signs of chronic ventilatory failure
Elevated bicarbonate
pco2<6.0kPa
normal blood Ph
pO2 <8kPa
Tx for chronic ventilatory failure
oxygen therapy, t-IPPV
symptoms of a pe
Pleuritic chest pain cough haemoptysis dyspnoea syncope cardiac arrest
symptoms of lung cancer
Shortness of breath wheezing weight loss regular infections haemoptysis pain Neurological Difficulty swallowing raspy voice haematuria fatigue
COPD symptoms
of Weight loss, progressive smoker’s cough , wheeze, chest tightness , breathlessness, coughing up sputum , muscle loss, regular chest infections
Curb 1 Tx
clarithromycin and amoxicillin with fluids, and oxygen if necessary
Curb 3-5 Tx
Fluids, intubation, ventilation, co-amoxiclav and clarithromycin
pneumothorax tx
cannula in 2nd intercostal space (IS) in mid-clavicular line – chest drain
MI syptoms
Chest pain angina tight band radiates to neck and jaw aggravating with stress increasing frequency and severity provoked even at rest Look unwell murmur crackles
aortic regurgitation symptoms
Increased LV systolic pressure
large volume and collapsing pulse
mitral stenosis symptoms
Pulmonary odema embolization diastolic thrill right ventricular heave prominent JVP a wave tapping apex beat
mitral regurgitation symptoms
Pulmonary oedema, cardiogenic shock
JVP prominent
brisk hyperdynamic apex beat
RV heave
valvular heart problems inv
ECG catheritersation CXR echocardiography MRI
young person hypertension Tx
ACEI
elderly with hypertension tx then
CCB +/- thiazide
transmural infarct refers too
Stemi
subendocardial infarct refers too
NonStemi
test for excluding HF
low BNP
tx for HF
Diuretics ace inhibitors betablockers aldosterone receptor blockers ARNI’s
HF symptoms
dyspnoea, oedema, paroxysmal nocturnal dyspnoea
acne vulgaris Tx
Topical retinoids benzoyl peroxide topical antibiotics azelaic acid antibiotics tablets combined oral contraception Isotretinoin tablet
pemphigus symptoms
Flaccid blisters face, axillae, groin \+ nikolsky sign mucousal erosion erosive stomatitis
pemphigoid symptoms
Intact epidermis forms roof of blister
intact and tense
eczema Tx
soap substitutes removal of causitive factors intermittent topical steroids antihistamines antimicrobials calcineurin inhibitors
psoriasis tx
Emollients soap substitutes vitamin D3 analogues topical steroids salicylic acid coal tar creams UVB sun bed retinoid methotrexate ciclosporin biologics
Addison’s symptoms
Weakness, anorexia, skin pigmentation, hypotension, vomiting, diarrhoea, salt craving, postural symptoms
Addison’s inv
Routine bloods U+E, glucose, FBC, random cortisol >550nmol/L synacthen test autoantibodies VLCFA adrenal imaging plasma renin level
Cushing’s symptoms
Central obesity hirsutism impotency purple stria plethoric faces easy bruisability osteoporosis personality changes Acne oedema headache poor wound healing skin atrophy
Cushing’s investigations
screen Screen – overnight dex, 24hr urine test
confirmation 24hr urine cortisol, low dose
ACTH dependent or no – paired morn-midnight ACTH cortisol
high dose dex test ACTH pit/ no pit
hypothyroid symptoms
Weight gain lethargy cold constipation heavy periods dry skin/hair bradycardia slow reflexes goitre severe puffy face, large tongue, hoarseness, coma
diabetes investigations + values
random >11.1mmol
OGTT >1.1mmol
HbA1C >40mmol
chronic pancreatitis investigations
AXR Ultrasound EUS CT blood tests (low albumin, increased glucose, LFT) pancreatic function tests. faecal serum enzymes (elastase) ERCP/MRCP
UC investigations
Albumin <30g/; Hb <10g/dl raised CRP blood tests stool calprotectin biopsy
UC tx
5ASA, then prednisone, then immunomodulators, then biologic agents then surgery with nutritional support
Cd Tx
Steroids thiopurines methotrexate biologics feeding surgery
right sided colon cancer symptoms
anaemia, polypoid, vague pain, weakness, obstruction
left sided colon cancer symptoms
bleeding, altered bowel habit, obstruction
PBC inv
Raised serum alkaline phosphatase and anti-mitochondrial auto-antibody
gall stones symptoms
dyspeptic symptoms
biliary colic
jaundice (maybe obstructive, painful
acute anterior uveitis signs
Hypopyon
small irregular pupil
past history
cells in anterior chamber
raised ICP symptoms
Headache Nausea seizures pulsatile tinnitus visual disturbance somnolence cognitive impairment altered consciousness pupillary dilation vomiting
Parkinson’s Tx
Levodopa MAOB inhibitors COMT inhibitors apomorphine functional neusurgery
epilepsy signs
Myoclonic jerks in morning, déjà vu, lip smacking, fiddling
primary general epileptic seizure Tx for adults
sodium valproate
status epilepticus tx
diazepam
migraine abortive
aspirin, triptans
migraine prophylaxis
propranolol, TCA’s
meningitis symptoms
Stiff neck fever altered mental status photophobia nausea vomiting
MS inv
CSF oligoclonal bands Visual/somatosensory response bloods CXR MRI
MS disease modifying Tx
injections B interferons, glatiramer acetate, oral dimethyl fumarate
MS relapse Tx
prednisolone
symptomatic myasthenia gravis tx
AChesterase inhibitor, prednisolone
steroid
immunoglobulin
Thymectomy
myasthenia gravis inv
AChR ab
Anti MuSK ab
neurophysiology
CT
kidney stone 1st line
1st ESWL then PCNL or lithoclast
hyperkalaemia tx
(calcium gluconate, salbutamol, insulin dextrose)