Cardio Resp etc Flashcards
NSTEMI + no C.Enzymes = ?
NSTEMI + C.Enzymes = ?
-RBBB/flat or T-invert
CA SpaZm = ?
-Tx?
@lying = ?
__________
RBBB = ? axis deviation
Left ant fascic block = ?AD
Left posterior fascic block = ?AD
RBBB + left ant fascic block = ?AD #?
RBBB + left post fascic block = ?AD #?
Trifascicular block (incomplete)?
Trifascicular block (Complete)? \_\_\_\_\_\_\_\_\_\_
developmental dx w/ narrowed ostium
STEMI + T-invert - sign?
ST dep + T-invert - reverse tick
-bradycardia
ST dep + R high
SUDDEN SYNCOPE Pt = bradycardia + ... -loads of Ps + and few QRS = don't match up.. -WIDE + DEEEEEP inverted T waves = ?Dx \_\_\_\_\_\_
ST elevation Ax?
ST depression AX?
T wave inversion Ax?
_____________
chest pain worse @inspiration/lying relief @lean-forward pericardial friction RUB - dx? SADDLE-ST / ?? = most specific ECG marker for pericarditis Dx? Tx?
Trops peak when?
Hypo and Hyper Kalaemia ECG
Sinus tachy
RBBB, RAD-strain
Resp Alk.
RBBB+RAD = ?
-EMBOLUS SHOOT OFF -> STROKE!!!!!!
RBBB+LAD = ?
-prime lad
_________
short PR interval (<120-200ms),
wide QRS complex (>120ms)
upsloping delta wave.
1 small square = 40ms
1 big square = 200ms
NSTEMI + no C.Enzymes = U.Angina
NSTEMI + C.Enzymes = NSTEMI
CA SpaZm = PrinZmetal
- Tx = DHP Amlodipine
@lying = decibitus
__________
RBBB = No axis deviation
Left ant fascic block = LAD
Left posterior fascic block = RAD
RBBB + left ant fascic block = LAD #bifascicular
RBBB + left post fascic block = RAD #bifascicular
Trifascicular block (incomplete) -Bifasicular + 1st/2nd degree heart block
Trifascicular block (Complete)
-Bifasicular + 3rd degree Heart block
__________
COSA
Coved/Convex STEMI + T-invert - BRUGADA
DIG TOXICITY
ST dep + R high =
Posterior MI
COMPLETE HB 3rd
-Stoke Adam = deep AF T inversion
________
ST elevation =
MI/ Pericarditis/ Brugada
ST dep = ischemia Conduction dx VHypert* Digox
T invert = ischemia/old Brugada VHypert* Digoxin
*(+ tall R = RVH(V1-3), LVH(V5-6, 2,3,avL))
________________
- PERICARD dx = worse @insp/ying; improve @lean-forward
- PR Depression = MOST specific for PPPeRRRicarditis!!
- NSAID+++++Colchicine BOTH!!!!
Trop T peak most sensitive - max accurate at 12 hrsssssss!
HypoKal - PRUQT
HIGH: PR, U QT
Low: ST/T
HyperKal - QRST
HIGH: QRS, T-wave
Low: P
Sinus tachy,
RBBB, RAD-strain -
Resp Alk = PEEEEEEEEE
RBBB+RAD = ASD secundum dx
-EMBOLUS SHOOT OFF -> STROKE!!!!!!
RBBB+LAD = ASD primum dx
-prime lad
____________
short PR interval (<120-200ms), wide QRS complex (>120ms) upsloping delta wave. -WPW -normal PR interval = 120-200ms QRS < 120ms
1st HB? PR > 0.?????s
Mobitz 1 v 2?
3rd HB tx?
Contraindication to thrombolysis
CI to AF anticoag tx?
1st HB = PR > 0.2 s!!!!!
Mobitz 1 = WENKEBACH -
PR Wenking BACKWARDS -> beat DROP
Mobitz 2 =
normal P -> absent QRS beat drop
no P and QRS relationship = 3rd HB - ATROPINE!!! bradycardia algorithm!! Recent asystole Complete HB Vent pause >2s Mobitz 2
Thrombolysis CI: V - stroke/ADiss/HTN 180/ ICH I - Endocard Neoplasm D - ACoags I Preg Congen AVMs Ax Trauma HI/Surg E:
AF tx CI: Reversible Ax AF -> HF AFlutter 4 ablation New-onset
- Cholestyramine causes ?2SEs
- Cholestyramine mechanism?
- Dyslipidaemia? Tx if statin fail? SE??
- Absent PulsusParadoxus - Ax?
- Flash Pul Oed causes?
- Stress test CI:
- QRS low voltage Ax?
- Cholestyramine=Gallstones + Constipation
2.
-Cholestyramine Bind 2 bile @GI ->
prev absorption -> shit out bile, HENCE…
-bile acid level drops -> chol convert 2 bile acid -> chol reduce!!
-CHOLESTYRAMINE=CONSTIPATION
- Dyslipidaemia=lowHDL highLDL
- Nicotinic Acid
- FLUSHING!!! - insp-> low SV-> BPdrop>12
PAH
AR / ASD
High Left EDV
Tam-PulsParadox-onade
CPericardKnock-Kussmaul
- MI / MR!!!! > AR / CCF
6. StAMP Stress test CI: ARrhythmias/ADiss/ASten MI / HF / PE Peri/Myocarditis
7.
Limb <5mm
Chest <10mm
Distance incr: CCoPPd*
Infiltrative
Metabolic MyxoedHypoT
COPD/CPericardiKnock
Obesity
Pericard/myocarditis
FHH GENE = ? receptor is mutated
Criteria to diagnose HETEROzyg FH?
GLTT FF
Refer hetero when?
Confirmed hetero FH tx?
Which ok @preg?
Aim?
Lipids how often?
Other bloods?
If use Amlodipine, what dose of simvastatin? why?
____________________
______________
Homozyg FH?
Confirmed HOMO FH tx?
___________
Fever +VTE/Stroke
Tx?
Osler nodes V Janeway ???
FHH GENE = LDL receptor is mutated
Simon-Broome:
Genetic mutation found
LDL > 4.9
TChol > 7.5
Tendon Xanthomata @pt/FDR
FHx: MI <60 FDR / <50 SDR
FHx: TChol >7.5 / 6.7kid @FDR/SDR
Refer hetero @:
- Established CHD
- FHx: MI <60 FDR / <50 SDR
- GSHD 2 RFs = Gend-MALE/Smoke/HTN/DM
Hetero: NERD AtE BALL CULT Nutrition ECG, RFs, Drug -ATorva 20 Titrate, -Ezetimibe -Bile seqeustrant/Fibrate/PCSK9i
- ALL CI @preg !!
- LDL reduce 50% aim
- Lipids/3m
-CK / U+E / LFT / TSH
20mg, cos amlod = CYP3i
_________________
Homozyg FH? = LDL>13
Homo: SELL BNF
-Statins/Ezetimibe/LDL apheresis/Liver transplant
-Bile sequestrant
-Nicotinic acid
-Fibrates
_________
Endocarditis
3xBloodcultures
Echo
MDT - Abx
Osler = PAIN, JaneNOT!! Roth = boat-shaped eye haemorrhages
woman short-lasting UNILAT side of face = behind eye. UNILAT-sided tearing + nasal congestion -no photophobia -Several times/day Tx: indomethacin -> attacks stopped Dx? Tx? \_\_\_\_\_\_\_\_\_
Lesion -> SPEECH = FLUENT sentences that make NO Sense -word sub / neologisms #word-salad -Normal REPETITION Pt Comprehension FUCKED
Lesion -> SPEECH = NON-FLUENT sentences that make Sense -Laboured + Halting -Poor REPETITION Pt Comprehension NORMAL
Lesion -> SPEECH = FLUENT sentences that make Sense -Poor REPETITION -AWARE of Errors making Pt Comprehension NORMAL \_\_\_\_\_\_\_\_
? @Oed from tumour
? @Raised ICP
? @SAH to reduce vasospasm
__________
Gait ataxia = ?
? = finger-nose ataxia
? - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)
? - sensory symptoms
? - dyLEXia, dysGRAPHia
? - motor symptoms
? expressive aphasia
? - disinhibition
________
suspected stroke. unable to speak BUT able to follow instructions
- do not know the handedness of the patient
- percentage of right and left handed individuals
- with a dominant left hemisphere is 90% and 60% respectively,
- making the left always the most likely affected side
- ? on dominant side supplies both Wernicke’s (sup Temp Gyrus) and Broca’s (inf Frontal Gyrus) areas
- which are responsible for understanding and production of speech.
Paroxysmal HemiCrania
-Indomethacin
__________
Wernicke Receptive
- SUP Temp gyrus
- Fluent + NO Sense + Comp FUCKED
- Repetition Normal
Broca Expressive
- INF Frontal gyrus
- NON-Fluent + Sense + Comp NORM
- Repetition fucked
Conduction aphasia -Arcuate Fasciculus -Fluent + Sense + Comp NORM -Repetition fucked \_\_\_\_\_\_
Dexa @Oed from tumour
Mannitol @Raised ICP
Nimodipine @SAH to reduce vasospasm
______
Gait ataxia = cerebellar vermis lesions
-Vermillion Gate
Cerebellar hemisphere = finger-nose past-pointing ataxia
-hemisPhere=PastPoint
Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)
Parietal lobe - sensory symptoms, dyslexia, dysgraphia
Frontal lobe - motor symptoms, expressive aphasia #BrocaInfFrontGyrus, disinhibition
________
suspected stroke. unable to speak BUT able to follow instructions
- do not know the handedness of the patient
- percentage of right and left handed individuals
- with a dominant left hemisphere is 90% and 60% respectively,
- making the left always the most likely affected side
- MCA on dominant side supplies both Wernicke’s (sup Temp Gyrus) and Broca’s (inf Frontal Gyrus) areas
- which are responsible for understanding and production of speech.
JVP rise
Muffled Heart sounds
BP drop
PulsusParadoxus
____________
Tietze’s VS Costochondritis?
__________
OLD WOMAN
‘crushing’ RETROsternal pain -> jaw/arm
‘gripping/stabing/pressing’
Cardio Ix ALLLLLL normal
Resolve >30-60min
Intermittent last few yeeears
- food NOT pass normally - Dysphagia
- food pass normally, PAIN-odynophagia
Tx?
Tampoade Pericaaardial EFFUSION
____________
Tietze - costal cartilage swelling
Costochondritis - NO swelling
__________
Oesophageal spasm
-barium: cork-screw oesophagus
- diff oesophageal spasm
UNcoordination @several points
Dysphagia - nutracker oesophagus -
COOrdinated contraction
Forceful = pain
PPI,
Iso Mononit #LAN
Nifed #CCB
Dilation balloon/Myotomy
Cx of cardiac catheterisation=
Pulsatile-mass, fem-BRUIT, fucked distal pulses
post-cardiac-cath
subcut nodules, livedo reticularis, ulcers/gangrene, cyanosis
GCS scale
__________
P- IMP -RCF —– C —- Opiod
O- c>d -DMPH - ODnr-OCD
PONV ?
______________
ICP high
Motion-labrynthine / MECH B.Obst
Preg
RT/Cancer/FuncBObst = ?
______________
Cytotoxics - ?
Opiod - ?
Metabolic stuff?
______________
OCDMPH?
what for high ICP?
what for metabolic stuff = high Ca / RF?
Funct V Mechan Bowel Obst?
