lectures A-E

Question 1

Paradoxical respiration (seesaw motion) is a hallmark of inhibition of gas exchange due to diaphragmatic or respiratory muscle fatigue seen in what

chest wall retracts and abdomen pushes out

Answer 1

COPD or airway obstruction

Question 2

Features of airway obstruction in comatose pt

Answer 2

snoring gurgling , lack of misting on oxygen mask , seas saw and intercostal recession as well as cyanosis

Question 3

SCOOP guidelines
management of haematoma after thyroid surgery

Answer 3

contact crash team
steri strips - remove
cut sutures
push fingers into wound
open skin to expose strap msucles
open strap musclesto expose the trachea
cover wound with a pack

Question 4

anaphylaxis adrenaline how mnay mintues apart

Answer 4

5 mins

Question 5

what is asthma called before 2years of age

Answer 5

viral induced wheeze

Question 6

where do you insert an epi pen

Answer 6

upper outer thigh

Question 8

adrenaline in small doses causes vadodialtion what does it do in higher doses

Answer 8

vasoconstriction
Although α receptors are less sensitive to epinephrine, when activated, they override the vasodilation mediated by β-adrenoceptors. The result is that high levels of circulating epinephrine cause vasoconstriction.

Question 9

what is an allergy

Answer 9

An allergy is a reaction your body has to a particular food or substance. - a condition of hypersensitivity to an allergen - considered harmless to msot people

Question 10

what is atopy

Answer 10

Atopy - a hypersensntivie response on a apart of the body not in direc contact with allergen - atopic dermiaitis

Question 11

what is anaphylaxis

Answer 11

Anaphylaxis - acute life threatening hypersensositvry reaction

Question 12

4 types of hypersensitivity

Answer 12

Type 1 hypersensitivity- anaphyalcitc reaction - short time from exposure to sx
IgE mediated with mast cell and basophilis

Type 2- cytotocix - IgM anad iGg binds to target natigen on a host cell cauin gimmune response - autoimmune response - eg graves disease , myasthenia, goodpastures

Type 3 - immune complex - intial exposure to antigen formation of immune complex - igG - serum sickness, lupus

Type 4 - delayed or cell mediated - T cell - contact with antigen - contact dermatitis or due to forming of granulomas (TB_)
Prukary mode of damage eg coealiacs or contact dermatitis - belt rash or ring

How to be primed first. Sensitization event - allergen b cells ige to mast cells
Allergic reaction - allergen to mast cell and hsitmaien released rom mast cel

Question 13

anaphylaxis is what type of shock

Answer 13

distributive

Question 14

angioodema caused by what drugs

Answer 14

ACEi

Question 15

what shocks have a narrow or wide pulse pressure

Answer 15

Shock
Narrow pulse pressure( difference between systolic and diastolic) shock - less fluid trying to fill same space
Hypovolaemic
Haemorrhaic
Cariogenic
Obstructive - tamponade or PE

Wide pulse pressure - unrecordable diastolic potentially
Septic shock
Anaphylactic

Question 16

what enzyme measure of anpahyalctic reaction

Answer 16

Tryptase - remains elevated for around 6 hours and highest afyer 3 - normal value is under 10

Question 17

A seventy-two-year-old woman with rheumatoid arthritis is recovering on the ward 6 days following a left hemi-colectomy for a tumour in the descending colon. She complains to the nurse looking after her that she has developed pain in her abdomen. The pain is diffuse and came on suddenly but has gradually been getting worse since onset. She ranks it an 8/10. She has not opened her bowels or passed flatus since the procedure.

On examination:

Blood pressure: 105/68 mmHg; Heart rate: 110/minute; Respiratory rate: 16/minute; Temperature: 38.2 ºC; Oxygen saturations: 98%.

Abdominal exam: abdomen is distended. Diffusely tender upon palpation and evidence of guarding throughout. No organomegaly. No pulsatile masses. Kidneys are non ballotable. No shifting dullness. Absent bowel sounds.

There is feculent matter in the abdominal wound drain.

Which of the following imaging modalities is the most appropriate investigation?

Answer 17

abdomianl CT for anastamotic leak - risk facotrs include steriods

Question 18

Pseudocholinesterase deficiency (also known as suxamethonium apnoea) is a rare abnormality in the production of plasma cholinesterases. This leads to an increased duration of action of muscle relaxants used in anaesthesia,

Answer 18

suxamethonium. Respiratory arrest is inevitable unless the patient can be mechanically ventilated safely while waiting for the circulating muscle relaxants to degrade.

Question 19

difference between pleomorphic adneoma dn warthin tumour

Answer 19

pleomorphic most common, slow growing and warthin associated with smoking, bilateral disease

Question 20

tx of ramsay hunt syndrome

Answer 20

Oral aciclovir for 7 days and oral prednisolone for 5 days

Question 21

gingival hyperplasia caused by what

Answer 21

phenytoin, ciclosporin, calcium channel blockers and AML

Question 22

otitis externa tx

Answer 22

Topical antibiotics with or without steroid are first line treatment in otitis externa
Topical antibiotic + a topical steroid for 1-2 weeks

Question 23

persistant mouth ulcer think

Answer 23

Persistent mouth ulcer → ?squamous cell carcinoma

Question 24

ototoxic meds

Answer 24

gentamicin, quinine, furosemide, aspirin and some chemotherapy agents

Question 25

Tonsilar SCC is associated with

Answer 25

HPV infection

Question 26

two types of dental abcess

Answer 26

Periapical abscess (dentoalveolar abscess) — originates in the dental pulp (centre of the tooth), and is the most frequently occurring type, in both adults and children.
Periodontal abscess — originates in the supporting structures of the teeth (such as the periodontal ligament) between the tooth and the gum.

Question 27

`CP causes

Answer 27

Heart attack (lack of blood to your heart).
Coronary artery disease (CAD, a narrowing or blockage in your heart’s arteries).
Coronary artery dissection (tear in a heart artery).
Pericarditis (inflamed sac around your heart).
Hypertrophic cardiomyopathy (thick heart muscle).
PE
Pulmonary hypertension. …
Collapsed lung. …
Gastroesophageal reflux disease (GERD) …
Esophageal Rupture. …
Hiatal Hernia. …
Costochondritis. …
Muscle Strain.

Question 28

syncope what do you need to know

Answer 28

what doing 10mins before build ip

Question 29

Carotid sinus hypersensitivity is an exaggerated response to pressure applied to the carotid sinus located in the carotid bifurcation, resulting in bradycardia, vasodilation, and hypotension.
how to treat

Answer 29

cardiac pacing

Question 30

what part of the ECG is synchronized during cardioversion

Answer 30

peak of the QRS

Question 31

to maintain sinus rhythm after dc cardioversion what drug can you give

Answer 31

IV amiodarone

Question 32

cx of LBBB

Answer 32

Aortic stenosis
Ischaemic heart disease
Hypertension
Dilated cardiomyopathy
Anterior MI
Lenègre-Lev disease: primary degenerative disease (fibrosis) of the conducting system
Hyperkalaemia
Digoxin toxicity