ICM - Data stuff! Flashcards
1
Q
What are the four cardiac arrest rhythms?
A
- Ventricular Fibrillation
- Pulseless ventricular Tachycardia
- Asystole
- Pulseless Electrical Activity
2
Q
What are the two shockable Cardiac Arrest Rhythms?
A
- Ventricular fibrillation
- Pulseless ventricular tachycardia.
3
Q
Which type of cardiac arrest rhythm is this?
A
Asytole (not-shockable)
4
Q
What kind of cardiac arrest rhythm is this?
A
Pulseless electrical activity. (Not shockable)
5
Q
What kind of cardiac arrest rhythm is this?
A
Pulseless ventricular tachycardia. (Shockable)
6
Q
What kind of cardiac arrest rhythm is this?
A
Ventricular fibrilation.
7
Q
Which valve does each of these points of auscultation listen to?
A
Green - Aorta
Red - Pulmonary
Yellow - Tricuspid
Blue - Mitral
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8
Q
The ‘lub’ of the heart is caused by the closing of which valves?
A
Tricuspid and mitral, at the start of ventricular systole.
9
Q
The ‘dub’ of the heart beat is caused by the closing of which valves?
A
Aortic and pulmonary valves, during diastole.
10
Q
What are some of the causes of systolic murmur?
A
Aortic valve stenosis
Mitral regurgitation
Pulmonary valve stenosis
Tricuspid regurgitation
11
Q
What are some of the causes of a diastolic murmur?
A
Mitral stenosis
Tricuspid stenosis
Aortic regurgitation
Pulmonary regurgitation
12
Q
What is one of the main causes of continuous murmur?
A
Patent ductus arteriosus.
13
Q
Why does a patient need to be upright for a chest X-ray?
A
So that free air can be seen under the diaphragm, pneumoperitoneum.
14
Q
Which type of X-ray will show an innacurate view of the heart?
A
AP - divergence of the x-ray beams show an enlarged heart.
15
Q
What is the normal cardiac-thoracic ratio?
A
<50%
16
Q
How should a chest X-ray be performed?
A
- PA
- Inspiration
- Erect
- No rotation
17
Q
What are the borders of the heart visible on an x-ray?
A
- Left Ventricle
- IVC
- Right Atrium
- SVC
- Aortic knuckle
- Left auricle
18
Q
What can you see on this X-ray?
A
1) Right Hilum
2) Left Hilum
3) Right hemidiaphragm
4) Left hemidiphargm
5) Gastric bubble
19
Q
What can you see on this x-ray?
A
A) Trachea
B) Carina
C) Right Clavicle
D) Left Ventricle
E) Aortic knuckle
20
Q
What can you see in this x-ray?
A
A)
B) ECG lead
C) Endotracheal tube
D) Nasogastric tube
E) Surgical staples
F)
21
Q
What are the four densities to look at in abdominal X-rays?
A
1) Gas
2) Fat
3) Soft Tissue
4) Bone
22
Q
Why is the liver visible on an abdominal X-ray?
A
It is denser than the retroperitoneal fat around it, so it is a darker shade of grey.
23
Q
What five abnormalities can we see on an abdominal radiograph?
A
1) Foreign bodies
2) Perforation
3) Kidney stones
4) Bowel obstruction
5) Abdominal masses
24
Q
What can you see in this abdominal X-ray?
A
Staghorn calculus in left kidney.
25
What is this abdominal X-ray?
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?
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?
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?
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?
Oralpharyngeal airway
From incisors to angle of jaw.
40
What is this airway and how is it sized?
Nasopharyngeal airway.
Start with 6mm diameter.
41
What instrument is this?
Bivalve / cusco speculum
42
What instrument is this and what are its indications for use?
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?
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?
Laryngeal mask airway.
63
What is the name of this oxygen delivery system? And how much % oxygen can it deliver at full flow?
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?
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?
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?
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?
• Papilloedema •
Oedema of the optic disc
Blurred elevated margin, dilated retinal veins, haemorrhages.
122
Whaty does this image show?
• Optic Atrophy •
Sharp disc margin, very pale disc.
123
What does this image show?
• 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?
• Branch retinal artery obstruction •
Ischaemia of corresponding quadrant.
May see plaques occluding artery.
125
What does this image show?
• Central Retinal Vein Obstruction •
Haemorrhages, flame, dot and blot.
Dilated veins, exudates, optic disc oedema.
126
What does this image show?
• Branch retinal vein obstruction •
127
What does this image show?
• Hypertensive fundus •
Arteriosclerosis, AV nippping, haemorrhages, soft exudates - cotton wool spots, hard exudates, optic disc oedema.
128
What does this image show?
• Glaucoma •
Increased disc diameter, optic atrophy.
129
What does this image show?
• 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?
• Macular Degeneration •
Hard exudates, haemorrhages, neovascularization.
131
What does this image show?
• Retinal detachment •
132
What does this image show?
• Retinoblastoma •
133
What does this image show?
• 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
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• 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?
* Cervcal Ectropion
* Mucus discharge, post coital bleeding.
* Young women, pregnancy and those taking oestrogen OCP.
158
