ACC Flashcards
(156 cards)
1
Q
First line initial management of DKA
A
Isotonic saline- IV 0.9% sodium chloride
THEN give fixed-rate insulin infusion
2
Q
At what point during DKA management do you worry about hypoglycaemia
A
When the glucose is <14mmol/L then you give 10% dextrose infusion alongside continuing fluids and insulin therapy to prevent hypoglycaemia when the glucose levels. Have corrected
3
Q
Which heart murmur is pan-systolic, high-pitched blowing murmur loudest on expiration
A
Mitral regurgitation
Leaky mitral valve causes backflow of blood back to the left atrium
Left heart sounds are louder on expiration
4
Q
Explain the regurgitation murmurs and when you hear them
A
Regurgitation is leaking through the leaky valves of the heart
Tricuspid and mitral are the two in between the atria and ventricles and so you hear them during systole as thats when the leaking happens (pan systolic)
Aortic and pulmonary would be heard during diastole as thats when the blood leaks back into the ventricles
Left side is heard louder during expiration and right side is heard louder during inspiration
So e.g. a pan-systolic murmur louder on expiration= tricuspid regurgitation
5
Q
What is the common vascular injury in a subdural haemorrhage
A
Ruptured bridgin veins
Connect the cortex to the dural sinuses
Characterized by fluctuating conscious level
6
Q
What is the difference between breathing and ventilation
A
Breathing is the chemical and mechanical processes of inhaling and exhcjanging gases (ventilation and respiration)
Ventilation is the act of moving gases through the conducting sections of the airway due to pressure gradients
7
Q
Causes of metabolic acidosis
A
DKA
Addison’s
Alcohol
Uraemia
Renal failure (build up of uric acid)
Lactate build up
High ectrolytes e.g. lhypercalcaemis
Lithium toxicity
8
Q
Causes of respiratory alkalosis
A
Increased respiratory drive e.g. thyroid, pregnancy, sepsis, anxiety, pain, DKA, hyperthermia,
Induced by hpoxaemia e.g. pneumonia , PE , asthma, congenital heart disease
9
Q
Causes of respiratory acidosis
A
Decreased respiratory drive e.g. Brain injury, sedative drugs,
neuro disorders e,g myasthenia gravies
Trauma to chest wall
Obstructive disease
10
Q
What is a curb65 score and how to calculate and interpret
A
To assess severity of pneumonia
Confusion (are they confused)
Uraemia (high urea >7.1)
Respiratory Rate (>30)
Blood pressure (<90/60)
65- Age > 65
If score is 0-1 consider OP Tx, single Abx
2= short inpatient and dual Abx
3= IP Tx and IV therapy
4-5= HDU/ specialist care, dual Abx
11
Q
How to interpret curb 65 score
A
If score is 0-1 consider OP Tx, single Abx
2= short inpatient and dual Abx
3= IP Tx and IV therapy
4-5= HDU/ specialist care, dual Abx
12
Q
How do you work out positive predictive value and how is it different to sensitivity
A
Sensitivity is the proportion of people that have a condition that have a positive test (e.g. there are total 100 people with a PE and 95 of these had positive D-dimer, 5 had negative so sensitivity is 95%)
Positive predictive value is the number of positive tests that actually have the condition (e.g. there 95 positive D-dimers that have a PE but also 55 positive D-dimers that didn’t have a PE. So total 150 people with positive D-dimers. Total number of people who actually have a PE is 120 as there were 35 that had a PE with D-dimer negative. So the positive predictive value is 120/150= 80%
TLDR positive predictive value is total number of people with condition/ total number of positive tests whereas sensitivity is the proportion of people who have the condition that also had positive test
Negative predictive value is the opposite (number of negative tests/ total number of negative individuals)
13
Q
What is first line Tx when PE is suspected
A
DOAC e.g. rivaroxaban
Even give when waiting for scan results
Don’t give if already on warfarin, pregnant/ BF or slots around metalworks
14
Q
3 CI of DOAC Tx for PE`
A
Patient already on warfarin
Pregnant/ breast feeding (give LMWH)
Clot formed around metalwork e.g. around stents
15
Q
How long do you treat a PE with anticoagulants for
A
If provoked minimum 3 months
If unprovoked consider beyond 3 months
16
Q
What defines a provoked VTE
A
Within 3 months of:
- surgery
- major immobility
- pregnancy
- hormonal contraception
Unprovoked is none of the above
17
Q
What do you investigate for in an unprovoked VTE even
A
Looking for cause of VTE (think malignancy)
bloods inc clotting factors for anticoagulation
Calcium and PSA
Consider breast/ postate/ testicular
Only investigate further e.g. CT if cancer suspicion
18
Q
What else can D-dimer be raised in
A
It is a marker of clotting burden, not to diagnose PEs
Pregnancy
After major surgery
After trauma
After severe infection
19
Q
How do you decide whether to skip to a CTPA or do a D-dimer first
A
Wells score 4 or more= straight to CTPA.
