Specialties - Liam Flashcards
Describe cell cycle
- G1 (cell growth)
- G0 (resting) or carry on to S (synthesis)
- G2
- M (mitosis)
Where do oncogenes, tumour suppresssor genes and DNA repair genes act?
Oncogenes - between G1 and G0/S
Tumour suppressor genes - between G1/G0 and S
DNA repair genes - between S and G2
Lynch syndrome/HNPCC
Mutation of mismatch repair genes
Excess colorectal, endometrial, urinary tract, ovarian and gastric cancer
Adenoma-carcinoma sequence for polyp formation
How often do people with BRCA1/2 mutation get investigated
2 yearly mammogram from 35-40
Yearly after 40
How often do people with HNCPP get investigated
2 yearly colonoscopy from 25 to 35
5 yearly from 50 if moderate risk
Different status of licenses medication can be
Unlicensed
Off-label
Specials (unlicensed)
Licensed
Who considers applications for expensive drug use
Patient access schemes assessment group
Once SMA approves a drug for use, who approves for local use
Area drugs and therpeutics committees
Regulation of new drugs is done by
Commission on Human Medicines
Who decides if drugs are cost-effective
Scottish Medicines Contorsium
Where can central lines be inserted
Internal jugular vein
Subclavian vein
Femoral vein
What are some medications continued pre and peri-operatively
Steroid inhaler for asthma
Lamotrigine for epilepsy
Bisoprolol after previous MI
Modified releasee morphine
Non-hypnotic effects of inhalation general anaesthetic agents
Vasodilation
Muscle relaxation
V/Q mismatching in lungs
Should muscle relaxants ever be used without general anaesthesia
No, as could result in awareness under anaesthesia
What do muscle relaxants act on
Nicotinic acetylcholine receptor
How do most hyponotic agents act
Mostly GABA chloride receptor agonists
Ketamine - NMDA receptor
Common general anaesthesia agents
Sevoflurane and desflurane
Local anaesthetic mechanism of action
Block sodium channels to prevent propagation of action potentials
What results in hypovolaemia
More fluid leaving body than going in
Signs of hypovolaemia
Hypotension
Tachycardia
Slow capillary refill
Cpold peripheries
Raised RR
Signs of hypervolaemia
Peripheral oedema
Pulmonary oedema (shortness of breath, reduced oxygen sat, raised RR, crackles)
Raised JVP
Increased body weight from baseline
Indications for IV fluid
Resuscitation (sepsis or hypotension)
Replacement (vomiting or diarrhoeaa)
Maintainance (nil by mouth due to bowel obstruction)
Types of IV fluid
Crystalloids - water with salt/glucose that spreads in all body compartments evenly
Colloids - large molecules that stay in IV space
Examples of crystalloids
0.9% sodium chloride (normal saline)
Hartmanns solution
5% dextrose
Tonicity
Refers to osmotic pressure gradient between fluid solution and blood plasma
Isotonic solutions
Match concentration of solutes in plasma
Hypotonic solutions
Lower concentration of solutes than the plasma
Hypertonic solutions
Higher concentration of solutes than plasma
Water flows from x to y
Low concentration of solutes to higher concentration of solutes by osmosis
0.9% saline is
Isotonic
5% dextrose is
Hypotonic
3% saline is
Hypertonic
Example of colloid
Human albumin solution
Resuscitation IV fluids
- Isotonic fluid
- 0.9% saline
- Hartmanns solution
Replacement IV fluids
Estimate loss and prescribe for it
Maintenance IV fluid amount:
- water
- sodium, potassium and chloride
- glucose
25-30ml/kg/day water
1mmol/kg/day of sodium, potassium and chloride
50-100g/day of glucose
What is often sued to maintenance IV fluids?
0.9% saline
5% dextrose
What does 1L of 0.9% saline contain
1L water
154mmol sodium
154mmol chloride
What does 5% dextrose contain
1L water
50g glucose