Cardiac cath -> Fem Pseudo-Aneurysm
Cardiac cath -> Chol Emboli
Visual: Spont, Speech, Pain/4
Verbal: Oriented, Confused, Words, Sounds/5
Motor: Obey, Localises, Withdraws, Flex, Ext/6
________
P- IMP -RCF —– C —- Opiod
O- c>d -DMPH - ODnr-OCD
PONV - Ondan5HT/Ginger
______________
ICP high
Motion-labrynthine / MECH Bowel Obst
Preg
-AntiHist > DopBlock
RT/Cancer/FuncBObst = DopBlock
_______________
Ondan5HT=CYTOTOXICS=DopBlock
- Nabilone=cannabinoid
- Rolapitant-NK1 blocker
Opiod - OCD
- Ondan5HT/Antihis/DopBlocker
- ChemoreceptorTrigger zone - CT-zone
Haloperidol - METABOLIC stuff ?highCa/RF
________________
OCDMPH:
Ondan5HTron - 5HeroTotinin blocker
CycliZINE - antihistaMINE
-ZINES - promethazine NOT prochlorperazine
FOR HIGH ICP!!!!!!!!!!!
DopBlockr: Domp
MetocloProkinetic
Prochlorperazine
Haloperidol - METABOLIC stuff ?highCa/RF
High ICP - cyclizine as mentioned above
Halloperidol for metabolic stuff
Funct - Metoclop / Mech - Cyclizine
Asian/South-east Asia
Collapse. Errythin else NORMAL
ECG - STEMI + T-invert -
Cx? Tx? ECG sign?
__________
Inspire –>
- BP drop >12 #exag < – lowSV
- JVP rise
ECG sign?
Filling pericardial sac -> compressive atelectasis -> area of DULLness + incr tactile fremitus below LEFT Scap \_\_\_\_\_\_\_\_
@RAAS: lowNa @MD/h2o Vol-Pressure Baroreceptirod -> RENIN convert ATensinogen @liver -> AT1 @blood --ACE@lungs-> AT2 does what 2 things? --> Ald@Adrenal does what 3 things?
Inc osmolality (~ Inc Na diet) -leads to what release? -ensures what? -then what's stimulated? --> ? permeable -> H20 absorb from where -V1 = ? -V2 = ?
Brugada - sudden cardiac death - ICD - Coved STEMI + T-invert \_\_\_\_\_\_\_\_\_\_
BP JVP @TamPax CPericardKnock-Kussmsul
BJ @TC = Inspire –>
-BP-PP-PAH* #TamPulsParadox #TamPax
-JKKK #CPericKnock-Kussm x+y
ECG = electrical ALTERNANS
-QRS Big small Big small Big small..
EWART’S sign @tamponade
*PAH
AR / ASD
High Left EDV
_________
AT2:
- constrict -> HTN + low GFR cos Aff RenalArtConstrict
- high Na/H+ pump @PCT = HCO3 + Na absorb
Ald@Adrenal:
- Inc Na absorb @principal-cell = HTN
- Inc K secr @principal-cell
- Inc H secr @alpha-intercalated-cell
Inc osmolality (~ Inc Na diet):
PostPit ADH release
–ensure ingested h2o retained by kidneys–>
Thirst (ORs 10 mosmol Higher than ADH ORs)
–>
CCD permeable -> H20 absorb @V1/V2 aquaporins:
-V1 = periph v.constriction
-V2 = selective h2o reabsorb NOT electrolytes
? = calc osmo ? = anion gap ? mmol/kg of Na/day ? mmol/kg of K /day ? mmol/kg of H2O/day ? g/day of Gluc
Paeds maintenance:
1st ? kg = ? ml/kg/?
2nd ? kg = ? ml/kg/?
Remainder = ? ml/kg/?
SV, CO, PP, EF, MAP formulae
HyperNat:
WITCH
-HiSALT-BODDI
HypoNat:
SALTLOSS
-HypoBDDAC/Iso/Hyper Tonic
HYPOtonic <275
Check? < 100 = ? > 100 = ? -> check what 2 things: -1. ? -2. Check Urine ? : <20 = ? 20-40 = ? >40 = ?
______________
HyperKal:
MURDER DREAD-BIT HID
HypoKal:
ASICWALT DIRE-DIP
________
HypoCalc Syx?
Low Ca, Low PO4 = PROVit
Low Ca, High PO4 CHAPDD
High ALP = OR HPN
Low Ca ?
High Ca ?
Physiologic/pathologic ALP rise?
HyperCalc Ax?
2(Na+K) + BM + Urea = calc osmo (Na + K) - (Cl - HCO3) = anion gap 1-2mmol/kg of Na/day 1mmol/kg of K and H2O/day 50-100g/day of Gluc
Paeds maintenance:
1st 10kg = 100ml/kg/d
2nd 10kg = 50ml/kg/d
Remainder = 20ml/kg/d
SV=EDV-ESV CO=SVxHR PP=SBP-DBP EF=SV/EDV MAP=COxSVR
HyperNat:
Weak Irritable Thirst Confusion HYPERreflex/tonia
HyperCortisol-Cushing, Inc Na intake-diet/IVF, Sodium retention, Aldosteronism, Loss of fluid*, Thirst dx
*Burns, osmotic diureis, D+V, DI, infection
______________
HypoNat:
SALTLOSS Hypo/Iso/Hyper Tonic
Seizure, anorexia, lethargy, thirst, limp tendon reflex, orthostat hypotn, stupor, stomach cramps
- Isotonic - Lipids/MM-PP;
- HYPERTonic - RF/Inc BM/Mannitol
HypoTonic:
- Hypovol=BDDAC**
- Isovol=Beer potoga, RF, SIADH, HypoT
- Hypervol=HF, LF, RF-nephrotic/XS-IVF
**Burns/D+V/Diuretics/Addisons/CerebralSaltWaste - urineNa<20 urineNa>20
Mild <135
- fluid restrict<20-30ml/kg / diuretics demeclocycline nephroDI
- mod<130 = HyperTonic Saline + ?slowNaTabs
- severe <120 = VAPTAN V1=p.vasoconstrict V2=selective h2o absorption NOT electrolytes
HYPOtonic <275
Check urine osmo
< 100 = polydypsia/ROSynd
> 100 = impaired h2o excretion ->
-1. PARTID: pit dx, addison, RF, thyroid dx, isovol, diuretics
-2. Check Urine Na:
<20 Hypo/ Hyper Vol = EABV dx eg hf/LF
20-40 = give 2L 0.9%/2days -> U+E Na
- if Inc by > 5 = HypoVol
- if static/decr = SIADH/ROSynd
> 40 = SIADH/ROSynd /Cerebral or Renal Na Waste
all that ADH -> absorb h2o from kidney 2 blood: -Plasma osmo <275 #blood dilutes -Urine Osmo>100 #piss concentrates -Urine Na >20 #piss concentrates \_\_\_\_\_\_\_\_\_\_\_\_\_\_
HyperKal:
MURDER DREAD
Muscle weakness, UO reduced, Resp shallow kussmaul, Dec contractility, ECG - HIGH: QRS, T-tender + Low P, Reflex dx
- Drugs-Suxameth/ACEi/K+spare
- Renal fail
- Excess loss: Inc loss-Burns/IV-KCl/Trauma - Hemolysis/Inc Tourniquet time
- Addisons
- DKA
Tx: CaGluc cardioprotect--> InsDex/SABA(EC 2 IC) -> Patiromer/CaResonium \_\_\_\_\_\_\_\_\_\_\_\_\_\_
HypoKal:
ASICKWALT DIRE
Alkalosis, Seizure, Irritable, Confusion,
Weak, Arrythmia - highPR,U,QT, lowST/T, Lethargy, Thready pulse
Drugs - liquorice/loops thiazides - barter gitelman/Ins-Dex+Saba/Patiromer Ca Resoinium
Inc loss - D+V, Int Fistula, Pyloric Stenosis
RTA 2+1
Endo: conns/cushing
______
HypoCalc = long QT: Spasms Trousseau Perioral parasthesiae Anxiety Seizure Mood dx Oriented TPP Dermatitis Impetigo herpetiformis Chvostek facial nerve
Low Ca, Low PO4 PROVit
Pancreatitis, Resp Alk, OM, Vit D
Low Ca, High PO4 CHAPDD
CKD, HypoPT, Acute Rhabdo
PsudoHypoPT, DiGeorge, Diuretics
High ALP = OR HPN
Low Ca: OM, RF
High Ca: HyperPT, Pagets, Neo-mets
LF, Preg/#heal, Pagets
Ca supplements/Li / Thiazides HyperPT Immobility Milk Alkali - antacids/supplements Pagets ABigThyrotoxicosis Neo/MM/Mets Zollinger-Ellison Excess Vit A Excess Vit C Sarcoid
Ca/VitD , PO4, PTH, ALP:
OM low low high high
OPet low/high ALP
Paget high ALP
Pri PTH = OFC high low high high
2ndry PTH = CKD / PseudoHypoPTH
-low high high high
3rtiary PTH = CKD
- high low high high
Low voltage QRS = DIM ccoPPd
< 5mm @ ?
< 10mm @ ?
Ax?
Stress ECG BP test CI
common sense tbh
_________
St 1, St 2, St 3 HTN
180/120/+ w/ what 3 things?
NO = ?
YES = (1.) ? (2.) ? :
- 1. Tx?
- 2. Syx?
160/110 / ?/+ PUria = ?
160/100 -ABPM-> ? = St ?
160/90 = ?
150/90 -ABPM-> ? St ? @?age
140/90 = ?
140/90 -ABPM-> ? St ? @?age
140/90 ? + ACR ?70
130/80 ? + ACR ?70
130/80 DM 1 or 2? = ? or ?
-? if DMI 1 + NO A/WTHG
______________
BP tx when?
- <40 = ?*
- <60 + ?
- <80 + ?
- > 80 ?
Ix?
Low voltage QRS
< 5mm @ limb
< 10mm @ chest
Distance inc* CCoPPd
Infiltrative dx,
Metabolic dx - HypoT myxoed
Inc dist*: COPD / CPericardKnock Obesity Pleural / Pericard Effusion DISTANCE inc
StArdsMP Stress test CI: ARrhythmias/ADiss/ASten MI / HF / PE Peri/Myocarditis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
St 1: 140/90 -ABPM-> 135/85
St 2: 160/100 -ABPM-> 150/95
St 3: 180/120
180/120/+ w/ PapOed/RetHaem/LT syx*
*Confusion/CP-CCF/AKI
NO = -CVD RF - Lipid profile/Q10 -Lifestyle -EODx Assx = HUria/HbA1c, Urine ACR/U+E, Fundoscopy, ECG: Y = Tx-ABPM N = BP 7d repeat
YES–1. 999 Malig Acc HTN 2. Suspected Phaemo*–>
- 1. Rest, Atenolol, Nitroprusside/Labetalol, DBP drop <100/12-24hrs
- *Suspected Phaemo:
-HA/HTN, Anxiety, Sweat
+
-pHoresis, pALlor/pALp, pOst HypoTN
_________
160/110 / 2/+ PUria = refer @preg
160/100 -ABPM-> 150/95 = St 2
160/90 = Isol Syst HTN
150/90 -ABPM-> 145/85 St 1 >80y
140/90 = gHTN/PreEcl
140/90 -ABPM-> 135/85 St 1 <80y
140/90 CKD + ACR <70
130/80 CKD + ACR >70
130/80 DM 1 = AlbuminUria OR 2/+ WTHG
-135/85 if NO WTHg
_________
BP tx when?
- <40 = 2ndary cause find*
- <60 + Q10/-
- <80 +
- CVD established
- DM
- EoDx
- Renal dx
- Q10/+ = 20mg Atorva - > 80 >150/90 @clinic = ?CONSIDER tx?!
