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Green book MCQs > Get Through SBAs > Flashcards

Get Through SBAs Flashcards

1
Q

What is the intralipid dose for a 70kg man?

A
  • initial bolus 100mls 20% lipid emulsion over 1 min
  • plus IV infusion 1000ml/hr
  • after 5 mins -> 2 repeat 100ml boluses
  • double to 2000ml/hr if required
  • max dose 850mls (>?)
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2
Q

What is the response time of a Severinghaus electrode?

A

2-3 mins

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3
Q

How does the Severinghaus electrode work?

A
  • modified pH electrode, measures CO2 tension
  • H+ sensitive glass probe encased in nylon mesh impregnated with bicarb solution
  • 2 electrodes placed on either side of the probe, one in the glass electrode and one in the buffer
  • plastic membrane permeable to CO2 separates sample from system
  • CO2 from the sample diffuses across the semi-permeable membrane
  • -> reacts with bicarbonate and water in the mesh -> changes pH
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4
Q

What is the half life of Ketorolac?

A

6hrs

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5
Q

What is the equivalent analgesic dose of 10mg of ketorolac?

A

10mg ketorolac = 50mg pethidine = 6mg morphine

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6
Q

How does ketorolac work?

A

COX inhibitor, prevents formation of prostaglandins. Inhibits platelet aggregation, may prolong bleeding time.

CIs: bronchospasm, angioedema, nasap polyps.

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7
Q

What receptors do cyclizine, metaclopramide, ondansetron, hyoscine/atropine and droperidol work on?

A

Cyclizine - histamine

Metaclopramide - dopaminergic

Ondansetron - 5HT3 (serotonin)

Hyosine/atropine - muscarinic

Droperidol - dopaminergic

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8
Q

What does the ABG directly measure?

A
  • Hb
  • electrolytes
  • PaCO2
  • PaO2
  • pH
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9
Q

What does the ABG indirectly (derive) measure?

A
  • HCO3
  • BE
  • O2 content
  • sats
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10
Q

How many days does lithium take to take effect?

A

10 days

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11
Q

What do fundal parietal cells produce?

A

0.15M hydrochloric acid

Helps protein breakdown, pepsinogen, augments iron absorption, kills pathogens.

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12
Q

What do chief cells produce?

A

Pepsin (proteolytic enzyme)

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13
Q

What do parietal cells in the stomach produce?

A

Intrinsic factor.

Important for B12 absorption, forms complex which is absorbed in terminal ileum)

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14
Q

What errors can you get in ABGs with prolonged storage at room temp, rapid cooling, air bubbles, clots or dilution with heparin?

A

Prolonged storage at room temp

  • ongoing cellular metabolism
  • lowered pH, pO2 and glucose
  • increased pCO2 due to aerobic metabolism
  • increased lactate due to anaerobic metabolism

Rapid cooling

  • haemolysis -> increased K+

Air bubbles

  • decreased pCO2 and increased pO2

Clots

  • increased K+

Dilution with heparin

  • decreased pCO2
  • decreased BE
  • decreased bicarb
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15
Q

What parts of the ECG corresponds with systole and diastole?

A
  • systole - beginning of QRS until end of T wave
  • diastole - end of T wave until beginning next QRS
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16
Q

How does trimethoprim work?

A

Inhibits production of purines and pyrimidine bases by inhibition of the enzyme dihydrofolate reductase.

Adverse effects can be lessened by giving folinic acid.

More potent than sulfamethoxazole.

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17
Q

What is surfactant?

A

Contains phospholipids and apoproteins.

Prevents alveolar collapse by variably changing surface tension.

As alveoli empty - concentration of surfactant increases which reduces surface tension -> prevents emptying of small alveoli into large.

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18
Q

What is the ejection fraction?

A

Fraction of end diastolic volume that is ejected during systole.

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19
Q

What is stroke work?

A

Work done by the myocardium with each contraction, can be calculated from area contained in pressure-volume loop.

If pre-load increases - volume increases - stroke work increases.

If afterload increases - pressure increases - stroke work increases.

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20
Q

How does sugammadex work?

A

It binds to rocuronium/vecuronium to form complexes which removes drug from the neuromuscular junction.

Both roc + sugammadex bind to plasma proteins.

