ICM - Data stuff! Flashcards Preview

Revision Cards > ICM - Data stuff! > Flashcards

Flashcards in ICM - Data stuff! Deck (158):
1

What are the four cardiac arrest rhythms?

• Ventricular Fibrillation

•  Pulseless ventricular Tachycardia

• Asystole

• Pulseless Electrical Activity

2

What are the two shockable Cardiac Arrest Rhythms?

• Ventricular fibrillation

• Pulseless ventricular tachycardia.

3

Which type of cardiac arrest rhythm is this?

 

Q image thumb

Asytole (not-shockable)

4

What kind of cardiac arrest rhythm is this?

Q image thumb

Pulseless electrical activity. (Not shockable)

5

What kind of cardiac arrest rhythm is this?

Q image thumb

Pulseless ventricular tachycardia. (Shockable)

6

What kind of cardiac arrest rhythm is this?

Q image thumb

Ventricular fibrilation.

7

Which valve does each of these points of auscultation listen to?

Q image thumb

Green - Aorta

Red - Pulmonary

Yellow - Tricuspid

Blue - Mitral

All Prostitutes Take Money

8

The 'lub' of the heart is caused by the closing of which valves?

Tricuspid and mitral, at the start of ventricular systole.

9

The 'dub' of the heart beat is caused by the closing of which valves?

Aortic and pulmonary valves, during diastole.

10

What are some of the causes of systolic murmur?

Aortic valve stenosis

Mitral regurgitation

Pulmonary valve stenosis

Tricuspid regurgitation

11

What are some of the causes of a diastolic murmur?

Mitral stenosis

Tricuspid stenosis

Aortic regurgitation

Pulmonary regurgitation

12

What is one of the main causes of continuous murmur?

Patent ductus arteriosus.

13

Why does a patient need to be upright for a chest X-ray?

So that free air can be seen under the diaphragm, pneumoperitoneum.

14

Which type of X-ray will show an innacurate view of the heart?

AP - divergence of the x-ray beams show an enlarged heart.

15

What is the normal cardiac-thoracic ratio?

<50%

16

How should a chest X-ray be performed?

• PA

• Inspiration

• Erect

• No rotation

17

What are the borders of the heart visible on an x-ray?

• Left Ventricle

• IVC

• Right Atrium

• SVC

• Aortic knuckle

• Left auricle

18

What can you see on this X-ray?

Q image thumb

1) Right Hilum

2) Left Hilum

3) Right hemidiaphragm

4) Left hemidiphargm

5) Gastric bubble

19

What can you see on this x-ray?

Q image thumb

A) Trachea

B) Carina

C) Right Clavicle

D) Left Ventricle

E) Aortic knuckle

20

What can you see in this x-ray?

Q image thumb

A)

B) ECG lead

C) Endotracheal tube

D) Nasogastric tube

E) Surgical staples

F)

21

What are the four densities to look at in abdominal X-rays? 

1) Gas

2) Fat

3) Soft Tissue

4) Bone

22

Why is the liver visible on an abdominal X-ray?

It is denser than the retroperitoneal fat around it, so it is a darker shade of grey.

23

What five abnormalities can we see on an abdominal radiograph?

1) Foreign bodies

2) Perforation

3) Kidney stones

4) Bowel obstruction

5) Abdominal masses

24

What can you see in this abdominal X-ray?

Q image thumb

Staghorn calculus in left kidney.

25

What is this abdominal X-ray?

Q image thumb

Intravenous urogram (pyelogram)

26

How do you distinguish between small bowel and large bowel?

Colon-
Peripheral
Haustra only goes half way across.
Faeces.

Small intestine-
Valvulae Conniventes
(lines that go all the way across)
Central
No faeces

27

What does the abdo. X-ray show?

Q image thumb

Dilated colon

28

What is a sigmoid volvulus?

A twisting of the sigmoid colon, that causes large dilation of the colon.

29

What does this abdo. X-ray show?

Q image thumb

Dilated small bowel. Volvulae conniventes, central location.

30

What is haustra?

