Urology Flashcards
Sexual intercourse
- snapping sound
- lateral bending of erect dick
EGGPLANT deformity \+/- blood @meatus, haematuria, dysuria, retention--> piss extravasation
Dx?
Which layer damaged?
Where does urethral damage occcur most likely in terms of fracture anatomy?
Ix @urethral injury?
Ix for the actual dick?
Tx:
_______
SUSTAIN pelvic fracture ->
cystogram = extraperitoneal
urine extravasation
-NO blood @meatus
Penile fracture
Which layer damaged?
-tunica albuginea
Urethral dx most likely @
-both corporsa cavernosum
Ix @urethral injury?
–Retrograde/Asc urethrogram -> SPC
Ix for the actual dick?
- caverno-sography
- MRI
Tx: -Hematoma evac -Fix T.Albuginea + Urethra -SPC \_\_\_\_\_\_\_\_
Bladder rupture:
- Tx = Conservative Foley urinary catheter
- LAPARATOMY @intraperitoneal
Phimosis:
if dont clean under foreskin, 2 issues?
Tx?
________
straddle injury e.g. bicycles
triad:
- perineal haematoma
- retention
- blood at the meatus
pelvic fracture ->
-Penile/Perineal oedema/hematoma
-O/E: PROSTATE displaced UPWARDS
_________
Pelvic fracture + inability to void
- haematuria/suprapubic pain
- UNABLE to retrieve ALL fluid used to irrigate bladder through a Foley catheter
Phimosis:
if dont clean under foreskin, 2 issues?
- stones @pre-putial sac
- penile cancer
Conservative
Steriods
Circumcision
______
Bulbar rupture
–Retrograde/Asc urethrogram -> SPC
Membranous rupture
–Retrograde/Asc urethrogram -> SPC
__________
Bladder/urethral rupture
- IVUrogram or Cystogram
- intraperitoneal = LAPARATOMY
- extraperitoneal = Conservative + Foley Catheter
Sterile Pyuria
i.e. WCC pus in urine
Partially/Recently Tx UTI
Chlamydia
Tumours - renal/bladder
TB/Schisto/AppendicitisDivertic-ureter irritation
Cystoscopy RT/Drugs Atrophic vaginitis Preg InterstitialNephritis/ATN
Communicating hydroceles are found in
>? % of newborn males
Communicating hydroceles are found in
>3% of newborn males
Enlarged kidneys ax?
G+ Bacilli?
G+ Cocci
G- Bacilli
G- Cocci
___________
ABx affecting:
FA synth = ?
-SEs?
___________
Cell-wall synth:
A-PeptidoGlyc synth: ?
B-PeptidoGlyc cross-link ?
1. Beta-lactam SENS: ?
2. Beta-lactam RESIST: ?
___________
30s ribosome = ? + SEs?
50s ribosomes = CCML?
Gyrase = ? + SEs?
mRNA synth ?
DNA integrity?
________
C.diff causes by Clinda + Cephalos
Enlarged kidneys:
PKD, HIV, Amyloidosis, DM
G+ Bacilli?
- Bacillus cereus
- C.diff
- Gardenella
- TB/ List/LactoBacillus
G+ Cocci
- Aureus - StaphyloCOCCUS
- StreptoCOCCUS
- EnteroCOCCUS
G- Bacilli
-Errrrrything else
G- Cocci
-Moraxella
-Neisseria Men/Gon
___________
ABx affecting:
FA synth = TMP SMX
-Hematopoesis, Itch, PS
-RTA 4 - resistance
___________
Cell-wall synth
A-peptidoglyc synth: Vanc/Bacitracin
B-peptidoglyc cross-link:
Penicillins/Cephalos->C.diff/Carbepenems:
1. Beta-lactam SENS:
-PMP-V, BenPenG, Amox
- Beta-lactam RESIST:
-Fluclox #cholestasis
___________
30s ribosome = Aminoglycosides + Tetracyclines -Aminoglyc = Oto/Nephro toxics -Tetracyclines: PS, Oesophagitis, IIHTN, Not <12yrs Teeth discolour
50s ribosomes = Chloramp = Aplastic Anemia Clinda - C.diff Macrolide - P450i, long QT, Nausea Lizenolid
Gyrase = Quiolones
P450i
Seizure threshold lower
Tendon dx
mRRRNA synth:
-RRRifampicin
DNA integrity - metronidazole = Alco rxn
_________
C.diff causes by Clinda + Cephalos
Tight white ring + phimosis @foreskin tip
Flat-PAP #ulcerate @foreskin = ?
Red-velvet plaque = ?
Orange/ red/ pinpoint = ?
Reactive Arthiritis -> red plaque , ragged white border = ?
_________
BPH tx:
- Conservative?
- Med?
- Surg: ? -> Cx due to #? #?electrolyte-dx
Finasteride take how long before results?
