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- FINALS: Presentations > Interpretation > Flashcards

Interpretation Flashcards

1
Q

CT Head - Process

A

Demographics
Non-contrast // Contrast (only for vascular)

Work from OUT -> IN

  • Soft Tissue swelling? asymmetry?
  • Bone fracture
  • Periphery? bleed, atrophy
  • Paranchyma? hypo/hyperdense
  • Ventricles? Symmetry
  • Mid line shift??
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2
Q

What does atrophy look like on CT?

A

Obvious, pronounced sulci and gyri

Symmetrical left to right

May not be symmetrical front to back
e.g. fronto-temporal dementia only anterior

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3
Q

Who is at risk of subdural and why?

A

Elderly, alcholics

  1. More likely to fall
  2. Atrophied brain, cortical bridging veins are more stretched and easier to severe
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4
Q

Subdural: Appearance

A

Concave ‘sliver’ on brain periphery

May be hyperdense (acute bleed) or hypodense (chronic)

OR acute on chronic (hyper and hypo dense)

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5
Q

Subdural: Hx

A

Repeated falls

Fluctuating consciousness

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6
Q

Who gets extradurals and why?

A

Often younger patients

Trauma related as middle meningeal artery bleed

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7
Q

Extradural: Appearance

A

Convex ‘eggtradural’ on periphery

Hyperdense, acute blood (high pressure bleed)

Within suture lines (between skull and dura)

May be midline shift

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8
Q

Extradual Hx

A

Traumatic incident with lucid interval

Then LOC, decreased GCS

e.g. rugby player took blow to head, carried on playing, dropped dead in changing room after match.

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9
Q

Extradural Mx

A

A to E, senior, refer neurosurgeons

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10
Q

SAH Mx

A

A to E, senior, refer neurosurgeons

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11
Q

Hypodense Brain Tissue: Causes

A

Ischaemia

Oedema

Old bleed

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12
Q

Hyperdense Brain Tissue: Causes

A

Acute bleed

Tumour

Calcification (often choroid plexus in ventricles)

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13
Q

SAH Risk Factors

A

Family history
HTN
PCKD

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14
Q

How to tell if old blood OR ischaemia/oedema on CT?

A

Old bleed will be much more defined than ischamia/oedema

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15
Q

SAH on CT

A

Could be central area of hyperdensity in the circle of willis area

May be midline shift

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16
Q

What anticoagulant?

Arterial vs Venous clot

A

Arterial e.g stroke, MI

  • Due to platelet aggregation
  • Give antiplatelets: aspirin, clopidogrel, ticagrelor

Venous e.g. DVT, AF clots

  • More to do with clotting factors and cascade
  • Give warfarin, DOAC
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17
Q

Ischaemic Stroke on CT

A

Initial CT Head may be normal
— Primarly to rule out haemorrhage

CT head 2-3 days later will show ischamia

  • Hypodense area in parenchyma
  • Asymmetrical
  • May be midline shift
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18
Q

Initial Ischaemic Stroke Management

A

A to E

NBM until pass swallow assessment

CT Head to rule out haemorrhage

Aspirin 300mg Oral/600mg PR if unsafe swallow

CALL STROKE TEAM
- Consultant will make decision RE thrombolysis

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19
Q

Stroke Medical Management

A

Aspirin 300mg for 14 days

then

Clopidogrel 75mg for life

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20
Q

Mx If CT head shows haemorrhagic stroke?

A

A to E
Swallow assessment and NBM
Refer neurosurgeons

DO NOT GIVE ASPIRIN

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21
Q

Definitive rx for Ischaemic stroke

A

Thrombolysis if <4.5 hours (Stroke consultant to decide)

NEW Rx:
<4 hours, possibly PCI for brain
= mechanical thromolectomy
- discuss with stroke

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22
Q

When is midline shift significant?

A

ALWAYS

there is no such thing as a minor midline shift!!!

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23
Q

Why would you do an AXR?

A

Obstruction (main)

Perf - but probably would do erect CXR, abdo CT instead

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24
Q

Good Xray?

A

Diagphragm -> hernial orifices

Should be able to see psoas muscle
- if not, ? AAA rupture

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25
Q

SBO?

A 
Dilation <3cm
Valvular coniventes (all the way across)
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26
Q

3, 6, 9 rule for bowel size

A

Small < 3cm
Trans. colon <6 cm
Caecum <9cm

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27
Q

LBO?

A

Haustra not all the way across

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28
Q

Signs of inflammation in LB

Usual cause?

A

Thumprinting
- thickened bowel wall

Lead pipe colon
- smooth, featureless

TMC

  • Smooth, featureless, +++ size
  • risk of perf

Cause = IBD

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29
Q

Cause of concurrent LBO and SBO?

A

Incompetent ileocaecal valve

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30
Q

Volvulus?

A

Sigmoid

  • towards RUQ, coffee bean sign
  • Common, elderly, rx with flatus tube

Caecal
- toward LUQ, rarer

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31
Q

Signs of perf?

