3rd Yr Med Flashcards
(222 cards)
1
Q
Stable Angina Features:
A
No pain at rest
No raised Trop
No ECG changes
2
Q
Unstable Angina Features:
A
Pain at rest
No raised Trop
Transient ECG changes (ST Depress, T wave Invers)
3
Q
nSTEMI Features:
A
Pain at rest
Raised Trop
ECG changes (ST Depress, T wave Invers)
4
Q
STEMI Features:
A
Pain at rest
Raised Trop
ECG changes (ST Elev, LBBB)
5
Q
Stable Angina Mx
A
Aspirin 75mg ACEi/ARB SL GTN Statin (Rate control: Beta-blocker, CCB, Ivabradine)
6
Q
Unstable Angina/nSTEMI Mx
A
Morphine + Antiemetic O2 Fondaparinux SL GTN Aspirin 300mg Stat (75mg OD) Repeat ECG + Angiography
7
Q
STEMI Mx + Tx
A
Morphine + Antiemetic O2 LMWHep SL GTN Aspirin 300mg Stat (75mg) Repeat ECG + Angiography
Tx:
(w/ in 90mis): PPCI (w/ Prasugrel)
Thrombolysis (IV Alteplase)
(Aspirin continued indefinitely, Prasugrel/Clopidogrel continued for 12 months)
8
Q
HF Class
A
NYHA:
1: No limitations
2: Mild limitations
3: Severe limitations
4: Sx at rest
9
Q
HF Ix
A
BNP/ANP
Echo (Trans-oesophageal)
CXR
(ECG, Trop)
10
Q
HF Meds
A
Cardiac meds:
Beta-blockers, CCB (Diltazem, Verapamil), Ivabradine (Slows HR w/out drop in BP)
Diuretics:
Furosemide, Thiazides, ACEi/ARB (If HT), Spironolactone (If Hypokalaemic)
Venodilators:
CCB (Amlodipine), GTN/Nitrates, Hydralazine
11
Q
ECG Analysis
A
Rate Rhythm Axis (LAD, RAD) P waves QRS PRi (0.12-0.2s) QRS (0.12s) QT (0.2s) R -> S Progress (L/RBBB) ST Elev/Depress T wave (Tall/Flat/Invers)
12
Q
AF Mx
A
Rate control:
Beta-blocker, CCB, Digoxin
Rhythm control:
Beta-blocker, Amiodarone
(If < 48hrs: DC Cardioversion)
Anti-coag:
Rivaroxaban 15mg BD (21 days), 20mg OD
13
Q
Bradyarrhythmia Mx
A
SAN ( + Sx): Pacemaker
AVN:
1/2T1 + Syncopal: Cardiac Monitor
2T2/3 + Sx: Permanent Cardiac Pacemaker
14
Q
Tachyarrhythmia Mx:
SVT
VT
A
SVT:
Vasovagal manoeuvres
IV Adenosine 6mg (If NSR: Re-entry - Anti-arrhythmic, If no NSR: AF)
Cardioversion (DC, Amiodarone)
VT:
Amiodarone
DC Cardioversion
15
Q
HT Mx
A
< 55yo, Diabetic:
ACEi/ARB (+/- CCB +/- Thiazide-like D)
> 55yo, Black:
CCB (+/- ARB/ACEi +/- Thiazide-like D)
16
Q
Features: AS AR MR MS
A
AS: (D, Carotids, Holding breath)
Eject-Syst, Cres-decres, Rad to Carotids
AR: (D, Leant forward, Exp)
Early Diast, Decres
MR: (D, L, Exp)
Pan-Syst, Blowing, Rad to Axillae
MS: (Bell, L, Exp)
Opening snap, Mid-Diast, Rumbling
17
Q
Non-funct Pit Adenoma Mx
Prolactinoma Mx
A
Non-funct Pit Adenoma Mx:
Surg/RadioTx w/ HRT (GH, HC, Oestrog/Prog/Test, Thyroxine)
Prolactinoma Mx:
D2 (Dopamine) Agonists: Cabergoline, Bromocriptine
18
Q
Acromegaly Ix
A
Raised IGF-1, PRL (Co-secreted w/ GH) Failed OGTT (Fails to Supp GH)
19
Q
Acromegaly Mx
A
Surg
GHIH (Somatostatin)
GH Antag
Dopamine Agonists (Prevent Release of GH)
20
Q
DI Features
A
Polydipsia
Polyuria (Large Vol, Diluted Urine: > 3L/day), Nocturia
Low Urine Osmolality (< 300)
High Serum Osmolality (> 295)
21
Q
DI Mx
A
Cranial:
Vasopressin (Exogenous ADH)
Nephrogenic:
Reduced NaCl/Protein Intake +/- Diuretic
(Carbamazepine: Sensitises Renal Tubules)
22
Q
SIADH Sx + Mx
A
Fluid Retention (Small Vol, Concentrated Urine)
Mx:
Fluid restrict (+/- Diuretic)
Demeclocycline/Tolvaptan (ADH Antag)
23
Q
Cushings D Patho + Complications
A
Pit Adenoma secreting ACTH
+/- DM, HT, Osteoporosis
24
Q
Cushings D Ix
A
Raised ACTH/Cortisol, Low CRH, (Raised Glu, BP)
Raised 24hr Urinary Cortisol
Failed Dexamethasone Supp Test (Low-dose does not Supp ACTH)
25
Cushings D Mx
Trans-sphenoidal Surg
26
Cause of Secondary Adrenal Insuff + Sx
LT Steroid use => Supp of ACTH => Low Cortisol
Hypoglycaemia, (Normal Aldosterone: Normal BP)
Weakness, Fatigue
Immunosupp
27
Secondary Adrenal Insuff Mx
Stop Steroids
| HRT: Cortisol Supp (HC)
28
Addisons Patho, Features + Complication
Auto-Immune Adrenal Destruction (Ald Def):
```
Low Ald/Cortisol (HypoT/HypoGlyc)
Low Adrenals (Hair loss, Reduced Libido)
High ACTH (Hyperpigmentation)
```
Addisonian Crises during stress/illness
29
Addisons Ix
9am ACTH/Cortisol levels