Tight white ring + phimosis @foreskin tip
-BXO-LSclerosis
Flat-pap #ulcerate @foreskin = SqCC
Red-velvet plaque = EoQ SqCC-IS
Orange/ red/ pinpoint = Zoon’s balanitis
Reactive Arthiritis -> red plaque , ragged white border = Circinate balanitis
________
BPH tx:
Conservative:
- Alco/Caffeine/Fizzy drinks
- Constipation
- Ex/diet
- Sweeteners/Smoke stop
Med:
- alpha-blocker Tamsulosin = post hypoTN
- 5alphaReduct-i = Finasteride
- Finasteride take 6 months before results
Surg: TURP -> TURP syndrome #glycine #HYPOnatraemia
UTI ? Biopsy ? Ex ? Ejac ? DRE ?
vHU, LUTS, ED
Age 50/+, FHx, Obesity, Black/Back-bone-WL ->
DRE (hard/nodular)
PSA 3/+ (age 50/+) -2ww->
SUSPECT= ?Ix ->
1. Likert 1/2 Systematic ? = NO ? / ? -PSA @?m -low p(PC)= ? + PSA/? -? @FHx/PSAhigh
- Likert 3:
?
-@neg= ?
-@PIN/PGIN/ainar = ?
—–Gleason….PSA
LR ^ ^
IR ?………….?–?
HR V V
LR= Tx?
IR/ HR-LAPC/ highPSAafterProstatectomy-RT
= Tx?
-LAPC=?
Mets=HRelapsed:
- ?
- ?
- -want boners? = ?
- -fail-> back to ?
HRelapsed:
- ? /? /?
- ?
- ? /? /?
Mets: Ix? -LHRHblocker = ? -? @bone-protection -? @pain -?/ ? \_\_\_\_\_\_\_\_\_\_
AS:
- ?Ix /?m @Y1; ?m @Y2
- ?Exam /12m
- ?Ix @12m
WW when?
-high PSA/ bone-pain + LPC -> ?
Hot-flushes = ?
TUMOUR FLARE RISK
-Goserelin + Cyproterone acetate 1st 3wks
UTI 4w Biopsy 6w Ex 48hr Ejac 48hr DRE 7d
vHU, LUTS, ED
Age 50/+, FHx, Obesity, Black/Back-bone-WL ->
DRE (hard/nodular)
PSA 3/+ (age 50/+) -2ww->
SUSPECT=mpMRI ->
- Likert 1/2
Systematic biopsy = NO TRUS/Tp-template / TRUS/Tp-template
-PSA @3-6m
-low p(PC)=GP PSA referral level + PSA/6m-yearly-2yearly@neg-biopsy
-TRUS/Tp-template @FHx/PSAhigh - Likert 3
mpMRI biopsy
-@neg=d/w MDT ± repeat biopsy
-@PIN/PGIN/ainar = d/w pt high p(PC)
—–Gleason….PSA
LR ^ ^
IR 7…………10-20
HR V V
LR= AS + Radical HIFU/Cryo -> Prostatectomy/RT(EBR/BT)
IR/ HR-LAPC/ highPSAafterProstatectomy-RT
= Radical (HIFU/Cryo): Prostatectomy/ RT(EBR/BT)
-LAPC=DEGARELIX-LRHRblocker @HDependent
–> PSA @w6/6m @2yrs/12m after
Mets=HRelapsed:
- Docetaxel
- ADT = orchidectomy > Goserelin LHRHag
- -want boners? = Bicalutamide a.androgen
- fail-> back to ADT
HRelapsed:
- Abiraterone(a.blocker)/ Enzalut(a.androgen)/ DEXAMETH @3rd-line
- Cabaz
- Docetax/ Abiraterone(a.blocker)/ Enzalut(a.androgen)
Mets: Spinal-MRI @Spinal Mets -LHRHblocker = Degarelix -Zolend @bone-protection -Bisphosphonates @pain -Radium/Strontium \_\_\_\_\_\_\_\_\_\_
AS:
- PSA /3m @Y1; 6m @Y2
- DRE /12m
- mpMRI @12m
WW @older/slow-tumour/comorbidities/elderly:
-high PSA/ bone-pain + LPC -> Urology MDT
Hot-flushes = MedroxyProg/ CyproAcetate
Hot-flushes = ?
TUMOUR FLARE RISK
-Goserelin + Cyproterone acetate 1st 3wks
Renal Stones: 3 places stones get stuck?
Ix < ? hrs / ?analgesia
AE
MET @ ? < ? cm
- Tx?
- if < 0.5cm + Aysyx = ?
- > 1cm = prognosis? -> Tx < ? w
Remove @ ? / ? :
- Lithotripsy < ? cm
- Ureteroscopy < ? cm + ?
- Nephrolithotomy > ? cm/ ? / ?
- Stent/Surg = ?
? @sepsis
Radiograph finding-Type-pH?:
?-Cysteine-? pH
?-Uric-Xanthine-? pH
?-Struvite Staghorn-? pH
-Urea –ProteusCHEM-Rxn?-> NH3 Mg PO4
?-Ca Oxal / Phosph-? pH
oXal=Appearance? > phosphate=Appearance?
________
-Non-seminomatous? #?
-Seminomatous? #?
-Non-germ?
_______________
…… ……(NSemi……Semi)….NGerm
AFP/ hcg: highorlow
………………..
Age: ………(? -? ……….? )……….?
Prognosis:……………..? )
RFs?
–> size/shape/texture change = ?
