1) What is Entonox used for?

2) What are the contraindications?

3) What are the cautions?

4) What are the benefits?

A1) Entonox is an inhaled analgesic suitable for musculoskeletal injuries and

pregnancy related pain, in addition to many other types of pain. It is 50% Nitrous Oxide and 50% O2 and is typically contained in a cylinder that has either a White or Blue body and a Blue/White collar. Pt’s must be able to understand administration instructions

A2) Contraindications are; Severe Head Injury, Bends (decompression sickness) or Psychiatric patients

A3) Cautions are pneumothorax

A4) Benefits are; no cardiac depression, no respiratory depression, no dosage requirements, mininmal side effects, self administered, valuable 50% o2 especially in trauma, fast acting and shortlasting.

1) Explain Furosemide

2) What are the side effects?

A1) Furosemide acts in the loop of Henle; increases blood flow causing increased glomerular filtration and inhibits sodium, potassium and chloride re-absorption. As the sodium, potassium and chloride are retained in the loop, so is the water. This leads to increased urination which aides in eliminating increased fluid volume. Furosemide also has a vaso dilating effect and encourages magnesium to be lost as a by product of the effects.

A2) Potassium is lost (Hypokalaemia) potentially leading to arrhythmias, gout, hypotension/shock when used in conjuction with ACE inhibitors as these also increase sodium/volume loss

1) What does Insulin do?

2) What does Glucagon do?

THINK ABCDE

A1) A – Accelerates transport of glucose into cells

B – Boosts lipogenesis (production/accumulation of fat)

C – Converts glucose into Glycogen

D – Decreases glycogenolysis (Glycogen to Glucose)

E – Encourages protein synthesis

A2) Glucagon acts on Hepatocytes in liver cells to convert glycogen into glucose. Glucose is released from Hepatocytes to increase Blood Sugar. It also forms glucose from Lactic Acid and Amino Acids.

1) Explain Cardiac Failure

A1) Cardiac Failure is in essence PUMP FAILURE. There is a problem contracting (Systolic) and a problem relaxing (Diastolic failure).

Right ventricle failure; congestion in veins causes the volume/pressure to increase. This forces pressure to increase in the capillaries and causes

leakage of plasma. If leakage is greater than what is drained away by lymphatics, the odema will develop. Gravity causes lower leg odema. The worse the situation, the higher up the body the odema will be evident

Left ventricle failure; congestion in the lungs and pressure in the left ventricle. Causes dyspnoea or pronounced pulmonary odema (gurgling on auscultation)

To treat, reduce preload/circulating volume with diuretics and afterload with vasodilating drugs; strengthen the force (inotropic)

1) The marginal branch delivers blood to what?

2) What is bronchiectasis?

3) What causes hypertropic cardiomyopathy?

4) Oesophageal varices are associated with what?

A1) To the left and right coronary arteries branch of the aorta. The right coronary artery branches off into the marginal branch and introventricular

A2) Bronchiectasis is abnormal and PERMANENTLY DILATED airways due to

irreversible damage

A3) Hypotropic cardiomyopathy is casued by a gene abnormality

related to the characteristics of the muscle.

A4) LIVER. Blood backs up causing hypertension as the pressure increased in the gastric veins and the veins surrounding the oesophagus.

1) What is Amiodorone?

2) What are Class 4 Anti-arrhythmics?

3) What is Acromegly?

4) Explain Cushings Syndrome and its effect on Glucose

A1) Amiodorone is a Class 3 antiarrhythmic drug that affects the repolarisation of the heart by lengthening the Q-T interval

A2) Channel blockers; these affect the action potential within the

Myocardium impulse therefore affecting depolarisation and repolarisation

A3) Excessive Growth Hormone

A4) Excess Cortisol from the Adrenal Cortex - This reduces carbohydrate metabolism so glucose is not utilised resulting in too much left in the body (Hypoglycaemia)

1) What is Sepsis?

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME.

Sepsis starts with an injury to cells from infection or toxin which triggers a profound inflammatory response from mediators such as Cytokines.

Damage to the endothelium triggers the coagulation cascade causing microclots of Fibrin, Neutrophils, Platelets, RBC which leads to poor cell

nutrition, oxygen delivery or perfusion of vital organs.

A consequence of the coagulation reaction is the activation of Bradykinin! Bradykinin os a circulating peptide that dilates blood vessels making capillaries leaky. An increase in Bradykinin adds to the vaso dilation and capillary leakage caused by the inflammatory response (histamine) which then allows fluids to leak into the interstitial spaces

1) What are Prostaglandins?

2) How does Paracetamol work?

3) How long can an Axon be?

A1)Prostaglandins are powerful vasodilators. Prostaglandins are pivotal in inflammation and these are catalysed by cyclooxygenase which activate and sensitise nociceptors

A2) Paracetamol reduces the nerve sensitising prostaglandins which reduces pain perception and affects the release of serotonin to help alleviate pain. It also affects thermoregulation controlled by the hypothalamus to reduce fever. Paracetamol has little anti-inflammatory action

A3) 100cm

1) What produces Renin?

2) What produces Angiotensinogen?

3) Together these form what?

4) What transforms Angiotensin I into Angiotensin II?

5) What does Angiotensin II do?

6) What is Histamine?

7) Suggest visual clues of an arrhythmia

A1) Kidneys (Senses low arterial pressure)

A2) Liver (Specialised protein plasma)

A3) Angiotensin I

A4) ACE (Angiotensin Converting Enzyme)

A5) Decreases glomerular filtration to increase or decrease reabsorption of Na, Cl and Water. Stimulates adrenal cortex to release Aldosterone which aides fluid retention and is a vaso constrictor

A6) An inflammatory mediator

A7) Pallor, diaphoresis, hypotension, chest pain, nausea, fatigue, LOC

1) Explain Metoclopramide?

An anti emetic. Metoclopramide is a dopamine receptor antagonist.

Dopamine relaxes gastric smooth muscle and metclop inhibits this. Metclop increased the cholinergic response of GI smooth muscle which accelerates intestinal motility and gastric emptying. Metclop also decreases reflux by resting the cardiac sphincter. The dopamine antagonist raises the threshold of activity in the chemoreceptor trigger zone and decreased input from visceral afferent nerves. High doses stimulate 5HT receptors.

Metoclopramide is contraindicated in Pheochromacytoma (tumor of the adrenal medullar)

1) Explain Bone Repair stages

2) What is subluxation?

3) Define Rabdomyalosis

A1) When a fracture occurs, a haematoma is formed. Cells die which causes an inflammation response where cytokines request osteoclasts to come and breakdown the bone fragments. Osteoblasts then lay down collagen and fibrocartlidge to start the repair process. Over time, new tissue becomes hard as the woven bone crystalises and calcifys. The final stage is smoothing

A2) Partial dislocation

A3) Happens in compartment syndrome where muscle death occurs and a protein called myoglobia gets released which is toxic to the kidneys

1) What are the following:

a) Abduction b)Adduction c)Supinate d) Pronate e)

Plantaflex f) Dorsiflex g) Evert h) Invert

2) What is the media malleolar?

3) What is lateral malleolar?

4) What is the calcaneous?

5) What is the test for positive plantar reflex?

A1)

a) Move away from body = abduction. Move toward the body = adduction. Hands push forward = Supinate. Hands push back = pronate. Toes point down = plantaflex. Feet point up = dorsiflex. Ankle turns out = evert. Ankle turns in = invert

A2) Inside the ankle bone

A3) Outside Ankle bone

A4) Heel bone

A5) Simmons Test – squeezing the calf

1) What defines complicated fractures?

2) What causes fractures?

3) What are the definitions or explanations of Direct,

indirect, pathological and muscular causes of fractures?

A1) Associated injury to important structures (organs). Fractures associated

with a dislocation. Bone is fragmented. Broken bone is impacted together.

A2) Direct, indirect force, pathological and muscular

A3) Direct = At the point of force

Indirect = fracture a distance from the point of impact due to kinetic energy

Muscular = violent contraction of muscle

Pathological = disease or degeneration

1) Describe the structure of Flat Bones and examples

2) Describe the structure of Irregular Bones and examples

3) Describe the structure of Sesamoid Bones and

examples

A1) Two layers of compact bone with a thin cancellous layer in between. These provide protection and extensive muscle attachement – eg Scapula, Cranium, Pelvis

A2) Complex in shape but similar to short bones in construction – eg

vertebrae, facial bones

A3) Small bones located int eh tendons around certain joints – eg Patella (Knee)

1) What covers bone?

2) What does the periosteum do and what is it made of?

3) How many different types of bone are there and what

are their names?

A1) Periosteum

A2) Contributes to bone growth, repair of bone and contains blood vessels for nourishment. Made from dense fibrous material

A3) 5 types – Long, Short, Sesamoid, Irregular, Flat

1) How many Metatarsals are there in the foot?

2) How many phalanges are in both feet?

3) How many types of joint are there? What are their

names and examples of them?

A1) 5

A2) 28 – 14 in each foot

A3) 3 types;

Immovable/Fibrous eg Skull or Pelvis

Freely moveable synovial eg elbow, hip, knee

Slightly moveable cartliganous eg symphysis pubis, vertebrae

1) What causes a Stroke?

2) What are the clinical signs of a stroke?

A1) Two types; Haemorrhage or ruptured blood vessel which applies pressure (15% of cases) or Embolus/Thombosis causing a blockage in the

brain leading to hypoxia in the brain tissue (85% of cases)

A2) Slow and full pulse. Flushed warm skin. Unequal pupils or slow to dilate on affected side. Noisy breathing (puffy cheeks), flaccid or paralysed muscles in the face i.e. drooping mouth. Inability to understand simple instructions, slurred speech. Incontinence or vomiting. Hypertension, headache, confusion, fits. Abnormal gait in walking. Unequal strength of grip. Unusual behaviour out of character.

1) What are the signs and symptoms of Myasthenia

Gravis?

2) Define Bursitis

A1) Double vision, ptosis (droopy eyes) monotone speech, difficulty swallowing, fatigue, airway compromise

A2) Inflammation of the Bursa which is the small fluid filled sacs that cushion bones and tendons

1) What are the guideline respiratory rates in children?

2) What are the cardiovascular differences between adults

and children?

3) How do you calculate a neonates BP systole without a

cuff?

A1) Under 2 years = 30-40 breaths p/min

2-5 years = 25-30 breaths p/min

5-12 years = 20-25 breaths p/min

12+ = 15-20 breaths p/min

A2) Under 4 months the Right Side of the Heart is more dominant

Generally the heart is healthy so cardiac arrest is typically attributed

to a respiratory problem

Lower BP but this increases with age

A3) BP is Stroke Volume (80ml) + Age x 2

1) What are the shockable rhythms?

2) What are the unshockable rhythms?

3) What are the 3 main oxygen mask types?

A1) VF (Ventricular Fibrillation) and Pulseless VT (Ventricular Tachycardia)

A2) PEA (Pulseless Electrical Activity) and Asystole

A3) Simple Face Mask 40-60% O2

Venturi 20-30% O2 (COPD Patients)

Non-rebreather or Trauma Mask 100% O2

1) What are the average Pulse Rates?

2) What should you always do when delivering analgesia?

A1) <1yr = 100-160 beats p/min

1-2 yrs = 100-150 beats p/min

2-5 yrs = 95-140 beats p/min

5-11 yrs = 80-120 beats p/min

12+ Adult = 60-80 beats p/min

A2) Pain score before and after to establish effectiveness and potentially progress up the pain management ladder as directed by WHO

1) Define Cartlidge

2) What do tendons do?

3) What do ligaments do?

4) What is a strain?

5) Define tendonistis

6) What is a sprain?

7) Name the types of facture and explain

A1) Fibres of collagen; shock absorbers and provide smooth surface over bone ends; adds to structure but have limited vascular supply so cant heal

well

A2) Connect muscle to bone; flat cord-like bonds of connective tissue

A3) Connect bone to bone; maintain stability

A4) An injury to muscle or tendon

A5) Calcium deposits along the tendon due to inflammation

A6) Ligament damage

A7) Spiral = Twisting; Compound = through the skin; Greenstick = only half bone breaks one side; Comminuted = multiple breaks in one bone;

Transverse = bone breaks but doesn’t come through the skin

1) What are the signs and symptoms of Hyperglycaemia? Remember the acronym LENGTHS PAD

A1) L = Lethargy

E = Excessive Urination

N = Nausea

G = Gradual onset

T = Thirst

H = Hunger

S = Shock

P = Pear Drops Breath (Ketoacidosis)

A = Abdominal Pain

D = Deep sighing breaths (Kussmauls)

1) Name the 8 bones in the cranium

2) Name the 14 bones in the face

3) What does the pelvis consist of?

