Finals Made Easy Flashcards
Middle aged lady with confusion, cough, brown coloured sputum, reduced air entry in RLL, what could it be?
Pneumonia(most likely lobar)
Pleural effusion
Need to check with an X-ray
Dullness in pleural effusion is described as…
Stony dull
Pleural effusion is…
Fluid on the OUTSIDE of the lung
Which organisms show cavitating lesions on X-ray?
Klebsiella
TB
Stash Aureus
Difference between bronchopneumonia and lobar pneumonia on X-ray
Bronchopneumonia = patchy on both sides Lobar = clear lobe effected, air bronchograms
Bronchiectasis on X-ray findings
See end on, widened airways
Most likely cause of infection in bronchiectasis
Haemophilus influenza
Can also be pseudomonas aureginosa
Causes of bronchiectasis
Idiopathic CF A1at deficiency Post infectious (TB, aspiration) PCD
Presentation of bronchiectasis
Clubbing
Chest sepsis
Chronic, productive cough (>2mo)
Best investigation for bronchiectasis
High resolution CT
Investigations for bronchiectasis
High resolution CT
Sputum MC&S
Spirometry
Specific tests for niche causes such as a1at, IG levels (autoimmune), sweat test, HIV antibodies
How long do you give antibiotics for in long standing lung disease? I.e. on background disease/lots of previous infections
14 days
How do you know if they are a chronic CO2 retainer?
ABG shows chronic compensation
What is PIFR?
Peak of the inspirations curve, roughly what they are attempting to breathe in a minute
What is a typical PIFR
20L/min
How does a Venturi mask give specific amount of oxygen?
The Venturi mask mixes it with air at a very precise proportion
Normal FiO2 of air
21% O2
How do you estimate PaO2 based on what they are breathing in?
Take 10 off the % oxygen they are breathing
21% - 10-13kPa
What do you expect CO2 to be in an asthma attack?
Low
CO2 is normal in asthma attack, is this bad?
Yes, should be breathing that CO2 off. Shows they are getting tired
First line management of PE not confirmed on CTPA
Rivoroxaban
Sign of major PE
Haemodynamic compromise
Causes of prehepatic jaundice
Haemolytic
Sickle cell disease
Haemolytic anaemia
Malaria
Hepatic causes of jaundice
Damage to hepatocytes (drugs, disease, failure)
Post hepatic jaundice causes
Intraluminal = gallstones Mural = cholangiocarcinoma, PBC, PSC Extrinsic = cancer, mets, pseudocysts (pressing on the bile duct)
Triad of acute liver failure
Jaundice
Encephalopathy
Coagulopathy
Causes of hepatitis
Viral hepatitis
Paracetamol overdose
Budd chiari
Wilson’s disease
Ix for acute liver failure
FBC
LFTs
Clotting (INR) (synthetic function)
ABG (pH and lactate)
CT abdo pelvis
Abdo USS
Paracetamol levels
ANA (autoimmune hepatitis)
Kings college criteria!
Cirrhosis increases risk of
Hepatocellular carcinoma
What screening should you do for chronic liver disease?
6 month USS and afP
Endoscopy every 3yr for varices
Prophylaxis of variceal bleeding
Propanalol
Drug to clear ascites
Spironolactone
Therapeutic paracentesis
Flare in Crohn’s, macrocytic anaemia, what is most likely cause?
B12 deficiency
Because terminal ileum is where it’s absorbed
What type of cell becomes myeloma?
Plasma cells
Protein electrophoresis in multiple myeloma
Shows one chain predominance
Cut off for high output stoma
1.5L
Which procedure might you use for sigmoid bowel obstruction?
Hartmanns procedure, create an end colostomy in LIF
Fracture management
4Rs
Resuscitate = ABCD, watch out for open fractures (worried about c.perfringens, need antibiotics). Need analgesia, saline gauze.
Make sure to take a photo of the wound to assess progress
Reduce = manipulate, may be in theatre or not
Restrict = don’t do plaster in <48hr because of compartment, can fixate (internal or external), POP
Rehabilitate = physio, movement, occupational therapy
Early problems with fractures…
Neuro vascular damage
Visceral damage
Later fracture issues
Compartment
Infection
Fat embolus
Later = malunion, avascular necrosis, growth disturbance, post traumatic osteoarthritis
Important vessels to consider in hip fractures
Retinacular vessels
Osteoporosis risk factors
Age Steroids Alcohol Low BMI Early menopause Low calcium
Hip fracture 1/2 use a …
Screw
Person older than 65 with good health and mobilising, intracapsular fracture, what might you do?
