Miscellaneous Flashcards
1
Q
What is the most suitable management for a ethylene glycol overdose?
A
ethanol, fomepizole, haemodialysis
2
Q
What are Beau’s lines?
A
Transverse furrows from temporary arrest of nail growth at times of biological stress e.g severe infection, Kawasaki disease, MI, chemotherapy, trauma
3
Q
What is cachexia?
A
General muscle wasting from famine, or decreased eating, malabsorption, or increased catabolism.
4
Q
What is clubbing and what are the causes?
A
Increased curvature of the nail and loss of the nail fold angle, the nail feels boggy.
Causes:
- Thoracic e.g. Bronchial cancer, emphysema, abscess, bronchiectasis, cystic fibrosis, TB, mesothelioma
- GI e.g. IBD, cirrhosis, GI lymphoma, malabsorption e.g. Coeliac
- CVS e.g. Cyanotic congenital heart disease, endocarditis, aneurysms, infected grafts
5
Q
What are the contraindications for thrombolysis?
A
- Previous intracranial haemorrhage
- Ischaemic stroke less than 6month ago
- cerebral malignancy or AVM
- Recent major trauma/surgery/head injury less than 3 wks ago
- GI bleeding less than a month ago
- known bleeding disorder
- aortic dissection
- non-compressible punctures less than 24hrs ago e.g. Lumbar puncture or liver biopsy
- severe liver disease, varices or portal hypertension
- seizures at presentation
- BP greater than 220/130
- Platelets less than 100
- Anticoagulated or INR greater than 1.7
6
Q
What is the torniquet test?
A
Tests valve competence in assessment of VVs. Largely replaced by doppler examination.
- Lie patient down
- lift leg and Milk veins
- apply the torniquet just below the level of the SFJ.
- ask patient to stand
- if VVs controlled incompetence is at SFJ
- If not incompetence is below the SJF
- Repeat at SPJ
7
Q
What is Perthes test?
A
Assesses competency of deep venous system:
- Ask patient to stand and the VVs should be filled
- Apply torniquet at SFJ and ask patient to walk for 5 minutes
- If deep system occluded legs will become painful and VVs more engorged.
8
Q
Describe the differences between arterial and venous uclers
A
Venous ulcers:
- Larger
- Shallow
- Irregular
- Often painless
- Medial gaiter area (lower leg)
Arterial Ulcers:
- Small
- Punched out
- Demarcated
- Painful
- Pressure areas/ between toes
9
Q
Describe Sensitivity
A
Sensitivity is the percentage of people who have the disease that test positive.
‘How good a test is at picking up people with the disease’
TP/ TP+FN
10
Q
Describe Specificity
A
Specificity is the percentage of people who dont have the disease that test negative
‘How good a test is at not picking up people that dont have the disease’
TN / FP+TN
11
Q
Describe Positive Predictive Value and its formulae.
A
‘If your test is positive, the chance you actually have the disease’
TP/FP+TP
PPV = Sensitivity x Prevalence / (Sens x Prev +( 1 - Specificity) x (1 - Prevalence) )
12
Q
Describe Negative Predictive Value and its formulae
A
‘If your test is negative, the chance you don’t have the disease’
TN/ FN+TN
NPV = Specificity x (1-Prevalence) / (1 - Sensitivity) x Prevalence + Specificity x (1 - Prevalence)
13
Q
Describe Absolute Risk
A
Absolute Risk is the proportion of people in the group with a condition
Number of positives / Number of people
14
Q
Describe Absolute Risk Reduction
A
(Absolute risk in control group) - (absolute risk in study group)
15
Q
Describe Number Needed to Treat
A
1/ Absolute risk reduction
16
Q
Describe Relative Risk Reduction
A
(Absolute risk of study group) / (Absolute risk of control group
17
Q
Describe Alcohol Withdrawal, its signs, and management
A
Usually starts 10-72h after last drink. Consider in any new (less than 3d) ward patient with acute confusion.
Signs: Delirium Tremens i.e. Raised Pulse, decreased BP, tremor, fits, visual or tactile hallucinations e.g. of insects crawling under the skin (Formication).
