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Year 6 Cross Section > PACES 2 > Flashcards

PACES 2 Flashcards

1
Q

key management points to remember

A

MDT
conservative
medical surgical

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2
Q

key investigation points

A

bedside
bloods
imaging
special tests

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3
Q

what to remember in resp stations?

A

ABG

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4
Q

mx of AF

A
  • acute (48hr) and unstable = cardioversion
  • rhythm control (BB or CCB)
  • anticoag using CHA2DS2VASc (apixaban)
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5
Q

NSTEMI vs UA

A

NSTEMI = +ve trop
UA = -ve trop
(measure trop twice)

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6
Q

STEMI management

A

A-E
oxygen if needed
morphine and metoclopramide
aspirin 300 and clopi 300
GTN
if <12 hours = PCI (give heparin)
if not thrombolysis

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7
Q

NSTEMI management

A

A-E
oxygen if needed
morphine and metoclopramide
aspirin 300 and clopi 300
GTN
Fondaparinux
Calculate GRACE score

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8
Q

ongoing therapy in IHD

A

ACEi
BB
Cardiac rehab
statin
DAPT (aspirin lifelong and clopi for 1 year)

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9
Q

angina management

A

GTN + BB/CCB + statin
consider ACEi if DM/HTN and angina

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10
Q

HF investigation to remember

A

BNP

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11
Q

management of HF

A

ACEi
BB
Spironolactone
SGLT-2
add ons: hydralazine, entresto, CRT
weights, manage RFs

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12
Q

Severe pulmonary oedema management

A

A-E
Sit up and give oxygen
Morphine
Furosemide
GTN
CPAP

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13
Q

Management of AS

A

Optimise RFs (statins, anti-HTN, DM)
Regular F/U with echo
BB if angina
Valve replacement (severe symptoms, dec EF, undergoing CABG)
Unfit = valvuloplasty, TAVI

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14
Q

Management of AR

A

Optimise RFs
Regular F/U
Dec afterload = ACEi / CCB
Replace (if HF or reduced EF)

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15
Q

Management of MR

A

Optimise RFs
Monitor
Control AF and anticoagulants
Dec afterload (ACEi)
Diuretics if HF
Replace valve (symptoms, dec EF)

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16
Q

Pneumonia management

A

CURB-65
Antibiotics
Oxygen
Fluids
Analgesia
Chest physio
X-ray

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17
Q

Bronchiectasis investigations

A

CXR (tramlines)
Spirometry
HRCT chest (dilated airways)

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18
Q

Management of bronchiectasis

A

Chest physio
Antibiotics for exacerbation
Bronchodilators
Treat underlying cause
Surgery if localised disease

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19
Q

Management of CF

A

MDT
Chest: physio, antibiotics (acute and prophylaxis), mucolytics, bronchodilators, vaccinate
GI: Creon, ADEK supplements, insulin, ursodeoxychokic acid

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20
Q

Lung cancer management

A

MDT
Assess risk of operative mortality
Smoking cessation
NSCLC: surgery, radio, chemo
SCLC: palliative mostly, radiotherapy

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21
Q

Asthma investigations

A

FBC (eosinophillia)
Inc IgE
Aspergillosis serology
CXR
Spirometry
PEFR monitoring

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22
Q

Management of asthma

A

TAME
Drugs:
1. SABA
2. SABA +ICS
3. LABA + ICS
4. + LTRA
specialist help

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23
Q

Investigations for COPD

A

Bloods (inc FBC)
ABG
CXR
ECG
Spirometry
Echo (PHT)
Assess severity by FEV1

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24
Q

Management of COPD

A

General: stop smoking, pulmonary rehab, vaccinate (influenza, pneumococcal)
Optimise treatment for co-morbidities
Meds:
Non-asthmatic features: LABA+LAMA, add ICS if lots of exacerbations
Asthmatic features: LABA+ICS, LABA+LAMA+ICS
LTOT

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25
Q

Pulmonary fibrosis investigations

A

CXR and HRCT: reticulonodular shadowing, honeycombing

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26
Q

Pulmonary fibrosis management

A

Supportive
Stop smoking, rehab, oxygen therapy, palliative

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27
Q

Treatment of hyderaldosteroism

A

Bilateral adrenal hyperplasia = spironolactone
Adrenal adenoma (Conn’s) = lap adrenelectomy

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28
Q

Dyspepsia what to check

A

ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset progressive symptoms
Melaena or haematemesis
Swallowing difficulties

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29
Q

Dyspepsia management

A

Stop smoking
Stop NSAIDs
Avoid hot drinks and spicy food
OTC (antacids)
Lose weight

