Finals - SBAs Flashcards
Loop diuretic better oral availability than furosemide
Bumetanide
400 - 2000 BNP
refferal for echo specilaist review <6 weeks
Most common complication post MI
Ventricular fibrillation - arrhythmia
Dresslers syndrome on ECG
ST elevation with PR depression
What is Brugada syndrome
ST elevation + TWI in V1-V3
Left ventricular aneurysm
Hypoxic, pulmonary oedema, persistent ST elevation
Cold peripheries and poor urine output
Cardiogenic shock
Bradycardia and AV nodal block
Inferior MI
Essential test for nstemi
Grace score
> 3 % statin and PCI within 72 hrs
Renal artery duplex scan is indicated when
dramatic rise in creatinine on starting ACEi is seen in renal artery stenosis - diagnosed via renal artery duppler US
Causes of secondary HTN
RAS
Primary kidney disease
Sleep apnoea
Endo - conns, cushing, pheo
A-V nipping on fundoscopy
Hypertensive retinopathy
Malignant HTN Mx
IV GTN, IV nitroprusside, IV BB - get to 160/120
BP targets
> 80 - 150/90 or diabetes
diabetes less than 80 - 135/85 home, 140/90 clinic
ckd / t1dm and ACR > 70 - 130/80
Pneumothorax new guideline
Sympto - no - conservative - primary discharge and review, secondary - inpatient
high risk and sympt ct thorax if not safe and safe = chest drain
not high risk and not safe - conservative care
patient priority - avoid prodcuer - conservative
rapid symptom relief - ambulatory device, needle aspirate if not successful proceed to chest drain
§
high risk features of pneumothorax
haemo compromise
significant hypoxia
bilateral pneumothorax
underlying lung disease or smoking with Hx
P HTn Ix and MX
Echo + PA wedge pressure >20
CCB, Endothelin antagonists e.g. bosentan
Heart-lung transplant
Signs of cor pulmonale
peripheral oedema, raised venous pressure, loud pulmonary second heart sound and systolic parasternal heave (tricuspid regurg)
LTOT
need multiple ABGs regularly
hypoxia reducs RR and ventilation perfusion mismatch raising co2
SCLC - lambert improve muscles
breast cancer with muscle stiffness
sclc cerebellar symptoms and sensroy neuropathy
anti-voltage
anti-amphiphysin
anti-hu
Unprovoked pe
ct tap - consistent with malignancy
no - bloods - gbc, clotting etc - concern then do thrombophilia screen
skin necrosis after warfarin
protein c deficiency
Extra intestinal symptoms of coeliac
dermatitis herpetiformis
osteomalacia
iron, b12, folate
hyposplenism
t cell gi lymphoma
scleroderma with diarrhoea
small bowel bacterial overgrowth
bile acid malabsorption
sehcat test
barley wheat and rye
coeliac patients should avoid
if Uc patient does not improve with iv hydro on severe admission
iv ciclosporin and input - biologic such as infliximab
suspected ibd
faecal calprotectin
before using infliximab what needs to be done
interferon gamma test and cxr
signs of decompensated liver disease
worsening jaundice
ascites
encephalopathy
coagulopathy
hypoglycaemia
dld discrimination scores
discrimination function - prothrombin and bilirubin - alcohol hepatitis only
child pugh - cirrhosis
meld - end stage liver and transplant planning
lille score assess response to steroids
DLD breakdown
discriminatory function >32
no infection
no ugi bleeding
give steroids
hep b treatment
interferon alpha
tenofovir if assessed at 24 weeks and still 20,000 units high
if negative consider stopping at 12 months
LFt
AST/ALT 2:1 - alcohol if not other causes of hepatitis e.g. nafld, viral, ischaemic, drugs e.g. tb, methotrexate, paracetamol
bilirubin alp raised - gallstone pathology with RUQ Pain if not - pancreatic, cholangio, pbc, psc, drugs: penicillins, sulfonyureas, cocp
hep b and HIV
tenofovir
needle stick with hep b
accelerated hep b vaccination
Gallstones
fat, forty, foetues, female and fair
cholesterol and calcium bilirubinate
RUQ pain gallstones
USS - no stones -> deranged liver -> MRCP
- stones -> CBD stones -> ERCP
- deranged -> MRCP if not choleystecotmy
Colorectal cancer
colonoscopy than stagin ct thorax etc or MRI if rectal
1 stool sample FIT test if abnormal get colonoscopy
t3 rectal - neoadjuvant than colonic resection than adjuvant chemo
Resections
right hemi - ileostomy
left hemi - colostomy , involves splenic flexure as well
sigmoid colectomy - hartmanns, stoma, colostomy