Management:
- Admit and monitor BP, beware BP drop.
- Give Chlordiazepoxide generously for first 3d (10-50mg/6h) if unable to take orally e.g. vomting, diazepam as an alternative 10mg/6h PR or IVI during fits.
- Wean off slowly during 7-10d.
- Vitamins e.g. Thiamine (B1) may needed.
- monitor CIWA score to manage chlordiazepoxide treatment.
18
Q
Describe Glasgow Coma Scale (GCS)
A
Used to quantify the conscious state of a person. 3 types of response are assessed:
Best motor response has 6 grades:
- 6 = Able to obey commands
- 5 = localising response to pain
- 4 = withdraws to pain
- 3 = flexor response to pain
- 2 = extensor posturing to pain
- 1 = no response to pain
Best Verbal response has 5 grades:
- 5 = Orientated
- 4 = Confused conversation
- 3 = inappropriate speech
- 2 = incomprehensible speech
- 1 = none
Eye Opening has 4 grades:
- 4 = spontaneous eye opening
- 3 = eye opening in response to speech
- 2 = eye opening in response to pain
- 1 = no eye opening
Score out of 15 severe injury = GCS less than 8 moderate 9-12 and minor 13-15. In severe injury airway need protection with endotracheal intubationo
19
Q
Describe Enteral feeding, its indications, types
A
Feeding via the gut as opposed to parenteral which is via the veins. May be oral, nasogastric, nasoduodenal, nasojejunal, gastrostomy, jejunostomy.
Indications: Dysphagia e.g. stroke patients, supplementary feeding for patients who can not meet all requirements orally, oesophageal aetiology e.g. partial obstruction, fistulae.
Nasogastric (NG): most common, first choice in those with functional GI tract, simple to initiate and manage, beware potential life-threatening pulmonary complications. Aspirate NG placement contents and test pH, 0-5 confirms NGT placement, if not 0-5 X-ray confirmation needed. Bridles may be used as a securing system but must not be used as restraint. Consent must be clearly documented.
Gastrostomy or Percutaneous endoscopic gastrostomy (PEG): formation of a fistula between stomach wall and anterior abdominal wall. Assess by MDT, referral made by medical team. Patient must be consented informed of risks and benefits, if not capacity, formal capacity assessment must be documented and consent form 4 completed by clinician making decision to carry out in best interests.
PEG Contraindications: Ascites, unable to tolerate endoscope, poor life expectancy, coagulation disorders, obesity, GI obstruction.
20
Q
What does PAPA stand for, and when is it used?
A
Used to explore patients agenda.
Permission: ask permission to share information
Ask: what does the person already know?
Provide: tailored information based on what you heard.
Ask: what the person thinks of the information and if they understand and would they like more
21
Q
What does OARS stand for, and when is it used.
A
Used to demonstrate accurate empathy.
Open ended questions: introduce topic with open question
Affirmations/normalising: praise patient on any achievements and normalise any failures.
Reflections: Credit effort, weigh up advantages and disadvantages
Summarise: Feed back information to patient to ensure understanding.
22
Q
What are the three enablers?
A
Agenda setting: identify issues and problems, prepare in advance, find out what’s important to the patient, agree a joint agenda.
Goal setting and action planning: small and achieve able goals SMART goals, build confidence and momentum
Goal follow-up: Proactive instigated by the system, timely, encouragement and reinforcement, review most challenging to achieve, key for maintenance and progress.
23
Q
What is the cycle of change?
A
Precontemplation: no intention of changing behaviour.
Contemplation: aware a problem exists but no commitment to action
Preparation: intent upon taking action
Action: active modification of behaviour
Maintenance: Sustained change, new behaviour replaces old.
Relapse: falls back into old pattern and behaviour
Pre contemplation
24
Q
What is a SMART goal?
A
Specific, Measurable, Appropriate, Realistic, Time based.
25
Define Heterosexism
A system of attitudes, bias, and discrimination in favour of opposite-sex sexuality and relationships. E.g. Assuming patients are heterosexual.
