From the Modules Flashcards
WHO criteria for T2DM diagnosis?
- fasting plasma glucose >/= 7mmol/L
- plasma glucose >/= 11.1mmol/L 2hrs after 75g oral glucose
- HbA1c >/= 6.5%
- in a symptomatic patient, a random plasma glucose of >/= 11.1mmol/L is diagnostic of T2DM under the WHO criteria
Features of diabetic retinopathy on opthalmoscopy?
micro-aneurysm or haemorrhage
hard exudates
neovascularisation
pre-retinal hemorrhage
cotton wool spots
Beck’s triad for cardiac tamponade + three other signs?
Beck’s triad = distended jugular veins, reduced heart sounds + hypotension.
Along with increased RR, tachycardia, and pulsus paradoxus.
3 signs of a PE?
suddenSOB
pleuritic chest pain
hyoptension
tachypnea
pleural rub on chest auscultation
low O2 saturations
possible calf tenderness
Differentials for vertigo?
Peripheral causes:
- benign paroxysmal positional vertigo
- vestibular neuritis (include ramsay hunt syndrome)
- meniere’s disease (too much endolymph causing an increase in pressure in the semicircular canals)
Central causes:
- stroke -> posterior circulation including cerebella, lateral medullary syndrome, vertebrobasilar)
- migraine
- demyelination -> MS
Interpret HINTs exam
- Head Impulse test:
- peripheral cause = corrective saccade (inability to maintain central fixation on a stationary target during head rotation → their eyes will ‘catch-up’
- central = normal head impulse test (no corrective saccade)
- Nystagmus:
- peripheral cause = unidirectional horizontal nystagmus (typically beats away from the side of the lesion)
- central cause = bidirectional nystagmus aka gaze evoked
- Test of skew:
- peripheral = skew deviation is absent (eye remains fixed on central gaze when uncovered)
- central = skew deviation
What is pernicious anaemia?
A rare autoimmune disorder that causes diminishment in dietary vitamin B12 (cobalamin) absorption, resulting in B12 deficiency and subsequent megaloblastic anemia.
Occurs due to autoimmune destruction of parietal cells, leading to a decreased production of intrinsic factor, this impaired vB12 absorption.
Blood work will show a high mean cell corpuscular volume and hypersegmented neutrophils (macrocytic anemia)
Differentials for haematuria plus proteinuria?
Nephritic syndrome
- post-strep glomerulonephritis
- Goodpasture syndrome (anti-GBM antibody disease)
- Thin basement membrane disease
- Alport syndrome (chronic)
- fx → usually X-linked, can be autosomal recessive or dominant though
- leads to a defected basement membrane in the kidneys → results in kidney damage
- recurrent haematuria, can also have hearing loss
- can progress to nephritic syndrome → will have some proteinuria
- IgA nephropathy (chronic)
- symptoms often during or immediately after a respiratory or gastrointestinal infection → infection triggers IgA antibodies to for immune complexes that deposit in the renal mesangium → can progress to nephritic syndrome which will involve protein deposition
DDx for haematuria with flank pain?
- uroliathesis
- polycystic kidney disease with cystic rupture (blood clot in the ureter)
- fx, ballotable kidneys
Which part of the spine does RA affect?
the cervical spine (the rest of the spine is typically spared)
What is terlipressin used for?
treatment of bleeding from oesophageal varices
3 anti-emetics recommended in the management of migraines?
metoclopramide (maxalon)
promethazine (phenergen)
prochlorperazine (stemetil)
Triptan MOA and indication
Used in abortive treatment of migraines.
5-HT(1B/1D) receptor agonist → causes vasoconstriction of painfully dilated cerebral blood vessels, inhibition of the release of vasoactive neuropeptides by trigeminal nerves (substances involved in pain transmission), and inhibition of nociceptive
Headache red-flad symptoms
SNOOP10
systemic symptoms (fever, signs of meningitis)
neoplasm hx
neurological deficits (e.g. altered mental state, seizures)
onset is abrupt
older age >50ys
pattern changes to headache hx
positional headache
presipitated by sneezing, coughing or exercise
papilledema/signs of raised ICP
pregnancy or postpartum period
pain of the eye with autonomic features an visual deficits
post-traumatic onset
pathology of immune system
painkiller overuse
Treatment for mastitis?