A

Wrigler’s sign

- double wall sign, gas on inside and out of bowel

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32
Q

Common surgical clips?

A

RUQ, cholystectomy clips

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33
Q

ECG placement

A

4th intercostal space for V1

Ride Your Green Bike
R = RA, Y = LA, G = LF, B = RF

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34
Q

Rate?

A

Count complexes on rhythm strip

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35
Q

Rhythm?

A

Irregular = likely AF!

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36
Q

P waves

  • Absent?
  • Shape?
A

Absent = AF

Triangular + tall = p pulmonale

  • indicative of large right atrium
  • usually due to lung disease causing pulm. hypertension

Bifid = p mitrale

  • indicative of large left atrium
  • usually mitral valve regurg/stenosis
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37
Q

Axis?

A

Look at V1 and V3

LAD = leaving: +ve in V1, -ve in V3

RAD = reaching: -ve in V1, +ve in V3

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38
Q

PR interval?

  • Normal?
  • What does length indicate?
A

should be 3-5 small sq

< 3 = accessory pathway e.g. WPW

> 5 = heart block

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39
Q

3 Features of WPW on ECG

A

Delta wave (slurred upstroke)
Short PR
Broad QRS

40
Q

Mnemonic for Reciprocal changes

A

PAILS

ST depression in the area after

e.g. Posterior STEMI = ST depression in ant. leads

41
Q

Narrow QRS?

A

< 3 sqs - ALSO NORMAL!

usually atrial problem if tachy

42
Q

Broad QRS?

A

> 3 sqs, never normal

ventricular cause // pathway obstruction

43
Q

To work out if LV Hypertrophy?

A

Count the squares of the deepest S wave in V1
Tallest R wave in V5 or V6

If total = >35 then the pt has LVH

44
Q

Causes of small voltage QRS?

A

Tamponade, pericardial effusion?

OBESITY!!

45
Q

Cause of QRS Alternans?

A

Pericardial effusion

Heart is mobile in fluid filled sack
Height of QRS alternates from smaller to larger regularly

46
Q

Causes of Broad QRS?

A

VT, VF
BBB
Hyperkalaemia
Drug OD

Pacemaker (see pacemaking spikes, talk to senior)

47
Q

VT w/ a pulse?

A

Unstable = DC shock, need anaesthetist

Stable = amiodarone

  • 300mg over 20 mins
  • 900mg over 24 hours (infusion)
48
Q

Signs of instability in arrhythmia?

A

Shock
MI
HF
Syncope

MUST BE DUE TO THE ARRHYTHMIA

49
Q

Unstable Tachy?

A

DC shock (need anaesthetist)

50
Q

Broad complex Stable Tachy?

A

Reg: VT w/pulse
- amiodarone 300mg

Irreg: AF with block, need senior

51
Q

Shockable Rhythms

A

Pulseless VT

VF

52
Q

Non-shockable rhythms

A

Aystole

PEA

53
Q

Risk of Amiodarone

A

Prolongs QT, be wary if patient already has long QT

54
Q

Narrow Complex Stable Tachy?

A

Reg: SVT

  • carotid sinus massage,
  • blow syringe,
  • adenosine 6mg, 12 mg, 12mg

Irreg: AF

  • Beta blocker (caution: asthma)
  • Digoxin (caution: HF)
55
Q

Cautions in asthmatics?

A

Beta-blockers = ABSOLUTELY NOT

Adenosine = DON’T YOU DARE

high risk of bronchospasm

56
Q

J wave

A

Osborne wave, usually in hypothermia

Homeless, old with long lie

May have shivering artifact (e.g. tremors)

57
Q

ST Elevation: Causes

A

INFARCT!

  • SAH (due to raised ICP)
  • LBBB
  • Pericarditis (saddle shaped)
  • Brugades (v1-v3: sudden death)
  • ventricular pacemakers
58
Q

ST Depression: Causes

A 
Hypokalaemia
Digoxin (dali reverse tick sign)
RBBB
Reciprocal change in infarct (PAILS)
Vent. pacemaker
59
Q

LBBB on ECG

A

With LAD = likely LBBB

Need to check old ECG
- If new, rx as STEMI

60
Q

Leads and areas?

A

V1-V4 = anterior
V5-V6, I and AvL = lateral
II, III, avF = inferior

61
Q

LBBB vs RBBB

A

LBBB = WiLLiaM (look at V1 and V6)
- Pathological

RBBB = MaRRow (look at V1 and V6)
- may be a normal varient

62
Q

Bad lead to have in ST elevation?

A

aVR - means very proximal infarct, not a good prognostic sign

63
Q

LAD + RBBB

A

Bifasicular block

64
Q

Most likely STEMI to cause arrhythmia?

