Miscellaneous Flashcards
What is the most suitable management for a ethylene glycol overdose?
ethanol, fomepizole, haemodialysis
What are Beau’s lines?
Transverse furrows from temporary arrest of nail growth at times of biological stress e.g severe infection, Kawasaki disease, MI, chemotherapy, trauma
What is clubbing and what are the causes?
Increased curvature of the nail and loss of the nail fold angle, the nail feels boggy.
Causes:
- Thoracic e.g. Bronchial cancer, emphysema, abscess, bronchiectasis, cystic fibrosis, TB, mesothelioma
- GI e.g. IBD, cirrhosis, GI lymphoma, malabsorption e.g. Coeliac
- CVS e.g. Cyanotic congenital heart disease, endocarditis, aneurysms, infected grafts
What are the contraindications for thrombolysis?
- Previous intracranial haemorrhage
- Ischaemic stroke less than 6month ago
- cerebral malignancy or AVM
- Recent major trauma/surgery/head injury less than 3 wks ago
- GI bleeding less than a month ago
- known bleeding disorder
- aortic dissection
- non-compressible punctures less than 24hrs ago e.g. Lumbar puncture or liver biopsy
- severe liver disease, varices or portal hypertension
- seizures at presentation
- BP greater than 220/130
- Platelets less than 100
- Anticoagulated or INR greater than 1.7
What is the torniquet test?
Tests valve competence in assessment of VVs. Largely replaced by doppler examination.
- Lie patient down
- lift leg and Milk veins
- apply the torniquet just below the level of the SFJ.
- ask patient to stand
- if VVs controlled incompetence is at SFJ
- If not incompetence is below the SJF
- Repeat at SPJ
What is Perthes test?
Assesses competency of deep venous system:
- Ask patient to stand and the VVs should be filled
- Apply torniquet at SFJ and ask patient to walk for 5 minutes
- If deep system occluded legs will become painful and VVs more engorged.
Describe the differences between arterial and venous uclers
Venous ulcers:
- Larger
- Shallow
- Irregular
- Often painless
- Medial gaiter area (lower leg)
Arterial Ulcers:
- Small
- Punched out
- Demarcated
- Painful
- Pressure areas/ between toes
Describe Sensitivity
Sensitivity is the percentage of people who have the disease that test positive.
‘How good a test is at picking up people with the disease’
TP/ TP+FN
Describe Specificity
Specificity is the percentage of people who dont have the disease that test negative
‘How good a test is at not picking up people that dont have the disease’
TN / FP+TN
Describe Positive Predictive Value
‘If your test is positive, the chance you actually have the disease’
TP/FP+TP
Describe Negative Predictive Value
‘If your test is negative, the chance you don’t have the disease’
TN/ FN+TN
Describe Absolute Risk
Absolute Risk is the proportion of people in the group with a condition
Number of positives / Number of people
Describe Absolute Risk Reduction
(Absolute risk in control group) - (absolute risk in study group)
Describe Number Needed to Treat
1/ Absolute risk reduction
Describe Relative Risk Reduction
(Absolute risk of study group) / (Absolute risk of control group
Describe Alcohol Withdrawal, its signs, and management
Usually starts 10-72h after last drink. Consider in any new (less than 3d) ward patient with acute confusion.
Signs: Delirium Tremens i.e. Raised Pulse, decreased BP, tremor, fits, visual or tactile hallucinations e.g. of insects crawling under the skin (Formication).
Management:
- Admit and monitor BP, beware BP drop.
- Give diazepam - 10mg/6h PR or IVI during fits.
- Wean off slowly during 7-10d.
- Vitamins e.g. Thiamine (B1) may needed.
Describe Glasgow Coma Scale (GCS)
Used to quantify the conscious state of a person. 3 types of response are assessed:
Best motor response has 6 grades:
- 6 = Able to obey commands
- 5 = localising response to pain
- 4 = withdraws to pain
- 3 = flexor response to pain
- 2 = extensor posturing to pain
- 1 = no response to pain
Best Verbal response has 5 grades:
- 5 = Orientated
- 4 = Confused conversation
- 3 = inappropriate speech
- 2 = incomprehensible speech
- 1 = none
Eye Opening has 4 grades:
- 4 = spontaneous eye opening
- 3 = eye opening in response to speech
- 2 = eye opening in response to pain
- 1 = no eye opening
Score out of 15 severe injury = GCS less than 8 moderate 9-12 and minor 13-15. In severe injury airway need protection with endotracheal intubationo
Describe Enteral feeding, its indications, types
Feeding via the gut as opposed to parenteral which is via the veins. May be oral, nasogastric, nasoduodenal, nasojejunal, gastrostomy, jejunostomy.
