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115 Cards in this Set
- Front
- Back
1. A patient undergoing liver surgery has a venous air embolism, what is the most appropriate position to place them in: |
VAE occurs when operative site is higher than right atrium. |
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Which of the following is NOT a side effect of cyclosporin |
ADRs can include gingival hyperplasia, convulsions, peptic ulcers, pancreatitis, fever, vomiting, diarrhea, confusion, hypercholesterolemia, dyspnea, numbness and tingling particularly of the lips, pruritus, high blood pressure, potassium retention possibly leading to hyperkalemia, kidney and liver dysfunction (nephrotoxicity[16] and hepatotoxicity), burning sensations at finger tips and an increased vulnerability to opportunistic fungal and viral infections |
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What is the half life of clopidogrel? |
Clopidogrel is a pro-drug activated in the liver by cytochrome P450 enzymes, including CYP2C19.After a single, oral dose of 75 mg, clopidogrel has a half life of approximately 6 hours. The half life of the active metabolite is about 30 minutes. |
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When administering adrenaline and atropine via ETT dose compared with IV should be |
Double dose |
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What splitting ratio gives a 3% concentration of isoflurane |
1/14 |
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What transfusion related complication is the commonest cause of mortality |
B. TRALI |
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Which of the following is not included in the CHADS2 AF thromboembolic risk scoring system |
CHADS2: |
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What is the ratio of breaths to compressions in neonatal resuscitation? |
A: one breath for every three compressions |
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What is the innervation of the hard palate |
The hard palate is innervated by branches of the maxillary nerve, both of which initially pass through the pterygopalatine ganglion. |
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Which of the following is suggesting of an inhaled foreign body in a child on chest x ray |
B: hyper-inflated hemithorax |
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What is the distance from the lips to the carina in an 70kg adult male in cm |
correlates better with height than weight: |
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What colour is the label for subcutaneously administered drugs |
Beige |
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How much air is the maximum to that should be used to inflate a 5 LMA classic cuff? |
Up to 40mL |
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Where should the tip of an IABP lie |
2-3 cm distal to L subclavian |
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A 60kg female is given 50 mg of rocuronium, she is unable to be intubated, what dose of sugamadex is required to reverse the rocuronium |
240mg (4mg/kg) |
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In a penetrating chest injury what part of the heart is most likely to be injured |
Right Ventricle |
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What is the maximum recommended dose of Intralipid in local anesthetic toxicity (ml/kg) |
10mL/kg over first 30 mins |
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What is a contraindication to an IABP? |
AR |
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An infant is born with meconium stained liquor and is apnoeic and floppy… your first step should be |
A: stimulate and dry |
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Central sensitization occurs due to |
NMDA is to blame: |
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What volume of FFP is required to increase fibrinogen level by 1g/L (I think it was FFP or did it say cryoprecipitate?) |
Uptodate: |
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An epidural in a healthy individual causes all EXCEPT |
a |
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Autologous transfusion results in less |
Uptodate: patients who have made autologous donations have higher rates of transfusion. The blood is often not needed (and wasted). Risk of incompatible transfusion still exists due to clerical error. |
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After an infusion of normal saline causing isovolumetric haemodilution what occurs? |
a |
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Bleeding in trauma has been shown to be reduced by |
TXA |
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The time constant of the lung is calculated by |
Mathematically, the time constant is defined as compliance multiplied by the airway resistance and the resulting value has units of seconds of time.. |
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The commonest post operative complication in a patient with a # NOF is |
Chest infection |
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In an infant, the intercristine line is at the level of |
L5/S1 |
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Which of the following is a contra-indication to a left DLT |
Tumour in bronchus? |
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What is the commonest symptomatic cardiac condition in pregnancy |
MS |
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What is the ratio of MAC awake:MAC of sevoflurance |
Sevoflurane MAC is 2% |
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A man presents to ED after a fight with his son in law in which he is punched in the head- calculate the GCS. |
a |
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Pain from the uterus during labour is transmitted via |
a |
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The features of Pierre Robin sequence include cleft palate, micrognathia and: |
Glossoptosis |
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A size C oxygen cylinder that reads 5000kpa contains approximately how many litres of oxygen |
full size C (13700 kPa) = 170 L |
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A patient having a craniotomy has the CVP/arterial transducers at the level of the right atrium. The head is 13cm above the level of the heart. If the MAP is 80mmHg and the CVP is 5mmHg what is the cerebral perfusion pressure in mmHg |
1mmHg = 1.36 cmH20 |
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After a procedure with an LMA in situ a patient complains of loss of sensation to the anterior part of the tongue. What nerve is likely damaged? |
A: Facial |
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What statistical test would be best to evaluate the effects of ? 2 drugs in patients at ? 3 different points in time |
ANOVA? |
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A man is working with electrical appliances at home with a residual current device. If he touches the active and the neutral (was it neutral or earth) wire he will suffer |