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21
Q

What is the metabolism of sugammadex?

A

Renal excretion of unchanged product of sugammadex, no metabolites formed.

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22
Q

What is the elimination 1/2 life of sugammadex?

A

1.8hrs

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23
Q

What is the plasma clearance of sugammadex?

A

88ml/min

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24
Q

How much sugammadex is excreted in the 1st 24hrs?

A

> 90%

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25
Q

What is the therapeutic dose of sugammadex?

A

Ranges from 2-16 mg/kg

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26
Q

How does a resistance wire measure temperature?

A

Incorporate length of platinum.

Very accurate between 0 - 100C.

Slow response.

Resistance of wire increases linearly with temperature.

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27
Q

How does a thermistor work?

A

Composed of metal oxide.

Respond rapidly to small temperature changes.

Increased temperature causes an exponential fall in resistance.

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28
Q

How does a thermocouple measure temperature?

A

2 different metals give rise to a potential difference (Seebeck effect).

Potential difference dependent on temperature, as temperature increases the potential difference increases.

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29
Q

How does Frank Starling work in the heart?

A
  • muscle fibres stretch as preload increases - which increases force of contraction/stroke volume up to a point then plateaus
  • increased afterload (SVR) tends to decrease CO
  • any rhythm which disrupts synchronised contraction of cardiac muscle will decrease CO
  • AF -> lowers ejected volume as atrial kick is lost (contributes to EDV)
  • increased diastolic pressure augments cardiac muscle perfusion - helps an ischaemic myocardium
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30
Q

What are the SEs of thiazide diuretics?

A
  • can cause an attack in gout (hyperuricaemia)
  • can cause LDL cholesterolaemia, increased risk in hyperlipidaemic patients
  • young HTN pt with tachycardia will benefit from B-blockade
  • not a good option in impaired renal function as they can’t increase sodium output in a failing kidney
  • better for african caribbean and elderly patients
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31
Q

What is relative humidity?

A

The absolute humidity/ mass of water required to fully saturate the gas

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32
Q

How does the Von Recklinghaus oscillometer work?

A
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33
Q

What ECG changes do you get in hypothermia?

A

At 30C - J waves (benign and no clinical significance) and ventricular arrhythmias.

At 28C - VF.

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34
Q

What is the order of steps in getting drug approval?

A
  1. In vitro/animal studies
  2. Phase I (drug safety and dosage in small group volunteers (100))
  3. Phase II (assess effectiveness + detect adverse effects in larger group (500))
  4. Phase III (confirm effectiveness + monitor SEs in much bigger group and longer duration (5000))
  5. FDA approval
  6. Post marketing testing (Phase IV)
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35
Q

What is double burst stimulation?

A
  • 2 bursts of supramaximal current (50-60 mA)
  • 50Hz 750ms apart
  • each burst contains 3 impulses of 0.2ms each and separated by 20ms
    • tactile evaluation more accurate than TOF
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36
Q

What is TOF?

A

4 impulses of supramaximal current at 2Hz 0.5s apart

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37
Q

How does caffeine work?

A

Inhibits breakdown of cAMP - augments beta adrenoceptor activity

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38
Q

How does nicotine work?

A

Stimulates ACh receptors on adrenal medulla which releases adrenaline and noradrenaline.

39
Q

What effect does ACh release have on M2 receptors in the heart?

A

Hyperpolarization of pacemaker cells, increases the time for cells to reach threshold

40
Q

What are the risks of TURP?

A

Hyponatraemia which increases intravascular volume and decreases serum osmolality.

CVS

  • bradycardia, hypo/hypertension, wide QRS, ST elevation, VT/VF

Resp

  • pulmonary odemea secondary to fluid overload

CNS

  • confusion, coma, seizures, visual disturbance

Increased risk in prolonged procedures (>60mins), haemorrhage leading to absorption of irrigant fluid from open prostatic sinuses, increased height of irrigant (increased hydrostatic pressure/increased absorption of irrigant).

41
Q

What is the treatment for hyponatraemia caused by TURP?

A

Hypertonic 3% saline or haemofiltration

42
Q

What is the potential in the myocardium vs the skin in volts?

A

90mV but at the skin it is reduced to only 1-2 mV

43
Q

What kind of waves is the ECG signal composed of?

