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Progress Tests > HFD > Flashcards

HFD Flashcards

1
Q

Scoring system to evaluate likelihood of appendicitis

A

Alvorado score

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2
Q

What is the psoas sign and what does it indicate?

A

RIF pain on right hip extension

Appendicits

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3
Q

What is the obturator sign and what does it indicate?

A

RIF pain on right hip internal rotation

Appendicits

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4
Q

Antibiotics in appendicitis

A

May be used as conservative treatment in uncomplicated appendicitis
All surgical patients should have pre-operative antibiotics and post-operative antibiotics if there is evidence of peritonism found in surgery

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5
Q

Management of sigmoid volulus

A

24 hour flatus tube

Surgery if recurrent

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6
Q

Management of cecal volvulus

A

Surgery

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7
Q

Endoscopic management in some patients with large bowel obstruction who are too frail for surgery

A

Endoscopic stenting

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8
Q

Acute bowel ischaemia on X-ray

A

Thumbpriniting

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9
Q

First line in diagnosis of acute bowel ischaemia

A

CT angio

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10
Q

Management of stable acute bowel ischaemia

A

first line is endovascular therapy such as thrombolysis, embolectomy or stenting
If these are ineffective, surgical intervention such as bowel resection may be needed

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11
Q

Signs of unstable acute bowel ischaemia

A

signs of perforation, peritonitis or infarction

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12
Q

Management of unstable acute bowel ischaemia

A

Emergency exploratory laparotomy to assess extent of the ischaemia
Depending on the severity, treatment may be endovascular such as thrombolysis, embolectomy or stenting if less severe or surgery such as an arterial bypass or if very severe then bowel resection may be indicated

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13
Q

Key investigations in biliary colic

A

Abdominal USS
LFTs to exclude other pathology
MRCP if USS inconclusive but high suspicion

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14
Q

Indications for surgery in biliary colic

A

All patients

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15
Q

Causes of acalculous cholecystitis

A

hypovolaemia, trauma or systemic illness which leads to gallbladder stasis and bile duct blockage

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16
Q

Management of acute cholecystitis

A

NICE guideline is that patients should have a laparoscopic cholecystectomy to remove the gallbladder within a week, though typically this surgery is done within 3 days. Patients will also need IV fluids, analgesia and antibiotics

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17
Q

Management of acute cholecystitis in patients where surgery is contraindicated

A

temporary cholecystostomy can be due to drain the gallbladder until a cholecystectomy can be performed later

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18
Q

LFTs in acute cholecystitis

A

Relatively normal

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19
Q

Imaging in ascending cholangitis

A

First line is abdominal USS
CT may be done if inconclusive or to rule out other pathology
MRCP is diagnostic

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20
Q

Management of ascending cholangitis

A

Initial management is IV fluids, analgesia, antiemetics and antibiotics
ERCP to remove stone within 24-48 hours
Stenting / surgery if this is ineffective
Followed by elective cholecystectomy

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21
Q

Key imaging in renal colic

A

CTKUB

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22
Q

Surgical options in AAA repair

A

open surgery in younger patients or endovascular aneurism repair in older patients

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23
Q

Score to assess severity of acute pancreatitis

A

Glasgow score

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24
Q

Management of acute pancreatitis

A

Most of the management is conservative, with aggressive fluid resuscitation and analgesia, an anti-emetic, oxygen, enteral feeding, abx if infection.
Underlying cause should be identified and treated

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25
Q

Management of exacerbation of COPD

A

O2 via venturi
First line meds are salbutamol and ipratropium nebulisers which are initially back-to-back stat doses then 2-4 times per day with extra salbutamol as needed
Five-day course of corticosteroids such as prednisolone
Abx
In severe cases, IV theophylline
Non-invasive ventilation such as BiPAP if severely unwell and in respiratory failure

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26
Q

Management of primary pneumothorax

A

If it is smaller than 2cm and they aren’t breathless, discharge with outpatient follow up
If it is over 2cm or the patient is breathless, management is aspiration with a 16-18 gauge cannula
If the aspiration was successful and the pneumothorax is now less than 1 cm and they aren’t breathless, they can be discharged with outpatient follow up
If it was unsuccessful, insert a chest drain