The lines on the colon that only go half way across.

31

What is Valvulae Conniventes?

The lines that go right the way across the small bowel.

32

What is the name for the lines that completely cross the small bowel?

Valvulae conniventes.

33

What are three causes of small bowel obstruction?

Adhesions

Perioneal malignancy

Hernias

34

What does the chest x-ray show?

Q image thumb

Perforated bowel, free air under the diaphragm (Pneumoperitoneum)

35

What two signs indicate large bowel perforation?

• Ringlers sign - Where both sides of the wall of the bowel are visible.

• Triangles of gas.

36

What are the causes of large bowel obstruction?

• Cancer

• Diverticulitis

• Hernias (rare)

37

How do the head tilt - chin lift and jaw thrust work?

• Open the pharynx by moving the tongue and epiglottis away from the posterior pharyngeal wall.

• Straightens and opens whole airway by stretching/extending the neck.

38

What precaution should be taken when performing head tilt / jaw thrust?

In trauma patients/ unstable cervical spine - manual in line immobilisation.

39

What is this airway and how is it measured?

Q image thumb

Oralpharyngeal airway

From incisors to angle of jaw.

40

What is this airway and how is it sized?

Q image thumb

Nasopharyngeal airway.

Start with 6mm diameter.

41

What instrument is this?

Q image thumb

Bivalve / cusco speculum

42

What instrument is this and what are its indications for use?

Q image thumb

A sims speculum.

Vaginal wall prolapse.

43

What instrument is used for getting an endometrial cell sampling?

Pipelle

44

What would 'stony dull' percussion indicate?

Normal: Muscle

Abnormal: Fluid in cavity

45

What would 'dull' percussion indicate?

Normal: Solid organ

Abnormal: Pneumonia, ascites, hypetrophy

46

What would a 'hyperresonant' percusion indicate?

Abnormal: Pneumothorax, COPD

47

What would 'tympanitic resonant' percussion indicate?

Normal: Hollow air containing structure.

Abnormal: Bowel obstruction.

48

What are crystalloids?

Solutions of dissolved low molecular weight chemicals in water. Crystalloids will diffuse into is distributed throughout all body water.

49

What are colloids?

Colloids are solutions of partially dissolved larger molecular weight chemicals. They stay for longer in the intravascular compartment so are useful for replacing blood volume.

50

What are the 5 F's for a distended abdomen?

• Flatus

• Fat

• Fluid

• Faeces

• Foetus

51

How would you convert micrograms into miligrams?

÷ 1000

52

How would you convert nanograms into miligrams?

÷ 1000 then ÷1000

53

How would you convert miligrams into micrograms?

x 1000

54

When given a percentage for a drug what does it mean?

% = number of grams in 100ml

i.e. 0.5% 200ml is 1g

55

When given a ratio in drug calculations, what does it mean?

Grams in however many mls.

e.g. 1:10000
is
1g in 10000ml

56

What is the formula for volume calculations?

What you want  x volume
What you've got                 

57

What steps can you take to encourage a vein for venepuncture / cannulation?

• Tourniquet

• Tap vein

• Position limb below right atrium

• Muscle contraction

• Temperature

58

What is the duration of use for a cannula?

72-96 hours.

59

What instrument is this?

Q image thumb

Venflon (Cannula)

60

Where do you apply the tourniquet for venepuncture?

10cm above the site.

61

What angle should you insert a venepuncture/cannula needle in?

10-15ª

62

What type of airway is this?

Q image thumb

Laryngeal mask airway.

63

What is the name of this oxygen delivery system? And how much % oxygen can it deliver at full flow?

Q image thumb

Simple face mask

50% at 15L/min

64

What sort of oxygen delivery system is this? And what is the advantage over simple face masks?

Q image thumb

Venturi mask.

Able to achieve accurate oxygen delivery at 24-60% through changeable valves.

65

What type of oxygen delivery system is this? And what is their purpose?

Q image thumb

Non-rebreathing masks.

Allows for delivery of 90-95% oxygen with a15L/min flow rate, used in seriously ill patients who can still self-ventilate.

