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year 3 revision > Data interpretation > Flashcards

Data interpretation Flashcards

1
Q

7 LFTs

A 
ALT
AST
ALP
GGT
bilirubin
albumin
prothrombin time
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2
Q

2 things ALT, AST, ALP and GGT are used to distinguish between

A

hepatocellular damage and cholestasis

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3
Q

what are bilirubin, albumin and PT used to assess

A

liver’s synthetic function

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4
Q

what is ALT a marker of

A

raised in acute hepatocellular injury

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5
Q

what is ALP a marker of

A

raised in cholestasis

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6
Q

what is a raised ALP, GGT and bilirubin suggestive of

A

cholestasis

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7
Q

4 causes of an isolated rise in ALP (i.e. GGT not raised too)

A

bony metastases/primary bone tumours
vit D deficiency
recent bone fractures
renal osteodystrophy

this is because ALP is also present in bone

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8
Q

what is an isolated rise in bilirubin suggestive of

A

pre-hepatic cause of jaundice

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9
Q

most common cause of isolated jaundice (just bilirubin raised)

A

Gilbert’s syndrome (also haemolysis common)

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10
Q

where is albumin made

A

liver

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11
Q

3 reasons why albumin levels can fall

A

liver disease e.g. cirrhosis = decreased production
inflammation
protein-losing enteropathies or nephrotic syndrome = excessive loss

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12
Q

when is ALT>AST seen

A

chronic liver disease

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13
Q

when is AST>ALT seen

A

cirrhosis

acute alcoholic hepatitis

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14
Q

what does a low paO2 and high paCO2 suggest

A

type TWO respiratory failure

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15
Q

what would a high HCO3 indicate in respiratory acidosis

A

metabolic compensation for respiratory acidosis = chronic

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16
Q

how does a high HCO3 affect base excess

A

increases base excess

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17
Q

cause of type 2 respiratory failure

A

ventilatory failure e.g. COPD, asthma, opiates, chronic bronchitis, MND, ankylosing spondylitis

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18
Q

what does a high pH and low CO2 show

A

respiratory alkalosis

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19
Q

ABG result if there was metabolic alkalosis

A

high HCO3/BE

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20
Q

cause of respiratory alkalosis

A

increased ventilation (increased RR) e.g. anxiety, pain, PE, pneumothorax

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21
Q

what does a high pH, normal CO2 and high HCO3/BE indicate

A

metabolic alkalosis

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22
Q

common cause of metabolic alkalosis

A

vomiting = lose stomach acid (less H+ to bind to HCO3 so more HCO3)

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23
Q

what should paO2 level be if a patient is on oxygen

A

10kPa less than the inspired concentration (FiO2) of oxygen e.g. 22% when there is 32% oxygen given

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24
Q

what does a normal paO2, low pH, normal paCO2 and low HCO3/BE indicate

A

metabolic acidosis

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25
Q

2 potential causes of metabolic acidosis

A

sepsis - lactic acidosis from tissue hypoxia

DKA

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26
Q

what would indicate respiratory compensation in metabolic acidosis

A

low CO2 (hyperventilation)

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27
Q

what does a low paO2 and a normal paCO2 suggest

A

type ONE respiratory failure

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28
Q

7 uses of PURPLE blood bottle (whole blood)

A 
FBC
ESR
blood film
reticulocytes
monospot test (EBV)
HbA1c
PTH
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29
Q

2 uses of PINK blood bottle (transfusion lab)

A

group and save

crossmatch

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30
Q

4 uses of BLUE blood bottle (clotting)

A

coagulation screen (PT, APTT, TT)
D-dimer
INR
anti-Xa assay

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31
Q

9 uses of GOLD blood bottle (wide range of tests)

A 
U&Es
CRP
LFTs
amylase
TFTs
vitamins
troponins and CK
lipid profile 
tumour markers
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32
Q

