Random Facts Flashcards
Side Effects of Steroids
Weight gain Osteoporosis Avascular necrosis (AVN) Cataracts, glaucoma Peptic ulcer disease (PUD) Susceptibility to infection Easy bruising Acne Hypertension Hyperlipidemia Hypokalemia Hyperglycemia Mood swings
Bornholm disease/pleurodynia
Uncommon infection of intercostal muscles by Coxsackie B virus.
Causes severe stabbing chest pain. Pleuritic and worse with movement.
Associated with fever, malaise, and headaches.
Causes of Mononeuritis Multiplex
1) diabetes
2) vasculitis
2 diameters of NGT - their purpose
Smaller - for giving
Larger - for sucking
Steroid use in premature babies
Help to grow
Matures type 2 pneumocytes to reduce surface tension and aid breathing
What is the Ross procedure?
Diseasedaortic valveis replaced with the person’s ownpulmonary valve.
A pulmonaryallograft(valve taken from acadaver) is then used to replace the patient’s own pulmonary valve.
For common in children.
Chiari malformation
Structural defect where cerebellum +/- brain stem tissue extends into the foramen magnum
2 things to ask before interpreting ECG
1 - pain?
2 - HTN?
Most common cause of LVH is HTN.
Shows upas high voltages
When can you have ectopic rupture or D/C?
7-9 weeks.
Need the mass to be big enough either to cause rupture or to scrape.
Bacterial vs viral illness
Bacterial - constitutional symptoms
Viral - coryzal symptoms, esp sore throat, runny nose
What investigations to rule out SAH?
CT brain and then LP - rules out 99%
If still suspicious, do MRI.
LP preferably done within 24hrs .
Expect blood in all tubes.
4th tube looking for xanthochromia. Must be wrapped in foil.
Dimples of Venus correlate to?
Sacroiliac joints.
They directly overlie them.
How long can viral cough last for?
2-3 months
Therapeutic dose of clexane
for DVT
1.5mg/kg daily
or
1mg/kg bd
How can we clinically assess for jaw dislocation or #?
Look at alignment of teeth
Look for any hematomas in/under the gum
Iron tablets - what can they cause?
Black stools without the offensive smell
Intra-uterine hematoma
what are we worried about besides the baby?
Rh -ve mother
Rh +ve baby
Creation of Abs that attack the next baby
Iliac crest correlates to
L4-5 interspinal space
How to treat panadol OD?
N-Acetylcysteine as IV infusion or oral.
NAPQI (metabolite) accumulates within the body in OD.
NAPQI is conjugated by glutathione, but in excess, glutathione reserves are not sufficient. NAPQI interact with hepatic enzymes and damage liver.
Acetylcysteine acts to maintain or replenish depleted glutathione reserves in the liver and enhance non-toxic metabolism of acetaminophen.
Levels of Hb we can tolerate
before transfusion
70 - young
100 - old/other co-morbidities
Accessory pathway in wPw
Bundle of Kent
Why do we ask about amphetamine use in seizures?
Can cause arrhythmias and spasms
DVT, PE in young person
Think:
- Prothrombotic state/coagulopathies
- Left to Right heart shunts
Otolith catastrophe
Sudden ‘drop attacks’ in the context of Meniere’s disease.
During attacks, the patient falls to the ground in the absence of vertigo, loss of consciousness or malaise.
Late in the stage of Meniere’s.
What raises Lactate levels?
Anaerobic rest
Adrenaline - causes increases metabolic rate.
Diverts blood away from non essential organs. Anaerobic rest for those organs.
Investigations when suspecting SBO
CT Abdo
With IV and oral contrast
Looking for transition point in oral contrast
Causes of ascites in a CLD patient
- further decompensation
- non compliance with medications
- hepatic vein thrombus
- malignancy causing a resistant ascites
Which murmurs become louder with Valsaver?
HOCM and click of MVP
all other murmurs become softer
Causes of low voltages on ECG?
Pericardial effusion Dilated cardiomyopathy (walls are thinner)
How long do you have with testicular torsion to act?
Adult - 6hrs
Child - 12 hrs
(want to preserve function: spermatogenesis and hormone production)
Common causes of raised Aa gradient
V/Q mismatch
Right to left shunt (intrapulmonary or cardiac)
Which is more sensitive V/Q scan or CTPA?
CTPA will only tell you about PE’s that are proximal.
Need V/Q scan to look for more distal PE’s
Long term overdose of Insulin
Can have hypo-unawareness
Body gets use to stress response (adrenaline release).
Then get a blunted response to hypos
Side effects of Rifampicin
Red urine
Tears
Interacts with NOAC and warfarin (up regulates hepatic metabolism - CYP3A4 )
Relationship between rifampicin and flucloxacillin
Adding Rifampicin can lower the dose of flucloxacillin used.