26
Describe likelihood ratios
Used to asses the value of performing a diagnostic test. They use sensitivity and specificity to determine whether at test result usefully changes probability that a condition exists.
Positive likelihood ratio is sensitivity / 1 - specificity
Negative likelihood ratio is 1 - sensitivity / specificity
27
What are the key features of Case-Control studies?
Observational and retrospective. Patients with a particular condition (cases) are identified and matched with controls. Data is then collected on past exposure to a possible causal agent for the condition. The usual outcome is the odds ratio. They are inexpensive, produce quick results and are useful for studying rare conditions, but they are prone to confounding (a extraneous variable that correlates directly or inversely with both the dependent variable and the independent variable)
28
What are epicanthic folds, and what are their significance?
The name for a Skin fold of the upper eyelid covering the inner corner (medial canthus) of the eye. May be prominent in Down syndrome children, also in Turner syndrome, phenylketonuria, and foetal alcohol syndrome.
29
What are the principles of sexual health clinics?
- Private, non-judgemental
- Easy access
- Systematic approach
- If you have 1 you are more than likely to have another
- Immediate treatment in clinic
- single dose therapy where possible
- public health issue, one diagnosed is others possible (contact tracing)
- HIV transmission facilitated by concurrent STI infection
- most people who attend do not have STIs
30
Describe RAST testing
A radioallergosorbent (RAST) test is a blood test using radioimmunoassay to detect specific IgE antibodies to determine the substances a subject is allergic to. This is different from a. Skin allergy test which determines allergy by the reaction of a persons skin to different substances.
31
Describe Marfan's syndrome and its features.
An autosomal dominant connective tissue disorder caused be a defect in the fibrillin-1 gene on chromosome 15 that affects around 1 in 3000 people.
Symptoms: tall stature with arm span to heigh ratio greater than 1.05, high-arched palate, arachnodactlyl, pe cuts excavatum, pres planus, scoliosis, dilatation of aortic sinuses which may lead to aortic aneurysm, dissection, regurgitation and mitral valve prolapse, suffer repeated pneumothoraces, upwards lens dislocation, blue sclera, myopia, dural ectasia.
Management:
- regular echo +/- beta-blocker/ACE-inhibitor therapy
- aortic dissection is leading cause of death.
32
Describe Mastitis, the types, symptoms and management.
Inflammation of breast tissue.
Types: Periductal Mastitis (smoking high risk factor), Lactational Mastitis
Symptoms: Breast tenderness, malaise, swelling of breast, burning/pain when breastfeeding, erythema often wedge shaped, fever, lumps (breast abscess)
Management:
- Continue breast feeding, does not present risk to infant and is very beneficial to mother. Reassure, advise not to wear a bra at night.
- Antibiotics
- Analgesia
33
What is the definition of penetrance and expressivity?
Penetrance refer to whether a disease or trait manifests. I.e. If a disease mutation is 100% you are certain to get the disease.
Expressivity refers to how a disease or trait manifests I.e. A disease may manifest in more than one system
34
What are the different chest and abdominal scars.
Median Sternotomy: Mostly for open heart surgery e.g. Valve replacement, CABG (look for vein harvesting on legs), Congenital corrections
Axillary thoracotomy: used for chest drains e.g. Pneumothorax
Posterolateral thoracotomy: Most commonly for pneumonectomy
Anterolateral thoracotomy: used for open chest massage
Pacemaker scar: horizontal scar in midclavicular line for pacemaker insertion.
Kocher scar: R side inferior and parallel to costal margin for gallbladder and biliary tract operations
Loin scar: renal surgery
Hockey stick/reverse hockey stick: Renal transplant scar
Midline laparotomy: Emergency abdominal surgery
Mercedes Benz scar: Rooftop plus incision through xiphisternum for liver transplant, bilateral adrenalectomy, diaphragmatic hernias.
Rooftop scar: Gastrectomy, oesophagectomy, hepatic resections
Pfannenstiel: C-section scar along pubic hairline
Lanz scar: at mcburneys point for appendicetomy
Paramedian scar: spleen, kidney, adrenal operations
35
What is a pleural cap on CXR?