Commence on ABx e.g. flucloxacillin 500mg orally, every 6hrs for 5-10 days (depending on results), or dicloxacillin 500mg orally, every 6hrs for 5-10 days.
Review in 1 week or re-assess earlier if symptoms worsen.
If penicillin allergy, then use cefalexin 500mg 6hrs for 5-10 days.
Outline NEXUS criteria for the assessment of neck injuries
If yes to any of the following, then refer for imaging. If no to all of them, then the C-spine can be cleared clinically.
- focal neurologic deficit present → motor weakness, impaired sensation, facial droop, absent reflexes
- midline spinal tenderness present
- altered level of consciousness → confusion, decreased GCS
- intoxication present
- distracting injury present - e.g. long bone fracture, significant visceral injury, large laceration, extensive burns
Predicted ALT and AST levels/ratio in alcohol induced hepatitis?
AST often >2x ALT
GGT also raised in binge drinking
LFT picture for intra vs post-hepatic jaundice
Raised ALT and AST in hepatic dysfunction
Raised ALP and GGT in cholestasis
two phases of measles?
Prodromal phase - conjunctivits, cough, coryza
Exanthem phase - widespread maculopapular rash, fever, malaise
Which paediatric rash typically comes after the fever subsides?
roseola infantum (human herpesvirus 6)
Describe features pf a fibroadenoma?
- is the most common type of breast mass in women <35 years
- usually a well-defined, non-tender, rubbery, and mobile mass → generally do not increase in size
- on US/mammography → well defined mass with possible popcorn-like calcification.
- requires confirmatory studies such as a core needle biopsy.
- expectant management or surgical excision
Which type of breast lump typically has popcorn-like calcification on mammography?
fibroadenoma
Which breast lump is associated with premenstrual hormone changes?
fibrocystic condition of the breast - patients will typically present with premenstrual bilateral multifocal breast pain with or without palpable nodules → these may be tender
Which benign breast lesion can be associated with bloody or serous nipple discharge?
Intraductal papilloma
duodenal atresia sign on xray?
Double bubble sign -> large gastric bubble proximal to an air-filled first part of duodenum. Nil air distally.
DDx for patient presenting with dysphagia
- osophageal stricture
- peptic → use dilation and PPI
- radiation → use dilation
- malignant → biopsy and surgery discussions
- web
- viral causes of oesophagitis (commonly HSV or CMV)
- fungal oesophagitis (candida)
- GORD → causes oesophagitis if severe
- Eosinophilic oesophagitis(EoE) → associated with atopy (asthma, eczema)
- eosinophils deposit within the oesophagus
- non-structural causes:
- achalasia
- dysmotility
- rumination syndrome
- neurological causes -> e.g. stroke
GORD DDx
lifestyle related - smoking, alcohol
hiatus hernia
oesophageal stricture insufficiency
Zollinger-Ellison syndrome -> tumours call gastrinomas that secrete gastrin which stimulate stomach acid release
h.pylori
Signs and symptoms of GORD
waterbrash
saliva on pillow
hoarse voice
heart burn
regurgitation
dysphagia
nausea
chronic productive cough
epigastric pain
belching/bloating
aspiration pneumona
name for painful swallowing?
odynophagia
Review HINTS exam and differentiating peripheral vs central vertigo:
Look up
Which domains are impaired in dementia according to DSM-5?
PLLECS:
Perceptural motor
Language
Learning and memory
Executive function
Complex attention
Social cognition
One or more domains affected in dementia
Link between anticholinergics and dementia? What medications are important to consider?
ACh is an important neurotransmitter for memory and cognitive processing. Anticholinergic medications linked to dementia risk.
Medications include:
Some antiparkinson meds, antidepressants (amitriptyline), bladder antimuscarinics, antipsychotics
Features of pancytopenia?
low RBC, platelets, and WBC
Treatment of acute gout?
NSAIDs or colchicine -> then use allopurinol for prevention
**Allopurinol contraindicated for treatment of acute flare as it can exacerbate symptoms
*be mindful using NSAIDs if renal impairment
What lymphoma are Reed-Sternberg cells pathognomonic for?
Hodgkin lymphoma
Hodgkin lymphoma clinical features?
