General Bits Flashcards
COPD key things increasing survival
stopping smoking most important!!
salbutamol
tiotropium also
mortality predictor PE
PESI score
anticipatory medications palliative
anti secretions drugs
morphine
midazolam
antiemetic
significant ST elevation
1mm in 2 consecutive non chest leads
2mm in 2 chest leads
inflammatory / septic bloods
raised platelets
low albumin
raised CRP
raised ferritin
and the usual
obstructive jaundice
ALP up and BR too
usually a stone
can be tumour etc
do USS then if not clear do MRCP
anaphylaxis treatmnet
remove cause 1 in 1000 0.5ml IM adrenaline 200mg IV hydrocortisone 500ml-1000ml saline 10mg chlorphenamine
can repeat adrenaline every 5 mins
hypoglycaemia, DKA, HHS
HHS - they are very very dehydrated with much higher sugars
DVT examination
colour changes swelling signs of venous insufficiency temp tenderness pitting oedema measure circumference 10cm below tibial top palpate pulses
when to do D dimer
if Well’s score <2
signs of venous insuffiency
venous eczema
haemosiderin deposits
lipodermatosclerosis (inverted champagne bottle leg)
venous ulcers
describe # xray
Describing a fracture: PAID • Radiographs must be orthogonal: request AP and lat. films. • Need images of joint above and joint below #. • Demographics § Pt. details § Date radiograph taken § Orientation and content of image • Pattern • Transverse • Oblique • Spiral • Multifragmentary • Crush • Greenstick • Avulsion • Anatomical Location • Intra- / extra-articular • Dislocation or subluxation • Deformity (distal relative to proximal) § Translation § Angulation or tilt § Rotation § Impaction (→shortening) • Soft Tissues § Open or closed § Neurovascular status § Compartment syndrome • ? Specific # classification/type § Salter-Harris § Garden § Colles’, Smith’s, Galeazzi, Monteggia
hyperthyroid o/e
– hyper -> hot, sweaty, palmar erythema, tachy, anxious, flushed hypo, fine tremor, oncholysis, fast reflexes +/- (pretib myx, thyroid acropachy, exopth, proptosis, lid lag, H test pain) thyroid swelling, AF
hypothyroid o/e
cold, muscle wasting, dry hair/waxy skin, lateral third of eyebrows gone, myxoedema, slow reflexes, +/- thyroid swelling,
extra thyroid exam bits
thyroglossal cyst moves on swallowing, proximal myopathy in hypo+hyper
diabetic foot exam
Charcot joints, clawed toes, dystrophic nails, hairless+pallor (vasc insuff), LPS, eczema HS deposits-> complete with ABPI, Doppler, blood gluc, HbA1c
venous ulcer
gaiter region, superficial, sloping edge, pink, some pain, diabetic skin changes
arterial ulcer
pressure areas, deep, punched out, sloughy, pale, painful, no pulses
neuropathc ulcer
pressure areas, depp, punched out, bloody, painless, neuropathy
Cushing’s syndrome o/e
NB ‘examine endocrine status’ can be hypoT, Cush or acromegaly. Central adiposity, intrascapular fat pad, hirsutism, osteoporosis, pigmented (Disease), thin skin, bruising, poor healing, moon face, acne, thrush, hoarse voice, striae, prox myopathy, signs of cause (complete with BP, urine dip, visual fields, hx, 24 hr cortisol, dex suppression test)
acromegaly o/e
large hands, osteoarthritis, boggy soft tissue, carpal tunnel scar, coarse features, enlarged nose/ears, macrognathia, bitemp hemianopia, frontal bossing, splayed teeth, macroglossia, goitre, +/- cardiomyopathy and rolling gait + prox myopathy
acromegay hx Qs
headaches vision pins and needles back ache muscle weakness change in shoe size change in appearnce what did you notice first?
Qs to differentiate Cushing’s and hypothyroid
taking any steroids?
changes in appearance?
mood?
heat/cold intolerance?
change in periods?
varicose veins
tortuous dilated superficial. Retrograde flow from deep to surface veins. May get pains, cramps, restless legs. Skin changes like diabetic ones. Colour flow duplex to assess.
Peripheral arterial disease – acute limb ischaemia (6Ps), critical ischaemia (rest pain at night,