Paper 1 Flashcards

Question

What are the other receptors involved in control of breathing?

Answer 1

* nose and upper airway receptors * arterial baroreceptors * joint and muscle receptors * higher centres: pain/temp/anxiety

Answer 2

The lungs convert angiotension I to angiotension II by ACE. Then this is metabolised to angiotensin III in RBCs and vascular endothelium.

Answer 3

* bradykinin (80%) * 5-HT (serotonin) * noradrenaline * prostaglandins E₂ and F_2α * leucotrienes

Answer 4

* metabolic processes (eg noradrenaline + leucotriene metabolism) * acid base balance * phospholipid synthesis (surfactant) * involvement in immune and coagulant function * reservoir of blood (500-900ml)

Answer 5

Each kidney has 1 artery and 2 veins

Answer 6

90% to the cortex 10% to medulla

Answer 7

Inner cortical efferent arterioles (which also supply the peritubular capillaries)

Answer 8

Interlobular arteries which then divides into arcuate arteries then the afferent arterioles that go to the glomerulus.

Answer 9

This is a proteolytic enzyme produced by the JGA. It acts on angiotensinogen (produced in the liver) to form angiotensin I. This is converted to angiotensin II by cleaving 2 amino acids.

Answer 10

GFR = UV/P ## Footnote U - urine concentration of the indicator V - urine flow rate P - plasma concentration of indicator

Answer 11

50 - 150 mmol reabsorbed 90% urine 10% faeces

Answer 12

99% intracellular, mostly in muscle, but some liver/erythrocytes

Answer 13

Insulin. Less fast - aldosterone, adrenaline, alkalosis

Answer 14

70% Then 20% in LoH Then the rest in DCT

Answer 15

15% 700ml/min 500ml/100g/min Grey matter.

Answer 16

2/3 from internal carotids 1/3 from the 2 vertebral arteries

Answer 17

At the anterior and posterior communicating arteries to form the Circle of Willis

Answer 18

MAP 80-150 mmHg Above this there is a sharp increase in CBF

Answer 19

Principle - the uptake/release of a substance by an organ is the product of the blood flow through the organ and the arteriovenous difference in content. Law- describes the rate of diffusion across a membrane being proportional to the concentration gradient

Answer 20

100-150ml (10% of intracranial volume)

Answer 21

0.3L/min by the choroid plexuses in lateral, third and fourth ventricles

Answer 22

No, it's independent.

Answer 23

* lateral ventricles to 3rd ventricle via foramen of Munro * 3rd to 4th ventricle via aqueduct of Sylvius * 4th ventricle down the spinal cord/over cerebral hemispheres via midline foramen of Magendie or lateral foramen of Luschka * absorbed form dural venous sinuses via arachnoid villi

Answer 24

Chloride and magnesium

Answer 25

Opthalmic * lacrimation, pupillary constriction CVS * bradycardia, reduced contractility, vasodilation in skeletal muscle/coronary/pulmonary/renal/viscera Pulmonary * bronchoconstriction, increased secretions GI * increased motility and secretions * sphincteric relaxation Metabolic * increased insulin + glucagon secretion GU * detrusor muscle contraction * sphincteric relaxation * penile erection

Answer 26

Polysynaptic

Answer 27

Changes in muscle length, rather than tension - so contraction of muscles causes shortening of spindles - to maintain posture.

Answer 28

They transmit impulses directly to effferent γ-motor neurones via type Ia or II fibres. This is the monosynaptic stretch reflex.

Answer 29

Golgi tendon organs

Answer 30

Involuntary reflex which is a series of autonomic pharyngeal muscular contractions which takes 1-2 seconds. * soft palate is pulled upwards to close posterior nares to prevent food entering nasal passage * palatopharyngeal folds pulled medially to allow food to pass posteriorly into pharynx * larynx pulled upwards and anteriorly by the neck muscles * epiglottis covers the opening of the larynx to prevent food entering

Answer 31

Around the pharyngeal opening - tonsillar pillars have greatest sensitivity

Answer 32

Active form of vit D that increases plasma calcium levels and is produced in cells of the proximal tubule of the renal nephron.

