Part 1 Flashcards
A pneumothorax is termed secondary is a patient is over _ _ years old or has history of significant _ _ _ _ _ _ _ or _ _ _ _ _ _ _ _ _ _ _ .
A pneumothorax is termed secondary is a patient is over 50 years old or has history of significant smoking or lung disease.
Hide answers
Back
Patients with a primary pneumothorax below _ cm, in the absence of symptoms, can be managed with _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . Pneumothoraxes over _ cm should be _ _ _ _ _ _ _ _ _ and if this is unsuccessful, a _ _ _ _ _ _ _ _ _ _ inserted
Patients with a primary pneumothorax below 2cm, in the absence of symptoms, can be managed with outpatient follow up. Pneumothoraxes over 2cm should be aspirated and if this is unsuccessful, a chest drain inserted
Secondary pneumothorax between 1-2 cm can be _ _ _ _ _ _ _ _ _ and _ _ _ _ _ _ _ _ . A pneumothorax over _ cm should be managed with a _ _ _ _ _ _ _ _ _ _ .
Secondary pneumothorax between 1-2 cm can be aspirated and observed. A pneumothorax over 2cm should be managed with a chest drain.
Hide answers
Back
Avascular necrosis
Vascular supply to end of bone is disrupted - leading to sseous cell death
RF for avascular necrosis
Bone fractures
Joint Dislocations
Excess Alcohol Consumption
High-dose Steroids
bisphospnate use
Radiation therapy
chemotherapy
Management
Conservative: rest+physio
Medical: NSAID
Surgery:
Core Compression surgery
Arthroplatsy (older, immobile patients)
Chronic Kidney Disease (CKD) is defined as evidence of kidney damage (eg urinary abnormality such as _ _ _ _ _ _ _ _ _ _ or _ _ _ _ _ _ _ _ _ _ _ or abnormal structure of the kidney) or estimated glomerular filtration rate (eGFR) < _ _ ml/min for at least _ months.
Chronic Kidney Disease (CKD) is defined as evidence of kidney damage (eg urinary abnormality such as haematuria or proteinuria or abnormal structure of the kidney) or estimated glomerular filtration rate (eGFR) < 60 ml/min for at least 3 months
End stage renal disease (ESRD) is defined as eGFR < _ _ ml/min/1.72 m2, or need for _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ or dialysis
End stage renal disease (ESRD) is defined as eGFR < 15 ml/min/1.72 m2, or need for renal replacement therapy or dialysis.
Hypertension control can slow the progression towards ESRD, and _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ are indicated first line because for their effects on the RAA system.
Hypertension control can slow the progression towards ESRD, and angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are indicated first line because for their effects on the RAA system
Anaemia of CKD usually appears when GFR < 45 ml/min. The major cause is the lack of endogenous _ _ _ _ _ _ _ _ _ _ _ _ _ _ secretion by the damaged kidneys
Anaemia of CKD usually appears when GFR < 45 ml/min. The major cause is the lack of endogenous erythropoietin secretion by the damaged kidneys
What next test in
skin photosensitivity + small joint polyathritis + renal vasculitis + Creatinine abnormal + haematuria + proteinuria
Lupus nephritis - Renal biopsy
Mysophobia
Fear of germs
Acromegaly test
igf-1
DVT Investigations
- D-dimer
- Doppler USS
- Wells score
- CT VENOGRAM
-high risk of DVT no contraindication - anticoagulate
- +ve doppler - anticoagulate regardless of risk
- -ve doppler but high probablilly -» repeat doppler in one week
Management of DVT
Anticoagulation
- LMWH
subcut injection no monitoring needed - Unfractionated Heparin (monitoring +IV + given where quick reversal may be needed)
- DOAC
(oral +no monitoring)
Urgent endovascular catheter-directed thrombolysis (alteplase) within 2 weeks of symotom onset
Long term management of DVT
Provoked - 3 months anticoagulation
Unprovoked -6 months of anticoagulation
Recurrent unprovoked - lifelong
Post Thrombotic Syndrome
Chronic venous stasis in the affected limb
pain, venous dilatation, oedema, pigmentation, venous ulceration
vilalta score
leg evlevation, exercise, compression stockings, skin care stent
DVT presentation
Unilateral leg swelling and pain
Tenderness
Skin colour changes
Vein distension
What infection are patients with complement deficiency more susceptible to?
