OSCE PREP
Which of these is NOT a function of the respiratory system?
PH regulation
Voice production
Gas exchange
Haemoglobin production
What is ventilation?
Movement of air between the environment and the lungs
Assisted breathing
What is inhalation? What pressure is it?
Positive pressure - air out
Negative pressure - air in
Where does the resp system transport gases to?
Plasma and HB
White cells
What is exhalation? Describe it's pressure?
Negative pressure - air in
Positive pressure - air out
What is external respiration?
O2 in -> difuses to the tissues -> CO2 -> difused to lungs -> out of system
.
What is internal respiration?
Exchange of gases, cellular respiration, ATP production
Ventilation, diffusion of gas to the tissues
Describe the mechanism of the alveolar?
Large capillary network
Large surface area
Thin cell wall
Close to heart
Fluid lined
What is type 1 respiratory failure?
Hypoxia
Hypercapnia
What is hypoxia?
Lack of O2 to perfuse the tissues
Build up of Co2
What are the causes of T1 resp failure? Select all that are correct.
Asthma attack
Chest infection
Hayfever
Pulmonary oedema
Stroke
Pulmonary embolism
Pneumonia
What is T2 resp failure?
Hypoxia
Hypoxia and Hypercapnia together
What is hypercapnia?
A build up or retention of o2
A retention or build up of Co2
What are the causes of T2 resp failure? Select all that apply
PE
COPD exacberation
Severe asthma
Pulmonary oedema
Overdose
Reduced conciousness
Respiratory depression
How does T1 resp failure sometimes result in T2?
Exhaustion -> eventually leads to inadequate breathing, can't excrete Co2 properly
It doesn't
Name some methods of respiratory assessment? Select all that apply:
Chest xray
Auscaulation
ABG
Spirometry
Breath test
Peak flow
Pt history
Respiratory rate
Sp02
Temperature
What is the purpose of an ABG?
To check the blood for pathogens and infection
To measure o2 leveles in the arteries or the Co2 level/PH of the blood
Give some examples of treatment for acute resp illness. Select all that apply.
Steroids
Antibiotics
O2 therapy
Isolation
Inhalers
Nebulisers
Non invasive ventilation (NIV)
Continuous positive airway pressure (CPAP)
Name some non-pharmacological interventions.
Chest physio
Smoking cessastion
Positioning
Reduce anxiety
Nutrition
Hydration
Describe methods of administering o2 therapy.
Venturi mask
Nasal cannula
Ventilation
Normal face mask
Airvo
Non rebreath mask
How many litres of o2 should be the maximum administered via a nasal cannula?
3L
4L
2L
6L - although no more than 4 recommended for comfort
What are normal BG levels for fasting?
3.0-7.0 mmol
4.0-6.0 mmol
2.0- 5.0 mmol
3.5-8.5 mmol
What are normal range BG levels 2hrs after food?
6.5-10 mmol
4.0-7.8 mmol
7.0-9.0 mmol
4.0 -5 mmol
What is diabetes?
A disease of the pancreas
Impaired ability to produce insulin
Too much insulin production
How does diabetes impact the body?
Starvation
Raised blood glucose levels
Andmormal metabolism of carbs
Obesity
What is T1 diabetes?
Beta cells in illets of langerhans fail to produce ANY insulin
Beta cells produce a small amount of poor quality insulin
How is Type 1 treated/controlled?
Insulin
Diet
What is T2 diabetes?
Failure to produce any insulin
Cells stop responding to insulin, preventing glucose uptake in cells
Poor production of insulin - quantity or quality
What is gestational diabetes?
Like T2 - cells unreceptive to insulin. Resolves after birth.
Like T1 - no production of insulin. Resolves after birth.
Name 3 main diabetic emergencies.
Diabetic Ketonone Acidosis
Hypergylacemia
Hypoglycaemia
Hyperosmolar Hypergylcaemia State
What are risk factors of gestational diabetes?
Pre pregnancy BMI of 30>
Ethnicity
Family history
Immunity
What type of insulin is Humalog?
Slow release
Rapid
Short acting
What type of insulin is Lantus?
Long acting
Rapid
Short acting
Mixed
What type of insulin is Actrapid?
Short acting
Slow relase
Long acting
Rapid
What type of insulin is Humalin m2?
Short
Mixed
Rapid
Long
What are normal BG levels for T1 when fasting?
4-6 mmol
5-7 mmol
What are normal BG levels for T1 before meals?
4-7 mmol
3-6 mmol
How often should HBA1C be checked in T1?
Once a year
Every 3-5 months
Every month
Every 6 months
When should T2 measure BG?
Once daily
Once a week
Every meal
What is the aim HBA1C for both types?
<3mmol
<4.8mmol
<6mmol
What are some services available for diabetic monitoring?
Specialist nurses
Neuropathy
Foot clinic
Dermatology
Kidney disease monitoring
Diabetic retinopathy (annually)
Select all symptoms of a diabetic emergency?
Mood changes
Paleness
Increased/decreased hunger
Temp
Tiredness
Headache
Sickness
Trembling
Jaundice
Paleness
Mood change
Sweating
What is hypoglycaemia?
BM LOW.
BM HIGH
What are the ranges of hypoglycaemia?
Mild 3-3.9
Moderate 1.5-3
Severe 1.5 or less (UNCONCIOUS)
What are the causes of hypos?
Stress or illness
Too much exercise
Too much insulin
Too much food
Not enough insulin
Too little/delayed food
What should you do if you think someone is HYPO but unable to check BM?
