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Medicine year 3- MACS > Extra > Flashcards

Extra Flashcards

1
Q

How to test for MRSA

A

3 swabs
mouth, nose then groin

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2
Q

CRE bacteria

A

Group of bacteria resistant to carbapenem class of antibiotics. These abx are used to treat severe infections.

Test- sample of faeces and rectal swab

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3
Q

Falls assessment

A

FRAT
Timed up and go
Turn 180 degrees
Tinneti test

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4
Q

Central line insertion sites

A

Internal jugular vien
Subclavian vein
Femoral vein

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5
Q

Indications for central line

A

Administering IV medication
Fluid balance monitoring using central venous pressure

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6
Q

Complications of a central line

A

Haemothorax
Pneumothorax
Haematoma
Arterial puncture

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7
Q

Arterial line insertion site

A

Radial artery
Ulnar artery
Brachial artery
Axillary artery
Posterior tibial artery
Femoral artery
Dorsalis pedis artery

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8
Q

Indications of an arterial line

A

Continuous direct BP monitoring
Frequent blood sampling

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9
Q

Complications of an arterial line

A

Artery occlusion
Haemaoma/bleeding
Infection, air emboli

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10
Q

Nice guidelines for end of life care

A
  1. Recognition
  2. Communication
  3. Shared decision making
  4. Maintain hydration
  5. Pharmacology
  6. Validated behavioural pain chart
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11
Q

Neurogenic shock

A

Loss of control over dilation and contraction of blood vessels causing a drastically lowered BP

Causes: injury to the brain or spinal cord

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12
Q

Components of 4AT

A

Test for delirium
Alertness
AMT 4 (Age, DOB, place, year)
Attention
Acute change/fluctuating course

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13
Q

CAM

A

Acute confusion with fluctuating pattern
Inattention
Disorganised speech
Altered level of consciousness

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14
Q

How to prevent falls

A

Exercise >2hrs a week, >6 months
Multifactorial falls prevention (MFFP)- Medication or fixing medical causes, getting rid of home hazards, physio

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15
Q

Time up and go test

A

Time it takes for a person to stand up from a seated position, walk three meters, turn around, and return to seated position in the chair. Normal < 10 seconds. 11-20 seconds is within normal limits for elderly.

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16
Q

Turn 180 test

A

Does it take them more than 4 steps to turn 180 degrees

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17
Q

Tinneti’s test

A

Stand, turn 360 degrees, sit
Walk few metres slowly, turn around and walk back quickly
Sit back down

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18
Q

QALY

A

Quality-adjusted life years; weigh each year of life by perceived quality from 0 to 1. Uses ADLs, freedom from pain and freedom from mental disturbance

years x quality of life score

1 QALY costs: £20,000- £30,000
End of life QALY: £50,000

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18
Q

QALY

A

Quality-adjusted life years; weigh each year of life by perceived quality from 0 to 1. Uses ADLs, freedom from pain and freedom from mental disturbance

years x quality of life score

1 QALY costs: £20,000- £30,000
End of life QALY: £50,000

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19
Q

Saline vs hartmans

A
  • Saline preferred if hypocholeramic
  • Hartmans is the most like plasma but dont give if hyponatraemic
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20
Q

Composition of saline

A

Na+ 154
Cl- 154
308 mosm/l

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21
Q

Composition of 5% dextrose

A

Glucose- 50g
mosm/l- 154

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22
Q

Composition of Hartmanns solution

A

Na+- 131
Cl- 111
K+ 5
HCO3- 29
Calcium 2
mosm/l 270

23
Q

Red flags for sepsis

A
  • Objective evidence of new or altered mental state
  • Systolic BP <90 mmHg or drop of >40 from normal
  • Heart rate >130 per minute
  • Respiratory rate >25 per minute
  • Needs O2 to keep SpO2 >92% (88% in COPD)
  • Non blanching rash/ mottled/ ashen/ cyanotic
  • Recent chemotherapy
  • Not passed urine in 18 hours (<0.5ml/kg/hr if catheterised)
24
Q

Amber flags for sepsis

A
  • Relatives concerned about mental status
  • Acute deterioration in functional ability
  • Immunosuppressed
  • Trauma/ surgery/ procedure in the last 8 weeks
  • Respiratory rate 21-24
  • Systolic Bp 91-100 mmHg
  • Heart rate 91-130 or new dysrhythmia
  • Temperature <36
  • Clinical signs of wound infection
25
Q

