QuQuick recall 3 Flashcards
Pathways!
Warfarin:
Heparin:
LMWH:
Warfarin: Extrinsic pathway –> prothrombin time
Heparin: Intrinsic pathway –> APTT
LMWH: enoXaparin - anti-factor Xa levels
Septic arthritis requires prolonged antibiotic therapy of at least
4-6 weeks
Standard heparin vs LMWH
Adverse effects of heparin:
–> bleeding
–> thrombocytopenia
–> osteoporosis (increased risk of fractures|0
–> hyperkalaemia
Heparin over dose: reversed by protamine sulphate
IgG,A,M,D,E
IgG: G for gestational - only Ig that can cross the placenta
IgA: A being the first letter, is the first Ig to be given to baby thru breastfeeding
IgM: M is a simp for the body (M’lady i’ll be the Main protector from pathogens)
IgD: D is like unsolicited dick pics, nobody knows what they’re good for
IgE: E is for Eosinophiles, which are also associated with the allergic response
IgM - pentamer
IgA - monomer / dimer
Rest monomer
The diagnostic criteria for HHS include
- hypovolaemia
- hyperglycaemia (BM > 30mmol)
- serum osmolality (320 mosmol/kg)
Clinical features
- fatigue
- lethargy
- altered consciousness
- hypotension
- tachycardia
monitor SERUM OSMOLALITY
Carcinoid syndrome: investigation and management
Investigation
–> Urinary 5-HIAA
–> plasma chromogranin A y
Management
–> somatostatin analogues e.g. octreotide
–> diarrhoea: CRYPTOHEPATIDINE
Features
- flushing
- diarrhoea
- bronchospasm
- hypotension
- right heart valvular stenosis
- rare: pellagra
Hyperkalaemia management
mild: 5.5-5.9mmol/l
moderate: 6-6.4 mmol/l
severe: > 6.5mmol/l
- stabilisation of cardiac membrane: IV calcium gluconate
- Short term shift i K+ from ECF to intracellular fluid compartment
–> combined insulin / dextrose infusion
–> nebulused salbutamol - Potassium removal from body
–> calcium resonium (enema»_space; oral)
–> loop diuretics
–> dialysis (w/ AKI
ECG: QRS widening and peaked T waves
TIA: assessment and referral
- ABCDE prognostic score
- Immediate antithrombotic therapy
–> aspirin 300mg
–> UNLESS: bleeding disorder, already on low dose aspirin or contraindicated - Specialist review
–> in last 7 days: arrange urgent assessment w/i 24 hrs
–> post 7 days: asap w/i 7 days
INVESTIGATION:
1. MRI (diffusion-weighted and blood-sensitive sequences)
2. Carotid imaging: urgent carotid dopller
Further management
1. Secondary prevention: clopidogel 1st line
–> OR aspirin + dipyridamole
2. Statin
3. carotid stenosis > 70% –> CAROTID A. ENDARECTOMY (on side contralateral to symptoms)
Episodic, intense, unilateral eye pain, lacrimation, restless →
cluster headache
–> high flow oxygen + subcutaneous sumatriptan
Prophylaxis
- verampil
Paroxysmal hemicrania responds well to indomethacin
mnemonic for raised anion gap based on symptoms
In acidosis –> kussmaul breathing
K - ketones
u - uraemia
s - sepsis
s - salicylate
m - methanol
a - aldehyde
l - lactic acidosis
OR
MUDPILES for high anion gap
Methanol
Uraemia
DKA
Paracetamol/Paraldehyde
Iron
Lactate
Ethanol
Salicylates/Sepsis
Normal ion gap metabolic acidosis:
normal anion gap (6 - 16 mmol/L)
HARD ASS
Hyperalimentation
Addison’s
RTA
Diarrhoea
Acetazolamide
Spironolactone
Saline
Triad of sudden onset abdominal pain, ascites, and tender hepatomegaly: seen in
BUDD CHIARI SYNDROME (hepatic vein thrombosis)
- raised SAAG >11 indicates portal HTN caused the ascites
IX - USS w/ doppler flow studies
Variceal haemorrhage: management
ABCDE
1. correct clotting: FFP, vit K
Before endoscopy
2. Vasoactive: terlipressin (or octreotide?)
3. prophylactic IV Abx (quinolones?)
4. Endoscopic varcieal band ligation
UNCONTROLLED HAEMORRHAGE
–> SENGSTAKEN-BLAKEMORE TUBE
TIPS if all else failed!
Prophylaxis of variceal haemorrhage
- Propranolol
- Endoscopic variceal band ligation (at 2 weekly intervals until eradication) + PPI
- TIPS if unsuccessful
DVLA: neurological disorders
Epilepsy
–> unprovoked: 6 months off IF no abnormalities on EEG (increased to 12 months)
–> established: driving licence if seizure free 12 months, no seizure for 5 years
–> withdrawal of AED: 6 months after last dose
Syncope
–> faint: no restriction!