If <4 do a D-dimer first. If also negative then PE excluded
20
Q
What are the rules for fasting before surgery
A
2 hours clear fluid e.g. orange squash
4 hours breast milk
6 hours solid food- light meals preferable e.g. not pizza
Paediatrics can have fluids up to 1 hour before to make sure they’re optimised before surgery e.g. moody
21
Q
3 essential medications to continue pre-op
A
Anti-epileptics
Parkinson meds (time critical)
Steroids (if taking 5mg a day)
Also important to continue if able:
- beta-blockers
- aspirin for IHD
- ppis for gord
22
Q
Do you continue aspirin pre op
A
Yes
23
Q
Do you continue clopidogrel pre op
A
No. Stop 7 days prior
Seek expert advice if they have had a CV event in the past year
24
Q
Do you continue DOACs pre op
A
Stop them 24-72 prior to surgery
(Depends on specific drug and renal function tho so check guidelines)
25
Do you continue warfarin pre op
Stop 5 days prior
If risk of thrombosis e.g. previous VTE then bridge with LMWH until 12 hours prior
26
Do you continue LMWH pre op
Last dose 12 hours before surgery.
27
Do you continue insulin in T1DM pre-op
Yes continue giving it
Give 80% of normal dose on the day before
28
Do you continue diabetes drugs in T2DM pre-op
Omit agents with a potential for hypos
- sulphonylureas, SGLT-2 inhibitors (-flozins)
Not insulin tho keep insulin even tho it can cause hypos
29
What are the 3 aspects of general anaesthesia
Amnesia (unconsciousness)
Analgesia (pain relief)
Akinesis (immobilisation)
30
What is an induction agent and types
Basically hypnosis drug to cause loss of consciousness very quickly
Intravenous
- propofol/thiopentone/etomidate/ketamine
Inhalations agents
- isoflurane/sevoflurane/desfluraje/enflurane
31
Name 4 IV induction agents
Propofol
Thiopentone
Etomidate
Ketamine
32
Name 4 inhalation induction agents
Isoflurane
Sevoflurane
Desflurane
Enflurane
33
Advantages and disadvantages of propofol
IV Induction agent
Most commonly used
Marked drop in BP
Causes pain on injection and involuntary movements
34
Advantages and disadvantages of thiopentone
Iv Induction agent
Mainly used for Rapid Sequence Induction
CI in prophyrias
35
Advantages and disadvantages of etomidate
IV induction agent
Mainly used in cardiac patients induction for its haemodynamic stability
Causes adrenal-cortical supression
36
Advantages and disadvantages of ketamine
IV INDUCTION AGENT
?used in emergency settings
CAUSES DISCCOCIATIVE ANASTHESIA AND EMERGENCE DELERIUM
INCREASES HEART RATE AND BP
37
What is MAC in anaesthesia
Dose of an inhalational agent that is needed for 50% of people to not respond to a surgical stimuli
Wants to be around 1
38
Which inhalational agent is sweet smelling
Sevoflurane
Often used for induction in needlephobic patients
39
Advantages and disadvantages of desflurane
Inhalation agent in anaesthesia
Rapid onset nd offset so used in long surgeries or in obese patients
Maximum greenhouse effect
40
Which inhalation agent is used in organ donations
Isoflurane
Least effect on organ blood flow
41
What is the most common depolarising muscle relaxant used and what are the advantages and disadvantages
Suxamethonium (1-1,5 mg/kg)
Rapid onset and offset so used in rapid sequence induction
Adverse effects include muscle pains, fascicukations, hyperkalaemia, hypothermia and a rise in body pressure leg. ICP
42
What is used to reverse muscle relaxants in surgery
Neostigmine and gylcopyrrolate
Neostigmine is a Acetylcholinesteras inhibitor which means that there is more Ach in the synapse that can bind to the muscle receptors
and glyco counteracts muscaricin effecrs of neo e.g. bradycardia as Ach powers the parasympathetic NS and so it would cause brady etc
