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Year 4 - 5 Qs A Day > 13/6 > Flashcards

13/6 Flashcards

1
Q

What eye has the RAPD defect?

A

The one that dilates

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2
Q

How is normal pressure hydrocephalus managed?

A

Surgical insertion of a shunt - ventriculoperitoneal

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3
Q

What is super important in managing any pt with signs of raised ICP

A

Elevate head of bed to 30/40 degrees

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4
Q

What medication OD is associated with down-sloping ST segment?

A

Digoxin

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5
Q

How do you work out the right size of oropharngeal, nasopharngeal and iGel

A

iGel = based on weight
Oro = angle of mouth to angle of mandible
Naso = edge of nose to tragus

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6
Q

Talk over how to insert a naso and oro

A

naso
- size
- lube
- longer bit of the bevel on the other side to the septum
- push along the flat
- O2 on top

oro
- size
- lube
- upside down first of all (curving up towards you)
- then twist - curving down the neck
- O2 on top

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7
Q

Indiations for ABx in otitits media

A

Antibiotics 4 SIck BoPs

4 days of sx
Systemically unwell
Immunocompromised
Bilateral <2yo
Perforation and/or discharge in canal

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8
Q

Who is most likely to get malignant otitis media?

What antibiotics should be used to cover the pseudomonas aeruginosa infection?

A

Diabetics

Ciprofloxacin

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9
Q

DDx for sensironeual vs obstructive

A

SN
- presbycusis
- noise-induced
- gentamicin
- post-meningitis
- vestibular schwannoma
- labrynithitis

Conductive
- otitis externa
- cholesteatoma
- otosclerosis
- blocked wax
- acute/chronic otitis media

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10
Q

Management of chronic sinusitis?

A

Avoid allergen
Intranasal corticosteroids
Nasal irrigiation with saline solution

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11
Q

Most common cause of bacterial otitis media

A

Haem influenza
Strep pneumonia

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12
Q

Atypical lymphocytes?

A

EBV

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13
Q

Glue ear in an adult

A

Concerning
Glue ear occurs due to a blocking of the Eustchian tubes - is it a ca?

Refer urgently to ENT

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14
Q

What causes acute epiglottitis?

A

Haem influenza

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15
Q

U find a pt unconcious with no pulse or resp

What do you do?

How does this differ if shockable vs unshockable rhythm?

A
  1. 2222 - cardiac arrest call
  2. Jump on the chest and start compressions
  3. Get colleague to fit i-gel and do ventilations
  4. fit defib and assess rhythm
  5. Get/establish IV access (if not prepare for IO)

Shockable
- 3 shocks then amiodarone 300mg and 1mg adrenaline (repeat adrenaline every 3-5mins)
- 5 shocks and still no response - 150mg amiodarone (lidocaine can be used instead if needed)

Unshockable
1mg adernaline ASAP and repeat every 3-5mins

Continue chest compressions whilst defib charging

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16
Q

What does Vfib and pulseless Vtach look like?

A

Vfib - chaotic rhythm and rate
Vtach - regular broach complex tachy

17
Q

How does your CPR approach change if the cardiac arrest was witnessed?

A

If witnessed - up to 3 successive shocks as opposed to 1 followed by CPR

18
Q

How would you assess and manage the 4Hs and 4Ts

A

Hypothermia
- steady rewarming and maintain pyshiological suppport

Hypovolaemia
- ABG
- FAST scan - USS to check for internal bleeding
- Bloods and fluids and potentially catastrophic haemorraghe control

Hyper/hypo electrolyte
U+Es
ABG
If hyperkalaemia = calcium gluconate + insulin/dextrose infusion
Hypokalaemia = give K+ and check Mg+

Hypoxia
- check O2 sats
- continue to deliver O2

Tension pneumothorax
- clinically assess and CXR
- needle decompression into 2nd intercostal mid-clavicular

Tamponade
- Bedside echo
- pericardiocentesis

Toxins
- U+Es
- core temp
- Toxbase and find correct reversal agents

Thrombis
- PE - if known PE = thrombolytic drugs
- if STEMI after ROSC = STEMI management

19
Q

How do diabetic drugs change for surgery?

A

Insulin - omit morning dose but take night time as normal

Metformin - can be taken up to BD

SUs - omit dose before the surgery on the day

SLGT2-i - omit on day of surgery

20
Q

Go over song for pregnancy checks

A

1st visit is from 8
- check everything with mum is great,
urine, bloods and resus state
Give advice and educate

From 11-13
Is the best time to the DOWNs screen
While you’re at it check the dates

At 16 or 10+6
Do BP and urine dipstick

Second scan is at 20
To check the fingers and toes
Make sure there’s plently (also check placenta location at this point)

Once again at 28
Urine, blood and resus state
Anti-D if appropraite

Must give anti-D once more
when the week is 34
And PLAN FOR BIRTH, what a chore

Check the lie at 36
If breech offer a quick fix

Last visit at 38
All that’s left to do is wait

21
Q

Explain rhesus status

What pregnancies is it dangerous to

What are sensitising events

What can it cause in babies if not appropraitely managed?

When is IM anti-D given and why does it help

A

Rhesus disease
- only an issue if mum is -ve as if baby is +ve they can produce Ig against their cells
- this then means in future pregnancies the Ig can travel across the placenta and attack babies Hb

haemolytic anaemia -> raised bilirubin -> brain damage

Haemolytic anaemia + jaundice = haemolytic disease of the newborn

Senisitising events = times when mum and babies blood can mix e.g. miscarriage >12wks
birth
Abdo trauma

Check for rhesus status at 8wks
Give IM Anti-D at 28 (+ sometimes 34 too wks)
Anti-D destroys the babies blood cells in mothers circulation and stops Ig from forming

22
Q

How is acute pancreatitis managed?

A

Conservative
ABCDE
Aggresive IV fluids
Catherised - to monitor fluid balance

Medical
Opioids
Anti-emetics - ondanestron
No need for antibiotics

Important to monitor fluid intake and losses so keeping pt in hospital is needed to be able to provide them with the best care and monitor for complications:
- infection (abscess formation) -> sepsis
- pancreatic necrosis
- haemorraghe
- hypovoleamia (often due to vomitting)

If it progresses to severe pts can die from this so best to have you in and monitor to enhance survival rates

23
Q

Meds at risk of Serotonin syndrome

A

SSTTM

SSRI
St Johns Wort
Triptans
Tramadol
MAOI

24
Q

Management of kawaski’s disease

A

High dose aspirin
Iv Ig
Echo - check for conorary artery anersyms

25
Q

When can anti-epileptic drugs be stopped?

A

After 2 years seizure free over 2-3 months
Done by a specialist

26
Q

reduced GCS, pinpoint pupils and paralysis =

A

Pontine haemorraghe

27
Q

When should men get urethral swabs?

What should be advised to pts who test positive?

A

Only when symptomatic

Abstain from sex for at least a week post injection or until treatment is finished

28
Q

What is the management for personality disorders?

A

DBT - dialect behaviour therapy

Year 4 - 5 Qs A Day (122 decks)

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