A curved density at the lung apex seen on chest radiograph.
Causes:
- pleural thickening/scarring e.g. Idiopathic, post-TB, Radiation fibrosis
- Pancoast tumour
- Haematoma e.g. Thoracic aortic injury,upper thoracic injury, fractured first rib
- lymphoma extending from neck or mediastinum
- abscess within the neck/mediastinum.
36
On a normal CXR what is the normal lie of the hilar?
Left Hilum lies higher than the right
37
What are some causes of a pulmonary cavity on CXR?
CAVITY
C: cancer e.g. Bronchogenic carcinoma (SCC), Metastasises
A: Autoimmune granulomas e.g. GPA, RA
V: Vascular e.g. Pulmonary embolus
I: Infection e.g. Pulmonary abscess, TB,
T: Trauma Pneumatocoeles
Y: Youth i.e. Congenital e.g. Pulmonary sequestration, Congenital pulmonary airway malformation, bronchogenic cysts.
38
What are the 4 stages of clubbing?
Grade 1: Nail bed fluctuation
Grade 2: Obliteration of lovibond angle
Grade 3: Parrot breaking aka curvature of nail
Grade 4: Hypertrophic Osteroarthopathy aka broadening of distill phalynx
39
What is the surgical sieve?
VITAMINCDEF
```
Vascular
Infective/inflammatory
Traumatic
Autoimmune
Metabolic
Iatrogenic/idiopathic
Neoplastic
Congenital
Degenerative
Endocrine
Functional
```
40
What are the ECOG performance status grades?
0 = Fully active, able to carry on all pre-disease performance without restriction
1 = restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature e.g. House of office work
2 = ambulatory and capable of all self are but unable to carry out any work activities and up and about more than 50% of waking hours
3 = capable of only limited self are, confined to bed or chair more than 50% of waking hours
4 = completely disabled, cannot carry out any selfcare, totally confined to bed or chair
5 = dead
41
What are Terry's Nails and its causes?
Nails appear white with a characteristic ground glass appearance with no lunula. Thought to be due to a decrease in vascularity and an increase in connective tissue within the nail bed.
Causes: Liver failure, cirrhosis, diabetes mellitus, congestive heart failure, hyperthyroidism, malnutrition.
42
Define metaplasia
The reversible replacement of one differentiated cell type with another mature differentiated cell type. Can progress to dysphasia and then malignant neoplasia and therefore requires monitoring.
43
What are the main DVLA restrictions regarding medical conditions?
Neurological:
- first seizure - 6months off, fit free for 12months inform DVLA
- stroke or TIA - 1 month off - no need to inform if no residual impairment
- multiple TIAs over short period - 3months off inform DVLA
- craniotomy - 1 year off, inform DVLA
- pituitary tumour craniotomy - 6month, trans-sphenoidal can drive if there is no residual impairment
- narcolepsy/cataplexy: cease driving until satisfactory control of symptoms
- chronic neurological disorders inform DVLA
Diabetes for patients using hypoglycaemic drugs e.g. Sulphonylureas, insulin:
- no hypoglycaemia in previous 12 months
- full hypoglycaemic awareness
- BM adequate plus at least 5 before driving
Cardiovascular:
- angioplasty (elective) - 1 week off
- CABG - 4weeks off
- ACS - 4 weeks off (1 week if treated with angioplasty)
- angina diving must cease if symptoms occur at rest
- pacemaker insertion - 1 week
- ICD 6 months off if for ventricular arrhythmia, prophylaxis 1 month, permenant ban for group 2
- catheter ablation - 2days off
- AAA - inform DVLA over 6.5 disqualifies
44
On an abdominal x-ray what are the normal diameters of bowel?
Small bowel 3cm, large bowel 6cm, caecum 9cm
45
What is HDL?
High-Density-Lipoprotein responsive for reverse cholesterol transport i.e. Taking cholesterol from peripheries to liver therefore a good lipoprotein
46
How is the Odds Ratio Calculated?
