secondary care learning points Flashcards
list differential diagnoses of sudden onset headache
Migraine
Stroke
Meningitis
temporal arteritis
alcohol dependance? recreational drugs (cocaine)?
what would make you suspicious of SAH?
reach full intensity by 10mins. and lasts up to 2hours
what is the priority in first presentation of thunderclap headache?
exclusion of ruptured intracranial berry aneurysm causing an acute SAH
how do you calculate units of alcohol?
alcohol vol X % / 1000
what are we looking for when doing an LP after suspected SAH?
(NB you would do a CT head 1st then LP 12hours later)
bilirubin breakdown product in CSF after 12 hours. will exclude traumatic tap.
name causes of finger clubbing
CV:
- infective endocarditis
- cyanotic CHD
Resp:
- lung Ca
- bronchiectasis
- lung abscess
- idiopathic pulmonary fibrosis
list the features of checking someones pulse
- rate
- rhythm
- character
- volume
- state of vessel wall
what is the diagnosis of someone with an irregularly irregular pulse (irregular in force, rate and volume)
AF
define JVP
double impulse visible not more than 3cm above the sternal angle with the pt at 45 degrees
what would cause a displaced or thrusting apex beat?
- thrusting - hypertrophied (AS or HTN)
- displaced - dilated heart (ischaemic heart disease)
both - AR - tapping - rheumatic fever –> MR
discuss heart murmurs..
..
what renal disease is associated with aneurysms/SAH
autosomal dominant PKD
what signs suggest third nerve palsy?
- fixed dilated pupil (unreactive to light)
- ptosis
- paresis of eye adduction and of upward and downward gaze
list causes of hyponatreamia
- PPI
- euvolaemic causes (siADH, polydipsia, IV fluids)
- hypovolemic causes (vomiting, diarrhoea, thiazide, burns)
- hypervolaemic causes (HF, cirrhosis, CKD)
what are the causes of siADH?
lung Ca (small cell) drugs (PPI, carbemazipine, SSRI, amitriptyline) idiopathic (usually in elderly) CNS injury (meningitis, SAH) hypothyroidism addisons
what are the symptoms and Rx of hyponatraemia?
asymptomatic -> nausea/ confusion/ headache/ agitation -> vomiting/ coma/ seizure
if rapid drop: brain swelling/ cerebral oedema or non-cardiogenic pulmonary oedema
Mx:
- fluid restriction
- acute or severe symptoms treat with hypertonic solution
- sodium replacement
is serum K+ is raised in the presence of hyponatreamia what should be suspected?
adrenal insufficency/ Addisons
- low serum cortisol/ short Synacthen test
- hypotensive
what are causes of low HS?
COPD
effusion - pericardial or lung
what is the max dose of lignocaine (LA) 1% (10ml per ml) you can give?
3mg/kg = 20ml in average person
what is the max dose of lignocaine + adrenaline yo can give?
5mg/kg = 35ml in average person
what suture would you use for face?
5/0 -6/0 ethilon (nylon)
3/0-4/0 ethilon for most stuff
2/0 for BIG wounds
how long do you keep sutures in?
head and neck - 5 days
upper limbs and torso - 7days
pelvis and lower limbs - 10days
what nerve palsy is indicated by dorsoradial movement of the hand?
posterior interosseous nerve palsy
- neuropathic compression of the PIN where it passes through the radial tunnel. may result in paresis or paralysis of the digital and thumb extensor muscles, resulting in an inability to extend the thumb and fingers at the MCP joint