- painless lymphadenopathy
- B-symptoms: night sweats, weight loss, fever
- Pel-Ebstein fever → intermittent fever with periods of high temperature for 1-2 weeks, followed by afebrile periods for 1-2 weeks (rare by specific for HL)
- alcohol induced pain → pain in lymph nodes after consuming alcohol
Clinical features of Q fever?
fever, myalgia, headache and granulomatous hepatitis
Q-fever organism?
Q fever is an infection caused by the bacteria Coxiella burnetii
Q-fever ABx treatment?
tetracycline (first line) or azithromycin
Duct ectasia features?
Milk duct becomes swollen and/or blocked - the duct walls thicken, and the duct fills with fluid. Can get nipple retraction and mucousy discharge
ABx to treat chlamydia?
doxycycline (7 day treatment) or azithromycin (single dose)
What 21 day progesterone level is indicative of annovulation?
<30 nmol/L
How does metaclopramide cause hyperprolactinemia?
It is a dopamine antagonist -> thereby increases prolactin secretion
What is Sheehan syndrome?
Pituitary necrosis following blood loss (commonly postpartum haemorrhage)
What is Felty’s syndrome?
splenomegaly and neutropenia in a patient with rheumatoid arthritis
What is the corticosteroid of choice administered for premature labour? (for premature lung development)
Betamethasone
Hypochondriasis vs somatisation disorder?
Hypochondriasis: preoccupation with a having a disease despite negative tests and reassurance
Somatisation disorder: preoccupation with symptoms, despite no underlying cause
How to prevent vertical hep B transmission in women who are pregnant and Hep B positive?
Neonatal hep B immunisation. Consider hepatitis B immunoglobulin (HBIG) immediately after birth is recommended for infants born to mothers with chronic HBV infection
What to start child on with asthmatic symptoms not well controlled by ventolin?
Commence on an inhaled corticosteroid inhaler e.g. flixotide.
Not on a corticosteroid with a LABA -> make treating acute exacerbations harder
Another name for EBV?
Infectious mononucleosis
Barriers to GP ABx stewardship
- perceptions of patient expectations or ABx prescriptions
- GP clinical routines
- Consultation time pressures
- Clinical uncertainty
- Fear of adverse outcomes with non-prescribing
Normal resting HR for babies and toddlers?
babies (birth to 3 months of age): 100–150 beats per minute.
kids 1–3 years old: 70–110 beats per minute.
kids by age 12: 55–85 beats per minute
pyloric stenosis vs duodenal atresia?
Stenosis = partial blockage -> may not be detected for a few weeks.
Atresia = total blockage -> sometimes detected on prenatal US or due to polyhydramnios. Otherwise detected in the first 24hrs of life as baby will vomit any oral intake. Double bubble sign is when there is fluid in the baby’s stomach and first part of the duodenum, but not fluid beyond that.
DDx for vomiting in infant
- pyloric stenosis
- CF
- gastroenteritis
- midgit volvulus or intestinal malrotation
- intussusception
- reflux or GORD
- intolerance → e.g cow’ milk protein
- cyclic vomiting syndrome
Management for splenic rupture?
Haemodynamically stable: aim for conservative management (hospital observation, angiographic embolisation of injured blood vessels)
Haemodynamically unstable: laparotomy, if salvageable then try splenic suturing and ligation of injured vessel/s. If not salvageable then require splenectomy or partial splenic resection.
Causes of splenic rupture?
Traumatic:
- blunt abdo trauma
- left sided rib fractures
- penetrating abdo trauma
Atraumatic splenic rupture:
- infection (malaria, mononucleosis, HIV)
- leukemia
- inflammation (e.g. pancreatitis)
- medications (anticoagulation)
- pregnancy (exact reason unknown)
Signs and symptoms of HSP? (IgA vasculitis)
- a skin rash, which looks like small bruises or small reddish-purple spots – it’s usually seen on the bottom, legs and around the elbows
- peripheral oedma, particular hands, feet, and legs
- pain in the joints, such as the knees and ankles
- stomach pain
- blood in the faeces (poo) or urine (wee) (haematuria), caused by the blood vessels in the bowel and the kidneys becoming inflamed
- may have high BP secondary to nephritis
HSP pathophysiology?
