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26/7 los > Haem questions > Flashcards

Haem questions Flashcards

1
Q

What does blood typing involve?

A

forward grouping - patient’s RBC vs. standard sera

reverse grouping for confirmation - patient’s sera vs. standard RBCs

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2
Q

What is antibody screening?

A

Patient’s serum + control RBC in saline

Screening for clinically relevant antibodies

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3
Q

What are the additives for PRBCs?

A 
SAGM 
sodium chloride 
adenine 
dextrose 
mannitol
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4
Q

What are the anticoagulant additive to blood at collection?

A

CPD
citrate
phosphate
dextrose

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5
Q

Define a circle system

A

Circle breathing system is a closed or semi-closed system used to deliver oxygen and anaesthetic gases, while eliminating CO2 and recirculates patient’s respiratory gases.

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6
Q

Advantages of circle system?

A

provides constant inspired concentration
conserve heat and humidity
reduced anaesthetic gas waste
efficient CO2 removal

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7
Q

Disadvantage of circle system?

A

slow equilibration of anaesthetic gas
soda lime degradation products
complex system prone to error
high resistance within circuit

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8
Q

how much O2 is dissolved in blood at room air?

A

PaO2 (RA) = 100mmHg

0.03 x 100 = 3ml/L of blood

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9
Q

How is intrapleural pressure different between the base vs. apex of lung?

A

Base - gravity, weight of lung onto tissue.

High intrapleural pressure, less negative.

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10
Q

How is FRC measured by gas dilution?

A

Helium dilution method
Known volume and concentration of helium.
Helium minimally uptaken

V1 x [He] = (V1 + FRC) x [He]

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11
Q

Define FRC

A

Lung volume at end-expiration of normal tidal breathing
RV + ERV
Volume at lung inward recoil and chest wall outward recoil are in equilibrium

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12
Q

What is the correction factor F in the alveolar gas equation

A

F = ~2mmHg on RA

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13
Q

How much does MV increase with every mmHg of CO2?

A

2-3L/min

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14
Q

What are the effectors of ventilatory response?

A

Phrenic nerve - diaphragm
intercostal nerves - external intercostal
C-spine nerves - scalenes
CNIX/X - pharyngeal dilators

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15
Q

What hormones are regulated by the liver?

A

EPO, 10% - hepatic synthesis of RBC particularly in neonatal period
Conversion of cholecalciferol to 25 hydroxy-D3
Angiotensinogen
Androgens/oestrogen

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16
Q

Effect of sevo on cardiac muscle?

A 
dose dependent reduction in HR/contractility 
anaesthetic preconditioning (activation of ATP-sensitive K channels) -> reduce risk of iscahemia 
Increase QT interval ?MOA 
Coronary steal syndrome - rarely significant
17
Q

How does hypokalaemia affect NMB?

A

HypoK -> increase K efflux gradient -> intracellularly become more negative -> hyperpolarisation of membrane -> potentiates effect of NMB

18
Q

How does amino glycoside affect NMB?

A

competes with Ca for binding site -> reduce Act release and potentiate NMB effect.

Also reduces post-synaptic nACHr sensitivity rot Ach

19
Q

What are the factors that affect venous return?

A

Flow = pressure change / resistance

RA flow = (MSFP - RAP) / RVR (resistance to venous return)

20
Q

What are the factors that affect MSFP?

A

Total blood volume
Venous tone
Posture
Skeletal muscle pump

21
Q

What factors affect RAP?

A

IPPV
PVR
Congestive heart failure

22
Q

What factors affect RVR?

A

arteriolar resistance - vasodilators -> move more blood for artery -> veins -> increase venous return

External compression - pneumoperitoneum

23
Q

Metabolic alkalosis

How does one gain alkali in ECF?

A

endogenous - recovery from lactic / kept acidosis, as acids are cleared by liver

exogenous - IV fluid, IV NaHCO3

24
Q

Endo causes of metabolic alkalosis?

A

Hyperaldosterone - Conn’s, Cushing’s, high dose steroids

Hypokalaemia

25
Q

Describe the formation of urea

A

Degradation of amino acid from protein and proteolysis.

Process almost entirely in the liver

Deamination via amino transferases - a-kteo acids and NH4.

Ammonia + CO2 -> urea

Important intermediate steps are ornithine, citrulline, arginine

26
Q

Key points for phenytoin PK

A 
saturable liver metabolism - zero order 
highly albumin bound 
Half life 24 hours
Many drugs inhibit metabolism of phenytoin 
enzyme inducer
27
Q

What are some of the potential drug interactions with amiodarone

A

potent CYP450 inhibitor

Increase concentration digoxin, amide LAs, warfarin

28
Q

What are the effects of pro-kinetics?

A

Increase LOS tone
Increase motility
Relaxation of pylorus

29
Q

Prokinetic drugs?

A

metoclopramide - anti-D2, cholinergic
cisapride - increase myenteric plexus release of Ach
Erythromycin - cholinergic

30
Q

What are the particulate of antacids?

A

aluminium or magnesium oxide

31
Q

What is hepatic extraction ratio?

A

fraction of drug irreversibly removed during one pass of blood through the liver

32
Q

Equation of hepatic extraction ratio

A

(Fraction unbound x intrinsic clearance ) / (Hepatic blood flow + (Fu x Cl int) )

26/7 los (5 decks)

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