(-) SynACTHen Stim Test (Low Cortisol)
U+Es (Hyponatraemia, Hypokalaemia, Raised Urea), HypoGlyc, Anaemia
30
Addisons Mx
HRT: Fludrocortisone, HC (Double dose when ill)
Steroid card
(Reg Fluids - IV Dextrose + HC when ill)
31
Bilat Adrenal Hyperplasia Patho + Features
Adrenal Enlargement => Excess Aldosterone/Cortisol
HT, Raised ICP
Cushings Synd
32
Bilat Adrenal Hyperplasia Mx
Spironolactone (Aldosterone Antag)
| Bilateral Adrenalectomy
33
Klinefelters Features
(47, XXY):
Tall, feminised Man (Infertility, Gynaecomastia)
Small, male Ext Genitalia (Hypogonadism)
34
Turners Features
(45, XO)
Small, androgynous, Woman (w/ webbed neck)
Ambiguous Ext Genitalia
35
AIS Features
(Test Def/Insens):
Ambiguous Genitalia + Undescended testis
Amenorrhoea, Infertility
36
CAH Features
(21-Hydroxylase Def):
Ambiguous Genitalia
Excess Test (Male characteristics/Virilisation: Deep voice, Hair growth, Cliteromegaly, Acne, Amenorrhoea)
Cortisol/Aldosterone Def (Addisonian/Cushing Crisis)
37
Pheochromocytoma Sx
Headache
Palpitations/TachyC
Sweating
(Anxiety/Panic, HT, HyperGlyc)
38
Pheochromocytoma Ix + Mx
```
24hr Urinary Metanephrines + Catecholamines
CT CAP (Mets)
```
Mx:
Alpha-block (Phenoxybenzamine, Doxazocin)
Beta-blocker
Surg
39
Causes of HypoTh
Hashimotos (Anti-Th AB's)
Diet (I2 Def)
Med (Amiodarone, Lithium)
Post-partum Thyroiditis, Sheehans Synd
40
HypoTh Ix + Mx
T3/4, TSH
Th-Peroxidase AB's
Mx:
Levothyroxine
41
Causes of HyperTh
Graves (Auto-AB's Stim TSH-R)
Nodular D
Thyroiditis (Viral Inf, Amiodarone, Post-partum)
42
HyperTh Ix
T3/4, TSH
TSH-R AB's
Thyroid USS (Confirm Nodules)
Nuclear Tc/I2 Uptake Scan (Assess Act): Uniform (Graves), Single (Nodule), None (Thyroiditis)
43
HyperTh Mx
Beta-blocker (Control Sx)
Carbimazole (Th Peroxidase Antag)
Radioactive I2
Thyroidectomy
44
HypoTh vs HyperTh Sx
```
Weight changes
HR (Brady/Tachy)
GI (Constipation/Diarrhoea)
Cold/Heat Intolerance
Depression/Anxiety
Hypo/Hyper-reflexia
```
45
Specific Sx:
HypoTh
Graves
HypoTh:
Myxoedema (Puffy Eyes)
Graves:
Proptosis (Eyes protrude)
Pre-tibial Myxoedema
46
Hypercalcaemia Causes + Sx
Primary Hyper-PTH/Osteoporosis,
RCC/Squamous CLC (Secreting PTHrP) =>
Stones, Moans, Groans, Bones, Psych
ECG changes
Polyuria/Polydipsia (Nephrogenic DI)
47
Hypercalcaemia Ix + Interpretations
PTH (High: HyperPTH, Low: Malig)
| (PTH => Bone Turnover): High ALP, Low Phosphate
48
Hypercalcaemia Mx
IV Fluids (w/ careful electrolyte monitoring)
49
Hypocalcaemia Causes + Sx
Diet/Hypo-Mg2+ (Low Ca2+),
Renal D/Lack of Sunlight (Low Vit D)
=>
ECG changes
Myalgia/Paraesthesia
Spasms (Laryngomalacia, Carpo-pedal)
Seizures
50
Hypocalcaemia Mx
Ca2+ Supp
51
DM Diagnosis Criteria
Fasting Glu: > 7mmol
Random: > 11mmol
HbA1c: > 6.5 (48mmol)
52
DKA Def/Criteria
HyperGlyc (> 11mmol)
Ketones (> 3mmol)
Acidosis (pH < 7.33)
53
DKA Ix + Mx
Hourly Glu + Ketones
FRII (IV Actrapid 0.1 Units/Kg/hr)
IV 0.9% NaCl (+/- Dextrose, K+)
54
HHS Def/Criteria
HyperGlyc (> 30mmol w/out Ketoacidosis)
HypoVol
Serum Osmolality > 320 (2Na + Glu+ Urea)
55
HHS Ix + Mx
Hourly Glu + Ketones
IV Fluids (1L/hr, 1L/4hr, 1L/4hr) +/- K+
LMWHep
56
DM Complications:
ST
LT
ST:
Lipodystrophy
Hyper/Hypo Episodes
LT:
```
Microvasc:
Nephropathy,
Retinopathy,
Periph Neuropathy,
Immunosupp (UTI, Pneumonia, Thrush)
```
Macrovasc:
Stroke/TIA,
CVS D/HT,
Ulcers/Gangrene (Periph Ischaemia - PVD)
57
Oesophageal Dysmotility Types + Features
Achalasia: (Non-distensible LOS):
Bird-beak (Ba Swallow)
Diffuse Oesophageal Spasm: (No control of Peristalsis):
Corkscrew (Ba Swallow)
Hypercontractile:
Nutcracker (Ba Swallow)
58
Oesophageal Dysmotility Ix + Mx
Ba Swallow
Endoscopy
Manometry
Mx:
SM Relaxants (CCB: Nifedipine, Nitrates)
Myotomy
Pneumatic Baloon Dilation
59
GORD Mx
PPi
H2 Antag (Ranitidine)
Alignates (Gaviscon)
60
Mallory-Weiss Tears Patho
Excess Vomiting => Tears w/in Endothelium of Oesophagus
| => Bleeding
61
UGIB Mx
```
Variceal:
Fluid Resus
IV PPi
IV ABx + Terlipressin (ADH Antag)
OGD (Band/Stent)
```
```
Non-Variceal:
Fluid Resus
IV PPi
OGD (+/- Radioembolization/Surg)
Post-OGD PPi
```
62
SB vs LB Obstruct Ix
Erect CXR:
Air under Diaphragm
```
AXR:
SB:
> 3cm,
Central,
Valv Conniventes (All the way across)
```
LB:
> 6cm,
Periph,
Haustra (Part way across)
Contrast CT:
ID Level of Obstruct
63
SB/LB Obstruct Mx + Surg Indications
NBM (Bowel Rest)
IV Fluids (+ Electrolytes)
NGT (Bowel Decompress)
(Stop Opiates)
Surg (Strangulated Hernia/Reversible Cause, > 48hrs, Ischaemia, Perf)
64
Coeliacs D Patho, Ix + Mx
Auto-Immune React to Gluten w/in S Intestine
=> Lymphocytic Infiltration + Villous Atrophy
Ix: Raised Tissue Transglutaminase (tTG)
Mx:
Gluten-free Diet
65
Appendicitis Ix
```
FBC, U+Es, LFTs, CRP
Amylase/Lipase (Excl Pancreatitis)
Urinalysis (Excl UTI)
ECG, Trop (Excl MI)
Preg test (Excl Preg)
```
66
Appendicitis Mx
Opiates + Antiemetic
Appendectomy
(If Perf: ABx)
67
PBC Eped + Features
Middle-aged Women
Early: Asymptomatic, Fatigue + Pruritus
Late: Cholangitis (Granulomatous Inflamm of Bile Ducts) => Cirrhosis
68
PBC Mx
Cholestyramine (Reduce Pruritus)
Ursodeoxycholic Acid (Improves Survival)
Liver Transplant
69
PSC Eped + Features
Younger men w/ Autoimmune D
Early: Progress Obstruct Jaundice
Late: Cirrhosis, Cholangiocarcinoma
70
PSC Mx
Cholestyramine (Reduce Pruritus)
Ursodeoxycholic Acid (Improves LFTs)
Liver Transplant
71
Biliary Colic vs Acute Cholecystitis vs Ascending Cholangitis
```
Biliary Colic:
RUQ Pain (1-5hrs after meal), N+V
```
Acute Cholecystitis:
RUQ Pain, N+V, Fever, TachyC
```
Ascending Cholangitis:
Charcots Triad (RUQ Pain, Fever, Jaundice),
Reynolds Pentad (+ Confusion, HypoT)
```
72
Biliary Colic/A Cholecystitis/Asc Cholangitis Ix + Mx
LFTs, ERCP
Mx:
Stone removal
Cholecystectomy (w/ Bile Salt replacement)
ERCP (w/ Biliary Decompress)
IV ABx (If Asc Cholangitis: Tazocin 4.5g TDS)
73
Pancreatic Ca Features:
Head
Tail
Head:
Painless, Obstruct Jaundice
Vague Epigastric Pain/Mass
Tail:
DM Sx
Loss of Enzymes (Malnutrition, Loose Stools)
74
Pancreatic Ca Ix
Amylase, Lipase, LFTs
ERCP/MRCP
AXR
CA19.9, CEA, aFP
75
Causes of Pancreatitis
```
G: Gallstones
E: Ethanol
T: Trauma
S: Scorpion/Spider Venom
M: Mumps
A: Autoimmune
S: Steroids
H: Hyperlipidaemia, Hypercalcaemia, Hypothermia
E: ERCP
D: Drugs
```
76
Pancreatitis Ix
FBC, U+Es, LFTs
Raised Amylase/Lipase (More Sens)
AXR
ERCP/MRCP
77
Pancreatitis Mx
```
Reduce Sx (Stop Alcohol, Remove Stones, Opiates)
Tx Cause (Electrolytes, ERCP, Steroids => Inflamm)
Exocrine Support (DM Insulin)
```
78
Colon Ca Features
L:
LIF
Constipation, Tenesmus, Late Diarrh
Anaemia (Blood of Surf + mixed)
R:
RIF
Diarrh, Late Constipation
Anaemia (Blood mixed)
79
Colon Ca Ix
AXR, CT
| CEA, aFP, LDH
80
IBD Features (UC vs CD) - 5
```
UC:
Rectum -> back (Continuous)
Submucosal Inflamm
No Granulomas
Cobblestone, friable mucosa
No Perianal D
```
```
CD:
Ileum (LIF, Skip lesions)
Transmural Inflamm
Non-caseating Granulomas
Fissuring Ulcers, Crypt Abscesses
Perianal D (Fistulas , Fissures, Strictures)
```
81
IBD Ix - 5
Faecal Calprotectin, Stool Cult (Excl: C.Diff)
FBC, U+Es, LFTs, CRP/ESR
Coeliac Serology (Anti-tTG)
Serum Ferritin/B12/Folate/Vit.D (Malabsorption => Def)
Sigmoidoscopy/Colonoscopy (+/- Biopsy)
82
IBD Mx
Steroids, Azathioprine, Sulfasalazine
LMWHep
(Acute: IV HC 100mg QDS)
83
Haemorrhoids Features
Prominent Vessels (Vascular bundles)
Above (Painless)
Below (Painful)
84
Haemorrhoids Classification
1: No Prolapse
2: Reduce Spontaneously
3: Reduce Manually
4: Unable to Reduce
85
Haemorrhoids Mx
GTN/CCB Cream
| Staples, Bands, Incision
86
TB Screening
Immigrants from highly Prevalent (Endemic) Countries
Healthcare workers
HIV (+) Pt's
Pt's beginning Immunosuppression
87
Latent TB Tx
Rifampicin + Isoniazid (with Pyridoxine) 3 months or
Isoniazid (with Pyridoxine) 6 months
(Avoid w/ Pt's > 35yo or at risk of Hepatotoxicity)
88
Active TB Features
Non-resolving Cough
Unexplained Persistent Fever
Drenching Night Sweats
Unexplained Weight loss (Cachexia)
```
Other:
