ICM Flashcards by Sophie Bowyer

What is the intracellular fluid composed of?

High Potassium

Low Sodium

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How is the intracellular gradient maintained?

Sodium-Potassium pump

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What is interstitial fluid composed of?

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

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What is intravascular fluid composed of?

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

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What are the 2 fluid compartments of the body?

Intracellular

Extracellular

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

Intracellular

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What is extracellular fluid divided into?

Interstitial and Intravenous

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Which is the smallest fluid compartment?

Intravenous (part of the extracellular compartment)

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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)

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How much urine is lost on average per day?

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

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What are the 2 types of fluid?

Crystalloid and Colloid

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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

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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

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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

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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

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What is the blue blood bottle used for?

What does it contain?

Coagulation screen
INR
D-dimer

it contains sodium citrate, a reversible anticoagulant

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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

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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

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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

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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

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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

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What is the blue lidded blood culture bottle used for?

Aerobic organisms

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What is the purple liddd blood culture bottle used for?

Anaerobic organisms

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What order do you take bloods in?

Blood cultures
Blue bottles
Red bottles
Yellow bottles
Black bottles
Green bottles
Navy bottles
Purple bottles
Grey bottles
Pink bottles

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Why is there a specific order for collecting blood?

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

How many times should you invert the blood bottles?

5-8 times

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

Pink bottle- to avoid cross match errors

What are the 5 sites for intra-muscular injections?

``` Deltoid Dorsogluteal Rectus femoris Vastus Lateralis Ventrogluteal ```

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

Why should you use the smallest needle size possible?

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

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

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

Give the size of cannula going from smallest to largest

``` Yellow Blue Pink Green Black Grey Brown ```

What questionnaire can you use to assess anxiety?

The GAD-7 questionnaire

What questionnaire can you use to assess depression?

The PHQ-9 questionnaire

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 ```

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 ```

What is clubbing a sign of?

Malabsorption Crohn's disease Cirrhosis

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

What is koilonychia? | What causes it?

Spoon shaped nail | Iron deficiency anaemia

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

What is palmar erythema and what is it associated with?

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

What is asterixis? | What is it associated with?

'Liver flap' | Encephalitis

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

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

What is the Kocher's surgical scar typically from?

Cholecystectomy

What is the Pfannensteil scar typically from?

C-section | Prostatectomy

What is the Lanz incision typically from?

Apendectomy

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

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

What is Caput Medusa? | What causes it?

Distended and engorged superficial veins Severe portal hypotension Inferior vena cava obstruction

What is gynaecomastia? | What causes it?

Man boobs Liver disease May also be drug induced

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

Left supra-clavicular lymph node | Strong association with abdominal cancer

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

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

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

Horizontally Vertically

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

Where do you place the ECG limb leads?

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

What is the normal paper speed for an ECG?

25mm/sec

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

.04 seconds .2 seconds 1 second

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.

How many squares should the P-R interval be?

3-5 small squares

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

2-3 small squares Ventricular conduction problems

What does elevation or depression of the ST segment mean?

Elevation- Infarction | Depression- Ischemia

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

Describe ventricular rhythm on an ECG

No P wave | Wider QRS complexes

Name the shockable cardiac arrest rhythms

Ventricular fibrilation Pulseless ventricular tachycardia

Name the non shockable cardiac arrest rhythms

Pulseless electical activity Asystole

What is foetal lie?

Relationship of longitudinal axis of foetus to the mothers spine

When is a foetus engaged?

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

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

12 weeks of gestation onwards

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

24 weeks of gestation onwards

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

20 weeks

What is the pterodactyl like speculum called?

Cusco speculum

What is an antalgic gait?

Avoidance of pain

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

``` Bradykinesia Hypokinetic Rigidity Shuffling En bloc turning ```

What is ataxic gait?

'drunk walking' Wide stance Poor coordination

What make a good X-ray?

Good Inspiration Good Penetration No rotation Good coverage of area

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

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

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

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

``` Valvulae Conniventes (lines all the way across) No faeces ```

What can cause small bowel obstruction?

Scarring from previous operations (adhesions) Herneas Peritoneal cancers

What is Rigler's sign?

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

What are the signs of pneumoperitonium?

Triangular patches of gas | Rigler's sign

What are the causes of large bowel obstructions?

Cancers | Strictures fro things like diverticulitis

What is a decubitus film?

Images of a baby side on- show pneumoperitoneum.

What is the best test for pneumoperitonium?

Erect chest X-ray

Name the 10 peripheral pulses

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

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

What does 'clean' mean?

Free from dirt

What does asepsis mean?

Free from pathogenic organisms

What does sterile mean?

Free from live bacteria and other microorganisms

What are the 2 types of ANTT?

Standard ANTT | Surgical ANTT

How do you distinguish between the 2 types of ANTT?

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

ICM Flashcards

(92 cards)