Avoiding intra-hepatic cholestasis and allergies.
Vasopressors used commonly in anaesthetics
Ephedrine
Metaraminol
Rare cases: NA
Empirical one-off Rx for gonococcal urethritis
Ceftriaxone 500mg IM
Azithromycin 1g PO
Painless ulcer on penis?
Syphilis
Primary Chancre
What test can we do to determine pancreatic exocrine insufficiency?
Low levels of faecal pancreatic elastase
CREON?
Pancreatic Enzyme Replacement Therapy
Which part of duodenum do you get PUD?
1st part of duodenum
Test in Autoimmune pancreatitis
IgG4 - RAISED
accumulation of IgG4 in pancreas causing a mass –> blockage
Common causes of pancreatitis (clinically)
GET Autoimmune ERCP Methotrexate Prednisolone
Lipase levels in pancreatitis
> 1000
Below that, think:
renal colic, renal failure, gastritis, ovarian pathology
Contrast the pain location in Cholangitis and Biliary colic
Cholangitis - RUQ
Biliary colic - Epigastric
What does a drop >0.1 in PCV mean in someone receiving fluid resus?
Quite dehydrated as the pt is requiring lots of fluid resuscitation.
Why do Xray in Pancreatitis?
Looking for fat saponification and effusion around the pancreas
Diagnostic features of someone who does not clinically fit the picture of pancreatitis?
Epigastric pain and fat stranding around the pancreas.
How does ERCP cause pancreatitis?
- Backwash of contrast or pressure into the pancreatic duct
2. Repeat cannulation causing trauma
Management of someone with Pancreatitis
IVT
ADC
PPI
Analgesia
Normal wall thickness of gallbladder
Level of bilirubin at which you cannot perform CT IVC
Bilirubin >30
As the contrast, biliscopin will not be excreted.
Indications for CT IVC
Visualising bile leaks
Looking for stones
2 types of AAA
Suprarenal or Infrarenal.
Difficult to operate on suprarenal AAA as cannot reattach the arteries back onto the aorta. Will electively perform EVAR.
In emergency situations, tend to palliate.
RUQ USS
What do you look for?
Liver Gallbladder Biliary tree Kidneys Pancreas
What do check in exam of #?
- tenderness
- deformity
- swelling
- temperature
- abnormal mobility and crepitus
- loss of function
- neurovascular status
How to calculate the the eGFR
Cockcroft-Gault equation
Dose of suxemethonium
1-2mg/kg of TBW
Why might you get a derm consult in setting of ablative therapy (chemo)
Skin cancers may transform.
Any dormant malignancies may activate.
Thus should get a skin check for things like SCCs etc.
Which type of leukaemia are more likely to cause splenomegaly?
Monocytic/monoblastic
Acute erythroid
Why might you inspect skin in acute leukaemia?
Looking for skin infiltrates (leukaemic deposits in skin which look like papules)
Also known as chloromas
More common in myeloid > lymphoid
Valganciclovir used for?
CMV prophylaxis
Do serology to check status.
Why check CMV serology status?
When giving blood products - do they need CMV-ve products?
Do they have dormant CMV? Must check before we immunosupress for fear of activation.
What can be used to treat oral thrush?
Amphotericin B mouth lozenges
Why worry about oral mucosa in leukaemic pts?
Because of the combo of neutropenia + chemo:
high risk of candida infections
mouth pain
nutrition also affected
Therefore do regular inspection of the mouth.
Why start allopurinol in someone with Leukaemia?
Large tumour burden –> hyperuricemia –> may precipitate gout
Also help prevent tumour lysis syndrome
What parameters do you look at for tumour lysis monitoring?
LDH
Urate
Potassium
eGFR
What type derangement can thiazide diuretics cause?
increase BSL
hyperuricaemia
Who do we need to dose adjust Clexane in?
Renal impairment
Obese or small ppl
In who do we need to monitor clexane?
with anti-factor Xa levels
renal impairment
someone who has a propensity to bleed from a site (PUD)
Difference in Mx in someone with proximal or distal DVT
Proximal - greater risk of PE
Distal - may not treat medically if small and not really symptomatic but are close to hospital and sensible.
3 type of Myeloproliferative disorders
- Polycythemia Rubra Vera
- Myelofibrosis
- Essential thrombocythemia
Commonly associated with JAK2 mutation
1 cause of acquired anti-thrombin deficiency
Nephrotic syndrome
The MW of the protein is such that it can leak.
Why might morphine be used in APO?
Dilates the abdominal great veins and decreases preload.
What is entorox used for?
Analgesic gas - used commonly in paeds
Someone bleeding profusely?
Direct pressure on bleeding vessel