Hypothesized pathophysiological mechanism: exposure to allergen/antigen (e.g., infection, drugs) → stimulation of IgA production → deposition of IgA immune complexes in vascular walls (e.g., in the skin, GI tract, joints, kidneys) → activation of complement → vascular inflammation and damage
get:
- abdo pain
- purpuric rash
- nephritis
- peripheral oedema
- HTN
- arthralgia (painful joints)
Causes of ‘floaters’ in vision?
- Eye infections
- Eye injuries
- Uveitis (inflammation in the eye)
- Bleeding in the eye
- Vitreous detachment (when the vitreous pulls away from the retina)
- Retinal tear (when vitreous detachment tears a hole in the retina)
- Retinal detachment (when the retina gets pulled away from the back of the eye)
S&S of Wernicke-Korsakoff syndrome?
Wernicke encephalopathy (acute and reservible):
- confusion
- oculomotor dysfunction (nystagmus, diplopia)
- gait ataxia
*Improves with thiamine administration
Korsakoff syndrome (chronic, irreversible)
- confabulation
- anterograde and retrograde amnesia
- personality changes
- disorientation to time, place, person
- hallucinations
Pharmacological management for alcohol misuse disorder?
- Naltrexone (first line) → reduces cravings for alcohol
- Disulfiram (antabuse) → exacerbates intoxication symptoms and induces negative conditioning
- Acamprosate → reduces cravings for alcohol
- thiamine and folic acid supplementation
management of hepatic encephalopathy?
- avoid any toxins that will contribute to liver impairment
- lactulose → decreases ammonia absorption within the bowel
- rifaximin → reduced the number of ammonia producing intestinal bacteria
- liver transplant
most common viral cause of pericarditis?
Coxsackie B virus infection (different from Coxsackie A which causes hand, foot and mouth).
Coxsackie B is associated with flu like symptoms and sudden thoracic and abdo pain caused by irritation of the pleura and muscles.
Triad for pericarditis?
Sudden onset positional pleuritic chest pain + pericardial rub + global ST elevation & PR depression
What do the right supraclavicular nodes drain?
Breast, lung, and oesophagus
Outline the four components of persistent pelvic pain?
- Pelvic pain from organs
- The musculoskeletal response to pain
- Central sensitisation of nerve pathways
- The psychological sequelae of persistent pain
Abnormal premenopausal bleeding DDx?
- polyps
- leiomyoma (fibroids)
- adenomyosis
- malignancy (cervical cancer)
- coagulopathy
- ovarian disorder (PCOS, ruptured cyst)
- endometriosis
- trauma
- STI
- cervical ectropion
- hypothyroidism (irregular, heavy periods)
Two ovulation induction medications?
letrozole and clomiphene
Diagnostic criteria for miscarriage on US?
- absence of foetal cardiac activity in embryo when crown to rump length (CRL) is > 7mm
- absence of a foetal pole when the mean sac diameter is > 2.5cm which corresponds to a gestational age of 6 weeks
Then there are some cases where the criteria is not met. In which case, follow up US is required.
DDx for PV bleeding in early pregnancy?
- miscarriage:
- threatened, incomplete, complete, inevitable
- ectopic pregnancy
- molar pregnancy
- normal pregnancy with unknown cause of bleeding (could be subchorionic haemorrhage present)
- infection or trauma co-existing with pregnancy
- implantation bleeding
placenta previa classifications?
- marginal → lies within 2-3cm of the internal os
- partial → implants near and partially covers the os
- total → completely covers the os
S&S of placenta previa?
Two classic presentations:
- antepartum haemorrhage:
- painless, bright red bleeding
- spontaneous, in third trimester and ceases spontaneously
- fetal malpresentation:
- remain high in uterus
- increased risk of transverse, oblique, or
breeched presentation
RA serology?
Antinuclear antibodies (ANA)
Anti-citrullinated peptide antibodies (ACPA)
Rheumatoid factor (RF)
DDx for joint pain?
Psoriatic arthritis
OA
Fibromyalgia
Reactive arthritis
Gout
Septic arthritis
Rheumatoid arthritis
What is the FAST imaging approach to blunt force trauma patients?
FAST scan (focused assessment with sonography for trauma) → assess for pericardial fluid, RUQ fluid (Morison’s pouch), LUQ fluid (splenorenal recess), suprabubic fluid
*helps to indicate the need for emergency laparotomy
Outline delirium tremens?
persistentalteration of consciousnessand sympathetic hyperactivitydue toalcoholwithdraw
- symptoms include:
- disorientation
- tremor
- tachycardia
- HTN
- sweating
- nausea
- alcohol withdrawal seizures → tonic clonic seizures occurring 8-48hrs after withdrawal
Why use benzodiazepines for alcohol withdrawal?
