Part B 05 Flashcards
Chancroid
Pathogen
Haemophilus ducreyi
Chancroid
Sx
Painful ulcers
“Kissing ulcers” (labia)
Painful lymphadenopathy
> abscesses (buboes)
Chancroid
Tx
Azithromycin PO 1g once only
Or
IM ceftriaxone
Chicken pox and pregnancy
Complication
Foetal varicella syndrome
1%
Foetal varicella syndrome
Sx
Eye defects
Limb hypoplasia
Skin scar
Neuro abnormality
Ix
Chicken pox exposure during pregnancy with unknown immunity
Test mother VZV Ig
If Neg give VZV Ig
Effective up to 10d post exposure
Chickenpox complications in adults
Pneumonia
Encephalitis
Hepatitis
Mother contracted chicken pox during pregnancy
Tx
> 20/40 consider aciclovir
<20/40 caution
Genital warts
Pathogen
HPV 6+11
Uterine rupture
RF
Multiparity Previous c section Previous uterine surgery Dysfunctional labour Augmented labour
Eclampsia
Pathology
Due to cerebral edema
Eclampsia
Tx
IV mg sulphate 4g IV
Delivery of foetus and placenta
Monitoring required during entonox
Pulse oximetry
Mod, deep and dissociative sedation
Location
Resus only
Mod, deep and dissociative sedation
Staff requirements
Doctor sedation
Doctor or ENP operator
Nurse
Mod, deep and dissociative sedation
Monitoring
ECG
nIBP
Pulse ox
Capnography
Propofol
Induction dose
2mg/kg
Propofol
Maintenance dose
4-12mg/kg/h
Propofol
SE
Pain on injection Drops BP Negative inotrope Decreases CO by ~25% Transient apnea Coughing
Panda eyes
Aka
Peri orbital ecchymosis
Neck immobilisation airway manoeuvres
Jaw thrust
Chin lift
Oxygen cylinders
C - 170L D CD - 460L E F - 1300L HX
RF
testicular torsion
Bell clapper deformity Previous torsion fHx Large testicular size Testicular tumour Trauma
Surgical correction
Testicular torsion
Saves x % testis
90%
Causes of bowel obstruction
Malignancy Hernia Adhesions Volvulus Diverticulitis IBD Constipation/impaction
Malignant HTN
Aka
Accelerated HTN
Malignant HTN
Define
BP>220/120
+
End organ damage
Malignant HTN
Comp
P edema Encephalopathy Angiopathic haemolytic anaemia Pappiloedema Eclampsia Nephropathy
Addison’s ds
Biochemical changes
Low Na, glu
High K, Ca
Metabolic acidosis
Thyroid storm
Aka
Thyrotoxic crisis
Gentamicin
Comp
Renal tubular acidosis
Damage to vehicular apparatus in inner ear
Malignant HTN
Signs
Focal neuro deficit Pappiloedema Ankle edema Pallor Encephalopathy 3rd HS
Warfarin
Action
Inhibits Vit K dependent clotting factors
2,7,9,10 and protein C/S
Major bleed on warfarin
Tx
5-10mg Vit K IV
+- PCC (F2,7,9,10)
Or FFP
INR>8 and minor bleed
Tx
Stop warfarin
1mg Vit K IV
Or 5mg Vit K PO
Restart warfarin when <5 INR
Burst # C1
Aka
Jefferson #
Jefferson #
Description
Burst # C1
Lateral displacement of lateral masses
Brown sequard
Sx
Ipsilateral: motor and proprioception
Contralateral: pain and temp
Massive haemothorax signs
Decreased
expansion
Breath sounds
Dullness to percussion
Open mouth X-ray aka
Odontoid peg view
Osteomyelitis
Commonest pathogen.
Staph aureus
Osteomyelitis
Abx
And duration
Flucloxacillin
Clindamycin (pen)
6 week’s
Central cord syndrome
Classical mechanism
Neck hyper extension in elderly with c spine stenosis
Most common incomplete spinal cord injury
Central cord syndrome
Central cord syndrome
Sx
Motor loss upper>lower
Variable sensory loss
Bladder dysfunction and urinary retention
Central cord syndrome
Cause of injury
Vascular comp anterior spinal artery
Central cord syndrome
Recovery
Lower limb
> bladder function
> proximal limb
> hands
C.I.