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27
Q

Management of secondary pneumothorax

A

If it is smaller than 1cm, they can be admitted for 24 hours for observation and oxygen
If it is 1-2cm, aspiration with a 16-18 gauge cannula
If the aspiration was successful and the pneumothorax is now less than 1 cm and they aren’t breathless, admit for 24 hours for observation and oxygen
If it was unsuccessful, insert a chest drain
If it is larger than 2cm, insert a chest drain

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28
Q

Management of tension pneumothorax

A

managed as an emergency with high flow oxygen and urgent needle decompression with a 14-gauge needle, followed by chest drain insertion

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29
Q

Management of recurrent pneumothoraces

A

May be eligible for preventative pleurectomy surgery

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30
Q

Score to exclude PE diagnosis

A

PERG

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31
Q

First line management of massive PE

A

Thrombolysis with alteplase

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32
Q

Second line management of massive PE

A

Embolectomy

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33
Q

Management of non-massive PE

A

anticoagulation with warfarin or a DOAC (or low molecular weight heparin if the patient has active cancer)

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34
Q

Pathogens in hospital acquired pneumonia

A

Pseudomonas aeruginosa, Staph aureus or Legionella pneumophilia

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35
Q

Interpretation of CRB-65 score

A

0 is low risk and outpatient treatment
1-2 indicated intermediate risk and inpatient treatment
3-4 suggests high risk and urgent admission

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36
Q

Interpretation of CURB-65 score

A

0-1 suggests low risk and outpatient care
2 suggests intermediate risk with inpatient care
3-5 indicates high risk and ICU care

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37
Q

Follow-up for pneumonia

A

Patients aged over 50 should have a follow-up X-ray a couple of months after discharge to screen for underlying lung cancer

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38
Q

Marker for anaphylactic reaction

A

Mast cell tryptase

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39
Q

Scoring system in nSTEMI

A

GRACE

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40
Q

Name for gastritis caused by bacterial infection

A

Phlegmonous gastritis

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41
Q

Limitation of urea breath testing for H.pylori

A

Must be off PPI

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42
Q

Limitation of serological testing for H.pylori

A

Will be positive if there has been a previous infection

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43
Q

Limitation of stool antigen testing for H.pylori

A

Must be off PPI

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44
Q

Management of phlegmonous gastritis

A

Supportive care and IV abx

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45
Q

Score to assess GI bleeds prior to intervention

A

Blatchford

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46
Q

Score to assess GI bleeds after endoscopy

A

Rockall

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47
Q

What prophylactic meds are needed in variceal bleeds?

A

Abx

48
Q

Treatment of gastric variceal bleed

A

endoscopic injection of N-butyl-2-cyanoacrylate

49
Q

Testing of gastric ulcers

A

All gastric ulcers should be biopsied to look for underlying malignancy

50
Q

Follow-up in peptic ulcer disease

A

Gastric ulcers should have a follow-up endoscopy after 6-8 weeks to ensure healing but duodenal ulcers don’t usually need follow-up

51
Q

Most common cause of upper GI bleeds

A

Peptic ulcer disease

52
Q

Causes of acute lower GI bleeds

A

Around half of all lower GI bleeds are caused by diverticulosis
Next most common cause is ischaemic colitis
Anal pathology such as haemorrhoids, fissures or fistulae
Malignancy
Less common causes include arteriovenous malformations, polyps, IBD and infective colitis

53
Q

Imaging in patients with active acute lower GI bleeding

A

CT angio

54
Q

Management of stable patients with minor lower GI bleed that has self-terminated

A

discharge with safety-netting advice and outpatient follow up

55
Q

Management of stable patients following a major lower GI bleed

A

Admit for colonoscopy
If lesion is seen, treat endoscopically.
If no lesion is seen and they have stopped bleeding, discharge with safety-netting advice and outpatient follow up
If no lesion is seen and they are actively bleeding, admit for further investigation

56
Q

Management of unstable patients with lower GI bleed

A

CT angio
If the site of the bleed is identified, it can be treated endoscopically or with interventional embolization
If no bleeding site is seen on the angiogram, do a colonoscopy then either endoscopic treatment if bleeding site identified or further investigations if not