Indications: Dysphagia e.g. stroke patients, supplementary feeding for patients who can not meet all requirements orally, oesophageal aetiology e.g. partial obstruction, fistulae.
Nasogastric (NG): most common, first choice in those with functional GI tract, simple to initiate and manage, beware potential life-threatening pulmonary complications. Aspirate NG placement contents and test pH, 0-5 confirms NGT placement, if not 0-5 X-ray confirmation needed. Bridles may be used as a securing system but must not be used as restraint. Consent must be clearly documented.
Gastrostomy or Percutaneous endoscopic gastrostomy (PEG): formation of a fistula between stomach wall and anterior abdominal wall. Assess by MDT, referral made by medical team. Patient must be consented informed of risks and benefits, if not capacity, formal capacity assessment must be documented and consent form 4 completed by clinician making decision to carry out in best interests.
PEG Contraindications: Ascites, unable to tolerate endoscope, poor life expectancy, coagulation disorders, obesity, GI obstruction.
Which commonly prescribed drugs require monitoring?
Cardiovascular:
Statins - LFT baseline, 3months and 12months
ACEi - U+E, prior to treatment, altering increasing dose and annual
Amiodarone - TFT, LFT every 6 months + U+E, CXR prior to treatment
Rheumatology Drugs:
Methotrexate- FBC, LFT, U+E every 3 months
Azathioprine - FBC, LFT enforce treatment, weekly and then 3 monthly
Psychiatric Drugs:
Lithium - Drug level, TFT, U+E prior to treatment weekly then 3 monthly, TFT, U+E may go 6 monthly
Sodium Valproate - LFT during first 6 months also FBC before treatment.
Endocrine Drugs:
Glitazone - LFT before treatment and regularly during treatment stop if ALT 3x over limit.
Describe likelihood ratios
Used to asses the value of performing a diagnostic test. They use sensitivity and specificity to determine whether at test result usefully changes probability that a condition exists.
Positive likelihood ratio is sensitivity / 1 - specificity
Negative likelihood ratio is 1 - sensitivity / specificity
What are the key features of Case-Control studies?
Observational and retrospective. Patients with a particular condition (cases) are identified and matched with controls. Data is then collected on past exposure to a possible causal agent for the condition. The usual outcome is the odds ratio. They are inexpensive, produce quick results and are useful for studying rare conditions, but they are prone to confounding (a extraneous variable that correlates directly or inversely with both the dependent variable and the independent variable)
What are epicanthic folds, and what are their significance?
The name for a Skin fold of the upper eyelid covering the inner corner (medial canthus) of the eye. May be prominent in Down syndrome children, also in Turner syndrome, phenylketonuria, and foetal alcohol syndrome.
Describe RAST testing
A radioallergosorbent (RAST) test is a blood test using radioimmunoassay to detect specific IgE antibodies to determine the substances a subject is allergic to. This is different from a. Skin allergy test which determines allergy by the reaction of a persons skin to different substances.
Describe Marfan’s syndrome and its features.
An autosomal dominant connective tissue disorder caused be a defect in the fibrillin-1 gene on chromosome 15 that affects around 1 in 3000 people.
Symptoms: tall stature with arm span to heigh ratio greater than 1.05, high-arched palate, arachnodactlyl, pe cuts excavatum, pres planus, scoliosis, dilatation of aortic sinuses which may lead to aortic aneurysm, dissection, regurgitation and mitral valve prolapse, suffer repeated pneumothoraces, upwards lens dislocation, blue sclera, myopia, dural ectasia.
Management:
- regular echo +/- beta-blocker/ACE-inhibitor therapy
- aortic dissection is leading cause of death.
Describe Mastitis, the types, symptoms and management.
Inflammation of breast tissue.
Types: Periductal Mastitis (smoking high risk factor), Lactational Mastitis
Symptoms: Breast tenderness, malaise, swelling of breast, burning/pain when breastfeeding, erythema often wedge shaped, fever, lumps (breast abscess)
Management:
- Continue breast feeding, does not present risk to infant and is very beneficial to mother. Reassure, advise not to wear a bra at night.
- Antibiotics
- Analgesia
What is the definition of penetrance and expressivity?
Penetrance refer to whether a disease or trait manifests. I.e. If a disease mutation is 100% you are certain to get the disease.
Expressivity refers to how a disease or trait manifests I.e. A disease may manifest in more than one system