66

What type of oxygen delivery system is this? What is its use?

Q image thumb

A bag valve mask.

Given during respiratory failure, can be used with atmosphere or supplemantary oxygen.

67

What angle should an intramuscular injection be given relative to the skin?

90 degrees.

68

What equipment is needed for an intramuscular injection?

• Drawing up needle.
• Needle for IM (usually blue or green)
• Cotton wool
• Alcohol wipe
• Syringe
• non-sterile gloves
• Sharps container

69

What are the four sites for intramuscular injection?

• Deltoid.
• Vastuslateralis muscle.
• Ventrogluteal muscle.
• Dorsogluteal muscle.

70

How do you locate the deltoid for IM injection and how much fluid can it hold?

Upside down V from the shoulder.
1ml

71

How do you locate the Vastus lateralis muscle for IM injection and how much fluid can it hold?

• Place one little finger on the lateral femoral condyl and the other on the greater trochanter. Try and touch thumbs together, where they meet is the site.
• Can hold 2ml 

72

What is the artery in the testicles and where does it arise?

The testicular artery, comes from the aorta just inferior to the renal artery.

73

What is the venous drainage of the testicles and where do they drain?

The L and R testular vein.

The left drains into the l renal vein at an acute angle.

The right drains into the IVC at a right angle.

74

What is the autonomic nervous supply of the testicles?

Efferent: Parasympathetic: Vagus nerve/Sympathetic T10-11

Afferent: As above.

75

What is the adequate exposure for a testicular exam?

Umbilicus to knees, use blanket to maintain dignity.

76

What is the name of the network of veins in the spermatic cord?

Pampiform plexus.

77

If you cannot get above a lump in the scrotum what does it inidcate?

• Either starts in the scrotom and is ascending into inguinal region (e.g. varicocele, hydrocele).

• Or, starts in inguinal region and is descending into the scrotum.

78

Transilumination of a testicular lump, discuss.

• If it is transilluminate, then it is probably a transudate (e.g. hydrocele)

• However and exudate (infection, blood) and a solid mass will not transilluminate.

79

What may be the cause of unilateral testicular atrophy?

• Inflammation/Infection

• Trauma

• Torsion

• Decreased venous/arterial blood flow

• Undescended testicle

80

How can you determine whether a hernia is direct or indirect through examination?

• If possible reduce the hernia, either manually or spontaneously by lying patient flat.

• Press on the deep inguinal ring, ask patient to cough, if it reappears it is a direct hernia but if it is controlled it is indirect.

81

How do you locate the deep inguinal ring using surface landmarks?

Halfway between the anterior superior iliac spine and the pubic tubercle.

82

When doing a digital rectal exam, what position is 12 when describing findings?

Anteriorly, i.e. between the legs.

83

During a DRE, if their is increased tone of the external anal sphincter, what would you suspect?

Upper motor neurone pathology, as opposed to lower motor neurone pathology that would be suggested decreased tone.

84

What would abnormally pale stools suggest?

Biliary obstruction.

85

What would pale and greasy stools suggest?

Steatorrhoea.

86

What would black, tarry stools represent?

Malaena, bleeding from the upper GIT.

87

What would grey or black stools indicate?

Oral iron or bismuth therapy.

88

What would silvery stools indicate?

Steatorrhoea and upper GI bleeding.
E.g. Pancreatic cancer.

89

What is responsible for ricewater stool? (Watery with mucus and cell debris)

Cholera

90

How would you investigate microscopic blood in stools?

faecal occult blood.

91

What are the dermotones of the perineum?

Anus - S5
Surrounding area and testicles - S4

Wider area inside bum - S3

Inner thighs - S2

92

What is the motor nerve supply of the external anal sphincter?

Somatic nervous system, voluntary control, Pudendal nerve S2, S3, S4

93

What is the nervous control of the internal anal sphincter?

Autonomic nervous system, involuntary.

• Sympathetic - T12, L1, L2

• Parasympathetic - S2, S3, S4

94

What is the nervous supply of the anal reflex?

