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Mnemonics Flashcards

1
Q

Inputs of vomiting centre

A

CHILL - Barf Prep

CTZ, higher cortical centres, GIT, labyrinth, limbic system, baroreceptors, peripheral pain pathways

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2
Q

Liver functions

A

BSC SMID

Biotransformation, synthetic, capacitance, storage, metabolic, immunological, digestive.

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3
Q

Hypoxia

A

HASH

Hypoxic, anaemic, stagnant, histotoxic

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4
Q

Osmolality and osmolarity

A

OsmoLality in the Lab but not in Litres

Osmolality = osmoles/kg of solvent (more accurate as not temperature dependent) 
Osmolarity = osmoles/L of solution
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5
Q

Describing a drug

A

Physicochemical: chemical structure, presentation, storage
Indications, contraindications, dose, toxicity
PD: mechanism, effects by system
PK: ADME

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6
Q

Mechanisms of heat loss

A

RCECR

Radiation (40%), convection (30), evaporation (15), conduction (10), respiration (5).

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7
Q

Layers of adrenal cortex

A

GFR ACT

Glomerulosa, fasciculata, reticularis (outer to inner)
Aldosterone (mineralocorticoids), cortisol (glucocorticoids), testosterone (androgens) respectively
Medulla makes NA and A from chromaffin cells

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8
Q

Catecholamine synthesis

A

Please: Long Live DNA

Phenylalanine, L-tyrosine, L-dopa, dopamine, NA, A

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9
Q

Roles of endothelium

A

V SCOF BID

Vasomotor tone, secretion (ACE) coagulation (damage –> exposure of tissue factor), osmosis, filtration, barrier, inflammation, diffusion

Types: continuous (BBB), discontinuous (sinusoids), fenestrated (glomeruli)

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10
Q

Risks of transfusion

A

RIM(ember): Transfusion Has Its Downsides

Reactions (haemolytic, febrile), infection (bacterial, viral, parasite, prion), metabolic (low Ca, high K, acidosis if liver failure), TRALI/TACO/GVHD, hypothermia, iron overload, depletion of platelets/clotting factors (5 and 8).

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11
Q

RBC storage solutions

A

ACCS

ACD, CPD, CAPD, SAGM (in order of increasing RBC survival)

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12
Q

Coagulation: classical and cell based

A

XTF

X to Xa, prothrombin to thrombin, fibrinogen to fibrin –> clot
Cell based: initiation, amplification, propagation

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13
Q

Oral hypoglycaemics

A

The Big Sugar Daddy: Missing In Action

Increase insulin sensitivity
- Thiazolidinediones (pioglitazone)
- Biguanides (metformin)

Increase insulin secretion

  • Sulphonylureas (gliclazide)
  • Dipeptidyl peptidase IV inhibitors (sitagliptin)
  • Meglitinides (repaglinide)
  • Incretin mimetics (exenatide)

Other
- Alpha glucosidase inhibitors (acarbose) - reduce carbohydrate absorption

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14
Q

Mechanisms of drug action

A

RENT-a-HIP

Receptors, enzymes, neurotransmitters, transport systems, hormones, ion channels, physicochemical.

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15
Q

Factors influencing drug absorption (and passage across placenta)

A

CLIPPR-M

Concentration gradient (Fick’s law), lipid solubility, ionisation and pKa, protein binding, route of administration, molecular weight (Graham’s law).

Extra factors for placenta:

  • pH maternal blood and fetal blood (more acidotic fetus means more basic drugs will cross e.g. opioids and LAs –> ion trapping)
  • placental blood flow

Also thickness of membrane and surface area.

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16
Q

Laminar vs turbulent flow

A

LV has DTs

Laminar - viscosity most important
Turbulent - density most important

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17
Q

Paediatrics

A

WET FLAG

Weight = (age + 4) x 2 --> superseded
Energy = 4J/kg 
Tube = diameter = (age/4) + 4; length = (age/2) + 12 (or +15 for nasal) 
Fluids = 20ml/kg 
Lorazepam = 0.1mg/kg 
Adrenaline = 0.1ml/kg of 1:10:000; atropine = 20mcg/kg
Glucose = 5ml/kg of 10%

BP = (age x 2) + 80 (median systolic value)