Acute use of alcohol produces CNS depression because of an increased GABAergic neurotransmission and reduced glutamatergic activity. However, in patients with chronic heavy alcohol use, because of neuro-adaptation, there is a down regulation of Gamma-Amino Butyric Acid (GABA) and up-regulation of the glutamate (NMDA receptor) neurotransmission. In alcohol withdrawal, this neurotransmitter imbalance gets unmasked and there is an unopposed glutamate activity which leads to excitotoxicity as a result of intracellular calcium influx and oxidative stress. This is precisely the reason that benzodiazepines which are GABAergic drugs reduce the excitetoxicity by restoring the neurotransmitter balance and are considered to be the drug of choice in alcohol withdrawal syndrome.
management of hepatic encephalopathy?
- avoid any toxins that will contribute to liver impairment (especially proteins)
- lactulose → decreases ammonia absorption within the bowel
- rifaximin → reduced the number of ammonia producing intestinal bacteria
- liver transplant
- avoid unnecessary medications that are metabolised by the liver
- treat precipitating factors
What are uterine fibroids?
aka leiomyomas
benign tumours of the myometrium -> can be subserous, intramural or submucosal
4 typical features of uterine fibroids/leiomyoma?
menorrhagia
abdominal mass
pressure effect from pressure on the bladder, stomach or bowel (feeling full, frequent urination)
3 cardinal symptoms of fibromyalgia?
Widespread muscle pain
Fatigue
Unrefreshing sleep/sleep disturbance
Management for osteporosis?
Non-pharmacological:
- discuss fall prevention strategies → identify and manage risk factors
- encourage physical activity that focuses on strength and balance
- consider physiotherapy and/pr occupational therapy
Pharmacological:
- oral bisphosphonates e.g. alendronate, risedronate
- can be taken daily or weekly
OR
- denosumab (prolia)
- taken as a subcutaneous injection 6mthly
Plus vitamin D and calcium supplementation.
Major adverse effects of bisphosponates and prolia (denosumab)
Bisphosphonates - osteonecrosis of the jaw and oesphagitis (take 30mins before food and stay upright)
Prolia: osteonecrosis of the jaw
Cardinal signs of psychosis:
delusions
hallucinations
thought disorder
agitation/agression
Key features of each particular non-sinister headache:
- migraine
- cluster headache
- sinusitis
- tension-type
- TMJ syndrome
Migraine:
unilateral, few times a year, photophobia, pulsatile, sound sensitivity, +/- aura
Cluster:
occur in clusters (6-12 weeks every 1-2 years), focused around one eye, intense pain, lasts 20-30mins, may have red, watery eye and Horner’s syndrome
Sinusitis:
often following coryzal symptoms
Tension type:
most common, stress anf fatigue are a trigger, described as a tightening band around head, nil other features (no photophobia or nausea).
TMJ:
associated with teeth grinding or jaw clenching
Sinister causes of headache:
VIVID
Vascular - SAH, subdural or extradural, cerebral venous sinus thrombosis, cerebellar infarct
Infection - meningitis, encephalitis
Vision-threatening - temporal arteritis, acute glucoma
Intracranial pressure (raised) - SOL, cerebral oedema, malignant HTN
Dissection - carotid dissection
Features of Kallmann syndrome?
Can affect males and females (46XX and 46XY).
Defective migration of GnRH neurons within the hypothalamus -> results in decreased GnRH production -> decreased FSH and LH secretion of the pituitary gland -> decreased testosterone production in males, decreased estrogen & progesterone production in females.
Results in absent or decreased pubertal changes. Can result in infertility without hormone treatment.
Also results in loss of smell (anosmia).
Other complications include osteoporosis, mental health complications.
Causes of delayed bone age in children/adolescents?
Hypothyroidism
Constitutional delay in growth
Growth hormone deficiency
Order of male puberty changes?
Testicular enlargement, then pubic hair, then growth spurt
Review Apgar scoring
Features of growing pains?