Clubbing
Lymphadenopathy
Hepatosplenomegaly
Erythema Nodosum
Pleural Effusion
Pericarditis
```
89
Active TB Ix + Findings
Sputum samples (3x AAFB + TB test), (If no Sputum: Bronchoscopy)
CXR (Cavitating Pneumonia, Pleural Effusion), CT/MRI
LN Biopsy + Histology (Caseating Granulomatous Inflamm)
LP (Raised Proteins, Reduced Glu, Lymphocytosis)
90
Active TB Mx
2 months of RIFATER (RIPE)
| 4 months of RIFINAH (RI)
91
Active TB Mx SE
RIP: Hepatotoxicity (Baseline LFT's)
I: Periph Neuropathy (Pyridoxine)
E: Retrobulbar Neuritis (Visual Acuity)
92
TB Paradoxical Reaction + Mx
Tx cause Bact to die => Inflamm
Mx:
Steroids (esp Pericardial + CNS): Prevent Inflamm
93
HIV Tx:
| ARVTx
```
ARVTx:
2 Nucleoside Reverse Transcriptase Inhib
+ 1:
Non-nucleoside Reverse Transcriptase Inhib,
Boosted Transcriptase/Protease Inhib,
Integrase Inhib
```
94
HIV Tx:
Prophylaxis
Vaccinations
Prophylaxis: (Falling CD4):
CD4 < 200: Cotrimoxazole (PCP)
CD4 < 50: Azithromycin (Mycobacterium)
Vaccinations:
Hep B
Pneumococcus
Annual Flu Vaccine
95
Skin Inf Org + ABx
If MRSA:
If Penicillin Allergy:
Strep + Staph: Flucloxacillin
| If MRSA: Vancomycin
(If Penicillin Allergy: Doxycycline, Meropenem)
96
MSK Inf Org + ABx
Strep + Staph: Tazocin
97
Resp Inf Org + ABx
Atypical
Viral
S Pneumoniae, H Influenzae: Amox, Co-amox, Doxy
Atypical (Legionella): Doxy, Fluoroquinolone
Viral (Rhino/Adeno/Entero): Oseltamivir
98
GI Inf Org + ABx
Salmonella: Ceftriaxone, Azithromycin
C Diff: PO Vancomycin, Metronidazole (IV)
Enterobacteria (Campylobacter, E-coli, Shigella): Ciprofloxacin
99
GUN Inf Org + Mx
Gonorrhoea: IM/IV Ceftriaxone
Chlamydia: Doxy
100
CNS Inf Org + ABx
Meningitis (N. Men, S Pneum, H Influenzae): IV Ceftriaxone + Dexamethasone
Viral (HSV): Aciclovir
101
CVS Inf Org + ABx
IE
Cult (-)
IE (S Viridans): Benzylpenicillin
IE (S Aureus - IVDU): Flucloxacillin
IE (Enterococci): Amox
(Cult - ): Ceftriaxone
102
```
Dementia Types + Features
Vascular D
D w/ Lewy Bodies
PD w/ D
FT D
```
Vascular:
Stepwise Progress w/ Risk Factors
D w/ Lewy bodies:
Gradually Progress (+/- PD Sx)
Persistent, Realistic A+V Hallucinations
```
PD w/ Dementia:
PD Sx (Bradykinesia, Rigidity, Tremor) precedes Dementia
```
FT Dementia:
Early-onset, Complex problems (Loss of Social Inhib)
103
Delirium Mx
```
Reverse Cause:
Hypoxia - O2,
Electrolytes - Fluids,
Inf - ABx,
Obstruct/Retention - Laxatives/Catheter)
```
Orient to Time/Place
Family members
Avoid sedatives/anticonvulsants/Intoxicants
104
Confirming Death
Pupils fixed + Dilated
No Resp to Pain
No Breath/Heart Sounds (> 1min)
105
K+ Sparing and Non-K+ Sparing Diuretic Examples + SE
K+ Sparing:
ACEi/ARB, Spirnolactone => Hyper-K+
Non-K+ Sparing:
Thiazides (Inhib NCC in DCT)
Loop (Inhib NKCC in Loop of Henle)
=> Hypo-K+
106
Causes of Hyper-K+
```
CKD +/- K+-rich Diet
Drugs (K+-sparing, NSAIDs, Digoxin, Hep, Trimethoprim, Cyclosporin)
Intracellular Shift:
Decreased SNS (Beta-blockers)
Decreased Insulin
Decreased pH (Acidosis)
Decreased Aldosterone (Addisons)
Rhabdomyolysis/Haemolysis/Lysis
```
107
Hyper-K+ ECG changes
Tall, Peaked T waves
Prolonged QRS
Loss of P waves (=> Asystole)
108
Hyper-K+ Mx
Cardiac protection:
IV 10ml 10% Ca2+ Gluconate (10mins)
Shift K+ Intracellularly:
IV Actrapid 10 Units + 50ml 50% Dextrose
Neb Salbutamol 10mg
(If Acidotic: IV 500ml 1.4% NaHCO3)
Remove Excess:
PO/PR Ca2+ Resonium
IV 80mg Furosemide
109
Causes of Hypo-K+
Losses (Renal: Diuretics, GI: Reduced Intake, Vom/Diarrh)
Intracellular Shift:
Increased SNS (Beta-agonists, Adren)
Increased Insulin
Increased pH (Alkalosis)
Increased Aldosterone (Hyperaldosteronism/Cushings, Hyper-RAAS)
110
Hypo-K+ ECG changes
Small T waves
U wave (after T)
Increase in PRi
111
Hypo-K+ Mx
(PO/IV) K+ and Mg2+ Supplements w/ IV Fluids
112
Causes of Hyper-Na+
Hypervolaemic:
Hyperaldosteronism/Cushings
Euvolaemic:
DI, Hypodipsia
Hypovolaemic:
Diuretics, Diarrh, Sweating
113
Hyper-Na+ Mx
Hypervolaemic: (Chronic): Fluid restrict +/- Furosemide, (Nutritional Support)
