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Wernicke’s encephalopathy triad and cause
Korsakoff syndrome
Opthalmoplegia:nystagmus
Ataxia
Confusion
Caused by thiamine deficiency, is life threatening
Korsakoff syndrome is progression of wernicke’s,associated with anterograde amnesia
Examples of air leak syndromes
Pneumothorax
Pneumomediastinum
Pneumoperitoneum
Subcutaneous emphysema
Most common cause of lambert eaton myasthenic syndrome
Para neoplastic syndrome secondary to small cell lung cancer
6 NOs of aminoglycosides
gram Negative Organisms?
NO pregnancy
NO myasthenia Gravis
Nephrotoxic and Ototoxic
Pathogen most responsible for GBS(Guillian barre syndrome)
Campylobacter jejuni from old seafood or post URTI
Drug used for chelation in Wilsons disease
Penicillamine
Mx of acquired hemochromatosis
Therapeutic Phlebotomy( Donating blood) or iron chelation
Methods of immunomodulation
Traditional immunosuppressants
Corticosteroids
Biologics
Sepsis 6
3+3
3 Mx: Empirical Abx, Oxygen and fluids
3 Invx: Lactate, Urine output and blood culture
Markers of inflammation
CRP
ESR
procalcitonin
Ferritin
Albumin(negative phase reactant)
Sx of hyponatremia
Seizures
Muscle cramps
Headache
Lethargy
AMS eg confusion, consciousness decreased
Causes of pseudohyponatremia
High blood cholesterol or proteins(HLD,hematological)
T2DM
Risk of running IV fluids too fast
Cerebral edema
Complications of running overly hypertonic IV fluids
Pontine demyelination
Immediate Mx of hyperK
- Calcium gluconate to stabilise cardiac membrane
- Insulin with dextrose to correct electrolytes
Cause of paradoxical aciduria in hypokalemic hypochloremic metabolic alkalosis
Body prioritises fluid volume over maintaining pH
At DCT, Na+ is reabsorbed in exchange for H+ and K+
Increased excretion of these leads to hypokalemia with paradoxical aciduria
Winters formula for calculating expected compensation for metabolic acidosis
Expected pCO2 =(1.5 X(conc bicarbonate)+8+-2mmHg
Measured>expected: concomitant respiratory acidosis
Expected>measured: compensatory respiratory alkalosis
Anion gap formula
Na-Cl-HCO3
Nornal is 5-14, measures unmeasured anions
Metabolic effects of salicylate poisoning
Metabolic acidosis with respiratory alkalosis
Causes of peripheral cyanosis
Cold environment
Hypothermia
Fever
Sepsis
Shock(except distributive)
Hypoglycemia
Acrocyanosis
Raynaud phenomenon
Anion gap formula
Na+K-Cl-Bicarb
4 Ts of mediastinal masses
Thyroid
Thymoma
Teratoma
Terrible Lymphoma
Holliday Segar method
4 2 1 or 100/50/20
Caveats to Holliday Segar method
Renal failure
Cardiac failure
Neonates
Obese patients
Immobility precautions
Wind,water and wound
Pneumonia/Atelactasis, UTI and decubitus ulcers
Drugs for treatment of osteoporosis
Anti resorptives:bisphosphonates and denosumab
Osteoblast stimulants: Teriperatide(shown to be more effective)
Histology of Henoch Schonlein Purpura
IgA deposits
Types of large vessel arteritis
GCA and Takayasu
Types of Medium vessel arteritis
Kawasaki and PAN
Types of small vessel arteritis
IgA vasculitis, Polyangiitis
Variable vessel Vasculitis
Behcet and Cogans
Cx of Necrotising Fasciitis
- Sepsis
- Renal failure
- Severe scarring
- Limb loss?
Risk factors for necrotising fasciitis
- Chronic disease eg DM, Malignancy
- Peripheral vascular disease
- Chronic alcoholism
- Malnutrition
- Obesity
- Trauma/Iatrogenic
- Varicella
Vaccinations for herpes zoster
Shingrix: 2 doses of recombinant inactivated virus
Zostavax: Live vaccine
What to look for on PE and CXR in Suspected pneumothorax or pleural effusion
Tracheal deviation
Causes of bilateral LL swelling
Pitting
- cardiac
- Liver
- Renal
- drugs eg CCB
Non pitting
- pretibial myxedema
- lympedema
- venous insufficiency
How to screen microvascular cx of DM
Eye: vision changes, past laser, past injections
PVD: prev amputations
Causes of chlye in uria
CCBs and one other drug?
Parasites: filiariasis
Thoracic duct obstruction
Examples of negative phase reactants
Albumin
Ferritin
Uric acid
Lipid/LDL
Cx of SVCO
1} Cerebral Edema
2) Stridor and respi failure
Symptoms of Hypercalcemia
Stones: Urinary stones/ colic
Groans: Abdo pain, constipation, N/V
Moans: Psychiatric eg AMS, confusion
Bones: Bone pain
Thrones: Urinary frequency
Mx of HyperCa
1) Mainstay is IV hydration
2) Calcitonin within 1st 48hrs
3) Bisphosphonates
4) Denosumab
Endocrine causes of transient urinary incontinence
Diabetes Mellitus
Diabetes Insipidus
HyperCa?
Clinical definition of Anaphylaxis
- Acute onset
- 2 or more systems involved post exposure( Mucocutaneous, CVS, Respi, GI)
- Hypotension post exposue
Mx of anaphylaxis
- IM adrenaline 1:1000
- Bronchodilator
- IV Hydrocortisone
- Antihistamines, both H1 and H2 blockers
Common causative agents of SJS/TENS
1) Antibiotics
2) Antiepileptics( Valproate, carbamazepine)
3) Sulfonamides
4) NSAIDs
5) Antiretrovirals
6) Allopurinol
Mx of SJS/TENS
- ABCs and supportive
- Withdraw offending drug
- Burns Mx, cold compresses
- Broad spectrum Abx and Anti tetanus
ECG Festures of HyperK
- Tall tented t waves
- Absent p waves
- QTc prolongation
- Broad QRS complexes
- Sine wave pattern
HyperK Mx
- Calcium gluconate
- IV Insulin
- IV dextrose
- Resonium
- Dialysis if refractory
Contraindications to central lines
Absolute:
Overlying infection
Vein thrombosis
Relative
Coagulopathy
Indications for Central lines
Vasoactive drugs( Noradrenaline)
Dialysis
TPN
Chemotherapy
CVP measurement
Frequent blood taking
Long term drugs eg abx
Mx of refeeding syndrome
- Refer dietician
- Electrolyte replacement and trend
- Thiamine repalcement
- Telemetry
Metabolic and Electrolyte imbalances of refeeding syndrome
HypoK
HypoMg
Hypophosphatemia
Thiamine deficiency
Numbers for UFEME
5
3
5