A

Inferior - NEED telemetry

65
Q

Hyperacute T waves

A

Pre-ischaemic change in early MI

Tall and broad
Asymmetrical

Usually follows lead pattern of infarct e.g. inferior = I, II, avF

66
Q

Tall-tented T waves

A

High K+

Tall and symmetrical

67
Q

Biphasic T waves

A

Ischamia (STEMI) =
- up then down

Hypokalemia
- down then up (U wave)

68
Q

Risk in Long QT?

Causes?

A

Cardiac arrest
- due to torsades de pointes

Low temp, low K+, low Ca2+, drug overdose

69
Q

Prolonged QT

A

Male: >440

Female: >460

70
Q

Risk in short QT?

Causes?

A

Sudden death

Congenital, hypercalcaemia

71
Q

Bradycardia Unstable

A

Shock, MI, syncope, HF

Atropine

Pacing

72
Q

Bradycardia Stable

Rx

A

Risk of asystole

  • Treat as unstable
  • Atropine
  • Pacing

Low Risk
- Observe

73
Q

Low Risk

A

First degree

Mobitz type 1

74
Q

High Risk of Aystole

A

> 3 seconds ventricular pause

Mobitz Type 2

Complete Heart Block

75
Q

Mobitz Type 1 (Wenkebach)

A

Clumping of QRS complexes
PR increases until 1 is dropped

If asymptomatic = observe
Symptomatic (rare) = atropine and pacing

76
Q

Mobitz Type 2

A

Ratio e.g. 2:1

No lengthening of PR

77
Q

When to do an ABG?

A

ONLY if worried about ventilation

e.g. high RR, low O2 sats

otherwise DO A VBG!

78
Q

When to do an ABG in asthma?

A

ONLY if life threatening or deterioration

Don’t want to stop people coming back to A&E as scared of ABG

79
Q

Process for ABG interpretation

A

pH

does CO2 account for pH?

HCO3

O2 - check amount of o2 patient is using

Lactate
Hb
Electrolytes

80
Q

Metabolic Acidosis with low Bicarb cause?

ABG?

A

Renal Failure // AKI

Very low bicarb
Low CO2 to try and compensate

(due to increased HCO3- excretion)

Raised anion gap

81
Q

Chronic Resp acidosis?

A

e.g. COPD
pH low, or may be compensation

High CO2
high bicarb to comp

82
Q

Lactic Acidosis Causes

ABG?

A

Seizure
Bowel ischameia
Sepsis
Metformin

  • due to anaerobic resp

low pH, norm CO2 + bicarb, high lactate

83
Q

Metabolic Acidosis

ABG

A

e.g. DKA

low pH, low CO2 (comp), low bicarb
Normal anion gap

84
Q

AKI Staging and meaning

A

I = risk

II = intermediate

III = failure

85
Q

Drugs to omit in AKI

A

ACEi/ARB
NSAIDs
Metformin
Diuretics

86
Q

Drugs to Keep in AKI

A

Aspirin 75mg (not damaging to kidneys)

87
Q

Drugs to dose review in AKI

A

ALL

Abx, opiates, insulin, digoxin, benzos, lithium

88
Q

How to assess Fluid Balance

A

Inspection: vomit bowls, stoma, catheter, blood loss
- Is the patient drowsy, well?

Hands: temp, perfused, CRT, turgor

Pulse: high HR?

BP: both arms lying and standing
- postural drop indicates poor fluid status before lying BP will drop

Face: mucous membranes?

Neck: Raised JVP?

Chest: Central cap refill, listen to bases of lungs for overload

Sacrum and legs: Check for fluid overload

89
Q

Process for AKI?

A

ABCCDD

Assess fluid balance
Bloods 
Catheter (monitor fluid balance)
Cannula (push oral or give IV fluids)
Drugs: REVIEW
Dialysis? senior decision
90
Q

Bloods in AKI?

A

Daily U+Es

  • creatinine
  • K+

VBG
- Check bicarb

Calcium and phosphate

FBC
- Check Hb (norm. anaemia, not acute change)

91
Q

ALT:ALP ratio

A

Is it hepatic or biliary tree?

ALT ++++ in damage to hepatocytes

ALP ++++ in damage to CBD e.g. obstructive pathology

  • also raised in bone conditions e.g. paget’s
  • also high in pregnancy

READ Hx

92
Q

Why is ALT not a good marker of function?

A

Produced by destruction of hepatocytes

If you have no hepatocytes left e.g. cirrhosis than ALT may be decievingly low even if function is bad

93
Q

How to measure liver function?

A

Synthetic function

  • Low albumin
  • Clotting - high PT (>30 secs) = bad
  • BM: low if non-functioning liver
94
Q

What else is AST found in?

A

Muscles

- Will be high in rhabdomyolysis

95
Q

Acute inflammatory markers?

A

Positive
- CRP, WCC, platelets, Iron

Negative
- Albumin

Don’t do ESR acutely - ONLY RHEUM!

96
Q

Hypocalcaemia?

A

CATs go Numb on a LONG QT

Convulsions
Arrythmias
Tetany
Numbness

Long QT

- FINALS: Presentations (30 decks)

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