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Y4 - Finals Edition > CBL notes 2 > Flashcards

CBL notes 2 Flashcards

1
Q

Features of metastatic spinal cord compression

A
  • backpain worse on bending and straining
  • loss of sensation and motor
  • incontinence
  • sensory disturbance

Irreversible damage to spinal cord –> Paraplegia

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2
Q

Cancers associated with MSCC

A
  • prostate
  • lung
  • breast
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3
Q

Management of MSCC

A
  1. Call MSCC coordinator
  2. Log roll
  3. 16mg dexamethasone stat w/ PPI cover
  4. Monitor
    - blood glucose (steroids can cause hyperglycaemia)
    - candida
  5. Radiotherapy or surgery
    - bisphosphonates (adjuvant for bone pain)
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4
Q

Features of opioid toxicity:

A
  • extreme drowsiness
  • pinpoint pupils
  • resp depression
  • mycoclonus
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5
Q

SE of opiods

A
  • constipation
  • N&V
  • agitation
  • drowsiness
  • pruritus
  • dry mouth
  • hallucination
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6
Q

Scoring system for TIA

A

ABCD2

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7
Q

Management of TIA

A
  • referral with in 24 hours
  • aspirin 300mg now
  • TIA clinic with in 24 hours
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8
Q

Definition of orthostatic hypotension

A

lying standing blood pressure

drop of more than 10mmHg diastolic

or 20mmHg systolic

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9
Q

Management of a patient with a FALL after hospital

A
  1. Falls alarm
  2. OT / PT input
  3. Comprehensive geriatric assessment
  4. Smoking, alcohol, BP
  5. Management polypharmacy

Comprehensive geriatric assessment
- physical
- socioenconomic / environmental
- functional
- mobility / balance
- psychological
- medication review
- personalised care pain

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10
Q

Important drugs to avoid in the elderly

A

STOPP criteria

  1. Anti-histamines
  2. Doxacosin
    - anticholinergic
    —–> urinary retention
    —–> worsening alzheimers
  3. Zopiclone
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11
Q

Name two frailty scores

A
  1. PRISMA 7
  2. Rockwood
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12
Q

Causes of falls and delerium

A

Pinch Me

P - pain
I - infection
N - nutrition
C - constipation
H - hydration (dehydration)

M- medication
E- environment

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13
Q

Summarise some causes of thrombocytopenia (5)

A
  1. Immune thrombocytopenic purpura
  2. Thrombotic thrombocytopenic pupura
    - ADAMST13 association
  3. Hypersplenism
    - increased spleen size
    - hyperactive spleen
  4. Disseminated intravascular coagulation
    - increased clotting
  5. Haemolytic uraemic syndrome
    - acute renal failure in kids
    - symptoms
    a) microangiopathy
    b) thrombocytopenia
    c) renal insufficiency
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14
Q

Summarise some oncological emergencies (5)

A
  1. Metastatic spinal cord compression
  2. neutropenic sepsis
  3. superior vena cava obstruction
  4. hypercalcaemia
  5. immune therapy induced colitis
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15
Q

Scoring system for neutropenic sepsis, what number would indicate low risk

A

MASCC score. < 21 = low risk

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16
Q

treatment of neutropenic sepsis

A

LOW RISK
1. PO coamoxiclav + ciprofloxacin
OR if pen allergic
2. doxy + cipro

High risk
1. IV TAZ AND GENT
OR
2. meropenem and gent
OR
3. Teicoplanin / cipro and gent

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17
Q

What scores are used to determine disability after stroke

A
  1. Modified rankin score
  2. Rosier score (stroke vs non-stroke)
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18
Q

Total anterior circulation stroke

A
  • hemiparesis / hemi sensory loss
  • homonymous hemianopia
  • higher cortical dysfunction
    ———-> speech
    ———-> perceptual problems
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19
Q

PACS

A
  • either 2/3 of TACs

OR

  • higher cortical dysfunction alone
    —–> speech
    —–> perceptual problems
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20
Q

Lacunar stroke

A
  • ataxia
  • hemiparesis / hemisensory / hemisensory motor
  • NO HEMIANOPIA

NEED JUST 1

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21
Q

POCS (posterior circulation stroke)

A

Involves damage to area of brain supplied by posterior circulation
(e.g. cerebellum and brainstem)

  • hemianopia
  • visual loss (cortical blindness)
  • cerebellar dysfunction (vertigo, nystagmus and ataxia)
  • diplopia
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22
Q

Ischaemic stroke management

A

FROM SYMPTOM ONSET

Within 4.5 hrs
- thrombolysis w/ alteplase
—-> IV, give 10% bolus then rest in an infusion over an hour

Within 6 hrs
- thrombectomy

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23
Q

Secondary prevention of stroke

A
  1. Start antiplatelet after 2 weeks of aspirin 300mg

Atrial fibrillation?
YES
- then start DOAC

NO
- clopidogrel 75mg

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24
Q

Key investigations in patient with suspected stroke

A

A-E assessment

Aspirin 300mg

Bloods: FBC, G+S, CRP, coagulation studies

Glucose to rule out stroke mimics

ECG: AF?

