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1
Q

Sepsis 6

A
  1. Administer high flow oxygen.
    1. Take blood cultures
    2. Give broad spectrum antibiotics
    3. Give intravenous fluid challenges
    4. Measure serum lactate and haemoglobin
      Measure accurate hourly urine output
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2
Q

Red flag sepsis symptoms

A 
• Systolic BP <90mm or >40mmhg fall from baseline
	• MABP <65mmHg
	• HR >130 bpm
	• RR >25 per min
AVPU = V, P, or U
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3
Q

Meningitis signs

A

non blanching rash, photosensitivity, stiff neck

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4
Q

How to reverse warfarin

A
  1. Stop warfarin
    1. IV Vit K - Takes 4-6h to work
    2. FFP - only if human prothrombin complex unavailable
      Human prothrombin complex - reversal in 1 hr eg Bereplex. Give with Vit K
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5
Q

Anaphylaxis tx. how to inject adrenaline?

A

adrenaline - 500mcg
hydrocortisone - 200mg
chlorphenamine - 10mg

adrenaline can be repeated every 5 mins if necessary. Anterolateral aspect of middle third of thigh

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6
Q

Emergency dialysis indications

A

• Severe pH disturbance
• Resistant pulmonary oedema
Resistant hyperkalaemia

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7
Q

Causes of metabolic acidosis normal and raised anion gap

A

○ Normal - GI loss, renal tubular acidosis, drugs, addisons
Raised - lactate (shock, hypoxia, metformin), ketones (DKA), urate (renal failure), acid poisoning (salicylates, methanol)

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8
Q

Can you take blood from cnanula?

A

CANT TAKE BLOOD FROM CANNULA AFTER FLUSHING

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9
Q

Causes of neutrophilia

A

bacteria, inflammation, necrosis, steroids, malignancy

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10
Q

Causes of neutropenia

A

chemo, viral

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11
Q

Lymphocytsisus cayses

A

viral, TB,

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12
Q

Eosinophilia causes

A

allergy, parasites

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13
Q

pancytopenia causes

A

sepsis

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14
Q

Hemolysis markers

A

• Bilirubin
• Haptoglobin (decrease as it mops up Hb)
Red cell spherocytes

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15
Q

What Hb level do you give transfusion for?

A

below 80

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16
Q

Iron deficiency anemia markers

A

Target cells
Iron molecule carriers:
• Carried by transferrin in blood - goes up if iron deficient
• Stored in body as ferritin and hemosiderin - goes down if deficient

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17
Q

Causes of macrocytic anemia

A

Macrocytic:
• B12 deficiency
• Folate deficiency
Alcohol

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18
Q

Causes of microcytic anaemia

A 
TAILS
	• Thalassaemia
	• Anaemia of chronic disease
	• Iron deficiency
	• Lead
Sideroblastic anemia
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19
Q

Causes of normocytic anaemia

A

• Hemolytic (LDH, reticulocytes)
Bleeding
Pregnancy (physiological)

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20
Q

How to know if there is mixed anaemia?

A

MCV could be normal as its average

check RDW

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21
Q

Causes of hyponatraemia

A

• Hyponatremia + decrease vol - fluid loss - GI, burns, diuretics
• Hyponatremia + normal vol - SIADH (syndrome of inappropriate ADH)
Hyponatremia + increase vol - Heart, liver, kidney failure

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22
Q

Causes of hypernatraemia

A

• Dehydration
• IV fluids
Diabetes insipidus

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23
Q

Tx of hyperkalaemia

A

• Treat underlying cause
• Stabilise cardiac membrane - IV Calcium gluconate
• Short term K+ shift to intracellular - Combined insulin/dextrose infusion, + Salbutamol nebs
Long term removal of K - Calcium resonium, loop diuretics