43
What is the most common analgesic used at the time of induction
Fentanyl as short acting
?most commonly alfentanil
After that longer acting is used e,g. Morphine
44
What are the 2 most common IV nsaids
Ketorolac and parecoxib
45
What are the 3 layers that surround the spinal cord from inside to out
Pia mater
Arachnoid mater
Dura mater
Spinal block goes into sub-arachnoid space
Epidural goes outside the dura
46
What are you worried about in someone presenting with SOB after surgery
High spinal/ epidural
Causing respiratory muscle weakness
Where the anaesthetic spreads above T4
Also presents with arm weakness or reduced GCS
47
Which two antiemetics are safe in Parkinson’s
Cyclizine and ondansetron
48
How does local anaesthetic toxicity present
Perioral tingling and metallic taste
Tinnitus
Confusion and drowsiness
Dizziness
Arrhythmias
Emergency- ABCDE approach and call 2222
Treat with intalipid
49
How to treat local anaesthesia toxicity
Intralipid
50
Paracetamol overdose symptoms
24-48 hours after:
RUQ abdo pain (liver)
Vomiting
72+ hours after:
More serious: (indicates liver failure)
Jaundice
Coagulopathy
Confusion due to hepatic encephalopathy
51
Name 6 P450 inducers and their relevance in an acute setting
Carbemazepine (mood stabilizer, anticonvulsant)
Rifampicin (Abx)
Alcohol
Phenytoin (seizure prevention)
Griseofulvin (antifungal)
Phenobarbitone (seizure prevention)
Sulphonylureas (T2DM e.g. gliclazide)
They induce P450 which increases the amount of NAPQI which is hepatoxic which is relevant in paracetamol overdose
52
Describe the mechanism of paracetamol overdose
Normally 95% of paracetamol is metabolised through a mechanism that is non toxic and 5% is metabolised through a mechanism that is helped by CYP450 enzymes. This process produces NAPQI which is toxic unless its neutralised by glutathione
When there is too much paracetamol, the glutathione runs out and the good mechanism gets overloaded resulting in more NAPQI being produces which is toxic to the liver
53
When is the paracetamol level maximum and when do you test
It is highest at 4 hrs after dose taken
Take measurement 4 hours after the last dose was taken- be aware that if they took it staggered then the values could be funky so don’t trust
54
What is the medical management of paracetamol overdose
N-acetylcysteine
It’s a precursor to glutathione which helps to neutralise the toxicity of NAPQI
Treat them if they are symptomatic or if they have any worrying investigations e.g. para high, deranged LFTs, coag screen or U+Es
55
What stuff are you looking for in an Echo that you have requested suspecting ACS`
Regional wall motion abnormality to see if there is any infarction of the myocytes
Ejection fraction and valves
56
When do you not do a CTPA in high well’s score
If pregnant/ young woman (or with contrast allergy)
Do a VQ instead which images the difference between which parts of the heart are getting perfused and ventilated
Due to breast cancer risk
57
How to grade AKI using creatinine
Grade 1= rise of 150-200% or 26.4
Grade 2= rise of 200-300%
Grade 3= rise of >300%
when i say rise i mean 200% of baseline i.e. double
58
How to grade AKI using urine output
Grade 1= <0.5 mls/kg/hour for >6 hours
Grade 2= <0.5 mls/kg/hour for >12 hours
Grade 3= <0.3 mls/kg/hour for >24 hours/ no urine for 12 hours
59
What fluids do you give to someone in hyperkalaemia
30mls 10% calcium gluconate, 50mls 50% dextrose and 10 units actrapid (fast-acting insulin)
60
Where is the best place for interosseous access if IV isn’t working
Proximal tibia
Distal femur or distal tibia in paeds.
