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Yr 4 - PassMed Corrections > ACC > Flashcards

ACC Flashcards

1
Q

What 2 criteria are required to diagnose septic shock?

A

1) MAP <65 mmHg despite fluid resus

2) Lactate >2 mmol/L

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2
Q

What BEDSIDE score can be used to identify patients with suspected infection who are at greater risk for a poor outcome outside of ICU?

A

qSOFA

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3
Q

What makes up the qSOFA score? (3)

A

1) RR >22

2) Systolic BP <100 mmHg

3) altered mental state

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4
Q

What qSOFA score indicates someone at a heightened risk of mortality (10% risk)?

A

≥2

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5
Q

What is the mean arterial pressure? (MAP?

A

The average pressure in a patient’s arteries during one cardiac cycle.

It is considered a better indicator of perfusion to vital organs than systolic BP.

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6
Q

How does sepsis cause hypoperfusion of organs?

A

Cytokines released due to inflammation increase the permeability of blood vessels.

This causes oedema and reduced intravascular volume.

Oedema creates a gap between the blood and the tissues, reducing the amount of oxygen that reaches the tissues.

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7
Q

What is released in sepsis that results in vasodilation?

A

Nitrous oxide

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8
Q

In order to generate a palpable femoral pulse, what arterial pressure is required?

A

> 65 mmHg

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9
Q

Which general anaesthetic has a side effect of pain on injection?

A

Propofol

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10
Q

2 key adverse effects of propofol?

A

1) Pain on injection site
2) Marked drop in BP

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11
Q

Which general anaesthetic has a side effect of laryngospasm?

A

Thiopental sodium

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12
Q

Which general anaesthetic has a side effect of 1ary adrenal suppression?

A

Etomidate

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13
Q

2 main side effects of etomidate?

A

1) 1ary adrenal suppression

2) Myoclonus

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14
Q

How does etomidate cause adrenal suppression?

A

As reversibly inhibits 11b-hydroxylase

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15
Q

What 2 things is malignant hyperthermia triggered by?

A

1) Suxamethonium

2) Volatile anaesthetics

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16
Q

Definitive diagnosis of malignant hyperthermia?

A

Genetic testing afterwards

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17
Q

Which general anaesthetic is post-op vomiting common in?

A

Etomidate

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18
Q

Mechanism of IV dantrolene in malignant hyperthermia?

A

Ryanodine receptor antagonist –> helps to decrease intracellular calcium concentration and muscle metabolism

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19
Q

What is the most common cause of malignant hyperthermia?

A

Autosomal dominant mutation in ryanodine receptor.

This results in an abnormality in calcium regulation within muscle cells –> leads to increased calcium levels in the sarcoplasmic reticulum and a consequent increase in metabolic rate.

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20
Q

Which general anaesthetic may cause marked myocardial depression?

A

Thiopental sodium

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21
Q

Inheritance of mutation in malignant hyperthermia?

A

Autosomal dominant

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22
Q

What does a simple general anaesthetic induction ‘recipe’ for tracheal intubation in a fit and well patient usually incorporate?

A

Quick acting opiate e.g. fentanyl + propofol

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23
Q

How many test breaths are delivered whilst confirming tube placement within the trachea?

A

5

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24
Q

How is tube placement confirmed within the trachea? (3)

A

1) 5 waves on capnography

2) Symmetrical chest expansion

3) Misting of tube

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25
Q

What intraoperative monitoring is required?

(3)

A

1) Obs: HR, BP, O2 & capnography

2) Depth of anaesthesia: BIS monitor or MAC

3) Neuromuscular blockade w/ peripheral nerve stimulator

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26
Q

What does a BIS monitor analyse?

A

EEG (brain activity)

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27
Q

What medication is used specifically to reverse the effects of certain non-depolarising muscle relaxants (rocuronium and vecuronium)?

A

Sugammadex

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28
Q

What is the NMDA receptor?

A

A receptor of glutamate (the primary excitatory neurotransmitter).

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29
Q

How can the degree of the neuromuscular blockade be assessed?

