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Year 3 > Specific Management > Flashcards

Specific Management Flashcards

1
Q

Symptomatic aortic stenosis?

A

fit patient = SAVR
Surgical aortic valve replacement - give warfarin if metal valve

Unfit patient - TAVI
Transcatheter aortic valve implantation

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2
Q

mx for non calcified mitral stenosis

A

balloon valvotomy

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3
Q

mx for moderate mitral stenosis

A

percutaneous mitral valvotomy

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4
Q

severe mitral stenosis mx

A

open valve repair

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5
Q

Tis - T1 bladder cancer?

A

Non muscle invasive = TURBT

transurethral resection bladder tumour

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6
Q

How to treat hyperkalaemia (6.5+)

A

IV calcium gluconate + Insulin + dextrose

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7
Q

Mx G1-G2 stage CKD

A

ACEi (lisinopril)

if ACR is 30+ add on dapagliflozin + statin

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8
Q

Mx G3-G4 stage CKD

A

ACEi + dapagliflozin + statin

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9
Q

Mx for G5 / uraemic CKD

A

dialysis

2nd like - transplant

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10
Q

Manage thyroid storm?

A

IV propranolol

IV digoxin

Propylthiouracil followed by Loguls Iodoine 6 hrs later

Prednisolone/hydrocortison

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11
Q

Atrial flutter has same mx as Afib, but a different curative treatment?

A

Available for recurrent flutter or if DC cardioversion failed

radiofrequency ablation

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12
Q

Wolf parkinson white mx

for unstable px?
for stable px with orthodromic AVRT?
for stable px with antidromic AVRT?

A

1 - DC cardioversion

2- radioablation + vagal manoeuvres and IV adenosine or AV nodal blocking drugs

3 - radioablation + anti-arrhythmics

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13
Q

Stable Vtach mx?
unstable Vtach mx?

A

stable - IV amiodarone 300mg

unstable - DC cardioversion

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14
Q

Torsades de pointes

A

stable - IV magnesium sulfate

unstable (like for overall vtach) - DC cardioversion

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15
Q

hypercalcaemia of malignancy

A

step 1 - give fluids

step 2 - Biphosphonates (or denosumab) most effective agents for treating malignancy-associated hypercalcaemia. Block osteoclastic bone resorption.

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16
Q

ischaemic colitis barium enema?

A

thumbprint sign

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17
Q

pulmonary embolism
if WELLS score is

4+
4-

A

4+ = do CT pul angiography ( if its delayed do anticoag as you wait )

4- = D - dimer

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18
Q

Manage acute limb ischaemia?

A

IV heparin + IV opioids (+ oxygen + fluids)

refer to surg

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19
Q

Stage III + IV cellulitis?

A

IV ABX ( co-amoxiclav + clindamycin + ceftriaxone/cefuroxime)

( also for immunocompromised, under 1, frail )
( also for rapidly deteriorating )
( also for significant lymphaoedema )
( also for facial / periorbital cellulitis )

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20
Q

Class I / no systemic upset cellulitis mx?

A

oral flucloxacillin

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21
Q

malaria with parasite count 2%

A

paraenteral treatment

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22
Q

malaria with parasite count 10%?

A

exchange transfusion

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23
Q

Management of shockable rythms in cardiac arrest?

A

CPR 30:2 ratio then defib

Give IV adrenaline after 3rd shock and then every other cycle

After 3rd shock delivered and persisting, can use amiodarone 300mg

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24
Q

Surgical fix for BPH?

A

TURP

Transurethral resection of prostate

( TURP syndrome (hyponatraemia, fluid overload, glycine toxicity), urethral stricture/UTI, retrograde ejaculation, perforation of prostate
Retrograde Ejaculation = most common complication )

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25
Q

BPH gold standard investigation?

A

Transrectal ultrasound guided needle biopsy = gold standard

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26
Q

Low Anal Fistula

A

Fistulotomy (care to prevent damage to sphincter)

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27
Q

High anal fistula

A

Seton + abx

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28
Q

grade I haemorrhoid

A

topical corticosteroids

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29
Q

grade II + III haemorrhoid

A

-> rubber band ligand

30
Q

Grade IV haemorrhoid

A

haemorrhoidectomy

31
Q

anal abscess

A

drainage under local (if no sphincter involvement) or general (if severe case)

32
Q

breast abscess

A

needle aspiration, incision and drainage in a secondary care area

33
Q

Mammography (35+) of breast cyst findings?

A

Halo appearance

34
Q

Side effects of giving N acetylcysteine for paracetamol overdose needs to be corrected how?

A

Stop the infusion and give IV chlorphenamine

due to anaphylactic reaction to the drug such as flushing and difficulty to breathe

35
Q

Pericardial disease management

A

Self limiting + NSAIDs

if viral add colchicine for 3 months (S/E diarrhoea)

if tamponade = pericardiocentesis

if recurrent = pericardiectomy

36
Q

management surgical subdural haemorrhage

A

surgical if large 10mm+ or neuro dysfunction is bad

acute = decompressive craniectomy
chronic = burr hole evacuation

37
Q

prevention of vasospasm induced cerebral ischaemia / subarachnoid haemorrhage?

