Special topics in lecture week Flashcards
Advance care planning in end of life
1) Finalizing social and financial matters
2) Acute care resuscitation plan( can be used as a temp. advanced health care directive) and discussion of CPR
3) EPoA
4) Advanced health care directive(AHD)
PREPARED is for palliative care
NOT FOR BREAKING BAD NEWS
Prepare for the discussion Relate to the person Elicit patient and caregiver preferences Provide information Acknowledge emotions and concerns Realistic hope Encourage questions Document and debrief
Tea colour urine or coca-cola urine
PSGN
Supportive treatment- prognosis is really good
symptomatic management- like HTN
What rate control drug can be used in AF in a patient with heart failure
NOT beta blocker
Calcium channel blockers
After cardioversion during AF how long do you anticoagulant them for
4 weeks at least
Haemodynamically unstable patient with AF presents to ED. What do you do next
Cardioversion
3 most common cause of aortic stenosis
1) age-related progressive calcification
2) Rheumatic aoritc stenosis( in ATSI)
3) congenital bicuspid aortic valve
3 classically symptoms of aortic stenosis
Syncope
Angina
Dyspnoea(SOB)
Angina need to ddx for chest pain- not just MI
4 most common features of Aortic stenosis murmur
Ejection systolic murmur
Loudest in the aortic region(base of the heart)
Radiating to the carotids
Loss of A2(2nd heart sound)
Management of aortic stenosis
1) TAVR
2) surgical replacement of Aoritc valve
Urea: creatinine- Urea will be high
This look like an Upper GI bleed
Having 3-4 normal vomits first and then having a vomit is
Mallory Weiss tear
not oesophageal bleeding
Hep B tablets
tenofovir
Smudge cells in
CLL
HACEK organisms seen in
- minority of IE cases
- gram negative anaerobes common in normal human flora
- setting of poor dentition/ periodontal infection
Which medication can aide in kidney stone passage?
Tamsulosin: alpha-1 antagonist that relaxes the ureteral muscle, decreases intraureteral pressure
a classic finding in ankylosing spondylitis
low back pain that classically improves with activity
Stroke score
NIH Stroke Scale/Score (NIHSS)
tPA therapeutic window for stroke
Time of symptom onset <4.5 hours
SMART-COP is the best why
superior in predicting the need for mechanical ventilation/inotropic support
Management of CF
• CF-bronchiectasis
- Chest physiotherapy, bronchodilator, pulmozyme, hypertonic saline,
antibiotics (nebulised tobramycin, azithromycin)
- Lung transplantation
• Pancreatic insufficiency
- Nutritional supplement & vitamin supplement (ADECK)
- Pancreatic enzyme replacement therapy (Creon)
- Insulin replacement therapy
- Hepatobiliary disease
- Infertility
Medications for CFTR
CFTR modulators
Queensland pneumonia
Burkholderia pseudomallei
Acinetobacter baumannii
nec fasc organisms is
Clostridium perfringes
Most common virus that cause Meningitis/ encephalitis
Viruses: Enterovirus (most common), HSV, arbovirus
Do not treat asymptomatic bacteriuria!!!! unless?
(unless undergoing elective urological procedure, or
pregnant)
Native valve triple therapy for IE
BFG- big friendly giant
Native valve: Benzylpenicillin + flucloxacillin + gentamicin
Prosthetic valve triple therapy for IE
Prosthetic valve: fluclox, vancomycin, gentamicin
Medial malleolus ulcer is always….
Venous ulcer
Which organisms cause bacterial vaginosis(spelt it right)
Gardnerella vaginalis
What is included in the Amsel’s criteria
3/4
1) Presence of white/grey discharge
2) Positive whiff test
3) PH>4.5(alkaline)
4) presence of clue cells under microscopy
BANDAID2- systolic heart failure
Beta blocker
ACEI
Neprilysin
Diuretics
Aldosterone-antagonist
Ivabradine
Devices(Implantable cardiac defibrillator (ICD)- prevent sudden cardiac death and Cardiac resynchronization therapy (biventricular pacemaker)- improves cardiac symptoms
Digoxin
Chronic Management - HFrEF (EF <40%)
- Treat ALL patients with HFrEF with ACE-I + Beta Blockers unless contraindications. PLUS consider aldosterone antagonist (spironolactone) in all patients.
- ACE or ARB- Aids in remodelling
- B blockers- Use long-acting- Bisoprolol-Reduces cardiac demand
- Diuretics - Spironolactone (aldosterone antagonist)
Chronic compensated CHF
clinically compensated CHF; the patient has signs of CHF on echocardiography but is asymptomatic or symptomatic and stable
Acute decompensated CHF
the sudden deterioration of CHF or new onset of severe CHF due to an acute cardiac condition (e.g., myocardial infarction)
Management of ADHF can be remembered with “LMNOP”:
which drug is NEVER given in decompensated heart failure–> beta blockers
L = Lasix (furosemide), M = Morphine, N = Nitrates, O= Oxygen, P = Position (with elevated upper body).
Beta blockers must be used cautiously in decompensated heart failure!
Noncardiogenic pulmonary edema causes
Noncardiogenic pulmonary edema due to
- ARDS
- pulmonary embolism(PE)
- transfusion-related acute lung injury
- high altitude
The equation to calculate # of standard alcohol drinks
Amount of drink in litres (the volume of the container) x percent by volume of alcohol (%) x
0.789
How to calculate pack-years of smoking
Number of pack-years = (packs smoked per day) × (years as a smoker)
In Belly’s palsy–>
The whole face side of the face is affected(peripheral facial nerve palsy)
vs
in the central facial nerve palsy - there is forehead sparing
Any geriatric patient who is inpatient needs a
Comprehensive geriatric assessment
Mini-Mental State Examination (MMSE) cateogories
what is the max score possible
- mild
- moderate
- severe
Attention Language Orientation Retention(short term) Recall( short term)
A maximum of 30 points is possible
LESS THAN 24–> dementia
20–24 points: mild dementia
13–20 points: moderate dementia
< 13 points: advanced dementia
All dementia patient get what blood test and imaging
In all patients: screening for vitamin B12 deficiency (cobalamin) and hypothyroidism
In all patients: noncontrast head CT or MRI
Treatment of dementia
-what is the side effect of the drug
Memory training
Pharmacotherapy
1 )Drugs: donepezil, rivastigmine, galantamine
Effect: Reversible cholinesterase inhibition leads to increased acetylcholine (ACh) concentration and can thus improve symptoms of some types of dementia.
Adverse side effects: (see symptoms of cholinergic crisis)
2) Memantine
In general, anticholinergic substances (e.g., tricyclic antidepressants) should be avoided, as they may lead to further deterioration in cognitive functioning!
Drugs with anticholinergic properties:
1) Tricyclic antidepressives (predominantly doxepin, amitriptyline, imipramine, and trimipramine)
2) Antipsychotics (e.g., clozapine, quetiapine)
3) First-generation antihistamines (e.g., promethazine, dimenhydrinate)
What are the 2 categories of symptoms seen in Alzheimer’s disease
Cognitive and non-cognitive