Answer 33

Thyroid parafollicular cells to reduce cerum calcium concentrations

Answer 34

Peptide hormone produced by the alpha-cells of the pancreatic islets of Langerhands to increase blood glucose concentration

Answer 35

Peptide hormone produced in small intestinal and duodenal mucosa in response to fat and protein in chime. It increases gastric transit time to allow further digestion of fats.

Answer 36

They're produced in the hypothalamus but released from the posterior pituitary

Answer 37

Adrenal cortex

Answer 38

Adrenal cortex

Answer 39

Adrenal medulla

Answer 40

The adrenal medulla

Answer 41

Mast cells

Answer 42

* gastrin * secretin * cholecystokinin * gastric inhibitory peptide

Answer 43

* GH * prolactin * ACTH * melanocyte stimulating hormone * TSH * FSH * LH

Answer 44

Oxytocin, ADH

Answer 45

Ferrous (Fe2+) - can carry one O2 molecule and there are 4 per Hb

Answer 46

High PCO2 reduces affinity of Hb for O2

Answer 47

Deoxygenated Hb has a higher affinity for CO2

Answer 48

Drugs absorbed from GI tract enter the portal vein and go to the liver where they undergo metabolism before reaching the systemic circulation. This is minimised by SL or PR routes - which have higher bioavailibility than oral.

Answer 49

It increases 1st pass metabolism, thereby reducing bioavailibility.

Answer 50

* lipophilic and hydrophilic * short half life * low melting point * low molecular weight (\<500 Da) * high potency * unionised

Answer 51

* oral * transdermal * IM * IV * intrathecal

Answer 52

A theoretical volume in which a drug would have to disperse in order to achieve observed plasma concentrations. Highly protein bound drugs also have a high VoD while highly polar/charged drugs don't cross membranes easily and stay within the central compartment so have a small VoD.

Answer 53

Fentantly is 600 times more lipid soluble than morphine. VoD of fentanyl is 4L/kg whilst morphine is 3.5L/kg.

Answer 54

\< 0.3 L/kg because they're all highly polar

Answer 55

**ACED LMNOP** ## Footnote **A**minoglycosides **C**ephalosporins **E**phedrine **D**igoxin **L**ithium **M**ilrinone/mannitol **N**eostigmine **O**xytetracycline **P**enicillins

Answer 56

Metabolised in the liver by catechol-O-methyl transferase ti metadrenaline and metnoradrenaline

Answer 57

* highly lipid soluble * water soluble formulation * short half life * analgesic at low doses * pre-prepared solution * rapid recovery, no accumulation after infusion * minimal CVS/resp depression * antiemetic properties * painless on injection * no interaction with other drugs * no histamine release * long shelf life at room temp

Answer 58

Sulphur analogue of the oxybarbiturate pentobarbitone. Formulated as a sodium salt, sodium thiopentone and appears as a yellow power in a glass vial.

Answer 59

Weak acid with pKa of 7.6 When dissolved in water it forms an alkaline solution

Answer 60

Sodium thiopentone is stored in glass vials containing nitrogen, while sodium carbonate is added to react with water to produce hydroxide ions. This forms an alkaline solution to prevent accumulation of H+ ions and therefore the undissociated acid.

Answer 61

The active form is **non-protein bound** and **unionised.** Only 12% of administered sodium thiopentone is available but it's highly lipid soluble so the brain receives a relatively large dose.

Answer 62

An inert, odourless gas - makes up a tiny % of the atmosphere and is produced by fractional distillation of air.

Answer 63

It does not sensitise the myocardium to catecholamines. It does not alter myocardial contractility. It may cause a small reduction in HR and hence cardiac output.

Answer 64

Xenon is 3 times denser Twice as viscous

Answer 65

-108C It is non-flammable and does not support combustion. It undergoes virtually no metabolism in the body.

