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ICM - Data stuff! Flashcards

1
Q

What are the four cardiac arrest rhythms?

A
  • Ventricular Fibrillation
  • Pulseless ventricular Tachycardia
  • Asystole
  • Pulseless Electrical Activity
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2
Q

What are the two shockable Cardiac Arrest Rhythms?

A
  • Ventricular fibrillation
  • Pulseless ventricular tachycardia.
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3
Q

Which type of cardiac arrest rhythm is this?

A

Asytole (not-shockable)

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4
Q

What kind of cardiac arrest rhythm is this?

A

Pulseless electrical activity. (Not shockable)

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5
Q

What kind of cardiac arrest rhythm is this?

A

Pulseless ventricular tachycardia. (Shockable)

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6
Q

What kind of cardiac arrest rhythm is this?

A

Ventricular fibrilation.

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7
Q

Which valve does each of these points of auscultation listen to?

A

Green - Aorta

Red - Pulmonary

Yellow - Tricuspid

Blue - Mitral

All Prostitutes Take Money

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8
Q

The ‘lub’ of the heart is caused by the closing of which valves?

A

Tricuspid and mitral, at the start of ventricular systole.

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9
Q

The ‘dub’ of the heart beat is caused by the closing of which valves?

A

Aortic and pulmonary valves, during diastole.

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10
Q

What are some of the causes of systolic murmur?

A

Aortic valve stenosis

Mitral regurgitation

Pulmonary valve stenosis

Tricuspid regurgitation

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11
Q

What are some of the causes of a diastolic murmur?

A

Mitral stenosis

Tricuspid stenosis

Aortic regurgitation

Pulmonary regurgitation

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12
Q

What is one of the main causes of continuous murmur?

A

Patent ductus arteriosus.

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13
Q

Why does a patient need to be upright for a chest X-ray?

A

So that free air can be seen under the diaphragm, pneumoperitoneum.

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14
Q

Which type of X-ray will show an innacurate view of the heart?

A

AP - divergence of the x-ray beams show an enlarged heart.

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15
Q

What is the normal cardiac-thoracic ratio?

A

<50%

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16
Q

How should a chest X-ray be performed?

A
  • PA
  • Inspiration
  • Erect
  • No rotation
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17
Q

What are the borders of the heart visible on an x-ray?

A
  • Left Ventricle
  • IVC
  • Right Atrium
  • SVC
  • Aortic knuckle
  • Left auricle
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18
Q

What can you see on this X-ray?

A

1) Right Hilum
2) Left Hilum
3) Right hemidiaphragm
4) Left hemidiphargm
5) Gastric bubble

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19
Q

What can you see on this x-ray?

A

A) Trachea

B) Carina

C) Right Clavicle

D) Left Ventricle

E) Aortic knuckle

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20
Q

What can you see in this x-ray?

A

A)

B) ECG lead

C) Endotracheal tube

D) Nasogastric tube

E) Surgical staples

F)

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21
Q

What are the four densities to look at in abdominal X-rays?

A

1) Gas
2) Fat
3) Soft Tissue
4) Bone

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22
Q

Why is the liver visible on an abdominal X-ray?

A

It is denser than the retroperitoneal fat around it, so it is a darker shade of grey.

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23
Q

What five abnormalities can we see on an abdominal radiograph?

A

1) Foreign bodies
2) Perforation
3) Kidney stones
4) Bowel obstruction
5) Abdominal masses

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24
Q

What can you see in this abdominal X-ray?

A

Staghorn calculus in left kidney.

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25
Q

What is this abdominal X-ray?

A

Intravenous urogram (pyelogram)

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26
Q

How do you distinguish between small bowel and large bowel?

A

Colon-
Peripheral
Haustra only goes half way across.
Faeces.

Small intestine-
Valvulae Conniventes
(lines that go all the way across)
Central
No faeces

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27
Q

What does the abdo. X-ray show?

A

Dilated colon

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28
Q

What is a sigmoid volvulus?

A

A twisting of the sigmoid colon, that causes large dilation of the colon.

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29
Q

What does this abdo. X-ray show?

A

Dilated small bowel. Volvulae conniventes, central location.

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30
Q

What is haustra?

A

The lines on the colon that only go half way across.

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31
Q

What is Valvulae Conniventes?

A

The lines that go right the way across the small bowel.