D: RCD will protect him from macroshock |
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An infant with failure to thrive is noted to have an apical systolic murmur weak pulses, with the femoral felt most easily. They most likely have |
VSD |
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Which radiological finding is most consistent with atlantoaxial instability in a patient with rheumatoid arthritis |
Atlantoaxial subluxation occurs in 25% of patients with severe RA |
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What is the most accurate method of determining fetal heart rate in a neonate |
Auscultation? |
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In acute liver injury what causes the highest risk of bleeding |
B or A? |
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A patient in recovery post op total hip replacement develops crushing central chest pain, ECG shows ST segment elevation (NB- no BP etc given, beta blockade was not an option). The most appropriate action is to give |
Oxygen |
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Stellate ganglion blockade causes |
?Dry eyes (change in tear consistency) |
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Features of ventricular tachycardia DO NOT include |
a |
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An inpatient becomes hyponatraemic 48 hours post op and has a seizure. The most appropriate treatment is |
Hypertonic saline is warranted in patients with severe and often acute hyponatremia (serum sodium usually below 120 meq/L) who present with seizures (uptodate) |
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A patient has a laparotomy for an acute abdomen, nothing in found intra-operatively. ABG reveals |
a |
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A child with 10% dehydration is likely to have |
5% dehydration (OHA) |
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Main heat loss in anaesthetic for neonate |
Radiation |
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One lung ventilation- FIO2 1.0, desaturate |
Increase FiO2 |
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Neonate to drug addicts found by grandmother in the house, brought into ed, mildly jaundice, slight tachycapnic. ABG PH 7.54, PaCO2 46, pO2 74, HCO 13 |
a |
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Jehovah's witness refused blood- you have told him you refuse to do the surgery/anaesthesia for his own good. Ethical principle: |
Beneficence |
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Patient with aortic stenosis, the signs indicate poor prognosis |
Severe AS = AVA < 1.0cm2 or gradient > 50mmHg |
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Patient indicated for prophylaxis of infective endocardititis |
30-60 mins prior: |
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Which drugs below does not need dose adjustment in renal failure patient |
Buprenorphine - hepatic metabolism, biliary excretion. |
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Patient on cisapride. What drug NOT to give in recovery? |
Cisapride - risk of long QT. |
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Which herbal supplement reacts with tramadol? |
St John's Wort |
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72 year old has had hip replacement surgery and 3 days postop has a pulmonary embolus. He is fully heparinised, but still dyspnoeic, clammy, BP 80/40, pulse 120 and CVP 18. The most appropriate next step is |
Is haemodynamically unstable. |
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The test to diagnose pulmonary embolism |
CTPA |
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Finding on haemophilia A patient |
Haemophilia A is an X-linked defect in factor VIII activity |
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LSCS for foetal distress, meconium stained liquor. Management of baby |
As amniotic fluid is NOT clear: |
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An elderly lady has a closed neck of femur fracture and presents to ED. She is in chronic AF and on warfarin. INR is 2.6 and she is not bleeding. It is 9am and she is scheduled for repair the following day. According to current guidelines, how should her warfarin be reversed? |
Surgery is not for 24 hours and she is not bleeding. Give 1mg IV Vitamin K |
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Subarachnoid haemorrhage patient. What percentage rebleed in the first 24hours |
First 24 hours: 4% rebleed rate, then 1.5% per day for next 4 weeks. |
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Post delivery neonate did not breath post stimulation by midwife, not vigorous, heart rate drop from 140 to 90bpm. Next step of action |
As apnoeic and HR less than 100: |
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The safe maximal pressure for endotracheal cuff at the lateral side of the trachea |
15cmH20 (EAA pg 69) |
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Patient with mastocytosis. Intraop would probably be: |
Hypotension due to degranulation |
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Complication of celiac plexus block |
Both ED and paraplegia |
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Post epidural and LSCS, the next day patient have persistent paraesthesia anterior thigh. What other injuries would indicate more of nerve roots instead of peripheral nerve injuries |
Anterior thigh is L2(-L3)/ femoral nerve and lateral cutaneous nerve. |
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Post carotid enderactomy in the ward, patient seizure. Noted patient operation side is more severe stenosis and post op difficult to control blood pressure. What would prevent seizure most |
Hyperperfusion syndrome caused by areas of brain protected by tight carotid being exposed to hypertensive BP (headaches, haemorrhagic CVA). |
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Post local anaesthetic block in difficult intubate patient- patient seizure. What would you give? |
LAST - local anaesthetic systemic toxicity |
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Carcinoid patient intraop hypotension- |
Carcinoid tumours release 5HT, bradykinin, histamine, substance P, prostaglandins, vasoactive intestinal peptide. Only have systemic effects if are post-hepatic or can bypass liver as otherwise are broken down in liver. |
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Allergic question, which is true |
Tryptase - neutral protease released from mast cells during degranulation. |
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After transfusion of 5 unit of FFP what is least likely to occur |
Hopefully infection? |
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There is evidence to avoid BIS <40 for more than 5minutes because |
BIS <45 associated with increased postop mortality |
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Most common cause of paediatric post anaesthesia cardiac arrest |