61
What does forehead sparing indicate in facial nerve palsy
LMN does not spare the forehead muscles (e.g. Ramsay-Hunt, Bell’s palsy, acoustic neuroma, HIV etc
UMN does spare the foreheard muscles (STROKE)
62
Causes of post-op pyrexia with timings
5W's of Post-op Pyrexia:
-Wind (1day): atelectasis
-Water(3days): UTI
-Wound(5days): surgical site infection/abscess
-Walking(7days): DVT/PE
-Wonder-drugs(Anytime): adverse drug reaction
63
What do you do when you see someone and suspect domestic abuse/stalking/honour based violence
Complete a DASH risk assessment (big questionnaire)
If >14/24 scored refer to MARAC (multi-agency risk assessment conference)
Which is a big MDT meeting including police who discuss the case
64
What is the gold standard Tx of septic arthritis
Surgical irrigation and debridement following Abx
65
How does gastric volvulus present
Retching without vomiting
Severe epigastric pain
Inability to place an NG tube
Called Borchardt’s triad and treat with urgent surgery
66
What do you give in cardiac arrest as a result of local anaesthetic
Intralipid is recommended for use in cardiac arrest associated with local anaesthetic toxicity.
67
Which type of haemorrhage and blood vessel is likely affected in a patient with fairly low-level trauma who has a lucid interval before loss of consciousness. Hyperdense biconvex collection around the surface of the brain
Middle meningeal artery
Extradural haemorrhage
68
Which type of haemorrhage and affected blood vessel in severe onset occipital headache with signs of meningism
Subarachnoid haemorrhage
Circle of Willis affected
69
how do you treat malignant hyperthermia caused by suxamethonium or inhalation induction agents
Dantrolene
Dantrolene interrupts the muscle rigidity and hypermetabolism by interfering with the movement of calcium ions in skeletal muscle.
MH presents with hyperthermia, muscle rigidity, tachycardia, hyperkalaemia and increased CO2 production
70
which anti-emetic do you not give operatively if the patient is at risk of prolonged QT interval
ondansetron
71
which anti-emetic do you not give in patients with heart failure and elderly patients
cyclizine
72
which reversal agent is given specifically in non-depolarising muscle relaxants e.g. rocuronium
Sugammadex
73
74
what are the two manouvres in a cardiac exam
1. Mitral area patient leaning to left for diastolic mitral stenosis
2. Tricuspid area with diaphragm with patient sat forward in expiration for aortic regurg
75
how do you do manouvres for mitral stenosis
listen to mitral area patient leaning to left with the bell
diastolic murmur
76
how do you manouvre for aortic regurg
tricuspid area with patient sat forward in expiration (diaphragm)
77
face section of a cardiac exam
peripheral cyanosis (lips) and central (tongue).
Xanthelasma or corneal arcus (high cholesterol), corneal arcus, high arched palate (Marfans -> heart failure)
Looking at dental hygiene risk of endocarditis.
Looking at eyes for conjunctival pallor.
78
what is radio-radial delay a sign of
coarctation of the aorta
79
what in a cardiac exam is indicative of aortic regurg
collapsing pulse
listen to tricuspid area with the diaphragm of the scope with patient sat forward in expiration
80
how do you work out routine maintenance IV fluids
Give maintenance IV fluids
Normal daily fluid and electrolyte requirements:
25–30 ml/kg/d water
1 mmol/kg/day sodium, potassium*, chloride
50–100 g/day glucose (e.g. glucose 5% contains
5 g/100ml).
