Prescribing, Procedures and Investigation Interpretation Flashcards
1
Q
Things to think before prescribing drugs
A
Indication, contraindication, route, dose, interactions, adverse effects
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.
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.
4
Q
When to use verbal prescriptions
A
When emergency
5
Q
Give 8 dirty drugs
A
Digoxin, warfarin, antiepileptics, antibiotics, antidepressants, antipscyhotics, theophylline and amidarone.
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
7
Q
What can renal disease do to drug dosing
A
Dont give nephrotoxic drugs without speaking to specialist.
8
Q
What drugs should never be given to children
A
Tetracyclines - bone staining
Aspirin - reye syndrome
9
Q
What drugs are controlled drugs
A
Strong opioids
Amphetamine-like agents (ritalin and cocaine LA)
Ketamine
Benzodiazepines
Anabolic steroids
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
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
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
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
14
Q
When do steroids become long term and thus a addisonian crisis risk
A
> 3 weeks
15
Q
Steroid conversion for 5mg of pred
A
Hydrocortisone 20mg
Methylpred - 4mg
dexamethasone 750 micrograms
16
Q
How to reduce steroid therapy
A
5-10mg a week until 10mg then reduce by 5mg a week thereafter.
17
Q
Presentation of C. diff
A
Usually older adults with unexplained fever
Recent C abx
Abdo pain
Watery diarrhoea
18
Q
What scan should be considered in C. diff along with stool cultures
A
AXR - toxic megacolon
19
Q
How is C.diff treated
A
Vanc or metronidazole then fidaxomicin if fail to repsond
20
Q
ACEI S/E
A
Postural hypotension, renail impairment, hyperkalaemia, dry cough, taste disturbance and angiooedema and utricaria
21
Q
When is NAC effective
A
8 hours or less after ingestion, discontinue if normal bloods
22
Q
What is the antidote for heparin
A
Protamine
Can partially work on LMWH too
23
Q
What is ranitidine
A
H2 antagonist
24
Q
What drug does SSRI’s react with
A
MOA inhibitors
Tramadol
25
What should happen to sulffonylureas on day of surgery
Stopped as hypo risk
26
How are sulfonylurea hypos treated
In hospital as can last many hours
27
What two drugs does tozocin contain
pipercillin and tazobactam
28
What antibiotics can affect contraception efficacy
Tetracyclines
29
When should you prescribe laxatives with opioids
If using opioids for >24hrs
30
What drugs can increase nephrotoxicty and ototoxicity with vancomycin
Nephrotoxicity - ciclosporin
Ototoxicity - loop diuretics
31
How to call an arrest
2222
"adult cardiac arrest team to ward XX"
Can be called in peri-arrests
32
Information required for ICU admission
Current/previous wishes, current illness, co-morbidities, reversibility?
33
Information required for an ICU step down onto the ward
Priorities of the care and next stages
Deterioration plan
Physio plans
Have all lines been removed
Any unfamiliar drugs
34
Levels of care in hospital
Level 0 - normal ward
Level 1 - Normal ward but ICU outreach
Level 2 - HDU
Level 3 - ICU
35
How to prioritise for a handover
Sickest patient, new admissions, urgent jobs, ward jobs, roles
36
The 4 important roles for ward rounds
Scribe
Kardex
Results
Urgent jobs
37
What questions to ask on a ward round
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?
38
How to prioritise jobs
Very ill
Radiology
Bloods
Jobs
Referrals
IDL
39
Why are gent and vanc monitored
Gent (to make sure its not toxic) - peak
Vanc (to make sure its in the theraputic range) - trough
40
Tips for specialty referrals
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
41
How to handover
Sickest patients
New admissions
Ward jobs
42
What are examples of non-night jobs
IDL
Family
PR
Kardex
Fluids - not unless needed
43
Tips for starting nightshift
Do an early walk around and say youll be back - stops you being bleeped so much
Eat, sleep, caffeine
44
How to read CTGs
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
45
What kind of blood tests do biochemistry deal with
Salt, mineral, drug and hormone levels
E.g. - LFTs, U+Es, TFTs, sodium valproate etc
46
What kind of blood test does haematology deal with
Blood
E.g. - FBC, ESR, clotting, G+S, crossmatching, blood films
47
What does microbiology deal with
Any pathogen tests
E.g - blood cultures, stool cultures, sputum cultures, urine cultures
48
What does histopathology deal with
Tissue samples aka biopsies
49
What does immunology deal with
Antibody levels e.g. ANA
Usually go in p;ane tubes
50
How is a femoral stab preformed
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.