4) What forms the pelvic girdle?

A1) 1; Occipital, 2; Temporal x2, 3; Parietal x2, 4; Frontal, 5; Sphenoid, 6; Ethmoid

A2) Mandible (only moveable joint), Maxilla x2, Zygoma x2, Nasal x2, Lacrimal x2, Palatine x2, Inferior Nasal Conchi x2, Vomer.

A3) Rght/Left Hip bones, Sacrum, Coccyx

A4) Right/Left Hip bone joined anteriorly at the symphysis pubis and posteriorly to the sacrum

1) What is the shaft of the long bone called?

2) What cover the internal bones surface?

3) What are the bone ends called?

4) What are the epiphysis made of?

5) What are the sutures in the skull called?

6) What is the hole in the base of the skull called where it

connects with the brain stem?

A1) Diaphysis

A2) Endosteum

A3) Ephysis

A4) Spongy (Cancellous) bone

A5) Coronal, Sagittal, Squamous, Lamboid sutures

A6) Foramen Magnum

1) What position is used for patients with hypovolaemic

shock or low systolic?

2) What types of bones are ribs?

3) How many tarsals are there and their names?

4) What is the true name for the ‘big toe’

A1) Trendelenburg

A2) Flat bone

A3) 7x Tarsals - Talus, Calcaneous, Navicular, Cuboid, Lateralcuniform, Intermediale cuniform, medial cuniform

A4) Hallux

1) What are the 4 characteristics of muscle?

2) What is the composition of the thoracic cage?

3) What are the 4 classifications of injury to bones?

4) How many types of fracture are there and their names?

5) What is the difference between open/closed fracture?

A1) Excitability, Extensibility, Contractability, Elasticity

A2) Sternum, 7 True Ribs, 3 False Ribs, 2 Floating Ribs

A3) Dislocation, fracture, sprain, strain

A4) Closed or Open = either can be complicated

A5) Closed means the skin surface is not broken and open is there is a wound

leading down to the fracture (bone doesn’t need to be protruding)

1) How long is the spinal cord in an average male?

2) How many bones are in the body?

3) What are the 6 functions of the skeleton? ACRONYM

S.S.M.M.B.P

4) In the composition of bone, how many types of tissue

are there and their characteristics

A1) 45cm

A2) 206

A3) Storage of energy (fat in yellow marrow), Support (point of attachment for muscles), Mineral storage (of calcium & phosphorous), Movement and levers for muscle attachment, Blood cell production in red marrow, Protection of vital organs

A4) 2 type = Compact dense bone with stress bearing capacity and spongy

cancellous bone which is light bone with lots of space for red marrow

1) What forms the shoulder girdle?

2) How many wrist carpals are there?

3) Where are metacarpals located – how many bones?

4) How many phalanges are in the hands

5) What makes up the lower limbs?

6) What do tarsals make up and how many per leg?

A1) Scapula, collar bones (clavicles), which attaches the upper limbs to the thoracic cage

A2) 8

A3) Palm of the hand – 5 bones

A4) 14 in each hand = 28 in both

A5) Femur, Patella, tibia, fibula, tarsals, metatarsals, phalanges

A6) Ankle, heel and instep = 7 per foot

1) What is the management of hypoglycaemia?

A1) Ensure an open airway. Check BM. Administer oral glucose if

patient is conscious or soak gauze with Glucogel to put buccal. Encourage sugar drink if pt conscious. Administer O2 if necessary. Administer 1mg IM Glucagon (be aware of depleting Glycogen stores in the Liver). Reassess/retest BM. Encourage carbohydrate foods to replenish stores. IV Glucose if unresponsive to previous attempts.

1) What is the most common type of pelvic injury?

2) What are the common sites of pelvic fractures?

3) What are the types of spinal injury?

4) What are the types of seizures?

A1) Book fracture

A2) Sacral, Medial Illiac, Pubic Rami, Supracetabular, Parasypheal

A3) Dislocation of Vertebrae, Fracture of Vertebrae, Displaced

Vertebrae

A4) Generalised, Partial, Status Epilepticus

1) Suggest the complications of pregnancy and labour

2) When is it called a miscarriage?

3) What are the 3 types of miscarriage?

A1) Miscarriage, Ectopic pregnancy, shoulder dystocia, cord prolapsed,

haemorrhage (post partum), premature delivery, breech birth or malpresentation, eclampsia

A2) Upto 24 weeks gestation. After this, it is called antepartum haemorrhage

A3)

Threatened = Light bleed, little pain

Inevitable = Labour pains, moderate bleeding

Incomplete = sever bleeding and possibly part of the placenta retained

1) What are the anatomical differences between and

adult and a child?

2) What is the blood volume for adults and children?

1A)

a) Epiglottis is larger/floppier

b) Larynx is funnel shaped, higher and more anterior

c) Crichoid ring is narrowest part of trachea

d) nostrils are narrower

e)Large occipital area

f) tongue is large in relation to head

g) Softer palate

h) symmetry of the carina angles is different as the right is shorter and at a

greater angle

A2) 70mls per kilo for adults

80mls per kilo for children

1) Name the two divisions of the skeleton and their contents?

2) What are the two sections of the skull called?

3) How many bones are in the head?

4) How many bones are in the spine? Name each section of the

spine

A1) Axial Skeleton = Skull, spinal column and thoracic cageAppendicular Skeleton = Upper limbs, lower limbs, pelvis, humerus, femur, tibia, fibula, radius, carpals, metacarpals, phalanges, ulna

A2) The cranium and the Face

A3) In the head are 22 bones

A4) There are 33 irregular vertebrae bones 7 Cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal (fused to

form coccyx)

1) What is the correct name for C1 & C2?

2) In a hospital setting, what does the acronym FOOSH mean?

3) How many carpals in each hand and their names?

4) What type of bones are carpals?

5) What type of bones are phalanges?

A1) C1 is the Atlas and C2 is the Axis

A2) Colles Fracture ( Fall on outstretched hand)

A3) Scaphoid, Lunate, Trapezium, Pisiform, Trapezoid, Triquetrium, Capitate and Hamate

A4) Short Bone

A5) Long Bone

1) What should be checked when managing a fracture?

2) What is dislocation?

3) What can cause dislocation?

4) What are the signs and symptoms of dislocation?

A1) Circulation, cap refill, nerve impairment above and below site of injury, loss of sensation, radicular pain, ensure bandages are not too tight due to continued swelling. Monitor obs and BP, pulse, pupilsA2) Displacement of one or more bones at a joint and may be accompanied by a fracture

A3) 3 causes = Direct, indirect and pathological – NO MUSCULAR CAUSE

A4) Same as fracture except there is fixation at a joint therefore no movement

1) What are the signs and symptoms of a fracture? BUSTCLIPD

2) What is the management of a fracture?

A1) Bruising, Unnatural movement, Swelling, Tenderness, Crepitas, loss of function, irregularities, pain and deformity

A2) Always assume a fracture – raise to reduce swelling. Never move a patient unless there is dange without stabilising the fracture. Administer analgesia before attempting to treat the fracture. Reassure and explain the procedures. Support and immobilise the body. Straighten limbs where possible. Apply dressing to open fractures.

1) Within the cardiovascular system, what are the 3 types of

circulation?

2) What stops the alveoli from collapsing?

A1) Systemic Circulation – Capillary beds/internal respirationPulmonary Circulation – Venous blood through the heartPortal Circulation – Absorbing nutrients from the GI Tract and into

venous blood

A2) Surfactant (chemical)

1) Define heat exhaustion

2) Define Heat Stroke

3) If unreplaced water is lost through skin, what happens?

4) Who is at risk of heat exhaustion/heat stroke?

A1) 39-40c Caused by excess sweating combined with inadequate water intake

A2) 41c or above

A3) The temperature regulating mechanism in the brain (the Hypothalamus) breaks down and the body continues to heat with no means of cooling

A4) People in high temp workplaces, long periods in the sun, excessive physical exertion, taking ecstasy

1) Causes of a Pelvic injury?

2) What can complications of a pelvic injury affect?

3) What are the signs and symptoms of a pelvic injury?

A1) Direct, Indirect, Muscular – NO PATHOLOGICAL

A2) Damage to internal organs i.e. bladder, urethra, reproductive organs

A3) Severe pain from the back of the pelvis, inability to stand, rigidity of the abdomen, legs in unnatural position, feeling that pelvis is falling open, high suspicion of index on mechanism of injury, abnormal mobility, urge to pass urine or haematuria

1) How do NSAIDS work to be antinflammatory drugs?

2) Why do Aspirin and Ibuprofen have adverse effects?

A1) Inhibit the effect of COX (Cyclooxygenase)

COX 1 is present in most tissues

COX2 produces inflammatory chemicals at site of inflammation

Botha re involved in Prostaglandin production

A2) They have more selectivity to COX1 inhibition causgin GI irritation, salt/water retention, hearing loss and vertigo and bronchospasm (which is the reason they are a caution on patients with Asthma)

1) What are the anatomical differences in a pregnant woman?

A1) Short obese neckFull dentitionEngorged breastsRaised DiaphragmSplayed ribsInferior vena cava compression

1) What does Cortisol in the body do?

2) Name the 4 types of brain lesion

3) How do you identify a brain bleed?

4) Suggest differential diagnosis to meningitis

A1) Affects almost all organs; maintains blood pressure and cardiovascular function; regulates metabolism; affects glucose levels; slows the inflammatory process

A2) Extradural haemorrhage; Subdural haemorrhage; Subarachnoid Haemorrhage; Intracerebral Haemorrhage

A3) Eye on the side of evolving haematoma will become fixed and dilated as Inter Cranial Pressure (ICP) increased and compresses the occulomotor nerve

A4) Encephalitis = inflammation of the brain; S&S similar to meningitis and still a possibility of having both diseases together

1) What considerations are given when deciding whether to

transport a mother to hospital?

2) When would you not transport?

A1) Any complications seen or expected; length of gestation; whether its the first baby; frequency of pain/contractions; whether the membranes have ruptured; whether the baby is crowning; distance to hospital; medical conditions; weather conditions; resources available; traffic conditions

A2) Regular 1-2 minutes contractions; an urge to push or bear down; crowning or presentation of the vulva

1) What is the management of a dislocation?

2) What are the signs and symptoms of a sprain?

3) What is the management of a sprain?

A1) The same as for a fracture but DO NOT ATTEMPT TO STRAIGHTEN OR MOVE LIMB

Immobilise as best as possible and improvise where necessary

A2) Sever swelling, cramp, bruising, pain worse on movement,

A3) P R I C E Pain Relief; Rest; Ice or cold compress; Compression; Elevate to reduce swelling

1) What are the 4 synovial joints and examples?

2) What is the definition of a ligament?

3) What is the definition of a tendon?

A1) Ball and Socket = Shoulder or hip (bones move freely)Hinge = Elbow or Knee (Flexion/extension in one direction)Gliding = Wrist or ankle (glide on one another)Pivot = Ulna or radius (allows for full movement)

A2) Dense fibrous connective tissue to attach bone to bone (joint)

A3) Dense fibrous connective tissue which is continuous with fibrous sheath and attached bone to muscle

1) Describe the structure of long bones and some examples?

2) Describe the structure of short bones and some examples?

A1) Elongated shaft of compact bone with two extremities of spongy cancellous bone surrounded by compact bone e.g. humerus, ulna, radius, femur, tibia, fibula, phalanges

A2) Generally cuboid in shape and smaller with no shaft – spongy cancellous bone surrounded by compact bone e.g. carpus (wrist) and tarsus (ankle)

1) How many types of meningitis are there?

2) Describe the symptoms of viral and bacterial meningitis

3) What is the treatment for meningitis?

A1) Viral and Bacterial

A2) Neck stiffness, photophobia, nausea, pyrexia, non blanching rash, head ache, brudinski sign, kernings sign, cold extremities, poor perfusion, tachycardia, seizure

A3) Benzylpenicillin

1) When would you correct a deformity?

2) What are the post immobilisation checks?

3) What are the immobilisation equipment available?

A1) If it is very sever and the skin is tightly stretched over a bone and there is evidence that the circulation is restricted. Lack of a pulse distal to the injury or engorgement

A2) Any bleeding is controlled? Any severe pain or cyanosis caused by the bandages? Any paralysis or numbness? Colour/temp of skin is normal? Pulse available distal to injury?