A

Complex arrangement of superimposed sine waves.

44
Q

What is bandwidth and what is the value for an ECG?

A

A range of frequencies, it must include the fundamental frequency and 8 further harmonics.

Typically 0.5 - 80Hz for the ECG.

Lower bandwidth will result in artefacts from breathing.

Higher bandwidth will result in interference from muscle twitches or electric equipment,

45
Q

How many litres in a C size oxygen cylinder?

A

170L

46
Q

How many litres in size D oxygen cylinder?

A

340L

47
Q

How many litres in Size E oxygen cylinder?

A

680L

48
Q

HOw many litres in size F oxygen cylinder?

A

1360L

49
Q

How many litres in size G oxygen cylinder?

A

3400L

50
Q

How is GTN metabolised?

A

By denitration to nitric oxide (potent vasodilator).

In vivo, nitric oxide is an endothelial derived relaxing factor derived from L-arginine.

Rapidly diffuses into myocytes one synthesised - induces relaxation via guanate cyclase pathway.

51
Q

What marker would you use to estimate total body water?

A

Isotopic H2O (deuterium)

52
Q

What marker would you use to measure ECF?

A

Mannitol or Inulin

53
Q

What marker would you use to estimate the volume of plasma?

A

Tracer labelled albumin or Evan’s blue dye

54
Q

What is absolute risk reduction?

A

The incidence in the treatment group minus the incidence in the control group.

55
Q

What is the number needed to treat?

A

NNT = 1 / ARR

56
Q

What is the treatment for propranolol or Beta blocker OD?

A

Glucagon (improves inotropy)

57
Q

What is present in whole blood?

A

RBCs, WBCs, platelets, plasma

58
Q

What is uncoagulated blood which is centrifuged made of?

A
  • Cellular components.
  • Fluid phase = plasma
    • water
    • ions
    • nutrients - glucose and AAs
    • hormones
    • proteins including albumin, immunoglobulins, clotting factors and fibrinogen
59
Q

What is the fluid component of coagulated whole blood?

A

Serum - devoid of clotting factors (otherwise same as plasma)

60
Q

What is sensitivity?

A

True +ves / true +ves + false -ves

61
Q

What is specificity?

A

true -ves / true -ves plus false +ves

62
Q

What is the best anticoagulant for a pregnant women with DVTs that won’t cross the placenta or be found in breastmilk?

A

Heparin (large - can’t cross placenta or be secreted in breast milk)

63
Q

What are RBCs derived from?

A

Myeloid lineage of haemopoetic pluripotent stem cells.

Start as proerythroblasts containing DNA.

Mature in bone marrow + synthesise Hb -> expell DNA.

This makes it a reticulocyte which matures over 1-2 days.

Remaining RNA lost to become mature RBC which is anucleate.

64
Q

What are essential for RBC production?

A

Iron for Hb

Vit B12 and folate for synthesis of nucleic acids for DNA (if decreased = macrocytic anaemia)

65
Q

Where is it most accurate to measure core temperature?

A
  • lower oesophagus
  • nasopharynx
  • blood with Swan Ganz catheter
  • tympanic (although inaccurate if wax)
66
Q

What signs would you see in amitriptyline overdose?

A
  • coma
  • tachycardia
  • prolonged QRS
  • anticholinergic signs
67
Q

What would lithium cause in overdose?

A

Coma + bradyarrhythmias

68
Q

What would MAO inhibitors cause in overdose?

A

Sympathomimetic effects like HTN, tachycardia, hyperthermia, sweating

69
Q

What can cause polycythaemia?

A
  • primary bone marrow (polycythaemia rubra vera)
  • iatrogenic (overtransfusion, over treatment with EPO)
  • secondary to chronic hypoxic drive
  • adaptation to altitude
  • can be relative due to loss of plasma volume in burns or extreme dehydration)
70
Q

Why are polycythaemia patients at higher risk of bleeding?

A

Due to platelet/clotting factor dilution

71
Q

What will increase and decrease the Reynolds number?

A

Increase

  • density
  • velocity
  • diameter/length

Decrease

  • viscosity
72
Q

What are causes of microcytic anaemia?

A
  • iron deficiency
    • increased requirements (pregnancy)
    • increased loss (chronic bleeding)
    • decreased iron intake (malnutrition)
  • chronic disease
73
Q

What are causes of normocytic anaemia?