Renal Stones @PUJ/ Pelvic Brim/ VUJ
NC helical CT <14-24hrs / NSAID-diclofenac50mgPR
AE
MET @distal ureteric stone < 1cm
- alpha-blocker
- if <0.5cm + Aysyx = WW
- > 1cm = UNLIKELY 2 pass -> Tx <4w
Remove @pain/not-passing:
- Lithotripsy <2cm
- Ureteroscopy <2cm + preg
- Nephrolithotomy >2cm/staghorn-struvite/prox ureter-lowerpole
- Stent/Surg = nephrostomy
ABx @sepsis
SO-Cysteine-low pH
L-Uric-Xanthine-low pH
O-Struvite Staghorn-high pH
-Urea -ProteusHydrolysis> NH3 Mg PO4
O-Ca Oxal / Phosph-high pH
oXal=spiky > phosphate=smooth
__________
-Non-semi=Choriocarc.Embryonic.Teratoma.Yolk-sac #germ
-Seminoma #germ
-Non-germ=Leydig-Lymohoma.Sertoli-Sarcoma
_______________
……..(NSemi……Semi)….NGerm
AFP/ hcg: high
…………………
Age: …..(20-30……40)…….50
Prognosis:…………good)
FHx Undesc Crypto-Orchid Kleinfelter Infertility TIN --> size/shape/texture change = 2WW + USS TESTES !!!
When to USS testicle?
_________
Varicocele - Refer:
_________
When 2 refer for Urology:
_________
Fluid AROUND testicle
#CANNOT FEEL testes
-TRANSILLUMINATES
Dx?
For CONGEN hydrocele:
-when 2 reassure - @?yrs
-when 2 refer for paeds?
Hydrocele @?
Hernia = ?
For non-CONGEN hydrocele?
__________
Varicoceles - how 2 manage:
-G1/subclin = ?
-@G2/3
Symmetrical - ?
Asymm = ?
Syx OR Abnormal semen = ?
Asyx AND Normal semen = ?
Most are on the left,
left varicocele = RCC cos left testicular vein drains into left renal vein
_________
Lump in INGUINAL groin area
Reducible disappears when laying flat scrotum fine
<6w - surg < ?
<6m - surg < ?
<6y - surg < ?
__________
BLACK kid
symmetrical bulge
@UMBILICUS
Dx? Tx? Resolve by?
Assoc w/?
-If syx/ large = Surg @ ? -? yr
-If Asyx+Small = ?Surg @ ? -? yr
When to USS testicle? Hematocele @non-trauma -if < x3 V contralat = chill Hx of pain/ persistent/ trauma Hydrocele = 20-35 Uncertain ddx Testicle = ETvTesticle ? \_\_\_\_\_\_\_\_\_
Varicocele - Refer: -Sudden pain -Not drain @supine -R-sided varicocele -TGA = low volume \_\_\_\_\_\_\_\_\_
When 2 refer for Urology: -Torsion -AEOrchitis -StrangHernia -Hematocele TRAUMA \_\_\_\_\_\_\_\_\_ Dx = Hydrocele
For CONGEN hydrocele:
-Reassure < 2yrs
-when 2 refer for paeds:
Hydrocele @SCord /Abdo-Scrotal Hernia
Hernia = Inguinal /Strang
For non-CONGEN hydrocele:
-Surg/Sclero/Asp
__________
Varicoceles - how 2 manage:
G1/subclin
-Reassure, Analgesia, Infertile 33.3%, Supportive underwear
-@G2/3
Symmetrical - Annual exam
Asymm = Urology ref
Syx OR Abnormal semen = Urology ref
Asyx AND Normal semen = Semen analysis
__________
Congenital inguinal hernia – paediatric surgery ASAP incarceration risk <6w - surg <2d <6m - surg <2w <6y - surg <2m \_\_\_\_\_\_\_\_\_\_\_\_\_
Infanta UMBILICAL hernia No tx - resolve <3yrs -Assoc with HypoT !!! If Syx/ Large = Surg @2-3yr -If Asyx+Small = ?Surg @4-5yr
yellow/green -strawberry cervix -smelly Dx? Tx? \_\_\_\_\_\_\_\_ Cda-Gcc
Chlamydia Tx? Refer for: -GUM -Repeat infection @?/+y/o = high p(re-infection) -Avoid sex till when? -STD screen/ Safe sex -Sex-abuse < ?yrs
Gonorrhoea Tx:
- UnCx:
- anogenital gon = ?
- anogenital/ pharyngeal gon + antimicrobial susceptibility known = ?
- needle phobia = ?
- Asyx = ?Ix ?/+w after ABx end
- Syx = ?Ix ?/+d after ABx end
Syx men = C+T:
- all partners < ?w
- most recent partner if >?w
The rest i.e. Asyx men /Women
- C+T all partners < ?m
_____
PID:
Mycoplasma genitalium?
Gon high risk?
Gon low risk?
yellow/green
-strawberry cervix
-smelly
Dx? Trichomoniasis Tx? Metro
Chlamydia= Doxy /Azithro 7d//////2d, respectively Refer for: -GUM -Repeat infection @25/+ y/o = high p(re-infection) -Avoid sex after ABx end/Azithro +7d -STD screen/ Safe sex -Sex-abuse < 18yrs
Gonorrhoea
- UnCx:
- anogenital gon = IM Ceft
- anogenital/ pharyngeal gon + antimicrobial susceptibility known = Cipro
- needle phobia = Cefix+Azithro
- Asyx = NAAT 2/+w after ABx end
- Syx = C+S 3/+d after ABx end
Syx men = C+T:
- all partners < 2w
- most recent partner if >2w
The rest i.e. Asyx men /Women
- C+T all partners <3m
_______
PID:
Mycoplasma genitalium
-moxifloxacin / ceftriax -> Azithro
Gon high risk = Ceftriax+Doxy+Metro
Gon low risk = Ceftriax/Oflox
EOrchitis
3 causes:
- ? - anal sex/ catheter -> Tx?
