ASSCC 1

Question 1

6 CT findings in acute pancreatitis:

Answer 1

1) Fat stranding
2) Pseudocyst
3) Oedema
4) Collection
5) Abscess
6) Necrosis

Question 2

Why does pancreatitis cause hyperglycaemia?

Answer 2

Pancreatic enzymes destroy β cells = increase in serum glucose

Question 3

5 complications of acute pancreatitis:

Answer 3

1) Hypovolaemic shock
2) ARDS
3) Pseudocyst
4) Haemorrhagic pancreatitis
5) Sepsis
6) Multiorgan failure

Question 4

6 causes acute pancreatitis:

Answer 4

1) Gallstones
2) Alcohol
3) Abdominal trauma
4) Post-ERCP
5) Thiazide diuretics
6) Steroids
7) Viral infections (mumps)
8) Hyperparathyroidism

Question 5

3 exocrine secretions of pancreas:

Answer 5

1) Trypsinogen
2) Amylase
3) Lipase

Question 6

Define pseudocyst:

Answer 6

Collection of amylase rich fluid enclosed in a wall of fibrous or granulation tissue. Takes > 4 weeks to form after onset of acute pancreatitis

Question 7

4 symptoms of pseudocyst:

Answer 7

1) Vomiting
2) Epigastric swelling
3) Dyspepsia
4) Mild fever

Question 8

5 complications pancreatitic pseudocyst:

Answer 8

1) Rupture
2) Bleeding from splenic vessels
3) Portal vein thrombosis
4) Infection
5) CBD obstruction
6) Cholangitis

Question 9

4 line related complications of parenteral feeding?

Answer 9

1) Infection
2) Thrombosis
3) Pneumothorax
4) Haemothorax

Question 10

2 feed related complications of parenteral feeding?

Answer 10

1) Fluid and electrolyte imbalances
2) Hypo/hyperglycaemia
3) Refeeding syndrome
4) Gut atrophy

Question 11

6 TPN Indications:

Answer 11

1) Severe malnutrition >10% weight loss
2) Multiple trauma
3) Sepsis with MOF
4) Severe burns
5) Enterocutaneous fistula
6) IBD
7) Radiation enteritis
8) Short bowel

Question 12

Routes of administration of TPN:

Answer 12

1) Central line

2) PICC

Question 13

Type of electrolytes in TPN:

Answer 13

1) Sodium chloride
2) Calcium chloride
3) Potassium chloride
4) Magnesium chloride

Question 14

What are the components of TPN?

Answer 14

Water
Carbohydrates 50%
Fats 30%
Protein
Vitamins
Nitrogen
Trace elements

Question 15

kcal/g of energy of FAT:

Answer 15

9.3 kcal/g

Question 16

kcal/g of energy of PROTEIN:

Answer 16

4.1 kcal/g

Question 17

kcal/g of energy of CARBs:

Answer 17

4.1 kcal/g

Question 18

4 Disadvantages of using glucose as sole energy source:

Answer 18

1) Critical ill pt unable to utilise due to stress response
2) Fatty liver
3) Deficiency in essential fatty acids
4) Respiratory failure (excess CO2 released on oxidation of glucose)

Question 19

5 factors affecting epidural efficiency:

Answer 19

1) Level of injection
2) Drugs used
3) Dose of drug
4) Vasoconstrictors
5) Posture
6) Age, height, weight

Question 20

Causes of gastric outlet obstruction:

Answer 20

Benign: pyloric stenosis due to chronic peptic ulceration
Malignant: Gastric or pancreatic carcinoma

Question 21

ABG result gastric outlet obstruction:

Answer 21

Metabolic alkalosis

Question 22

3 Biochemical abnormalities in gastric outlet obstruction:

Answer 22

1) Metabolic alkalosis
2) Hypochloraemia due to vomiting
3) Hypokalaemia due to ^aldosterone

Question 23

Why is bicarbonate increased in gastric outlet obstruction?

Answer 23

• Increase in reabsorption of bicarb in renal tubules due to loss of Cl- due to vomiting
• Reduced pancreatic secretions = more bicarb rich secretions retained

Question 24

Why paradoxical acuduria in gastric outlet obstruction?

Answer 24

• Hypovolaemia
• RAAS activation
• Na+ and H20 retained in exchange for H+ + K+
• Aciduria

Question 25

Clinical presentation of hyponatraemia:

Answer 25

1) Agitation 2) Confusion 3) Reduced GCS 4) Seizure

Question 26

5 differentials air under diaphragm on CXR:

Answer 26

1) Perforated viscus 2) Perforated DU 3) Perforated diverticulum 4) Ischaemic bowel 5) Necrotising enterocolitis

Question 27

5 complications of aortic stenosis:

Answer 27

1) Left ventricular failure 2) Myocardial infarction 3) Arrhythmias 4) Infective endocarditis 5) Sudden death

Question 28

Define perioperative hypothermia:

Answer 28

< 36 degrees

Question 29

5 Risk factors for perioperative hypothermia:

Answer 29

1) Major surgery 2) Exposed surgery 3) Massive blood transfusion 4) Combined general and regional anaesthesia 5) Preoperative temp < 36 degrees

Question 30

Causes of perioperative hypothermia:

Answer 30

1) Abolished behavioural responses (shivering) 2) Increased heat loss via radiation 3) Increased heat loss via evaporation from open cavities 4) Cooling effect of cold anaesthetic gases 5) Hypothalamic function altered by anaesthetic gases reducing heat production 6) Reduced metabolic heat production 7) Reduced muscle activity

Question 31

CVS complications of hypothermia:

Answer 31

``` Reduced CO Arrhythmias Vasoconstriction ^PR interval Wide QRS ```

Question 32

Resp complications of hypothermia:

Answer 32

Reduced resp drive Increased pulmonary vascular resistance V/Q mismatch

Question 33

Renal complications of hypothermia:

Answer 33

Reduced renal blood flow Reduced GFR Cold diuresis

Question 34

Haem complications of hypothermia:

Answer 34

``` Reduced plt function Reduced coagulation Increased fibrinolysis Increased haematocrit Left shift O2 dissociation curve ```

Question 35

Metabolic complications of hypothermia:

Answer 35

Reduced basal metabolic rate Metabolic acidosis Insulin resistance Hyperglycaemia