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FY1 > Prescribing, Procedures and Investigation Interpretation > Flashcards

Prescribing, Procedures and Investigation Interpretation Flashcards

1
Q

Things to think before prescribing drugs

A

Indication, contraindication, route, dose, interactions, adverse effects

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2
Q

What can metoclopramide cause in young women

A

Oculogyric crises are defined as spasmodic movements of the eyeballs into a fixed position, usually upwards. These episodes generally last minutes, but can range from seconds to hours. At the same time there is often increased blinking of the eyes and these episodes are frequently accompanied by pain.

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3
Q

Key parts to writing a prescription

A

Type of drug - PRN, regular, once off etc
Allergy box
Labelling kardex
Think of common abbreviations
Cross out any change in prescription with a reason and signed.

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4
Q

When to use verbal prescriptions

A

When emergency

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5
Q

Give 8 dirty drugs

A

Digoxin, warfarin, antiepileptics, antibiotics, antidepressants, antipscyhotics, theophylline and amidarone.

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6
Q

What can liver disease do to drug dosing

A

Can alter P450 enzymes
Reduce the amount of protein so decreases binding of drug making more drug free
Fluid overload due to low albumin
Avoid IM as increased bleeding

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7
Q

What can renal disease do to drug dosing

A

Dont give nephrotoxic drugs without speaking to specialist.

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8
Q

What drugs should never be given to children

A

Tetracyclines - bone staining
Aspirin - reye syndrome

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9
Q

What drugs are controlled drugs

A

Strong opioids
Amphetamine-like agents (ritalin and cocaine LA)
Ketamine
Benzodiazepines
Anabolic steroids

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10
Q

Give some causes of insomnia

A

Anxiety, stress, depression, mania, alcohol, pain, coughing, diuretics, restless leg syndrome, steroids SSRIs, aminophylline, benzos/opioids withdrawal, poor sleep hygiene

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11
Q

How to manage insomnia

A

Treat cause
Dose stimulants at the start of the day - steroids, SSRIs, aminophylline
Give sedatives at night - tricyclics, anti-histamines
Ear plugs, sleep hygiene, eye shades
Avoid caffeine late on

If persistent, treat with - hypnotics (zopiclone) for 5 or less days

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12
Q

How to manage insomnia

A

Treat cause
Dose stimulants at the start of the day - steroids, SSRIs, aminophylline
Give sedatives at night - tricyclics, anti-histamines
Ear plugs, sleep hygiene, eye shades
Avoid caffeine late on

If persistent, treat with - hypnotics (zopiclone) for 5 or less days

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13
Q

How to manage insomnia

A

Treat cause
Dose stimulants at the start of the day - steroids, SSRIs, aminophylline
Give sedatives at night - tricyclics, anti-histamines
Ear plugs, sleep hygiene, eye shades
Avoid caffeine late on

If persistent, treat with - hypnotics (zopiclone) for 5 or less days. Dont let them go home on them

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14
Q

When do steroids become long term and thus a addisonian crisis risk

A

> 3 weeks

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15
Q

Steroid conversion for 5mg of pred

A

Hydrocortisone 20mg
Methylpred - 4mg
dexamethasone 750 micrograms

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16
Q

How to reduce steroid therapy

A

5-10mg a week until 10mg then reduce by 5mg a week thereafter.

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17
Q

Presentation of C. diff

A

Usually older adults with unexplained fever
Recent C abx
Abdo pain
Watery diarrhoea

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18
Q

What scan should be considered in C. diff along with stool cultures

A

AXR - toxic megacolon

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19
Q

How is C.diff treated

A

Vanc or metronidazole then fidaxomicin if fail to repsond

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20
Q

ACEI S/E

A

Postural hypotension, renail impairment, hyperkalaemia, dry cough, taste disturbance and angiooedema and utricaria