81
things that slow gastric emptying
trauma
diabetes
gastroparesis e.g. neuropathy
opioid use
take care with fasting
82
what is normal O2 on ABG if they're on 15L O2 via a non-rebreathe mask
85KPa is the partial pressure of 15L O2 via non-rebreathe
take away 10 for normal O2 levels
so expected would be 75KPa
83
tracheal deviation in simple and tension pneumothorax
in a simple pneumothorax the trachea is pulled towards the affected side
in a tension the trachea is deviated away from the affected side. there will also be hypotension
84
FEV1:FVC ratio cut off for COPD
0.7
85
opioid overdose drug management with route and dose
naloxone 400micrograms IV
86
what is used to treat benzo overdose
flumazenil
be careful as it can induce seizures
87
what is used to treat beta blocker overdose
glucagon
also used to treat hypos
88
how do you manage severe hypoglycaemia (1 thing)
10g glucose given as a 20% solution IV
89
bull's eye bite diagnosis and causative organism
Lyme Disease
(bulls eye rash called erythema migrans )
caused by borrelia burgdorferi
90
what do you need to do specifically when doing group and save/ cross match
group and save saves their blood group
cross match matches their blood with someone elses
so you need to ask for an amount of blood to be sent back
1 unit is 10 Hb
91
which blood bottle is FBC
purple
92
which blood bottle is UandEs
yellow
LFT's and CRP are also yellow
93
which blood bottle is group and save/ cross match
pink
94
which blood bottle is clotting
blue
make sure this is full so do it first
95
PEA in cardiac arrest what do you do alongside CPR
think about reversible causes of PEA
4H's and 4T's;
Hypovolaemia
Hypoxia
Hyper/hypokalaemia
Hypo(/hyper)thermia
Thrombosis
Tamponade
Tension PT
Toxins (drugs e.g. para, opioids, think broad)
96
4H's and 4T's of reversible causes of pulseless electrical activity
Hypovolaemia
Hypoxia
Hypo/hyperkalaemia
Hypo(/hyper)thermia
Thrombosis
Tension PT
Toxins (drugs e.g. para, opioids etc)
Tamponade
97
which blood culture bottle first
aerobic first which i think is blue
98
what are the two types of partial seizure
partial or complex seizure is where patients remain awake but have a problem with e.g. hearing, speech
simple partial seizure where patients remain aware
complex partial seizures are where the patient does lose awareness
99
difference between tonic-clonic and myoclonic seizures
tonic-clonic is tensing and jerking movement phases with loss of consciousness
myoclonic is sudden brief muscle contractions and they remain awake
100
how do you treat all the different seizure types (excluding women of childbearing age)
- sodium valproate for most
- lamotrigine/ levetiracetam for partial
- ethosuximide for absence
for women of child bearing age dont give sodium valproate and think either lamotrigine or levetiracetam
101
tx of tonic clonic seizure and in women able to have kids
sodium valproate normally
lamotrigine/ levetiracetam for WATHK
102
Tx of partial seizure and in women able to have kids
lamotrigine or levetiracetam for both
103
Tx of myoclonic seizures and in women able to have kids
sodium valproate
levetiracetam in WATHK
104
Tx of tonic or atonic seizure and in women able to have kids
sodium valproate
lamotroigine in WATHK
105
Tx of an absence seizure and in women able to have kids
Ethosuximide for all
106
notable side effects of sodium valproate
Teratogenic (harmful in pregnancy)
Liver damage and hepatitis
Hair loss
Tremor
Reduce fertility
also in pregnancy can cause NTD and developmental delay so dont give it at all to women able to have kids
107
define status epilepticus
seizure last >5mins
OR
multiple seizures not regaining consciousness
108
Mx of status epilepticus
ABCDE approach
benzo (buccal mid, rectal diaz, or IV loraz) repeated after 5-10 mins if still going
then IV levetiracetam, phenytoin or sodium valproate
then ?GA?
109
what are the different benzos you can give in status epilepticus
Buccal midazolam (10mg) is first line in community
Rectal diazepam (10mg)
IV lorazepam (4mg) is first line if IV access already established
110
what do you do if you dont get aspirate from an NG tube
- Check the mouth for coiling
- lean patient to their left
- perform mouth care
- flush NGT with AIR
- let them drink if safe swallow
- advance/ withdraw NGT a bit
- wait 15-30 mins
111
Safe dose of lignocaine (lidocaine) with and without adrenaline
Lignocaine without adrenaline= 3mg/kg
Lignocaine with adrenaline= 7mg/kg
112
Safe dose of bupivicaine with and without adrenaline
Bupivicaine= 2mg/kg
Adrenaline doesn’t matter
113
What is the typical presentation of MND
Late middle age e.g. 60 male
Potentially with affected relative
Insidious and progressive weakness of muscles throughout the body often first in upper limb
Can affect upper or lower motor neurons so can present either with increased or decreased tone
114
Medical management of MND
Riluzole can slow the progression of the disease and extend survival by several months in ALS.