A3) Triangular bandages; fracture straps/padding; slings; splints; cervical collars; spinal boards; sagar traction splint

1) What is the management of a seizure?

A1) Airway, breathing, circulation assessmentMake comfortable usually lying downLoosen tight clothingSupport head with a pillowProtect from harm/dangersDo not attempt to restrainDo not put anything in the mouthO2Check BM readingAllow recovery in own timeDeal with any injuries; allow to sleepIf indicated, Diazepam/ Diazemuls

1) What is placenta previa?

2) What are the signs and symptoms of shoulder dystocia?

3) Describe the rule of twos?

A1) Where the placenta partly or fully occludes the cervix

A2) Uterus is larger than usual; slow labour progress; neck and shoulders not visible after the head

A3) If the shoulders do not follow the head after two contractions, contact the hospital and advise shoulder dystocia, assume the McRoberts position and wait two more contractions; place left lateral side; supr-pubic pressure while in the McRoberts position applying pressure towards the baby during a contraction

1) How do you manage cord prolapsed?

2) What are the signs and symptoms of pre eclampsia?

3) Describe the patient positioning of a pregnant woman to

prevent hypotension and why?

A1) Left lateral positioning with padding to raise pelvis; cover with warm saline dressing; avoid contact; transport immediately

A2) Protein in urine; hypertension above 140 systolic post 20weeks gestation; headache; visual disturbances; abdominal pain; facial odema; vomiting

A3) Placing a pregnant woman in the supine position may cause the uterus to exert pressure on the inferior vena cava which will reduce venous return. Incline the female 30 degree on her left lateral side

1) How do you transport a patient with chest injuries i.e.

pneumothorax etc?

2) What are the two types of near drowning and explain the

difference

3) Name the 5 types of drowning

A1) If conscious, in a semi recumbent position inclined to the injured side. If unconscious, recovery position with the injured side lowest to allow for drainage

A2) Sumbersion and Immersion: Submersion the head is below the water and the main problem is asphyxia and hypoxia. Immersion the head is above the water and main problems are hypothermia and cardiovascular instability

A3) Near, Dry, Freshwater, Saltwater, Secondary

1) Describe the heart, location and position

2) Name the 12 cranial nerves

3) What is the Frank Starling Law of the Heart?

A1) A hollow cone shaped organ the size of a fist; located in the mediastum; lies obliquely at an angle; the base is at the 2nd intercostals muscle and the apex is at the 5th intercostals muscle. The apex rest on the central tendon of the diaphragm. Superior is the aorta/aortic arch

A2) Olfactory; Optic; Occulomotor; Trachear; Trigeminal; Accessory; Facial; Vagus; Glossopharangeal; Vestibularchochlear; Abducens; Hypoglossal

A3) The stroke volume of the heart increases in response to an increase in the volume of blood filling the heart i.e. the end diastolic volume. The increased volume of blood stretched the ventricular wall causing cardiac muscles to contract more forcefully (inotropic)

1) What is the Bainbridge Reflex?

2) What Act of law relates to controlled drugs?

3) What enables a Paramedic to administer controlled drugs?

A1) The Bainbridge reflex is also called the Atrial reflex and is an increase in heart rate due to an increase in Central Venous Pressure. Increased blood volume is detected by baroreceptors located in both atria at the venolateral junctions – baroreceptors detect arterial pressure and adjust heart rate accordingly.

A2) Health Act 2006

A3) Legal exemption under “Prescriptions only medicine” order 1997, provision 7. The life saving administration in an emergency

1) Describe the process of the heart

A1) Deoxygenated blood from the superior/inferior vena cava fills the right atrium; tricuspid valve opens to allow blood to fill right ventricle; tricuspid valve closes to prevent backflow; right ventricle contracts and pulmonary valve opens; blood fills the pulmonary artery to travel to the lungs for oxygenation. Oxygenated blood arrives back at the left atrium via 4 pulmonary veins; the mitral valve opens to allow the blood to move into the left ventricle. The contraction of the left ventricle open the aorta valve and oxygenated blood travels through the aorta to the rest of the body

1) What are the 3 functions of the nervous system?

2) Describe the layers of meninges

A1) RIC= R; Recieves stimuli from outside/inside the body and analyses to produce the appropriate response

I; Integrate and unify the different functions of organs, tissue and cells

C; Conveyed Impulses from the brain to stimulate or depress activity in muscles, glands and tissues

A2) Dura Mater = Tough fibrous double membrane which lines the skull and spinal column

Arachoid Mater= Delicate serous membrane with CSF underneath

Pia Mater = Inner membrane which is rich in blood and attached to the surface of the brain

1) What is a ligand?

2) What does the lock and key analogy refer to?

3) Bonding between a protein and ligand is usually reversible –

what happens when this takes place?

4) Why does liver disease slow drug metabolism?

5) Name the 3 types of muscle

6) Define osteoclasts

7) Define osteoblasts

A1) A mechanism that allows substances into a cell

A2) refers to a high degree of specificity

A3) The receptor site is permanently blocked = no response

A4) Liver disease causes a reduction in enzymes. The liver assists in the excretion of medication so if its not working properly it allows the enzymes to remain and become toxic. The liver metabolises water soluble metabolites which are toxic to the liver if it becomes over saturated

A5) Smooth, cardiac, striated skeletalA6) Clear debris (50+ white blood cells); reabsorbs and breaks down bone matrixA7) Builds new bone; osteogenic cells divide to form osteoblasts; osteoblasts secrete collagen and build bone from osteocytes

1) How does Aspirin work?

2) Which receptors do Nalaxone attach to?

3) Name the two cholinergic receptors

4) How do you calculate pulse pressure?

5) How do you calculate mean arterial pressure?

6) How does benzylpenicillin work?

A1) Prevents clotting by inactivating cyclooxygenase

A2) Delta, Kappa, Mu

A3) Nicotnic and Muscarinic

A4) Systolic minus diastolic

A5) MAP = diastolic + pulse pressure divided by 3

A6) Interfering with the ability of bacteria in forming a cell wall. It impairs the bond of the wall allowing holes to form. Destroys transpeptidase which is needed by bacteria for cell walls. This allows interstitial fluid to enter the cell and osmotic pressure ruptures the bacteria

1) Define Osteoporosis

2) Define Osteomylitis

3) Define Muscular Dystrophy

A1) Metabolic bone disorder = rate of bone reabsorption is greater than bone formation resulting in decreased bone mass. Loose calcium and phosphate causes bones to be porous and brittle

A2) Bone infection = may be fungal or bacterial and results from a route into the bone from invasion or disease. Could be attributed to poor aseptic technique in IO or diabetes

A3) Umbrella term for nerves affecting muscles and is also known as Duchennes. Muscle fibres are replaced with fibrous tissue

1) What is gout?

2) Define Osteoarthritis

3) Define Rheumatoid Arthritis

A1) Over production of uric acid causing red, swollem and painful joints

A2) Localised wear and tear disease due to aging when cartlidge is worn down. This is mechanical degeneration

A3) Not due to mechanical degeneration. This is an auto immune disease and can affect all joints so is not localised. The bodys own immune system causes inflammation of joints. Usually affects both sides of the body. The synovial membranes become enflamed and vasodilation occurs causing increased permeability leading to hard granular pus. Enzymes/inflammatory mediators are released and cartlidge is destroyed. Panas builds up and hardens

1) What is myasthenia gravias?

2) What is Stills Disease?

3) What nerve affects carpal tunnel syndrome?

4) What is ankylosis?

A1) Presents like Stroke as facial muscles weaken first. It is a neuromuscular disorder caused by auto immune response blocking ACH receptors preventing contraction. This can be caused by tumor of the thymus gland

A2) A form of arthritis characterised by spiking temperature and a salmon coloured rash (mainly affecting children)

A3) Median Nerve

A4) Abnormal stiffening and immobility due to bone fusion at the joint

1) What can cause hypoglycaemia?

2) What are the signs and symptoms of hypoglycaemia?

A1) Overdose of insulin; metabolic disorder; sepsis; inadequate food intake; vomiting/diarrhoea; excessive alcohol; exercise

A2) Shallow to normal resps; headache; dizziness; nausea; aggression; uncoordination; rapid onset; pale and sweaty; confusion; drowsiness; seizure; hunger; anti social behaviour; speech difficulty; palpitations; odd behaviour

1) What are the signs and symptoms of Croup?

2) What is Croup?

3) How do you manage Croup?

A1) Stridor, barking cough; shortness of breath; sluggish; pyrexia; dyspnoea – typically preceded by an upper respiratory infection

A2) Croup is caused by a virus that affects the entire laryngo-tracheal tree; usually self limiting but can result in airway diameter reduction due to swelling causing obstruction.

A3) Position pt upright; deliver oxygen therapy if tolerated without distressing the child. Reassure the patient and child; Pt requires Dexamethasone from appropriate source; this is a glucocorticosteroid that suppresses the inflammation by decreasing inflammatory mediators, activity of inflammatory mediators and decreasing odema and mucous production. It also increase the number of B2 receptors and their responsiveness

1) What are the signs and symptoms of Emphysema?

2) What is the management?

A1) Patients with Emphysema are typically referred to as Pink Puffer as they are pursed lipped puffing and red in the face. This is due to trying to force air out. Patients present as thin, tachycardic, tachypnoeic; dyspnoea; using accessory muscles, tripod position, cyanosis, hypertensive

A2) Ensure open airway; Salbutamol therapy and upright positon, reassure and coach resps, Ipatropium bromide where appropriate; escalate treatment to Hydrocrtisone if applicable

1) What are the 6 stages of hospital care?

A1) 1) Survey the scene – dangers, casualties, backup, mechanisms of injury,

1) Primary survey – rapid assessment of patient. cABCD2) Secondary survery – Medical model3) Patient management and treatment/outcome4) Reassessment 5) Pre alert where applicable

1) What is the management of a pelvic injury?

2) What is the reason for immobilisation of a pelvic fracture?

3) What does a sunken fontinelle suggest in babies?

A1) Do not allow the patient to pass urine; make as comfortable as possible; do not spring the pelvis; immobilise knees and ankles to prevent movement; pain management; trauma alert

A2) To support and steady limbs which will reduce paint and prevent further risk of damage

A3) Dehydration

1) What are the associated temperatures and signs to show hypothermia?

A1) 35-36C = Shivering or sensation of col

34-35C = Confusion or amnesia

33C = Shivering ceased and replaced by muscular rigidity, irregular pulse

31C = Noticeable drowsiness

30-33C = Loss of reflexes and pupils dilated

24 - 28C = Pulse absent – apparent death

1) How much blood is considered to be signs of post partum

haemorrhage?

2) How long should stage 3 labour be?

3) Define the 3 stages of labour

4) What are the 4 ways in which body heat is lost?

A1) 500mls

A2) 15-20 mins

A3) First Stage is the longest and cervix gradually dilates; second stage the baby descends through the birthing canal; Third stage is the expulsion of the placenta

A4) Convection – Carried from the body by moving airConduction – Passing from the body into a solid objectRadiation – Dissipating into surrounding airEvaporation – lost by wet skin or clothing

1) What are the respiratory differences between adults and

children?

2) How would you recognise respiratory distress in a child?

3) Which pulse do you check on paediatric patients?

4) What are the SIDS risk groups

5) Suggest some possible cardiac arrest causes in children

A1) Lungs are immature; higher respiratory rate; higher metabolic rate/oxygen uptake; chest wall is more compliant and soft and springy; Children under 6 months are obligate nasal breathers

A2) Nasal flaring, head bobbing/grunting, subcostal recession, central cyanosis, panic/fear

A3) Brachial

A4) 1-6 months; parents sleeping with babies; sleeping prone; parental smoking; young mothers; premature babies; socioeconomic factors; male babies

A5) Hypoxia; acidosis; cot death; trauma; congenital defects; deliberate malice

1) What are the 10 major body systems?

2) What is the definition of an organ?

A1) Circulatory; Lymphatic; Digestive; Reproductive; Muscle; Skeletal; Respiratory; Nervous; Urinary; Endocrine

A2) A collection of tissues organised to carry out specific function

1) How many ribs are there?

2) Name the 3 sections of the sternum

3) What is the largest muscle in the respiratory system

4) Name the two accessory muscles

A1) 12 pairs of ribs – 7 pairs of true ribs, 3 pairs of false ribs, 2 pairs of floating ribs

A2) Superior section is Manubrium Sternum, Medial Section is Body of Sternum, Inferior section is Xiphoid of Sternum

A3) Diaphragm

A4) Sternocleomastoid and Scalene

1) What is the pressure of air at sea level?