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21
Q

When is NAC effective

A

8 hours or less after ingestion, discontinue if normal bloods

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22
Q

What is the antidote for heparin

A

Protamine

Can partially work on LMWH too

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23
Q

What is ranitidine

A

H2 antagonist

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24
Q

What drug does SSRI’s react with

A

MOA inhibitors
Tramadol

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25
Q

What should happen to sulffonylureas on day of surgery

A

Stopped as hypo risk

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26
Q

How are sulfonylurea hypos treated

A

In hospital as can last many hours

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27
Q

What two drugs does tozocin contain

A

pipercillin and tazobactam

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28
Q

What antibiotics can affect contraception efficacy

A

Tetracyclines

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29
Q

When should you prescribe laxatives with opioids

A

If using opioids for >24hrs

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30
Q

What drugs can increase nephrotoxicty and ototoxicity with vancomycin

A

Nephrotoxicity - ciclosporin
Ototoxicity - loop diuretics

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31
Q

How to call an arrest

A

2222
“adult cardiac arrest team to ward XX”

Can be called in peri-arrests

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32
Q

Information required for ICU admission

A

Current/previous wishes, current illness, co-morbidities, reversibility?

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33
Q

Information required for an ICU step down onto the ward

A

Priorities of the care and next stages
Deterioration plan
Physio plans
Have all lines been removed
Any unfamiliar drugs

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34
Q

Levels of care in hospital

A

Level 0 - normal ward
Level 1 - Normal ward but ICU outreach
Level 2 - HDU
Level 3 - ICU

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35
Q

How to prioritise for a handover

A

Sickest patient, new admissions, urgent jobs, ward jobs, roles

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36
Q

The 4 important roles for ward rounds

A

Scribe
Kardex
Results
Urgent jobs

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37
Q

What questions to ask on a ward round

A

Abx needed?
VTE prophylaxis needed?
Pain managed?
Anti-emetics needed?
DNA CPR/TEP filled out?
Imaging needed?
Impression from consultant?
Nurses to be included on ward round?

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38
Q

How to prioritise jobs

A

Very ill
Radiology
Bloods
Jobs
Referrals
IDL

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39
Q

Why are gent and vanc monitored

A

Gent (to make sure its not toxic) - peak
Vanc (to make sure its in the theraputic range) - trough

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40
Q

Tips for specialty referrals

A

Vascular - pulses and doppler
Cardio - ECG
Ortho - ADL and NVM compromise
Neuro - GCS
Infection - micro results
Gen surgery - PR

Use an SBAR with a starting statement of what you want from them
Get name of recieving colleage

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41
Q

How to handover

A

Sickest patients
New admissions
Ward jobs

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42
Q

What are examples of non-night jobs

A

IDL
Family
PR
Kardex
Fluids - not unless needed

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43
Q

Tips for starting nightshift

A

Do an early walk around and say youll be back - stops you being bleeped so much
Eat, sleep, caffeine

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44
Q

How to read CTGs

A

1cm/min scale

Baseline - foetal HR (110-160BPM)
Variability - (beat to beat should be >=5BPM)
Acceleration - (transient increase in HR of >15BPM for 15s)
Decelerations - (transient decrease in HR of >15BPM for 15s)

Three types of decelerations -
Early - with contractions, psychiological as sign of foetal head compression
Late - occur after contraction, abnormal
Variable - the relation of uterine tone and deceleration is variable and thus abnormal

WORRYING FEATURES - baseline outside of normal, reduced variability, late decelerations, persistent variable decelerations, prolonged decelerations

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45
Q

What kind of blood tests do biochemistry deal with

A

Salt, mineral, drug and hormone levels

E.g. - LFTs, U+Es, TFTs, sodium valproate etc

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46
Q

What kind of blood test does haematology deal with

A

Blood

E.g. - FBC, ESR, clotting, G+S, crossmatching, blood films

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47
Q

What does microbiology deal with

A

Any pathogen tests

E.g - blood cultures, stool cultures, sputum cultures, urine cultures

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48
Q

What does histopathology deal with

A

Tissue samples aka biopsies

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49
Q

What does immunology deal with

A

Antibody levels e.g. ANA

Usually go in p;ane tubes

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50
Q

How is a femoral stab preformed

A

Patient lying flat
Feel for femoral pulse (between ASIS and pubic tubercle), insert needle vertically 1cm medially to the artery.
Pull back on syringe until you get flashback and then when needle is out put pressure on area for >2mins.
Put plaster on.

