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specialities general Flashcards

1
Q

name two vasopressors

A

metaraminol

noradrenaline

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2
Q

name two inotropes

A

adrenaline

dobutamine

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3
Q

four broad categories of neurological failure in critical care

A

metabolic
trauma
infection
stroke

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4
Q

what number of people are living in pain

A

1/4

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5
Q

what is the number 1 disease for years lost to disability worldwide

A

low back pain

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6
Q

which one is protective the nociceptive pain or neuropathic

A

nociceptive

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7
Q

peripheral pain pathway

A

release of substance P and prostaglandins. stimulation of nociceptors and signal travels in A(delta) or C nerve to spinal cord.

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8
Q

spinal cord pain pathway

A

A(Delta) or C nerve second nerve travels up opposite side of spinal cord

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9
Q

Brain pain pathway

A

thalamus second relay, connects to cortex, limbic and brain stem but perception occurs in the cortex.

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10
Q

amitriptyline and duloxetine are forms of

A

antidepressants

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11
Q

gabapentin is a form of

A

anticonvulsant

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12
Q

NMDA receptor antagonist is

A

ketamine

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13
Q

disadvantages of NSAIDs

A

Gastrointestinal and renal side effects plus cause bronchospasm in sensitive asthmatics

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14
Q

disadvantage of paracetamol

A

Liver damage in overdose

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15
Q

disadvantage of tramadol

A

nausea and vomiting

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16
Q

advantages of tramadol

A

less respiratory depression, can be used opioids, simple analgesics, no a controlled drug

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17
Q

tramadol mechanism

A

Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake (

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18
Q

morphine disadvantage

A

constipation, respiratory depression, misunderstandings about addiction, controlled drug

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19
Q

amitriptyline advantage

A

Cheap, safe in low dose
Good for neuropathic pain
Also treats depression, poor sleep

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20
Q

disadvantages amitriptyline

A

Anti-cholinergic side effects (e.g. glaucoma, urinary retention)

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21
Q

amitriptyline mechanism

A

Increases descending inhibitory signals

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22
Q

potential areas for anaesthetic respiratory problems

A

Airway
spine
reflux
obesity

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23
Q

walking around the house no. of METS

A

2

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24
Q

walk 100-200 metres on the flat no. of METS

A

4

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25
Q

walking on the flat at a brisk space no. of METS

A

6

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26
Q

run a short distance no. of METS

A

8

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27
Q

do either strenuous exercise or heavy physical work no. of METS

A

9

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28
Q

oropharyngeal airway insertion risk of

A

laryngospasm

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29
Q

why intubate?

A

protect airway, muscle relaxation, prevent contamination, tight gas control and restricted access to airway

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30
Q

risk factors for awareness under anaesthesia

A

major trauma, cardiac surgery

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31
Q

local anaesthetics examples

A

lignocaine, bupivacaine, prilocaine

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32
Q

contraindications for spinal/epidural anaesthesia

A

patient refusal, fixed CO, infection, anticoagulation, technical difficulties, spinal problems

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33
Q

features of amyotrophic lateral sclerosis

A

prog. muscle weakness, wasting and increased reflexes. pure motor signs, death from respiratory failure.

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34
Q

the three forms of superoxide dismutase that can be found in amyotrophic lateral sclerosis

A

cytoplasm, mitochondria, extracellular

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35
Q

function of superoxide dismutase

A

catalyses conversion of intracellular superoxide radicals during normal metabolism. its presence is protective from free radical damage.

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36
Q

germline mutations are

A

inherited from single alteration in egg or sperm, heritable or cause cancer family syndromes

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37
Q

somatic mutations are

A

occurring in non-germline tissues, are nonheritable

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38
Q

Lynch syndrome/HNPCC

A

mutation In mismatch repair genes results in excess of colorectal, endometrial, urinary tract and gastric cancers

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39
Q

BRAC1 AND BRAC2 associated cancer risks

A

breast cancer
second primary breast cancer
ovarian cancer

40
Q

when to suspect hereditary cancer syndrome?

A 
cancer in 2 or more close relatives
early age
multiple primary tumours
bilateral or rare cancers
autosomal dominant transmission
41
Q

early clinical surveillance guideline for breast cancer

A

5yr

42
Q

prophylactic oophorectomy outcome

A

eliminates risk of primary ovarian cancer but peritoneal carcinomatosis may still occur. induces menopause.

43
Q

genetic testing for lynch syndrome

A

IHC/microsatellite instability testing are inexpensive ways of determining if lynch syndrome is associated.

