S4 CCA prep Flashcards
1
Q
For an intradermal injection of 0.1ml, what needle and syringe size would you use?
A
25G and 1ml
2
Q
When do you remove the sheath of the needle? How do you do this safely?
A
Once its firmly on the syringe, with your hand RESTING on the bench! Hold the lip of the needle below the sheath and gently pull
3
Q
How much stock solution would you draw up in your syringe to administer 0.1ml? Why?
A
Roughly 0.3ml - get rid of the excess drug and the air bubble (let the excess solution drip onto a tissue/cotton wool but dont let needle touch it)
4
Q
Where is the drug measured from on the syringe?
A
The straight black bit (top of this) - not the coned bit
5
Q
before you withdraw the drug, what should you check?
A
Drug name and expiry date
6
Q
How should you inject an intradermal injection? (approach etc)
A
5-15 degrees with the bevel upwards, then once under the epidermis pull the syringe back! (ensures you’re not in a blood vessel - safe practice) Slowly inject
if you dont see the wheal, repeat at a different site (with clean needle and syringe)
7
Q
Explain the procedure of taking a blood sample to measure blood glucose
A
- Wipe with alcohol swab and then let it dry
- Hold puncture site below heart level and massage gently from the base to improve blood flow
- TWIST (not pull) the cap off the lancet
- WARN patient of sharp scratch (or say you would warn them)
- Press it against finger and press release
- Gently massage finger base (not tip)
- Insert a test strip into the glucometer (black bit facing you)
- When theres a flashing dot on the meter, press sample of blood up against the strip
- Cover puncture site with folded clean tissue and apply pressure
- Remove the test strip after reading the recording and put into the yellow bin
8
Q
Explain the procedure of urinalysis
A
- Observe urine sample colour and clarity first (cloudy or dark= pathology, dehydration, infection)
- Immerse the coloured portion of the dipstick in the urine sample, remove excess off by wiping the edge of the stick along rim of the container
- Place it on blue tissue
- May require 2 minutes before colour changes have developed
- Read manually against the colour chart
- Remove gloves and regel hands
9
Q
When measuring haematological indices, how much blood needs to be drawn up and what size pipette?
A
10 μL of blood.
Place a yellow pipette tip on to the 5-50 μL BIOHIT automatic pipettes (P50)
10
Q
Explain the procedure of drawing up fake blood into the pipette
A
- Always invert the blood before starting (few times)
- Select the correct volume on the pipette by turning the end knob
- blue tip on end of big pipette for diluent (normally 490ul for a 10ul blood)
- dispose pipette tip into sharps bin
- for fake blood use the 50ul pipette (blue and grey) with a yellow tip, select 10ul
- gently mix sample by inverting
- Label vial with patient identifier
11
Q
What size pipettes should be used for each ul of blood?
A
P10: 1.0 - 10.0
P20: 2.0 - 20.0
P200: 20 - 200
P1000: 200 - 1000
12
Q
What is vital capacity?
A
Max volume expired following max inspiration
13
Q
What is inspiratory capacity?
A
Max volume inspired following normal expiration
14
Q
What is functional residual volume?
A
Volume remaining in lungs after normal expiration (ERV + RV)
15
Q
What is total lung capacity?
A
Volume in the lungs at the end of max inspiration
16
Q
What is tidal volume?
A
volume of air exchanged during normal inspiration or expiration
17
Q
How might FEV1 and FVC change with obstructive vs restrictive lung diseases?
A
Obstructive: FEV1 reduced, FVC normal (ratio of FEV1/FVC= low)
Restrictive: FEV1 normal or reduced, FVC reduced (ratio= normal)
18
Q
What is an obstructive lung disease? Give examples
A
limitation of airflow due to partial or complete obstruction, i.e. asthma, bronchitis
19
Q
What is a restrictive lung disease? Give examples
A
Reduced expansion of the lung with decreased total lung capacity, i.e. pulmonary fibrosis
20
Q
What is FEV1?
A
Forced expiratory volume 1= volume of air expired in 1 second and is often used to assess any changes in resistance to airflow in patients
21
Q
What should the sampling rate and amplitude be for spirometry?
A
200m/s, 100 mV
22
Q
What spirometer would you use for mimicking asphyxia and hypercarbia?
A
Bellows type
23
Q
How would you mimic asphyxia environment?
A
Rebreath so CO2 accumulates and O2 concentration falls
24
Q
How would you mimic hypercarbia?
A
Rebreathing so Co2 accumulates, but it is filled initially with very high O2 so that it always remains above normal (not hypoxic)
25
How would a spirometry trace appear for asphyxia?