- > do ABPM ->
- <145/85 = lifestyle
- >145/85 and comorbdities = tx
- >145/85 and NO comorbdities = fkn hope they dont ask this but ?tx/just lifestyle?! - @St 1: Clinic AND ABPM>Target
*Ix: CVD - Coarc/RAS Renal dx = LUMP* Eye dx Keith Wagner ECG Endo - Thyroid/Acromeg/GFR** dx Drugs = cocaine/Leflunamide
*Lump - RCC
Urine: PUria/AlbUria = DM / HUria = g.nephritis
Mass = obst uropathy/RCC @loin
Pyelo
**G(Ald:Renin/synACTHen) F(DexaSuppTest) R Catechol (urine metaneph/CT-AP/meta-IBG) \_\_\_\_\_\_\_\_\_\_
Age<55/DM Age>55/Black
- ACE/ARB C/D @ccb-CI e.g.CCF
- A+C > A+D
- A+C+D
- K 4.5/- = Spiro / 4.51/+ = alpha/beta-block
- Refer specialist
Periph Neuropathy
Psych Dx
_______________
Parasthesiae Eye dx NNumbness Cog dx Eye dx
Lemon tinge skin
Ulcer oral
NNeuro Psych dx
Glossitis - BEEFY RED TONGUE!!!!!!
B12 def -> tracts: -? dx - ataxia -? dx - fine movement of ipsilateral limbs -? dx - prop/vib + fine touch ? knee reflexes
Subacute Degen SC
- HIGH-STEP-GAIT
- Eye dx
- Reflex: kneeLMN ankleLMN plantarUMN
Which test?
Neuro syx YES = ?
Neuro syx NO = ? -> -DietRelated= ? -DietUnRelated= ? \_\_\_\_\_\_\_\_\_\_
Duod
Jej
Term Ileum
_______
TICS MATCH RALPH FBD
1. Microcytic:
- Normocytic:
- Macrocytic:
Non-megalo?
Megalo?
P450 inducers = INR low or high?
P450 inhibitors - INR low or high?
___________
Organophosphates
Heparin
Ethylene glycol*
Methanol*
Salicylates
Lithium* tremor HYPERreflexia ataxia
TCA-wide QRS, tachy
Cyanide*
Digoxin: bradycardia, reverse tick t-wave inversion, eye syx green/yellow vision
Lead/Arsenic*
Diet - broccoli/sprout
Oral folate 5mg - 4m
_______________
SCD: Subacute Combo Degen of SC
B12 def -> tracts: -Spinocerebellar dx - ataxia -CorticoSpinal dx - fine movement of ipsilateral limbs -DC-ML dx - prop/vib + fine touch brisk knee reflexes
B12 def - SCHILLING TEST
Neuro syx YES =
Admit + ?IM-HCB
Neuro syx NO = IM-HCB x3/w/2w -DietRelated=OralCyanoCobalamin -DietUnRelated=IM-HCB/3m \_\_\_\_\_\_\_\_\_\_\_
Duod - Iron
Jej - Folate
Term Ileum - B12
___________
TICS MATCH RALPH FBD
- Microcytic:
- Thalassaemia, Iron Def, ChrDx, Sidero - Normocytic:
- Marrow dx
- Acute blood loss
- Thyroid LOW
- ChrDx early / CKD
- Hemolytic
3. Macrocytic: Non-megalo -Myelo-prolif/dysp/mm -Reticulocytosis -Alco XS - GGT CDT high MCV -LF -Preg -HypoT
Megalo:
-Folate, B12, Drugs (allop/phenyt/OHcarbimide)
P450 inducers = INR low
- Phenytoin
- Carbemazapine
- Barbituates
- Rifampicin
- Alco
- SUs
P450 inhibitors - INR HIGH -PPI/grapefruit -LF -Allopurinol -NSAID -Cranberry -DISULFIRAM -Erythromycin -Valproate -Isoniazid -Cipro/Ketocon -Ethanol -Sulfonamides \_\_\_\_\_\_\_\_\_\_
Organophosphates - atropine
Heparin - protamine sulfate
Ethylene - Fomepizole/ Ethanol / Dialysis
Methanol - Fomepizole>Ethanol / Dialysis
Salicylates - Bicarb /dialysis
Lithium - Fluids /dialysis
TCA - Bicarb
Cyanide - OH-cobalamin
Digoxin - Dig-specific Antibodies
Lead/Arsenic*- dimercaperol / edetate
MR: (Valsalva -> Syst @mitral-area)
SAM AsH #LVH=deep Q @V1-3ish
OFTEN ASYMPTOMATIC
-SOBOE, angina
Ex -> Syncope #sudden-death
O/E: Jerky/Bisfriens pusle
ECG: deep Q @V1-3ish + ST depr + T-invert
-HOCM assoc w/ which arrythmic dx?
\_\_\_\_\_\_\_\_\_ B12 def -> tracts: -? dx - ataxia -? dx - fine movement of ipsilateral limbs -? dx - prop/vib + fine touch
Subacute Degen SC
- HIGH-STEP-GAIT
- Eye dx
- Reflex: kneeLMN ankleLMN plantarUMN
Neuro syx YES = ?
Neuro syx NO = ? -> -DietRelated= ? -DietUnRelated= ? \_\_\_\_\_\_
Brown Sequard:
_________________
If damaged above T1, may present with?
______________
Classic pt accidentally burn their hands without realising.
- ‘cape-like’ (neck arms trunk)
- SENSORY loss of pain + temperature
- wasting of small muscles @hand
-Preservation of what sensory modality #?Tract
This is due to the
crossing ? tracts
@anterior ? of spinal cord
#first tracts to be affected
Ix?
___________
P Painless retention E Eversion of foot weak N No ankle/knee jerk I Impotence S Saddle anaesthesia -Anatomy of compression? \_\_\_\_\_\_\_\_
__________
Argyll-Robertson, Charcot #House-Case DC-ML dx: - prob/vibr dx-> ataxia + absent DTRs + Romberg POS - fine touch dx \_\_\_\_\_\_\_
BOTH UMN+LMN dx:
-UMN: Pseudobulbar palsy
[eg, dysarthria, dysphagia,
emotional lability, spastic gait, clonus]
-LMN: anterior horn cell involvement
(eg, dysarthria, dysphagia, WAFER)
NO SENSORY/BOWEL-BLADDER dx… this shit is NORMAL
____________
Stiff spastic tongue Donald Duck Speech Brisk Jaw Jerk i.e. HyperReflexia -get the BSC syx!!! \_\_\_\_\_\_\_\_
Palsy of the -Tongue -Chewing muscles -Swallowing and -Facial muscles due to loss of function of Brainstem Motor Nuclei -get WAFER syx!!! \_\_\_\_\_\_\_\_\_\_
Starts with
- patients having impaired balance #falls
- O/E vertical-gaze Palsy
- Symmetrical onset + POOR response to levodopa
- Recent ‘diagnosis’ of Parkinson’s…
Classical history of -poor response to levodopa, -impotence, -urinary retention -OLD age group \_\_\_\_\_\_\_\_
- foot deformities (eg, pes Cavus HIGH arch, hammer toe),
- lower extremity weakness (eg, foot drop)
- sensory deficits.
Mitral Regurg #systolic
Syst Ant Motion of Ant Mitral leaflet
Asym Hypertrophy #LVH=deep Q @V1-3ish
-HOCM assoc w/ Wolff-Parkinson White
\_\_\_\_\_\_\_\_\_ SCD: Subacute Combo Degen of SC B12 def -> tracts: -Spinocerebellar dx - ataxia -CorticoSpinal dx - fine movement of ipsilateral limbs -DC-ML dx - prop/vib + fine touch
B12 def tx:
Neuro syx YES =
Admit + ?IM-HCB
Neuro syx NO = IM-HCB x3/w/2w --> -DietRelated=OralCyanoCobalamin -DietUnRelated=IM-HCB/3m \_\_\_\_\_\_\_\_\_
Same:
@level =
- ALL SENSATION
- LMN
@below level:
- Prop/Vib + FINE-touch #DC-ML
- UMN #CSTract
Opp:
-Pain/Temp + CRUDE-touch: below level - #SPTract
__________________
T1 dx ->
OculoSymp Dx
#same-sided Horners
____________
Syringomyelia
-Preservation of Prop/Vibr + FINE-touch #DC-ML
This is due to the
crossing SpinoThalamic tracts
@anterior commissure of spinal cord
#first tracts to be affected
MRI
_______
Cauda Equina
-MRI -> Neurosurg+Steds
-spinal roots L2 and below
________
________
Tabes Doraslis-DORSAL-COLUMN
________
ALS-Lou Gehrig
-ALS and polio are LLLLLLLMN conditions
__________
PseudoBulbar Palsy
-UMN CN 9-12 ALL fucked
_______
Progressive bulbar palsy = LMN
-WORST Prognosis
__________
Progressive supranuclear palsy #PSP
Multi-system atrophy
_______
Charcot Marie Tooth aka (HSMN)
-hereditary motor and sensory neuropathy
MALE ONLY XLr - NJ-GS*
African
NADPH reduced
No SMeg
ManORWoman w/: SMeg/NJ-GS* EMA>OsmoticFragTest European EXtravasc AD-RBC membrane struct dx
*NeonatalJaundice/Gallstones
Ddx?
Retic LOW + Hb LOW = ?
Retic HIGH = ?
________
Feeding a person following a period of starvation. -extended period of catabolism ends abruptly -> switching to carbohydrate metabolism
-hypoPhosphataemia
-hypoKalaemia
-hypoMagnesaemia: #torsades de pointes
-Abnormal fluid balance (pitting oedema etc)
________
Cuts->ProlongedBleeding
MucousMemb Bleed
PURPURA
Delayed bleeding @: -joints / muscles -GI tract \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
- BMI < ?;
- unintentional WL > ?% @last 3-6 months; or
- BMI < ? + unintentional WL > ?% @last 3-6 months
? = WL 10% / 6m (any faster = worsen fibrosis)
WL 5% pre-preg Weight, Electrolyte dx, Dehydration
__________
Mandem had accident -> Cord injury @above T6 -> HTN + Bradycardia + ... -Flushed + Sweating #Red ABOVE shoulders -PALE BELOW shoulders Ax of HTN?
Mandem in accident
-HTN and Bradycardia
-flushed above shoulders, pale below
?Dx can only occur if the spinal cord injury occurs above WHERE?
? are the most common triggers of autonomic dysreflexia
Patients with a GCS < ? should be considered for both
i) review by an anaesthetist
ii) intubation and ventilation
XLr G6PD Oxidative RBC stress:
- Mehndi
- ABx=Sulfa/Quinine/Quionlone-cipro/sulfasal
- FavaBeans - Heinz/Bite cells
- INTRAvasc
- AFRICAAAAAAA
AD hereDitary Spherocytosis
Retic LOW + Hb LOW
-ParvoAplasticHemolysis
Retic HIGH=Sequester
________
Reefeding syndrome
_______
Vasc/Plt dx
Coag dx
__________
__________
- BMI < 18.5;
- unintentional WL > 10% @last 3-6 months; or
- BMI < 20 + unintentional WL > 5% @last 3-6 months
NAFLD = WL 10% / 6m (any faster = worsen fibrosis)
WL 5% pre-preg Weight, Electrolyte dx, Dehydration
__________
Mandem had accident -> Cord injury @above T6 -> HTN + Bradycardia + ... -Flushed + Sweating #Red ABOVE shoulders -PALE BELOW shoulders Ax of HTN = Autonomic Dysreflexia
Mandem in accident
-HTN and Bradycardia
-flushed above shoulders, pale below
Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level
Faecal impaction / urinary retention are the most common triggers of autonomic dysreflexia
Patients with a GCS below 8 should be considered for both i) review by an anaesthetist and ii) intubation and ventilation
MALE ONLY XLr - NJ-GS*
African
NADPH reduced
ManORWoman w/: SMeg/NJ-GS* EMA>OsmoticFragTest European EXtravasc AD-RBC membrane struct dx
*NeonatalJaundice/Gallstones
Cuts->ProlongedBleeding
MucousMemb Bleed
PURPURA
Delayed bleeding @:
- joints / muscles
- GI tract
G6PD Oxidative RBC stress:
- Mehndi
- ABx=Sulfa/Quinine/Quionlone-cipro
- FavaBeans - Heinz/Bite cells
- INTRAvasc
- AFRICAAAAAAA
-Hereditary Spherocytosis
Vasc/Plt dx
Coag dx
WhyTF would you give HaemCancer pt IRRADIATED blood products?