51
What to do if go through vein wall with cannula
Withdraw a small distance and gain flashback then advange plastic tip
52
What to do if cannula is blocked
CHeck theres no kinks in the giving set and try flushing with 0.9% saline
53
What other arteries can you try for an ABG
Radial --> ulnar --> femoral --> brachial
54
Tips to help get a good ABG sample
Dorsiflex the wrist more
Put the sample in ice if cant get to ABG machien quickly
Expel air bubbles before getting sample
55
Tips for IM/SC injections
Grab for S/C and pinch for IM
Use a longer needle for obese patients
Remember to aspirate
56
Tips for IV injections
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
57
How is a psterior ECG done
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
58
What drugs should you NOT give on your own for the first time, espcially as an FY1 (>=FY2)
Adenosine
Thrombolysis
59
Give some relative contraindications for a catheter
Suspected urethral injury
Urethral strictures/fistulas
Active UTI
Prostatic tumour or hypertrophy
60
Tips for catheterisation
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)
61
How to replace a suprapubic catheter
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
62
How is a PEG feeding tupe replaced if fallen out
Lie patient flat, apply gentle pressure to introduce a well-lubricated urinary catheter into the hole. Gently inflate balloon
63
How is a NG tube inserted
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.
64
What are the two serum-albumin gradients for ascities
<11g/L - infection, pancreas, malignancy, nephrotic
>11g/L - cirrhosis, portal vein thrombosis, congestive HF
65
Why is adrenaline used in lidocaine solutions
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
66
How is LA toxicity managed
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
67
When are LA injetions less effective
When infection as active at alkali conditions and infection and inflammation is very acidic.
Can be very painful when first injected
68
What is the maximum dose of lidocaine
3mg/kg
69
What is the maximum dose of lidocaine with adrenaline
7mg/kg
NOT USED ON ANY DISTAL BODY PART
70
How does the percentage correlate to the mg/ml
0.25% --> 2.5mg/ml
0.5% -->5mg/ml
1% --> 10mg/ml
4% --> 40mg/ml
71
When are wounds not sutured
If dirty or infected
If bite wound
72
What should you check before suturing
Tetanus status
Foreign bodies
NV deficit
Damage below skin
73
Where should absorbable sutures be used
Inside mouth and lips
E.g. vicryl, PDS, monocryl
74
What are some non-absorbable sutures
Nylon
Prolene
Silk
75
What wound care advice would be given to patients
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
76
What are some important checks to do before reducing fractures or dislocations
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
77
How does anaemia present on FBC
Low Hb
78
How does acute blood loss present on FBC
Normal initially
79
How does infection/inflammation present on FBC
Raised WCC
Raised platelets
80
How does haematological malignances present on FBC
Very raised WCC
81
How do bone marrow disorders present on FBC
Persistent change in 1 or more cell line
82
How does dehydration present on FBC
Raised Hb (polycythemia vera can also present like this)
Consider LMWH for thrombus risk
83
Give some causes of raised neutrophils
Bacterial infection
Inflammation
Acute illness
Myeloid leukaemia
Steroid therapy
84
Give some causes of low neutrophils
Viral infection
Sepsis
Drugs (carbimazole, chemo, steroids)
Splenomegaly
Bone marrow failure
Low vitamin B12 or folate
Autoimmune disease
85
Give some causes of high lymphocytes
Viral infection
Lymphoid leukaemia
Inflammation
86
Give some causes of low lymphocytes
Steroids
Chemo
HIV
Autoimmune disease
Bone marrow failure
87
Give some causes of high eosinophils
Parasitic/fungal infection
Asthma
Atopy
Lymphoma
88
Give some causes of low eosinophils
Rarely pathological
89
Give some causes of high platelets
Inflammation
Infection
