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MRCS-Critical care > Deck 1 > Flashcards

Deck 1 Flashcards

1
Q

Endocrine function of pancreas

A

Alpha: glucagon
Beta: insulin
Delta: somatostatin
PP: pancreatic polypeptide

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2
Q

What is trypsin’s function and how is it activated

A

Produced by pancreas as trypsinogen
Proteolytic enzyme
Activated by enterokinase enzyme in duodenum

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3
Q

How does pancreatitis lead to hyperglycaemia

A

destruction of beta cells of langerhans

no insulin

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4
Q

Acid-base balance formula

A

Henderson-Hasselbach equation

pH= pKa + log ([HCO3]/[PCO2*0.03])

pKa = acid dissociation constant

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5
Q

Anion gap

A

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

Difference between plasma cations and anions

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6
Q

Normal range of anion gap

A

4 - 12

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7
Q

What does an increased in anion gap mean

A

External acid:

  • ketones
  • poisoning (salicylate)
  • lactate
  • Kidney failure

(Bicarb consumed by unmeasured acid, leaving a big anion gap)

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8
Q

What is a buffer

A

Weak acid + conjugate base

or

Weak base + conjugate acid

Resists change in pH

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9
Q

What are buffers in blood

A

Bicarbonate

Haemoglobin

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10
Q

Causes of metabolic acidosis

A

Normal anion gap (loss of bircarb)

  • diarrhoea
  • ileostomy
  • tubular damage

Increased anion gap (gain of acid)

  • ketones (starvation or diabetes)
  • lactate (sepsis)
  • poisoning (salicylate)
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11
Q

Causes of metabolic alkalosis

A
  • vomiting
  • renal loss of H+
  • low chloride state
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12
Q

Causes of resp acidosis

A
  • pneumonia
  • ARDS
  • Neuro: guillian barre
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13
Q

Causes of resp alkalosis

A
  • hyperventilation
  • anxiety
  • altitude
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14
Q

Mx of high K

A
  1. calcium glucanate 10 mls of 10%
  2. insulin (10u actrapid) + 50mls 50% dextrose
  3. Salbutamol nebs
  4. Resonium
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15
Q

Normal urine output for a child and adult

A

Adult: 0.5 ml/kg/hr
Child: 1ml/kg/hr

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16
Q

Causes of acute limb ischaemia

A

Atherosclerosis -> thrombosis

Embolic (secondary to AF)

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17
Q

Rutherford classification of acute limb ischaemia

A

I: not immediately threatened
IIa: salvageable if prompt rx
IIb: salvageable if immediate rx
III: amputation

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18
Q

Definitive mx of acute limb ischaemia

A

Embolic: embolectomy

Thrombotic: thrombolysis or bypass graft

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19
Q

What makes a pneumonia HAP and not CAP

A

HAP: develops after 48hrs post admissi

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20
Q

Early onset vs late onset HAP bacterial causes

A 
Early onset (less than 5 days in hospital): 
Strep pneumonia

Late onset (>5d)

  • MRSA
  • pseudomonas
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21
Q

Causes of ARDS

A

Primary lung cause:

  • pneumonia/COVID
  • contusion
  • aspiration

Secondary:

  • Pancreatitis
  • sepsis
  • Polytrauma
22
Q

Mx of ARDS

A
  1. supportive + rx cause
  2. Mech ventilation
    High PEEP to keep alveoli open on expiration
  3. Prone ventilation
    Improves V/Q mismatch
    Minimises basal atelectasis
    Redistributes secretions
  4. Steroids
23
Q

Mx of ARDS

A
  1. supportive + rx cause
  2. Mech ventilation
    High PEEP to keep alveoli open on expiration
  3. Prone ventilation
    Improves V/Q mismatch
    Minimises basal atelectasis
    Redistributes secretions
  4. Steroids
24
Q

Prognosis of ARDS

A

30-60 % mortality

90% when associated with sepsis

25
Indications for surgical airway
- Failed intubation - Laryngeal trauma: # - Upper airway obstruction
26
CIs to patient controlled analgesia
Delirium/cognitive impairment They need to understand how to use
27
Indications for patient controlled analgasia
Pancreatitis | Major ops
28
Non medication examples of anasthesia
Splinting Hot/cold packs Acupuncture TENS (transcutaneous electrical nerve stimulation)
29
Risk factors for Chronic post-surgical pain
``` Pre-op pain Intra-op nerve injury Post-op SEVERE pain Long ops Chemo/radiotherapy ```
30
Allodynia
Sensation of pain in presence of non-painful stimuli
31
Neuropathic pain def
32
Means of achieving rhythm control in AF
Pharmacological Electrical cardioversion Ablation
33
Indications for electrical cardioversion
Acute AF (within 48hrs) and hemodynamic instability Elective to new-onset AF
34
Scoring system for bleeding/stroke for AF
CHADSVAsc: risk of ischaemic stroke ORBIT: risk of bleeding If chadsvasc 2 or more and orbit ok, give anticoagulation
35
Dysentery def
Diarrhoea with blood caused by infection
36
Common cause of dysentery in the UK
Shigella | Abroad could be amoeba
37
Differentials for bloody diarrhoea in 25yo
``` IBD Dysentery Gastroenteritis (o157 serotype of Ecoli) Malignancy Haemorrhoids ```
38
Pharmacological options for Crohns?UC
``` Steroids Mesalamine Azathioprine Methotrexate Infliximab ```
39
Reversible causes of coma
Hypothermia Hypoglycaemia Hypovolaemia Electrolyte disturbance (Na, Ca, Mg)
40
Reversible causes of apnoea
C-spine injury | Guillian Barre syndrome
41
How to do apnoea test
1. oxygenate pt 2. hypoventilate till PCO2>6.0 3. continue oxygenating but not ventilating. if PCO2 rises by 0.5 then confirms that there is loss of respiratory drive
42
Absolute CIs for organ donation
CJD | HIV associated illness eg AIDS
43
Superficial epidermal
Red Pain Normal texture Blanching and refilling capillary
44
Superficial dermal burn fx
Pink skin Normal texture Painful Blanching and slowly refilling capillary Blisters present
45
Assessing extent of burn
Wallace's rule of 9 Lund & Browder charts Patient's hand = 1 %
46
IV fluid regimen in resus in burns
Heat: 2ml * kg * TBA Electrical: 4ml* kg* TBA Give first half in 8hrs, rest over 16hrs
47
Indication for IV resus for burn pts
adults > 15% TBA | children > 10% TBA
48
Indications for referral to burns unit
``` Circumferrential Children > 5% adults >10% Under 5yo or over 60 yo Electric/chemical Inhalation ```
49
Mount Vernon formula
(TBA % * kg) /2 fluid needed over the first 36 hrs GIve the above volume at the following intervals 4,4,4,6,6,12
50
Deep dermal burn fx
mottled/red Non-blanching capillary Slightly painful Normal skin texture
51
Full thickness burn fx
White Leathery/waxy Pale nonblancing Painless

MRCS-Critical care (10 decks)

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