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Book paper questions 500 Flashcards

1
Q

Pin index: 3,5

A

N20

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2
Q

Pin index: 2,5

A

O2 (o2 think two first)

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3
Q

pin index: 1,5

A

air

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4
Q

pin index 1,6

A

co2 (carbon has 6 letters)

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5
Q

pin index 7

A

entonox = 7 letters

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6
Q 
Acute severe asthma:
PEFR
RR
HR
one breath
A 
Acute severe asthma:
PEFR 33-50% predicted
RR>25
HR>110
inability to complete sentences in one breath
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7
Q 
Life threatening asthma:
PEFR
SPO2
Chest signs
Consciousness
PaCO2
PaO2
pH
A 
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
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8
Q

Rx asthma severe adults:

A

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

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9
Q

ARDS definition:

A

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

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10
Q

ARDS management:

A

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

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11
Q 
paeds dose
para
ibu
diclo
fent
morph
codeine
dex
ondans
A 
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
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12
Q 
paed lma size:
1
1.5
2
2.5
3
A 
paeds lma size for weight
1 → <5kg
1.5 →  5-10kg
2 → 10-20kg
2.5 → 20-30kg
3 → 30-50kg
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13
Q

paeds ett diameter size:

e.g. 9 yo

A 
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
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14
Q

paeds tube length at lips

e.g. 9 yo

A

(age/2) + 12cm

e.g 9 yo → 16.5cm

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15
Q

nasal ett tube length

A

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

9 yo → 19.5cm

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16
Q

adult tube length at lips =

A

(height cm/7)-2.5cm

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17
Q

ankle block nerves:

A 
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
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18
Q

raised icp anaes drugs:

A

ketamine
volatile
suxamethonium (transient)

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19
Q

decreased icp anaes drugs:

A

barbiturates, etomidate propofol, opioids

20
Q

ICP mx:
paco2
pao2
general

A

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

21
Q

CPP =?

A

CPP = MAP - (ICP +CVP)

22
Q

Compliance =?

A

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

23
Q

∆P in lung measured difference btw :

A

∆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

24
Q

Normal lung compliance = ?

Normal chest wall compliance = ?

total thoracic compliance = ?

1/Ctotal = ??

A

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

25
Q

hysteresis of pr-vol loop because ?

A

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

26
Q

static compliance = ?

A

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

27
Q

dynamic compliance =?

A

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

28
Q

specific compliance = ?

A

specific compliance = Ctotal/FRC

29
Q

Increased compliance: ?

Reduced compliance:?

A

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)

30
Q

end tidal co2 in cardiac arrest =?

A

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.

31
Q

anatomical dead space increased: ?

anatomical dead space decreased by: ?

alveolar deadspace increased : ?

A

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

32
Q

physiological dead space =?

A

antamonical 150ml + alvealr 0ml

normally about 30% of tv VD/VT=0.3 calc by bohr equation

33
Q

Hypoxemia stimulates ventilation by effect on: ____

A

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

34
Q

Central chemoreceptors respond to changes in ___

A

pH + pCO2

35
Q

Central respiratory neurones are ____ by hypoxia

A

depressed

36
Q

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.

A

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.

37
Q

  • -
A

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.

38
Q

In normal blood:

  • ___ml O2 carried per 100ml plasma
  • o2 combines with ___ in haemoglobin
  • viscosity due to ____
  • as veolcity increases
A

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
39
Q 
Carotid bodies found \_\_\_. 
Respond to: 
1.
2.
3.
A

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)

40
Q

Carotid bodies blood flow vs myocardium blood flow

A

200ml/100g/min carotid bods&raquo_space; 84ml/100g/min myocardium

41
Q

Valsalva manouevre assoc with:

A 
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.
42
Q

Thyroid stimulating hormone produces:

A

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
43
Q

Post pancreatectomy:

A
  • 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
44
Q

Glucagon actions:

A 
Glucagon actions:
glycogenolytic
gluconeogenetic
lipolytic
ketogenic
45
Q

A decreased ECF volume would likely cause increased secretion of:

A

A decreased ECF volume would likely cause increased secretion of :
vasopressin
renin

( progesterone blcoks action of aldosterone)

46
Q

high plasma calcium causes:

A

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

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