Essential Facts Flashcards
SIRS Criteria
- Temp >38 or <36
- P >90
- RR > 20
- WCC >12 or <4
GLASGOW Score
- PO2 < 8
- Age > 55
- Neut > 15
- Ca < 2
- Ur > 16
- LDH > 600
- Alb < 32
- Glu > 10
Characteristics of ARDS
- Diffuse pulmonary infiltrates
- Normal PAWP
- PO2:FiO2 < 200
Henderson Hasselbach Equation
CO2 + H2O <-> HCO3- + H+
Anion Gap
(Na + K) - (HCO3- + Cl)
(Normal Range 12 +/- 2)
Normal Infrarenal Aortic Diameter
2cm
When to consider AAA for repair
>4.5cm or growing >1cm per year
Follow up for AAA
If < 3cm require no further follow up
3-4cm = annual USS
4-5.4cm = 6 monthly USS
>5.5 cm = immediate referral for repair
Breast Screening
Three yearly screening to all females 50 - 70y
(Currently being extended 47 to 73y)
Hormonal Therapy in Breast Cancer
Oestrogen dependant in 70% of cases
Pre-menopausal: Tamoxifen for five years (Selective oestrogen receptor modulator)
Post-menopausal: Aromatase inhibitors (eg Anastrazole) - block peripheral conversion only
Branchial cyst location
Anterior Triangle
Cystic Hygroma Location
Posterior Traingle
CVP Trace
ACXVY
A - Atrial Contraction
C - Tricuspid closure
X - Atrial relaxation
V - Venous return
Y - Opening of tricuspid
Surface area for burns
Rule of nines - Head, Arms, half leg, half torso 9% Genitals 1%
Hand - Patient’s hand = ~1%
Parkland Formula
4 x wt x surface area
Half over 8 hours
Half over 16 hours
Note: timer starts from time of burn, not time of assessment - inc rate of resuscitation appropriately.
Mount Vernon Formula
(wt x surface area) / 2
Give over 4,4,4,6,6,12
Charcot’s traid
Fever, Jaundice and RUQ pain
(Suggests ascending cholangitits)
Indications for central line
Monitoring fluid balance / resuscitation
TPN
Certain medication infusions
Failed peripheral access
Haemodialysis
Transvenous cardiac pacing
Hartmann’s Contents
Na 131,
K 5,
Cl 111,
Ca 2,
Bicarb (as lactate) 29
Normal Saline Contents
Na 150,
Cl 150
Formula for MAP
MAP = (CO x SVR) + CVP
Distribution of body fluids
1/3 Extra cellular
25% Intravascular
75% Interstitial
2/3 Inta-cellular
ECG Axis
Normal: -30deg to +90deg
Leads 1+2 both positive = Normal
Lead 1 positive, Lead 2/3 negative = Left axis deviation
Lead 1 negative = Right axis deviation
Pain transmition pathway / fibres
Sharp pain - A-delta fibres
Dull pain - C-fibres
Spinothalamic tract
Classification of blood loss
Class % P BP RR UO Mental
1 <15 <100 Norm <20 >30ml Anxious
2 15-30 <120 Wide PP <30 <30ml Anxious
3 30-40 <140 Red. <40 <15ml Confused
4 40+ >135 Red >35 Nil Lethargic
Anterior Pituitary Hormones
ACTH
TH
LH
FSH
GH
Prolactin
Posterior Pituitary Hormones
Oxytoncin
ADH
Parotid Gland Neoplasias
80% benign. (Pleomorphic adenoma (70%), Warthin’s tumor)
15% malignant. (Mucoepidermoid carcinoma, adenoid cystic carcinoma) - Facial nerve palsy suggests malignancy.
FAP + Gardner’s Syndrome
FAP: Predisposes to hundreds of adenomatous polyps. Autosomal dominant, due to loss of APC gene. 100% risk GI Ca by 40y. Associated with small bowel polyps and mandibular osteomas.
Gardner syndrome: Associated with FAP - Osteomas of skull, epidermoid cyst, multiple desmoid tumours
Peutz-Jegher’s Syndrome
Multiple hamartomatous polyps, autosmal dominant
Stages of organ rejection
Hyper-acute
Due to presence of recipient anti-bodies. Kidney swells and becomes necrotic, requires nephrectomy.
Acute
T-cell mediated diffuse lymphocytic infiltration. Reversible with high dose steroids
Chronic
Humoral system responsible for graft fibrosis and atrophy.
Testicular Ca
- Germ Cell Tumours
- Seminoma
- Non-Seminomatous
- Teratoma
- Embryonal Carcinoma
- Choriocarcinoma
- Yolk Sac Tumour
- Mixed Germ Cell Tumour
- Non Germ Cell
Seminoma
Peak Age - 30-40
Placental Alk Phos
Radiotherapy effective (In effective for all non-seminomas)
B-HCG and lactate for monitoring following treatment
Teratoma
Peak Age 20 - 30
markers: B-HCG, CEA, AFP (Also found in HCC)
Melanoma Margins
<0.75mm = 1cm margin
< 1mm = 2cm
> 1mm = 3cm
Primary / Secondary / Tertiary healing
Primary healing
Wound closed within hours of formation, usually with sutures or clips
Secondary Healing
Left open without formal closure - spontaneous closure via contraction and re-epithelialisation
Tertiary Healing
Initial debridement with normal closure at a later date.
Vaccines required post splenectomy
Pneumococcal
H. Influenza B
Meningococcal
Flu
Duke’s Staging (and 5yr survivals)
A - Confined to tumour wall (95 - 100%)
B - Through bowel wall (65 - 75%)
C - Lymph node Mets (30 - 40%)
D - Distant mets (5 - 10%)
Nb Modified:
C1 = Upper LN not involved
C2 = Upper LN is involved
TNM Staging
Tis - Mucosa
T1 - Submucosa
T2 - Muscularis
T3 - Serosa
T4 - Adjacent Organs
N1 - <=3
N2 - > 3
Virchow’s Triad
Abnormal blood flow
Hypercoagulable state
Endothelial Injury
Causes of thrombus
MEN
I - Pancreatic (usually gastrinoma), Parathyroid (hyperplasia), Pituitary (usually prolactinoma)
IIa - Phaeochromocytoma, Parathyroid adenoma, Medullary Thyroid Ca
IIb - As IIa with Marfanoid features + Mucosal Neuromatosis
AFP Associations
Hepatocellular Carcinoma, Teratoma
CEA Associations
Colon, Teratoma
PSA Associations
Prostate
CA 125 Associations
Ovarian
CA 19-9 Associations
Pancreatic
B-HCG Associations
Teratoma
Placental Alk Phos Associations
Seminoma
Autograft
Graft from host
eg skin grafting
Allograft
Transplant between two individuals who are not genetically identicle
Isograft
Transplant between genetically identicle individuals
Xenograft
Transplant between species