Odds are a ratio of the number of people who incur a particular outcome to the number of people who do no incur the outcome.
The odds of rolling a six is 1/5
Odds ratio often reported in case-control studies approximates to the relative risk if the outcome in interest is rare. It is calculated by dividing the Odds of two events e.g. Experiment Odds/ Placebo Odds
47
What is the daily fluid and electrolyte requirements?
```
Water = 25-30mL/kg/day
Na = 1-2mmol/Kg/day
K = 0.5-1mmol/kg/day
Cl = 0.5-1mmol/kg/day
```
48
Describe the formal assessment of a chest radiograph.
Assessment of quality/airway:
- Position supine/AP/PA
- inspiration count posterior ribs at least 8
- Exposure able to see ugliness of vertebral column
- Rotation, space between medial clavicle and margin of adjacent vertebra, spinous process viewed underneath trachea.
Bones and Soft tissues: asymmetry, fractures, lesions, subcutaneous air, foreign bodies, swelling
Cardiac: Heart size, Shape, Calcification, Borders
Diaphragm:
- Position (right high than left)
- Shape, tented, flattened
- Free gas
Effusions/extrathoracic soft tissue: Pleural effusion, costophrenic angles
Fields, fissures and foreign bodies: Infiltrates interstitial vs alveolar, masses, consolidation, air bronchograms, pneumothoraces, vascular markings.
Great vessels, Gastric bubble: Unfolding of aorta
Hilar and mediastinum: L Hilum higher than right, widened mediastinum.
Impression,
49
Describe the A-a Gradient
Calculated as PAO2 - PaO2 where PAO2 is the ‘ideal’ compartment alveolar PO2 determined from the alveolar gas equation: PAO2 = PiO2 - PaCO2/0.8.
A normal A-a gradient for a young adult non-smoker is between 5-10mmHg however it increases with age (For every decade of life the A-a gradient is expected to increased by 1mmHg)
Classification of hypoxia by A-a gradient:
Normal A-a gradient: Alveolar hypoventilation (Elevated PaCO2), Low PiO2 (FiO2 less than 0.21).
Raised A-a gradient: Diffusion defect (rare), V/Q mismatch, right-to-left shunt, Increased O2 extraction.
50
Describe Positron Emission Tomography (PET) and its uses.
A form of nuclear imaging which uses Flurodeoxyglucose (FDG) as there radiotracer. This allows a 3D image of metabolic activity to be generated using glucose uptake as a proxy marker. The images obtained are then combined with a conventional imaging such as CT to decide whether lesions are metabolically active.
Uses:
-Evaluating primary and possible metastatic disease.
51
What is Pre-test probability?
The proportion of people with the target disorder in the population at risk at a specific time (point prevalence) or time interval (Period prevalence).
52
What is post-test probability?
The proportion of patients with that particular test who have the disorder.
Post-test probability = Pre-test odds / (1 + Post-test odds)
53
What is pre-tests odds?
The odds that the patient has the target disorder before the test is carried out
Pre-test odds = Pre-test probability / ( 1 - Pre-test probability)
54
What is post-test odds?
The odds that the patient has the target disorder after the test is carried out.
Post-test odds = pre-test odds x likelihood ration
Where the likelihood the a positive test result = sensitivity / (1-specificity)
55
What are the main types of membrane receptors?
Four main types:
- Ligand-gated ion channel receptors
- Tyrosine kinase receptors
- Guanylate Cyclase receptors
- G protein-coupled receptors.
56
Describe ligand-gated ion channel receptors.
Generally mediate fast responses e.g. nicotinic acetycholine, GABA-A, GABA-C, glutamate receptors.
57
Describe Tyrosine Kinase receptors.
Two main subtypes:
- Intrinsic tyrosine kinase e.g. insulin, Insulin-like growth factor (IGF), Epidermal growth factors (EGF)
- Receptor-assocaited tyrosine kinase e.g. growth hormone, prolactin, interferon, interleukin
58
Describe Guanylate cyclase receptors.
Contain intrinsic enzyme activity e.g. atrial natriuretic factor, brain natriuretic peptide.