?Respiratory |
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Post cervical spine op, there is bulging noted under the incision site.. Patient desaturated, combative, keep pulling off the oxygen facemask. Next course of action |
Need to release haematoma to decompress trachea - needle aspiration seems a little high risk in a combative patient... |
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What drug known to cause prolong QT and risk of Torsades de Pointes |
Droperidol |
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During cardiac catheterisation (?) patient become BP 80/60, HR 110, CVP 16. What is the next most important investigation |
Hypotension/tachycardia/elevated CVP = possible tamponade. |
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Intraop hyperfibrinolysis- how to diagnose (euglobulin lysis time NOT an option in the answer) |
TEG |
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75yo patient seen for femoral bypass surgery, no significant cardiac risk factor. He will be admitted 3 days prior to operation. You decided NOT to start on beta blocker and you are justified because: |
Excess of mortality and ischaemic CVA vs placebo |
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You see a man in his 60s in clinic 1 week prior to laparoscopic cholecystectomy. He has dilated cardiomyopathy with an ejection fraction of 30%, but does not get dyspnoeic with normal activities of daily living. What is the most appropriate management of his heart failure? |
both ACEI and beta-blockers have been shown to improve survival in heart failure. enalapril dose here more appropriate than metoprolol dose |
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A line isolation monitor protects against microshock |
??? |
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Patient ingested 500mg/kg aspirin. In ICU, the most effective method to remove aspirin |
Depends on plasma levels: |
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The most effective method for cerebral protection in aortic arch aneurysm repair |
? |
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Interscalene block after injection of 2ml bupivacaine- patient seizure. Most likely injected to |
Vertebral artery |
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Post intubation, you manual ventilate and noted patient high airway pressure. What would you do next |
Auscultate lungs |
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Modified Cormack and Lehane grade - You cannot see beyond the epiglottis and there is a little space between the epiglottis and the posterior pharyngeal wall (? remembered as epiglottis touching posterior pharyngeal wall) |
3b? |
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Most safe side to insert subtenon block |
Inferonasal |
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Diastolic dysfunction Not caused by |
?Adrenaline |
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Compared to retrobulbar block, peribulbar block is associated with |
?? |
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Lumbosacral trunk does not supply: |
These all arise from lumbar plexus: |
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Trauma patient best indicator of good resuscitation (?)- |
?lactate |
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Pregnant patient seatbelt, driver- involved in car accident. Suddenly developed severe central chest pain, HR 110, BP 154/80, RR 26, Sat 100%. The most likely cause? |
?fracture |
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ASD murmur heard at |
wide, fixed split S2 |
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Apnoeic oxygenation in obese patient can be increased by |
?apparently nobody knows... |
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Post partum sudden collapse, suspected amniotic fluid embolism. The consistent finding is: |
Increased tryptase |
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Young pregnant patient with moderate mitral stenosis, normal LV function. The best delivery method |
Either epidural NVD or LSCS |
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Neonate desaturate faster than adult at induction because |
A |
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The cause of hypoxia in one lung ventilation |
A: shunt through non-ventilated lung |
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Suxamethonium dosage higher in neonates compare to adult because |
A: Increased volume of distribution due to greater TBW |
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Indicates autonomic neuropathy except |
A: sinus arrhythmia is normal, LOSS of it is a sign of AN |
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Best indicator of return function of laryngeal muscle |
Head lift? |
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A nulliparous woman in labour for 8 hours with epidural analgesia has a fever 37.6 degrees. The most likely reason for this is |
Altered thermoregulation (OHOA) |
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Periop clinic reviewing a patient with chronic/ end stage renal failure. Her calcium found to be low. He most certainly have |
Secondary (low calcium, high PTH) due to lack of vit D and CRF |
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Pre eclamptic patient post LSCS continue on Mg infusion in ICU. Found to be in respiratory depressed. Next management |
IV calcium gluconate or chloride |
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What proportion of the population are heterozygous for pseudocholinesterase deficiency, i.e. have a dibucaine number 30-70? |
4%? |
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When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch? |
adductor pollicis |
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When intubating over a bougie / awake fibreoptic, which direction do you rotate the tube to stop it catching on structures in the glottis |
a |
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Advantages of off-pump CABG over on-pump CABG |
ROOBY trial |
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After coronary artery bypass graft surgery, the FRC is |
a |
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A 60 year old man 24 hours post CABG is confused, oliguric, with BP 80/40, pulse 120. The most appropriate and useful investigation is |
echo - does he have tamponade? |
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Iron deficiency |
decreased iron, decreased ferritin, increased TIBC (OHM) |
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Why should NSAIDs be avoided in pregnant women >30 weeks gestation? |
Avoid in 3rd trimester due to risk of closure of ductus and fetal pulmonary hypertension |
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A 62 year old man has chronic renal failure. You notice his total serum calcium is 2.05 mmol/L. This is because he has |
secondary hyperparathyroidism |