16/5 Flashcards
What is each of the following nail findings and what they are associated with?
- Koiloncyhia
- Nail pitting
Spoon shaped nails - iron deficency anaeamia
Punctuate depressions of the nail bed - psoriasis
When you have an upper limb injury how do you do a neurovascular assessment?
Check for pulses
Movement = rock paper scissors (median, radial, ulnar)
Rock + OK sign = medial + anterior interosseous (branch of median)
Paper (fingers spread out) = radial
Scissors = ulnar
Angina investigation and management
Bedside
- cardio exam with BP
- ECG
Bloods
- FBC (check for anaemia)
- TFTs (high or low)
- U+E’s (before starting on ACE)
- LFTs (before starting on statin)
- HbA1c - check for diabetes
Imaging
1. CTA
2. (if CTA inconclusive) functional imaging - exercise tolerance test)
Management
Conservative
- stop smoking, better diet and more exercise
- refer to RACPC
Medical
1. GTN spray
2. Secondary management (AAAA)
ACEi
Atorvastatin 80mg ON
Aspirin 75mg OD
Already on a B-blocker
Surgical
If multivessel disease AND
- >65 OR
- diabetic OR
- complex 3 vessel disease
can offer PCI or CABG
Why are statins contraindicated in liver disease?
They are hepatically cleared and cause an increase in LFTs
MRSA is resistant to flucoxacillin - what is used instead?
Vancomycin
Patient with trauma caused injury - what questions do you ask?
When
Where
How
Any other injuries? Did you hit your head?
What questions do you ask in a 4AT?
Name, DOB, where are you and current year?
Starting with December - tell me months of the year backwards
What are the cut-offs for AAA
<3cm - normal
3-4.4 - rescan every 12 months
4.5-5.4 - rescan every 3 months
>5.5 - urgent referral to vascular for EVAR or open repair (risk of dying of rupture > risk of dying in operation)
Sagittal vs coronal vs axial planes
Coronal = splits anterior and posterior
Axial = splits superior and inferior
Sagittal = seperates left and right
What analgesia is used in major trauma?
IV morphine
What questions in the cardio/resp HPC are important to ask
SOCRATES
Assoc sx (head to toe)
- headaches, dizziness or syncope
- palpiations and SOB
- nausea, dysphagia and reflux
- oedema
- waking up during night or needing more pillows to sleep?
General red flags - weight loss, fevers, night sweats?
- cough w/wo haemoptysis
TINA
What is the bit of your hx to add after SOCRATES
TINAS
Trauma/travel - any injury? long haul flights?
Infection - feeling well? any bowel or bladder sx? being sick?
Neoplasm/neurological - weight loss, fever, night sweats? any tingling or weakness?
Autoimmune - pain lasting >30 mins? skin changes? ocular sx?
Systemic enquiry - work top to bottom
Hip# VIVA
What?
Fracture of the hip joint mostly caused by trauma - worried about it as unique blood supply can lead to AVN
Hx
SOCRATES
Ask about falls - before, during and after
TINA + MSK red flags (back ones)
Invx
Bedside
- Hip exam
- appropriate exam based on falls hx
Bloods
- match to falls hx
Imaging
XR of hip
- look for Sheehan’s line
- intra/extracapsular fractures - displaced or not?
Management
Conservative
- try mobilise as soon after the surgery
- make as comfortable as poss
Medical
1. Paracetamol every 6 hrs
2. IV morphine in major trauma
3. Nerve block if morphine not cutting it
Surgical
Intracapsular - non-displaced - screw
Displaced - replace
If unfit - replace even if not displaced
Extracapsular
- intertrochanteric - dynamic hip screw
- subtrochanteric - inter medullary nail
How is HTN diagnosed?
- Ambulatory home BP (due to white coat syndrome, now 1.)
- >135/85
