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MRCS-Critical care > QNA2 > Flashcards

QNA2 Flashcards

1
Q

Metabolic abnormalities in gastric outlet obstruction

A

Metabolic alkalosis
Low cl
Low K (excreted as aldosterone tries retain Na)

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2
Q

Differentials for goitre

A

Benign:
Simple multinodular goitre
Toxic multinodular goitre

Neoplasm:
follicular
papillary

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3
Q

Why high bicarb in gastric outlet obstruction

A
  • pancreatic juices being retained as patient not eating (rich in bicarb)
  • bicarb is reabsorbed in renal tubule to replace chloride loss and maintain ionic neutrality
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4
Q

Differentials for goitre

A

Benign:
Simple multinodular goitre
Toxic multinodular goitre

Neoplasm:
follicular
papillary

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5
Q

Why do patients get an acidic urine in gastric outlet obstruction

A

Vomiting->loss of Na

Aldosterone -> reabsorbs Na/H2O for K/H+

H+ in urine leads to acidity

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6
Q

What is the pain pathway

A

C (dull) and Adelta (sharp pain) fibres detect nociception -> synapse in dorsal horn -> decussate at the same level and travel to thalamus via lateral spinothalamic tract

-> enter somatosensory cortex

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7
Q

Side effects of opioids

A

Resp depression
N+V
Constipation
Itching

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8
Q

Pain mx

A
  • WHO ladder
  • PCA/regional anaesthesia/epidural
  • ref to acute pain team
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9
Q

How to assess pain severity?

A

0-10
Verbal rating scale
Visual analogue scale
Functional assessment

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10
Q

What is PCA

A

Syringe pump attactched to an IV line

Administers boluses of morphine

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11
Q

Safety mechanisms of PCA

A
  1. restricted dose
  2. restricted frequency
  3. lock out time (ineffective clicking)
  4. one way valve preventing backflow into infusion chamber
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12
Q

Problems with PCA

A
  1. reduced mobility of patient
  2. cant give to confused patients
  3. sleep disturbance
  4. breaks down/runs out of battery
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13
Q

Complications of pain

A
  1. resp distress
  2. CVS: increased sympathetic drive -> risk of MI
  3. MSK: immobility and risk of DVT
  4. GI: delayed gastric emptying: paralytic ileus
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14
Q

What is bilirubin conjugated to

A

Conjugated to glucouronic acid by glucoronyltransferase in liver

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15
Q

Function of bile

A

Emulsifies fat -> gives it more surface area for lipase from pancrease to metabolise it

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16
Q

Constituents of bile

A

Water
Cholesterol
Bile pigments (bilirubin and verdin)

17
Q

How do bile salts emulsify fat

A

Anions (hydrophilic/hydrophobic sides)
Form around droplets of fat forming micelles

Hydrophillic side (outside) is negatively charged, stops the fat molecules to aggregate into larger fat particles

18
Q

What happens to conjugated bilirubin

A

Haem -> biliverdin -> unconjugated bilirubin -> conjugated bilirubin

Step 1: Excreted in bile -> deconjugated by intestinal bacteria -> urobilinogen (colourless)

Step 2a. 10 % of urobilinogen gets reabsorbed into the enterohepatic circulation

Step 2b. Rest is Urobilinogen is oxidised into stercobilinogen -> brown colour of stool

19
Q

What is enterohepatic circulation

A

Reabsorption of bile salts from terminal ileum back to liver (not conjugated bilirubin is NOT reabsorbed)

20
Q

Causes of jaundice

A

Prehepatic:
- haemolytic anaemia (eg sickle cell)
- Congenital (Gilberts syndrome)

Hepatic:
- viral hepatitis
- drug induced
- wilsons

Post hepatic:
- gallstones
- PSC
- malignancy

21
Q

How to check cold sensation in theatre

A

Ethyl chloride spray or ice pack

22
Q

Causes of perforated viscus

A

Perforated ulcer
Diverticulum
Ischaemic colitis
Necrotising enterocolitis

23
Q

Why BP decreasing in pregnant lady in reverse trendelenburg position

A

(aka head up)

IVC compressed by uterus decreasing preload -> reducing cardiac output

24
Q

How does body respond to reduced BP

A
  1. barroreceptor reflex produce a compensatory tachycardia and vasoconstriction
  2. Hormones:
    Aldosterone (RAAS) increases salt and water retention
    Adrenaline/norad increases contractility/
25
Q

Devices that stop VTE

A

TEDS
Intermittent pneumatic compression devices

26
Q

What is TURP syndrome

A

Dilutional hypotonic hypervolaemia as a result of using glycine rich irrigation solution -> absorption and dilutional hyponatraemia

27
Q

Why is glycine used instead of saline for irrigation

A

Isotonic solution limits use of diathermy: dissemination of electric current will be dangerous to both patient and surgeon

MRCS-Critical care (10 decks)

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