Year 5 Flashcards
Indications for urgent head CT < 1 hour
- GCS <13 on initial assessment
- GCS <15 2 hours post injury
- Suspected open or depressed skull fracture
- signs of basal skull fracture (e.g panda eyes or battle sign or CSF from ears/nose)
- Post traumatic seizure
- Focal neurological deficits
- > 1 episode of vomitting
Indications for CT head <8 hours
For anyone who has had loss of concioussness/reduced conciousness and;
* Age >65
* History of bleeding/clotting disorders OR on anticoagulation
* dangerous mechanism of injury
* >30 minutes of retrogade amnesia following event
NOTE - if on warfarin patient must have CT head <8hours regardless of conciousness level.
Clinical presentation of anastamotic leak post surgery
Typically presents 2-7 days following surgery (usually day 5)
May present with new onset AF
Feculent material in wound drain
Tachycardia
Pyrexia
Absent bowel sounds / signs of peritonitis
1st line investigation for appendicitis
Abdo ultrasound - especially in females to rule out ovarian causes of RIF pain.
2nd line do a CT scan
AAA management
Screening offered at age 65
<3cm = no further action
3 - 4.4 = small aneurysm, rescan in 12 months
4.5 - 5.4 = rescan in 3 months
>5.5cm = 2ww referal to vascular for intervention
If growth >1cm per year or Symptomatic refer for intervention.
Single most useful blood test (not LP) in pts with subarachnoid haemorrhage
U&Es - to detect hyponatremia (a common complication of SAH)
1st line investigation for suspected prostate cancer
Multiparametric MRI scan
diagnostic investigation for small bowel obstruction
CT abdo
Bladder cancer RF & Types
Transitional cell (urothelial) = most common:
* Smoking
* Alanine dyes (printing/textile industry)
* rubber manufacture
* cyclophosphamide (chemo drug)
Squamous cell - <10% of cases;
* Schistosomiasis
* smoking
Causes of hydronephrosis
Bilateral (PACT)
* Abberant renal vessels
* Calculi
* Tumours of renal pelvis
Unilateral (SUPER)
* Stenosis of urethra
* Urethral valve
* Prostatic enlargement
* Extensive bladder tumour
* Retro-peritoneal fibrosis
Management = urethral catheter
Serotonin syndrome
Causes;
* SSRIs
* MAOIs
* Ecstasy/amphetamines
* NOTE - tramadol + SSRIs often causes serotonin syndrome
Features;
* Neuromuscular excitation - Hyperreflexia, myoclonus + rigidity
* Autonomic excitation - sweating + hyperthermia
* Confusion
Mx = benzos + chlorpromazine
Neuroleptic malignant syndrome
Causes;
* Antipsychotics
Features;
* Slow onset (hours-days)
* Decreased reflexes
* lead pipe rigidity
* hyperthermia
* CK will be raised
Mx if severe = dantrolene
Primary sclerosing cholangitis
Associated with UC & HIV
Features;
* cholestasis
* RUQ pain
* Fatigue
* Increased risk of Cholangiocarcinoma + CRC
INVx = ERCP/MRCP shows beading appearance to biliary tree (biliary strictures)
p-ANCA +ve
Onion skin appearance on liver biopsy (not v helpful)
Churg strauss syndrome
Eosinophilic granulomatosis with polyangitis
Features;
* Asthma
* Blood eosinophilia
* Paranasal sinusitis
* nasal polyps
* mononeuritis multiplex
* Vasculitis
* Dyspnoea
p-ANCA +ve
Wegener’s granulomatosis
Granulomatosis with polyangitis
Features;
* Renal failure
* Saddle nose deformity
* Epistaxis / Haemoptysis
* Vasculitis
* Dyspnoea
C-ANCA +ve
Rosacea
Features;
* typically affects nose, cheeks and forehead
* Flushing often first sx
* telangiectasia
* pustules/papules + persistent erythema
* Rhinophyma
* Sunlight may exacerbate sx
Mx = Conservative mx (sunscren)
* Topical brimonidine gel for flushing
* Topical ivermectin 1st line if pustules or papules present
* Topical metronidazole / azelaic acid is an alternative
If severe pustules/papules then give Oral doxy + topical ivermectin
Tumour lysis syndrome
Typically occurs in pts with lymphoma or leukemia on the introduction of chemotherapy.
Prophylaxis with allopurinol will prevent it.
Features; Mainly related to electryolyte abnormalities
* Abdo pain, N&V
* weakness
* arrythmias
* seizures
Cairo-bishop scoring system (used for diagnosis)
* Uric acid >475
* K+ >6
* Hyperphosphatemia
* Low calcium
Mx;
* IV fluids
* Rasburicase (high risk pts) or allopurinol (in lower risk groups)
Which oral anti-hyperglycemic agents are contraindicated in heart failure?
Pioglitazone (the glitazones) as they can cause fluid retention which would worsen HF.
Rapid correction of hypernatremia can cause what?
Cerebral oedema
Rapid correction of hyponatremia can cause what
Central pontine myelinosis
A cavitating lung lesion indicates which type of lung cancer?
Typically squamous cell
Management of life threatening C.diff infection
Oral vancoymycin and IV metronidazole
Management of severe cellulitis
IV Co-amoxiclav, clindamycin or ceftriaxone
Mild-moderate cellulitis is treated with flucoxacillin
Causes of PAINLESS genital ulcers
- Syphillis - Caused by Treponema pallidum. Infection is characterised b primary, secondary adn tertiary stages. A painless chancre is seen. incubation 9-90 days.
