PACES Flashcards
Types of suture and uses
Absorbable- vacryl MCP- used got rapidly healing- urology or small bowel
Mono- monocryl, catgut, PDS
Non
Prolene SEE
Braided- Silk, ethibond
Mono- Ethilon (Skin), proline (bowel and vascular)
CI of epidural
Raised ICP
Hypovovlaemia
Infection at site
Coag problems
Types of catheter material
Silastic- 3 three weeks
Latex- week – irritates, uti, collapse
What must you not forget in each station
ISOLATE JOINT, FEEL SAME BOTH SIDES
Upper- pronator
Lower- gait
CN- accommodation , ANY DOUBLE VISION OR PAIN
Cardio- FEEL CAROTIDS delay and carotids
Resp- neck and cross arms
Hip- measure and gait
Knee- stand and effusion
Hand- wrist
Vascular-ULCER!!! burgers, auscultate!
Breast- cervical?
What to offer in cardio exam
History
Obs
Vascular, resp
Urine
Fundoscopy
ECG
ABG
CXR
Echo
Complete resp exam
History
Obs
Peak flow
Spirometry
Sputum
CXR
ABG
ECG
Complete CN examination
History
Obs
Nerve- upper and lower
Fundoscopy
Neuroimaging
Hearing assessment
Complete breast exam
History
Obs
Assess lymph nodes
Cervical spine
Resp exam
Triple
Biopsy
mammography
Clinical
Complete abdominal exam
History
Obs
Hernial orifices?
DRE?
Urine dip
Genitalia
Examine- stoma ect in more detail
Complete musk station
History
Obs
Examine other joints- above and below
X rays
Neurovascular
Complete wrist exam
History
Obs
Examine other joints
Neurovacualr
X ray
FBC, CRP, UE, CCP, RHF
Complete vascular exam
History
Obs
CV exam, vascular
ABPI
Neuro
Presenting abdo x ray
Supine AP x ray of x patient on this date
Good quality film with adequate exposure
Bowel - lead pixie, loss of haustra- UC
Bones - sclerosis- mets
Calcification - aorta, renal
Present chest X ray
Patient
AP/PA date
Rotation- clavicles
Inspiration and penetration
Airway
Lung fields
Cardio - within normal limits, borders are visible
Diaphragm- costophrenic angles
E- bony pathologies, pacemakers
What would you investigate in PKD
USS
CT
Renal function
Calcium
FBC- anaemia
CT head
Echo- mitral prolapse
Mx of PKD
Education
BP- ACEi
Nephrotoxic drugs
RRT
Screen
Chr 16
What should you assess with suspected renal transplant
Old Fistula/scars- neck scar, no thrill or needle marks
Fluid status
SE from meds
Check- it is working
Renal function
FBC- anaemia
Ca
Volume
ABG
Opportunistic infections- CMV, PCP
Causes of hornets and 3rd nerve palsy
Horners
Central
Pre- rib, pancooast
Post - courted artery, cavernous sinus thrombosis
3rd- dilated
Medical - diabetes, vasculitis, GCA
Surgical- Post comm aneurysm
Causes of facial weakness
Stroke
Tumour
Ramsay
Bells
Vasculitis
Myotonic dystrophy exam
Facial weakness
Dysarthria
tongue weakness
Weak neck
Weak distally
Signs and causes of foot drop
Sciatic nerve- hip surgery, truma, tumour
Common perineal - trauma, knee surgery, DM, tumours
L5 radiculopathy
CPN- fibula head - inversion intact
L5- lateral aspect - ankle reflex
Scaitic - causes weak inversion, eversion, hip abduction
Cause and signs of proximal weakness
Endo- Cushing, hypo, acromegaly
Inflammatory- poly, sclerosis
Drug- statins
Congenital- Duchenne, beckers
When to surgically manage AR
symptomatic, pulse pressure >100, ECG TWI lateral, LV failure <50%
Surgically manage aortic stenosis
pressure gradient >40, valve are <1cm2
TAVI – no bypass needed, no large scar, higher risk of stroke
Questions to syncope
Cardiac- palps, siting
Neuro - epilespy stroke- wet yourself, bite tongue, confused - sensation, power- secondary to DM autonomic
Resp
VV- dehydrated - light headed, nauseous
Drugs
Palpitation causes and history
Cardiac- AF, SVT, WPW, ectopics
