SFP Flashcards
Definition of funnel plot
a scatterplot of treatment effect (e.g. OR on x axis) against a measure of study precision (e.g. SEM on y axis)
Definition of forest plot
graphical display of estimated results from a number of scientific studies addressing the same question
Definition of standard deviation
measure of amount of variation or dispersion of a set of values
Definition of per-protocol analysis
only subjects who completed the entire protocol are included in the analysis of a randomised clinical trial
Definition of intention to treat analysis:
all subjects randomised are included in the analysis regardless of whether they completed the study
Definition of clinical equipoise
state of genuine uncertainty on relative value of two interventions being compared in a trial
Definition of MHRA Yellow Card scheme
provides early warning that safety of a medicine or medical device may require further investigation
Definition of standard error
SD / square root of (N)
Definition of null hypothesis
hypothesis that there is no significant difference between specified populations
Definition of type I error
falsely rejecting a null hypothesis that is true in the population
Definition of type II error
failing to reject null hypothesis that is false in the population
Definition of power
probability of picking up a significant difference, if there is one
1 – probability of Type II error
Definition of p-value
probability of event happening by chance = wrongful rejection of the null hypothesis = type 1 error
Definition of confidence interval
range within which the true answer will lie 95% of the time
Definition of a priori
pre-specifying end-points & outcomes of a study to reduce reporting bias
Definition of surrogate endpoint
variable relatively easily measured that predicts a distant outcome of the intervention being tested
Definition of composite outcome
combination of two or more outcomes into single endpoint
Definition of Cohen’s kappa coefficient
statistic used to measure inter-rater reliability for qualitative variables
Definition of confounder
variable that influences both exposure & outcome in triangular fashion, causing a spurious association not demonstrating causality
Definition of selection bias
systematic differences between baseline characteristics of groups due to selective recruitment
Definition of performance bias
systematic differences in care provided to different study groups other than the intervention of interest
Definition of detection bias
systematic differences between groups in how outcomes are determined
Definition of recall bias
systematic error that occurs when participants do not remember previous events or experiences accurately or omit details
Definition of attrition bias
type of selection bias due to systematic differences in the number & way participants are lost from a study between study groups
Definition of publication bias
when the outcome of a researfch study biases the decision to publish or otherwise distribute it
Definition of absolute risk
probability that an event will occur
number of events/total number of people
Definition of absolute risk reduction
difference in rate of events between 2 groups
ARR = AR (C) – AR (T)
Definition of relative risk
risk ratio = relative likelihood of an event occurring in the treatment vs control group throughout study period
RR = AR (T) / AR (C)
cumulative risk
Definition of relative risk reduction
reduction in rate of outcome in treatment group vs. control group
RRR = ARR / AR (C)
Definition of number needed to treat
number of pts needed to treat to prevent 1 additional bad outcome, e.g. death, stroke
NNT = 1 / ARR
Definition of hazard rate
probability of the event occurring in the next time interval divided by the length of that time interval
