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Z IPE > Cross blocks > Flashcards

Cross blocks Flashcards

1
Q

Sepsis 6

A
  1. Administer high flow oxygen.
    1. Take blood cultures
    2. Give broad spectrum antibiotics
    3. Give intravenous fluid challenges
    4. Measure serum lactate and haemoglobin
      Measure accurate hourly urine output
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2
Q

Red flag sepsis symptoms

A 
• Systolic BP <90mm or >40mmhg fall from baseline
	• MABP <65mmHg
	• HR >130 bpm
	• RR >25 per min
AVPU = V, P, or U
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3
Q

Meningitis signs

A

non blanching rash, photosensitivity, stiff neck

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4
Q

How to reverse warfarin

A
  1. Stop warfarin
    1. IV Vit K - Takes 4-6h to work
    2. FFP - only if human prothrombin complex unavailable
      Human prothrombin complex - reversal in 1 hr eg Bereplex. Give with Vit K
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5
Q

Anaphylaxis tx. how to inject adrenaline?

A

adrenaline - 500mcg
hydrocortisone - 200mg
chlorphenamine - 10mg

adrenaline can be repeated every 5 mins if necessary. Anterolateral aspect of middle third of thigh

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6
Q

Emergency dialysis indications

A

• Severe pH disturbance
• Resistant pulmonary oedema
Resistant hyperkalaemia

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7
Q

Causes of metabolic acidosis normal and raised anion gap

A

○ Normal - GI loss, renal tubular acidosis, drugs, addisons
Raised - lactate (shock, hypoxia, metformin), ketones (DKA), urate (renal failure), acid poisoning (salicylates, methanol)

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8
Q

Can you take blood from cnanula?

A

CANT TAKE BLOOD FROM CANNULA AFTER FLUSHING

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9
Q

Causes of neutrophilia

A

bacteria, inflammation, necrosis, steroids, malignancy

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10
Q

Causes of neutropenia

A

chemo, viral

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11
Q

Lymphocytsisus cayses

A

viral, TB,

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12
Q

Eosinophilia causes

A

allergy, parasites

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13
Q

pancytopenia causes

A

sepsis

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14
Q

Hemolysis markers

A

• Bilirubin
• Haptoglobin (decrease as it mops up Hb)
Red cell spherocytes

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15
Q

What Hb level do you give transfusion for?

A

below 80

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16
Q

Iron deficiency anemia markers

A

Target cells
Iron molecule carriers:
• Carried by transferrin in blood - goes up if iron deficient
• Stored in body as ferritin and hemosiderin - goes down if deficient

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17
Q

Causes of macrocytic anemia

A

Macrocytic:
• B12 deficiency
• Folate deficiency
Alcohol

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18
Q

Causes of microcytic anaemia

A 
TAILS
	• Thalassaemia
	• Anaemia of chronic disease
	• Iron deficiency
	• Lead
Sideroblastic anemia
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19
Q

Causes of normocytic anaemia

A

• Hemolytic (LDH, reticulocytes)
Bleeding
Pregnancy (physiological)

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20
Q

How to know if there is mixed anaemia?

A

MCV could be normal as its average

check RDW

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21
Q

Causes of hyponatraemia

A

• Hyponatremia + decrease vol - fluid loss - GI, burns, diuretics
• Hyponatremia + normal vol - SIADH (syndrome of inappropriate ADH)
Hyponatremia + increase vol - Heart, liver, kidney failure

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22
Q

Causes of hypernatraemia

A

• Dehydration
• IV fluids
Diabetes insipidus

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23
Q

Tx of hyperkalaemia

A

• Treat underlying cause
• Stabilise cardiac membrane - IV Calcium gluconate
• Short term K+ shift to intracellular - Combined insulin/dextrose infusion, + Salbutamol nebs
Long term removal of K - Calcium resonium, loop diuretics

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24
Q

Causes of hyperkalaemia

A

• K sparing diuretics
• Think Kidney damage
Rhabdomyolysis

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25
Q

Hypokalaemia causes

A

Causes with hypertension:
• Cushings
• Conns syndrome (primary hyperaldosteronism)
Liddles syndrome

Causes without hypertension:
• Diuretics
• GI loss
Renal tubular acidosis

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26
Q

tx of hypokalaemai

A

• Oral K+ supplement if mild

If severe give IV K+ SLOWLY

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27
Q

Bone profile of osteoporosis

A

All normal

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28
Q

Bone profile of osteomalacia

A

Low calcium and P

High ALP

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29
Q

Bone profile of pagets

A

Ca + P normal

Raised ALP

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30
Q

COPD exacerbation abx?