2) What part of the brain regulates the respiratory centre?

3) What nerve controls inspiration?

4) What nerve controls expiration?

5) Where are the apneustic and pneumotaxic centres locate?

A1) 760 mmHg (mmHg= Mercury)

A2) Medulla Oblangata

A3) Inspiration is adjusted by the apneustic centre; expiration is adjusted by the pneumotaxic centre

A4) Located in the Pons (superior to the Medulla Oblangata

1) What is a Pneumothorax?

2) What are the 3 types of Pneumothorax?

3) What is a Flail Chest?

4) Describe the signs and symptoms of a Flail Chest

A1) Air in the lung cavity (Pleural Cavity) caused by penetrating chest injury

A2) Spontaneous Pneumothorax; Open Pneumothorax; Tension Pneumothorax

A3) Stove in the chest – one side rises and the other is sucked in caused by 2 or more rib fractures in 2 or more place

A4) Paradoxical movement when breathing

1) How do you calculate pulse pressure rate?

2) What is subcutaneous emphysema?

3) What is the myocardium?

4) What is the Pericardium?

A1) Difference between Systolic and Diastolic

A2) Air escaping into the subcutaneous tissue giving a crackling sound

A3) Blood filling the pleural cavity caused by damage to the blood vessels.

A4) Heart Muscle

A5) Heart Sac

1) What is the PH level of blood?

2) Where are chemoreceptors located?

3) What happens to the Ph level during hyperventilation?

4) What is the Buffer System?

5) What do chemoreceptors do?

6) How much O2 do you give to a COPD patient?

A1) 7.4

A2) In the Carotid and Aortic bodies

A3) Increasing the Ph level to become more Alkaline as breathing in too much Carbon Dioxide

A4) The body’s wat of regulating Acid in the body

A5) Detect level of CO2

A6) 28% maximum due to hypoxic drive and o2 sensitivity

1) What are the components of the lower airway?

2) Where for external respiration take place?

3) Name the two layers in the pleural cavity?

4) What disease affects the pleural cavity?

5) What fluid is contained in the pleural cavity?

6) What is the junction called where the trachea divides into

the bronchus?

A1) Trachea; Bronchi; Diaphragm

A2) Alveoli

A3) Visceral Pleura and Parietal Pleura

A4) Pleurisy

A5) Serous

A6) Hilum

1) Which nerve controls respiration?

2) Where does it originate from?

3) Which nerve controls the intercostals muscles?

A1) Phrenic Nerve

A2) C3, C4, C5

A3) Intercostal Nerve

1) What is the anatomy of the upper airway?

2) What is the function of the nasal cavity?

3) What is the narrowest part of the upper airway in adults?

4) What is the larynx made up of?

A1) Pharynx (Nasopharynx; oropharynx; laryngopharynx); larynx (houses the vocal cords); Trachea (anterior to oesophagus)

A2) Warming, filtering, moistening

A3) Rimaglottis

A4) 9 Cartlidges 3x single cartlidge and 2 pairs of cartlidge

1) How many cavities are there?

2) What organs are contained in each cavity?

A1) There are 4 cavities –

A2) Cranial Cavity contains the brain, cranial nerves, blood vessels; the Thoracic cavity contains the heart, lungs, oesophagus, diaphragm, trachea, bronchi and aorta; The Abdominal cavity contains the stomach, liver, duodenum, ileum, gall bladder, spleen, adrenal glands; the Pelvic cavity contains the reproductive organs, bladder

1) What is pulsal paradoxis?

2) What is hyporessonance? Hyperressonance?

3) What are the signs and symptoms of a Tension

Pneumothorax?

A1) The pulse disappears when inhaling

A2) Hyporessonance = high echo sounds in lungs signifying air build up; Hyperressonance = dull sounds in lower lungs due to fluid builds up

A3) Extreme respiratory distress; increasing cyanosis; tracheal shift; severe pain; diminished breath sounds on the affected side; narrow pulse pressure; subcutaneous emphysema

1) What are the cartlidges called in the trachea? How many are

there?

2) Where does internal respiration occur?

3) What vessels carry Oxygenated blood?

4) What carries deoxygenated blood?

A1) Hyaline Cartlidges – 16-20 C shaped

A2) At the tissue; O2 is given to relevant organs

A3) 4 Pulmonary Veins

A4) 2 Pulmonary arteries

1) What are cells?

2) What are the 4 main functions of a cell>

3) What 3 things do cells need?

4) What are nutrients?

A1) The smallest unit of function in the body

A2) Produce energy; repair tissues/organs; build or replace old cells; provide raw materials for chemical synthesis

A3) Oxygen, water and nutrients

A4) Carbohydrates; lipds; proteins; vitamins; minerals

1) How many types of tissue are there? Name each one

2) Name the 3 types of muscle tissue?

3) Name the 4 types of epithelial tissue?

4) Name the reversible causes within a cardiac arrest

A1) Nervous Tissue; Muscle tissue; Connective tissue; Epithelial tissue

A2) Skeletal (voluntary), Smooth (involuntary), Cardiac (heart only)

A3) Simple Squamous i.e. lungs; Simple Cubodial i.e. Kidneys/Glands; Simple Columnal i.e. Digestive organs; Stratified Squamous i.e. outer skin/vagina

A4) Hypoxia, Hypothermia, Hypokalaemia, Hypovolaemia, Toxins, Tension Pneumothorax, Tamponade cardiac, Thrombosis

1) What is Asthma

2) Name the 4 receptor types

3) What are the roles of glucocorticoid steroids in Asthma

A1) Inflammatory disease; episodic obstruction of the small airways; IgE antibodies to allergens which embed themselves in the membrane of mast cells; repeat exposure to allergencs disrupt mast cell membranes which then release pro-inflammatory mediators Histamine. This leads to broncho constriction, mucosal oedema and the activation of other inflammatory cellsA2) Classic = part of the membraneEnzyme = Intra/extra cellular and results in increase/decrease metabolic reaction

Ion Channel = 2 types (Ligand and Voltage Gated) = Ligand spans the membrane and when a drug binds to it opens and changes the flow if ions across. Voltage causes and action potentialTransport = against a concentration gradient or slightly lipid solubleA3) Suppress inflammation by decreasing synthesis and release of inflammatory mediators; decrease activity of inflammatory cells; decrease oedma of airway mucous. Decrease mucous production and viscosity of secretions. Increase the number of Beta2 receptor sites and responsiveness to Beta2 agonist

1) What modifications are added to ALS in hypothermic

patients?

2) What modifications are applied to pregnant women in ALS?

A1) Take up to 1 min to assess for signs of lifeDo not give repeat doses of AdrenalineDefibrillation is less effective but can be used up to 3 times whilst core is <30cNever stop CPRDeath can only be confirmed when the patient core temperature is +30c

A2) Left lateral tilt by 30 degrees to remove pressure from the inferior vena cavaUterine displacementEarly intubation due to increased risk of vomiting

1) How many membranes are there and examples of each

2) Explain coughing

A1) Synovial fluid eg Knee JointCutaneous Membrane eg SkinMucous Membrane used to move infection

Serous membrane (pleural cavity, pericardium, peritoneum). Two membranes contain serous fluid to reduce friction/surface tension

A2) A physiological reflex. The reflex acts in the bronchial walls where afferent nerves transmit a signal to the cough reflex centre in the brain stem. The message relays back to the muscles of the larynx and ventilator muscles. The larynx occludes the airway and the muscles start a fast forceful contraction preparing for a powerful expiratory breath. The larynx opens and the breath is expelled at force.

1) Explain how Morphine works

2) What is Emphysema

A1) Morphine is an agonist for opiod receptors. Opiod receptors are neurons involved with pain perception. When Morphine binds, the result is potassium channels open and an efflux of potassium from the neuron and the cell excitability decreases. This means the number of action potentials that reach the brain is reduced which means less pain. Morphine is a respiratory depressant = reduction in Co2 sensitivity . Stimulates the chemoreceptors trigger zone in Medulla Oblongata to vomiting centre to stimulate vomiting.

A2) Tissue degeneration of alveoli and capillary beds leading to a reduction of elasticity and collapse of small airways which compromises ventilation and gas exchange

1) Explain how Aspirin works

2) Explain how Diazepam works

A1) Is an anti pyretic; anti inflammatory and analgesic – Aspirin inhibits the enzyme cyclooxygenase and prevents the formation of prostaglandin and thromboxanes from fatty acids located int he cell membrane

A2) An anticonvulsant, anti anxiety. Sedative/hypnotic with muscle relaxing qualities. Potentiates GABA-ergic neurotransmission (increasing the affinity of GABA), thus there is increased conduction of chorine ions which produce membrane hyperpolarisation. This induces a neuronal inhibition making the neurone less excitable and causing CNS depression. Highly lipid soluble and diffuses across the rectal membrane

1) Name short acting Beta2 Agonists?

2) Name long acting Beta 2 agonists?

3) What do Beta agonists do?

4) How does Cocaine work?

5) What causes Diabetic insipidous?

A1) Salbutamol; Fenoterol

A2) Bambuterol; Terbutalin; Formaterol; Salmeterol

A3) Causing relaxation by stimulating B2 receptors in airways smooth muscle resulting in dilation; Also increase the capillary transport of mucous and decreases the release of mediators which casue odema

A4) It works by blocking the re-uptake of Dopamine into the re-synaptic cleft leaving more Domine in the cleft for longer

A5) A deficiency in Antidiuretic hormone due to damage to the pituitary gland

1) Morphine is which classification drug?

2) What drug is schedule 3?

3) How many part does schedule 4 have?

4) What is schedule 5 drug classification?

A1) Schedule 2 1973 misuse of drugs act

A2) Midazolam

A3) Two parts – Part 1 is Benzodiazipines (apart from Midazolam) and Part two is Anabolic Steriods/Growth Hormones

A4) Preparations that contain schedule 2 drugs in low concentration so are exempt from controlled requirements

1) Name the directional terms when describing the body

A1) Superior – higher or upper thanInferior – lower or underneathLateral – to the side or side of the bodyMedial – centre of the bodyProximal – toward a jointDistal – away from joinAnterior – frontPosterior – back

1) Describe the phases of metabolism in the Liver

2) Explain absorption of drugs

A1) The two phase are needed for a drug to become water soluble:Drug is modified to a reactive metabolite that can bond with other molecules

It fuses with other compounds to form a water soluble complexThese can be excreted in urine or bile

A2) Taken in and absorbed from the intestine. They then go to the Liver via the hepatic portal vein. From the Liver (following metabolism) drugs are excreted into inferior vena cava (known as first pass metabolism). From the Kidneys, blood passes through kidneys in blood vessels in the glomerulus and is filtered by the glomerular membrane of the Bowmans capsule. This capsule is found in the renal nephron

1) In normal adults, explain the amounts of lung volume and capacities

A1) Tidal Volume – 500mlInspiratory Reserve Volume (extra air that can be inhaled during exertion) – 3100mlInspiratory Capacity Volume = A+B together = 3600ml Maximum inspired

Expiratory reserve volume (air forced out) = 1200mlResidual volume – 1200ml

Vital capacity (inspiratory capacity+expiratory capacity) = 4800ml

Total lung capacity = 6000ml

Anatomical dead air space = 150ml

1) What is the composition of Air (inspired and expired)

2) Why is expired oxygen still effective in CPR

A1) Inspired Expired

Oxygen 20% 16%

Nitrogen 79% 79%

Carbon Dioxide 0.04% 4%

Water vapour Variable to saturation

Inert Gas 1% 1%

A2) As it still contains 16% O2

1) Define diffusion

2) Define Osmosis

3) Name the 2 types of Glands

4) What tissue are glands formed from?

5) What factors can affect/increase cellular diffusion

A1) The movement of particles from an area of high concentration to low concentration

A2) The movement of a solvent or liquid through a semi permeable membrane to make concentration levels equal

A3) Endocrine; Adrenal, Thyroid (these secrete into the bloodstream and are DUCTLESS)Exocrine glands; Nose, Liver, gallbladder (Secrete to the surface via DUCTS)

A4) Epithelial cells (glandular epithelial)

A5) Increased temperature or increased Carbon Dioxide

1) Name the muscles between the ribs?

2) Describe the mechanics of respiration

A1) Intercostal muscles (internal and external)

A2) Air is drawn in and the ribs move up and out; diaphragm contracts and flattens; intrathoracic pressure lowers – this is an active process!