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51
Q

What to do if go through vein wall with cannula

A

Withdraw a small distance and gain flashback then advange plastic tip

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52
Q

What to do if cannula is blocked

A

CHeck theres no kinks in the giving set and try flushing with 0.9% saline

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53
Q

What other arteries can you try for an ABG

A

Radial –> ulnar –> femoral –> brachial

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54
Q

Tips to help get a good ABG sample

A

Dorsiflex the wrist more
Put the sample in ice if cant get to ABG machien quickly
Expel air bubbles before getting sample

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55
Q

Tips for IM/SC injections

A

Grab for S/C and pinch for IM
Use a longer needle for obese patients
Remember to aspirate

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56
Q

Tips for IV injections

A

Always flush cannula with 5ml saline or water
Keep IV infusion sets above patients heart to stop blood entering the giving set
Keep syringe driver below patients heart
Most IV injections must be given by doctors

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57
Q

How is a psterior ECG done

A

For posterior MIs

move V1,V2,V3 to V4,V5,V6 positions
V4,V5,V6 attached to the posterior chest following the curvature of the scapula

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58
Q

What drugs should you NOT give on your own for the first time, espcially as an FY1 (>=FY2)

A

Adenosine
Thrombolysis

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59
Q

Give some relative contraindications for a catheter

A

Suspected urethral injury
Urethral strictures/fistulas
Active UTI
Prostatic tumour or hypertrophy

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60
Q

Tips for catheterisation

A

Dont touch lubricant gel with the catheter as it can become slippy
Hold penis vertically if it becomes resistant
Flush catheter with saline if in and no urine as gel might be blocking it
Use a wider catheter if haematuria or clots
Have male and female catheters (shorter)

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61
Q

How to replace a suprapubic catheter

A

Wearing gloves and deflate baloon with 20ml syringe and remove.
Sterile technique, clean site and put instilagel around and in hole then reinsert new one.
Inflate new balloon

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62
Q

How is a PEG feeding tupe replaced if fallen out

A

Lie patient flat, apply gentle pressure to introduce a well-lubricated urinary catheter into the hole. Gently inflate balloon

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63
Q

How is a NG tube inserted

A

Dont do if basal skull fracture or facial trauma

Gauge length from angle of jaw to xiphisternum
Wash hands and wear non-sterile gloves
Lubricate end and ask patients to take sips of water as you aim tube directly backwards and swallow until reaching length measured (50mm)
Attach drainage bag if required and tape tube to nostril
Confirm insertion - CXR (bwlow diaphragm and not in bronchial tree)/ test pH <4 with aspiration (may be raised if on PPIs.

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64
Q

What are the two serum-albumin gradients for ascities

A

<11g/L - infection, pancreas, malignancy, nephrotic
>11g/L - cirrhosis, portal vein thrombosis, congestive HF

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65
Q

Why is adrenaline used in lidocaine solutions

A

To cause vasoconstriction and to stop it being redistributed across the body, making it last longer and larger doses to be give. Used mostly in scalp and facial.
DO NOT USE if fingers, toes, penis, nose, ears

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66
Q

How is LA toxicity managed

A

Usually 45-60mins after use -
S - tingling around mouth, metallic taste, slurred speach, convulsions, reduced GCS, arrhythmias
Ix - clinical
Rx - stop LA, ABCDE, oxygen, senior help, midazolam IV to prevent seizures, intubation and IV lipid emulsion

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67
Q

When are LA injetions less effective

A

When infection as active at alkali conditions and infection and inflammation is very acidic.
Can be very painful when first injected

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68
Q

What is the maximum dose of lidocaine

A

3mg/kg

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69
Q

What is the maximum dose of lidocaine with adrenaline

A

7mg/kg

NOT USED ON ANY DISTAL BODY PART

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70
Q

How does the percentage correlate to the mg/ml

A

0.25% –> 2.5mg/ml
0.5% –>5mg/ml
1% –> 10mg/ml
4% –> 40mg/ml

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71
Q

When are wounds not sutured

A

If dirty or infected
If bite wound

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72
Q

What should you check before suturing

A

Tetanus status
Foreign bodies
NV deficit
Damage below skin

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73
Q

Where should absorbable sutures be used

A

Inside mouth and lips

E.g. vicryl, PDS, monocryl

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74
Q

What are some non-absorbable sutures

A

Nylon
Prolene
Silk

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75
Q

What wound care advice would be given to patients

A

Keep wound clean and dry for 48hrs
Seek medical advice if looks infected - increased pain, redness, puss, swelling
Avoid heavy lifting for 6 weeks
Drive when you can look over shoulder and preform an emergency stop