Would expect to see significant increases in tidal volume and respiratory frequency due to 2 drivers of ventilation (low O2 AND high CO2)
26
How would a spirometry trace appear for hypercarbia?
Would expect to see increased tidal volume and respiratory (breathing) frequency, but a lower magnitude of increase than asphyxia. The length of time will also be longer as O2 concentration was high.
27
What are the 4 types of hypoxia?
- Arterial hypoxia: low PaO2
- Anaemic hypoxia: O2 carrying capacity of the blood is low
- Ischaemic hypoxia: cardiac output or local blood flow is inadequate
- Histotoxic hypoxia: ability of tissues to take up and use O2 is impaired
28
What would O2 concentration have to fall to to see an increase in ventilation?
60 mmHg, as shown in the oxyhaemoglobin curve, O2 delivered to tissues doesn’t change much unless partial pressure of O2 falls below 60 mmHg.
29
How could you produce hypoxic conditions on a spirometer?
- Bellows-type spirometer filled with air but fitted with a soda-lime canister (which absorbs CO2)
- Rebreathing will cause oxygen concentration to fall but CO2 won’t increase much
- Volunteer should produce a signature every 30 seconds, and variables recorded continuously (O2 saturation, HR, ventilation)
30
What would the results be from a hypoxic spirometer trace?
Would expect to see increased HR, ventilation may increase at first but after a few minutes it may fall. The patient may look pale, experience tingling in hands and feel lightheaded. They will have a lack of cognitive function.
31
Describe how to perform spirometry
1. Wear a nose clip and form a tight seal over mouthpiece
2. Breathe normally into the spirometry for at least 60 seconds
3. Ask to make a maximum inspiration immediately followed by a maximum expiration (vital capacity measurement)
4. Return to normal breathing
5. Repeat 2 more times = 3 vital capacity measurements (L) in total
32
How would you work out TV and respiratory frequency?
1. Draw a box around the 60 seconds of normal breathing
2. Select data pad tool from the menu bar
33
How would you measure FVC?
1. Breathe out as fast and as completely as possible
2. Encourage volunteer to continue until the trace reaches a plateau
3. Repeat 2x (3 measurements total)
4. Can be used to also measure FEV1 (which is low in obstructive diseases)
5. Measure using M marker and when you read the value STATE UNITS (litres)
34
What muscles are used during quiet and forced inspiration?
Quiet= diaphragm, external intercostals
Forced= additionally SCM, scalenes, serratus anterior and pectoralis minor
35
What muscles are used during quiet and forced expiration?
Quiet= none
Forced= abdominals (rectus abdominis, internal and external obliques), internal intercostals, transversus thoracis, quadratus lomborum (& serratus and lats have a minor role)
36
What are the key points you need to cover when you are explaining to a patient how to use an inhaler?
- Explain you have been asked to describe how to use an inhaler
- Ask their current understanding
-Ask if they have any pain or shortness of breath
- explain what a blue inhaler is, i.e. reliever when you have symptoms, salbutamol (works to widen your airway)
- explain they may also have a brown or purple inhaler, to take every day which prevents asthma attacks
- Check dosage and expiry date
- Check there's nothing in the mouth piece
- Give it a good shake
- Sit upright and tilt chin up to help it get into your lungs
- tight seal, then breath in slowly while pressing until lungs feel full
- Hold breath for 10s or as long as you can
- If prescribed 2 puffs, wait 30-60s then repeat
- If a purple or brown, rinse your mouth to avoid side effects
- Ask them to show you and watch their technique = give feedback
37
What should you say to a patient after explaining how to use an inhaler, as precaution?
- explain they may experience side effects, for example a fine tremor, dry mouth or headaches
- As a precaution, if you are having an asthma attack that isn’t responding to your salbutamol inhaler after 10 puffs (with 30-60 seconds in between), you should call 999 for medical assessment
38
What are the 2 types of breathing techniques for a spacer device?
- Tidal or multiple breathing: for young children or during asthma attacks, still keep chin lifted and sit upright, but can put 1 puff into the spacer and then breathe in and out steadily 5x.
- Single breathe and hold: 1 puff and then breathe in until lungs feel full, hold for at least 10s or as long as you can.
39
Why would a spacer be used?
Overcome coordination issues
40
What should the sampling rate and time axis compression be for an ECG?
400/s
Time axis compression 10:1
41
What is the normal length of time of:
- QRS complex
- PR interval
- QT interval
QRS= 0.08-0.12
PR interval= 0.12-0.2
Qt interval= 0.36-0.44
42
What is a segment vs an interval on an ECG?