A
  • acute blood loss
  • haemolytic disease (sickle cell/autoimmune)
  • chronic renal and liver disease
  • bone marrow failure
74
Q

What causes macrocytic anaemia?

A
  • B12/folate deficiency
  • alcoholism
  • hypothyroidism
  • pregnancy (dilutional)
  • bone marrow infiltration
75
Q

What are the problems associated with ultrasonic nebulization?

A
  • droplets of various sizes (1 micrometre = alveoli, 20 micrometers = upper resp tract, breathing system, trachea)
  • large volumes of H20 can be nebulized and deposited in alveoli causing pulmonary oedema
  • small diameter droplets carry infection readily
  • as more water added, increased density, which increases Reynolds number and makes turbulent flow more likely
76
Q

What are causes of inaccurate pulse oximetry?

A
  • low perfusion
  • diathermy/motion artefact/lights
  • metHb (eg from LAs, sodium nitroprusside) will underread
  • methylene blue or indocyanine dye used in thyroid surgery causes inaccurately low readings
  • smokers will have a high level of carboxyHb (10-15%) which OVERestimates sats
  • bilirubin doesn’t interfere as not absorbed at wavelengths used by pulse oximeter
77
Q

What is the formula for calculating the total amount of drug in the body?

A

Total amount of drug in body = volume of distribution x plasma concentration

78
Q

Does cryprecipitate require cross matching?

A

No, it only contains fibrinogen

79
Q

What does plasma contain?

A

Clotting factors

Fibrinogen

H2O

Salts

Proteins (albumin/immunoglobulins)

80
Q

What does FFP contain?

A

Albumin

Most clotting factors

Very little fibrinogen

81
Q

How often can you repeat the TOF?

A

15 seconds

82
Q

Which electrode goes proximally when setting up the TOF monitor?

A

Positive proximally (minimizes current?)

83
Q

How does warfarin work?

A

Prevents recycling of Vit K to oxidized form.

Oxidized Vit K is required to mature precursors of clotting factors (II, VII, IX, X) by gamma carboxylation of glutamic acid residues.

Takes 72hrs to full effect.

84
Q

What are the complications associated with blood transfusion?

A

Immunity/incompatibility

  • ABO + rhesus / other blood group haemolytic reactions - may be acute/delayed

Febrile reactions

  • non-haemolytic

Hypersensitivity reactions

  • rashes

Risk of infection

  • bacterial/viral (hepatitis, CMV, HIV), fungal, prion diseases

Biochemical disturbance

  • hyperkalaemia, hypocalcaemia, iron overload, acidosis

Haematological

  • dilutional coagulopathy, DIC, polycythaemia

Cardiac

  • fluid overload and cardiac failure

Resp

  • pulmonary oedema + TRALI

Other

  • hypothermia, shift of O2 curve left
85
Q

What is the order of the bits in the circle system?

A
  • excess gas exits via APL valve before passing through CO2 absorber - improves efficiency
  • FGF enters downstream - not wasted through APL valve
  • plenum vaporizers have high resistance so are not suitable for VIC (vaporizers in circuit)
  • Goldman (low resistance) used if VIC needed
86
Q

What are the acquired causes of immunodeficiency?

A
  • HIV/AIDS
  • diabetes
  • chemo/radiotherapy
  • drugs
    • steroids
    • methotrexate
    • azothioprine
  • burns
  • trauma
  • splenectomy
87
Q

What are the class IA antiarrhythmics?

A

Sodium Channel Blockers

Prolong AP

Quinidine, procainamide

88
Q

What are the Class IB antiarrhymics?

A

Sodium channel blockers.

Shorten AP.

Lignocaine, melexitine, phenytoin.

89
Q

What are the Class IC antiarrhythmics?

A

Sodium channel blockers.

No effect on AP.

Flecainide.

90
Q

What are the class II antiarrhythmics?

A

Beta blockers

91
Q

What are the class III antiarrhythmics?

A

Potassium channel blockers.

Sotalol.

92
Q

What are the Class IV antiarrhythmics?

A

Calcium channel blockers.

Verapamil, diltiazem.

93
Q
A

Green book MCQs (3 decks)

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