AKT Flashcards
C) essential to exclude hypercalcaemia due to hyperparathyroidism before continuing to water deprivation test
CHADSVASC -> AF with stroke, anticoagulate
increased risk of contrast nephropathy -> IV saline
B
rhabdo would give CK of over 10,000
D
Sounds like cervical spine fracture -> CT neck
D
Non-invasive diagnostic test for PSC is MRCP
nuclear enlargement,
hyperchromasia and pleomorphism suggest…
carcinoma
treating respiratory acidosis in an alert patient
NIV
anterior pack vs cautery for epistaxis?
cautery - bleeding point visible
anterior pack - profuse bleeding with site difficult to localise
source of major bleeding in peptic ulcer disease
gastroduodenal artery runs posterior to
the first and second parts of the duodenum and may be a source of major
haemorrhage in peptic ulcer disease
spinal cord compression, likely due to mets -> frail so radiotherapy
vasopressors after fluid resuscitation!
supraspinatus tendinopathy -> refer for physio/general advice for home exercises
early Alzheimer’s - particularly temporal lobe affected, especially hippocampus
treating TCA overdose
bicarbonates
for major abdominal surgery in
respiratory disease opioid, by whatever route, should be avoided!!
epidural anaesthia can be topped up and titrated
i-gels are often used in cardiac arrest
situations as they are easier to place than tracheal tubes. However, only the
tracheal tube can seal the trachea off and protect against aspiration.
B) 2h for clear liquids, 6h for solids
osteoarthritis - RA typically affects multiple joints
Myasthenic crisis is an acute respiratory failure
characterised by forced vital capacity (FVC) below 1 L, negative inspiratory
force (NIF) of 20 cm H2O or less, and the need for ventilatory support.
ovary commonly drains to para-aortic
diabetes medications pre-op
diabetes medication can be broadly subdivided
into two categories.
o Drugs that lower blood glucose levels.
These include insulin and the
sulphonylureas. These drugs are
associated with hypoglycaemia in the
fasted state, and will always require
perioperative dose manipulation.
o Drugs that prevent blood glucose from
rising e.g. metformin, GLP-1 analogues,
DPP-IV inhibitors, SGLT2 inhibitors.
These drugs will never/rarely cause
hypoglycaemia in the fasted state, and
will only require dose manipulation if
there are other concerns.
* In basal – bolus insulin regimens and the
continuous subcutaneous insulin infusion (CSII),
the basal component provides the background
insulin, whilst the bolus component provides the
insulin to deal with the glucose load from meal
times. Perioperative manipulation will always
involve avoidance of the bolus dose associated
with meals. Minor reduction of the basal dose is
prudent to avoid hypoglycaemia that may be
associated with lack of snacking/ lack of early
morning breakfast.
symptomatic gallstone disease
laparoscopic cholecystectomy
compression bandages vs stocking
bandages - treating a venous ulcer
stockings - preventing further lesions
The combination of hypoalbuminaemia,
proteinuria, oedema, hypercholesterolaemia etc. is characteristic of nephrotic
syndrome. The most likely causes in the age group (without diabetes) would be
membranous nephropathy, minimal change or FSGS. Myeloma would also
need to be considered. A renal biopsy would be required to confirm the
diagnosis
neurogenic claudcation (coming on with walking, better when leaning forwards incl riding a bike)
prevents passage of gastric contents into the airway
- cricoid cartilage is a complete ring; pressure on the front is transmitted to the back and this seals the oesophagus, preventing gastric contents in a patient who is not fasted or has abdominal problems from passing higher up and possibly entering the airway
the breakthrough dose should be one-sixth of
the total daily dose. The current daily morphine dose is 180 mg, hence MST
continus at 90 mg 12 hourly and the breakthrough at morphine 30 mg.
T1 nerve root - intrinsic hand muscle wasting suggests T1. normal reflexes and normal other arm are against a cord lesion. sensory loss on forearm excludes median and ulnar nerve lesions. T1 dermatome often thought to be higher in the arm medially
cervical spine immobilisation!
sequence of care for potential trauma patient. no mention of a collar so should be applied. need to be done before any of the other options. CT head and CXR required. IV vit K not indicated as he is not on warfarin
right temporal lobe: aura implicates this
lobar pneumonia -> strep pneumoniae
intestinal metaplasia
compression bandages vs stockings
bandages - treating a venous ulcer
stockings - preventing further lesions
acute cholecystitis
- amylase not high enough for pancreatitis, bilirubin not high enough for choalngitis, no inflammatory response for biliary colic, LFTs normal excluding hepatitis
ICP secondary to mets
short duration acute low back pain in fit person -> continue usual activity
sub-massive pulmonary embolus but also at risk of haemorrhage. in this setting, IV unfractionated heparin can be stopped and reversed in event of recurrent bleeding
first line investigation for renal stones
CT KUB
repeat urea and electrolytes in 2 weeks
culture results can be false -ve, immuosuppressed so higher risk of SA -> treat with IV fluclox
sitagliptin approved for use in CKD
when there is a unilateral sensorineural hearing loss, it is vital to exclude the presence of a vestibular schwannoma or other neoplasm of VIII nerve or brainstem - done via an MRI scan
E: stool cultures should form part of work up in primary care before referral
cataplexy - presents with loss of skeletal muscle tone with strong (usually positive) emotions
De Quervain tendinopathy - history of atraumatic radial wrist pain with tenderness and enlargement at the first dorsal compartment over the radial styloid and pain at the radial styloid with active or passive stretch the thumb tendons over the radial styloid in thumb flexion
activated charcoal for people who have self harmed by poisoning, who present early (within 1 hour of ingestion), fully conscious with a protected airway, and are at risk of significant harm as a result of poisoning
perform a full primary survey
clinical cord compression imaging
MRI
spirometry -> COPD
lung mets
add paracetamol as required
SNB is diagnostic not therapeutic if 3 nodes are involved, so more surgery is needed
patient has had 2 weeks of tx for suspected mastitis with no effect
- if condition does not improve with Abx treatment, raises questionof whether diagnosis correct or if underlying issue e.g. abscess or inflammatory breast cancer which can mimic mastitis
all patients with claudication to be offered structured exercise programme before considering angioplasty, surgical intervention, or vasodilator therapy. Intervention only considered if structured exercise programme has been followed but no satisfactory improvement in Sx.
Vasodilator therapy after structured exercise programme + patient declines angioplasty/surgery
Heterozygous familial hypercholesterolaemia commonest genetic lipid disorder which would give this profile
NICE CKS says to suspected FH in an adult if:
- total cholesterol concentration > 7.5mmol/L and there is a personal or family history of premature CHD (before age of 60 in first-degree relative)
what is this rash
urticaria
classic history of malignant transformation in a pleomorphic salivary adenoma
primary pneumothorax: 2cm or w symptoms -> treat with aspiration or ambulatory device
secondary pneumothorax: chest drain for pneumothorax greater than 2cm
osteoarthritis first line management
topical NSAID
trigeminal neuralgia first line
carbamazepine
haemorrhage compressing the airway - complication of carotid endarterectomy
amaurosis fugax due to emboli from atherosclerotic plaques in carotid artery. Emboli typically originate from the ipsilateral internal carotid artery. Right eye sx -> right internal carotid artery
if SABA insufficient, either LAMA or LABA may be used
patient hsa a history of prostatic enlargement, so LAMA contraindicated
cryptosporidium management
self limiting, usually no treatment needed
bendroflumethiazide increases renal calcium absorpion -> low level hypercalcaemia
