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AKP > Other - A&E, Sexual health > Flashcards

Other - A&E, Sexual health Flashcards

1
Q

presentation of carbon monoxide poisoning

A
  • headache
  • dyspnoea
  • coma
  • convulsions
  • death
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2
Q

management of carbon monoxide poisoning

A
  1. hyperbaric oxygen / 100% oxygen therapy
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3
Q

presentation of TCA overdose

A
  • blurred vision, dry mouth, dilated pupils
  • hypotension, tachycardia
  • drowsy, seizures, tremors, muscle rigidity, agitation
  • hyperthermia
  • ventricular arrythmias
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4
Q

ECG changes in TCA overdose

A

prolonged QRS interval
tachycardia
ventricular arrythmias

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5
Q

investigations for TCA overdose

A
  1. ECG
  2. gas - metabolic acidosis, high lactate
  3. u&e
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6
Q

management of tCA overdose

A
  1. observe for 6 hours if asymptomatic
    2.if <1 hour ingestion -> activated charcoal
  2. IVF bolus
  3. IV sodium bicarbonate
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7
Q

presentation of salicylate (aspirin) overdose

A

MILD >125mg/kg
- tinnitus, deafness, dizziness, lethargy

MODERATE >250mg/kg
- sweating, restlessness, tachypnoea

SEVERE >500mg/kg
- pulmonary oedema, seizures, hyperpyrexia, coma, rhabdomyolysis

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8
Q

investigations for salicylate overdose

A
  1. gas - mixed resp alkalosis + metabolic acidosis
  2. plasma salicylate level - 2 hours after or 4 hours after in asymptomatic
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9
Q

management of salicylate overdose

A
  1. activated charcoal every 4 hours if present within 1 hour of ingestion
  2. observe
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10
Q

presentation of paracetamol overdose

A

serious toxicity if >150mg/kg (<6 y/o) + >75mg/kg (>6 y/o)

  • nausea, vomiting, abdo pain
  • hepatomegaly
  • hypoglycaemia
  • encephalopathy
  • acute liver failure 48-96 hours after
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11
Q

investigations for paracetamol overdose

A
  1. paracetamol levels - at 4 hours or at presentation if staggered
  2. LFT
  3. gas
  4. clotting
  5. sugar
  6. u&e
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12
Q

management of paracetamol overdose

A
  1. N-acteylcysteine (replaces glutathione stores) over 21 hours if paracetamol level over line at 4 hours
    - need repeat if ALT x2 upper normal or paracetamol >10 or INR >1.3 and ALT rising
  2. activated charcoal if present within 1 hour and >150mg/kg
  3. liver transplant - PT best prognostic indicator
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13
Q

presentation of opioid overdose

A
  • pin point pupils
  • hypoventilation
  • bradycardic, hypotension
  • sedation
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14
Q

management of opioid overdose

A
  1. nalaxone - competitive antagonist of opioid receptor
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15
Q

presentation of benzodiazepine overdose

A
  • ataxia
  • slurred speech
  • blurred vision, nystagmus
  • hallucinations
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16
Q

management of benzodiazepine overdose

A

FLUMAZENIL - antagonist for benzodiazepine receptor site

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17
Q

causes of lead poisoning

A
  • old paint
  • mines
  • glazed ceramics
  • stored battery casings
  • lead based gasoline
  • cosmetics
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18
Q

presentation of lead poisoning

A
  • nausea, vomiting, abdo pain
  • headache, irritable
  • seizures, encephalopathy, papilloedema
  • interstitial nephritis, HTN
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19
Q

investigations for lead poisoning

A
  1. blood lead levels **
  2. FBC - microcytic , hypochromic anaemia
  3. blood film- basophilic strippling of RBCS
  4. XR - increased metaphyseal density in distal ulna and proximal fibula
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20
Q

management of lead poisoning

A
  1. penicillamine or DMSA or EDTA
  2. versenate (calcium disodium edetate)
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21
Q