A

Peripheral nerve stimulator

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30
Q

Where are the leads typically over in a peripheral nerve stimulator?

A

Facial or ulnar nerve

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31
Q

Mechanism of ketamine?

A

NMDA receptor antagonist

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32
Q

What class of medication can reverse the effects of neuromuscular blocking medications?

A

cholinesterase inhibitors e.g. neostigmine

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33
Q

What 2 GA agents do NOT cause marked hypotension?

A

Ketamine & etomidate

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34
Q

Who cyclizine be used with caution in?

A

HF & elderly

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35
Q

What inhaled GA has the worst environmental effect?

A

Desflurane

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36
Q

What is the main contraindication for thiopentone?

A

Porphyria

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37
Q

Which inhaled GA is used in organ donation?

A

Isoflurane (due to least effect on organ blood flow)

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38
Q

Which inhalational agent is sweet smelling?

A

Sevoflurane

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39
Q

What is ‘train of four’ stimulation?

A

Four consecutive 2 Hz stimuli to a chosen muscle group and the respective number of twitches evoked.

This provides information on the patient’s recovery from neuromuscular blockade.

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40
Q

What are 3 common antiemetics given for prophylaxis given at the end of the operation?

A

1) Ondansetron
2) Cyclizine
3) Dexamethasone

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41
Q

How do muscle relaxants work?

A

Block ACh action at NMJ

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42
Q

What is the most common short acting opioid used at time of anaesthesia induction?

A

Fentanyl

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43
Q

Mechanism of cyclizine?

A

Antihistamine (H1 receptor antagonist)

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44
Q

What result of train-of-four (TOF) stimulation indicates that muscle relaxants haven’t fully worn off?

A

Muscle responses get weaker with additional stimulation

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45
Q

What is minimum alveolar concentration (MAC)?

A

Minimum concentration of inhaled anaesthetic at which 50% of people don’t move in response to a noxious stimuli.

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46
Q

When can MAC be used to measure the depth of anaesthesia?

A

If VOLATILE agents are used

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47
Q

What is suxamethonium apnoea also known as?

A

Pseudocholinesterase deficiency

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48
Q

Which inhaled GA is associated with hepatotoxicity?

A

Halothane

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49
Q

What is the muscle relaxant of choice for RSI for intubation?

A

Suxamethonium

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50
Q

What drug is often used in epidural anaesthesia?

A

Levobupivacaine +/- fentanyl

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51
Q

What is the caudal space?

A

Extension of epidural space (at bottom of spine)

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52
Q

What are anaesthetics used for spinal anaesthesia mixed with?

Why?

A

Dextrose

To make them hyperbaric (i.e. denser than CSF)

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53
Q

Purpose of local anaesthetics used for spinal anaesthesia being hyperbaric?

A

1) Greater spread in the direction of gravity

2) More predictable with minimal inter-patient variability

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54
Q

Which nerve block is mostly performed to provide analgesia following rib fractures and thoracic surgery?

A

Intercostal

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55
Q

What type of peripheral nerve block is used for hand operations?

A

Axillary

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56
Q

Who is caudal anaesthesia more useful in?

A

Paediatric patients

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57
Q

What type of peripheral nerve block is used for elbow operations?

A

Supraclavicular

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58
Q

What is a complication of an intercostal block?

A

Pneumothorax

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59
Q

What are the 2 key risk factors for lidocaine toxicity?

A

1) Hypoalbuminaemia (as lidocaine is protein bound)

2) Hepatic dysfunction

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60
Q

Which local anaesthetic has the fastest onset?

A

Lidocaine

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61
Q

What is the safe dose for Lignocaine with and without adrenaline?

A

Without –> 3mg/kg

With –> 7mg/kg

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62
Q

Presentation of ipsilateral phrenic nerve palsy?

A

SOB

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63
Q

Where does the subarachnoid space end?

A

S1

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64
Q

What is the safe dose for bupivacaine?

A

2mg/kg

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65
Q

A patient is administered local anaesthetic at the end of an operation.

The surgeon infiltrates 20ml of 2% lidocaine.

How many mg of lidocaine dose this amount to?

