Critical care

Question 1

What are the components of the Glasgow criteria for panceatitis?

Answer 1

PANCREAS
PaO2<8
Age >55
Calcium <2
Renal impairment
Urea >16
Enzymes - LDG >600 or AST >200
Sugar >10
At least 3 = severe pancreatitis

Question 2

Why do you get hypocalcaemia in pancreatitis?

Answer 2

Omental fat is broken down into fatty acids which chelate calcium leading to hypocalcaemia

Question 3

Why do you get hyperglycaemia in pancreatitis?

Answer 3

Islets of Langerhans destroyed meaning insulin cannot be produced

Question 4

How do you calculate the anion gap?

Answer 4

(Na+K)-(Cl+HCO2)

Question 5

How is base excess interpreted?

Answer 5

More negative - acidosis
More positive - alkalosis

Question 6

How is carbon dioxide transported in the blood?

Answer 6

Dissolved
Buffered with water as carbonic aacid
Bound to proteins (e.g. haemoglobin)

Question 7

What is a buffer?

Answer 7

Weak acid and its conjugate base
OR
Weak base and its conjugate acid

Question 8

List causes of a metabolic acidosis with a normal anion gap

Answer 8

RTA
Diarrhoea
Ileostomy
Hyperparathyroidism

Question 9

List causes of a metabolic acidosis with an increased anion gap

Answer 9

Sepsis
Cardiac arrest
Hypotension
Methanol
Insulin deficiency
Metformin
Starvation
Salicylates

Question 10

What are causes of a metabolic alkalosis?

Answer 10

Vomiting
Diuretics
Excess antacids

Question 11

What are causes of a respiratory acidosis?

Answer 11

Neurological conditions
Lung conditions
Low GCS

Question 12

What are the causes of respiratory alkalosis?

Answer 12

Panic attack
Altitude
Hyperventilation

Question 13

Define ARDS

Answer 13

Acute respiratory failure with non-cardiogenic pulmonary oedema

Question 14

Define HAP

Answer 14

Pneumonia that develops >48 hours after admission to hospital

Question 15

What organisms commonly causes HAP?

Answer 15

Early - strep pneumoniae
Late - MRSA, pseudomonas, gram negatives

Question 16

What are the key characteristics of ARDS?

Answer 16

Diffuse bilateral pulmonary infiltrates
Normal pulmonary artery wedge pressure
PaO2/FiO2 ratio <26

Question 17

Define pain

Answer 17

Unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 18

What are possible outcomes of poor pain management?

Answer 18

Reduced mobility
Increased sympathetic tone leading to increased myocardial oxygen demand
Delayed gastric emptying
Sputum retention
Atelectasis

Question 19

What is the shelf life of blood?

Answer 19

35 days

Question 20

What are blood products screened for?

Answer 20

Hepatitis B, C, E
HIV
Syphilis
HTLV

Question 21

Define massive transfusion

Answer 21

> blood volume in 24 hours
50% blood volume in 4 hours

Question 22

What are complications of massive transfusion?

Answer 22

Fluid overload
Coagulopathy
Hyperkalaemia
Hypocalcaemia
Hypothermia

Question 23

What is involved in confirming brainstem death?

Answer 23

Fixed pupils unresponsive to light

Question 24

What is a partial thickness burn?

Answer 24

Burn that has breached the epidermis and dermis

Superficial - epidermis and upper dermis
Deep - epidermis and full dermis

Question 25

Characteristic features of superficial dermal burn

Answer 25

Painful Blistering Pink

Question 26

Describe the rule of nines

Answer 26

Head - 9% Arm - 9% Front torso - 18% Back torso - 18% Leg - 18% Genitals - 1%

Question 27

Which burns patients require IVF?

Answer 27

>15% TBSA adults >10% TBSA children

Question 28

Describe fluid resuscitation in a burns patient

Answer 28

2ml x % burn x weight (kg) Half within 8 hours, rest over 16 hours

Question 29

What are the indications for referral to a specialist burns unit?

Answer 29

>5% TBSA (children) >10% TBSA (adults) Under 5 years Over 60 years Steam, electrical and chemical burns Burns to face, hands, feet, genitals, flexures Circumferential burns Inhalation injuries NAI

Question 30

Characteristic features of a deep partial thickness burn

Answer 30

Red, blotchy or mottled Non-blanching Less painful

Question 31

Describe a full thickness burn

Answer 31

Burn through entire epidermis and dermis, into the subcutaneous tissue

Question 32

Characteristic features of a full thickness burn

Answer 32

White, brown, black Painless Leathery, waxy, dry

Question 33

What are potential complications of central line insertion?

Answer 33

Immediate: Haematoma, haemorrhage, pneumothorax, arrhythmia, right atrial perforation, air embolus Early: Blockage, chylothorax, pseudoaneurysm Late: Infection, thrombosis, vascular erosion, vascular stenosis, catheter fracture

Question 34

Where should the tip of a central line lie?

Answer 34

In the SVC just before it enters the right atrium

Question 35

How do you locate the IJV with US when inserting a central line?

Answer 35

At C4 (upper border of thyroid cartilage), compressible structure next to carotid artery

Question 36

What layers are transversed when inserting a subclavian line?

Answer 36

Skin Subcutaneous fat and fascia Pectoralis major Subclavius muscle Subclavian vein

Question 37

Define compartment syndrome

Answer 37

Pathological condition characterised by elevated interstitial pressure in a closed osteofascial compartment that results in microvascular compromise

Question 38

What is the definition of rhabdomyolysis?

Answer 38

Release of potentially toxic muscle cell components into the systemic circulation

Question 39

What biochemical abnormality is typically seen in severe vomiting?

Answer 39

Hypokalaemic, hypochloremic metabolic alkalosis

Question 40

What ECG changes are associated with hypokalaemia?

Answer 40

Flat or inverted T waves U waves ST depression Prolonged PR

Question 41

Why can blood transfusions cause hypocalcaemia?

Answer 41

Citrate in blood binds calcium

Question 42

What causes acute haemolytic transfusion reactions?

Answer 42

ABO incompatibility

Question 43

What is myoglobin?

Answer 43

Oxygen binding protein found in muscles

Question 44

What is the classical triad of fat embolism syndrome?

Answer 44

Respiratory insufficiency Cerebral features Petechial rash

Question 45

What is a fistula?

Answer 45

An abnormal communication lined with granulation tissue between two epithelial or endothelial surfaces

Question 46

What is an abscess?

Answer 46

A localised collection of pus surrounded by granulation tissue

Question 47

What is a normal urine output in an adult?

Answer 47

0.5ml/kg/hour

Question 48

What is sedation?

Answer 48

An alteration in conciousness +/- analgesia +/- decreased anxiety

Question 49

How do you calculate MAP?

Answer 49

MAP = (COxSVR)+CVP

Question 50

Name the vitamin K dependent clotting factors

Answer 50

2, 7, 9, 10

Question 51

What is beriplex?

Answer 51

Prothrombin complex concentrate Contains factors 2, 7, 9, 10