Answer 66

Occurs when larger doses of a drug are required to achieve a given response, often due to altered receptor sensitivity such as in chronic opioid use.

Answer 67

Reversible, acute decrease in response to a given dose of drug after repeated administration and is synonymous with **desensitisation** (which takes place over a longer period ot time) Underlying mechanisms include: * change of receptor structure * loss of receptors * reduction of mediators * increased breakdown of drug * physiological adaptation

Answer 68

They contain the CO-O linkage and undergo hydrolysis in the plasma

Answer 69

They have the NH-CO linkage and undergo hepatic metabolism

Answer 70

Increasing systemic vascular absorption: 1. Subcutaneous (least) 2. Femoral 3. Brachial plexus 4. Epidural 5. Caudal 6. Intercostal (most)

Answer 71

Most local anaesthetics cause vasodilation at low concentrations with vasoconstriction at higher doses. However, cocaine is a pure vasoconstrictor.

Answer 72

Structurally similar to bendroflumethiazide and acts as a vasodilator by modulating cAMP in arteriolar smooth muscle

Answer 73

**Class I** Local anaesthetic properties that exhibit membrane stabilising activity and affect conduction, refractoriness and the AP. _They all slow phase 0 of the AP._ **Ia** - block Na+ channels, prolong refractory period (eg disopyramide, procainamide, quinidine) **Ib** - block Na+ channels, shorten refractory period (eg lidocaine, mexiletine, phenytoin) **Ic** - block Na+ channels, no effect on refractory period (flecaineide, propafenone)

Answer 74

Beta adrenoceptor blockers (eg atenolol, propranolol)

Answer 75

Potassium channel blockers (eg amiodarone, sotalol, bretylium)

Answer 76

Calcium channel blockade (diltiazem, verapamil)

Answer 77

* adenosine * digoxin * magnesium sulphate

Answer 78

* beta blockers * class IV drugs * digoxin

Answer 79

Class Ic and IV drugs Beta blockers Digoxin Adenosine

Answer 80

Class III and I drugs

Answer 81

Class Ia and Ic drugs Beta blockers Class III drugs

Answer 82

Class Ia and III drugs

Answer 83

Dobutamine is a synthetic analogue of dopamine (derivative of isoprenaline) and is a beta1-adrenoceptor stimulator. It is a positive inotrope. It does have beta2 efffects causing peripheral vasodilatation which can cause hypotension and reflex tachycardia. Dopamine is a catecholamine-like agent used for treatment of severe heart failure and cardiogenic shock.

Answer 84

Dopamine. The conversion of dopamine to noradrenaline occurs in granulated vesicles and is dependent on the enzyme **dopamine beta hydroxylase**.

Answer 85

B1 \> B2 \> alpha. No effect on dopaminergic receptors.

Answer 86

Both beta and alpha-adrenergic reponses and causes vasodilatation through it's action on dopaminergic receptors. At high doses (\>10 mcg/kg/min) it causes predominantly alpha effects with peripheral vasoconstriction, increased PVR and reduced renal blood flow.

Answer 87

Large coronary arteries and arterioles with diameters \>100 micrometres

Answer 88

* They redistribute blood flow from epicardial to endocardial regions * They relieve coronary spasm and dynamic stenosis * They increase the venous capacitance, causing pooling of blood in the peripheral veins and reduce venous return and ventricular volume. This reduces mechanical stress in the myocardial wall and myocardial O2 demand is reduced. * they cause a fall in aortic systolic pressure, which further reduces myocardial O2 demand

Answer 89

They are converted to nitrites followed by enzyme-mediated release of unstable nitric oxide. They vasodilate whether or not the endothelium is physically intact or functional. The NO produced then stimulates the enzyme guanylate cyclase to produce cyclic guanosine monophosphate (cyclic GMP). This reduces calcium in the vascular monocyte and therefore vasodilation occurs.