44
Q

neurofibromatosis type 1 genetic transmission

A

autosomal dominant

45
Q

signs/ symptoms of neurofibromatosis type 1

A 
Café au lait spots
neurofibromas
axillary freckling
lisch nodules
optic glioma
thinning of long bone cortex
FH
46
Q

further features of neurofibromatosis type 1

A

short stature, epilepsy, scoliosis, raised B.P. macrocephaly

47
Q

features of neurofibromatosis type 2

A

acoustic neuromas (usually bilateral), CNS and spinal tumours)

48
Q

triad of tuberous sclerosis

A

epilepsy, learning difficulty, skin lesions

49
Q

transmission genetically of tuberous sclerosis

A

autosomal dominant

50
Q

features of tuberous sclerosis

A 
depigmented macules
angiofibromas
fibrous plaque forehead
shagreen patches
ungual fibromas
rhabdomyomas in heart
phakomas in eye
51
Q

myotonic dystrophy transmission genetically

A

autosomal dominant

52
Q

myotonic features

A

bilateral onset cataract, muscle weakness, stiffness, myotonia, low motivation, diabetes, heart block

53
Q

what are the typical syndromes of presentation for geriatrics

A

falls, immobility, functional decline, delirium and incontinence

54
Q

psych geriatric considerations

A

mood, confidence and cognition

55
Q

function geriatric considerations

A

mobility, daily living skills

56
Q

behaviour geriatric considerations

A

activities, occupation

57
Q

nutritional geriatric considerations

A

MUST screening tool

58
Q

spiritual geriatric considerations

A

what’s important, meaning of life, self image

59
Q

environmental geriatric considerations

A

housing, heating, sanitation, adaptation

60
Q

social geriatric considerations

A

support networks, potential for abuse

61
Q

societal geriatric considerations

A

attitudes, technology, regulation

62
Q

key professions in the CGA

A

geriatrician, OT, PT, skilled nurses.

63
Q

what is the commonest complication of hospitalisation?

A

delirium

64
Q

why care about delirium?

A

morbidity, mortality, longer length of stay, increased rates of institutionalisation, persistent functional decline

65
Q

4AT area of questions

A

Alertness
age, DOB, place, year
attention
acute change or fluctuating course

66
Q

tranquilizer

A

quetiapine

67
Q

how much more likely to fall if you have delirium

A

4.5x

68
Q

no. of death attributed to ADRS

A

100,000 deaths yearly

69
Q

what fractions of ADRs in an ambulatory settings preventable

A

1/3rd

70
Q

ADRs are associated with

A 
cognitive loss
dehydration
incontinence
depression
falls
71
Q

example of how absorption is altered in geriatrics

A

A reduction in saliva production may result in a reduction in the rate of absorption of buccally administered drugs e.g. glyceryl trinitrate (GTN)

72
Q

what are the two most important factors that effect drug distribution in the elderly?

A

changes in body composition and protein binding

73
Q

beer’s criteria is

A

List of ‘inappropriate’ drugs for older people

74
Q

STOPP-START is

A

Advice on medical optimisation

75
Q

high stepping gait may be a sign of

A

Peripheral neuropathy

76
Q

small steps shuffling gait sign of

A

Parkinson’s

77
Q

hemiplegic gait sign of

A

stroke

78
Q

ataxic gait sign of

A

cerebellar damage

79
Q

arthralgia gait sign of

A

arthritis

80
Q

CT a head injury immediately if

A 
low GCS <13
still confused after 2 hours
focal neurology
signs of skull fracture
basal skull fracture
seizure
vomiting 
anti-coagulants
81
Q

what cause this fall?

Mary 88
Lives alone, PMH, AF, hypothyroid, recent diagnosed mild dementia, hypertension,
Shopping in Marks and Spencer when she feels dizzy and collapses. Was looking at coats, not exerting herself.
No trip. Gives clear history herself
Friend with her agrees. No LOC
On Apixiban, levothyroxine, bisoprolol 10mg, Donepezil 10mg,
O/E Systolic murmur, BP 110/80 lying 90/70 standing, HR 55 irregular. No heart failure, neurologically intact. No injury FBC, CRP, U+E, LFTs Normal

A

Most likely diagnosis?
Postural hypotension due to Bisoprolol
Bradycardia due to Bisoprolol, Donepezil and possible undertreated hypothyroidism
Rarer but life threatening ones not to miss
Aortic stenosis

82
Q

internal urethral sphincter is made of what muscle?

A

smooth

83
Q

normal storage volume of the bladder?

A

400-600mls

84
Q

sympathetic receptors for causing detrusor to relax

A

beta adrenoreceptor

85
Q

sympathetic receptor for causing contraction of neck bladder and internal urethral sphincter

A

alpha adrenoreceptor.

86
Q

high risk patient groups for alt. medicine

A

Children
Pregnancy and fetogenesis
Patients using prescribed medication
Polypharmacy

87
Q

main cam in the u.k.?

A

herbal products

88
Q

cams may contain

A

heavy metals
bacteria
medicines

89
Q

what fraction of women use CAM during early pregnancy

A

2/3rd’s

90
Q

homeopathy could be registered under

A

registered under Simplified Scheme 1992 or National Rules Scheme 2006.

91
Q

company licence for medication refers too

A

manufacturing and wholesaler dealer licences

92
Q

GMC expectation for unlicensed medication

A

carefully consider any treatment that you prescribe,

be able to justify your decisions and actions when prescribing, administering and managing medicines regardless of whether they are licensed or unlicensed.

93
Q

specific prescription sheets examples

A

diabetes, warfarin, fluid additive prescription, variable rate IV infusion

94
Q

ways to work out sensible water deficit

A 
Catheters, drains
Input charts
Vomit bowls
Sputum Pots
Stool charts and stoma losses
95
Q

ways to work out insensible water deficits

A 
Sepsis (sweat)
 Ventilation
 Open wounds
 Burns
 Bleeding

specialities (2 decks)

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