–> single, explained, treated –> 4 WEEKS OFF
–> single, unexplained –> 6 MONTHS off
–> 2 or more –> 12 months off
Stroke / TIA
–> 1 month off, no need to inform DVLA if no neurological deficiit
–> multiple TIAs: 3 months off driving and inform DVLA
Craniotomy
–> 1 year off driving
Pituitary tumour
–> 6 months
Statin doses for primary and secondary prevention
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller →
DENGUE fever
–> maculopapular after 3-4 days after onset of illness
–> thrombocytopenia
Recent sore throat, rash, arthritis, murmur →
rheumatic fever
- following streptococcus pyogenes infection
Hyperosmolar hyperglycaemia state: Pathophysiology
hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion
Managment:
1. IV fluid replacement (0.5-1L/hr) , monitor K+
2. Insulin (not until BG stops falling while giving IV Fluids)
3. VTE prophylaxis
The anion gap is calculated by:
(sodium + potassium) - (bicarbonate + chloride). A normal anion gap is 10-18 mmol/L.
Paget’s disease of the nipple:
Diagnosis made via punch biopsy, mammography and USS of breast
Needs breast clinic referral urgent!
THESE are typically spared in motor neurone disease
Eye movements
CT shows:
**Aortic dissection **
- intraluminal tear formed a ‘flap’ in the ascending aorta
- Stanford TYPE A DISSECTION
HTN common in AD aar cathecholamine surge
Hoffman’s sign
Involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail down.
Degenerative cervical myelopathy.
typically presents with abdominal, neurological and psychiatric symptoms
acute intermittent porphyria
- autosomal dominant
- enzyme involved in biosynthesis of haem
- leads to toxic accumulation of delta aminolaevulinic acid and porphobilinogen
1st line treatment for chronic myeloid leukaemia
Imantinib - tyrosine kinase inhibitor
Philadelphia chromosome !
- high white cell
- blast cells would indicate acute anaemia
P450 enzyme inducers
PC BRATS- inducers
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol
Topiramate
Sulfonylureas
Tracheal deviation, resonant to percussion and absent breath sounds in the context of respiratory distress and shock -
TENSION PNEUMOTHORAX
MX: immediate decompression via needle thoracostomy
Causes:
1. Traumatic: blunt / penetrating chest trauma
2. Iatrogenic: thoracentesis, central venous catheter placement, positive pressure mechanical ventilation
3. Spontaneous: COPD / CF, lung blebs may rupture
A 25-year-old lady presents with an swelling located at the anterior border of the sternocleidomastoid muscle. The swelling is intermittent and on examination it is soft and fluctuant.
Branchial cysts are remnants of the branchial cleft. They may become infected.
Differentiating posterior vitreous detachment, retinal detachment and vitreous haemorrhage:
POSTERIOR VITREOUS DETACHMENT
- Flashes of light (photopsia) in peripheral field of vision
- Floaters (often temporal side of central vision)
Differentiating posterior vitreous detachment, retinal detachment and vitreous haemorrhage:
- dense shadow starting peripherally moving towards central vision
- a veil or curtain over field of vision
- straight lines appear curved
- central vision loss
RETINAL DETACHMENT
Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
Vitreous haemorrhage
Anti-GBM disease typically presents with:
Haemoptysis + AKI/proteinuria/haematuria
Small vessel vasculitis associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis.
–> may be exacerbated by cold
IX: renal biopsy showing linear IgG deposits
Mx:
–> plasma excahnge
–> steroids
–> cyclophosphamide
key complication is pulmonary haemorrhage!
ASA gradings
Osteomalacia
Causes: Vit D deficiency, CKD, Liver disease, coeliacs
Feature: bone pain, muscle tenderness, fractures, proximal myopathy (waddling gait)
IX:
Bloods : vit D, raised ALP
X-RAY: translucent bands (looser’s zones or psuedofractures)
Tx:
1. Vit D supplementation (loading dose needed)
2. calcium supplementation if dietary calcium inadequate
Softening of bones secondary to low vitamin D levels
Causes of respiratory alkalosis:
Respiratory Alkalosis
PAST PH
Panic attacks
Anxiety attacks
Salicylates
Tumour
Pulmonary embolism
Hypoxaemia
Note: salicylate overdose can cause mixed primary resp alkalosis and metabolic acidosis
first-line treatment for magnesium sulphate induced respiratory depression.
Calcium gluconate
This woman has a symptomatic megaloblastic anaemia associated with glossitis. This is likely due to
Pernicious anaemia: B12 deficiency
Intrinsic factor antibodies
Mx: Vit B12 injections, 3 injections weekly for 2 weeks followed by 3 monthly treatment of vitamin b12 injections
–> folic acid supplementation?
B12 important for RBC production and myelination of nerves
Different type of cysts
Epidermoid cyst - ‘Blackhead’
Sebaceous cyst - ‘Whitehead’
Dermoid cyst - Can contain hair (or teeth/other abnormal growths within -dependent on the location [ovaries])
Desmoid tumours are benign tumours of connective tissue
What does the following show:
- papilloedema
- lurring of the optic disc edges
- enlargement of the surrounding veins.
- small haemorrahges surrounding optic disc
