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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
BPH gold standard investigation?
Transrectal ultrasound guided needle biopsy = gold standard
26
Low Anal Fistula
Fistulotomy (care to prevent damage to sphincter)
27
High anal fistula
Seton + abx
28
grade I haemorrhoid
topical corticosteroids
29
grade II + III haemorrhoid
-> rubber band ligand
30
Grade IV haemorrhoid
haemorrhoidectomy
31
anal abscess
drainage under local (if no sphincter involvement) or general (if severe case)
32
breast abscess
needle aspiration, incision and drainage in a secondary care area
33
Mammography (35+) of breast cyst findings?
Halo appearance
34
Side effects of giving N acetylcysteine for paracetamol overdose needs to be corrected how?
Stop the infusion and give IV chlorphenamine due to anaphylactic reaction to the drug such as flushing and difficulty to breathe
35
Pericardial disease management
Self limiting + NSAIDs if viral add colchicine for 3 months (S/E diarrhoea) if tamponade = pericardiocentesis if recurrent = pericardiectomy
36
management surgical subdural haemorrhage
surgical if large 10mm+ or neuro dysfunction is bad acute = decompressive craniectomy chronic = burr hole evacuation
37
prevention of vasospasm induced cerebral ischaemia / subarachnoid haemorrhage?
Nimodipine
38
gastric cancer
on severity: - partial resection stomach - partial gastrectomy - total gastrectomy * monitor B12 in these px
39
red flags to look out for that indicate gastric cancer?
new-onset dyspepsia in a patient aged >55 years unexplained persistent vomiting unexplained weight-loss progressively worsening dysphagia/ odynophagia epigastric pain
40
pancreatic cancer risks?
lifestyle: - smoking - drinking - having chronic pancreatitis Hereditary: - inherited pancreatitis - (LYNCH) nonpolyposis colorectal carcinoma - peutz jeghers - mole melanoma
41
signs of pancreatic cancer?
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
pancreatic cancer investigation?
CT - double duct sign
43
Oesophageal cancer ix?
Upper GI endoscopy with biopsy
44
Oesophageal cancer surgical mx?
Ivor Lewis type Oesophagectomy
45
Intestinal obstruction?
Drip and suck - NBM - IV fluids - NG tube - surgery if indicated
46
Addisonian crisis tx?
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
Addisons investigation ?
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
sigmoid volvulus sigmoid volvulus with peritonitic signs?§
- flexible sigmoidoscopy / flatus tube - skip and do urgent lapratomy
49
Hep C
Direct acting antivirals (DAAS) : Combination of protease inhibitors – dactlasvir + sofosbuvir or sofosbuvir + simeprevir
50
what Hb indicates need for blood transfusion? what about in ACS
7 / 70 8 / 80
51
Chronic asymptomatic AR, when is surgical intervention indicated?
EF <50% left ventricular end diastolic diameter 70mm+ or left ventricular end systolic diameter 50mm+
52
gold standard investigation for renal calculi?
non contrast CT KUB USS if child or preggies
53
Renal stones Under 10mm 10-20 mm 20mm +
Small - should pass itself, if its in the distal ureter give tamsulosin 10-20 = corporeal shock wave lithiotripsy 20mm+ = percutaneous nephrolithotomy
54
First line management for pregnant women kidney stones removal?
ureteroscopy
55
renal stone obstruction + infection tx?
IV abx + renal decompression nephrostomy + IV abx if its severe, or hydronephrosis is occuring
56
analgesia for renal stones?
IM diclofenac
57
tumor lysis syndrome akak during chemi kidney stone type?
Uric acid
58
1st line ix suspected lung cancer?
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
Asbestosis Ix
CXR (lower lobe fibrosis) = reticular nodular shadowing + pleural plaques
60
Mesothelioma Ix?
Diagnosis based on histology = thoracoscopy Pleural fluid analysis via tap (bloody) (effusion)
61
Secondary pneumothorax 1-2cm or px without SOB mx? Secondary pneumothorax >2cm or SOB
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
Tuberculosis 1st line Ix Tuberculosis gold standard Ix Tuberculosis screening latent Tb
- CXR - Sputum culture (acid fast bacilli mear using Z-Neelson stain, AFB positive) - Mantoux test (family)
63
Anaphylaxis
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
Ix for orbital cellulitis
Orbital and head CT with contrast
65
Ix for optic neuritis
godulinuim enchanced MRI
66
Initial Ix for hiatus hernia most sensitive ix for hiatus hernia
- upper GI endoscopy (due to symptoms this just is likely to happen before) - barium swallow
67
surgery for rolling hiatus hernia?
Fundoplication ( also can be used in bad GORD )
68
cholecystits?
IV abx + laparascopic cholecystectomy within 1 week (in comparison just having gallstones/colic = electic surgery no timeframe)
69
acute cholangitis?
Iv antibiotics ERCP drainage after 24-48 hours to relieve obstruction when px is well do an elective cholcystectomy
70
toxic megacolon
IV fluids and IV hydrocortisone if Iv steroids do not work within 48-72 hrs = surgery

Year 3 (14 decks)

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