Make a Medic - Medicine & Surgery Flashcards
What is PRES? Where does it affect? Common causes?
Posterior Reversible Encephalopathy Syndrome (PRES) is a constellation of symptoms that results in oedema of the posterior occipital and parietal lobes.
Manifestations include headache, changes in vision, confusion and seizures.
It can be caused by severe hypertension, and it should resolve once the blood pressure is under control.
Initial management of acute HF
Sitting the patient upright, administering high flow oxygen and offloading the fluid with IV diuretics (usually furosemide 40-80 mg)
Management of Furosemide resistant HF. How may this present on an ABG?
Non-invasive ventilation. T1RF
What type of NIV is useful for each type of respiratory failure? Why?
T1RF - CPAP - CPAP is to splint open collapsed airways, thereby recruiting more alveoli for oxygenation. It is appropriate for type I respiratory failure when poor oxygenation is the main issue.
T2RF - BiPAP - BiPAP is useful for both oxygenation of the blood and removing carbon dioxide, so it is a useful treatment for type II respiratory failure.
Where are venous ulcers typically found?
gaiter region of the leg
Characteristics of venous ulcers
shallow, relatively painless with irregular boundaries and a wet sloughy appearance
Characteristics of arterial ulcers
clearly defined borders, are extremely tender and the pain worsens with elevation of the leg (this reduces blood flow to the ischaemic tissue by removing the beneficial effect of gravity).
Characteristics of neuropathic ulcers
painless and will tend to arise at pressure points across the foot (e.g. balls of the foot).
What is preferred method of VTE prophylaxis in hospital? When is this contraindicated? What should be used instead?
VTE prophylaxis in hospital is usually given as a low-molecular weight heparin (e.g. tinzaparin), however, it is contraindicated in renal impairment (eGFR < 30 mL/min) as it is primarily renally excreted. Patients with renal impairment should, therefore, be started on IV unfractionated heparin instead.
Scoring system for severitty of an upper GI bleed
Glasgow-Blatchford scale
Scoring system post-endoscopy to determine how likely a patient is to have another bleed
Rockall score
How does gliclazide lead to increased insulin secretion?
They act on SUR1 receptors, which are associated with the KATP channel, and lead to its closure. They increased intracellular K+.
1st line treatment for MODY
Sulphonylurea
Immediate management of addisonian crisis
IV hydrocortisone and IV fluids
Criteria for diagnosis of Adrenal insufficiency following synACTH administration
Individuals with adrenal insufficiency will not demonstrate a sufficient rise in cortisol (< 420 nmol/L).
How can ACTH level be used to guide whether it is priamry or secondary adrenal failure?
If the ACTH level is low, then the adrenal insufficiency is due to secondary adrenal failure.
Causes of secondary adrenal failure include hypopituitarism and exogenous glucocorticoid administration.
4 types of MND
There are four main types of motor neurone disease depending on the types of motor neurones affected:
amyotrophic lateral sclerosis (upper and lower motor neurones)
primary lateral sclerosis (upper motor neurones only)
progressive bulbar palsy (cranial nerves IX, X and XII)
progressive muscular atrophy (lower motor neurones only).
Triad of Wernicke’s
confusion, ophthalmoplegia and ataxia.
Treatment of Wernicke’s
Pabrinex is a medication that contains thiamine and should be given to all alcoholic patients, irrespective of whether they have presented with signs of Wernicke’s encephalopathy.
Treatment of beta blocker OD
Atropine (if patient is bradycardic)
Treatment of benzo OD
Flumazenil
Treatment of malignant hyperthermia following suxamethomium
IV dantrolene
Treatment of cyanide poisoning
Hydroxocobalamin
Treatment of paraccetemol OD
NAC
What is used to look for CF during the heel prick test?
Immunereactive trypsinogen
What is a Hartmann’s procedure? When is it used? What stoma are they left with?
A Hartmann’s procedure is an emergency procedure that is used to manage acute presentations caused by diseases of the sigmoid colon (e.g. diverticular complication or bowel obstruction). As the conditions are usually suboptimal for an anastomosis to heal, patients are left with an end colostomy and a rectal stump which can be reversed at a later stage.
What is a left hemicolectomy used for? What does it involve removal of?
A left hemicolectomy can be used for descending colon cancers and utilises a colocolic anastomosis. This involves removal of the inferior mesenteric artery.
What type of cancer is an abdomino-perineal resection used for? What does it involve the removal of?
For rectal cancer that is less than 5 cm from the anal verge, an abdomino-perineal resection is used. This involves the removal of the anus and results in a permanent end colostomy situated in the left iliac fossa.
What type of cancer is an anterior resection used fro? What type of stoma is used? Why?
An anterior resection is the operation of choice for any rectal tumours that are more than 5 cm from the anal verge. The operation leaves the anus intact, an anastomoses the distal end of the colon to the remaining portion of rectum, thereby preserving continence. Due to the poor blood supply of the rectum, a temporary defunctioning loop ileostomy is created to protect the distal bowel and allow time to heal. This can be reversed electively at a later stage.
NOTE: an anterior resection involves the removal of the inferior mesenteric artery up to its origin at the aorta. This is significant in oncological surgery as the lymphatic drainage of the tumour follows the arterial supply and is a crucial route of metastasis.
What type of cancer is a right hemicolectromy used for? What type of stoma is formed?
A right hemicolectomy is the operation of choice for caecal or ascending colon cancers. The cancer is resected, and the bowel loops re-joined using an ileocolic anastomosis; this is commonly a side-to-side stapled anastomosis. This procedure involves the removal of the relevant branches of the superior mesenteric artery (right colic, ileocolic and right branch of the middle colic).
Which procedure involves removal of SMA?
Right hemicolectomy
Which procedure involves removal of IMA?
Left hemicolectomy + Anterior resection
Clinical features of osmotic demyelination syndrome. When do they present?
Spastic quadriparesis, pseudobulbar palsy and reduced GCS. They tend to manifest about 3-5 days after overcorrection of sodium.
When should a lap chole be done in acute cholehycstitis?
within 1 week of diagnosis
When should a lap chole be done in biliary colic?
6-12 weeks after Sx onset
Mackler’s triad for boerhaave syndrome
vomiting, chest pain and subcutaneous emphysema
CXR findng of boerhaave
pneumomediastinum
Definitive imaging for diagnosis of boerhaave syndrome
CT scan of the chest, abdomen and pelvis with oral and IV contrast - Leakage of oral contrast from the oesophagus into the mediastinum confirms the diagnosis
Most common sources of gram negative sepsis
urinary tract and the biliary system.
What does the presence of a new-onset left sided varicocele in an older man (over the age of 40 years) suggest?
It could be the presenting symptom of an underlying renal cell carcinoma that is compressing the venous drainage of the left testicle into the left renal vein.
1st line treatment for BPH
Tamsulosin (alpha blocker)
Criteria for tonsillectomy
≥7 episodes of tonsillitis in the past 12 months
● ≥5 episodes of tonsillitis per year for 2 years
● ≥3 episodes of tonsillitis per year for 3 years
● ≥2 peritonsillar abscesses at any point in the patient’s life (≥1 in children)
Treatment of thyroglossla cyst
Thyroglossal cysts are managed by surgical excision, typically with a Sistrunk procedure, which involves complete removal of the cyst and part of the hyoid bone
Dual antiplatelet therapy post STEMI
aspirin 75 mg OD AND clopidogrel 75 mg OD OR ticagrelor 90 mg BD for 1 year. Aspirin 75 mg OD will continue as a single antiplatelet agent lifelong.
How does infective endocarditis affect the spleen? How might this present?
The vegetations in bacterial endocarditis can give rise to septic emboli which can get lodged in the renal glomeruli and cause microscopic haematuria. They can also lead to splenic infarcts and splenomegaly.
Equivalent dose of 40mg furosemide for bumetanide
1mg PO
What does a normal BP and high HR indicate? How should you manage this?
As this patient’s blood pressure is stable and their heart rate is high, it is likely that the rise in heart rate is attempting to compensate for their hypovolaemia. Given that hypovolaemia is the key issue that is driving this tachycardia, a fluid bolus will help replenish the intravascular volume and, hence, balance the equation such that the heart rate will come down.
What agents should avoided in those with severe aortic stenosis? Why?
Vasodilatory agents should be avoided, such as isosorbide mononitrate.
This is because, by causing vasodilation, these agents reduce the preload of the heart and can therefore further reduce cardiac output in a patient whose left ventricular outflow is already compromised. This could lead to a dangerous fall in blood pressure and a reduction in myocardial perfusion.
Most common cause of aortic stenosis in a younger patient
bicuspid aortic valve
Most pathognomic ECG finding for pericarditis
PR depression
Pericarditis following STEMI
Dressler syndrome
Medical management of encephalopathy
Lactulose
Classification for oesophagael or gastroesophagael pathology
Paris and Prague classification
LP finding of GBS
Albuminocytologic dissociation is a CSF analysis result that is often associated with GBS
Tumour marker for medullary thyroid cancer
Calcitonin (produced by parafollicular C cells)
1st line treatment for prolactinoma
Why is it used?
The first-line treatment option for prolactinoma is a dopamine agonist such as bromocriptine or cabergoline. It is used because dopamine has a negative effect on the production of prolactin by the anterior pituitary gland.
