19.02.24 Flashcards
Order of potency of topical steroids:
Hydrocortisone acetate
Euvomate
Betnovate
Dermovate
Venous ulcer features:
Shallow, flat margins
Gaiter area location
Palpable peripheral pulses and normal CRT
Haemosiderin deposits
Venous eczema
Varicosity
Lipodermatosclerosis
Lifestyle factors to help prevent recurrence of venous ulcers:
Stop smoking
Weight loss
Wear correctly fitted compression stockings
Avoid injury to legs, and proper care
Avoid sedentary lifestyle
Elevation on rest
‘E’ scoring on GCS:
E1 - no response
E2 - opens to pain
E3 - opens to speech
E4 - opens spontenously
‘V’ scoring on GCS:
V1 - no response
V2 - incomprehensible sounds
V3 - inappropriate words
V4 - confused
V5 - orientated to time, place and person
‘M’ scoring on GCS:
M1 - no response
M2 - abnormal extension (decerebrate)
M3 - abnormal flexion (decorticate)
M4 - flexion withdrawal from pain
M5 - localises to pain
M6 - obeys command
Figures in nephrotic syndrome:
Hypoalbuminaemia <30g/L
Proteinuria >3g/24hrs
What score is used for diagnosing RA?
EULAR criteria - need 6/10 for a diagosis.
It assesses joint involvement, serology, acute phase reactants and duration of symptoms.
Types of psoriasis:
Plaque
Guttate
Flexural
Pustular
Erythrodermic
4 drugs that can cause exacerbation of psoriasis:
NSAIDs
BB
Lithium
Hydroxychloroquine
Discuss the inflammatory process in RA:
RA is characterised by synovitis. Inflamed synovium released cytokines including IL-6 that activate the liver to produce acute phase proteins such as CRP to clear dead and damaged cells.
Inflammatory cytokines also reduce iron metabolism by decreasing the sensitivity of bone marrow to EPO, reducing Hb.
Bone marrow may also be suppressed due to antirheumatoid drugs like MTX, and NSAID use can cause GI blood loss.
H.pylori eradication therapy:
Omeprazole
Clarithromycin
Amoxicillin / Metronidazole if allergic
Who should be tested for H.pylori?
All patients with gastroduodenal ulcer history
Patients with persistent dyspepsia for >1 month
ITP and gastric MALT lymphoma
What do you give post endoscopic haemostasis for a bleeding ulcer:
Hong Kong Protocol: IV PPI infusion
Repeat endoscopy 6-8 weeks later to check healing of gastric ulcer.
4 different types of Clostridium infection:
Difficile - diarrhoea
Perfringens - gas gangrene
Botulinum - flaccid paralysis
Tetani - spastic paralysis
When considering fluid resus in a patient, you should consider if there are any ongoing fluid losses:
Third space losses e.g. pancreatitis or bowel obstruction
High output stoma
Diuresis
Tachypnoiec or febrile
Types of surgery that most commonly require prophylactic antibiotics:
GI, vascular and orthopaedic
Bolus / infusion should be given <60 mins prior to skin incision.
Virchow’s triad:
At least 1 must be present for VTE:
Hypercoagulability
Stasis of blood flow
Endothelial damage
qSOFA score:
Altered mental state
SBP <100
RR >22
SIRS criteria:
HR >90
Temp <36 or >38
RR >20
WCC <4 or >20
Sepsis is defined as infection (SIRS criteria) with evidence of organ hypoperfusion, which can be elicited using qSOFA.
Definiton of sepsis:
Life threatening organ dysfunciton due to inapproprite response to infection
Septic shock = sepsis + hypotension , despite adequte fluid resus, or requiring ongoing inotropic agents. Underlying circulatory or metabolic abnoramlities are profound enough to substanitally increase mortality.
What non-invasive imaging should be performed in all patients with SAB?
TTE
Refer to cardio if suggestive of endocarditis
Refer for TOE if negative but still high suspicion of endocarditis
How often should blood cultures be reassessed in SAB?
48 hours after starting Abx, and at 48 hour intervals until negative.
Assessment of SAB:
- Assess for severity and sepsis: if NEWS>5 then seek immediate senior help
- Consider source of SAB e.g. skin or soft tissue, surgical site, vascular device, indwelling device or prosthesis, bone or joint, spine, endocarditis, pacemaker etc etc
- Take relevant blood samples e.g. additional 2 if endocarditis suspected.
- Document SAB source and management plan