Resp- PE
Endo- hyperthyroid, hypoglycaemia, phaeo
Drugs
Anxiety
Fainting, pain, SOB, heart conditions
PE RF
Hot, tremor, DM
SOB questions
Cardiac
Resp- fever, FLAWS, occupation, hands tight skin, swallowing, ulcers
Anaemia - blood loss- stool, periods
Neuro- weakness
DKA
FLuid- liver, nephrotic, renal - any swellng
Gynaecomastia ques
Abdo- liver
Test- headaches, lump, sense of smell,
Drug
Abdo pain ques
Hepato- Yellow
Pain urine
Pale stools
Dark urine
Acute- ischaemia- pain worse with eating
Palpitations
joint pain
Menstrual period
DKA
Dysphagia
Cancer
Achalasia
PV- tiredness
Weakness
Tight skin
Pain- infection
Weight loss causes
Cancer- FLAWS
Infection
Pain eating
Endo- hyper
Malabsorption
Ask about bowels
Bruising questions
AC
Fam
Swollen joints
Excessive bleeding
Drugs
Cushings
Polyarthritis
Septic- infection, fever
RhA- extra features
Gout
Sclerosis- tight skin
Psoriatic- patches
Reactive- infections recent- sexual
AS- pain in back, eyes, heel
Headaches questions
Inflammatory - eye
Vascular- confusion, weakness, sensation
Infectious- must ask meningitis
ICP - mornings
Hyperviscosity - clots
Cancer - FLAWS
Visual loss
Flashes, floaters
RF - coagulation, daibetes- haemorrhage
Curtain coming down
Painful- MS - weakness
Infectious- wear contact lenses, swimming
Medications
GCA- headaches, pain in shoulders
Gradual
Halos - age, DM, steroids
Central or peripheral- central ARDM, peripheral chronic glaucoma
ARDM- line, night time
Diff of hyperthyroid and hypo
Cancer
Infection - goitre tender
Adenoma
Graves- shins, eyes
Hypo
Surgery
Drugs- cardiac
Iodine
TB
Hashimotos- other AI conditions
Cushing questions and diff
Changes in weight face
Striae
Steroids
eye sight
Bruises
Weakness
sob
Ix- cortisol, overnight suppression
DEXA
Acromegaly questions
Changes to appearance
Sight
Heachaes
Sweating
Joint pain
DM- polyuria, polydipsia
Prolactin- periods, ED
Snoring
Check Hba1c
ECG
Hormone screen
Reasons for lobectomy/pneumectomy
Localised BE
Uncontrolled haem
Early NSC
Abcess
COPD reduction
CF
Use of syringe
Flush equipment
Inflate
How to use tracheostomy
cricothyrotomy
Guide wire
Dilator
Inflate
Order of Venturi mask
Blue - 24
White -28
Yellow - 35
Red - 40
Green -60
How to use nebuliser
Used to deliver liquid by inhalation
Pour into cup and attach touting
Turn on machine- breath normally
Infection if it isn’t cleaned
How to use non rebreather mask
Oxygen tube at level
Allow bag to fill by putting thumb on port before putting around face
How to use self inflating bag valve
Used in those with resp failure
Apnea
Undergoing anaesthesia
Sniff air
Mouth- jaw thrust
Seal over
Press bag
Central line pack uses
Use USS
Local
Needle
Inscision
used for irritant meds
Paraenteral nutrition
Long term treatment
Haemodylasis
Use of epidural
Pain relief- labour, abdominal surgery, Chronic pain
Insert needle - syringe
Nemove needle
Aspirate- no CSF Or blood
plastic tubing- medication
Use of Seldinger
Pneumothorax
Effusion- malgnant
Empyema
Haemothorax- trauma
Complcations- perforation
Fistula
Infection
How to use proctoscopy/sigmoid/lap port
Left lateral
DRE
Inflate with air
Colorectal cancer screen
Lap port- incision- CO2- insert port
How to use PICC line
IV therapy for extended use
PN, medications, Chemo, long term blood sampling
Remains for 2-6 weeks
Lower motor neurone differentials
GBS
Fredrichs ataxia
B12
MND
Muscle- myopathy- Cushing, acromegaly, hypothyroid
Polymyositis
Sclerosis
Duchennes, Beckers, statins
MG
Diabetes history
Polyuria, dipsa
Eye, neurone
Chest pain
Ulcers
Feet
Glucose well controlled
Other meds
