Acute medical presentation 2 Flashcards
What key things should in include in a history for a collapsed patient?
What is the neurological approach?
What are the different parts of the brain where a problem could be?
What neurological problems could you get in the brainstem?
What neurological causes are there of impaired consciousness?
What metabolic causes are there of impaired consciousness?
What diagnoses should you always consider in a neurological patient?
What could a fluctuating GCS indicate?
What spontaneous movements could you observe in an unconscious patient?
What is the approach to the acute neurological evaluation?
What quick cognitive assessment would you do in a neurological evaluation?
What do you check for in the eyes for a neurological evaluation?
How do you check for brainstem reflexes?
What special tests could you conduct for a neurological evaluation?
How is DKA defined?
How is DKA managed?
How much fluid deficit are pts in DKA usually?
100ml/kg
Why do we give insulin in DKA?
Clear ketones, suppress ketogenesis and avoid avoid hypoglycaemia
How much insulin do you give in DKA?
When do you give dextrose in DKA?
when CBG <14
When would you switch to variable rate insulin infusion in DKA?
When ketones <0.6
pH >7.3
HCO3 >18
When do you measure hourly in DKA?
CBG
Blood ketones
Venous bicarbonate
K+
When is DKA resolved?
When blood ketones <0.3mmol/l
and venous pH >7.3
How long do you give IV insulin for in DKA, when patient has started back on usual sc insulin?
1 hour to make sure CBG’s are stable without huge variability.
signs of euglycaemic DKA?
Acidosis
Ketonaemia
normal/slightly raised CBG
Why does euglycaemic DKA occur?
As a result of insulin deficiency/inactivity accompanied by an increase in counter regulartory hormones.
What medications can cause Euglycaemic DKA?
What are the characteristic features of HHS?
How is HHS managed?
How long does resolution of HHS take?
up to 72 hours
What history and examination should you take for an endocrine problem?
what is the pathophysiology of addisons disease (primary hypoadrenalism)?
What is an adrenal crisis?
what is the role of glucocorticoids?
What is the role of mineralocorticoids?
What are the causes of Addisons disease?
What are the symptoms of addisons disease?
What are the signs of addisons disease?
What investigations do you do for addisons disease?
What are the ACTH levels for adrenal failure?
What is the normal cortisol response in a short synacthen test?
What is the management of adrenal crisis?
What is the regular treatment and education of addisons disease?
What do thyroid hormones do?
What are the clinical features of thyrotoxicosis?
What are the poor prognostic features of a thyroid storm?
What would the TSH be in patients with acute thyrotoxicosis?
Low (except TSHoma)
How would you establish a cause of acute thyrotoxicosis?
What antithyroid drugs would you commence in acute thyrotoxicosis?
What is the definitive treatment for acute thyrotoxicosis?
What precipitating factors contribute to thyroid storm?
How do you manage thyroid storm?
What is malignant HTN?
What is the difference between HTN urgency and HTN emergency?
What complications could arise from a HTN emergency?
What are the signs of malignant HTN?
What is the criteria for LVH?
S in V1 + R in V5 or V6 (whichever is larger) >35mm (7 large squares)
What investigations would you do in malignant/accelerated HTN?
When would you admit a patient with high BP?
How would you treat a HTN emergency?
What is the drug class of nifedipine?
dihydropyridine calcium channel blocker
What is there a risk of if MAP is decreased too quickly?
Organ infarction (CNS)
What are the endocrine secondary causes of HTN?
What are the clinical features of a phaeochromocytoma?
How is phaeochromocytoma managed?
What is the reticular system?
Essence of awareness/consciousness