Acute illness
Recovery from splenectomy
Essential thrombocytosis
Polycythaemia vera
90
Give some causes of low platelets
Idiopathic thrombopenic purpura
Chronic alcoholism
Bone marrow failure
DIC
Viral infections
Splenomegaly
HELLP
91
Give some causes of a raised PT
Warfarin
Sepsis
DIC
Heparin
Deficient in factor 7
92
Give some causes of low PT
Rarely pathological
93
Give some causes of prolonged APTT
Heparin
Haemophillia A and B
Von willebrand disease
DIC
Sepsis
Deficiency of factors II, V, VII, IX, X, XI, XII
Liver disease
Warfarin
94
Give some causes of low APTT
Rarely pathological
95
Give some causes of prolonged PT and APTT
DIC
Sepsis
Liver disease
Warfarin
Heparin
96
Give some causes of a raised troponin
MI
PE
Sepsis
Blunt trauma to chest
97
Give some causes of raised CK
MI
Rhabdomylosis
Hypothyroidism
Blunt chest trauma
Recent surgery
Exercise
98
Give biochemical signs of an inflammatory response
Raised - ESR, CRP, Ferritin, platelets, WCC
Decreased - albumin
99
Give some causes of a very raised ESR
GCA
Myeloma
Polymyalgia rheumatica
100
On U+Es, how would dehydration present
Raised urea
Raised creatinine
101
On U+Es, how would an AKI present
Raised potassium
Very raised urea
Raised creatinine
102
On U+Es, how would CKD present
Raised urea
Very raised creatinine
Low Hb
103
On U+Es, how would upper GI bleeds present
Very raised urea
104
On U+Es, how would addisions disease present
Low sodium
High potassium
High urea
High creatinine
105
Give some causes of raised urea
Dehydration
UGIB
Acute illness
Renal failure
106
Give some causes of decreased urea
Rarely pathological - can be pregnancy, renal failure, malnutrition, alcoholism
107
Give some causes of raised creatinine
Renal failure (AKI or CKD)
Muscle injury
108
Give some causes of low creatinine
Small and thin people with low muscle mass
Pregnancy
109
Give some causes of raised urea and creatinine
Renal failure
Check K and ECG
110
Give some causes of hyponatraemia
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
Give some causes of hypernatraemia
Fluid loss
Inadeqaute intake
Excess - conns syndrome or iatrogenic
112
Give some causes of hypokalaemia
D+V
Conn's syndrome
Inadequate intake
Steroids
Diuretics
Cushings
Alkalosis
113
Give some causes of hyperkalaemia
AKI
Iatrogenic
DKA
Haemolysed samples
Drugs - ACEI, spironolactone, amiloride
Addisons disease
Large blood transfusions
CKD
114
How does pre-hepatic jaundice present
Raised unconjugated bilirubin
Low Hb
Raised reticulocytes
Raised LDH
Lower hepatoglobin
115
How does hepatic jaundice present
Raised mixed bilirubin
Very high ALT
Very high AST
Raised gamma GT
116
How does cholestatic jaundice present
Raised conjugated bilirubin
Very raised ALP
Raised gamma GT
117
How does hepatocellular damage present
Very raised AST
Very raised ALT
Raised Gamma GT
Raised ALP
118
How does liver failure present
Raised bilirubin
Raised PT
Lower albumin
119
How does alcohoism present
Raised gamma GT
Raised MCV
Lower platelets
120
How does pancreatitis present
Very raised amylase
Very raised lipase
Lower calcium
High glucose
Very high CRP
121
How does HELLP syndrome present
Raised AST
Raised ALT
Raised gamma gt
Lower Hb
Lower platelets
122
Give some causes of raised ALT and AST
Hepatocellular damange
Biliary disease
Alcohol
Muscle damage
MI
Pancreatitis
123
Give some causes of lower ALT and AST
Rarely pathological
Low vitamin B6
124
Give some causes of raised ALP
Biliary disease
Liver disease
Alcohol
Bone disease (Paget's)
Pregnancy
Bony metastases
125
Give some causes of lower ALP
Rarely pathological
126
Give some causes of high albumin
Dehydration
127
Give some causes of low albumin
Inflammation
Cirrhosis
Pregnancy
Chronic disease
128
Give some causes of raised amylase
Acute pancreatitis
Chronic pancreatitis
Abdo perforation
Burns
Anorexia
Renal disease
129
Give some causes of raised lipase
Acute pancreatitis
130
How do bone metastases present on bone profile bloods
Raised calcium
Raised ALP
131
