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FFICM > MCQ OnExamination > Flashcards

MCQ OnExamination Flashcards

1
Q

The openings in an HME filter are about 0.2microm, given that viruses and bacteria can be smaller than that how do they filter them out?

A

Though a seive action the Brownian motion of particles means that they do not slip through

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2
Q

Tell me about pyloric stenosis?

A

Usually week 3-5 of life, male 6:1. Characteristic projectile vomit with hypoCl, hypoK metab alkalosis.
Hungry and keen to feed

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3
Q

Where is most thyroid hormone stored in the thyroid gland?

A

Thyroglobulin

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4
Q

Post partum what happens to ABG, blood volume, CO, gastric emptying and WBC?

A

ABG normal within a few days
Blood volume normal after 6 weeks
CO both SV and HR take 6-8 weeks to normalise
Gastric emptying reduced for 48hrs post partum
WBC normalise over 4-6 weeks

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5
Q

What are the characteristics of a drug that has low hepatic extraction ratio?

A

Drug clearance insensitive to changes in liver blood flow
Clearance very sensitive to protein binding, intrinsic metabolism and excretion
No first pass metabolism if given PO

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6
Q

Is lung compliance high or low in neonates? and Children?

A

Neonates high because of soft chest wall but after 1 year the value is lower

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7
Q

How does FEV1/FVC vary with age?

A

High as children, slowly decreases to old age

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8
Q

How is the carotid body altered in neonatal period?

A

At birth the response to hypoxia is blunted but get their normal sensitivity over a matter of days or weeks

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9
Q

How long after birth are HbF mostly superceded by HbA?

A

6 months

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10
Q

Whats the effect of anticholinergics on the lower oesophgeal sphincter?

A

Decreases tone

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11
Q

Why do you get postural hypotension in early pregnancy?

A

Progesterone causes reduced SVR

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12
Q

What happens with angiotensin II in pregnacny?

A

Increases therefore increasing water and sodium retention

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13
Q

What happens with iron levels in pregnancy?

A

Iron levels fall but transferrin and TIBC rise

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14
Q

What is TXA a synthetic analgoue to?

A

Amino acid Lysine,

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15
Q

How does TXA work?

A

it binds to plasminogen preventing plasmin formation and displaces plasminogen from thrombin
It may also have anti-inflammatory effects and improve plt fn

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16
Q

By how much did CRASH 2 say mortality was improoved by TXA?

A

If given with 8 hours ARR 1.5%

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17
Q

Is mycoplasma associated with pneumothorax?

A

No

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18
Q

What are normal pressures in RA, RV, PA and pulm occlusion pressure?

A

RA 0-12
RV2-25
PA 12-25
Occ pressure 8-12

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19
Q

What is A-mode and B-mode US?

A

A-mode is the single line in the scan, B-mode (what you see normally) is many many A-mode images

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20
Q

How does increased pulmonary venous pressure affect lung compliance?

A

decreases compliance

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21
Q

What is normal lung compliance?

A

About200ml/cmH2O (combined with chest wall complaince which is about 70-80ml/cmH2O)

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22
Q

What is the most sensitive measure of mild COPD?

A

FEF 25-75% which is the forced exp flow between 25 and 75% of an FVC manoeuvre. It corresponds to the airflow in the bronchioles. Can be difficult to interpret if the FVC is way off from predicted

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23
Q

Post extubation stridor is apparently a frequent complication of intubation !? occuring in 2-16%. What are the risk factors?

A

Female, intubated >36hrs, excessive cuff pressure, large tube size, tracheal infection

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24
Q

When should a ACEi be stopped after it has been started acutely?

A

If cr increases by >20%

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25
Q

If someone in cardiac arrest is on a thiazide what electrolyte abnormality should be empirically corrected in refractory VF?

A

Mg

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26
Q

What drugs are affected by the acetylator status of the patient?

A

Fast 40%, slow 60% of pop

Hydralazine, isoniazid, suphonamides, procainamide are all affected

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27
Q

What is the dose of adrenaline in cardiac arrest in children?

A

10microg/kg, use 1:10000 soln

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28
Q

What is the energy substrate used by the heart at rest?

A

50-70% is fatty acids, 30% glucose.

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29
Q

The superior pharyngeal nerve arises from which cranial nerve?

A

Vagus

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30
Q

How many branches does the superior laryngeal nerve have and what do they innervate?

A

small external- cricothyroid muscle

large internal gives sensation to larynx above cords

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31
Q

A parameteric test requires normal distribution. what are their outputs?

A

P-value

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32
Q

Do parametric tests themselves measure give an analysis of variance?

A

No, ANOVA is required for rhat and is used to test multiple groups of parametric data

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33
Q

What is the pH aim in TCA overdose bicarb bolus?

A

pH>7.4

If doesnt work can try glucagon, adrenaline and Mg

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34
Q

What is the best way to reverse thrombolysis-if that is something you need to do?

A

FFP and TXA

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35
Q

When should the thickness of a burn be examined?

A

Secondary survey

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36
Q

How are additional fluids calculated in a paediatric burn?

A

% burn xweight x4 same as adults

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37
Q

What is the definition of 1st dgree, 2,3 and 4th degree burn?

A

1st- supericialonly epidermis
2nd- partial thickness- epidermis and dermis
3rd- full thickness sub cut tissue inc hair follicles and sebaceous glands
4th complete- tendon, muscle, bone affected

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38
Q

In WPW is a wide or narrow complex expected?

A

Orthodromic and antidromic are possible, orthodromic in 70% and antidromic in the rest. Therefore narrow complex is to be expected

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39
Q

If someone with WPW comes with a narrow complex tachy how treat? And more advanced interventions?

A

Carotid sinus massage
NEVER adensoine if AF underlying as this can ppt VF
If shocked can DCCV with amiodarone
Avoid Verapamil

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40
Q

When is the best respiratory phase to see a pneumothorax?

A

End exp

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41
Q

Is FEF 25-75% under patient control?

A

No but the FVC is so where you define it starting and ending may affect your interpreation

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42
Q

Is eosinophilia useful in delineating between intrinsic and extrinsic asthma?

A

No, elevated commonly in both

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43
Q

The anterior pituitary produces what? Which subunits are similar and which different?

A

Produces glycoproteins with similar alpha subunits but unique beta subunits

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44
Q

Hormones of anterior pituitary?

A

LH, FSH, ACTH, GH, TSH

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45
Q

RIFLE classification- what is ‘loss’

A

Loss is complete loss of renal fn for 4 weeks

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46
Q

What are some syndromes that make airway management difficult

A

Crouzon, cystic hygroma, Edward’s, Goldenhar, Hurler’s

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47
Q

What are the cardiovascular changes in HRS?

A

Increased CO, low BP, reduced SVR and renal vasoconstriction

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48
Q

What are the diagnostic criteria for HRS?

A

Cirrhosis, Cr >133, no improvment of Cr after 2/7 of albumin and stopping nephrotoxics, no shock, no proteinuria

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49
Q

What are the ECG changes in profound hypothermia T<28?

A

J waves prolonged PR, QRS and QTc, ectopics deteriorating into VT/VF

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50
Q

Give some L->R shunt conditions

A

ASD, VSD, PDA, coarc, AVSD and AS/PS

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51
Q

What are common cyanotic R->L shunt conditions?

A

ToF, transposition, anomalous PV drainage, tricuspid atresia, hypoplastic L heart

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52
Q

What are the four phases of a Valsalva?

A
  1. Inc venous return from intra-thoracic vessels with associated dec HR and inc BP
  2. High intra-thoracic pressure reduces venous reutrn, HR inc, BP dec tending to normal
  3. release of pressure causes pooling of blood in lungs dec BP and HR remains high
  4. reflex brady back to baseline as venous return stabilises
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53
Q

What is the classic blood picture of Addison’s?

A

HypoNa, Hyper K (30% normal), metab acid withnormal AG, hypoglycaemia

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54
Q

What sort of RTA is Addison’s?

A

type 4

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55
Q

Causes of adrenal insufficiency?

A

Autoimmune, withdrawal of steroids, TB, meningococcal haemorrhage into glad (Waterhouse-Friderichsen), HIV, Malignancy infiltration

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56
Q

What anaesthetic drugs are contra-indicated in porphyria?

