October #3 Flashcards
In patients who are critically ill (anaphylaxis, shock etc) oxygen should initially be given via a — mask at – l/min. Hypoxia kills. The BTS guidelines specifically exclude certain conditions where the patient is acutely unwell (e.g. —) but stable. Oxygen saturation targets acutely ill patients: —% patients at risk of hypercapnia (e.g. COPD patients): — (see below) oxygen should be reduced in stable patients with satisfactory oxygen saturation Management of COPD patients prior to availability of blood gases, use a –% – mask at 4 l/min and aim for an oxygen saturation of –% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis adjust target range to –% if the pCO2 is normal
In patients who are critically ill (anaphylaxis, shock etc) oxygen should initially be given via a reservoir mask at 15 l/min. Hypoxia kills. The BTS guidelines specifically exclude certain conditions where the patient is acutely unwell (e.g. myocardial infarction) but stable. Oxygen saturation targets acutely ill patients: 94-98% patients at risk of hypercapnia (e.g. COPD patients): 88-92% (see below) oxygen should be reduced in stable patients with satisfactory oxygen saturation Management of COPD patients prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis adjust target range to 94-98% if the pCO2 is normal
Severe depression can mimic dementia but gives a pattern of – memory loss rather than short-term memory loss - this is called —
Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia
Skin manifestations of systemic lupus erythematosus 1.photosensitive ‘— rash 2.-lupus 3. al- 4. livedo reticularis: —like rash
Skin manifestations of systemic lupus erythematosus (SLE) photosensitive ‘butterfly’ rash discoid lupus alopecia livedo reticularis: net-like rash
Neuroleptic malignant syndrome is a rare but dangerous condition seen in patients taking –medication. . It may also occur with — drugs (such as —) for Parkinson’s disease, usually when the drug is suddenly stopped or the dose reduced the typical features are: p- m— autonomic lability: typical features include h-, tachy–and tachy— agitated delirium with confusion A raised – is present in most cases. Acute – (secondary to —) may develop in severe cases. A — may also be seen
Neuroleptic malignant syndrome is a rare but dangerous condition seen in patients taking antipsychotic medication. It carries a mortality of up to 10% and can also occur with atypical antipsychotics. It may also occur with dopaminergic drugs (such as levodopa) for Parkinson’s disease, usually when the drug is suddenly stopped or the dose reduced It occurs within hours to days of starting an antipsychotic (antipsychotics are also known as neuroleptics, hence the name) and the typical features are: pyrexia muscle rigidity autonomic lability: typical features include hypertension, tachycardia and tachypnoea agitated delirium with confusion A raised creatine kinase is present in most cases. Acute kidney injury (secondary to rhabdomyolysis) may develop in severe cases. A leukocytosis may also be seen
Hoffman’s sign: is a reflex test to assess for – It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the —on the same hand in response to the flick.
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
CTS is a disease of the peripheral nervous system, resulting from – nerve compression at the — inside the carpal tunnel. It therefore affects only the aspects of the hand innervated by the — nerve: Sensation; — / — / — Finger. This typically manifests as intermittent — or —- Motor; LOAF : Motor signs are less commonly seen with presentations of CTS, but wasting of the — may be present.
CTS is a disease of the peripheral nervous system, resulting from median nerve compression at the wrist inside the carpal tunnel. It therefore affects only the aspects of the hand innervated by the median nerve: Sensation; Thumb / Index / Middle Finger. This typically manifests as intermittent pain or parasthesiae. Motor; LOAF Muscles(lateral lumbricals, opponens pollicis, abductor pollicis brevis and flexor policis brevis). Motor signs are less commonly seen with presentations of CTS, but wasting of the thenar eminence may be present.
Otitis externa Causes: infection: bacterial x2 or fungal seborrhoeic — contact — (allergic and irritant) Features ear pain, itch, – otoscopy: x3 canal The recommended initial management of otitis externa is: topical— or a combined topical – with a — if the tympanic membrane is perforated — are traditionally not used* if there is canal debris then consider — if the canal is extensively swollen then an ear wick is sometimes inserted
Otitis externa is a common reason for primary care attendance in the UK. Causes of otitis externa include: infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal seborrhoeic dermatitis contact dermatitis (allergic and irritant) Features ear pain, itch, discharge otoscopy: red, swollen, or eczematous canal The recommended initial management of otitis externa is: topical antibiotic or a combined topical antibiotic with a steroid if the tympanic membrane is perforated aminoglycosides are traditionally not used* if there is canal debris then consider removal if the canal is extensively swollen then an ear wick is sometimes inserted
Pregnancy: DVT/PE Pathophysiology increase in factors V–, V–, X and – decrease in protein - uterus presses on — causing venous stasis in legs Management – contraindicated S/C — preferred to IV – (less bleeding and thrombocytopenia)
Pregnancy: DVT/PE Overview pregnancy is a hypercoagulable state majority occur in last trimester Pathophysiology increase in factors VII, VIII, X and fibrinogen decrease in protein S uterus presses on IVC causing venous stasis in legs Management warfarin contraindicated S/C low-molecular weight heparin preferred to IV heparin (less bleeding and thrombocytopenia)
As a first line investigation, all people with iron deficiency anaemia should be screened for —
As a first line investigation, all people with iron deficiency anaemia should be screened for coeliac disease
Irradiated blood products are used to avoid transfusion-associated —
Irradiated blood products are used to avoid transfusion-associated graft versus host disease
Situation CMV negative Irradiated Granulocyte transfusions Intra-uterine transfusions Neonates up to 28 days post expected date of delivery Pregnancy: Elective transfusions during pregnancy (not during labour or delivery) Bone marrow / stem cell transplants Immunocompromised (e.g. chemotherapy or congenital) Patients with/previous Hodgkins Disease HIV
Situation CMV negative Irradiated Granulocyte transfusions ✓ ✓ Intra-uterine transfusions ✓ ✓ Neonates up to 28 days post expected date of delivery ✓ ✓ Pregnancy: Elective transfusions during pregnancy (not during labour or delivery) ✓ CMV negative Bone marrow / stem cell transplants✓Irradiated Immunocompromised (e.g. chemotherapy or congenital) ✓Irradiated Patients with/previous Hodgkins Disease✓Irradiated HIV
A sudden anemia and a low reticulocute count indicates – Acute — and — causes a high reticulocyte count.
