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FRCA Final > Primary Revision > Flashcards

Primary Revision Flashcards

1
Q

Context sensitive half time

A

Time taken for the plasma concentration of a drug to fall to 50% after stopping that infusion

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2
Q

3 causes of calcified CXR lesions

A

Asbestosis Mitral valve disease Chicken Pox

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3
Q

Visual symptoms of papilledema

A

Visual obfuscations Enlargement of blind spot Blurring of vision

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4
Q

Mapleson A minimum flow (SV)

A

0.8-1x MV

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5
Q

Mapleson B minimum flow (SV)

A

1.5-2x MV

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6
Q

Mapleson C minimum flow (SV)

A

1.5-2x MV

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7
Q

Mapleson D minimum flow (SV)

A

2-3x MV

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8
Q

Mapleson E minimum flow (SV)

A

2-3x MV

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9
Q

Mapleson A minimum flow (MV)

A

2x MV

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10
Q

Lack system

A

co-axial Mapleson A

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11
Q

Bain system

A

co-axial Mapleson D

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12
Q

Bain system FGF is carried through…

A

The inner tube

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13
Q

Closing capacity = FRC when?

A

Age 44 supine Age 66 upright

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14
Q

Identify the structures of the descending tracts

A
  1. Medial longitudinal fasciculus
  2. Lissaur’s tract
  3. Lateral corticospinal Tract
  4. Rubrospinal tract
  5. Pontine reticulospinal tract
  6. Medullary reticulospional
  7. Lateral vestibulospinal
  8. Tectospinal
  9. Ventral corticospinal
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15
Q

Identify the structures of the ascending tracts

A
  1. Fasciculus gracilis
  2. Fasciculus cuneatus
  3. Dorsal spinocerebellar tract
  4. Ventral spinocerebellar tract
  5. Spinothalamic tract
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16
Q

Anion Gap

A

[Na] + [K] - [HCO3] - [Cl]

Range 8 - 16 mEq/L

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17
Q

Causes of a high anion gap metabolic acidosis

A
  • High unmeasured anions
    • Lactic acidosis
    • DKA
    • Alcohol, Methanol, Ethelyne Glycol
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18
Q

Clearance

A

A measure of the body’s ability to remove a drug. It is the volume of plasma, from which a drug is completely removed in a given time (mL/min). This is commonly indexed against body mass (mL/kg/min)

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19
Q

Clearance (formulas)

A

Cl = Vd / T and since T = 1 / K, Cl = K.Vd

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20
Q

Pharmacokinetics

A
  • Absorbtion
  • Distribution
  • Metabolsim
  • Excretion
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21
Q

Bioavailibility

A

The fraction of a drug availible to the systemic circulation compared with IV administration. Calculated by area under the curve.

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22
Q

1st Pass metabolism

A

Metabolism by the gut wall or liver prior to reaching systemic circulation. PR, SL, TD, Inhalational, IV etc. all bipass 1st pass metabolism

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23
Q

First Order Kinetics

A

Rate of elimination of a drug is directly propertional to drug concentration

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24
Q

Time to reach steady state (first order kinestics)

A

5 half lives

25
Q

Elimination profile in a single compartment.

A

C = C0.e-kt

where:

  • C = concentration at time = t
  • C0 = concentration at time = 0
  • k = rate constant
  • t = time
  • -kt is a dimentionless term
26
Q

Describe C0

A

The concentration of a drug at time = 0.

C0 = dose / Vd

27
Q

Express C=C0e-kt logarhythmically

A

ln C = -kt ln C0

or

log C = (-kt/2.303) . log C0

28
Q

What is the time constant (T)

A

The time taken for a drug to be completely eliminated, had the original rate of decline continued. The inverse of the rate constant.

29
Q

What is the value of C at t = T

A

C = C0 - (e.C0)

i.e. C0 has fallen by a factor of e

30
Q

Half life

A

The time taken for conentration to reach half its starting value

31
Q

Relationship between half life and the time constant (T)

A

T½ = T.ln2

32
Q

Which is bigger? the time constant or half life?

A

time constant > half life

ALWAYS

Since T½ = T.ln2 and ln2 < 1

33
Q

Why do you wake up quickly following a propofol infusion at steady state?