type of reaction anaphylaxis

A

type 1 hypersensitivity reaction - IgE antibodies

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22
Q

presentation of anaphylaxis

A
  1. airway - angioedema of lips and tongue, swallowing difficulties
  2. breathing - SOB, wheeze, resp arrest
  3. CV - sweating, hypotension, tachycardia, dizziness
  4. skin - urticaria, abdo pain, flushing
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23
Q

management of anaphylaxis

A
  1. ABCDE
  2. IM adrenaline 1 in 1000 to anterolateral aspect of thigh and repeat after 5 mins
  3. mast cell tryptase levels check in 2-4 hours
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24
Q

dose of IM adrenaline in anaphylaxis

A

ADRENALINE 1:1000
< 6 months - 0.1 ml
6 mo- 6 y/o - 150 micrograms
6 - 12 y/o - 300 micrograms (0.3ml)
> 12 y/o - 500 micrograms (0.5mls)

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25
Management of drowning
1. ABCDE, high flow oxygen 2. early intubation 3. remove wet clothing and wrap in warm dry blankets 4. warm with warmed IV fluids, overhead heaters and humidified gas (warm at 0.5 degrees per hour) 4. if hypothermia and need shock... <30 degrees: 3 x shocks until warm, no drygs 30-35 degrees: double dose of drugs, shocks until temp >32
26
describe 1st degree burns
only epidermis - skin red, dry - blanching - no blisters
27
describe 2nd degree burns
epidermis and dermis - skin moist - blisters - very painful - underlying skin mottled
28
describe 3rd degree burns
entire epidermis and dermis with fat / fascia/ bone/ muscle - no pain (loss of nerve endings) - no cap refill / no blanching - mixed discolouration
29
management of burns
1. laser doppler imaging - determines depth - yellow= 2nd degree/ blue = 3rd degree 2. lung and browder charts- estimate burn BSA with rule of 9s 3. cool for 20 mins, wash wound, fluid resuscitate and analgeisa 4. wound dressings 5. prophylactic abx 6. pain relief - morphine
30
which formula used for fluids in burns
PARKLAND FORMULA 4mls x weight (kg) x % BSA burnt 1/2 given over first 8 hours. 1/2 given over remaining 16 hours. on day 2, 50% of day 1 fluids given use normal saline
31
common pathogens to infect burns
- pseudeomonas - s. pyogenes - staph aureus
32
effects of solvent abuse (glue)
- distal renal tubular acidosis - optic atrophy - ceberebellar dysfunction - polyneuropathy
33
presentation of chlamydia
- asymptomatic - vaginal discharge - post coital bleeding - dyspareunia - urethritis
34
complications of chlamydia
1. PID 2. reactive arthritis 3. infertility 4. ectopic pregnancy 5. epididmyo-orchitis
34
diagnosis of chlamydia
NAAT (nucleic acid amplication test) via vulvo-vaginal swab or 1st catch urine
34
management of chlamydia
doxycycline
35
mechanism of action of doxycycline
binds to 30s subunit of bacterial ribosome
35
presentation of syphilis
PRIMARY - chance (usually genitals) - local immune response SECONDARY - rash - mucus membranes lesions - lymphadenopathy TERTIARY - aortitis - neurosyphilis - gummatous lesions
36
investigations for syphilis
VDRL titre - detects anti cardiolipin antibodies high titre = active disease
37
management of syphilis
benzylpenicillin for 2 weeks contacts - doxycycline
38
presentation of herpes simplex 2
genital ulcers or blisters for 1 month inguinal lymphadenopathy neuropathic pain flu like illness
39
presentation of iron deficiency
- koilonychia - microcytic anaemia - pallor, lethargy - angular stomatitis - breath holding spells
40
presentation of vit E deficiency
- neuropathy (ataxia_ - retinopathy - hypereflexia -malabsorption - offensive stools
41
bloods film of vit E deficiency
haemolytic anaemia acanthocytes on blood film
42
vit B1 (thiamine) deficiency presentation
- peripheral neuritis - soundless cry - restless - reduced tendon reflexes - wernickes encephalopathy
43
presentation of vit A deficiency
- night blindness - dry eyes - corneal ulceration - follicular hyperkeratosis - increased infections
