week 3 Flashcards
acute bronchitis
viral pneumonia, copd pic
wheeze fever
crp normal
comsrbative mangement
if crp high - doxy
coryzal symps
ards
pao2<300, bilateral opacities, acute pnset
non cardio PO
prone psoitoning, A toE
ABG - refractory to oxygen
pul cap pressure <18mmhg
hydrocephalus
sah and meningitis
medical can be furosemide
motor neurone
ALS = mixed
PLS = UMN, Betz
PBP = both, absent jaw jerk, flaccid fasciculation of tongue, Donald duck speech
Pseudobulbar: UMN, increased jaw ja=erk, hot potato
PMA = LMN
riluzole -prolong 3 monthd
percutaneous gastrostomy tube
NIV
vit D if bed boung
eye spared, autonomic fx spared
myasthenia gravis
criss: lithium, BB - need for NIV, FVC low
diplopia. ptosis
hypernasal speech
plasmapharesis + IVIG in crisis
SCLC, brrast, ovarian cancer = Lambert
pyridostigmine
hypogonadism
eunucoid
chemo radio dmaage to gonads
menopause symps
buccal, oral, IM
gynaecomastia, erectile dsfucntion
DEXA
polycythaemia due to testosterone
haemochromatosis
pelvic imaging - amenorrhoea - structural defects
carcinoid
appendix, small inetstine
5-HIAA
right sided murmurs, bronchospasm,, wheeze, pulm stenosis
octreotide
prolactinoma
cabergoline/ bromocriptine
hypothyroid
amenorrhoea (secondary)
men1
thyroditis
riedel’s: woody painless, psc assoc
rapid thryoid enlargement: dyspnoea, dysphagia
nephrotic
Membranous nephropathy = SLE, hep B
Focal segmental glomerulosclerosis = HIV
4-6 weeks steroids
biopsy if haematuria, steroid unrepsonsive
3.5g/24 hours protein
anti PL2R = membranous glomerulonephritis
hydrocoele
straining, raising arms, coughing
tetsicular tumour
patent processus vainalis
torsion, tumour, epididymo orchitis
USS
fibroadenoma
> 3cm = surgical excision
aterial and venous
venous oozes and bleeds
sloping shallow
atrophie blanche
bppv
brandt daroff exercises
if no improvement by 4 weeks - follow
admit if unable to keep down fluids
saccade
viral labyrinthtisi
horizontal nystagmus towards unaffected side
prochlorperazine/ antihistamines
scleirtis
RA, SLE, sarcoid, granulomatosis w polyangitis
red eye, painful
same day assessment
NSAIDs
episcleritis, blanching vessels, not painful
reactive arthritis
sterile pyuria
circinate balanitis
NSAIDs may need PO steroids
dysentery
alcoholic hepatitis
Maddrey’s discriminant function to determine if need steroids for severe
3 months abstinence and best mx and sutiable candidate –> liver transplant
AI hepatitis
type 1: ANA, ASMA
type 2: ALKM
cushingoig features
steroids then axatjioprine (LFT and FBC)
6-12 monthly USS and AFP
liver biopsy
hypergammaglobulinaemia
diverticular disease
colovesical fistula -faecaluria, pneumaturia, brown urine
IV fluids, abx .etc. in itis
hartmann’s if peritonitis
brown coloured urine
CT
barium and colonoscpy can be done but perf in acute
aspergillus lung disease
abpa - cf, asthmatics, eosinophilia, IGE, proximal bronchiectasis
aspergilloma - tb, sarcoid
invasive - septic
steroids and antifungals for abpa
can cause tracheal deviation and haemoptysis if massive aspergilloma
obstructive sleep apnoea
4 week referral in comorbidities, affecting work - sleep clinic
epworth sleepiness scale
hypoglycaemia
sepsis, adrenal insufficiency, alcohol
short synacthen, cortisol
ffa’s
two hypoglycaemia requqiring help - no licence
avoid choc
bph
obesity, afrocaribbean
5a redcutase - finasteride (test to dihydrotest inhi)
phosphodiesterase-5
anticholinergic - tolterodine, oxybutinin
acute retention - cathter
TURP, TUIP
REZUM - use vapour,
HoLEP - laser - bigger prostate
glycine –> ammonia toxicitiy
mastittis/ breast abscess
12-24 no improvment
I&D - diagnostic and therapeutic
infectious mono
palatal petachiae
posterior cervical lymph
burkitt’s, gbs
monospot in rapid point of care
LFTs - affects liver
atypical lymphocytes of blood film
rhinosinusitis
12 weeks
back up abx
smelly discharge
cataracts
hypocalcaemia
dex and chlormaphenicol, reading glasses
retinal detach, posterior capsule opacification
endolphthalmitis
optic neuritis
sarcoid, lupus
red desat, central scotoma, like looking through clouds, RAPD
vWD
type 3 is AR
epistatxis, menorrhagia
APTT and bleeding time prolonged
desmopressin
tranexamic acid for minor bleeding
neutropenic sepsis
<0.5 x10^9
prophyalxis - fluoroquinolone
tx: tazocin, if no imp meropenem. venc if no ikmrpovement after few days - fungal cause ix
pressure sores
type 1: non blanching erythema
2: blister - dermins/ epdiemris
3: subcut
4: necrosis of msucle, bone .etc.
Waterlow score - nutrition, bmi - screen likelihood of presure sores
nutrition, fluids, analgesia, debridement
psoriasis
subungal hyperkeratosis
guttate - strep, tear drop
eyrhtrodermic
pustular - also emegency
topical steroids + vit d
alcohol, beta blockers, trauam worsens
4 week break between steroids
syphilis
jarish heixhmer - steroid 24 hours before to prevent - fever, chills, headache
uveitis in secondary
lighning pains
argyll robertson pupil – small irregular pupils contrists on convergence not direct light
carpal tunnel
wasting of thenar
amyloid, sarcoid, ra
normal reflexes
septic arthritis
2 weeks IV then oral 4 weeks
e coli in elderly
prostehtic orhto in theatre
gonorrhoea in young men
aspirate ebfore abx
barrett’s
metapalsia: 3-5 years surveillnce and PPI
high grade: radioalblation + mucosal resection + PPI
low grade: mucosal resection + PPI
pulm ht
loud s2 hs
grham steel murmur - pulm regurg
tricuspid regurg
right heart catheterisation