Neisseria
Seizure
A transient occurence of signs and symptoms due to abnormal excessive or synchronous neuronal activty in the brain
Causes of isolated seizure
Toxic
Metabolic
Structural
Infectious
Focal Seizures
Originate in networks limited to one hemisphere and may be localized or more widely distributed
Divided into:
1. Retained Awareness
2. Imparied Awareness
Generalised Seizure
Originate in bilaterally distributed networks
- Motor
- Non-motor (absence seizure)
Tonic-clonic seizure
- no warning signs may be noted
- loss of consciousness is present
- Brief tonic phase followed by clonic movements after falling to the ground
- Tongue biting
-post-ictal confusion
Absence seizure
- children
- sudden, brief lapses of consciousness without loss of postural control
- subte motor signs (blinking or chewing)
- EEG: abrupt, generalised, symmetric spike and slow-wave discharge superimposed on a normal EEG background
Focal Aware Seizure
Consciousness in tact
Symptoms begin in a very restiricted region like fingers and over seconds to minutes include larger portions of extremities (Jacksonian March)
Can develop into generalised tonic-clonic seizures
EEG: local discharge starting over the corresponding cortical area
Focal impaired awareness seizure
Medial temporal focurs
Impaired or loss consciousness
Auro precedes seizure (strong smell, a sense of deja vu)
Automatism is often present (chewing, picking movements, etc.)
Post-ictal confusion
Delirium Tremens
Begins 24-48 hours after stoppoing drinking
Symptoms include:
- Visual Hallucinations
- Delirium
- Deluision
- Coarse Tremor
- Seizures
- Tachy, hypertensive, sweating
- Dehydration/electrolyte disturbance
Wernickes Encephalopathy
- Acute encephalopathy secondary to thiamine deficiency
- reversible + acute
Symptoms: Confusion, Ataxia, Ophatlmoplegia
Korsakoff
Progression from wernicke with confabulation, cognitive deficit, and psychois (amnesia)
- irreversible + chronic
Stroke/ Cerebrovascular accident
Sudden interruption of blood supply to the brain , leading to rapidly developing focal or global neurological disturbance which lasts more than 24 hours
2 causes - cerebral infarct and cerebal haemorrhage
- Cerebral Infarction
- 85% of strokes - Haemorragic stroke
A. Within brain - intracerebral haemoragic stroke (10%)
B. Subarachnoid haemorrage
Transient Ischaemic Attack (TIA)
Transient neurological deficit caused by focal cerebral infarction without evidence of changes on CT
Less than 24 hours
Ischaemic Stroke
- Thrombotic stroke - most common seen in atherosclerosis
- Embolic stroke - seen in patients with AF, valvular defects, and endocarditis
Haemorragic stroke
Intracranial haemorrhages - most common in people with uncontrolled hypertension
Subarachnoid haemorrages - occur in AV malformations, Berry aneurysms (PKD), cerebral angiomas
Tests to do if transfusion reaction suspected
FBC
Blood film
LDH
Reticulocyte count
Bilirubin
Renal function
Coagulation
Crosmmatch and direct antiglobulin test
Blood cultures
Facial flushing treatment
alpha-2 receptor agonist like brimonidine topical
Where is CSF reabsorbed
Arachnoid granulations
Most common heart defects seen in trisomy 21
Atroventricular septal defect
Carcinoid syndrome
facial flushing
palpitations
diarrhoa
First line agent for >55 who do not have type 2 DM + in afro-carribeans of any age
Calcium channel blockers
