Passmed Concepts Flashcards
What is required for patients taking prednisolone before surgery?
Hydrocortisone supplementation
Why is hydrocortisone given before surgery?
if patients have their HPA axis suppressed by prednisolone then they will not be able to cope with the stress of surgery and need hydrocortisone to replace
Complete fracture
Both sides of cortex are breached
Toddlers fracture
Oblique tibial fracture in infants
Plastic deformity
Stress on bone resulting in deformity without cortical disruption
Greenstick fracture
Unilateral cortical breach only
Buckle fracture
Incomplete cortical disruption resulting in periosteal haematoma only
Fracture through the physis only (x-ray often normal)
I
Fracture through the physis and metaphysis
II
Fracture through the physis and epiphyisis to include the joint
III
Fracture involving the physis, metaphysis and epiphysis
IV
Crush injury involving the physis (x-ray may resemble type I, and appear normal)
V
Why does OSA cause hypertension?
due to the drop in blood oxygen levels and rise in carbon dioxide during apnoea
malignant tumour that occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure
osteosarcoma
What are PDE 5 inhibitors e.g. sildenafil contraindicated by?
Nitrates and nicorandil
What is a normal QT interval
430ms in males, 450 ms in females
What are the causes of long QT interval?
Congenital
>Jervell-lange-neilsen syndrome
> romano-ward syndrome
Drugs > amiodarone, sotalol > TCAs, SSRIs > Methadone > chloroquine > terfenadine > erythromycin > haloperidol > odansetron
Other > electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia > MI > Myocarditis > hypothermia > SAH
Investigation for anastamotic leak
abdominal CT
Classical findings in primary hyperparathyroidism
high serum calcium
low phosphate
How do thrombosed haemorrhoids present?
significant pain and tender lump
o/e: purplish, oedematous, tender subcutaenous perineal mass
management of thrombosed haemorrhoids
if patient presents within 72 hours then referral should be considered for excision. Otherwise patients can usually be managed with stool softeners, ice packs and analgesia. Symptoms usually settle within 10 days
Action if one COCP is missed
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
Action if two COCP are missed
> take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms or abstain from sex until she has taken pills for 7 days in a row.
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
infusion rate in severe hypokalaemia
The infusion rate should not exceed 10mmol/hr.
Types of testicular cancer
Germ cell
> seminoma
> non-seminoma= embryonal, yolk sac, teratoma and choriocarcinoma
Non-germ cell
>leydig cell tumour
>sarcoma
peak incidence for testicular teratomas and seminoma respectively
25 and 35
RF for testicular cancer
Infertility cryptoorchidism FHx kleinfelters mumps orchitis
management of testicular cancer
orchidectomy
chemotherapy and radiotherapy
seminomas have a _____ prognosis than teratomas
better
What can hyperparathyroidism cause
pseudogout
chondrocalcinosis
cause of hepatic encephalopathy
excess absorption of ammonia and glutamine from bacterial breakdown of protein in gut
Features of hepatic encephalopathy
> confusion, altered GCS (see below)
asterix: ‘liver flap’, arrhythmic negative myoclonus with a frequency of 3-5 Hz
constructional apraxia: inability to draw a 5-pointed star
triphasic slow waves on EEG
raised ammonia level (not commonly measured anymore)
Grading of hepatic encephalopathy
Grade I: irritability
Grade II: confusion, inappropriate behaviour
Grade III: incoherent, restless
Grade IV: coma
Precipitating factors of hepatic encephalopathy
> infection e.g. spontaneous bacterial peritonitis > GI bleed >post transjugular intrahepatic portosystemic shunt > constipation > drugs: sedatives, diuretics > hypokalaemia > renal failure > increased dietary protein (uncommon)
Management of hepatic encephalopathy
> Treat any underlying precipitating cause
NICE recommend lactulose first-line, with the addition of rifaximin for the secondary prophylaxis of hepatic encephalopathy
lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria
antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production
other options include embolisation of portosystemic shunts and liver transplantation in selected patients
Which murmur are IV drug users at risk for?
right sided cardiac valvular endocarditis
what makes aortic sclerosis more likely than aortic stenosis
if not radiating to carotids
how to prevent tumour lysis syndrome
giving allopurinol or rasburicase prior to chemo
what is TLS
related to the treatment of high-grade lymphomas and leukaemias.
usually triggered by the introduction of combination chemotherapy.
can occur with steroid treatment alone.
What happens in TLS
breakdown of the tumour cells and the subsequent release of chemicals from the cell
high potassium and high phosphate level in the presence of a low calcium
when should TLS be suspected
any patient presenting with an acute kidney injury in the presence of a high phosphate and high uric acid level
Jittery + hypotonic baby
neonatal hypoglycaemia
Side effects of ciclosporin
everything is increased - fluid, BP, K+, hair, gums, glucose
When does functional tricuspid regurgitation occur?
2ry to pulmonary hypertension
Types of AF
first-detected episode
recurrent episodes; paroxysmal or persistent
permanent AF
For cardioversion of AF: patients must either be …
anticoagulated or have had symptoms for < 48 hours to reduce the risk of stroke.
Investigating suspected PE, CTPA -ve
consider proximal leg vein USS
what is d-dimer used for?
exclude PE in patients with wells of 4 or less
Management of chickenpox exposure in pregnancy
check if mum has antibodies
if < 20 weeks & she doesnt then give VZIG ASAP
if > 20 weeks & she doesnt then give VZIG or antivirals
if develops chickenpox give oral acivlovir if > 20 weeks
thyrotoxicosis with tender goitre
subacute (de quervains thyroiditis)
phases of de quervains thyroiditis
Phase 1 (3-6 weeks): hyperthyroidism, painful goitre, raised ESR
Phase 2: (1-3 weeks) euthyroid
Phase 3 (weeks-months): hypothyroid
Phase 4: return to normal
What are Thiazolidinediones
PPAR-y agonists
natural ligands are free fatty acids and it is thought to control adipocyte differentiation and function.
adverse effects of Thiazolidinediones (pioglitazone)
weight gain
liver impairment
fluid retention
bladder cancer
maturation time for AV fistula
6-8 weeks
benefit of SGLT-2 inhibitors
empagliflozin
weight loss
management of type 2 respiratory failure
BiPAP
medical therapy in exacerbation of COPD
> O2 to keep patient within the individualised target range
Nebulised bronchodilators
Steroid therapy
Antibiotics if indicated
Chest physiotherapy
Intravenous theophyllines would be considered if the response to nebulised bronchodilators is poor.
long term topical treatment for psoriasis
calcipotriol
patients with asthma who are not controlled with a SABA + ICS
add LTRA not LABA
macrocytic anaemia in presence of hyper-segmented neutrophil polymorphs
megaloblastic anaemia
signs of B12/folate deficiency
anaemia, glossitis, macrocytosis, hyper-segmented neutrophils
antibiotic for BV
metronidazole
antibiotic for human bite
co-amoxiclav
antibiotic for campylobacter
clarithromycin