- never present at the start of the day after the child has woken
- no limp
- no limitation of physical activity
- systemically well
- normal physical examination
- motor milestones normal
- symptoms are often intermittent and worse after a day of vigorous activity
Hormone serology features of Turner syndrome?
Elevated FSH and LH, but decreased estrogen and androgen (due to impaired ovarian development)
Central vs peripheral precocious puberty? Give examples
Central - gonadotropin (FSH and LH) dependent. Will have an increase in FSH and LH (may also have increase in GnRH depending on the cause).
e.g. idiopathic, pituitary tumors, hypothalamus haemartoma, trauma, obesity related precocious sexual development.
Peripheral - gonadotropin independent. Will not have increase in GnRH or FSH/LH. Will have increase in testosterone/estradiol levels.
e.g. congenital adrenal hyperplasia, adrenal tumor, McCune-Albright syndrome (increase in estrogen production), ovarian/testis tumor
Differentiating between central vs peripheral precocious puberty?
Central: high FSH, LH, estrogen/progesterone/testosterone
Peripheral: low FSH & LH, raised estrogen/testosterone
GnRH stimulation test - administer GnRH and test FSH and LH.
Central will have raised FSH and LH.
Peripheral will have unchanged FSH and LH.
How does congenital adrenal hyperplasia cause precocious puberty?
Genetic deficit in enzyme involved in cortisol production. Results in negative feedback to the pituitary gland -> increased ACTH -> caused adrenal hyperplasia -> results in decreased cortisol and aldosterone production, but increase in androgen production.
Clinical features of congenital adrenal hyperplasia?
hypoglycemia (lack of cortisol)
adrenal crisis
hyperpigmentation esp. mucous membranes.
Workup for someone presenting with precocious puberty?
Labs:
- FSH, LH (particularly), estrogen/testosterone
- GnRH stimulation test (if LH is increased then indicative of central cause - perform brain MRI)
Imaging:
- x-ray non-dominant hand (within 1yr of child’s age = puberty likely not started. If >2yr of child’s age then puberty has been present for a year or longer)
- MRI of brain if LH raised (basal or following GnRH test)
- consider US of the pelvis and adrenal glands if suspecting peripheral cause
**Important to perform neurological examination - particularly looking at visual fields
Triad of McCune- Albright syndrome?
Cafe-au-lait spots
Polyostotic fibroud dysplasia
Endocrinopathies - peripheral precocious puberty, cushing syndrome, acromegaly
Initial examination of someone presenting with a headache?
Vitals - temp for infection, BP for malignant HTN
Head and neck examination - msk tenderness/stiffness (tension headache). Feel for temporal/scalp tenderness.
Neurological exam - focal neurological signs - SOL, haemorrhage
Fundoscopy - to exclude raised intracranial pressure
History should guide diagnostic suspicion but still perform exam to rule out other causes.
What is homonymous hemianopia?
Think and look up - consider where the lesion is
What is a heterotopic pregnancy?
a rare condition involving multiple gestations, in which one is intrauterine and another is ectopic. Occurs more frequently in patients undergoing infertility treatments, e.g., in vitro fertilization.
List some symptoms of lithium toxicity?
Tremor
Confusion
Ataxia
Renal impairment - diabetes insipidus (polyuria), uremia
Hypothyroidism
Diarrhoea
Treatment of lithium toxicity?
Acute (e.g. overdose) - forced diuresis
Chronic - hemodialysis
Formula for calculating predicted PCO2 in metabolic acidosis?
Winters formula: Anticipated pCO2 = 1.5 x [bicarb] + 8 (±2)
Treatment of bleeding in mild haemophillia A?
Factor VIII + desmopressin
Desmopressin can also be used in von willebrand disease - works to release von Willebrand’s antigen from the platelets and the cells that line the blood vessels where it is stored
A high pitched, crescendo-decrescendo systolic murmur, loudest over the left sternal border and augmented by Valsalva, with a palpable double impulse apex beat, is most consistent with….
hypertrophic obstructive cardiomyopathy
**Manoeuvres that decrease left ventricular volume (Valsalva, standing from a squatting position) will augment a HOCM murmur.
**Manoeuvres which increase preload (rapid squatting) or afterload (hand-grip) will decrease the intensity of a HOCM murmur.
Management of CO poisoning?
If airway not a problem and ok GCS, then hyperbaric oxygen therapy.
