Ix + Mx Flashcards
PE:
Cardio/resp exam
Ix:
Basic obs/
Bedside/
- ECG: arrhythmias or heart strain
Bloods/
- FBC: anaemia
- CRP + cultures: infection
- U+E/LFTs: baseline and medications can affect function
- ABG: hypoxia or sepsis
Imaging:
- CXR: fluid + consolidation
- CTPA
Mx: Oxygen Analgesia Anticoagulation Prevention advice e.g. cessation of pill/smoking
ACS
Cardio/resp exam
Ix:
Basic obs/
Bedside/
ECG - guides management
Bloods/
FBC - anaemia (can cause chest pain)
U+E/LFTs - baseline and medications can affect function
Troponin
Imaging/
CXR - rule out lung pathology
Mx: Oxygen if hypoxic Analgesia Dual anti-platelet therapy PCI
Pericarditis
Cardio/resp exam
Ix:
Basic obs/
Bedside/
ECG - can rule out ACS and show changes of pericarditis
Bloods/
FBC - anaemia (can cause chest pain)
U+E/LFTs - baseline and medications can affect function + dehydration (may need admission for IV fluids)
Troponin - rule out MI
Imaging/
CXR
Echo - confirm
Mx:
Self limiting + pain relief
Safety net if pain gets worse/not improving
TB
Resp exam
Ix:
Basic obs/
Bedside/ Sputum sample (for AFB)
Bloods/
FBC - anaemia (can cause chest pain)
U+E/LFTs - dehydration (IV fluids), baseline and medications can affect function
CRP and cultures - infection
ABG if hypoxic
Imaging/
CXR
Mx:
Refer to respiratory team for antibiotic management for 8 months
CAP
Resp exam
Ix:
Basic obs/
Bedside/
Sputum sample
Bloods/
FBC - anaemia (can cause chest pain)
U+E/LFTs - baseline and medications can affect function. CURB 65.
CRP and cultures - infection
ABG if hypoxic
Imaging/
CXR
Mx:
Calculate CURB-65
Management in hosp or at home based on this.
Antibiotics
Lung cancer
Resp exam
Ix:
Basic obs/
Bedside/
Sputum sample
Bloods/
FBC - anaemia (can cause chest pain)
U+E/LFTs - baseline and medications can affect function. CURB 65.
CRP and cultures - infection
ABG if hypoxic
Imaging/
CXR
CT
Biopsy if necessary
Mx:
Refer to MDT including resp and onc
Heart failure
Cardio/resp exam
Ix:
Basic obs/
Bedside/
ECG - heart strain and arrhythmia
Bloods/
FBC - anaemia (can cause chest pain)
U+E/LFTs - baseline and medications can affect function
BNP
Troponin - rule out MI
Imaging/
CXR
Echo - confirm
Mx: Acute: Oxygen Analgesia Furosemide Monitor urine, fluid intake and weight
Chronic:
Monitor urine, fluid intake and weight
ACEi + B-blocker and symptomatic management
Bowel obstruction
Abdo + PR exam
Ix:
Basic obs/
Bloods/
FBC - anaemia due to blood loss
U+E/LFTs - baseline and medications can affect function + paralytic ileus
CRP
ABG - lactate (ischaemia)
G+S/X match
Imaging/
Erect CXR - perforation
AXR - obstruction
CT - identify the cause
Mx: NBM NG tube + fluids Analgesia Call surgeons
Variceal bleed
Abdo exam
Ix:
Basic obs/
Bloods/ FBC - anaemia due to blood loss Clotting U+E/LFTs - baseline and medications can affect function CRP
G+S/X match
Imaging/
Endoscopy
CXR - oesophageal perf
Mx: IV access Fluid/blood resus Terlipressin Call gastro for emergency endoscopy
Mallory Weiss
Abdo exam
Ix:
Basic obs/
Bloods/ FBC - anaemia due to blood loss Clotting U+E/LFTs - baseline and medications can affect function CRP
G+S
Imaging/
Erect CXR
Endoscopy
Mx:
Antiemetics + PPI
Call gastro for emergency endoscopy
Oesophageal cancer
Abdo exam
Ix:
Basic obs/
Bloods/ FBC - anaemia due to blood loss Clotting U+E/LFTs - baseline and medications can affect function CRP
Mx:
Either 2WW or referral to MDT with gastro + onc fo endoscopy + CT
Chemo/radiotherapy + surgery
Haemorrhoid
Abdo + PR exam
Ix:
Bloods/
FBC - anaemia due to blood loss
Clotting
U+E/LFTs - baseline and medications can affect function
Imaging/
Colonoscopy - rule out IBD + cancer
Mx:
Pain relief, lubricants + increasing fibre
Colorectal cancer
Abdo + PR exam
Ix:
Bedside/
Stool MC+S
Bloods/
FBC - anaemia due to blood loss
Clotting
U+E/LFTs - baseline and medications can affect function
CEA tumour marker
Imaging/
Colonoscopy
Mx:
2WW or MDT referral for colonoscopy
CT for spread and staging
Appendicitis
Abdo + PR exam
Ix:
Bedside/
Stool MC+S
Pregnancy test
Bloods/ FBC - anaemia due to blood loss Clotting U+E/LFTs - baseline and medications can affect function CRP
G+S for surgery
Mx:
Admit + NBM and fluids
Call surgeons
Biliary colic
Abdo exam
Ix:
Bloods/ FBC - anaemia due to blood loss Clotting LFTs - jaundice and ALP U+E - medications can affect CRP
G+S for surgery
Imaging/
USS or ERCP (cholangitis)
Mx:
Analgesia
Refer to general surgeons for gall bladder removal
IBD
Abdo exam + PR
Ix:
Bedside/
Stool MC+S
Bloods/ FBC - anaemia due to blood loss Clotting U+E/LFTs - baseline and medications can affect function CRP - inflammation
Imaging/
Colonoscopy
Mx:
Admit if dehydrated (feeling weak and tired)
Refer to gastro for outpatient colonoscopy + biopsy
Meningitis
Full neuro exam especially looking for raised ICP
Ix:
Basic obs/
Bloods/ FBC - anaemia due to blood loss Clotting U+E/LFTs - baseline and medications can affect function CRP + cultures
Blood glucose
Special/
CT head (encephalitis + SAH)
LP
Mx: Admit Fluids + supportive care Abx based on local guidance (ceftriaxone) Prophylactic Abx for friends and family
Ectopic
Abdo exam
Ix:
Basic obs/
Pregnancy test
Bloods/ FBC - look for any blood loss LFTs - medication can affect function U+E - dehydration CRP - infection for appendicitis
G+S/X-match
Mx:
+ve pregnancy test = urgent EPAC referral for USS
Mx = risk of rupture
Low risk = expectant or medical (methotrexate)
High risk = surgical
Will need repeat blood tests to check it is managed properly
Hyperemesis Gravidarum
Clinical examination for dehydration
Ix:
Basic obs/
Bedside/
Urine dip - ketones
Weight
Bloods/
FBC - anaemia for fatigue
U+E - dehydration
Mx:
Admit for IV fluids
Give anti-emetic + vit B1 (lost in vomiting)
PET
Full neuro and abdo exam
Ix:
Basic obs/
BP
Bedside/
Urine dip - protein
Bloods/
Platelets and LFTs - to get a baseline and to check for complications fo PET (HELLP)
Mx:
- BP medication (labetalol)
- MgSO4 if it becomes more severe
- Aim for delivery at 37 weeks, if it happens before +steroids
- After labour we will need to recheck your BP, urine and bloods 6 weeks afterwards.
Ovarian Cancer
Full abdo exam
Ix:
Basic obs/
Bloods/
FBC - blood loss
U+E/LFTs - baseline and medications can affect function
CA-125 tumour marker
Imaging/
Mx:
Risk malignancy index = USS + CA125 + pre/post menopause
Surgery + chemo
Endometriosis
Endometriosis:
This is where you have endometrial tissue - which is the lining of your uterus - deposited in other areas around you pelvis. The most common area is in the pouch of Douglas which is area between your rectum and uterus. This tissue is still responsive to hormonal changes which accompany your cycle which is what is causing your symptoms.
Investigations:
- We want to rule out any changes to your cervix which might be causing problems so we will need to do an abdominal, BM and speculum examination.
- To confirm endometriosis we will refer you to the gynaecologists who will perform a laparoscopy. This is where they will look inside your tummy with a camera to look for this endometrial tissue.
Management:
The management of endometriosis will depend on whether or not you wish to be fertile currently. Then your options will be medical or surgical.
1. Medical management will involve hormonal contraception or non-normal medication if you choose to remain fertile.
2. If this doesn’t help then we may consider surgery to remove the endometriosis.
Endometrial cancer: DDx (3) Explanation Investigations (3) Management (1)
Endometrial cancer:
DDx = endometrial hyperplasia, atrophic vaginitis, cervical ectropion
I am worried that this could be endometrial cancer so I am going to put you on a 2WW referral to gynaecology. This is a cancer of the inner lining of uterus.
Investigations:
- I would like to perform and BM and speculum examination first to exclude any other cause of your bleeding such as dryness in your vagina.
- Then they will do an USS to look for any abnormal endometrial thickness.
- Then they may do a hysteroscopy to accurately visualise your uterus with a camera.
Management:
1. If they are suspicious that this is cancer then it is likely that you will require surgery to remove your uterus, fallopian tubes and ovaries.
Fibroids
Explanation
Investigations (2)
Management (2)
Fibroids:
Fibroids are benign smooth muscle tumours which can grow in the pelvis. They are benign so they cannot turn into a cancer or increase your risk of cancer but they can cause problems such as pain and bleeding.
Investigations:
- First we need to rule out other causes of bleeding such as changes to the cervix so we need to do an abdominal, BM and speculum examination
- Then we will do an USS to confirm the diagnosis. If we are still really unsure then an MRI or hysteroscopy maybe required.
Management:
The management of fibroids can be separated in medical and surgical management and will vary depending on whether you plan to conceive in the near future.
1. Medical management will involve controlling your symptoms through either the COCP or mirena coil if you have no plans for conception. We can try tranexamic or mefanamic acid if current fertility is important.
2. We can surgically remove the fibroids in a myomectomy - but this is usually the last resort or if you are having problems with sub fertility.
PID
Explanation
Investigations (2)
Management (3)
PID:
This sounds like it could be PID which is inflammation and infection of your pelvic organs due to untreated infection. Unfortunately PID can result in reduced fertility and chronic pain.
Investigations:
- I will need to perform an abdominal, BM and speculum exam to see if there are any changes to your cervix which may point to current infection. I will also be assessing for cervical excitation which is pain on movement of your cervix. .
- I will also be taking swabs for STI.
Management:
- If, based on the results we think it’s PID then we will start you on a combination of antibiotic treatment. One will be an injection into the muscle and there will be two other tablets to be taken for 12 weeks.
- I would like to touch base with you in a week or so just to see how things are getting on and hopefully improving.
- We will also need to discuss in more detail what this means regarding fertility and contact tracing.