Philadelphia chr - (?,?) - ?=Tx? RAI staging - dx? Histology? Transform? Reed Sternberg - ?*,?,? Auer Rods - ? / ? Ann Harbor ? Multiple nodes, B>T cells, Extranodal = ?**
*Hodgkin: ? - Women+Lacunar cells ? - Eooooosinophils ? - RS cells HIGH Lymphocytic -Predom=? prog -Deplete=? prog
**NHL - High > Low: High: ?=chest nodes/HIV/nonMalt ?=EBV/Malaria/StarrySky/C-myc ?=Tokyo/hTlv
Low: MALT-? / ? 11,14 LC/LPC waldenstroM-Macroglob-IgM ? 14,18 Skin/?
PathPhys -> what 2 products form?
MGUS = ?
MM = ?
WaldenstromMacroglob ?
Pepperpot v Raindrop skull?
_________
MAHA / AKI / TCP
Self-limiting
- kids-acute
- EVANS-AIHA+TCP
- women-chronic
O-anti ? -Recieve from others ? -Give 2 others ? A - anti ? ANti-D @ Rh ?
What Tx @ Haemophilia And vWD? ? -A f? Xr -B f? Xr -C f? Ar
?+?
- 1 A?
- 2 A?
- 3 A?
Thalassemia+SCDx= ?
-?type gallstones Assoc w/ with Sssickle cell
Irradiated blood products = AVOID
-transfusion-associated
GvH dx
Philadelphia chr - 9,22 - CML=Imatinib
RAI - CLL SmudgeSmear –RichterTransform-> NHL-Bcell
Reed Sternberg - Hodgkin*, EBV, Localised
Auer Rods - AML APML15,17
Ann Harbor Lymphoma: 1node, 2nodes, 2sideDiaphragm, Extranodal
Multiple nodes, B>T cells, Extranodal = NHL
Hodgkin: Nodular - Women+Lacunar cells Mixed - Eosinophil/RS cells HIGH Lymphocytic -Predom=BEST -Deplete=WORST
NHL - High > Low: High: B-cell diffuse=chest nodes/HIV/nonMalt Burkitt=EBV/Malaria/StarrySky/C-myc T-cell=Tokyo/hTlv
Low: MALT-pylori / Mantle 11,14 LC/LPC waldenstroM-Macroglob-IgM Follicular 14,18 Skin/SezaryMycosis
XS prolif Bone-Marrow Plasma-Cells, Heavy>light chain, Bence-Jones LIGHT @URINE MGUS=no CRABIE MM=*CRABIgG>AEsrrouleaxy WaldenstromMacroglob=IgM-LC/LPC LowGradeNHL
*Ca URB RF-dialysis ANT Bone-Cytokines release-> oClast -> -RAINDROP* LyticLesions IgG>A ESRouleax clump/Clots
*PepperPot = fucking HyperParaThyroidism !!!!!!!!!!!!!!!!
Raindrop = MM !!!
_________
MAT - TTP - large vWF multimers
SKEW - ITP - Gp2b3a ABs
O-anti A+B -Recieve FFP -Give ABO A - antiB ANti-D @ Rh neg
Desmopressin @ Haemophila -A8 Xr -B9 Xr XMAS -C10 Ar
vWDx + TXA
- 1 AD
- 2 AD
- 3 Ar
Thalassemia+SCDx= AR
- Pigmented gallstones Assoc w/ with sickle cell
- bilirubin and Hemolysis etc occurs
Fever, Dry cough, SOB
Myalgia, crackles - NOWHEEZE
Bloods: NEUTS + ESR high
BAL=Lymphocytes
CXR=mid-zone+/-hilarLNs
FEV/FVC=Restrictive
- ORGANIC Allergens:
- Avian bird poo= ?
- Fungal=?/?/? - Inhaled organic dust–> HSR type…
- acute ?
- chronic ? - Dx?
Later: SOBOE, WL, T1RF, corpulmonlae, fibrosis - Tx - what 2 things?
_______
Bakers lung = ?
_________
SOB Non-pleuritic CW pain fever/NS/WL - asbestos exposure Ferruginous bodies -diaphragm obliteration -nodular pleural thickening -white-washout -reduced-lung-size
Despite the above question, what is more likely in asbestosis - Lung cancer V Mesothelioma?
- Allergens:
- Avian bird poo=Bird/PigeonFancier
- Fungal=Farmer/Malt/Mushroom - Inhaled organic dust–>HSR:
- Type 3 I-C = Acute
- Type 4 cell-mediated = Chronic - Extrinsic Allergic Alveolitis AKA
HSR pneumonitis
-Later: SOBOE, WL, T1RF, corpulmonlae, fibrosis - Tx = Avoid allergy + Steroids
________
Bakers lung = Occ Asthma
_________
MesoTheliOma
-But ACTUALLY Asbestosis ->
LUNG CANCER >Mestothelioma!!!!!!!!!!!!!!!!!!!
Lung cancer - Give location - Ix and type of following:
Central = ? biopsy - which type?
Peripheral = ? > ? biopsy - which type?
UNdx after Bronch / CT/USS biopsy=?
CT shows large LNs ->
check status B4 surg ??
Paraneoplastic @lung cancer:
- Small cell? - Cell type..?
- which lung cancer has high PTHrP?
- which lung cancer has high hCG?
- which lung cancer has gynaecomastia?
Lung cancer in NOn-smoker?
Lung cancer in SSSmoker?
Central = BronchoScopy biopsy
-Squamous (get clubbing)
Peripheral = CT > USS guided biopsy
-Adeno/Large
UNdx after Bronch / CT/USS biopsy= ThoracoScopy
CT shows large LNs -> check status B4 surg = MediastinoScopy
Paraneoplastics:
- Small cell: Kulchitksy cells = SAL*
- Squamous = PTHrP
- Adeno = Gynaecomastia
- Large = hcg
- SIADH, ACTH, Lambert-Eaton
Lung cancer in NOn-smoker - AdeNO
Lung cancer in SSSmoker - SSSquamous
INC vocal resonance / fremitus /WhispPectoriloquy
- ?
HyperResonance aside from pneumothorax?
- ?
- Bronchial breath sounds means ?
- ?
- ?
- ?
Pleural rub
- ?
Ronchi aka ?
- ?
Creps/Rales
- ?
- ?
- ?
*Vesic insp > exp
Bronchial exp > insp
Inc vocal resonance / fremitus
-consolidation
HyperResonance
- Pneumothorax
- EmphySema
Bronchial* breath sounds means PATENT bronchi+conducting tissue -Infection out of tube -Neoplasm out of tube -fibrosis out of tube
Pleural rub
-pleuritis
Ronchi aka WHEEZE
-asthma
Creps/Rales
- Alveolitis
- Bronchiectasis
- Consolidation/CCF
*Vesic insp > exp
Bronchial exp > insp
Lobar pneumonia+RUSTY sputum
-what virus contributes?
IVDU
-what virus
Prodromal illness WCC normal (sometimes) \+ HypoNat, LFTs high A/C use.. Travels Effusion
Alco DM UPPER cavitation / Red-currant JELLY sputum
Pt has CF / burns
Prodromal illness WCC normal (sometimes) \+ AIHA Dry-cough EMultiforme GBS/GI dx/GN; Myocarditis Meningitis Myringitis; Pancreatitis Pericarditis
HIV-SOBOE
-Ix
-Tx?
__________
fever, night sweats, weight loss, cough,
FOUL-smell/taste sputum
PMH: sutin that causes ASP pneumonia
O/E clubbing, ?pleural-rub (effusion/PyoPx)
CXR - cavity w/ air-fluid level
_________
CXR=RLL patchy opacification
-Recent intubation
Dx?
Strep Pneu - HSV
Staph
-Influenza
Legionella
Klebsiella
Pseudomonas
Mycoplasma
PCP
-Ix: BAL / Biopsy
-Tx: CoTrimox, Atovaquone, Pentamadine, STEDS @hypoxia
__________
Lung abscess -Anaerobes -Bronchiectasis STINKY too!!! -Clinda \_\_\_\_\_\_\_
Asp Pneumonia
- RLL + Recent intubation
- FB can get stuck here too
TACO ? BP
TRALI ? BP
Fever, night sweats, weight loss,
SOB/Cough/Arthralgia/ENodosum
Dx? Ix? - CXR classification?
- CN Palsy, Uveitis, Parotitis (face stuff basically)
- BHL, Arthritis, ENodosum
Tx sarcoid when?
Upper Zone
Mid Zone ?EGGSHELL ?@RA
Lower Zone
PBC liver transplant criteria
-USDA for what?
Raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril
-Dx?
TACO high BP
TRALI low BP
Sarcoid
- ACE
- Ca
- ESR
- imageCXR = BIP
1BHL Infiltrates - 2BHL Infiltrates - 3 PUL 4 PUL - FIBrosis - CUP: Hertford-Waldenstrom
- BAE: Loffgren
Tx: steds @brain, heart, lung, skin, calcium
-I. E. Systemic dx / HyperCalcaemia
Upper zone
-PMF-coal/beryliosis
HSRpneumonitisAKAExtAllAlveolitis,
AnkSpond, RTherapy, TB
Mid Zone
- Sarcoid
- Silicosis-EGGSHELL/Caplan@RA
- Histoplasmosis
Lower Zone
- IdiopathPF
- Asbestosis
- Amiodarone/Bleomycin/MTX/Nitro
PBC liver transplant @:
- Bili >100
- Recurrent cholangitis
- Refractory itching
- Ascities
USDA 2 reduce CHOLESTASIS
Lupus pernio = sarcoidosis
- raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril
Thoracotomy at?
…….. FEV FVC FEV/FVC
Obst
Rest
Lights criteria
TLCO/DLCO high/low
___________
Skin:
- Prick–>RAST @
- Patch test @
Exudate V Transudate causes?
Thoracotomy: in haemothorax include
>1.5L blood initially, OR
>200ml/hr >2hr loss
……… FEV FVC FEV/FVC
Obst <80 <70
Rest <80 <80 >70
Exudate > ?
Transudate < ?
25-30 = Light’s criteria
Pleura : Serum
Prot : Prot >0.5
LDH : LDH >0.6
pH < 7.2 / GramMCS/Cloudy
PF-LDH > 2/3 UL serum / >200
Low TLCO/DLCO: Pefo + CO-low, Pneumonia, COPD -Scoliosis/Kyphosis -NMwall dx -AnkSpond -Pneumonectomy #KCo
High TLCO/DLCO: -Hemorrhage -Asthma -L->R shunt -Polycythemia -Ex/Male \_\_\_\_\_\_\_\_\_\_\_
Exudate: RIM
-Rheum dx/Infection/Infarction/Malignancy
Transudate = HM
- HF, LF, RF / HypoT
- Miegs / Malabsorption
prIck–>RAST @food/pollen
-IrrItant? Pr1ck=1gE=T1HSR
p4tch test @ Allergy = T4HSR
2m
3m
4m
12m
3yr4m
12-13yr
13-18yr
________
6in1
4in1
Developmental failures REFERRAL:
- doesn’t smile @ ?w
- can’t sit UNsupported @ ?m
- can’t walk @ ?m
-Hand pref B4 ?m is ABnormal #CPalsy
_______
BF benefits
______
Cremaster L??, Anal Wink S??
Reflex: Ankle S??, Knee L?? Bicep C?? BRadialis C?? Tricep C?? \_\_\_\_\_\_\_\_\_\_\_
Thumb C?
Middle Finger C?
Little finger C?
________________
Nipple ?
BellyButton - ?
Coeliac ?
_______________________
Inguinal?
SMA ?
MID-Thigh?
IMA ?
________________________
Kneecap ?
Big Toe ?
Lat foot small toe ?