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32
Q

What is the name for the lines that completely cross the small bowel?

A

Valvulae conniventes.

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33
Q

What are three causes of small bowel obstruction?

A

Adhesions

Perioneal malignancy

Hernias

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34
Q

What does the chest x-ray show?

A

Perforated bowel, free air under the diaphragm (Pneumoperitoneum)

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35
Q

What two signs indicate large bowel perforation?

A
  • Ringlers sign - Where both sides of the wall of the bowel are visible.
  • Triangles of gas.
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36
Q

What are the causes of large bowel obstruction?

A
  • Cancer
  • Diverticulitis
  • Hernias (rare)
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37
Q

How do the head tilt - chin lift and jaw thrust work?

A
  • Open the pharynx by moving the tongue and epiglottis away from the posterior pharyngeal wall.
  • Straightens and opens whole airway by stretching/extending the neck.
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38
Q

What precaution should be taken when performing head tilt / jaw thrust?

A

In trauma patients/ unstable cervical spine - manual in line immobilisation.

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39
Q

What is this airway and how is it measured?

A

Oralpharyngeal airway

From incisors to angle of jaw.

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40
Q

What is this airway and how is it sized?

A

Nasopharyngeal airway.

Start with 6mm diameter.

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41
Q

What instrument is this?

A

Bivalve / cusco speculum

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42
Q

What instrument is this and what are its indications for use?

A

A sims speculum.

Vaginal wall prolapse.

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43
Q

What instrument is used for getting an endometrial cell sampling?

A

Pipelle

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44
Q

What would ‘stony dull’ percussion indicate?

A

Normal: Muscle

Abnormal: Fluid in cavity

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45
Q

What would ‘dull’ percussion indicate?

A

Normal: Solid organ

Abnormal: Pneumonia, ascites, hypetrophy

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46
Q

What would a ‘hyperresonant’ percusion indicate?

A

Abnormal: Pneumothorax, COPD

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47
Q

What would ‘tympanitic resonant’ percussion indicate?

A

Normal: Hollow air containing structure.

Abnormal: Bowel obstruction.

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48
Q

What are crystalloids?

A

Solutions of dissolved low molecular weight chemicals in water. Crystalloids will diffuse into is distributed throughout all body water.

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49
Q

What are colloids?

A

Colloids are solutions of partially dissolved larger molecular weight chemicals. They stay for longer in the intravascular compartment so are useful for replacing blood volume.

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50
Q

What are the 5 F’s for a distended abdomen?

A
  • Flatus
  • Fat
  • Fluid
  • Faeces
  • Foetus
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51
Q

How would you convert micrograms into miligrams?

A

÷ 1000

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52
Q

How would you convert nanograms into miligrams?

A

÷ 1000 then ÷1000

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53
Q

How would you convert miligrams into micrograms?

A

x 1000

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54
Q

When given a percentage for a drug what does it mean?

A

% = number of grams in 100ml

i.e. 0.5% 200ml is 1g

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55
Q

When given a ratio in drug calculations, what does it mean?

A

Grams in however many mls.

e.g. 1:10000
is
1g in 10000ml

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56
Q

What is the formula for volume calculations?

A

_What you want _ x volume
What you’ve got

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57
Q

What steps can you take to encourage a vein for venepuncture / cannulation?

A
  • Tourniquet
  • Tap vein
  • Position limb below right atrium
  • Muscle contraction
  • Temperature
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58
Q

What is the duration of use for a cannula?

A

72-96 hours.

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59
Q

What instrument is this?

A

Venflon (Cannula)

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60
Q

Where do you apply the tourniquet for venepuncture?

A

10cm above the site.

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61
Q

What angle should you insert a venepuncture/cannula needle in?

A

10-15ª

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62
Q

What type of airway is this?

A

Laryngeal mask airway.

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63
Q

What is the name of this oxygen delivery system? And how much % oxygen can it deliver at full flow?

A

Simple face mask

50% at 15L/min

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64
Q

What sort of oxygen delivery system is this? And what is the advantage over simple face masks?

A

Venturi mask.

Able to achieve accurate oxygen delivery at 24-60% through changeable valves.

65
Q

What type of oxygen delivery system is this? And what is their purpose?

A

Non-rebreathing masks.

Allows for delivery of 90-95% oxygen with a15L/min flow rate, used in seriously ill patients who can still self-ventilate.