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30
Q

Upper GI bleeding

A
  1. Resus (fluids, oxygen, check coagulopathy)
  2. Terlipressin if variceal, prophylactic antibiotics
  3. Urgent endoscopy
  4. After endoscopy = IV omeprazole, NBM, daily bloods
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31
Q

Scoring systems for UGI bleed

A

Glasgow blatchford
Rockall

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32
Q

Cirrhosis investigations

A

Bloods (FBC: dec WCC, dec platelet, inc LFTs, inc INR, dec albumin)
Find cause

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33
Q

Cirrhosis management

A

General: good nutrition, ETOH absence, colesytramine
Screening: HCC= US +AFP, Varices = endoscopy
Treat specific cause
Treat decompensation (acute, coag, encephalopathy, SBP)
Child Pugh Grading

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34
Q

Alcoholic Hepatitis

A

Check CAGE
Stop ETOH, withdrawal, Pabrinex, optimise nutrition
Check LFT/U&E/INR, manage complications

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35
Q

NAFLD investigations

A

BMI, glucose, fasting lipids, LFTs, biopsy

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36
Q

NAFLD management

A

Lose weight,
Control HTN, DM, lipids

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37
Q

PBC/PSC

A

Symptomatic: priorities (colestramine), diarrhoea (codeine)
Specific: ADEK vitamins, ursodexoycholic acid

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38
Q

IBD extra-articular

A

Skin: clubbing, erythema nodosum
Eyes: arthritis
Joints: arthritis
HPB: PSC, gallstones

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39
Q

Chron’s pathology

A

Skip lesions
Rose thorn ulcers
Cobblestoning
String sign of kantor

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40
Q

Chronic pancreatitis management

A

Drugs: analgesia, CREON, ADEK vits, DM
Diet: no ETOH, dec fat, inc carb
Surgery: pancreatectomy

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41
Q

Criteria for AKI

A

RIFLE criteria

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42
Q

chronic renal failure management

A

general: reverse reversible causes, stop nephrotoxic drugs
lifestyle: exercise, healthy weight, stop smoking, fluid/phosphate retention
CV risk: statins, treat DM
HTN: target <140/90 (give ACEi)
Anaemia: EPO
Bone disease: phosphate binders

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43
Q

renal transplant complications

A

post-op: bleeding, graft thrombosis, infection
hyderacute rejection: ABO incompatibility
acute rejection (<6mo)
chronic rejection (>6mo): interstitial fibrosis
SEs of immunosuppression
CVD (HTN, atherosclerosis)

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44
Q

PCKD management

A

General: inc water, dec Na
monitor U&Es, BP
genetic counselling, MRA for berry aneurysms
medical: treat HTN and infections aggressively
surgical: cyst removal, nephrectomy

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45
Q

stroke management

A

urgent CT
aspirin 300mg
consider thrombolysis <4.5 hrs
consider thrombectomy

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46
Q

primary prevention of strokes

A
  • control RFs (HTN, inc lipids, DM, smokers)
  • consider lifelong and anti-coag in AF
  • carotid endarterectomy if symptoms 70% stenosis
  • exercise
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47
Q

secondary prevention of strokes

A
  • RF control = start statin after 48 hours
  • aspirin/clopi 300mg for 2 weeks, then clopi for 75mg
  • carotid endarterectomy if good recovery and ipsilateral stenosis >70%
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48
Q

stroke rehab

A
  • MDT (OT, physio, SALT, dietacian, neurologist)
  • eating (consider swallow)
  • neurorehan
  • DVT prophylaxis
  • sores
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49
Q

TIA management

A
  1. anti-plt therapy (300mg for 2 weeks, then 75mg/d)
  2. cardiac RF control
  3. specialist referral to TIA clinic (MRI)
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50
Q

subdural management

A

irrigation/evacuation via burr hole craniostomy

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51
Q

extradural management

A

neuroprotective ventilation
consider mannitol
craniectomy for clot evacuation

52
Q

GCS verbal

A

1: none
2: sounds
3: words
4: confused
5: orientated

53
Q

Parkinson’s management

A

MDT
Assess disability
Physio
Depression screening
Medical: L-DOPA, MOA-B inhibitors, Da agonists
+ COMT (lessen end of dose)
+ Quietapine (disease-induced psychosis)
+ Citalopram (depression)

54
Q

MS management

A

MDT
acute attack: methylpred
preventing relapse: IFN-beta, natalizumab
symptomatic management

55
Q

poor prognostic features of MS

A
  • older
  • male
  • motor signs at onset
  • many relapses
  • many MRI lesions
56
Q