A

Thiopentone and Etomidate

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57
Q

What are the advantages of goal directed fluid therapy?

A

Redues length of stay by 1.16 days, no different in criticl care, reduces renaland resp failure and post op wound infection

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58
Q

Can St John’s Wort cause seretonin syndrome? What about Amitriptyline?

A

Yes and yes

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59
Q

Low plasma cholinesterase is associated with what?

A

Liver and renaldisease pregnancy, burns, hyper or hypothyroid

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60
Q

What sort of wave is used to calibrate the pressure transducer signal?

A

A square wave signal

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61
Q

What sort of frequency response should the transducer system have relative to the fundamental frequency?

A

10 times

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62
Q

What is the optimal damping factor for a pressure transducer cirtuit?

A

0.6-0.7

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63
Q

What is the ideal tubing to use in a pressure transducer?

A

stiff, less than 1.2m and of large diameter

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64
Q

How does T3 and T4 bind to thyroxine binding globulin and albumin?

A

Bind to both, very avidy to TBG but TBG only has a low capacity. Albumin has a larger store but T3/T4 less avidly binds.

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65
Q

How do brachial plexus injuries usually arise and how is it assocaited with clavicular fracure?

A

It is usually a traction injury but can occasionally be associated with a clavicle fracture

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66
Q

What nerve roots for Erb’s palsy?

A

C5/6/sometimes 7

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67
Q

What does a T1 brachial plexus injury look like?

A

Klumpke’s palsy weak flexors of wrist and fingers and intrinsic hand muscles. Loss sensation forearm. Can be associated with Horner’s syndrome

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68
Q

What nerve root injury associated with winged scapula?

A

C567

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69
Q

TPN is suspended in soya bean oil. Whatis the ratio of nitrogen to potassium and magnesium?

A

1g nitrogen to 5-6mmo K and 1-2mmol Mg

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70
Q

What are the three zones of the adrenal cortex?

A

Zona glomerulsa, fasiculata, reicularis

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71
Q

What do each of the zones of the adrenal cortex produce?

A

Zona glomerulosa- outer most ->aldosterone
Fasciculata- glucocot-> cortisone, corticosterone, deoxycorticosterone (most physiologically active is cortisol)
Reticularis-> androgens-> DHEA and androstenedione

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72
Q

The adrenal medulla secretes mainly what?

A

Adrenaline with a little noradrenaline

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73
Q

What is the sympathetic innervation of the adrenal glands?

A

pregang symp nerve fibres from T5-11 mediated by cholinergic nicotinic transmission

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74
Q

What can a lupus mother cause in a neonate due to transmission of products through placenta?

A

Anti-Ro and La antibodies can cause neonatal lupus syndrome which usually cause arrhythmia most commonly complete block

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75
Q

What drugs to avoid in porphyria?

A

Definite:Barbiturates, phenytoin,
Possible: ketamine, atracurium, lignocaine, steroid

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76
Q

What are the advantages of HFNO?

A

Reduced anatomical dead spaceby increasing pharyngeal washout
Reduce work of breathing
Element of CPAP
Improvesmucociliary clearance

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77
Q

What are the changes in pregnancy that mean seizure frequency increases?

A

Compliance, altered pharmacokinetics and normal hormonal changes means seizures are more likely

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78
Q

What are the effects of anaesthetic drugs on SSEP and MEP in spinal surgery?

A

Sevo

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79
Q

What column does the SSEP travel in?

A

dorsal columns (ascending)

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80
Q

In inter-hospital transfers what do the guidelines say about hyperventilation, GCS drop and need for intubation?

A

If GCS<8 intubate. If GCS drops by 2 prior to transfer consider intubation. If M score drops by 2 then must intubate
Hyperventilation 4.5-5 if no raised ICP 4-4.5 if raised

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81
Q

Where is the classic mass of pyloric stenosis felt?

A

just to right of midline

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82
Q

At what level do the R phrenic nerve and IVC penetrate the diaphragm?

A

T8

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83
Q

Where does the azygoud vein and aorta penetrate the diaphragm?

A

T12

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84
Q

In ABO incompatibility what are the mechanisms of antibody-mediated reactions?

A

Intravascular and extravascular

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85
Q

What are the steps in intravascular ABO incompatibility reaction?

A

IgM, IgG, Anti-A or B activate the complement cascade by the classical pathway resulting in free haemoglobin in the bloodstream

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86
Q

How does an extra-vascular ABO incompatibility come about?

A

Intact RBC are removed from circ by mononuclear phagocytes in liver and spleen. Any cell coated with igG or C3 is broken down resulting in bilirubin, urobilinogen etc Caused by IgG, anti-D and other rhesus ab

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87
Q

What does a non-immune haemolytic reaction look like in blood transfusion?

A

RBC are damaged before hitting the veins, result in asymptomatic haemoglobinuria nad haemoglobinaemia

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88
Q

What may happen to someone with C1 inhibitor deficiency in blood transfusion?

A

May get angio-oedema from standard plasma products

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89
Q

What is a normal urine output for a 7 year old in ml/kg/hr?

A

1

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90
Q

How does gabapentin work?

A

Alpha 2 delta Ca channel subunit acting on Ca channels and NMDA receptors to increase production of GABA

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91
Q

What are Moclobemide and Tranylcypromine?

A

MAOIs though the latter is the dirtier of the two

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92
Q

Risk of anaphylaxis per 100k administrations for chlorhex, sux, teic, co-amox?

A

Chlorhex- 0.78
Sux 11.1
Teic- 16.4
Co-amox 8.7

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93
Q

The bundle of His has three fascicles, R and ant L and post L. What does bifasicular block mean?

A

R and either ant or post L block

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94
Q

What axis deviation does L ant hemi-block cause?

A

L axis (post L block causes R axis)

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95
Q

What is Moxisylyte?

A

a alpha 1 blocker for Raynaud’s

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96
Q

With regards CPX what is the anaerobic threshold that conveys poorer outcomes?

A

<11ml/kg/min

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97
Q

In a severly unwell patient, what can be said of RR and a lactate >1.5?

A

RR is very sensitive but not specific at all. Onviously if you’re sick your RR will be up but if you run the same is true.
Lact >1.5 is associated with a higher mortality

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98
Q

What does diabetic autonomic neuropathy usually affect?

A

Parasymp system with particular vagal disturbance. Troubling nocturnal diarroea, postural hypotension (30mmHg), gastroparesis, painless urinary retention, lower pulse on standing and pupils sluggish

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99
Q

Where is ADH synthesised?

A

Supra-optic nucleus of hypothalamus as a precursor molecule which is taken to the posterior pituitary where it is released

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100
Q

What channel does ADH act on in kidney?

A

Aquaporin 2 (ADH also stimulated by nicotine!)

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101
Q

Features of life-threatening asthma

A

PEF <33%
SpO2 <92%
PaO2<8
silent chest, cyanosis, poor resp effort, reduced GCS

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102
Q

What is the role of calcitonin?

A

reduces Ca by inhibiting absorption in intestine and renal tubules and inhib osteoclastic action. It inhib PO4 reabsorption in renal tubules

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103
Q

Can low PO4 cause central pontine muelinolysis?

A

Yes

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104
Q

In ROTEM define

  1. clotting time
  2. clot formation time
  3. alpha angle
A

Clotting time is time from baseline to 2mm amplitutde
formation time- time for amplitude to inc from 2->20mm
Alpha angle is tangent to waveform at 2mm amplitude

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105
Q

in ROTEM what is A5 and A10?

A

Amplitude at 5 and 10min

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106
Q

What is a normal urine fractional excretin of Na? What causes it to be high and low?

A

1% is normal. of zero use if on diuretics
Less that 1% can be pre-renal but also seen in hepatic and cardiac failure
More than 1% intrinsic renal injury but not always

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107
Q

What causes renal red-cell casts?

A

Diseases affecting glomerulus- IgA neh, lupus nephritis, Goodpastures, Granulomatosis with polyangiitis

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108
Q

What are the causes of renal white-cell casts?

A

interstitial cell kidney disease such as pyeloneph and parenchymal infection

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109
Q

When do you see eosinophils in urine?

A

AIN which is caused by allergic reaction usually to drugs

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110
Q

What is a respiratory quotient?

A

Te ratio of CO2 produced by the volume of O2 per unit time

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111
Q

What is a noraml resp quotient?

