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MRCS Part b > Critical Care > Flashcards

Critical Care Flashcards

1
Q

FFP Diseases screened for and not screened for

A

HBV, HCV, CMV, HIV, Syphillis

Not screened for prion

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2
Q

What is bile?

A 
Complex material containing:
Water
Bile salts (form micelles with triglycerides)
Conjugated bilirubin 
Cholesterol
Phospholipids
  1. Aid in fat emulsification into fatty acids for absorption in terminal ileum
  2. Help to excrete bilirubin (ie: Hb breakdown product, therefore reduced excretion causes jaundice).
  3. Excrete cholesterol
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3
Q

DIC blood test findings:

Treatment

A
  1. Thrombocytopenia
  2. Raised d-dimer (ie. fibrin breakdown products)
  3. Low fibrinogen
  4. Raised PT and APTT
  5. Reduced individual clotting factors
  6. MAHA (microangiopathoc haemolutic anaemia)
Treatment:
Platelets
FFP
Cryoprecipite
PRC if anaemic
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4
Q

Cryoprecipitate:

  1. Composition and production
  2. Uses
A
  1. VII, XIII, fibrinogen, vWF. Produced from centrifuge of FFP, for more concentrated above components.
  2. Massive haemorrhage
    DIC
    Last resort in haemophilia ans vWD
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5
Q

FFP

  1. Components
  2. Storage
  3. Uses
  4. Dose
A
  1. All the clotting factors and fibrinogen and vWF, albumin, complement. When centrifuged, produces cryoprecipitate and cryosurfactant
  2. -30deg, used immediately when thawed. Shelf life 1yr
  3. Liver disease causing deranged clotting
    DIC
    Massive transfusion
    Factor V problems
  4. 15ml/kg
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6
Q

Prothrombin Complex Concentrate

A

Vitamin K dependent clotting factors:
2, 7, 9, 10

For correction of warfarin and prolonged PT

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7
Q

Massive Transfusion

  1. Definition
  2. Complications
A
  1. Patients circulating volume replaced within 24 hours
  2. Pulmonary oedema
    Thrombocytopaenia (dilutional)
    Reduced clotting factors (?dilutional)
    Reduced 2-3BPG therefore reduced oxygenation
    Hypothermia
    Hypocalcaemia (citrate chelation)
    Hyperkalaemia
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8
Q
  1. Cardiac index calculation
  2. Normal cardiac index
  3. Cutoff for suspicion of cardiogenic shock
A
  1. Cardiac output(ie. SV*HR)/ BSA (body surface area)
  2. 2.4-2.5ml/min/m^2
  3. <2.2ml/min/m^2
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9
Q

Absolute contraindications for organ donation

A

New variant CJD

HIV

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10
Q

Normal adult blood volume

A

7% of total adult body weight.

Therefore 70kg person will have 4.9L total blood volume

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11
Q

Definition of “Massive Haemorrhage”

A
  1. Loss of total circulating volume within 24hr
  2. Loss of 50% circulating volume within 3 hours
  3. 150ml/min
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12
Q

Indications for CVC

A 
Medications
Fluid monitoring
IV access
TPN
Haemodialysis
Transvenous cardiac pacing
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13
Q

CVP waveform:

A
C
X
V
Y
A 
A: atrial contraction
C: Closure of tricuspid valve
X: atrial relaXation
V: Venous filling into RA
Y: tricuspid opening
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14
Q

CVC Complications

A 
Pneumothorax
Damaging thoracic duct in left IJV causing chylothorax
Haemothorax 
Cardiac: arrhythmias, tamponade
Arterial puncture 
Air embolus
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15
Q

Daily recommended protein intake

A

0.8g/kg/day

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16
Q

Daily recommended nitrogen intake

A

1.5g/kg/day

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17
Q

Non-traumatic causes of fat embolism

A

Bone marrow transplant
Bone tumour lysis

Acute pancreatitis
Fat necrosis of omentum

Liposuction
Sickle cell crisis
Parenteral lipid infusion

Cardiopulmonary bypass

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18
Q

Traumatic causes of fat embolism

A

Fractures: long bone, pelvic, femur, tibia
Orthopaedic procedures: intramedullary reaming, knee arthroplasty
Massive soft tissue injury (ie. major burns)

19
Q

“Sepsis six”

A
  1. Oxygen via non-rebreathe
  2. Blood cultures
  3. Broad spectrum Abx
  4. IV fluids (early goal directed therapy)
  5. Monitor lactate and Hb
  6. Urinary catheter and monitor hourly output
20
Q

