Book paper questions 500

Question 1

Pin index: 3,5

Answer 1

N20

Question 2

Pin index: 2,5

Answer 2

O2 (o2 think two first)

Question 3

pin index: 1,5

Answer 3

air

Question 4

pin index 1,6

Answer 4

co2 (carbon has 6 letters)

Question 5

pin index 7

Answer 5

entonox = 7 letters

Question 6

Acute severe asthma:
PEFR
RR
HR
one breath

Answer 6

Acute severe asthma:
PEFR 33-50% predicted
RR>25
HR>110
inability to complete sentences in one breath

Question 7

Life threatening asthma:
PEFR
SPO2
Chest signs
Consciousness
PaCO2
PaO2
pH

Answer 7

Life threatening asthma:
PEFR <33% pred
SPO2 <92%
Chest signs: silent, cyanosis reduced effort
Consciousness - altered
PaCO2 - normal 4.6-6.0kPa
PaO2 - <8kPa
acidosis

Question 8

Rx asthma severe adults:

Answer 8

o2 –> sats 94-98%
neb salb 5mg or terbutaline 10mg (beta2 agonist)
neb ipratropium bromide 0.5mg (antimuscarinic)
oral pred 40-50mg or 100mg iv hydrocort
cxr only if pneumo/consolid suspected/need intubation
consider - ventilaiton, 1.2-2g mag sulf iv
freq neb salb

Question 9

ARDS definition:

Answer 9

onset within 7 days of defined event (e.g sepsis)
bilat opacities consistent c pulm odema
resp failrure not fully explained by cardiac failure/fuild overload. objective assessment with ECHO

Question 10

ARDS management:

Answer 10

alveolar recruitment, increase mean airway pressure with PEEP or prolong inspiratory time. ardsNET TRIAL:
- PCV
- TV 6ml/kg ideal body wt
- plateau pr <30cm h20
- titrare fio2 to pao2 8kpa
permissive hypercapnia 8kPa increase RR to reduce paco2

Question 11

paeds dose
para
ibu
diclo
fent
morph
codeine
dex
ondans

Answer 11

paeds doses:
paracetamol 15mg/kg
ibuprofen 10mg/kg
diclofenac 1mg/kg
fentanyl 1mcg/kg
morphine 0.1-0.2mcg/kg
codein 0.5mg/kg
dex 0.1-0.2mg/kg
ondans 0.1-0.2mg/kg

Question 12

paed lma size:
1
1.5
2
2.5
3

Answer 12

paeds lma size for weight
1 → <5kg
1.5 →  5-10kg
2 → 10-20kg
2.5 → 20-30kg
3 → 30-50kg

Question 13

paeds ett diameter size:

e.g. 9 yo

Answer 13

ett size (age/4) +4
(9/4)+4 = 6.25 so 6.0-6.5
as 8 yo is 6, 10 yo is 6.5

Question 14

paeds tube length at lips

e.g. 9 yo

Answer 14

(age/2) + 12cm

e.g 9 yo → 16.5cm

Question 15

nasal ett tube length

Answer 15

age/2 + 15 ( tube at lips +3cm)

9 yo → 19.5cm

Question 16

adult tube length at lips =

Answer 16

(height cm/7)-2.5cm

Question 17

ankle block nerves:

Answer 17

ankle block nerves:
tibial - only nerve with motor component: plantar flexion of toes, contract flex digitoum longus+ flexor hallucis longus, sensory medial aspect ankle + foot
deep+ superficial peroneal
sural
saphenous

Question 18

raised icp anaes drugs:

Answer 18

ketamine
volatile
suxamethonium (transient)

Question 19

decreased icp anaes drugs:

Answer 19

barbiturates, etomidate propofol, opioids

Question 20

ICP mx:
paco2
pao2
general

Answer 20

paco2 4.5-4.0kpa (2-4% reduction CBF for 0.13kPa reduction in paco2)
avoid hypoxia icp doesn’t increase above pao2 of 6.7kPA
avoid hypotension, fluid restrict to reduce MAP so reduce cpp
Dex for tumours cerebral oedema but not in TBI

Question 21

CPP =?

Answer 21

CPP = MAP - (ICP +CVP)

Question 22

Compliance =?

Answer 22

Compliance = ∆V/ ∆P reflects ELASTIC RECOIL of organ

Question 23

∆P in lung measured difference btw :

Answer 23

∆P in lung measured difference btw : alveolar pr at mouth with no gas flow and intrapleural pr measured by balloon in lower third of oesophagus

Question 24

Normal lung compliance = ?

Normal chest wall compliance = ?

total thoracic compliance = ?

1/Ctotal = ??

Answer 24

Normal lung compliance = 150-200ml/cmh20 (1.5-2L/kpa)

Normal chest wall compliance = 200ml/cmh20 (2l/kpa)

total thoracic compliance is 85-100ml/cmh20 (0.85-1l/kpa)

1/Ctotal = 1/Cchest + 1/Clung

Question 25

hysteresis of pr-vol loop because ?

Answer 25

hysteresis of pr-vol loop because inflation and deflation curves different due to need to overcome surface tension upon inflation or inspiration

Question 26

static compliance = ?

Answer 26

static compliance = stiffness of lung and chest wall (alveolar stretachbility, measure with no gas flow

Question 27

dynamic compliance =?

Answer 27

dynamic compliance = airway resistnace during equilibration of gases at end inspiration or end expiration. less than static

Question 28

specific compliance = ?

Answer 28

specific compliance = Ctotal/FRC

Question 29

Increased compliance: ? Reduced compliance:?