_______________________
2m:
DTaP *6in1, MenB, Rota
3m:
DTaP *6in1, PCV, Rota
4m:
DTaP *6in1, MenB
12m:
MMR
HiBBB-MenCCC-MenBBB
PCCCV
3yr4m:
MMR
*4in1 DTaP
12-13yr - HPV
13-18yr '3-in-1' Diphtheria, Tetanus Polio Men ACWY \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
6in1:
Diphtheria, Tetanus, Pertussis,
Polio, Hib, Hep B
4in1:
Diphtheria, Tetanus, Pertussis,
Polio
Developmental failures REFERRAL:
- doesn’t smile @ 10w
- can’t sit UNsupported @ 12m
- can’t walk @ 18m
-Hand pref B4 12m is ABnormal #CPalsy
_____________
Mother:
- BabyBond
- Reduce BreastCancer / PPH-risk
Kid: i-AIRD
-Infections
-Allergy/ IBD / RA / DM 1
________
Cremaster L1/2, Anal Wink S3/4
Reflex: Ankle S1/2, Knee L3/4 Bicep C5/6 BRadialis C5/6 Tricep C7/8 \_\_\_\_\_\_\_\_\_\_
Thumb C6, Middle Finger C7, Little finger C8
_______________________
Nipple T4
BellyButton - T10
Coeliac T12
_______________________
1nguinal L1
SupMA L1
MidThigh L3
InfMA L3
_______________________
Kneecap L4 all 4’s…
Big Toe L5 ;
Lat foot small toe S1
________________________
Chlamydia - ?
Aureus - ?
Legionella - ?
Mycoplasma - ?
HAP:
<5d = ? /? - SHM
>5d = ? / ? / ? ALE
W1 - ? gone
W4 - ? gone
W12 - ? gone
W24 - ? gone
Chlamydia - Azithro/Doxy
Aureus - fluclox/rifampicin
Legionella - MACROLIDE
Mycoplasma - Doxy/MACrolide
HAP: <5d = CoA / Cefuroxime -S.pneu/H.flu/Moraxella >5d = TAZ / Ceftaz / Cipro -Aureus/Legionella/E.coli
W1 - Pyrexia gone
W4 - Sputum gone
W12 - Tiredness gone
W24 - ALL gone
GvH - Tx?
-irradiated blood products=reduce ?
Overload - TACO - ?BP = Tx?
TCP-DIC = Tx?
Allo-?
BPdrop Ax?
Acute Heme Rxn - ?incompat = Tx?
Delayed Heme Rxn - ?incompat = Tx?
Urticaria - ?
NonHemolytic = Tx?
Infection- ?rophilia - ?signs
TRALI -?BP Tx?
GvH tx?
Acute Heme Rxn tx?
Delayed Heme Rxn tx?
Non-hemolytic rxn tx?
GvH - Stop+STEDS
-irradiated blood products=reduceTcells
Overload - TACO - high BP = furosemide
TCP-DIC = plts/FFP
Allo-Immunisation
BPdrop - TRALI/SAICA
Acute Heme Rxn - ABO incompat = STOP, SALINE
Delayed Heme Rxn - Rh incompat = STOP, IVIg
Urticaria - anthistamine
NonHemolytic = STOP, Slooow, Paracetamol
Infection-NEUTrophilia - sepsis signs
TRALI - lowBP 02HF
S-SSI-S G=Stop+Steds A=Stop+Saline D=Stop+IVIg N=Stop+Slow+Paracetamol
Transfusion:
<100 !!!!!!!!!! days since transfusion
skin > GI+Liver
PAIN MacPap Rash
-Jaundice, Diarrhoea, N+V
> 100 !!!!!!!!!!! days since transfusion
Skin, Eye, Lung, GI dx
______________
SHORTLY after transfusion START: Fever, Nausea, Back/Joint pain Burning @canula-site DARK-urine -Inc (HR RR), Low BP, Temp high
Delayed Heme Rxn - ? incompat = ?
Gets transfusion –> towardsEND
few HOURS later = hot/cold feeling
Collapse @transfusion- High HR RR, Low BP, Temp HIGH \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Started transfusion then gets
SOB/Wheezy
Low BP, stuff swells up..
Acute GvH stop + steds
–PAINful MacPap Rash
Chronic GvH
______________
Acute Heme Rxn ABO dx
- STOP, SALINE
- dark urine probs cos of the broken down RBCs -> bilirubin pathway -> piss out all the hemolysed RBCs
Delayed Heme Rxn - Rh incompat = STOP, IVIg
Non-hemolytic rxn
-STOP, Slooow, Paracetamol
Infection-sepsis
-Neuts
________________
Anaphlaxis - SAICA
Spur cells
Burr cells
________
Schistocytes
Target cells
________
Basophilic stippling - ? Iron
Pappenheimer - ? Iron
_______
Teardrop
Bite cells/Heinz bodies
Howell-Jolly
-which organisms assoc with asplenia?
-Tx for asplenia?
________________
body: 1st infection response - Ig? surfAcEs - Ig? fluids - Ig? immature B-cell plasma membranes - Ig? \_\_\_\_\_\_\_\_\_\_\_\_\_\_
HSR: Type 1 - ? Type 2 - ? Type 3 - ?- dx? Type 4 - ? - dx? GvH, Allergic dermatitis TB/Transplant, Scabies \_\_\_\_\_\_\_\_
Ext: Coag/Tissue Factors i-PBL
- immune cells/ placenta/ brain/ lung
- factor 7
Int: Endothelial Trauma BM Collagen
-12, 11 —-> 9 10 -> 2hrombin -> Fibrin
Fibrin –Plasmin*–> PolyPeptides
- Plasminogen –tPA-> Plasmin*FibrinolyticSystem
- -TXA stops tPA #hemostasis
- -Altepase IS tPA #thrombolysis
_______________
PT –10a–> 2hrombin
2hrombin –Heparin–>
Upregulate AT3 –> stop f8-12
Ox Vit K –EpoxReduct–> Red Vit K –>af2,7,9,10,ProtC+S
Spur cells - LF / ABLP:abetalipoproteinemia
Burr cells - LF/RF
________
Schistocytes - Hemolysis
Target cells -
ThalARremia, HbC dx, Asplenia, LF
________
Basophilic stippling - NOiron
- sidero=LEAD
- myelodysplasia
Pappenheimer - w/ Iron -sidero -myelodysplasia -Asplenia \_\_\_\_\_\_\_
Teardrop - Myelofibrosis
Bite cells/Heinz bodies - G6PD
Howell-Jolly - HypoSplenia -ENCAPSULATED: SHiN SKiS -Pneumo one/Flu annual/PMP-V prophylaxis S.pneu/H.flu/N.Men - Strep-B/KlebsIella/Sally \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
body: 1st infection response - IgM surfAcEs - IgA IgE (AllErgy), fluids - IgG immature B-cell plasma membranes - IgD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
HSR: Type 1 - Anaphyl/Atopy Type 2 - antiBody Type 3 - immComplex - SLE/PAN/PSGN Type 4 - Delayed cell-meDiated -GvH, Allergic dermatitis TB/Transplant, EAA-HSRpneumonitis delayed, Scabies
Pneumothorax BTS main top bit ffs
- 2 fucking things
_________
Sinusitis ?d Syx = Tx?
Sinusitis ? d Syx = Tx?
ABx only @ Cx?
Tx = ? -> ?/ ? @allergy
__________
FeverPANIC
-when give ABx?
_________
Allergen exp -> B/L syx develop asap: Sneezing, Discharge (rhinorrhoea) -nasal CONGESTION / ITCH / Drip-postNasal -Palate ITCH , Cough -Hayfever-Eye syx too
Nasal CONGESTION features:
-Snoring, MOUTH breathing, and Halitosis.
PMH/FHx of atopy (asthma, eczema, or allergic rhinitis).
Fatigue, Sneeze, Post-nasal drip,
Eye-water
Itch posterior-pharynx
Tx mild-mod? Mod-severe?
- Chronic bilat rhino-sinusitis?
- Chronic UNILAT rhino-sinusitis?
- ALLyear?
- worse @spring/summer?*
- worse @work e.g. bakery?
- House dust mites - ?
- *Pollens:
- Tree = ?
- Grass = ?
- Weed = ?/?/? - Work
Px:
-Age >50 + Sig Smoke Hx
-Lung dx O/E or CXR
________
Sinusitis <10d Syx - NO ABx
Sinusitis >10d Syx:
-nasal c.sted
ABx only @ Cx:
- Systemic dx
- Peri-orbital/orbital cellulitis
- Ophthalmoplegia
- Sub-periosteal abscess
- Meningitis
Tx = PMP-V -> Co-Amox/ Doxy @allergy
__________
- Fever > 38/ 3-14y
- Purulent exudate
Admit <3d - No cough/Coryza
Inflamed tonsils - C.LNopathy
FeverPAIN 4/5 = PMP-V
Centor 3/4 = PMP-V
________
Allergic Rhinitis: Mild-Mod: AHist > MastCellStab 1. AHist: - a. Intranasal Azelastine > - b. Oral AHist >
- MastCellStab-NaCromoGlic
Mod-Severe/ Mild fail:
-Intranasal Csted
Chronic Bilat rhino-sinusitis?
-saline nasal douches
-Chronic UNILAT rhino-sinusitis = 2WW!!!
- PERENNIAL - house dust mites
- seasonal hayfever
-Occupational
- House dust mites
- all the time/ALLyear #PERENNIAL - Pollens:
- Tree = spring
- Grass = early summer
- Weed = spring/summer/autumn - Occupational
MA-SHg FAVRett
Autosomal recessive conditions are ‘??? ‘ - exceptions: inherited ????????
Autosomal dominant conditions are ‘??? ‘ - exceptions: ?????’s, ??????? type 2
XLr? = FAVRett
MA-SHg FAVRett
- AR dx = ‘METabolic’ - exceptions: inherited ataxias
- AD dx = ‘STRUCTural’ - exceptions:
Gilbert’s, HyperLipidaemia type 2
*MA-SHg
Ar: Met + Ataxias
AD: Struct + Hyperlipidemia 2/Gilbert
_________________
XLr = FAVRett Fragile X Alport Vit D Resistance #RicketsOM Rett Syndr
Crohns symptoms?
Ileo-anal pouch reconstruction
@Crohns = high risk of:
-?
-?
Commonest disease site @crohns?
- ? #what deficiency
- what op?
- may affect enterohepatic bile salt recycling -> increase the risk of ?
Severe perianal/rectal Crohns = what op?
Crohns symptoms:
Cobblestone/Creeping fat = StringSx @ B.Swallow
Rectal spare / Cancer - SB/colon / Skip lesions + TMiFT* -> Fistulae
Obstruction = Fistulae / Abscess-perianal-Adhesions / STricture-skin Tags
Haem = duo-Fe, jej-Folate, ileum-B12
NCG+LA=PA
Stones (oxalate/GB) / Sych / Systemic*
*TransMuralInflam=FullThick
*Dx Related:
PauciArth / Asymm / OP
E.Nodosum
Episcleritis
C>UC
Dx UNrelated: PolyArth / P - Symm / Clubbing = PSCholang P.gangrenosum Uveitis Smoking UC>C
Ileo-anal pouch reconstruction
@Crohns = high risk of:
-fistula formation
-pouch failure
Commonest disease site @crohns?
- terminal ileum #b12 dx
- limited ileocaecal resections.
- may affect enterohepatic bile salt recycling -> increase the risk of gallstones.
Severe perianal/rectal Crohns = proctectomy.
5Vacc <10yr + any wound = ?
-Clean/TetProne/HRisk
5Vacc >10yr + Clean = ?
5Vacc >10yr + TetProne = ?
5Vacc >10yr + HRWound =
- ?
?/Not vacc + Clean = ?
?/Not vacc + TetProne/HRWound =
-?