A

Conductance between the peripheral and central compartments is low. The terminal elemination take a long time, but plasma concentrations fall rapidly and you wake

34
Q

Michaelis constant

A

The concentration of a substrate at which an enzyme system is working at half its maximal capacity

35
Q

What factors affect hepatic extraction of a drug

A
  1. Protein binding
  2. Blood flow
  3. Michaelis constant
36
Q

Volume of Distribution

A

The apparent volume into which a drug disperses in order to produce the observed plasma concentrations.

Vd = Dose / C0

37
Q

Seddon-Sunderland Classification

A

Classifcation of peripheral nerve injury

  1. Neuropraxia
  2. Axonotmesis
  3. Neurotmesis with preservation of perineurium
  4. Neurotmesis with preservation of epineurium
  5. Neurotmesis with complete transection of nerve trunk
38
Q

Isomer

A

Molecules that have the same molecular formula but whose atoms are arranged differently

39
Q

Structural Isomer

A

Molecules with the same molecular formula but different chemical structure

40
Q

Colloid

A

A substance that has insoluble microscopic particles suspended within another medium, most commonly a liquid

41
Q

Blood Gas Solubility Coefficient

A

The ratio of the amount of a substance in one phase to the amount in another phase, at a stated temperature, when both phases are in equilibrium and of equal volume and pressure

42
Q

What is the embryological origin of the adrenal medulla?

A

Chromaffin cells derived from the ectodermal cells of the neural crest

43
Q

What is the embryological origin of the adrenal cortex?

A

Mesoderm

44
Q

What does the adrenal cortex secrete?

A
  • Steroid hormones:
    • Glucocorticoids
    • Mineralocorticoids
    • Androgens
45
Q

What are glucocorticoids?

A

Steroid hormones that affect the metabolism of carbohydrates, fats and proteins and are important in mediating the response to fasting and stress

46
Q

What are the primary effects of glucocorticoids?

A
  • Liver
    • Protein catabolism
    • Gluconeogenesis
  • Cardiovascular
    • Maintenance of response to catecholamines
  • Kidney
    • Weak mineralocorticoid activity
  • Immune
    • Immunosuppresion
    • Slowed healing
47
Q

What are the primary effects of mineralocorticoids?

A
  • Liver - none
  • Cardiovascular - none
  • Kidney
    • Resorbs Na+ in the Distal Convoluted Tubule at the expense of loss of K+ and H+ lost into the urine
    • Expantion of the intravasular compartment
  • Immune - none
48
Q

What factors control the release of Aldosterone?

A

Aldosterone is released in response to:

  • Decreased Na
  • Decreased plasma volume
  • Increased K
  • Activation of the Renin-Angiotensin System

The final common pathway is the binding of angiotensin-II to receptors in the zona glomerulosa. This acts via G-protein to activate phospholipase-C. It facilitates the conversion of corticosterone to aldosterone.

49
Q

What is Hyperaldosteronism?

A

Excess circulating aldosterone:

  • Primary
    • Conn’s Syndrome - adrenal adenoma (60%)
    • Bilateral adrenal hyperplasia (30%)
    • Carcinoma
  • Secondary
    • Increased activation of the R-A-A system e.g. CCF or liver cirrosis
50
Q

What are the core features of hyperaldosteronism?

A
  • Hypertension
  • Hypokalaemia
  • Metabolic alkalosis
51
Q

What is SVR?

A

80 x (MAP - CVP)/CO = 1000 - 1500 dyne/s/cm5

52
Q

What factors cause a right shift of the oxyhaemaglobin dissociation curve?

A

Think about which factors require or result in increased oxygen delivery in tissues.

  • Increased temperature
  • Reduced pH
  • Raised PaCO2
  • Raised 2,3 DPG
  • Pregnancy
  • Anaemia
  • Post-acclimatisation at altitude
53
Q

Which components in PRC help prevent depletion of 2,3-DPG?

A
  • Phosphate
  • Adenosine
  • Glucose

NB, mannitol helps prevent oxidative stress to RBC, but has no impact upon 2,3-DPG

54
Q

What are the “classical” anti-inflammatory cytokines?

A
  • IL4
  • IL-10
  • IL-13
  • IFN-alpha
  • Transforming growth factor-beta
55
Q

Define Osmolarity

A

Osmolarity refers to the number of osmoles per litre of specific solvent

56
Q

Define osmolality

A

Osmolality refers to the number of osmoles per kg of specific solvent

57
Q

Maximum concentrating capacity of the kidneys

A

1200-1400 mOsm.L-1

58
Q

Minimum mandatory renal solute excretion

A

800 mOsm/day

FRCA Final (21 decks)

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