44
causes of B12 deficiency
1. inadequate intake - vegans, breastfeeding 2. malabsorption (in terminal ileum) - coeliac, nec, crohns, gastric surgery 3. pernicious anaemia - autoimmune
45
presentation of vit B12 deficiency
- glossitis (beefy red tongue) - failure to thrive - peripheral neuropathy - hypotonia - seizures
46
investigations for vit B12 deficiency
1. macrocytic anaemia (large neutrophils) 2. reudced serum b12 3. check for anti IF antibodies and anti parietal cell antibodies
47
presentation of vit C deficiency
- curly hair - petechiae and bruising - gingivitis - impaired wound healing
48
folate deficiency presentation
- peripheral neuropathy - anaemia - confusion - spina bifida in babies
49
presentation of zinc deficiency
- poor wound healing - eczema, nappy rash -> acrodermatitis enteropathra - oral ulcers - chronic diarrhoea - hair loss
50
features of arsenic poisoning (e.g. rodent pesticides)
- hyperkeratosis of hands - mees lines on nails - polyneuropathy - GI symptoms
51
cause of toxic shock syndrome
staph aureus strep pyogenes
52
presentation of toxic shock syndrome
high feer hypotension generalised erythematous rash "sunburn" multi organ failure
53
management of toxic shock syndrome
1. blood cultures *** 2. clinical diagnosis 3. IV antibiotics 4. IV immunoglobulin 5. wound debridement
54
causes of stephen johnsons syndrome
1. drugs e.g. penicillin, carbamazepine cephalosporins sulphonamide 2. infections - HSV, mycoplasma 3. vaccinations
55
presentation of stephen johnson syndrome
1. erythema multiforme 2. mucosal involvement 3. fever, malaise 4. toxic epidermal necrolysis
56
management of steven johnson syndrome
1. skin biopsy = keratinocyte necrosis in epidermal layer 2. supportive 3. ITU
57
causes of erythema multiforme
1. infections e.g. HSV ** , mycoplasma 2. drugs e.g. NSAIDs ,anti epileptics, penicillins
58
presentation of erythema multiforme
target lesions - dusky centre and bullous, start peripherally and spread centrally ,symmetrical, can be painful NO mucosal involvement
59
causes of erythema nodosum
1. drugs e.g. contraceptive pill penicillin 2. infections e.g. TB, streptococcal sore throat ** 3. IBD (UC) 4. behcets
60
presentation of erythema nodosum
painful red nodules on shins, bilateral fever / malaise/ joint pain new lesions for 3-6 weeks
61
types of epidermolysis bullosa
1. JUNCTIONAL - blisters from birth, separation at lamina lucida 2. DYSTROPHIC * - blisters at brith with widespread blistering, separation at dermal epidermal junction 3. SIMPLEX - blisters when crawling (at site of friction), seaparation at basal cell layer
62
diagnosis of epidermolysis bullosa
1. skin biopsy with immunofluoresnce mapping - confirms subtype 2. genetic testing
63
presentation of staphylococcal scalded skin syndrome
1. sandpaper red rash 2. systemic involvement (bullous impetigo - milder localised lesions of flaccid blister in a well child)
64
cause of eczema
mutations in filaggrin gene causing impaired skin barrier function and predisposes to infection IL-17 and IL-22 involved
65
strength of steroid cream
mild = Hydrocortsione 1% moderate Eumovate (0.05% clobetasone) high = Betnovate very high = Dermovate
66
complications of eczema
1. lichenification 2. post inflammatory pigmentary change 3. bacterial infection - with staph aureus or group A strep 4. eczema herpeticum 5. herpes zoster ophthalmicus
67
cause of acne
1. excess sebum production 2. hyperkeratinization of pileosebaceous follicles 3. accumulation of propionbacterium acne (gram +ve) 4.inflammation
68
side effects of isotretinoin
- teratogenic - dryness - increased photosensitivity - depression - MSK complaints - increased cholesterol
69
conditions seen with cafe au lait spots
- neurofibromatosis - mCcune albright - russel silver - tuberous sclerosis - bloom syndrome

AKP (12 decks)

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