______________
Hep B - risk of needlestick transmission -? %
look at source - HBsAg Pos+ OR unknown?
- HBsAg Pos+ :
- known responder = ?
- non-responder/being vacc = ? - Unknown source:
-known responders = ?
-non-responders = ?
-being vacc = ?
_________________
Rabies:
Animal in UK - NO risk =
-?
Animal bite elsewhere - HR = -? + ... -Already immunised: ? -NotPrevImmunised: ? \_\_\_\_\_\_\_\_\_
5Vacc <10yr + any wound
-Clean/TetProne/HRisk = CLEAN+CHILL
5Vacc >10yr + Clean = CLEAN+CHILL
5Vacc >10yr + TetProne = bVacc
5Vacc >10yr + HRWound =
-bVacc + Tet Ig
?/Not vacc + Clean = bVacc
?/Not vacc + TetProne/HRWound =
-bVacc + Tet Ig
______________
Hep B - risk of needlestick transmission -20-30 %
look at source - HBsAg Pos+ OR unknown?
- HBsAg Pos+ :
known responder = booster
non-responder/being vacc:
-HBIg + vaccine - Unknown source:
-known responders = booster
-non-responders = HBIg + vaccine
-being vacc = accHBV vaccine
_________________
Rabies:
Animal in UK - NO risk =
-WASH + ?CoAmox
Animal bite elsewhere - HR =
- WASH + …
- Already immunised: 2 vaccines
- NotPrevImmunised: HRIg+FullCourse
UC Rheum Anti-body?
__________
UC symptoms
-toxic mega colon diag criteria
poorly controlled colitis =
fails to respond to medical therapy –>
What op?
Dysplastic transformation of colonic epithelium +
mass lesions
-> what op?
Fucking P-ANCA!!!
-like in PSC…PP-anca, onionSSkin-onion, uCC
__________
Ulcers / NoctPoo-Urgency-Tenesmus
-pseudopolyp
LargeI: - JALAN Criteria*
Lead pipe=ToxicMegaColon #AXR
Loss of haustra - pseudoPolyp
LLQ pain
Clots-VTE
Continuous=rectum-> IleoCecal Valve
Colorectal cancer
Crypt abscess - low goblets
Extend proximally
Red diarrhoea
Sych/Systemic*
*dx Related:
Bone PauciArth/Asymm/OP
Skin E.Nodosum
Eye Episcleritis
*dx UnRelated:
Bone PolyArth/P-symm/Clubbing - PSC
Skin P.gang
Eye Uveitis
poorly controlled colitis = fails to respond to medical therapy --> -sub total colectomy -end ileostomy -rectum = stapled off + left in situ/ mucous fistula @oedematous-bowel
Dysplastic transformation of colonic epithelium +
mass lesions
-> procto-colectomy
________
- JALAN MEGACOLON:
- Fever >38, HR >120, WCC >10.5, Anemia
Lump in INGUINAL groin area
Reducible disappears when laying flat scrotum fine
<6w - surg < ?
<6m - surg < ?
<6y - surg < ?
probability of strangulation = ?%
Direct V Indirect Ing Hernia
-Direct = ?
-Indirect = ?
______________
BLACK kid
symmetrical bulge
@UMBILICUS
Tx? Resolve by?
-Syx and large = 2-3yrs
-Asyx and small = 4-5yrs
_______________
epidural analgesia helps
to accelerate WHAT
after abdo SURGERY?
2y/o RECTAL BLEED
cherry red lesion @anal verge
Constipation ACUTE, PainPoo,
Blood on paper
6/12 o’clock skin TAG
-?PMH: crohns
FEVER and severe pain
@anus, skin looks legit
i.e. No skin tag…
Constipation CHRONIC, strain, PainPoo,
Blood on paper
O/E Inside=iNDURATED area PROX to anal verge
Constipation, BLOOD in PAN,
3, 7, 11 o’clock
No pain - unless..?
OBSTRucted POO + childbirth = May be internal/external
> 6/52: triad:
Ulcer,
Sentinel pile,
Enlarged anal papillae
PainPoo -> O/E red-purple pea-size lump
Proctitis Causes:
Crohn’s, UC and…?
Ano-rectal abscess –> ?Cx
? rule determines location
_______________
Ann Arbor 1234
Duke ABCD - mwnd
Low Rectal tumours/ Anal tumours - No mets
Rectal tumour @mid-rectum/sigmoid
Acute abdominal pain Erect CXR = free air At laparotomy = PERF sigmoid cancer -what operation? \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Trauma, got abdo BRUISING
-?Fluid in abdomen - which scan?
Diverticula most commonly where?
Indications for thoracotomy?
Ginkgo leaf where can pec muscles?
Old/Psych dx/Parkinson/CHAGAS - which volvulus?
Parklands formula
Alco units
Which type of stoma needs spouting? Why?
- Firm mass @abdo-wall. Overlying skin = dusky
- Signs of ischaemia + necrosis.
- Met Acidosis.
- NOOOO sign of obstruction.
-Lower lateral ventral hernia - tense/red/irreducible??
TPN derranges what bloods?
ABDO pain, HTN, hydronephrosis, displaced ureters
- cancer/Ai dx BG
- high CRP/ESR, Uraemia + Anaemia
Gastric MALT lymphoma - tx??
colovesical fistula Ix?
Bowel obstruction Ix - definitive?
organise an Ix in 2w time to
ensure anastomosis is not leaking,
prior to reversing the ileostomy
Congenital inguinal hernia – paediatric surgery ASAP incarceration risk
<6w - surg <2d
<6m - surg <2w
<6y - surg <2m
probability of strangulation = 3%
Direct V Indirect Ing Hernia
-Direct = weakness @posterior wall of the inguinal canal
-Indirect = persistent PVaginalis
_____________
Infanta UMBILICAL hernia No tx - resolve <3yrs -Syx and large = 2-3yrs -Asyx and small = 4-5yrs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
epidural analgesia helps
to accelerate the
return of NORMAL bowel function
after abdominal surgery
Juvenile polyp hamartomas
Fissure FPG - -?PMH: crohns
fever + severe pain = Intersphincteric Abscess > fissure
Solitary Rectal Ulcer - excl cancer #biopsy
Haemorrhoids FP BDISH
-No pain - unless thrombosed
Rectal prolapse/intususception
Chronic fissure > 6/52: triad
Perinanal Hematoma
Proctitis Causes:
Crohn’s, UC, C.difficile
Ano-rectal abscess –> Fistuale
Goodsall rule determines location
___________
______________
1 node, 2 node, b/l diaphragm, extranodal
MWND: Mucosa, Wall, Node met, Distant mets
A-P resection @low-rectun/anus
- Anterior Resection @mid-rectum + above
- High Ant Resection @sigmoid
Hartmanns at @Perf
______________
FAST SCAN
Diverticula most commonly at SIGMOID
Thoracotomy: in haemothorax include
>1.5L blood initially, OR
>200ml/hr >2hr loss
Subcut emphysema!! Not fkn Perf 🤦🏽♂️😶
SIGMOID at oldie, psychos, Parkinsons, Chagas
4-BSA-kg 8+16hrs
mls.% / 1000
Spout SMALL Bowel stoma cos of enzymes!!!
- Richters hernia = Strang Syx w/out Obst
- SPIGELIAN HERNIA!! LLVH tense red
TPN derranges LFTs!!!!!
-retroperitoneal FIBROSIS
Gastric MALT lymphoma - eradicate H. pylori!!!
colovesical fistula - CT!!!!
Bowel obstruction Ix - definitive = CT!!!!!
-Abdo = initial
GASTROGRAFIN
- HD Stable
Small SUBCAPsular haematoma
MINIMAL intra-abdo blood
NOOOOO hilar disruption - ?HD Unstable
Lacerations affecting <50%/!!!!!!
INCR amounts of intra-abdo blood
MODerate HD instability compromise
3. HD UNstable Hilar injuries Maajor haemorrhage Maajor associated injuries \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Which of the following is the best option for long term feeding?
________
Liver USS = 7cm cystic lesion -Eosinophilia -DAUGHTER cysts present -Echinococcus Dx - organism? Ix? Tx --> Tx? What's CI?
Liver USS hyperechoic,
- Bloods+LFTs NOOOOORMAL
- Constant RUQ pain
Liver USS hyperechoic
- Fluid filled structure
- FEVER, RUQ pain, Jaundice - Dx?
Liver USS hyperechoic - Fluid filled structure - FEVER, RUQ pain, Jaundice Fluid filled structure + POORLY DEFINED boundaries + Aspiration = odourless ANCHOVY paste Colon biopsy: Aask shaped ulcers -Dx? Tx?
OCP use, 30-50 y/o
USS = sharply demarcated
heterogeneous mix echoity
-Gastrectomy–>years later–>
Ataxia, HYPOreflexia, vibration/pinprick gone
Carcinoid Investigation?
- Assoc w/ Pellagra Niacin B3 def 3D’s
- H.pyloyi + Carcinoid relation to heart…?
- which heart murmurs?
Epithelial defects
2cm superiorly @midline coccyx.
-HIRSUTE
_______________
Boas sign - dx?
Cullen @?dx = where?; Grey-Turner = ?
?@appendicits = rebound tenderness ?@appendicitis = touch LIF = pain RIF
heart/breath sound @abdo = PERF
SBO Ax -?
LBO Ax -?
_______________
Fever, RUQ pain
-Dx? Tx?
what to do @syx gallstones?
- commonest site of GS?
- does Asyx need op?
- what if NOT well for lap chole?
- what med can be used?
- what to do @CBD stones?
- what to do if ERCP fails for above?
cholecystectomy 6 months ago ->
since the operation = experienced
-chronic diarrhoea #float in the toilet
Tx?
Isolated hyperbilirubibemia Ix?
Lidocaine max dose? With Adren? \_\_\_\_\_\_ -Location + Blood supply? Foregut, Midgut, Hindgut -Ligament of ? = upper GI v lower GI #D-J jct
- Conservative
- Laparotomy with conservation
- Resection
______________
PEG BEST LONG TERM!!!
____________
Hyatid Echinococcus Cysts #Eosino #Daughter
- CT abdomen!!!!
- MEBENDAZOLE -> ?Resection + HyperTonic swabs
- Perc Asp is contraindicated
Liver hemangioma
Liver abscess
AMOEBIC cyst = Asp anchovy paste + poorly defined boundary = METRONIDAZOLE
Liver cell adenoma
-OCP 30-50 y/o
B12 def
-Subacute Combined Degen of Spinal Cord cos #NO INTRINSIC FACTOR
Urinary 5HiAA
- H.pylori + Carcinoid –> Coronary-itis
- TR/PS
Spine epithelial defect + HIRSUTISM = pilonidal sinus
______________
Boas = shoulder/scapula excitation @cholecystitis
Cullen @panc = umbilicus; Grey-Turner = flank
Blumberg@appendicits = rebound tenderness
Rovsing @appendicitis = touch LIF = pain RIF
Claybrook@PERF
-heart/breath sound @abdo = PERF
SBO Ax - ACHI: adhesions/cancer/hernia/ibd-crohns
LBO Ax - cancer
_______________
ACUTE Cholecystitis
-AUSS, AMG+Lap Chole <1wk
- lap chole @syx gallstones #day-case #elective
- CYSTIC DUCT!!!
- Asyx NOT need op
- not well for lap chole = Cholecystostomy
- USDA @radio-lucent <1.5cm + funct GB @cystography
-CBD stones = lap chole + CBD clearance via:
ERCP or @lap chole
-if ERCP fail = temporary stenting
cholecystectomy 6 months ago -> since the operation = experienced -chronic diarrhoea #float in the toilet Tx = CHOLESYTRAMINE - help absorb bile salts
Isolated hyperbilirubibemia Ix? =
- FBC - check for hemolysis
- UCB + CB in 1-3 months
Lidocaine max dose? With Adren?
