General mix (3) Flashcards
management of ventricular tachycardia and fibrillation
unsynchronised cardioversion
10ml 1:10,000 adrenaline
then amiodarone
torsades de pointes management
synchronised DC cardioversion
IV MgSO4
management of AV node blo0ck
1st line: atropine
2nd : transcutaneous pacing
3rd: pacemaker
bifascicular block
RBBB and LAD
trifasicular block
RBBB, LAD and 1st degree AV block
RBBB
LBBB
william marrow
initial management of someone with aortic stenosis who has collapsed
stope ACEi
cause of aortic stenosis and presentation
- aortic stenosis
- calcification- age
- bicuspid- Turners
- exertional chest pain and syncope if very severe
aortic stenosis dinitive management
if large valve gradient / poor LVEF : valvuloplasty
- open if well
- TAVI if old
- transcather aortic valve implantation
aortic stenosis dinitive management
if large valve gradient / poor LVEF : valvuloplasty
- open if well
- TAVI if old
- transcather aortic valve implantation
mitral regurg causes
- calcification
- MI (<1 week)- papillary rupture→ flash pulmonary oedema
- Infective endocarditis
Ankolysing spondylitis- As
- Anterior uveitis
- AV block
- Apical fibrosis
- Aortitis
what medication are all T1DM on
insulin
statin
q
Q75.) You are called to see an 83-year old patient on the ward as the nurses are concerned she has not opened her bowels in the past 5 days. The patient has a pmhx of Alzheimer’s dementia and is on the ward recovering from a recent pneumonia infection, but appears well. On abdominal examination you feel a palpable mass in the Lower left quadrant. You decide to perform a PR examination on the patient with a chaperone and you notice a relaxed anal spinter tone with some hard stool in the rectum. How would you manage this patient?
- Stimulant laxative
- Oral macrogol
- Glycerol suppository
- Enema
- Oral lactulose
macrogol
HHS
Immediate vigorous IV rehydration (0.9 saline)
HHS patients’ main problem is dehydration. It is not recommended to start insulin therapy until after the patient’s fluid balance is positive. Oftentimes, insulin isn’t even needed once the patient’s fluids are corrected.
Generally, even in DKA (where insulin is needed), potassium replacement is only started a little while into fluid therapy.
neuropathic ulcers ulcers found
likely to be toes- rubbing for shoes
in asthma if CO2 raised
life-threatening
mitral stenosis causes
Mitral stenosis
- Rheumatic and scarlet fever
- Malar flush
Pericarditis cause
- Post viral
- Post Mi
*
investigation for H.pylroi
- urea breath test- Carbon 13 ura
- stool antigen test
- rapid ureas test during endoscopy
all must be done 2 weeks without PPI
management of H.pylori
PPI+
Amoxicillin + metronidazole
if pen allergic: clarithromycin and metronidazole
barrets
metaplasia : squamous → columnar
management
- PPI
- endoscopic surveillance
if dysplasia identified during endoscopy: endoscopic mucosal resection
endoscopic findings in coeliac
villous atrophy and crypt hypertrophy in small intestine
presentation of coeliac
fatigue, ulcers, weigthlsos, bloating, farting
- dermatitis herpiteformis
investigation for coeliac
6 week gluten diet
- IgA leveles - anti TTG
- jejunum biopsy
haematochromotosis symptoms
- bronzed skin
- joint pain
- fall in cog and memory
can cause:
liver cirrhosis and cancer
haemochromotosis
autosomal recessive
excess iron- free radicals- damage
e.g. women after menopause (period removes iron)
investigations for haematochromatosis
serum ferritin
serum transferrin
derranged LFTs
wilsons presentation
autosomal recessive: excess copper absorptiona and decreased hepatic excretion
- Copper
- Confusion
- Kayser-fleischer
- Young
investigations for wilsons
- reduced caeruloplasmin
- reduced serum copper
- increased urinary copper excretion
can cause liver hepatitis and cirrhosis
management of wilsons
pencillamine (chelates copper) can cause PF
primary biliary cholangitis
M rule
Middle age women
anti-Mitochondrial antibodies
IgM
- associated with sjogrens, RA and system
primary sclerosing cholangitis
UK, pANCA and cholangiocarcinoma, beaded bile duct
which pathogens can cause hepatitis
Types A, B, C, D, E, cytomegalovirus, adenovirus
LFT for hepatitis
ALT>AST
acute Hep
A (vaccine) and E (no vaccine) (RNA)
foecal oral
Hep D can only infect people if they have
HEP B
alcoholic liver LFTS
AST x2>2
management of alcoholic liver disease
for hepatitis - prednisolone
management of varcies
terlipress
propanolol
band ligation
Abx
hepatic encephalopathy
patient with infection and constipation
- excess absorption of ammonia and glutamine from bacterial breakdown of protein in the gut→ confusion
-
management
- laxative e.g. lactulose- wash out bacteria
ascites can look at
SAAG
- serum-ascites albumin gradient
SAAG <11g/l
not much of a difference between albumin in the blood and ascitic fluid
cancer
TB
- lots of albumin
SAAG >11g/l
HF
liver failure
- not much albumin
