Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBChB4 > new things 15/02 > Flashcards

new things 15/02 Flashcards

1
Q

Subdural haematoma features:

A

Elderly
Alcoholic
Head injury
Insidious onset
Fluctuating levels of consciousness

Rupture of bridging veins that cross the subdural space is the common cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Investigation of choice for PSC?

A

MRCP/ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Recent chemo + fever >38 management:

A

Immediate prescription of IV tazocin.
Do not wait for wcc, suspect neutropenic sepsis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Extradural vs subdural haemorrhage:

A

Extradural = lucid period, usually following major head injury.The majority occur in the temporal lobe where the middle meningeal artery is damaged.

Subdural = fluctuating consciousness, often following trivial injury in elderly or alcoholics.
Majority occur in frontal / parietal lobes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which artery is most likely to be damaged in an extradural haemorrhage?

A

Middle meningeal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to manage patients with intracranial bleeds that become unresponsive :

A

Urgent CT head to check for hydrocephalus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the Modified Glasgow Score entail and what is it used for?

A

Severity of pancreatitis:

PaO2
Age
Neutrophilia
Calcium
Renal function - Urea
Enzymes - LDH, AST
Albumin
Suagr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations in acute pancreatitis:

A

Serum amylase.
Note a diagnosis can be made without imaging if characteristic pain + Amylase >3x upper limit of normal

Early ultraound imaging for aetiology e.g. gallstones.

Other options would include contrast enhanced CT.

Serum lipase is more sensitive and specific and expensive, but has a longer half life so may be useful in late presentations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 components of the triad of death?

A

Hypothermia
Acidosis
Coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the process of tension pneumothorax causing obstructive shock:

A

Air enters the thoracic cavity and punctures the lung but cannot escape.
Its a one way air leak from damaged wall or lung, leading to increase in pressure, collapsing the affected lung.
Mediastinal shift occurs.
Occlusion of the vena cava, reducing venous return to heart, reducing cardiac output and therefore causing obstructive shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical signs of tension pneumothorax:

A

Respiratory distress
Absent breath sounds on one side
Tracheal deviation
Hyperresonance on affected side
Tachycardia and hypotension
Minimal chest movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of a tension pneumothorax:

A

Emergency

15L trauma mask
Grey venflon in 2nd intercostal space miclavicular line to buy some time
Chest drain
Check x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical signs of cardiac tamponade:

A

Pulsus paradoxusus
Distended neck veins
Tachycardia
Hypotension
Muffled heart sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Complications of chest trauma:

A

Hypovolaemic shock
Obstructive shock
Hypoxic arrest
Cardiac arrest
Empyema
Intrathoracic infection
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3 most common organs affected in abdominal trauma:

A

Liver
Kidneys
Spleen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is management of abdominal trauma based on?

A

Haemodynamic stability of the patient

Specific abdomen pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3 types of management in abdominal trauma and indications:

A

Conservative, if haemodynamically stable

IR

Immediate damage control laparotomy if unstable, or evidence of e.g. perforation or mechanism e.g. stabbing through peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Goals of damage control laparotomy:

A

Stop bleeding
Infection control
Abdominal packing
Temporary closure device e.g. laparostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical signs in abdomen trauma:

A

Haematoma, seatbelt sign
Shoulder tip pain due to blood irritating the diaphragm
Hypovolaemic shock
Haematuria
Abdo pain, rigid, distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How are liver, spleen and kidney injuries classified in trauma:

A

Grade I-V (kidney and spleen) and VI in liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Clinical signs of basal skull fractures:

A

Anterior cranial fossa = raccoon eyes, csf leaking from nose (separates on pillow)

Petrous temporal bone: Battle’s sign, mastoid bruising, CSF leaking from eyes, haemotypanum, cranial nerve signs e.g. facial paralysis / hearing loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the aetiology of diffuse axonal injury:

A

Rapid aceleration/ deceleration causes shearing of axons diffusely - can cause persistent vegetative state after trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Traumatic brain injury can be permanent. Describe the relationship between grade of TBI and GCS:

A

GCS 13-15 = mild
GCS 9-12 = moderate
GCS 3-8 = severe, can’t protect airway, need to be intubated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe Cushing’s reflex:

A

Hypertension and bradycardia, a pre-terminal sign as brain is herniating through foramen magnum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Investigations in head trauma:

A

Full neuro exam if possible
Neuro obs every 30-60 mins
Blood gas for gas exchange
CT Trauma or head and neck

MRI/EEG later on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are 2 factors that contribute to poor prognosis in a head injury?

