Phase 3B 2015 Flashcards
Mechanism of action that causes an ankle fracture
Inversion of the foot
Eversion of the foot
Classify the types of ankle fractures and outline the subsequent management
Weber Classification
A: below the syndesmosis
Stable
Cast
B: At the syndesmosis
No talar movement: stable, cast
Talar movement: unstable ORIF
C: Above the levels
Unstable
ORIF
Principles of fracture management
Anatomic reduction (realignment of feature fragment)
Stabilisation of fracture
Neurovascular supply must be maintained
Encourage early rehab
Complications of fracture
Non union Delayed union Infection NV injury Malunion VTE events
Features of AF seen on ECG
Lost of P waves
Irregularly irregular rhythm
Medical management of AF
B-blockers: Bisoprolol
CCB: Verapamil (diltiazem)
Digoxin (cardiac glycoside)
Outline the drugs used in drug cardioversion and their mechanism of action
Amiodarone
- Anti-arrhythmic
- Potassium channel blocker
- Also in this class (soltalol)
Flecanide
- Don’t use this if structural heart problems
- Sodium channel blocker
Outline the role for anticoagulation in AF
CHA2DS2-VASc
Acute
- Heparin until full assessment complete for possible emboli
- AF >48 3/52 of anticoagulation prior to cardioversion. Use warfarin INR 2.5
Chronic
- Warfarin
- INR 2-3
- Dabigatran (thrombin inhibitor)
Causes of unilateral facial drop
Bell’s palsy
Stroke
Ramsay Hunt
Trauma to the facial nerve during parotid surgery
Tumour (acoustic neuroma, facial nerve tumour)
Causes of Ramsay Hunt
Reactivation of the varicella Zooster virus
Dormant in the geniculate ganglion of CNVII
Symptoms of Ramsay Hunt
Ear pain Vesicular rash Hyperacusis Tinnitus Vertigo Hearing loss Facial palsy
Treatment of Ramsay Hunt
Aciclovir (1st 72hrs)
Prednisolone
Actions of PTH
Increases osteoclast activity = release of calcium and phosphate
Increase calcium reabsorption from the kidney
Increase phosphate reabsorption from the kidney
Activate 1,25 dihydroxy Vitamin D3 production, increase absorption of calcium from the gut
Name the types of renal stone
Calcium oxalate Calcium phosphate Struvite Urate Cystine
Gold standard investigation for renal stones
Spiral non contrast KUB
Management of renal stones
- Diclofenac (IM/PR)
<5mm: pass freely
>5mm: Medical explosion therapy (tamulosin)
> 10mm: extracorpeal shockwave lithoplexy
Diagnosis of thalassaemia
Blood film
HB electrophoresis
Complications of recurrent blood transfusions
Myocardial: cardiomyopathy
Endocrine: DM, low PTH
Athralgia
Liver cirrohosis
Treatment of iron overload
Deferiprone (PO) + Desferrioxamine (SC)
Risk factors for head and neck cancers
Alcohol Smoking HPV Vitamin A & C deficiency GORD
investigations for a possible head and neck cancer
MRI Fibreoptic endoscopy of upper digestive tract Biopsy masses Lymph node biopsy CT thorax for staging Blood HPV status
Causes of a PR bleed
IBD Diverticultits Colon Ca Infective gastroenteritis Fissure Haemorrhoids
Mainteance regime in UC and in Crohns
UC
- Melsazine
- Azathioprine
- Infliximab
Crohn’s
- Azathioprine
- Methotrexate
- Infliximab
Mainteance regime in UC and in Crohns
UC
- Melsazine
- Azathioprine
- Infliximab
Crohn’s
- Azathioprine
- Methotrexate
- Infliximab
Triggers for eczema
New washing/cleaning products
Stress
Warm weather
Poor compliance with treatment
Questions to assess the severity of severe depression
Length of symptoms Suicide plans/ self harm Unexplained guilt/worthlessness Inability to function Concentration impaired Impaired appetitis Decreased sleep/ early waking Energy low
Assessing suicide risk
Plans made Methods Planned or spontaneous (under the influence) Reasons for or against Protective factors Support network
Classes of antidepressants with examples and side effects for each
SSRIs
- Sertraline
- headache, GI disturbance, sexual dysfunction
SNRIs
- Venlafaxine
- Headache, constipation, weight changes, sexual dysfunction
TCA
- Amitrptylline
- dry mouth, urinary retention, dry eyes, constipation
MAOi
- selegline
- Arrhythmia, headache, GI upset, muscle aches
