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Medicine year 3- MACS > Extra > Flashcards

Extra Flashcards

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1
Q

How to test for MRSA

A

3 swabs
mouth, nose then groin

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2
Q

CRE bacteria

A

Group of bacteria resistant to carbapenem class of antibiotics. These abx are used to treat severe infections.

Test- sample of faeces and rectal swab

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3
Q

Falls assessment

A

FRAT
Timed up and go
Turn 180 degrees
Tinneti test

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4
Q

Central line insertion sites

A

Internal jugular vien
Subclavian vein
Femoral vein

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5
Q

Indications for central line

A

Administering IV medication
Fluid balance monitoring using central venous pressure

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6
Q

Complications of a central line

A

Haemothorax
Pneumothorax
Haematoma
Arterial puncture

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7
Q

Arterial line insertion site

A

Radial artery
Ulnar artery
Brachial artery
Axillary artery
Posterior tibial artery
Femoral artery
Dorsalis pedis artery

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8
Q

Indications of an arterial line

A

Continuous direct BP monitoring
Frequent blood sampling

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9
Q

Complications of an arterial line

A

Artery occlusion
Haemaoma/bleeding
Infection, air emboli

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10
Q

Nice guidelines for end of life care

A
  1. Recognition
  2. Communication
  3. Shared decision making
  4. Maintain hydration
  5. Pharmacology
  6. Validated behavioural pain chart
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11
Q

Neurogenic shock

A

Loss of control over dilation and contraction of blood vessels causing a drastically lowered BP

Causes: injury to the brain or spinal cord

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12
Q

Components of 4AT

A

Test for delirium
Alertness
AMT 4 (Age, DOB, place, year)
Attention
Acute change/fluctuating course

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13
Q

CAM

A

Acute confusion with fluctuating pattern
Inattention
Disorganised speech
Altered level of consciousness

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14
Q

How to prevent falls

A

Exercise >2hrs a week, >6 months
Multifactorial falls prevention (MFFP)- Medication or fixing medical causes, getting rid of home hazards, physio

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15
Q

Time up and go test

A

Time it takes for a person to stand up from a seated position, walk three meters, turn around, and return to seated position in the chair. Normal < 10 seconds. 11-20 seconds is within normal limits for elderly.

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16
Q

Turn 180 test

A

Does it take them more than 4 steps to turn 180 degrees

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17
Q

Tinneti’s test

A

Stand, turn 360 degrees, sit
Walk few metres slowly, turn around and walk back quickly
Sit back down

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18
Q

QALY

A

Quality-adjusted life years; weigh each year of life by perceived quality from 0 to 1. Uses ADLs, freedom from pain and freedom from mental disturbance

years x quality of life score

1 QALY costs: £20,000- £30,000
End of life QALY: £50,000

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18
Q

QALY

A

Quality-adjusted life years; weigh each year of life by perceived quality from 0 to 1. Uses ADLs, freedom from pain and freedom from mental disturbance

years x quality of life score

1 QALY costs: £20,000- £30,000
End of life QALY: £50,000

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19
Q

Saline vs hartmans

A
  • Saline preferred if hypocholeramic
  • Hartmans is the most like plasma but dont give if hyponatraemic
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20
Q

