3/11/21 Flashcards
Symptom Control for Asthma - Points to consider and cutoffs between good, partial and poor.
- Partial → 1 or 2 of the below, Poor Control → ≥3 of below
1. Daytime Symptoms → > 2 episodes per week
2. Nocturna Symptoms → any symptoms at night or on waking
3. Limitation to Activity → any limitation to activites
4. Use of SABA reliever → >2 days per week of SABA
Difference between PMR and Statin Induced Muscle Symptoms
Pain for statin induced -> can occur in large muscle groups including thighs and buttocks. PMR - more shoulder and hip.
Timeframe is related to the commencement of a statin - 4-6 weeks following the commencement of a statin
Elevated CK in statin induced muscle pain. ESR and CRP elevated in PMR.
When considering statin induced muscle symptoms -> what are the steps to be taken? What blood test needs to be completed?
CK
if CK > 5x upper limit of normal -> cease statin for 6-8 weeks.
if CK <5x upper limit of normal -> cease statin for 2-4 weeks
if symptoms continue - look for other cause of muscular pain and symptoms.
if symptoms improve -> resume original statin at lower dose or change to different statin.
Baseline investigations for Neonatal Jaundice (4 points)
- FBE + Film + Reticulocyte Count
- Bilirubin → unconjugated/conjugated split
- Group/Coombs
Causes of Biliary Atresia (1 main and 4 bonus)
- Biliary Atresia
- Needs to be detected early to improve chances of success of surgical repair → before 45-60 days of life
- Other Causes:
- Neonatal Hepatitis
- Metabolic
- Choledochal Cyst
- Complication of TPN
Additional Investigations of Conjugated Hyperbilirubinaemia (7 tests)
- LFT
- Clotting Profile
- TFT
- Septic Screen
- Viral Serology
- Alpha-1 Antitrypsin Levels
- Abdominal U/S
Causes of Unconjugated Hyperbilirubinaemia (5 points - 2 main + 3 bonus)
- Physiological Jaundice
- Exaggerated physiological response that should resolve within 2 weeks in a term baby
- Breast Milk Jaundice
- Common → jaundice may continue for many weeks
- Cessation of breast feeding is NOT indicated
- Sepsis
- Haemolysis
- Excessive, non-haemolytic red cell destruction
Diagnostic Criteria for Left Bundle Branch Block
- Widened QRS Complex → >120ms
- Dominant S wave in V1
- Broad monophasic R wave in lateral leads → (I, aVL, V5-6)
WillaM LEFT
Causes of Left Bundle Branch Block (3 main
+ 5 others)
- Aortic Stenosis
- Ischaemic Heart Disease
- New LBBB in the context of chest pain is traditionally consider part of the criteria for thrombolysis
- Hypertension
- Dilated Cardiomyopathy
- Anterior MI
- Primary Degenerative Disease (Fibrosis) of the conducting system → Lenegre Disease
- Hyperkalaemia
- Digoxin Toxicity
How to assess severity of pneumonia? Based of this assessment - how do you manage patients?
CRB-65
- *C** → Confusion (Acute Onset)
- *R** → Respiratory Rate >30
- *B** → Blood Pressure (Systolic <90, Diastolic <60)
- *65** → Age >65
0 Points → 1% 30-day mortality → likely suitable for management in the community
1-2 Points → 5-12% mortality → consider referral to hospital
3-4 points → up o 33% mortality → urgent hospital admission
Indications for ambulatory BP monitor (6 points)
- Suspected white-coat hypertension (including pregnancy)
- Suspected masked hypertension → untreated subject with normal clinic BP and elevated ABP
- Suspected nocturnal hypertension or no night time reduction in BP
- Hypertension despite appropriate treatment
- Patient with high risk of future CV events - even if clinic BP is normal
- Suspected episode HTN
Normal Ranges for Ambulatory BP Monitoring (24hr average, daytime, nighttime)
24 Hour Average <115/75mmHg → HTN if >130/80mmHg
Day Time <120/80 → HTN if >135/85mmHg
Night Time <105/65 → HTN if >120/75mmHg
Diagnosis of Pre-Eclampsia (HTN numbers, at what gestation, 6 points of other organ/system features)
BP >140/90 After 20/40 Proteinuria -> ACR >30 Renal -> elevated Cr Liver -> elevated transaminases Haem -> thrombocytopenia <100 Neuro -> headaches or visual changes Lung -> pulmonary oedema
Characteristics of Hyperosmolar Hyperglycaemic Syndrome (HHS) (5 points)
- Hyerosmolar - >320
- Hypergycaemia
- Severe Dehydration
- Change in Mental Status
- Little or No Ketoacidosis
When is Bow Legs seen physiologically? When is Knocked Knees seen physiologically?
