Other - A&E, Sexual health Flashcards
presentation of carbon monoxide poisoning
- headache
- dyspnoea
- coma
- convulsions
- death
management of carbon monoxide poisoning
- hyperbaric oxygen / 100% oxygen therapy
presentation of TCA overdose
- blurred vision, dry mouth, dilated pupils
- hypotension, tachycardia
- drowsy, seizures, tremors, muscle rigidity, agitation
- hyperthermia
- ventricular arrythmias
ECG changes in TCA overdose
prolonged QRS interval
tachycardia
ventricular arrythmias
investigations for TCA overdose
- ECG
- gas - metabolic acidosis, high lactate
- u&e
management of tCA overdose
- observe for 6 hours if asymptomatic
2.if <1 hour ingestion -> activated charcoal - IVF bolus
- IV sodium bicarbonate
presentation of salicylate (aspirin) overdose
MILD >125mg/kg
- tinnitus, deafness, dizziness, lethargy
MODERATE >250mg/kg
- sweating, restlessness, tachypnoea
SEVERE >500mg/kg
- pulmonary oedema, seizures, hyperpyrexia, coma, rhabdomyolysis
investigations for salicylate overdose
- gas - mixed resp alkalosis + metabolic acidosis
- plasma salicylate level - 2 hours after or 4 hours after in asymptomatic
management of salicylate overdose
- activated charcoal every 4 hours if present within 1 hour of ingestion
- observe
presentation of paracetamol overdose
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
investigations for paracetamol overdose
- paracetamol levels - at 4 hours or at presentation if staggered
- LFT
- gas
- clotting
- sugar
- u&e
management of paracetamol overdose
- 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 - activated charcoal if present within 1 hour and >150mg/kg
- liver transplant - PT best prognostic indicator
presentation of opioid overdose
- pin point pupils
- hypoventilation
- bradycardic, hypotension
- sedation
management of opioid overdose
- nalaxone - competitive antagonist of opioid receptor
presentation of benzodiazepine overdose
- ataxia
- slurred speech
- blurred vision, nystagmus
- hallucinations
management of benzodiazepine overdose
FLUMAZENIL - antagonist for benzodiazepine receptor site
causes of lead poisoning
- old paint
- mines
- glazed ceramics
- stored battery casings
- lead based gasoline
- cosmetics
presentation of lead poisoning
- nausea, vomiting, abdo pain
- headache, irritable
- seizures, encephalopathy, papilloedema
- interstitial nephritis, HTN
investigations for lead poisoning
- blood lead levels **
- FBC - microcytic , hypochromic anaemia
- blood film- basophilic strippling of RBCS
- XR - increased metaphyseal density in distal ulna and proximal fibula
management of lead poisoning
- penicillamine or DMSA or EDTA
- versenate (calcium disodium edetate)
type of reaction anaphylaxis
type 1 hypersensitivity reaction - IgE antibodies
presentation of anaphylaxis
- airway - angioedema of lips and tongue, swallowing difficulties
- breathing - SOB, wheeze, resp arrest
- CV - sweating, hypotension, tachycardia, dizziness
- skin - urticaria, abdo pain, flushing
management of anaphylaxis
- ABCDE
- IM adrenaline 1 in 1000 to anterolateral aspect of thigh and repeat after 5 mins
- mast cell tryptase levels check in 2-4 hours
dose of IM adrenaline in anaphylaxis
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)
Management of drowning
- ABCDE, high flow oxygen
- early intubation
- remove wet clothing and wrap in warm dry blankets
- warm with warmed IV fluids, overhead heaters and humidified gas (warm at 0.5 degrees per hour)
- 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
describe 1st degree burns
only epidermis
- skin red, dry
- blanching
- no blisters
describe 2nd degree burns
epidermis and dermis
- skin moist
- blisters
- very painful
- underlying skin mottled
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
management of burns
- laser doppler imaging - determines depth - yellow= 2nd degree/ blue = 3rd degree
- lung and browder charts- estimate burn BSA with rule of 9s
- cool for 20 mins, wash wound, fluid resuscitate and analgeisa
- wound dressings
- prophylactic abx
- pain relief - morphine
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
common pathogens to infect burns
- pseudeomonas
- s. pyogenes
- staph aureus
effects of solvent abuse (glue)
- distal renal tubular acidosis
- optic atrophy
- ceberebellar dysfunction
- polyneuropathy
presentation of chlamydia
- asymptomatic
- vaginal discharge
- post coital bleeding
- dyspareunia
- urethritis
complications of chlamydia
- PID
- reactive arthritis
- infertility
- ectopic pregnancy
- epididmyo-orchitis
diagnosis of chlamydia
NAAT (nucleic acid amplication test) via vulvo-vaginal swab or 1st catch urine
management of chlamydia
doxycycline
mechanism of action of doxycycline
binds to 30s subunit of bacterial ribosome
presentation of syphilis
PRIMARY