Don't treat until you are sure
Treat as hypo anyway
What is HYPERglycaemia and the ranges?
BM of 3 or less
BM of more than 7 fasting
BM of more than 8.5 2hrs after food
What are the causes of hyperglycaemia?
Stress
Illness
Infection
Not enough food
Too many carbs
Overeating
Overtreated Hypo
Symptoms of HYPERglycaemia ?
Shaking
Abdo pain
Polydipsia (increased thirst)
Polyuria (increased urination)
Sickness
Polyphagia (increased hunger)
Why does polyuria occur in hyperglycaemia?
To rid sugar
Too much sugar = body removes too much water from cell = too much for kidneys to process
Why does polyphagia present in hyperglycaemia?
Body unable to access sugar due to not enough insulin, so uses fat for food, resulting in signals to eat for energy
What is diabetic ketoneacidosis? DKA?
Complication of T2
Complication of T1
What are the medical signs of DKA?
BM of more than 11mmols
PH < 7.3 ACIDIC
Ketones > 3mmol
GCS <12
SPo2 of 92% on Ra
Describe the cause of DKA?
Using fat for energy due to lack of insulin. Creates ketones as a bi product which make the blood acidic. Pt's already HYPER byt body cant access insulin to use the glucose. So hyperglycaemia continues to rise.
Symptoms of DKA?
3 P's: polyuria, polydipsia & polyphagia
Weight loss
Abdo pain
nausea/vomitting
Weakness
Tachycardia
Tacypnea
Acetone breath
Hypothermia
General DKA treatmenent?
Simple carbs
Antibiotics
Clear ketones
Correct electrolytes
Insulin to reduce BM
Fluid replacement
IV glucose to prevent hypo when clearing ketones
What is hypersmolar hyperglycaemia HHS?
Complication of t1
Complication of type 2
What is a thrombo embolic stroke?
A bleed
A clot
Name 3 types of surgically treated neuro illnesses?
M.S
Tumour
Spinal cord compression
Subarrachnoid haemorrge
Parkinsons
What is the cerebral cortex?
Outer layer of the cerebrum
The outer brain
What are the 2 functions of the temporal lobe?
Hearing speech + smell
Smell + memory
Voice + smell
Is spatial awareness and memory a function of the parietal or occipital lobe?
Occipital
Parietal
What is the main function of the occipital lobe?
Visual perception
Smell
The diencephalon (the thalamus and the hypothalamus) are responsible for:
THALAMUS: interpret and relay sensory info/emotions. Pass them to cerebral cortex for interpretation.
HYPOTHALAMUS: regulates temp, appetite, thirst, sleep, hormones and emotional reactions
What is ICP?
Intracranial Pressure
Intrahepatic Pregnancy
Select the correct statements about ICP:
Measure in mmhg
Normal range 0-10 mmhg
Pressure within the skull
Measured accurately by putting a bolt in the brain tissue
Describe the monro-kellie hypothesis:
Skull is a fixed structure so any increase in matter (Blood, fluid, tissue) increases the ICP. Body componsates by reducing another componant.
Select all causes of temporary ICP increase
Defecation
Coughing
Vomitting
Hypercapnia
Airway obstruction
Positional change
Seizure
Stress
Early signs of ICP increase:
Subtle pupil change
Worseing motor response
Headache thats worsening
Change in verbal response
Level of conciousness reduced
Seizure
Vomitting
Late signs of ICP increase:
Difficult to rouse
Unequal pupils
Posturing poor
RR change
Abnormal reflex
Cardiac changes
The pathophysiology of a brain injury:
Brain suffers injury
Brain swells or bleeds, intracranial volume increases
The cranium allows no room for expansion so ICP increases
Cerebral hypoxia + ischemia occurs
ICP continues to rise. Brain may herniate
CEREBRAL BLOOD FLOW STOPS
What is autoregulation?
Maintenance of a constant cerebral blood flow
What happens if cerebral perfusion is low in a healthy brain?
Vasodilation- maintains the blood flow
What happens if cerebral perfusion is high in a healthy brain?
Vasoconstriction - maintains blood flow
If low perfusion occurs in an injured brain..
Autoregulation fails. Low flow occurs. ISCHAEMIA OCCURS *blood flow restricted
If high perfusion occurs in an injured brain..
Autoregulation fails. High flow occurs. OEDEMA
What does AVPU stand for?
Alert, voice, pain, unconcious
Alert, void, pain, unresponsive
What is the best score for a healthy individual on GCS?
0/15
15/15
What does NICE say about neuro obs?
Perform every 30 mins until 15/15 GCS achieved
1/2hourly for 2 hrs
1hrly for 4 hrs
2hrly thereafter... Any deterioration = half hourly neuro obs
Select the potential impacts of neuro illness of injury.
Physical deficit
Cognitive impairment
Psychological deficit
Consequences- family, social, work
What are the symptoms of a STROKE? FAST
Face: Face dropped to one side, may not be able to smile or eye may have dropped
Arms: may not be able to lift both arms and keep them there. WEAKNESS
Speech: may be inappropriate, mixed up, slurred, or no speech
Time; GET HELP QUICKLY
What is a TIA? Transient Ischaemic Stroke?
A temporary interuption to the blood flow in the brain, lasting from minutes to hours
What is the treatment for an ischaemic stroke?
Medication to dissolve the clot (thrombolysis)
Sometimes surgery to remove clot
Antiplatelets - aspirin
Anticoagulants - apixiban, warfarin
Treatment for a haemorrhagic stroke
Surgery to remove blood from inside brain and repair broken vessels
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