specialities general Flashcards
name two vasopressors
metaraminol
noradrenaline
name two inotropes
adrenaline
dobutamine
four broad categories of neurological failure in critical care
metabolic
trauma
infection
stroke
what number of people are living in pain
1/4
what is the number 1 disease for years lost to disability worldwide
low back pain
which one is protective the nociceptive pain or neuropathic
nociceptive
peripheral pain pathway
release of substance P and prostaglandins. stimulation of nociceptors and signal travels in A(delta) or C nerve to spinal cord.
spinal cord pain pathway
A(Delta) or C nerve second nerve travels up opposite side of spinal cord
Brain pain pathway
thalamus second relay, connects to cortex, limbic and brain stem but perception occurs in the cortex.
amitriptyline and duloxetine are forms of
antidepressants
gabapentin is a form of
anticonvulsant
NMDA receptor antagonist is
ketamine
disadvantages of NSAIDs
Gastrointestinal and renal side effects plus cause bronchospasm in sensitive asthmatics
disadvantage of paracetamol
Liver damage in overdose
disadvantage of tramadol
nausea and vomiting
advantages of tramadol
less respiratory depression, can be used opioids, simple analgesics, no a controlled drug
tramadol mechanism
Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake (
morphine disadvantage
constipation, respiratory depression, misunderstandings about addiction, controlled drug
amitriptyline advantage
Cheap, safe in low dose
Good for neuropathic pain
Also treats depression, poor sleep
disadvantages amitriptyline
Anti-cholinergic side effects (e.g. glaucoma, urinary retention)
amitriptyline mechanism
Increases descending inhibitory signals
potential areas for anaesthetic respiratory problems
Airway
spine
reflux
obesity
walking around the house no. of METS
2
walk 100-200 metres on the flat no. of METS
4
walking on the flat at a brisk space no. of METS
6
run a short distance no. of METS
8
do either strenuous exercise or heavy physical work no. of METS
9
oropharyngeal airway insertion risk of
laryngospasm
why intubate?
protect airway, muscle relaxation, prevent contamination, tight gas control and restricted access to airway
risk factors for awareness under anaesthesia
major trauma, cardiac surgery
local anaesthetics examples
lignocaine, bupivacaine, prilocaine
contraindications for spinal/epidural anaesthesia
patient refusal, fixed CO, infection, anticoagulation, technical difficulties, spinal problems
features of amyotrophic lateral sclerosis
prog. muscle weakness, wasting and increased reflexes. pure motor signs, death from respiratory failure.
the three forms of superoxide dismutase that can be found in amyotrophic lateral sclerosis
cytoplasm, mitochondria, extracellular
function of superoxide dismutase
catalyses conversion of intracellular superoxide radicals during normal metabolism. its presence is protective from free radical damage.
germline mutations are
inherited from single alteration in egg or sperm, heritable or cause cancer family syndromes
somatic mutations are
occurring in non-germline tissues, are nonheritable
Lynch syndrome/HNPCC
mutation In mismatch repair genes results in excess of colorectal, endometrial, urinary tract and gastric cancers
BRAC1 AND BRAC2 associated cancer risks
breast cancer
second primary breast cancer
ovarian cancer
when to suspect hereditary cancer syndrome?
cancer in 2 or more close relatives early age multiple primary tumours bilateral or rare cancers autosomal dominant transmission
early clinical surveillance guideline for breast cancer
5yr
prophylactic oophorectomy outcome
eliminates risk of primary ovarian cancer but peritoneal carcinomatosis may still occur. induces menopause.
genetic testing for lynch syndrome
IHC/microsatellite instability testing are inexpensive ways of determining if lynch syndrome is associated.