Answer 90

Hydrolyzed by plasma cholinesterase to choline and succinylmonocholine - so only 20% reaches the neuromuscular junction. Succinylmonocholine is a weakly active ester of succinic acid with choline. It's rapidly metabolised - only 10% is excreted via the kidneys in the urine.

Answer 91

2 acetylcholine molecules joined through acetyl groups.

Answer 92

**Monoquaternary (contain a single N+ -CH3 group)** * vecuronium * rocuronium **Bisquaternary (contain 2 N+ -CH3 groups)** * pancuronium (more potent analogue of vecuronium)

Answer 93

85% Analgesic + antipyretic +++ Anti-inflammatory ++

Answer 94

99% Analgesic and antipyretic + Antiinflammatory +++

Answer 95

99% Analgesic + antipyretic + Anti-inflammatory +

Answer 96

99% Analgesic/antipyretic ++ Anti-inflammatory +

Answer 97

10% Analgesic/antipyretic +++ Anti-inflammatory ++

Answer 98

Naturally occuring opiate with a phenanrene structure comprising 3 fused benzene rings

Answer 99

Constricts gut sphincters - causes immobility of bowel resulting in constipation. Causes contraction of the sphincter of Oddi, causing an increase in intraluminal pressure within the biliary tree.

Answer 100

It stimulates the chemoreceptor trigger zone via 5HT3 and dopaminergic receptors. Muscarinic receptors are NOT activated by morphine.

Answer 101

As a result of dopaminergic and GABA pathways in the substantia nigra interacting with the opioid receptors.

Answer 102

Inhibits: * adrenocorticotropic hormone * prolactin * gonadotrophic hormones Increases: * vasopressin - can cause water retention and hyponatraemia

Answer 103

Hypnotic drugs that act on the **alpha-subunit of GABA_A**receptors to **open the ligand gated chloride channel** causing hyperpolarisation of post synaptic neuronal membranes. They do not act via second messenger systems.

Answer 104

Highly protein bound and usually have active metabolites - however lorazepam is glucuronated to inactive metabolites.

Answer 105

It's a non-benzodiazepine "Z-drug" that lacks the benzodiazepine structure but binds to GABA_A receptors in a similar fashion.

Answer 106

* hyponatraemia * hypokalaemia * hypochloraemic alkalosis * hypomagnesaemia * hyperuricaemia * hypocalcaemia - by increasing Ca2+ excretion

Answer 107

Causes hypercalcaemia through reducing renal excretion

Answer 108

* competitive aldosterone antagonist * reduces excretion of K+ * hyperkalaemia * increases excretion of Na+ and H2O * used to treat ascites, Conn's syndrome (primary hyperaldosteronism) and nephrotic syndrome

Answer 109

It's usually given as a loading dose for treatment of raised ICP at a dose of 1g/kg then an infusion. Due to the large infusion volumes - the initial circulating volume is increased which increases preload and cardiac output.

Answer 110

Haemolytic anaemia Aplastic anaemia Leucopaenia Thrombocytopenia Agranulocytosis

Answer 111

Electricity is the flow of electrons from one atom to another under the influence of a potential difference or under the influence of a changing magnetic field.

Answer 112

They're conductors because they contain positive and negative ions, which can move when a potential difference is applied to them - conducting electricity. Electrons in a conductor are loosely bound, so can readily move when influenced by a potential difference.

Answer 113

Semiconductors

Answer 114

Low frequency AC or direct current is more likely to cause VF than surgical diathermy at high frequency.

Answer 115

**Monopolar** - 2 connections, one the patient plate (neutral) and one the active/cutting electrode **Bipolar** - 2 connections but both are the ends of the forceps, diathermy plate not required

Answer 116

Yes, isolating capacitors are placed within the diathermy apparatus to increase the safety and reduce the risk of burns to the patient in the event of the diathermy pad becoming detached

Answer 117

Yes - when the magnetic field gradient is switched, eddy currents can be induced and this can induce small currents in biological conductors- especially nerve fibres, which can cause involuntary muscle contraction. There is also a small risk of breathing difficulties and VF.

