ENDO MCQ megaSesh Flashcards
1
Q
What does APO-CPAP improve in patients with pre-existing LV dysfunction?
A
Cardiac output
It achieves this by reducing preload.
2
Q
How does CPAP work in relation to LV afterload?
A
Creates positive intrathoracic pressure, reducing LV afterload
3
Q
What is the benchmark level of PEEP for CPAP that is considered safe and effective?
A
10 cmH2O
4
Q
True or False: CPAP has an effect on short-term mortality.
A
False
5
Q
What is the potential risk of using BiPAP?
A
May increase myocardial infarction (MI)
6
Q
What is the survival advantage of NIV in COPD patients?
A
3 month/1 year survival advantage
7
Q
How does increasing IPAP during NIV affect tidal volume (TV) and work of breathing (WOB)?
A
Augments TV and reduces WOB
8
Q
What is the normal range for PaCO2 and what does an increasing level indicate in asthma patients?
A
Normal PaCO2/increasing = bad
PaCO2 range: 35-45cmH20
9
Q
Fill in the blank: During RSI, aim for excessive airway pressure to minimize _______.
A
lung hyperinflation
10
Q
What are the recommended respiratory rates (RR) for NIV in ARDS?
A
20-25
11
Q
What should Plateau pressures be kept under during NIV?
A
<30 mmHg
12
Q
What is the target FiO2 to maintain oxygen saturation levels in ARDS?
A
88-95% saturation
13
Q
What is the acceptable level of permissive hypercapnia in terms of pH?
A
pH >7.25
14
Q
What is the compression to breath ratio during ALS for an arrested patient?
A
30:2 compressions:breaths
15
Q
What is the recommended defibrillation energy setting for biphasic defibrillation?
A
200J
16
Q
True or False: There is a benefit from 3 stacked shocks in established cardiac arrest.
A
False
17
Q
In what scenario should 3 stacked shocks be considered?
A
Witnessed arrest, defibrillator available, recharge <10 seconds
18
Q
What are the advantages of biphasic waveforms in defibrillation?
A
- More effective at low energy
- Better first shock efficacy than monophasic
- Effective for atrial fibrillation (AF)
19
Q
What is the Vaughan-Williams Class I in cardiology?
A
Sodium channel blockers
20
Q
What is the primary use of procainamide in cardiology?
A
For SVT/ventricular arrhythmias/AF/broad complex tachycardia
21
Q
What is the half-life of procainamide?
A
3-6 hours
22
Q
What drug is classified as Class Ib in the Vaughan-Williams classification?
A
Lignocaine
23
Q
Fill in the blank: Adrenaline increases _______ but has no survival benefit.
A
ROSC
24
Q
What is the ideal timeframe for resuscitative hysterotomy in pregnant cardiac arrest?
A
Within 5 minutes
25
What is the recommended sodium replacement in DKA if osmolality becomes >320?
0.45% NaCl
26
What is the initial treatment for DKA?
IV rehydration with NaCl 0.9%
27
What should be monitored when treating DKA to prevent cerebral edema?
BGL and osmolality
28
What is the average water deficit in DKA patients?
100ml/kg
29
What are the diagnostic criteria for DKA?
* Ketones >3 mmol/L
* pH <7.3
* BGL >11 mmol/L
* HCO3 <15 mmol/L
30
What is the most commonly missing factor in DKA presentations?
Insulin (40%)
31
What is the management for DKA if pH <6.9?
Consider bicarbonate
32
What is the common cause of hyperglycemic hyperosmolar state (HHS)?
Infection
33
What is the mortality rate for HHS?
15-40%
34
What is the primary metabolic disturbance caused by DKA?
Metabolic acidosis
35
What is the typical fluid deficit in Hyperglycemic Hyperosmolar State (HHS)?
6-10L fluid deficit
36
What is the recommended rate for correcting sodium levels in HHS?
SLOW correction of Na+, glucose and osmolality
37
What occurs during osmotic diuresis in HHS?
Urinary loss of Na/K/CMP
38
What are some causes of Hyperglycemic Hyperosmolar State (HHS)?
* Infection
* Alcohol
* Insulin non-compliance
* CVA
* Diuretics
* Glucocorticoids
* Vomiting any cause
39
What is the blood sugar level range indicative of HHS?
