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MRCS-Critical care > Deck2 > Flashcards

Deck2 Flashcards

1
Q

Functions of bile

A

Emulsification of fat -> ADEK absorption

Elimination of cholestero

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2
Q

Where is bile reabsorbed

A

terminal ileum

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3
Q

How is billirubin formed

A

RBCs broken down to Haem and globin
Haem converted to biliverdin
Biliverdin = unconjugated bilirubin and iron

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4
Q

How is unconjugated bilirubin transported to liver

A

insoluble

Binds to albumin

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5
Q

How is bilirubin conjugated

A

In liver

Becomes water soluble excreted in bile

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6
Q

Relationship between preload and cardiac output

A

Frank-Starling Law

Increase end diastolic volume, stretches the cardiac muscle, allowing it to contract more forcefully

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7
Q

What causes Frank Starling curve to become flatter and shift to right

A

Reduced contractiliy:
Acidosis
B blockers
Heart failure

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8
Q

What makes the Frank Starling curve to shift to left

A

Increased contractility or reduction in afterload:

- adrenaline

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9
Q

Indications for a central line

A
  1. Monitoring
    - CVP
    - CO (Swann-Ganz catheter)
  2. Intervention
    - TPN
    - Adenosine rich solution
    - high K content
    - Haemodialysis
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10
Q

CVP trace

A
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11
Q

Incision landmarks for fasciotomy for compartment syndrome of leg

A

Anterolateral: just above ankle to tibial tuberosity
Posteromedial: 5 cm above medial mal to tibial tuberosity

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12
Q

Closure of fasciotomy

A

Should not be closed

Loose subcuticular suture could be place to later reduce the size of the defect

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13
Q

Blood test for rhabdomyolysis

A

CK elevated 5 times normal range

Also AKI

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14
Q

Most common cervical fracture

A

C5

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15
Q

What further investigation should be considered when the is a cervical fracture

A

CT angio of neck damage to carotids

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16
Q

Spinal shock fx

A

Flaccid paralysis
Areflexia
Lack of sensation to spinal cord

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17
Q

Neurogenic shock

A

Lack of sympathetic outflow (unopposed parasympathetic innervation)

Bradycardia
Hypotension

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18
Q

Cause of neurogenic or spinal shock

A

Spinal cord injury/trauma

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19
Q

How to test improvement from spinal shock

A

Bulbocavernous reflex returns:

Tugging on Foley catheter or pressing on clitoris or glans causes contraction of anal sphincter (S2-4)

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20
Q

What is autonomic dysreflexia

A

Autonomic dysfunction to an insult (eg infection or urinary retention) in spinal injury above T6

  1. Sympathetic response below level of insult: hypertension and peripheral vasoconstriction
  2. Parasympathetic response above the level of insult: bradycardia and vasodilation: headache/blurred vision/CVE
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21
Q

Why right IJV preferred over left IJV for central line insertion

A

Right has a straighter more direct route into SVC and right ventricle

22
Q

Why right IJV preferred over left IJV for central line insertion

A

Right has a straighter more direct route into SVC and right ventricle

23
Q

Where should the tip of central line be placed

A

In SVC just before right atrium

24
Q

How to troubleshoot a central line that is not flushing

A

Make sure no kinks
Slowly move the line whilst pt coughing/deep breathing and flush simultaneously
Anti-thrombolytics such as urokinase could be used

25
Q

Tissues producing ALP

A

Bile duct epithelial cells
Bone
Placenta

26
Q

Which of ALT and AST more specific for liver

A

ALT (L for liver)

AST found in heart kidney brain intestine

27
Q

Complications of central line insertion

A

Immediate: bleeding/ haematoma, pneumothorax
Early: pseudoaneurysm, Chylothorax
Late: infection, thrombosis

28
Q

Complications of central line insertion

A

Immediate: bleeding/ haematoma, pneumothorax
Early: pseudoaneurysm, Chylothorax
Late: infection, thrombosis

