Other Flashcards
1
Q
complications of SAH
A
rebreeding, vasospasm, hydrocephalus
2
Q
contraindications to LP in meningitis
A
rash, raised ICP, significant bleeding risk, signs of sepsis
3
Q
abx for meningitis in <3 months
A
IV amoxicillin and ceftriaxone
4
Q
abx for menignitis in > 3months
A
IV ceftriaxone
5
Q
Abx for legionella
A
macrolide
6
Q
bloods in legionella
A
raised LFT, lymphopaenia, hyponatraemia
7
Q
causes of Torsades de pointes
A
hypothermia, macrolides, SAH, hypocalcaemia, hypokalaemia, hypomagnesia
8
Q
most common virus causing meningitis in adults
A
enterovirus
9
Q
Tx for penicillin anaphylaxis
A
transfer to hospital and IV chloramphenicol
10
Q
MX of acute heart failure
A
IV loop diuretics
-oxygen
-consider nitrates (cannot use if hypotensive)
-CPAP if in resp failure
specialist input –> may consider inotropic agents and vasopressor agents
11
Q
complications of MI
A
1) chronic heart failure
2) cardiac arrest
3) cardiogenic shock
4) acute pericarditis / Dressler syndrome
5) left ventricular aneurysm - persistent ST elevation
6) left ventricular free wall rupture –> present with tamponade
7) VSD
8) acute mitral regurg (patient may have hypotension)
11
Q
how is the severity of COPD graded
A
on FEV1
12
Q
what is Dressler syndrome
A
about 4 weeks after MI - pericarditis due to autoimmune reaction to the inflammatory proteins
12
Q
more general Mx points for COPD / HF
A
annual flu, one off pneumococcal
13
Q
people treated conservatively with pneumothorax should have follow up when
A
2-4 days at outpatient
14
Q
symptoms of legionella
A
dry cough and relative bradycardia
15
Q
criteria for prophylaxis with azithromycin in COPD
A
> 3 exacerbations requiring steroid therapy and at leats one requiring hospital admission in the last year
16
Q
most common organism causing exacerbations in COPD
A
Haemophilus influenzae (gram - coccobacillus)
17
Q
what is webers syndrome (stroke)
A
infarction in the posterior cerebral artery - get ipsilateral CNIII palsy and contralateral hemiparesis
18
Q
best treatment for an aneurysm causing SAH
A
aneurysm coiling!
19
Q
which artery supplies brocas and wernickes
A
the middle cerebral artery on the dominant side
20
Q
what is the management of a chronic subdural haematoma (hypodense)
A
burr hole evacuation
21
Q
signs of DKA
A
increased thirst, reduced consciousness, pear drop, kussmauls breathing, dehydration
22
Q
what do you rehydrate with in DKA
A
saline - 1L over 1 hour
for children saline 10ml/kg
23
what are some other Mx points for DKA
1-1 nursing
ECG monitoring
U+E monitored
continue long acting insulin, but stop short
24
what is the concern in Tx of DKA
cerebral oedema !!
25
when is DKA considered resolved
ketones <1, considered resolved once the child is clinically well and eating + drinking
26
how often should type 1 diabetes have HbA1c monitored
every 3-6 months
27
what is short stature defined at and at what centile does it need investigating
<2nd centile and needs investigating at <0.4
28
screening tests for short stature
FBC, U+E, LFTs, vitamin D, coeliac screen, thyroid function, karyotype
29
causes of short stature
small parents, constitutional delay, endocrine abnormalities, chronic illness, turners, achondroplasia
30
precocious puberty is defined as what
before age 8 in females and before age 9 in males
31
what does a raised GnRH in precocious puberty indicate
that it is a central / true cause
32
what is meant by false precocious puberty
GnRH not raised
33
what do small testes in a precocious puberty indicate
that it is an adrenal and not a gonadal cause
34
how does kallman syndrome present
BOY with delayed puberty (hypogonadatropic hypogonadism) and no smell, may have short stature and cleft lip
Ix --> low FSH and LH, low levels of sex hormones
Mx --> testosterone supplementation and gonadotrophin supplementation may produce sperm
35
definition of primary amenorrhoea
no period by 13 If sexual characteristics or 15 without any
36
Dx of T1DM
fasting > or equal to 7 or random > or equal to 11.1
if asymptomatic this must be demonstrated on two separate occasions
37
what nerve is most likely to be damaged in a colles
median
38
Mx of colles
simple - MUA + casting (below elbow)
more complex - ORIF and K wiring
39
Mx of Smiths
always unstable --> ORIF and fix with plate and screws
40
is Afib or A flutter more sensitive to cardioversion
A flutter (but may respond less well to medication)
41
for a persistent or recurrent pneumothorax - what should be done
VATS (video assisted thoracoscopic surgery) +/- pleurodesis +/- bullectomy
42
if pneumothorax not recovering with a chest drain / lung not re-expanding, what should be done?