Euvolaemic: IV Dextrose
Hypovolaemic: (Acute): IV NaCl 0.9%
114
Causes of Hypo-Na+
Hypervolaemic:
3rd Spacing (HF, Cirrhosis, Nephrotic Synd)
Polydipsia
Euvolaemic:
SIADH
HypoTh
Preg
Hypovolaemic:
Fluid loss (Vom/Diarrh, Bleeds, Diuretics, Burns)
Pancreatitis
Hypoaldosteronism (CAH/Addisons)
115
Hypo-Na+ Mx
IV NaCl 0.9%
116
AKI Classification
1: Serum Cr x 1.5-2
2: Serum Cr x 2-3
3: Serum Cr x > 3, UO < 0.5ml/Kg/hr
117
Causes of Pre-renal AKI
Hypoperfusion:
Hypovolaemia
HF
Impaired Auto-regulation (ACEi/ARB, NSAIDs)
118
Pre-renal AKI Ix + Mx
FBC, U+Es, BP, RAAS
Mx:
Stop meds
Tx Hypovolaemia/Sepsis/Anaemia
119
Causes of Renal AKI
Drugs (Nephrotoxins)
Inflamm (GN, Vasculitis), Inf
Trauma (HT, Sepsis/Ischaemia)
120
Renal AKI Ix + Mx
Urinalysis, Renal Biopsy, CRP/ESR, USS-KUB
```
Mx:
Stop Nephrotoxicity meds
Tx Cause
Assess Fluid balance
Steroids (Reduce Inflamm)
```
121
Def ATN + Mx
Fluid-resistant AKI
Mx:
Stop IV Fluids (+/- => Pulmon Oedema)
Fluid restriction + Diuretics
122
Cause of Post-renal AKI, Ix + Mx
Obstruction
USS-KUB
Mx: Surg
123
RRTx Indications
Uraemic Pericarditis/Encephalopathy
Intoxicants (Antifreeze, Methanol, Lithium)
Fluid-overloaded despite Diuretics
Hyperkalaemia, Metabolic Acidosis despite Tx
124
CKD Causes
Diabetic
HT
APCKD
125
Diabetic CKD Ix
Raised Urin Albumin : Cr (Raised PCR): > 2.5 (Females)/ > 3.5 (Males)
Glu on Dipstick
(Evidence of poorly-controlled DM: Retinopathy, Nephropathy, Neuropathy)
126
HT in CKD Ix
```
Urin metanephrines (Phaeochromocytoma)
Aldosterone : Renin (Hyperaldosteronism)
Dexamethasone Supp test (Cushings)
T3/4, TSH (HyperTh)
MR Angiography (Renal A Stenosis)
```
127
DM/HT CKD Mx
ACEi/ARBs (HT + Proteinuria)
Statin (Reduce CVS Risk Factors)
Screening (Microvascular Complications)
128
APCKD Ix + Mx
(+) FHx
USS (Kidneys + Liver)
Mx:
ACEi/ARBs (HT + Proteinuria)
Tolvaptan (ADH Antag: Reduce Cysts)
129
CKD Classification
eGFR
1: > 90
2: 60-90
3a: 45-60
3b: 30-45
4: < 30
130
CKD Complications (Anaemia) Patho - 5
```
Anaemia:
Reduced EPO
Blood loss + Reduced lifespan of RBC's
Uraemic Myelosuppression
Fe Def (Absolute: Reduced Absorption, Funct: Inflamm => Raised Hepcidin)
Vit B12/Folate Def
```
131
CKD Complications (Min Bone D)
Min Bone D:
Increased Excretion of PO4-
Reduced Synthesis of Vit D (=> Reduced Absorption of Ca2+)
Hypocalcaemia => Rise in PTH
Hyper-PTH => Increase in ALP (Increase Bone Turnover + Osteoclast Act) => Rise in Serum Ca2+
(Tertiary Hyper-PTH: High PTH + Ca2+) =>
Vascular/Soft Tissue Calcification + Skeletal PTH Resistance (Osteodystrophy)
132
Causes of Nephrotic Synd
Min change D (M Common in Children)
Focal Segmental Glomerulosclerosis
Membranous Nephropathy
133
Nephrotic Synd Features
Proteinuria
Hypoalbuminaemia
Ascites, Oedema
(Hyperlipidaemia)
134
Nephrotic Synd Mx
```
Tx Cause
ACEi/ARB (HT, Proteinuria)
Diuretics (Reduce Oedema)
LMWHep
Statins (Hyperlipid)
```
135
Causes of Nephritic Synd
Autoimmune/Inflamm (SLE, Vasculitis, IgA)
| Inf (HIV, Hep B/C, IE, Post-strep)
136
Nephritic Synd Features
Oliguria, AKI (Drop in eGFR)
Haematuria
Proteinuria
HT
137
Nephritic Synd Mx
```
Tx Cause
ACEi/ARB (HT, Proteinuria)
Diuretics (Reduce Oedema)
LMWHep
Steroids (Reduce Inflamm)
```
138
Blood Gas Features:
Alkalosis
Acidosis
Alkalosis (pH > 7):
Resp (pCO2 Low)
Metabolic (BE High)
Acidosis (pH < 7):
Resp (pCO2 High)
Metabolic (BE Low)
- Anion Gap: Na - (HCO3 + Cl) = 8-12 (H+ added: AG > 12, HCO3- lost: AG < 8)
139
Causes of Alkalosis + Acidosis
Resp Alkalosis: Hyperventilation
Metabolic Alkalosis: Loss of Acid (GI/Renal Loss)
Resp Acidosis: Poor Ventilation
Metabolic Acidosis: Gain of Acid (Toxins + Renal Fail, Lactic Acidosis, DKA), Loss of Base (GI/Renal Loss)
140
Fluid Routine maintenance
H2O: 25-30ml/Kg/day
K+/Na+/Cl-: 1mmol/Kg/day
Glu: 100g/day
141
Fluid Resus Indications + Mx
```
Syst BP < 100
HR > 90
RR> 20
CRT> 2s
NEWS > 5
```
Mx:
IV 0.9% NaCl 500ml over 15mins
142
Asthma Mx
1: SABA (Blue Reliever)
2: ICS (Brown Preventer)