66
Q

What type of oxygen delivery system is this? What is its use?

A

A bag valve mask.

Given during respiratory failure, can be used with atmosphere or supplemantary oxygen.

67
Q

What angle should an intramuscular injection be given relative to the skin?

A

90 degrees.

68
Q

What equipment is needed for an intramuscular injection?

A
  • Drawing up needle.
  • Needle for IM (usually blue or green)
  • Cotton wool
  • Alcohol wipe
  • Syringe
  • non-sterile gloves
  • Sharps container
69
Q

What are the four sites for intramuscular injection?

A
  • Deltoid.
  • Vastuslateralis muscle.
  • Ventrogluteal muscle.
  • Dorsogluteal muscle.
70
Q

How do you locate the deltoid for IM injection and how much fluid can it hold?

A

Upside down V from the shoulder.
1ml

71
Q

How do you locate the Vastus lateralis muscle for IM injection and how much fluid can it hold?

A
  • Place one little finger on the lateral femoral condyl and the other on the greater trochanter. Try and touch thumbs together, where they meet is the site.
  • Can hold 2ml
72
Q

What is the artery in the testicles and where does it arise?

A

The testicular artery, comes from the aorta just inferior to the renal artery.

73
Q

What is the venous drainage of the testicles and where do they drain?

A

The L and R testular vein.

The left drains into the l renal vein at an acute angle.

The right drains into the IVC at a right angle.

74
Q

What is the autonomic nervous supply of the testicles?

A

Efferent: Parasympathetic: Vagus nerve/Sympathetic T10-11

Afferent: As above.

75
Q

What is the adequate exposure for a testicular exam?

A

Umbilicus to knees, use blanket to maintain dignity.

76
Q

What is the name of the network of veins in the spermatic cord?

A

Pampiform plexus.

77
Q

If you cannot get above a lump in the scrotum what does it inidcate?

A
  • Either starts in the scrotom and is ascending into inguinal region (e.g. varicocele, hydrocele).
  • Or, starts in inguinal region and is descending into the scrotum.
78
Q

Transilumination of a testicular lump, discuss.

A
  • If it is transilluminate, then it is probably a transudate (e.g. hydrocele)
  • However and exudate (infection, blood) and a solid mass will not transilluminate.
79
Q

What may be the cause of unilateral testicular atrophy?

A
  • Inflammation/Infection
  • Trauma
  • Torsion
  • Decreased venous/arterial blood flow
  • Undescended testicle
80
Q

How can you determine whether a hernia is direct or indirect through examination?

A
  • If possible reduce the hernia, either manually or spontaneously by lying patient flat.
  • Press on the deep inguinal ring, ask patient to cough, if it reappears it is a direct hernia but if it is controlled it is indirect.
81
Q

How do you locate the deep inguinal ring using surface landmarks?

A

Halfway between the anterior superior iliac spine and the pubic tubercle.

82
Q

When doing a digital rectal exam, what position is 12 when describing findings?

A

Anteriorly, i.e. between the legs.

83
Q

During a DRE, if their is increased tone of the external anal sphincter, what would you suspect?

A

Upper motor neurone pathology, as opposed to lower motor neurone pathology that would be suggested decreased tone.

84
Q

What would abnormally pale stools suggest?

A

Biliary obstruction.

85
Q

What would pale and greasy stools suggest?

A

Steatorrhoea.

86
Q

What would black, tarry stools represent?

A

Malaena, bleeding from the upper GIT.

87
Q

What would grey or black stools indicate?

A

Oral iron or bismuth therapy.

88
Q

What would silvery stools indicate?

A

Steatorrhoea and upper GI bleeding.
E.g. Pancreatic cancer.

89
Q

What is responsible for ricewater stool? (Watery with mucus and cell debris)

A

Cholera

90
Q

How would you investigate microscopic blood in stools?

A

faecal occult blood.

91
Q

What are the dermotones of the perineum?

A

Anus - S5
Surrounding area and testicles - S4

Wider area inside bum - S3

Inner thighs - S2

92
Q

What is the motor nerve supply of the external anal sphincter?

A

Somatic nervous system, voluntary control, Pudendal nerve S2, S3, S4

93
Q

What is the nervous control of the internal anal sphincter?

A

Autonomic nervous system, involuntary.

  • Sympathetic - T12, L1, L2
  • Parasympathetic - S2, S3, S4
94
Q

What is the nervous supply of the anal reflex?

