis

A

Sagittal sinus (50% cases)

94
Q

Blood glucose level in DKA

A

11mmol/L +

95
Q

Ketonaemia in DKA

A

3mmol/L in blood

Ketones 2++ in urine

Ketonuria does not always = ketoacidosis

96
Q

Acidosis in DKA

A

Venous pH <7.3
OR
Venous Bicarbonate < 15mmol/L

97
Q

Insulin infusion rate in DKA

A

0.1 units/kg/hour
(1 unit/mL)

Initially 50ml made up of Insulin Actrapid

98
Q

Initial Fluid in DKA if BP >90

A

1L Saline

99
Q

When is glucose added to IV fluids in DKA

A

10% Glucose at 125ml/hr is added when BM is < 14 mmol/L

100
Q

How to estimate serum osmolality

A

2Na + Glucose + Urea

101
Q

Investigations if DVT Wells Score 2+

A

Proximal Leg Vein USS within 4 hours

If negative, D-Dimer

102
Q

Investigations if DVT Wells Score 1 or less

A

D-Dimer test

If positive, Proximal Leg Vein USS

103
Q

Duration of warfarin treatment after a DVT

A

3-6 months, particularly if unprovoked

104
Q

6P’s of Acute Limb Ischaemia

A 
Pale
Pulseless
Pain
Paraesthesia
Paralysis
Perishingly cold
105
Q

What ABPI indicates critical limb ischaemia

A

Less than 0.5

106
Q

Which metabolite of paracetamol is Hepatotoxic

A

NAPQI (5%)

107
Q

Which enzyme normally converts the toxic metabolite of Paracetamol to a conjugate excretable in urine?

A

Glutathione

Body has an 8 hour supply of Glutathione

108
Q

How is N-Acetylcysteine administered as a treatment for Paracetamol OD?

A

Infused over 1 hour in 5% glucose. Must be commenced within 8 hours

109
Q

SEs of N-Acetylcysteine

A

Erythema, urticaria, angioedema, bronchospasm

110
Q

Alternative to N-Acetylcysteine

A

Methionine

111
Q

Anticholinergic SEs of TCA (or Atropine) OD

A

Dry mouth, urinary retention, dilated pupils, agitation

112
Q

Overdose with which drug may require treatment of arrhythmias with Sodium Bicarbonate

A

TCAs

113
Q

Most common cause of Cellulitis (organism)

A

Strep pyogenes

114
Q

What may suggest a diagnosis of septic arthritis from blood tests?

A

Polymorphonuclear cells >75%

115
Q

Antibiotics for tonsillitis

A 
Penicillin V (Phenoxymethylbenicillin) 10 days
or clarithromcyin

Centor 3+

116
Q

Most common position of leg in hip fracture

A

External rotation
Adduction
Shortening of leg

117
Q

Common XR finding in hip fracture

A

Loss of shenton’s Line (arc around femur and pubic tubercle)

118
Q

Ligaments affected in medial ankle sprain

A

Deltoid Ligament

119
Q

Ligaments affected in lateral ankle sprain

A

Calcaneofibular ligament
Anterior talofibular ligament
Anterior/ Posterior Inferior talofibular ligaments

120
Q

Ligaments affected in syndesmotic ankle sprain

A

Interosseus and lower tibiofibular ligaments

121
Q

Grading of ankle sprains

A
  • Grade 1- Stretched ligament with microscopic tearing
  • Grade 2- Ligament stretched with partial tearing
  • Grade 3- Ligament is completely ruptured, severe swelling
122
Q

Colle’s versus Smith’s Fractures

A

Colle’s: Distal radius fragment displaced dorsally

Smith’s: Distal radius fragment displaced ventrally

123
Q

XR Findings in anterior shoulder dislocation

A

Humeral head under coracoid process (AP)

Head anterior to glenoid process

124
Q

XR Findings in posterior shoulder dislocation

A

Lightbulb sign

Humeral head posterior to glenoid process

125
Q

Drugs which may cause acute urinary retention

A 
Anticholinergics
Opioids
Benzodiazepines
NSAIDs
CCBs
Detrusor relaxants
Alcohol
Antihistamines
126
Q

Reversible causes of VF (4H’s, 4T’s)

A

Hypoxia
Hyper/hypokalaemia
Hypovolaemia
Hypothermia

Tamponade
Tension Pneumothorax
Thromboembolism
Toxin

127
Q

Reasons to consider admission for acute AF

A

Pulse above 150
BP <90
Chest pain/ LOC/ acute SOB
Stroke/ TIA/ Acute HF

128
Q

How often is Adrenaline given in cardiac arrest

A

After 3 shocks

Then every 3-5 minutes

129
Q

How often is Amiodarone given in cardiac arrest/ ALS

A

After 3 shocks

Another after 5

130
Q

How many posterior ribs on a CXR can indicate hyperinflation?

A

7

131
Q

What is the San Francisco Syncope Rule?

