Project 1 : Kevinda

14 May 2019
Question 1
• Which of the following statements are true?
A. Cells change from aerobic to anaerobic metabolism when perfusion to
tissues is reduced.
B. The product of aerobic respiration is lactic acid.
C. The product of anaerobic respiration is carbon dioxide.
D. The accumulation of lactic acid in the blood produces systemic respiratory
acidosis.
E. Lack of oxygen and glucose in the cell will eventually lead to failure of
sodium/ potassium pumps in the cell membrane and intracellular
organelles.
Answer : A, E
• Cells switch from aerobic to anaerobic metabolism when deprived of
oxygen. The product of aerobic respiration is carbon dioxide. This is
eliminated efficiently through the lungs. The product of anaerobic
respiration is lactic acid. When enough tissue is underperfused, the
accumulation of lactic acid in the blood produces systemic metabolic
acidosis. As tissue ischaemia progresses, the immune and complement
systems are activated. This also results in the complement and neutrophil
priming with the generation of oxygen-free radicals and cytokines. This
leads to injury of the epithelial and endothelial cells, which leads to loss of
integrity and ‘leaky’ walls. The resultant oedema further increases tissue
hypoxia. As glucose within the cells is exhausted, anaerobic respiration
ceases and there is a failure of the sodium/potassium pump. Intracellular
lysosomes release autodigestive enzymes and cell lysis ensues. Intracellular
contents, including the potassium, are released into the bloodstream.
Question 2
• Which of the following statements regarding hypovolaemic shock are
true?
A. It is associated with high cardiac output.
B. The vascular resistance is high.
C. The venous pressure is low
D. The mixed venous saturation is high.
E. The base deficit is low.
Answer : B,C
Types of shock
A. Septic shock
B. Cardiogenic shock
C. Hypovolaemic shock – haemorrhagic
D. Neurogenic shock
E. Anaphylactic shock
F. Endocrinal shock
G. Hypovolaemic shock – non-haemorrhagic
Choose and match the correct diagnosis with
each of the scenarios given below:
1. A 7-year-old boy with nut allergy develops stridor and collapses after eating a snack. He requires airway and breathing support.
His BP is 60/38 mmHg.
2. A 78-year-old man with known ischaemic heart disease (IHD) complains of chest pain and collapses. His pulse is irregular and
BP is 74/48 mmHg. ECG shows features of an anterolateral myocardial infarction (MI).
3. A 76-year-old male is brought to the hospital with persistent diarrhoea and vomiting for the past 4 days. He has been unable to
keep his food down and feels very tired. On examination he is very dehydrated. His pulse is 128/min and his BP is 88/52 mmHg.
4. A 55-year-old woman with poorly controlled hypothyroidism is found comatose. She is hypothermic. Her pulse is irregular and
her BP is 96/70 mmHg.
5. An 86-year-old male has been complaining of increasing lower abdominal pain for the past week. On examination he looks
very unwell with warm peripheries. He has signs of generalised peritonitis. His pulse is 130/min and his BP 84/50 mmHg.
6. A 28-year-old motorist is brought to the A&E after a road traffic accident (RTA). He has sustained an isolated injury to his back
and has motor and sensory deficits in both lower limbs. His pulse is 122/min and his BP 100/62 mmHg
7. A 19-year-old male is brought to the hospital after sustaining an abdominal injury while playing rugby. He is complaining of left
upper abdominal pain and has some bruising over the same area. His pulse is 140/min and his BP is 100/82 mmHg.
Answers
1E, 2B, 3G, 4F, 5A, 6D, 7C
Which of the following statements regarding
the treatment of burns are true?
A. Cooling of a scald for a minimum of 10 min is of no value in giving
analgesia or slowing the injury associated with a fresh burn.
B. Other non-burn injuries may coexist with a burn.
C. Major determinants of burn outcome are percentage of TBSA,
depth and the presence of any inhalation injury.
D. Criteria for acute admission to a burns unit do not exist or are
unnecessary.
E. A significant hand burn should not be admitted to a burns unit and
can easily be managed as an outpatient.
Answer : B, C
• Cooling of a fresh burn for 10 min by lowering the temperature of the
agent causing the burn and the local tissues will help to reduce burn
injury – this may sometimes be done by using cold water but not for
every burn. Non-burn injuries may coexist with burns and should not
be overlooked. Criteria for admission to each burns unit exist and
advice on this and any burn is readily available. A significant hand
burn should always be admitted even though the percentage of TBSA
may be small.