ICM Questions Flashcards
What is “Stony Dull” sound on percussion indicative of?
Fluid in Pleural Cavity
What is “Dull” sound on percussion indicative of?
Pneumonia, atelectasis, (solid organ enlargement)
What is “Resonant” sound on percussion indicative of?
Normal
What is “Hyperresonant” sound on percussion indicative of?
Pneumothorax, COPD, bullae
When prescribing what does the term “MANE O.M.” mean?
in the morning
When prescribing what does the term “STAT” mean?
Immediately
A patient has a complete airway obstruction, what should you do?
CPAP and maximum % oxygen until Anaesthetist and Surgeon arrive
Cricothyrotomy - if pt deteriorates and help does not arrive
What does the Glasgow Coma Scale (GCS) rate?
Conscious level of patient (3-15)
Takes into account eye opening, motor and verbal response
What happens to cells in:
1) Hypotonic solution; 2) Hypertonic Solution
1) Hypotonic solution - Cell Swell
2) Hypertonic Solution - Cell Shrink
What controls the distribution of fluid between the ECF and ICF?
Na/K ATPase
What is so Abnormal about “Normal Saline”?
↑Cl - causes hyperchloraemic metabolic acidosis
Leading to hyperkalaemia
Name some Crystalloids
Hartmanns Solution
5% Dextrose
What are the problem associated with giving too much 5% Dextrose?
Glucose is metabolised by RBCs, the water that is left is HYPOTONIC and is distributed throughout the tissues
Water enters cells
Name a Colloid
Gelafusine - consists of electrolytes + larger weight molecule
Hypertonic - water will diffuse out of cells
What are the possible causes of Cardiac Arest?
4Ts & 4Hs Tension Pneumothorax Caridiac Tamponade Toxins Thrombosis Hypoxia Hypovolaemia Hyper/Hypokalaemia/Hypocalcaemia Hypothermia
What should be checked on “A”?
Airway
What should be checked on “B”?
RR Respiratory Pattern Trachea position Palpation/Percussion/Ausculation SpO/FlO2 Arterial blood gas
What should be checked on “C”?
ECG 3 lead continuous monitoring Pulse rate + rhythm + volume BP JVP CRT Auscultation
What should be checked on “D”?
GCS/AVPU
Pupils
Blood Glucose
What does NEWS stand for?
National Early Warning Score
What is Resuscitation Algorithm?
Signs of life? (15 secs)
Call Resuscitation Team
CPR 30:2
Apply Pads/Monitor
What do you look for on inspection for the Upper and Lower Neuro exam?
Posture Muscle Bulk Scars Fasciculation Involuntary movements (tremors, tics, chorea, athetoid) Ulceration
What are Choreiform movements?
Involuntary movements - rapid and jerky
What are Athetoid movements?
Involuntary movements - Sinous and writhing
What scale is used to assess Power as part of the neurological exam?
MRC
0 - No muscle contraction
1 - Flicker of movement
2 - Able to move but NOT against gravity
3 - Movement against gravity BUT NOT against Resistance
4 - Against Resistance - but NOT full strength
5 - Full Strength
What is Rhomberg’s Test used to differentiate between?
Ataxic gait due to proprioceptive disturbance (+ve) vs cerebellar disease (-ve)
What is Allen’s Test?
Close off radial +ulnar arteries -> hand goes white
Let go of ulnar artery -> should go red
If not, ulnar artery is not sufficient
What can splinter haemorrhages be indicative of? (cardio exam)
Subacute infective endocarditis
What can Koilonychia be indicative of? (cardio exam)
Iron Deficiency
What can Leuconychia be indicative of? (cardio exam)
Hypoalbuminaemia
What can Osler’s Nodes be indicative of? (cardio exam)
Bacterial endocarditis
What can Janeway lesions be indicative of? (cardio exam)
Infective Endocarditis
What is Xanthelasma?
Yellow (cholesterol) deposits around the eye
What is collapsing pulse testing for?
Aortic Regurgitation
What valves are heard to close on S1 and S2?
S1 - mitral and tricuspid
S2 - aortic and pulmonary
What added sounds can be heard on heart auscultation?
S3 - physiological (<30yrs); or pathological (consider heart failure)
S4 - can be heard before S1, pathological
What can be heard in mitral and aortic stenosis?
A CLICK - on valve opening (normally silent)
Describe the Korotkoff sounds
Phase 1 - Sharp Tapping (systolic pressure)
Phase 2 - swishing sound
Phase 3 - Tapping
Phase 4 - Tapping sounds replaced by muffled sound
Phase 5 - Sounds cease altogether (diastolic pressure)
What can the different colours of sputum suggestive of?