A

amox

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31
Q

CAP abx?

A

amox

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32
Q

Atypical pneumonia abx?

A

Clarithromycin

33
Q

HAP abx?

34
Q

UTI abx?

A

Trimethoprim or nitrofurantoin

35
Q

Acute pyelonephritis abx?

A

ceftriaxone

36
Q

animal or human bite abx?

37
Q

Cellulitis abx?

38
Q

Otitis media abx?

39
Q

otitis externa abx?

40
Q

C diff abx

A

metronidazole

41
Q

Daily fluid requirements

A

• K and Na - 1mmol/kg/day
• 50-100g glucose/day
25-30ml water/kg/day

42
Q

Surgical sieve?

A

T - Trauma
I - Inflammation
N - Neoplasia

C - Congenital
A - Arteriovenous
N - Neurological

B - Blood
E - Endocrine
D - Drugs

P - Psychogenic
A - Allergic
N - Not known

43
Q

Patho of shock

A

Shock is when there is insufficient tissue perfusion

44
Q

Types of shock

A 
SHANC
	• Septic
	• Haemorrhagic
	• Neurogenic
	• Cardiogenic
Anaphylactic
45
Q

Tx of hemorrhagic shock

A

• Fluid challenge Saline 500ml ASAP and reassess BP.

Ensure Hb above 7g/dl otherwise transfusion is necessary

46
Q

Tx of neurogenic shock

A

• Peripheral vasoconstrictors - adrenaline

47
Q

ADRs of NSAIDs

A 
ADRs - I-GRAB:
	• I - Interactions with warfarin
	• G - Gastric ulceration
	• R - Renal impairment
	• A - Asthma sensitivity
B - Bleeding risk due to antiplatelet function
48
Q

egs of strong and weak opioids

A

weak - codein

Strong - morphine, fentanyl, oxycodone

49
Q

ADRs of opiooids

A

• Resp depression
• Constipation
Nausea

50
Q

egs of anti-emetics

A

Metoclopromide, domperidone, ondansetron

51
Q

Give ions that diarrhoea and vomit are high in

A

• Diarrhoea - high in K (50mmol/l) and HCO3 (50mmol/l)

Vomit - High in K (14mmol/l), H+ (60mmol/l), and Cl (140mmol/l)

52
Q

upper limb myotomes

A 
C5 - shoulder abduction
C6 - elbow flexion
C7 - elbow extension
C8 - Wrist flexion
T1 - Finger abduction
53
Q

Lower limb myotomes

A 
Lower limb:
L1,2 - Hip flexion
L3,4 - Knee extension
L5 - Knee flexion
S1 - Hip extension
S2 - Ankle plantarflexion
54
Q

Brachial plexus nerve roots

A 
MAMRU:
M - Musculocutaneous, C5-7
A - Axillary, C5,6
M - Median, C6-T1
R - Radial, C5-T1
U - Ulnar, C8-T1
55
Q

ABCDE approach

A

ABCDE IS FOR SIGNS OF LIFE.
IF NO SIGNS OF LIFE ATTEMPT LIFE SUPPORT AND CALL RESUS

Airway:
• Look inside mouth
○ Suction if secretions present
• Listen for breathing
• Head tilt chin lift and gudel or laryngeal mask
• Call for help and apply 100% oxygen via non-rebreath mask

Breathing:
• Monitor O2 sats and RR
• Look for chest expansion - fogging of mask. Does L = R chest expansion?
• Auscultate for air entry

Circulation:
	• Feel for carotid and radial pulse
	• Cap refill
	• ECG and BP
	• Establish IV access, send bloods and give fluids if BP <90

Disability:
• Assess GCS
• Check glucose
• Look for pupil reflexes

Exposure:
• Remove all clothing, check for temp
• Look all over for rash or injuries
• Repeat A-E until help arrives

