EM + CC Flashcards
What is metoclopramide used for?
anti-sickness medication
BNF:
N&V associated with acute migraine
delayed (but not acute) chemotherapy-induced N&V
radiotherapy induced N&V
prevention of post-op N&V
Hiccup/N&V in palliative care
acute migraine
What is a Bier block?
IV injection of local anaesthetic with a BP cuff inflated proximally to block
Charcot’s Triad
jaundice
fever
RUQ pain
-> may be ascending cholangitis
Reynaud’s pentad
jaundice
fever
RUQ pain
hypovolaemic shock
altered mental status
suggests obstructive ascending cholangitis
Blood results in DIC
low platelets and fibrinogen, and high PT, APTT and D-dimer.
Features of serotonin syndrome
neurological: altered mental state, tremor, ataxia, hyperreflexia
autonomic: tachycardia, HTN, diarrhoea, hyperthermia
Indications for urgent haemofiltration/dialysis
- metabolic acidosis
- hyperkalaemia
- pulmonary oedema
What is Fournier’s gangrene?
An acute necrotic infection of the scrotum; penis; or perineum
What is lupus anticoagulant?
- heterogenous class of IGs (IgG or IgM)
- binds to phospholipids
- has a paradoxical effect on coagulation (in vivo associated with recurrent thrombosis, in vitro they increase the phospholipid dependant clotting time)
associated with arterial and venous thrombosis as well as recurrent spontaneous abortions
Other name for antiphospholipid syndrome
hughes syndrome
What is antiphospholipid syndrome?
AI disorder
increases blood clot formation
higher risk of miscarriages and pre-ecclampsia
What is rapunzel syndrome?
Rapunzel syndrome is a very rare condition in which a large hair ball (trichobezoar) gets lodged in your stomach and extends into your small intestine.
What are bezoars?
Gastrointestinal (GI) bezoars are aggregates of inedible or undigested material found in the GI tract.
e.g. trichobezoar is made of hair
can be treated with Coca Cola (because of low pH) or surgery; can be dangerous
What is the common type of bezoar seen in female patients with a psych background?
trichobezoar (made out of hair)
What are the different levels of care in a hospital?
0 - ward
1 - AMU/AAU - some more monitoring
2 - HDU
3 - ICU
What are the differences between heamodialysis and filtration?
Haemodialysis removes solutes by diffusion. As such, it is relatively inefficient for solutes of high molecular weight as clearance by diffusion is inversely related to the molecular weight of the solute.
Haemofiltration removes solutes by convection (from high hydrostatic pressure to low hydrostatic pressure). As such, efficiency remains more constant for all solutes able to cross the semi-permeable membrane.
The choice between haemodialysis and haemofiltration can be difficult.
Points in favour of haemofiltration include:
- better control of blood pressure
- less risk of hyperlipidaemia
Those in favour of haemodialysis:
- less expensive
- technically easier
- toxicity of molecules of high molecular weight has yet to be demonstrated
- haemofiltration can only reduce, not normalise, the concentration of larger solutes
Source: GP notebook
Would you dialyse or haemofiltrate an acutely unwell patient?
- haemofiltrate (continuous)
- dialysis - there is a loss of blood volume initially, could be harmful to an unstable patient)
Tacrolimus - what is it?
immunosuppressant (calcineurin inhibitor)
given dermal for eczema and psoriasis
given
Tacrolimus - what is it?
immunosuppressant (calcineurin inhibitor)
- given dermal for atopic eczema and psoriasis
- given PO/IV for prophylaxis of graft rejection following liver/kidney/heart transplant;
- PO/IV for allograft rejection resistant to conventional immunosuppressive therapy
- PO for rejection therapy
Why do you not give NSAIDs in renal failure?
They are PG-inhibitors
PGs are important for xxxx
What is the CIWA score used for? What are the components
Alcohol withdrawal
- N&V
- tremor
- paroxysmal sweats
- anxiety
- agitation
- tactile disturbances
- auditory disturbances
- visual disturbances
- headache/fullness in head
- orientation/clouding of sensorium
absent or minimal withdrawal < mild to moderate withdrawal < severe withdrawal
Sliding scale insulin quest
What antihypertensive can make pre-renal AKI worse and how?
Ramipril
via decreased renal perfusion (though dilation of renal arterioles)
Which renotoxic drugs would you want to stop in a case of AKI?
ACE-I/ARBs
Spironolactone
Diuretics
Gentamicin - may need dose adjustment if necessary for treatment
NSAIDs
How does cerebral oedema in children with DKA present?
headache
drop in GCS
bradycardia
Management of cerebral oedema in children with DKA
- Slowing IV fluids
- alerting seniors as soon as this has been done (they manage it because of the high mortality)
- IV mannitol may be used once the fluids have been slowed but would be a step that senior colleagues would initiate.
What causes cerebral oedema in DKA?
It is due to rapid correction of hyperglycaemia, which causes a shift of water out of the brain cells.
How long must PTSD symptoms go on for, for a diagnosis to be made?
Symptoms must be present for over a month and interfering with day-to-day activities before a diagnosis of PTSD can be made.
What are factors that warrant a CT head following a fall?
- LOC
- age =/+65
- more than 30 minutes retrograde amnesia
- coagulopathy
- treated with anticoagulants
- dangerous mechanism of injury
What are factors that warrant a CT head following a fall?
- LOC
with any of the following:
- age =/+65
- more than 30 minutes retrograde amnesia
- coagulopathy
- dangerous mechanism of injury
OR
if the patient is anti coagulated (without the other risk factors or LOC)
-> CT head within 8h
what is retrograde amnesia?
amnesia where you can’t recall memories that were formed before the event that caused the amnesia.
What is Felty’s syndrome?
triad of
- rheumatoid arthritis
- splenomegaly
- neutropenia
Acute Mesenteric ischaemia presentation
Triad:
- severe abdominal pain
- unremarkable abdominal examination
- shock
bowel oedema on CT scan is a non-specific sign but indicates and inflammatory process
How do you manage malignant hyperthermia?
- remove the causative agent (e.g. suxamethonium/inhaled anaesthetic)
- administer 2mg/kg bolus dantrolene (a ryanodine receptor antagonist)
- restore normothermia
How do you manage malignant hyperthermia?
- remove the causative agent (e.g. suxamethonium/inhaled anaesthetic)
- administer dantrolene (a ryanodine receptor antagonist)
- restore normothermia
Dantrolene
- ryanodine receptor antagonist
- given as a 2mg/kg bolus
- used to treat malignant hyperthermia (which is most commonly caused by an AD mutation in ryanodine receptor 1)
Dx of malignant hyperthermia
diagnosed by genetic testing after the episode
What are adverse features on SVT?
HISS
- heart failure
- ischemia
- shock
- syncope
How do you manage SVT?
stable patient:
Regular rhythm:
1) vagal maneuvers (Valsalva or carotid sinus massage)
2) if fails: 6mg adenosine IV over 1-3s followed by 20 ml 0.9& NaCl)
3) if fails 12 mg adenosine IV
4) if fails repeat 12 mg adenosine IV
irregular:
manage as AF
unstable patient:
synchronised DC cardioversion
CI to adenosine use
CI to adenosine use