BSL >30 mmol/L up to 90 mmol/L
40
What is the osmolality level that indicates HHS?
Osmolality >320 mosm/L
41
What is the ketone level typically seen in HHS?
Ketones <3
42
What is the usual pH level in HHS?
pH usually >7.3
43
What is the initial treatment for HHS?
1L of NaCl 0.9% over 1 hour
44
How should the fluid deficit be replaced in HHS treatment?
Replace 50% deficit in 24 hours
45
What should be done if sodium rises 8-10mmol/L in the first 24 hours during HHS treatment?
Use 0.45% NaCl
46
When should 5% dextrose be used in HHS treatment?
When BGL <14 (+ continued normal saline)
47
What is the maximum rate for insulin administration in HHS treatment?
Slow max 0.05 units/kg/hr
48
What is the desired reduction in blood glucose levels per hour during HHS treatment?
Reduce BGL by 3-5mmol/L/hr
49
What is required to diagnose hypoglycemia?
WHIPPLES TRIAD
50
What are the components of WHIPPLES TRIAD?
* Hypoglycemia for age
* Symptoms of hypo
* Relief with correction of hypo
51
What is the normal blood glucose level for infants aged 0-6 months?
2-5mmol/L
52
What is the normal blood glucose level for children aged 1-12 months?
1.9-8 mmol/L
53
What is the normal fasting blood glucose level for adults?
3.6 - 5.8 mmol/L
54
What are some drug causes of hypoglycemia?
* Propranolol
* Sulphonamides
* Fe
* Sodium valproate
* Tramadol
55
What is the Somogyi effect?
Rebound hyperglycemia following hypoglycemia
56
What are the biochemical parameters for Insulinoma?
* Increased insulin
* Increased c-peptide >2.5ng/ml
* Pro-insulin >25% of immunoreactive insulin on assay
* Insulin:glucose ratio >0.25
57
What is the recommended oral treatment for hypoglycemia?
Glucose gel/OJ/sweets followed by carbs
58
What is the dose of glucagon for children <25kg?
0.5mg SC/IM/IV
59
What is a common side effect of glucagon treatment?
Nausea/Vomiting
60
What are the chronic diabetic care targets for HbA1c?
* <7.5% = 1 agent
* 7.5-9% = 2 agents
* >9% = 2 or more +/- insulin
61
What is the first line treatment for diabetes?
Metformin
62
What are the two types of adrenal insufficiency?
* Primary = adrenal tissue destruction
* Secondary = hormone suppression
63
What is the most common cause of primary adrenal insufficiency?
Autoimmune
64
What is the classic presentation of adrenal insufficiency?
Fluid-resistant hypotension
65
What is the cortisol half-life?
90 minutes
66
What is the result of adrenal suppression?
HypoNa with hyperK
67
What is the cortisol measurement for confirming adrenal insufficiency?
<150nmol/L = confirmed
68
What is the treatment for adrenal crisis?
Hydrocortisone 100mg + fludrocortisone 50mcg
69
What is Cushing's syndrome?
Excess glucocorticoids from any source
70
What are the signs of Cushing's syndrome?
* Moon facies
* Buffalo hump
* Striae
* Acne
* Hirsutism
71
What is the most common cause of hypercalcemia?
Primary hyperparathyroidism or malignancy
72
What are the symptoms of hypercalcemia?
* Stones
* Bones
* Abdominal moans
* Thrones
* Psychic overtones
73
What is the treatment for hypercalcemia?
* 4-6L NaCl 0.9% over 24 hours
* Zoledronic acid 4mg IV
* Calcitonin 100 units SC
74
What is the most common pituitary insufficiency cause?
Adenomas
75
What is the classic presentation of pituitary apoplexy?
Headache, bitemporal hemianopia, nausea, vomiting
76
What is the treatment for pituitary apoplexy?
Hydrocortisone 100mg + fludrocortisone 50mcg
77
What is the most common thyroid cancer?
Papillary/follicular thyroid cancer
78
What are the characteristics of hyperthyroidism?
* <0.1mIU/L TSH
* Elevated free T4
79
What is the treatment for thyroid storm?
* Beta-blockers
* PTU
* Hydrocortisone
* Lugol's iodine
80
What is the remission rate for PTU/Carb treatment?
