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Deficiency of B12 may also be due to impaired absorption of the vitamin in the terminal ileum eg Crohn’s disease. The requirements increase during pregnancy. 30 QUESTIONS: MRCS CORE MODULE 2 4 5 The following statements regarding plasma substitutes are true: (a) Gelofusine and Haemaccel are physiologically the closest to plasma (b) Hartmann’s solution contains 5 mmol/l of potassium (c) 5% dextrose solution contains no sodium (d) Cell Saver techniques are passive reinfusions of lost blood (e) normal saline has a pH of 8 Disseminated intravascular coagulation: (a) platelet fibrin thrombi cause end organ ischaemia (b) blood is found in the sputum (c) follows massive blood transfusion (d) requires anti-coagulation (e) is associated with subarachnoid haemorrhage 31 ANSWERS: MRCS CORE MODULE 2 4 (a) F (b) T (c) T (d) F (e) F The fluid replacement that most closely resembles plasma is Hartmann’s solution.
Neurological injury may also occur, most commonly of the sciatic and sacral nerves the latter of which can lead to impotence. 48 QUESTIONS: MRCS CORE MODULE 3 5 Splenic rupture: (a) may be associated with Kehr’s sign (b) is accompanied by the fracture of the transverse processes of the lumbar spine (c) is ideally treated with conservation in infants (d) may present following reactive haemorrhage (e) produces left flank shifting dullness 49 ANSWERS: MRCS CORE MODULE 3 5 (a) T (b) F (c) T (d) T (e) F Splenic rupture should be suspected in multiply injured patients and in particular those in whom trauma to the left upper quadrant or left lower thorax has occurred.
To maintain cardiac output the heart rate increases to compensate for the reduced stroke volume. There is also a peripheral vasoconstriction. The shift in fluids from extravascular compartments into the circulation aids in the compensation of hypovolaemia, however the haematocrit does not change for at least 1 hour. The circulation preferentially supports the brain and heart with resultant increased anaerobic respiration and lactic acidosis in the peripheries. Anti diuretic hormone and aldosterone are the most potent hormones in the conservation of water.