A

1% lidocaine = 1g per 100ml

2% = 2g per 100ml

2g = 2000mg

2000 / 5 (as 100 / 20 = 5) = 400mg

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66
Q

What is wound dehiscence?

A

A post-operative complication in which a wound ruptures along the surgical incision site.

Superficial –> non-urgent senior review

Deep –> emergency

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67
Q

How should OD insulin be adjusted on the day before and day of surgery?

A

Generally reduced by 20%

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68
Q

How can suxamethonium affect K+?

A

Can cause hyperkalaemia

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69
Q

Adrenaline dose in anaphylaxis:

a) IM
b) IV

A

a) 0.5ml 1:1000
b) 0.5ml 1:10000

Repeat doses every 5 mins

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70
Q

When should you suspect pulmonary oedema following general anaesthetics?

A

In hypoxic patients following laryngospasm

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71
Q

respiratory sound in bronchospasm vs laryngospasm?

A

Bronchospasm - wheeze

Laryngospasm - stridor

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72
Q

What 2 things should be ruled out following laryngospasm?

A

1) Pulmonary oedema

2) Aspiration

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73
Q

What is intraoperative hypothermia defined as?

A

<36 degrees

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74
Q

What electrolyte abnormality can contribute to post-op ileus?

A

Hyperkalaemia

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75
Q

How can laryngospasm result in pulmonary oedema?

A

Inspiratory effort against the closed glottis leads to excessive negative pressure within the alveoli, resulting in pulmonary oedema.

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76
Q

How can perioperative hypothermia cause prolonged recovery from anaesthesia?

A

Reduction in body temperature can lead to prolongation of anaesthetic drugs, neuromuscular blocking agents and inhalational agents.

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77
Q

What 2 methods are used to monitor temp in anaesthetics?

A

1) Tympanic thermometer

2) Oesophageal probe

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78
Q

What is laryngospasm?

A

Partial or complete reflex adduction of vocal cords due to the involuntary contraction of the intrinsic muscle of the larynx.

This may cause a variable degree of upper airway obstruction.

Closure of the glottic opening is a primitive protective airway reflex to prevent aspiration.

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79
Q

At what volume should IV fluids be warmed prior to administration?

A

> 500 ml

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80
Q

Define the pre-operative phase

A

Starting 1 hour before induction of anaesthesia

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81
Q

What are the 3 most common sites of insertion for a central line?

A

1) Internal jugular vein (most common)

2) Subclavian vein

3) Femoral vein

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82
Q

Which LA can cause cardiotoxicity?

A

Bupivacaine

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83
Q

Why is bupivacaine contraindicated in regional anaesthesia?

A

Due to cardiotoxicity - in case tourniquet fails

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84
Q

Mx of the following drugs before surgery:

a) ACEi e.g. ramipril

b) sulfonylureas

c) warfarin

d) clopidogrel

A

a) stop day before

b) stop day of (unless BD and morning surgery - can have afternoon dose)

c) 5 days before (bridge with LMWH)

d) 7 days before

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85
Q

Which type of anaesthetic drug can cause fasciculations?

A

Depolarising muscle relxanats e.g. Suxamethonium

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86
Q

Which term refers to the volume of air pushed in per breath during mechanical ventilation?

A

Tidal volume

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87
Q

What abdominal findings may be seen in tricuspid regurgitation? (2)

A

1) Pulsatile liver

2) Ascites

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88
Q

What is the name for treatment with a triple chamber pacemaker in severe heart failure with an ejection fraction of less than 35%? (1)

A

CRT

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89
Q

What pH is sufficient to confirm the placement of an NG tube?

A

<5

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90
Q

What is the recommended volume of maintenance fluids in adults?

A

25-30 ml/kg/day

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91
Q

How does diarrhoea affect the anion gap?

A

Does not affect anion gap

Causes normal anion gap metabolic acidosis

92
Q

Mx of ischaemic stroke?

A

300mg aspirin daily for 2 weeks

75mg clopidogrel lifelong (or aspirin + dipyridamole if clopidogrel contraindicated)

93
Q

What is a useful stategy for lowering ICP in cases of conservative management?