3: + LTRA (Montelukast)
4: + LABA (w/ SABA, Remove LTRA)
5: LABA + ICS (MART) - Begin Increasing dose of ICS
6: MART + LTRA
7: + Aminophylline/LAMA (Ipratropium)
143
Severe vs Life-threatening vs Near-fatal Asthma
Severe:
Cannot complete sentences
RR > 25, HR > 110, PEFR: 33-50%
Life-threatening:
Silent Chest, Cyanosis
RR < 12, HR < 60, PEFR: < 33%, SpO2 < 92%
Near-fatal:
Hypercapnia + Hypoxia (T2RF)
Req Mech Ventilation
144
Acute Asthma Exacerbation Mx:
| If Severe/Life-threatening/Near-fatal
```
ABCDE
O2
Neb Salbutamol 5mg
PO Pred 40mg
(If Severe: Neb Ipratropium 500 micrograms)
(If Life-threatening: IV Aminophylline)
(If Near-fatal: Mech Ventilation)
```
145
Asthma Safe Discharge
```
Off Nebs > 24hrs
Peak Flow > 75%
Nurse R/v
PO Pred 40mg 5 days
GP f/up w/in 2 days
OTP Asthma Clinic w/in 4wks
Peak Flow Meter + Written Action Plan
```
146
Inadequate Asthma Control Sx - 5
```
Rescue meds > twice a week
Sx > twice a week
Awakening w/ Sx
Excessive SE's or Sx => Activity limitation
FEV1: < 80%
```
147
Acute COPD Exacerbation Mx - 6
```
ABCDE
O2 (88-92%) via Venturi mask
Neb Salbutamol 5mg
Neb Ipratropium 500 micrograms
PO Pred 30mg STAT + OD (7 days)
(If Inf: CXR, IV Abx + f/up)
```
148
COPD Mx:
Care bundle - 2
Med - 5
Surg - 1
Care bundle:
Pulmon Rehab
Smoking Cessation
```
Med:
Bronchodilators (Beta-Agonists)
Antimuscarinics (Ipratropium)
Steroids,
Mucolytics
LTOT (Non-smokers w/ SpO2: < 7.3KPa, < 8KPa w/ CP)
```
Surg:
Lung Vol Reduction (Lobectomy)
149
Bronchiectasis Sx
Large Vol of Clear Sputum
Chronic Cough/SOB
Obstruct LD
150
Bronchiectasis Ix + Findings
```
HR CT (Signet rings: Thickened Alveolar Walls)
CXR (Lobar Collapse/Atelectasis, Intercurrent Inf)
```
151
Bronchiectasis Mx - 6
Physio (Improve Mucus Clearing)
(If MRC Dyspnoea Score > 3: Pulmon Rehab)
Bronchodilators
Flu Vaccine
Reg ABx (After 3 Exacerbations and + Cult)
(If Inf Exacerbation: ABx for 14 days, may need to change class if already taking Reg)
152
MRC Dyspnoea Score - 5
1: No Sx
2: SOB walking up hill
3: SOB => Slower walking
4: SOB => Stop after 100m or 2mins
5: SOB => Immobility
153
Pneumonia Scoring
```
CURB-65:
Confusion
Urea > 7mmol
RR > 30
BP < 90 (Syst)
Age > 65yo
```
154
Causes of Non-resolving Pneumonia Inf
```
C: Complication (Abscess, Empyema)
H: Host (Immunosupp)
A: Abx (Inadequate)
O: Org (Atypical, Resistant)
S: Secondary Diagnosis (PE, Cancer)
```
155
Haemoptysis Mx + Ix - 6
```
ABCDE
O2
Lie Pt on side of Lesion
IV/PO Tranexamic Acid (Antifibrinolytic)
Stop Anticoags + NSAIDs
```
CT Aortogram
156
Haemoptysis Ddx
Inf (TB, CF, Bronchiectasis, Fungal, Pneumonia)
Malig (Primary, Mets)
Bleeding D (Vasculitis, Coagulopathy, PE, Arterial Erosion)
157
Tension Pneumothorax Criteria
Pleuritic Chest Pain
SOB
Silent Lung, Hyperresonance, Asymmetrical Chest Expansion
Shock (TachyC, HypoT)
(Deviated Trachea + Mediastinal Shift Away)
158
Tension Pneumothorax Mx
Large Bore Cannula + Chest Drain (2nd IC Space MCL, Above Rib)
159
Anaphylaxis Mx
```
ABCDE
O2 + Secure Airway
Remove Trigger
IM Adren 0.5mg (Repeat every 5mins)
IV HC 200mg + Chlorpheniramine 10mg
```
160
PE Sx + Signs
Sx:
Sudden, Constant, Severe Pleuritic Chest Pain
SOB, Cough (+/- Haemoptysis)
Signs:
(Recent DVT)
Shock (TachyC, HypoT)
Pulmon HT, RV Strain
161
PE Mx + Ix
```
ABCDE
O2
Anticoag
IV Alteplase (Thrombolysis)
(Confirm RV Strain: CT/Echo/ECG)
```
162
Def FEV1 + FEVC
FEV1: Vol of Air expelled in 1s after Max Inspiration
FEVC: Total Vol of Air expelled after Max Inspiration
163
Obstructive vs Restrictive Lung Function
Obstruct: (FEV1:FEVC 50%)
Normal/Low FEVC
Reduced FEV1
Restrict: (FEV1:FEVC 90%)
Reduced FEVC
Reduced FEV1
164
TB Supp Mx - 4
Admit to SR
Specialist TB Nurse
Notify Public Health
Start ABx
165
CF Advice - 8
```
No Smoking
Annual Flu Vaccine
Avoid other CF Pt's or Pt's w/ Pneumonia
Avoid Smokers
Avoid Animals/Composts (Aspergillus)
Avoid Jacuzzis (Pseudomonas)
Clean + Dry Nebulisers Regularly
Frequent fluids + NaCl Tablets (esp during Illness/Exertion)