Procedural sedation
High risk aspiration (eg EtOH) ASA grade 4 or above (unless emergency) No trained individual No monitoring Allergy/hypersen
Schneider’s 1st rank Sx
1) Auditory hallucinations
2) thought passivity
3) delusions
4) Neg sx
Schneider’s 1st rank Sx
Types
Auditory hallucinations
3rd person
Thought echo
Commentary on actions
Schneider’s 1st rank Sx
Types
Thought passivity
Thought insertion
Withdrawal
Broadcast
Schneider’s 1st rank Sx
Types
Delusions
Primary
Secondary
Schneider’s 1st rank Sx
Types
Negative sx
Social withdrawal Reduced activity Depression Flat affect Poverty of thought/speech
CIWA score
Criteria
Nausea Tremor Sweating Anxiety Agitation Tactile/auditory/visual disturbance Headache Clouding sensorium
LBBB
Causes
IHD Anterior MI HTN AS Cardiomyopathy Lenegre ds High k Digoxin toxicity
Lenegre ds
Pathology
Primary fibrosis of conducting system
Heart - causes BBB
Goodpastures syndrome
Sx
Pulmonary haemorrhage
Glomerulonephritis
Goodpastures syndrome
Pathology
Anti GBM Abs
Troponin I
Rise in
Peak
Normal after
Rise 3-12h
Peak 24h
Normal after 3-10d
Weakest cruciate ligament
ACL
Test for ACL tear
Lachmans
Pivot shift test
Lachmans test
Process
Flx 30 degrees
Tibia pulled forward
Abx
Septic arthritis
1st Fluclox
Clindamycin (pen aller)
Vanc (Mrsa)
Gram neg/ gonnococcal (cefotaxime)
Entonox
Ratio N2O to O2
50:50
Indication for
Procedural sedation
Behavioural and analgesia management not sufficient
For procedure/examination
Intussusception
Peak incidence
5-10m
Dances sign
Absence of bowel RLQ
Intussusception
APLS guideline
Seizure
>5min: Loraz - 0.1mg/kg >10min: 2nd dose benzo >20min: phenytoin infusion — 20mg/kg over 20min >40min : anaesthetist and RSI
CI
Central venous catheterisation
Obstructed vein Overlying skin infx No consent Uncooperative pt Coagulopathy Resp arrest
Ketamine
Actions
Analgesic
Hypnotic
Amnesiac
Ketamine
SE
Psychotic Diplopia Nystagmus Rash Nausea
Ketamine
Doses
IM - 10mg/kg
IV 2mg/kg
Laryngoscope view
Structure
Medial to arytenoids
Corniculate tubercle
Laryngoscope view
Structure
Overlying arytenoids
Cuneiform tubercle
Transferring intubated patient
Sudden desaturation
Most likely cause
Dislodged ET tube
Bleeding
Aka
Haemorrhaging
FAST
Stands for
Facial droop
Arm weakness
Speech difficulties
Time to call 999
> 1 TIA in a week
Dx
Crescendo TIA
Trifascicular block
ECG shows
Primary HB
RBBB
And L ant/post block
Trifascicular block
Comp
Tx
Precursor to complete HB
~50% need pacemaker
Acute severe asthma
Dx
PEFR 33-50%
RR>25
HR>110
Unable to complete sentence
Life threatening asthma
Dx
PEFR<33% Sats<92% pO2<8kPa Normocapnia Silent chest Cyanosis Poor respiratory effort Arrhythmia Low GCS Hypotension
Near fatal asthma
Dx
High CO2
Ventilation with raised pressure
Congenital prolonged QT
Romano ward syndrome
Metabolic causes long QT
Low: TSH Calcium K Mg Temp
Malaria
Most common pathogen
Plasmodium falciparum
Malaria
Tx
Plasmodium falciparum
- artensunate
P vivax, malariae, ovale
- chloroquine
Blind pericardiocentesis
Process
Only in emergencies
Subxiphoid (1cm below)
Sat up at 30-45deg
Needle at 30deg angle aimed at midpoint of left clavicle
Classification tibial plateau fracture
Schatzker classification system
Tibial plateau #
Ix
Requires CT knee
Tibial plateau #
Tx
ORIF
