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Critical Care MRCS Part B > Critical Care MRCS part B > Flashcards

Critical Care MRCS part B Flashcards

1
Q

organic compound containing arrangement of 4 cycloalkane rings joined together - describes what substance?

A

Steroids

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2
Q

which factors increase aldosterone production?

A

Angiotensin II (via RAA)
reduced Na+
Increased K+

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3
Q

sodium reabsorption and potassium excretion at the distal convoluted tubule andcollecting duct - describes what steroid?

A

Aldosterone

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4
Q

aldosterone leads to water retention by what mechanism?

A

Sodium reabsorption

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5
Q

Excretion of potassium causes what effect on acid base balance?

A

Metabolic alkalosis

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6
Q

glucocorticoids have their hyperglycaemic effect by what mechanisms?

A

Antagonise insulin

Stimulate gluconeogenesis

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7
Q

corticotrophic releasing hormone is produced where?

A

Hypothalamus

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8
Q

ACTH is produced where?

A

Anterior pituitary

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9
Q

what hormones are produced by the anterior pituitary?

A 
ACTH
GH
Prolactin
TSH
FSH, LH
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10
Q

what hormones are produced by the posterior pituitary?

A

ADH

Oxytocin

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11
Q

what are the 4 main features of addisonian crisis?

A

Abdominal pain
Nausea/Vomiting
Unexplained Shock
Hyper/Hypothermia

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12
Q

when does addisonian crisis occur?

A

Acute reduction in circulating steroids

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13
Q

what is the specific management of addisonian crisis?

A

IV Fluids
IV steroids
Adjustment and replacement of electrolytes

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14
Q

in addison’s disease what happens to the sodium and potassium levels?

A

Low Na+

High K+

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15
Q

what does ASA 6 correspond to?

A

A declared brain dead person whose organs are being removed for donor purposes

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16
Q

what does the LEMON assessment stand for when assessing for signs of difficult intubation?

A 
L = Look
E = Evaluate
M = Mallampati score
O = Obstruction
N = Neck mobility
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17
Q

what does the 3-3-2 rule stand for when allowing alignment for easier intubation?

A

Incisors - 3 fingers between
Hyoid + Chin - 3 fingers between
Thyroid notch + floor of mouth - 2 finger between

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18
Q

what are the admission criteria to HDU?

A

HDU - 2:1 nursing
Close/invasive monitoring of unstable patient
Single Organ support

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19
Q

what are the admission criteria to ITU?

A

ITU = 1:1 nursing
Mechanical support of organ function
Multi-organ support
Reversible condition

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20
Q

what is the definition of shock?

A

Inadequate tissue perfusion to meet metabolic requirements

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21
Q

what type of shock can occur after spinal anaesthesia?

A

Distributive shock

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22
Q

what specific examination would you perform in a patient after a spinal anaesthetic?

A

Neurological status of legs

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23
Q

blood pressure is equal to what?

A

BP = CO x SVR

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24
Q

what are the contents of a tracheostomy box?

A 
Tracheostomy tube of same size
Tracheostomy tube one size smaller
Spare inner tubes
Resuscitation bag and mask
Suction and suction catheters
0.9% NaCL + syringe to moisten plug
Scissors + tape
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25
Q

what are the airway indications for a tracheostomy tube?

A

Upper Airway Obstruction eg. trauma, oedema
Prophylaxis eg. H+N surgery
Emergency Procedure

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26
Q

what are the breathing indications for a tracheostomy tube?

A

Prolonged Ventilation eg. NM disorders
Facilitation of Ventilator weaning
More efficient Secretion Management + pulmonary toilet

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27
Q

what are the indications for renal replacement therapy?

A 
Anuria/Oliguria
Hyperkalaemia K+ >6.5
Acidaemia ph <7.1
Fluid overload (refractory)
uraemic complications (encephalopathy, pericarditis)
drug overdose
temp control
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28
Q

which diseases are blood transfusions screened for in the uk?

A 
Hep B
Hep C
HIV
Syphilis
CMV
HTLV - in 1st time donors
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29
Q

what dose of steroid is given at induction to pts at risk of adrenal insufficiency?

A

Hydrocortisone 100mg IV

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30
Q

what regular daily dose of prednisolone puts pts at risk of adrenal insufficiency?

A

Pred 5mg or over

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31
Q

for how long can RBC be stored and at what temp?

A

35 days, 2-6 Celsius

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32
Q

for how long can platelets be stored and at what temp?

A

5 days, 20-24 Celsius (room temp)

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33
Q

for how long can FFP/Cryoprecipitate be stored and at what temp?

A

1 year, -30 celsius

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34
Q

what are the constituents of FFP?

A 
Albumin
All clotting factors
Complement
Fibrinogen
vWF
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35
Q

what are the constituents of Cryoprecipitate?