The ribs move down and in, the diaphragm relaxes and moves up, intrathoracic pressure rises and air is forced out – called elastic recoil and is a positive process

1) What is Bradypnoea?

2) What is Tachypnoea?

3) What is Dyspnoea?

4) What is Hypoxia?

5) What is hypocapnia

6) What is the waste product of respiration

A1) Slow breathing

A2) Fast Breathing

A3) Difficulty laboured breathing

A4) Lack of O2 in blood

A5) Low Co2 in the blood

A6) Carbon Dioxide

1) Name the contents and functions of these in a cell

Nucleus; The brain or control centre – contains DNA for instruction and chemical makeup (also contains RNA for cell to cell communication)

Gogli Apparatus; Packaging of enzymes for exocytosis

Ribosomes; Protein production

Mitochondria; Energy ATP production

Cytoplasm; fluid for suspension (intracellular 70% and extracellular 30%)

Plasma membrane; semi permeable, phospholipid bilayer

Rough endoplasmic reticulum; Lysosomes

1) Name the 9 regions of the abdomen

2) What does the acronym ACE mean

3) Explain what ACE inhibitors are

4) What does Angiotensin 2 cause?

5) What do ACE inhibitors cause and why?

A1) Right hypochondriac epigastric left hypochondriacright lumbar umbillical left lumbarright iliac fossa hypogastric left iliac fossa

A2) Angiotensin Converting Enzymes

A3) These inhibit angiotensin conversion by binding to the enzyme and preventing function. They stop angiotensin 1 from converting to angiotensin 2

A4) Angiotensin 2 stimulates smooth vascular muscle causing contraction (leads to high BP)

A5) Preventing Angiotensin conversion stops the contraction of the vascular muscle so it stays relaxed and therefore keeps BP low or lowers BP

1) What does the thymus do?

2) What do the adrenal glands do ?

3) Name the parts of the adrenal glands?

4) Thyroid problems are called Hypo/Hyper thyroidism (name the exacerbation of these)

5) Major signs and symptoms of Thyrotoxicosis and Myxoedma

A1) The Thymus controls the release of T cells and Lymphocytes which are responsible for immune system

A2) Adrenal glands sit atop the kidneys and have two parts to them – the Medulla and the Cortex

A3) The Medulla releases Adrenaline; The Cortex releases Cortisol and Aldosterone

A4) Thyrotoxicosis (Hyper) and Myxodema (Hypo)A5) Thyrotoxicosis = Agitation/psychosis; fine downy hair on skin;

Graves disease (bulging eyes); tachycardia; pyrexia; increased metabolic rate

Myxodema = Hard non pitting odema; flaky skin; puffy face; enlarged tongue; husky voice

1) Within the nervous system, what do somatic and visceral mean?

2) Which neurotransmitters are used in the sympathetic nervous system and parasympathetic nervous system

3) Describe the difference in sympathetic and parasympathetic responses

A1) Visceral = around organs; somatic = conscious act

A2) Sympathetic = Adrenergic (on smooth muscles), Noradrenaline

Parasympathetic = Acetylcholine (relates to cholinergic)

A3) Sympathetic = pupils dilate, HR increased, reduced peripheral circulation, decrease in GI tract, inhibits mucous in Bronchi

Parasympathetic (cholinergic) = pupils constrict, HR decreases, stimulate bronchial secretion, increases GI motility

1) State the 3 elements that comprise ‘Consent’

2) What 3 incidents where there is a requirement for the police involvement in sudden death?

3) State the indications where forced entry is permitted by ambulance

4) What are the guidelines for forcing entry to a property

A1) Capacity = Comprehend, retain, analyse and communicate their decision)

Volition – makes a conscious decision with the freedom of choice without coercion

Information – honest, full and clear information including consequences to make full and informed decision

A2) Suspicious circumstances; crime committed; public placeA3) If you can see or hear a patient or unresponsive patient or a reasonable

belief that life is in dangerA4) Check to see if other entry point; contact police but don’t delay if life in

danger; least amount of damage to gain entry; reasonable belief life in danger

1) State the differences between stable and unstable angina

A1)

Stable is typically brought on following exertion whilst unstable commences at periods rest; Stable has a 50% reduction of lumen and unstable has 90% reduction; Stable is shorter lasting and passes following the use of nitrates or rest; Unstable suggests the pattern of angina has changed and the frequency or intensity of pain has altered;Stable is a build up of lactic acid irritating nerve endings and unstable is plaque eruption or rupture of atherosclerotic plaque triggering an inflammatory response

1) What is Addisonian Crisis?

2) Signs and Symptoms – treatment of Addisonians

3) What is Cushings Syndrome?

4) Signs and symptoms of Cushings

A1) Acute adrenal insufficiency resulting in decline of Cortisol and Aldosterone

A2) Hypoglycaemia; vomiting; cramps; craving salty food; diarrhoea; hypotension; arrhythmia - Hydrocortisone, potentially anti emetic and glucose if appropriate

A3) Opposite to Addisons – excess production of Cortisol

A4) Thin legs but large trunk; tired and depressed; increased urination; increased thirst; acne; facial hair growth; repeat infections.

1) What are the sign and symptoms of ectopic pregnancy?

2) What are the signs and symptoms of Pelvic Inflammatory

disease?

3) What are the signs and symptoms of a UTI?

4) What additional signs would be associated with kidney

stones

A1) Pain in lower abdomen, pelvic area or back; nausea; missed menstrual cycle; history of PID; previous ectopic; shoulder tip pain; feeling faint or collapse

A2) Pain in lower abdomen; abdominal tenderness; vaginal discharge; nausea; fever

A3) Pain in the lower back; pain/burning when urinating; cramping pain; polyuria or nocturia; malodour of urine; dark colour urine; cloudy urine; haematuria; fever, fatigue, increased confusion or falls

A4) Pain in back/sides radiating into the groin; pallor; sweaty

1) Which bone elements contain red marrow

2) What contains yellow marrow

3) When one bone forms a joint with another bone, what replaces the periosteum?

4) On a long board, where should the straps be placed?

5) What are the 5 spinal board manoeuvres?

A1) Spongy cancellous bone

A2) Medullary canal

A3) Articular cartlidge

A4) Chest, pelvis, lower limbs

A5) Rear extricationEmergency side extricationOrthopaedic stretcher to lift on to long boardLog roll manoeuvres Rapid take down

1) What is the main problem in cerebral compression?

2) What is the period of awareness called inbetween consciousness and unconsciousness?

3) What are the risks associated with a cervical collar?

A1) Water as blood volume in the brain is reduced

A2) lucid interval

A3) Airway difficulties (always have suction available); increased intercranial pressure: increased risk of aspiration; restricted respiration; dysphagia (inability to swallow); skin ulceration; discomfort/pain/anxiety

1) What are the 4 pressure points in controlling bleeding?

2) What burns are caused by dry heat

3) What burns are caused by wet heat?

4) What are the 3 dangers in thermal burns?

A1) Carotid, subclavian, femoral, brachial

A2) Flame/radiation (thermal); electricity; friction; corrosive chemicals

A3) Water; steam; fat; hot liquid chemicals

A4) Shock caused by loss of body fluids; infection; damage to respiratory tract

1) From the following organs, what type of blood would you see if they were damaged? Lungs, Stomach, Kidneys, Intestine, Brain

2) How do you assess the severity of bleeding using clinical indicators?

A1) Lungs – bright red, frothy – coughed up through trachea and airway. Called Haemoptysis

Stomach – dark coffee coloured

Kidneys – smoky grey coloured urine (Haematuria)

Intestine – black sticky stool – Malaena

Brain – escapes through ears/eyes/nose (epistaxis is nose bleed)

A2) Pulse – fast but weak as condition deteriorates; Respiration increases but pt develops air hunger; pupils dilated, skin is ashen and pallor deteriorates, cold extremities and cyanosys develops, hypotension

1) What are the 6 causes of seizure?

2) What does METHANE stand for in relaying information?

A1) Cardiac dysrthymia Cerebral damage from infection i.e. encephalitis or meningitisBrain injury at birth (lack of O2)Cerebral haemorrhage or tumorBrain traumaCryptogenic (unknown cause in at lease 60% of patients)

A2) M= Major incident (declared or suspected)E = Exact location of incidentT = Type of incidentH= Hazards present and potentialA = Access and egressN = Number of casualtiesE = Emergency service require police fire HART etc

1) What is syncope?

2) What are the 3 types of fainting?

3) What is the management of fainting?

A1) Fainting

A2) Postural fainting; Emotional stress; Cardiac origin

A3) Position pt recumbent to facilitate cerebral reperfusion; loosen tight clothing; elevate lower limbs to facilitate venous return

1) What is a ganglion?

2) What is contained in grey matter?

3) What 2 things are needed for a neurone to convey an

electrical impulse

4) What ions are needed to cross the plasma membrane to

achieve an action potential?

5) What ions are where during a resting potential?

A1) A group of cells that lie outside the CNS

A2) Cell bodies, dendrites, nonmylienated axons, axon terminal and neuroglia

A3) Specific ions channels and the existence of a resting membrane potential

A4) Sodium (Na+), Potassium (K+), Calcium (Ca+), Chloride (Cl-)

1) What is the hearts pacemaker called?

2) What is the function of the AV node?

3) Where does the myocardium receive its blood supply?

4) What is portal circulation?

5) What are the differences between arteries and veins?

A1) Sinoatrial Node (SA Node)

A2) To relay the impulse generated by the SA Node

A3) Coronary Arteries

A4) A branch of the systemic circulation which carries blood to and from the Liver

A5) Arteries carry blood away from the heart and have a strong outer coat and muscle. Veins carry blood back to the heart and have thinner walls and valves to prevent back flow

1) What are Ureters?

2) What is the bladder?

3) What is the Urethra?

4) What are the female reproductive organs and their

location?

A1) Two tubes (one from each kidney) 25-30cm long that connects the kidneys to the bladder

A2) A muscular bag which is a reservoir for holding urine. It lies in the pelvic cavity but rises out when full. It can hold 300ml of urine but capable of holding more

A3) The canal leading from the bladder to the outside

A4) The uterus lised between the bladder and rectum and has two fallopian tubes running out towards to two ovaries which produce Ova

1) What are the 5 types of wounds?

2) What are the 2 types of wound bleeding and the

differences?

3) What does the management of wounds centre of?

4) What are the common eye injuries?

5) What should you do when treating an eye injury?

A1) Incision; Puncture; Laceration; Contusion; Gunshot

A2) External – Arterial spurts, venous constant flow/trickle, capillary oozes to the surface

Internal – Into the cavities i.e. thoracic, abdominal

A3) Control of bleeding; prevention of infection; prevent further complications

A4) Chemical contamination; embedded objects

A5) Cover both eyes

1) How many axons are in a neuron?

2) What is the characteristics of the neurones?

3) What do neurones need a constant supply of and why?

4) What is irritability in the nervous system?

5) What is conductivity in neurones?

A1) One

A2) Conductivity and Irritability

A3) Glucose and O2 – Glucose allows the neurone to produce chemical energy

A4) Initiate a nerve impulse in response to stimuli

A5) Transmitting a nerve impulse

1) What are anastamoses?

2) What are cusps made from within the semi lunar valves?

3) What size cannulas relate to the following colours? Orange,

Grey, Pink, Green, Blue

4) How many types of Shock are there – names?

A1) An artery which forms a link between main arteries and provides alternative collateral circulation. Anastamoses create an alternative route when one is occluded, ischaemic or necrotic

A2) Tunica Intima

A3) Orange 14g, Grey 16g, Green 18g, Pink 20g, Blue 22g

A4) 5 - CardiogenicHypovolaemicNeurogenicAnaphylactic Toxic

1) Describe the 4 stages of shock

2) What are the Signs of Appendicits

A1) Stage 1 – Upto 15% blood loss – pallor, normal cap refill, increased pulse upto 100Bpm, Normal BPStage 2 – 15%-30% blood loss – Pallid clammy, cool skin, cap refill over 2 secs, 100bpm+, tachypnoeaStage 3 – 30%-40% blood loss – Anxiety, restlessness, >120bpm, low systolic pressureStage 4 – 40%+ blood loss – moribund appearance, weak pulse, loss of radial, respiratory distress, altered consciousness

A2) Pain in lower right quadrant although early stages can present in umbilical region; rebound tenderness however mindful of palpation as not to rupture appendix, pain on raising legs, pyrexia, nausea and vomiting

1) Name the 4 Generalised seizures and describe

2) What are the 3 partial seizures

3) What are the 3 categories of seizure?

