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MRCS Past Questions Knowledge > Critical Care > Flashcards

Critical Care Flashcards

1
Q

Layers of the adrenal gland and what is produced?

A

Adrenal cortex- ACE, GFR

Medulla- adrenaline/norad

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2
Q

Role of aldosterone?

A

Upregulate Na/K channels in DCT

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3
Q

Impact of steroids on surgery

Steroid SE

A

PUD, pancreatitis, poor wound healing, surgical site infections/other infections, increase risk of addisonian crisis

CUSHINGOID
Cataracts
Ulcers
Skin: striae, thinning, bruising
Hypertension/ hirsutism/ hyperglycemia
Infections
Necrosis, avascular necrosis of the femoral head
Glycosuria
Osteoporosis, obesity
Immunosuppression
Diabetes
Fuid retention- hypernatraemia
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4
Q

Addisonian crisis presentation

A

Abdo pain, nausea, v, shock, HypoNa, HyperK

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5
Q

Method of action of insulin?

A

Increased glucose uptake by cells, glyogenosis, fatty acid synthesis
via Glut 4 transporter

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6
Q

Hyperglycaemia periop risks?

A

Poor wound healing
Infections
Poor cardiovascular status
HHS

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7
Q

How to Dx rhabo?

A

Massively raised CK

Urine dip for Hb/Myoglobin

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8
Q

Causes of pneumoperitoneum?

A

Rupture- peptic ulcer,
Post laparoscopy
Peritoneal dialysis
Pneumothorax/mediastinum

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9
Q

Why do you get variable BP in AF

A

Variable pulse pressures

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10
Q

Management of AF?

A

Haemodynamically unstable?
Investigate for causes and treat underlying
Treatment rhythm vs rate control
Long term VTE
Cardiovert- DC vs chemical (flecanide vs amiodarone)
Medics

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11
Q

Causes of AF?

A 
Cardiac- MI, HF, valvular disease
Pulmonary- PE/infection
Spetic
Electrolyte disturbances
Dehydration
Thyroid
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12
Q

What is central cord syndrome?

A

Upper limbs worse than lower

Upper limbs corticospinal tracts run centrally, lower run peripherally

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13
Q

Hypothermia definition and causes?

A

<35oc
Pre hospital- Prolongued exposure, low exterior temperature, wet
Patient- unable to shive, hypotension, Alcohol
Pre op- exposure for examination, massive transufsion- blood/fluids
Op- anaesthetic, open stomach, cold theatre

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14
Q

Complications of hypothermia?

A

Coagulopathy, acidosis, hypothermia- trauma triad
Enzyme dsyfunction
Arrythimas- J waves, widened QRS
Decreased cerebral blood flow, coma
Decreased gut motility
Hypoxia- left shifting of curve leading to holding on ton O2
Death

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15
Q

Fluid resuscitation volume in kids?

A

20ml/kg for bolus

Crystalloid

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16
Q

Haematemesis management?

A 
A2E
Early intubation, resuscitate, access, correct coagulopathy
IV somatostatin/omeprazole
TXA
Abx
Endoscopy- banding/sclerotherapy
Balloon tamponade- minnesota/blakemore
Propanolol-2o prohylaxsis

Rockall/Blatchford

TIPSS
Shunt surgery
Liver transplant

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17
Q

What is the monoroe kelly doctrine?

A

Skull is a closed box, pressure within regulated by brain tissue, blood and csf

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18
Q

How to measure ICP?

A

ICP/LP opening pressure/doppler?

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19
Q

Aortic stenosis effect on heart?

A

Hypertrophied, increased O2 demand, decrease compliance, inability to adapt to changing BP, Increased hypotension/MI risk

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20
Q

Why AF/tachycardia leads to MI?

A

Shorter diastole time, less filling time for coronaries

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21
Q

Definition of TURP syndrome?

A

Excessive absorption of irrigation fluid during TURP

Leading to rapid hyponatraemia and fluid overload

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22
Q

How to treat TURP syndrome?

A

Stop irrigation
Avoid it- short op, haemostasis
Treat hyponatraemia- hypertonic saline- central line ITU
Treat overload- mannitor/furosemide

May need ITU and haemofiltration

23
Q

What is a pseudocyst?

A

GOO, abdo pain, vomiting, fullness

Leakage of pancreatic enzymes/fluid surrounded by fibrous/granulation tissue

24
Q

Why may amylase not be raised in pancreatitis?

A

Peaks at 48 hours- before/after

25
Q

Causes of jaundice and obstructive jaundice?

A

Causes of jaundice- pre hepatic (haemolysis), hepatic (hepatitis) and post hepatic
Obstructive jaundice causes- intraluminal, luminal and extraluminal

26
Q

What is the enterohepatic circulation?

A

Process by which bile salts are reabsorbed and rescreted in bile
95% of them
Liver to small intestine then back to liver

27
Q

Where is ALP, AST, ALT and GGT produced?