Answer 118

Flashing lights and various taste sensations

Answer 119

Rate of work (watts) 1 W = 1 J/sec

Answer 120

Energy is expended and work is done It's measured in joules. The energy expended when applying a force of 1 N through a distance of 1 metre.

Answer 121

The area under the pressure/volume curve = work done Power is the rate of work done So for power of breathing, divide the work done (AUC) by time.

Answer 122

Converted to heat energy, only a small proportion is converted to mechanical energy.

Answer 123

Measures ambient humidity, while relative humidity is obtained from a set of tables and is not directly measured.

Answer 124

mg H2O/litre of gas

Answer 125

The amount of water vapour at a particular temperature, expressed as a % of the amount that would be held if the gas were fully saturated.

Answer 126

The water vapour will condense out. The amount of condensed water vapour will be the amount held at the original temperature minus the amount it can hold at the lower temperature. The absolute humidity will therfore fall, but relative humidity remains at 100%.

Answer 127

The energy that can be transferred from a hotter object to a coller object down it's temperature gradient.

Answer 128

A measure of the tendency of an object to gain or lose heat.

Answer 129

The temp at which it exists as a solid, liquid and gas simultaneously. 273.16K or 0.01°C

Answer 130

A form of matter that changes shape under shear forces and can either be liquids or gases.

Answer 131

Across the pipe during laminar flow is parabolic, with the highest flow in the centre. The peak velocity in the centre is twice the average across the pipe at equilibrium.

Answer 132

Mechanical. In the form of high frequency vibrations.

Answer 133

Wavelength is the reciprocal of the frequency.

Answer 134

50 microamps

Answer 135

**Class I** * any accessible conducting part of the equipment is connected to an earth wire * live, neutral and earth wires never come in contact with each other **Class II** * double-insulated * all accessible parts have 2 layers of insulation * power cables contain live and neutral conductors with a single fuse **Class III** * can't have electrical supply \>50V DC or 24V AC * "safety extra low voltage" * still provides theoretical risk of microshock

Answer 136

Type B * safe for external patient connection * class I = 500mA * class II = 100mA Type BF * same as type B * but the part connected to the patient is isolated "floating" Type CF * safe for direct connection to the heart with isolated circuits * class I = 50mA * class II = 10mA

Answer 137

Consists of a live wire and neutral wire attached to a relay circuit breaker. Faulty currents (eg high leakage current) lead to magnetic field between the live and neutral wires that induces the relay to break the circuit. There is no fuse.

Answer 138

French blue bodies and shoulders

Answer 139

Cylinders with white and blue quartered shoulders

Answer 140

4400 kPa 44 bar

Answer 141

It decreases slowly until all the liquid is utilised with only vapour remaining at which point the pressure decreases rapidly. The slow decrease is due to the latent heat of vaporisation cooling the cylinder, thereby reducing vapour pressure, Therefore, cylinder pressures do not decrease in a linear manner.

Answer 142

-160°C 7 bar /700kPa

Answer 143

With reduced use of O2, the temperature rises (less latent heat of vaporisation). Internal pressure rises, if this exceeds 17 bar then a safety valve opens. Vapourised O2 escapes. This leads to further vaporisation, reducing the temperature once more.

Answer 144

At low flow - orifice is long and narrow, so flow is laminar depending on gas *viscosity*. At high flow - orifice is wider, so flow is turbulent, depending on gas *density*.

Answer 145

* dirt in the flowmeter tubes * static electricity build up (35% inaccurate) * back pressure from the common gas outlet of up to 10%

Answer 146

Halothane - 10 ppm Enflurane - 50 ppm Isoflurane - 50 ppm Nitrous oxide - 100 ppm

Answer 147

* Mapleson A (Magill) breathing system that can also be arranged in parallel. * 14mm inner tube attached to an APL valve for exhaled gases and a 30mm outer tube supplying the FGF * efficient for spontaneous ventilation - requires 70ml/kg/min FGF * inefficient for controlled ventilation - requiring a FGF 2-3x minute ventilation

Answer 148

Mapleson D - the Bain.