A1) Tonic Clonic (AKA Grand Mal) – rigid and falls to the ground jerking all over; trismus; excessive salivation; cyanosisTonic – Stiffness and falls – no jerkingAtonic – Loss of muscle tone, falls – sometimes called a drop attackAbsences – blank staring, fluttering eyelids, head bobbing – Called Petit Mal

A2) Simple Partial – Conscious and normal awareness; pins/needles; unusual smell/taste; localised jerkingComplex Partial – Altered consciousness, plucking at self – can appear drunk

Secondary generalised – Develops from the above into a full Tonic ClonicA3) Generalised, partial and status epilepticus

1) The skin is part of which body system?

2) What protein helps waterproof the skin?

3) What is the function of the Stratum Corneum?

4) What is the function of the Stratum Basale?

5) Where are hair follicles/sweat glands found?

6) Where is adipose tissue found?

A1) Intergumentary

A2) Keratin

A3) Layers of Epidermis containing dead Keratinocytes

A4) Layer of Epidermis contain dividing Keratinocytes

A5) Dermis

A6) Subcutaneous Layer

1) What brings blood back to the heart2) What does myogenic mean?3) Define stroke volume4) Name the correct sequence of layers for the filtration of

molecules5) Name the pressure due to fluid in the lumen of the bowmans

capsule6) Name the pressure due to proteins remaining in the glomerular

blood7) What pressure is due to high pressure of blood in the glomerulus?8) What part of the nephron does most reabsorption occur?

A1) Pulmonary veins and vena cava

A2) Ability of cardiac muscle to contract without stimulation

A3) Volume of blood leaving the heart at each beat

A4) Blood – Glomerular endothelium – Basal Lamina – Filtration Slits

A5) Capsular Hydrostatic pressure

A6) Blood Colloid Osmotic Pressure

A7) Glomerular Blood Hydrostatic Pressure

A8 ) Proximal Convoluted Tubule

1) Suggest cardiac risk factors and why

2) Name the 3 layers of the heart

A1) Smoking – Speeds up atherosclerosis as chemicals cause narrowing of the lumenAlcohol – causes higher viscosity changes and arrhythmiasObesity/Poor Diet – High Sugar Increases BM; High fat increases cholesterol; High Salt increase kidney dysfunction Age – elderly have less elasticity of muscles and lowered metabolismStress Workload – can increase hypertension causing stress of preload of the heartOral Hygiene – Can lead to endocarditisDiabetes – irregular control of sugars

A2) Endocardium – Inner layerMyocardium – MusclePericardium – Outer Sac to prevent over distension of the heart

1) Explain Inotropic

2) Explain chronotropic

3) Explain Dromotropic

4) Give examples of medication to increase and decrease

above effects

A1) Inotropic affect the force of cardiac contractions

A2) Chronotropic affects the rate of the heart

A3) Dromotropic affects the conduction velocity

A4) Inotropic effectors include Adrenaline or Dopamine – Antagonists to slow force include Propanalol

Chronotropic agonist include Adrenaline – Antagonist to slow rate include Digoxin

Dromotropic agonist include Phenytoin – antagonist to slow conduction velocity include Verapamil

1) What is the largest gland in the body?

2) How many lobes foes the liver have?

3) What does the portal vein do?

4) What carries arterial blood in the liver

5) Where do the left and right hepatic ducts carry bile to?

6) What are the functions of the Gall Bladder?

A1) The Liver

A2) 4

A3) Carries blood from the Stomach, Spleen, Pancreas, Small/Large Intestine

A4) Hepatic Artery

A5) The Gall Bladder

A6) Reservoir for Bile; Releases Stored Bile; Concentrates Bile by absorbing water

1) What is the feature of 1st Degree Heart block

2) What is the feature of 2nd Degree, type 1 Heart block

3) What is the feature of 2nd degree, type 2 heart block

4) What is the feature of 3rd degree/complete heart block

A1) The P wave is greater than 5 small boxes but regular before every QRS segment

A2) The P wave intervals are differently spaced before each QRS and on occasion there is a P wave without a QRS – Mobitz

A3) P waves are present and normal but there is the occasional dropping of a beat so no QRS complex follows a P wave – Wenkeback

A4) P waves are present and regular but completely disassociated with QRS. P and QRS are independent of eachother. AV is blocking any impulse from SA Node

1) What does the SA node fire at?

2) What does the AV node fire at?

3) What do the Purkinje Fibres fire at?

4) How do you identify where the Pacemaker site is?

5) What does the P wave represent?

6) What does the QRS represent?

A1) SA = 60-100 times per minute

A2) AV = 40-60 times per minute

A3) Purkinje = 20-40 times per minute

A4) By counting the number of beats within a six square segment and multiplying by 10 – if the amount is lower than 60 the origin is elsewhere than the SA nose in an irregular heart beat

A5) Depolarisation of the Atria

A6) Depolarisation of the Ventricles

1) What are the 10 questions for reading an ECG/

2) What is normal PR Interval

3) What is normal QRS width?

A1) What is the rate?Is it Regular?Are there P waves Present?Is there a P before every QRS?Is there a QRS after every P?Is the PR interval normal?Is the QRS width Normal?Is the T wave present?Is the ST segment isoelectric?Where is the pacemaker site?

A2) 3-5 small boxes

A3) 1-3 small boxes

1) What are the signs and symptoms of Sickle Cell crisis?

2) Who are prone to Sickle Cell and what is the management

of Sickle Cell crisis

3) What is Chvosteks Sign?

4) What are fungi?

5) What do anti-fungals do?

A1) Sickle cell is an illness that affects Haemaglobin. Tiredness, weakness, fever, dyspnoea, pallor, severe pains in back/abdomen/legs, swelling of joints

A2) Accurate history taking – pt is likely to be aware of the condition. Transport and reduce movement as exacerbation of hypoxia. African, Afro Caribbean, Mediterranean, Asian and Middle East

A3) A clinical sign of hypoglycaemia and also called tetany as a result of hyperexcitability in facial nerves

A4) Eukcryotic – Single celled

A5) Inhibitors of fungal membrane synthesis

1) Describe the process of blood clotting

2) What is bioavailability?

3) What are the two types of medication storage?

4) Explain Pharmacokinetics

5) Explain Pharmacodynamics

1- Damaged platelets/tissue cells release the enzyme Thrombokinase2 -Thrombokinase, Prothrombin and Calcium salt combine to form Thrombin3 -Thrombin converts Fibrinogen into Fibrin threads4 -Fibrin threads entrap blood cells and binds them to the tissues to form a clot

A2) The amount of medication left in the body after it has passed the membranes and reached the targetA3) Within Plasma (protein bound) and Tissue Reservoir (Fat/muscle/bone)A4) Pharmacokinetics is How it gets thereA5) Pharmacodynamics is what is does when it gets there

1) Explain Pneumonia

An acute or chronic infection resulting from invading pathogen that can be viral, bacterial, fungal and affects the lung tissue

Can be primary or secondary to other respiratory disorders

Most common is bacteria called Streptoccocous and although Viral is less common, it can weaken the lung and allow secondary bacterial to take hold

Streptoccocous release a toxin called Pneumolsin that damages the blood vessels in lung tissue causing bleeding into the air space rsulting in a rust coloured sputum

Causes immune response from Leukotrienes that cause vasodilation and mucosal swelling and the macrophages engulf the invading bacteria. Alveoli fills with fluid as a result and the available area for gas exchange is reduced

1) What part of the nephron is glucose totally reabsorbed?

2) Name the epithelial cells in the respiratory tract

3) What is the assessment for Cardiac Tamponade?

4) What should you do if considering a cardiac tamponade?

5) Where is the Lunate?

6) Where is the Glenoid Cavity?

A1) Proximal convoluted tubule

A2) Cilliated Columnar

A3) Becks triad – JVD, Muffled Heart Sounds and Hypotension

A4) No fluids as could overload the system

A5) Wrist

A6) Socket where the Humerus sits

1) What type of joint is Acromialclavicular?

2) What nerve pathways are in the upper limbs?

3) Where is the greater Trochanter?

4) What type of joint is the Pubic Symphasis?

5) What is a Smiths Fracture?

6) What is a Bennetts Fracture?

A1) Synovial

A2) Ulna, Radial and Median

A3) Lateral aspect of proximal Femur

A4) Cartliganous

A5) Over flexion of the hand resulting in wrist fracture

A5) Fracture at the base of the Thumb

1) Where is breathing controlled?

2) What does Apneustic and Pneumotaxic do?

3) Where are Chemoreceptors located?

4) What nerve controls breathing?

5) What produces mucous?

6) In the lungs, what protects against pathogens?

A1) Breathing is regulated by the Medulla which receives messges from the Pins and adjusts the rate and depth of breathing

A2) Apneustic slow deep breathing and Pneumotaxic speeds the rate of breathing

A3) Aortic Arch and Carotid bodies to monitor O2/Co2

A4) Intercostal controls muscle and Phrenic controls Diaphragm

A5) Cubodial cells secrete surfactant

A6) Goblets cells, Macrophages and Phagocytes

1) Name the Endocrine Glands

2) Name the Exocrine Glands

A1) Pituitary HypothalamusPineal GlandThyroidParathyroidAdrenal (sit atop the kidneys)Pancreas (Endocrine and Exocrine)Ovaries/Testes

A2) Saliva/mucousGall BladderSweat glandsPancreas

1) Explain Bronchitis

A1) A long term condition of chronic irritation causing inflammation of the bronchial walls - causing airway obstruction due to increased mucous production and damaged cilia due to coughing

Often patients become insensitive to CO2 and depend on hypoxemia to drive ventilation – giving these patients oxygen could cause respiratory failure as these patients cannot expire co2 – hypoxic drive

Commonly get pulmonary hypertension due to the hypoxic drive causing vasodilation of the pulmonary arteries in an attempt to redirect blood flow to help gas exchange. Can lead to Cor Pulmonale

1) What is Diabetes Mellitus?

2) What are the two types of Diabetes Mellitus?

3) What is Diabetes Insipidous?

A1) A disorder which means inadequate insulin for Carbohydrate metabolism. Glucose absorbed from the GI tract cannot be metabolised or stored so reaches high than normal levels in the blood stream

A2) Type 1 insulin dependant and Type 2 non insulin dependant (Tablet controlled)A3) A rare form of Diabetes due to inadequate ADH (Antidiuretic Hormone). Water reabsorbtion by the Kidneys is ineffective leading to more than 10l of dilite urine daily causing dehydration and extreme thirst

1) What does Affinity mean?

2) What does Efficacy mean?

3) Explain the following terms; Agonist, Antagonist,

Agonist/Antagonist, Competitve Antagonism and non

competitive antagonist

4) Name factors which affect response to medication

A1) Affinity – force of attraction to receptor site

A2) Efficacy – whether it causes the desired response

A3) Agonist – Causes the expected responseAntagonist – Does not produce a responseAgonist/Antagonist – Some response but not othersCompetitive Antagonist – Can overcome with large enough dosesNon Competitve – blocks response completely – cannot be overcome

A4) Age due to metabolic rate; bodymass; gender; time of administration; genetics; environment; health and pathological state

1) Describe Boyles Law

2) Describe Henrys Law

3) Describe Daltons Law

A1) High pressure to low pressure – i.e. air is sucked into the alveoli

A2) Dependant on solubility and partial pressure – i.e. when gas comes into contact with liquid it dissolves according to its partial pressure

A3) Each gas within a mixture of gases exerts its own pressure i.e atmospheric pressure is 760mmHg

1) What are the signs and symptoms of Acute Cholecystitis?

2) What are the signs and symptoms of Intestinal Obstruction

3) Where is the Spleen located?

4) What is the function of the Spleen?

A1) Sharp pain in the upper right quadrant of the abdomen; may experience shoulder tip pain so can be confused with ectopic (check history in menstrual cycle); clay coloured stools and history of fat intolerance. Pyrexia, nausea, vomiting, pain worsening on palpation

A2) Cramping abdominal pain, abdominal distention, constipation

A3) Left Hypochondriac region

A4) Produce new white blood cells; stores red blood cells and destroys old red blood cells

1) What are the signs and symptoms of Diverticulitis?

2) What are the signs and symptoms of acute Pancreatitis?

