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Yr 3 Medicine > Acute Medicine > Flashcards

Acute Medicine Flashcards

1
Q

A 60 year old man who has been in hospital for 4/52. He complains of a new sore leg. What would you like to ask?

A

Unilateral or bilateral?
Any trauma or break of skin?
Any associated fever?
Is it tender?

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2
Q

What will a DVT look like?

A

Unilateral
Leg swelling
Dilated superficial veins
oedema
Tenderness
Colour changes

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3
Q

What further examination would you like to perform if you suspect DVT?

A

Measure 10cm below the tibial tuberosity if you suspect DVT on each leg.

3cm+ difference is significant

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4
Q

What tests will you order for suspected DVT?

A

Doppler US of leg
D-dimers

Possible CTPA if PE suspected

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5
Q

What is the treatment for DVT? When should it be started?

A

Apixiban (straight away if suspected… don’t wait for Dgx)

Catheter-directed thrombolysis if not working

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6
Q

What preventions can be put in place to prevent DVT?

A

1) TED/Anti-Embolism Stockings
2) SCD (Sequential Compression Device)
3) DOACs

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7
Q

A man presents with SOB and pleuritic chest pain. What are the differential diagnosis?

A

PE
Pneumonia
TB
Rib Fracture
SLE

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8
Q

How do you decide whether a patient has a low, medium or high probability of PE?

A

Well’s Score > 4

Incl.
Symptoms of DVT
Tachycardia
Haemoptysis
Cancer
Immobile/Surgery

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9
Q

What test is used to confirm PE? Is there any contraindications to this?

A

CTPA

Renal Disease
Contrast Allergy?

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10
Q

If PE is confirmed what could be the possible underlying causes?

A

Underlying Malignancy
Thrombophillia
SLE
Oestrogen Therapy
Pregnancy

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11
Q

How do you treat a confirmed PE?

A

Apixiban (LMWH while awaiting results)

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12
Q

What is massive PE? How do we treat this?

A

Hypotensive or signs of R sided heart strain on echo

Thrombolysis w/ IV Alteplase

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13
Q

A woman presents to the Emergency Department with lip and tongue swelling following a bee sting. She is feeling breathless.

What initial assessments should be made?

A

A - Secure airway

B - Provide O2 if needed, wheeze/stridor? Salbutamol will help

C - IV Fluids, tachcardaic?

D - Lie patient flat to improve cerebral perfusion

E - Look for urticaria and angio-oedema

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14
Q

What treatment should be given in anaphylaxis?

A

IM Adrenaline (repeat every 5 mins)

Antihistamines (PO cetirizine)
IV Hydrocortisone

High Flow o2
IV Fluids

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15
Q

What are the common causes of anaphylaxis?

A

Drug Allergy
Food Allergy
Insect bites/stings

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16
Q

What is the pathophysiology of anaphylaxis?

A

Type 1 hypersensitivity reaction

IgE stimulates mast cells to release histamine + other pro-inflammatory mediators.
Causing vasodilation and bronchial constriction
(mast cell degranulation)

17
Q

What are the potential consequences of anaphylaxis?

A

Cardiogenic Shock
Death

18
Q

What advice should be given to a patient on discharge after anaphylaxis?

A

Need Allergy Action Plan
Given an epipen and shown how to use it
Avoid trigger

19
Q

When would you suspect sepsis in a patient?

A

HR > 100
RR > 25
Sats < 95%
Temp > 38 (below 35 in elderly)
Confused
SBP < 100

20
Q

What is the immediate management for sepsis?

A

Give fluids
Give IV abx (ceftriaxone)
Give O2

Take lactate
Take blood cultures
Take urine output

21
Q

What further investigations should be carried out after the sepsis 6 has been given?

A

FBC
U+Es
LFTs
CRP
BM
Blood gases
CXR
Urine Dip/MCS
Lumbar puncture (meningitis)

22
Q

If you are told the blood culture is growing gram -ve rods. What is the possible organism and source of infection? How would you treat this?

A

E coli (gastroenteritis)

Piperacillin or Tazobactam

23
Q

What do we look for with head injury/suspected neurology presentation?

A

1) Meningism features
2) Raised ICP signs
3) Localising near signs?
4) Is patient fitting?
5) Neuromuscular weakness?

24
Q

What’s the most common drug to cause headache?

A

GTN spray (vasodilator)

25
Q

What is the main concern when a pregnant women or patient on the COCP comes to you with a headache? How can we confirm diagnosis?

A

Cerebral Venous Thrombosis

CT Venogram

26
Q

How do we treat raised ICP?

A

1) Mannitol IV
2) IV Dexamethasone
3) Urgent CT Brain
4) Neuro/anaesthetics input

27
Q

How do we treat a sub-arachnoid haemorrhage?

A

Nimodipine (Ca channel blocker)
Saline
Analgesics

28
Q

How do we decide what management is needed for a stroke?

A

CT Brain to see if there is a bleed
NO BLEED:
Aspirin or thrombolysis w/ alteplase in the young

29
Q

What drug do we give in an alcohol withdrawal seizure?

A

IV Pabrinex

Yr 3 Medicine (11 decks)

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