Answer 149

90mV but this is reduced as it passes through the tissues until it leaves a signal output of 1-2 mV

Answer 150

The initial signal is increased by a differential amplifier that may be set at a monitoring mode (freq 0.5 - 40Hz) or diagnostic mode (0.05 - 100Hz). The differential amplifier minimises noise and signal interference using common mode rejection - where interference that is the same in 2 leads is eliminated. Signal output - displayed via oscilloscope or on paper running at 25mm/s with a signal of 1mV/cm

Answer 151

Bipolar: I, II, III, aVR, aVL, aVF Unipolar: V1-V6

Answer 152

That no difference exists between 2 sample groups. It must be set before any clinical trial, and if a difference between the 2 samples is detected, the null hypothesis must be rejected.

Answer 153

Alpha error / false positive. A difference is found where one does not truly exist causing incorrect rejection of the null hypothesis. Most commonly due to a high p-value or small sample size.

Answer 154

Beta error/ false negative. No difference is found when one does exist causing incorrect acceptance of the null hypothesis. Most commonly due to small sample sizes.

Answer 155

It indicates what size of sample is required. It measures the probability of a difference being detected when one exists and is calculated as 1 - ß. A power of \>80% (ie ß \<20%) is sufficient for a study to be adequately powered.

Answer 156

A measure of spread around central tendancy.

Answer 157

By detecting a difference in pressure between two sides of a given sensor. It compares a measurement sample with a reference sample to give a pressure difference, which can be analyzed and interpreted.

Answer 158

Yes - it measures the pressure difference between the top and bottom of a cylinder to calculate the liquid O2 remaining

Answer 159

A reference gas of 21% oxygen is compared with a measured gas with a set concentration of oxygen. When exposed to a magnetic field the paramagnetic properties of oxygen cause it to be attracted to the field, leading to a difference in pressure between both chambers that is proportional to the partial pressure of O2.

Answer 160

Yes - between the FGF channel and vapourising channel, which is then interpreted and electronically alters the gas flow accordingly.

Answer 161

Some pneumotachographs use this design. One tube faces the direction of FGF, while the other faces the opposite direction, being the reference tube. The pressure difference between the 2 tubes is proportional to the flow rate squared.

Answer 162

0.4 kPa There is no cardiac output, no perfusion of the lungs - this is extreme dead space. Arterial CO2 will be elevated but end tidal will be low if there is effective CPR or zero if ineffective.

Answer 163

* surfactant * emphysema * old age * acute asthma

Answer 164

* pulmonary fibrosis * pulmonary venous engorgement * pulmonary oedema * ARDS * pneumonia * neonates * extremes of lung volume * chronic bronchitis (dynamic)

Answer 165

* ketamine * volatiles * suxamethonium (transiently)

Answer 166

* barbiturates * etomidate * propofol * opioids

Answer 167

* sural * deep and superficial peroneal nerves * saphenous nerve * tibial nerve Tibial is the only one with a motor component beyond the block site, so is the only one that can be blocked using a nerve stimulator. This leads to plantar flexing of the toes via contraction of flexor digitorum longus and flexor hallicus longus. It supplies sensory supply to the medial aspect of the ankle and foot.