neurofibromatosis type 1 genetic transmission
autosomal dominant
signs/ symptoms of neurofibromatosis type 1
Café au lait spots neurofibromas axillary freckling lisch nodules optic glioma thinning of long bone cortex FH
further features of neurofibromatosis type 1
short stature, epilepsy, scoliosis, raised B.P. macrocephaly
features of neurofibromatosis type 2
acoustic neuromas (usually bilateral), CNS and spinal tumours)
triad of tuberous sclerosis
epilepsy, learning difficulty, skin lesions
transmission genetically of tuberous sclerosis
autosomal dominant
features of tuberous sclerosis
depigmented macules angiofibromas fibrous plaque forehead shagreen patches ungual fibromas rhabdomyomas in heart phakomas in eye
myotonic dystrophy transmission genetically
autosomal dominant
myotonic features
bilateral onset cataract, muscle weakness, stiffness, myotonia, low motivation, diabetes, heart block
what are the typical syndromes of presentation for geriatrics
falls, immobility, functional decline, delirium and incontinence
psych geriatric considerations
mood, confidence and cognition
function geriatric considerations
mobility, daily living skills
behaviour geriatric considerations
activities, occupation
nutritional geriatric considerations
MUST screening tool
spiritual geriatric considerations
what’s important, meaning of life, self image
environmental geriatric considerations
housing, heating, sanitation, adaptation
social geriatric considerations
support networks, potential for abuse
societal geriatric considerations
attitudes, technology, regulation
key professions in the CGA
geriatrician, OT, PT, skilled nurses.
what is the commonest complication of hospitalisation?
delirium
why care about delirium?
morbidity, mortality, longer length of stay, increased rates of institutionalisation, persistent functional decline
4AT area of questions
Alertness
age, DOB, place, year
attention
acute change or fluctuating course
tranquilizer
quetiapine
how much more likely to fall if you have delirium
4.5x
no. of death attributed to ADRS
100,000 deaths yearly
what fractions of ADRs in an ambulatory settings preventable
1/3rd
ADRs are associated with
cognitive loss dehydration incontinence depression falls
example of how absorption is altered in geriatrics
A reduction in saliva production may result in a reduction in the rate of absorption of buccally administered drugs e.g. glyceryl trinitrate (GTN)
what are the two most important factors that effect drug distribution in the elderly?
changes in body composition and protein binding
beer’s criteria is
List of ‘inappropriate’ drugs for older people
STOPP-START is
Advice on medical optimisation
high stepping gait may be a sign of
Peripheral neuropathy
small steps shuffling gait sign of
Parkinson’s
hemiplegic gait sign of
stroke
ataxic gait sign of
cerebellar damage
arthralgia gait sign of
arthritis
CT a head injury immediately if
low GCS <13 still confused after 2 hours focal neurology signs of skull fracture basal skull fracture seizure vomiting anti-coagulants
what cause this fall?
Mary 88
Lives alone, PMH, AF, hypothyroid, recent diagnosed mild dementia, hypertension,
Shopping in Marks and Spencer when she feels dizzy and collapses. Was looking at coats, not exerting herself.
No trip. Gives clear history herself
Friend with her agrees. No LOC
On Apixiban, levothyroxine, bisoprolol 10mg, Donepezil 10mg,
O/E Systolic murmur, BP 110/80 lying 90/70 standing, HR 55 irregular. No heart failure, neurologically intact. No injury FBC, CRP, U+E, LFTs Normal
Most likely diagnosis?
Postural hypotension due to Bisoprolol
Bradycardia due to Bisoprolol, Donepezil and possible undertreated hypothyroidism
Rarer but life threatening ones not to miss
Aortic stenosis
internal urethral sphincter is made of what muscle?
smooth
normal storage volume of the bladder?
400-600mls
sympathetic receptors for causing detrusor to relax
beta adrenoreceptor
sympathetic receptor for causing contraction of neck bladder and internal urethral sphincter
alpha adrenoreceptor.
high risk patient groups for alt. medicine
Children
Pregnancy and fetogenesis
Patients using prescribed medication
Polypharmacy
main cam in the u.k.?
herbal products
cams may contain
heavy metals
bacteria
medicines
what fraction of women use CAM during early pregnancy
2/3rd’s
homeopathy could be registered under
registered under Simplified Scheme 1992 or National Rules Scheme 2006.
company licence for medication refers too
manufacturing and wholesaler dealer licences
GMC expectation for unlicensed medication
carefully consider any treatment that you prescribe,
be able to justify your decisions and actions when prescribing, administering and managing medicines regardless of whether they are licensed or unlicensed.
specific prescription sheets examples
diabetes, warfarin, fluid additive prescription, variable rate IV infusion
ways to work out sensible water deficit
Catheters, drains Input charts Vomit bowls Sputum Pots Stool charts and stoma losses
ways to work out insensible water deficits
Sepsis (sweat) Ventilation Open wounds Burns Bleeding