Bowed Legs - Physiological Bowing → seen from birth until 2-3yo-
Knocked Knees - Physiological → seen from 3-5 years of age, resolves by growth by age 8
Examination Findings for Bow Legs?
Examination Findings for Knocked Knees?
Bow Legs - Measure intercondylar distance in standing with feet together
Knocked Knees - Measure intermalleolar distance in standing with knees together
What investigation is used for both bow legs and knocked knees? What criteria do you have to go ahead to investigate bow legs and knocked knees?
X-Ray of Knees if:
- Progressive Deformity
- Unilateral Deformity
- Lack of Spontaneous Resolution
- Aged >3yo -> for Bow Legs
Indications for Specialist Referral for Bow Legs and Knocked Knees. Common Criteria of both and distance criteria for both.
COMMON
- Progressive Deformity or Lack of Spontaneous Resolution
- Pain
- After Trauma
- If accompanied by other skeletal deformity such as height <5th centile
BOW LEGS - >6cm intercondylar
KNOCKED KNEES - >8cm intermalleolar
Management:
If bilateral discharge and only on expression + no discrete lesions on examination + negative for bleeding.
cease expression, mammogram if due, review in 2-3 months, do prolactin if persistent bilateral discharge
Management:
If bilateral discharge and only on expression + clinically abnormal breast examination
follow New Breast Symptom flowchart but likely will require Mammogram/Ultrasound
Management:
If unilateral spontaneous discharge or age >60
Refer to surgeon
Causes of Abnormal Nipple Discharge (7 points)
- Duct Ectasia
- Nipple Eczema
Duct Papilloma
Breast Cancer
Paget’s Disease of the Nipple
Hormonal Changes
Drugs + Medications
Pharmacological Management of Anxiety in Palliative Care
- Antidepressant
2. Benzos
Options for Pharmacological Management of Rheumatoid Arthritis (5 points)
- Simple Analgesics - Paracetamol
- Fatty Acids → Omega-3 Supplements
- NSAIDs/COX-2 Inhibitors
- DMARDs → consider when there are several swollen joints (especially if the tests for RhF and anti-CCP are positive
- Corticosteroids - oral/intra-articular
Aspects of Non-Pharmacological Management of Rheumatoid Arthritis (6 points)
- Weight Control
- Patient Education
- Occupational Therapy
- Exercise
- Psychosocial Support
- Sleep Promotion
Factors to consider in assessing the severity of the child with bronchiolitis. (6 points)
- Behaviour
- Respiratory Rate
- O2 Saturation
- Apnoeic Episodes
- Use of Accessory Muscles
- Feeding
Characteristics of Ankylosing Spondylitis (5 points)
- gradual onset < 40yo
- duration of symptoms >3 months
- prolonged morning stiffness and night pain
- improvement with physical activity or exercise, and failure to improve with rest
- response to NSAIDs
What does flexural psoriasis look like? Where does it present mostly?
Well-defined, smooth or shiny red patches, can fissure (crack) in the crease
Very persistent + symmetrical
Common in the skin folds (moist) submammary and groin creases
Steps for management of a bite or clenched fist injury (4 steps)
- Examination for deeper injuries, foreign body, devitalised tissue
- Consider need for post exposure prophylaxis -> lyssavirus or HepB or HIV
- ADT
- consider need for ABx
What kind of bites need post-exposure prophylaxis and against what? (2 points)
- Bat Bites → rabies or lyssavirus prophlaxis
- Human Bite → consider if blood exposure and therefore the need postexposure prophylaxis against bloodborne disease (Hep B or HIV)
Discuss tetanus following a bite or clenched fist injury -> when is tetanus booster needed? when is tetanus immunoglobulin required?
- Tetanus Booster if >5 years + Dirty or Major Wound
- Tetanus Immunoglobulin only indicated if not completed 3 dose course of ADT in the past + Dirty or Major Wound
When does a non-infected wound considered high risk therefore require ABv?
- presentation to medical care is >8/24
- wound is a puncture wound that cannot be debrided appropriately
- wound is on the hand, feet or face
- wound involves deeper tissue → bones, joints, tendons
- wound involves an open fracture
- patient is immunocompromised or alcoholic liver disease or diabetes
- cat bite
