Miscellaneous Flashcards
Certifying death
Pupils fixed and dilated
No breath sounds on auscultation - 3 minutes
Central pulse palpable - 1 minute
No heart sounds on auscultation in 1 minutes
When to refer to a coroner
In hospital for
When can you fill out a death certificate
you must have seen the patient 14 days before death (/after)
Provided care in the last illness before death
Registered medical practitioner
Knowledge and belief of the cause of death
Stoma complications
Early: high output stoma (dehydration, hypokalaemia), retraction, bowel obstruction, ischaemia of stoma
Late: parasternal hernia, prolapse, fistulae, psychological, skin dermatitis
Causes of hepatomegaly
V Budd-chiari, RVF I Glandular fever, hepatitis viruses, liver abscess T A Sarcoidosis. Amyloidosis M Alcoholic liver disease, haemochromatosis, NASH I TB drugs N Liver mets, HCC, leukaemia, lymphoma D C Riedels lobe
Dupuytrens causes
Liver disease Antiepileptics Diabetes Genetic (Peyronies, ledderhose, garrods)
Dupuytrens treatment options
Non surgical - conservative, splintage and physio, collagenase
Minimally invasive - percutaneous needle fasciotomy
Surgical - partial fasciectomy, dermofasciectomy
Carpal tunnal syndrome causes
Idiopathic Pregnancy Obesity Endocrine - diabetes, hypothyroid, acromegaly Local extrinsic pressure
Management of carpal tune syndrome
Conservative:
- wait, splint, steroids, NSAIDs
Surgery
CYP2D6 deficiency
inability to convert codeine to morphine (so no analgesic effect)
5-10% of population
Fluid normal requirements
20-30ml/kg/day
Fluid resus
500ml bolus 15 mins crystalloid
How long to infuse blood products for
RBCs 2-3 hours
FFP 30 mins
Platelets 30 mins
Scabies
Permethrin 5%
Don’t use steroids
Erythema nodosum
Type IV hypersensitivity - inflammation of subcutaneous fat
Causes: group A strep, TB, pregnancy, malignancy, sarcoidosis, IBD, Chlamydia, leprosy
Discrete tender nodules on shins
Erythema multiform
Acute self limiting inflammatory condition
Herpes simplex
Steven-Johnson - mucocutaneous, necrosis with 2 or more mucosal sites involved
Similar to toxic epidermal necrosis
Erythroderma
= exfoliative dermatitis
>90% of skin
Causes: lymphoma, drugs, idiopathic, previous skin disease
Leads to inflamed, oedematous, scaly skin. Can have lymphadenopathy and malaise
Management: treat cause, emollients and wet wraps. topical steroids
Eczema herpeticum
Kaposis varicelliform eruption
Serious complication of atopic eczema
- herpes simplex
Give antivirals
Staphylococcal scalded skin syndrome
Production of circulating epidermolytic toxin from phage group II
Benpen resistant staph
Treatment: ABs, analgesia
Recovery: 5-7 days
Tinea
Corporis - trunk/limbs Cruris - groin/natal cleft Pedis - athletes foot Manuum - hand Cupitus - scalp Unguium - nail Incognitio - inappropriate treatment with systemic steroids
Bullous pemphigoid
autoantibodies against antigens between the epidermis and dermis - causing a sub epidermal split in the skin
Commonly affects the elderly
Pemphigus vulgaris
Blistering skin disorder, commonly affects middle aged
Autoantibodies against antigens within the epidermis - causing intraepidermal split in the skin
Leriche syndrome
Triad of:
- claudication
- atrophy of legs
- impotence (Paralysis of L1)
Test for glandular fever
Mono spot/Paul bunnel test
AIDS defining illnesses
PCP kaposis sarcoma Cerebral lymphoma Pulmonary tb Cryptococcocis CMV retinitis
Cd4 count in AIDS
dermatomyositis antibodies
Anti-Jo-1
Klinefelters syndrome
XXY ASD psychopathy Learning difficulties Libido decreased Gynaecomastia Sparse facial hair Small firm testes
Antibodies for systemic sclerosis
anti-centromere
antinuclear ANA
Antitopoisomerase (scl 70)
Wegeners antibodies
ANCA
PBC antibodies
AMA
Mechanism of action go heparin
Activate antithrombin III
Inhibits thrombin, Xa, IXa. Xia, XIIa
Mechanism of action of LMWH
Activates antithrombin III,
forms complex that inhibits factor Xa
Most common thrombophilia
Factor V leiden
Polycythaemia rubra vera mutation
JAK2
Anaphylaxis doses
Adrenaline IM 0.5mg
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
