CBL notes 2 Flashcards
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
Cancers associated with MSCC
- prostate
- lung
- breast
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)
Features of opioid toxicity:
- extreme drowsiness
- pinpoint pupils
- resp depression
- mycoclonus
SE of opiods
- constipation
- N&V
- agitation
- drowsiness
- pruritus
- dry mouth
- hallucination
Scoring system for TIA
ABCD2
Management of TIA
- referral with in 24 hours
- aspirin 300mg now
- TIA clinic with in 24 hours
Definition of orthostatic hypotension
lying standing blood pressure
drop of more than 10mmHg diastolic
or 20mmHg systolic
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
Important drugs to avoid in the elderly
STOPP criteria
- Anti-histamines
- Doxacosin
- anticholinergic
—–> urinary retention
—–> worsening alzheimers - Zopiclone
Name two frailty scores
- PRISMA 7
- Rockwood
Causes of falls and delerium
Pinch Me
P - pain
I - infection
N - nutrition
C - constipation
H - hydration (dehydration)
M- medication
E- environment
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
Summarise some oncological emergencies (5)
- Metastatic spinal cord compression
- neutropenic sepsis
- superior vena cava obstruction
- hypercalcaemia
- immune therapy induced colitis
Scoring system for neutropenic sepsis, what number would indicate low risk
MASCC score. < 21 = low risk
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
What scores are used to determine disability after stroke
- Modified rankin score
- Rosier score (stroke vs non-stroke)
Total anterior circulation stroke
- hemiparesis / hemi sensory loss
- homonymous hemianopia
- higher cortical dysfunction
———-> speech
———-> perceptual problems
PACS
- either 2/3 of TACs
OR
- higher cortical dysfunction alone
—–> speech
—–> perceptual problems
Lacunar stroke
- ataxia
- hemiparesis / hemisensory / hemisensory motor
- NO HEMIANOPIA
NEED JUST 1
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
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
Secondary prevention of stroke
- Start antiplatelet after 2 weeks of aspirin 300mg
Atrial fibrillation?
YES
- then start DOAC
NO
- clopidogrel 75mg
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
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
- Lund and Bower chart (whole arm 9%) (leg 18%)
- 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
- Middle zone of coagulation (will not heal)
- Zone of stasis
- 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
- 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
