General Questions Flashcards
What is a key difference in management between a STEMI & an NSTEMI
With a STEMI you NEED to send the patient for Percutaneous Coronary Intervention (PCI) whereas you don’t for NSTEMI. This is a key aspect of the management.
If you give calcium gluconate you NEED to give
insulin
What is Co-dydramol?
a particular compound analgesic, a combination of dihydrocodeine tartrate and paracetamol used for moderate pain relief.
Why do we not do an arterial blood gas for DKA patients?
arterial blood gases are very painful so we do a venous blood gas instead - it will suffice. all we need to know really is pH, Bicarbonate, Glucose. We do not want to discourage the patient from coming to hospital.
What is Oxybutynin?
an anticholinergic that is used to relieve urinary and bladder difficulties by decreasing muscle spasms of the bladder
a 52 year old woman has right knee swelling and severe pain, her other signs are mostly normal. what is next in her management? broad spectrum antibiotics intra-articular steroid injection knee aspiration knee x-ray physiotherapy
KNEE ASPIRATION
with something like swelling, the first thing you have to exclude is infection. aspiration lets you do this by culturing the aspirate.
How can you tackle an unknown neurological diagnosis?
Anatomy: brain spinal cord nerve roots peripheral nerves NMJ
pathology: vascular infection inflammation/autoimmune toxic/metabolic
chronic:
hereditrary
What are the difference between UMN & LMN lesions?
UMN increased tone
UMN & LMN decreased power
UMN increased reflexes - Babinski’s sign (plantar up)
(so UMN increased tone and reflexes and up foot but both UMN & LMN less power)
A 42-year-old man with a history of subcutaneous heroin use presented to the hospital with slurred speech, diplopia, and dysphagia. The physical examination showed bilateral ptosis (Panel A), a sluggish pupillary response to light, bilateral sixth-cranial-nerve palsies, and multiple skin abscesses on his arms and legs. Shortly after admission, the dysphagia progressed, necessitating intubation for airway protection. Single-fiber electromyography suggested a disorder of neuromuscular transmission, and a clinical diagnosis of wound botulism was made. He received empirical treatment with equine serum trivalent botulism antitoxin and antimicrobial therapy, and the abscesses were surgically débrided (Panel B). Subsequently, botulinum toxin was detected in his serum, and Clostridium botulinum was cultured from abscess specimens. The patient was extubated after 2 weeks, but complete neurologic recovery took several months. Botulinum toxin irreversibly disrupts stimulation-induced acetylcholine release at peripheral cholinergic synapses. The resulting clinical syndrome is typically characterized by bilateral cranial neuropathies and descending symmetric muscle weakness. Subcutaneous or intramuscular injection of heroin that is contaminated with spores of C. botulinum is a major risk factor for the development of wound botulism.
Think about the anatomy. If the patient’s symptoms signify there is damage in CN 3,4,6,11,12 it is improbable the lesion lies in the brainstem, as this would be a massive lesion and he would be dead.
Thus it is somewhere else
What do problems with the cerebellar present as?
Problems with coordination
Ataxia Nystagmus Dysdiadochokinesia Intention tremor: finger nose finger test Speech: slurred, scanning
In obese patients what nerve do you commonly get compression of? this can lead to a decreased pinprick sensation in the anterolateral thigh
lateral femoral cutaneous nerve.
What is radiculopathy and what is often caused by
Radiculopathy is a disease of the nerve roots
Compression by disc herniation or spinal canal stenosis
What does GCS assess?
Consciousness
min score 3 max score 50
eyes (4)
verbal response (5)
motor response (6)
What does AMTS assess?
Confusion
What four conditions do you need to be thinking of when presented with a headache in the emergency department?
Meningitis (fever, neck stiffness, Kernig’s sign - extension in knee is painful)
Subarachnoid Haemorrhage (sudden onset, CT, LP)
xanthochromia - yellowish CSF instead of straw coloured)
Giant Cell Arteritis (>50)
Migraine (throbbing, aura, vomiting, photo/phonophobia, FHx)
