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year 3. > clasp Ixs and txs > Flashcards

clasp Ixs and txs Flashcards

1
Q

Subdural haemorraghe ixs

A

CT scan mainstay of investigation

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2
Q

Subarachnoid haemorraghe ixs

A

CT cerebral angiogram - (to identify an anyeursm)

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3
Q

Spinal cord compression ix

A

immediate MRI

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4
Q

what are the reversible causes of cardiac arrest

A

4 H’s and 4 T’s
Hypoxia, Hypovalemia, Hypo/hyperkalemia/metabolic, Hypothermia

Thrombosis, Tamponade (cardiac), Toxins, Tension pneumothorax

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5
Q

hypovalaemic shock tx

A

fluids and electrolytes

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6
Q

cardiogenic shock tx

A

inotropics by beta or dopaminergic stimulation- dobutamine, adrenaline, dopamine, dopexamine

intra-aortic baloon pump if pharmacological tx not working

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7
Q

what is obstructive shock and causes

A

physical obstruction to filling of the heart → reduced preload and cardiac output

tamponade, PE, tension penumothorax

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8
Q

obstructive shock tx

A

PE - DOAC + thrombolysis (thrombolysis used in pe when there is haemodynamic instability)
Cardiac tamponade - pericardial drainage
Tension pneumothorax - decompression and chest drainage

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9
Q

distributive shock, what is it and subtypes

A
  • significant reduction in SVR beyond the compensatory limits of increased cardiac output
  • Generally initial high cardiac output but insufficient to maintain forward perfusion
  • main subtypes:
    • Septic - bacterial endotoxin mediated capillary dysfunction
    • Anaphylactic - mast cell release of histamnergic vasodilators- (tx adrenaline as vasoconstricts and stabilises mast cell)
    • Neurogenic - loss of thoracic sympathetic outflow following spinal injury (= loss of sympathetic tone= bradychardia due to unopposed vagal tone)
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10
Q

neurogenic shock tx

A
  • Dopamine alongside vasopressors are the mainstays of treatment
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11
Q

what are shockable and non shockable cardiac arrest rythms

A

shockable:
vfib
pulseless ventricular tachycardia

non shockable
pulseless electrical activity
asystole

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12
Q

sepsis vs septic shock
(define septic shock)

A

septic shock is sepsis but assoc with cellular/metabolic dysfunction.
septic shock = sepsis + persistant hypotension lactate>/= 2

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13
Q

SIRS defined

A

sirs is >/=2 of the following

  • Heart rate >90 bmp
  • Respiratory rate >20/min
  • Temperature >38℃ or <36℃
  • WCC >12 000/mm3 or <4 000/mm3 or >10% immature neutrophils
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14
Q

what antibiotics inc risk of c.difficile

A

the 4 cs

co-amoxiclav, cephlasporins (eg. ceftriaxone), clindamycin, ciprofloxacin (quinolones)

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15
Q

where are anaerobes found

A

mouth, teeth throat, sinuses and lower bowel

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16
Q

Gram positive found where in the body

A

skin and mucous membranes

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17
Q

Gram negative found

A

GI tract

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18
Q

(types of allergy) which occurs sooner- immediate onset reaction (type 1) or accelerated/immediate reaction

A

accelerated occurs later- within 1-6 hours of last dose.

immediate (type 1) within 1 hour

both IgE mediated

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19
Q

what in penillicin is responsible for allergic reaction

A

B-lactam ring

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20
Q

How is sepsis monitored/defined

A

Early news warning score
Score of 5 or more with known/suspected infection= sepsis till proven otherwise
Or can be less than 5 but concerning features eg. Non blanching rash

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21
Q

Adjust news score up if

A

Clinical/carer concern
Deterioration,surgically remidiable sepsis
Neutropenia
Blood gas/ lab evidence organ dysfunction/lactate

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22
Q

Staph a test

A

First gram stain
Then rapid PCR- also tells u if its mrsa

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23
Q

When does PCR not work

A

On dirty samples eg urine, stool

24
Q

Gram pos cocci in pairs or chains ix

A

Agglutination aasay (serological test antibodies antigens)