How does hypoparathyroidism present on bone profile
Reduced calcium
Raised phosphate
Reduced PTH
132
How does primary hyperparathyroidism present on bone profile
Raised calcium
Reduced phosphate
Raised ALP
Reduced PTH
133
How does myeloma present on bone profile
Raised calcium
Raised urea
Raised creatinine
Reduced haemoglobin
Raised ESR
134
How does Paget's disease present on bone profile
Raised ALP
Normal calcium
Normal phosphate
135
Give some causes of hypercalcaemia
Primary and tertiary hyperparthyroidism
Malignancy
Excess vitamin D
Sarcoidosis
Myeloma
136
Give some causes of hypocalcaemia
Vitamin D deficiency
Hypoparathyroidism
Acute pancreatitis
Alkalosis
Magnesium deficiency
137
Give some causes of high phosphate
Chronic renal failure
Reduced PTH
Myeloma
Excess vitamin D
Rhabdomylosis
Cell lysis (post-chemo)
Acidosis
138
Give some causes of reduced phosphate
Malabsoprtion/malnutrition
Alcohol
PTH
Burns
Alkalosis
Post-DKA treatment
139
What is the calcium, phosphate and PTH levels in people with primary hyperperathyroidism
Raised calcium
Lower Phosphate
Raised PTH
140
What is the calcium, phosphate and PTH levels in people with secondary hyperperathyroidism
Lower calcium
Lower phosphate
Raised PTH
141
What is the calcium, phosphate and PTH levels in people with tertiary hyperperathyroidism
High calcium
High phosphate
High PTH
142
What is the calcium, phosphate and PTH levels in people with hypoparathyroidsm
Low calcium
High phosphate
Low PTH
143
What are the blood glucose levels on a fasting glucose and glucose after 2hrs that indicate diabetes
>6.9mmol/l
>11mmol/l
144
How does TSH, T4 and T3 present on a blood test for primary hyperthyroidism
Raised T3
Raised T4
Low TSH
145
How does TSH, T4 and T3 present on a blood test for subclinical hyperthyroidism
Normal T4
Raised T3
Low TSH
146
How does TSH, T4 and T3 present on a blood test for primary hypothyroidism
Low T4
Low T3
High TSH
147
How does TSH, T4 and T3 present on a blood test for secondary hypothyroidism
Low T4
Low T3
Low or normal TSH
148
How does TSH, T4 and T3 present on a blood test for subclincal hypothyroidism
Normal T4
Normal T3
High TSH
149
How does RVH present on a ECG
Right axis deviation
Dominant R waves in V1
150
How does LVH present on ECG
Left axis devation
Dominant R waves in V6
151
Give some causes of ST elevation
STEMI
Pericarditis
Ventricualr aneurysm
Hypothermia
High takeoff
152
What vessel is affected by inferior leads (AVF, II, III)
RCA
153
What vessel is affected by anterior leads (V1,V2,V3,V4)
LAD
154
What vessel is affected by lateral leads (I, AVLV5,V6)
Circumflex artery
155
How does pneumonia present on CXR
Asmmetrical shadowing and consolidation
Blunting of costophrenic angles
Blurring of heart and diaphragm borders
Air bronchograms
156
How does pulmonary oedema present on CXR
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
How does a pleural effusion present on CXR
Whiteout area at the base with lost of costophrenic with or without loss of costophrenic angles
May have meniscus lines
158
How does asthma/COPD present on CXR
Hyperinflated, flattened diapgragm and barrel chest
159
How does a pneumothorax present on CXR
Line of seperted pleura with peripheries lacking lung markngs
Deviated mediastinum if tension
160
What are the causes of localised white lesions on CXR
Abscess - may have fluid line
Nodules
Tumours
161
How many posterior ribs are normal to be seen on chest x-ray and how many are considered hyperinflated
6 or less is poor inspiratory effort
7-9 is normal
10 or more is hyperinflated
162
How many posterior ribs are normal to be seen on chest x-ray and how many are considered hyperinflated
6 or less is poor inspiratory effort
7-9 is normal
10 or more is hyperinflated (may have flat diaphragms)
163
What level should central lines be
Level of carina
164
WHat level should NG tubes be
Below carina and if not try pushing 5cm more to see if it places it
If trachea then remove
165
Give a sign of significantly impaired respiratory function