Fluid deficit: each % deficit means 10ml/kg deficit to be replaced over 48h

Adrenaline for anaphylaxis = 0.01ml/kg of 1:1000 IM

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18
Q

Receptor types

A

Let’s Go To India

Ligand gated ion channel (nAChR, GABA-A), G-protein coupled (opioid, adrenoceptors, mAChR), tyrosine kinase (insulin), intracellular (steroid, thyroxine)
In order of increasing time taken for response (ms, s, min, hours)

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19
Q

ICU daily review

A

FLATCHUG

Feed/fluids, lines/devices, analgesia/aperients/abx, thromboprophylaxis, communication, hydration/head up, ulcer prophylaxis, glycaemic control

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20
Q

Difficult BMV

A

OBESE

Obese, bearded, elderly (>55), snorers, edentulous

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21
Q

Surgical sieve

A

VITAMIN CDEF

V: vascular
I: infective/Inflammatory
T: traumatic
A: autoimmune
M: metabolic
I: iatrogenic/idiopathic
N: neoplastic
C: congenital
D: degenerative/developmental
E: endocrine/environmental
F: functional
22
Q

Difficult LMA insertion

A

RODS

Restricted mouth opening, obstruction, distorted anatomy, stiff lungs or C-spine

23
Q

Difficult front of neck access

A

SHORT

Surgery, haematoma, obese, radiation, tumour

24
Q

Causes of PPH

A

4 Ts

Tone (70%), tissue, trauma, thrombin

25
3 Es of APLS
Effort - WOB, RR, recession, grunting, flared nostrils, accessory muscles Efficacy - air entry, chest expansion, exhaustion, SpO2 Effectiveness - heart rate/cardiovascular status, mental status
26
Valvular heart disease goals
Regurgitant: full, fast + forward | Stenotic (inc HCM, and PHTN): full, slow + tight
27
Cytotoxics
PASTA HAM Platinum-based agents (cisplatin) - alter ca cell DNA Alkaloids (vinca alkaloids) - block cell division Steroids (dex) - damage lymphoma cells Topoisomerase inhibitors (etoposide) - interfere with transcription/replication Antitumour antibiotics (doxorubicin) Hormones (tamoxifen, finasteride) - oestrogen receptor modulator, 5 alpha reductase inhibitor respectively Antimetabolites (methotrexate) - mimic nitrogenous bases to stop cell division Monoclonal antibodies (rituximab) - attach to ca cells to increase immune response Example regimes NHL: CHOP (cyclophosphamide, hydroxydaunomycin (doxorubicin), oncovin (vincristine), prednisolone HL: ABVD (adriamycin, bleomycin, vinblastine, dacarbazine)
28
Immunosuppressants
SCAT Steroids - methylpred - inhibit T cell lymphokine production; Cushing's Calcineurin inhibitors - ciclosporin, tac - prevent T cell activation/cell-mediated immune reactions; nephro/neurotoxic, HTN, DM, hyperkalaemia, enhance NMBs Antiproliferative - MMF, aza - inhibit T/B cells; myelosuppression, antagonise NMBs, hepatotoxic Target of rapamycin (TOR) inhibitors - sirolimus - prevent T/B cell activation; HTN, oedema, diarrhoea All increase skin and lymphoproliferative malignancy and predispose to infection.
29
Types of sickle cell crisis
VASH Vaso-occlusive - classic sickling, ischaemia, organ damage e.g. acute chest syndrome Aplastic - acutely worsening anaemia - often caused by parvovirus B19, low retics Sequestration - splenic, childhood, normal or high retics Haemolytic - common with co-existent G6PD
30
Cholinergic side effects
Cholinergic (caused by anticholinesterases): DUMBBELS ``` Diarrhoea/diaphoresis Urination Meiosis/muscle weakness Bronchospasm Bradycardia Emesis Lacrimation Salivation ```
31
ETT/ventilation problem
DOPES ``` Displacement Obstruction Pneumothorax Equipment Stomach/Stacking ```
32
Pacemakers
PSRRA ``` Pacing Sensing Response Rate modulation Anti-tachycardia pacing ```
33