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76
Q

What are some important checks to do before reducing fractures or dislocations

A

X-rays taken in two views
No NV deficit - check before and after
Adequate analgesia
Adequate midazolam
Have the right support after - sling, crutches etc

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77
Q

How does anaemia present on FBC

A

Low Hb

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78
Q

How does acute blood loss present on FBC

A

Normal initially

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79
Q

How does infection/inflammation present on FBC

A

Raised WCC
Raised platelets

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80
Q

How does haematological malignances present on FBC

A

Very raised WCC

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81
Q

How do bone marrow disorders present on FBC

A

Persistent change in 1 or more cell line

82
Q

How does dehydration present on FBC

A

Raised Hb (polycythemia vera can also present like this)

Consider LMWH for thrombus risk

83
Q

Give some causes of raised neutrophils

A

Bacterial infection
Inflammation
Acute illness
Myeloid leukaemia
Steroid therapy

84
Q

Give some causes of low neutrophils

A

Viral infection
Sepsis
Drugs (carbimazole, chemo, steroids)
Splenomegaly
Bone marrow failure
Low vitamin B12 or folate
Autoimmune disease

85
Q

Give some causes of high lymphocytes

A

Viral infection
Lymphoid leukaemia
Inflammation

86
Q

Give some causes of low lymphocytes

A

Steroids
Chemo
HIV
Autoimmune disease
Bone marrow failure

87
Q

Give some causes of high eosinophils

A

Parasitic/fungal infection
Asthma
Atopy
Lymphoma

88
Q

Give some causes of low eosinophils

A

Rarely pathological

89
Q

Give some causes of high platelets

A

Inflammation
Infection
Acute illness
Recovery from splenectomy
Essential thrombocytosis
Polycythaemia vera

90
Q

Give some causes of low platelets

A

Idiopathic thrombopenic purpura
Chronic alcoholism
Bone marrow failure
DIC
Viral infections
Splenomegaly
HELLP

91
Q

Give some causes of a raised PT

A

Warfarin
Sepsis
DIC
Heparin
Deficient in factor 7

92
Q

Give some causes of low PT

A

Rarely pathological

93
Q

Give some causes of prolonged APTT

A

Heparin
Haemophillia A and B
Von willebrand disease
DIC
Sepsis
Deficiency of factors II, V, VII, IX, X, XI, XII
Liver disease
Warfarin

94
Q

Give some causes of low APTT

A

Rarely pathological

95
Q

Give some causes of prolonged PT and APTT

A

DIC
Sepsis
Liver disease
Warfarin
Heparin

96
Q

Give some causes of a raised troponin

A

MI
PE
Sepsis
Blunt trauma to chest

97
Q

Give some causes of raised CK

A

MI
Rhabdomylosis
Hypothyroidism
Blunt chest trauma
Recent surgery
Exercise

98
Q

Give biochemical signs of an inflammatory response

A

Raised - ESR, CRP, Ferritin, platelets, WCC
Decreased - albumin

99
Q

Give some causes of a very raised ESR

A

GCA
Myeloma
Polymyalgia rheumatica

100
Q

On U+Es, how would dehydration present

A

Raised urea
Raised creatinine

101
Q

On U+Es, how would an AKI present

A

Raised potassium
Very raised urea
Raised creatinine

102
Q

On U+Es, how would CKD present

A

Raised urea
Very raised creatinine
Low Hb

103
Q

On U+Es, how would upper GI bleeds present

A

Very raised urea

104
Q

On U+Es, how would addisions disease present

A

Low sodium
High potassium
High urea
High creatinine

105
Q

Give some causes of raised urea

A

Dehydration
UGIB
Acute illness
Renal failure

106
Q

Give some causes of decreased urea

A

Rarely pathological - can be pregnancy, renal failure, malnutrition, alcoholism

107
Q

Give some causes of raised creatinine

A

Renal failure (AKI or CKD)
Muscle injury

108
Q

Give some causes of low creatinine

A

Small and thin people with low muscle mass
Pregnancy

109
Q

Give some causes of raised urea and creatinine

A

Renal failure
Check K and ECG

110
Q

Give some causes of hyponatraemia

A

Hypovolaemic and high urine sodium - addisions or diuretics (renal issue)
Hypovolaemia and low urine sodium - hypovolaemia due to D+V, small bowel obstruction, burns etc

