8/06/22 Flashcards
how is pabrinex adminstered?
always IV
triad of dementia, gait disturbances and urinary incontinence?
why is this not alzheimers
Ix?
management?
normal pressure hydrocephalus
alzheimers presents with urinary incontinence later on
first kumbar puncture
ct/mri
ventriculoperitoneal shunting
what is the dose of lorazepam given in status epilepticus
diazepam?
8mg
10mg
what are the mainstay in treatment of stable angina?
Aspirin
Statin
Sublingual GTN
Beta blocker or rate limiting calcium channel blocker
in a patient with normal cholesterol levels after first stroke is a statin indicated?
yes shown to improve mortality
what is the criteria for asses pt for home oxygen requirements? COPD mx
FEV1<30% cyanosis polycythaemia peripheral oedema jvp raised o2 sats less than 92%
criteria for LTOT in COPD
what is timeframe for assessment?
abg 2 in 3 weeks
- pO2 <7.3
if pO2 is 7.3-8 then offer of they have one of the following
polycythaemia
oedema
pulmonary htn
routine maintenance first 24 hours
25-30 ml/kg/day sodium chloride 0.18% in 4% glucose with 27 mmol/l potassium on day 1
when should hartmanns not be given?
in hyperkalaemia as it has K+
what is the risk of using large volumes of 0.9% saline ?
hyperchloraemic metabolic acidosis
what is in 0.9% saline?
154mm/l Na+
154mmol/l K+
HHS management goals?
normalise osmolality with 0.9 saline
replace fluid and elctrolytes 0.45 na+, cl-
normalise glucose
DKA management principles
fluid replacement
insulin
correction of electrolyte disturbance
long acting insulin continued and short stopped
what fluid in DKA?
isotonic saline
insulin administration in dka?
when should you infuse dextrose?
0.1unit/kg/hour
when glucose is <15mmol/l
5% dextrose
correction of electrolyte disturbancein DKA
serum potassium is often high on admission despite total body potassium being low
this often falls quickly following treatment with insulin resulting in hypokalaemia
potassium may therefore need to be added to the replacement fluids
if the rate of potassium infusion is greater than 20 mmol/hour then cardiac monitoring may be required
in acute management of dka what type of insulin
fixed rate whilst continuing regular injected long acting but stopping short acting
how is DKA resolution criteried
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
hypoglycaemia management
if awake?
if unable to swallow
10-20g oral glucose - short acting
like glucogel / dextrogel
IM glucagon
or IV glucose solution through large vein
how is specificity detected?
detection of true negative
= number of true negatives/ [true negatives and false positives] x100
what kind of ascites does nephrotic syndrome present?
low SAAG as albumin is lost through urine
low saag causes?
periotenal cancers - ovarian
chronic infection; tb
nephrotic syndrome
what parameters can diagnose DM
what common glucose is not a diagnostic measure?
fasting glucose >7
random glucose >11.1
urine dip
OGTT- when investigating impaired glucose tolerance
HBA1c
is HBA1C a good diagnostic measure fpr DM?
no
differentiating a malignant melanoma from a benign pigmented lesion
An irregular pigment network may be highly important in differentiating a malignant melanoma from a benign pigmented lesion
Intramuscular glucagon may not work in?
alcohol-related hypoglycaemia,
liver disease
prolonged hypoglycaemia.
which antibiotics do not interact with warfarin?
gentamicin
broad spectrum - amoxicillin?
how is alzheimers managed?
how does the drug work?
cholinesterase inhibitors - pyridistigimine
increases functional acetylcholine at synapses
travellers diarrhoea?
e.coli
how does HTN happen in conns?
aldosterone secretions lead to increased plasma sodium whihc leads to fluid retention = htn
features of constrictive pericarditis
occurs post Mi / dresslers
raised JVP
kussmaul sign - paradoxical rise in JVP with inspiration
pulsus paradoxus - cardiac output drop in inspiration
heart sounds quiet due to pericardial effusion
s3