S4, S5

95

What are the myotomes for the movement of the knee?

• Extension - L3,L4

• Flexion - L5,S1

96

What are the myotomes for the movements of the hip?

•Extension - L1,L2

• Flexion - L5, S1

97

What are the myotomes for the movement of the ankle?

• Inversion  (Pronantion?) - L4

• Eversion (Suppination?) - L5, S1

• Dorsi Flexion - L5

• Plantar Flexion - S1

98

What nerves are responsible for the internal urethral spincter contraction and relacation?

• Sympathetic - Contraction T9-T12

• Parasympathetic - Relaxation S2-S4

99

Which myotomes are responsible for big toe extension?

L5

100

What nerve is responsible for the knee reflex?

L4 (Femoral nerve)

101

Which nerve is responsible for the ankle reflex?

S1 (Sciatic nerve)

102

What would be the normal response during a babinski reflex test?

Plantar flexion of does.

103

What is Gowers sign?

This is where the patient climbs up himself to get up, a sign of proximal muscle weakness.

104

What is Romberg's test?

An examination of whether a stance is steady or not, eyes closed etc..

105

What does the Snellen chart test?

Visual Acuity

106

What are the symbols of a Snellen chart called?

Optotypes

107

If a patient cannot read a Snellen chart what should happen next?

• Move them to 3 metres and then 1 metre.

108

What aperture should be used for a general examination of the eye?

The large aperture (In dilated eyes)

109

What is the power of a lens measured in and does a convex lens have a positive or negative value?

Dioptres= 1/focal length(metres)

Convex: +ve

Concave: -ve

110

What type of lens should you use for a hypermetropic eye?

Hypermetropic means long-sighted so a convex lens should be used to bring the retina into focus.

111

What type of lens should be used for a myopic eye?

A Myopic lens is (short-sighted), so a concave lens should be used to bring the retina into focus.

112

What is the term for normal vision?

Emmetropia.

113

The size of the pupil is controlled by both the sympathetic and parasympathetic system, which receptors are responsible and what effect do they have?

Parasympathetic- Muscarinic (M3 receptors) on circular muscle.
- Agonist contricts
- Antagonist dilates

Sympathetic- Beta-1 receptors on radial muscle
- Agonist dilates
- Antagonist constricts

114

Which division of the autonomic nervous system is responsible for the accomodation of the lens?

Parasympathetic (M3 receptors), on the ciliary muscle.

115

Should an examiner using an opthalmoscope remove their glasses?

No, the examiner is aiming for emmetropia.

116

At what angle should you stand from the patients visual axis when using an opthalmoscope?

15-20˚

117

What can cause an abnormal red reflex?

Oedema, Ulcer, Cataract, Aqueous humour, Retinoblastoma.

118

What is the name of the cancer in a child that causes an abnormal red reflex?

Retinoblastoma

119

How much of the retina can be viewed with an opthalmoscope with a dilated pupil?

• 30%

120

What contraindicates the use of a pharmacological pupil dilator?

• Driving, patient alone, intracranial pathology (undiagnosed), head injury.

121

What does this image show?

Q image thumb

• Papilloedema •
Oedema of the optic disc
Blurred elevated margin, dilated retinal veins, haemorrhages.

122

Whaty does this image show?

Q image thumb

• Optic Atrophy •

Sharp disc margin, very pale disc.

123

What does this image show?

Q image thumb

• Central retinal artery obstruction •

Ischaemia of anterior retina excepth fovela/macula.

Optic disc is pale and the fovea has a cherry red spot.

124

What does this image show?

Q image thumb

• Branch retinal artery obstruction •

Ischaemia of corresponding quadrant.

May see plaques occluding artery.

125

What does this image show?

Q image thumb

• Central Retinal Vein Obstruction •

Haemorrhages, flame, dot and blot.

Dilated veins, exudates, optic disc oedema.

126

What does this image show?

Q image thumb

• Branch retinal vein obstruction •

127

What does this image show?

