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Medicine Block > Acute Medicine > Flashcards

Acute Medicine Flashcards

1
Q

What is the pathophysiology of a DVT ?

A

Venous thrombi can form in the deep veins of the legs due to a stasis of the blood which could be due to an extended period of immobility.

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2
Q

Risk factors of DVT ?

A

Increased age
Pregnancy
Surgery
Past DVT
Cancer
Obesity
Immobility

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3
Q

What are the signs of a DVT ?

A

Calf warmth
Tenderness
Swelling
Erythema
Mild fever
Pitting oedema

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4
Q

Investigations when suspecting a DVT ?

A

D-dimer ( not specific to a DVT )
USS
Thrombophilia tests
Urine dipstick
FBC

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5
Q

What preventative measures can be put in place for a DVT ?

A

Stop the pill
Mobilise early
Low molecular weight heparin / Fondaparinux
Compression stockings

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6
Q

What treatment options are there for a DVT ?

A

Low molecular weight heparin ( enoxaparin ) or Fondaparinux
Stop heparin when INR is 2-3

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7
Q

What is used to assess the probability of a DVT forming ?

A

The well’s score

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8
Q

What should always be suspected if there is a sudden collapse 1-2 weeks after surgery ?

A

PE

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9
Q

How do PE’s occur ?

A

Venous thrombi, usually from a DVT, pass into the pulmonary circulation and block blood flow to the lungs.

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10
Q

What are the risk factors of a PE ?

A

Malignancy
Surgery
Immobility
COCP
Previous thromboembolism or inherited thrombophilia

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11
Q

Signs and symptoms of a PE ?

A

Acute dyspnoea
Pleuritic chest pain
Haemoptysis
Syncope
Hypotension
Tachycardia
Increased JVP
Tachypnoea

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12
Q

Investigation for a PE ?

A

U & E
FBC
ECG - can be normal or sinus tachycardia
CXR - often normal
ABG
Serum D dimer
CT pulmonary angiography

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13
Q

What is the management of a large PE ?

A

Oxygen if hypoxic
Analgesia
Start low molecular weight heparin
If stable BP start warfarin loading regime

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14
Q

Signs and symptoms of sepsis

A

Slurred speech or confusion
Extreme shivering or muscle pain
Not passing urine
Severe breathlessness
Skin mottled or discoloured

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15
Q

Risk factors for sepsis

A

Age ( under 1 or over 75 )
Cancer - chemotherapy
Diabetes
Splenectomy
Immunosuppressants
Recent surgery
Breach of skin integrity
Indwelling lines or catheters

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16
Q

What should be assessed for suspected sepsis ?

A

Temp
HR
RR
BP
O2 sats
Consciousness level
Any breaches of the skin
Non-Blanching rash
Cyanosis of the skin

17
Q

What is the treatment for sepsis ?

A

The sepsis 6 bundle
- give oxygen
- take a blood culture
- give IV antibiotics ( meropenem )
- give fluids
- measure lactate ( do a blood gas )
- measure urine output

18
Q

What is shock ?

A

Circulatory failure that results in inadequate organ perfusion.

19
Q

Signs of shock

A

Low GCS
Pallor
Cool peripheries
Tachycardia
Slow capillary refill
Tachypnoea
Oliguria

20
Q

How does sepsis cause shock ?

A

An infection from any organism can cause acute vasodilation from inflammatory cytokines.

21
Q

What can cause inadequate cardiac output causing shock ?

A

Hypovolaemia - bleeding ( trauma, GI bleed, ruptured aortic aneurysm), vomiting, diarrhoea, burns

Pump failure - cardiogenic shock ( arrhythmias, aortic dissection ), PE, cardiac tamponade, pneumothorax

22
Q

What should be done for shock in the ABCDE assessment ?

A

Large bore IV access
ECG

23
Q

If there is a raised JVP which shock is indicated ?

A

Cardiogenic

24
Q

What should be looked for in a general review of someone with shock ?

A

Cold and clammy skin or warm skin
Signs of anaemia
Signs of dehydration
Pulse - bounding or weak
Tachycardia
Abdomen

25
Q

What is anaphylaxis ?

A

A type 1 IgE mediated hypersensitivity reaction causing a release of histamine.

26
Q

Signs and symptoms of anaphylaxis ?

A

Wheeze
Cyanosis
Oedema
Urticaria
Itching
Hypotension
Sweating
Diarrhoea and vomiting
Erythema

27
Q

What are some potential triggers for anaphylaxis ?

A

Drugs - penicillin
Latex
Stings
Eggs
Fish
Peanuts

28
Q

Management of anaphylaxis ?

A

Secure the airway ( give oxygen and intubate if needed )
Raise feet and remove cause
Give adrenaline IM and repeat every 5 mins
Chlorphenamine and hydrocortisone IV

29
Q

What drugs can cause respiratory depression if there is an overdose ?

A

Opiates
Benzodiazepines

30
Q

What drugs can cause a coma if there is an overdose ?

A

Benzodiazepines
Alcohol
Opiates
Barbiturates

31
Q

What drugs can cause metabolic acidosis if there is an overdose ?

A

Alcohol
Methanol
Paracetamol
Carbon monoxide

Medicine Block (4 decks)

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