A

AST produced by hepatocytes, heart, kidney, brain
ALT- hepatocyctes
ALP- biliary epithelium, bone, placenta
GGT- hepatocytes and biliary epithelium

28
Q

Role of bile salts in fat absorption?

A

increase surface area, globules to micelles

29
Q

Composition of bile?

A

water, bile salts, bile pigment, cholesterol

30
Q

Common organisms of cholangitis?

A

E.coli

Klebisella

31
Q

Causes of LBO/SBO?

A

LBO- malignancy, volvulus, diverticulitis

SBO- hernia and adhesions

32
Q

Types of nutritional delivery?

A

Oral, NG, NJ, PEG, Jejunostomy

Partial parenteral and TPN

33
Q

Complications of TPN?

A 
Venous access: 
	• Pneumothorax
	• Air embolism
	• Bleeding
	• Venous thrombosis
	• Vascular injury 
	• Line infections
Metabolic abnormalities:
	• Refeeding syndrome in chronic alcoholic patients, and in patients who have nothing-by-mouth status (NPO) for more than 7 to 10 days
	• Hyperglycemia 
	• Serum electrolyte abnormalities
TPN Jaundice- hepatotoxic?
34
Q

Components of TPN?

A

lipid emulsions, dextrose, amino acids, vitamins, electrolytes, minerals, and trace elements

35
Q

Complications of enteral feeding?

A 
Blockage
Fistula
Refeeding syndrome
Aspiration
Nausea/bloating/diarrhoea
36
Q

Which drug improves gastric motility?

A

Metoclopramide

37
Q

Why may you get a neutral pH on correctly sited NG?

A

PPI

38
Q

Duke’s criteria?

A 
2 major and 1 minor
1 major and 3 minor
Confirmed- +biopsy
Major- 2x +ve blood culture, +ve echo
Minor- vascular/immunological phenomena
Fever
Predisposing factor- IVDU/Heart disease
39
Q

ARDS definition?

A

Bilateral pulmonary infiltrates, non cardiogenic aetiology, with reduced lung compliance, PaO2<8 and PAWP >18

40
Q

Causes of ARDS

A

Burns, SEPSIS, Pancreatitis, trauma, massive transfusion

41
Q

How to calculate burns coverage?

A

Lund Bowder charts
Rule of 9s-https://medical-dictionary.thefreedictionary.com/rule+of+nines
Palm = 1%

42
Q

What is CRP?

A

Acute phase protein released by the Liver in response to inflammation, activates complement

43
Q

Blood pressure drops

What happens?

A 
Decreased pressure in baroreceptors
Fires to cardio centre in hypothalamus
Fires off symphathetic nerve response
Adrenaline/epinephrine
Tachycardia/vascoconstriction
44
Q

Fluid used in burns?

A

Hartmanns

45
Q

Indications for surgery in hypoT?

A

Goitre with airway comprimise

46
Q

Where is calcium stored?

A

99% bone- hydroxapatite
Intracellular
Albumin bound
Ionised form in plasma

47
Q

Hypocalcaemia symptoms?

A 
Parasethesia, paralysis, cramps
Chvosteks
Trousseaus
Arrythmias
Seizures
48
Q

What are the causes of gastric outlet obstruction?

A

Congenital- pyloric stenosis
Benign- pseudocyst, peptic ulcer fibrosis
Malignant- gastric/duodenal/pancreatic

49
Q

In GOO why hypo K/Cl/Na?

Why aciduria?

A

Why hypokalaemic/chloraemic- loss from vomiting, aldosterone activated leading to K excretion to retain fluid and Na

Hyponatraemia- kidneys secrete NaHCO3 to offset metbolic alkalosis, loss of sodium in vomit, no absorption due to vomiting

Raised bicarb?- increased uptake in renal tubules due to loss of Cl- to maintain charge

Aciduria?- paradoxical aciduria despite metabolic alkalosis, attempt to retain water, retain Na+ but secrete K+/H+ ions leading to aciduria

50
Q

Describe the coag pathway
What activates it?
How to measure it

A

Extrinisic factor
Exposure of basemement membranes- Kallikrein

APTT- intrinsic
PT- extrinsic

51
Q

Pacemaker indications?

A

AV block- 3rd degree
SAN dsyfunction
Bundle branch blocks

52
Q

Pacemaker operative considerations?

A 
Model, indication and date of insertion
		Degree of HF
		Placed in basic mode
		Post op check
		Continous ECG monitoring
		Pacing available
		Limit monopolar- make sure current does not pass through monopolar
53
Q

Sutures- ethilon, vicyl, silk, prolene, PDS, monocryl

A

Ethilon= nylon= non absorbable monofilament

Silk= natural, braided, non absorbable

Vicryl= braided, absorbable

Prolene= unbraided, non absorbable

PDS/Monocryl= absorbable monofilaments

54
Q

How to reverse warfarin?

A

5 days then out of system

Vit k, FFP, beriplex

MRCS Past Questions Knowledge (6 decks)

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