11/3 Flashcards
when to use fluid resusc
SPB<100
HR>90
CRT>2
RR>20
causes of dyspesia - drugs
alendronic acid
prednisolone
drugs causing diarrhoea
lansoprazole
alendronic acid
caution NSAIDs in who
elderly
IBD - CD, UC (gastro-intestinal disorders)
mx DKA
A-E
continue long acting insulin
1L 0.9% over 1 hr OR 500ml over 15 mins if hypo
fixed rate insulin 0.1unit/kg/hour via syringe driver - aim for decrease of glucose of 3mmol/L/hour
2+3rd L over 2hrs
4th L over 4 hrs
- add 10% glucose at 125ml/hr once less than 14 (keep between 8-14)
- add K+ from 2nd bag if <5.4
recovered - transfer to s.c. insulin onec E+D and pH>7.3 and wait til 1hr post s.c. to stop insulin infusion
WHO performnce status
0 - normal 1 - restricted to light work 2 - capable of self care but no work activity, up for more than 50% of waking hours 3 - in chair for >50% waking hours 4 - completely disabled
how long can’t you drive or after an implantabe cardc defib
6m
CHA2-DS2-VASc score
C - CCF H - HTN A - 2 if >75 D - DM S - stroke, TIA - 2 Vasc - vasc A - 65-74 Sc - female
feature of AF - signs
apical to radial pulse deficit irregular irregular pulse variable volume pulse single waveform JVP variable intensity 1st HS
secondary AF
hyperthyroid
alcohol excess
sepsis
hepatitis vaccien and serology
positive anti-HbS
acute hepatitis serology
IgM to HBcAg
acute bacterial meningitis - mx
community - IM benzyl P
- allergic to pen - chloramphenicol
hosp
- IV 2g ceftriaxone b.d.
+ IV amox in old/ young for listeria
+ IV aciclovir - virtal encephalitis
tumour lysis syndrome - present
RF
nausea, vomiting, mm pain
raised urate, potassium phosphate
asthma - bronchodilator reversibility should be >___
> 12%
FeNO for asthma
FeNO >40ppb - adults
PEF variability in asthma
> 20%
hypersegmented neutrophil polymorphs indicate what
megaloblastic macroytic anaemia
replace B12 or folate first
B12
avoid subacute combined degeneration of spinal cord
mx of b12 deficiency
IM replacement
NF1 vs 2
NF 1 - cafe aut lait, axillary/ groin frecklesm iris haematomas, scoliosis, phaochromocytomas
NF2 - bilateral vest schwannoma, multi intracran schwannoma, meningioma, ependymoma
____ prior to appendicetomy
prophylactic abx
thiazide diureitc
bendroflumethiazide
indapamide diuretic
indapamide
paracetamol overdose - liver enzymes
high ALT
low ALP
high ALT:ALP
features of gilbert’s
unconjugated hyperbilirubinaemia
jaundice - concurrent illness, exercise, fasting
mx and ix - gilberts
rise in bilirubin after prolonged fasting or IV nictonic acid
no treatment
gilberts patho
auto recessive
defective bilirubin conjugation
deficiency of UDP glucuronosyltransferase
pain in bum on walking
iliac stenosis
immediate management of SVC obstruction in lung cancertq
immediate oral dex 8mg
AFP raised in
teratoma
beta HCG raised in
teratoma
seminoma
mx renal stones
<5mm - spont pass
5mm-2cm - ESWL
<2cm and pregnant - ureteroscopy
complex renal calcili and staghorn - perc nephrolithotomy
unstable, sepsis - nephrostomy to add stent and urgent decompress
mx stress incontinence
duloxetine
RF for gallstones
6Fs
- female
- fertile - multi pregnancy
- forty
- fat >30
- fair - caucasian
- fhx
also:
- CD
- DM
- rapid wt loss
- fibrates, cocp
dx pancreatitis
characteristic pain + amylase/lipase>3x upper limit
uss
contrast enhanced CT
dx acute cholecystitis
uss
most sensitive and specific enzyme in pancreatitis
lipase
drugs causing pancreatitis
azathioprine messalazine didanosine bendroflumethiazide fureosemide pentamidine steroids sodium valproate
dx boerhaave’s
ct contrast swallow
reynold’s pentad
charcot triad + hypotension and confusion
severe ascending cholangitis
