Miscellanous 1 Flashcards
Inotropes versus vasopressors?
Inotropes = increases contractility rate
-Adrenaline and Dobutamine ( B -receptor)
Vasopressors = Vasoconstriction
- Noradrenaline and Metaraminol ( A-receptor)
- use for septic shock
What is Dopamine?
DA/ B receptor
-use for cardiorenal syndrome - but have tachyarrhythmias
Ventilation mode - PEEP causes what?
Why it causes that?
Cardiac MI
Barotrauma ( intrinsic peep)
Cardiac MI - increases stroke volume
Barotrauma - blocks exhalation - gas-trapping - increases FRC
In pregnancy - what must be given with anti-convulsants?
Folic acid
OGTT best performed when in pregnancy?
24 weeks ( end of 2nd trimester)
intrahepatic cholestasis in pregnancy - when and invx, treatment?
3rd trimester
Free bile acid increases
Ursodeoxycholic acid
Acute fatty liver of pregnancy - clinical features?
Severe RUQ pain - mitochondrial LCFA metabolism defect
Noradrenaline converted to adrenaline via?
phenyl-ethanolamine N methyl
-stimulated by stress/cortisol from amygdala
HELLP pathogenesis?
Fibrin deposits in hepatic sinusoids - hemorrhage + necrosis
=DIC
Best painkillers in palliation - TCA class?
SNRI - duloxetine has what side effects?
Amitryptyline
SNRI - cholinergic side effects
Spinal cord compression - veterbrae mets into which epidural space region first?
Thoracic!
Nausea receptors in which site of brain and the triggers + receptors involved?
Vestibular nuclei - Movement triggers it
ACH + H1
Cerebral cortex - Emotion/ICP/ hyponatremia triggers it
GABA + 5HT2
Postrema region - CTZone
5HT3 = chemotherapy/uremia - triggers it
D2 = morphine/uremia - triggers it
Treatment for nausea according to site and triggering factor?
Vestibular nuclei (movement) = Largactil, cyclizine, promethazine
Cerebral cortex - Benzodiazepines, Cyczline if raised ICP
CTZone
5HT3 - ondansetron
D2 - metoclopramide/Haloperidol
Nausea receptors in which site of gut and triggers + receptors involved
Vagal and splanchnic receptors 5HT3 - ondansetron D2 - Domperidone 5HT4 (prokinetic) - metoclopramide Anti-inflammatory - dexamethasone Anti-secretory - hyoscine/ glycopyronnium (anti-muscarinic)/ocreotide
Myotonia a/w what channels and exercises causes what?
Paramyotonia a/w what channels and exercises cause what?
Myotonia - Sodium chloride (NACI) channel
Exercise improve it
Paramyotonia - Sodium (NA) channel
Exercise worsens it
High intensity exercise causes what myopathy?
Glycogen storage - McCardle phosphorylase deficiency
Moderate intensity exercise/ fasting causes what
myopathy?
histology of it?
Lipid storage - Carnitine palmitoyl transferase II deficiency
Type IIb atrophy - moth eaten fibres
Highest affinity towards 5HT3 receptor - what drug?
Palonosetron (2nd generation)
Cyanide intoxication/poisoning - antidote?
Hydroxocobalamin binds to cyanide to form cyanobalamin - excrete in urine
Gastric emptying in critically ill patients - why and treament?
Impaired stomach and pylorus function
IV erythromycin and Metoclopramide - helps
Which HAART drug is contraindicated in prgnancy?
Efavirenz
CCR5 D32 mutation means what in HIV?
slower progression to aids
Memory T cells express CD what?
CD45
ARDS - what method improve oxygenation ONLY - not mortality?
- Nitric oxide therapy
- Muscle relaxant infusion for 48 hours
- Fluid conservative therapy due to aspiration/pneumonia/inhalation injury
Commonest cause of shock in ICU?
Least common shock in ICU?
Distributive shock - sepsis/anaphylaxis
Least common - obstructive
Intra-aortic balloon pump indications?
Low Output Bridge to ASMRec
Severe AS
Mechanical complications + cardiogenic shock ( severe MR, ventricular or papillary muscle rupture)
Low Cardiac output post CABG
Bridge to definitive treatment
Types of necrotising fasciitis?
Type 1 = polymicrobial
Type 2 = Group A streptococcal
type 3 = Gas gangrene/clostridial myonecrosis
Serial measure of CVP using CVC recommended in septic shock?
No role, just aim MAP > 65 mmHG
Milrinone mechanism of action?
Phosphodiesterase III inhibitor - decrease cAMP ( prevents vasodilatation)
Phenylepherine mechanism of action?
pure A1 agonist
In VT due to hyperkalemia - give what?
Any role of calcium chloride in VF?
Calcium chloride because 3x more calcium and no need to be metabolised by liver
Calcium chloride - NO ROLE