40%
## Footnote
PTU stands for propylthiouracil, commonly used to treat hyperthyroidism.
81
What are the risks associated with PTU treatment?
Hepatotoxicity, agranulocytosis
## Footnote
Agranulocytosis is a potentially life-threatening drop in white blood cell count.
82
What laboratory findings are indicative of thyroid storm?
Low TSH, high T3/4
## Footnote
Levels cannot distinguish storm from hyperthyroidism.
83
What percentage of patients with thyroid storm experience altered mental status?
90%
## Footnote
Altered mental status is a critical sign of thyroid storm.
84
What is the mortality rate if thyroid storm is missed?
90%
## Footnote
Timely recognition and treatment are crucial.
85
What are the key symptoms of thyroid storm?
Hyperreflexia without clonus
## Footnote
Clonus is a series of involuntary muscle contractions.
86
What is the first-line treatment for thyroid storm?
Beta-blockers, PTU, hydrocortisone, Lugol's iodine
## Footnote
These treatments help to manage symptoms and reduce thyroid hormone levels.
87
What is the standard dosing for propranolol in thyroid storm?
0.5 mg/minute up to 10 mg
## Footnote
Propranolol is a beta-blocker used to manage heart rate and symptoms.
88
What is the role of hydrocortisone in treating thyroid storm?
Reduces metabolic demand
## Footnote
It also helps to manage adrenal insufficiency.
89
What is the mechanism of action of PTU?
Decreases iodination in the thyroid
## Footnote
PTU blocks the synthesis of new thyroid hormones but does not block the release of pre-formed hormones.
90
What is the normal range for TSH levels?
0.3-5.0 mIU/L
## Footnote
A TSH level greater than 7 confirms hypothyroidism diagnosis.
91
What are common causes of hypothyroidism?
* Idiopathic (majority)
* Hashimoto's thyroiditis
* De Quervain's thyroiditis
* Iodine excess/deficiency
* Amiodarone/lithium
* Post-surgical
## Footnote
These causes can lead to varying degrees of thyroid hormone deficiency.
92
What are the features of hypothyroidism?
* Folate or B12 deficiency
* Macrocytic anemia
* Hemolysis
* Proximal myopathy
* Alopecia (outer ⅓ of eyebrow loss)
* Myxedema coma
## Footnote
Myxedema coma is a severe form of hypothyroidism that requires immediate medical attention.
93
What is the treatment for myxedema coma?
75-150 ug/day of thyroxine
## Footnote
IV T3/T4 can be used in coma situations.
94
What is the most common breast lump type in individuals under 30?
Fibroadenomas
## Footnote
Fibroadenomas are benign breast tumors.
95
What breast conditions are common in the age group of 30-40?
* Fibroadenoma
* Cyst
* Carcinoma
* Mammary dysplasia
## Footnote
These conditions have an equal prevalence in this age group.
96
What is Paget's disease of the nipple characterized by?
Nipple eczema and lymph obstruction
## Footnote
This condition is always associated with carcinoma.
97
What is the ratio of breast cancer incidence between females and males?
150:1
## Footnote
Breast cancer is significantly more common in females.
98
What is the main risk factor for breast cancer?
Previous cancer or benign breast disease
## Footnote
Other risk factors include family history and shorter menstrual cycles.
99
What is the significance of hormone receptor positivity in breast cancer?
70% of breast cancer has estrogen receptors
## Footnote
Hormone receptor positivity is crucial for treatment decisions, as it often allows for the use of hormone therapy.
100
What is the active metabolite of testosterone?
5-DHT
## Footnote
5-DHT stands for dihydrotestosterone, which is responsible for many androgenic effects.
101
What are potential cardiovascular side effects of testosterone therapy?
* Arrhythmia
* Sudden cardiac death
* Cardiomyopathy
* Embolism
## Footnote
These risks highlight the importance of monitoring during testosterone therapy.
102
What is the testosterone:epitestosterone ratio that indicates potential abuse?
>1
## Footnote
Elevated ratios can suggest exogenous testosterone use.
103
What percentage of testosterone users experience gynaecomastia?
20%
## Footnote
Gynaecomastia can be treated with tamoxifen.