A

Predicts adverse outcomes for patients presenting with syncope at 7 days. Any of the following classes the patient as high risk:

  • Congestive Heart Failure History
  • Haematocrit <30%
  • ECG Abnormalities
  • SOB
  • Systolic BP <90 at triage
132
Q

Serious causes of ventilation compromise in trauma

A 
Airway Obstruction
Tension Pneumothorax
Open Pneumothorax
Massive Haemothorax
Flail Chest
Cardiac Tamponade
133
Q

On the floor and four more

A

Visible blood loss, plus:

  • Chest
  • Abdomen
  • Pelvic cavity
  • Long Bones
134
Q

Most common type of shock in trauma

A

Haemorrhagic

135
Q

Cushing response to raised ICP

A

Bradycardia
Hypertension
Irregular respiration

136
Q

Brainstem testing in DBD

A 
Absent pupillary light reflexes
Absent corneal light reflex
No cranial/ limb response to pain
Absent vestibulo-cochlear reflexes
Absent gag/ cough reflex
Apnoea test
137
Q

Criteria of diagnosis for ARDS

A

Clinical symptoms

  • Acute onset
  • Pulmonary oedema- bilateral infiltrates on CXR
  • PCWP < 19mmHg (demonstrates non-cardiogenic)
  • Refactory hypoxaemia (pO2:FiO2 <200mmHg)
138
Q

Key settings of control on a mechanical ventilator

A 
Tidal volume/ RR
Inspiratory flow
I:E ratio
FiO2
PEEP
139
Q

Ventilating below what FiO2 reduces risk of oxygen toxicity

A

0.5

140
Q

Key indications for Non-Invasive Ventilation

A

COPD with respiratory acidosis pH 7.25-7.35*
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation

141
Q

Minimal daily requirements: H20

A

25-30 ml/kg/day

142
Q

Minimal daily requirements: Sodium

A

1-2 mmol/kg/day

143
Q

Minimal daily requirements: Potassium

A

0.5-1 mmol/kg/day

144
Q

Minimal daily requirements: Glucose

A

50-100 g to prevent starvation ketosis

- does not cover nutritional requirements

145
Q

What volume of blood loss produces a fall in Hb of approximately 10g/dL

A

500ml

Significant when below 70g/dL; may be higher in elderly/ co-morbidity

146
Q

What is in a Massive Transfusion protocol

A

1:1:1 Packed RBCs, FFP, Platelets

Up to 10 units

147
Q

Important drugs in renal failure

A 
NSAIDs
ACEi and ARBs
Diuretics
Contrast Medium
Penicillins
Metformin
Statins
Gentamicin
148
Q

Key indications for RRT

A 
Severe fluid excess e.g. Oedema
Stage 3 AKI
Hyperkalaemia
Clearance of nephrotoxics
Rising creatinine or urea
149
Q

Appropriate Mannitol dose for raised ICP and SEs

A

Mannitol 20% solution 0.5g/kg over 20 minutes

The effects only last 2-6 hours so may get a reboound rise in ICP

150
Q

Why are patients hyperventilated in Head Injury

A

Reduces PaCO2: this causes cerebral vasoconstriction and reduces ICP almost immediately

151
Q

GCS criteria warranting a 1 hour CT Head following a head injury:

A

GCS <13 on Initial Assessment

GCS < 15 2 hours after injury

152
Q

1 hour CT head criteria

A 
GCS <13 on Initial Assessment
GCS < 15 2 hours after injury
Suspected open/ depressed skull fracture
Sign of basal skull fracture
Post traumatic seizure
Focal neurological deficit
2+ episodes of vomiting
153
Q

8 hour CT head criteria

A

Aged 65+
Clotting/ bleeding disorder
Dangerous mechanism of injury
Retrograde amnesia lasting 30+ minutes

154
Q

Signs of basal skull fracture

A

Haematotypanium
Panda Eyes
CSF leakage from ear or nose
Battle Sign

155
Q

Minimum monitoring standards for Anaesthesia

A 
Cardiac (ECG)
NIBP
SpO2
FiO2
EtCO2
Airway Pressure (Peak Inspiratory Pressure)
156
Q

When is temperature monitored in anaesthesia

A

For procedures lasting longer than 30 mins

157
Q

When is a Peripheral nerve stimulator used to monitor in anaesthesia

A

When Akinesis (NM blockade) is performed

158
Q

Normal level of Epidural anaesthesia

A

L3-L4

Can be anywhere between L1 and sacrococcygeal hiatus

159
Q

Normal level of Spinal anaesthesia

A

L2-S2

Less change of cord damage with a lower level

160
Q

Which type of Regional anaesthesia has a quicker onset of action

A

Spinal

161
Q

Which vasoactive drug is avoided in obstetric anaesthesia, to reduce the risk of foetal acidosis?

A

Ephedrine

162
Q

Why should an FiO2 above 0.3 be avoided in neonates

A

Causes proliferative retinopathy

163
Q

Which local anaesthetics have a slow onset and duration, but a long duration of action?

A

Bupivicaine and Levobupivicaine

164
Q

Types of LA and their hydrostatic properties

A

Esters -> Hydrophobic

Amides -> Hydrophilic

165
Q

When can extubation occur

A
  • When muscle paralysis has worn off
  • Troughs in EtCO2 monitoring
  • Return of cough reflex
  • Nerve stimulator e.g. TOF with no fade
166
Q

How is the size of a nasopharyngeal airway assessed

A

Against size of patient little finger

167
Q

Criteria to confirm correct ET tube placement

A

Misting of ET tube
EtCO2 observed on monitor
EQUAL chest expansion
Auscultation of chest (confirm to air entry into stomach)

168
Q

Cormack- Lehane Score above which you would want to use a bougie or stylet for laryngoscopy

A

Grade 2B+

169
Q

Cormack- Lehane Score above which you would want to use additional devices

A

Grade 4

170
Q

Angina Chest Pain: NICE definitions

A
  1. constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
  2. precipitated by physical exertion
  3. relieved by rest or GTN in about 5 minutes

All 3 features: typical angina
2 of the above features: atypical angina
0-1: Non-anginal chest pain

171
Q

Eron Classification of Cellulitis

A

1: No systemic symptoms, no co-morbidities
2: Co-morbidity that may complicate treatment e.g. peripheral arterial disease, obesity
3: Significant systemic symptoms e.g. acute confusion, tachycardia, tachypnoea, hypotension, OR unstable co-morbidities, OR limb threatening infection
4: Sepsis/ necrotising fasciitis

4th Year (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions