Last Push Flashcards
1
Q
- How does pancreatitis present ?
A
- Acute severe abdominal pain
- Vomiting, nausea and fever
- Tachycardia or shock
- Peritonitis
2
Q
- 3 common causes of pancreatitis ?
A
- Alcohol
- Gallstones
- ERCPs
3
Q
- How is pancreatitis investigated ?
A
- Obs
- Routine bloods including LFTS, Amylase (or lipase), calcium
- ABG if 02 demand
- USS or CT depending on clinical picture
4
Q
- What score can measure severity of pancreatitis ?
A
- Glasgow score
- PANCREAS
- Pa02 < 8
- Age > 55
- Neutrophils (WBC > 15)
- Calcium < 2
- Urea > 16
- Enzymes (AST/ALT 200)
- Albumin < 32
- Sugar (glucose > 10)
5
Q
- How is pancreatitis managed ?
A
- IV fluid resuscitation
- Anglesea
- Eat as able
- Cholecystectomy
- CT if unwell 7-10 days after presentation
6
Q
- How can UGI bleed risk be stratified ?
A
- Blatchford score
- 0 = no intervention and discharge early
- > 6 = likely to need urgent intervention
7
Q
- What are the most common causes of small bowel obstruction ?
A
- Adhesions
- Incarcerated hernia
- Crohn’s
- Malignancy
8
Q
- How is a small bowel obstruction managed ?
A
- NBM
- IV fluids
- NG tube for decompression
- Most have conservative management
- (Analgesia and antiemetics)
9
Q
What type of small bowel obstructions are operated on ?
A
- Closed loop obstructions
- Surgical emergency
10
Q
- How is ileus managed ?
A
- NG tube
- Fluids
- Daily bloods
- Encourage mobilization and reducing opioids
11
Q
- How is Diverticular disease managed ?
A
- Diverticular disease Fluid and simple analgesia
- Acute diverticulitis: Abx, IVI, analgesia, Ix with flexi sig
12
Q
- What surgery could be performed for severe diverticulitis ?
A
- Harmann’s
13
Q
- In AAA how often is it monitored ?
A
- 3-4.5cm yearly USS
- 4.5-5.4: 3 monthly USS
- > 5.5/growing >1cm/yr/unstable – urgent
14
Q
- How is AAA rupture managed ?
A
- Oxygen
- Access
- Urgent bloods including crossmatch
- Assess whether stable
15
Q
- Most important sites for renal stones ?
A
- Pelviuteric junction
- Pelvic brim
- Vesicouteric junction
16
Q
- DDs for upper right abdo pain ?
A
- Cholecystitis
- Pyelonephritis
- Ureteric colic
- Hepatitis
- Pneumonia
17
Q
- DDs for lower right abdo pain ?
A
- Appendicitis
- Ureteric colic
- Inguinal hernia
- IBD
- UTI
- Gynecological pain
- Testicular torsion
18
Q
- DDs for upper left abdo pain ?
A
- Gastric ulcer
- Pyelonephritis
- Ureteric colic
- Pneumonia
19
Q
- DDs for lower left abdo pain ?
A
- Diverticulitis
- Ureteric colic
- Inguinal hernia
- IBD
- UTI
- Gynecological
- Testicular torsion
20
Q
- What are differentials for dysmenorrhea ?
A
- PID
- Endometriosis
- Fibroids
- Adenomyosis
21
Q
- What is the gold standard investigation endometriosis ?
A
- Laparoscopy
22
Q
- What is endometriosis management ?
A
- 1st line NSAIDS or paracetamol
- Hormonal – COCP or progesterone
- Surgical – Laparoscopic to excise or ablate – or hysterectomy
23
Q
- How does adenomyosis present ?
A
- Dysmenorrhea
- Menorrhagia
- Enlarged boggy uterus
24
Q
- How is adenomyosis investigated ?
A
- 1st line = transvaginal USS
25
Q
- How is adenomyosis managed ?
A
- TXA
- GnRH agonists
- Uterine artery embolization
- Definite treatment – hysterectomy
26
Q
- How does fibroids present ?
A
- May be asymptomatic
- Menorrhagia
- Subfertility
- Bulk-related symptoms
- Lower abdominal pain
- Bloating
- Urinary symptoms
27
Q
- How is fibroids investigated ?
A
- Transvaginal USS
28
Q
- How is fibroids managed ?
A
- Asymptomatic – monitor size and growth
- Menorrhagia – Levonorgestrel intrauterine system, NSIADs, TXA, COCP
- Treatment to shrink or remove e.g. GnRH agonists
29
Q
- What are conservative management for urogenital prolapse ?
A
- Pelvic floor exercises
- Incontinence pads
- Vaginal oestrogen cream
- Treat related symptoms
30
Q
- What is medical management for urogenital prolapse ?
A
- Many different types
- Should be removed and cleared periodically
- They may cause irritation
31
Q
- What could be used to treat urge incontinence if there was worry about anticholinergic side effects in frail elderly patients ?
A
- Mirabegron
32
Q
- What heart murmur is normal in pregnancy ?
A
- Systolic ejection murmur over the left sternal border
- 3rd intercostal space (erb’s point) is common due to increased blood flow across the aortic valve
33
Q
- Transudate
A
- Low in protein
- Heart failure
- Liver failure
- Nephrotic syndrome
34
Q
- Exudates
A
- High in protein
- Pneumonia/TB
- Malignancy
- Infarction
- Blood
- Empyema
35
Q
- Definition of death
A
- Irreversible loss of the capacity for consciousness
- Irreversible loss of the capacity to breath
36
Q
- How long should the examination and observation take at a minimum to certify a death ?
A
- 5 minutes listening for heart and breath sounds with stethoscope
- 5 minutes feeling for a central pulse with a finger
- Then check response to voice, pain (supra-orbital pressure) and pupillary light or corneal reflex
37
Q
- What procedure should one could through in establishing death using a neurological criteria ?
A
- An established Aetiology
- An exclusion of reversible conditions
- A clinical examination (neurological test and apnoea test)
- This is for patients who will be breathing on a ventilator but will be brain dead
38
Q
- What conditions can mirror death but are reversible ?
A
- Extreme hypothermia
- Paralytic agents
39
Q
- What is an apnoea test ?
A
- Take off ventilator and make sure they don’t start breathing as C02 rises
40
Q
- Who looks into unnatural death ?
A
- The coroner
41
Q
- What needs to be documented RE cause of death ?
A
- 1A e.g. left ventricular failure
- 1B e.g. myocardial infarction
- 1C e.g. ischemic heart disease
- 2 – contirubting but not directly causing death e.g. diabetes mellitus and chronic kidney disease
42
Q
- Before documenting and confirming death you need to ensure one of the following criteria has been fulfilled
A
- The patient meets the criteria for not attempting cardiopulmonary resuscitation e.g. DNACPR form
- Attempts at CPR have failed
- Treatment aimed at sustaining life has been withdrawn as it has been decided that it would be to no further benefit to the patient