- chance (usually genitals)
- local immune response
SECONDARY
- rash
- mucus membranes lesions
- lymphadenopathy
TERTIARY
- aortitis
- neurosyphilis
- gummatous lesions
investigations for syphilis
VDRL titre - detects anti cardiolipin antibodies
high titre = active disease
management of syphilis
benzylpenicillin for 2 weeks
contacts - doxycycline
presentation of herpes simplex 2
genital ulcers or blisters for 1 month
inguinal lymphadenopathy
neuropathic pain
flu like illness
presentation of iron deficiency
- koilonychia
- microcytic anaemia - pallor, lethargy
- angular stomatitis
- breath holding spells
presentation of vit E deficiency
- neuropathy (ataxia_
- retinopathy
- hypereflexia
-malabsorption - offensive stools
bloods film of vit E deficiency
haemolytic anaemia
acanthocytes on blood film
vit B1 (thiamine) deficiency presentation
- peripheral neuritis
- soundless cry
- restless
- reduced tendon reflexes
- wernickes encephalopathy
presentation of vit A deficiency
- night blindness
- dry eyes
- corneal ulceration
- follicular hyperkeratosis
- increased infections
causes of B12 deficiency
- inadequate intake - vegans, breastfeeding
- malabsorption (in terminal ileum) - coeliac, nec, crohns, gastric surgery
- pernicious anaemia - autoimmune
presentation of vit B12 deficiency
- glossitis (beefy red tongue)
- failure to thrive
- peripheral neuropathy
- hypotonia
- seizures
investigations for vit B12 deficiency
- macrocytic anaemia (large neutrophils)
- reudced serum b12
- check for anti IF antibodies and anti parietal cell antibodies
presentation of vit C deficiency
- curly hair
- petechiae and bruising
- gingivitis
- impaired wound healing
folate deficiency presentation
- peripheral neuropathy
- anaemia
- confusion
- spina bifida in babies
presentation of zinc deficiency
- poor wound healing
- eczema, nappy rash -> acrodermatitis enteropathra
- oral ulcers
- chronic diarrhoea
- hair loss
features of arsenic poisoning (e.g. rodent pesticides)
- hyperkeratosis of hands
- mees lines on nails
- polyneuropathy
- GI symptoms
cause of toxic shock syndrome
staph aureus
strep pyogenes
presentation of toxic shock syndrome
high feer
hypotension
generalised erythematous rash “sunburn”
multi organ failure
management of toxic shock syndrome
- blood cultures ***
- clinical diagnosis
- IV antibiotics
- IV immunoglobulin
- wound debridement
causes of stephen johnsons syndrome
- drugs e.g. penicillin, carbamazepine cephalosporins sulphonamide
- infections - HSV, mycoplasma
- vaccinations
presentation of stephen johnson syndrome
- erythema multiforme
- mucosal involvement
- fever, malaise
- toxic epidermal necrolysis
management of steven johnson syndrome
- skin biopsy = keratinocyte necrosis in epidermal layer
- supportive
- ITU
causes of erythema multiforme
- infections e.g. HSV ** , mycoplasma
- drugs e.g. NSAIDs ,anti epileptics, penicillins
presentation of erythema multiforme
target lesions - dusky centre and bullous, start peripherally and spread centrally ,symmetrical, can be painful
NO mucosal involvement
causes of erythema nodosum
- drugs e.g. contraceptive pill penicillin
- infections e.g. TB, streptococcal sore throat **
- IBD (UC)
- behcets
presentation of erythema nodosum
painful red nodules on shins, bilateral
fever / malaise/ joint pain
new lesions for 3-6 weeks
types of epidermolysis bullosa
- JUNCTIONAL - blisters from birth, separation at lamina lucida
- DYSTROPHIC * - blisters at brith with widespread blistering, separation at dermal epidermal junction
- SIMPLEX - blisters when crawling (at site of friction), seaparation at basal cell layer
diagnosis of epidermolysis bullosa
- skin biopsy with immunofluoresnce mapping - confirms subtype
- genetic testing
presentation of staphylococcal scalded skin syndrome
- sandpaper red rash
- systemic involvement
(bullous impetigo - milder localised lesions of flaccid blister in a well child)
cause of eczema
mutations in filaggrin gene causing impaired skin barrier function and predisposes to infection
IL-17 and IL-22 involved
strength of steroid cream
mild = Hydrocortsione 1%
moderate Eumovate (0.05% clobetasone)
high = Betnovate
very high = Dermovate
complications of eczema
- lichenification
- post inflammatory pigmentary change
- bacterial infection - with staph aureus or group A strep
- eczema herpeticum
- herpes zoster ophthalmicus
cause of acne
- excess sebum production
- hyperkeratinization of pileosebaceous follicles
- accumulation of propionbacterium acne (gram +ve)
4.inflammation
side effects of isotretinoin
- teratogenic
- dryness
- increased photosensitivity
- depression
- MSK complaints
- increased cholesterol
conditions seen with cafe au lait spots
- neurofibromatosis
- mCcune albright
- russel silver
- tuberous sclerosis
- bloom syndrome