57
Q

Medication that may be considered in subarachnoid haemorrhage

A

Nimodipine (for a few weeks)

58
Q

Complications of subarachnoid haemorrhage

A

Vasospasm is a common complication whereby the cerebral arteries can spasm in the week following the subarachnoid haemorrhage, causing a stroke. Nimodipine is given for a few weeks following the subarachnoid haemorrhage to reduce the likelihood of this.
Other common short-term complications are re-bleeding, and hydrocephalus
Long-term neurological complications may develop such as SIADH

59
Q

Score to assess likelihood of complications after subarachnoid haemorrhage

A

Modified Fisher score

60
Q

Symptoms of third nerve palsy

A

pupils pointing “down and out” with ptosis, pupil dilation and double vision

61
Q

Prophylactic meds in intracranial haemorrhage

A

Anticonvulsants

Antibiotics if open skull fracture

62
Q

Gold standard for diagnosis of GCA

A

Temporal artery biopsy

63
Q

Imaging that may be useful in GCA

A

Duplex ultrasound

If atypical vessel involvement is suspected, PET scan may be done

64
Q

What emergency referral should be considered in patients with GCA?

A

Same day ophthalmological assessment if visual symptoms

65
Q

Second line medication in migraine prophylaxis

A

Topiramate or amitriptyline

66
Q

Complications of migraines

A

psychiatric conditions such as depression, anxiety and bipolar disorder
increased risk of cardiovascular events, in particular stroke

67
Q

Most common bacterial causes of meningitis

A

N. meningitidis, S. pneumoniae and H. influenzae (children)

68
Q

What is Kernig’s sign and what does it indicate?

A

inability to extend knees when hip is flexed due to pain

Meningitis

69
Q

What is Brudzinski’s sign and what does it indicate?

A

flexion of knees and hips on neck flexion due to pain

Meningitis

70
Q

Non-infectious causes of meningitis

A

malignancy, systemic inflammatory conditions, head injury and medications

71
Q

Medications in bacterial meningitis

A

Abx (ceftriaxone first line)

Dexamethasone

72
Q

Cerebral abscess treatment

A

Empirical abx (may be adjusted once cultures returned)
Prophylactic anticonvulsants
Steroid in deteriorating patients
Consider surgery

73
Q

Indications for surgery in cerebral abscess

A

mass effect on imaging
decompensation
an abscess over 2.5cm in a surgically accessible place
failure to respond to medication

74
Q

Definition of tonic siezure

A

Muscle stiffening

75
Q

Definition of clonic seizure

A

Muscle jerking

76
Q

Definition of myoclonic seizure

A

Shock like jerks

77
Q

Definition of atonic seizure

A

Loss of muscle tone (leads to collapse)

78
Q

Investigations after a seizure

A

CXR to look for aspiration pneumonia
ECG
Bloods to look for underlying cause e.g. electrolyte imbalance and to check levels of anti-epileptic drugs

79
Q

Airway management in a seizure

A

Ideally insert oropharyngeal or nasopharyngeal airway and start on high-flow oxygen

80
Q

Route of administration of diazepam in seizure

A

Rectal

81
Q

Route of administration of midazolam in seizure

A

Buccal

82
Q

When to repeat benzodiazepines in seizure

A

after 10-20 mins if still seizing

83
Q

Indications for other meds with benzodiazepines in a seizure

A 
IV thiamine (pabrinex) if there is a suspicion of alcohol abuse
IV glucose if there is a suspicion of hypoglycaemia
84
Q

Second line meds in seizure

A

Phenytoin / phenobarbital

85
Q

Management of seizure lasting over an hour

A

anaesthetist will give general anaesthetic with propofol, midazolam or thiopental and they will be transferred to ICU

86
Q

Acute complications of seizure

A

aspiration, hyperthermia, pulmonary oedema and arrhythmias

87
Q

Driving restrictions in epilepsy

A

Complex criteria but in general:
Cars: 6 months ban after first seizure and 1 year after subsequent seizures
HGVs: 5 years after first seizure and 10 years after subsequent seizures

