Miscellaneous Flashcards
Signs of benzodiazepine overdose?
Treatment?
Slurred speech, ataxia, drowsiness, respiratory depression, coma
Flumenazil
Signs of opiod overdose?
Treatment?
Miosis, CNS and respiratory depression, euphoria, +ve response to naloxone
Ventilation then naloxone
Alcohol overdose treatment?
Benzodiazepines
Signs of cocaine overdose?
Treatment?
Dilated pupils, hallucinations, paranoia, angina and sudden cardiac death, perforated nasal septum
Benzodiazepine
Depression symtoms and management?
At least 2 weeks with 5 or more of the following symptoms (must include depressed mood or anhedonia): D - depressed mood I -interest diminished/anhedonia G - guilt or feelings of worthlessness S - sleep disturbances S - suicidal ideation P - psychomotor retardation or agitation A - appetite/ weight changes C - concentration decreases E - energy reduction
*no evidence of manic or hypomanic episodes
CBT and SSRIs = 1st line = sertraline, fluoxetine, citalopram
Key symptoms of delirum?
Hallucinations, disturbance in sleep, cognitive dysfunction, altering levels of consciousness
Treat underlying cause, consider haloperidol
Generalised anxiety disorder management?
What drug is given for severe disabling anxiety which may be associated with insomnia? It is only given in the short term.
SSRI, SNRI or atypical antidepressant (citalopram, duloxetine, venlafaxine) and or CBT
Benzodiazepines
Fibroadenoma symptoms
Well defined mobile breast mass that fluctuates with menstrual cycle PAINLESS (unlike fibrocystic breasts which are TENDER and fluctuate with menstrual cycle)
Mammography
Breast ultrasound
Biopsy
Atrophic vaginitis symptoms?
Investigation?
Treatment?
Vaginal dryness, burning, itching, discharge
Urinary frequency, dysuria, recurrent UTIs
Discomfort with intercourse/light bleeding
DIAGNOSIS of exclusion! Must do a transvaginal ultrasound(TVUS) to rule out endometrial cancer
Topical oestrogen = 1st line
Also use lubricants and moisturisers
also called genitourinary symptoms of menopause
Testicular torsion symptoms investigation management
Testicular pain - SUDDEN ONSET, may be associated with nausea and vomiting
Affected testicle is HIGH-RIDING
Scrotal swelling, erythema
No pain relief with elevation of scrotum (-ve Prehn’s sign) - rules out epididymitis
ABSENT CREMASTERIC REFLEX on the affected side = diagnostic
Doppler ultrasound - absent or decreased blood flow in the affected testicle
Grey-scale ultrasound - presence of fluid and the whirlpool sign
Emergency surgical consult
What is the management pathway for an unexplained breast lump?
Women 30 and over - should be referred under a 2-week wait for triple assessment in breast clinic
>35 = Mammogram <35 = Ultrasound
What are the differentials for breast
- Lump
- Discharge
- Erythema
Lump - fibroadenoma, fibrocystic disease, cyst, cancer
Discharge - duct ectasia(tender lump around areola +/- green discharge), Ductal papilloma(clear or blood stained discharge no lump), cancer
Erythema/ pain - mastitis, breast abscess(walled-off lump)
When does breast cancer screening occur?
50-70 YO every 3 years
When do you do 2WW referral for breast signs?
30 or over with unexplained breast lump
Or 50 or over with nipple discharge, retraction or other changes of concern
What medication is given for a breast cancer patient that is ER +ve and post menopausal?
Anastrazole
Letrozole
What medication is given for a breast cancer patient that is ER +ve and pre menopausal?
Tamoxifen
What medication is given for a breast cancer patient that is HER2 +ve?
Trastuzumab (Herceptin)
What are the range for lab values for the following?
Na
K
U
Cr
Na+ : 133-146
K+ : 3.5-5.3
U: 2.5-7.8
Cr: 59-104 men, 45-84 women
Femoral hernia are located _ and _ to pubic tubercle.
What are signs of strangulation?
Management of femoral hernia?
- inferior and lateral
- strangulation - tenderness and erythema, vomiting, obstipation
- URGENT SURGICAL referral. Femoral hernias have a high risk of strangulation
What are some causes of onycholysis?
Trauma
Thyrotoxicosis
Fungal infection
Psoriasis
What are the causes of euvoleamic hyponatremia?
How would diagnose SIADH?
Diagnosis of exclusion.
First, TFTs to rule out hypothyroidism
Then short synACTHen test to rule out adrenal insufficiency
Then proceed with special tests for SIADH
Name some causes of crackles/crepitations on auscultation of lungs
Pulmonary fibrosis
Pulmonary oedema
Calculate GCS for a patient
Eyes (4) Voice(5) Movement(6)
- look this up! Comes up in exams
Define these terms in desease screening:
Sensitivity
Specificity
Positive predictive value
Negative predictive value
Sensitivity - the probability that when the disease is present, the test is positive. High sensitive test used for screening as it is good at ruling OUT disease when result is negative. “SN-N-OUT”
= TP/(TP + FN)
Specificity - probability that when the disease is absent, the test is negative. Used for confirmation after a positive screening test. Also known as true negativity rate. Good at ruling IN disease when positive. “SP-P-IN”
= TN/(TN + FP)
Positive predictive value - probability that a person who has a positive test result actually has the disease
Negative predictive value - probability that a person with a negative test result actually does not have the disease.
How do you calculate sensitivity and specificity? How do you set up the two by two table?
Sensitivity = TP/(TP + FN)
Specificity = TN/ (TN + FP)
Left column all the people that have disease, right column is all that don’t
How do you calculate positive predictive value and negative predictive value? How do you set up the calculation table?