Euvolaemic - SIADH

Hypervolaemic - renal, liver or heart failure

111
Q

Give some causes of hypernatraemia

A

Fluid loss
Inadeqaute intake
Excess - conns syndrome or iatrogenic

112
Q

Give some causes of hypokalaemia

A

D+V
Conn’s syndrome
Inadequate intake
Steroids
Diuretics
Cushings
Alkalosis

113
Q

Give some causes of hyperkalaemia

A

AKI
Iatrogenic
DKA
Haemolysed samples
Drugs - ACEI, spironolactone, amiloride
Addisons disease
Large blood transfusions
CKD

114
Q

How does pre-hepatic jaundice present

A

Raised unconjugated bilirubin
Low Hb
Raised reticulocytes
Raised LDH
Lower hepatoglobin

115
Q

How does hepatic jaundice present

A

Raised mixed bilirubin
Very high ALT
Very high AST
Raised gamma GT

116
Q

How does cholestatic jaundice present

A

Raised conjugated bilirubin
Very raised ALP
Raised gamma GT

117
Q

How does hepatocellular damage present

A

Very raised AST
Very raised ALT
Raised Gamma GT
Raised ALP

118
Q

How does liver failure present

A

Raised bilirubin
Raised PT
Lower albumin

119
Q

How does alcohoism present

A

Raised gamma GT
Raised MCV
Lower platelets

120
Q

How does pancreatitis present

A

Very raised amylase
Very raised lipase
Lower calcium
High glucose
Very high CRP

121
Q

How does HELLP syndrome present

A

Raised AST
Raised ALT
Raised gamma gt
Lower Hb
Lower platelets

122
Q

Give some causes of raised ALT and AST

A

Hepatocellular damange
Biliary disease
Alcohol
Muscle damage
MI
Pancreatitis

123
Q

Give some causes of lower ALT and AST

A

Rarely pathological
Low vitamin B6

124
Q

Give some causes of raised ALP

A

Biliary disease
Liver disease
Alcohol
Bone disease (Paget’s)
Pregnancy
Bony metastases

125
Q

Give some causes of lower ALP

A

Rarely pathological

126
Q

Give some causes of high albumin

A

Dehydration

127
Q

Give some causes of low albumin

A

Inflammation
Cirrhosis
Pregnancy
Chronic disease

128
Q

Give some causes of raised amylase

A

Acute pancreatitis
Chronic pancreatitis
Abdo perforation
Burns
Anorexia
Renal disease

129
Q

Give some causes of raised lipase

A

Acute pancreatitis

130
Q

How do bone metastases present on bone profile bloods

A

Raised calcium
Raised ALP

131
Q

How does hypoparathyroidism present on bone profile

A

Reduced calcium
Raised phosphate
Reduced PTH

132
Q

How does primary hyperparathyroidism present on bone profile

A

Raised calcium
Reduced phosphate
Raised ALP
Reduced PTH

133
Q

How does myeloma present on bone profile

A

Raised calcium
Raised urea
Raised creatinine
Reduced haemoglobin
Raised ESR

134
Q

How does Paget’s disease present on bone profile

A

Raised ALP
Normal calcium
Normal phosphate

135
Q

Give some causes of hypercalcaemia

A

Primary and tertiary hyperparthyroidism
Malignancy
Excess vitamin D
Sarcoidosis
Myeloma

136
Q

Give some causes of hypocalcaemia

A

Vitamin D deficiency
Hypoparathyroidism
Acute pancreatitis
Alkalosis
Magnesium deficiency

137
Q

Give some causes of high phosphate

A

Chronic renal failure
Reduced PTH
Myeloma
Excess vitamin D
Rhabdomylosis
Cell lysis (post-chemo)
Acidosis

138
Q

Give some causes of reduced phosphate

A

Malabsoprtion/malnutrition
Alcohol
PTH
Burns
Alkalosis
Post-DKA treatment

139
Q

What is the calcium, phosphate and PTH levels in people with primary hyperperathyroidism

A

Raised calcium
Lower Phosphate
Raised PTH

140
Q

What is the calcium, phosphate and PTH levels in people with secondary hyperperathyroidism

A

Lower calcium
Lower phosphate
Raised PTH

141
Q

What is the calcium, phosphate and PTH levels in people with tertiary hyperperathyroidism