Q image thumb

• Hypertensive fundus •

Arteriosclerosis, AV nippping, haemorrhages, soft exudates - cotton wool spots, hard exudates, optic disc oedema.

128

What does this image show?

Q image thumb

• Glaucoma •

Increased disc diameter, optic atrophy.

129

What does this image show?

Q image thumb

• Diabetes Mellitus •

Microaneurysms, haemorrhages, soft exudates, hard exudates, neovascularisation, optic disc oedema.

• Laser treatment to neovascularised area leads to white round scars.

130

What does this image show?

Q image thumb

• Macular Degeneration •

Hard exudates, haemorrhages, neovascularization.

131

What does this image show?

Q image thumb

• Retinal detachment •

132

What does this image show?

Q image thumb

• Retinoblastoma •

133

What does this image show?

Q image thumb

• Malignant Melanoma •

134

What is Allen's test?

This is a test to check the functionality of the Ulnar artery, both arteries are occluded and then the ulnar is released and perfusion to hand is observed.

135

What is Fromment's sign?

The thumb and index fingert are used to hold a piece of paper, make sure flexion is not used. It tests for ulnar nerve palsy, specifically the action of adductor policis.

136

What is Tinnel's test?

This is the tapping of a nerve to illicit a 'pins and needles' sensation, to detect irritated nerves.

Commonly used in the investigation of Carpal tunnel syndrome.

137

What is Phalen's test?

The back of the hands are put together, it is used as a diagnostic test for carpal tunnel syndrome.

138

What is Finkelstein's test?

Used as an investigation for DeQuervains tenosynovitis.

The thumb and wrist are flexed and the wrist put into ulnar deviation, if pain occurs along the distal part of the radius then it is likely to be DeQuerains tenosynovitis.

139

What are some of the benefits of the Vacutainer system?

Reduced infection risk, reduced needlestick injury, reduced trauma, reduced haemolysis, faster, cheaper.

140

What is the number to call inside a hospital for the crash team?

2222

141

How far should you push down in an adult for chest compressions?

5-6cm

142

At what rate should you do chest compressions, and how many should you do between each set of 2 rescue breaths?

100-120/min

30:2

143

What is the maximum rate of delivery of oxygen that most nasal canulas can produce?

6L/min

144

What O2 saturation should be aimed for in people with COPD?

88-92%

145

Why should flow rates of below 5L/min be avoided when using a simple face mask?

It can lead to rebreathing of CO2, which can lead to hypercapnia.

146

The venturi system is most commonly used for which patients?

Those that need to avoid high oxygen levels, for example those with COPD.

147

What % oxygen can non-rebreather masks administer when using a flow of 15L/min?

90-95%

148

What the body water compartments of the body?

• total body water = 60% of body weight.

• Extracellular Fluid- 20%
- Made up of interstilial(20%), Intravascular(5%), transcellular (1.5%).

• Intracellular fluid - 40%

149

What are the indications for the use of a Bivavle/Cusco speculum?

• Cervical smear

• Endometrial cells

• Secretions/discharge

• Pharmacological delivery systems

150

How many times should a smear sample brush be rotated?

5 complete turns in a clockwise direction.

151

What are the indications for the use of a sims speculum?

• Vaginal wal prolapse

• To observe for organ bulging.

152

What are the three parts of the male urethra, going from proximal to distal?

1) Prostatic part

2) Membranous part

3) Spongy part

153

What are the contraindications of using a male catheter?

• Urethral rupture

• Acute infection of the prostate gland

• Abnormal urethral anatomy due to urethral or prostate surgery

154

On the Glasgow Coma Scale, is the score for an alert patient high or low?

High

155

Q image thumb

• Flame haemorrhages due to hypertension.

156

How do you calculate HR from an ecg?

Take the number of big squares between R waves and / 300.

157

What is this a picture of?

What symptoms would be associated with this?

Which women are likely to get this?

Q image thumb

• Cervcal Ectropion

• Mucus discharge, post coital bleeding.

• Young women, pregnancy and those taking oestrogen OCP.

158