Charcot-Marie Tooth investigations

A

PMP22 gene mutation
nerve conduction speed

57
Q

CMT management

A

supportive
physio, podiatry, orthoses

58
Q

MND management

A

MDT
Riluzole
Supportive: drooling (amitriptyline), dysphagia (NG feed), resp failure (NIV), spasticity (baclofen)

59
Q

OA management

A

cons: wt loss, alter activites, physio, walking aids
med: analgesia, joint injection
surg: replacement

60
Q

RA management

A

cons: rheum, regular exercise, PT, OT
med: monitor with DAS28, DMARDs, steroids, NSAID
manage CV risk

61
Q

conservative management of gout

A

lose weight
avoid prolonged fasting and ETOH excess

62
Q

osteoporosis investigations

A

DEXA scan
FRAX score

63
Q

management of osteoporosis

A

cons: stop smoking, dec ETOH, weight bearing, Ca/Vit D, falls prevention
med: bisphosphonates, supplements

64
Q

Pre-op checks

A

OP CHECS
Operative fitness (cardio resp co-morbidities)
Pills
Consent
History (conditions, complications of anaesthesia)
Ease of intubation
Clexane (DVT prophylaxis)
Site

65
Q

oesophageal Ca management

A

MDT
Surgical (25%): oesophagectomy (2 or 3 stage approach)
Palliative: stenting, analgesia, radiotherapy

66
Q

perforated peptic ulcer management

A
  1. Resus –> fluid
  2. NBM
  3. Analgesia
  4. Abx: cef and met
  5. NGT
    consider laparotomy if defect needs repairing
67
Q

biliary colic management

A

cons: hydrate, NBM, opioid analgesia
surg: lap chole (try for same admission)

68
Q

ascending cholangitis management

A

Cef + Met
ERCP

69
Q

pancreatitis management

A

cons: fluid resus, NBM, NGT, analgesia (opioid)
interventional: ERCP if dilated ducts secondary to gallstones

70
Q

chronic pancreatitis management

A
  • lifestyle: no ETOH, dec fat, increase carb
  • drugs: analgesia, CREON, ADEK, DM Rx
71
Q

appendicitis management

A

fluids, NBM
abx (cef and met)
analgesia
operation

72
Q

acute severe UC management

A

resus: IV hydration, NBM
hydrocortisone
LMWH
monitoring
improvement = switch to oral therapy

73
Q

what additional thing would you add to management in Chron’s?

A

dietician review

74
Q

mesenteric ischaemia management

A

fluids
Abx
LMWH
laparotomy

75
Q

anal cancer management

A
  • most chemoradiation
  • surgery reserved for tumours that fail to respond to radiotherapy/ GI obstruction/ small anal margin tumours
76
Q

definition of hernia

A

protrusion of a viscus through walls of its containing cavity into abdominal position

77
Q

inguinal hernia management

A

non-surgical: control RFs of cough, constipation, lose weight, truss
surgical: tension free mesh

78
Q

complications of hernia repair

A

early = haematoma, infection, intra-abdo injury
late = recurrence, chronic groin pain

79
Q

general aspects of breast Ca management

A

MDT
1-2 = surgical
3-4 = chemo, palliation

80
Q

surgical management of breast Ca

A

WLE + radiotherapy or mastectomy
sentinal node biopsy +/- axillary clearance

81
Q

breast cancer surgical complications

A

haemotoma
frozen shoulder
long thoracic nerve palsy
lymphodema

82
Q

systemic breast cancer management

A

radio
chemo
endocrine therapy
biological therapy

83
Q

main sx and management of duct papilloma

A

bloody discharge
excise

84
Q

management of phyllodes

A

WLE

85
Q

claudication values of ABPI

A

0.6-0.8

86
Q

fontaine classification

A

asymp
intermittent claudication
ischaemic rest pain
ulceration/gangrene

87
Q

chronic limb ischaemia management

A

cons: inc exercise, stop smoking, wt loss, foot care
med: RFs (BP, lipids, DM), anti-plt, analgesia
surg: bypass, endarterectomy

88
Q

acute limb ischaemia management

A

NBM
rehydration
analgesia
unfractionated heparin
complete occlusion: yes (embolectomy/bypass), no (angiogram and observe)

89
Q

venous ulcer management

A
  • refer to leg ulcer communtiy clinic
  • optimise RFs (nutrition, smoking)
  • analgesia
  • 4 layer graded bandaging (if ABPI >0.8)
90
Q