anterior - rectacl tumour, rectum spar sphincters, colostomy
abdomino perineal resection - rectal tumour less thaan 5cm from anal verge, includes sphincters, stoma and colostomy
Colonic polyps and APC
FAP
Colon cancers do not need neoadujvant therapy because
need more operating space
SBO workup
suspected - unstable - emergency laparotomy
- ct abdo pelvis with contrast (low egfr <30 without)
- ischaemia shown or closed loop - emergency
- adehsional if not - conservative - ng, nbm, iv fluids drip and suck
indications of ischaemia
peritonism
high lactate
irreducible & discoloured hernia
Mechanisms of SBo
extrinsic - external compressions - hernia, adhesions, volvulus
intrinsic - disease of small bowel, internal blockages e.g. strictures and tumours
intrinsic process - normal bowel wall but forgein body e.g intussectopin
unexplained acute large bowel obstruction
ogivies syndrome
ischaemic bwoel what category
1 within 1 hr surgery
saccular vs fusiform
one sided vs dilatation around whole vessel
treat endovascular anerusym repair and open repair
IVC collapse or Halo sign on Ct
hypovolaemic shock
aneurysmal sac enlargement post evar
endoleak
chest pain and connective tissue disorder
aortic dissection
IDA guidance
40-49 wiht unexplained weight loss, pain and bleeding - 2ww
50-59 - rectal bleeding - 2ww colonoscopy
- no bleeding - faecal occult blood test - if positive - 2ww
60 - 2 ww
upper gi concerning features
ALARMS
anaemia
loss of weight
anorexia
recent onset
melaena
swollowing
microcytic disproportionally low mcv
thalassaemia
normocytic reduced renal function
ckd related anaemia
asthma eosinophilia panca
churg strauss
obesity t2rf osa
obesity hypoventilatory syndrome
asthma diagnosis
symptoms - 3 times a week notrunal once saba 3
+ 2 diagnotic tests
features of hhs
hypovolaemia
hyperglycaemia >30
keotnaemia below 3
ph above 7.3
osmolality above 320
mx of HHS
within 60 mins
fluids
iv insulin if - ketonaemia with ph above 7.3 etc 0.05 units
ketonaemia above 0.6 - 0.01 and ph below 7.3
ankle swelling, erythema, loss of foot sensation and t2dm
charcot arthropathy
Sus of melanoma
nodal involvement mets - excision biopsy + SLNB + met screening - if IV - resect, chemo, metastatectomy, palliative
not sus of nodal mets - excision biopsy - if more than 2mm - slnb - staging - if 3 - lymh node dissection and chemo
stage 2 follow up advice
if less than 2mm and non cancerous discharge
najor = size, colour and shape
Mnemonic for suspicious lesions
Asymmetry
Borders
Colour
Diameter
Exposed area
superficial spreading most common
skin scc and bcc
SCC - male bowens, lips, forearms and legs, scaly crusted that bleed
bcc - previous scc, head and neck, pearly nodule rolled and erythamtous edge
multiple flat and light brown plaques, waxy surface aong scalp
sebhorreic keratosis
scaly and thick plaques on sun exposed areas
actinic keratosis
hard rasied growth with ulcerated centre boil
keratocanthomas
visual hallincations + macular degeneration
charles bonnet syndrome
bisphosphonate use jaw pain and swelling
osteonecrosis of jaw
Best long term anitthrombotic post stroke
Anti-platelet - clopidogrel 75mg
Af = apixiban
Causes of atherosclerosis
stenosis
athermoa
small vessel disease
carotid and vertebral stenosis - if symptomatic carotid endarterectomy
Cardio emobolic sources of stroke
Af and cardiac thrombus
Other causes of stroke
aterial dissection
giant cell arteritis
vasculitis
haem disorders - antiphospholipid and sickle cell disease
genetic - MELAS
Cerebellum innervation
signs on the same side of the lesion
Vertigo and ataxia - blood infarct location
vertebral supplies posterior circulation - carotid supplies anterior
ipsilateral horners
Causes of lateral medullary syndrome
vertebral artery or posterior inferior cerebellar artery
Horners
sympathetic chain affected
ptosis, meiosis, anhidrosis, enophthalmos
SAh if normal on Ct
LP - raised bilirubin - 12 hrs from symtpom onset
then ct angiogram of intracerebral blood vessels if either positive
GCS scoring
M: obey, local, flexed withdraw, abnormal flexion, abnormal extension
orient, confused, inappropwo words, incomprehensible, none
eyes - comman, voice, pain, none
Predom lymphocytes LP
CSF viral PCR - HSV - encephalitis
