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Flashcards in ICM Deck (92):
1

What is the intracellular fluid composed of?

High Potassium
Low Sodium

2

How is the intracellular gradient maintained?

Sodium-Potassium pump

3

What is interstitial fluid composed of?

High Sodium
Low Potassium
(Identical to blood but with lower levels of protein, and no red blood cells)

4

What is intravascular fluid composed of?

High Sodium
Low Potassium
(Identical to interstitial fluid but with higher protein and red blood cells)

5

What are the 2 fluid compartments of the body?

Intracellular
Extracellular

6

Which of the 2 major fluid compartments contain the most fluid?

Intracellular

7

What is extracellular fluid divided into?

Interstitial and Intravenous

8

Which is the smallest fluid compartment?

Intravenous (part of the extracellular compartment)

9

What are the basic daily requirements of sodium, potassium and fluid?

Sodium- 2mmols/kg/day
Potassium- 1mmol/kg/day
Fluid- 1-1.5mls/kg/hour (for adults, roughly 1.5l- 2.5l per day)

10

How much urine is lost on average per day?

1ml/kg/hr (adults, roughly 1.5l- 2.5l per day)

11

What are the 2 types of fluid?

Crystalloid and Colloid

12

Describe a crystalloid fluid

give examples of crystalloid fluids

Crystalloid fluids have low mollecular weight salts or sugars, that can pass freely between the intravascular and interstitial compartments. (Stays in the extracellular compartment)

Hartman's
Dextrose
Normal Saline

13

Describe colloid fluids

give examples of colloid fluids

Colloid fluids are larger molecules and may take longer to diffuse out of the intravascular space.

Gelatins
Albumin
Plasma proteins

14

What is the purple blood bottle used for?
What does it contain?

Full blood count
Erythrocyte sedimentation rate
Blood film
Red cell folate

it contains EDTA, a strong anti-clotting factor

15

What is the pink blood bottle used for?
What does it contain?

Group and save
Crossmatch
Coomb's test

it contains EDTA, a strong anti-coagulant

16

What is the blue blood bottle used for?
What does it contain?

Coagulation screen
INR
D-dimer

it contains sodium citrate, a reversible anticoagulant

17

What is the yellow blood bottle used for?
What does it contain?

Urea and Electrolytes (Us+Es)
C-reactive protein (CRP)
Liver function tests (LFTs)
Amylase
Troponins
Creatine Kinase (CK)
Lipid profile

it contains silica particles and a serum separating gel

18

What does the grey blood bottle test for?
What does it contain?

Glucose
Lactate

It contains sodium fluoride as an antiglycolytic agent and potassium oxalate as an anticoagulant

19

What is the red blood bottle used for?
What does it contain?

Hormones
Toxicology
Drug levels
Bacterial and viral serology
Antibodies

It contains silica particles, acting as a clot activator

20

What is the dark green blood bottle used for?
What does it contain?

Ammonia
Insulin
Renin and aldosterone

It contains sodium heparin which acts as an anticoagulant

21

What is the light green blood bottle used for?
What does it contain?

Routine biochemistry (although the yellow bottle tends to be preferred)

it contains lithium heparin as an anticoagulant and plasma separator gel

22

What is the blue lidded blood culture bottle used for?

Aerobic organisms

23

What is the purple liddd blood culture bottle used for?

Anaerobic organisms

24

What order do you take bloods in?

1. Blood cultures
2. Blue bottles
3. Red bottles
4. Yellow bottles
5. Black bottles
6. Green bottles
7. Navy bottles
8. Purple bottles
9. Grey bottles
10. Pink bottles

25

Why is there a specific order for collecting blood?

To avoid contaminating samples with the products that the bottles contain, anticoagulants etc.

26

How many times should you invert the blood bottles?

5-8 times

27

Which blood bottle label should you write by hand at the bedside?

Pink bottle- to avoid cross match errors

28

What are the 5 sites for intra-muscular injections?

Deltoid
Dorsogluteal
Rectus femoris
Vastus Lateralis
Ventrogluteal

29

How long should intra-muscular needles be?

Long enough to penetrate the muscle and still leave 1/4 of the needle to remain external.

Commonly 21-23 G

30

Why should you use the smallest needle size possible?

Reduce the risk of thromboli; blood can still flow around it.

31

How tight should the tourniquet be?

Tight enough to occlude venous flow but not arterial flow; you should be able to fit 2 fingers under the torniquet

32

When would you not want to cannulate in the veins of the forearm?

If the patient has any fistulas, i.e. if they are on or due to have dialysis treatment

33

Give the size of cannula going from smallest to largest

Yellow
Blue
Pink
Green
Black
Grey
Brown

34

What questionnaire can you use to assess anxiety?

The GAD-7 questionnaire

35

What questionnaire can you use to assess depression?

The PHQ-9 questionnaire

36

List the scores and severity for anxiety when using the GAD-7 questionnaire

Mild= 0-5
Moderate= 6-10
Moderate-Severe= 11-15
Severe= 16-21

37

List the severity scores for depression when using the PHQ-9 questionnaire

Mild= 0-5
Moderate= 6-10
Moderate-Severe= 11-15
Severe= 16-20

38

What is clubbing a sign of?

Malabsorption
Crohn's disease
Cirrhosis

39

What is leuconychia a sign of?
Describe it, what is it associated with?

White marks on the nails
Hypoalbuminaemia
Associated with renal failure, fungal infection and lymphoma

40

What is koilonychia?
What causes it?

Spoon shaped nail
Iron deficiency anaemia

41

What is dupuytrens contracture?
What is it associated with?