Nothing really work though
Non-invasive ventilation is used when resp muscles weaken
115
What is the most common type of MND
Amyotrophic lateral sclerosis (ALS)
Causes range of symptoms to do with muscle weakness:
- tripping
- slurred speech
- twitching
Often starts in the upper limb (or lower limb)
116
What investigation might you do if you suspect MND to rule out a neuropathy
Nerve conduction studies
Will show normal motor conduction
117
Typical prognosis of MND
Poor
50% of patients die in 3 years
118
How does ALS typically present in MND in the different limbs
typically LMN signs in arms and UMN signs in legs
119
What is the mechanism of myasthenia gravis
Immune response causes blockage of the Ach receptors a neuro-muscular junctions
Therefore difficult to initiate e.g. movement. Most commonly presents with fatigue ability
Progressive onset
120
What abnormal blood tests are normal in pregnancy
Decreased urea
Decreased creatinine
121
What is the most common complication and also most deadly complication of measles
OM is most common
Pneumonia is most deadly
122
Wernickes encephalopathy presentation
Wernicke's encephalopathy is characterised by a tetrad of ataxia, ophthalmoplegia, nystagmus and confusion.
123
What are the Venturi mask colors and their FiO2
Blue 2-4L/min= 24%
White 4-6 L/min= 28%
Yellow 8-10 L/min= 35%
Red 10-12 L/min= 40%
Green 12-15 L/min= 60%
124
What is the flow rate through a nasal cannula
1-6 L/min
Comfortable up until 4l/min
FiO2 of 24-around 50%
125
What size NPA for males and females
7 for males
6 for females
126
Common causes of high base excess
Elevated lactate
Elevated urea
Elevated ketones
127
What would make you admit someone with pre-eclampsia inc bloods
BP >160
High creatinine, high ALT, low platelets
Clinical signs that cause concern e.g. impending eclampsia
Suspected foetal compromise
128
What bloods in pre-eclampsia
FBC-> low platelets= admit
LFTs -> high ALT= admit
UandEs-> high creatinine= admit
129
How to treat regular narrow complex ventricular tachycardia
= pure SVT
Do vagal maneuvers first e.g. hold breath, blowing, massaging carotids)
THEN give adenosine
130
How to treat regular narrow complex ventricular tachycardia
= pure SVT
Do vagal maneuvers first e.g. hold breath, blowing, massaging carotids)
THEN give adenosine
131
How to differentiate between sinus tachycardia and SVT on an ECG
Sinus tachycardia would have a HR below 140bpm
SVT is usually above 140
They may often look similar on ECG
132
What are the 4 life-threatening features of tachycardia which would make you manage with Synchronised DC shock
Shock
Syncope
Myocardial Ischaemia
Several heart failure
Up to 3 attempts
Done with sedation/ anesthesia is conscious
133
What do you do if synchronised DC cardioversion is unsuccessful (up to three attempts) in tachycardia
give amiodarone 300mg IV over 10 mins
Then repeat the shock
134
What do you do if synchronised DC cardioversion is unsuccessful (up to three attempts) in tachycardia
give amiodarone 300mg IV over 10 mins
Then repeat the shock
135
How do you treat irregular broad complex tachycardia
This is likely to be polymorphic VT (e.g. torsades de pointes)
Treat with magnesium sulphate IV 2g over 10 mins
This would definitely require senior input
136
How do you treat broad complex regular tachycardia
Amiodarone 300mg IV over 10-60 mins
137
How do you treat narrow complex regular tachycardia
Vagal maneuvers e.g. feet over heads, blow into a syringe
If ineffective give adenosine 6mg rapid IV bolus
If unsuccessful give 12mg
If unsuccessful give 18mg
138
How to treat narrow complex irregular tachycardia
Treat as atrial fibrillation
Control rate with a beta blocker
Consider digoxin
Anticoagulate if its been going on for over 48 hours
139
What are the 4 common sites for central venom catheter insertion
Internal jugular vein (most commonly used)
Subclavian vein
Femoral vein
Axillary vein
140
Stop COCP before surgery?