A

0.8

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112
Q

What is the RQ of fat, protein, ethyl alcohol, pure carbs?

A 
Carb 1
Fat 0.7
Protein 0.9
Ethyl alc
0.67
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113
Q

From where does the azygous vein arise and end?

A

Left ascending lumbar vein draining posterior thorax and oesophagus joining directly onto SVC

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114
Q

What drugs potentiate non-depolarising muscle relaxants?

A

Inh anaesthetics, amionglycosides and tetracyclines, hyperMg

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115
Q

Drugs that can be removed by filter?

A

Aspirin, ethylene glycol,Li, methanol, procainamide, theophylline, vanc, carbamaz

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116
Q

When is FFP recommended in major haemorrahge? Dose?

A

If Fib<1g, PT/APTT >1.5x

Dose 15-30ml/kg

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117
Q

Can you get fibrinogen concentrate?

A

No,its not licenced in the uk

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118
Q

If patient has Eisenmenger’s will O2 help oxygenation?

A

The answer says yes because O2 is a pulmonary vasodilator and will reduce the R->L shunt

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119
Q

Can steroids cause a metabolic alkalosis?

A

Yes

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120
Q

How does adrenal insufficiency result in distributive shock?

A

There are fewer alpha 1 receptor expression on arterioles due to low cortisol resulting in vasodilatation

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121
Q

How is osmolality measured?

A

Depression of freezing point as this is directly correlated to the concentration of solutes

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122
Q

Above what level is amylase virtually diagnostic of pancreatitis?

A

1000

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123
Q

What are other causes of raised amylase apart from pancreatitis?

A

Ruptured panc cyst, perf peptic ulcer, cholecystisi, mesenteric infarction, mumps, pregnancy

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124
Q

Does octriotide reduce mortatliy in pancreatitis?

A

No

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125
Q

In cocaine overdose what would you use first line for agitation and hypertension? Second line? What is contraindicated?

A

First benzo then CCB like nifedipine

BB contra because of unopposed alpha effects resulting in worse htn

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126
Q

How does unopposed alpha stimulation lead to hypertension?

A

Balance between alpha 1 (constrict) and beta 2 (dilate) is reached. If unselected BB reduces B1 but also B2 then alpha 1 wins out leading to worse vasoconstriction

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127
Q

Does midazolam work on GABA A or B?

A

A

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128
Q

What is the bioavailability of midazolam?

A

40%

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129
Q

When transferring a patient in an ambulance what should monitoring be?

A

Non-invasive cuff useless
Should be able to see and hear screen
Needed for level 1-3 patients
Should be mounted either at level of or below patient

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130
Q

How does SNP work? Problems withit?

A

Prodrug causing arterial and venous dilatation, reduce BP and reflex tachy
Problems- breaksdown in sunlight making it dark brown/blue (from straw colour), also tachyphylaxis

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131
Q

What are the voltage criteria for LVH?

A

S in V3 and R in aVL >24mm in men and 20 in women
R in I and S in III >25mm
Sin V1 + R in V5or6 >35mm
Mostly used S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm

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132
Q

What does lead II look at on ECG?

A

Inferior (posterior) part of heart

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133
Q

What are the poor prognostic factors in OOHCA?

A

Sepsis, CVA, cancen, dementia, 2 or more chronic diseases, cardiac disease, CPR >5min

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134
Q

If patient makes it to hospital afer OOHCA what are the poor prognostic indicators?

A

Coma after CPR, hypotension, pneumonia or AKI, need for intubation, NYHA III or IV and older age

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135
Q

Symptoms and signs of seretonin syndrome?

A

Fever, confusion, clonus, hyperrelex, tremor, rigidity, hyperydrosis, shivering

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136
Q

Which breakdown product of codeine accumulated in renal impairment?

A

Morphine 6 glucuronide

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137
Q

When does sux cause hyperK?

A

Burns after 24 hrs, neuromusc disease inc tetanus, malig, hypovol shock, prolonged immobilisation

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138
Q

Why is adrenaline given in VF?

A

Preferential distribution of blood to coronary and ceebral circulation

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139
Q

What information is gathered during CPX?

A

12 lead with ST analysis, O2 consump and CO2 prod, MV, O2 sats, NIBP and subjective measure of exertion including Borg score (which is just that)

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140
Q

Which murmur would you expect in carcinoid syndrome and whats the underlying pathophys?

A

Tricuspid regurg (also PR) 50%have cardaic involvement usually R side with plaque-like thickening of valvular cusps being the issue

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141
Q

What dose of paracetamol allowed if 33-50kg, 10-33kg?

A

33-50 15mg/kg not exceeding 3g

10-33 15mg/kg not exceeding 2g

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142
Q

Class I antiarrhythmics all inhibit Na influx and slow phase 0 depolarisation are negaively inotropic and slow conduction velocity but what is the difference between Ia, b and c?

A

a- procainamide- increase refractory period
b- reduces refractory period
c - no effect on refractory period
all rely on K channel efflux regulation

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143
Q

In fat embolism what causes the rash? Can fat be seen in urine?

A

Can be seen in urine but who is looking?

Rash is petechial directly secondary to fat emboli

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144
Q

acute intermittent porphyria- inheritance

A

Auto dom

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145
Q

What enzyme is missing in acute intermittent porphyria?

A

porphobilinogendeaminase means a build up of ALA and PBG which are increased in urine ( other conditions like variegate porphyria and coproporphohyria can also have these products present so the presence of elevated PBG ppts genetic testing)

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146
Q

Is ketamine safe in AIP?

A

Controversial but in high doses it has been implicated

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147
Q

What is the bioavailability of oral digoxin and how does it work?

A

70% available
direct and indirect actions
direct inhib Na/K ATPase rasising intracellular Na which increases intra cellular Ca->inotrope
Indirect- acetylcholine release prolong AV and budle of His refractory period

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148
Q

What ECG changes are seen with digoxin treatment (not toxicity)

A

longer PR, ST depression, T wave flat and short QT

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149
Q

Are steroids evidence based in thyroid storm

A

yes

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150
Q

Give examples of prodrugs and their active metabolites

A

Enalapril- enalaprilat
Diamorph- 6 monoatcylmorphine
codeine-morphine
parecoxib-> Valdecoxib

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151
Q

In CKD incidence of gout is unchanged. What happens ith 25-hydroxycholecalciferol?

A

25-hydroxycholecalciferol remains unchanged, vit D converts it to 1,25-hy…
RBC life is also reduced in CKD

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152
Q

What are the effects of hyperglycinaemia? (TURP absorption syndrome)

A

Fluid overload, acute hypoNa, cardiac toxicity (infarction), AKI (hyperoxaluria) and transient blindness (min-24r)

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153
Q

What is the advantage of thermodilution over indocyanine green dilution in PA catheter estimation of CO?

A

In thermodilution there’s no recirculation peak

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154
Q

What are the equivalent doses to 5mg Pred in hydrocort, dex, methyl pred

A

Hydrocort 20mg
Dex 750microg
Methylpred 4

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155
Q

Which local anaesthetic is metabolised to O-Toluidine resulting in methaemoglobinaemia?

A

Prilocaine

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156
Q

How many Murphy eyes on an uncuffed RAE?

A

2, only one on cuffed

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157
Q

What characteristics means a drug can pass the BBB?

A 
Molecular weight of drug <600 daltons
Degree of ionisation (non-polar)
Lipid solubility
Protein binding, and
Tertiary structure
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158
Q

What is the ALS protocol for arrest if T<30?

A

Give 3x shocks if shockable. If doesn’t work warm them up.

If 30-35C double length of time between drugs

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159
Q

What is ethylene oxide?

A

Industrial steralisation gas, used for plastics and sutures. Things like Iodine and Chlorhex only disinfectants

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160
Q

What is a platelet life span and what chemicals of note do they contain?

A

Adenosine di-phosphate and serotonin. 9-10days

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161
Q

Which organ has the biggest art->venous O2 extraction?

A

Heart- 80% at rest 90% during exercise

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162
Q

Half life od IV Mg

A

4 hours

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163
Q

How does Mg vasodilate?

A

Magnesium amplifies the release of prostacyclin by vascular endothelium

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164
Q

How does WHO say you should kill prions?

