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QNA1 Flashcards

1
Q

MGS mortality rates

A

Score 0 to 2: 2% mortality

Score 3 to 4: 15% mortality

Score 5 to 6: 40% mortality

Score 7 to 8: 100% mortality

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2
Q

How to check the level of epidural

A

Using temperature sensation (cold)

Epidural affects smaller diameter nerves more

Diameters: autonomic < sensory < motor

Sensory easiest smallest nerves to test

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3
Q

Advantages of epidural to GA

A

Quicker recovery
Less cardiovascular stress

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4
Q

Causes of shock post epidural

A

High epidural block

Distributive shock

Paralysis of intercostal muscles/diaphragm

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5
Q

Why give epidural post op

A

Post op analgesia shown to improve outcomes

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6
Q

Is there any WCC in packed RBC

A

1 10 ^6

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7
Q

Lifespan of RBC

A

120 days

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8
Q

What is PVL staph aureus

A

Panton-valentine leucocidin is a cytotoxin

Present in majority of MRSA

Creates pores in cell membranes causing necrosis

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9
Q

Causes of AF

A

PIRATES
P: pulmonary.
I: ischaemic.
R: rheumatic.
A: atrial myxoma.
T: thyroid.
E: embolism.
S: sepsi

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10
Q

Consequences of hypothermia

A

CVS: low CO, arrhythmia
Resp: hypoxia (left shift of oxy dissociation curve)
Haem: platelet dysfunction -> bleeding
CNS: reduced cerebral flow

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11
Q

Indications for platelet transfusion

A

Massive transfusion >4units

Platelets <50

DIC

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12
Q

Mech of haemostasis

A

Vasoconstriction
Platelet plug formation
Fibrin polymerize

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13
Q

How is T3/4 produced

A
  1. iodide enters follicular cells
  2. iodide -> iodine by TOP
  3. Iodine + tyrosine = either MIT (monoiodotyrisine) or DIT (diiodotyrosine)

4.a MIT + DIT = T3
4.b. DIT + DIT T4

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14
Q

Difference between T3 and T4

A

T3 biologically more active, less protein binding capacity
T4 inactive, more protein binding capacity

T3 normally formed by peripheral conversion of T4 to T3

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15
Q

Anaemia associated with hypothyroid

A

Pernicious anaemia

antiparietal cell antibody stops intrinsic factor production

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16
Q

Causes of hypothyroid

A

Primary:
- Hashimotos
- thyroidectomy
- iodine deficiency

Secondary:
- TSH deficiency

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17
Q

Signs of hypothyroid

A

Wt gain
Fattigue
Low mood
Cold peripheries
Constipation
Pretibial oedema

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18
Q

Risks of hypothyroid patient coming for surgery who isnt compliant with meds

A

Myxoedema coma
Delayed recovery from GA
Cardiac arrhythmia

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19
Q

Problems with using glucose as the only source of energy

A
  1. Glucose intolerance: as part of stress response, leads to glucose not being utilised, patients will not receive any energy
  2. Fatty liver: excess glucose not being utilized converts to fat and affects liver function (fatty liver)
  3. Resp failure: Glucose utilisation creates most CO2 could lead to resp failure
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20
Q

Complications of TPN

A

I. Nutritional:
1. Hyperlipidaemia
2. Hyper/hypo glycaemia
3. Hyperchlroaemic acidosis

  1. Line related
  2. metabolic related: bone, immune system
  3. Gut: atrophy and bacterial translocation
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21
Q

Indications for TPN

A
  1. Critical illness
    - severe malnutrition
    - severe burns
  2. GI related:
    - fistula
    - short bowel
    - IBD
22
Q

Content of TPN

A
  1. Water
  2. Carb
  3. Lipid
  4. protein
  5. vitamins
  6. nitrogen
  7. electrolytes
23
Q

Electrolytes in TPN

A

NaCl
CaCl2
KCL
MgCl

24
Q

Why does gut atrophy occur with TPN use

A

abscence of trophic signals released to luminal nutrients-> bacterial translocation to blood -> sepsis

25
Nutritonal requirements in burns calculation
Basal requirement + replacement 25-30 kcal/kg/day + 70kcal/kg/%burn
26
Intrinsic vs extrinsic pathway activation
Intrinsic: vessel injury leading to activation XII Extrinsic: tissue thromboplastin from damaged cells
27
Clotting ix results for extrinsic pathway issues
Prolonged PT
28
Pathophysiology of ARDS
Acute: - widespread destruction of alveolar endothelium -> filled with protein rich fluids Later: - healing by extensive scaring and fibrosis with reduced lung compliance
28
Pathophysiology of ARDS
Acute: - widespread destruction of alveolar endothelium -> filled with protein rich fluids Later: - healing by extensive scaring and fibrosis with reduced lung compliance
29
Normal range of PaO2 on oxygen
FiO2 -10 If on 15l (80%) 80-10 = 70 should be the PaO2
30
CO2 bicarb equation
31
Where is carbonic anhydrase found
Renal tubules Brain Osteoclast
31
Where is carbonic anhydrase found
Renal tubules Brain Osteoclast
32
What is chloride shift
Chloride diffuses inside the RBC after forming HCO3 (leaves the cell) and H+ (binds to Hb) to maintain the balance
32
What is chloride shift
Chloride diffuses inside the RBC after forming HCO3 (leaves the cell) and H+ (binds to Hb) to maintain the balance
33
Ways to measure ICP
Lumbar puncture Intracranial monitoring
34
Surgical mx options for PUD ulcer perforation
1. Omental patch repair 2. primary closure
35
Difference in surgical mx of perforated gastric ulcer and deodenal ulcer
Gastric: needs biopsies taken as increase risk of malignancy Duodenal: doesn't need biopsies
36
Action of HCL in stomach
Converts pepsinogen to pepsin (pepsin acts on protein breakdown to peptone)
37
NCEPOD categories
37
NCEPOD categories
38
Dose of clexane
1.5mg/kg OD 1mg/kg BD
38
Dose of clexane
1.5mg/kg OD 1mg/kg BD
39
How is calcium transported in blood
45% bound to albumin 50% unbound and ionised
40
Roles of calcium
1. muscle contraction 2. neurotransmitter 3. mineralisation of bone 4. coagulation
41
How is Vit D activated
42
Clinical signs of hypocalcaemia
Muscular cramps Tetany: spasms Trousseaus's sign (tapping median nerve after BP -> hand spasm) Chvosteks sign
43
Which muscle is most worrying for hypocalcaemic tetany
laryngeal muscles (fear of laryngospasm)
44
Hypocalcaemia mx
10mls of 10% calcium gluconate over 10 mins then 10-40 mls over 4-8 hours in saline
45
Causes of hypocalcaemia post hypothyroidism
Ischaemia of parathyroid glands Removal of parathyroid glands
46
Complications of enterocutanous fistula
Sepsis Electrolyte distrubance (high output) Dehydration Malnutrition

MRCS-Critical care (10 decks)

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