Brainscape's Knowledge GenomeTM

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


See full index

MRCS Part B > Critical Care > Flashcards

Critical Care Flashcards

1
Q

What are some causes of chronic kidney disease?

A

Diabetic nephropathy
HTN
Glomerulonephritis
PCKD
Pyelonephritis
Obstructive nephropathy

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

What are the features of chronic kidney disease?

A

Fatigue
Anorexia
N+V
Anaemia
Plt dysfcuntion
Bony disease
Encephalitis/pericarditis (due to the high urea).

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

What are the stages of CKD?

A

1 = GFR >90 (required RF management).
2= GFR 60-90
3 = GFR 30-60 (needs to manage any complications e.g. K+ restriction, protein restriction and consider EPO)
4= 15-30
5= <15 (needs dialysis/transplant

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

What are the advantages and disadvantages or dialysis?

A

Haemodialysis:
Advantages - shorter treatment, efficient K+ removal.
Disadvantages - required heparin, needs a fistula, large fluid shift, BP control is harder, requires hospital.

Peritoneal dialysis:
Adv - lower biochemical changes, higher Hct, self care
Disadv - peritonitis, hernia

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

What are the types of AV fistula?

A

Autologous - direct joins of veins to arteries.
Autologous bridge - uses a vein graft
Synthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the complications of an AV fistula?

A

Nerve Injury
Thrombosis
Steal phenomenon
Venous HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between haemofiltration and haemodialysis?

A

Haemodialysis: requires dialysis fluid. The blood and the dialysis fluid flow in counter current on either side of a permeable membrane to allow osmotic pressure gradient to filter blood.

Haemofiltration: filters blood via hydrostatic pressure.

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

What is an embolus?

A

This is an abnormal mass of material that travels in the flowing circulation from one part of the body to another.

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

What causes necrotising fasciitis?

A
  • Necrotising fasciitis may be caused by a solitary organism or a combination.
  • Group A haemolytic streptococci and Staphylococcus aureus frequently initiate infection, followed by anaerobes, such as Bacteroides spp. and clostridium spp., and coliforms, Proteus
    spp., Pseudomonas spp. and Klebsiella spp.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the role of hyperbaric oxygen therapy in necrotising fasciitis?

A

It improves the oxygenation to infected wounds, it has a bactericidal effect and improves healing.

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

What is gas gangrene?

A

This is a particularly severe form of necrotising fasciitis which is caused by Clostridium perfringens. The necrosis can destroy subcutaneous tissue and muscle rapidly, with copious gas production.

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

What conditions may you need to measure ICP?

A

Traumatic brain injury
Intracerebral/subarachnoid haemorrhage
Hydrocephalus
Malignant Infarction
Cerebral oedema
CNS infection
Hepatic encephalopathy

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

What is the normal ICP?

A

7-15mmHg

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

What are the ways to measure ICP?

A
  • Intraventricular catheter (GOLD STANDARD but most invasive).
  • Intraparenchymal probe
  • Subarachnoid probe
  • Epidural probe
  • Lumbar puncture
  • Tympanic membrane displacement
  • Transcranial doppler
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the Cushing reflex?

A

This is a physiological nervous system response (with mixed vagal and sympathetic stimulation) to an elevated ICP that results in Cushing’s triad. It leads to hypertension, which ensures an adequate CPP.

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

What are the symptoms of raised ICP?

A

Headache
Nausea
Vomiting
Papilledema
Fall in GCS (pressure symptoms and ischaemia)
Dilated pupil due to oculomotor nerve palsy
Defect in lateral gaze
Cushing’s triad

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

How would you manage a raised ICP?

A
  1. Improve venous drainage from the brain: elevate the head of the bed to 30, ensure ties holding the endotracheal tube do not compress the neck veins
  2. Reduce cerebral oedema with mannitol +/- furosemide. Maintain sodium levels at a range of 140-145mmol/l
  3. Reduce the cerebral metabolic rate: avoid hyperthermia, sedation, anticonvulsants, thiopentine infusion reduces the cerebral metabolic rate.
  4. Reduce intracranial blood volume: hyperventilation can be used to reduce PaCO2 as a temporary measure.
  5. Reduce CSF volume: drains
  6. Surgical decompression.
17
Q

What does loss of grey-white mater suggest?

A

This is the areas of the brain that contain nerve cell bodies, this can cause long-lasting cognitive dysfunction.

18
Q

What is the management of an acute subdural haematoma?

A

Urgent surgical evacuation of haematoma for:
- acute SDH +/- coma, with neurological deterioration.
- clot thickness 10mm or midline shift >5mm on initial brain CT
- Signs of neurological deterioration or persistently increased ICP (>20mmHg)

19
Q

What are the advantages of a tracheostomy tube?

A

Easier to clean mouth and face
Better tolerated in the long term
Less likely to aspirate
May help weaning off ventilator
Allows swallowing
Less dead space

20
Q

What is the management of a liver laceration?

A

Conservative: Blood transfusion and monitoring.
Surgical: damage control: perihepatic packing, repair or resection.

