10/6 Flashcards
Amiodarone dosage
300mg
What always ALWAYS ALWAYS needs to come in with depression Qs
SUICIDE RISK
The name of the vitamin injection for alcoholics
Parbinex
Hyperaldosteronism is the most common cause of secondary HTN
How do you invx the difference between primary and secondary and what can cause both
How do you manage both
Primary (increased aldosterone but reduced renin)
- single adenoma (Conn’s syndrome)
1. bilateral adrenal hyperplasia - MOST COMMON
- cancer
Secondary (reduced BP to the kidneys = increased renin = increased aldosterone)
- renal artery stenosis
- compression of renal arteries by mass
Invx
- renin:aldosterone ratio
-> just aldosterone high = primary
-> both high = secondary
Imaging
1. CT abdo if normal ->
2. Adrenal venous sampling (distinguish between Conns and bilateral hyperplasia)
Manage
Primary = resection of tumour, if bilateral = spironalcatone
Secondary = renal artery angioplasty
When does the HbA1c target move from 48 to 53
If on more than one med or if one of the meds has an increased risk of hypo
What meds are used in alcohol abstinence that:
- deterrent med -> makes you violently sick if u drink on it
- anti-craving medication
- Disulfiram (D = deterrant)
- Acamprosate (AC = anticraving)
LAMBAST meds again
Lithium
Aspirin
Methotrexate
Benzos
Amiodarone
Sulfonamides (-zole)
Tetracyclines
How long must have depressive symptoms before it can be classed as a depressive episode?
2 weeks
Core symptoms of depression relate to mild, moderate and severe
MEE
Mood - low mood
Energy - low energy
Excitement - none anymore
2/3 core + others = mild
3/3 + others = moderate
3/3 core + severe others (often with agitation/ can have psychosis) = severe
Pain on supination/pronation with golfers/tennis elbow
Golf = closed game = palm shut = pronation
Tennis = open game for all = palm open = supination
How many doses of IM adrenaline can be given before needing IV?
2 doses
What can trigger a migraine
CHOCOLATE
Chocolate
Hangovers
Organsms
Caffeine/cheese
Oral contraceptives
Lie-in
Alcohol
Travel
Exercise
When do surgeries require prophylactic abx?
- If perforating a viscus e.g. appendectomy
- already contaimanted surgery
Single dose IV antibiotic on anaesthesia
Exercise-induced desaturation in HIV?
Pneumocystis jiroveci pneumonia
Most common cause of endocarditis <2months post prosthetic valve replamcent
Staph epidermis - NOT THE CASE AFTER 2 MONTHS
What blood bottles for each thing in ABCDE
Purple - FBC, HbA1c
Pink - clotting and group and save
Yellow - U+Es, LFTs, troponin, amylase
Grey - lactate and glucose (grey of clouds in cloudy with a chance of meatballs = raining sugary milk - lactate and glucose)
Blue = d-dimer and coag (cold blue = cold coag and dimer)
What colours are wide bore cannulas?
Orange and grey
What are each of the following meds:
- salbutamol
- salmeterol
- beclothemasone
- budenoside
- ipatropium
- tiotropium
- SABA
- LABA
- ICS
- ICS
- SAMA
- LAMA
I stop for a TIA = I = short, TIA = long
Overview of COPD management
Conservative
- stop smoking
- flu and pneumoccal vaccinations
- nutritional support
- pulmonary rehab
Drugs
1. SAMA/SABA
If asthmatic features -> 2. ICS + LABA (use SABA/SAMA as req)
No asthma -> 2. LABA + LAMA (use SABA PRN)
(can’t have SAMA and LAMA together as exacerbates side effects)
- If affecting daily life/ >1/2 exacerbations/yr = LABA + LAMA + ICS
(If asthmatic and affecting daily life but not 1/2 exacerbations per year - just do a 3 month trial of triple)
Surgery
- select pts get lung volume reduction surgery
Drug management of asthma
- SABA
- ICS + SABA
- LABA OR MART
- Increase ICS dose or montelukast
- Specialist referral
Signs of a life-threatening asthma attack
A CHEST
Arrthmyia/altered GCS
Cynaosis/normal CO2
Hypoxia/ <92%/ hypotension
Exhuastion
Silent chest
Threatening PEF <33%
What antibiotic is used to reduce COPD exacerbations?
Azithromycin
Go over asceptic - how to ask after each bit in a psych hx
A - will be covered by looking
- age
- clothing
- weight
- hygiene
- anything brought with them
- obvious scarring
- obvious stigmmata of disease
- maintaining eye contact
- body language
- distractable?
- build rapport
- facial expressions
S - rate and rhythm - assessed by just answering Q
- quantity -> poverty of speech and excessive speech
- tone -> monotonous or tremulous
- volume -> quiet and loud
- fluency -> stammering/stuttering, slurred, stilted
E - mood = exact words, affect = how they respond = “How are you feeling”
-> appropraite/incongurancey = mood matches affect
-> blunted/heighted
-> range (fixed, restricted or labile)
ASK ABOUT SUICIDE AND SELF/HARM TO OTHERS
P - hallucinations = visual/somatic/olfactory or auditory
auditory = 2nd/3rd person, thought echo (hear their own thoughts spoken/repeated out loud), command hallucinations
“do you ever see, hear, smell, feel or taste things that are not really there?”
what do these voices tell you? do they ever tell you to do certain things?
- if it’s a constant stream of chat = running commentary on their life
- do you feel like you’ve changed or that you don’t recognise the person you currently are” = derealisation (world around them is not true reality) and depersonalistion (aren’t you true self anymore)
T -Thoughts
- go over specific thought terms
what’s been on your mind recently?, do you ever feel that people are you to harm you?, do you have any beliefs that aren’t shared by others you know? do you ever feel that specific events in the world relate to you somehow?”
- insertion = “do you ever feel like people are putting thoughts in your head”
- withdrawal - “people are taking ideas out your head”
- broadcasting - “others can hear your thoughts”
I - what do you think the cause of the problem is?
- what would you do if you went home now?
Cognition
where are you, what day is it, who bought you here and what is your name and DOB”
REMEMBER RISK ASSESSMENT - self harm and risk to others, substance misuse, taking care of physical needs e.g. meds
SOCRATES for dementia/delirium
S - what are you forgetting - faces, names, words
O - when first start? when been getting more concerning? any partcicular trigger - infection, trauma, grief
C - personality changed?
R - affecting daily life - carers?, driving, ADLs
A - systemic enquiry - movement disorders + mood/psych assess
T - how is the memory loss changing over time?
E - any times or places that it is worse or more evident
S - safety = police, driving, wandering, cooking, finances