- ? - Age < ? -> Tx?
- ? - supportive - Tx?
–f/u ?w->
f/u = ? + Refer @?
___________
WPW
A - which sided pathway ->?AD = dom R wave @ which lead??
B - which sided pathway ->?AD = dom R wave @ which lead??
Assoc:?
Tx:?
Avoid sotalol when? Why?
_______
EOrchitis
3 causes:
- E.coli - (anal sex/ catheter) -> Cipro
- STD - (Age <35) -> Ceft+Doxy /Cipro
- Mumps - (supportive) - MSU/dipstix
–f/u2w->
f/u = ?ABx change + Refer @UTI/ STI/ Fail
___________
WPW = AL BRt
A - left sided RAD = dom R wave @ V1
B - right sided LAD = no dom R wave @ V1
Assoc: MESH
MVP, Ebstein anomaly, Secundum ASD, HOCM/HyperT
Tx: radioFreq ablation of acc pathway
FAPS
Avoid sotalol @AF cos it
- prolongs refractory period @AVN ->
- inc transmission rate through acc pathway ->
- Inc vent rate = VF
? = bladder infection (aka cystitis)
?:
Typical pathogens @normal: S+F+CMs
-UT + kidney function + no predisposing co-morbidities -> UTI
?: UTI + incr p(Cx e.g. Persistent/Recurrent infection, Tx failure)
-Cx UTI RFs = S+F dx, catheters, virulent/atypical organisms and co-morbidities (DM or IC)
? = Ureters + kidneys infection #(pyelonephritis)
Recurrent = Relapse/Reinfeciton
- UTI 2/+ / ? m
- UTI 3/+ /? m
- ? — same strain infection
- ? — different strain infection
? = UTI + catheter inserted last <48hr
? = bacteria @urine = asyx/syx
L-UTI = bladder infection (aka cystitis)
UnCx UTI — Typical pathogens @normal UT + kidney function + no predisposing co-morbidities -> UTI
Cx UTI — UTI + incr p(Cx e.g. Persistent/Recurrent infection, Tx failure)
-Cx UTI RFs = S+F dx, catheters, virulent/atypical organisms and co-morbidities (DM or IC)
Upper UTI = Ureters + kidneys infection #(pyelonephritis)
Recurrent = Relapse/Reinfeciton
- UTI 2/+ / 6 m
- UTI 3/+ /12m
- Relapse — same strain infection
- Reinfection — different strain infection
Catheter-UTI = UTI + catheter inserted last <48hr
Bacteriuria = bacteria @urine = asyx/syx
UTI tx?
- Cath change @?/+d
- A
- M
- Preg = Tx when? ; ? @GBS-agalactae
Refer: SA RC AS TIC
- S+F dx
- Atyp org
- Recurrence/Persistence
- CATHETER
- Atyp org
- S+F dx
-TwoWW@
?/+ and ?HU:
-w/ ?
-w/out ?
?/+ and ?HU +
- ? / ?
- ? / ?
-IC/ Urology dx @prostatitis = ?
-Acute = ? + ? –f/u=?d->
? d/w @f/u
-?
-? @STD
Chronic = ?
UTI tx?
- Cath change @7/+d
- ABx/Analgesia
- MSU/ Dipstix
- Preg = Tx NOW; ANC @GBS-agalactae
Refer:
- S+F dx
- Atyp org
- Recurrence/Persistence
- CATHETER
- Atyp org
- S+F dx
-TwoWW@
45/+ + vHU
45/+ + vHU + (UTI + Tx fail)
60/+ nvHU +
- dysuria / inc WCC
- recurrent/persistence
IC/ Urology dx @prostatitis = REFER -Acute = cipro+CS --f/u=2d-> C+S result d/w @f/u -ABx accordingly -GUM @STD
Chronic =
-Lactulose @pain-poo, Alpha-blocker, CBT/ADep, Trimeth
________
45/+ + vHU:
- w/ UTI + Tx fail
- w/out UTI
S1-2 sounds?
-Soft -Loud
Wide split ??
Paradox split??
Fixed split??
S4-3 sounds?
____________
Causes of 1st and 2nd degree HB KIMBAD
Causes of 3rd degree complete HB FASTI
____________
Pericardial rub - ??
Pleural rub - ??
Pericardial knock - ??
____________
Causes of LBBB
RBBB causes?
S1 = AV valves mitral/tricuspid closing
soft @Regurg
loud @MS
S2 = Aortic/pul closing soft @ASten Loud @ -HTN, Hyperdymamic states, -ASD-PulHtn
Wide s2-
delay RV empty
-(PS; PAH{MRegurg severe}; RBBB)
Paradox s2
-WPW-b, AS/LBBB, RVPacing, PDA
Fixed s2 - ASD
S4 = atria contract against STIFF ventricle
HOCM/HTN
ASten
S3 = diastolic filling of ventricle Const pericarditis - pericard knock, X+Y, X ✔️; Dilated CM, MRegug NORMAL<30y \_\_\_\_\_\_\_\_\_\_\_\_
1st and 2nd degree:
K+low; IHD; myocarditis;
Beta-blockers; Athletes; Digoxin
3rd degree complete block:
Fibrosis; AS; Surg Trauma; IHD/Congen
____________
Pericardial rub - pericarditis
Pleural rub - pneumonia/PE
Pericardial knock - C. Pericarditis
____________
LBBB=CM, HTN, AS, IHD
RBBB=PE, ASD, Normal
LVH: deep S @V1-2; tall R @V5-6
- Pulse = slow rising/narrow pressure
- Apex = thrill
- S4
Tx for:
- Asyx?
- Asyx >40/50mmHg + LV sys dx?
- Syx?
Common Ax @ <65 ? >65 ? iNFECTION? \_\_\_\_\_\_\_\_\_\_\_\_\_
For bioprosthetic valve: Inc risk of?? >age? get aortic one >age? get mitral one AC needed? give what antithrombotic Tx?
For mechanical valve for YOUNGER
Inc risk of??
AC needed? And what else if IHD??
____________
@Obesity NICE recommend:
BMI at 91st centile or above
- consider ?
BMI at 98th centile or above
- consider ?
RFs: FAT???
Endo: ??, ??, ?? CHG
Genetic: ??, ?? DP
AStenosis
-S4=HOCM/HTN/ASten
Asyx = OBSERVE
Asyx >40/50mmHg + LV sys dx = SURG
Syx = valve replacement -> balloon valvuloplasty
Ax Aortic stenosis:
<65 - bicuspid aortic valve
>65 - calcification
Rheumatic Fever
LVH= deep S @V1-2; tall R @V5-6
-inverted T @V5-6 (I, II, VL)
RVH= RAD+tall R @V1
-inverted T @V1-2, I II, aVF
wave inversion in the
leads looking at the right ventricle (T wave
inversion is normal in lead Vl
, and may be
normal in lead V2, but in white adults is
abnormal in lead V3)
________________
For bioprosthetic valve: Inc risk of calcification >65 get aortic one >70 get mitral one Long term AC not needed, give aspirin
For mechanical valve:
Inc risk of thrombosis
Give warfarin + aspirin if IHD.
____________
NICE recommend
-TCI: Tailored Clinical Intervention if BMI
@91st centile or above
-ComorbiditiesAssx if BMI
@98th centile or above
RFs: Females, Asians, Tall
Endo: Cushing’s, HypoT, GH deficiency
Genetic: Down’s Prader-Willi
Ax LAD
Ax RAD
_______
ECG signs:
Tall R @V5+6
Inverted T @V5+6, 1, VL
LBBB+LAD
R tall @V1
Inverted T @V1+2,
RBBB+RAD
Bifid/Broad P-mitrale +/- AF = ?
(what letter does Bifid P look like? 🤔)
Peaked P-pulmonale = ?
____________
Pulses paradoxes? PAH
Slow rising/plateau?
_________
COLLAPSING? API
Pulsus alternans?
_________
Bisfriens pulse - DOUBLE systolic beat
Jerky
_________
J wave Osborn
Widespread/SADDLE ST elevation
_________
PR depression?!
pericardial knock
_______
- Collapsing pulse = ?
- Wide Pulse Pressure = ?
- Narrow Pulse Pressure = ?
- slow rising pulse =?
RAD vs LAD
A(R>S @ V1) - WWPW - B (S»>R + Tinvert)+ VT
AAAArm switch/dextrocardia
RRRRVH - LVH
Lat (circumflex) - MMMMI - Inf (RCA)
TTTTall thin = RAD
Left post fasicle - HHHHemiblock - left ant fasicle/(bifasicular)
p176 ECG John Hampton book \_\_\_\_\_\_\_ LVH: R>25mm @V5+6 Inverted T @ V5+6, 1, VL LBBB+LAD
RVH:
R tall @ V1
Inverted T @ V1+2,
RBBB+RAD
Bifid/Broad P-mitrale +/- AF = LAH
-MS -> LAH
Peaked P-pulmonale #RAH
-TS>RVH(PS/PAH)
As per John Hampton p112
____________
Tamponade/ Severe asthma:
- PAH, AR/ASD, High Left EDV
AS
_________
AR/PDA/ Incr requirement
LVF
_________
HOCM/Aortic valve Dx
HOCM
_________
J = hypothermia HyperCalcemia
Widespread ST elevate = pericarditis
_________
PR depression = most sensitive for pericarditis!!!!!
pericardial knock = constr pericard
_______.
- Collapsing pulse = AR/PDA/ Incr requirement
- Wide Pulse Pressure = PDA/3rd HB/AR
- Narrow Pulse Pressure = ASten
- slow rising pulse = ASten
AD - long QT + NO sensorineural deafness
AR - long QT + sensorineural deafness
AD Asian men pseudoRBBB + ST elevation (downsloping mostly V1-3ish) T-invert Risk? Tx? Gene?
Antiarryhtmics causing long QT?
Others?
Electrolytes?
_________
Aspirin
Clopidogrel
Enoxaparin/Fonda
Bivalirudin Reversible
Abciximab, eptifibatide, tirofiban ???
TxA2, ADP plt receptor, aAT3 stop f10a, DTi, gp2b3a blocker
Romano Ward, KCN(Q1+H2) fucked K channels
Jervell Nielsen
Brugada = tachy-arrhythmias, sudden cardiac death. ICD!! Gene SCN5A mutation -> fucked Na Channel
Not FAPS -SSRI/TCA; APsych; Li -ABx = MACROLIDES -Low Mg K Ca/ Low Temp HypoThermia -Typ>>>>Atyp \_\_\_\_\_\_\_\_
Aspirin Antiplatelet -
inhibits thromboxane A2 production
Clopidogrel Antiplatelet -
inhibits ADP + plt receptor binding
Enox/fonda = Activates AT3 ->
-stop f8-12a
Bivalirudin Reversible DTi
Abciximab, eptifibatide, tirofiban
GP2b/3a receptor blockers
Soft, Systolic-ejection
- Short , S1+2 ok, SymptomLESS,
- Standing-Sitting varies w/ position
_______
1.
Short BUZZZZZ @Aorta, OR
Soft BLOWWW @Pul
- Continuous blowing = BELOW the clavicles
- Low-pitched sound @LLSE
#3 innocent murmurs \_\_\_\_\_\_\_\_\_
—EJECTION Mid-Systoic Murmurs
Andy:
-ASten/Sclerosis
Pandy:
- Syst: innocent/ PS(carcinoid-noonan)/ ASD/ ToF/ HOCM
- Diast: AR / PR
PDA = continous machine, wide/collapsing below clavicle Coarctation = Turner, EMSyst to back Carcinoid = TR/PS
—PANSYSTOLIC murmurs
Teddy:
-Syst: TR carcinoid-ivdu / VSD harsh
-Diast: TSten
Me:
- Syst: MRegurg(high-pitch)/ MVP(EMS click)
- Diast: MSten(Rumbling)
1-Ejections* - turb OUTFLOW tract
2-Venous - turb INFLOW venous tract
3- stiLLSe - LLSE low pitched
_________
*EJECTION:
Pulmonary=soft blowing/Aortic=short Buzzing
-Assoc w/Valsalva
#3 innocent murmurs \_\_\_\_\_\_\_\_\_
_________
—EJECTION Mid-Systoic Murmurs
Andy:
-ASten/Sclerosis
Pandy:
- Syst: innocent/ PS(carcinoid-noonan)/ ASD/ ToF/ HOCM
- Diast: AR / PR
PDA = continous machine, wide/collapsing below clavicle Coarctation = Turner, EMSyst to back Carcinoid = TR/PS
—PANSYSTOLIC murmurs
Teddy:
-Syst: TR carcinoid-ivdu / VSD harsh
-Diast: TSten
Me:
- Syst: MRegurg(high-pitch)/ MVP(EMS click)
- Diast: MSten(Rumbling)
Pulse = Bounding + COLLAPSING*
Murmur = continuous MACHINE
-Wide pulse pressure
-Thrill + Heave
- Whats PDA?
- Why PDA legit in utero?
- Why not need after born?
- If persists whats the issue?
- Similar to Aortic regurg, what kind of pulse you get?
-Tx?
_______
- Collapsing pulse = AR/PDA/ Incr requirement
- Wide Pulse Pressure = PDA/3rd HB/AR
- Narrow Pulse Pressure = ASten
- slow rising pulse =?
PDA= pul art + aorta connection
inutero, baby gets O2 from mum
Doesn’t need lungs #pul HTN ->
R->L shunt
-i.e. need it go through PDA
after born, Pul HTN gone ->
blood go to lung for oxygenation
#dont need PDA
If persists #uncorrected, you get: L->R shunt -> PAH + RVH -> R->L shunt @Eisenmenger --> -murmur = disappears --> infant = CYANOTIC, not shocked
Pulse = Bounding + COLLAPSING*
Murmur = continuous MACHINE
-Wide pulse pressure
Tx = Indomethacin closes PDA!!
Prostaglandins keeps it open @ TGA to allow some oxygenation before surgical fixing
- Collapsing pulse = AR/PDA/ Incr requirement
- Wide Pulse Pressure = PDA/3rd HB/AR
- Narrow Pulse Pressure = ASten
- slow rising pulse =ASten
Explain eisenmenger
Sx?
Ax?
____________
ASD:
-RBBB+RAD - Dx? Risk?
-RBBB+LAD - Dx?
___________
Man/Turner’s girl
- HTN in arms
- R-F delay
- E-MSys @ LUSE through to BACK!!
- CXR = notched ribs cos of?
Dx? Anatomy? HTN in which vessels?
_______
MITRAL AREA:
S3: Pansystolic = blowing high pitched ->
Radiate to AXILLA
Pansystolic + EMSyst click
Diastolic @Exp -> opening snap + Rumbling
_______
Collapsing pulse = ?
Wide Pulse Pressure = ?
Narrow Pulse Pressure = ?
_______
Pansystolic @LLSE
- louder @insp #incrVenReturn #carcinoid
- harsh?
If persists #uncorrected, you get: L->R shunt -> PAH + RVH -> R->L shunt @Eisenmenger --> -murmur = DISAPPEARS --> infant = CYANOTIC #not shocked
CCPP:
- cyanosis clubbing
- polycythemia PAH
Ax = VSD, ASD, PDA.
_____________
ASD:
RBBB+RAD = secundum dx
-EMBOLUS SHOOT OFF -> STROKE!!!!!!
RBBB+LAD = primum dx
-prime lad
__________
Coarctation -Aorta NARROW near PDA -> -HTN in Bracioceph + LSubclavian -CXR = collats eroding ribs -> notched ribs \_\_\_\_\_\_\_\_
MR
- Pansys blowing high pitched -> Axilla
MVP = Pansys + EMSyst click
MS
-opening snap + Rumbling
________
Collapsing pulse = AR/PDA/ Incr requirement
Wide Pulse Pressure = AR/PDA/ 3rdHB
-Narrow Pulse Pressure = ASten
_________
Pansystolic @LLSE
- louder @insp #incrVenReturn=TR
- harsh=VSD
MITRAL AREA:
S3: Pansystolic = blowing high pitched ->
Radiate to AXILLA
Pansystolic + EMSyst click
Diastolic @Exp -> opening snap + Rumbling
_______
Collapsing pulse = ?
Wide Pulse Pressure = ?
Narrow Pulse Pressure = ?
_______
Pansystolic @LLSE
- louder @insp #incrVenReturn #carcinoid
- harsh?
MR
- Pansys blowing high pitched -> Axilla
MVP = Pansys + EMSyst click
MS
-opening snap + Rumbling
________
Collapsing pulse = AR/PDA/ Incr requirement
Wide Pulse Pressure = AR/PDA/ 3rdHB
-Narrow Pulse Pressure = ASten
_________
Pansystolic @LLSE
- louder @insp #incrVenReturn=TR
- harsh=VSD
Codeine to PO morphine
PO morphine = to…
SC moprhine /?
OXYCOD PO /?
SC diamorphine /?
IV moprhine /?
OXYCOD SC /?
- SP—SI–S
- MO-DM-O
- 22—33–4
Alcohol units?
-AST > ALT (ratio usually> 2:1)
-toAST
________
Monoplegia -?
Hemiplegia -?
Quadriplegic -?
-Paraplegia -?
ACA–MCA–PCA*
*PCA - midbrain Weber
________________
Amaurosis fugax - which vessel?
Locked in syndrome - which vessel?
__________
- Absent < – > horizontal eye-move
- Miosis
- Paralysis=Quadriplegia
- Same FACE: PD/PT (paralysis/deaf // pain/temp)
- Opp limb
- Nystagmus
- Ataxia
- Same FACE: PD/PT (pain/temp)
- Opp limb
- Nystagmus
- Ataxia
__________
- Unilat sensory/motor FAL
- Cog dx - VisuoSpatial/Dysphasia
- HomoHNopia
1 of: -Sensory -AtaxicHemiParesis -Motor PURELY + HTN
CN dx + CONTRALAR motor/sensory dx
Conjugate EYE dx
CEREbellar dx - ataxia/nystag/vertigo
HomoHNopia
4-6-4 H:
CN4 present?
CN3 present?
CN6 present?
________
Nystagmus: central v peripheral?
______
Brainstem death
_________
Delirium > Dementia
________
?vessel lesions (dominant side - i.e. most ppl are ?-handed so ?-sided MCA fucked):
Lesion -> SPEECH = FLUENT sentences that make Sense -Repetition = FUCKED -AWARE of Errors making Comprehension is NORM
Lesion -> SPEECH = FLUENT sentences that make NO Sense -word substitution / neologisms #word-salad Comprehension FUCKED Repetition NORM
Lesion -> SPEECH = NON-FLUENT sentences that make Sense -Laboured + Halting -Repetition = FUCKED Comprehension NORM \_\_\_\_\_\_\_\_\_\_
alexia, acalculia, finger agnosia
RIGHT-LEFT disorientation
-?
? involuntary, irregular, non-rhythmic movements of UNILATERAL side of the body
? involuntary, flinging, violent movements of UNILATERAL side of the body
Codeine to PO morphine /10
PO morphine = to…
SC moprhine /2
OXYCOD PO /2
SC diamorphine/3
IV moprhine /3
OXYCOD SC /4
Alcohol units = %.mls / 1000
-make a toAST with alcohol > ALT. 2>1
_________
Monoplegia - 1 limb
Hemiplegia - Unilat 2 limbs
Quadriplegic - 4 limbs
-Paraplegia - Bilat LOWER limbs
ACA MCA PCA*
L>UL ; UL>L
< – HemiParesis
……..Aphasia – > Agnosia
……..Sensory
….HomoHAnopia – > Mac-Sparing
*PCA - Weber Midbrain
-Same CN3, opp HemiParesis
-Agnosia
-Macular sparing HomoHNopia
________________
Amaurosis fugax - Retinal/Ophthalmic Artery
Locked in syndrome - Basilar Artery
____________
Pontine bleed: PAMP
- Absent < – > horizontal eye-move
- Miosis
- Paralysis=Quadriplegia
AICA: Lat Pont
- Same FACE: PD/PT
- ——(paralysis/deaf // pain/temp)
- Opp limb
- Nystagmus
- Ataxia
PICA: Lat Med Wallenburg
- Same FACE: PD/PT (pain/temp)
- Opp limb
- Nystagmus
- Ataxia
______________
Anterior Circulation Stroke:
3=TotalACS
2=PartialACS
-UCH
- Unilat sensory/motor FAL
- Cog dx - VisuoSpatial/Dysphasia
- HomoHNopia