get opinion from surgeons
43
what artery can be disrupted in a scaphoid fracture
dorsal carpal branch of the radial artery
44
which season is croup most prominent in
AUTUMN
45
most important predictive factors of SAH
age, amount of blood seen on CT and consciousness
46
meningitis complications in the infant
1) most common - sensorineural hearing loss
2) epilepsy and ADHD
47
what does arterial pressure need to be to palpate a femoral pulse
>65mHg
48
what class of haemmorrhagic shock is of concern
III (lost 1500-2000ml of blood)
49
what does neurogenic shock occur after
spinal cord transection (interruption of ANS) --> decreased sympathetic tone or increased parasympathetic tone
50
what happens in neurogenic shock
there is marked peripheral vasodilation
51
what agent is useful for the induction of anaesthesia when the BP is already low
ketamine as it does not cause a drop inBP
52
how is serum osmolality estimated
2 Na + glucose + urea
53
most likely presenting feature of a PE
tachypnoea
54
if you have a low clinical suspicion of PE what can you do
PERC - pulmonary embolism rule out criteria
-all criteria must be ABSENT for this to be fulfilled, then the change of PE is less than 2%
-if it cannot be ruled out then do the 2 levels wells
55
how do you Ix for PE
CTPA - this is gold standard but cannot be done in allergies or poor renal impairment
-if this is negative it rules out PE but may consider doing a proximal leg US if suspicion of DVT remains
VQ mismatch
56
how does Progressive multifocal leukoencephalopathy (PML) present in HIV patients
hemiparesis, ataxia, visual disturbance
-Ix with MRI --> demyelinating lesions
57
Mx of cerebral toxoplasmosis (HIV)
-ring enhancing lesions and focal neurological deficits/headaches /seizures
sulfadiazine and pyrimethamine
58
what normally causes encephalitis in HIV patients
CMV
59
cause of meningitis in HIV
cryptococcus (fungus, meningitis symptoms, india ink stain)
60
what happens in neuroleptic malignant syndrome
pyrexia, autonomic lability (hypertension, tachyP and tachyC), agitation and rigidity
Ix --> raised CK, may have raised WCC and AKI
Mx --> stop drug, admit to medical wards, IV fluid to prevent AKI, dantrolene or bromocriptine
61
Tx of legionaires and mycoplasma
macrolide
62
symptoms of Addisonian crisis (occurs when the body in stress and cannot supply the adrenal hormones)
syncope, N+V, hyperkalaemia, hyponatraemia, hypoglycaemia, reduced consciousness, hypotension
O/E --> abdominal tenderness
63
Mx of addisonian crisis
IV hydrocortisone and 1L of 0.9% saline within first hour and other fluids administered over next 24 hours. Also check U+E.
64
what is the pathophysiology of ARDS
increased permeability of alveolar capillaries which causes increased fluid accumulation in the alveoli due to a NON CARDIAC cause.
Caused by sepsis, blood transfusion, pancreatitis and COVID.
65
Presentation of ARDS
dyspnoea, increased RR, bilateral lung crackles and low oxygen saturations
66
Ix for ARDS
CXR (bilateral pulmonary infiltrates)
67
How can a Dx of ARDS be made if unsure
pulmonary capillary wedge pressur must not be raised (to rule out a cardiac cause)
68
MX of ARDS
poor prog, ITU, O2 and ventilation, organ support, may do prone positioning and muscle relaxation, Tx underlying conditions
69
how do you Ix a diffuse axonal injury (acceleration or deceleration injury --> LOC, does not come back)
CT head may be normal so may need MRI
70
ECG signs of hypothermia
J wave / Osborne wave (after QRS, small upward deflection which looks a bit like an M)
bradycardia
prolongation of all the segments
71
why can you not rapidly rewarm someone with hypothermia
they get peripheral vasodilation and shock
72
apart from ECG, what other Ix do you do for hypothermia?
