Skills

Question 1

When are ABGs superior to VBGs?

Answer 1

If you need PaO2 or in severe shock/Hypercapnia/Lactate >2

Question 2

Causes of respiratory acidosis

Answer 2

Decreased respiratory drive
Decreased chest wall movement
Chronic obstruction

Question 3

Causes of respiratory alkalosis

Answer 3

Increased rep drive

Hypoxaemia induced- Altitude

Question 4

What does an increased anion gap mean?

Answer 4

Increased acid production or ingestion

Question 5

What does a decreased anion gap mean?

Answer 5

Decreased acid excretion or loss of HC03

Question 6

Increased anion gap metabolic acidosis causes

Answer 6

Lactate 
Urea
Ketones 
Aspirin OD 
CO

Question 7

Decreased anion gap metabolic acidosis causes

Answer 7

Lithium toxicity
Inc Ca
Inc K
Inc Mg

Question 8

Normal gap metabolic acidosis causes

Answer 8

Addisons, RTA

Question 9

What does Aspirin OD cause

Answer 9

Metabolic acidosis and Respiratory alkalosis as compensation

Question 10

Causes of metabolic alkalosis

Answer 10

GI loss of H+

Renal loss of H+- Nephrotic, Diuretics, Conn’s

Question 11

What does base excess >2 mean?

Answer 11

Increased Bicarb

Met alkalosis or comp.Resp acidosis

Question 12

What does base excess

Answer 12

Decreased Bicarb

Met acidosis or comp.Resp Alkalosis

Question 13

In terms of compensation what does a normal PH indicate?

Answer 13

Fully compensated

If still abnormal then it is partially compensated

Question 14

System for CXR interpretation

Answer 14

Demographics
RIPE
A->E

Question 15

What does RIPE mean in relation to CXR interpretation?

Answer 15

Rotation- Clavicles and spinous processes
Inspiration- 5-6 Ant.Ribs
Penetration- Vertebrae through mediastinum
Exposure- Can you see it all?

Question 16

What is ABCDE in relation to CXR interpretation?

Answer 16

Airway- Deviation?
Breathing- Pleura, Collapse, Consolidation, hilar, reticular shadowing
Circulation- Heart size, Heart position, shape, Great vessels
Diaphragm- Shape, Costophrenic angles, Air below?
Extra- Bones and soft tissue

Question 17

Sail sign?

Answer 17

Lower lobe collapse

Question 18

Veil sign

Answer 18

Upper lobe collapse

Question 19

System to interpret an AXR?

Answer 19

Demographics 
Bowels (+ pother organs)
Bones 
Calcification 
(BBC)

Question 20

Diameter of the DB, LB and caecum?

Answer 20

3, 6, 9 CM

Question 21

What does the coiled spring sign suggest?

Answer 21

SB obstruction

Valvulae conniventes become more prominent

Question 22

How does faeces look on an AXR?

Answer 22

Mottled

Question 23

What does the coffee bean sign suggest

Answer 23

Volvulus

Can also be the ‘fetal sign’ in the sigmoid

Question 24

What suggests pneumoperitoneum?

Answer 24

Double wall sign- inner and outer wall visible of abdomen
SHOULD ONLY SEE INNER WALL
Also look for air under diaphragm on CXR

Question 25

What is a lead pipe sign?

Answer 25

No haustra LB suggests IBD

Question 26

What does toxic mega colon look like on AXR?

Answer 26

Dilated colon

Question 27

Possible causes of calcification/artefact on AXR?

Answer 27

Gallstones, Renal calculi, Pancreatic/vascular/costochondral calcification Surgical clips Ureteric stents

Question 28

Structure for ECG interpretation

Answer 28

``` Demographics Rate and Rhythm Axis P wave PR QRS Rhythm strips QRS V1-V6 ST T Other- QT ```

Question 29

How to calculate rate on an ECG

Answer 29

Total R X6

Question 30

How to work out Axis on an ECG

Answer 30

I +II 1 +VE II -VE LAD 1 -VE 2 +VE RAD

Question 31

P wave height

Answer 31

< 2 small squares

Question 32

Normal PR length

Answer 32

3-5 small squares

Question 33

Decreased PR?

Answer 33

Accessory conduction pathway

Question 34

Explain what R wave progression is?

Answer 34

V1= Dominant S V6= Dominant R V3/4 is the transition point

Question 35

What does it mean if the R wave transition point is after V4 on an ECG?

Answer 35

Chronic lung disease | RVH

Question 36

What could it suggest if there is a dominant R wave in V1/2?

Answer 36

RVH | Post.MI

Question 37

QRS length?

Answer 37

< 3 small squares

Question 38

RBBB has what V1 and V6 QRS pattern?

Answer 38

``` V1= RSR1 V2= qRS ``` M->W

Question 39

LBBB has what V1 and V6 pattern?

Answer 39

``` V1= rS V6= Monophasic R wave V5/6= Bunny ears ``` WM

Question 40

Height of QRS in V5/6?

Answer 40

< 4 Big squares If > 5 Big sqaures then LVH

Question 41

Dominant R wave in V1 could suggest?

Answer 41

RVH

Question 42

What defines ST elevation/Depression?

Answer 42

> 1 small sq

Question 43

What causes a saddle ST segment?

Answer 43

Pericarditis | Tamponade

Question 44

What causes a reverse flick ST segment?

Answer 44

Digoxin toxicity

Question 45

Flat T waves

Answer 45

Hypokalaemia

Question 46

In which leads is T wave inversion normal

Answer 46

III + aVR + V1

Question 47

What should a normal QT be?

Answer 47

< 450ms

Question 48

What does an enlarged QT predispose you to?

Answer 48

Polymorphic VT

Question 49

Narrow Tachy and abn P

Answer 49

SVT

Question 50

Broad tachy and no p

Answer 50

VT/VF

Question 51

What represents a severe fluid deficit?

Answer 51

>8% body Wx lost, Profound oliguria, CNS collapse

Question 52

What do crystalloids do?

Answer 52

``` Water soluble Diffuse through semi-permeable membrane Can infuse rapidly in large volumes Short duration in circulation Saline/Hartmann's/Dextrose ```

Question 53

What do Colloids do?

Answer 53

Not a solution Suspension of finely divided particles in a continuous medium If capillary permeability is normal then the particles stay in circulation and keep fluid with them! Gelatins/Albumin/Blood/Starches

Question 54

What is the sensitivity and specificity of D-Dimer?

Answer 54

50% Specificity 95% Sensitivity | Good for ruling people out

Question 55

When is D-Dimer confounded?

Answer 55

Sepsis, Trauma, Surgery, Pregnancy

Question 56

What does the PESI score do?

Answer 56

Predicts 30 day outcomes for PE

Question 57

What is D-Dimer?

Answer 57

Fibrin degradation product