59
Describe G protein-coupled receptors
Generally mediate slow transmission and affect metabolic processes. Activated by a wide variety of extraceullar signals e.g peptide hormones, biogenic amines, lipophilic hormones, light. 7 helix membrane-spanning domains, consists of 3 main subunits, alpha, beta and gamma. The alpha subunit is linked to GDP. Ligand binding causes conformational changes to receptor, GDP is phosphortyated to GTP and the alpha subunit is activated. G proteins are named according the alpha subunit (Gs, Gi, Gq).
Gs stimulates adenylate cyclase to increased cAMP activated protein kinase A. examples include B1-receptors, B2-Receptors, H2 receptors, D1 receptors, V2-receptors, Receptors for ACTH, LH, FSH, Glucagon, PTH, Calcitonin, prostaglandins.
Gi Inhibits adenylate cyclase to decreased cAMP inhibiting protein kinase A. Examples include M2 receptors, A2 Receptors, D2 receptors, GABA-B receptors.
Gq Activates phospholipase C which splits PIP2 to IP3 & DAG this leads to activation of protein kinase C. Examples include A1 Receptors, H1 Receptors, V1 Receptors, M1,M3 Receptors.
60
Describe Yellow Nail Syndrome and its associations
Slowing of the nail growth leads to characteristic thickened and discolour nails seen in yellow nail syndrome.
Associations:
- Congenital Lymphoedema
- Pleural Effusions
- Bronchiectasis
- Chronic sinus infections
61
Describe Laurence-Moon-Biedl Syndrome
A rare autosomal disorder associated with retinitis pigments, spastic paraplegia, and mental disability.
62
What are the different types of significance tests?
The type of significance test depends on whether the data is parametric (Something which can be measured, usually normally distributed) or non-parametric.
Parametric Tests:
- Student's T-test - Paired or Unpaired (Paired date refers to data obtained form a single group of patients e.g. measurement before and after an intervention. Unpaired data comes from two different groups of patients e.g. comparing response to different interventions in two groups.)
- Pearson's product-moment coefficient - correlation.
Non-Parametric Tests:
- Mann-whitney U test - Unpaired data
- Wilcoxon Signed-rank test- compares two sets of observations on a single sample
- Chi-swaured tests used to compare proportions or percentages
- Spearman/Kendall rank - correlation
63
Describe the different types of interferon
Interferons are cytokines released by the body in response to viral infections and neoplasia. They are classified according to cellular origin and the type of receptor they bind to. IFN-alpha and IFN-beta bind to type 1 receptors whilst IFN-gamma binds only to type 2 receptors.
IFN-alpha:
- Produced by leucocytes
- Antiviral action
- useful in hepatitis B+C, Kaposi's sarcoma, metastatic renal cell cancer, hairy cell leukaemia.
- Adverse effects include flu-like symptoms and depression
IFN-beta:
- Produced by fibroblasts
- antiviral action
- Reduces the frequency of exacerbations in patients with relapsing-remitting MS
IFN-gamma:
- Produced by T-lymphocytes and NK cells
- weaker antiviral action, more of a role in immunemodulation particular in macrophage activation
- May be useful in chronic granulamatous disease and osteoporosis.
64
What are the main types of trials that can be used to evaluate a new drug and the advantages and disadvantages of each?
Placebo controlled trial: considered unethical if established treatments are available and it also does no provide a comparison with standard treatments.
Superiority: Whilst this may seem the natural aim of trial one problem is the large sample size needed to show a significant benefit over an existing treatment.
Equivalance: An equivalence margin is defined (-delta to +delta) on a specified outcome. If the confidence interval of the difference between the two drugs lies within the equivalence margin then the drugs may be assumed to have a similar effect.