Autoregulation theories
MnMs Are Easily Hidden Metabolic (K+/H+/lactate) Myogenic (smooth muscle) Autonomic (alpha 1/beta 2) Endothelial (NO/PGI2 vasodilate vs. TXA2, endothelin vasoconstrict) Hormonal (ANP vasodilates, angiotensin II vasoconstricts)
34
Response to blood loss
No Has Hamburger Neuronal: vasoconstriction, venous reservoir constriction, baroreceptor activation Hormonal: reduced RA stretch, ANP falls, ADH rises; RAAS activation Haematological: dilutional anaemia from water resorption, increased epo production
35
MEN
1: pit, pan, para 2a: para, ad, thy 2b: ad, thy, Marf 2a/2b and von Hippel Lindau get phaeos
36
Trauma history
AMPLE ``` Allergies Medications Past medical history Last meal Events ```
37
Deadly Dozen (traumatic injuries) - Lethal Six - Hidden Six
Lethal Six (diagnose and treat in 1ry survey): ATOM FC - Airway obstruction - Tension PTX - Open PTX (when would >2/3 tracheal diameter, air will enter it preferentially) - Massive haemothorax - Flail chest - Cardiac tamponade ``` Hidden Six (diagnose and treat in 2ndry survey) 4 disruptions: - Thoracic aorta - Tracheobronchial tree - Oesophagus - Diaphragm 2 contusions: - Myocardial - Pulmonary ```
38
Blood loss in trauma
Blood on the floor, plus four more - Chest - Abdomen - Pelvis - Long bones
39
Hypotension in the newly intubated asthmatic
SHIT Stacking (hence first action = disconnect circuit) Hypovolaemia Induction drug effect Tension PTX
40
Lung segments
Right: A PALM Seed Makes Another Little Palm Left: ASIA ALPS Right: - Upper (3): apical, posterior, anterior - Middle (2): lateral, medial - Lower (5): superior, medial, anterior, lateral, posterior Left: - Upper (4): apicoposterior, superior, inferior, anterior - Lower (4): anteromedial, lateral, posterior, superior
41
Toxidromes
CHAOSS Cholinergic: DUMBBELS - rx atropine, pralidoxime (anticholinesterase reactivator) Hypno-sedative: CNS depression, ataxia, nystagmus, hypotension, hypothermia. Rx supportive Anti-cholinergic: tachy, hypotension, confusion, dry flushed skin, retention. Rx supportive (+ lipid emulsion for TCAs) Opioid: coma, resp dep, pinpoint pupils, brady, hypotensive. Rx opioid antagonists Sympathomimetic: tachy, hypertensive, hyperreflexia, diaphoresis. Rx BDZ Serotonin syndrome: autonomic dysfunction, neuromuscular hyper-reactivity, altered GCS. Rx BDZ, cyproheptadine (serotonin antagonist) Also: NMS: rigidity, fever, autonomic instability. Tx cooling, BDZ, dantrolene, bromocriptine
42
Glasgow criteria for pancreatitis
PANCREAS ``` PaO2<8 Age >55 Neuts - WBC>15 Ca<2 Renal - urea>16 Enzymes - AST/ALT>200, LDH>600 Albumin <32 Sugar - glu>10 ``` 3 or more = severe, need critical care
43
Clinical Pulmonary Infection Score (VAP)
SPT - Wait and C ``` Secretions PFR Temperature WBC CXR ``` Each out of 2 so max 12 6 or more suggests VAP but poor sensitivity and specificity.
44
VAP organisms
PHAKE (Gram negs) ``` Pseudomonas Haemophilus Acinetobacter Klebsiella Enterobacter ```
45
Antifungals
APE Azoles Polyenes Echinocandins
46
P450 inducers/inhibitors
Inducers: PC BRAS + smoking, volatiles, steroids, broccoli Inhibitors: AO DEVICES + metronidazole, amiodarone, etomidate, grapefruit
47
Major incidents
METHANE ``` Major incident declared Exact location (grid reference) Type of incident Hazards - current and potential Access routes Number and type of casualties Emergency services present and required ```
48
Bulbar palsy
4 Ds Dysphagia Dysarthria Diplopia Dysphonia
49
Spontaneous bacterial peritonitis
SBP - 123 100ml 20% HAS Every 3L drained
50
Coming off bypass
TRAVEL ``` Temperature Rate >60 ABG - pH, pO2 Ventilation Electrolytes Level table ```

FFICM (8 decks)

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