time-sensitive = instantaneous risk
Definition of hazard ratio
relative likelihood of an event occurring in the treatment vs control group at any given point
Definition of logistic regression
statistical analysis method to predict a binary outcome, such as yes or no, based on existing independent variables
Definition of linear regression
regression model that estimates relationship between one independent variable and one dependent variable using a straight line
Definition of chi-squared test
hypothesis test to determine whether observed frequencies are significantly different to expected frequencies if the null hypothesis was true
categorical variables
Definition of t-test
hypothesis test to determine whether means of two groups are significantly different from each other
continuous variables
Definition of ANOVA
hypothesis test to determine whether means of three or more groups are significantly different from each other
continuous variables
Definition of log-rank test
hypothesis test to compare the survival distributions of two samples
Definition of Kaplan Meier curves
probability of survival curves for categorical values
Definition of Cox proportional hazards regression analysis
survival analysis for both quantitative & categorical variables, which can simultaneously assess the effect of several risk factors on survival time
Meningitis/encephalitis treatment
IV broad-spectrum ABx:
o ceftriaxone 2g OD (Gram +ve)
o aciclovir 10 mg/kg/8 hrs (viral)
o amoxicillin 2g/4 hrs (Listeria)
IV dexamethasone 10 mg/6 hrs within 4 hrs of ABx if meningococcal
Wernicke’s encephalopathy treatment
IV pabrinex 2-3 pairs TDS
Opiate overdose treatment
IV naloxone 0.4-2 mg/min intervals
can be given intranasally
Paracetamol overdose treatment
acetylcysteine algorithm
BDZ overdose treatment
IV flumazenil ONLY if airway compromise, risk of seizures
Kings College criteria for transplant after paracetamol overdose
- acidosis pH <7.35
- INR >6.5 or PT >100
- creatinine >300
- Grade III/IV encephalopathy
Causes of reduced GCS
Metabolic/systemic
- poisoning, e.g. CO, alcohol, tricyclics
- hypo- & hyperglycaemia
- hypoxia, hypercapnia
- septicaemia, hypovolaemia
- hypothermia
- myxoedema
- electrolyte imbalance, AD, SIADH
- hepatic/uraemic encephalocapthy
Neurological
- trauma
- infection meningo-encephalitis, malaria, typhoid
- tumour: 1° or 2°
- vascular: stroke, haemorrhage
- epilepsy: non-convulsive SE, post-ictal
qSOFA score
qSOFA score
* GCS < 15
* RR > 22
* SBP < 100 mmHg
Sepsis antibiotics
EITHER: piperacillin w tazobactam (Tazocin) 4.5 g/6 hrs
OR
ceftriaxone 2g OD (Gram +ve) PLUS
amikacin 15 mg/kg OD (Gram -ve) PLUS
metronidazole 500 mg/8 hrs (anaerobic)
CONSIDER vancomycin 15 mg/kg/8 hrs if MRSA
post-seizure care
monitor post-ictal phase
first-fit clinic
DVLA 6 months driving ban
Berkson bias
study sample taken from a sub-population
e.g. health-conscious people are more likely to join a trial
Bradford Hill criteria
group of nine principles used in establishing evidence of a causal relationship between an exposure & an event
include strength, consistency, specificity, temporality
Definition of sepsis
organ dysfunction caused by host response to infection
Definition of septic shock
sepsis + lactate > 2mmol/L OR vasopressor dependence to maintain MAP > 65 mmHg
Mean arterial pressure
MAP = DBP + 1/3 (SBP-DBP)
Anaphylaxis medications
IM adrenaline 500 mcg
IV chlorpheniramine 10 mg
IV hydrocortisone 200 mg
PO cetirizine 10 mg
Definition of anaphylaxis
severe, life-threatening type I hypersensitivity reaction
Moderate asthma
PEF 50-75%
sPO2 > 92
RR < 25
HR > 110
Acute severe asthma
PEF 33-50 %
RR > 25
HR > 110
unable to complete sentences
Life-threatening asthma