Answer 168

(Age/4) + 4

Answer 169

Age/2 + 12

Answer 170

**SIZE WEIGHT** 1 \<5 kg 1.5 5 - 10 kg 2 10 - 20 kg 2.5 20 - 30kg 3 30 - 50 kg

Answer 171

* Paracetamol = 15mg/kg IV * Ibuprofen = 10mg/kg * Diclofenac = 1mg/kg * Codeine = 0.5mg/kg * Fentanyl = 1mcg/kg * Morphine = 0.1 - 0.2mg/kg * Dexamethasone = 0.1 - 0.2 mg/kg * Ondansetron = 0.1 - 0.2 mg/kg

Answer 172

Neuromuscular blocking drugs (60% -mostly sux, rocuronium) Latex (20%) Antibiotics (15% - penicillins and cephalosporins account for 70% of these) Rare - colloids, opioids, LAs, anaesthetic agents (propofol/thio)

Answer 173

Nearly 100% of patients have a phrenic nerve block. Other complications : * stellate canglion block causing Horner's syndrome in up to 25% of patients * recurrent laryngeal nerve palsy (10%) + vagal nerve damage * vertebral artery and other vessel puncture may occur, and intrathecal/epidural injection may take place * pneumothorax is rare but more common in COPD patients

Answer 174

* best achieved with alveolar recruitment * increase mean airway pressures, either by increasing the PEEP or prolonging inspiratory time * use pressure controlled ventilation * aim for tidal volumes 6mg/kg * plateau pressure of \<30cm H2O * PEEP 10-12cm H2O * titrate FiO2 to a PaO2 of 8kPa * permissive hypercapnia of 8kPa, increasing RR to reduce PaCO2

Answer 175

Because the absorption coefficient is so similar to that of oxyHb.

Answer 176

Left atrium

Answer 177

Mapleson A - most efficient for spontaneous ventilation and FGF required are equal to alveolar minute ventilation. This system is not efficient for controlled ventilation (needs FGF 3x minute ventilation). Mapleson B + C are not efficient for spontaneous/controlled ventilation. B is more efficient than A or C for controlled ventilation. The Bain (coaxial D) is not efficient for spontaneous ventilation (FGF required 2x min ventilation) but is efficient during controlled ventilation.

Answer 178

Process of removing contaminants such that they are unable to reach a site in sufficient quantities to initiate an infection or other harmful reaction. The process always starts with clearning and is followed by sterilisation or disinfection. Fibroscopes are classed as intermediate risk equipment (don't penetrate skin/enter sterile cavities) so decontamination by cleaning followed by disinfection is an acceptable method of cleaning this type of equipment.

Answer 179

Process of physically removing foreign material from an object without necessarily destroying any infective material. An example of manual cleaning is washing, automated cleaning is performed using an ultrasonic bath or low temp steam.

Answer 180

Process of rending an object free from all pathological organisms except bcaterial spores. Chemicals used for disinfection are glutaraldehyde 2%, alcohol 60-80%, chlorhexidine 0.5-5% and hydrogen peroxide.

Answer 181

Process of using heat to destroy pathogenic organisms without destroying bacterial spores. It's an alternative to chemical disinfection.

Answer 182

Process of rendering an object completely free of all visible infectious agents including bacterial spores. This can be done using chemicals such as ethylene oxide and glutaraldehyde 2%, using radiation like gamma irradiation using heat such as the autoclave.

Answer 183

* *a wave* - atrial contraction * *c wave* - bulging of closed tricuspid at the start of isovolumetric ventricular contraction * *x descent* - atrial relaxation * *v wave* - venous return against a closed tricuspid valve * *y descent* - atrial relaxation while emptying into the right ventricle

Answer 184

Superior vena cava obstruction

Answer 185

Tricuspid regurg

Answer 186

Constrictive pericarditis

Answer 187

* reduced pH * reduced PaO2 * increased PaCO2 * reduced glucose * increased lactate

Answer 188

Increases potassium

Answer 189

Increased PaO2 and increased pH

Answer 190

This occurs when fat from bone marrow enters the circulation and restricts right ventricular outflow by increasing pulmonary artery pressures. **RS**: tachypnoea, dyspnoea, pulmonary oedema, hypoxia **Neuro**: confusion, drowsiness **Petechial rash:** usually on chest wall, axilla or conjunctiva Treatment is supportive.

Answer 191

680L of O2