25
Q

How to testbfor weird bacteria species

A

MALDI-TOF

26
Q

Bacteria testing order

A

Bloods>(1-5days)> positive alert + gram stain> culture results and maldi tof> discs etc

27
Q

Important causes if gram negative sepsis

A

E. Coli, neiserria meningitis, psuedomonas aerginusa

28
Q

Mechanisms of abx resistance (5)

A

-change target cell
-reduced uptake
- pump which spits bacteria back out
- inactivating enzymes
-decrease cell membrane permeability

29
Q

Malaria ix

A

Thick and thin smear

30
Q

c.difficile tx

A

ORAL vancomycin
if cant take orally then NG tube etc- has to go into stomach

if life threatening add IV metronidazole

if recurrs within 12 weeks- oral fidaxomin

31
Q

what additional test must be carried out for c.difficile

A

abdo x-ray- check for toxic megacolon

32
Q

what does coagulese negative staph usually indicate in a culture

A

usually a contaminant

suspect pathogenic if presence of ICED (implantable Cardiac electronic Device) or prosthetics etc.

33
Q

symptom of anaerobic pneumonia

A

pleural infection

34
Q

pneumonia treatment

A

amoxicillin——IV co-amoxiclav + doxy depending on severity
(<2 CURB65= mild, >3=severe)

all get pneumococcal and influenza vaccine

35
Q

additional tests for pneumonia

A

HIV test
Chest x-ray at 6 weeks

36
Q

ICED infection tx

A

1st line: IV vancomycin

37
Q

staph A bacteraemia ixs

A

48 hourly blood culture until negative
transthoracic echo

38
Q

staph A tx

A

flucox
if allergic: vancomycin

(IV is septic etc)

39
Q

Which drugs have a b lactam ring

A

Penicillins
Cephalosporins
Carbapenams
Aztreonam

40
Q

Sepsis 6 o
Oxygen- when given and targets

A

Start is sats <92- take this with a pinch of salt, if unwell just give as unlikely to do harm
Aim: 94-98

41
Q

Sepsis 6 targets in hypercapniac patients
Who is at risk for this

A

Target 88-92

ABG- pco high indicates hypercapnic pt.
Ppm at risk: COPD, end stage lung disease etc

42
Q

What are you testing for when taking blood cultures for sepsis 6

A

Check for infection + fbc u&es, LFTs, CRP, clotting, lactate

43
Q

How are fluids given in sepsis 6.and what type of fluid

A

20mls/kg in divided doses, crystalloid

Consider pt history eg. Hf

Can use lactate to guide response

Do not give dextrose- does not restore circulating volume

44
Q

What is pharmacokinetics

A

What the body does to the drug
- absorption & bioavailability
-distribution
-excretion
-

45
Q

new score of 1-4 when should initial treatment be started by

A

<6h (6h cut off for max time)

46
Q

news of 5-6 when is max time for starting initial tx

A

<3hrs

47
Q

news score of >/=7 what is the max time for starting initial treatment

A

<1hr

48
Q

What mutation causes marfans

A

Fibrillin

49
Q

What mutation causes marfans

A

Fibrillin

50
Q

What is a mendelian disorder

A

Disease predominantly caused by a change in a single gene
(High penetrance)

51
Q

What mutation causes loeys dietz syndrome

A

Mutation in TBR1 or TBR2

52
Q

animal bites antbiotic tx

A

co-amoxiclav

53
Q

what contraindicates trimethoprim

A

methotrexate

54
Q

bacteriuria tx in asymptomatic Catheterised patients:

A

no treatment! the longer catheter is in situ the greater the likliehood of developing bacteriuria.
only treat if symptomatic

if symptomatic 7 day course of abx not 3

55
Q

cavitating lesion pneumonia- what organism

A

staph a
hameophillus type A

56
Q

Lyme disease tx

A

Doxcy- 3 weeks

57
Q

jirovecci pneumonia tx

A

co - trimaxazole

year 3. (32 decks)

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