33-92-CHEST
PEF < 33%
sPO2 < 92%
cyanosis
hypotension
exhaustion
silent chest
tachycardia + arrhythmia
altered GCS
Near fatal asthma
increased CO2
Asthma medications
nebulised salbutamol 5 mg / 15-20 mins
nebulised ipratropium bromide 0.5mg
PO prednisolone 40 mg or IV hydrocortisone 100 mg
IV magnesium sulphate 2g
theophylline
Diagnostic criteria of COPD
FEV1 <80% predicted value
FEV1/FVC < 70%
Classification of COPD
GOLD criteria
mild: FEV1 >= 80%
moderate: FEV1 50-80%
severe: FEV1 30-50%
very severe: FEV1 <30%
COPD medications
nebulised salbutamol 5 mg
nebulised ipratropium bromite 0.5mg
PO prednisolone 30 mg or IV hydrocortisone 100 mg
COPD ITU referral criteria for ventilation
pH < 7.25
Pneumothorax treatment algorithm
discharge: 1° < 2 cm
observe: 2° < 1 cm
aspirate: 1° > 2cm, 2° 1-2 cm
chest drain: 2° > 2cm
CURB 65
score 1: outpatient
score 2: inpatient
score 3+: urgent + ITU
C – confusion
U – urea > 7 mmol/L
R – RR > 30/min
B – SBP < 90 or DBP < 60
65 – age > 65
CAP medications
IV co-amoxiclav 1.2g/8 hrs
AND
IV clarithromycin 500 mg/12 hrs
consider IV vancomycin 15 mg/kg/8 hrs if MRSA
CAP organisms
S. pneumoniae
H. influenzae
M. pneumoniae
HAP medications
piperacillin w tazobactam (Tazocin) 4.5 g/6 hrs
HAP organisms
Gram -ve, Pseumonas, anaerobes
Aspiration pneumonia medications
IV metronidazole 500 mg/8 hrs
AND
IV ceftriaxone 2g OD
Aspiration pneumonia organisms
anaerobes, S. pneumoniae
Pulmonary embolism medications
DOAC
PO rivaroxaban 15 mg OD or PO apixaban 10 mg OD
otherwise SC fondaparinux treatment dose OD (weight-dependent)
focal oligaemia distal to PE
Westermark’s sign
Cardiogenic shock medications
dobutamine 2.5-10 mcg/kg/min
Absolute C/Is thrombolysis
prvs IC haemorrhage
ischaemic stroke < 6 mths
cerebral malignancy, AVM
recent trauma/head injury
GI bleeding
known bleeding disorder
aortic dissection
Causes of PE
DVT
acquired coagulopathy: OCP, HRT, pregnancy, malignancy, surgery/trauma, infection
inherited coagulopathy: factor V Leiden, factor C or S deficiency, antiphospholipid syndrome
Classification of acute MI
Killip classification
Class I: no evidence of HF
Class II: mild to moderate HF
Class III: pulmonary oedema
Class IV: cardiogenic shock
Acute MI medications
IV morphine 5-10 mg
IV metoclopramide 10 mg
high-flow O2 if sPO2 < 94 %
sublingual nitrates if raised BP
PO Aspirin 300 mg
STEMI: PO ticagrelor 180 mg or clopidogrel 300 mg or prasugrel 60 mg (PCI)
NSTEMI: SC fondaparinux 2.5 mg
Definition of STEMI
STE >1mm in contiguous limb leads
STE >2mm in contiguous chest leads
>1mm ST depression + dominant R in V1-3
new LBBB
MI medications on discharge
Clopidogrel 75 mg
Aspirin 75 mg OD
Bisoprolol 2.5 mg OD
Ramipril (ACEi)/nifedipine (CCB)
Atorvastatin 80 mg OD
ACS risk assessment
GRACE score
Acute HF medications
IV furosemide 80 mg
IV diamorphine 5 mg
IV metoclopramide 10 mg
high-flow O2, consider NIV
SL or IV nitrates
Score used for diagnosis of HF
Framingham criteria
Causes of different types of HF
LHF: hypertension, valve disease, MI
RHF: LHF, pulmonary hypertension, MI
high output: sepsis, anaemia, thyrotoxicosis
Causes of AF
idiopathic
cardiac: valve disease, HF, MI
systemic: alcohol, thyrotoxicosis, infection
respiratory: PE
Risk assessment of AF
CHA2DS2VAS score for risk of stroke
HASBLED or ORBIT score for risk of bleeding
CHA2DS2VAS score
C cardiac failure
H hypertension
A2 age > 75
D diabetes
S2 stroke/thromboembolism/TIA history
V vascular disease history
A age 65-74
S sex female
Acute AF medications
SC enoxaparin 40 mg
rhythm control: PO flecainide 50 mg
rate control: PO bisoprolol 2.5 mg
Anticoagulation in AF
non-valvular: DOAC
valvular: warfarin
Reversal of anticoagulation
DOAC – andexanet alfa
heparin – protamine sulphate