A

Hypotension
Hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Initial management in head trauma:

A

Stop / reverse blood thinners
Resus
CT scan
Neurosurgery review
Consider transfer depending on site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

2 types of surgical management in head trauma:

A

Burr hole decompression

Trauma craniectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Complications of head trauma:

A

TBI
Disability
CND infection
Coning - herniation of cerbellar tonsils through foramen magnum, causing compression of the brainstem and respiratory arrest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a complication of all types of trauma:

A

Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the role of a pelvic binder?

A

Tamponades bleeding, a factor in C of A-E.
Stabilises fracture.
Should only be taken off by orthopaedic surgeons.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Discuss initial assessment of a patient presenting with trauma / shock:

A

Hx and AMPLE if possible.

A-E assessment with c-spine control in A and haemorrahge contorl in C.
Resuscitation is included in the A-E in trauma e.g. control of bleed.

Secondary survery, looking for other injuries / wounds etc.

Trauma series CXR and pelvic xr
FAST
Trauma CT (head neck CAP) if stable enough
Intervention e.g. theatre, IR, ICU

Tertiary survey 24 hours later once distracting injuries have been dealt with.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe the 4 types of shock and causes of each:

A

Hypovolaemic - haemorrhage, burns, other fluid loss

Obstructive - cardiac tamponade, tension pneumothorax, PE

Cardiogenic - heart pump failure

Distributive - septic, anaphylaxis, neurogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Patients who’s vital signs / response may be abnormal in shock:

A

Young patient e.g. athlete with very low HR to start with, may not detect he is tachycardic until later.

Drugs e.g. BB, patients may not be able to amount an appropriate tachy response.

Elderly - e.g. polypharmacy, depressed response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What do you get when you put out a major haemorrhage 2222 call?

A

6U prcs
4U FFP that needs defrosted
+/- platelets.
No doctors will come to a major haemorrhage call.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Methods for stopping bleeding during major haemorrhage:

A

Direct pressure and elevation
Adrenaline soaked gauze / haemostatic dressing
Reduce and splint long bone and pelvic fractures using pelvic binder.

+ Suture, tamponade with foley catheter, tie off vessels.

37
Q

Goals of resuscitation in haemorrhage:

A

Maintaining circulating volume.
Stop bleeding.
Avoid the triad of death.

38
Q

What constitutes the triad of death?

A

Hypothermia
Acidosis
Coagulopathy

39
Q

3 categories of patients when it comes to fluid response, and what this indicates.

A

Fluid responders - estimated loss <15%.

Transient fluid responders - estimated loss 15-40%.

Minimal / no response - estimated loss >40%.

Transient and no responders will generally require blood products.

40
Q

What is the leading cause of death for under 45s?

A

Trauma

41
Q

General investigations in trauma:

A

Blood gas, looks at gas exchange and fast Hb

Trauma series = cxr and pelvic xr

FAST scan to look at free fluid, bleeding etc, effusion, tamponade etc.
(Focused assessment with sonography in trauma)

Trauma CT = head, neck, CAP

42
Q

Specific investigations in pelvic trauma:

A

CTA if worried about bleeding.

CT cystogram if bladder injury suspected - dye injects into bladder and seeing if urine in intra-peritoneal.

43
Q

Urine in intraperitoneal cavity management:

A

Emergency laparotomy

44
Q

4 commonly used IV induction agents for anaesthesia:

A

Propofol = MOST COMMON
Thiopental
Etomidate = RARE
Ketamine

45
Q

Triad of general anaesthesia:

A

Loss of awareness / hypnosis

Analgesia

Optimized surgical conditions / mmuscle relaxant.

46
Q

4 inhaled options for GA:

A

sevoflurane - only this one is really used.
desflurane
isoflurane
NO

47
Q

2 drugs that cause muscle relaxation and their mechanism:

A

Suxamethonium - depolaring

Rocuronium - non depolarising

They block the NMJ from working by blocking Ach.

