important basics Flashcards
normal body temperature range
36.5–37.5 °C
what are haemorrhoids
Haemorrhoids are disrupted and dilated anal cushions. The anus is lined mainly by discontinuous masses of spongy vascular tissue—the anal cushions, which contribute to anal closure. Viewed from the lithotomy position, the 3 anal cushions are at 3, 7, and 11 o’clock (where the 3 major arteries that feed the vascular plexuses enter the anal canal). They are attached by smooth muscle and elastic tissue, but are prone to displacement and disruption, either singly or together. The effects of gravity (our erect posture), increased anal tone (?stress), and the effects of straining at stool may make them become both bulky and loose, and so to protrude to form piles (Latin pila, meaning a ball). They are vulnerable to trauma (eg from hard stools) and bleed readily from the capillaries of the underlying lamina propria, hence their other name, haemorrhoids (≈running blood in Greek). Because loss is from capillaries, it is bright red. NB: piles are not varicose veins.
what are the sepsis 6?
6 basic interventions that can be done rapidly to reduce the risk of death in a patient believed to have sepsis
The Sepsis Six are:
1 - Administer high flow oxygen.
2 - Take blood cultures
3 - Give broad spectrum antibiotics
4 - Give intravenous fluid challenges
5 - Measure serum lactate and haemoglobin
6 - Measure accurate hourly urine output
uk gov guidelines on calorie consumption
men 2600
women 2000
what is orlistat
lowers fat absorption
used in obesity
SE oily incontinence
normal BMI range
18.5-25
weight in kg/height in m^2
what is angular stomatitis
fissuring of the mouth’s corners caused by iron or B2 deficiency or candidiasis
white fur on an erythematous tounge
oral candidiasis. white patches and erythema. patches are hard to remove and bleed if scraped.
oral pigmentation
addison’s disease
drugs
Peutz-Jeghers syndrome, also known as hereditary intestinal polyposis syndrome
what is glossitis
a smooth, red sore tounge. iron, folate or B12 deficiency.
dysphagia - 5 key questions to ask
1- solids AND liquids from the start? yes = motility. no and progressive = stricture, both benign and malignant.
2 - difficult to make the swallowing movement? bulbar palsy
3- odynophagia? cancer, ulcer, candida, spasm.
4 - intermittent or constant and progressive - intermittent = oesophageal spasm. constant = malignant stricture
5 - neck bulges or gurgles on drinking? phyrangeal pouch.
overview of causes of dysphagia
1 - mechanical block a - malignant stricture b - benign stricture c - extrinsic pressure (AAA, lung ca, LA enlargement) d - phyrangeal pouch
2 - motility disorders
a - achalasia, spasm
b - neurological - myasthenia gravis, PD,
3 - other
a - oesophagitis, globus
how to classify antiemetics
1 - H1R antag
- cyclizine
2 - D2 antag
- metclopramide
- domperidone
- haloperidol
3- 5ht3 antag
- ondansentron
4 - other
- dexamethasone (unknown MOA)
what is cushing’s
Cushing’s syndrome describes the signs and symptoms associated with prolonged exposure to inappropriately high levels of the hormone cortisol. This can be caused by taking glucocorticoid drugs, or diseases that result in excess cortisol, adrenocorticotropic hormone (ACTH), or CRH levels.[1]
Cushing’s disease refers to a pituitary-dependent cause of Cushing’s syndrome: a tumor (adenoma) in the pituitary gland produces large amounts of ACTH, causing the adrenal glands to produce elevated levels of cortisol. It is the most common non-iatrogenic cause of Cushing’s syndrome, responsible for 70% of cases excluding glucocorticoid related cases.[2][3] An easy way to distinguish Cushing’s syndrome (primary hypercortisolism, specifically) from Cushing’s disease is that the measured ACTH levels are lower in the former. The decrease in ACTH is due to increased negative feedback of cortisol on the hypothalamus and anterior pituitary.
H pylori eradication
triple therapy eg amoxicillin clarithromycin and PPI
-prazoles
dyspepsia DD
duodenal/gastric ulcer
NSAIDS
duodeo/gastr/oesophag-itis
malignancy
etymology of dyspepsia
Dyspepsia (from the Greek δυσ- dys-, “bad” or “difficult”, and πέψις pepsis “digestion”), also known as indigestion,
whats a hiatus hernia
common.
2 types
1- sliding hiatus hernia - 80% - GOJ slides up into chest. acid reflux is common
2 - rolling hiatus hernia - 20% - GOJ remains in abdomen but a bulge of stomach herniates into the chest alongside the oesophagus.
do a barium swallow. lose weight, treat symptoms. surgery if intractable symptoms or if a rolling hernia as these can strangulate.
common causes of diarrhoea
- gastroenteritis
- parasites
- IBS
- colorectal cancer - do a PR
- crohn’s, UC, coeliac
less common
- chronic pancreatitis
- laxative abuse
- overflow diarrhoea - do a PR
- c. diff
- thyrotoxicosis
- drugs
what is thyrotoxicosis
Thyrotoxicosis is a common condition associated with excess circulating thyroid hormones that may present in myriad ways and thus will be encountered by practitioners in all medical disciplines. In Europe, it affects around 1 in 2000 people annually.1 Although thyrotoxicosis typically presents with weight loss, heat intolerance, and palpitations, there are a large variety of additional features, which manifest more variably with advancing age and in people with milder disease. It is important to determine the cause of the thyrotoxicosis, as this determines treatment. Some experts distinguish between thyrotoxicosis and hyperthyroidism by restricting the latter term to describe the conditions associated with excess synthesis and secretion of thyroid hormones from the thyroid gland
treatment of C Diff
metronidazole or vancomycin
probiotics may help prevent recurrences
constipation - questions
freq, nature, consistency blood or mucus alternating diarrhoea (IBS) recent change in bowel habit pain diet and drugs
PR exam
idiopathic can be improved by drinking more, diet and exercise advice.
constipation medication
1- bulking agents
- methylcellulose
2- stimulant laxatives - SE stomach cramping
- senna
- glycerol
3 - stool softeners
- arachis oil enemas
4 - osmotic laxatives
-lactulose
definition of constipation
lots of different colloquial definitions relating to frequency, difficulty or incompleteness.
the Rome criteria to formalise: greater than or 2 of the following in 25% of BMs. - straining - hard - incomplete sensation - blockage sensation - manual facilitation needed - less than 3 BM pw
overview of causes of constipation
1- general
- poor diet and exercise
- low fluid intake
- IBS
- old age
2 - anorectal disease
- cancer
- fissures
- prolapse
3- intestinal obstruction
- cancer
- strictures - crohn’s
- pelvic mass - foetus, fibroids
- diverticulosis
4 - drugs
- opiates
- anticholinergics eg TCAs
- others
5 - metabolic/endo
- hypercalcaemia
- hypokalaemia
6- neuromuscular
7- other
idiopathic
psychological
best indicators of hepatic synthetic function
clotting factors and albumin.
cause of dark urine with jaundice
cholestatic - urine conjugated bilirubin. whisky.
good written patient notes should be and include what?
should be succinct and legible.
and contain:
1 - Hx of PC, HPC, DH, FH, allergies, social.
2 - PT ICE
3 - legible and ordered details of examination
4 - documented risk factors and the aspects of social Hx that are relevant to care of the PT
5 - a summary including a DD and problem list.