- Lymphogranulpoma vereneum - caused by chlamydia. Infection comprises 3 stages; (1 = small painless pustule, later forms an ulcer) ( 2=Painful inguinal lymphadenopathy) (3=protocolitis)
Causes of PAINFUL genital ulcers
- Genital herpes - usually caused by HSV2. Typically multiple painful ulcers.
- Chancroid - tropical disease caused by hameiphilus ducreyi. Causes painful genital ulcers associated with unilateral painful inguinal lymphadenopathy. Ulcers have shaprly defined, ragged, undermined borders.
Which antibiotic is best to treat MRSA infection
Vancomycin
Clindamycin can be used as monotherapy once sensitivities are available due to high rates of resistance. (Also associated with C.diff so avoid in elderly!)
Severe side effet of Etomidate?
Adrenal suppresion
Tx of prostatitis
Quinolone antibiotic (e.g Ciprofloxacin) for 14 days.
Enteric fever (Typhoid)
Caused by Salnonella typhi/parathyphi.
Faeco-oral transmission.
Features;
* Systemic upset initially - headache, fever & arthralgia
* Relative bradycardia
* Abdo pain & distension
* Constipation
* Rose spots - typically on the trunk
Complications = osteomyelitis, GI bleed, meningitis, cholecystitis.
Malaria
Cause = plasmodium (P.Falciparum most common. P.Vivax ‘benign malaria’)
Features;
* Systemic features - fever, headache & splenomegaly.
* Cyclical fever (every 48hrs)
* Hypoglycemia
* Acidosis
* Severe anemia
* Schizonts on a blood film
Dengue fever
Viral infection - may progress to viral haemoharrgic fever.
RNA virus of the Flavivirus - transmitted by Aedes mosquito.
Features;
* Fever & Retro-orbital headache & Myalgia/arthralgia - A.K.A break-bone fever
* Pleuritic pain
* Maculopapular rash
* Haemorrhagic manifestations e.g petechiae, purpura, epistaxis.
Severe dengue gives a DIC type picture (spontaneous bleeding & thrombocytopenia)
Invx = serology or NAAT for viral RNA.
Amoebiasis
Caused by entamoeba histolytica.
Features;
* Profuse bloody diarrhoea
* Long incubation period
* Stool microscopy - may show trophozoites if examined within 15 mins.
*May cause liver abscess - Typically a single mass in right lobe (anchovy sauce)
This presents with fever & RUQ pain & hepatomegaly.
Tx = oral metronidazole
Giardiasis
Caused by giardia lamblia.
RF = foregin travel, swimming/drinking from river or lake. MSM.
Features;
* May be asymptomatic.
* Non-bloody diarrhoea
* Bloating, abdo pain
* Steattorhoea
* Lethardy
* Weight loss
* Malabsoprtion and lactose intolerance can occur.
Tx = metronidazole
Leptospirosis
Caused by the spirochete leptospira interrogans.
Typically spread by contact with infected rat urine (sewage workers, farms, abbotoir etc)
Features;
* Fever, flu-like Sx.
* Subconjunctival redness/haemorrhage
* Second immune phase (weil’s disease) = AKI + Jaundice + hepatomegaly + aseptic meningitis.
Mx = Benpen or doxy.
Management of legionella pneumonia
Macrolide antibiotics (Clarithromycin)
Legionella diagnosis
Urinary antigen testing
What electyrolye imbalance may be caused by Legionella pneumonia
Hyponatremia
Treatment of syphillis genital ulcers
IM Benzylpenecillin
Treatment of latent TB
3 months of Isoniazid + rifampicin
OR
6 months of Isoniazid
(dont forget to prescribe pyroxidine with isoniazid to reduce risk of peripheral neuropathy)
Most common cause of travellers diarrhoea
E.coli
Features = watery stools + severe abdo cramps.
Q fever
caused by coxiella burnetti. (found on cattle & sheep)
Features;
* Typical prodrome = fever & malaise
* Pyrexia
* Transaminitis
* Atypical pneumonia
* Endocarditis
Mx = doxycycline
What antibiotic should be added in pneumonia if staphyloccic suspected (influenza)
Flucoxacillin
ebola
Filoviridae family
west africa
human-human transmission
incubation = 2-21days (only infectious once sx start)
Features;
* suspect ebola in pts presenting with a fever >37.5 with recent history in africa/affected areas.
* Other features = Fatigue + muscle pain + headache + sore throat + vomitting + diarrhoea + impaired kidney/liver function.
Management of metastatic bone pain
Typically responds to strong opiates, bisphosphanates or radiotherapy.
Which beta blockers should be used in CVD?
Bisoprolol and Carvedilol
What rash/skin change can you get in reactive arthritis
Keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles of feet)
What is the brownish disclouration called seen in chronic venous insufficiency?
Haemosiderin staining
What causes the ‘inverted champagne bottle’ apperance to the legs in Chronic venous insufficiency
Lipodermatosclerosis (chronic inflammation of the subcutaneous tissue)
Atrophy blanche
Smooth porcelain white scar tissue - usually surrounded by haemosiderin deposition. Caused by chronic venous insufficiency
Side effects of adenosine
Flushing
Chest pain
abdo pain
headache
hypotension
dry mouth
Dyspnoea