3mg/kg, 7mg/kg w/ adrenaline
______
Foregut- Oesoph -> U.Duod AoVater
-Coeliac T12
Midgut- L.Duod -> prox 2/3 TC
-SMA L1
Hindgut- distal 1/3 TC -> anal canal above pectinate line
- Ligament of Treitz = upper GI v lower GI D-J jct
- IMA L3
Painful skin dx = NODULAR @ facial areas #sharp-demarcated due to: -V=Haem/Lymph spread -I=TB foci ext through skin -D=BCG -Iatro=Pri Inoc
Breakdown of skin OVERLYING TB foci @:
-Node
-Skin over infected bone/joint
_________
MIDDLE-AGED woman
Dry coarse hair, Dry skin, Menorrhagia
#HypoT Ax #rare:
- dense fibrous tissue
- REPLACING normal thyroid parenchyma
O/E: a HARD, fixed, painLESS goitre = NOTED. Assoc with retroperitoneal fibrosis.
__________
WOMAN > Man gets standard
Hyperthyroid Syx (Palp, SOB, Fatigue, Oligomenorrhoea) +
PainLESS goitre:
1-Proptosis/Exophthalmos - lid retraction lag, Pretibial Myxoedema, SMOKER, Young<60
2-BIG lump in neck
-PMH: BEFORE was asyx… NOW turned rogue…
O/E NOOO exophthalmos/ lid lag/ PreTib Myx
-Older >60
-Scanty uptake on RadioIod Uptake Scan
- Enlarging, painless, midline neck swelling
- TFTs normal, NO hyperthyroid Syx
- O/E moves on swallowing NOT with tongue protrusion
- -i.e. not thyroglossal cyst
Which Ax of hyperthyroidism are these?
- sweating, palpitations, diarrhoea.
-WL = >3 kilograms
PMH: AF
MOST likely cardiac sequeale?
_________
Graves:
TSHrAB
stim ? –?75%–> ?
? = ?
Toxic: 1. ? 2. Nodular #BenignFollicular? --> XS ? = suppress ?
Goitre:
- Painful Ax? #ESR
- Painless Ax?
Amiod Induced Thyroiditis
PathPhys/goitre?/tx?
1. Goitre
2. NO Goitre
Talk about causes of low TSH, high/norm/low T4/4 i.e. that damn table
_______
Thyrotox crisis?
_______
How to differentiate between HypoT+HyperT:
Lupus Vulgaris
Scro-Fulo-Derma
______
Riedel Thyroiditis
______
- Graves
- Eye shit, PreTib Myxoed
- EYE SHIT ABSENT 30%!!!!!! FFS
- SMOKER !!!!! - Toxic Multinodular
- Plummer Dx
- B4 Asyx -> now Syx
- NO eye syx, NO pretib myxoed - Non-Toxic Goitre
- Thyrotoxicosis -> HIGH-OUTPUT Cardiac Failure
_________
Graves <60 TSHrAB stim TSH receptor -anti-TPO75%-> Thyroid HYPERplasia XS T4/3 = suppress TSH
Toxic >60
1. Multinodular
Iod def areas
DENMARK
2. Nodular #BenignFollicularAdenoma --> XS T4/3 synth = suppress TSH
Goitre:
- Painful Ax? #ESR
a. SadQT 1. HyperT <6w 2. Euthyroid <3w 3. HypoT
b. Acute Thyroiditis #bacteria @pyriformSinus
c. Preg PPT - Painless Ax= graves, toxic
Amiod Induced Thyroiditis
PathPhys/goitre?/tx?
1. XS iod induced T4/3 synth -> Goitre #AT drugs/K-percolate
2. Destructive Thyroiditis -> No goitre #csteds
_______________
ABCDE Paracetamol Propranolol PTU /Lugol Dexamethasone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
HypoT:
Dry hair-coarse/skin
Menorrhagia
HyperT:
Pretib myxoed
Oligomenorrhoea
Lat malleoli oed lesions
Framingham PAINS criteria?
-wtf dyou always forget?! (1st 2 basically..)
NYC HF thing?
MRC dyspnoea scale?
PND ACUUUUTE pul oed Inc cardiomeg / HJR Neck vein dilate S3 gallop
Pl effusion Ankle oed Inc HR >120 / HMeg Noct cough - pink frothy sputum SOB
None
Slight
Marked
Unable
None 1 Slight hill/hurrying 2 MOST ppl 3 Unable to after: -100m/few mins 4 -Leave house/dressing 5
A.
A?A/SMA, IgM, Middle-aged women
HyperPigment, OP
High ALP/GGT > alt/ast
B. 1. A?A/SMA adults 2. ? kids antibodies, Raised IgGGGGGGGGGG levels Piecemeal necrosis High ALT/AST > alp/ggt
- MAN - PPP-anca, onion SSSkin, uCCC
-MRCP - ?appearance
High ALP/GGT > alt/ast - PBC liver transplant?
- PSC/PBC Tx?
- PBC/PSC Cx?
___________
Raised Bili, what to check and when?
- PBC - AMA/SMA IgM
- Autoimmune hepatitis ANA/SMA LKM1kids
- PSC
- PBC liver transplant @:
- Bili >100
- Recurrent cholangitis
- Refractory itching
- Ascities
5. Kolestyramine for ITCH Usda #FIRST-LINE BASTARD!!!!! Transplant ADEK MONITOR AFP LFT USS Stop Smoke
6.
PBC: HCC
PSC: Cholangiocarcinoma/Colorectal/UCC
___________
- FBC - check for hemolysis
- UCB + CB in 1-3 months
Wilson Ix? Tx?
- NeuroPsych syx
- fucking TRAPS!!!!!!!!!!
- Keyser-Fleischer
Haemchromatosis Ix? What see on X-ray?
- Bronze skin
- DM
- EDysfunction
Tx? Aim of VS?
COPD+LF= Ix? Tx?
Eponymous signs: Bead sign? Pearl sign? PAS +? Piecemeal necrosis? Porcelain?
Wilson - AR Ix? MRI, Slit lamp, Copper: serum/ceruloplasmin LOW Copper: 24hr urine HIGH
Tx: Penicllamine Avoid Cu foods Screen kids Transplant/Trientine/TetraThio.. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
HChr - AR
Ix: HFE/C28Y/H63D/Pearl stain Image: MRI, Xray Tx: VeneSection -> ferritin/TF sats <50% Desferioxamine \_\_\_\_\_\_\_\_\_\_\_\_\_
Alpha-1 antitrypsin = ACoDominant!!! Ix: PiSS>PiZZ Slow>V.slow COPD Ix and LFTs
Tx: IV alpha 1 antitrypsin
Bead sign? MRCP PSC Pearl sign? HChr PAS +? Alpha-1 antitrypsin Piecemeal necrosis? Autoimmune hep Porcelain? Cholecystitis - cancer risk
Location: 3, 7, 11 o’clock position
Internal or external
Location: midline 6 and 12 o’clock position. Distal to the dentate line
-?PMH: crohns
Chronic straining / constipation –> Histology:
-mucosal thickening
-lamina propria -> collagen and SM
(? obliteration)
O/E Inside=iNDURATED area PROX to anal verge
> 6/52: triad:
Ulcer,
Sentinel pile,
Enlarged anal papillae
PainPoo -> O/E red-purple pea-size lump
Proctitis Causes:
Crohn’s, UC and…?
_________
E.coli, S.aureus @:
Perianal, Ischiorectal, Pelvirectal, Intersphincteric
Ano-rectal abscess –> ?Cx
? rule determines location
Assoc w/ childbirth and rectal intussceception. May be internal or external
_________
Rectal=Adeno
Anal cancer=Squamous
Haemorrhoid
Fissure -?PMH: crohns
Solitary rectal ulcer Histology: -mucosal thickening -lamina propria replaced w/ collagen and SM (fibromuscular obliteration)
Chronic fissure > 6/52: triad
Perinanal Hematoma
Proctitis Causes:
Crohn’s, UC, C.difficile
___________
Ano rectal abscess
Ano -rectal abscess –> Anal fistula
Goodsalls rule determines location
Rectal prolapse = childbirth and rectal intussceception. = int/external
_________
Rectal=Adeno
Anal cancer=Squamous
- Hypo: Kalaemic/Chloraemic
- Met Alkalosis
- Bloods ix - Ddx?
Tx for:
- Adenoma?
- Barters?
- Conn’s
Bart+Git= ?BP/ Liddle = ?BP
Bart+Git= Inheritance? / Liddle = Inheritance?
___________________
Hypo causes?
Whipple’s triad?
Insulinoma Ix Tx?
__________
High prolactin –> low what pit hormones? –> ?Syx
Causes of raised prolactin?
Ix: Bloods? Imaging? Another test?
Prolactinoma
- < 10mm? Cx of one of the drugs?
- > 10mm?
_____________
Gynaecomastia ax:
Anabolic steds Buserelin Cimetidine/Cannabis-WEED Digoxin Estrogens Finasteride Goserelin HyperT/Hcg-seminoma Isoniazid Jaundice-LF KleinFeltHerTits K-sparing-SPIRO
High Ald:Renin Ratio = HyperAldosteronism
-HyperNatraemia
- Surg @Adenoma
- Barters - ACEi/NSAID/K+IV
- Spiro @Conn’s B/L hyperplasia
-Bart+Git=normoten / Liddle = HTN
-Bart+Git= AR / LiDDle = AD
___________________
EXPLAIN:
- EXogenous agents
- Bblock/Asp/Malaria/Pentamadine/SU-insulin - Pit dx / PostPraDUMPINGsynd-whipple’s
- LF
- Addisons
- Insulinoma/SU ->
- PrePro -> Pro ->
- C-pep+Insulin(munchausen) - Neisidoblastoma
Non-panc tumour
Whipple - SIN
Syx
Improve Syx @ Inc BM
Number: <3.5
Prolonged fast INSULINOMA CT panc/Diazoxide Surg/SomatoStain \_\_\_\_\_\_\_\_\_\_
High prolactin –> low GnRH + low FSH/LH –>
Amenorrhoea/
Galactorrhoea-Gonad small/
OP cos of low FSH/LH and hence low oestrogen
HA/Opthalmoplegia/GCS low
Metoclop, Ecstasy, AntiPsychs, Tumour
(prolactinoma/craniopharyngioma/stalk dx)
PCOS/Preg, low T4 -> high TRH + high Prolactin, Estrogens/eGFR=low #reduced clearance
Ix:
Pit profile - FSH/LH/Prolactin
MRI
Eye test
Prolactinoma
- < 10mm - Bromocriptine/Cabergoline
- > 10mm - TS surg
ALCO + Severe vomiting –>
painful Mucosal LACERATIONS @GOJ –>
Blood @vomit = Haematemesis
dysPEPsia + OVERWEIGHT.
Severe VOMIT → Chest PAIN + PNEUMONIA syx:
- chest pain WITHOUT cardiac ax
- pneumonia sx WITHOUT convincing hx
- Normal ECG
- Erect CXR = infiltrate or effusion
Dyspepsia+Odynophagia
-no ALARM syx
- Blood @vomit = Haematemesis LOTS
- Malaena
- AVM Difficult difficult to detect endoscopically
Blood @vomit = Haematemesis LOTS
Epigastric dx
NSAID Hx
older men = Hallitosis
Lump = GURGLES on palpation
Dysphag / Regurg / Aspiration / chronic-cough.
Dx? - AKA WHAT?!?!?!
Eye muscle dx / Ptosis
Dysphagia with Liquids + Solids
HIV / Steroid inhaler + dyshagia/pain
___________
Progressive dysphagia + WL Usually little or NO history of previous GORD type symptoms.
Progressive dysphagia + GORD/Alco/Smoker -GORD/Barretts Hx -treated for COPD #smoker -macrocytosis and high GGT #alcoholic . \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dysphagia LIQUIDS+SOLIDS
- Ix? Tx? MBE
Longgggggg history of dysphagia,
Non-progressive.