A

Hyperventilation

This results in decreased pCO2 –> vasoconstriction

94
Q

What medication may be beneficial in the prophylactic treatment of cluster headaches?

A

Verapamil

95
Q

Patients with which condition are particularly sensitive to non-depolarising agents (e.g. rocuronium)?

A

Myasthenia gravis

96
Q

Which two factors contribute to the mean arterial pressure? (2)

A

1) Systemic vascular resistance
2) Cardiac output

97
Q

Why should you avoid using hypotonic (0.45%) saline in paed patients?

A

Risk of hyponatraemic encephalopathy

98
Q

Which are the main spinal tracts that carry pain signals through the spinal cord? (2)

A

1) Spinothalamic

2) Spinoreticular

99
Q

At what dose of prednisolone do patients require hydrocortisone supplementation during surgery?

A

10mg or more

100
Q

What enzyme is deficient in suxamethonium apnoea?

A

Acetylcholinesterase

101
Q

What score can be used to predict mortality at time of admission to ICU?

A

APACHE score

102
Q

What does inspiratory vs expiratory stridor indicate?

A

Inspiratory - laryngeal obstruction

Expiratory - tracheobronchial obstruction

103
Q

Dose of nebulised ipratropium bromide given in acute severe asthma in adults?

A

0.5mg every 4-6 hours

104
Q

Dose of prednisolone given in acute severe asthma in adults?

A

40-50mg

105
Q

What AMTS score indicates confusion?

A

≤8, or new disorientation in person, place or time.

106
Q

Mechanism of LA?

A

Block sodium channels

107
Q

What amount of lidocaine dose 1% lidocaine contain?

A

1% lidocaine = 1g per 100ml

= 1000mg per 100ml

108
Q

How many mg in a gram?

A

1000

109
Q

Why should TPN be administered via a central line?

A

As it is strongly phlebitic

110
Q

How much should OD insulin dose be reduced on day before and day or surgery?

A

Reduce by 20%

111
Q

What should be used for pharmacological VTE prophylaxis in patients with CKD?

A

UH

112
Q

How should DPP-4 inhibtiors (-gliptins) and GLP-1 analogues (-tides) be altered prior to surgery?

A

Keep taking as normal

113
Q

Describe ASA grade VI

A

Declared brain dead - organ removal for donor purposes.

114
Q

Calculation for serum osmolality?

A

2xNa + glucose + urea

115
Q

What 2 diuretics can cause hyponatraemia?

A

1) thiazide

2) potassium sparing

116
Q

What is ADH released in response to?

A

Increased serum osmolality

117
Q

Who is primary polydipsia seen in?

(4)

A

1) Psychiatric disturbances

2) MDMA

3) Severe hypothyroidism

4) Glucocorticoid deficiency

118
Q

The clinical features of hyponatraemia are primarily neurological.

Why?

A

Due to the effects of cerebral oedema

119
Q

If the sodium is corrected too quickly in hyponatraemia, what is the patient at risk of?

A

Osmotic demyelination syndrome

120
Q

How does osmotic demyelination syndrome typically present?

(2)

A

1) Quadriplegia

2) Pseudobulbar palsy

121
Q

Management of hypervolaemic hyponatraemia?

A

Fluid restriction

122
Q

Management of hypovolaemic hyponatraemia?

A

Rehydration with 0.9% saline

123
Q

Management of SIADH?

A

Fluid restriction

124
Q

How can serum glucose affect sodium?

A

Significant hyperglycaemia can cause hyponatraemia, often with raised serum osmolality.

125
Q

How can hypothyroidism affect sodium?

A

Can cause hyponatraemia due to SIADH

126
Q

How can NMS affect WCC?

A

Can cause raised WCC (leukocytosis)

127
Q

What happens in COPD patients that receive too much O2?

A

Lose their hypoxic drive –> retain CO2 –> hypoventilate –> respiratory distress

128
Q

Why does hypomagnesaemia need to be corrected before hypokalaemia?

A

As hypomagnesaemia prevents potassium absorption

129
Q

What 3 electrolyte abnormalities can thiazide like diuretics cause?