Answer 29

Increased compliance: surfactant, emphysema (loss of elastic recoil), old age, acute asthma ( loss of elastic recoil at total lung capacity and increased compliance of airways in spite of airway oedema) Reduced compliance: pulm fibrosis, pulm vein engorgemnet, pulm oedema (interstitial oedema), ARDS, pneumonia, neonates, extreme lung volumes, chonric bronchitis(dynamic)

Question 30

end tidal co2 in cardiac arrest =?

Answer 30

end tidal co2 in cardiac arrest = o.4kpa no cardiac output, no perfusion of lungs extreeme deadspace with both lungs; although arterial co2 may be elevated end tidal co2 will be low if there is effective CPR or 0 if ineffective. Asystolic pts have no bp, likely to have resp/met acidosis so bicarb liekly to be low.

Question 31

anatomical dead space increased: ? anatomical dead space decreased by: ? alveolar deadspace increased : ?

Answer 31

anatomical dead space increased: neck ext, jaw prot, incr tv, neonates, elderly, bronchodilation, anticholinergic, catecholamine anatomical dead space decreased by: neck flex, low tidals, gen anaes, intubation, trach, 5 hydroxytryptamine, histamine alveolar deadspace increase: pe, pulm disease, hypovolaemia, hypoten, general ana, ippv, peep

Question 32

physiological dead space =?

Answer 32

antamonical 150ml + alvealr 0ml | normally about 30% of tv VD/VT=0.3 calc by bohr equation

Question 33

Hypoxemia stimulates ventilation by effect on: ____

Answer 33

carotid bodies via glossopharyngeal and aortic bodies via vagus nerve (sensitive to o2 tension, NOT content)

Question 34

Central chemoreceptors respond to changes in ___

Answer 34

pH + pCO2

Question 35

Central respiratory neurones are ____ by hypoxia

Answer 35

depressed

Question 36

Muscle fibres are long ____ cells, ___micrometers in diameter, length is from ___ to ___. individual fibres have ___ neural contact near midpoint from where the ____ travels along _____ membrane, down _ ____ to initiate contraction.

Answer 36

Muscle fibres are long multinucleate cells, 50-70 micrometers in diameter, length is from mm to cm. individual fibres have single neural contact near midpoint from where the Action potential travels along sarcolemmnal membrane, down T-tubule to initiate contraction.

Question 37

Section of dorsal root nerves C3-L2 causes: - - -

Answer 37

Section of dorsal root nerves C3-L2 causes: - hypotonia - loss of reflexes - loss of sensation (NOT paralysis, not loss of supply to symp sweat glands) Because dorsal = sensory roots as only has sensory fibres and Preganlionic output to ANS travels in ventral nerve root. Sensory neurones enter via dorsal horn into spinal cord, 2/3 synapse in dorsal grey horn, 1/3 travel up cord to gracile and cuneate nuclei. Sensory neuroens form part ofpathway for reflex arcs and moitoring of muscular tone via muscle spindles.

Question 38

In normal blood: - ___ml O2 carried per 100ml plasma - o2 combines with ___ in haemoglobin - viscosity due to ____ - as veolcity increases

Answer 38

In normal blood: - 0.3ml O2 carried per 100ml plasma = 0.03ml/l per mmHg partial pressure (most is bound to Hb) - o2 combines with haem moiety in haemoglobin - viscosity due to haematocrit. plasma 1.8x more viscous as water. - as veolcity increases plasma skimming occurs when red cells flow in cntre of vessels leaving relatively red cell poor blood at periphery. 95% of RBC glucose consumed by anaerobic glycolysis

Question 39

``` Carotid bodies found ___. Respond to: 1. 2. 3. ```

Answer 39

bifurcation of common carotid supplied with branch from ext carotid Respond to: 1. low o2 tension (not content) Low Pa O2 2. increase in PaCO2 3. pH (c.f. aortic bodies that respond to low PaO2 + high paCO2 only)

Question 40

Carotid bodies blood flow vs myocardium blood flow

Answer 40

200ml/100g/min carotid bods >> 84ml/100g/min myocardium

Question 41

Valsalva manouevre assoc with:

Answer 41

``` Valsalva manouevre assoc with: rise in intrathoracic pr compresses central veins reduces preload + CO baroreceptor output is inhibitied resulting in a tachycardia + increased peripheral vascular resistance. ```

Question 42

Thyroid stimulating hormone produces:

Answer 42

Thyroid stimulating hormone increases: - thyroidal uptake iodine - coupling of monoiodotyrosine and diiodotyrosine, formation T3,T4 - synthesis of thyorglobulin and secretion into colloid - cyclic amp in thyeorid cells - BMR

Question 43

Post pancreatectomy:

Answer 43

- failure of exocrine + endocrine function - decrease insulin + glucagon - impaired carb + fat metabolism so higher plasma levels of ffas steatorrhea due to lack fo pancreatic lipase

Question 44

Glucagon actions:

Answer 44

``` Glucagon actions: glycogenolytic gluconeogenetic lipolytic ketogenic ``` glucose is formed from anio acids thus lowering plasma levels while ffa released, exerts positive inotropic and chrootropic action on myocardium via increased myocardial calcium realease and used in treatment of beta blocker overdose but doesn't stimulat SNS directly -

Question 45

A decreased ECF volume would likely cause increased secretion of:

Answer 45

A decreased ECF volume would likely cause increased secretion of : vasopressin renin ( progesterone blcoks action of aldosterone)

Question 46

high plasma calcium causes:

Answer 46

high plasma calcium causes: - reduced intestinal absorption via reduction in 1,25 dihydroxycholecalciferol and formation of 24,25 dihydroxycholecalciferol instead Calcitonin is increased inhibiting bone reabsoption and increasing urinary Ca exretion bone deminieralisation may occur in presence of primary hyperparathyroidsm but notdue to hypercalcemia itself