Segment = between 2 waves, it seperates them
interval= includes a segment and a wave (or more than 1 wave), it includes them
43
What is PR interval and what does it represent?
Time from the start of the P wave to the start of the QRS complex. It represents the conduction through the AV node
44
What is a QT interval and what does it represent?
Time from the start of the Q wave to the end of the T wave, represents time taken total ventricular depolarisation and repolarisation
45
What is the PR segment? What should it look like?
Flat isometric line from the end of the P wave to the start of QRS
46
What is the ST segment? What does this represent?
Time from the end of QRS to the start of T wave, represents the interval between ventricular depolarisation and depolarisation
47
Where do you find the following pulses:
- Temporal
- Dorsalis pedis
- Posterior tibial
- Temporal, in front of ear or where the temporalis is (ask them to clench)
- Dorsalis pedis: lateral to tendon of big toe
- posteior tibial: below and behind medial malleolus
48
How does the pulse change with inspiration and expiration?
Increases with inspiration
Decreases with expiration
49
Explain the 5 Korotkoff sounds
Phase 1: when artery first opens and tapping sounds can be heart (from turbulence) = SBP
Phase 2: tapping gets louder then it goes into a quiet murmur
Phase 3: gets louder then appears like a 'thumping'
Phase 4: muffled sounds
Phase 5: absent sounds = DBP
50
What do you need to tell a patient before measuring their BP?
- May be uncomfortable but shouldnt hurt
- Ask if any pain
- Ask if they need a toilet as it will take 5 mins
- explain politely they need to be quiet for you to concentrate
51
After estimating the SBP by palpation, how much should you inflate the cuff by?
20-30 mmHg more
52
What should the sampling rate, scale amplitude and time compression be for an EMG?
100m/s = sampling rate
1-2mV scale amplitude
5:1 time compression
53
What wave should you be focusing on when measurnig an EMG?
The top line, then the first wave of activity
54
How do you measure amplitude of an EMG trace?
- Highlight the first wave and press windows / zoom
- Put the M marker to the start of the wave, then move your mouse to the highest point of electrical activity
- Read off the time interval and peak electrical activity at the top
55
How do you measure the total electrical activity of an EMG trace?
- Highlight the first wave then press data pad
- Read the values in the table for: integrated biceps (usually column A) and integrated triceps (usually column B)
- Values are in uV (microvolts) but you need to report mV (millivolts), so if so divide by 1000
56
What is a motor unit?
muscle fibres controlled by a single motor neurone
57
When testing reflexes, if it is absent what can you do to potentiate it?
Clenching their teeth (for upper limb reflexes), or:
Clasping their hands together with interlocked fingers, and ask them to pull as you strike the tendon (for lower limb reflexes).
58
What are the nerve roots, muscle and the nerve involved for the knee reflex?
Quadriceps femoris muscle; level L2, L3, L4; Femoral nerve
59
What are the nerve roots, muscle and the nerve involved for the tricep reflex?
Triceps muscle; level C6, C7 (or C7/C8); Radial nerve
60
What are the nerve roots, muscle and the nerve involved for the ankle reflex?
Gastrocnemius muscle; level L5, S1, S2; Tibial nerve
61
What are the nerve roots, muscle and the nerve involved for the supinator reflex?
Brachioradialis muscle; level C5, C6; Radial nerve
62
What are the nerve roots, muscle and the nerve involved for the bicep reflex?
Biceps muscle; level C5, C6; Musculocutaneous nerve
63
What are the nerve roots involved for the Babinski (plantar) reflex? What should you expect to see?
level L5, S1, S2
Should see plantar flexion of toes
64
With a UMN lesion, what would a Babinski reflex indicate?
the big toe dorsiflexes and the others fan out.
65
What is the rhombergs test?
Ask the subject to stand with their feet together without support, first with their eyes open and then with their eyes closed. Closing the eyes eliminates vision- if the proprioception and vestibular pathways are intact the subject will not sway.
66
What can the results of the Rhombergs test indicate?
If the subject starts to sway, (with eyes closed) this indicates a defect in their proprioception pathways. This is known as Romberg's test positive.
If the patient starts to sway with their eyes open or closed, this indicates a cerebellar lesion (which is not compensated by sensory input from other systems).
67
What are some important things to remember when using a peak flow meter?
- Need to be sat upright
- Blow as forcibly as possible
- Take 3 measurements, use highest
68
For CPR, what should the depth and rate of the compressions be?
5-6cm
100-120 compressions/minute
69
For CPR: “If no one was near to help, what would you do?”