A

1) hyponatraemia
2) hypokalaemia
3) hypercalcaemia

130
Q

How can temp affect pancreas?

A

Hypothermia is a cause of acute pancreatitis

131
Q

Correcting sodium levels rapidly is dangerous.

What is the risk of:

a) hyponatraemia correction
b) hypernatraemia correction

A

a) osmotic demyelination syndrome

b) cerebral oedema

132
Q

Which diabetic drug can cause fluid retention?

A

Pioglitazone

133
Q

1st line investigation in typical/atypical angina?

A

CT coronary angiography

134
Q

How can acute pancreatitis affect calcium?

A

Can cause hypocalcaemia

135
Q

What is the most common organism causng necrotising fasciitis (NF)?

A

GAS i.e. Strep. pyogenes

136
Q

Which type of NF causes gas gangrene?

A

Type III

137
Q

What classification system is used to guide management of cellulitis?

A

Eron classification

138
Q

What is cellulitis an infection of?

A

Dermis + subcutaneous tissue

139
Q

What Eron classification indicates admission for IV Abx in cellulitis?

A

III and IV

140
Q

2 main organisms causing cellulitis?

A

GAS & S. aureus

141
Q

1st line anticoagulation in DVT if patient has antiphospholipid syndrome?

A

LMWH

142
Q

What pupillary defect may be seen in orbital cellulitis?

A

RAPD (indicates optic nerve involvement)

143
Q

Abx of choice in cellulitis in penicillin allergic patients?

A

Erythromycin

144
Q

Next step in DVT if proximal US scan is negative but d-dimer is positive?

A

Stop anticoagulation, repeat US scan in 1 week

145
Q

Mx of a cyanide OD?

A

Hydroxocobalamin

146
Q

Dose of morphine given in ACS?

A

1-10mg

Titrate according to patient’s pain level.

147
Q

What structure connects the 3rd & 4th ventricle?

A

Cerebral aqueduct

148
Q

What is the most common cancer to spread to the brain?

A

Lung

149
Q

Most malignant tyoe of a glioma?

A

Glioblastoma multiforme

150
Q

What are glial cells?

A

These cells surround and support the neurones

151
Q

Give 3 examples of glial cells?

A

1) Astrocytomas

2) Ependymal cells

3) Oligodendrocytes

152
Q

Which cells regulate the circulation of CSF?

A

Ependymal cells

153
Q

Where do ependymomas typically form?

A

4th ventricle

154
Q

What layer do meningiomas arise from?

A

Arachnoid mater

155
Q

What is the most common 1ary brain tumour in children?

A

Pilocytic astrocytoma

156
Q

Most common location of brain tumours in adults vs paeds?

A

Adults: supratentorial

Paeds: infratentorial

157
Q

Key histological feature of pilocytic astrocytoma?

A

Rosenthal fibres (corkscrew eosinophilic bundle)

158
Q

What is the most common type of brain tumours?

A

Brain mets

159
Q

Prognosis of a glioblastoma?

A

Around 1 year

160
Q

What type of tumour is a glioblastoma?

A

Astrocytoma

161
Q

Role of acetazolamide in idiopathic intracranial HTN?

A

Carbonic anhydrase inhibitor –> reduces CSF production –> reduces ICP

162
Q

What may an ependymoma cause?

A

Hydrocephalus

163
Q

Where are oligodendromas typically found?

A

Frontal lobes

164
Q

What is the most aggressive paediatric tumour?

A

Medulloblastoma

165
Q

How does a medulloblastoma spread?

A

Via CSF

166
Q

What 2 medications can be used in pituitary tumours causing hormonal excess?

A

1) Bromocriptine (dopamine agonist)

2) Somatostatin analogue e.g. ocreotide

167
Q

Give an example of a carbonic anhydrase inhibitor

A

Acetazolamide

168
Q

What condition are haemangioblastomas associated with?

A

Von Hippel-Lindau syndrome

169
Q

1st line pharmacological therapy for IIH?

A

Acetazolamide (carbonic anhydrase inhibitor)

170
Q

What Abx are associated with idiopathic intracranial HTN?