```
166
Lung Ca Sx + Complications
Hoarse Voice, Dysphonia
SOB, Dry Cough, Haemoptysis
B Sx
Lymphadenopathy
SVCO (Facial Oedema, Engorged Neck Veins, Airway Compromise)
Horner's Synd (Miosis, Anhidrosis, Ptosis, Enopthalmos)
167
Lung Ca Paraneoplastic Syndromes
Anaemia, Clubbing
SIADH (Small Cell LC)
Cushings (Small Cell LC)
Hyper-PTH/Hypercalcaemia (Squamous Cell LC)
168
Lung Ca Ix
CXR
Staging CT (Spiral Thorax + Abdo)
US-guided FNA of LN
169
ILD Sx - 4
SOB
Dry Cough
Restrictive Lung Pattern (Reduced FEV1 + FEVC)
Weight loss
170
Transudate vs Exudate
Transudate: (Prot < 30g/L):
HF
Cirrhosis
Hypo-Albumin
Exudate: (Prot > 30g/L):
Inf (HIV, TB)
Malig
Inflamm
171
Pleural Effusion Ix
US-guided Pleural Aspiration:
Biochem (Protein, LDH, pH, Cytology)
Microbiology (Microscopy, Culture + Sensitivity)
172
```
Added Lung Sounds Features:
Crackles
Wheeze
Stridor
Pleural Rub
```
Crackles:
Inspiratory (Opening of Alveoli)
Fine (Fibrosis) + Coarse (Effusion, Consolidation)
Wheeze:
Continuous, Musical
High-pitch (Bronchospasm) + Low-pitch/Rhonchi (Secretions)
Stridor:
Inspiratory, High-pitch Whistle (Large Airway Obstruct)
Pleural Rub:
Inspiratory, Grating (Friction of Inflamm Pleura)
173
OA Xray changes
Loss of Joint space
Osteophytes
Subchondral Sclerosis
Subchondral Cysts
174
RA Xray changes
Loss of Joint Space
Erosions
Soft Tissue swelling
Soft Bones (Osteomalacia)
175
OA Mx
OT/PT
Walking Aids
Analgesia (NSAIDs, Paracetamol, Opiates)
Surg (Joint Replacement/ Fusion)
176
RA Mx:
Conservative
Med
Surg
OT/PT +/- Walking Aids
Analgesia (Opiates)
DMARDs
(After 2 Failed DMARDs: Monoclonal AB's - Rituximab: CD20 Inhib)
Surg (Joint Replacement)
177
Sero (-) Spondyloarthropathies Types + Features
(+) HLA-B27, (-) RhF
Psoriatic
Enteropathic
Reiters
Ankylosing Spondylitis
178
Psoriatic Features
```
R: Rheumatoid Arthritis (Hands + Wrists)
O: Oligo (2-4 Joints)
A: Arthritis Mutilans (Erosions => Deformities)
D: Dactylitis (Sausage-shaped fingers)
S: Sacroiliac Back Pain
(Psoriatic Plaques)
```
179
Enteropathic Features + Mx
IBD
Asymmetrical Arthritis of Digits
Mx:
DMARDs + Anti-TNF
(Avoid NSAIDs - IBD)
180
Reiters Synd Features, Ix, Mx
(Knee) Arthritis following Urethritis (STI) + Conjunctivitis
Severe, Unilat Pain (Unable to Flex/Ext Passively/Actively)
Fever, Raised WCC
Ix: Joint Asp
Mx:
IV ABx 6wks
181
Ankylosing Spondylitis Features - 3
Back/Buttock Pain (Radiates Up)
Spinal Deformities (Kyphosis, Scoliosis) + Reduced/Asymmetrical Chest Wall Expansion
LL Weakness/Paraesthesia
182
Sjogrens Sx + Ix
```
M: Myalgia
A: Arthritis
D: Dry Eyes
F: Fatigue
R: Raynaud's
E: Enlarged Parotids
D: Dry Mouth
```
Ix:
Raised Anti-Ro/La, RhF
183
Sjogrens Mx
Anti-Inflamm
| Frequent fluids, Eye Lubricants
184
SLE Sx
S: Serositis (Pericarditis, Pleurisy)
O: Oral Ulcers
A: Arthralgia
P: Photosensitive Rash
185
SLE Ix
Normal CRP, Raised ESR/PV
Anti-Ro/La, Anti-dsDNA
Haem changes (Anaemia, Thrombocytopaenia, Leukopaenia + Low Complement Proteins)
186
SLE Mx
Anti-Inflamm (DMARDs)
| Sun Protection
187
PMR Sx + Ix
Widespread Pain (Shoulders, Neck/Spine, Hips)
Fatigue, Fever, Weight Loss
Headache (Associated w/ GCA)
Ix:
Raised CRP/ESR
(+) ANA/ANCA
188
PMR Mx
| No Improvement
15mg Prednisolone, (Methotrexate: Steroid-sparing)
| If no Improvement w/in 18 month: Reconsider Ddx - Cancer, RA
189
GCA Sx
```
Jaw Claudication
Scalp Tenderness
Unilat Throbbing/Pulsating Headache
Vision changes (Diplopia, Blindness)
(Associated w/ PMR)
```
190
GCA Ix + Mx
Temple A Biopsy (Giant Cell Granulomas + Necrotising Vasculitis)
Mx:
Prednisolone 60mg 2wks
Aspirin (Prevent VTE)
(If Vision changes: IV Methylpred 1g)
191
Osteopaenia/Osteoporosis Features + Ix
Rib/Vertebral #'s w/out Trauma
```
Ix:
Dexa scan (T: < -1)
```
192
Vasculitis Sx - 6
```
Fever
Fatigue
Weight loss
Rash
Haematuria
SOB
```
193
Vasculitis Mx
ID Cause, Stop Drugs
| Steroids/DMARDs (Excl Inf before starting)
194
Gout vs Crystal Arthropathy
Gout: (-) Bifringent Crystals