A

Factor VIII
Factor XIII
Fibrinogen
vWF

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36
Q

what electrolyte abnormalities can occur after blood transfusion?

A

Hyperkalaemia

Hypocalcaemia (due to citrate binding calcium)

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37
Q

what biochemical abnormality commonly occurs in prolonged and persistent vomiting?

A

Hypokalaemic, hypochloraemic metabolic alkalosis

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38
Q

what are the clinical features of hypokalaemia?

A

Mild: muscle weakness, cramps, myalgia
Severe: paralysis, hyporeflexia

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39
Q

what are the ECG findings in hypokalaemia?

A

Flat/inverted T waves
ST depression
U waves
Prolonged PR interval

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40
Q

what is the max speed limit of K+ replacement using a peripheral line?

A

10mmol/hr

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41
Q

what is the most common level of C spine fracture?

A

C5

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42
Q

the balthazar scoring system for pancreatitis uses which imaging modality?

A

CT scan

43
Q

what does the glasgow criteria stand for in pancreatitis staging?

A 
P - PaO2 <8
A - Age >55y
N - Neuts >15
C - Calcium <2
R - Renal function (urea >16)
E- Enzymes LDH >600, AST >1000
A - Albumin <32
S - Sugar glucose >10
44
Q

Why does hypocalcaemia occur in pancreatitis?

A

Saponification of omental fat by pancreatic enzymes. Free fatty acids released from breakdown of omental fat by pancreatic enzymes - chelate calcium

45
Q

which cells produce insulin?

A

B cells of islets of langerhans

46
Q

what cells produce somastatin?

A

Delta cells of islets of langerhans

47
Q

what cells produce glucagon?

A

Alpha cells of islets of langerahns

48
Q

what is the henderson hasselback equation?

A

CO2 + H20 = H2CO3 = HCO3 + H+

49
Q

what is a normal anion gap?

A

8-16

50
Q

what is the equation to calculate anion gap?

A

(Na+ + K+) - (Cl- + HCO3-)

51
Q

what are the most important blood buffers?

A

Bicarbonate and haemoglobin

52
Q

what are the ECG findings in hyperkalaemia?

A 
Tall tented  waves
Shortened QT
ST depression
Absent P waves
Progressive QRS widening
53
Q

what is the definition of oliguria?

A

<0.5ml/kg/hr urine output

54
Q

in the classification of acute limb ischaemia at which category is muscle paralysis noted?

A

Partial muscle paralysis stage IIb

55
Q

in the classification of acute limb ischaemia at which category is sensory loss noted?

A

Partial sensory loss from IIa

56
Q

what are the risks of an embolectomy?

A 
Intimal damage
Arterial puncture
Pseudoaneurysm formation
Amputation if ischaemia is irreversible
Damage to femoral vein/nerve
57
Q

what are the chest x ray findings in ARDS?

A

Diffuse bilateral pulmonary infiltrates

58
Q

what is the definition of ARDS?

A

Clinical syndrome consisting of acute respiratory failue, non cardiogenic pulmonary oedema leading to hypoxaemia + decreased lung compliance that is refractory to oxygen therapy

59
Q

What are the 3 key characteristics of ARDS?

A
  1. Diffuse bilateral pulmonary infiltrates on CXR
  2. Normal pulmonary artery wedge pressre (PaWP <18mmHg)
  3. PaO2/FiO2 ratio <26.6Kpa
60
Q

how does mechanical ventilation aid treatment in ARDS?

A

Aid oxygenation, reduce work of breathing, improve CO2 clearance

61
Q

how does prone ventilation improve ARDS?

A

Improves V/Q mismatch
Minimises basal atelectasis
Redistributes secretions

62
Q

where is a tracheostomy commonly performed?

A

2nd - 5th tracheal ring

63
Q

where is a crichothyroidotomy performed?

A

Through cricothyroid membrance between cricoid cartilage and thyroid cartilage

64
Q

what is the definition of pain?

A

Unpleasant sensory + emotional experience associated with actual or potential tissue damage

65
Q

what can occur as a complication of pain?

A 
Increase sympathetic tone
Atelectasis + LRTI
Reduced mobility
Chronic pain
Imparied sleep
negative psychological effects
66
Q

what is another name for a pain receptor?

A

Nociceptor

67
Q

what sensation is carried by myelinated A-delta fibres?

A

Quick sharp localised pain

Fast transmitted

68
Q

What sensation is carried by the unmyelinated C fibres?

A

Dull, deep throbbing pain
Poorly localised
Slow conducting

69
Q

what are the risk factors for chronic post surgical pain?