A

Nimodipine

38
Q

gastric cancer

A

on severity:

  • partial resection stomach
  • partial gastrectomy
  • total gastrectomy
  • monitor B12 in these px
39
Q

red flags to look out for that indicate gastric cancer?

A

new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain

40
Q

pancreatic cancer risks?

A

lifestyle:
- smoking
- drinking
- having chronic pancreatitis

Hereditary:
- inherited pancreatitis
- (LYNCH) nonpolyposis colorectal carcinoma
- peutz jeghers
- mole melanoma

41
Q

signs of pancreatic cancer?

A

Courvoisier sign (palpable painless gallbladder, painless jaundice = malignancy)

dark urine, pale stools, itching from jaundice

New onset diabetes with flaws signs

Trousseu sign - thrombophlebitis

42
Q

pancreatic cancer investigation?

A

CT - double duct sign

43
Q

Oesophageal cancer ix?

A

Upper GI endoscopy with biopsy

44
Q

Oesophageal cancer surgical mx?

A

Ivor Lewis type Oesophagectomy

45
Q

Intestinal obstruction?

A

Drip and suck

  • NBM
  • IV fluids
  • NG tube
  • surgery if indicated
46
Q

Addisonian crisis tx?

A

Hydrocortisone 100mg IV/IM

1L saline over 30-60 mins

continue hydrocortisone 6 hourly until the patient is stable. No fludrocortisone is required because high cortisol exerts weak mineralocorticoid action

oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days

47
Q

Addisons investigation ?

A

Short synacthen test (ACTH given) in a healthy px cortisol should rise

then consider doing morning cortisol or if this test is not available

48
Q

sigmoid volvulus

sigmoid volvulus with peritonitic signs?§

A
  • flexible sigmoidoscopy / flatus tube
  • skip and do urgent lapratomy
49
Q

Hep C

A

Direct acting antivirals (DAAS) :

Combination of protease inhibitors – dactlasvir + sofosbuvir or sofosbuvir + simeprevir

50
Q

what Hb indicates need for blood transfusion?

what about in ACS

A

7 / 70

8 / 80

51
Q

Chronic asymptomatic AR, when is surgical intervention indicated?

A

EF <50%
left ventricular end diastolic diameter 70mm+
or
left ventricular end systolic diameter 50mm+

52
Q

gold standard investigation for renal calculi?

A

non contrast CT KUB

USS if child or preggies

53
Q

Renal stones

Under 10mm

10-20 mm

20mm +

A

Small - should pass itself, if its in the distal ureter give tamsulosin

10-20 = corporeal shock wave lithiotripsy

20mm+ = percutaneous nephrolithotomy

54
Q

First line management for pregnant women kidney stones removal?

A

ureteroscopy

55
Q

renal stone obstruction + infection tx?

A

IV abx + renal decompression

nephrostomy + IV abx if its severe, or hydronephrosis is occuring

56
Q

analgesia for renal stones?

A

IM diclofenac

57
Q

tumor lysis syndrome akak during chemi kidney stone type?

A

Uric acid

58
Q

1st line ix suspected lung cancer?

A

CXR

-PET-CT Scan → look for metasteses and lymph node involvement

  • Bronchoscopy → allows biopsy for histological diagnosis and TNM staging
    ( Image-guided (CT-guided) if peripheral lung lesion )
59
Q

Asbestosis Ix

A

CXR (lower lobe fibrosis) = reticular nodular shadowing + pleural plaques

60
Q

Mesothelioma Ix?

A

Diagnosis based on histology = thoracoscopy

Pleural fluid analysis via tap (bloody) (effusion)

61
Q

Secondary pneumothorax 1-2cm or px without SOB mx?

Secondary pneumothorax >2cm or SOB

A

Aspiration

Chest drain

( if SOB even less than <1cm, admit for 24hr and give oxygen )

  • for primary if rim is 2+ aspiration is first line, only do chest drain is aspiration doesnt work
62
Q

Tuberculosis 1st line Ix

Tuberculosis gold standard Ix

Tuberculosis screening latent Tb

A
  • CXR
  • Sputum culture (acid fast bacilli mear using Z-Neelson stain, AFB positive)
  • Mantoux test (family)
63
Q

Anaphylaxis

A

High flow 15L/min non rebreather

IM adrenaline 500mcg adults
(tx with 2 doses, if persists try IV)

Persists despite adrenaline -> Iv chlorphenamine 10mg + IV hydrocortisone 200mg

64
Q

Ix for orbital cellulitis

A

Orbital and head CT with contrast

65
Q

Ix for optic neuritis

A

godulinuim enchanced MRI

66
Q

Initial Ix for hiatus hernia

most sensitive ix for hiatus hernia

A
  • upper GI endoscopy (due to symptoms this just is likely to happen before)
  • barium swallow
67
Q

surgery for rolling hiatus hernia?

A

Fundoplication ( also can be used in bad GORD )

68
Q

cholecystits?

A

IV abx + laparascopic cholecystectomy within 1 week

(in comparison just having gallstones/colic = electic surgery no timeframe)

69
Q

acute cholangitis?

A

Iv antibiotics

ERCP drainage after 24-48 hours to relieve obstruction

when px is well do an elective cholcystectomy

70
Q

toxic megacolon

A

IV fluids and IV hydrocortisone

if Iv steroids do not work within 48-72 hrs = surgery

Year 3 (14 decks)

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