GORD syx
dysphagia = episodic
Non-progressive.
1. Dysphagia
2. Odynophagia/Retrosternal pain
Mallory-Weiss Tear
Hiatus Hernia
-What should NOT be associated
with dysphagia or haematemesis?
UnCx hiatus
ORBS: Oesopghageal Rupture Boerhaave Syndome
-Complete disruption of the oesophageal wall in absence of per-existing pathology.
Oesophagitis
Dieulafoy Lesion - can be HDunstable
Diffuse erosive gastritis - can be HDunstable
Pharyngeal Pouch - ZENKER DIVERTIC
-herniation between thyropharyngeus and cricopharyngeus muscles
#Killian’s Dehiscence - BSwallow
MGravis
Oesophag Candidiasis
____________
Squamous cell carcinoma of the oesophagus
Adenocarcinoma of the oesophagus - GAS
___________
Achalasia: MCS BED CaMP
- Manometry Contrast Swallow = dilated tapered oesophagus
- BalloonEndoDilation – > CardioMyotomy+PPI
Peptic stricture
Dysmotility disorder -
- Oesophageal spasm - coodination messed
- Nutcracker - all @same time
Alco units calculation
-vol in pint?
Parklands formula
Beta-blockers/ CCB-RL such as bisoprolol are common precipitants of myasthenic crises.
? reduce hypoglycaemic awareness
? may cause insomnia
1 Pack year?
%.mls/1000
-568ml in pint
4BSAkg = half 8-hrs, half 16-hrs
Beta-blockers/ CCB-RL such as bisoprolol are common precipitants of myasthenic crises.
Beta-blockers reduce hypoglycaemic awareness
Beta-blockers may cause insomnia
1 Pack year = 20 cig/d/yr
Organophosphates
Heparin
Ethylene glycol*
Methanol*
Salicylates
Lithium*
TCA-wide QRS, tachy
Cyanide*
Digoxin
Lead/Arsenic*
Organophosphates - atropine
Heparin - protamine sulfate
Ethylene glycol - Fomepizole/ Ethanol / Dialysis
Methanol - Fomepizole>Ethanol / Dialysis
Salicylates - HCO3/ dialysis
Lithium - Fluids/dialysis
TCA - HCO3
Cyanide - OH-cobalamin
Digoxin - Dig-specific Antibodies
Lead/Arsenic*- dimercaperol / edetate
Acromeg pathphys? Tx? Ix?
-what does Octreotide stop?
Pathphys:
High GHRH (ectopic) –>
High GH (panc/pit tumour MEN) –>
High IGF @liver (muscle growth)
Tx:
TS surg
Octrotide=SS analog-stop GH release +/- RT
Pegvisomant
Ix: IGF-1 -high-> OGTT: -Norm=GH<2 \ GH/30min -Acro=GH high AF \ IGF lvl MRI head
PAST SHIPDOC
Person had surgery, their cortisol drops then
- suddenly get mass effect symptoms
- HyperPigmentation Whagwan…?
ACTH-dependent / independent ax?
Cushing’s syndrome V disease?
-syndrome = positive Dexa LD
-disease - PIT adenoma
_____________________
Suspect cushings, what Ix?
DEXAMETH SUPP TEST
- low dose @ ?
- high dose @ ?
Low cort @LD = ?
~/high cort @LD = Syndrome*/PseuoCush (?/? - ?test to r/o)
(already a pool of cort/sted in body so adding tiny bit of LD aint gna do much to the negative feedback loop business)
Low cort @HD = ?: Cause of 'disease' = -high ACTH -> ? -> -high cortisol DexaHD=high enough to suppress ACTH @PitAd -> suppress cortisol
~ / high cort @HD: low CRH/ACTH BUT STILL: -high cortisol = ? -high ACTH+Cortisol = ? Tx: ?
Perioral dermatitis, Acne/Atrophy, SkinStriae, Telangiectasia
Stomach ulcer, HTN, IHD, Psychosis, DM, OP/Obesity-buffalo hump, Cushing/cataract
Drop in cort -> massive ACTH rise = pit enlargment -> mass effect + Hyperpigment #NELSON SYNDROME
ACTH-dependent =
- 3 (Pit-Adenoma)
- 4b (ectopic/carcinoid)
Rest ACTH independent eg Cune-Albright/Carney syndrome, Steroids, Adr Adenoma
Cushings syndrome V disease?
-syndrome = positive Dexa LD
-disease - PIT adenoma
_____________________
Suspect cushings, what Ix?
- 24hr urine cortisol
- Serum/saliva
- DEXAMETH SUPP TEST
DEXAMETH SUPP TEST
- low dose 0am 9am
- high dose 0hr 48hr
Low cort @LD = NORM
~ / high cort @LD = Syndrome/PseuoCush (alco/depression - insulin tol test to r/o)
Low cort @HD = Disease: Pit Adenoma = -high ACTH -> b/l adr hyperplasia -> -high cortisol DexaHD=high enough to suppress ACTH -> suppress cortisol
~ / high cort @HD: low CRH/ACTH BUT STILL: -high cortisol = Adr Adenoma -high ACTH+Cortisol = SmallCellLungCancer / Carcinoid Tx: Surg/Conazole
- Anti-ACh receptor
- Anti-presynaptic voltage-gated calcium channel
- Antinuclear (ANA)
- Anticardiolipin, lupus anticoagulant
- Anti-dsDNA, anti-Smith
- Anti-Ul RNP (ribonucleoprotein)
- Rheumatoid factor (IgM antibody against IgC
Fe region), anti-CCP (more specific) - Anti-Ro/SSA, anti-La/SSB
- Anticentromere
- Anti-Scl-70 (anti-DNA topoisomerase I)
- Antisynthetase (eg, anti-Jo-I), anti-SRP, anti-
helicase (anti-M i-2) - Anti mitochondrial AMA/SMA
- Anti-smooth muscle ANA/SMA
- Anti-phospholipase A2 receptor
- Anti microsomal, antithyroglobulin, anti-TPO
- TSHrAB receptor
- IgA anti-endomysial, IgA anti-tissue
transglutaminase, IgA and IgG deamidated
gliadin peptide - Anti-glutamic acid decarboxylase, islet cell
cytoplasmic antibod ies - Antiparietal cell, anti-intrinsic factor
- Anti-glomerular basement membrane
- Anti B2-glycoprotein I
- Anti-histone*
- Anti-Ul RNP (ribonucleoprotein)
- Anti-Mi, Anti-Jo
- AMA/SMA
- ANA/SMA
- MPO-ANCA/p-ANCA
- PR3-ANCA/c-ANCA
- Anti-hemidesmosome
- Anti-desmoglein (anti-desmosome)
- Anti-glutamic acid decarboxylase, islet cell
cytoplasmic antibod ies
- Myasthenia gravis
- Lambert-Eaton myasthenic syndrome
- Nonspecific screening antibody, often associated
with SLE - SLE, antiphospholipid syndrome
- SLE
- Mixed connective tissue disease
- Rheumatoid a rthritis
- Sjogren syndrome
- Scleroderma (Limited)
- Diffuse scleroderma (CREST syndrome)
- Polymyositis, dermatomyositis
- AMA/SMA = PBC
- ANA/SMA = Ai Hepatitis
- Prim membranous nephropathy
- Hashimoto thyroiditis
- Graves disease
- Celiac disease
- Type I diabetes mellitus
- Pernicious anemia
- Goodpasture syndrome
- Antiphospholipid syndrome
- Drug-induced lupus*
- Mixed Connective Tissue Dx
- Dermatomyositis, Polymyositis - Mid Jop
- AMA/SMA = PBC
- ANA/SMA = Ai Hepatitis
- Churg-Strauss Eosinophilic Granulomatosis with polyangiitis/Microscopic polyangiitis/ Ulcerative colitis
- GPA (Wegener)
- Bullous pemphigoid
- Pemphigus vulgaris
- DM1
* TNF-tb/cancer Tetracyc-mino Epileptics - Phenytoin Anti-Arryhtmics - Procainimide Chlopromazine Hydralazine
Non-Granulomatous vasculitis?
Granulomatous vasculitis?
HHT = AKA…?
Which ones are large, med and small vessel vasculitis’?
___________
Midsystolic crescendoed decrescendo murmur radiating to the carotids @ RUSE
Midsystolic murmur @ LUSE
- fixed split?
- s4?
Mid ejection syatolic murmur @ BACK
What is carcinoid assoc with?!
_________
Pansystolic @LLSE
- blowing high pitched
- harsh V2
Diastolic @ LLSE
Pansystolic @ apex
- blowing high pitch
- mid ejection systolic click
Diastolic @ apex = LHS hold breath + opening snap
Non-gran: Microscopic polyangiitis P-ANCA
Large: GCA, Takayasu
NONE of the medium ones!!
Small: GPA, eChurg Strauss
Olser Weber Rendu!!!
Large: GCA/Takayasu
Med: Kawasaki makes Buergers on a PAN
Small: the rest…
___________
EJECTION MSys@RUSE Aortic Stenosis Sys-mid C-D
EJECTION Sys=MSys@LUSE= PS, ASD fixed split, ToF, HOCM S4, innocent!!!!
Late MESys @ back = coarctation
Carcinoid -> PUL STENOSIS/TricInsuff
___________
PSys LLSE = TR/VSD
Dias LLSE = TSten
PSys = MR/MP(actually is late sys)
Late Diastolic = MS = LHS Hold Breath, Opening snap
____________
PSys LLSE = TR/VSD
Dias LLSE = TSten
PSys = MR/MP(actually is late sys)
Late Diastolic = MS = LHS Hold Breath, Opening snap
Elderly females.
Unilateral headache/scalp tenderness, possible temporal artery tenderness,
jaw claudication.
?shoulder/pelvic girdle pain
May lead to irreversible blindness due to
Ant Isch Optic Neuropathy
-Ophthalmic artery occlusion.
Focal granulomatous inflammation, high ESR
Dx? Type?
Tx? Tx @ eye dx?
Additional med for bone health?
_______________
fever, night sweats,
arthritis/myalgias,
“Pulse less disease”
(Weak UPPER extremity
PULSES)
skin nodules
EYE disturbances.
Granulomatous
thickening and narrowing
of aortic arch and
proximal great vessels
Usually Asian females< 40 years old.
high ESR.
Giant cell (temporal) arteritis
Large vessel disease
Pred 40 mg/60mg @ eye dx –> reduce dose at syx control
Bisphosphonate
_________________
Takayasu PULSELESS
Large vessel disease
Young <40 + Heavy smokers
Segmental Thrombosing vasculitis
-vein/nerve involvement
Intermittent Claudication -> Gangrene
-autoamputation of digits,
Superficial nodular phlebitis
Raynauds
CorKKKK screw COLLATERALS
________________
Conjunctival injection,
Rash (polymorphous
- desquamating),
Adenopathy (cervical),
Strawberry tongue (oral mucositis)
Hand and foot changes (edema, erythema},
BURN - fever
coronary artery aneurysms, thrombosis
Asian children< 4 years old.
TREATMENT????????
________________
Fever, weight loss, malaise, headache.
- jaundice -palpable-purpura
- HUria -no lung dx
neurologic dysfunction - stroke/eye dx,
Hypertension
GI: abdominal pain, melena.
Skin eruptions - livido reticularis
-PALPABLE PURPURA
Renal damage - nephritic : involves renal and visceral vessel
Hepatitis B seropositivity in 30% of patients.
Transmural inflammation of the arterial wall with fibrinoid necrosis.
Usually middle-aged men.
Buergers - medium vessel
-smoking cessation.
DIFF FROM BERGERS IGA NEPHROPATHY!!! IN RENAL TOPIC!!!
___________________
Kawasaki - medium vessel
Aspirin Echo IVIG
____________________
Polyarteritis Nodosa - medium vessel
- PALPABLE purpura
- jaundice = HEP B