A

Tetracyclines

171
Q

What blood test can be done to confirm an anaphylactic reaction afterwards?

A

Serum tryptase within 6 hours

172
Q

What antihistamines can be given in anaphylaxis?

A

Non-sedating antihistamines e.g. cetirizine (i.e. NOT chlorphenamine)

173
Q

name a non-sedating antihistamine

A

cetirizine

174
Q

name a sedating antihistamine

A

chlorphenamine

175
Q

When can discharge be considered in anaphylaxis in those:

1) needing 1 dose of IM adrenaline

2) needing 2 doses of IM adrenaline

3) have previously had a biphasic reaction

4) also have severe asthma

5) present late at night

A

1) 2 hours after symptom resolution

2) 6 hours after symptom resolution

3) 6 hours after symptom resolution

4) 12 hours after symptom resolution

5) 12 hours after symptom resolution

176
Q

Define refractory anaphylaxis

A

Not responded to 2x IM doses of adrenaline 5 mins apart.

177
Q

Injection site for IM adrenaline in anaphylaxis?

A

Anterolateral aspect of middle third of thigh

178
Q

IM adrenaline in paeds (6m to 6y)?

A

IM adrenaline 150mcg (0.15ml 1:1000)

179
Q

IM adrenaline dose in anaphylaxis:

a) 6m to 6y

b) 6y to 11y

c) adults

A

a) 0.15ml 1:1000

b) 0.30ml 1:1000

c) 0.5ml 1:1000

180
Q

What is the underlying cause of vision loss in temporal arteritis?

How does this look on fundoscopy?

A

Anterior ischaemic optic neuropathy –> caused by inflammation in the posterior ciliary artery (a branch of the ophthalmic artery) which leads to occlusion and subsequent ischaemia to the head of the optic nerve.

This leads to a swollen and pale optic disc with blurred margins.

181
Q

What is Takayasu’s arteritis?

A

A large vessel arteritis affecting younger females (10-40y).

It typically causes occlusion of the aorta and questions commonly refer to an absent limb pulse.

182
Q

Why may a biopsy be normal in temporal arteritis?

A

due to skip lesions

continue steroids even if biopsy is negative

183
Q

Features of optic neuritis?

A
  • unilateral decrease in visual acuity over hours or days
  • poor discrimination of colours, ‘red desaturation’
  • pain worse on eye movement
  • relative afferent pupillary defect
  • central scotoma
184
Q

What investigation is diagnostic in most cases of optic neuritis?

A

MRI of the brain and orbits with gadolinium contrast

185
Q

Mx of optic neuritis?

A

High dose steroids

186
Q

mx of temporal arteritis:

a) vision affected
b) vision not affected

A

a) oral pred

b) IV methylprednisolone

187
Q

‘Double sickening’ is associated with bacterial sinusitis.

What is this?

A

An initial period of recovery followed by a sudden worsening of symptoms.

It is thought to be caused by a 2ary bacterial infection following a viral rhinosinusitis.

188
Q

What is the most common extra-renal manifestation of ADPKD?

A

Liver cysts (can cause hepatomegaly)

189
Q

What cancer can PBC predispose to?

A

Cholangiocarcinoma

190
Q

1 unit of blood should increase a patient’s Hb by how much?

A

10 g/L

191
Q

What is anaphylaxis caused by a blood transfusion thought to be the result of?

A

Can be caused by patients with IgA deficiency as they have anti-IgA antibodies.

IgA is found in most blood products.

192
Q

What are the 2 main electrolyte abnormalities that can occur in blood transfusions?

A

1) Hypocalcaemia

2) Hyperkalaemia

193
Q

What is irradiated blood depleted of?

A

T lymphocytes

194
Q

What blood products should patients with IgA deficiency receive?

A

Washed blood products (IgA immunoglobulins have been removed)

195
Q

What does the ABO blood system refer to?

A

Type of glycoproteins found on surface of RBCs

196
Q

How may urine appear in acute haemolytic transfusion reaction?

