Quick recall Flashcards
Features of serotonin syndrome
3As
- Altered mental status
- Neuromuscular abnormalities
- Autonomic hyperactivity
Plummer-vinison syndrome characterised by triad of what:
Plummers DIE
D- dysphagia
I- iron deficiency anaemia
E- eosophageal webs
A 5-year-old boy presents with recurrent episodes of sinusitis. The casualty staff are surprised to find his liver lying in the left upper quadrant of the abdomen
Kartagener’s syndrome
- immotile cilia syndrome
- assocaited with sinus inversus
What is vestibular neuronitis?
–> cause of vertigo
–> develops following viral infection
Features:
1. recurrent vertigo attacks lasting hours or days
2. nausea and vomiting may be present
3. horizontal nystagmus is usually present
4. no hearing loss or tinnitus
Differentiating vestibular neuronitis from posterior circulation stroke
HiNTs exam
Management of vestibular neuronitis:
- buccal or intramuscular prochlorperazine : rapid relief for sever cases
- vestibular rehab exercises for patients with chronic symptoms
mydriasis
dilated eye
miosis
smaller pupil
3rd nerve palsy characterised by:
- ptosis
- down and out eye
- mydriasis
Status epilepticus management
Management
1. ABC
2. BENZOs
–> Prehospital –> PR diazepam or buccal midazolam
–> Hospital IV lorazepam –> repeated once after 5-10 mins
3. Established status
–> leve, phenytoin, sodium valproate
4. No response w/i 45 mins?
–> call the anaesthetist!–> RSI
Mx Bells palsy
- PRED, w/i 72 hrs onset of bells palsy
- Eyecare
–> artificial tears
–> eye lubricants - refer to ENT if paralysis no improvement 3/52
51 y/o female
PC: facial flushing + diarrhoea
HPC: 6/12 facial flushing, worse on exertion, associated palpitations. 3/12 diarrhoea.
OE: peripheral oedema, soft mid-diastolic murmur
characteristic of:
CARCINOID SYNDROME
–> secretion of serotonin, kinins and amines leads to flushing
Murmur –> tricuspid stenosis, R heart failure
Investigation for carcinoid syndrome
24 hour collection of urinary 5-HIAA
Management of carcinoid syndrome
- Somatostatin analogues e.g. octreotide
- diarrhoea: cyproheptadine
What occurs in primary hyperparathyroidism?
Cause –> solitary parathyroid adenoma –> increase release of PTH
Result:
–> high calcium and low phosphate
–> increase bone turnover by OC activation –> more ALP
Presentation: hypercalcaemia symptoms: constipation and mood changes
Describe secondary hyperparathyroidism:
Chronically low serum [Ca2+] –> parathyroid hyperplasia
Increased PTH secretion will not be able to reverse chronically low calcium and high phosphate caused by condition.
PTH –> excessive bone turnover –> high ALP
Presentation: bone pain, tenderness, proximal myopathy and recurrent fractures
Tertiary hyperparathyroidism is caused by:
ongoing hyperplasia of parathyroid glands after correction of long standing renal disorder.
Presentation of tertiary hyperparathyroidism
- high calcium
- elevated PTH
- decreased phosphate
- elevated ALP
management of endometrial hyperplasia
Simple w/o atypia –> high dose progestogens with repeat sampling in 2-4 months. maybe IUS.
If Atypia: HYSTERECTOMY w/ bilateral salpingectomy
what sound be suspected in a patient who develops post operative shortness of breath and hypoxaemia
Atelectasis
management of atelectasis
- position patient upright
- chest physio: breathing exercises
What rules are used to minimise use of X-rays in patients presenting with ankle injuries
OTTAWA ANKLE RULES
- inability to weight bear for 4 steps
- tenderness over distal tibia
- bone tenderness over distal fibula
Weber classification
A - below syndesmosis (CAM + weight bearing)
B- tibial plafond may extend proximally to involve syndesmosis
C - above syndesmosis (ORIF)
What is Wolff-Parkinson-White syndrome?
- accessory pathway that bypasses the AVN
- causing early depolarisation of the ventricles
- short PR interval (<120ms)
Possible ECG features
- short PR
- widened QRS
Management of WPW syndrome
Definitive treatment –> radiofrequency ablation of accessory pathway
Medical therapy: amiodarone, flecainide
THIS
may be used in patients with stress incontinence who don’t respond to pelvic floor muscle exercises and decline surgical intervention
duloxetine
Triad which is seen in children with haemolytic uraemic syndrome
- AKI
- microangiopathic haemolytic anaemia
- thrombocytopenia
Most cases caused by: shiga toxin producing E.coli
DDs for painless red eye
If the eye is painless and red, hold on a SEC
S- subconjunctival haemorrahge
E- episcleritis
C- conjunctivitis
Diagnostic criteria for PCOS
Rotterdam 2/3 present.
- infrequent / no ovulation
- polycystic ovaries on USS
3 hyperandrogenism signs (hirsutism, acne, or elevated total or free testosterone)
In Broca’s you Fumble your speech
STRIFE
STR: Superior temporal: Receptive aphasia
IFE: Inferior frontal: Expressive aphasia
tetralogy of fallot
- VSD
- RV hypertrophy
- RV OTO, Pulmonary stenosis
- overiridng aorta
management of toxoplasmosis
Only treated in HIV/immunosuppressed patients.