Warfarin – Vit K or PCC
dabigatran – idarucizumab
Investigations of upper GI bleed
erect CXR
AXR
OGD
gastrograffin contrast CT
CT CAP
Doppler US
Variceal bleed medications
IV terlipression 2 mg/6hrs
post-endoscopy
PO propanolol 40 mg
IV omeprazole 80 mg
Upper GI risk stratification
Glasgow-Blactchford score for initial mortility
Rockall score for post-endoscopy rebleeding
Emergencies to rule out in acute abdomen
pancreatitis
cholecystitis
ruptured gastric ulcer
appendicitis
bowel obstruction/perforation
ruptured AAA
aortic dissection
ectopic pregnancy
ovarian torsion
Acute pancreatitis score
Glasgow-Imrie score
Antiemetic medications
IV metoclopramide 10 mg
IV ondansetrom 4 mg
Colitis severity score
Truelove & Witt’s score
blood in stool, or >6 stools/day AND 1+ of
* T > 37.8°C
* HR > 90
* Hb < 105g/L
* ESR > 30 mm/hr
C diff medications
PO metronidazole 400 mg or PO vancomycin 125 mg
IBD exacerbation medications
IV hydrocortisone 100 mg
immunosuppressants to induce remission
Stages of AKI
Stage 1: <0.5ml/kg/hr for 6 hrs
Stage 2: <0.5ml/kg/hr for 12hrs
Stage 3: <0.3 ml/kg/hr for 24hrs, anuria/12 hrs
Indications for dialysis
refractory hyperkalaemia
refractory metabolic acidosis
pulmonary oedema
end-organ complications
poisoning
UTI medications
women: PO nitrofurantoin 50 mg QDS
men: IV ciprofloxacin 400 mg BD
Benign prostatic hyperplasia medications
alpha blocker: tamsulosin
5 alpha reductase inhibitor: finasteride
Medications that can cause urinary retention
TCA
anticholinergics
opioids
Kernig’s sign
pain on passive knee extension w hips flexed
Brudzinski’s sign
pain on passive hip flexion w neck flexed
Meningo-encephalitis medications
IM benzylpenicillin 1.2g
IV ceftriaxone 2 g BD
IV aciclovir 10 mg/kg
IV amoxicillin 2 g/4hrs
IV dexamethasone 10 mg/6hrs
C/Is to LP
↑ICP
local infection
coagulopathy
Meningitis prophylaxis
PO ciprofloxacin 500 mg
Causes of seizures
epilepsy
metabolic: hypoglycaemia, hypoxia, electrolyte imbalance
drugs: AED, alcohol
intracranial: infection, ischaemia, haemorrhage
Seizure medications
IV lorazepam 4 mg/5 mins
IV phenytoin 15 mg/kg
IV levetiracetam
RSI
Causes of syncope
systemic: hypoglycaemia, dehydration
neurological: vasovagal, seizure
cardiac: postural hypotension, arrhythmia, aortic stenosis
Management of raised ICP
urgent intubation by anaesthetist
hyperventilate
IV mannitol 0.25 mg/kg over 20 mins
therapeutic hypothermia
IV dexamethasone 10 mg if tumour
Signs of raised ICP
loss of retinal vein pulsation
Cushing’s response
Cheyne-Stokes breathing
Indications for CT head < 1 hr
initial GCS < 13
GCS < 15 after 2 hrs
seizure
vomiting > 1
focal neurology
signs of skull fracture
anticoagulation
Alcohol withdrawal medications
PO chlordiazepoxide reducing regiment over 7-10 days
IV pabrinex 2-3 pairs TD
200 ml 10% dextrose
Management of haemorrhagic stroke
bleed Neurosurgery SpR
BP control w IV labetolol
reverse anticoagulation
Differentials to stroke
hypoglycaemia
partial seizure, Todd’s paresis
hemiplegic migraine
Stroke medications
(following CT head)
PO aspirin 300 mg for 14 days + omeprazole 40 mg
long-term PO clopidogrel 75 mg
Supportive measures for stroke
SALT assessment
NIHSS tool & PT/OT
Definition of acute confusional state
Change or fluctuation in:
Cognition: attention, confusion
Perception: hallucinations, paranoia
Activity: hyper or hypoactivity
Assessment score for delirium
4AT score
Causes of delirium
pain
infection
metabolic: hypoxia, hypoglycaemia, B12 deficiency, dehydration, electrolyte imbalance
outflow: constipation, urinary retention
medications & toxins
Rapid tranquilisation
PO lorazepam 0.5 mg
PO haloperidol 1 mg
DKA definition
pH < 7.30
glucose > 11 mmol/L
ketones > 3 mmol/L
DKA medications
rehydration: 1L over 1hr, then 2 hrs etc.