21
Q

What four areas are typically examined in a FAST scan?

A

Peri-hepatic space, peri-splenic space, pericardium and pelvis.

22
Q

What are the grades of liver tear?

A

Grade 1:
Haematoma: subscapular <10%
Laceration: capsular tear: <1cm depth

Grade 2:
Haematoma: subscapular 10-50%
Intraparenchymal haematoma: <10cm diameter
Laceration: 1-3cm depth and <10cm length

Grade 3:
Haematoma subscapular: >50% of SA
Intraparenchymal haematoma: >10cm or expanding
Laceration: capsular tear >3cm depth.

Grade 4:
Laceration involving 25-75% of hepatic lobe or 1-3 segments.

Grade 5:
Laceration involving >75% of hepatic lobe or >3 segments
Vascular injury

Grade 6: Hepatic avulsion

23
Q

What are the types of shock?

A

Distributive: septic, SIRS, neurogenic, anaphylactic, endocrine

Cardiogenic

Hypovolaemia (haemorrhagic and non-haemorrhagic)

Obstructive

24
Q

What is the difference between spinal shock and neurogenic shock?

A

Spinal shock= temporary loss of total power, sensation and reflexes below the level of the injury. This occurs due to the peripheral neurons being temporarily unresponsive to brain stimuli.
They get hypotensive and bradycardic, they have an absent bulbo-cavernosus reflex.

Neurogenic shock occurs due to the loss of the sympathetic nervous system signals, leading to loss of sympathetic tone and vasodilation.

25
Q

What agents should be given in neurogenic shock?

A

Vasopressors (noradrenaline, phenylephrine, dopamine).

26
Q

What are the spinal cord syndromes?

A

Central cord:
- greater loss of strength in the upper limbs than lower limbs with varying degrees of sensory loss.
- occurs after hyperextension.

Anterior cord:
- paraplegia and loss of pain and temperature sensation, but intact dorsal column (deep pressure, vibration and proprioception).
- typically due to ischaemia
- poorest prognosis

Brown Sequard syndrome:
- ipsilateral motor loss and loss of proprioception and contralateral pain and temperature loss.
- hemi-section of cord (typically penetrating trauma).

27
Q
A
28
Q

What are the different types of pelvic fracture?

A

AP compression
Lateral compression
Vertical shear
Complex pattern

29
Q

Why do you get a narrow pulse pressure in shock?

A

In hypovolaemia, a decrease in the circulating blood volume will increase SVR to maintain BP. The increase in basi motor tone will raise the diastolic pressure.
Systolic is decreased due to the volume loss.
Therefore pulse pressure is decreased.

30
Q

What is the definition of hypothermia?

A

Core body temp below 32 degrees.

31
Q

What are the stages of hypothermia?

A

<35 = mild - shivering present
<32 = moderate - reduced GCS, loss of fine motor control
<28 = severe - no shivering + arrhythmia

<25 cardiac arrest
<22 death

32
Q

What are some causes of hypothermia?

A

Increase in heat loss vs decrease in thermogenesis
- environmental: prolonged exposure to cold environments, drowning
- drugs: alcohol/sedatives
- sepsis
- shock
- CNS disorder - hypothalamic lesions
- Endocrine - hypothyroidism
- iatrogenic- cold fluids, surgical exposure

33
Q

What are ways heat is lost intraoperatively? What factors increase risk?

A
  • Radiation
  • Convection
  • Evaporation
  • Long operative time
  • Open surgery
  • Large area of exposure
  • Local anaesthetic/ spinal causing vasodilation due to loss of sympathetic tone
  • Propofol causes vasodilation
  • Muscle relaxants prevent shivering
  • Pre-operative sepsis/ hypothermia
  • High ASA grade
34
Q

How are temp changes detected by the body?

A

Core thermoreceptors in hypothalamus and spinal cord.
Peripheral in the skin

35
Q

What physiological responses may you see in hypothermia?

A
  • Peripheral shut down
  • Tachycardia
  • Shivering
  • Reduced CNS function (confusion)
  • Decreased reflexes
  • Loss of fine motor skills
  • Arrhythmia
  • Bradycardia
  • Paroxysmal undressing due to disorientation (pre-terminal)
36
Q

What ECG changes might you see in hypothermia?

A

Bradycardia
Wide QRS
PR interval increase
J wave (positive deflection at the end of the QRS)

37
Q

What are complications of hypothermia?

A

Peripheral ischaemia
End organ ischaemia (due to R shift of O2 curve)
Decreased drug metabolism
Coagulopathy
Reduced metabolism
Cardiac instability; arrhythmia: VF
CNS damage
Death

38
Q

How would you manage hypothermia?

A

Mild: passive warming
- blankets
- remove wet clothes
- warm environment
- minimal exposure

Moderate: peripheral active warming
- warming blankets
- hot water bottles
- bear hugger
- warm fluids

Severe: central active warming
- heated humidified o2
- bladder and intraperitoneal warm lavage

Very severe:
- blood warming via haemodialysis
- cardiac bypass

39
Q
A

MRCS Part B (14 decks)

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