Misc Flashcards
In which neuromuscular condition can sux be used safely?
Myasthenia gravis and in fact may need 2x normal dose
However in ELS need to use a reduced dose although again can be used
In which conditions must you avoid anti cholinesterases and why?
Myotonic dystrophy and myotonic congenita
Can lead to hyperkalaemia
Myasthenia gravis - can actually prolong block and lead to cholinergic crisis
Myotonic dystrophy and myotonic congenita inheritance
Both autosomal dominant
MD - chromosome 19
MC - chromosome 17
Drugs to avoid in patients with prolonged QT
Ketamine
Suxamethonium
Methadone
Most antiemetics but not cyclizine or dex
Oxytocin
Macrolides
Avoid anticholinergics and adrenergic drugs - CAN use meteraminol and phenyl safely however
Systemic sclerosis/Scleroderma features
Limited scleroderma - CREST
Calcinosis, Raynauds, oesophageal dysmotility, sclerodactyly and telangectasia
Most concerning complications of systemic sclerosis (responsible for most mortality)
Pulmonary fibrosis
Myocardial disease
PAH
What is systemic sclerosis
A rare autoimmune condition leading to inflammation and progressive multi system connective tissue disease
Small vessel vasculopathy and abnormal collagen deposition leading to fibrosis of skin and organs
Risk factors for abnormal placental adherence
Placenta praevia
Previous C section
IVF
Advanced maternal age
Previous endometrial surgery Ie myomectomy or ablation
Multiparity
Ashermans syndrome
Classes of chemotherapy agents
See photo
Functions of the spleen
Drugs used in Parkinson’s
NAP 5 findings
What operations are highest risk for CPSP?
Amputation
Thoracotomy
Mastectomy
Cholecystectomy
Inguinal hernia
Vasectomy
Caesarean
Safety re ABO compatibility for transfusion of FFP/cryo/platelets
FFP and cryo should be ABO compatible ideally but if not possible, AB is universal donor, Rh compatibility is not required
Platelets should ideally be ABO compatible but any can be used in emergency, just may not see such good increment
What is Marfans
Autosomal dominant disorder
Connective tissue disorder
Defect in fibrillin 1 gene on chromosome 15
Clinical features of marfans
Criteria for CRT device
NYHA classification class III or IV
Patient in sinus rhythm with wide QRS(ie LBBB) or normal QRS with vent dyssynchrony on ECG
EF < 35%
Already on max medical therapy
Symptoms of TCA overdose
Hypotension
Tachycardia
ECG changes inc wide QRS
Cardiac depression
Vent arrhythmias
Mydriasis
Reduced consciousness
Hyperreflexia
Seizures
MOA of TCAs
Inhibition if pre-synaptic reuptake of noradrenaline and serotonin
Packed red cells storage
- temp and solution
4 degrees to inhibit bacterial growth and reduce RBC energy use
Solution - usually citrate, phosphate, dextrose and adenine
Citrate prevents clotting and phosphate is a buffer
Others are nutrients
Store - for up to 35 days
FFP storage
-20 degrees
Use immediately when thawed
AB is universal donor
Cryo storage
-30 degrees for up to 1 year
Contains high levels of factor 8, vWF and fibrinogen
AB is universal donor
What is in prothrombin complex concentrate and when to give it
Clotting factors 2/7/9/10 and protein C and S
For reversal of raised INR in bleeding patient on warfarin
Platelet storage
At room temp (22degrees) for up to 5 days with continuous agitation to avoid clumping
Ideally ABO matched but can use any
Transfusion reaction associated lung injury
What are the nervous system changes in the development of phantom limb pain/neuropathic pain
- in peripheral/spinal cord and central NS
Sickle cell genetics
Causes of oxygen debt post exercise
Mechanism of action of metformin and dose on day of surgery?
MOA of gliclazide (sulphonylurea) and whether to give on day of surgery
Dapagliflozin MOA and dosing on day of surgery
Also what class??
What is carcinoid syndrome?
What is used to treat carcinoid syndrome? And what is the dose in carcinoid crisis?
Octreotide
20-50mcg in crisis
What are the symptoms of carcinoid syndrome? And carcinoid crisis
Syndrome
- flushing
- lacrimation
- rhinorrhoea
- diarrhoea
-hypotension
- shortness of breath
Crisis
- hypotension
- Tachycardia
- sweating
- Confusion
- breathing difficulties & bronchospasm
What vasopressors are safe and which unsafe in pt with carcinoid tumour?
Safe - phenylephrine and vasopressin
Unsafe - adrenergic agents (use with extreme caution)
What hormones are secreted by carcinoid tumours?
What is the score to identify candidates for acute liver transplant in paracetamol toxicity? And what are the parameters?
Causes of pulmonary hypertension
Clinical features of pulmonary HTN?
Phosphodiesterase 5 inhibitor
MOA and example
sildenafil
Increases cGMP levels
NO is a potent vasodilator that acts via cGMP
Symptoms + signs of myasthenia gravis
Symptoms of myasthenic crisis
Lipid emulsion for LA-ST
Concentration
Bolus dose
Infusion rate
Max dose
Toxic doses of LA with and without epi
Lidocaine
Bupivicaine
Ropivicaine
Prilocaine
Coeliac plexus nerves
Greater/lesser/least splanchnic
Define the term vo2 peak
Peak rate of oxygen uptake measured when the individual exercised up to symptom limitations or fatigue
Define anaerobic threshold
The VO2 at which oxygen demand exceeds supply and anaerobic metabolism takes place
Define VE/VCO2
The ratio of minute ventilation to carbon dioxide production
Ie a measure of gas exchange efficiency during exercise
VE/VCO2 cut off for high risk
> 34 predicts post op morbidity and mortality
Post brain stem death physiological changes
Describe the 4 stages of spinal shock
What is autism spectrum disorder
Lifelong disability
Triad of difficulty with social interaction, social communication and social imagination
May have low or normal IQ
Thoracoscore parameters
Age (years)
Sex
ASA Classification
Performance Status Classification
Dyspnea score
Priority of surgery
Procedure class
Diagnosis group
Comorbidity Score
Indications for one lung ventilation
What is the pathophysiology of phantom limb pain?
Boundaries of epidural space
CRPS criteria - criteria and categories of signs
Transplant criteria for non paracetamol acute liver failure
How does gas exchange occur with HFOV
Bulk flow
Taylor dispersion
Pendelluft mixing
Molecular diffusion
Cardiogenic mixing
Hazards of MRI
- Displacement im force from static magnetic field - Ie projectiles
- Induced current from time varying magnetic fields Ie leading to cause arrhythmia
- acoustic noise
- heating from radiofreq fields
- helium escape
Contraindications to MRI
Ferromagnetic eye fragments
Cochlear implants
Ferromagnetic aneurysm clips
Moffett’s solution - what is the mix?
Cocaine 1-2ml of 5%
Adrenaline 1ml of 1:1000
Sodium bicarbonate 8.4% 2ml
Define preload/afterload/MAP definitions
Define major haemorrhage and massive transfusion
Vaughn Williams classification and where they act on cardiac cycle
