Corrections 2 - Anaesthetics & ICU Flashcards
Which are the main spinal tracts that carry pain signals through the spinal cord? (2)
1) Spinothalamic
2) Spinoreticular
What genetic condition involves the heart muscle being progressively replaced with fibrofatty tissue and becoming prone to ventricular arrhythmias? (1)
Arrhythmogenic cardiomyopathy
What is the name for treatment with a triple chamber pacemaker in severe heart failure with an ejection fraction of less than 35%? (1)
Cardiac resynchronisation therapy (CRT)
Which ECG leads are affected when acute coronary syndrome affects the left coronary artery? (1)
The left anterior descending? (1)
The circumflex artery? (1)
The right coronary artery? (1)
a) I, aVL, V3-V6
b) V1-V4
c) I, avL, V5-V6
d) II, III, aVF
Which class of drug, used as premedication, can help reduce the hypertensive response to the laryngoscope during intubation? (1)
Opiates
Which common condition can lead to gastrointestinal bleeding in critically unwell patients in ICU? (1)
Stress related mucosal disease
What is the name for the stiff metal wire (with a plastic coating) that is inserted into the endotracheal tube before intubation is attempted to help hold the endotracheal tube in a specific shape? (1)
Stylet
What is the first-line medication for managing trigeminal neuralgia? (1)
Carbamazepine
What are the features of the murmur caused by mitral regurgitation? (2)
Where does it radiate? (1)
Pansystolic
High pitched ‘whistling’
Radiates to L axilla
Give two examples of antimuscarinic medications used to treat bradycardia? (2)
1) Atropine
2) Glycopyronium
What are the most common causes of atrial fibrillation? (5)
1) IHD
2) Sepsis
3) Mitral valve pathology (stenosis or regurgitation)
4) Thyrotoxicosis
5) HTN
What are the features of the murmur caused by aortic regurgitation? (2)
1) Early diastolic
2) Soft murmur
What is the first step in maintaining cardiac function and cardiac output in an unwell patient? (1)
Optimise the fluid status
What is the atrial rate in atrial flutter? (1)
Around 300 bpm
Which term refers to the volume of air pushed in per breath during mechanical ventilation? (1)
Tidal volume
What is the mechanism of action of ondansetron? (1)
When would you avoid using it? (1)
5HT3 receptor antagonist
In patients at risk of prolonged QT interval
What is the most common use of a Vas Cath? (1)
Short term haemodialysis
What abdominal findings may be seen in tricuspid regurgitation? (2)
1) Pulsatile liver
2) Ascites
What are the levels of escalation for patients admitted to hospital? Where are they generally managed? (3)
Level 1 - general acute ward
Level 2 - HDU
Level 3 - ICU
What are the two groups of nerve fibres that transmit pain? (2)
Which of these is myelinated? (1)
Which has a larger diameter? (1)
C fibres & A delta fibres
A delta fibres are myelinated
A delta fibres have a larger diameter
Give an example of an alpha-2-adrenergic agonist that may be used as premedication before a general anaesthetic. (1)
Clonidine
What clinical sign is part of the diagnostic criteria for familial hypercholesterolaemia? (1)
Tendon xanthomata
What type of catheter involves a small chamber under the skin at the top of the chest? (1)
Where does this type of catheter enter the venous system? (1)
Where is the tip located? (1)
Portacath
Subclavian vein
Superior vena cava
What are the 3 sites for central line insertion?
1) Internal jugular vein (most common)
2) Subclavian vein
3) Femoral vein
Where does the central line tips terminate?
If inserted into IJV or SV –> SVC near the RA
If inserted into FV –> IVC
What are the key indications for a central line?
1) Medications
2) Fluids (allows rapid flow)
3) Nutrition e.g. TPN
4) Haemodialysis
5) Patients have poor vascular access
Why are some medications given via central line?
1) Some medications are irritants e.g. potassium –> can cause issues if infused into small veins (i.e. in peripheral cannulas).
2) Some medications need central line e.g. vasoactive medications
3) Secured access
Which type of line is used if the patient is going to be going home with the line?
Tunnelled e.g. Hickmann
What are the indications for acute dialysis in patients with a severe acute kidney injury? (AEIOU mnemonic) (5)
Acidosis (severe and not responding to treatment)
Electrolytes (particularly treatment resistant hyperkalaemia)
Intoxicants e.g. overdose of certain medications
Oedema (severe and unresponsive pulmonary oedema)
Uraemia symptoms e.g. seizures, reduced consciousness
What is the mechanism of action of cyclizine? (1)
H1 receptor antagonist
Which two factors contribute to the mean arterial pressure? (2)
1) systemic vascular resistance
2) cardiac output
Which scoring system can be used for identifying delirium in acutely unwell patients? (1)
Confusion assessment method (CAM)
What are the three beneficial cardiovascular effects of using an intra-aortic balloon pump? (3)
Increased coronary blood flow
Reduced afterload
Increased cardiac output
What is the APACHE score used for? (1)
To predict mortality at the time of admission to ICU
What is the name of the extra hole on the side of the tip of an endotracheal tube that gas can flow through should the main opening become occluded? (1)
Murphy’s eye
What are the four stages used when there is unanticipated difficulty intubating a patient? (4)
1) Laryngoscopy with tracheal intubation
2) SGA
3) Face mask ventilation and wake patient up
4) Cricothyroidectomy
What duration of symptoms is required to diagnose chronic pain versus acute pain? (1)
> 3 months
What duration of symptoms is required to diagnose chronic pain versus acute pain? (1)
Allodynia
Which class of medication are most positive inotropes? (1)
Catecholamines
What is the treatment for malignant hyperthermia? (1)
Dantrolene
Which other term can be used to describe a spinal anaesthesia / spinal block? (1)
Central neuraxial anaesthesia
What type of catheter is a Swan-Ganz catheter? (1)
Where is the tip of the catheter located? (1)
What does measuring the pressure in this area indicate? (1)
Pulmonary artery catheter
Pulnonary artery
LA pressure
When is a variable rate intravenous insulin infusion (VRIII) required in surgery?
1) Patients on insulin who are either undergoing major procedures (surgery requiring a long fasting period of more than one missed meal)
2) Patients whose diabetes is poorly controlled