add 40 mmol K+ to from second bag of saline
50 U insulin at 0.1 U/kg/hr
add 10% glucose at 125 mL/hr once glucose < 14 mmol/L
continue with fixed-rate long-acting insulin
restart SC insulin w at least 1-2 hrs overlap
DKA medications
rehydration: 1L over 1hr, then 2 hrs etc.
add 40 mmol K+ to from second bag of saline
50 U insulin at 0.1 U/kg/hr
add 10% glucose at 125 mL/hr once glucose < 14 mmol/L
continue with fixed-rate long-acting insulin
restart SC insulin w at least 1-2 hrs overlap
DKA supportive measures
nutrition: NG tube if drowsy or vomiting, keep NBM for at least 6 hrs
DKA prophylaxis
DAFNE course
Diabetes sick day rules
Transfusion reactions
mild allergic
febrile non-haemolytic
ABO incompatibility
TACO
TRALI
Hyperkalaemia ECG features
tall-tented T waves
loss of P waves
widened QRS
sine waves -> VF
Causes of hyperkalaemia
reduced excretion: renal, endocrine (Addison’s), drugs (ACEis, ARBs)
release from cells: rhabdomyolysis, acidosis, TLS
increased intake: iatrogenic
Management of hyperkalaemia
IV 10% calcium gluconate 10 ml if ECG changes
200 ml 10% glucose + 10U insulin over 15-20 mins
nebulised salbutamol 5 mg
Treatment for TLS
rasburicase
Definition of haemorrhagic shock
blood loss causing a SBP < 90mmHg or HR > 110bpm
Stages of shock
Stage 1: up to 750ml, BP normal, HR <100
Stage 2: 750-1500ml, BP normal, HR>100
Stage 3: 1500-2000ml, SBP <100, HR >120
Stage 4: >2000ml, SBP <100, HR >140
Major haemorrhage medications
Packed red blood cells
FFP
reverse anticoagulation
tranexamic acid
Components of capacity
understand
retain
weigh up
communicate
Rib fractures mortality score
Battle score
Signs & symptoms of thyrotoxic crisis
sweating, tachycardia, pyrexia
agitation
D&V
Treatment of thyrotoxic crisis
IV propanolol 60 mg/4-6hrs
PO carbimazole 20 mg/6 hrs
Lugol’s iodine
IV hydrocortisone 100 mg/6 hrs
IV paracetamol & tepid sponging
Causes of thyrotoxic crisis
infection
trauma
radioiodine treatment
Signs & symptoms of myxoedema coma
hypothermia
hyporeflexia
hypoglycaemia
bradycardia
psychosis
Treatment of myxoedema coma
IV liothyronine (T3)
IV hydrocortisone 100 mg/6 hrs if pituitary or adrenal insufficiency
correct hypoglycaemia
warming blankets
Treatment of Addisonian crisis
rapid IV fluid rehydration: 500 ml 0.9% saline
IV 100 mg hydrocortisone/6 hrs
correct hypoglycaemia
correct hyperkalaemia
Causes of Addisonian crisis
iatrogenic: stopping steroid
trauma/surgery
infection
infiltration
hypopituitarism
autoimmune polyendocrine syndrome
Analgesia for renal colic
PR diclofenac 75-150 mg
Acute management of urinary tract calculi
if obstruction: ureteroscopy + JJ stent
if infection: percutaneous nephrostomy + tazosin 4.5 g TDS
General management of urinary tract calculi
< 5 mm -> conservative
< 10 mm -> medical expulsion therapy, e.g. tamsulosin
> 10 mm or obstruction -> surgical, e.g. ESWL
Definition of HHS
hyperglycaemia >30mmol/L
