Finals Flashcards
What is the criteria for infective endocarditis?
Major criteria
Positive blood cultures
two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or
persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or
positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or
positive molecular assays for specific gene targets
Evidence of endocardial involvement
positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
new valvular regurgitation
Minor criteria
predisposing heart condition or intravenous drug use
microbiological evidence does not meet major criteria
fever > 38ºC
vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots
What is the minor criteria for IE?
vascula phenomena
immunological phenorma
microbe evidence
tempature above 38 degrees celcius
other - drug user
drink
What is the major criteria for Duke’s?
Two +ve cultures over twelve hours or three to four over 1 hour
Echocardiogram
Altered valve
What is the single most important evidence for pneumothorax?
Smoking cessation
Avoid flying for 6 weeks
What is conservative management of most respiratory diseases?
Smoking cessation
Avoid triggers
Weight loss
Which blood prpduct poses greatesrisk of infection?
Platelets
What is treatment for stroke in 4.5 hour period?
A combination of thrombolysis AND thrombectomy is recommend for patients with an acute ischaemic stroke who present within 4.5 hours
Important for meLess important
This patient has presented with an acute ischaemic stroke of the anterior cerebral circulation, as manifested by a unilateral hemiparesis and homonymous hemianopia.
What is the criteria for managing a stroke?
The Royal College of Physicians (RCP) published guidelines on the diagnosis and management of patients following a stroke in 2004. NICE updated their stroke guidelines in 2019.
Selected points relating to the management of acute stroke include:
blood glucose, hydration, oxygen saturation and temperature should be maintained within normal limits
blood pressure should not be lowered in the acute phase unless there are complications e.g. Hypertensive encephalopathy*
aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded
with regards to atrial fibrillation, the RCP state: ‘anticoagulants should not be started until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke’
if the cholesterol is > 3.5 mmol/l patients should be commenced on a statin. Many physicians will delay treatment until after at least 48 hours due to the risk of haemorrhagic transformation
What are the three tests for syphillis?
Enzyme immunoassay test (EIA)Positive
Treponema pallidum particle agglutination assay (TPPA)Positive
Rapid plasma reagin (RPR)1 in 2
Treatment for CAP?
Amoxiccilin and clarithryomycin
When should all cases of pneunomia be tested with a CXR?
All cases of pneumonia should have a repeat chest X-ray at 6 weeks after symptoms have resolved. A repeat chest X-ray is indicated to rule out any underlying malignancies which may be hidden by the original pneumonia consolidation.
What is hepatorenal syndrome (HRS)?
Type of AKI and high creatinine.
Vasoconstriction of renal arteries preventing filtration and are common in patients with cirrhosis and high albumin.
The most accepted theory regarding the pathophysiology of HRS is that vasoactive mediators cause splanchnic vasodilation which in turn reduces the systemic vascular resistance. This results in ‘underfilling’ of the kidneys. This is sensed by the juxtaglomerular apparatus which then activates the renin-angiotensin-aldosterone system, causing renal vasoconstriction which is not enough to counterbalance the effects of the splanchnic vasodilation.
How is phaeochromocytoma diagnosed and treated?
PHaeochromocytoma - give PHenoxybenzamine before beta-blockers
metanePHrines
What are gliptins?
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
What are some investigations for meningitis?
nvestigations suggested by NICE
full blood count
CRP
coagulation screen
blood culture
whole-blood PCR
blood glucose
blood gas
What is the hallmark finding for myasthesia gravis?
The hallmark finding of myasthenia gravis is fatiguable, painless muscle weakness that improved with rest
How do you treat cellulitis in a pregnant woman with a penicicllin allergy?
Eerythromycin
What are the features of DKA?
Answer: diabetic ketoacidosis. In this case scenario, a young man is presenting with diabetic ketoacidosis (DKA). The signs suggestive of this include the presenting complaint of abdominal pain, significant dehydration, the pattern of breathing consistently with Kussmaul respiration and the significantly raised capillary glucose. Patients presenting with DKA are depleted around 5-8 litres which need to be corrected as a matter of urgency.
The diagnostic criteria for diagnosing DKA are:
pH <7.3 and/or bicarbonate <15mmol/L.
Blood glucose >11mmol/L or known diabetes mellitus.
Ketonaemia >3mmol/L or significant ketonuria ++ on urine dipstick
In Hep B, what features point to a chronic Hep B infection?
The appearance of ground-glass hepatocytes on light microscopy can point towards a diagnosis of chronic hepatitis B infection
How does the Resucitation council suggest reading an ABG?
The Resuscitation Council (UK) advocate a 5 step approach to arterial blood gas interpretation.
- How is the patient?
- Is the patient hypoxaemic?
the Pa02 on air should be >10 kPa
- Is the patient acidaemic (pH <7.35) or alkalaemic (pH >7.45)
- Respiratory component: What has happened to the PaCO2?
PaCO2 > 6.0 kPa suggests a respiratory acidosis (or respiratory compensation for a metabolic alkalosis)
PaCO2 < 4.7 kPa suggests a respiratory alkalosis (or respiratory compensation for a metabolic acidosis)
- Metabolic component: What is the bicarbonate level/base excess?
bicarbonate < 22 mmol/l (or a base excess < - 2mmol/l) suggests a metabolic acidosis (or renal compensation for a respiratory alkalosis)
bicarbonate > 26 mmol/l (or a base excess > + 2mmol/l) suggests a metabolic alkalosis (or renal compensation for a respiratory acidosis)
What is a feature of giving too much NaCl?
risk of hyperchloraemic metabolic acidosis
What are some features of COPD on a chest X ray?
Chronic obstructive pulmonary disease requires spirometry to confirm the diagnosis but this chest x-ray is highly suggestive.
Features include:
hyperinflation
flattened hemidiaphragms
hyperlucent lung fields
What are the features of primary, secondary and tertiary syphillis?
Primary features
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
Secondary features - occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia )
Tertiary features
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil
Features of congenital syphilis
blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness
When should warfarin be stopped before a surgery?
5 days
