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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
Q

Indications for surgical airway

A
  • Failed intubation
  • Laryngeal trauma: #
  • Upper airway obstruction
26
Q

CIs to patient controlled analgesia

A

Delirium/cognitive impairment

They need to understand how to use

27
Q

Indications for patient controlled analgasia

A

Pancreatitis

Major ops

28
Q

Non medication examples of anasthesia

A

Splinting
Hot/cold packs
Acupuncture
TENS (transcutaneous electrical nerve stimulation)

29
Q

Risk factors for Chronic post-surgical pain

A 
Pre-op pain
Intra-op nerve injury
Post-op SEVERE pain
Long ops
Chemo/radiotherapy
30
Q

Allodynia

A

Sensation of pain in presence of non-painful stimuli

31
Q

Neuropathic pain def

A
32
Q

Means of achieving rhythm control in AF

A

Pharmacological

Electrical cardioversion

Ablation

33
Q

Indications for electrical cardioversion

A

Acute AF (within 48hrs) and hemodynamic instability

Elective to new-onset AF

34
Q

Scoring system for bleeding/stroke for AF

A

CHADSVAsc: risk of ischaemic stroke
ORBIT: risk of bleeding

If chadsvasc 2 or more and orbit ok, give anticoagulation

35
Q

Dysentery def

A

Diarrhoea with blood caused by infection

36
Q

Common cause of dysentery in the UK

A

Shigella

Abroad could be amoeba

37
Q

Differentials for bloody diarrhoea in 25yo

A 
IBD
Dysentery
Gastroenteritis (o157 serotype of Ecoli)
Malignancy 
Haemorrhoids
38
Q

Pharmacological options for Crohns?UC

A 
Steroids
Mesalamine
Azathioprine
Methotrexate
Infliximab
39
Q

Reversible causes of coma

A

Hypothermia
Hypoglycaemia
Hypovolaemia
Electrolyte disturbance (Na, Ca, Mg)

40
Q

Reversible causes of apnoea

A

C-spine injury

Guillian Barre syndrome

41
Q

How to do apnoea test

A
  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
Q

Absolute CIs for organ donation

A

CJD

HIV associated illness eg AIDS

43
Q

Superficial epidermal

A

Red
Pain
Normal texture
Blanching and refilling capillary

44
Q

Superficial dermal burn fx

A

Pink skin
Normal texture
Painful
Blanching and slowly refilling capillary

Blisters present

45
Q

Assessing extent of burn

A

Wallace’s rule of 9

Lund & Browder charts

Patient’s hand = 1 %

46
Q

IV fluid regimen in resus in burns

A

Heat: 2ml * kg * TBA
Electrical: 4ml* kg* TBA
Give first half in 8hrs, rest over 16hrs

47
Q

Indication for IV resus for burn pts

A

adults > 15% TBA

children > 10% TBA

48
Q

Indications for referral to burns unit

A 
Circumferrential
Children > 5% adults >10%
Under 5yo or over 60 yo
Electric/chemical
Inhalation
49
Q

Mount Vernon formula

A

(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
Q

Deep dermal burn fx

A

mottled/red
Non-blanching capillary
Slightly painful
Normal skin texture

51
Q

Full thickness burn fx

A

White
Leathery/waxy
Pale nonblancing
Painless

MRCS-Critical care (10 decks)

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