3) Give 5 examples of non epileptic seizure

4) Define epilepsy

A1) Abdominal pain in lower left quadrant, nausea, vomiting, bloating, pain in waves, pyrexia

A2) Constant pain in upper or middle abdomen, pain may radiate into back, Abdominal tenderness, hypotension, dehydration, altered BM, history of gall stones or alcohol abuse, nausea and vomiting

A3) Meningitis; Febrile Convulsions; Hypoglycaemia; Eclampsia; CVA; Psuedo fit; Hypoxia

A4) Transient paroxysm of uncontrolled discharge of nerve tissue within the brain. Chloride channels in action potential activating too quickly

1) What does the Pineal Gland do?

2) The Pituitary gland has two parts – name them and their

function

3) What does the Paratyhroid Gland do?

4) What does the Hypothalamus do?

A1) Controls sleep/wake pattern; releases Seratonin/Melatonin. Antidepressants target this gland

A2) Anterior – dispatches the following: Thyroid Stimulating Hormone (TSH), Levtenesing Hormone for ovulation or Testosterone, Prolactin, Follicular Stimulating Hormone, Growth Hormone, and ATCH for cortisol production.

Posterior – dispatches Anti diuretic hormone and Oxytocin

A3) Controls Calcium distribution and uptake

A4) Stimulates pituitary gland to release the hormone it controls the dispatch of hormones

1) Explain the V:Q ration

2) What does V0:Q1 mean?

3) What does V1:Q0 mean?

4) Give an example of illness for V1:Q0

5) Discuss inflammation in lung tissue

A1) V:Q means Ventilation:Perfusion. The supply of O2 through ventilation and normal blood through capillary perfusion. Normal lung function is 4ltr/min and capillary blood is 5ltrs/min so normal V:Q ratio is 4:5

A2) Ventilation is reduced

A3) perfusion is reduced

A4) PE as blood is occluded at the site of diffusion

A5) Can be chronic or acute. Body sends white blood cells containing macrophages. Lungs can become fibrosed and elasticity/expansion/perfusion is reduced

1) Name some important neurotransmitters

2) How much CSF is produced by the Chroid Plexuses per hour

3) Where does the first pair of spinal nerves emerge

4) Are spinal nerves mixed nerves?

5) Where do the intercostals nerves leave the spine?

6) Where does the Femoral nerve leave the spine?

7) What are skin sensory neurones called?

8) Where does Cauda Equina exit the vertebrae?

A1) Acetycholine; Adrenaline; Seratonin; Dopamine; Noradrenaline; GABA

A2) 20mls per hour

A3) Atlas (C1)

A4) Yes

A5) T2-T12

A6) L2-L4

A7)Dermatomes

A8) L1-L5

1) What are the Digestive accessory organs?

2) What vein takes nutrient rich blood to the liver after it has

been absorbed?

3) What are the function of the Liver?

A1) Liver, Gall Bladder, Pancreas and Peritoneum

A2) Hepatic Portal Vein

A3) Secretion of BileBreakdown of Stored fat for energy use Storage of Vitamins and IronSynthesis of Plasma proteinsConversion of amino acids into UreaConversion of Glucose to Glycogen and vice versaInactivation of Drugs and HormonesProduction of HeatMetabolises AlcoholSynthesis of Vitamin A

1) What are the 3 depths of burns

2) Explain the rule of Nines in Burns

3) How much Gastric juice is secreted daily?

4) What joins the Ileum to the Colon?

5) Name the four parts of the large intestine?

6) What are the main functions of the Colon?

7) How long is the Anal canal?

A1) Erythema – slight or superficial reddening of the skin – sensation is still presentPartial thickness – reddening with blistersFull thickness – charring and sever blistering – loss of sensation

A2) Adult – Arms 9% each, Head 9%, torso 18%, Each leg 18%, groin 1%Child – Arms 9% each, Head 18%, torso 18%, each leg 14%, groin 1%

A3) 2000-3000ml

A4) Caecum

A5) Ascending colon, transverse colon, descending colon, and sigmoid colon

A6) Absorbtion of water via Osmosis; Absorbtion of mineral salts, vitamins and some drugs; Microbes synthesise Vitamin K and Folic Acid

A7) 3.8cm

1) How long is the Duodenum?

2) What opens into the Duodenum and why?

3) Why is the pancreatic juice essential to be released into the

Duodenum?

4) The Pancreas is an accessory organ, what are its functions?

5) Insulin is a hormone produced by which specialist cells

within the Pancreas?

6) How big is the Pancreas?

A1) 25cm

A2) The bile ducts from the Liver, Pancreas and Gall Bladder – to further digest proteins, carbs and fats

A3) Strongly Alkaline to counter the acid nature of the Chyme

A4) The production and secretion of Alkaline Pancreatic juice into the Duodenum; Production of Insulin to control the metabolism of GlucoseA5) Islets of Langehan

A6) 12-15cm long

1) What are the 4 stages in the digestive system?

2) What does the Alimentary tract consist of?

3) How long is the average Oesophagus? What is it lined with?

4) What are the two sphincters in the stomach?

5) What does gastric juice contain?

6) What product is produced in the stomach?

7) Where does the chyme go after the stomach?

A1) Ingestion; Digestion; Absorption; Elimination

A2) Mouth, Pharynx, Oesophagus, Stomach, Duodenum, Small Intestine, Large Intestine, Rectum

A3) 25cm mucous membrane

A4) Cardiac Sphincter and Pyloric Sphincter

A5) Water, Hydrochloric Acid and the Enzyme Pepsin

A6) Chyme

A7) Duodenum via the pyloric sphincter

1) State the conditions unequivocally associated with death?

2) What is the labelling system when in a major incident to

assess importance of patient treatment?

A1) IncinerationRigor MortisDecapitationDecomposition HaemostatisHemicorporectomy Submersion over 1.5hoursMassive cerebral haemorrhage not conducive with lifeFoetal macerationMassive trunk injury

A2) P1 – Red (Transport immediately) P2 – Yellow, P3 Green, White – Deceased

1) How long is the small intestine?

2) What is the function of the small intestine?

3) Where does the large intestine join the small intestine?

4) How long is the large intestine?

5) What also features near the intersection of the small and

large instestine?

6) Where does the colon/large intestine terminate?

A1) Over 6m in length (2.5 is Jejunum and 3.6 is Illeum)

A2) Nutrients from the chyme are absorbed into the lining of the small intestine where they are finally broken down into Sugars (Carbs), Amino Acids (proteins), Fats and Glyceryl. These are absorbed into the bloodstream,

A3) Lower right Abdomen

A4) 1.5m

A5) The Appendix

A6) The rectum which leads to the anus – 13cm long

1) Explain the inflammatory response in developing

atherosclerosis

2) How long is each part of the conduction cycle?

A1) Initial injury to the endothelium causes epithelial dysfunction; Cytokines are released; Increase of Collagen produced; Proteins and Lipids come together to form Phoam cells which encompass the damaged area; Repair leaves thickening within the Lumen causing narrowing of the space

A2) 0.8s Conduction0.1s SA node firing0.3s AV node receives signal0.4s Rest of conduction cycle

1) For capacity to be determined, there are 4 criteria a patient

must satisfy – what are they?

2) List factors that can temporarily/permanently affect

capacity?

A1) Comprehend – Understand informationRetain – Repeat the informationAnalyse – Make a rational decisionCommunicate – relay the response back

A2) Mental health; illness; injury; emotional distress; drugs or alcohol

1) Can Neuroglia generate an electrical impulse?

2) What is the function of Neuroglia?

3) Name the 4 glial cells most familiar with

A1) No

A2) Support and protect the Neurones

A3) Astrocytes – metabolise neurotransmitter and maintain potassium balance. Form a blood brain barrier

Oligodendrocytes – produce myelin and smaller than astrocytes

Microglia – protect against microbes, clear foreign debris by exocytosis

Ependymal Cells – Gilliated epithelial cells and line ventricles of the brain and spinal cord

1) What is the peritoneum? What is its function?

2) Describe the location and characteristics of the Kidneys

3) What are the 3 functions of the Kidneys?

A1) A serous membrane which lines the abdomen and covers the organs. It prevents friction, keeps organs in positions, carries blood vessels and fights infection

A2) Two Kidneys position on either side of the Lumbar vertebrae. The right is slightly lower than the Left to make room for the liver. Bean shaped and 6cm wide and 4cm thick. Each weighs approx 130g. The adrenal glands lie atop each kidney

A3) Filter blood to remove waste urea; regulate salt and water balance; excrete urine

1) How many sacs does the pericardium have?

2) Name the double inner layer of serous membrane within

the pericardium

3) What is the function of the pericardium?

4) What is the inner layer of the heart called and its function?

A1) Two; An outer fibrous sac called the Fibrous Pericardium and a double inner layer of Serous Membrane

A2) Visceral Pericardium adhered to the Myocardium and the Parietal Pericardium adhered to the Fibrous Pericardium

A3) Prevent over distention of the heart muscle

A4) Endocardium – composed of endothelium and prevents localised blood clotting

1) Which blood vessels dilate and contract to control blood

flow to the capillary beds?

2) What are the functions of capillarys?

3) What is the composition of blood?

A1) Arterioles and Venules

A2) Allow the interchange of gases and transfer nutrients/waste at the tissue

A3) Plasma, white cells, platelets red cells. 45% cells and 55% liquid

1) Where is the vomiting centre?

2) Explain how vomiting happens

A1) Lateral reticular formation of the Medulla Oblongata

A2) Stimulated by the sensory inputs through higher cortical centres and peripheral nerves i.e. Labyrynth and Stomach

Chemoreceptor Trigger Zone stimulates the vomiting centre in situations of higher chemicals/drugs (i.e. dopamine or histamine) and stomach

Higher cortical sensors such as pain, memory, smell or fear can trigger the vomiting centre

1) Explain GTN and how it works

A1) GTN is an organic nitrate which releases Nitric Oxide. This causes vasodilation. This means preload is lowered and systemic pressure is reduced.

All of the reduction means the heart works less and its demand for 02 is reduced.

Dilation opens up collateral circulation – redistributing blood to ischemic areas

Increases clyclic GMP synthesis and reduces calcium in smooth muscle causing them to relax

1) Explain Ipatropium Bromide

A1) It is an antimuscarinic bronchodilator;

An antagonist at muscarinic cholinergic receptors in the parasympathetic ANS (Autonomic nervous system) – reduces mucous secretion

Blocks the action of acetylcholine in the bronchial smooth muscle which reduce intracellular Guanine Monophosphate Synthetase (a bronchoconstrictive substance)

1) Explain the hormonal response to blood loss

2) Explain the sympathetic response to blood loss

3) Explain the adrenal response to blood

A1) ADH secretion from pituitary gland and RAAS activation from adrenal gland encourage water and sodium retention to help replenish plasma volume

A2) Increase cardiac output, increase heart rate, increase contractility and peripheral vascular resistance

A3) Adrenal glands further initiate vasoconstriction increase arterial pressure to perfuse heart and brain. Blood is shunted from the skin, muscle, kidney and liver

1) What 2 systems regulate Blood Pressure – describe how they achieve this

A1) Autonomic Nervous System: Baroreceptors in large arteries near the heart and left ventricle are pressure receptors. An increase in BP is detected as pressure rises and walls get over stretched. Message gets sent to medulla and ANS responds by inhibiting vasoconstriction, decreasing the heart rate and reducing the force of ventricle contraction. The opposite takes place if blood pressure is sensed to be low

Renin-Angiotensi-Aldosterone System (RAAS): Baroreceptors in Kidneys respond if blood volume is low then Renin is released. Renin metabolises angiotensinogen into angiotensin 1. This is then further metabolised into angiotensin 2 in the presence of ACE (Angiotensin converting enzymes). Angiotensin 2 is a vasoconstrictor and also stimulates the adrenal galdns to release Aldosterone. Aldosterone increase reabsorbtion of Sodium from urine to blood (where sodium goes, water follows) hence blood volume increases

1) Explain how hormones are released

2) Explain how Entonox works

3) Explain Ketamine

A1) Hypothalamus secretes hormones which make other glands secrete their hormones

A2) Entonox inhibits NMDA receptors in the Dorsal Horn and stimulate GABA production

A3) Ketamine is an analgesia in subanasthetic doses; inhibits neurone transmission at NMDA receptors in Dorsal Horn and binds to Opiod receptors

1) Explain how ulcers (Duodenal and Peptic) occur

2) What cells are contained in the stomach mucosa?

