Elective 1 Flashcards
Biliary colic
RUQ Radiates to scapula After food Gradually builds over hours Early hours morning
Pancreatitis
Pain through to back
NV
Gall stones, alcohol
Jaundice
Pale stools, dark urine
Pain
Offensive stool, difficulty flushing
Trigger, RF
IHD
Central heavy CP radiates L
Exertion, rest, nitrates
Hx MI, angina, cardiac RF
NV, sweaty, clammy
Arrhythmia
Type of rhythm
Dizzy, fall LOC
CP, orthopnea
Infx; fever, cold, LRTI, UTI, skin
ACS
V
Angina
ACS; pain >20mins
V
Angina; walking distance/ rest time, nitrate spray
HF
SOB at rest, sentences
Orthopnea
Edema
Cause???
Endocarditis
New murmur
Fever
+- petechiae
Dissection
Tearing -> interscapula/ back
Weakness/ numbness arms
Diff arm BP
CXR widened mediastinum
Pericarditis
Pleuritic pain Worse lying, better leaning forward Recent viral illness Pericardial rub Saddle shape ST
Acute asthma attack
SOB; sentences Wheeze, cough Triggers Normal meds Previous admissions
Acute exacerbation COPD
SOB; sentences Wheeze, cough, sputum, fever Normal meds; inhaler, steroids, O2 Still smoke? Previous admissions - ventilation
Pleural effusion
Gradual onset SOB
+- pleuritic CP
Dull percussion note
Pneumothorax
Sudden onset SOB Pleuritic CP RF; smoking, COPD, chronic chest condition, tall thin male Hyper resonant Deviated trachea?
ARDS
SOB
Concurrent severe illness
Anaphylaxis
Trigger; food, drugs
Itching, rash
Swelling
SOB
Pneumonia
SOB Cough, sputum Fever Confusion, muddled Hx Chest condition, smoking
Peptic ulcer
Epigastric/ chest pain Heartburn, bloating, burping Antacids Melaena RF; Previous ulcers, NSAIDs, alcohol
Gastric ulcer
V
Duodenal ulcer
G: Worse with food
V
D: Better with food, night pain
Esophageal cancer
Swallowing; pain, sticking Haematemesis Hoarseness, Cough Lymphadenopathy, hepatomegaly RF; GORD, smoking
Stomach Ca
Dyspepsia
Epigastric pain
Virchows node
RF ulcers, gastritis, blood group a
Perforation
Sudden onset
Worse on movement/ coughing
RF ulcers, Ca, IBD, NSAIDs, alcohol
No bowel sounds
GORD
Burning CP +\- reflux \+\~ Waterbrash; excess saliva Worse bending forwards Nocturnal cough Antacids better
Diverticular ds
Pain/ cramps Better on BO Irregular BO Flatus, bloating PR bleed
Renal colic
Exclude AAA
Acute loin to groin
N&V
Haematuria, dysuria, frequency
Jaundice ddx
Pre; Gilbert, haemolysis, malaria
Hepatic; paracetamol, viral, alcohol, medications, vascular
Obstructive; luminal, mural, extra
Causes of chronic pancreatitis
Alcohol Gall stones Hyperparathyroidism CF Familial
Migraine
4-72h Unilateral Pulsating Avoid activity N or V Photophobia, photophobia Aura 25% pt, lasts 5-60mins
Meningitis V Encephalitis V Cerebral abscess
M: headache, fever, stiff, photophobia
- common to all
E; focal signs and cognitive deficits - headache is not usually not the primary feature
A: subacute onset
Courvoisiers law
In the presence of jaundice
A palpable gall bladder
Is unlikely due to gall stones
Rule out Ca
IBS
Central/ lower pain Relieved by BO Changeable BO Bloating Minimal mucus
Causes of imbalance/ ataxia
Cerebellar disorder; DANISHP
Spinal ds; dorsal column
Peripheral neuropathy
Post LP headache
When? Tx
Usually within 24h, but up to 7d
Tx
Lie pt flat
Analgesia, increase fluid intake
Tx seizures
Start clock High flow O2 Recovery position Venous access, take bloods Check BM >5 mins - call senior - Lorazepam (IV)/ diazepam (PR)
Tx
Hypoglycaemia
Hypostop Low GCS - 50ml, 50% glucose - 100ml, 20% glucose Aim BM over 5
Ix and Tx
DKA/ HONK
BM, ABG, urine dip
1L normal saline stat
Insulin
Insulin plus glucose
Painful arc aka
Supraspinatus tendinitis
Impingement syndrome
Facet joint pain
Acute or chronic
Worse in morning and on standing
Worse in extension of back
May be tender over facets
Extra dose of morphine for breakthrough pain
1/6 daily morphine dose
Worrying fevers in children
> 38C under 3m; red flag
39C: 3-6m, yellow flag
Fever >5d; yellow flag
Legionella features
Flu like Sx Dry cough Hyponatraemia Deranged LFT Pleural effusions; 30%
L dopa drug names
Madopar
Sinemet
Causes of purpuric rash
Vascular;
- meningococcus, HSP, scurvy, vWds
Thrombocytopenia
- idiopathic, infx, drug, DIC
K+ additives to fluid rules
- No more than 40mmol per L
- 10mmol per hour max
Sx thyrotoxicosis
Goitre Palpitations, tremor Heat intolerance, sweating Weight loss, diarrhoea SOB, tired, increase appetite
Before azathioprine tx
Check
Thiopurine methyl transferase (tpmt) deficiency
Results in azathioprine toxicity
Chondromalacia patella
Softening of cartilage
Common teenage girls
Anterior knee pain: up/ down stairs
Tx physio
Max lidocaine infiltration dose
200mg
500mg with adrenaline
Guidelines for paracetamol OD tx
N acetyl cysteine
Tx: Staggered overdose, or if any doubt over time of OD
Or
Plasma conc above tx line at 4-15hrs
Lidocaine conc
1% = 10mg/ml 2% = 20mg/ml
w/o adrenaline max 200mg
Doses of adrenaline
0.5mg IM ; anaphylaxis
1mg : cardiac arrest
Length warfarin tx
DVT
Unprovoked: 6m
Provoked: 3m
Causes of confusion/ behavioural changes
CVA MI Infx: LRTI/ UTI/ CNS infx metabolic conditions drug overdoses or poisonings.
Blatchford score criteria
Urea
Hb
sBP
Other markers; pulse, malaena, syncope, HF, LF
Drugs to be taken at night
Simvastatin
Amitriptyline
Daily fluid, Na, K requirements
1.5 ml/kg/hr : 2-3L / day
Na: 1-2mmol/ kg
K: 1mmol/ kg
Typical maintenance fluids
NBM pt
3x8h bags
2 sweet 1 salty, all with 20mmol K
5% dextrose
Normal saline
5% dex
Medications contra indicated in HF
Verapamil : neg inotrope
NSAIDs/ steroids : fluid retention
Pioglitazone: fluid retention
Beclometasone inhaler names
Clenil
Qvar
Easyhaler
When to gradually withdraw steroids
> 40mg for >1w
3w of tx
Recently received repeated courses
Deep ST depression. V1-V3 and talk at waves
Posterior STEMI
Posterior STEMI
ECG changes
Deep ST depression V1-V3
and tall T waves
Contraindications
Exercise tolerance test
MI less than 7d ago Unstable angina Uncontrolled HTN/ hypotension Aortic stenosis LBBB
Status epilepticus tx
Oxygen BM - correct blood sugar After 5 mins: IV lorazepam 4mg - or PR diazepam, buccal midazolam Repeat after 10mins if no response/ recur
