Conditions Flashcards
Cardiovascular drugs pre-op
Beta-blockers / alpha 2 agonists - continue
ACEI/ARB/diuretics; w/h morning dose
Statins; continue
Blood thinners pre-op
Warfarin; w/h 5 days
Xarelto; 48hrs
Apixaban; 48hrs
Aspirin; most continued, but if need - stop 5-7/7 prior
Clopidogrel; w/h 5-7/7
NSAIDS; 7-10/7 prior
Pre-op warfarin mx
Check INR 5-7/7 prior to surgery
INR 1.5-1.9; stop 3-4 days prior
INR 2-3; stop 5 days prior
INR >3; stop at least 5 days
Bridge; clexane 1.5mg/kg subcut (1mg/kg if CrCL <30)
Imaging of breast mass
<35yo; USS
- do mammogram if suspicious clinical findings, USS indeterminant/suspicious, or if USS not consistent with clinical exam findings
>=35yo; USS + mammogram
Bariatric surgery post-op checklist
Monitor weight and complications at each visit
Adherence to diet/exercise
Medication; avoid NSAID, adjust antiHTN/diabetic meds
Supplement
- Iron, folic acid, thiamine, B12
- Citrated calcium - elemental Ca 1200mg/day
Bloods
- FBC, U+E, LFT, uric acid, glucose, lipids every 6/12
- VD, PTH, Ca, albumin, PHo, B12, folate, iron annually
Carotid artery stenosis mx
Antiplatelet
Statin
Smoking cessation
BP control
screen DM
>80% stenosis -> non urgent vascular surgery review
<80%: medical mx + annual USS
Risk factors AAA
> 65yo
Peripheral atherosclerotic disease
Smoking
COPD
Marfan
Ehler’s-Danlos syndrome
HTN
FDR
Cholesterol
Indication to screen for AAA
Male >65yo and smoking
>65yo and FDR
Known popliteal/thoracic aortic aneurysm
Venous leg ulcer features
Haemosiderin
Lower third of leg
Shallow poorly defined edges
Granulating/sloughy base
Venous leg ulcer mx
Cleaning/debridement
Compression 30-40mmHg
Nutrition; omega 3 fatty acids, vitamin C, zinc
Leg elevation
Exercise
Weight loss
Skin care for dermatitis; paraffin emollient , steroid
Early referral to vascular surgeon
Superficial thrombophlebitis mx
If IVC complication; topical or oral NSAID
Consider anticoagulation if involves thigh veins
- Clexane 40mg 6/52
Elevation
Compression
Warm
Review in 7-10 days to ensure resolution
Mx of DVT
Exercise
Compression
Cease OCP
Anticoagulation
- Xarelto 15mg BD 3/52 -> 20mg daily
- Apixaban 10mg BD 1/52 -> 5mg BD
- Clexane 1.5mg/kg subcut
PICC related VTE; elevation, NSAID, anticoag 3/12, remove PICC if non-functional
USS surveillance as alternative if high bleeding risk
- 2-3 x USS over 2 weeks to assess progression
Duration of anticoagulation DVT
Distal DVT
- Provoked; 6/52
- Unprovoked; 3/12
Proximal
- Provoked; 3/12
- Unprovoked; 6/12
Examination of foot with ulcer
Assess for infection; discharge, smell
Hair loss / skin trophic changes
Peripheral pulses
ABPI (<0.9 abnormal)
Sensation
Reflex
Joint deformity
Gait
Footwear
Wound dressings
Hydrogel (Aquaclear); dry wounds with necrotic tissue
Hydrocolloid (Duoderm): chronic wounds with mild-moderate exudate
Foam (Allevyn): granulating wounds, mild-moderate exudate, non-infective
Cadexomer iodine (Iodosorb): wounds with malodorous exudate
Alginate (Algisite): heavy exudate
Steroids ADR
Gastric irritation
Weight gain
Glucose intolerance
Cushinoid appearance
Osteoporosis
HTN
Insomnia
Psychosis
Hypoadrenalism
Risk factors of NSAID induced UGIB
Age
Hx UGIB
Hx peptic ulcer
H pylori
Anticoag/antiplatelets/SSRI
Smoking
Antipsychotics ADR
Cognitive decline
Somnolence
EPSE
Oedema
Metabolic syndrome
CVA
Falls
Causes of anovulation
Hypothalamic amenorrhoea
HPRL
Pituitary disease
PCOS
Congenital adrenal hyperplasia
Premature ovarian insufficiency
Causes of male infertility
Hypogonadotrophic hypogonadism
HPRL
Varicocoele
Cryptorchidism
Testicular cancer
Radiation
Klinefelter syndrome
Anti-sperm Abs
Retrograde ejaculation
Congenital bilateral absence of vas deferens
Incidence
Number of new cases of disease in defined population within specified period of time
Prevalence
Total number of individuals with disease at a particular time in a population
Case control study
Compares pt with disease/outcome vs patients without disease/outcome - looks retrospectively to see any relationship between exposed risk factor
Specificity
= true -ve / (true -ve + false +ve)
Highly specific test rules IN disease