56
Q

Ix of meningitis

A 
Ix:
	• FBC
	• U&amp;E
	• LFT
	• LP - DO NOT PERFORM IF NEURO SIGNS OR CONSCIOUSNESS REDUCED. CT HEAD FIRST
	• Blood culture
	• CXR
	• CT head
57
Q

Patho of encephalitis

A

Patho:
• Infection of brain parenchyma
• Most likely cause HSV

58
Q

S&S and ix and tx

A 
S&amp;S:
	• Headaches
	• Fever
	• Meningism
	• Confusion
	• Delirium
	• Neuro deficits
Ix:
	• FBC
	• U&amp;E
	• Clotting
	• MRI head
	• LP
	• CT head

tx - aciclovir

59
Q

S&S of extradural haematoma. how it happens

A

signs of raised ICP
Lucid interval
Results from acceleration-deceleration trauma or blow to side of head

60
Q

S&S of subdural and RFs

A

RFs - old age, alcoholism, anticoagulation
S&S - confusion, headache, nausea
occurs after head injury but slower onset than extradural. can take days to weeks

61
Q

What should you co-prescribe with LT steroids

A

Co-prescribe with LT steroids:
• Bisphosphonates
• PPI
• Aspirin

62
Q

Daily requirements for fluids

A

Daily requirements:
• K and Na - 1mmol/kg/day
• 50-100g glucose/day
• 25-30ml water/kg/day

63
Q

Contraindications in asthma?

A

BAN in asthma
Beta blockers
Adenosine
NSAIDs

64
Q

Ix of HIV

A

Ix:
• HIV antibodies can take 3 months to develop
• HIV tests may miss early stages of infection

65
Q

Tx of HIV AIDS

A

Tx:
• Antiretroviral drugs - HAART therapy
• Prophylactic abx against opportunistic infections
• Inactivated vaccines, live vaccines if not AIDS

66
Q

S&S of genital herpes

A

H&E:
• Lesions appear commonly on lips, conjunctiva, cornea, and genitals
• Multiple painful ulcers on red background +/- inguinal lymph nodes <1wk after sex
• Lesions crust then heal

67
Q

Tx of genital herpes

A 
Tx:
	• Refer to GUM for contact tracing
	• Treat with aciclovir if in first 5 days
	• Analgesia, ice packs for pain
	• Condoms etc
68
Q

Causes of DIC

A

Sepsis, surgery, majkor trauma, cancer, pregnancy

69
Q

Tx of DIC

A

• Treat cause
• IV Platelets
• FFP
Low fibrinogen - Cryoprecipitate

70
Q

Ix of DIC

A 
Ix:
	• High INR
	• Low platelets
	• Low fibrinogen
	• High D-Dimer
71
Q

Meconium risks

A

Smoking, oligohydramnios, placental insufficiency

72
Q

Tx of Neuroleptic malignant syndrome

A 
Treatment:
	• Removal of antipsychotic
	• IV fluids
	• Dantrolene
	• Cool patient
73
Q

Severe hypothyroidism can result in..?

A

Myxedema coma

74
Q

Pathophysiology of HF

A

Patho:
• Heart overstretches and is unable to increase the force of its contraction in times of stress, as in starling’s curve - reduced exercise tolerance
• Decrease in BP as heart unable to sustain pressure - body compensates with increased TPR, increased heart workload
• Decreased blood flow to kidneys, increase in renin, increase in salt and fluid retention

75
Q

C section cx

A 
Complications:
	• Post partum hemorrhage
	• Bladder injury
	• Lung aspiration
	• Pulmonary embolus
	• Infection
76
Q

Cx of AEDs in pregnancy

A

• Atrial septal defect
• NTDs eg spina bifida
Autism

77
Q

Tx of ILD

A

Oxygen therapy, physiotherapy, Vaccines, ppx abx

78
Q

Extra GI manifestations of Crohsn

A 
Extra GI manifestations:
	• Erythema nodosum
	• Uveitis + Episcleritis
	• HLA B27 spondyloarthropathies - Ank spon, reactive arthritis, psoriatic arthritis
	• Clubbing
	• Osteoporosis
	• Pyoderma gangrenosum
79
Q

Organisms in UTIs

A

e coli, enterococcus bacillus, pseudomonas aeruginosa

Z IPE (15 decks)

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