A

autoclave at 121°C for 30 minutes with 1N NaOH then autoclave them normally

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165
Q

Which BB have intrinsic sympathomimmetic properties?

A

Labetalol and Pindolol (along with others you’ve not heard of)

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166
Q

Water soluble BB don’t enter the brain, which ones are they?

A

Atenolol, Sotolol and others you’ve never heard of

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167
Q

A positive congo-red stain is indicative of what disease?

A

Amyloidosis

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168
Q

What does a cholinergic crisis look like?

A

Hyperstimulated so diarrhoea, cramps, N+V secretions++, miosis, fasiculations

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169
Q

What does organophosphate poisoning look like?

A

Anticholinergic posion- so similar to a cholinergic crisis- hypersalivation, diarrhoea, miosis, etc

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170
Q

Can Carbimazole be used in pregnancy and in breast feeding?

A

Yes

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171
Q

With what is SIADH associated?

A 
Drugs, (e.g. carbamazepine)
Selective serotonin reuptake inhibitors (SSRIs)
Head injury
Tumours
Pneumonia, and typically with
Oat cell lung cancer.
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172
Q

What happens to the RV in tetralogy of fallot?

A

hypertrophy

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173
Q

What happens to LV in PDA?

A

Hypertrophy

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174
Q

How long after thrombolysis is LP/epidural allowed?

A

10 days at least

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175
Q

What is the safes metal in MRI?

A

Chrome

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176
Q

What % of nec fasc is type 1 and type 2?

A

Type 1 80% polymicrobial

Type 2 mono

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177
Q

What time frames do acute and chronic rejection occur?

A

Acute first 6/12 chronic thereafter

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178
Q

How is tissue rejection mediated in acute and chronic rejection?

A

Acute- T cell mediated

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179
Q

How does chronic rejection occur and present?

A

cell-mediated and antibody-mediated immune attack

Fibrosis is the hallmark with slowly increasing Cr

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180
Q

What is a normal CO2 and bicarb at term in pregnancy?

A

CO2 32 (4.3), HCO3 21

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181
Q

Does vecuronium have active metabolites?

A

Yes, accumulate in renal failure

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182
Q

Intubating dose of Vecuronium?

A

0.1mg/kg (least histamine release of all relaxants)

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183
Q

What is qSOFA?

A 
Low blood pressure (systolic equal or less than 100mmHg): 1 point
High respiratory rate (greater or equal to 22 breaths per minute): 1 point
Altered mentation (GCS<15): 1 point
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184
Q

What are the clotting changes in pregnancy?

A

Upregulation of all factors, plt normal, relative anaemia (50% inc in blood vol, 20-30% inc in RBC)

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185
Q

What happens to WBC in preg?

A

Slowly increase to about 9.5 at term

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186
Q

Does abdo radiotherapy cause pancreattis?

A

YEs but chronic rather that acute (is that right)?

187
Q

Drugs associated with pancreatitis

A

Steroid, thiazide, GLP1, valproate, azathioprine

188
Q

Amino amide LA

A 
Lidocaine
Bupivacaine
Ropivacaine
Prilocaine
Levobupivacaine, and
Mepivacaine.
189
Q

Amino ester LA

A

Chloroprocaine
Procaine
Tetracaine, and
Articaine.

190
Q

Difference between amino esters and amino amide?

A

Amino amides metab in liver whilst esters metab by plasma cholinesterase

191
Q

If VSD at birth what heart sounds do you hear and how is it corrected if cyanotic?

A

Splitting second heart sound. Most resolve spont but if pulmonary HTN and R->L shunt will need an operation but seldom do well

192
Q

Can a ketostix be negative in DKA?

A

Yes because of reduced clearance

193
Q

Is there evidence for PPI in variceal haemorrhage?

A

No

194
Q

When do you start Terlipressin in a haemodynamially stable patient presenting with UGIB?

A

ASAP is nice recommnedation. Wouldnt in practice atm

195
Q

What happens to lung compliance with age?

A

In elderly the lung compliance may not change much in health but the chest wall loses its compliance

196
Q

How does dynamic compliance vary with frequency of ventilation?

A

inversely prop

197
Q

Give some drugs tht have >50% pulmonary metabolism?

A

basic amines with pKa>8

Fentayl is an example

198
Q

What does STPD stand for?

A

Standard temp and pressure, dry

199
Q

How do TCA exert their cardiac effect in overdose?

A

Slow phase 0 with their quinidine-like action resulting in slow conduction. Other mechanisms include abnormal repolarisation and impaired automaticity, cholinergic blockade and inhibition of neuronal catecholamine uptake

200
Q

When would sodium bicarb be indicated in TCA overdose?

A

Tachy is ususal and is well tolerated. If QRS>100ms predicts higher chance of arrhythmia and so bicard should be given. It works by alikalinisation of serum which favours dissociation of tricyclic away from cardiac Na channels

201
Q

Albumin half life?

A

30 days

202
Q

Which is most common cranial or renal DI?

A

Cranial

203
Q

What happens to DI in pregnancy?

A

Plaenta makes vasopressinase, this increases symptoms

204
Q

Give examples of rare causes of bronchospasm

A

Aspergillosis (transient infiltrates, eosinophilia, cough and ashtma)
Carcinoid
Polyarteritis nodosa

205
Q

What is the standard outer diameter of the end of an ETT>

A

15mm

206
Q

What anaesthetic technique most reduces the stress response to surgery?

A

GA plus spinal above level of surgery. (said T4 on question so wonder if it always needs to be high)

207
Q

What forms of thyoid hormone resistance are there? They are rare

A

Generalised and pituitary specific (GrTH and PrTH) They have high T4 and FT3 with normal or high TSH whilst being hypothyroid or hyperthyroid respectively

208
Q

If someone stable on thyroixine for years and suddenly seen to need more it is usually because of another drug. What dugs increase thyroxine metabolism?

A

Rifampicin, st johns wort, carbamazepine, warfarin

209
Q

What is the fourth heart sound?

A

High atrial activity in say LVH leading to dilated LA

210
Q

What are the causes of a pathological third heart sound (may be normal <40)

A

MR/TR,dilated LV, AMI, low pitched (split S2 high)

211
Q

What is the classical finding on auscultation in HTN?

A

Loud S2

212
Q

What are the grades of hypertensive retinopathy?

A

G1- arterial narrowing
G2-AV nipping
G3- haem and exudates
G4- all above and papilloedema

213
Q

What does prilocaine do to a pulse oximiter?

A

Makes it read low due to methaemoglobin

214
Q

What is the gold standard for diagnosing renal artery stenosis, and best investigation?

A

Gold standard is angiogram but best Ix is MRI renal angiography, the USS RA has many false negatives

215
Q

What would make you think of renal artery stenosis as a cause for HTN?

A

Refractory HTN to 3 agents >150/90
recurrent pulmonary oedema with normal LV
>20% rse Cr in 2/12 after starting ACEi

216
Q

Which structure has the highest blood flow at rest (ml/min/100g)

A 
Carotid body 2000
Brain 54
Heart 87
Tyroid 560
Kidney 420
217
Q

What is the gold standard marker, using Fick’s principle, for measuring GFR?

A

insulin clearance

PAH is used in renal blood flow analysis

218
Q

How much does anaerobic threshold fall between 60-80 years?

A

10-20%

219
Q

Define anaerobic threshold

A

The point in exercise where products of anaetobic metabolism can no longer be eliminated

220
Q

Below what anaerobic threshold does mortality increase with surgery?

A

11ml/kg/min

221
Q

What type of RTA does spiro mimick?

A

Type 4

222
Q

What is the clinical presentation of botulism?

A

Descending bilateral weakness with autonomic dysfn (dilated pupils with cranial neuropathies, normal sensation and no fever

223
Q

How does botulism occur?

A

Clostridium botulinum produces endotoxins which prevent ACh release causing NMJ dysfunction and paralysis

224
Q

normal urine output for neonate, infant, child and adolescent?

A

N-2-3ml/kg/hr
I- 2
child 1-2
ad 0.5

225
Q

What sort of fast metabolisers are not allowed codeine? Why?

A

CYP2D6 rapidly metab to morphine putting them at risk

226
Q

Can kids have codeine post op?

A

Avoid <12yrs and in breastfeeding as it passes via milk. Contra in any child after tonsillectomy for OSA

227
Q

How does PTH exert its effects on osteoclastic and osteoblastic action?

