20/5 Flashcards
What med is used to manage delirium tremens?
Lorazepam
DD for single ulcer on the genitals
Chancroid
LGV
Syphillis
PAINFUL ulcer + PAINFUL lymphadenopathy = chancroid
painless ulcer + painless lymph = syphilis
painless ulcer + PAINFUL lymph = LGV
Howell-Jolly bodies are a sign of what?
What GI condition is it associated with?
Functional hyposplenism
Coeliac disease
What is the name for the PANCREAS severity score?
Glasgow score
How is AKI split into stage 1/2/3
Stage 1
- creatine rise of 1.5x
OR
- urine output <0.5ml/kg/hr for 6hrs
Stage 2
- creatine rise of 2x
OR
- urine output <0.5ml/kg/hr for 12hrs
Stage 3
- creatine rise of 3x
OR
urine output <0.3ml/kg/hr for 24hrs (or anuria for 12hrs)
Creatine rise matches staging (1 has to be 1.5 or won’t be a rise)
double time for each stage and 0.3 = stage 3
What are the side effects of anticholingeric drugs?
can’t SEE - dilated pupils = blurred vision
can’t PEE - urinary retention
can’t SHIT - constipation
can’t SPIT - dry mouth
increased temp and no sweating
confusion
VIVA for urinary inconteince
Urge - overactivity of the detrusor muscle
Stress - inability of the pelvic floor muscles to control urine when the intra-abdominal pressure increases e.g. coughing, sneezing, exercise etc.
Hx
- when did it start? is it new?
- assoc. symptoms e.g. coughing, sneezing, getting up during night to wee?
- urge?
- risk factors e.g. high fluid intake, caffeine, sugary/fizzy drinks
- any dragging sensation - check for prolapse
How much volume?
TINA
T - not relevant
I - any pain on urination, blood in wee?
N - weight loss, fevers, night sweats, reduced appetite, faecal incontinence, any loss/change of sensation anywhere
Gynae
- anything you see gynae for?
- any surgeries/procedures down there?
- contraception/menopause?
- smears - up to date? any follow up?
Obs
- kids?
- type of birth/complications? any tears?
Invx
Bedside
- pelvic exam - get to squeeze fingers and cough
- urine dip - exclude UTI
- bladder diary for at least 3 days
- QoL and incontience specific questionnaire
Bloods
- HbA1c - rule out diabetes (if indicated)
Imagining
- not routinely needed
Manage
Conservative
- Avoid caffeine, fizzy/sugary drinks (chemicals can irritate bladder) and too much fluid intake
- Pelvic floor muscle training with PT
(urge only) - bladder training with specialised nurses/PT
Medical
- Urge = anticholingeric = oxybutynin, solifenacin + botox injections
- Stress = duloxetine (if not a surgical candidate and conservative failing)
Surgical
- not for urge
- stress =
- pessary if prolapse present
- mid-urethral slings (compresses urethra against supportive layer and aids in closure of urethra during raised intra-ado pressure)
What is pyramidal weakness?
Weakness that spares the antigravity muscles
= flexed upper limbs and extended lower limbs
Sing of UMN syndrome
3 risk factors for ischaemic stroke vs haemorraghic stroke
All strokes
- Age
- HTN
- smoking
Ischaemic
- hypercholesterolaemia
- obesity
- FH
- AF
- diabetes
Haemorraghic
- AC
- Alcohol
- Stress
What is the pattern to follow with neuro exams?
- Inspection
- Tone
- Reflexes
- Power
- Sensation
- Proprioception /vibration
- Co-ordination
How is power graded?
0 = absoulelty nothing
1 = fascinations and twitching can be seen or felt
2 = can move but only when gravity eliminated
3 = can move against no resistance
4 = can move against slight resistance
5 = can move against full resistance
What kind of stroke can give you Horner’s syndrome?
Lateral medullary syndrome
What are causes of cerebellar problems?
V - thromboembolic, haemorraghe
I
N - SOL (tumour or abscess)
D - alcohol
I
C - Friedrich’s ataxia
A - MS
T
E
MAVIS
MS
Alcohol
Vasucular
Inherited
SOL
VIVA for stroke
- invx and management
Invx
Bedside
- appropriate neurological exam
—- UMN signs but typically reduced reflexes and reduced tone acutely
—– pyramidal weakness
—–
- ECG - check for AF
Bloods
- FBC, U+Es, LFTs, CRP, clotting screen
- HbA1c - diabetes
Imaging
- Urgent head CT
Management
Ischaemic
Acute
<4.5hrs = thromoblysis with atlepase - make sure no CI - recent head trauma, previous haemorrhage, recent surgery
>4.5hrs = 300mg aspirin
Long term (HALTSS)
MDT approach with specialised PT and OT and doctors and nurses
- everyone’s stroke is different and it’s hard to predict how someone will be impacted longterm/recover
Conserative
- stop smoking
- reduce alcohol intake
- check for diabetes and manage as necessary
- give PT and OT contacts
- stroke support groups
- can’t drive for 4 weeks
Medical
- HTN meds
- Aspirin 300mg for 2 weeks, clopidrogel 300mg loading dose then 75mg lifelong
- Statin ON
Surgical
- >70% carotid stenosis - endartectomy
Haemorraghic
- ABCDE
- strict HTN control
- neurosurgery evaluation