Daily calorie requirements

  1. Normal adult
  2. Trauma
A
  1. 30kcal/kg/day

2. 50kcal/kg/day

21
Q

AKI definition

A

Biochemical diagnosis. Acute inability of kidneys to clear nitrogenous waste and other metabolites, reflected in Ur and Creat.
Reversible, <48hr onset

22
Q

Urine output for a child

23
Q

Indications for burns unit (7)

A

Inhalation
>10% burn
Sensitive areas (face, hands, perineum)
Weird burn (ie. electricity, chemical)

Kids/old (<5 and >60)
Comorbidities
NAI

24
Q

NICE guidelines for Peri-operative hypothermia

A
  1. Bair hugger
  2. Warmed IV and wash fluids
  3. Expose patient only when necessary
  4. Patient should not leave recovery until temperature >36deg
25
Q

Familial adenomatous syndromes

A 
FAP
HNPCC
juvenile polyposis
Hyperplasia
Peutz-Jeger
26
Q

Gardener syndrome

A

FAP + other rumours:

Epidermoid cysts, osteomas, retinal tumours

27
Q

HNPCC

  1. Genetic defect and chromosomes
  2. Other tumours
A
  1. DNA mismatch repair, chromosomes 2 and 3

2. Gynae tumours (uterus,ovary), other GI (small bowel, pancreas), renal

28
Q

Prevention of sickle crisis

A 
Oxygen
Well hydration
Warm
Transfuse (Hb >9)
Analgesia (opioid)
Early antibiotics
29
Q

Why aortic stenosis is dangerous in surgery

A

Fixed cardiac output, cannot compensate when there is a reduction in afterload (ie. TPR).

Therefore high risk of cardiac events due to reduced coronary perfusion pressure.

Spinal anaesthetic particularly risky

30
Q

Loop diuretic mechanism

A

Loop of henle
Blocks Na/K pump, prevents sodium reabsorption by vasa recta.
Prevents concentration gradient generated by countercurrent gradient

31
Q

Thiazides diuretic mechanism of action

A

PCT and DCT

Blocks Na/Cl symporter

32
Q

Potassium sparing diuretics

  1. MoA
  2. Examples
A
  1. DCT. Na/K exchanger, therefore Na absorption reduced, K increased
  2. Spironolactone
    Amiloride
33
Q

Enzyme which warfarin inhibits

A

Vitamin K epoxide reductase

WEPT - warfarin, extrinsic, PT

34
Q

What is a pancreatic pseudocyst

  1. Presentation
  2. Management
A

Encapsulated fluid collection, encased by distinct fibrous capsule. Usually is from leakage of enzyme rich pancreatic fluid from pancreatitis.
Lesser sac

  1. Abdo pain, N&V, mass
  2. 50% spontaneously resolve, conservative management, catheter or surgical drainage. Wait 3 months before draining. Can become infected
35
Q

Lifespan of a RBC

36
Q

Common organisms to cause OPSI in post-splenectomy

A

“SHEN”

S. Pneumonia
Haemophilus B
E. Coli
Neisseria

(Also need annual flu vaccines)

Prophylactic penicillin V for 2 years post splenectomy or until 16y/o

37
Q

Splenectomy complications

A

Immediate: haemorrhage

Early: gastric stasis
Gastric necrosis
Subphrenic abscess
Pancreatitis (ie all related to blood supply)

Late: pancreatic fistula
Thrombocytosis and increased plate size
Thrombotic risk
OPSI

38
Q

PRC shelf life

A

35 days, stored at 4deg

39
Q

Respiratory quotient

A

CO2 excretion/O2 consumption

40
Q

TPN indications

A 
Systemic:
Burns
Malnutrition
Pancreatitis 
Trauma

GIT:
Enterocutaneous fistula
Short gut syndrome
Crohn’s disease

41
Q

Shelf life of platelets

A

5 days, kept in incubator at 20-40degrees

42
Q

TPN Cx

A 
Metabolic:
Glucose imbalances
Raised lipids
Deranged LFT from enzyme induction due to amino acid imbalance 
Refeeding
FA deficiency

NB. Too much glucose increase CO2, therefore increased ventilation required

GIT:
Mucosal atrophy and bacteria translocation

Line complications:
Thrombophlebitis
Thromboembolic

43
Q

Locations of carbonic anhydrase enzyme (x4)

A

Places that make HCO3

RBC
Renal tubules
Pancreas
Gastric mucosa (?salivary glands)

MRCS Part b (12 decks)

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