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Final basic sciences short case 27

Created: 24/12/2013
1. Describe the anatomy of the femoral nerve, giving details of its course from the lumbar plexus, anterior/posterior divisions to the terminal branches, motor and sensory supply etc.
- Discuss femoral nerve block – the technique, indications, contraindications, local anaesthetic choice and dose.
- Discuss 3-in-1 block. Which nerves are blocked (or not blocked!)?
- Discuss the management of local anaesthetic toxicity.

2. What are the causes of secondary brain insult?
- Define intracranial pressure (ICP), the normal range, monitors, causes of raised ICP, management of raised ICP.
- Discuss the management of head injury on the ITU.
- How does near-infrared spectroscopy work?
- How does transcranial Doppler work, and which artery is used?

3. Discuss the pathophysiology, clinical presentation and management of diabetic ketoacidosis.
- Discuss the synthesis of ketone bodies, acetone, acetoacetic acid, beta-hydroxybutyric acid.
- Discuss the utilisation of ketone bodies by the brain, heart and tissues.
- Discuss the synthesis and actions of insulin, particularly with respect to ion shifts.
- What happens if hypernatraemia is corrected rapidly?

4. What is surgical diathermy and how does it work?
- Discuss current density, frequency, current and the risk of electrocution.
- Discuss the difference between bipolar and unipolar diathermy
- Discuss the effect of diathermy on pacemakers/implantable cardioverter defibrillators.
- What happens if the diathermy plates are loosely applied?
- What is an isolating capacitor?

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