Data interpretation Flashcards
1
Q
7 LFTs
A
ALT AST ALP GGT bilirubin albumin prothrombin time
2
Q
2 things ALT, AST, ALP and GGT are used to distinguish between
A
hepatocellular damage and cholestasis
3
Q
what are bilirubin, albumin and PT used to assess
A
liver’s synthetic function
4
Q
what is ALT a marker of
A
raised in acute hepatocellular injury
5
Q
what is ALP a marker of
A
raised in cholestasis
6
Q
what is a raised ALP, GGT and bilirubin suggestive of
A
cholestasis
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
8
Q
what is an isolated rise in bilirubin suggestive of
A
pre-hepatic cause of jaundice
9
Q
most common cause of isolated jaundice (just bilirubin raised)
A
Gilbert’s syndrome (also haemolysis common)
10
Q
where is albumin made
A
liver
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
12
Q
when is ALT>AST seen
A
chronic liver disease
13
Q
when is AST>ALT seen
A
cirrhosis
acute alcoholic hepatitis
14
Q
what does a low paO2 and high paCO2 suggest
A
type TWO respiratory failure
15
Q
what would a high HCO3 indicate in respiratory acidosis
A
metabolic compensation for respiratory acidosis = chronic
16
Q
how does a high HCO3 affect base excess
A
increases base excess
17
Q
cause of type 2 respiratory failure
A
ventilatory failure e.g. COPD, asthma, opiates, chronic bronchitis, MND, ankylosing spondylitis
18
Q
what does a high pH and low CO2 show
A
respiratory alkalosis
19
Q
ABG result if there was metabolic alkalosis
A
high HCO3/BE
20
Q
cause of respiratory alkalosis
A
increased ventilation (increased RR) e.g. anxiety, pain, PE, pneumothorax
21
Q
what does a high pH, normal CO2 and high HCO3/BE indicate
A
metabolic alkalosis
22
Q
common cause of metabolic alkalosis
A
vomiting = lose stomach acid (less H+ to bind to HCO3 so more HCO3)
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
24
Q
what does a normal paO2, low pH, normal paCO2 and low HCO3/BE indicate
A
metabolic acidosis
25
2 potential causes of metabolic acidosis
sepsis - lactic acidosis from tissue hypoxia
| DKA
26
what would indicate respiratory compensation in metabolic acidosis
low CO2 (hyperventilation)
27
what does a low paO2 and a normal paCO2 suggest
type ONE respiratory failure
28
7 uses of PURPLE blood bottle (whole blood)
```
FBC
ESR
blood film
reticulocytes
monospot test (EBV)
HbA1c
PTH
```
29
2 uses of PINK blood bottle (transfusion lab)
group and save
| crossmatch
30
4 uses of BLUE blood bottle (clotting)
coagulation screen (PT, APTT, TT)
D-dimer
INR
anti-Xa assay
31
9 uses of GOLD blood bottle (wide range of tests)
```
U&Es
CRP
LFTs
amylase
TFTs
vitamins
troponins and CK
lipid profile
tumour markers
```
32
2 uses of GREY blood bottle
glucose
| lactate
33
3 uses of DARK GREEN blood bottle
ammonia
insulin
renin and aldosterone
34
lid colour of blood culture bottle for aerobic culture media
blue
35
lid colour of blood culture bottle for anaerobic culture media
purple
36
lid colour of blood culture bottle for mycobacterial cultures
black
37
order of draw of blood bottles
```
blood cultures
light blue
gold
purple
pink
grey
```
38
cause of type ONE respiratory failure (low paO2 and normal paCO2)
V/Q mismatch - e.g. from pulmonary oedema, bronchoconstriction, PE
39
how is INR calculated
from a prothrombin time result
40
normal INR in healthy people
<1.1
41
INR range to aim for in those taking warfarin
2-3
42
what does a high INR mean
blood clots more slowly than desired
43
what does a low INR mean
blood clots more quickly than desired
44
4 causes of high INR (and therefore slow clotting)
Blood-thinning medications
Liver problems
Inadequate levels of blood clotting proteins
Vitamin K deficiency
45
2 causes of low INR (and therefore fast clotting)
high vit K levels e.g. supplements
| high oestrogen e.g. HRT or OCP
46
normal speed of paper on an ECG
25mm/s
47
what does PR interval represent
time taken for electrical activity to move between atria and ventricles
48
what does ST segment represent
time between depolarisation and repolarisation of ventricles (CONTRACTION) - end of S-wave to start of T-wave
49
how is ventricular repolarisation represented
T-wave
50
how is the time taken between ventricular depolarisation and repolarisation represented
QT interval
51
where to put V1
4th intercostal space - right sternal edge
52
where to put V2
4th intercostal space - left sternal edge
53
where to put V3
midway between V2 and V4
54
where to put V4
5th intercostal space - midclavicular line
55
where to put V5
left anterior axillary line - same horizontal level as V4
56
where to put V6
left mid-axillary line - same horizontal level as V4 and 5
57
mnemonic for 4 limb electrodes
ride (red - right arm)
your (yellow - left arm)
green (green - left leg)
bike (black - right leg)
58
3 leads representing inferior heart
II
III
aVF
59
4 leads representing lateral heart
I
aVL
V5
V6
60
2 leads representing anterior heart
V3
| V4
61
2 leads representing septal heart
V1
| V2
62
how much does one small square on ECG represent
0.04 seconds
63
how many large squares is 1 second
5 - each is 0.2 seconds
64
how many large squares in 1 minute
300
65
normal cardiac axis?