48
Q

Reversal agents of neuromuscular blocking agents:

A

Neostigmine

Sugammadex is used specifically with rocuronium, non-depolarising muscle relaxants.

49
Q

Features of malignant hyperthermia:

A

Hypermetabolic response to anaesthesia.
Risk is mainly iwth volatile anaesthetics (sevoflurane) and suxamethonium (NMJ blocker).

AD genetic mutation - important aspect of anaesthetic pre-op assessment.

Signs and symptoms:
Increased body temp
Increased CO2 production
Tachycardia
Muscle rigidity
Acidosis
Hyperkalaemia

Treated with Dantrolene.

50
Q

List 3 common anti-emetics and their receptor targets:

A

Cyclizine = H1 antagonist

Ondansetron = 5HT3 antagonist

Metoclopramide = D2 receptor antagonist

51
Q

Patient risk factors for PONV:

A

Age <50
Female
Non-smoker
Previous PONV or motion sickness

52
Q

Surgical and anaesthetic risk factors for PONV:

A

prolonged surgery
inner ear / intracranial / gynae / laparoscopic surgery

inhaled anaesthetic
prolonged surgery
insufficient analgesia intra-op
Prolonged BVM use (gastric dilation)
Opiate or spinal anaesthesia
Intra-op bleeding or dehydration.

53
Q

Factors to decrease baseline risk of PONV:

A

Limit opioid analgesia
Use local / regional anaesthetic vs GA if possible
Avoid volatile anaesthetic and NO

54
Q

Side effects of ondansetron:

A

5HT3 antagonist.

Reduces peristalsis and cause significant constipation if taken long term.

55
Q

Classically used d2 antagonist in anaesthesia PONV, and side effect:

A

Droperidol, prolongs QTc

Metoclopramide is a second line agent.

56
Q

Common side effects of opioids:

A

Constipation
Drowsiness
N+V common when starting or increasing
Dry mouth
Flushing
Hallucinations
Headache
Dependence and addiction risk

Longer term side effects include risk of falls, ED, amenorrhoea, infertility, depression and hyperalgesia.

57
Q

Which animal is yersinia enterocolitica associated with?

A

pigs
+ can cause reactive arthritis
+ can be mistaken for appendicitis due to right mesenteric lymphadenitis

58
Q

Which cause of gastroenteritis is a cause of GBS?

A

Campylobacter

59
Q

Which cause of gastroenteritis causes a recognisable biphasic presentation?

A

Bacillus cereus.
From rice.
Cereulide toxin first causes vomiting and abdo cramps, and then further toxins are produced in the intestines causing diarrhoea +8hrs later.

60
Q

Which 2 bacteria cause HUS in gastroenteritis, and describe the presentation:

A

E.coli 0157
Shigella
From Shiga toxin production.

Triad of HUS:
AKI
Microangiopathic haemolytic anaemia
Thrombocytopenia

61
Q

Causes of HUS:

A

E.coli + Shigella
Pneumococcal infection
HIV
Rare = SLE, antiphospholipid, drugs, cancer

62
Q

Common infections in HIV patients with CD4 count 200-500:

A

Shingles HZV
Oral thrush Candida albicans
Hairy leukoplakia - EBV
Kaposi sarcoma HHV-8

63
Q

Common infections in HIV patients with CD4 count 100-200:

A

Cerebral toxoplasmosis
PML
PJP
Cryptosporidium
HIV dementia

64
Q

Common infection in HIV patients with CD4 count 50-100:

A

Oesophageal candidiasis
Cryptococcal meningitis
Aspergillosis
Primary CND lymphoma

65
Q

What virus is associated with hairy leukoplakia and primary CNS lymphoma?

A

EBV

66
Q

Differences between cerebral toxoplasmosis and primary CNS lymphoma:

A

TP has multiple ring enhancing lesions, PCL has homogenous enhancement, usually one lesion.

Toxoplasmosis is associated with cats, thallium spect -ve.

67
Q

What is the most common opportunistic infection in HIV and how does it present?

A

PJP pneumonia.

Few chest signs, sob, dry cough etc.
Exercise induced desaturation.
Pneumothorax is a common complication.

Often can’t be shown on a sputum, so BAL with silver staining is required.
CXR typically shows bilateral interstitial pulmonary infiltrates.