NEWS score: respiration rate

A

3: <8 or >25
2: 21-24
1: 9-11
0: 12-20

26
Q

NEWS score: O2 score scale 1

A

3: <91
2: 92-93
1: 94-95
0: <96

27
Q

NEWS score: O2 scale 2

A

3: <83 and >97 on oxygen
2: 84-85 and 95-96 on oxygen
1: 86-87 and 93-94 on oxygen
0 88-92 or <93 on air

28
Q

NEWS score oxygen requirement

A

Oxygen: 2 points

29
Q

NEWS score: systolic blood pressure

A

3: <90 or >220
2: 91-100
1: 101-110
0: 111-219

30
Q

NEWS score: pulse per minute

A

3: <40 or >131
2: 111-130
1: 41-50 or 91-110
0: 51-90

31
Q

News score: Consciousness

A

3- CVPU

32
Q

NEWS score: temperature

A

3: <35
2: >39.1
1: 35.1-36 or 38.1-39
0: 36.1-38

33
Q

MUST score BMI

A

> 20= 0
18.5-20= 1
<18.5= 2

34
Q

MUST score weight loss

A

Unplanned weight loss in the past 3-6 months

<5%= 0
5-10%= 1
>10%= 2

35
Q

MUST scores

A

1= medium risk, observe in hospital weekly, in a care home monthly, in the community every 2-3 months

2 or more= high risk. Monitor weekly in hospital, and monthly in the care home and community

36
Q

The incident reporting cycle

A

Incident occurs
Take immediate action
Inform the person in charge
Take further immediate action
Complete an incident form
Incident review and feedback
Classification and grading of the incident
Inclusion of incidents in the trust reporting system

37
Q

Definition of dehydration

A

1% or greater loss of body mass due to fluid loss where the body has less water than it needs to function properly

38
Q

The initialsymptoms of dehydration

A

Impaired cognitive function
Reduced physical performance
Headaches
Fatigue
Sunken eyes
Dry, less elastic skin

39
Q

The more serious effects of dehydration

A

Circulating blood volume decreases= hypotensions, tachycardia, weak/thready pulse, cold peripheries, oliguria, then organ failure and death

40
Q

Symptoms of fluid excess

A

Fatigue, dyspnoea and pitting oedema

41
Q

The 3 stages of assessing fluid balance

A

Clinical assessment
Review of fluid balance charts
Review of blood chemistry

Bloods: Na (increased), K, Cl, HCO3 and blood urea
Gold standard for dehydration: plasma osmolarity

42
Q

What plasma osmolarity is the threshold for dehydration

A

> 300 mOsm/kg

43
Q

Shock

A

Acute circulatory failure or inappropriately distributed tissue perfusion resulting in generalised cellular hypoxia and/or inability for cells to use oxygen.

44
Q

Explain the process of septic shock

A

Bacterial toxin induces expression of NO-producing enzyme iNOS causing overproduction of NO resulting in vasodilation and decreased BP

45
Q

What type of shock does blood pooling in anaphylaxis cause

A

Disruptive shock

46
Q

How does anaphylaxis cause shock

A

Excessive immune response
Overproduction of histamine
Increased Ca in cells
Increased production of NO by cNOS enzymes
Increased cGMP causing decreased BP.
Redistribution of blood leads to blood pooling and decreased arterial pressure

47
Q

What indicates hypovolaemia

A

SBP<100, HR>90, cap refill >2s, RR >20 and NEWS >5

48
Q

What kind of response does a NEWS of 8 require

A

Emergency response (response team must include staff with critical care skills, including airway management

49
Q

Role of central line

A

Allows multiple and greater volumes of IV fluids to be given, allows blood to be drawn easily, can measure central venous BP and can be used to measure fluid volume status (can be used for dialysis, fluid resuscitation and when patients need many blood samples or long term IV therapy or for caustic medications eg. chemo)

50
Q

What is enhanced recovery

A

An evidence-based approach that helps people recover more quickly after having major surgery. Research has shown that the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their recovery time will be

51
Q

Riglers sign

A

Double wall on the bowel on AXR, air in the abdomen

52
Q

What treatment is needed in bowel obstruction

A

Decompression- NJ or endoscope i.e. top or bottom

53
Q

Why might sigmoid volvulus need resection

A

They can be recurrent

54
Q

What part of the bowel distends and burst quickest

A

Caecum- as its more spherical

55
Q

What does large bowel distention, abrupt cut off anf loss of features on AXR mean

A

Lead piping i.e. toxic megacolon

Medicine year 3- MACS (7 decks)

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