A

S4, S5

95
Q

What are the myotomes for the movement of the knee?

A
  • Extension - L3,L4
  • Flexion - L5,S1
96
Q

What are the myotomes for the movements of the hip?

A
  • Extension - L1,L2
  • Flexion - L5, S1
97
Q

What are the myotomes for the movement of the ankle?

A
  • Inversion (Pronantion?) - L4
  • Eversion (Suppination?) - L5, S1
  • Dorsi Flexion - L5
  • Plantar Flexion - S1
98
Q

What nerves are responsible for the internal urethral spincter contraction and relacation?

A
  • Sympathetic - Contraction T9-T12
  • Parasympathetic - Relaxation S2-S4
99
Q

Which myotomes are responsible for big toe extension?

A

L5

100
Q

What nerve is responsible for the knee reflex?

A

L4 (Femoral nerve)

101
Q

Which nerve is responsible for the ankle reflex?

A

S1 (Sciatic nerve)

102
Q

What would be the normal response during a babinski reflex test?

A

Plantar flexion of does.

103
Q

What is Gowers sign?

A

This is where the patient climbs up himself to get up, a sign of proximal muscle weakness.

104
Q

What is Romberg’s test?

A

An examination of whether a stance is steady or not, eyes closed etc..

105
Q

What does the Snellen chart test?

A

Visual Acuity

106
Q

What are the symbols of a Snellen chart called?

A

Optotypes

107
Q

If a patient cannot read a Snellen chart what should happen next?

A

• Move them to 3 metres and then 1 metre.

108
Q

What aperture should be used for a general examination of the eye?

A

The large aperture (In dilated eyes)

109
Q

What is the power of a lens measured in and does a convex lens have a positive or negative value?

A

Dioptres= 1/focal length(metres)

Convex: +ve

Concave: -ve

110
Q

What type of lens should you use for a hypermetropic eye?

A

Hypermetropic means long-sighted so a convex lens should be used to bring the retina into focus.

111
Q

What type of lens should be used for a myopic eye?

A

A Myopic lens is (short-sighted), so a concave lens should be used to bring the retina into focus.

112
Q

What is the term for normal vision?

A

Emmetropia.

113
Q

The size of the pupil is controlled by both the sympathetic and parasympathetic system, which receptors are responsible and what effect do they have?

A
  • *Parasympathetic- **Muscarinic (M3 receptors) on circular muscle.
  • Agonist contricts
  • Antagonist dilates
  • *Sympathetic- **Beta-1 receptors on radial muscle
  • Agonist dilates
  • Antagonist constricts
114
Q

Which division of the autonomic nervous system is responsible for the accomodation of the lens?

A

Parasympathetic (M3 receptors), on the ciliary muscle.

115
Q

Should an examiner using an opthalmoscope remove their glasses?

A

No, the examiner is aiming for emmetropia.

116
Q

At what angle should you stand from the patients visual axis when using an opthalmoscope?

A

15-20˚

117
Q

What can cause an abnormal red reflex?

A

Oedema, Ulcer, Cataract, Aqueous humour, Retinoblastoma.

118
Q

What is the name of the cancer in a child that causes an abnormal red reflex?

A

Retinoblastoma

119
Q

How much of the retina can be viewed with an opthalmoscope with a dilated pupil?

A

• 30%

120
Q

What contraindicates the use of a pharmacological pupil dilator?

A

• Driving, patient alone, intracranial pathology (undiagnosed), head injury.

121
Q

What does this image show?

A

• Papilloedema •
Oedema of the optic disc
Blurred elevated margin, dilated retinal veins, haemorrhages.

122
Q

Whaty does this image show?

A

• Optic Atrophy •

Sharp disc margin, very pale disc.

123
Q

What does this image show?

A

• Central retinal artery obstruction •

Ischaemia of anterior retina excepth fovela/macula.

Optic disc is pale and the fovea has a cherry red spot.

124
Q

What does this image show?

A

• Branch retinal artery obstruction •

Ischaemia of corresponding quadrant.

May see plaques occluding artery.

125
Q

What does this image show?

A

• Central Retinal Vein Obstruction •

Haemorrhages, flame, dot and blot.

Dilated veins, exudates, optic disc oedema.

126
Q

What does this image show?

A

• Branch retinal vein obstruction •

127
Q

What does this image show?