Yes
Stop 4 weeks pre-op
141
How to treat a small non-tension unilateral pneumothorax, bilateral pneumothorax, tension pneumothorax
Small non-tension unilateral= aspiration aka thoracocentesis
Bilateral= chest drain
Tension= immediate needle decompression
142
ABCDE management of anaphylaxis inc doses
adrenaline 1:1000 0.5ml IM
500ml 0.9% NaCl IV (if hypotensive)
Note that steroids (hydrocortisone) and anti-histamines (chlrphenamine) are given just not in the resus ABCDE algorithm
143
How does upper MN and LMN signs differ on inspection , tone, power and reflexes
Upper= muscle bulk preserved, hypertonia, slightly reduced power, brisk reflexes
Lower= reduced muscle bulk with fasciculations, hypotonia, dramatically reduced power, reduced reflexes
144
How to manage cerebral palsy
‘MDT approach’:
- physio to strengthen muscles
- OT to adjust houses etc
- SALT for speech and swallowing
- dieticians
- orthopedic surgeons for tendon lengthening
- Paediatric doctors
Etc etc etc
145
Causes of cerebral palsy
Often unknown
Antenatal with chorioamnionitis/ trauma
Perinatal with asphyxia, pre-term birth
Postnatal with meningitis/ trauma
146
Different types of squint
Esotropia= inward positioned squint
Exotropia= outward positioned squint
Hypertropia= upward positioned eye
Hypotropia= downward positioned eye
Note that strabismus is misalignment of the eyes and amblyopia is when one eye becomes passive (lazy eye)
147
How to manage squints
Ophthalmology referral for sure
Occlusive patch over the good eye to force the weak eye to develop
Atropine drops in the good eye to make vision in good eye blurry
148
4 risk factors for squint/ strabismus
Family history of strabismus
Low birth weight
Premature birth
Maternal smoking
149
What is the difference between exo/endo phoria and tropia
Exotropia is when your eye is misaligned outwards without covering either eye
Exophoria is when your eye is misaligned outwards only when covering that eye, it returns to normal as you move the cover away
150
which leads are raised in which type of STEMI and which artery affected
V1-V4= anterior STEMI= LAD
V5,V6, 1 and AVL= lateral STEMI= Left circumflex/ diagonal part of the LAD
2,3 and AVF= Inferior STEMI= Right Coronary/ LCx
151
Where to inject adrenaline
IM adrenaline should be injected in the anterolateral aspect of the
middle third of the thigh
152
Different types of dialysis and advantages and disadvantages of each
Continuous haemodialysis-> large volumes of fluid removed and large volumes of physiologically balanced solution given. Can do arteriovenous using BP from artery (low) or venovenous using a pump (high BP). AV is better as it is simple but gives unreliable flow
intermittent haemodialysis-> blood is taken out and ran against a semi-permeable membrane with physiological electrolyte levels to try and normalize. Intermittent cos u come in for sessions i think. Likely to cause hypotension during the session and difficult to control blood pressure
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Adverse effects of epidural and spinal
- hypotension
- headache (epidural -> dural tap)
- infection, bleeding, nerve damage (rare)
- motor weakness e.g. retention
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What is the definition of a massive bleed
Objective= 20% blood loss in 1 hour, or 50% blood loss in 3 hours
Subjective= clinical concern
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First thing to do when Major haemmorhage
Call 2222 state major hemorrhage and location and this will alert blood bank and also send a porter there. Blood bank will then need clinical details
Then ABCDE. Take bloods, give fluids warm to prevent hypothermia
Use cap refill to assess perfusion
Consider TXA
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What to do pre-op for someone on insulin
Reduce by 20%
