Others Flashcards
fragility fracture?
fracture as a result of normal activity: from falls within the height of the body
INR
- Normal range?
- Target therapeutic range
- Suitable for surgery
- worrying
- 1.1 or less
- 2-3
- <1.5
- > 10
Warfarin
- How to reverse?
- how quickly reverses?
- What can be done in mean time if quick reduction of INR is needed?
- Vit K (IV or oral)
- takes 6 hours
- Give berryplex solution (includes clotting factors 2,7,9,10) to replace blockade of clotting factors by warfarin
Thrills vs heaves?
thrills: palpable murmer
heave: abnormal movement of ventricular wall
Causes of finger clubbing?
C.L.U.B.B.I.N.G,,,,, L has an extension of A.B.C.D.E.F
Cyanotic heart disease Lung disease - Abscess - Bronchiectasis - Cystic Fibrosis - Dont say COPD - Empyema - Fibrosis Ulcerative Collitis + Inflammatory Bowel Disease(Crohn's Disease) Biliarty cirrhosis Birth Defects Infective Endocarditis Neoplasm (eg. Lung cancer or mesothelioma) Gastrointestinal malabsorption syndrome(Coeliac disease)
4 basic non-imaging investigations?
- FBC
- Urea and electrolytes
- Liver function test
- Clotting screen
4 things in FBC test?
Normal range?
1. Haemoglobin (Hb) M: 130-175 g/L F: 115-160 g/L 2. Mean cell volume 80-98 fL 3. White cell count 4-11 - Neutrophilia: infection - Neutropenia: malignancy, chemotherapy - Lymphcytosis: malignancy 4. Platelets >150
5 things in Urea & electrolytes test?
- Creatinine
- 60-120
- produced in muscle at constant rate - eGFR
- normal > 90
- if muscle mass stays constant, changes in creatinine is reflected by changes in eGFR
- In patients with low muscle mass, creatinine may not be abnormal until eGFR is reduced by 50% - Urea
- 2.5-6.5 - Sodium
- 135-145 mmol/L - Potassium
- 5-5 mmol/L
4 things in Liver function test?
- Bilirubin
- raised in liver diseases, haemolysis - Alkaline phosphatase
- raised in chronic lung disease, metabolic bone disease, fracture - Alanine aminotransferase
- raised in hepatocellular damage - Albumin
- reduced in malnutrition, lung disease, acute inflam response
Proteins produced by liver in acute phase response to cell injury/inflammation?
- CRP
- Fibrinogen- wound healing
- antitrypsin- controls inflam cascade
- iron binding proteins (ferritin)- decrease iron available for uptake by bacteria
Synovial fluid
Normal vs inflammation (volume, cells, viscosity and colour)
Investigations
- small vs increased volume
- few vs increased cells/neutrophils
- high vs low viscosity (due to enzyme breakdown)
- colourless/pale yellow vs coloured
- microscopy and culture? gram stain to find presence of bacteria (takes an hour) culture to identify the type present
- look for crystals
Sensitivity vs Specificity?
Sensitive:
- true positive rate
- ability to detect people who have the disease
Specific:
- true negative rate
- ability to identify people who do not have the disease
Lupus antibodies?
ANA (anti nuclear) and anti-dsDNA
Vasculitis antibody?
ANCA (anti neutrophil cytoplasmic)
C-ANCA: Wegner’s granulomatosis
P-ANCA: micorscopic pilyangitis and churg-strauss vasculitis
WHO ladder of analgesia
Mild pain
- NSAIDS (ibuprofen, diclofenac, naproxene)
- paracetamol
Moderate pain:
- Weak opioids (eg codeine, tramadol)
- NSAIDS (ibuprofen, diclofenac, naproxene)
- paracetamol
Severe pain
- strong opioids (eg morphine)
- NSAIDS (ibuprofen, diclofenac, naproxene)
- paracetamol
