specialities general Flashcards
(95 cards)
1
Q
name two vasopressors
A
metaraminol
noradrenaline
2
Q
name two inotropes
A
adrenaline
dobutamine
3
Q
four broad categories of neurological failure in critical care
A
metabolic
trauma
infection
stroke
4
Q
what number of people are living in pain
A
1/4
5
Q
what is the number 1 disease for years lost to disability worldwide
A
low back pain
6
Q
which one is protective the nociceptive pain or neuropathic
A
nociceptive
7
Q
peripheral pain pathway
A
release of substance P and prostaglandins. stimulation of nociceptors and signal travels in A(delta) or C nerve to spinal cord.
8
Q
spinal cord pain pathway
A
A(Delta) or C nerve second nerve travels up opposite side of spinal cord
9
Q
Brain pain pathway
A
thalamus second relay, connects to cortex, limbic and brain stem but perception occurs in the cortex.
10
Q
amitriptyline and duloxetine are forms of
A
antidepressants
11
Q
gabapentin is a form of
A
anticonvulsant
12
Q
NMDA receptor antagonist is
A
ketamine
13
Q
disadvantages of NSAIDs
A
Gastrointestinal and renal side effects plus cause bronchospasm in sensitive asthmatics
14
Q
disadvantage of paracetamol
A
Liver damage in overdose
15
Q
disadvantage of tramadol
A
nausea and vomiting
16
Q
advantages of tramadol
A
less respiratory depression, can be used opioids, simple analgesics, no a controlled drug
17
Q
tramadol mechanism
A
Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake (
18
Q
morphine disadvantage
A
constipation, respiratory depression, misunderstandings about addiction, controlled drug
19
Q
amitriptyline advantage
A
Cheap, safe in low dose
Good for neuropathic pain
Also treats depression, poor sleep
20
Q
disadvantages amitriptyline
A
Anti-cholinergic side effects (e.g. glaucoma, urinary retention)
21
Q
amitriptyline mechanism
A
Increases descending inhibitory signals
22
Q
potential areas for anaesthetic respiratory problems
A
Airway
spine
reflux
obesity
23
Q
walking around the house no. of METS
A
2
24
Q
walk 100-200 metres on the flat no. of METS
A
4
25
walking on the flat at a brisk space no. of METS
6
26
run a short distance no. of METS
8
27
do either strenuous exercise or heavy physical work no. of METS
9
28
oropharyngeal airway insertion risk of
laryngospasm
29
why intubate?
protect airway, muscle relaxation, prevent contamination, tight gas control and restricted access to airway
30
risk factors for awareness under anaesthesia
major trauma, cardiac surgery
31
local anaesthetics examples
lignocaine, bupivacaine, prilocaine
32
contraindications for spinal/epidural anaesthesia
patient refusal, fixed CO, infection, anticoagulation, technical difficulties, spinal problems
33
features of amyotrophic lateral sclerosis
prog. muscle weakness, wasting and increased reflexes. pure motor signs, death from respiratory failure.
34
the three forms of superoxide dismutase that can be found in amyotrophic lateral sclerosis
cytoplasm, mitochondria, extracellular
35
function of superoxide dismutase
catalyses conversion of intracellular superoxide radicals during normal metabolism. its presence is protective from free radical damage.
36
germline mutations are
inherited from single alteration in egg or sperm, heritable or cause cancer family syndromes
37
somatic mutations are
occurring in non-germline tissues, are nonheritable
38
Lynch syndrome/HNPCC
mutation In mismatch repair genes results in excess of colorectal, endometrial, urinary tract and gastric cancers
39
BRAC1 AND BRAC2 associated cancer risks
breast cancer
second primary breast cancer
ovarian cancer
40
when to suspect hereditary cancer syndrome?
```
cancer in 2 or more close relatives
early age
multiple primary tumours
bilateral or rare cancers
autosomal dominant transmission
```
41
early clinical surveillance guideline for breast cancer
5yr
42
prophylactic oophorectomy outcome
eliminates risk of primary ovarian cancer but peritoneal carcinomatosis may still occur. induces menopause.
43
genetic testing for lynch syndrome
IHC/microsatellite instability testing are inexpensive ways of determining if lynch syndrome is associated.