A1) When mucous is exposed to Pepsin and Acid, they can cause ulceration. Dyspepsia is a term used to describe the symptoms of ulcers (burning, bloating, fullness)

A2) Mucous producing (protective); Parietal (produce hydrochloric acid which are stimulated by histamine); Chief cells (Produce Pepsinogen = converted to pepsin in acid environment); Gastrin producing (stimulate acid production)

1) What are the clinical terms for the following clinical signs

a) Bruising along the side of the body

b) Bruising around the belly button

c) Swelling around the abdomen

d) Tears of the mucous lining between oesophagus and

stomach

e) Whites of the eyes

f) Blood from the rectum

A1) a) Grays Turner Signa) Cullen Signb) Ascites (backup of pressure from the hepatic portal)c) Mallory Weiss Syndromed) Sclerae) Haemotochezia

1) What are the clinical terms for the following signs

a) Curvature of the spine

b) Hump in the spine due to osteoporosis

c) Depression of the sternum

d) Pigeon breast (outward protrusion of the sternum)

e) White pattern on fingernail

f) Thickening o the hand tendons

g) Spots on hands indicative of subacute endocarditis

h) Bulging eyes

A1) a)Scoliosis

b) Kyphosis

c) Pectus Excavatum

d) Pectus Carinatum

e) Leukonikia

f) Dupitons Contracture

g) Oslandes/Janeways

h) Graves Disease

1) What do Inotropic Glicazides such as Digoxin do?

2) Why are Inotropic drugs used in Heart Failure?

A1) Increase the influx of Calcium to the heart muscle which increase the force of contractabilityReduce the heart rate in SVTInhibit Sodium/Potassium pump causing increased intracellular sodiumAffect the ANS and increase Vagal tone

A2) When force is increased, blood is pumped more efficiently thus improving renal blood flow which reduces odema seen in cardiac failure

1) What produces Cerebral Spinal Fluid (CSF)?

2) How many cranial nerves are there?

3) What are the functions of the cranial nerves?

4) List the Cranial Nerves and the associated number

A1) Choroid Plexuses

A2) 12 pairs

A3) To relay sensory information i.e. sight, hearing, smell and tasteTo relay information relating to touch, temperature and pain from

the head and neckControl motor functions of muscles around the head and neckAutonomous control of many internal organs by the Vagus Nerve

A4) 1) Olfactory. 2)Optic. 3) Occulomotor. 4) Trochlear. 5) Trigeminal. 6) Abducent. 7) Facial. 8) Vestibulochoclear. 9) Glossopharangeal. 10)Vagus. 11) Accessory. 12) Hyposglossal

1) Name the 4 terms relating to paralysis of different limbs

2) Which body tissue cannot regenerate

3) How many cavities produce and contain CSF?

4) What are the functions of CSF?

A1) Paraplegia: paralysis of lower limbs, bladder and rectumQuadraplegia: Paralysis of all 4 limbsHemiplegia: Paralysis of one side of the bodyMonoplegia: Paralysis of one limb

A2) Nerve cells

A3) 4 Ventricles

A4) To lubricate the brain, spinal cord to prevent friction; Support the brain in its location; act as a shock absorber; nourish and cleanse by washing away waste and toxic substance

1) How many functional components are within a reflex arc?

2) What is a reflex arc?

3) Which nerve impulses travel slower (Myleinated or

unmyleinated)

4) Name the typical contents of a neurone

5) Name the sheaf of nerves at the end of the spinal cord

A1) Sensory receptor to afferent neurones to the spinal cord (the integrating centre) to the epherent neuron to the effector organ

A2) A fast unplanned unvoluntary action from a stimuli in response to danger or to protect

A3) UnmyleinatedA4) Dendrites; Soma; Axon; Axon Terminal; Nodes of Ranvier; Mylein Sheath; Schwann Cell

A5) Cauda Equina

1) What is the nervous system divided into and what does it

compromise of?

2) What are neuroglia?

3) How much does the average brain weigh?

4) What are neurones responsible for?

A1) Central Nervous System comprising the brain and Spinal Cord and the Peripheral Nervous System comprising of 12 pairs of cranial nerves, 31 pairs of spinal nerves and the Autonomic Nervous System

A2) Special non-conductive connective tissue cells which bind together to protect neurones

A3) 3lb

A4) the conduction of nerve impulses from one part of the body to another

1) What are the 3 main parts of the brain called?

2) Which part of the brain contains the Right and Left

Hemispheres?

3) What are the main components and functions of the

Cerebrum?

A1) Cerberum; Cerebellum; Brain Stem

A2) Cerebrum

A3) Motor areas which initiate contraction of voluntary musclesSensory areas receive impulses from skin, muscles, joints, bonesSpecial sense centres which deal with sight, hearing, smell, taste and touchCentres for ‘higher power’ which allow for consciousness, intelligence, memory and learningThe centres hypothalamus/thalamus which control Autonomic Nervous System

1) What is the function of the Mid Brain?

2) What is the location of the Pons Varolli?

3) What are the main components and functions of the

Medulla Oblongata?

4) What are the protective membranes surrounding the brain

and spinal cord called?

A1) The relay station connecting the upper parts of the brain and the lower parts of the brain and spinal cord. It contains important reflex centres which affect the eyes, head and neck in response to visual and other stimuli

A2) The Pons joins the Cerebrum above and through the Mid Brain to the Medulla and Cerebellum

A3) The motor fibres which cross overVital centres i.e respiratory, cardiac and vasomotorReflex centres

A4) Meninges

1) Explain what beta blockers do?

A1) Block adrenoreceptor sites in the heart. It is antagonist so that Noradrenaline/Adrenaline cant attach therefore effects of these are reduced. Workload reduces which decreas demands on the coronary system. The force os contractions are lower and the length of diastole increases

Suppresses CNS stimulation of the heart/arteries which decrease HR

Suppresses activity in the RAAS; reduces the production of Angiotensin 2 which decreased vascular resistance and results in decreased BP

1) What is Coning?

2) Where is the Vault?

3) What are the 5 checks of Defib Safety?

A1) Pressure pushing down on the brain stem

A2) Top of the Skull

A3) Perspiration; Piercings; Underwire; Patches (GTN); Pacemaker

1) Describe the signs and symptoms of LVF and RVF

2) Signs and Symptoms of Ketoacidosis

A1) LVF: Orthopnoea (fear of lying down); Haemoptysis; JVD; respiratory Distress; Hyporessonance; LOCRVF: Tachycardia; peripheral odema, venous congestion, JVD, history of LVF, SOB, Ascites

A2) Characterised by hyperglycaemia and acidosis. Fat metabolism occurs so that the body uses fat as a source of fuel causing the buils up of acids/ketones. Polyuria; polydipsia; kussmauls breathing; ketones smell; hypovolaemia; abdo pain; weakness; LOC and vomiting

1) Explain Antihistamine (Chlorphenamine)

A1) Used in allergic reactions or anaphylaxis; it is a H1 receptor antagonist so will inhibit the smooth muscle constriction in the respiratory tract and GI muscles; decrease capillary permeability; decrease salivation/tear formation. Has cholinergic properties

1) The adrenal gland is divided into 3 zones – explain each

A1) Outer: Mineral corticoids are produced which are important for water regulation and electrolytes (aldosterone)

Middle: Glucocorticoids are produced which are important in regulating metabolism of Carbohydrates, Proteins and fats. Has an immunomodulating and anti inflammatory effect

Inner: Androgens are produced which are anabolic and masculinising

1) What drugs treat vomiting and how?

2) What is Anaerobic Metabolism

A1) Antiemmetics: These block the 5H or Dopamine receptor sites. 5Ht antagonists selectively inhibit 5HT which is a CNS receptor

(Ondestron). Blocks Histamine H1 receptors preventing vomitingDopamine 5HT antagonist blocks dopamine in low doses and 5HT in high doses but these increase gastric emptying as motility is stimulated.

A2) The body produces ATP in the absence of O2 – glucose is catabolised to form Pyruvic acid to generate ATOP. Much of the acid is converted to Lactic acid lowering blood Ph

Mental Health Act

1) What is a Section 135?2) What is a Section 136?3) What is a Section 2?4) What is a Section 3?5) What is a Section 4?

A1) A court warrant needed to remove a person from their home for 72 hours to a place of safety for assessment

A2) Remove a patient from a public place

A3) Mental Health Act 1983 Admission for assessment for 28 days.

A4) Admission for treatment for 6 months initially but renewable for a further 6 months

A5) Admission for assessment for 72 hours

1) State the key differentials between

Appendicitis

Cholecystitis

Ulcerative Cholitis

Diveticulitis

Chrons Disease

A1) Appendicitis – Right Iliac fossa pain and rebound tendernessCholecystitis – Gall stones of emulsified fat so clay coloured stoolsUlcerative cholitis – Pus in stools or rectal bleeding/urgencyChrons disease – Constipation caused by lymphatic obstructionDiverticulitis – Left lower abdo pain, aching and tired. Caused by diverticuli in GI wall

1) What is the difference between pre-eclampsia and

eclampsia?

2) What manoeuvre is used in Breech Birth?

3) What term is given to babies born between 20-30weeks?

4) What is the purpose of incubators?

A1) Preeclampsia has the signs of eclampsia but includes the seizures

A2) Mariceau Smeille Veit

A3) Pre-term

A4) Control temperature; supply oxygen at a controlled rate; maintain humidity at 65%; reduce the risk of infection; reduce unnecessary handling; provide ventiallation

1) What is haemolytic disease?

2) What is anaemia?

3) What is the average blood volume?

4) When checking a pulse, what do you check?

5) What are Cheyne Stokes?

A1) Erythroblastsosis Fetalis. This occurs with a Rhesis Neg mother and a Rhesis Pos Father

A2) Blood cannot carry as much oxygen as it should causing poor peripheral perfusion

A3) 7 litres

A4) Rate, Rhythm and Volume (force)

A5) The Death Rattle – Abnormal pattern of breathing characterised by alternating periods of apnoea and deep rapid breathing

1) What is a Priapism?

2) What are the principal functions of blood?

3) What factors can obstruct the air passage

A1) Damage to the spine causing an erection in men due to blood level dropping and gravity

A2) Transportation of Oxygen, Carbon Dioxide,Waste, Nutrients and HormonesThe regulation of Ph, temperatureInfluence over water content of cell protection via platelets

A3) Tongue during unconsciousness; Maxillofacial injuries (teeth, nose broken); Blood or vomit; inhaled foreign objects; suffocation (hanging, inhalation, crush injuries); Drowning; internal swelling (allergy)

1) Which sides would you cover in sealing a chest wound?

2) Explain TWELVE FLAPS

3) What are the chest exam areas?

4) How many times greater is a thrombosis when a skull

fracture is present?

A1) Superior and lateral sides

A2) Tracheal tug, Wounds, Surgical Emphysema, Larygneal Crepitas, Distended neck Veins, Expose and examine – Feel, look, Auscultate and percuss

A3) 6 areas at the front and 8 areas at the back

A4) 60 times greater

1) Explain Syntometrine

2) What are Noradrenaline and Adrenaline?

3) What are the two fluids administered to correct

hypovolaemic shock?

4) How fast does ECG paper travel

5) In Seconds, what does 1 square equate to on an ECG paper

strip?

A1) It is a synthetic Oxytocin that stimulate lactating and uterine contraction; The posterior pituitary release Oxytocin and ADH

A2) Both are Catecholamines – Noradrenaline is the main neurotransmitter of the sympathetic nervous system and Adrenaline is the main hormone secreted by the Adrenal Medulla

A3) Crystalloids (Electrolyte solution) and Colloids (Plasma Substitue)

A4) 2.5cm per second

A5) 0.04 seconds

1) How many joules does a pre-cordial thump deliver?

2) What is the correct depth for chest compressions?

3) What is the step wise approach in managing Asthma

A1) 15 Joules

A2) 5-6cm

A3) Beta2 Agonist for immediate relief; Glucocorticosteroids for further prevention; Long lasting Beta2 agonist; Leukotrine Antagonist plus Beta2; Single dose of Prednisalone

1) What is the equipment needed for intubation or assisting

the Paramedic in airway management?

A1) Bag/Mask reservoir (BVM)OxygenLaryngoscope and Blade of correct sizeMagil ForcepsSuction Lubrication gelEndotracheal Tube20ml SyringeSpencer Wells ForcepsCatheter mountStethoscopeOro-Pharangeal AirwayRibbon for securingBougie/introducer

1) Describe the Pancreas

A1) Small and weighs 60g. It is 12-15cm long and located in the upper abdomen. It has endocrine and exocrine functions. The Head/Neck of the Pancreas extends to the Duodenum and lies against the Spleen