Values and basic principles Flashcards
Normal IOP
10-21 mmHg
If >21 mmHg :
Glaucoma
Raised IOP
When to stop statin due to hepatotoxicity?
>3 ULN!
When to check renal arteries in ACEi / ARB use?
>30% Creatinine raise
When to stop a statin due to myositis?
When CK is 5x ULN as this can lead to rhabdomyolysis and ATN
Normal ABPI
ABPI indicating diabetic arterial disease
normal ABPI range 0.9-1.2
>1.3 = diabetic disease and is unreliable. Should do a toe measurement instead (classically) or more appropriately do doppler studies +
Resection margins in SCC
Melanoma
If Lesion <20mm then margins of 4mm will do
If lesions >20 mm then need margins of 6mm
Melanoma -
Margins by Breslow’s thickness (Also clark’s classification)
Melanoma in situ - 5mm
<1mm - 1cm
1-4 mm - 1-2cm
>4 mm - 2cm
Plasma Osmolality
Urine Osmolality
Plasma - 275-295
Urine - 300-900
Drug doses in asthma
Salbutamol - 5m
Ipatropiam - 0.5 mg
Hydrocortisone - 100 mg (200mg for COPD)
MgSO4 - 2g IVI
Working out PaO2 from FiO2
FiO2 - 10 is roughly what the PaO2 should be
Normal cup to disc ratio?
0.4-0.7
>0.7 = Optic disc cupping (cup is the inner circle)
Other glaucoma features (bayonetting of vessels - beraks as they disappear and enter at the base, cup notching )
DKA Monitoring
Resolution of DKA?
Fall in ketones by >0.5 mM/h
Inrease bicarb by >3 mM/h
Fall in glucose by >3 mM/h
Aim for a normal ptoassium level
Resolution:
Ketones <0.3 mM
Venous pH >7.3
Cut offs for rockall score?
Components?
<3 - good prognosis
>8 - high risk of mortality
Components:
Age
Evidence of Shock
Comorbidities
Post endoscopy
After how many hours do you check for:
Trop
Parecetomal levels
Trop - 12 hours
Paracetomal levels - 4 hours
Botulinism
vs
Tetanus
Botulinism - Prevents the SNARE complex formation which normally leads to acetylcholine release across the synapse
Tetanus - Prevents the release of inihibitory neurotransmitters
Leydig Cells
Sertoli Cells
Tumours secrete?
Leydig = Lad
So: oestrogens and androgens
Sertoli - Androgens
Normal Pulmonary artery occlusioon pressure
What is this an indicator for?
8-12 mmHg
This is an indicator of the Left Atrial Pressure
Will be raised (overload) in : (>18)
- Cardiogenic Pulmonary Oedema
- Mitral stenosis
- Left vetnricular failure
Will be low in : (<5)
- ARDS
Base Excess
What is it
Values
Base excess - measure of how many H+ ions would be required to return the pH to 7.3
<-3 = Metabolic Acidosis
>+3 = metabolic alkalosis
Rectum
Anus
Relative anatomical concepts and figure
Rectum:
Sacral promantery —> levator ani
Anorectal ring –> puborectal sling + internal and external anal sphincter complex
Rectum is 12 cm long.
Anterior resection - Malignancies should be >5 cm from the anal verge / 2 cm from the anorectal ring
Anus:
Levator ani to the anal verge
Divided into:
upper 2/3 - Super rectal artery/ vein - insensate with colulmnar epitheliam
Internal iliac node drainage
Dentate line - between upper 2/3 and lower 1/3
Lower 1/3 - Inferior/middle rectal artery/vein - sensate with squamous epithelium
Superficial inguinal node drainage
MOA
Organophosphate poisononing
Atropine MOA
Organophosphates - Phosphate radicals bind and reduce action of acetycholinesterases —> increasing the concentration of acetylcholine in synapse—> SLUDGEM symptoms (Salivation, lacrimation, urination, defecation, GI upset (diarrhoea), emesis, meiosis )
Atropine - Is a competitive inhibitor of the ACh- R. So will stop binding of acetylcholine to receptor —-> produces anticholinergic effects
Drugs used in bradycardia
When are they used ?
Used in conjunction with adverse signs
Atropine - 500mcg IV
Isoprenaline - 5mcg/min IV (beta 1 and 2 agonist- no real alpha action)
adrenaline - 2-10mcg/min IV
Recurrent laaryngeal nerves:
Anatomy
Which is more commonly injured in thyroid surgery
Anatomy -
Right comes off of the vagus nerve and travels superiorly after wrapping underneath the right subclavian artery
Left comess of the vagus nerve and travels superiorly after wrapping underneath the arch of the aorta at around the level of the common carotid artery
Right is injured more commonly in thyroid surgery due to the oblique ascemt
Renin aldosterone ratios
High Renin low aldosterone
Low renin High aldosterone
Low renin and low aldosterone
High Renin low aldosterone - RAS
Low renin High aldosterone - Cushing’s/ Conn’s
Low renin and low aldosterone - Liddle’s syndrome
Calculations
Osmolality?
Osmolar Gap?
Anion Gap?
Calculated Osmolality = 2Na+ Glucose + Urea
Osmolar Gap = Measured osmolality - Calculated osmolality (normal <10)
(If gap >10 indicates there is another toxic substance in the blood which is making up the difference like ethylene glycol, methanol etc.)
Anion Gap = Na - { Cl- + HCO3-) (normal is <11 (8-16) )
(If raised = Raised anion gap metabolic acidosis —> think about extra things in the blood which are contributing to the acidosis like lactate, ketones etc.)