A

High calcium
High phosphate
High PTH

142
Q

What is the calcium, phosphate and PTH levels in people with hypoparathyroidsm

A

Low calcium
High phosphate
Low PTH

143
Q

What are the blood glucose levels on a fasting glucose and glucose after 2hrs that indicate diabetes

A

> 6.9mmol/l
11mmol/l

144
Q

How does TSH, T4 and T3 present on a blood test for primary hyperthyroidism

A

Raised T3
Raised T4
Low TSH

145
Q

How does TSH, T4 and T3 present on a blood test for subclinical hyperthyroidism

A

Normal T4
Raised T3
Low TSH

146
Q

How does TSH, T4 and T3 present on a blood test for primary hypothyroidism

A

Low T4
Low T3
High TSH

147
Q

How does TSH, T4 and T3 present on a blood test for secondary hypothyroidism

A

Low T4
Low T3
Low or normal TSH

148
Q

How does TSH, T4 and T3 present on a blood test for subclincal hypothyroidism

A

Normal T4
Normal T3
High TSH

149
Q

How does RVH present on a ECG

A

Right axis deviation
Dominant R waves in V1

150
Q

How does LVH present on ECG

A

Left axis devation
Dominant R waves in V6

151
Q

Give some causes of ST elevation

A

STEMI
Pericarditis
Ventricualr aneurysm
Hypothermia
High takeoff

152
Q

What vessel is affected by inferior leads (AVF, II, III)

A

RCA

153
Q

What vessel is affected by anterior leads (V1,V2,V3,V4)

A

LAD

154
Q

What vessel is affected by lateral leads (I, AVLV5,V6)

A

Circumflex artery

155
Q

How does pneumonia present on CXR

A

Asmmetrical shadowing and consolidation
Blunting of costophrenic angles
Blurring of heart and diaphragm borders
Air bronchograms

156
Q

How does pulmonary oedema present on CXR

A

Enlarged heart (seen on PA only)
Pulmonary venous diversion
Blunting of costophrenic angles - pleural effusion
Alveolar batwing oedema
Kerly B lines - horizontal lines at the edges extending to pleural margin

157
Q

How does a pleural effusion present on CXR

A

Whiteout area at the base with lost of costophrenic with or without loss of costophrenic angles
May have meniscus lines

158
Q

How does asthma/COPD present on CXR

A

Hyperinflated, flattened diapgragm and barrel chest

159
Q

How does a pneumothorax present on CXR

A

Line of seperted pleura with peripheries lacking lung markngs
Deviated mediastinum if tension

160
Q

What are the causes of localised white lesions on CXR

A

Abscess - may have fluid line
Nodules
Tumours

161
Q

How many posterior ribs are normal to be seen on chest x-ray and how many are considered hyperinflated

A

6 or less is poor inspiratory effort
7-9 is normal
10 or more is hyperinflated

162
Q

How many posterior ribs are normal to be seen on chest x-ray and how many are considered hyperinflated

A

6 or less is poor inspiratory effort
7-9 is normal
10 or more is hyperinflated (may have flat diaphragms)

163
Q

What level should central lines be

A

Level of carina

164
Q

WHat level should NG tubes be

A

Below carina and if not try pushing 5cm more to see if it places it
If trachea then remove

165
Q

Give a sign of significantly impaired respiratory function

A

Low or normal PO2 on high concentration of inspired oxygen

166
Q

Give some causes of metabolic acidosis

A

Shock
DKA
Renal failure
Liver failure
Lactate
Drug overdose (TCA)

167
Q

Give some causes of metabolic alkalosis

A

Vomiting
Diarrhoea
Hypokalaemia

168
Q

Give some causes of respiratory acidosis

A

Severe asthma/COPD
Severe pneumonia
Severe pulmonary oedema
Myasthenia gravis
Drugs - sediatives, opioids
Chest trauma/scoliosis
Obesity

169
Q

Give some causes of respiratory alkalosis

A

Cranial lesions
Anxiety/hyperventilation

170
Q

Give causes of a raised anion gap

A

LADR

Lactic acidosis
Alcohol
DKA
Renal failure

171
Q

Give causes of a normal anion gap

A

ABCD

Addisions
Bicarbonate loss (vomiting)
Chloride loss (diarrhoea)
Drugs nsaids spironolactone

