Random

Question 1

Describe the presentation of DIC

Answer 1

Severely unwell patient eg. sepsis, burns, trauma

Bleeding from everywhere: lines, eyes, ears, mucous membranes

Question 2

Describe the investigation results in DIC

Answer 2

Abnormal clotting 
^ APTT
^ PT
^ D-dimer
Low platelets
Low clotting factors

Question 3

Describe the management of DIC

Answer 3

Treat cause

Replace clotting factors: cryoprecipitate, FFP

Question 4

Describe the presentation of tumour lysis syndrome

Answer 4

Electrolyte abnormalities in patients receiving chemotherapy (specifically haem malignancies)

• High K+
• High urate
• High phosphate
• Low Ca

-> AKI, arrhythmia + cardiac arrest, seizures

Question 5

Describe the management of tumour lysis syndrome

Answer 5

A to E approach

• IV fluids
• Manage hyperkalaemia: eg Ca gluconate, insulin
• Stop nephrotoxic drugs
• Phosphate binders eg. Aluminium salts

Question 6

Describe the prevention of tumour lysis syndrome

Answer 6

Lots of fluids

Allopurinol

Question 7

Describe the causes of upper GI bleeding

Answer 7

Peptic ulcer disease, erosions
Mallory Weiss tear
Oesophagitis
Varices 
Drugs: NSAIDs, anticoagulants 
Malignancy
Boerhave's perforation

Question 8

Describe the presentation of upper GI bleeding

Answer 8

-Haematemesis, melaena, pain
-Fe deficiency: fatigue, SOB, reduced exercise
-Blood loss: dizziness, syncope, shock
+/- signs of chronic liver disease

Question 9

What scoring systems can be used with upper GI bleeding?

Answer 9

Glasgow-Blatchford bleeding scale: characterises patients as high and low risk to determine admission
-Takes into account: Hb, urea, BP + HR, history of melaena/syncope/liver disease/heart failure

Rockall score: risk stratification for rebleeding risk + mortality
-Takes into account age, obs, comorbidities, endoscopy findings

Question 10

Describe the initial management of upper GI bleeding

Answer 10

A to E approach
A: protect airway
B: high flow O2
C: IV acces with 2 large bore cannulae, take bloods (FBC, U+Es, LFTs, clotting, G+S)
-Give IV fluids while waiting for blood products
-Insert catheter, measure urine output

Further:

• Stop anticoagulation
• CXR, ECG, ABG
• Correct clotting abnormalities
• If variceal: IV terlipressin 2mg/6 hours
• IV antibiotics eg. Tazocin, erythromycin
• Endoscopy + haemostasis (clips, cautery, adrenaline)

-> continue to monitor for rebleed