5/4/22 Flashcards
How do you calculate regular and irregular heart rate?
Regular - 300/no.of large squares between QRS
Irregular - no of QRS complexes in 30 big squares (6s) x 10
Describe the differences between the different types of heart block
Which ones do you treat?
1st degree - long PR interval
Mobitz type 1 - longer and longer PR interval followed by drop of QRS
Mobitz type 2 - regular long PR, every nth QRS missing
3rd degree - no relationship between P and QRS
Treat - 3rd degree with ventricular pacing
What does AF mean on ECG?
No P waves
Talk through how you would report an ECG back to an examiner.
Name and DOB Where and when ECG was taken Axis (high in L = left, high in III = right, high in I and II = normal) Rhythm Rate P waves present? PR interval? QRS complex always follow a P wave? QRS complex normal?
Anything else:
- Tall tented T waves (hyperkalaemia)
- Delta waves (WPW)
- ST elevation (>2mm)
Describe the difference between the two types of urinary incontience?
And explain some of the pathology
Urge
- can’t hold it in and expel large amounts of urine
- due to fault in detrusor muscles in the bladder or hyperrelfexia (MS, spinal cord injury or stroke)
Stress
- small amounts of urine come out when coughing, sneezing or laughing
- due to poor strength of pelvic muscles e.g. levator ani and sphincter incompontence
You have a patient present with episodes of wetting herself, write up what you would ask her:
HPC
- how long being going on for?
- how regularly? day and night?
- any trigger?
- any factors that make it better or worse?
= worse = caffiene, alcohol and excessive amount of water
- starts after coughing, sneezing or laughing?
- get sudden urge to wee and can’t make it to the bathroom on time?
- how much volume?
- any pain?
- any blood?
- faceal incontience?
- weight loss?
- fever?
- loss of appetite?
- vaginal prolapse? - “dragging sensation/lump down there?”
Obs
- any kids?
- mode of delivery?
- any tears or complications?
Gynae - anything see gynaecologist for? - any previous surgeries or procedures down there? - when last period? = contraception? = menopause symptoms? - smear tests = up to date? = anything that has prompted further investiagtion
PMH and DH+A history as normal
- keep eye out for diuertics they can increase stress incontience
Social
- drink
- smoke
- home
- hobbies
- work
- how is the condition affecting it?
What would your next investigations be in a patient with: - stress - urge - mixed incontience?
Urine diary
- record all fluid intake, urination and incontience over at least 3 days
Avoid exaccerbating factors
- caffiene
- alcohol
- excess fluid intake
- lose weight if necessary
Pelvic examination (remember to get patient to cough to check for stress)
Urinary dipstick (rule out infection)
If urge first line not working or unsure (mixed) -> urodynamic studies
BMI parameters
<18.5 = underweight 18.5-24.9 = healthy weight 25-29.9 = overweight 30+ = obese
What management options do you tell a patient with stress and same again for urge?
Stress
- avoid exacerbating factors
- weight loss
- physio for at least 3 months of pelvic floor exercises before surgery
- surgery = mesh insertion (goes around the urethra and up behind pubic symphsis to the abdo wall) keeps urethra and bladder stable
Urge
- bladder retraining - increase time between voiding for at least 6 weeks
- anti-cholingeric (solifenacin)
- if this fails = urodynamic studies
- intrustive e.g. botox injection into detrusor muscle
What is the drug used to treat opiod overdose?
Nahloxon
What drug is used in delirious patients to help sedate them?
Haloperidol
DO NOT USE IN PARKINSONS / LEWY BODY DEMENTIA
instead use lorazepam
What are the side effects of anti-cholingerics?
Name one again?
Solifenacin
Dry mouth Dry eyes Tachycardia Urinary retention Constipation
(remember it is an anti-parasympathetic so basically all the fight or flight response)