Grey - COPD Yellow - Infection (e.g. pneumonia) Green - Bronchiectasis/Abscess Red - PE, Pulmonary carcinoma Rusty/Gold - Pneumococcal pneumonia
What is Asterixis (Flapping Tremor) suggestive of (Resp Exam)?
Metabolic Encephalopathy
What organisms would you look for from a High Vaginal Swab?
Candida albicans/Gardnerella vaginalis
What organisms would you look for from an Endocervical swab?
Chlamydia trachomatis/Neiserria gonorhoeae
If oxygen supply is stopped, how long can the stored oxygen last?
3 minutes in a 70kg male
What is the most reliable method to detect whether intubation has been successful?
Carbon dioxide waveform and maximum partial pressure (Capnogram)
How do you know that the cuff of an endotracheal tube has been optimally inflated?
Pressure too low = leak, hypoxaemia, hypercapnia + aspiration risk
How long is the period of time that intubation should be done in?
20-30 seconds (Max 2 attempts)
What do you do if you can’t intubate the trachea?
Ventilate using non rebreathing self inflating bag-valve-mask
What are the contraindications for oral tracheal intubation?
Inability to open mouth
Inabilioty to move neck
Pathology in upper airway
Friable: fragmentation, haemorrhage, oedema
What are the complications associated with tracheal intubation?
Laryngeal trauma
Oesophageal trauma ->✞
Bronchial intubation
Dental Trauma
Airway Reflexes: Laryngeal spasm, Coughing, Bronchospasm
↑Sympathetic activity: ↑BP, arrhythmias, MI, ↑Intracranial pressure
In what patients should you avoid the use of a Laryngeal Mask Airway?
Pregnant
Obese
Alcoholic + Ate a lot
How is a nasopharyngeal airway measured?
Tragus of ear to tip of nose
How is an oropharyngeal airway measured?
Incisor teeth to angle of jaw
What are the indications for intubation?
Surgery
If aspiration is a possibility
Airway may collapse (anaphylaxis, burns)
What is guarding?
Reflex contraction due to inflammation of the parietal peritoneum
Where can IM injections be given?
Deltoid muscle
Dorsogluteal muscle
Vastus Lateralis muscle
What are the features of an IM injection into the Deltoid Muscle?
1mL
Easy Access
Fast Absorption
What are the features of an IM injection into the Dorsogluteal Muscle?
5mL
Slow Absorption Rate
(Double Cross method)
What are the features of an IM injection into the Vastus Lateralis Muscle?
4mL
Fast Absorption
At what angle should venopuncture be performed?
10-15
Why? -Reduces risk of trauma to underlying structures
What size of cannula requires anaesthesia?
> 20G use lignocaine (topical/subcut)
What complications are associated with Cannulation?
Vasovagal syncope (sinus brady & sometimes asystole)
Venous haemorrhage
Arterial Cannulation - immediate severe pain + paraesthesia
Infection (Staph epidermidis, Staph aureus, enterococcus)
Embolism
Nerve Injury
“Tissueing” -extravasation, fluid goes into tissues instead of blood
What viruses are transmitted during a needlestick injury?
Hep B
Hep C
HIV
What are the contraindications for cannulation?
Mastectomy, fistulas, fractures -> use opposite limb
What is the angle of entry during cannulation?
20-40
What is the speed and calibration on an ECG?
25mm/sec
i.e. large square= 0.2s; small square 0.04s
1cm = 1mV
Where do the V leads (ECG) look?
V1+V2 = Right Ventricle V3+V4 = Septum V5+V6 = Left Ventricle
How do you position the ECG leads?
V1 = 4th intercostal space (R) V2 = 4th intercostal space (L) V4 = 5th intercostal space mid clavicular line V3 = between V2 and V4 V5 = anterior axillary line V6 = mid-axillary line
What does a P wave signify? (ECG)
Atrial depolarisation
What does a Q wave signify? (ECG)
Septal depolarisation
What do RS waves show? (ECG)
Ventricular depolarisation to apical epicardium and then widespread to surface
What are the features of a 3 Lead ECG?
Can tell rhythm changes
Part of Minimal Mandatory Monitoring (O2, BP, ECG)
When attaching the leads for a 12 Lead ECG, where do the Red, Yellow, Green and Black leads go?