Low or normal PO2 on high concentration of inspired oxygen
166
Give some causes of metabolic acidosis
Shock
DKA
Renal failure
Liver failure
Lactate
Drug overdose (TCA)
167
Give some causes of metabolic alkalosis
Vomiting
Diarrhoea
Hypokalaemia
168
Give some causes of respiratory acidosis
Severe asthma/COPD
Severe pneumonia
Severe pulmonary oedema
Myasthenia gravis
Drugs - sediatives, opioids
Chest trauma/scoliosis
Obesity
169
Give some causes of respiratory alkalosis
Cranial lesions
Anxiety/hyperventilation
170
Give causes of a raised anion gap
LADR
Lactic acidosis
Alcohol
DKA
Renal failure
171
Give causes of a normal anion gap
ABCD
Addisions
Bicarbonate loss (vomiting)
Chloride loss (diarrhoea)
Drugs nsaids spironolactone
172
What are the FEV1/FVC values for Normal, obstructive and restrictive disease
Normal - 75%-80%
Obstructive - <75%
Restrictive >80%
173
How is bowel perforation seen on AXR
Free gas under the diaphragm or two-sided wall on bowel
174
How does caecal volvus seen on AXR
foetal-sign
175
How is sigmoid volvus seen on AXR
Coffee-bean sign
176
How is constipation seen on AXR
Faecal loading in the la rge bowel starting from rectum
177
How is chronic pancreatitis seen on AXR
Calcifications in epigastric area
178
How is CKD seen on AXR
Small kidneys
179
If psoas muscle is absent on CXR what does this suggest
Ascites
180
On urine dipstick what is suggested by nitrates
Produced by gram negative bacteria (E.coli) and suggest urinary tract infection
181
On urine dipstick what is suggested by leukocytes
Inflammation of kidneys, urinary tract but also high in stones, trauma, malignancy, infection in prostate or appendix
182
On urine dipstick what is suggested by blood
Can be actual RBC or haemoglobinuria as seen in rhabdomylosis
183
On urine dipstick what is suggested by protein
Detects albumin which shold not be present in the urine (bence jones protein not detected on urine dip)
184
On urine dipstick what is suggested by glucose
Common with increasing age but may suggest DM
185
On urine dipstick what is suggested by ketones
Raised with DKA, fasting, low carbohydate diets and acute illness
186
On urine dipstick what is suggested by pH
Normal 4.5-8
Acidic pH suggests acidosis
Alkali pH suggests alkalosis
187
On urine dipstick what is suggested by cast cells
Epithelial casts - renal disease
White cell casts - pylonephritis
188
What do normal CSF results look like
Apperance - clear
White cells - <4
Type of cell - lymphocytes
Glucose - >70% plasma
Protein - <0.4g/l
189
What does bacterial CSF results look like
Apperance - cloudy
White cells - very very high
Type of cell - neutrophils
Glucose - very low
Protein - high
190
What does TB CSF look like
Apperance - clear
White cells - high
Type of cell - Lymphocytes
Glucose - <50% glucose
Protein - High
191
What does viral CSF look like
Apperance - clear
White cells - very high
Type of cell - lymphocytes
Glucose - normal
Protein - mediocrely high
192
How are cervical spine x-rays interpreted
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
How are skeletal radiographs interpreted
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
What are the driving regulations for stroke/tia
1 month and resume only if minimal residual deficit
195
What are the driving regulations for epilepsy
Cease until 1 year since last seizure
6 months if first seizure
196
What are the driving regulations for unexplaiend syncope
4 weeks if low risk or 6 months if no cause found
197
What are the driving regulations for those with diabetes on insulin or hypoglycaemic drugs
Must be able to recognise hypo and not had >1hypo requiring assistance in last 12 months
198
What are the driving regulations for those with MI/ACS
1 week if successful angioplasty
4 weeks if no angioplasty or unsuccessful
199
What are the driving regulations for drug addiction
1 year once clean
200
Wuat are the driving regulations for sleep apnoea
Cease until symptoms are controlled