68
Q

Which opportunistic infection presents with red cysts on Ziehl-Neelsen stain?

A

Ziehl-Neelsen is an acid-fast stain. Reveals red cysts of cryptosporidium.

Can affect the whole GI tract resulting in sclerosing cholangitis and pancreatitis.
Watery diarrhoea. abdo cramps and fever.

69
Q

Protective factors for malaria:

A

Sickle cell disease
G6PD deficiency
HLA-B53
Absence of Duffy antigens

70
Q

4 types of Plasmodium protozoa:

A

Falciparum
Vivax
Ovale
Malariae

71
Q

Criteria for uncomplicated malaria:

A

Parasitaemia <2%
Temp <39
Ambulatory patient
No complications

72
Q

Crtieria for complicated / severe malaria:

A

Parasitaemia >2%
Complications present
Schizonts seen in peripheral blood smear
Non ambulatory

All patients will >2% will require IV antimalarials.

73
Q

Complications of malaria:

A

AKI
Hypovolaemia
DIC
ARDS
Severe anaemia
Jaundice
Pulmonary oedema
Cerebral involvement

74
Q

Pathophysiology of the complications of severe malaria:

A

Adherence of schizonts and sequestration of rbcs to vascular endothelium

75
Q

How do you exclude a diagnosis of malaria?

A

3 negative samples taken over 3 consecutive days to exclude it, as the parasites are released from the rbcs cyclically every 48-72 hours.

Gold standard is thick and thin blood films, and antigen detection test.

76
Q

What information will a malaria blood film show?

A

The type of Plasmodium and the concentration / parasitaemia.

77
Q

Incubation period of malaria:

A

P.falciparum is usually 1-4 weeks.

Other types e.g. ovale and vivax can lay dormant for years though, so if very characteristic they can be asked about any travel history.

78
Q

Endemic areas to each type of Plasmodium:

A

Falciparum - Sub Saharan Africa
Ovale - Africa
Vivax - Central America and Indian Subcontinent
Knowlesi - South East Asia

79
Q

Infectious mononucleosis triad:

A

Sore throat, pyrexia and lymphadenopathy.

80
Q

Features of infectious mononucleosis and diagnosis:

A

Monospot test and FBC in 2nd week of illness.

Petechiae on the palate.
Malaise, anorexia, headache.
Splenomegaly
Transient rise in ALT
Lymphocytosis
Maculopapular / pruritic rash if you take ampicillin / amoxicllin

Resolves after 2-4 weeks.

81
Q

Define pyrexia of unknown origin:

A

Prolonged fever >38 persisting for >3 weeks without an obvious cause despite >1 week of inpatient investigation.

82
Q

Different diagnosis of pyrexia of unknown origin (that are already in ILOs) :

A

Vasculitides
Cryptococcus
TB
HIV
CMV/EBV
Toxoplasmosis

Lymphoma
Liver / CNS mets
Pancreatic carcinoma
Atrial myxoma
Endocarditis - culture for 21 days to detect slow growing organism

83
Q

Top causes of pyrexia of unknown origin (4):

A

Abscess
Lymphoma
TB
Preleukaemia

84
Q

Investigations in pyrexia of unknown origin:

A

Initial:
bloods, urine dipstick +/- MSSU, cultures, imaging (plain film CXR)

Further investigations depending on specific history points:
Malaria? repeated bloods films
IVDU - hepatitis serology +HIV
CTD? ANA, anti-dna, CRP
Look for other random causes etc.

85
Q

Symptoms of staph aureus bacteraemia:

A

perisistent high fever
shock
common cause of death in people with severe burns

86
Q

What investigation should all patient with S.aureus bacteraemia have?

A

ECHO to evaluate presence of endocarditis.

87
Q

A patient has been found to have S.aureus bacteraemia. What are important features of the history / examination that will ensue?

A

Recent skin / soft tissue infections.
Hardware / iatrogenic equipment in the patient.
Symptoms and signs of endocarditis, or osteomyelitis.
Beside infectious diseases consultation.

88
Q

Borders of the triangle of safety:

A

Sup = base of axilla
Ant = lateral border of pec major
Inf = 5th intercostal space
Lat = edge of latissimus dorsi

MBChB4 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions