Trickies Flashcards
Cytochrome P450
- Mitochondrial proteins or in the ER.
- Involved in synthesis and breakdown of hormones.
- Major enzymes in drug metabolism; excreted and deactivated by CYP.
- Some drugs increase or decrease the activity of CYP.
CYP inhibitors
- grapefruit
- Bergamot
- St john’s wort
- Tobacco
- Valproate
- Isoniazid
- Cimetidine
- Ketoconazole
- SSRI
- Fluconazole
- Alcohol
- Chloramphenicol
- Cipro
- Erythromycin
- Amiodarone
- Omeprazole.
CYP inducers
- Carbamazepine
- Steroids
- Phenobarbital
- Phenytoin
- Rifampicin.
GCS
1) Eyes = 1-4 1 = does not open eyes 2 = open eyes to pain 3 = opens eyes to voice 4 = normal
2) Verbal = 1-5 1 = makes no sounds 2 = makes sounds 3 = words 4 = confused 5 = normal
3) Motor = 1-6 1 = make no movements 2 = extension to pain 3 = abnormal flexion away from painful stimuli 4 = withdrawal from pain 5 = localises to painful stimuli 6 = obeys commands.
MUST score
1) BMI
>20 = 0
18.5-20 = 1
<18.5 = 2
2) Unplanned weight loss in the past 3-6 months
<5% = 0
5-10% = 1
3) Patient is ill and not likely to adequately receive nutrition = 2
Low risk = 0
Medium risk = 1 (observe)
High risk = 2 0r more
Wells score
- Clinical Sx of DVT = 3
- PE most likely = 3
- HR >100 = 1.5
- Immobilization for 3 days of surgery in the previous 4 weeks = 1.5
- Previous DVT/PE = 1.5
- Haemoptysis = 1
- Malignancy = 1
PESI (PE severity index)
- age
- sex - male = 10
- Hx of cancer = 30
- HF = 10
- Chronic lung disease = 10
- HR >110 = 20
- Sys BP <100 = +30
- RR >30 = 20
- temp <36 = 20
- altered mental status = 60
- O2 saturation <90 = 20.
Frax
- Age
- sex
- BMI
- previous #
- parent # hip
- smoking
- steroids
- RA
- Osteoporosis
- Alcohol >3 units a day
- Femoral neck BMD.
CHADVASC
- Age - 65-74 = 1, >75 = 2
- Sex - female = 1
- CHF Hx - yes =1
- HTN - yes = 1
- Stroke/TIA/thrombus - yes = 2
- Vascular Hx (Mi, pvd) - yes =1
- DM - yes =1
HASBLED
1) HTN - yes =1
2) Renal disease - yes = 1
3) Liver disease - Yes =1
4) stroke Hx - yes = 1
5) prior major bleed - yes = 1
6) Labile INR - yes = 1
7) Age >65 - yes = 1
8) Medication which predispose to bleeding; NSAIDs, antiplatelet - yes = 1
9) Alcohol use >8 units/week - yes = 1.
NOF
Shortened and externally rotated leg.
When looking at a XR of a #
AABCS
- Adequacy of film
- Alignment
- Bones
- Cartilage
- Soft tissue
OLD ACID -bones
- Open vs closed
- Location, proximal, mid, distal
- Degree (complete/incomplete)
- Articular involvement
- Communion
- Intrinsic bone quality
- Displacement
Open # management
- ABCDE
- Photo
- Saline soaked gauze
- IV ABx (augmentin)
- Tenatus booster
- Analgesia
CXR interpretation
ABCDE A = airway - trachea and bronchi B = Breathing - lung fields C = Circulation - heart and aortic knuckle D = diaphragm - pnemoperitoneum E = everything else
NG tube
- Aspirate = pH <5.5 = safe to feed.
- Location check with CXR.
Pelvic XR
- 3 rings (the pelvis inlet + 2 obturator foramen)
- SI joints
- Acetabulum and lines
- Hip joint and proximal femur
Colles #
distal radius + dorsal displacement
Smiths #
Distal radius + Volar displacement.
Monteggia #
proximal third of the ulna + dislocation of the radial head.
Lisfranc
One or all of the MTP are displaced from the tarsus.
NOF # classification
- Femoral head or neck = intracapsular
- Between the two trochanters = intertrochanteric
- Or sub trochanteric.
NOF # management
- Intracapsular = screw or plate fixation. Hemiarthroplasty in the elderly or total hip replacement.
- Intratrochaenteric = open reduction + dynamic hip screw or plate.
- Sub trochanteric = Intramedullary nail.
Complications following NOF repair
1) Non-union
2) Mal-union
3) Infection
4) Avascular necrosis of the femoral head
5) Limb deformity
Describing an XR
- What and where it is.
- What is the # (complete or incomplete?)
- Where is the # (diaphysis (shaft), metaphysis (wider part), epiphysis (growth plate))
- Is it displaced
- Anything else
adrenaline dose anaphylaxis
1:1000 solution 0.5ml (0.5mg) IM and repeat in 5 mins if no improvement
Adrenaline dose in cardiac arrest
1:10,000 1mg in 10ML and repeat in 3/5 mins if no improvement
Loop diuretics
- inhibit the body’s ability to reabsorb sodium in the ascending loop of henle at the nephron.
- Increased water loss
- Furosemide
Thiazide
- Works on the DCT and inhibits the sodium-chloride symporter leading to the increased excretion of water.
- Anti-hypertensive effects due to decreased pre-load.
- Bendroflumethiazide
Carbonic anhydrase inhibitors
- Inhibit enzyme located in the PCT.
- Increased bicarbonate in the urine and decreased sodium absorption.
- Acetazolamide
Potassium sparing
- Potassium remains in the blood whilst other things are excreted.
- Aldosterone antagonists (spironolactone) compete with aldosterone (which normally adds sodium channels in the collecting duct) and prevents its action.
Osmotic diuretics
- Increase the osmolarity of urine hence keeping water in the urine.
- Mannitol.
Brachial plexus
C5-T1
Median nerve
C5/6/7/8/T1
- Anterior compartment of the forearm, thenar eminence and lumbricals
Ulnar nerve
C8/T1
- Sensation to the medial 1.5 fingers.
Lots of muscles.
Radial nerve
C5/C6/C7/C8/T1
- Posterior compartment of the arm. Skin of lateral dorsum 3.5 fingers.
Warfarin MOA
- Vitamin K antagonist
- Decreases ability of factor 2,7,9 and 10 to clot
Dabigatran MOA
Direct thrombin inhibitor
Apixaban/Rivoraxaban MOA
Direct factor 10a inhibitor
Heparin MOA
Inhibits antithrombin
Mental state exam
Appearance, behaviour, speech, affect, thoughts (form and content), perception, cognition, insight.
Tests before someone starts lithium
Renal function
TFT
Lithium toxicity
Blurred vision, coarse tremor, muscle weakness, ataxia, hyper-reflexia, oliguria, circulatory failure, seizures.
Bulbar palsy
Lower motor neurone
- Dyarthria
- Dysphagia
- jaw thrust absent
- Tongue atopy
- Tongue fasciculations
Pseudobulbar palsy
Upper motor neurone
- Dyarthria
- Dysphagia
- Emotional lability
- Jaw thrust absent
Upper motor neurone sign s
- Spasticity
- Ridgidity
- Hyper-reflexia
- Weakness
Lower motor neurone signs
- Weakness
- Muscle wasting
- Fasciculations
- Absent of diminished reflexes
- Decreased tone
Nephrotic syndrome
Protein loss >3.5g/1.73m body surface are per day.
+ Hypoalbuminaemia
+ Hyperlipidaemia
Activates RAAS to stop loss and oedema makes things worse.