osmolality >320 mosmol/kg
no ketonaemia <3 mmol/L
no acidosis pH >7.3
ABC of trauma
ATOM FC
Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac Tamponade
Management of SVT
Valsalva manoeuvre
Carotid sinus massage
Adenosine: fast IV 6mg, then 12mg, then a further 12mg if no improvement
C/I: asthma, COPD, HF, heart block, severe hypotension
Alternative: IV verapamil (CCB) 5-10mg
Management of SVT
Valsalva manoeuvre
Carotid sinus massage
Adenosine: fast IV 6mg, then 12mg, then a further 12mg if no improvement
C/I: asthma, COPD, HF, heart block, severe hypotension
Alternative: IV verapamil (CCB) 5-10mg
Management of VT
IV Amiodarone hydrochloride 300mg over 20-60 mins
then 900mg over 24 hours via central line
Management of Torsades de Pointes
IV magnesium sulphate 2g over 10 mins
Management of VF/pulseless VT
CPR & DC cardioversion
IV adrenaline 1 mg every 5 mins
ECG changes in hypokalaemia
prolonged PR
ST depression
small or inverted T waves
prominent U waves
Definition of correlation coefficient
how closely 2 continuous variables move with each other
Types of correlation coefficient
parametric: Pearson’s R
non-parametric: Spearman’s rank correlation Rho
Definition of receiver-operating characteristic (ROC) curve
graphical plot showing diagnostic ability of a binary classifier as its discrimination threshold varies
ROC curve axes
X axis: 1-specificity (false +ves)
Y axis: sensitivity (true +ves)
Funnel plot axes
X axis: study outcome, e.g. OR
Y axis: study precision, e.g. SEM
Colon cancer screening UK
FIT test every 2 years in 60-74 years
Breast cancer screening UK
Mammogram every 3 years on 50-71 years
Cervical cancer screening UK
Smear test every 3 years from 25 years
Definition of systematic review
review which identifes, appraises & synthesizes all evidence that meets pre-specified eligibility criteria for a specific research question
Definition of meta-analysis
statistical analysis that combines results of multiple scientific studies
Definition of RCT
comparison outcomes of group receiving intervention with control group
Definition of Cohort study
groups classified based on exposure followed up prospectively to analyse outcomes
Definition of Case-control study
groups classified based on outcome and analysed retrospectively regarding exposure
Definition of Cross-sectional study
survey of a defined population at a single point in time
Biases in SR & MA
Publication bias
Language bias
Duplicate data
Heterogeneity - statistical, clinical, methodological
Outdated studies
Measure of forest plot heterogeneity
I squared
Initial Upper GI bleeding score
Glasgow-Blatchford
> 8 -> ITU
Post-endoscopy Upper GI bleeding score
Rockall
<3 -> low risk of rebleeding
Targets for MHP
Hb > 80
INR < 1.5
Fibrinogen levels > 1.5g/L
Plts > 75
Adult safeguarding investigations
skeletal survey
ophthalmological examination
bloods: coagulation
CXR
CT head