1) Hb and haematocrit --> may be elevated due to haematoconcentration
2) low platelets and WBVC due to sequestration in the spleen
3) electrolytes --> hypokalaemia as it moves into cells
3) temp --> using rectal or oesophageal probes
73
what happens in flail chest
normally in thoracic trauma, the chest wall disconnects from the thoracic cage due to multiple rib fractures so get abnormal chest motion and pulmonary contusion
74
when do you give a long acting carbohydrate in tx of hypoglycaemia
when glucose is >4
75
although staph aureus is the most common cause of septic arthritis, what should be considered in the sexually active patient
gonorrhoea
76
kocher criteria for septic arthritis
fever > 38.5
WCC > 12
ESR > 40
unable to weight bear
a score of 4/4 --> 99% chance of septic arthritis
77
Ix for septic arthritis
bloods (FBC, U+E, CRP, ESR)
blood cultures
joint arthrocentesis (MC+S and gram stain)
may do X-ray as a baseline/look at underlying joint disease
US for guidance of aspiration
78
MX of septic arthritis
empirical antibiotics and joint aspiration until all infectious fluid is out
79
complications of septic arthritis
joint destruction, osteomyelitis and sepsis
80
classification of a major haemorrhage
150ml/min
half blood volume in 3 hrs
total blood volume in 24 hrs
81
for upper GI haemorrhage, when do you consider discharge
when GBS is 0
82
Mx of upper GI bleed
A-E
2 wide bore cannulas
bloods - FBC, LFT, clotting, G+S and cross match
Correct any clotting abnormalities (PTC if on warfarin, FFP if others, platelets if <50)
Endoscopy in 24 hours
-no PPI given
-give terlipressin and abx if variceal
83
what does rockall sore look at
used after endoscopy to look at risk of rebleeding and death
84
whats a less common cause of a huge haematemesis
aorta-enteric fistula (post AAA surgery)
85
what is the definition of shock
insufficient tissue perfusion
lots of types
1) distributive
-anaphylactic
-septic
-TSS
2) cardiogenic
-failure of the pump
3) mechanical / obstructive
-tamponade
-massive PE
-tension pneumothorax
4) neurogenic
-spinal cord transection causes loss of sympathetic tone so get peripheral vasodilation
5) haemorrhagic
-hypovolaemic shock graded from 1-4
-where 1 is losing up to 15% blood volume and 4 is losing >40%
86
Initial Mx of shock
A-E
2 wide bore cannulas
fluid resus
monitoring
catheter to monitor output (aim >0.5ml/kg/hour)
-other Tx depends on cause of the shock
87
red flag features of sepsis
-recent chemo
-lactate over 2
-O2 requirement
-systolic < 90
-new onset altered mental state
88
symptoms of lymes disease
rash (erythema migrans, diameter of which is normally 15cm), headache, fever, arthlagia
89
if no rash present for lymes, what Ix do you do next
ELISA to borrelia burgdorferi
90
Tx of lymes
doxycycline
91
complications of lymes
cardiovascular - heart block and pericarditis
facial nerve palsy
Lyme arthritis
92
complication of lymes treatment
JArisch herxheimer reaction
93
definition of acute limb ischaemia
sudden decrease in arterial blood flow to a limb, irreversible tissue damage occurs in 6 hours
94
features of toxic shock syndrome (TSST-1 super antigen toxin from staph aureus)
fever>38.9, diffuse erythematous rash, desquamation, hypotension, altered mental state, 3 + organ systems involved
95
apart from tampons, what else can cause TSS
post op infection, cellulitis, burns
96
investigations for TSS
blood cultures, swab any wounds
97
Mx of TSS
remove infection focus, IV fluids, IV antibiotics, IVIG if refractory
98
main features of SCC
1) Back pain
2) weakness
3) sensory disturbance
4) UMN signs
99
an overdose of exogenous insulin would cause what
high insulin and not raised C peptide
(whereas gliclazide causes high insulin and high C peptide as gliclazide cause endogenous production of proinsulin which then gets broken down into insulin and C peptide)
100
under what indiction do you NOT give dex in meningitis
1) septic shock
2) rash
3) immunocomp
4) surgery
101
Abx for meningitis if
<3 m
>3m - 50y
>50y
< 3 months = cefotaxime and amoxicillin
3months - 50 years = cefotaxime
> 50 years = cefotaxime and amoxicillin
-if immediate hypersensitivity treat with chloramphenicol instead
102
warning signs in meningitis
rapidly progressive rash, poor peripheral perfusion, GCS < 12, poor response to fluid challenge
103
if DKA has not resolved in 24 hours, what should happen
review by senior endocardiologist
104
what happens in ALS when someone has acute hypothermia
only deliver 3 shocks, then just chest compressions until temperature is over 30 degrees as less effective when cold
-also withhold any drugs until patient is at 30 degrees
105
if simple analgesia is not working for rib fractures, what else can be used
nerve blocks
106
what scan is used In trauma to quickly assess for the presence of free fluid in the abdomen
FAST scans
(note also safe in pregnancy)
107
108
how do you always mx simple pneumothorax in trauma
chest drain
109
Ix for mediastinal transversing wounds
-CT angiogram
-oesophogeal contrast swallow
110
Mx of haemothorax
1) chest drain
2) if losing a lot of blood need to do a thoracotomy
111
what do a high riding prostate on PR suggest
urethral disruption
112
what causes a haemothorax
laceration or lung, intercostal or internal mammary vessel
113
what can cause death after a car crash very suddenly after initial;y appearing lucid
aortic disruption
114
what is pulmonary contusion
lung injury caused by blunt chest trauma --> blood and fluid accumulate which impairs gas exchange and then causes resp failure, need urgent intubation
115
what side are you more likely to get a diaphragmatic hernia and how does it present
left and get non visible diaphragm on xray and may have bowel / stomach loops in the hemithroax
116
firstline abx for COPD exacerbation
1) amoxicillin 2) clarithromycin (but remember this interacts with statin) 30 doxycycline
-also need to give SABA and ipratropoium NEBS
117
septic shock defined as
host not being able to compensate, not responding to fluid treatment, need ITU for consideration to vasopressors
118
what are the sepsis 6
GIVE 3
1) oxygen (if needed)
2) fluids
3) antibiotics
TAKE 3
1) urine output and observations --> may insert catheter
2) bloods and cultures
3) senior input
119
Tx of a cerebral abscess
craniotomy --> to deride the abscess
IV abx --> 3rd gen cephalopsporin and metronidazole
Dex for the pressure