-30 to +90 degrees
66
how to see if there is a normal cardiac axis
look at lead I and lead III/aVF - both pointing up = no axis deviation
67
how to see if there is left axis deviation
I and III/aVF leaving each other - LEFT = left deviation
68
how to see if there is right axis deviation
I and III/aVF are pointing towards each other - Reaching = Right deviation
69
right ventricular hypertrophy, pulmonary conditions and very tall people can all show what on ECG?
right axis deviation (+90 to +180)
70
conduction defects can show what on ECG?
left axis deviation (-30 to -90)
71
how to calculate heart rate from ECG if regular
count number of large squares in 1 RR interval and divide 300 by this number
72
how to calculate heart from ECG if irregular
count number of complexes on rhythm strip (each strip = 10 seconds) then X by 6
73
what should PR interval be
120-200ms (3-5 small squares)
74
sign of 1st degree heart block (AV delay)
PR interval >200ms or 5 squares (long)
75
cause of 2nd degree heart block
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
sign of Mobitz type 1 2nd degree heart block
progressive lengthening of PR interval until non-conducted P wave
77
sign of Mobitz type 2 2nd degree heart block
PR interval constant and 1 P wave not conducted
78
sign of 3rd degree heart block (complete heart block)
completely unrelated P waves and QRS complexes
79
only treatment for complete heart block
pacemaker
80
location of 1st, 2nd and 3rd degree heart block on the heart
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
normal QRS complex length
<0.12 seconds
82
2 signs of Wolff-Parkinson white syndrome on ECG
- short PR interval (uses a faster shortcut pathway)
| - delta wave (slurred upstroke of QRS)
83
sign of ventricular hypertrophy on ECG
tall QRS complex
84
when is ST elevation significant
>1mm (1 small square) in 2+ contiguous limb leads
>2mm in 2+ chest leads
85
sign of myocardial ischaemia on ECG
ST depression >0.5mm in >2 contiguous leads
86
2 causes of tall T waves
hyperkalaemia
| hyper acute STEMI (first 30 mins)
87
2 leads where T waves are normally inverted
```
V1
III (normal variant)
```
88
5 causes of inverted T waves in other leads
```
ischaemia
bundle branch block
PE
LVH
hypertrophic cardiomyopathy
```
89
T waves are inverted in which 3 leads in LBBB
V4
V5
V6
90
T waves are inverted in which 3 leads in RBBB
V1
V2
V3
91
are there Q waves in NSTEMI
no - but there is ST depression and T wave inversion
92
2 causes of biphasic T waves
ischaemia
| hypokalaemia
93
2 causes of U waves
hypokalaemia or hypothermia
| anti-arrythmic therapy e.g. digoxin or amiodarone
94
SBARR stands for
- situation (who where when what why)
- background
- assessment
- recommendation (both state diagnosis and ask for advice)
- response/review/read back
95
8 things to include in background
```
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
3 things to include in assessment
vital signs
clinical exam findings
overall clinical impression
97
length of time to administer bolus of IV drugs
3-5 minutes
98
length of time to administer intermittent infusion of IV drugs
15 min-2 hours
99
size syringe for flushing
10ml
100
technique used to flush
positive pressure technique (push-pause injecting 1ml at a time)
101
2 types of IV fluids
crystalloid (small particles e.g. 0.9% saline, 5% dextrose
| colloid (large particles e.g. gelofusin)
102
3 parts to the GCS
```
eye opening (out of 4)
verbal response (out of 5)
motor response (out of 6)
```
103
4 aspects of eye opening for GCS (4, 3, 2, 1)
spontaneously = 4
to speech = 3
to pain = 2
no eye opening = 1
104
5 aspects of verbal response for GCS (5, 4, 3, 2, 1)
```
oriented, time, place, person = 5
confused, conversation = 4
inappropriate words = 3
incomprehensible words = 2
no verbal response = 1
```
105
6 aspects of motor response for GCS (6, 5, 4, 3, 2, 1)
```
obeys commands = 6
moves to localised pain = 5
flexion withdrawal from pain = 4
abnormal flexion = 3
abnormal extension = 2
no response = 1
```
106
monitoring if NEWS 0
12 hourly
107
monitoring if NEWS 1-4
minimum 4-6 hourly, inform nurse who needs to assess
108
monitoring if NEWS 3 in one parameter, or 5-7
minimum 1 hourly, med team urgent assessment
109
monitoring if NEWS 7+
continuous monitoring, med team immediately informed, emergency assessment, HDU/ITU