Composition of saline

A

Na+ 154
Cl- 154
308 mosm/l

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21
Q

Composition of 5% dextrose

A

Glucose- 50g
mosm/l- 154

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22
Q

Composition of Hartmanns solution

Study These Flashcards
A

Na+- 131
Cl- 111
K+ 5
HCO3- 29
Calcium 2
mosm/l 270

23
Q

Red flags for sepsis

Study These Flashcards
A
  • Objective evidence of new or altered mental state
  • Systolic BP <90 mmHg or drop of >40 from normal
  • Heart rate >130 per minute
  • Respiratory rate >25 per minute
  • Needs O2 to keep SpO2 >92% (88% in COPD)
  • Non blanching rash/ mottled/ ashen/ cyanotic
  • Recent chemotherapy
  • Not passed urine in 18 hours (<0.5ml/kg/hr if catheterised)
24
Amber flags for sepsis
- Relatives concerned about mental status - Acute deterioration in functional ability - Immunosuppressed - Trauma/ surgery/ procedure in the last 8 weeks - Respiratory rate 21-24 - Systolic Bp 91-100 mmHg - Heart rate 91-130 or new dysrhythmia - Temperature <36 - Clinical signs of wound infection
25
NEWS score: respiration rate
3: <8 or >25 2: 21-24 1: 9-11 0: 12-20
26
NEWS score: O2 score scale 1
3: <91 2: 92-93 1: 94-95 0: <96
27
NEWS score: O2 scale 2
3: <83 and >97 on oxygen 2: 84-85 and 95-96 on oxygen 1: 86-87 and 93-94 on oxygen 0 88-92 or <93 on air
28
NEWS score oxygen requirement
Oxygen: 2 points
29
NEWS score: systolic blood pressure
3: <90 or >220 2: 91-100 1: 101-110 0: 111-219
30
NEWS score: pulse per minute
3: <40 or >131 2: 111-130 1: 41-50 or 91-110 0: 51-90
31
News score: Consciousness
3- CVPU
32
NEWS score: temperature
3: <35 2: >39.1 1: 35.1-36 or 38.1-39 0: 36.1-38
33
MUST score BMI
>20= 0 18.5-20= 1 <18.5= 2
34
MUST score weight loss
Unplanned weight loss in the past 3-6 months <5%= 0 5-10%= 1 >10%= 2
35
MUST scores
1= medium risk, observe in hospital weekly, in a care home monthly, in the community every 2-3 months 2 or more= high risk. Monitor weekly in hospital, and monthly in the care home and community
36
The incident reporting cycle
Incident occurs Take immediate action Inform the person in charge Take further immediate action Complete an incident form Incident review and feedback Classification and grading of the incident Inclusion of incidents in the trust reporting system
37
Definition of dehydration
1% or greater loss of body mass due to fluid loss where the body has less water than it needs to function properly
38
The initialsymptoms of dehydration
Impaired cognitive function Reduced physical performance Headaches Fatigue Sunken eyes Dry, less elastic skin
39
The more serious effects of dehydration
Circulating blood volume decreases= hypotensions, tachycardia, weak/thready pulse, cold peripheries, oliguria, then organ failure and death
40
Symptoms of fluid excess
Fatigue, dyspnoea and pitting oedema
41
The 3 stages of assessing fluid balance
Clinical assessment Review of fluid balance charts Review of blood chemistry Bloods: Na (increased), K, Cl, HCO3 and blood urea Gold standard for dehydration: plasma osmolarity
42
What plasma osmolarity is the threshold for dehydration
>300 mOsm/kg
43
Shock
Acute circulatory failure or inappropriately distributed tissue perfusion resulting in generalised cellular hypoxia and/or inability for cells to use oxygen.
44
Explain the process of septic shock
Bacterial toxin induces expression of NO-producing enzyme iNOS causing overproduction of NO resulting in vasodilation and decreased BP
45
What type of shock does blood pooling in anaphylaxis cause
Disruptive shock
46
How does anaphylaxis cause shock
Excessive immune response Overproduction of histamine Increased Ca in cells Increased production of NO by cNOS enzymes Increased cGMP causing decreased BP. Redistribution of blood leads to blood pooling and decreased arterial pressure
47
What indicates hypovolaemia
SBP<100, HR>90, cap refill >2s, RR >20 and NEWS >5
48
What kind of response does a NEWS of 8 require
Emergency response (response team must include staff with critical care skills, including airway management
49
Role of central line
Allows multiple and greater volumes of IV fluids to be given, allows blood to be drawn easily, can measure central venous BP and can be used to measure fluid volume status (can be used for dialysis, fluid resuscitation and when patients need many blood samples or long term IV therapy or for caustic medications eg. chemo)
50
What is enhanced recovery
An evidence-based approach that helps people recover more quickly after having major surgery. Research has shown that the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their recovery time will be
51
Riglers sign
Double wall on the bowel on AXR, air in the abdomen
52
What treatment is needed in bowel obstruction
Decompression- NJ or endoscope i.e. top or bottom
53
Why might sigmoid volvulus need resection
They can be recurrent
54
What part of the bowel distends and burst quickest
Caecum- as its more spherical
55
What does large bowel distention, abrupt cut off anf loss of features on AXR mean
Lead piping i.e. toxic megacolon

Medicine year 3- MACS (7 decks)

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