8/3 Flashcards
What does a large rise in urea compared to creatine suggest?
Pre-renal cause of AKI
What are the causes of acute food poisoning?
ABC
staph Aureus
Bacillus cereus
Clostridium perfringens
What is the management of acute cholecystitis?
IV fluids an abx with analgesia
AND
within 1wk - laparoscopic cholecystectomy
If DKA has not resolved within 24hrs - what do you do next?
Senior endocrine review
Addison’s disease is managed with both hydrocortisone and fludrocortisone - what are they both?
What would you change if someone became ill?
Hydrocortisone = steroid - replace cortisol
Fludrocortisone = mineralocorticoid replacement - replace aldosterone
Steroids need doubled during sick day rules but fludro can stay the same
What are the cut-offs for gestational diabetes?
How is it managed?
5,6,7,8
Fasting => 5.6
2-hour => 7.8
- Diet and exercise ( fasting <7)
- Metformin (fasting >7)
- can add insulin
Pre-existing - only metformin and insulin can be used
- TREAT retinopathy can worsen during pregnancy - important to scan
- 5mg folic acid
- weight loss BMI >27
Reflex acronym
S1-2 - buckle my shoe (achilles)
L3-4 - kick the door (patellar)
C5-6 - pick up sticks (biceps)
C7-8, lay them straight (triceps)
What symptoms would necessitate a urine sample for women?
> 65
pregnant
haematuria (visible or non-visible)
atypical symptoms
catheter
recurrent UTI (2 in 6 months, 3 in 12 months)
persistent symptoms not responding to abx
What is the SSRI of choice in children?
Fluoxetine
UC vs Crohns
How is each managed?
What test can be done to exclude IBS and rule it in before colonscopy?
UC - Close UP
Continous inflam
Limited to rectum and colon
Only superfical mucosa
Smoking is protective
Excert blood and mucus
Use aminosalicylates (mesalazine) - topical (up the bum - won’t work if inflammation is too far away from rectum) or oral
PSC/psuedopolyps
Crohns - NESTS
No blood
Entire GI tract
Skip lesions
Transmural inflam/terminal ileum
Smoking (increases)/ Strictures
UC
1. mesalazine
2. flare-ups = steroids
- start with IV in hospital and then wean off to oral
3. curative = surgery
crohn’s
- steroids in flare-ups
- azathioprine in remission
Faceal calprotectin can rule out IBS
What should be prescribed if pt on SSRI and NSAID?
PPI - increases GI bleeding risk
Oral vancomycin not worked for C.diff - what’s next?
- Oral vancomycin
- Fidaxomicin (recurrent episode within 12 weeks go straight to this)
- Oral vancomycin + IV metronidazole (if life-treatening straight to this)
Inguinal vs femoral hernia
Indirect vs direct hernia
What can go wrong? When is it an emergency and need immediate surgical intervention?
Inguinal - superior and medial to pubic tubercule - through the superficial ring of inguinal canal
Femoral - inferior and lateral to pubic tubercule - through the femoral canal found medial in the femoral triangle (NAVY-C)
Indirect - through the superficial ring
- REDUCIBLE if press over deep ring
Direct - straight through the Abdo wall in hesselbach’s triangle
- NOT REDUCIBLE if press over deep ring (1/2 between ASIS and pubic tubercule)
Bowel can get caught outside and not be reducible and get ischaemic (very very painful with vomiting) - surgical emergency
Most common cause of traveller’s diarrhoea?
E.coli
How does a hiatus hernia present?
How is it managed?
What is most sensitive invx?
What are the two types
Chest pain
Dyspesia
Heartburn
regurg
Barium swallow (most found on endoscopy)
Medically for most - PPIs
If symptomatic ~surgery
Sliding (GOJ above diaphragm) - 95%
Rolling (GOJ remains below but other part of stomach has come up) - 5%