A 
Pre op pain
longer duration of surgery
ADjuvant chemo/radiotherapy
Intraoperative nerve injury
Psychological factors
Severe post op pain
70
Q

what is the definition of massive transfusion?

A

Replacement of >1 blood volume in 24 hrs

>50% blood volume in 4 hours

71
Q

what are the pharamcological alternatives to blood transfusion?

A 
Iron tablet
EPO
TXA
Recombinant FVIIIa
Cell saver device - autologous transfusion
72
Q

what are the reversible causes of apnoea (non brain stem)?

A

C-spine injury
Hypoxia
Neuromuscular weakness

73
Q

what is parklands formaula?

A

Fluid requirement (ml) = 2-4% burn x weight (kg)

74
Q

over what time is fluid resuscitation given in burns?

A

Half given in 1st 8 hours from burn

Half given subseuqent 16 hours from burn

75
Q

what are the immeadiate complications of central line insertion?

A

Haemorrhage
Pneumothorax
R atrial perforation

76
Q

what are the early complications of central line insertion?

A

Bloackage
Cyclothorax (L side)
pseudoaneurysm

77
Q

what are the late complications of central line insertion?

A 
Infection
Thrombosis
Catheter failure
Vascular erosion
Vascular stenosis
78
Q

what does a CXR performed after insertion of a central line check for?

A
  1. Position of radioopaque tip (should be in SVC just uperior to its insertion into R atrium)
  2. Pneumothorax
79
Q

what is a normal tissue pressure?

A

0-10mmHg

80
Q

what delta pressure is suggestive of compartment syndrome?

A

<30mmHg

81
Q

how is delta pressure calculated?

A

Diastolic BP - intracompartment pressure

82
Q

where is the incision placed to decompress the anterior and lateral compartments of the leg?

A

Full length anterolateral incision, 2 fingerbreadths lateral to subcutaneous border of tibia, from just above ankle to tibial tuberosity

83
Q

where is the incision placed to decompress the posterior compartments of the leg?

A

Full length incision 2 fingerbreadths medial to subcutaneous border of tibia from tibial tuberosity to 5cm above medial malleolus

84
Q

what is the underlying pathology behind rhabdomyolysis causing renal failure?

A

Acute tubular necrosis

nephrotoxic effect of myoglobin on renal tubules

85
Q

what is myoglobin?

A

Oxygen binding protein found in muscle

86
Q

what is gamma glutamyltransferase and where is it found?

A

In hepatocytes and epithelium of small bile ducts

87
Q

Aside from the liver, where is ALP found in the body?

A

Bone and placental tissur

88
Q

what enzyme is responsible for the conjugation of bile?

A

Glucoronyl transferase - conjugates bilirubin with glucuronic acid. It is then water soluble and extrected in bile

89
Q

what bacteria are responsible for metabolising conjugated bilirubin?

A

Colonic bacteria - form stercobilinigen which is further oxidised into stercobilin + excreted in faeces

90
Q

what is the definition of spinal shock?

A

Flaccid paralysis, areflexia, loss of sensation associated with spinal cord trauma

91
Q

what is the definition of neurogenic shock?

A

Loss of sympathetic outflow (and therefore unopposed parasympathetic outflow) due to spinal cord injury.Presents with bradycadia, hypotension due to decreased peripheral vascular resistance

92
Q

which nerve roots are tested for in the bulbocavernosus reflex?

A

S2,3,4

93
Q

absence of the bulbocavernosus reflex is indicative of what?

A

Spinal shock

94
Q

what is the definition of complete spinal cord injury?

A

Occurs in the presence of an intact bulbocavernosus reflex where there is no sensory or motor function below the level of injury

95
Q

what is the definition of incomplete spinal cord injury?

A

Occurs in presence of an intact bulbocavernosus reflex where there is some neurological function below the level of injury

96
Q

autonomic dysregulation can occur in patients with a spinal cord injury above what level?

A

T6

Sympathetic response below level
Parasympathetic response above level

97
Q

what operation is curative in UC?

A

Panproctocolectomy

98
Q

what are the main medical management options in IBD?

A 
Steroids
Aminosalicylates
Thiopurines
Methotrexate
Biologic agents
99
Q

in which type of IBD is mesenteric fat wrapping seen?

A

Crohns

100
Q

in which type of IBD does bowel wall thickening occur?

A

Crohns

101
Q

which internal jugular vein has a straighter and more direct route to the SVC and R ventricle?

A

Right internal jugular

102
Q

NICE guidelines suggest conservative management with antibiotics for diverticular abscesses of what size?

A

<3cm

103
Q

long standing use of what drugs increase risk of diverticular disease?

A

Opiates

104
Q

which bones make up the pterion of the skull?

A

Frontal
temporal
sphenoid
Parietal

Critical Care MRCS Part B (1 decks)

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