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MRCS-Critical care > QNA1 > Flashcards

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
Q

Nutritonal requirements in burns calculation

A

Basal requirement + replacement

25-30 kcal/kg/day + 70kcal/kg/%burn

26
Q

Intrinsic vs extrinsic pathway activation

A

Intrinsic: vessel injury leading to activation XII
Extrinsic: tissue thromboplastin from damaged cells

27
Q

Clotting ixresults for extrinsic pathway issues

A

Prolonged PT

28
Q

Pathophysiology of ARDS

A

Acute:
- widespread destruction of alveolar endothelium -> filled with protein rich fluids

Later:
- healing by extensive scaring and fibrosis with reduced lung compliance

28
Q

Pathophysiology of ARDS

A

Acute:
- widespread destruction of alveolar endothelium -> filled with protein rich fluids

Later:
- healing by extensive scaring and fibrosis with reduced lung compliance

29
Q

Normal range of PaO2 on oxygen

A

FiO2 -10

If on 15l (80%)

80-10 = 70 should be the PaO2

30
Q

CO2 bicarb equation

A
31
Q

Where is carbonic anhydrase found

A

Renal tubules
Brain
Osteoclast

31
Q

Where is carbonic anhydrase found

A

Renal tubules
Brain
Osteoclast

32
Q

What is chloride shift

A

Chloride diffuses inside the RBC after forming HCO3 (leaves the cell) and H+ (binds to Hb) to maintain the balance

32
Q

What is chloride shift

A

Chloride diffuses inside the RBC after forming HCO3 (leaves the cell) and H+ (binds to Hb) to maintain the balance

33
Q

Ways to measure ICP

A

Lumbar puncture
Intracranial monitoring

34
Q

Surgical mx options for PUD ulcer perforation

A
  1. Omental patch repair
  2. primary closure
35
Q

Difference in surgical mx of perforated gastric ulcer and deodenal ulcer

A

Gastric: needs biopsies taken as increase risk of malignancy

Duodenal: doesn’t need biopsies

36
Q

Action of HCL in stomach

A

Converts pepsinogen to pepsin

(pepsin acts on protein breakdown to peptone)

37
Q

NCEPOD categories

A
37
Q

NCEPOD categories

A
38
Q

Dose of clexane

A

1.5mg/kg OD
1mg/kg BD

38
Q

Dose of clexane

A

1.5mg/kg OD
1mg/kg BD

39
Q

How is calcium transported in blood

A

45% bound to albumin
50% unbound and ionised

40
Q

Roles of calcium

A
  1. muscle contraction
  2. neurotransmitter
  3. mineralisation of bone
  4. coagulation
41
Q

How is Vit D activated

A
42
Q

Clinical signs of hypocalcaemia

A

Muscular cramps

Tetany: spasms

Trousseaus’s sign (tapping median nerve after BP -> hand spasm)

Chvosteks sign

43
Q

Which muscle is most worrying for hypocalcaemic tetany

A

laryngeal muscles (fear of laryngospasm)

44
Q

Hypocalcaemia mx

A

10mls of 10% calcium gluconate over 10 mins

then 10-40 mls over 4-8 hours in saline

45
Q

Causes of hypocalcaemia post hypothyroidism

A

Ischaemia of parathyroid glands
Removal of parathyroid glands

46
Q

Complications of enterocutanous fistula

A

Sepsis
Electrolyte distrubance (high output)
Dehydration
Malnutrition

MRCS-Critical care (10 decks)

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