A

Osteoblasts direclty, oesteoclasts indirectly via RANKL secreted by osteoblasts under control of PTH

228
Q

Neonates compared to adults have what differences in airway and respiration?

A

Diaphragm main muscle, static compliance is lower

Epiglottis is higher in neck, narrowest part of airway below flottis, main bronchi divide at equal angles

229
Q

What is the largest contributor numerically to the net filtration pressure in the kidney which allows GFR

A

Afferent glomerular capillary hydrostatic pressure

230
Q

on which side of the neck is the thoracic duct?

A

L side runs post to LIJ

231
Q

In acute tubular necrosis what nitrogen/Cr ratio, specific gravity, urine osmo and urine Na would you expect?

A

NH3/Cr 10-20
spec grav <1.01
Urine os <350 and urine Na>40

232
Q

What are key features of severe malaria?

A

Low GCS/seizure, renal impairemen (Cr>265), acidosis <7.3, ARDS, Hb<80, Spont bleeding, shock, haemaglobinuria, hypoglycaemia

233
Q

Which common toxins can be filtered?

A

BLAST

Barbiturates, Li, Alcohol, Salicylates, Theophyllines

234
Q

MEN II which cancers?

A

Phaeo, Hyperparathyroid and medullary Ca thyroid

235
Q

VWF deficiency, what does it do to PT and APTT?

A

PT is not invovled with platelets so normal

APTT is so prolonged

236
Q

What drugs stop labour?

A

Atosiban (oxy antagonist), terbutaline salbutamol, nifedipine, indomethacin

237
Q

Why is GTN give S/L rather than PO?

A

High first pass metabolism

238
Q

At what sort of level of aspirin do you think about RRT?

A

800mg/L

239
Q

what is the effect on glycogen, gluconeogenesis and plasma glucose in catcholamine, corticosteroid and glucagon?

A

Catechol-glyc down, gluconeo up, glucose up
corticost- glyc up, gluconeo up, glucose up
glucagon - glycogen down, gluconeo up, gluc up
GH glycogen down, plasma glucose up

240
Q

What do the presence of HBV e antigen?

A

If positive then highly infectious

241
Q

What does HB surface ag mean?

A

its only seen in someone who has at some point seen the real virus. Ag being present could be acute or chronic

242
Q

HBV surface antigen antibody means?

A

This is what the vaccine aims to make. It is also what someone who mounts a response makes. The issue with HBV is not everyone mounts a response

243
Q

What does a HBV core ab mean>

A

Simply means you’ve had it at some point

244
Q

IgM HBV core ab means what?

A

Acute infection, lasts for 6/12

245
Q

What gives you a clue that a sickle cell pt has parvovirus as the driver for their anaemia and admission?

A

Low reticulocytes, in other causes like bleed, haemolytic crisis or splenic sequestration the retics would go up.

246
Q

Afferent and efferent of gag reflex?

A

Glossopharyngeal aff

Vagus eff

247
Q

How does Mg help prevent seizure in eclampsia?

A

Dilates cerebral vessels and prevents vasospasm

248
Q

What is the biochemical signature of Cushing’s syndrome?

A

High urine free cortisol, 71% hypokalaemia and 72% high ACTH with peripheral oedema, personality change and skin pigmentation

249
Q

What cancers can produce ectopic ACTH?

A

Bronchial carcinoid and small cell lung, pancreatic islet cell, medullary thyroid, thymic and met adeno

250
Q

What happens to aldosterone in Cushing’s syndrome?

A

Goes down

251
Q

In ischaemic stroke when do you intervene with high BP?

A

?220/110

252
Q

In nephrotic syndrome you become hypercoagulabel, why?

A

You lose antithrombin III from kidney (increased beta 2 microglobulin and reduced fibrinolysis

253
Q

In ATN what would you expect the urine Na to be?

A

> 30mmol/L

254
Q

What does hypoglycaemia do to prolactin and ADH?

A

Elevate both

255
Q

How does protamine work?

A

It binds and inactivates heparin

256
Q

In glycolysis how many ATP molecules per molecule of glucose?

A

2

257
Q

WHat does AF with CHB look like?

A

No P waves but regular rhythm. Important as it still needs a PPM and can be missed

258
Q

How is Ca distriubuted in the plasma?

A

50% ionised, 40% bound (90% of which is on albumin), 10% are bound to anions

259
Q

What neuro findings would you expect in hypoCa?

A 
Dementia or overt psychosis
Irritability
Confusion
Hallucinations
Extrapyramidal manifestations (including hemiballismus), and
Seizures.
260
Q

What cardiac changes would you expect in hypo Ca?

A 
Bradycardia/tachycardia
Signs of heart failure
Prolongation of QT interval
Refractory hypotension, and
Arrhythmias
261
Q

How long is a complete test in TEG/ROTEM?

A

60min

262
Q

Is TEG/ROTEM good for plt function?

A

No, it doesn’t take into account plt inhibition

263
Q

GBS has a 10% mortality, if the cause is campylobacter is that better or orse?

A

Worse

264
Q

If you MRI GBS whatould you likely see?

A

Gadolinium enhanced MRI scanning of the spinal cord may show selective anterior root enhancement

265
Q

When is legionella serology useful>

A

Not in initial phase but if ongoing infection with urine screen negative can be useful after immune reaction has occured

266
Q

What do you find in Conn’s?

A

hypokalaemic alkalosis, low renin hypertension, muscle weakness because of alkalosis

267
Q

What symptoms of SSRI OD?

A

tremor
drowsiness
nausea, and
vomiting.

268
Q

Efferent in pupillary reflex?

A

Oculomotor III nerve fibres from the Edinger-Westphal nuclei

269
Q

Which HLH is assciated with higher risk of SJS if given phenytoin?

A

HLA-B*1502)

270
Q

Why consider vit D if long term pheytoin?

A

Can cause osteomalacia

271
Q

Causes CSF protein of greater than 1.5 g/L

A

GBS, bacterial meninigits, TB

272
Q

Does omeprazole inhibit cytochrome p450?

A

Yes

273
Q

Oseltamivir 150 mg orally bd for 10 days is indicated for H1N1 but what do you give if absorption poor?

A

Zanamivir 300 mg IV for 10 days

274
Q

When does pyloric stenosis ususualy presnt?

A

1 month of age

275
Q

spinothalamic tract carries what?

A

Pain and temp terminating in thalamus

276
Q

Posterior (dorsal) columns carry what?

A

Light touch and proprioception

277
Q

What does methyl alcohol break down into?

A

Formic acid

278
Q

What metabolic picture would you expect in methanol poisoning?

A

metab acid with low bicarb

279
Q

Should digoxin be used in AV block?

A

No, it makes the block worse

280
Q

Lambert -eaton is associatd with what cancer?

A

small cell lung

281
Q

What sort of muscle weakness is classical of Lambert Eaton?

A

muscle weakness which improves with repetition and bulbar palsy

282
Q

Whats the defib energy for paeds?

A

4J/Kg

283
Q

Drugs that cause SIADH?

A 
Selective serotonin reuptake inhibitors (SSRIs) (fluoxetine)
Tricyclic antidepressants
Sulphonylureas
Thiazides, and
Carbamazepine.
284
Q

Where is SVR mostly modulated?

A

In small aterioles. In the pre-capillary artereoles autoregulation ocurs

285
Q

Can phenytoin be used in digoxin toxicity?

A

Type IB anti-arrhythmics (e.g., phenytoin, lidocaine) can be used if digoxin immune Fab is unavailable or is being prepared and patients have rapid ventricular dysrhythmias unresponsive to supportive measures.

286
Q

what is a gas critical temp?

A

A temp above which it is impossible to liquify with pressure alone

287
Q

ACEi are teratogenic, what do they cause?

A

Oligohydramnios and skull deformity

288
Q

How does digoxin work?

A

Slows conduction in AV node

289
Q

Myasthenia Gravis is ab against ACh or Muscle specific kinase, the total ab count is unrelated to severity of symtpoms. What drug can ppt MG?

A

Pencillamine (chelating and RA drug)

290
Q

In active cooling post cardiac arrest what temp fluids are ‘ideal’

A

4C

291
Q

Congential adrenal hyperplasia is due to 21-hydroxylase deficiency in 90%. What is the metabolic pattern and when does it present?