This is the thickening of connective tissue in the palm.
It is associated with numerous things including diabetes, alcohol and epilepsy

42

What is palmar erythema and what is it associated with?

Red palms
Alcohol related liver disease, diabetes and Wilson's diseas

43

What is asterixis?
What is it associated with?

'Liver flap'
Encephalitis

44

What are Kayser-Fleischer Rings?
What are they associated with?

Brownish-yellow rings around the eye.
Copper deposits and Wilson's disease

45

What is the Kocher's surgical scar typically from?

Cholecystectomy

46

What is the Pfannensteil scar typically from?

C-section
Prostatectomy

47

What is the Lanz incision typically from?

Apendectomy

48

What is ascities?
What causes it?
How can you test for it?

Accumulation of fluid in the peritoneal cavity
Cirrhosis, cancer, heart failure
Percuss for shifting dullness

49

What are spider Naevi?
What cause them?

Red dot on abdomen with 'spider-leg' like projections around it
High oestrogen levels, pregnancy or liver disease

50

What is Caput Medusa?
What causes it?

Distended and engorged superficial veins

Severe portal hypotension
Inferior vena cava obstruction

51

What is gynaecomastia?
What causes it?

Man boobs
Liver disease
May also be drug induced

52

Where would you find Virchow's node?
What is it a sign of?

Left supra-clavicular lymph node
Strong association with abdominal cancer

53

From foetal to puberty, what percent of growth is done when?

Foetal- 30%
Infantile- 15%
Childhood- 40%
Puberty- 15%

54

How should you measure height from birth to 2 years?
Then from 2 years and old?

Horizontally

Vertically

55

Where should you place the chest ECG leads?

V1- Right sternal edge, 4th intercostal space
V2- Left sternal edge, 4th intercostal space
V3- Mid way between V2 and V4
V4- 5th intercostal space, mid clavicular line
V5- Mid way between V4 and V6
V6- Left axillary line, at the same level as V4

56

Where do you place the ECG limb leads?

Red- Right wrist
Yellow- Left wrist
Green- Left foot
Black- Right foot

57

What is the normal paper speed for an ECG?

25mm/sec

58

How long does 1 small square on an ECG represent?
1 large square?
5 large squares?

.04 seconds
.2 seconds
1 second

59

What is the formula for working out heart rate on an ECG?

No. of large squares between R peaks x .2,

60 divided by ans.

60

How many squares should the P-R interval be?

3-5 small squares

61

How many squares should the QRS complex be?
What does a widened QRS complex mean?

2-3 small squares

Ventricular conduction problems

62

What does elevation or depression of the ST segment mean?

Elevation- Infarction
Depression- Ischemia

63

What does inversion of the T wave mean?
What does a large peaked T wave mean?
What does a flattened T wave mean?

Inversion- could be due to infarction
Large peaked- Hyperkalaemia
Flattened- Hypokalaemia

64

Describe ventricular rhythm on an ECG

No P wave
Wider QRS complexes

65

Name the shockable cardiac arrest rhythms

Ventricular fibrilation

Pulseless ventricular tachycardia

66

Name the non shockable cardiac arrest rhythms

Pulseless electical activity

Asystole

67

What is foetal lie?

Relationship of longitudinal axis of foetus to the mothers spine

68

When is a foetus engaged?

When there are 2 or fewer fifths of the head palpable per abdomen

69

When can you hear the baby's heartbeat with a dopler?

12 weeks of gestation onwards

70

When can you hear the baby's heartbeat with a Pinard?

24 weeks of gestation onwards

71

From when does the PSH match the number of weeks gestation?

20 weeks

72

What is the pterodactyl like speculum called?

Cusco speculum

73

What is an antalgic gait?

Avoidance of pain

74

What are the signs of Parkinson's in terms of gait?

Bradykinesia
Hypokinetic
Rigidity
Shuffling
En bloc turning

75

What is ataxic gait?

'drunk walking'
Wide stance
Poor coordination

76

What make a good X-ray?

Good Inspiration
Good Penetration
No rotation
Good coverage of area

77

On an abdominal x-ray, what are haustra a sign of?

Colon or large bowel,
lines that do not go all the way accross

78

On abdo X-ray, how large should the small bowel and large bowel (or colon) be?

3cm across for small bowel
6cm across for large bowel

79

What, on an abdo x-ray, indicates small bowel?

Valvulae Conniventes (lines all the way across)
No faeces

80

What can cause small bowel obstruction?

Scarring from previous operations (adhesions)
Herneas
Peritoneal cancers

81

What is Rigler's sign?

Being able to see the inside and outside of the bowel. It is a sign of free gas (pneumoperitoneum)

82

What are the signs of pneumoperitonium?

Triangular patches of gas
Rigler's sign

83

What are the causes of large bowel obstructions?

Cancers
Strictures fro things like diverticulitis

84

What is a decubitus film?

Images of a baby side on- show pneumoperitoneum.

85

What is the best test for pneumoperitonium?

Erect chest X-ray

86

Name the 10 peripheral pulses

Carotid
Subclavian
Axillary
Brachial
Radial
Ulnar
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis

87

Name the oxygen masks in order from low flow rate to highest flow rate

Nasal cannula
Venturi mask
Medium concentration mask (Hudson)
Non-rebreathe mask

88

What does 'clean' mean?

Free from dirt

89

What does asepsis mean?

Free from pathogenic organisms

90

What does sterile mean?

Free from live bacteria and other microorganisms

91

What are the 2 types of ANTT?

Standard ANTT
Surgical ANTT

92

How do you distinguish between the 2 types of ANTT?

Can you do the procedure without touching the key parts?
yes- Standard
no- Surgical