44
neurofibromatosis type 1 genetic transmission
autosomal dominant
45
signs/ symptoms of neurofibromatosis type 1
```
Café au lait spots
neurofibromas
axillary freckling
lisch nodules
optic glioma
thinning of long bone cortex
FH
```
46
further features of neurofibromatosis type 1
short stature, epilepsy, scoliosis, raised B.P. macrocephaly
47
features of neurofibromatosis type 2
acoustic neuromas (usually bilateral), CNS and spinal tumours)
48
triad of tuberous sclerosis
epilepsy, learning difficulty, skin lesions
49
transmission genetically of tuberous sclerosis
autosomal dominant
50
features of tuberous sclerosis
```
depigmented macules
angiofibromas
fibrous plaque forehead
shagreen patches
ungual fibromas
rhabdomyomas in heart
phakomas in eye
```
51
myotonic dystrophy transmission genetically
autosomal dominant
52
myotonic features
bilateral onset cataract, muscle weakness, stiffness, myotonia, low motivation, diabetes, heart block
53
what are the typical syndromes of presentation for geriatrics
falls, immobility, functional decline, delirium and incontinence
54
psych geriatric considerations
mood, confidence and cognition
55
function geriatric considerations
mobility, daily living skills
56
behaviour geriatric considerations
activities, occupation
57
nutritional geriatric considerations
MUST screening tool
58
spiritual geriatric considerations
what's important, meaning of life, self image
59
environmental geriatric considerations
housing, heating, sanitation, adaptation
60
social geriatric considerations
support networks, potential for abuse
61
societal geriatric considerations
attitudes, technology, regulation
62
key professions in the CGA
geriatrician, OT, PT, skilled nurses.
63
what is the commonest complication of hospitalisation?
delirium
64
why care about delirium?
morbidity, mortality, longer length of stay, increased rates of institutionalisation, persistent functional decline
65
4AT area of questions
Alertness
age, DOB, place, year
attention
acute change or fluctuating course
66
tranquilizer
quetiapine
67
how much more likely to fall if you have delirium
4.5x
68
no. of death attributed to ADRS
100,000 deaths yearly
69
what fractions of ADRs in an ambulatory settings preventable
1/3rd
70
ADRs are associated with
```
cognitive loss
dehydration
incontinence
depression
falls
```
71
example of how absorption is altered in geriatrics
A reduction in saliva production may result in a reduction in the rate of absorption of buccally administered drugs e.g. glyceryl trinitrate (GTN)
72
what are the two most important factors that effect drug distribution in the elderly?
changes in body composition and protein binding
73
beer's criteria is
List of ‘inappropriate’ drugs for older people
74
STOPP-START is
Advice on medical optimisation
75
high stepping gait may be a sign of
Peripheral neuropathy
76
small steps shuffling gait sign of
Parkinson's
77
hemiplegic gait sign of
stroke
78
ataxic gait sign of
cerebellar damage
79
arthralgia gait sign of
arthritis
80
CT a head injury immediately if
```
low GCS <13
still confused after 2 hours
focal neurology
signs of skull fracture
basal skull fracture
seizure
vomiting
anti-coagulants
```
81
what cause this fall?
Mary 88
Lives alone, PMH, AF, hypothyroid, recent diagnosed mild dementia, hypertension,
Shopping in Marks and Spencer when she feels dizzy and collapses. Was looking at coats, not exerting herself.
No trip. Gives clear history herself
Friend with her agrees. No LOC
On Apixiban, levothyroxine, bisoprolol 10mg, Donepezil 10mg,
O/E Systolic murmur, BP 110/80 lying 90/70 standing, HR 55 irregular. No heart failure, neurologically intact. No injury FBC, CRP, U+E, LFTs Normal
Most likely diagnosis?
Postural hypotension due to Bisoprolol
Bradycardia due to Bisoprolol, Donepezil and possible undertreated hypothyroidism
Rarer but life threatening ones not to miss
Aortic stenosis
82
internal urethral sphincter is made of what muscle?
smooth
83
normal storage volume of the bladder?
400-600mls
84
sympathetic receptors for causing detrusor to relax
beta adrenoreceptor
85
sympathetic receptor for causing contraction of neck bladder and internal urethral sphincter
alpha adrenoreceptor.
86
high risk patient groups for alt. medicine
Children
Pregnancy and fetogenesis
Patients using prescribed medication
Polypharmacy
87
main cam in the u.k.?
herbal products
88
cams may contain
heavy metals
bacteria
medicines
89
what fraction of women use CAM during early pregnancy
2/3rd's
90
homeopathy could be registered under
registered under Simplified Scheme 1992 or National Rules Scheme 2006.
91
company licence for medication refers too
manufacturing and wholesaler dealer licences
92
GMC expectation for unlicensed medication
carefully consider any treatment that you prescribe,
be able to justify your decisions and actions when prescribing, administering and managing medicines regardless of whether they are licensed or unlicensed.
93
specific prescription sheets examples
diabetes, warfarin, fluid additive prescription, variable rate IV infusion
94
ways to work out sensible water deficit
```
Catheters, drains
Input charts
Vomit bowls
Sputum Pots
Stool charts and stoma losses
```
95
ways to work out insensible water deficits
```
Sepsis (sweat)
Ventilation
Open wounds
Burns
Bleeding
```