A

At birth, severe salt asting HypoNa, hypo glycaemia and hypotensionn (addisons)

292
Q

What % is propofol protein bound?

A

98%

293
Q

What receptors does propofol target?

A

GABA and glyceine

294
Q

What factors increase O2 affinitiy for Hb (L shift dissociation curve)?

A 
Hypothermia
Reduced PaCO2
Alkalosis
Reduced 2,3-DPG levels
Carbon monoxide
Methaemoglobinaemia and
Fetal haemoglobin
295
Q

What factors decrease O2 affinity for Hb?

A 
Elevated PaCO2	
Acidosis
Hyperthermia
Elevated 2,3-DPG
Pregnancy
Haemoglobin S
Altitude
296
Q

Typical plasma electrolytes in acute renal failure?

A 
hyperkalaemia
hypocalcaemia
hypermagnesaemia
hyperphosphataemia
normal or reduced sodium concentration, and
high urea and creatinine concentrations.
297
Q

To what is paracetamol conjugated?

A

Paracetamol is conjugated to glucuronic acid and sulphate under normal conditions

298
Q

Side effects of organophosphate poisoning?

A 
Salivation
Lacrimation
Urination
Defecation 
 (SLUD)
299
Q

In child when should CT head be done within one hour?

A

Suspicion of non-accidental injury
Post-traumatic seizure but no history of epilepsy.
On initial Emergency department assessment, GCS less than 14, or for children under 1 year GCS (paediatric) less than 15.
At 2 hours after the injury, GCS less than 15.
Suspected open or depressed skull fracture or tense fontanelle.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Focal neurological deficit.
For children under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head.

300
Q

What is the resting O2 demand for adult, pregnancy at term, sepsis, thyrotoxicosis, neonate at rest?

A 
adult at rest 3.5ml/kg/min
Thyrotoxicosis 3.86
Neonate 7
Preg 5
Sepsis 4.5
Dobutaine infusion 4
301
Q

What has the biggest impact on how long a LA block lasts?

A 
Protein binding
(Bupivacaine 95%
Ropivacaine 94%
Levobupivacaine 97%
Lidocaine 75%
302
Q

In what overdoses is repeated charcoal dose useful?

A 
carbamazepine
aspirin
dapsone
paraquat
phenobarbitone
quinine, and
theophylline.
303
Q

What K would you expect in threophylline OD?

A

HypoK

304
Q

Why in an estabised T2DM can a glucose of 20 not give glucosuria?

A

There is adaptation to absorb more glucose above the 11mmol/l usual limit. It is thought to be due to more glucose transport molecules under insulin control.

305
Q

Which cytochrome p450 is most likely to be subject to genetic variation?

A

CYP2D6

306
Q

Whe would Digibind be considered?

A 
Progressive bradyarrythmias not responsive to atropine
Ventricular tachycardia/fibrillation
Potassium greater than 5 mmol/L
Acute ingestion >10 mg in adults
Serum concentration >15 ng/mL.
307
Q

Which hormones are secreted from the anterior pituitary?

A

TSH, LH, FSH, ACTH, GH, prolactin

308
Q

Stroke in pregnancy is 1.5 per 100k, is bleed or ischaemia most likely?

A

ischaemia. RF migraine, pre-eclampsia and gestational DM

309
Q

Are parametric more or less powerful (more likely to show a difference that actually exists) than non-parametric?

A

Parametric are more powerful, report p-values and should be normally distributed.

310
Q

Thyroid is usually 30g, is Iodine internalised actively or passively?

A

Active

311
Q

Acute intermittent porphyria present with what?

A 
acute abdominal pain
peripheral and cranial nerve palsies
mental disturbances
seizures, and
coma.
312
Q

What is the dose of intralipid for LA toxicity?

A

initial bolus of 20% lipid emulsion is 1.5 ml/kg followed by an infusion of 15 ml/kg/hour.

313
Q

Normal dietary intake for Na, K, Ca, Mg, Cl, PO4 per day?

A 
Sodium - 1-2 mmol/kg/day
Potassium - 0.7-1.0 mmol/kg/day
Calcium - 0.1 mmol/kg/day
Magnesium - 0.1 mmol/kg/day
Chloride - 1-2 mmol/kg/day
Phosphate - 0.4 mmol/kg/day.
314
Q

Ephedrine can be used for other things apart from hypotension, given PO or IM, what conditions?

A

nocturnal enuresis and narcolepsy

315
Q

Half life of mast cell tryptase?

A

2 hrs

316
Q

hat cells of liver make plasma protein?

A

periportal

317
Q

What cells of liver metabolise drugs mostly?

A

Centrilobular

318
Q

10mg dex is the same as how much of pred?

A

70mg

319
Q

What causes bronchoconstriction in asthmatics who react badl to NSAIDs?

A

Leukotrienes

320
Q

Phenyleph is a direct acting sympathomimmetic why is it preferred over ephedrine in obstetrics?

A

Gives a better umbilical blood gas

321
Q

What is the objective of renal autoregulation apart from maintaining flow beween MAP 80-160

A

Renal autoregulation minimises the impact of changes in arterial blood pressure on Na+ excretion.

322
Q

What two mechanisms underlie renal autoregulation?

A

myogenic response and Tubuloglomerular feedback (afferent arteriole)

323
Q

What will a gaviscon overdose do in children?

A

HyperNa

324
Q

If you gave 1L 5% dex to someone, what would make them pee it out?

A

Inhibition of vasopressin

325
Q

What is the best way of assessing pancreatitis severity?

A

Serial CTs, not serial Ca

326
Q

Li potentiates NDMBs, how?

A

Inhibition of synthesis and release of ACh

327
Q

Does MAC go up or down in preg?

A

Down, the progesterone levels are high which acts as a sedative

328
Q

What is the dose adjustment for adeosine in theophylline co-administration?

A

Adeonsine dose should be increased as theophylline blocks its action

329
Q

In mothers with hyperthyroid, can they take carbimazole whist breast feeding?

A

Yes

330
Q

What is the most common cause of high T4 in preg?

A

Graves 1:500-2000 preg

331
Q

What is the toxin that causes liver failure after ingestion of mushrooms? After how many days does it present?

A

After 3 days, liver and HRS. Amatoxin

332
Q

Normal FRC is 3L M and 2.5L F. How does this alter under GA, moving from supine to standing, with age and in obesity?

A

Under GA loss of muscle tone decreases by about 500ml, standing increses by about 1L, aging increases FRC slightly and obesity it falls

333
Q

How is WPW sub-divided and what’s the difference?

A

Sort PR, elta wave and wide QRS but divided into type A+B

Type A V1 +ve, Type B V1 -ve

334
Q

Is adenosine a coronory dilator or constrictor?

A

Dilator

335
Q

Which ECG leads are useful in diagnosing LVH?

A

Sokolov-Lyon criteria are rather cumbersome but leads V1,2,4,5,6 and I, III, aVL, aVF and aVR

336
Q

After DCCV for AF how long should someone at high risk of stroke cont anticoag?

A

4 weeks (and pre-anticoag for 3-4/52)

337
Q

What is the drug of choice for AF for <72hrs?

A

Flecanide

338
Q

What are the causes of hypoNa with high urine Na (>20mmol/L)

A

Diuretic, Addison’s, poor DM control

339
Q

What are the two most significant factors in the Goldman cardiac risk index?

A

3rd HS and MI in last 6/12

340
Q

What are the other 7 factors in the Goldman cardiac risk index?

A

age >70, AS, JVP up, non sinus rhythm, >5 ectopics/min (MI in last 6/12 and 3rd heart sound confer the worst outcome on their own)

341
Q

What type of Ca channel do CCB work on?

A

L-type not N type

342
Q

How are nimodipine and nifedipine related?

A

Nimodipine is a more lipid sol analogue of nifedipine

343
Q

In quadraplegic patients what percentage gt autonomic dysreflexia?

A

85%

344
Q

What are the aims early on in spinal cord injury?

A

avoid hypotension, mild hypocarbia, avoid high sugar and hyperthermia

345
Q

What is the best buffer in whole blood and in plasma>

A

Haemoglobin accounts for 35% of whole blood’s ability to buffer. If removed and only plasma then bicarb is most important, also 35%

346
Q

In VSD what findings imply significant shunt?