Red = RA (right arm) Yellow = LA Green = LL Black = RL
How can you tell dextrocardia from an ECG?
P wave inverted in lead I
Poor R wave progression
To confirm: position chest leads on Right Side
What are the Fraser Guidelines?
Followed when prescribing contraception for women under 16 yrs - is the child mature enough to make decision?
What are combined hormonal contraceptives?
Contain oestrogen and progesterone
What are adv. and disadv, of combined hormonal contraceptives?
Reliable & Reversible Reduced dysmenorrhoea & Menorrhagia ↑Breast + endometrial cancer ↓Ovarian & Cervical cancer ↑CVA, DVT, migranes
What are women at the increased risk of when taking oral contraceptives?
DVT during travel
When are progestogen only contraceptives indicated?
When oestrogens are contraindicated (h/o DVT)
Suitable for older women
People with migraine
DM
What are the options for Emergency contraception?
Levonorgestrel (effective within 72hrs)
Ulipristal (effective within 120hrs)
Should be taken asap
Efficacy decreases with time
What level does the knee reflex test?
L4 (femoral nerve)
What level does the ankle reflex test?
S1 (sciatic nerve)
What can the external anal sphincter tone tell you?
↑Tone = UMN pathology ↓Tone = LMN pathology
What is Gower’s sign? ( assessing gait, neuro exam)
Patient climbs up himself to stand (cannot stand-up without using hands)
What symptoms would you get with central and posterolateral disc protrusion?
Central - Leg pain (bilateral), Reflex loss, Paraesthesia, sphincter paralysis
Posterolateral - affects one nerve root, therefore symptoms reflect this, no autonomic symptoms
What are the actions of sympathetic and parasympathetic stimulations on the eye?
Parasympathetic system - circular muscles contract (constrict)
Sympathetic system - radial muscles contract (dilate)
What structures will retinal artery obstruction affect?
Anterior retina
Posterior ciliary arteries supply posterior retina, fovea/macula, optic nerve head and photoreceptors (therefore won’t be affected)
What is classed as “legally blind”?
6/60
What signs should be looked for when taking a history regarding the Neck?
5 Ds and 3 Ns
Dizziness, Drop attacks, Diplopia, Dysarthria, Dysphagia
Ataxia
Nausea, Numbness, Nystagmus
What myotomes are tested in the neck assessment?
C1 - Cx Sp Flx C2 - Cx Sp Ext C3 - Cx Sp Side Flex C4 - Shoulder elevation C5 - GH Abd C6 - Elbow Flex C7 - Elbow Extension C8 - Thumb Extension T1 - Finger Abduction
What is the function of the Dartos Muscle in the male genitalia?
Wrinkling of scrotum when cold
What is the function of the Cremaster Muscle in the male genitalia?
Draws testicles in in cold/during exercise
What is the venous drainage of the testicle
Pampiniform plexus -> Lt Renal Vein (L) & IVC (R)
What do Seminiferous tubules do?
Make sperm & testosterone
What is the difference between direct and indirect inguinal hernia?
Indirect: commonly descends into scrotum
Direct: Rarely descends into scrotum
What are the 5Ps to ask for in a sexual history?
Partners Prevention of pregnancy Protection from STIs Practices Past STIs
What is Paediatric Basic Life Support Algorithm outline? (up 12 yrs of age)
1)Unresponsive?
2)Not breathing Normally?
3)5 Rescue breaths
4) 15 chest compressions
Continue 15:2
What is an average RR for a 1 yr old?
30-40
What is an average RR for a 1-2 yr old?
26-34
What is an average RR for a 5-12 yr old?
20-24
What is an average RR for 12 yrs and over?
12-20
What is the average HR for a newborn?
140
What is the average HR for a 3mnts-2yrs?
130
What is the average HR for a 2-10yr old?
80
What do you do with a child who is conscious and choking? (ineffective cough)`
5 back blows
5 thursts
What do you do with a child who is conscious and choking? (effective cough)`
Encourage cough
What are the signs of shock?
1) Pallor
2) Tachycardia
3) Decreased capillary return
4) Air hunger
5) Oliguria
What is Kussmaul breathing indicative of?
Labored breathing (hyperventilation) Indicative of metabolic acidosis
What are the roles of Cinnamon, Vanadium and Chromium in the treatment of diabetes?
↑ sensitivity to insulin
What should happen to any UNEXPECTED blood glucose result ranging 20mmols/l?
Reading should be verified by sending off a grey topped bottle to analysis (venous blood sample)