A sudden anemia and a low reticulocute count indicates parvovirus. Acute sequestration and haemolysis causes a high reticulocyte count.
Following Wells’ scoring, if a DVT is ‘likely’ (> 2 points) then arrange a proximal leg vein —within— hours
Following Wells’ scoring, if a DVT is ‘likely’ (> 2 points) then arrange a proximal leg vein ultrasound scan within 4 hours
The universal donor of fresh frozen plasma is – RhD – blood
AB negative
This patient is blood group B RhD negative, meaning her red cells possess – antigens only from the ABO grouping, and she naturally produces anti– antigens in her plasma. Therefore, she needs to receive red cells with only - antigen or no antigens at all (i.e. Groups - or -) but needs to receive FFP that does not have anti– in it. Group - donors naturally produce anti-A and anti-B, Group - donors naturally produce only anti-B, so she can only receive FFP from groups - or –. Group – is the universal donor for FFP because they produce neither anti– or anti– and is therefore compatible with all ABO groups. In many cases the RhD status would not matter for blood transfusion, however as this is a woman of childbearing age who is RhD negative, she should receive RhD negative blood in order to avoid problems with future pregnancies in which the foetus is RhD positive.
This patient is blood group B RhD negative, meaning her red cells possess B antigens only from the ABO grouping, and she naturally produces anti-A antigens in her plasma. Therefore, she needs to receive red cells with only B antigen or no antigens at all (i.e. Groups B or O) but needs to receive FFP that does not have anti-B in it. Group O donors naturally produce anti-A and anti-B, Group A donors naturally produce only anti-B, so she can only receive FFP from groups B or AB. Group AB is the universal donor for FFP because they produce neither anti-A or anti-B and is therefore compatible with all ABO groups. In many cases the RhD status would not matter for blood transfusion, however as this is a woman of childbearing age who is RhD negative, she should receive RhD negative blood in order to avoid problems with future pregnancies in which the foetus is RhD positive.
Fresh frozen plasma (FFP) most suited for ‘clinically significant’ but without ‘major haemorrhage’ in patients with a prothrombin time (PT) ratio or activated partial thromboplastin time (APTT) ratio > — typically 150— mL can be used prophylactically in patients undergoing — where there is a risk of significant bleeding In contrast to red cells, the universal donor of FFP is – blood because it lacks any - or – antibodies Cryoprecipitate contains concentrated Factor –:-, — factor, f–, Factor – and f–, produced by further processing of . Clinically it is most commonly used to replace — much smaller volume than FFP, typically 15—mL most suited for patients for ‘clinically significant’ but without ‘major haemorrhage’ who have a fibrinogen concentration < – g/L example use cases include —coagulation, – failure and hypo– secondary to massive transfusion. It may also be used in an emergency situation for – (when specific factors not available) and in — disease can be used prophylactically in patients undergoing invasive surgery where there is a risk of significant bleeding where the — concentration < 1.0 g/L Prothrombin complex concentrate used for the emergency reversal of — in patients with either severe — or a head injury with suspected intracerebral — can be used prophylactically in patients undergoing emergency surgery depending on the particular circumstance
Fresh frozen plasma (FFP) most suited for ‘clinically significant’ but without ‘major haemorrhage’ in patients with a prothrombin time (PT) ratio or activated partial thromboplastin time (APTT) ratio > 1.5 typically 150-220 mL can be used prophylactically in patients undergoing invasive surgery where there is a risk of significant bleeding In contrast to red cells, the universal donor of FFP is AB blood because it lacks any anti-A or anti-B antibodies Cryoprecipitate contains concentrated Factor VIII:C, von Willebrand factor, fibrinogen, Factor XIII and fibronectin, produced by further processing of Fresh Frozen Plasma (FFP). Clinically it is most commonly used to replace fibrinogen much smaller volume than FFP, typically 15-20mL most suited for patients for ‘clinically significant’ but without ‘major haemorrhage’ who have a fibrinogen concentration < 1.5 g/L example use cases include disseminated intravascular coagulation, liver failure and hypofibrinogenaemia secondary to massive transfusion. It may also be used in an emergency situation for haemophiliacs (when specific factors not available) and in von Willebrand disease can be used prophylactically in patients undergoing invasive surgery where there is a risk of significant bleeding where the fibrinogen concentration < 1.0 g/L Prothrombin complex concentrate used for the emergency reversal of anticoagulation in patients with either severe bleeding or a head injury with suspected intracerebral haemorrhage can be used prophylactically in patients undergoing emergency surgery depending on the particular circumstance