A

HF, pulmonary plethora, mid dia murmur due to increased mitral valve flow

347
Q

What cardiac abnormalities usually present with cyanosis?

A

ToF, TGA, hypoplastic L heart, tricuspid atresia, Eisenmenger’

348
Q

What is thought to be the underlying mechanism in amniotic fluid embolism?

A

Foetal antigens start a cascade similar to anaphylaxis. Not simply and embolism

349
Q

What are the phases of an amniotic fluid emolus?

A

Phase 1 - vasoactive mediators released in response to antigens in fluid. Causes massive pulm vasoconstriction causing hypotension and hypoxia
Phase 2 - LVF and pulm oedema, DIC, massive haem and uterine atony

350
Q

When does amniotic fluid embolus occur?

A

80% in labour, 11% soon after. Can also be during evacuations and in second trimester

351
Q

What makes up APACHE II?

A

GCS, Cr, hct, T, MAP, HR, RR, pH, oxygenation (A-a or PaO2), Na, K, WBC
Worst value of each in first 24 hrs

352
Q

Where is water reabsorbed in kidney?

A

65-70% in prox conv tubule

20-25% in the descending limb which is freely permeable to water (thick ascending is impermeable to water)

353
Q

Why are women more affected by alcohol?

A

Lower volume of distribution given fat composition

354
Q

Define intrinsic activity

A

the capactiy of a drug-receptor interaction to produce maximal effect. Therefore antagonists have equal or greater affinity but zero intrinsic activity. Partial agonsits have similar affinity but partial intrinsic activity

355
Q

Which antiemetics avoid in parkinson’s?

A

Metoclop, haloperidol, droperidol, prochlorperazine

356
Q

AAGBI recommendations for transport vent

A

Disconnection and high pressure alarms
The ability to supply positive end expiratory pressure
The ability to change the I:E ratio
The ability to alter the respiratory rate
The ability to change tidal volume, and
The ability to vary inspired oxygen concentration.

357
Q

hat is normal HR, RR, SBP and U/O for children ages <1, 1-2, 2-5, 5-12 and >12?

A 
<1 HR 110-160, RR 30-40, SBP 80-90, u/o 1-2
1-2 HR 100-150, 25-35, 85-95, 1-2
2-5 95-140, 25-30, 85-100, 1-2
5-12 80-120, 20-25, 90-110, >1
>12 60-100, 15-20, 100-120, >0.5
358
Q

Dexmed is an alpha 2 agonist that has an 8 fold greater affinity cf clondine. What are its targets in the CNS and what effect do they have?

A

Lateral reticular nucleus and locus ceruleus reduce sympathetic output with sedation and anxiolysis. Dorsal horn of spinal cord modulate endogenous opiate

359
Q

Use of gabapentinin acute pain is associated with what beneficial outcomes?

A

Reduced N+V, reduced opioid and other opioid s/e at expense of dizziness

360
Q

Dose phenytoin in kids?

A

20mg/kg

361
Q

Vasopressin is a nonapeptide similiar in structure to oxytocin. What vasopressin receptor stimulates the release of ACTH?

A

Via receptor V3 (antidiurectic effect V2)

362
Q

Between Bup and morph which has the higher affinity for receptors?

A

Bup has 30x higherafinity but is obvious partial agonist

363
Q

How much more potent is Fent vs morph?

A

100x

364
Q

Morphine’s bioavailablity PO?

A

30%

365
Q

What class of evidence (I-IV) is RCT? Meta-analysis? Controlled study but not randomised?

A

Meta- Ia
RCT- Ib
Controlled but not randomised IIa

366
Q

Define dromotropy and lusitropy

A

Dromotropy is ability to incease conduction velocity

Lusitropy is acceleration of cardiac relaxation

367
Q

How is levosimendan a novel inotrope?

A

It sensitises myocytes to intracellular Ca

368
Q

How do people get NAC reactions?

A

Prev exposure means they are left with IgE ab
This would cause anaphylaxis.
Anaphylactoid reactions are common on first administration, slow rate of infusion if that happens

369
Q

Dose of steroid in child for meningitis?

A

Dex 0.15mg/kg

370
Q

Causes of hyperCa?

A

PTH, Malig (bone or PTHrp), sarcoid, myeloma, iatrogenic

371
Q

During exercise uscle blood flow increases 20-50x, under what mechanism mostly?

A

Local autoreg

372
Q

Why is dexmed only given IV?

A

has 100% first pass metab

373
Q

Which abx for tetanus

A

Penicillin (or met if allergic)

374
Q

What are the features of peptide (insulin, LF, FSH, GHRH)?

A

Lipophobic and interact on cell surfaces having auto and paracrine activity

375
Q

What are benzo withdrawal symptoms?

A

Anx, insomnia, irritability, seziure and loss of appetite

376
Q

Brown sequard distribution of deficit?

A

Contra pain temp

Ipsi fine touch, proprio, vibration and motor tone

377
Q

With what pelvic injury is urethral damage associated?

A

Anterior (ureter posterior)

378
Q

For Vit D which reaction occurs in liver and which in kidney?

A

25 hydroxylation in iver, 1hydroxylationin kidney

379
Q

What are the main stimulatns of 1 alpha hydroxylation (kidney) for Vit D?

A

Hypo PO4 and hypo Ca2+

380
Q

Define 1 Gray

A

1J of ionising radiation per 1kg matter

381
Q

What damage does x-ray or gamma ray of 2, 3,4,5 Gy cause?

A

2Gy cataracts
3Gy skin burn
4Gy sterility
5Gy hair loss

382
Q

What is the most likely cause of A-a gradient in health?

A

low V/Q likely from atelectasis

383
Q

What does methylene blue doto SpO2 readings?

A

absorbs at 670 so gives false low reading

384
Q

Etomidate causes adrenal cortex suppression by what mechanism?

A

inhib 11 beta hydroxylase

385
Q

If you inject oxytocin (syntocinon) what would the effects be?

A

Inc CO (SV) , transient fall in SVR with reflex tachy, skin flush, autotransfusion from uterine contraction, reduced uretoplacental blood flow and hold onto water with water intoxication if large dose

386
Q

Which abx interfere with cell wall synthesis?

A

Penicilin, cephs and Vanc

387
Q

Which abx interefere with cell membrane integrity?

A

Polymyxin B

388
Q

Which abd prevent DNA synthesis?

A

Fluroquinolones (cipro, levo), metronidazole

389
Q

Which abx interfere with folate synthesis?

A

Trimeth sulphonamides

390
Q

Which abx interfere with protein synthesis

A

Aminoglycosides, tetracyclines, eryth, clinda, chlorampnehnicol

391
Q

What forms of Sickle cell disease exist? What PaO2 do each sickle at?

A

HbAS and HbSS
Heterozyg HbAS 2.5-4kPa
Homo HbSS 5-6kPa
Other possible Hb have low sickling about 4kPa

392
Q

What is the Sickledex test?

A

Reagent added to blood, if goes turbid know HbS present then genetic ttesting to check which one

393
Q

Ho many spinal roots are there?

A

31 (c8, T12, L5,S5, coccygeal 1)

394
Q

How many arteries go to spinal cord?

A

Two post, one ant that do not form anastomoses at each spinal level

395
Q

Posterior arteries ensure what sesnation?

A

proprioception, vibratio and two-point discrimination

396
Q

If someone ha gone crazy after hyoscine how do you treat them?

A

They could have central anticholinergic syndrome

Treat with 15-60mcg/kg Physostigmine

397
Q

Over what range is a pulse ox accurate?

A

70-100

398
Q

What is the spont revertion to SR from AF?

A

60% over a few days (if given drugs 90% revert in first 7 days)

399
Q

When should flecanide be avoided?

A

Structural or IHD

400
Q

How does glucose get into cells?

A

There are 4 glucose transport proteins (GLUT) in cel walls.
GLUT1- universally
GLUT2- gut, liver, panc
GLUT3- CNS
GLUT4-skeletal muscle, adipose tissue, heart

401
Q

Which GLUT is not insulin dependent?

A

GLUT3-CNS

402
Q

Insulin makes K go into cells, which other electrolytes?

A

Mg an PO4

403
Q

How is acute blood loss dealt with by the body in the first few minutes?