2 uses of GREY blood bottle

A

glucose

lactate

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33
Q

3 uses of DARK GREEN blood bottle

A

ammonia
insulin
renin and aldosterone

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34
Q

lid colour of blood culture bottle for aerobic culture media

A

blue

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35
Q

lid colour of blood culture bottle for anaerobic culture media

A

purple

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36
Q

lid colour of blood culture bottle for mycobacterial cultures

A

black

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37
Q

order of draw of blood bottles

A 
blood cultures
light blue 
gold
purple
pink
grey
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38
Q

cause of type ONE respiratory failure (low paO2 and normal paCO2)

A

V/Q mismatch - e.g. from pulmonary oedema, bronchoconstriction, PE

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39
Q

how is INR calculated

A

from a prothrombin time result

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40
Q

normal INR in healthy people

A

<1.1

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41
Q

INR range to aim for in those taking warfarin

A

2-3

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42
Q

what does a high INR mean

A

blood clots more slowly than desired

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43
Q

what does a low INR mean

A

blood clots more quickly than desired

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44
Q

4 causes of high INR (and therefore slow clotting)

A

Blood-thinning medications
Liver problems
Inadequate levels of blood clotting proteins
Vitamin K deficiency

45
Q

2 causes of low INR (and therefore fast clotting)

A

high vit K levels e.g. supplements

high oestrogen e.g. HRT or OCP

46
Q

normal speed of paper on an ECG

A

25mm/s

47
Q

what does PR interval represent

A

time taken for electrical activity to move between atria and ventricles

48
Q

what does ST segment represent

A

time between depolarisation and repolarisation of ventricles (CONTRACTION) - end of S-wave to start of T-wave

49
Q

how is ventricular repolarisation represented

A

T-wave

50
Q

how is the time taken between ventricular depolarisation and repolarisation represented

A

QT interval

51
Q

where to put V1

A

4th intercostal space - right sternal edge

52
Q

where to put V2

A

4th intercostal space - left sternal edge

53
Q

where to put V3

A

midway between V2 and V4

54
Q

where to put V4

A

5th intercostal space - midclavicular line

55
Q

where to put V5

A

left anterior axillary line - same horizontal level as V4

56
Q

where to put V6

A

left mid-axillary line - same horizontal level as V4 and 5

57
Q

mnemonic for 4 limb electrodes

A

ride (red - right arm)
your (yellow - left arm)
green (green - left leg)
bike (black - right leg)

58
Q

3 leads representing inferior heart

A

II
III
aVF

59
Q

4 leads representing lateral heart

A

I
aVL
V5
V6

60
Q

2 leads representing anterior heart

A

V3

V4

61
Q

2 leads representing septal heart

A

V1

V2

62
Q

how much does one small square on ECG represent

A

0.04 seconds

63
Q

how many large squares is 1 second

A

5 - each is 0.2 seconds

64
Q

how many large squares in 1 minute

A

300

65
Q

normal cardiac axis?

A

-30 to +90 degrees

66
Q

how to see if there is a normal cardiac axis

A

look at lead I and lead III/aVF - both pointing up = no axis deviation

67
Q

how to see if there is left axis deviation

A

I and III/aVF leaving each other - LEFT = left deviation

68
Q

how to see if there is right axis deviation

A

I and III/aVF are pointing towards each other - Reaching = Right deviation

69
Q

right ventricular hypertrophy, pulmonary conditions and very tall people can all show what on ECG?

A

right axis deviation (+90 to +180)

70
Q

conduction defects can show what on ECG?

A

left axis deviation (-30 to -90)

71
Q

how to calculate heart rate from ECG if regular

A

count number of large squares in 1 RR interval and divide 300 by this number

72
Q

how to calculate heart from ECG if irregular

A

count number of complexes on rhythm strip (each strip = 10 seconds) then X by 6

73
Q

what should PR interval be

A

120-200ms (3-5 small squares)

74
Q

sign of 1st degree heart block (AV delay)

A

PR interval >200ms or 5 squares (long)

75
Q

cause of 2nd degree heart block

A

intermittent failure of conduction from SAN - often from drugs or structural heart defects e.g. post MI when arteries aren’t supplying some of the nerve fibres

76
Q

sign of Mobitz type 1 2nd degree heart block

A

progressive lengthening of PR interval until non-conducted P wave

77
Q

sign of Mobitz type 2 2nd degree heart block

A

PR interval constant and 1 P wave not conducted

78
Q

sign of 3rd degree heart block (complete heart block)

A

completely unrelated P waves and QRS complexes

79
Q

only treatment for complete heart block

A

pacemaker

80
Q

location of 1st, 2nd and 3rd degree heart block on the heart

A

1st = between SAN and AVN
Mobitz 1 = in AVN
Mobitz 2 = after AVN in bundle of His or Purkinje fibres
complete = anywhere from AVN down

81
Q

normal QRS complex length

A

<0.12 seconds

82
Q

2 signs of Wolff-Parkinson white syndrome on ECG

A
  • short PR interval (uses a faster shortcut pathway)

- delta wave (slurred upstroke of QRS)

83
Q

sign of ventricular hypertrophy on ECG

A

tall QRS complex

84
Q

when is ST elevation significant

A

> 1mm (1 small square) in 2+ contiguous limb leads

> 2mm in 2+ chest leads

85
Q

sign of myocardial ischaemia on ECG

A

ST depression >0.5mm in >2 contiguous leads

86
Q

2 causes of tall T waves

A

hyperkalaemia

hyper acute STEMI (first 30 mins)

87
Q

2 leads where T waves are normally inverted

A 
V1
III (normal variant)
88
Q

5 causes of inverted T waves in other leads

A 
ischaemia
bundle branch block
PE
LVH
hypertrophic cardiomyopathy
89
Q

T waves are inverted in which 3 leads in LBBB

A

V4
V5
V6

90
Q

T waves are inverted in which 3 leads in RBBB

A

V1
V2
V3

91
Q

are there Q waves in NSTEMI

A

no - but there is ST depression and T wave inversion

92
Q

2 causes of biphasic T waves

A

ischaemia

hypokalaemia

93
Q

2 causes of U waves

A

hypokalaemia or hypothermia

anti-arrythmic therapy e.g. digoxin or amiodarone

94
Q

SBARR stands for

A
  • situation (who where when what why)
  • background
  • assessment
  • recommendation (both state diagnosis and ask for advice)
  • response/review/read back
95
Q

8 things to include in background

A 
PC
date of admission
current diagnosis
relevant past medical and surgical history
medications
allergies
investigation results
any interventions tried and patient's clinical response to them
96
Q

3 things to include in assessment

A

vital signs
clinical exam findings
overall clinical impression

97
Q

length of time to administer bolus of IV drugs

A

3-5 minutes

98
Q

length of time to administer intermittent infusion of IV drugs

A

15 min-2 hours

99
Q

size syringe for flushing

A

10ml

100
Q

technique used to flush

A

positive pressure technique (push-pause injecting 1ml at a time)

101
Q

2 types of IV fluids

A

crystalloid (small particles e.g. 0.9% saline, 5% dextrose

colloid (large particles e.g. gelofusin)

102
Q

3 parts to the GCS

A 
eye opening (out of 4)
verbal response (out of 5)
motor response (out of 6)
103
Q

4 aspects of eye opening for GCS (4, 3, 2, 1)

A

spontaneously = 4
to speech = 3
to pain = 2
no eye opening = 1

104
Q

5 aspects of verbal response for GCS (5, 4, 3, 2, 1)

A 
oriented, time, place, person = 5
confused, conversation = 4
inappropriate words = 3
incomprehensible words = 2
no verbal response = 1
105
Q

6 aspects of motor response for GCS (6, 5, 4, 3, 2, 1)

A 
obeys commands = 6
moves to localised pain = 5
flexion withdrawal from pain = 4
abnormal flexion = 3
abnormal extension = 2
no response = 1
106
Q

monitoring if NEWS 0

A

12 hourly

107
Q

monitoring if NEWS 1-4

A

minimum 4-6 hourly, inform nurse who needs to assess

108
Q

monitoring if NEWS 3 in one parameter, or 5-7

A

minimum 1 hourly, med team urgent assessment

109
Q

monitoring if NEWS 7+

A

continuous monitoring, med team immediately informed, emergency assessment, HDU/ITU

year 3 revision (9 decks)

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