29
Q

National guidance for standards of central line insertion

A
  1. USS guided

2. Post insertion CXR to check position and r/o pneumothorax

30
Q

Where to approach a IJV central line

A

The apex of triangle between two heads of sternocleidomastoid inserting on to the clavicle and sternum and clavicle itself

31
Q

Step by step of central line insertion through IJV

A
  1. USS to identify IJV and carotid
  2. either medial border of SCM at upper border of thyroid cartilage (C4) or apex of the clavicular triangle
  3. aim the needle at 30 degrees towards to ipsilateral nipple
  4. incision made -> guidewire inserted through dilator -> line inserted of guidewire -> sutured in place
32
Q

Anatomical landmark for central line insertion through subclavian

A

Inferior surface of midpoint of clavicle, towards jugular notch

33
Q

Anatomical landmark for central line insertion through subclavian

A

Inferior surface of midpoint of clavicle, towards jugular notch

34
Q

Which layers do you go through when inserting a subclavian line

A 
Skin
Subcut fascia
Pec major
Subclavius
Subclavian vein
35
Q

Blood results for DIC

A

High PT, APTT, d-dimmer

Low fibrinogen

36
Q

Causes of DIC

A

Infection
Malignancy
Trauma
Transfusion

37
Q

Define core temp

A

Temp of blood and internal organs

38
Q

Measurement of core temp

A

Axilla
Rectum
Sublingual

39
Q

Consequences of hypothermia

A

Increased Hb affinity for oxygen ->hypoxia
Platelet dysfunction
Enzyme dysfunction
Cardiac arrhythmia

40
Q

Diverticular abscess mx

A

<3cm -> conservative with abx

Hinchey 1 (>3cm) or 2 -> IR drainage 
Hinchey 3 and 4 -> Surgery
41
Q

Factors determining the area/level of analgaesia achieved with an epidural

A

Patient position
Initial bolus
Level that is placed
Rate of infusion

42
Q

Clinical sx of hypovolaemic shock

A 
Pale, anxious and SHOCKS
Sinus tachy
Hypotension
Oliguria 
CK cool Klammy peripheries
S slow capillary refill
43
Q

Difference between spinal and epidural anasthaesia in terms of area of blockade

A

Spinal: blocks everything below the level of insertion

Epidural: segmental blockade (if inserted at T3/4, blocks T2-T6, sparing legs)

44
Q

Consequence of high thoracic spinal block

A

Paralysis
Numbness
Respiratory compromise (intercostal nerves)
Cardiovascular compromise (loss of sympathetic)

45
Q

Consequence of high thoracic spinal block

A

Paralysis
Numbness
Respiratory compromise (intercostal nerves)
Cardiovascular compromise (loss of sympathetic)

46
Q

Indications for CT head within 1 hr post trauma

A 
GCS >13 or >15 after 2 hrs
Seizure
>1 vomiting
Skull #
Base of skull signs
Focal neurology
47
Q

Indications for CT head post trauma within 8 hrs

A

> 65
Coagulopathy
Dangerous mech of injury
30 min retrograde amnesia before the head injury

48
Q

Indications for ET intubation

A 
GCS < = 8
Failure to ventilate/oxygenate
Inhalational injuries from burns
Maxillofacial fractures
Neck injury
49
Q

Indications for extradural haematoma conservative (series CTs and neurological obs) mx

A
  1. Extradural haematoma <30cm3
  2. <15mm thickness
  3. <5mm midline shift
  4. GCS>8 and no neurological deficit
50
Q

Cerebral perfusion pressure

A 
CPP = MAP - ICP
MAP = diastolic + 1/3 pulse pressure
51
Q

Causes of raised ICP

A

Hydrocephalus (infection)
Space occupying lesion
Bleeding

52
Q

Cushings reflux

A

Result of raised ICP:
Low HR
High BP
Irregular breathing (Cheyne-Stokes)

MRCS-Critical care (10 decks)

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