Crystal Arthropathy: (+) Bifringent Crystals
195
Gout Mx
Diet/Lifestyle changes (Reduce Meat/Alcohol, Avoid Dehydration)
Acute: NSAIDs, Colchicine
Prophylaxis: Allopurinol
196
Crystal Arthropathy Mx
Acute: NSAIDs
Prophylaxis: Colchicine
197
Fibromyalgia Triad + Sx
Pain, Poor sleep, Fatigue
Vague, Widespread Pain (Above + Below, Bilat)
Fibrofog (Diff Conc)
Diff Sleeping, Exercising
Fatigue, Fever, Weight loss
198
Fibromyalgia Ix
```
Normal Ix (No Raised CRP/ESR/PV)
Normal Exam
```
199
Fibromyalgia Mx
Education
CBT
Amitriptyline
200
Scleroderma Patho, Sx + Ix
Fibrosis of CT => Raynauds, Calcinosis, HT
| Ix:
+) ANA
(Normal CRP/ESR/PV
201
Scleroderma Synd
```
C: Calcinosis Cutis
R: Raynauds
E: Oesophageal Dysmotility
S: Sclerodactyly
T: Telangiectasia
```
202
Scleroderma Mx
Scleroderma: Methotrexate
(Flares: Prednisolone)
Calcinosis: Ca2+ Antagonist
HT: ACEi
203
Dermamyositis/Polymyositis Sx + Ix
Acute + Symmetrical M Weakness (=> SOB)
Photosensitive Rash
Raynauds
Ix:
Raised CK, ALT
Normal CRP
204
Bisphosphonates Indications, Info, SE
Indications: Osteoporosis, (Co-prescribed w/ Steroids)
(Ca2+, Vit D Co-prescribed)
Taken weekly, w/ water on empty stomach, whilst standing/sitting upright + for 30mins after
+/- Oesophagitis (Discontinue)
205
Monoclonal AB's Info
Require TB test
| Increased risk of Intracellular Pathogens (Viral/Parasite)
206
Sulfasalazine Contraindications
Aspirin Allergy
| Do not take w/ NSAIDs => Kidney Fail, Peptic Ulcers
207
Azathioprine Info
Assess TPMT Act (+/- => Myelosuppression)
Reg weekly FBC test for 8wks
+/- Skin sensitisation (Sunscreen)
208
Methotrexate Info
Require Contraception + Preg test (Teratogenic)
| Weekly doses w/ Folic Acid Supplements
209
Inflamm vs Mech Pain
Inflamm:
Improves w/ Activity
Fatigue + Syst Sx
Mech:
Better w/ Rest (Shorter morning Stiffness)
No Fatigue/Syst Sx
210
HF (w/ Reduced EF) Mx
ACEi
Beta-blocker
+/- Spironolactone
(Annual Flu Vaccine, One-off Pneumococcal Vaccine)
211
HF CXR Signs
```
A: Alveolar oedema (Bat wing opacities)
B: Kerley B lines (Horizontal lines)
C: Cardiomegaly
D: Dilated upper lobe vessels (Pulmonary Congestion)
E: Effusion (Pleural)
```
212
BPH Mx
Alpha-1 Antag (Tamsulosin)
5a-Reductase Inhib (Finasteride)
TURP
213
Post-MI Complications
```
Death
Arrhythmia
Rupture
Tamponade
HF
Valvular D
Aneurysm
Dressers (Pericarditis)
Embolus
Recurrence
```
214
COPD Diagnosis + Ix
Post-bronchodilator FEV1 < 0.7
PEFR/Spirometry
CXR (Emphysema: Bullae, Hyperinflation: Flattened Diaphragm + Barrel-chest A-P on Lat)
FBC (Anaemia/Polycythaemia, Eosinophil Count)
BMI
(Serum alpha1 Anti-trypsin Def)
215
Asthmatic/Steroid-Responsive Features
Diagnosis of Asthma/Atopy
Raised Eosinophil Count
Diurnal variation of PEFR
Variation of FEV1
216
COPD Step-up Mx
1: SABA/SAMA
2: (If no Asthmatic/Steroid-Resp):
SABA + LABA + LAMA (Discontinue SAMA)
+/- ICS
2: (If Asthmatic/Steroid-Resp):
SABA + LABA + ICS
+/- LAMA (Discontinue SAMA)
(Prophylactic ABx: Azithromycin)
217
COPD Staging
S1: (Mild): FEV1 > 80%
S2: (Mod): FEV1 50-70%
S3: (Sev): FEV1 30-50%
S4: (V.Sev): FEV1 < 30%
218
GI Tract Blood Supply
Coeliac Trunk (Comm Hep, Splenic, L Gastric)
Sup Mesenteric (Middle Colic, Right Colic, Ileocolic, Jejunal + Ileal)
Inf Mesenteric (L Colic, Sigmoid, Sup Rectal)
219
GI Anatomy affected by Ulcers
Post Gastric: Splenic A, Pancreas
L Curvature: L Gastric A
Duodenal: Gastroduodenal A
220
Virchows Triad of Clotting
```
Hypercoaguability (Surg/Trauma, Malig, Preg, Sepsis, Inflamm/Auto-Immune)
Endothelial Inj (Atherosclerosis, Vasculitis, Thrombophlebitis)
Haemostasis/Turbulent Blood flow (Immobility, AF/Arrhythmias, BradyC/HypoT, Venous Obstruct)
```
221
Acute LVHF Mx
```
(Sit Pt up)
Morphine + Antiemetic
O2
IV Furosemide 80mg
SL GTN
(+/- Isosorbide Nitrate +/- CPAP)
```
222
Stroke Ix + Mx
Non-contrast CT Head:
- If Haem: Refer to Neurosurg (Do not give Aspirin/Thrombolysis), Reverse Anticoags
- If Ischaemic: Aspirin 300mg
(If < 80yo + Pc < 4.5hrs => Thrombolysis: IV Alteplase)