CXR: rule out other pathology

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25
Q

Summarise different types of heart block

A

1st degree = PR prolongation

2nd degree
Mobitz 1 = PR gradually getting longer and longer, drops 1 QRS (Wenckebach)

Mobitz 2 = consistent PR interval duration with intermittently dropped QRS complexes , often a repeating cycle

3rd degree = NO ASSOCIATION between P waves and QRS

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26
Q

Causes of hemiplegic gait

A

Stroke

Space occupying lesion

Brown sequard

27
Q

Causes of diplegic

A

Early cauda equina

central cord syndrome

brain lesion

cerebral palsy

midline tumour

28
Q

Leuckonikia associated with

A

Hypoalbuminaemia

29
Q

Nephrotic syndrome is protein loss of over how much

A

over 3.5

Nephrotic
- oedema
- proteinuria
- hypoalbuminaemia

30
Q

Common causes of nephrotic syndrome

A

Dirty Monkeys Fling Mud Smearing All

D- diabetes M-mellitius
F- focal glomerular sclerosis
M-minimal change disease
S-SLE
A-amyloidosis

31
Q

What is amaurosis fugax

A

transient loss of vision in one eye

32
Q

Temporal arteritis key investigations

A

ESR

Temporal artery biopsy
- has skip lesions so may not be diagnostic

Temporal artery USS

33
Q

Key features in acute angle closure glaucoma

A
  • fixed dilated pupils
  • halo around lights
  • headache
  • nausea and vomitting
34
Q

Management of acute angle closure glaucoma

A
  • Timolol eyedrops
  • Pilocarpine (to constrict pupils)
  • lie patient down

Tx = Laser iridotomy

35
Q

Management of temporal arteritis

A

CHECK THIS FLASHCARD

IV METHYLPRED

refer to rheum and opthal

Tx Visual symptoms?
Yes –> 60mg IV methylpred
No –> 40mg PO methylpred (no jaw claudication either)

36
Q

Risk factors for head and neck cancer

A
  • alcohol
  • smoking
  • chewing tobacco
  • HPV, EBV
37
Q

2WW for laryngeal cancer if

A

anyone over 45

with persistent hoarse voice and unexplained lump

38
Q

When to refer for 2ww oral cancer

A
  • leukoplakia, erythroplakia
  • ulceration for more than 3 weeks
39
Q

When to refer for thyroid cancer

A

any age with unexplained thyroid lump

40
Q

Medication which can cause oral ulcers

A

Nicorandil

other causes of ulcers
- Crohn’s
- Behcets (mouth and genital ulcers)

41
Q

Key radiotherapy side effects

A
  • fatigue
  • osteonecrosis of jaw
  • mucositis
42
Q

Burns - working out TBSA

A
  1. Lund and Bower chart (whole arm 9%) (leg 18%)
  2. Patients palm is 1%
43
Q

Describe superficial epidermal burns

A
  • painful
  • erythematous
  • blanches
  • heals without scar

e.g. sun burn

44
Q

Describe superficial partial thickness burns

A
  • epidermis and dermis involvement
  • pink and painful
  • blistering
  • does blanch
45
Q

Deep partial thickness burn

A
  • red but not blanching
  • will scar
46
Q

full thickness burn

A
  • not painful
  • white, waxy appearance
  • doesn’t blanch
47
Q

Three zones of a burn

A
  1. Middle zone of coagulation (will not heal)
  2. Zone of stasis
  3. Zone of hyperaemia
48
Q

Formula for resuscitation fluids in burns

A

PARKLAND FORMULA

1/2 in first 8 hours
1/2 in next 16 hours

49
Q

Concerns of electrical burns

A
  • rhabdomyolysis
  • myocardial instability
  • compartment syndrome
50
Q

What features may indicate a inhalation injury

A
  • resp distress or failure
  • soot around mouth and nose
  • dry mucous membranes
  • hoarse voice
51
Q

Necrotising fasciitis commonly caused by what pathogens

A

group A strep

Beta-haemolytic strep

Tx = clindamycin or vancomycin

52
Q

What scoring system is used for nec fasc

A

LRINEC score for necrotizing soft tissue infection

53
Q

Gas gangrene common pathogen

A

CLOSTRIDIUM PFRINGENS

  • cause of diarrhoea
  • GI malignancy
  • diabetes
  • penetrating injury
54
Q

Abx used for gas gangrene

A

MEROPENEM
- will need debridement
- oxygen
- IV immunoglobulins

55
Q

classification system for open fracture

A

Gustulo-anderson

56
Q

Spinal injuries are recorded on what chart

A
  • ASIA CHART
57
Q

Classification for Odontoid peg fractures

A

Anderson and Dalanzo

58
Q

40M severe back pain + IVDU + chest infection

DDx

A
  • discitis
  • osteomyeltis
  • iliopsoas abscess
  • metastatic spinal cord compression
59
Q

Common pathogens to cause discitis

A
  1. Staph aureus

In IVDU –> Psuedomonas aeurginosa

Tx = IV ABx for 6-12 weeks

60
Q

What is Prehn’s sign

A
  • to help differentiate between testicular epididymitis or torsion
  • reduction in pain upon elevation of testes is seen in epididymitis
61
Q

Tumour markers for testicular cancer

A
  • AFP
  • bHCG
  • lactate dehydrogenase
62
Q

Staging of testicular cancer

A

CT for staging

THE ROYAL MARSDEN STAGING

63
Q

Management of testicular cancer

A

Radical orcidectomy

Note
- go through groin
- don’t go through scrotum because it has different lymphatic system and you don’t want it to spread
—-> SEEDING

Y4 - Finals Edition (40 decks)

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