A

Venoconstriction is the first mechanism followed by liver peri-sinusoidal vasoconstriction reducing the 15% blood volume in liver and dumping it back into circulation

404
Q

1 MET =?

A

3.5ml/kg/min

405
Q

Over what time period does the ductus venosus, ductus arteriosus and foramen ovale close?

A

DV- 3-10days
DA- 36hrs
FO- immediately on birth due to reduced PVR

406
Q

What is a reasonable anti-pseudomonal abx in CF?

A

Ceftazidime is an alternative to Taz

407
Q

Common side effect of ketamine?

A

Salivation, lacrimation, nystag and pupil dilatation

408
Q

Where is aldosterone synthesised?

A

Zona Glomerulosa

409
Q

What does agiontensin II do to aldosterone?

A

Increaes secretion

410
Q

Under optimal conditions is PPV or SVV better?

A

PPV but passive leg raise is even better

411
Q

What did the relief study show?

A

2018, 3000 abdo surgical pts, restrictive (3.7L) vs liberal (6.1L) fluid for day 1 post op. No survival diff. AKI higher in restrictive group

412
Q

Mortality of fat embolus? What % develop DIC?

A

5-15% mort, 50% develop DIC

413
Q

What would Sarin poisoning look like?

A

Muscarinic and Nicotinic effects
Musc- paralysis, fasiculations, hypergly, ketosis
Nicotinic- Hypoten, Meiosis, GI disturbance

414
Q

How many lumens does a PA catheter usually have? What is the balloon filled with?

A

3

Air

415
Q

What usually ppts an oculogyric crisis?

A

A typical neuroleptic like haloperidol or chlorpromazine

Can happen but is unusual with new agenst like olanzapine

416
Q

How do you treat an oculogyric reaction?

A

IV or IM procyclidine

417
Q

Salicylate acide directly stim resp centre causing a resp alkalosis what happens then?

A

Excerete HCO3, K and H2O resulting in hypoK, dehydration and metab acidosis which is due to uncoupling of oxidative phosphorylation and increased fat metabolism. This occurs more quickly in kids

418
Q

what happens to urine in aspirin OD?

A

Goes alkaline then becomes more acidic

419
Q

What are the charaacteristics of type 2 fast twitch muscles?

A

Big, white (no blood), few mitochondira and ow myoglobin

420
Q

Which components of the ABG are derived?

A

HCO3, BE, SpO2

421
Q

Treatment for myxoedmea coma?

A

IV T3 and hydrocortisone

422
Q

Where does pregabalin work?

A

Presynaptic calcium channels

423
Q

What is the most frequent s/e of pregab?

A

visual disturbance NNH6

424
Q

Pregabalin risk benefit means it isn’t used after minor surgery. If used in after major surgery what are its benefits?

A

Less opioid
Slight decrease PONV
(gabapentin better tolerated but is more sedating)

425
Q

Which common anaesthetic gas interferes with CO2 monitoring?

A

Nitrous

426
Q

Normal ferretin?

A

> 100mcg/l

427
Q

What is Virchow’s triad?

A

Local injury- vasculitis, prev throbosis
Inc coagulability- polycy, OCPD, cancer
Circ stasis- immobility, post op period, HF preg

428
Q

Dose atropine in paeds?

A

Limited role in resus but if needed is 20mcg/kg

429
Q

Half life ADH?

A

10-15min

430
Q

Why is physostigmine used in central anticholinergic syndrome and not other anticholinergics?

A

Its the only one that crosses the BBB being a tertiary rather than quaternery amine

431
Q

With regards resp control, to what do the medullary chemoreceptors respond directly?

A

CSF pH (though pH does not change rapidly due to the need for CO2 to diffuse)

432
Q

The resp response to barorecptors detecting hypotension is what?

A

Resp stimulation

433
Q

What artery is usually damaged in EDH?

A

Ant branch middle meningeal artery

434
Q

What happens to ESR, albumin, WBC, plt and blood volume in pregnancy>

A

RBC and plasma volume inc by 50%
ESR (and CRP) inc in preg due to inc fibrinogen
Plt only fall by 5% (though there is increased turnover)
Alb production does not match plasma volume expansion so goes down by 25%, normal third trimester alb is 24-31

435
Q

In type 1 VWF deficiency what blood product given in emergency?

A

Intermediate purity factor VIII (eg Humate-P)

436
Q

How does LA protein binding affect duration of action?

A

The greater the binding, the greater the action

437
Q

What does a high pKa mean for LA?

A

The higher the pKa the quicker the onset of action

438
Q

Where is iron stored/used in the body?

A

Haem 65%, ferretin and haemosiderin 30%, myoglobin 3.5%

439
Q

How do you calculate PVR?

A

PVR=(MPAP-PCWP/CO) x80

440
Q

What is a normal pericardial fluid volume?

A

30-50ml

441
Q

Who described the triad of hypotension, raised JVP and muffled heart sounds?

A

Beck

442
Q

With nitrous, what happens to cerebral blood flow, PVR, myocardial contractility, GFR and SVR?

A 
Cerebral flow- inc
PVR- inc
SVR- slight inc
contractility- slight dec
GFR- no effect
443
Q

How is DM diagnosed with fasting and random glucose?

A

Fasting >7

Random >11.1

444
Q

What is your pO2 on summit of Mt Everest?

A

4kPa (atmos pressure 1/3 that at sea level)

445
Q

How are drug clearance, vol dist and elimination constnat related?

A

CL=VdxK

446
Q

How much energy is derived from 1g glucose and 1g fat?

A

1g gluc 4kcal

1g fat 9kcal

447
Q

In severe aspirin toxicity haemofiltration or haemodialysis?

A

Haemodialysis. Nothing wrong with filtration it removed the drug more slowly is all

448
Q

What is Lemiere’s disease?

A

Rare, Fusobacterium necrophorum causs peritonsillar abscess with seeding of bacteria into jugular vein causing sepsis

449
Q

How treat bradycardia in heart trasnplant?

A

Could use glucagon but Theophylline 100-200mg slow infusion is far better

450
Q

What does theophylline do to the heart?

A

Positive chorno and dromotropy, inc SN and AV conduction likely through blockade of adenosine receptors

451
Q

In kid with meningitis, how asssess if safe to do an LP with regards raised ICP?

A

Not CT as unreliable, use clinical assesssment

452
Q

Where are mu receptors? and what do stimulating them caus?

A

brain, spinal cord, periaqueductal grey

Causesanalgesia, meiosis, euphoria, brady, resp dep

453
Q

What does kapa opioid receptor do?

A

analgesia, sedation, miosis

454
Q

Delta opioiid receptor does?

A

analgesia and resp depression

455
Q

What does hyperaldosteronism look like?

A

Alkalosis with uscle weakness or tentany if really bad, low renin levels, hypoK and hypertension

456
Q

What is the rule for maintenance fluid in children?

A 
Holliday-Segar 4-2-1 rule
1-10kg -4ml/hr
10-20kg 40ml+2ml/kg/hr over 10Kg
>20Kg 60ml +1ml/kg/hr above 20kg
Should be as close to normal osmo as possible. Children are very prone to hypoNa
457
Q

Is coronary blood flow autoregulated?

A

yes

458
Q

What do alpha glucosidase inhibitors do?

A

slow digestion of starch in small intestines

459
Q

If PCP pt allergic to co-trimox what next?

A

Clinda and primaquine (+ pred)

460
Q

What is charcot’s triad?

A

Fever, RUQ pain and jaundice->cholangitis

461
Q

What are the components of the bedside index for severity of acute pancreatitis? (BISAP)?

A 
Urea >8.8
Impaired mental status
2 or more SIRS criteria
Age >60
Pleural effusion
ttaken within 24 hrs
462
Q

What are Ranson’s criteria for pancreatisi severity based on admission variables?

A

WBC >15
Age >55
Gluc >10
aised AST and LDH

463
Q

Characteristis of acute adrenal insufficiency?

A

HypoNa, HyperK, raised urea, hypoCl, Hypuglycaemia, normochrom normocyt anaemia, neutropenia, high lymphocytes, hyperCa in 10-20%, metab acid due to low bicarb

464
Q

What happens if you’re on dobutamine for days?

A

Tolerance by downreg of B1 receptor

FFICM (4 decks)

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