A

• Hypertensive fundus •

Arteriosclerosis, AV nippping, haemorrhages, soft exudates - cotton wool spots, hard exudates, optic disc oedema.

128
Q

What does this image show?

A

• Glaucoma •

Increased disc diameter, optic atrophy.

129
Q

What does this image show?

A

• Diabetes Mellitus •

Microaneurysms, haemorrhages, soft exudates, hard exudates, neovascularisation, optic disc oedema.

• Laser treatment to neovascularised area leads to white round scars.

130
Q

What does this image show?

A

• Macular Degeneration •

Hard exudates, haemorrhages, neovascularization.

131
Q

What does this image show?

A

• Retinal detachment •

132
Q

What does this image show?

A

• Retinoblastoma •

133
Q

What does this image show?

A

• Malignant Melanoma •

134
Q

What is Allen’s test?

A

This is a test to check the functionality of the Ulnar artery, both arteries are occluded and then the ulnar is released and perfusion to hand is observed.

135
Q

What is Fromment’s sign?

A

The thumb and index fingert are used to hold a piece of paper, make sure flexion is not used. It tests for ulnar nerve palsy, specifically the action of adductor policis.

136
Q

What is Tinnel’s test?

A

This is the tapping of a nerve to illicit a ‘pins and needles’ sensation, to detect irritated nerves.

Commonly used in the investigation of Carpal tunnel syndrome.

137
Q

What is Phalen’s test?

A

The back of the hands are put together, it is used as a diagnostic test for carpal tunnel syndrome.

138
Q

What is Finkelstein’s test?

A

Used as an investigation for DeQuervains tenosynovitis.

The thumb and wrist are flexed and the wrist put into ulnar deviation, if pain occurs along the distal part of the radius then it is likely to be DeQuerains tenosynovitis.

139
Q

What are some of the benefits of the Vacutainer system?

A

Reduced infection risk, reduced needlestick injury, reduced trauma, reduced haemolysis, faster, cheaper.

140
Q

What is the number to call inside a hospital for the crash team?

A

2222

141
Q

How far should you push down in an adult for chest compressions?

A

5-6cm

142
Q

At what rate should you do chest compressions, and how many should you do between each set of 2 rescue breaths?

A

100-120/min

30:2

143
Q

What is the maximum rate of delivery of oxygen that most nasal canulas can produce?

A

6L/min

144
Q

What O2 saturation should be aimed for in people with COPD?

A

88-92%

145
Q

Why should flow rates of below 5L/min be avoided when using a simple face mask?

A

It can lead to rebreathing of CO2, which can lead to hypercapnia.

146
Q

The venturi system is most commonly used for which patients?

A

Those that need to avoid high oxygen levels, for example those with COPD.

147
Q

What % oxygen can non-rebreather masks administer when using a flow of 15L/min?

A

90-95%

148
Q

What the body water compartments of the body?

A

• total body water = 60% of body weight.

• Extracellular Fluid- 20%
- Made up of interstilial(20%), Intravascular(5%), transcellular (1.5%).

• Intracellular fluid - 40%

149
Q

What are the indications for the use of a Bivavle/Cusco speculum?

A
  • Cervical smear
  • Endometrial cells
  • Secretions/discharge
  • Pharmacological delivery systems
150
Q

How many times should a smear sample brush be rotated?

A

5 complete turns in a clockwise direction.

151
Q

What are the indications for the use of a sims speculum?

A
  • Vaginal wal prolapse
  • To observe for organ bulging.
152
Q

What are the three parts of the male urethra, going from proximal to distal?

A

1) Prostatic part
2) Membranous part
3) Spongy part

153
Q

What are the contraindications of using a male catheter?

A
  • Urethral rupture
  • Acute infection of the prostate gland
  • Abnormal urethral anatomy due to urethral or prostate surgery
154
Q

On the Glasgow Coma Scale, is the score for an alert patient high or low?

A

High

155
Q
A

• Flame haemorrhages due to hypertension.

156
Q

How do you calculate HR from an ecg?

A

Take the number of big squares between R waves and / 300.

157
Q

What is this a picture of?

What symptoms would be associated with this?

Which women are likely to get this?

A
  • Cervcal Ectropion
  • Mucus discharge, post coital bleeding.
  • Young women, pregnancy and those taking oestrogen OCP.
158
Q
A

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