4 R’s of fracture management

A
  1. Resus (ATLS, neurovasc, X-rays)
  2. Reduce (closed vs open reduction)
  3. Restrict (non-rigid, plaster, ex-fix, internal fixation)
  4. Rehab (OT, PT)
91
Q

fracture complications

A

Imm: NV damage, visceral damage
Early: compartment syndrome, infection, fat embolism
Late: AVN, problems with union, complex regional pain syndrome

92
Q

Hip fracture appearance

A

short, externally rotated

93
Q

Garden classification of intracapsular fractures

A
  1. incomplete, undisplaced
  2. complete, undisplaced
  3. complete, partially displaced
  4. complete, completely displaced
94
Q

management of 1 and 2

A

ORIF with cannulated screws

95
Q

management of 3 and 4

A

young = ORIF with screws
55-75 = THR
>75 = hemi

96
Q

OA management

A

MDT
cons: lifestyle, dec wt, inc exercise
physio for muscle strengthening and OT
med: analgesia, joint injection
surg: arthroscopic washout, replacement

97
Q

L5 nerve root compression

A

foot drop
weak inversion
dec sensation on inner dorsum

98
Q

S1 root compression

A

weak plantarflexion and eversion
loss of ankle jerk
dec sensation over sole of foot and back of calf

99
Q

management of Dupuytren’s

A

cons: physical exercises
fasciectomy

100
Q

stoma exam findings

A

exam standing up
patient = well, no acute abdo
abdomen = scar from stoma formation operation
stoma = site, surrounding skin, opening, contents, pt coughs
palpate = abdo around stoma

101
Q

definition of a stoma

A

artificial conduit between internal viscera and outside of skin

102
Q

indications of end colostomy

A

AP resection
Hartmann’s

103
Q

indications of loop colostomy

A
  • divert faecal load from newly formed distal anastomosis
  • palliative in Ca patient with distal obstruction
  • bowel decompression
104
Q

indications of loop ileostomy

A
  • anterior resection (bowel rest before reversed)
  • following panprotocolectomy who have ileo-anal pouch formed
105
Q

indications of end ileostomy

A

following panprotocolectomy when can’t anastomose

106
Q

complications of stoma

A

early: surg complication, ischaemia, high output, stomal retraction
late: parastomal hernias, prolapse, obstruction due to adhesion

107
Q

indications for stoma

A
  • exteriorisation
  • diversion
  • decompression
  • feeding
  • lavage
108
Q

any acute station

A

A-E approach

109
Q

acute abdo key investigation

A

amylase

110
Q

important questions in endo history

A
  • menstrual cycle
  • headache and vision
  • muscle weakness
  • weight changes
  • urinary symptoms
  • sweaty/hypoglycaemia symptoms
  • blood pressure
  • libido
111
Q

important screening questions

A
  • headache
  • changes to vision
  • SOB
  • nausea/vomiting
  • chest pain
  • palpitations
  • abdo pain
  • change in bowel habit
  • change in urinary symptoms
  • back pain
  • leg swelling
  • leg weakness
  • any change in sensation
  • FLAWS
    ( rashes)
112
Q

what to give in any chronic lung condition

A
  • vaccinations
  • chest physio
113
Q

c spine exam

A
  • look
  • feel (trapezius, C7 up to C2) - put hand on pt forehead
  • move (left to right, up and down, side to side)
  • special test (Spurling = extend neck, tilt to one side, push down)
  • neuro (power, tone, sensation, reflexes)
114
Q

breast screening

A

50-71 every 3 years

115
Q

common breast mets

A

liver
lung
brain
bones

116
Q

bowel screening

A

60-74 every 2 years

117
Q

what to do in vascular ?

A

radial femoral delay

118
Q

views of CT scan

A

axial
coronal

119
Q

extra bits of hand exam

A

hands on table - Duputyrens
Finklestein test

120
Q

appearance of blood and oedema in CT scan

A
  • blood is high attenuation
  • associated oedema is low attenuation
  • check mass effect
121
Q

location of descending aorta on scan?

A

more towards the back

122
Q

look part of spinal exam

A
  • gait
  • inspect from behind and side
123
Q

feel part of spinal exam

A
  • spinous processes and sacroiliac joints
  • paraspinal muscles
  • also schober’s test
124
Q

move part of spinal exam

A
  • lateral flexion (arm down leg)
  • lumbar flexion and extension
  • cervical spine movements
  • thoracic rotation
125
Q

special tests in spine

A
  • Schober’s test
  • femoral nerve stretch test (pt prone, passively flex knee and extend hip)
  • straight leg raise (pt supine, lift leg to full flexion then passively dorsiflex foot)

Year 6 Cross Section (23 decks)

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