Misc Flashcards by Sarah Loftus

In which neuromuscular condition can sux be used safely?

Myasthenia gravis and in fact may need 2x normal dose
However in ELS need to use a reduced dose although again can be used

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In which conditions must you avoid anti cholinesterases and why?

Myotonic dystrophy and myotonic congenita
Can lead to hyperkalaemia
Myasthenia gravis - can actually prolong block and lead to cholinergic crisis

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Myotonic dystrophy and myotonic congenita inheritance

Both autosomal dominant
MD - chromosome 19
MC - chromosome 17

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Drugs to avoid in patients with prolonged QT

Ketamine
Suxamethonium
Methadone
Most antiemetics but not cyclizine or dex
Oxytocin
Macrolides

Avoid anticholinergics and adrenergic drugs - CAN use meteraminol and phenyl safely however

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Systemic sclerosis/Scleroderma features

Limited scleroderma - CREST
Calcinosis, Raynauds, oesophageal dysmotility, sclerodactyly and telangectasia

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Most concerning complications of systemic sclerosis (responsible for most mortality)

Pulmonary fibrosis
Myocardial disease
PAH

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What is systemic sclerosis

A rare autoimmune condition leading to inflammation and progressive multi system connective tissue disease
Small vessel vasculopathy and abnormal collagen deposition leading to fibrosis of skin and organs

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Risk factors for abnormal placental adherence

Placenta praevia
Previous C section
IVF
Advanced maternal age
Previous endometrial surgery Ie myomectomy or ablation
Multiparity
Ashermans syndrome

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Classes of chemotherapy agents

See photo

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Functions of the spleen

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Drugs used in Parkinson’s

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NAP 5 findings

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What operations are highest risk for CPSP?

Amputation
Thoracotomy
Mastectomy
Cholecystectomy
Inguinal hernia
Vasectomy
Caesarean

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Safety re ABO compatibility for transfusion of FFP/cryo/platelets

FFP and cryo should be ABO compatible ideally but if not possible, AB is universal donor, Rh compatibility is not required
Platelets should ideally be ABO compatible but any can be used in emergency, just may not see such good increment

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What is Marfans

Autosomal dominant disorder
Connective tissue disorder
Defect in fibrillin 1 gene on chromosome 15

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Clinical features of marfans

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Criteria for CRT device

NYHA classification class III or IV
Patient in sinus rhythm with wide QRS(ie LBBB) or normal QRS with vent dyssynchrony on ECG
EF < 35%
Already on max medical therapy

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Symptoms of TCA overdose

Hypotension
Tachycardia
ECG changes inc wide QRS
Cardiac depression
Vent arrhythmias
Mydriasis
Reduced consciousness
Hyperreflexia
Seizures

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MOA of TCAs

Inhibition if pre-synaptic reuptake of noradrenaline and serotonin

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Packed red cells storage
- temp and solution

4 degrees to inhibit bacterial growth and reduce RBC energy use
Solution - usually citrate, phosphate, dextrose and adenine
Citrate prevents clotting and phosphate is a buffer
Others are nutrients
Store - for up to 35 days

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FFP storage

-20 degrees
Use immediately when thawed
AB is universal donor

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Cryo storage

-30 degrees for up to 1 year
Contains high levels of factor 8, vWF and fibrinogen
AB is universal donor

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What is in prothrombin complex concentrate and when to give it

Clotting factors 2/7/9/10 and protein C and S
For reversal of raised INR in bleeding patient on warfarin

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Platelet storage

At room temp (22degrees) for up to 5 days with continuous agitation to avoid clumping
Ideally ABO matched but can use any

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Transfusion reaction associated lung injury

What are the nervous system changes in the development of phantom limb pain/neuropathic pain - in peripheral/spinal cord and central NS

Sickle cell genetics

Causes of oxygen debt post exercise

Mechanism of action of metformin and dose on day of surgery?

MOA of gliclazide (sulphonylurea) and whether to give on day of surgery

Dapagliflozin MOA and dosing on day of surgery Also what class??

What is carcinoid syndrome?

What is used to treat carcinoid syndrome? And what is the dose in carcinoid crisis?

Octreotide 20-50mcg in crisis

What are the symptoms of carcinoid syndrome? And carcinoid crisis

Syndrome - flushing - lacrimation - rhinorrhoea - diarrhoea -hypotension - shortness of breath Crisis - hypotension - Tachycardia - sweating - Confusion - breathing difficulties & bronchospasm

What vasopressors are safe and which unsafe in pt with carcinoid tumour?

Safe - phenylephrine and vasopressin Unsafe - adrenergic agents (use with extreme caution)

What hormones are secreted by carcinoid tumours?

What is the score to identify candidates for acute liver transplant in paracetamol toxicity? And what are the parameters?

Causes of pulmonary hypertension

Clinical features of pulmonary HTN?

Phosphodiesterase 5 inhibitor MOA and example

sildenafil Increases cGMP levels NO is a potent vasodilator that acts via cGMP

Symptoms + signs of myasthenia gravis

Symptoms of myasthenic crisis

Lipid emulsion for LA-ST Concentration Bolus dose Infusion rate Max dose

Toxic doses of LA with and without epi Lidocaine Bupivicaine Ropivicaine Prilocaine

Coeliac plexus nerves

Greater/lesser/least splanchnic

Define the term vo2 peak

Peak rate of oxygen uptake measured when the individual exercised up to symptom limitations or fatigue

Define anaerobic threshold

The VO2 at which oxygen demand exceeds supply and anaerobic metabolism takes place

Define VE/VCO2

The ratio of minute ventilation to carbon dioxide production Ie a measure of gas exchange efficiency during exercise

VE/VCO2 cut off for high risk

>34 predicts post op morbidity and mortality

Post brain stem death physiological changes

Describe the 4 stages of spinal shock

What is autism spectrum disorder

Lifelong disability Triad of difficulty with social interaction, social communication and social imagination May have low or normal IQ

Thoracoscore parameters

Age (years) Sex ASA Classification Performance Status Classification Dyspnea score Priority of surgery Procedure class Diagnosis group Comorbidity Score

Indications for one lung ventilation

What is the pathophysiology of phantom limb pain?

Boundaries of epidural space

CRPS criteria - criteria and categories of signs

Transplant criteria for non paracetamol acute liver failure

How does gas exchange occur with HFOV

Bulk flow Taylor dispersion Pendelluft mixing Molecular diffusion Cardiogenic mixing

Hazards of MRI

- Displacement im force from static magnetic field - Ie projectiles - Induced current from time varying magnetic fields Ie leading to cause arrhythmia - acoustic noise - heating from radiofreq fields - helium escape

Contraindications to MRI

Ferromagnetic eye fragments Cochlear implants Ferromagnetic aneurysm clips

Moffett’s solution - what is the mix?

Cocaine 1-2ml of 5% Adrenaline 1ml of 1:1000 Sodium bicarbonate 8.4% 2ml

Define preload/afterload/MAP definitions

Define major haemorrhage and massive transfusion

Vaughn Williams classification and where they act on cardiac cycle