MACS

Question 1

immediate drug management for anaphylaxis

Answer 1

give 500 micrograms IM adrenaline 1:1000

Question 2

indications for long term oxygen therapy

Answer 2

chronic hypoxaemia:
- COPD
- interstitial lung disease
- CF
- bronchiectasis
- pulmonary arterial disease
- pulmonary HTN
- severe HF

–> when PaO2 is consistently at/below 7.3 kPa

Question 3

use of nasal cannulae O2

Answer 3

mild hypoxia, usually non-acute
prongs positioned in nose

Question 4

flow rate of nasal cannula O2

Answer 4

24-30% O2 –> max 4L/min

Question 5

issues with nasal cannula O2

Answer 5

high flows will dry and irritate nasal passages
do not allow close control of FiO2

Question 6

flow rate of non-rebreather mask

Answer 6

~70% when used with 15L O2 flow rate

Question 7

who are venturi masks used on

Answer 7

those with COPD due to risk of T2 resp failure

Question 8

what are the colours of venturi mask and their flow rates?

Answer 8

blue venturi
2-4 L/min, 24%
white venturi
4-6L/min, 28%
yellow venturi
8-10L/min, 35%
red venturi
10-12L/min, 40%
green venturi
12-15L/min, 60%

Question 9

how do you interpret the bradens score?

Answer 9

out of 24, low score =high risk
some risk=15+

moderate risk=13-14

high risk=10-12

very high risk=9 or below

Question 10

what factors does the Bradens score take into account

Answer 10

sensory perception
moisture
activity
mobility
nutrition
friction/shear

Question 11

components of MUST tool

Answer 11

BMI score
weight loss score
acute disease effect score
–> added together calculate overall malnutrition risk

Question 12

scoring in MUST tool

Answer 12

0 = low risk
1 = medium risk
2 + = high risk

Question 13

normal urine output in health individual

Answer 13

between 0.5-1.5ml/kg/hr
should urinate at least every 6 hours

Question 14

oliguria definition

Answer 14

production of inadequate urine volumes
<500ml/day in adults

Question 15

composition of NaCl 0.9%

Answer 15

isotonic
154 mmol/L of Na+
154 mmol/L of Cl-

Question 16

composition of Hartmann’s

Answer 16

isotonic
131 mmol/L of Na+
5 mmol/L of K+
111 mmol/L of Cl-
29 mmol/L of HCO3-

Question 17

composition of NaCl 0.18% + glucose 4%

Answer 17

hypotonic
30 mmol/L of Na+
30 mmol/L of Cl-
40 g/L of glucose

Question 18

composition of 5% dextrose fluid

Answer 18

hypotonic
50g/L of glucose

Question 19

what are the daily maintenance fluid requirement

Answer 19

• 25-30ml/kg/day of water
• ~ 1mmol/kg/day of K, Na, Cl
• ~ 50-100g/day of glucose to limit starvation ketosis

Question 20

what is obstructive shock?

Answer 20

Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body’s tissues.

Question 21

what is distributive shock?

Answer 21

Shock due to a shift of fluid from blood to tissues

Question 22

when would there not be an increase in HR in shock

Answer 22

if on beta blockers

Question 23

clinical conditions associated with obstructive shock

Answer 23

• cardiac tamponade
• tension pneumo
• PE
• coarctation of aorta
• air embolus
• aortocaval compression

Question 24

what is malar flush associated with

Answer 24

mitral stenosis

Question 25

what is a narrow pulse pressure

Answer 25

<25mmHg between

Question 26

what is a wide pulse pressure

Answer 26

more than 100mmHg between

Question 27

what is the difference between a central line and an arterial line?

Answer 27

arterial-into artery central-into large vein eg internal jugular, subclavian going into the vena cava.

Question 28

examples of medications which need central line

Answer 28

amiodarone inotropes high conc electrolytes

Question 29

what is the surgical site bundle

Answer 29

- antibiotic prophylaxis within last 60 mins - patient warning - hair removal - glycaemic control

Question 30

types of adrenaline

Answer 30

1/1000 = anaphylaxis 1/10000 = cardiac arrest

Question 31

atropine use

Answer 31

symptomatic bradycardia bradydysrhythmias

Question 32

what is the treatment for asymptomatic inguinal hernia?

Answer 32

routine referral for surgical repair-because most become symptomatic and have surgery anyway but obvs is not urgent

Question 33

what are the 3 types of distributive shock?

Answer 33

septic anaphylactic neurogenic (due to redistribution of body fluids)

Question 34

what is a contraindication of bipap?

Answer 34

current smoking

Question 35

what is a common cause of fever a few days after surgery?

Answer 35

pneumonia -especially in those who have undergone thoracic/abdominal procedures

Question 36

what are the causes of post-op fever in the timeline of after the operation?

Answer 36

5Ws: wind, water, walking, wound, wonder about drugs 1-2 days: lungs -aspiration, pneumonia, atelectasis, PE 3-5 days: UTI, CAUTI (catheter associated UTI) 4-6 days: DVT/PE, immobility 7+ days: wonder about drugs -doesn't fit the picture

Question 37

what are used for reporting suspected adverse drug reactions to medicines, medical device incidents, and suspected fake or defective medicines?

Answer 37

yellow cards

Question 38

what investigations imaging wise do you do for bowel obstruction?

Answer 38

CT abdo pelvis -gold standard for diagnosis. go straight to this if you're pretty sure it's bowel obstruction. AXR -to rule it out

Question 39

what substances do you use to clean wounds post op?

Answer 39

sterile saline -up to 48 hours after past 48 hours -can shower tap water past 48 hours if wound has seperated /has been surgically opened to drain pus

Question 40

what is oliguria?

Answer 40

production of inadequate volumes of urine (<500ml/day in adults, <1ml/kg/hour in infants)

Question 41

what are the types of post op bleeding?

Answer 41

primary =within intraoperative period reactive =within 24h of operation secondary =7-10 days post op

Question 42

what is staging tool for pressure ulcers and the different stages?

Answer 42

NPUAP/EPUAP pressure ulcer classification system stage 1-non blanchable erythema stage 2-partial thickness skin loss stage 3-full thickness skin loss stage 4 -full thickness tissue loss