88
Q

First line in most epilepsy

A

Sodium valproate

89
Q

First line in focal seizures

A

Carbamezepine

90
Q

Second line anti-epileptics

A

carbamazepine, lamotrigine, levetiracetam and phenytoin

91
Q

Driving restrictions in non-epileptic attacks

A

Patients should be advised to inform the DVLA who will make a decision around whether it is safe for them to drive based on the nature of the symptoms

92
Q

Scoring system for likelihood of stroke

A

ROSIER score

93
Q

Most likely site of a stroke if aphasia is a symptom

A

Middle cerebral artery (in dominant hemisphere, which is usually the left)

94
Q

Visual changes in MCA stroke

A

Contralateral homonymous hemianopia

95
Q

Visual changes in PCA stroke

A

Contralateral hemianopia with macular sparing

96
Q

Driving restrictions after stroke

A

Patients aren’t able to drive cars for 1 month or HGVs for 1 year after a stroke

97
Q

Contraindication to thrombolysis in stroke

A

over 4.5 hours form symptom onset

active bleeding, a recent cranial bleed / trauma or recent surgery

98
Q

Criteria for thrombectomy in stroke

A

Present within 24 hours

Angiography shows clot is proximal in the artery

99
Q

Medication after a stroke

A

All patients with a stroke will be put on an antiplatelet (unless contraindicated). This is typically 300mg aspirin for 2 weeks which is then switched to 75mg lifelong clopidogrel after 2 weeks. If the patient has AF, a DOAC will be used rather than clopidogrel.
Lifelong statin
Drug for other predisposing conditions e.g. HTN

100
Q

TIA management

A

TIA should be started on 300mg aspirin (swapped to clopidogrel after 2 weeks) and referred to a TIA clinic to be seen within 24 hours

101
Q

Symptoms of Kawasaki disease

A

The main symptoms are a fever lasting more than 5 days, polymorphic rash, conjunctivitis, mucosal erythema with a strawberry tongue, pain in the hands and feet and unilateral cervical lymphadenopathy

102
Q

Treatment of Kawasaki disease

A

IV IgG and aspirin (continued for a few months)
Corticosteroids in severe cases
Monitor and treat cardiac complications

103
Q

Imaging in dental abscess

A

OPG X-ray (X-ray of the teeth)

104
Q

Management of airway compromise secondary to dental abscess

A

Dexamethasone

Anaesthetic review

105
Q

Classification of risk in cellulitis

A

Eron

106
Q

Long term complications of cellulitis

A

persistent leg ulceration, recurrent cellulitis and lymphoedema due to damage to the lymphatic system

107
Q

DVT treatment

A

Treatment for a DVT is anticoagulants. If a delay in imaging or diagnosis is expected this may be started before the diagnosis is confirmed. The anticoagulant used is typically a DOAC or a LMWH if a DOAC is contraindicated

108
Q

What is post-thrombotic syndrome?

A

chronic pain, swelling and skin changes secondary to venous stasis (within 2 years of a DVT). Varying severity

109
Q

What metabolic abnormality is a common complication of alcohol withdrawal?

A

Hypoglycaemia

110
Q

Symptoms of opioid overdose

A

constricted pupils, respiratory depression, hypotension, reduced consciousness and coma

111
Q

Symptoms of cocaine, ecstasy or amphetamine overdose

A

sweating, hyperthermia, hypertension, dilated pupils, tachycardia, agitation and anxiety and seizures

112
Q

Symptoms of antipsychotic or amitriptyline overdose

A

confusion, hyperthermia, dilated pupils, flushing, urinary retention, dry mouth and hypotension

113
Q

Treatment of opioid overdose

A

Stat naloxone then infusion

114
Q

Treatment of cocaine, ecstasy or amphetamine overdose

A

benzodiazepines, fluids, GTN and cooling

115
Q

Treatment of amitriptyline or amphetamine overdose

A

benzodiazepines, fluids and cooling

116
Q

management of aspirin overdose

A

Urinary alkalisation

117
Q

Management of benzodiazepine overdose

A

supportive care and flumazenil if severe

Progress Tests (17 decks)

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