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)

- constipation - N&V - agitation - drowsiness - pruritus - dry mouth - hallucination

- referral with in 24 hours - aspirin 300mg now - TIA clinic with in 24 hours

- either 2/3 of TACs OR - higher cortical dysfunction alone -----> speech -----> perceptual problems

- ataxia - hemiparesis / hemisensory / hemisensory motor - NO HEMIANOPIA NEED JUST 1

CBL notes 2 Flashcards by Andrea Jayawardena

Features of metastatic spinal cord compression

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

Irreversible damage to spinal cord –> Paraplegia

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Cancers associated with MSCC

prostate
lung
breast

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Management of MSCC

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

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Features of opioid toxicity:

extreme drowsiness
pinpoint pupils
resp depression
mycoclonus

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SE of opiods

constipation
N&V
agitation
drowsiness
pruritus
dry mouth
hallucination

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Scoring system for TIA

ABCD2

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Management of TIA

referral with in 24 hours
aspirin 300mg now
TIA clinic with in 24 hours

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Definition of orthostatic hypotension

lying standing blood pressure

drop of more than 10mmHg diastolic

or 20mmHg systolic

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Management of a patient with a FALL after hospital

Falls alarm
OT / PT input
Comprehensive geriatric assessment
Smoking, alcohol, BP
Management polypharmacy

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

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Important drugs to avoid in the elderly

STOPP criteria

Anti-histamines
Doxacosin
- anticholinergic
—–> urinary retention
—–> worsening alzheimers
Zopiclone

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Name two frailty scores

PRISMA 7
Rockwood

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Causes of falls and delerium

Pinch Me

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

M- medication
E- environment

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Summarise some causes of thrombocytopenia (5)

Immune thrombocytopenic purpura
Thrombotic thrombocytopenic pupura
- ADAMST13 association
Hypersplenism
- increased spleen size
- hyperactive spleen
Disseminated intravascular coagulation
- increased clotting
Haemolytic uraemic syndrome
- acute renal failure in kids
- symptoms
a) microangiopathy
b) thrombocytopenia
c) renal insufficiency

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Summarise some oncological emergencies (5)

Metastatic spinal cord compression
neutropenic sepsis
superior vena cava obstruction
hypercalcaemia
immune therapy induced colitis

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

MASCC score. < 21 = low risk

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treatment of neutropenic sepsis

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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What scores are used to determine disability after stroke

Modified rankin score
Rosier score (stroke vs non-stroke)

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Total anterior circulation stroke

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

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PACS

either 2/3 of TACs

higher cortical dysfunction alone
—–> speech
—–> perceptual problems

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Lacunar stroke

ataxia
hemiparesis / hemisensory / hemisensory motor
NO HEMIANOPIA

NEED JUST 1

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POCS (posterior circulation stroke)

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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Ischaemic stroke management

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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Secondary prevention of stroke

Start antiplatelet after 2 weeks of aspirin 300mg

Atrial fibrillation?
YES
- then start DOAC

NO
- clopidogrel 75mg

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Key investigations in patient with suspected stroke

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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Summarise different types of heart block

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

Causes of hemiplegic gait

Stroke Space occupying lesion Brown sequard

Causes of diplegic

Early cauda equina central cord syndrome brain lesion cerebral palsy midline tumour

Leuckonikia associated with

Hypoalbuminaemia

Nephrotic syndrome is protein loss of over how much

over 3.5 Nephrotic - oedema - proteinuria - hypoalbuminaemia

Common causes of nephrotic syndrome

Dirty Monkeys Fling Mud Smearing All D- diabetes M-mellitius F- focal glomerular sclerosis M-minimal change disease S-SLE A-amyloidosis

What is amaurosis fugax

transient loss of vision in one eye

Temporal arteritis key investigations

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

Key features in acute angle closure glaucoma

- fixed dilated pupils - halo around lights - headache - nausea and vomitting

Management of acute angle closure glaucoma

- Timolol eyedrops - Pilocarpine (to constrict pupils) - lie patient down Tx = Laser iridotomy

Management of temporal arteritis

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)

Risk factors for head and neck cancer

- alcohol - smoking - chewing tobacco - HPV, EBV

2WW for laryngeal cancer if

anyone over 45 with persistent hoarse voice and unexplained lump

When to refer for 2ww oral cancer

- leukoplakia, erythroplakia - ulceration for more than 3 weeks

When to refer for thyroid cancer

any age with unexplained thyroid lump

Medication which can cause oral ulcers

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

Key radiotherapy side effects

- fatigue - osteonecrosis of jaw - mucositis

Burns - working out TBSA

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

Describe superficial epidermal burns

- painful - erythematous - blanches - heals without scar e.g. sun burn

Describe superficial partial thickness burns

- epidermis and dermis involvement - pink and painful - blistering - does blanch

Deep partial thickness burn

- red but not blanching - will scar

full thickness burn

- not painful - white, waxy appearance - doesn't blanch

Three zones of a burn

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

Formula for resuscitation fluids in burns

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

Concerns of electrical burns

- rhabdomyolysis - myocardial instability - compartment syndrome

What features may indicate a inhalation injury

- resp distress or failure - soot around mouth and nose - dry mucous membranes - hoarse voice

Necrotising fasciitis commonly caused by what pathogens

group A strep Beta-haemolytic strep Tx = clindamycin or vancomycin

What scoring system is used for nec fasc

LRINEC score for necrotizing soft tissue infection

Gas gangrene common pathogen

CLOSTRIDIUM PFRINGENS - cause of diarrhoea - GI malignancy - diabetes - penetrating injury

Abx used for gas gangrene

MEROPENEM - will need debridement - oxygen - IV immunoglobulins

classification system for open fracture

Gustulo-anderson

Spinal injuries are recorded on what chart

- ASIA CHART

Classification for Odontoid peg fractures

Anderson and Dalanzo

40M severe back pain + IVDU + chest infection DDx

- discitis - osteomyeltis - iliopsoas abscess - metastatic spinal cord compression

Common pathogens to cause discitis

1. Staph aureus In IVDU --> Psuedomonas aeurginosa Tx = IV ABx for 6-12 weeks

What is Prehn's sign

- to help differentiate between testicular epididymitis or torsion - reduction in pain upon elevation of testes is seen in epididymitis

Tumour markers for testicular cancer

- AFP - bHCG - lactate dehydrogenase

Staging of testicular cancer

CT for staging THE ROYAL MARSDEN STAGING

Management of testicular cancer

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