Non-inferiorty: similar to equivalence trials but only the lower confidence interval needs to lie within the equivalence margin. Small sample sizes are needed for these trials. Once a drug has been shown to be non-inferior large studies may be performed to show superiority
65
Describe some secondary causes of hyperlipidaemia
Causes of predominantly hypertriglyceridaemia:
- Diabetes mellitus
- Obesity
- Alcohol
- Renal Failure
- Drugs: thiazides, non-selective betablockers. unopposed oestrogen
- liver disease
Causes of predominantly hypercholesterolaemia:
- Nephrotic syndrome
- Cholestasis
- Hypothyroidism
66
Describe the management of hiccups
- Breath holding, Valsalva, pulling on tongue, sneezing, sipping iced water. Pullin knees to chest.
- Intractable hiccups: Chlropromazine, Metoclopramide, Baclofen
67
What is multiple linear regression?
A linear approach to modelling the relationship between a scale response and one or more explanatory variables.
68
Describe Oral Allergy Syndrome and it’s features
An allergic reaction in the Mouth followed by eating food that typically develops in patients with hay fever. It is not an individual food allergy but represents cross reactivity with the pollen associated with food e.g. birch apple pollen. It is a type 1 IgE mediated hypersensitivity reaction.
Features: burning itching of mouth, localised swelling.
69
What is the management of suspected Body packers?
Body packer is an individual who ingests wrapped packets of illicit drugs to transport them.
First line management is whole bowel irrigation with ethylene glycol. May be a role for Flexi sig retrieval.
70
What is Cardiac Index?
A Haemodynamic parameter that relates the Cardiac Output from left ventricle in one minute (Stroke Volume x Heart Rate) tk the body surface area thus relating heart performance to the size of the individual. Normal range at rest is 2.6-4.2 L/min/m2. If cI falls below 2.2 the patient may be in cardiogenic shock.
71
What is ascorbic acid?
Vitamin C
72
What is Myocardial Depressant Factor?
A low molecular weight peptide released from the pancreas into the blood in mammals during various states of shock.
MDF is a significant mediator of shock pathophysiology reducing myocardial contractility, constricting splanchnic arteries and impairing phagocytosis by the reticuloendothelial system.
Survival can be improved by preventing its release or blocking its activity for example using glucocorticoids, prostaglandins, aprotinin, captopril, imidazole, or lidocaine
73
Describe the Transplant type classification.
Autografts: In which the same individual acts as both donor and recipient
Isografts: In which the donor and the recipient are genetically identical
Allografts: Where the donor and recipient are genetically dissimilar but belong to the same species
Xenografts: In which the donor and the recipient belong to different species
Orthotopic: Transplants placed in the normal anatomical location
Herterotropic: Transplants placed in a different anatomical location
74
What is a procaine reaction?
Procaine reaction occurs when procaine Penicllin is accidentally given IV rather than IM. It results in instantaneous feeling of impending doom with delusions and hallucinations. Patients often need restraining. The process is self-limiting within 20 minutes. Occasionally the patient may have a seizure which should be terminated with IV or PR Diazepam.
75
Describe Fingolimod its subsea and side effects.
Fingolimod modulates the Sphingosine-1-phosphate receptor and alters lymphocyte migration across the blood brain barrier. It is consider one of the more effective drugs in the modern efficacy or catergory 1 group of MS disease modifying treatments, reducing relapse rate by 54%.
It is a daily oral medications.
The most common side effects include first dose bradycardia, headache, influenza, diarrhoea, back pain, leveraged liver enzymes and cough. More serious side effects include basal cell carcinoma. Macular oedema and there are cases of PML associated with fingolimod use.
76
What are the Major CYP enzymes?
```
CYP3A4 - Ciclosporin, Statins, Macrlolide antihistamines
CYP2D6 - Warfarin anticonvulsants Taxols
CYP2C9 - PPIs, Clopidogrel
CYP2C19 - Clozapine SSRIs
CYP2E1 - Paracetamol, Ethanol
```
77
What is the equation for oxygen content of blood?
(O2 carried by Hb) + (O2 in solution) = (1.34 x Hb x SpO2 X 0.01) + (0.023 x PaO2)
78
What is the Alveolar Gas Equation?
PAO2 = FiO2 (Patm = Ph2o) - (PaCO2( 1 - FiO2(1-RER))/RER
RER = 0.8