LacACS = L-SAMP 1 of: -Sensory -AtaxicHemiParesis -Motor PURELY + HTN
POstCS
_________
4-6-4 H:
CN4 vertical nystagmus
CN3 Ptosis, Dilated, Vertical nystagmus
CN6 horizontal nystagmus
Nystagmus: Central v Periph:
central is:
- B/L
- Assoc sens/motor dx
- Direction = multi / purely uni or rotatory
Brainstem Death: Coma unknown Ax Reversible ax excluded Sedation X Electrolytes fine
Bronchial stim -> no cough Response to sound/Supra-Orb Pressure Occ-Vestib Reflex absent Corneal Reflex absent Disconnect ventilator 5-mins -> no resp support \_\_\_\_\_\_\_
-Emotions = fear, agitation
-Fluct Syx = worse @night, normal periods
-GCS impaired
-Hallucinations/Illusions/Delusions #perception
_________
MCA lesions (dominant side - i.e. most ppl are right-handed so left-sided MCA fucked):
Conduction aphasia
- Arcuate Fasciculus
- Fluent + Sense
- Comp NORM
Wernicke Receptive
- SUP Temp gyrus
- Fluent + NO Sense
- Repetition NORM
Broca Expressive -INF Frontal gyrus -NON-Fluent + Sense -Comp NORM \_\_\_\_\_\_\_\_\_\_
alexia, acalculia, finger agnosia
RIGHT-LEFT disorientation
-Gerstman’s
hemichorea: involuntary, irregular, non-rhythmic movements of one side of the body
hemiBALLismus: involuntary, flinging, violent movements of one side of the b
Exudate: RIM
Transudate = HM
______
What @absence seizure EEG? \_\_\_\_\_\_\_\_\_\_\_\_\_ ?lobe -Head/leg movements -ictal weakness -Posturing -Jacksonian-march
?lobe
- Hallucinations,
- Epigastric-rising,
- Automatisms-LIPSMACKING/PUCKING,
- Deja-vu/Dysphasia
- ?lobe = Paraesthesia
- ?lobe = Floaters/flashes
Exudate: RIM
-Rheum dx/Infection/Infarction/Malignancy
Transudate = HM
-HF, LF, RF / HypoT
-Miegs / Malabsorption
________
Absence = 3Hz @EEG
_____________
Motor FRONTAL lobe
- Head/leg movements
- ictal weakness
- Posturing
- Jacksonian-march
Non-motor: -Temporal Hallucinations, Epigastric-rising, Automatisms-LIPSMACKING/PUCKING, Deja-vu/Dysphasia
- Parietal lobe (sensory) = Paraesthesia
- Occipital lobe (visual) = Floaters/flashes
Catheter UTI = ? ?d
-what to do @ Asyx bacteria @catheterised pts
Recurrent UTI = ? (?? >?? ) proph SD @:
- ?
- ?
Preg:
- Asyx BU == ? ?d
- UTI @preg = ? ?d
Bog-standard UTI w/ no catheter/preg
-man = ? ?d
-woman = ? ?d
________
Kids:
1. UTI < 3m U or L-UTI = ?+?+?
- UTI > 3m = ?Ix ->
- nitrite POS AND leukocyte POS = ?
- nitrite POS + leukocyte NEG = ?
- nitrite NEG + leukocyte POS = ?
–@infants and toddlers =
?type of sample -> ?
Kids >3m Upper-UTI #fever + flank-pain
- Pyeloneph = ? / ?
Kids >3m Lower-UTI
- ?
- @recurrent?
Kids < 3m U or L-UTI = ?+?+?
_______
?Ix @: Flow dx / Mass Atyp org Sepsis Tx fail Recurrence, USS-KUB @: - acute infection if ?age @recurrent - <6w if ?age @recurrent
Acute infection @Recurrent /Atyp<3y
–? - ?m-> ?Ix #parenchymal dx
For reflux = ?
________
Recurrence:
x2 (L-UTI + U-UTI)
x1 (L-UTI + U-UTI) AND x1 (L-UTI)
Catheter UTI = TANP 7d
-do NOT treat Asyx bacteria @catheterised pts
Recurrent UTI = TANC (TN>AC) proph SD @:
- expose2trigger
- ON
Preg:
- Asyx BU == NAC 7d
- UTI @preg = NAC 7d
Bog-standard UTI w/ no catheter/preg
-man = NT 7d
-woman = NT-PF 3d
_________
Kids:
1. UTI < 3m = Refer asap + ABx + C+S
- UTI > 3m = dipstick ->
- nitrite POS AND leukocyte POS = ABx
- nitrite POS + leukocyte NEG = ABx
- nitrite NEG + leukocyte POS = UrineMCS
–@infants and toddlers, sample =
Clean Catch Urine -fail-> Suprapubic
Kids >3m Upper-UTI #fever + flank-pain
- Pyeloneph = Cefalexin/ Co-amox
Kids >3m Lower-UTI
- TANC (TN>AC)
- Even recurrent = -TANC (TN>AC) /6m-r/v
Kids < 3m U or L-UTI = Refer asap + ABx + C+S
_______
USS-KUB @: Flow dx / Mass Atyp org Sepsis Tx fail Recurrence, USS-KUB@: - acute infection if < 6m/o @recurrent - <6w if > 6m/o @recurrent
Acute infection @Recurrent /Atyp< 3y
–4-6m-> DMSA #parenchymal dx
For reflux = MCUG