A

Red (due to haemoglobinuria)

196
Q

How can febrile nonhaemolytic transfusion reaction be avoided?

A

Leukoreduction (WBCs are removed from blood prior to transfusion)

197
Q

What is the number 1 cause of death among all transfusion reactions?

A

TRALI

198
Q

What can be given intraoperatively to reduce risk of PONV?

A

Dexamethasone

199
Q

Mechanism of haloperidol?

A

D2 receptor antagonist

200
Q

How soon before surgery can a baby breastfeed?

A

4 hours before

201
Q

1st line for manipulation in adults & children?

A

Adults –> benzos

Children –> ketamine

202
Q

What is next step in getting in an ET if 1st attempt unsuccessful?

A

Bougie

203
Q

NG tube aspirate pH to be in the right place?

A

≤5

204
Q

How to increase CO2 clearance on BIPAP?

A

1) Increase RR

2) Increase tidal volume (total volume of each breath) i.e. T insp

205
Q

How to increase O2 delivery on BiPAP?

A

Increase PEEP and FiO2

206
Q

Mx of HAP vs severe HAP?

A

Co-amoxiclav

Severe - tazocin

207
Q

What investigations may be indicated in a PE?

A

1) ECG - sinus tachy, S1Q3T3

2) ABG - hypoxia, respiratory alkalosis (also required as most likely been put on O2)

3) Bloods - FBC, U&Es, coag, d-dimer, consider troponin/BNP

4) CXR - exclude alternative diagnosis

5) CTPA - imaging of choice

6) V/Q scan - in certain circumstances (e.g. pregnancy, renal impairment)

7) Echo - right heart strain

208
Q

What is the Wells score?

A

Clinical probability of DVT

209
Q

What is the PERC score?

A

A ‘rule out’ score for PE/DVT in low-risk patients

210
Q

What is the PESI score?

A

Risk stratification to determine severity in patients with suspected/confirmed PE

211
Q

What investigation is key before CTPA?

A

U&Es - look for any renal impairment

212
Q

Why is coag blood test necessary in PE?

A

As likely to be put on anticoagulation

213
Q

What score can be used to determine the severity of a PE?

A

PESI score (low = possible outpatient mx)

214
Q

What anticoag should be used in PE in patients with CKD stage 5?

A

Warfarin

215
Q

Is UH or LMWH indicated in renal failure?

A

UH

216
Q

3 options for hyperacute mx of ischaemic stroke?

A

1) Thrombectomy - if presenting <6h, then aspirin 300mg 24h later

2) Thrombolysis - if presenting <4.5h, then aspirin 300mg 24h later

3) Aspirin 300mg alone (i.e. if not suitable for thrombectomy or thrombolysis)

217
Q

Where must the clot be in an ischaemic stroke to qualify for thrombectomy?

A

There has been a LARGE vessel occlusion i.e. middle cerebral artery (most commonly)

218
Q

When do patients with ischaemic stroke who have received thrombectomy or thrombolysis receive aspirin 300mg?

A

24h after (then continue for 2 weeks)

219
Q

VTE prophylaxis following ischaemic stroke?

A

Intermittent pneumatic compression (IPCs) for the first 2 weeks.

LMWH VTE prophylaxis thereafter.

220
Q

Why should LMWH VTE prophylaxis not be used for the first 2 weeks following ischaemic/haemorrhagic stroke?

A

As they are at increased risk of bleeding into that area in the brain.

221
Q

A pneumothorax with a lung margin that is >2cm from the chest wall on CXR represents what % lung volume?

A

This represents a pneumothorax of 50% lung volume

222
Q

Mx of CAP in patients with CURB-65 0-1?

A

Treat at home

Oral amoxicillin

223
Q

What is an alterantive to oral amoxicillin in the mx of CAP?

A

Doxycycline or clarithromycin

224
Q

Mx of CAP in patients with CURB-65 2?

A

Hospital

Oral amoxicillin

225
Q

Mx of CAP in patients with CURB-65 3-4?

A

Hospital (consider HDU/ICU)

IV co-amoxiclav

226
Q
A

Yr 4 - PassMed Corrections (36 decks)

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