Mx: pyrimethamine plus sulphadiazine for atleast 6 weeks
Group B strep and pregnancy management
- Universal screening.
- If positive: intrapartum ABx prophylaxis.
- if pyrexia during labour –> give IAP
Choice of Abx –> benzylpenicllin
first-line treatment for syphilis.
Benzathine penicillin G (IM stat dose)
Local anesthetic toxicity can be treated with
IV 20% lipid emulsion
Diagnostic criteria for multiple sclerosis
Macdonald criteria
- two or more clinical episodes which are disseminated over time and affect anatomically different areas
Multiple sclerosis: investigations
MRI
- Dawson’s fingers? hyperintense lesions perpendicular to corpus callosum
Management of renal stones
Renal stones:
- watchful waiting if <5mm and asymptomatic
- 5-10mm –> shockwave lithotripsy
- 10-20mm –> SL or ureteroscopy
- > 20mm percutaneous nephrolithotomy
Uretic stones
- shockwave lithotripsy +/- alpha blockers < 10mm
- 10-20mm ureteroscopy
Syringomyelia
selectively affects the spinotholamic tracts.
TB management
RIPE drugs
First 2 months: initial phase
R-rifampicin
I-isoniazid
P- pyrazinamide
E-ethambutol
Continuation phase
R-rifampicin
I-isoniazid
Subacute combined degeneration of the spinal cord is due
vitamin B12 deficiency resulting in impairment of the:
1.dorsal columns
–> impaired proprioception and vibration
2. lateral corticospinal tracts
–> muscle weakness, hyperreflexia and spasticity
–> brisk knee reflexes
–> absent ankle jerk
3. spinocerebellar tracts
–> sensory ataxia: gait abnormalities
–> positive romberg’s sign
The classic presentation is painless, bright red vaginal bleeding that occurs during the second or third trimester.
Placenta Praevia
- placenta partially / completely covers the cervix
This condition often presents with painful vaginal bleeding and uterine contractions
Placental abruption
- premature separation of placenta from uterine wall
- abdominal pain
- uterine irritability
This condition
- vaginal bleeding
- fetal distress
- severe abdominal pain: shoulder tip
- abnormal CRG
- shock
Uterine rupture
CRAP induces liver enzymes
carbamazepine, rifampin, alcohol (chronic), phenytoin,
ECG features of hypokalaemia
- U waves
- small or absent T waves (occasionally inversion)
- ST depression
- long QT
* U have no Pot and no T, but a long PR and a long QT
Pulmonary embolism: management
Anticoagulation
1. DOAC
If contraindicated:
a) LMWH + WARFARIN (vit k antagonist)
–> given in renal impairment
b) LMWH + dabigatran/edoxaban
**Length of coagulation **
1. Provoked?
- AC stopped after **3 months **
2. Unprovoked ?
- AC stoppped after **6 months **
PE w/ haemodynamic instability
1. Thrombolysis w/ alteplase
Scoring system used to assess bleeding risk in patients with PE
ORBIT
Atrial fibrillation: management
1. W/I 48hrs
–> electrical DC cardioversion
–> or pharmalogical w/
———> a) amiodarone (structural HD)
———> b) flecaindied / amiodarone (w/o SHD)
2. AFTER 48hrs
–> AC for atleast 3 weeks before cardioversion
OR –> TOE to exclude left atrial appendage
Management of intratrochanteric fracutres vs subtrochanteric
Intratrochanteric –> DHS
Subtrochanteric –> Intramedullary nail
DHS
REVISION
Intramedullary nail
REVISION
Anti-phospholipid syndrome characterised by:
- Predisposition to both venous and arterial thromboses.
CLOT - C - Clotting time increased, increased APTT
- L - Livedo reticularis
- O - obstetric complications
- T - thrombocytopenia
Haemochromatosis characterised by:
- Fatigue
- Erectile dysfunction
- Arthralgia
vesicles extending to the tip of the nose:
Hutchinson’s sign
Associated w/ Herpes zoster opthalmicus
Herpes zoster opthalmicus: mx + complications
- oral antiviral 7-10 days
- start w/i 72hrs
- IV is severe / immunocompromised - topical corticosteroid for inflammation of eye
- urgent opthalmology review if ocular involvement
Complications
a) OCULAR –> conjunctivitis, keratitis, epislceritis, anterior uveitis
b) ptosis
c) post-herpetic neuralgia
This patient presents with signs and symptoms of anaemia (tiredness, pale conjunctivae and increased pulse), massive splenomegaly and erratic blood tests results:
Likely diagnosis:
CML
- anaemia
- splenomegaly
- thrombocytosis
systolic murmur in the pulmonary area and a fixed splitting to the second heart sound
Atrial septal defect
Patients may experience:
- SOB
- lethargy
- poor appetite and growth
Ventricular septal defect
Pansystolic murmur in lower left sternal border
Coarctation of the aorta
Crescendo-decrescendo murmur in the upper left sternal border
Patent ductus arteriosus
Diastolic machinery murmur in the upper left sternal border
Pulmonary stenosis
Ejection systolic murmur in the upper left sternal border