Go get help first before starting CPR as cannot carry on forever.
70
When might you stop CPR?
If the patient regains consciousness, I’m told to stop by a health care professional, or if I’m too tired to continue.
71
What would you do if the individual started to breath normally?
Put them into the recovery position, summon help from the ambulance service or send a bystander if this is not possible. Continue to assess that breathing remains normal.
72
How might CPR be modified in children?
- 5 rescue breaths before chest compressions, and then continue at ratio of 15 chest compressions to 2 rescue breaths
- Perform CPR for 1 minute before going for help
- Compress chest by 1/3 of its depth, i.e. approx. 4cm for infants, 5cm for older child
- Use 2 fingers for chest compressions of an infant <1 year, and 1-2 hands on a child >1 year (depends on how much you need to get the depth)
73
How do you conduct a Rinne's and Webers test?
- Rinnes= 256 or 512 tuning fork, place on mastoid process, when no longer heard move the tongs in front of the ear and ask patient to tell you when the sound goes
- Webers= Same tuning fork but on middle of forehead, ask if it lateralises to either side
74
How can you interpret Rinne's test results?
- Normal (POSITIVE): AC > BC, i.e. can hear for longer when tongs in front of ear
- Negative: AC < BC, defective ear (cant hear when tongs in front of ear) = conductive of that ear
75
How can you interpret Weber's test?
- If defective ear hears it louder, its a conductive loss
- if normal ear hears it louder, its a sensorineural loss
76
How are the results of both R and W tests interpreted?
Webers tells you whether it is conductive hearing loss or sensorineural loss of the other ear
Rinne's tells you which ear is affected
77
What should you start an audiogram on? (frequency, signal dB, ear)
Frequency 1000 Hz and 30 dB
Left ear, mark with a small cross
78
What would you do if they can/can't hear the signal?
if cant hear it, then increase dB by 5 increments,
if they hear it then go down 10 dB
79
After checking the dB for frequency 1k Hz, what would you check next?
2 k, 4 k, 6 k up to 8 kHz
Then back to 1k to recheck, then 500, 250
THEN change ear
80
What 2 areas are important for speech?
Wernicke's area (left temporal lobe). Responsible for the comprehension of speech.
Broca's area (frontal lobe). Involved in the articulation and hence production of speech.
81
What is normal vs hearing loss for different values of dB?
Normal= <20dB
Mild: 20-40
mod: 40-70
severe 70-90
profound >90
82
What are some normal and abnormal palpation signs during a abdominal exam?
normal= soft and elastic
Guarding=muscles contract to protect the area, i.e. inflammation or pain
Rigid= whole abdomen feels hard, sign of peritonitis
Rebound tenderness= patient feels pain when you release the pressure suddenly
83
What might you inspect the abdominal wall for?
scars, distension, swellings, distended veins, discolouration and abdominal wall movement
84
When palpating for the spleen and liver where would you start and finish?
Spleen: right iliac fossa to left costal margin
Liver: right iliac fossa to right costal margin
85
If the spleen isnt palpable, what can you do to see if it is slightly enlarged?
Ask the patient to lie on their right side and repeat palpation using your right hand but with your left hand behind the lower part of the ribcage, applying gentle pressure towards you
86
What might you assess in a patients neck and chest?
- JVP
- Supraclavicular lymph nodes, i.e. Virchows
- Spider naevi, some may occur in normal people but if present could indicate excess oestrogen in liver failure, pregnancy or contraception pill
- Gynaecomastia in males
87
What are the axis on an audiogram?
X-axis= frequency in Hz (pitch)
Y-axis= hearing level in dB (loudness)
88
For an audiogram plot, what would be considered as an air-bone gap? What would this suggest?
more than 10dB at a given frequency (for air conduction vs bone conduction) - suggests a conductive hearing loss
89
Histology Q=What are the identifying features for:
- Pyloroduodenal junction
- Jejunum
- Ileum
- Pyloroduodenal junction, has Brunners glands (alkaline mucus) and thick external layer (intra)
- Jejunum= plicae circularis, picture we did for parasymp ganglia
- Ileum= Peyer's patches (aggregated lymphatic follicles)
90
explain spasticity and ridigity
Types of hypertonia, i.e. increased resistance to passive limb movement:
- Spasticity: increased resistance to certain passive movements with a sudden catch and release, it is velocity-dependent so is detected with quick movements
- Rigidity: sustained resistance throughout the RoM, can be uniform throughout (lead-pipe), or interrupted (cogwheel in PD). Detected with low movements