172
Q

What are the FEV1/FVC values for Normal, obstructive and restrictive disease

A

Normal - 75%-80%
Obstructive - <75%
Restrictive >80%

173
Q

How is bowel perforation seen on AXR

A

Free gas under the diaphragm or two-sided wall on bowel

174
Q

How does caecal volvus seen on AXR

A

foetal-sign

175
Q

How is sigmoid volvus seen on AXR

A

Coffee-bean sign

176
Q

How is constipation seen on AXR

A

Faecal loading in the la rge bowel starting from rectum

177
Q

How is chronic pancreatitis seen on AXR

A

Calcifications in epigastric area

178
Q

How is CKD seen on AXR

A

Small kidneys

179
Q

If psoas muscle is absent on CXR what does this suggest

A

Ascites

180
Q

On urine dipstick what is suggested by nitrates

A

Produced by gram negative bacteria (E.coli) and suggest urinary tract infection

181
Q

On urine dipstick what is suggested by leukocytes

A

Inflammation of kidneys, urinary tract but also high in stones, trauma, malignancy, infection in prostate or appendix

182
Q

On urine dipstick what is suggested by blood

A

Can be actual RBC or haemoglobinuria as seen in rhabdomylosis

183
Q

On urine dipstick what is suggested by protein

A

Detects albumin which shold not be present in the urine (bence jones protein not detected on urine dip)

184
Q

On urine dipstick what is suggested by glucose

A

Common with increasing age but may suggest DM

185
Q

On urine dipstick what is suggested by ketones

A

Raised with DKA, fasting, low carbohydate diets and acute illness

186
Q

On urine dipstick what is suggested by pH

A

Normal 4.5-8

Acidic pH suggests acidosis
Alkali pH suggests alkalosis

187
Q

On urine dipstick what is suggested by cast cells

A

Epithelial casts - renal disease
White cell casts - pylonephritis

188
Q

What do normal CSF results look like

A

Apperance - clear
White cells - <4
Type of cell - lymphocytes
Glucose - >70% plasma
Protein - <0.4g/l

189
Q

What does bacterial CSF results look like

A

Apperance - cloudy
White cells - very very high
Type of cell - neutrophils
Glucose - very low
Protein - high

190
Q

What does TB CSF look like

A

Apperance - clear
White cells - high
Type of cell - Lymphocytes
Glucose - <50% glucose
Protein - High

191
Q

What does viral CSF look like

A

Apperance - clear
White cells - very high
Type of cell - lymphocytes
Glucose - normal
Protein - mediocrely high

192
Q

How are cervical spine x-rays interpreted

A

ABCDE approach -

Adequacy - X-ray penetration appropriate? soft tissues, spinous process, vertebral bodies, C1-T1
Bodies - smooth outlines and attached to spinous process, C2 and below should have similar size and shape, look for fragments or avulsion, check the odontoid peg has a equal margin to C1 all the way around and no fractures in AP view
Curves - follow anterior, middle and posterior border curves on lateral view to look for distruption of these subtle arcs
Disc spaces - roughly equal (wide suggsts serious injury)
Everything else - soft tissue changes or localised buldge

193
Q

How are skeletal radiographs interpreted

A

Identification - patient name, dob, chi, correct side and good image quality
Bones - follow the edge of the cortex look for cracks, opaque bones, sclerotic (dense) bone
Joints - normal border around joint between bones, re-check for breaks in the cortex of the bones
Soft tissue signs - may have swelling or overlying oedema

Greenstick fractures are common in kids as bones are more malluable in kids.

194
Q

What are the driving regulations for stroke/tia

A

1 month and resume only if minimal residual deficit

195
Q

What are the driving regulations for epilepsy

A

Cease until 1 year since last seizure
6 months if first seizure

196
Q

What are the driving regulations for unexplaiend syncope

A

4 weeks if low risk or 6 months if no cause found

197
Q

What are the driving regulations for those with diabetes on insulin or hypoglycaemic drugs

A

Must be able to recognise hypo and not had >1hypo requiring assistance in last 12 months

198
Q

What are the driving regulations for those with MI/ACS

A

1 week if successful angioplasty
4 weeks if no angioplasty or unsuccessful

199
Q

What are the driving regulations for drug addiction

A

1 year once clean

200
Q

Wuat are the driving regulations for sleep apnoea

A

Cease until symptoms are controlled

FY1 (6 decks)

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