Total hip replacement
Which nerve can be damaged in posterior approach hip surgery
Sciatic nerve
Which nerve can get damaged in anterior hip surgery
Superior gluteal nerve
Damage to superior gluteal nerve can cause…
Trendelenbergs gait
What are the rules for if you X-ray an ankle?
Ottawa rules
Classification for ankle fractures
Weber classification
B Weber classification for ankle fracture. Where is the fracture?
Along the joint line
86yo uses a Zimmer frame, grade 3 garden classification, what do you do?
Hemiarthroplasty
Because not very mobile and over 65yo
Basic management of ACL injury in community
RICE Rest Ice Compress Elevate
SCD damages spleen and leads to more infections by what?
Capsulated organisms (e.g. staph aureus)
RILE rules of murmurs
Right sided louder on inspiration
Left sided louder on expiration
Where do you aspirate in the joint?
Upper outer region
Management of ACL injury
Rest
MRI
Ice
Arthroscopy
Trauma primary survey
Visible, catastrophic haemorrhage -> code red (alerts everyone and also gets 4 units O negative blood)
A = C spine 1st, jaw thrust,
B = flail chest, pneumothorax, haemothorax
Sites of haemorrhage = floor and 4 more = chest, abdo, bones, pelvis
Secondary survey in trauma mnemonic =
AMPLE
How do you tell between rolling and sliding hiatus hernia
Rolling = bit of stomach gets trapped like strangulation
ERCP vs MRCP
ERCP is invasive but can be therapeutic
How can you sort out obstructive jaundice?
ERCP
First line Ix for pancreatitis
Abdo uss
Left side of bowel supplied by
Left colic artery
Where does the nasopharynx roughly begin (posterior epistaxis zone)
At the end of the hard palate
Where do 95% nosebleeds originate?
Littles area
What is a coroners clot?
Posterior nosebleed causing a clot that chokes you
Causes of epistaxis
Often idiopathic HtN Cold weather (damages mucosa) Clotting derangement Trauma (often from nasal cannula, because cold, dry air)
Management of nosebleed
Nasal examination = thudichum’s speculum
Investigation = bloods (FBC, clotting, group and save)
Nasal first aid, lean forwards, spit blood, pinch nose, gentle suction, gentle suction (all for 15 minutes)
Next steps = senior input Vasoconstrictors and analgesic Lidocaine solution Oxymetazoline spray Adrenaline soaked gauze as last resort
Next step = silver nitrate cautery (only ever one one side, once)
Then ENT -> rapid rhino
Key tonsillitis differentials
Infectious mononucleosis
HIV
Acute epiglottitis
Retro tonsillar abscess
Bedside tonsillitis test
Throat swab
Rapid streptococcal antigen test
Managing acute tonsillitis
Analgesia and reassure
Censor scoring
Dependent on the score, either start on antibiotics or test then give dependent on result
Antibiotics for tonsillitis
Co-amoxiclav
Amoxicillin
Phenoxymethylpenicillin
When do you refer for tonsillectomy?
Dependent on frequency
Strict and need it a lot in 1yr!
Most common breast cancers
Invasive ducal (70%) Invasive lobular (20%) Pagets (5%)
When do you do ultrasound in triple assessment?
<35yo
Because breast tissue is denser
Difference between breast abscess and mastitis clinically
Abscess feels like it’s full of pus, which it is
Management of mild mastitis in woman breastfeeding
Reassure and safety net
Management of moderate mastitis in non breast feeding woman
MRSA testing and antibiotics
What defines moderate/severe mastitis?
Constitutional symptoms
Can’t manage with analgesia
Most common sites of blockage from renal stones
Pelvoureteric junction (1st narrowing)
What is a percutaneous nephrolithotomy
Put a needle into the kidney with a nephroscope and get rid of the stones
Cremasteric reflex is…
Stroke the inner thigh and ipsilateral testicle rises
When might cremasteric reflex be absent?
Testicular torsion
Where does prostrate cancer metastasise?
Back and abdomen
What examinations do you want to do in prostate cancer other than DRE
Abdo
Spine
Neurological
Chest and spine X-ray
When might we use PSA?
Monitoring
Gold standard investigation for prostate ca
Trans rectal ultrasound guided biopsy
What is brachytherapy?
Radiological rods inserted into prostate
Disadvantage of brachytherapy
Very painful