If airway a concern then intubate and 100% oxygen delivery.
Medication used to prevent varice’s bleeding
A non-selective beta-blocker such as propranolol is the drug of choice for primary prophylaxis of varices in patients with decompensated cirrhosis. The non-selective beta-blockers cause reduced splanchnic blood flow and splanchnic vasoconstriction, resulting in reduced portal pressure.
e.g. propanolol
Review side effects of red belly, brown, and tiger snake bites.
Think bleeding/VICC, myotoxicity, neurotoxicity, systemic symptoms
https://www.rch.org.au/clinicalguide/guideline_index/Snakebite/
Treatment for febrile non-haemolytic transfusion reaction
The immediate management is to stop the blood transfusion, administer an antipyretic (e.g. panadol), exclude serious adverse events (especially acute haemolytic reaction, transfusion associated sepsis and transfusion-related acute lung injury) and send a reaction form to the transfusion lab.
Usually patients just experience fever and chills. If there are more systemic symptoms then need to rule out more serious reaction.
First step for snake bite management?
The first step in management should always be to apply a broad pressure immobilisation bandage to the affected limb starting from the bite site. The joints on either side of the bite site should then be immobilised using a splint, and the entire patient immobilised.
Then can administer antivenom
Not appropriate investigation/management strategies for CO poisoning:
a.
CT scan of the brain
b.
Putting the patient in a hyperbaric chamber.
c.
Oxygen therapy via a non rebreather mask.
d.
A measure of the patient’s carboxyhemoglobin level.
e.
Pulse oximetry investigation
e.
Pulse oximetry investigation
HbCO absorbs light almost identically to that of oxyhemoglobin. Although a linear drop in oxyhemoglobin occurs as HbCO level rises, pulse oximetry will not reflect this change and is therefore a useless investigation in this scenario.
A serum creatinine increase < 30% is acceptable following commencement of an ACE inhibitor
List 3 conditions associated with seronegative spondyloarthropathies:
Seronegative spondyloarthropathies (SpA) area family of rheumatologic disorders that classically include:Ankylosing spondylitis (AS),Psoriatic arthritis (PsA),Inflammatory bowel disease (IBD) associated arthritis
What is the following condition and what is the management?
- unwell - sudden severely painful red eye - blurred vision - severe headache, nausea, vomiting - experiencing halos in visual field
Acute angle closure glaucoma
Requires emergency ophthalmology referal to relieve pressure in the eye. Pressure build up from impaired aqueous humour drainage in the anterior and posterior chambers of the eye
optic neuritis three main features
sudden loss of vision (unilateral) (blurred, washed out, colour blindness), pain of eye movement, feeling pain behind the eye
Which eye condition is ankylosing spondylitis associated with?
anterior uveitis.
Symptoms include:
* acute onset
* ocular discomfort & pain (may increase with use)
* pupil may be irregular and small
* photophobia (often intense)
* blurred vision
* red eyes
* lacrimation
* ciliary flush
* visual acuity initially normal → impaired
Three causes of optic neuritis?
multiple sclerosis
diabetes
syphilis
Two appropriate management options for acute angle closing glaucoma?
reducing aqueous secretions with acetazolamide and
inducing pupillary constriction with topical pilocarpine
Are mydriatic drops a known precipitant of acute angle closure glaucoma?
Yes
What does Hordeolum externum refer to?
A stye on the eyelid
Review entropion and ectropion of the eye
Key feature differentiating scleritis and episcleritis?
Scleritis is painful, episcleritis is not painful
Sudden painless unilateral loss of vision in one eye + relative afferent pupillary defect + cherry spot seen on ophthalmoscope?
Central retinal artery occlusion
Two clinical features of retinitis pigementosa?
Night blindness (loss of rods)
Tunnel vision
Two syndromes associated with retinitis pigmentosa?
Alport’s syndrome, Hereditary ataxia
Review what papilloedema on fundoscopy looks like
What are reed sternberg cell a hallmarker of?
Hodgkin lymphoma
Prognostic factors for melanoma?
- thickness (Breslow classification)
- level or depth (worse in level IV or V)
- site (worse on head and neck, trunk)
- sex (worse for men)
- age (worse >50 years)
- amelanotic melanoma
- ulceration
What is achalasia?
A disorder of oesophagus motility where the oesophagus does not effectively propel food downward.
