4/3 Flashcards
bilateral loss of dexterity
degenerative cervical myelopathy
sick euthyroid - Ix
normal or low TSH
low T4/T3
common in hosp patients
steroid therapy - Ix
low TSH
normal T4
breathing in DKA
kussmaul’s - deep and laboured
DKA - blood results
hyponatraemia
hypokalaemia
low bicarb
UMN sx - ipsi or contralateral
contralateral
type 4 RTA causes
hyperkalaemia
symptoms of anastomotic leak
general sepsis
peritonitis - guarding
abdo pain
fever
anastomotic leak - Ix
CT abdo
incubation period of staph
1-6hrs
incubation period of campylobacter
48-72hrs
non-bloody diarrhoea
incubation period salmonella
16-48hrs
eggs
incubation period e.coli
12-24hrs
travellers
bloody diarrhoea
e.g. loop diuretics
bumetanide
furosemide
autonomic dysreflexia
- what
- cause
- present
- comp
- mx
what - injury T6 and above
cause - faecal or urianry retention
present - extreme HTN, flushing, sweating above level of lesion
comp - heamorrhagic stroke
mx - remove stimulus and treat LT HTN and bradycardia
mx acutre intermittent porphyria
Iv haem arginate
lithuim causes
nephrogenic diabeties insipidus
nn suppling ant and lat thigh
lat cutaneous nn thigh
femoral nn injury presentation
weak hip flexion
weak knee extension
impaired quadriceps tendon reflex
multiple myeloma - skull xray
raindrop lesions
ALP raised in
paget’s disease
multiple myelopma - CRAB
Calcium raised
renal failure
anaemia
bone lesions
when is rhythm controlled first line in AF
HF
reversible cause
co-morbidity
new onset (<48hrs)
cerebellar syndrome - symptoms
DANISH dysdiadochokinesis ataxia nystagmus intention tremor slurred speech hypotonia
causes - cerebellar syndrome
carbamezpaine
mx - malignant htn
iv labetalol
nimodipine in SAH
prevent vasospasm
normal ECG and K+<6 mx
calcium resonate
BDZ overdose mx
flumazenil
TCA overdose mx
sodium bicarbonate
lifestyle mx of hyperthyroidism
avoid caffiene
hyperthyroid eye symptoms
lid lag - lid normal except when looks down, the one that lags won’t come down
joints - hyperthyroidism
thyroid acropachy -soft tissue swelling
- Grave’s!
signs - hyperthyroidism
HTN sinus tachy/ AF hyer-reflexia warm peripheries - sweaty, flushed prox weakness - quads, difficulty getting out of chair with arms crossed
Ix - lump in neck
exams bloods, ab CT of neck - single lobe vs bilaterally - insufficient - technectium scan - r/o depending on uptake - rarely done FNAC if ?Cancer
mx - hyperthyroidism
bblock - propanolol if symptomatic
1) carbimazole - uptitrate drug, review in 4-8weeks and can increase
- given for 12-18 months, decrease dose once sx controlled
- safety net agranulocytosis - risk of infection and come back if sore throat or fever
2) propylthiouracil - severe liver disease, rarely used
3) drugs not work - radioactive iodine therapy EXC grave’s/ pregnant women
- avoid children for 3 weeks and not get pregnant for 6M
4) surgery - total or sub total
- post-op comp - haematoma (get a suture remover quickly), hypothyroidism, hypocalcaemia, vocal cord paralysis
rarely use block and replace
psoriasis - ask about
joint pain
scalp problems
skin changes - scaly, silvery, plaque, raised, erythematous base
mx psoriatic arthritis
avoid smoking, drinking exercise 1 joint - NSAIDs, +- steroid injections dmards - methotrexate, leflunomide, sulfasalazine anti-TNF ustekinumab - MAB12/23
insulin s.c. or IM
s.c.
mx dka
1- 1L 0.9% over 1hr if SBP>90, bolus if <90
2 - fixed rate insulin 0.1units/kg/hr - once 14 add 5%-10% dextrose
- VBG
3 - 1L over 2hrs K + if <5.4
4 - 1L over 1hrs
5 - 1L over 4hrs
assess every 4-6hrs - blood sugars
once eating and drinking - s.c. insulin
counselling dm
basal bolus regime
se insulin - wt gain and so carb count to prevent (DAPHNE)
normally - check bms every 2 days four times, morning should be 5-7, before meals 4-7, after meals 5-9
lipohypertrophy - vary site
insulin resistance - we may have to increase insulin due to getting use to it
sick day rule - get advise, monitor bms more frequently, drink more fluids, add metformin with heavier bmi, sugary drinks if not eating, monitor every 3-4hrs even over night