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24
Q

Causes of hyperkalaemia

A

• K sparing diuretics
• Think Kidney damage
Rhabdomyolysis

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25
Hypokalaemia causes
Causes with hypertension: • Cushings • Conns syndrome (primary hyperaldosteronism) Liddles syndrome Causes without hypertension: • Diuretics • GI loss Renal tubular acidosis
26
tx of hypokalaemai
• Oral K+ supplement if mild | If severe give IV K+ SLOWLY
27
Bone profile of osteoporosis
All normal
28
Bone profile of osteomalacia
Low calcium and P | High ALP
29
Bone profile of pagets
Ca + P normal | Raised ALP
30
COPD exacerbation abx?
amox
31
CAP abx?
amox
32
Atypical pneumonia abx?
Clarithromycin
33
HAP abx?
Co-amox
34
UTI abx?
Trimethoprim or nitrofurantoin
35
Acute pyelonephritis abx?
ceftriaxone
36
animal or human bite abx?
co-amox
37
Cellulitis abx?
Fluclox
38
Otitis media abx?
amox
39
otitis externa abx?
fluclox
40
C diff abx
metronidazole
41
Daily fluid requirements
• K and Na - 1mmol/kg/day • 50-100g glucose/day 25-30ml water/kg/day
42
Surgical sieve?
T - Trauma I - Inflammation N - Neoplasia C - Congenital A - Arteriovenous N - Neurological B - Blood E - Endocrine D - Drugs P - Psychogenic A - Allergic N - Not known
43
Patho of shock
Shock is when there is insufficient tissue perfusion
44
Types of shock
``` SHANC • Septic • Haemorrhagic • Neurogenic • Cardiogenic Anaphylactic ```
45
Tx of hemorrhagic shock
• Fluid challenge Saline 500ml ASAP and reassess BP. | Ensure Hb above 7g/dl otherwise transfusion is necessary
46
Tx of neurogenic shock
• Peripheral vasoconstrictors - adrenaline
47
ADRs of NSAIDs
``` ADRs - I-GRAB: • I - Interactions with warfarin • G - Gastric ulceration • R - Renal impairment • A - Asthma sensitivity B - Bleeding risk due to antiplatelet function ```
48
egs of strong and weak opioids
weak - codein Strong - morphine, fentanyl, oxycodone
49
ADRs of opiooids
• Resp depression • Constipation Nausea
50
egs of anti-emetics
Metoclopromide, domperidone, ondansetron
51
Give ions that diarrhoea and vomit are high in
• Diarrhoea - high in K (50mmol/l) and HCO3 (50mmol/l) | Vomit - High in K (14mmol/l), H+ (60mmol/l), and Cl (140mmol/l)
52
upper limb myotomes
``` C5 - shoulder abduction C6 - elbow flexion C7 - elbow extension C8 - Wrist flexion T1 - Finger abduction ```
53
Lower limb myotomes
``` Lower limb: L1,2 - Hip flexion L3,4 - Knee extension L5 - Knee flexion S1 - Hip extension S2 - Ankle plantarflexion ```
54
Brachial plexus nerve roots
``` MAMRU: M - Musculocutaneous, C5-7 A - Axillary, C5,6 M - Median, C6-T1 R - Radial, C5-T1 U - Ulnar, C8-T1 ```
55
ABCDE approach
ABCDE IS FOR SIGNS OF LIFE. IF NO SIGNS OF LIFE ATTEMPT LIFE SUPPORT AND CALL RESUS Airway: • Look inside mouth ○ Suction if secretions present • Listen for breathing • Head tilt chin lift and gudel or laryngeal mask • Call for help and apply 100% oxygen via non-rebreath mask Breathing: • Monitor O2 sats and RR • Look for chest expansion - fogging of mask. Does L = R chest expansion? • Auscultate for air entry ``` Circulation: • Feel for carotid and radial pulse • Cap refill • ECG and BP • Establish IV access, send bloods and give fluids if BP <90 ``` Disability: • Assess GCS • Check glucose • Look for pupil reflexes Exposure: • Remove all clothing, check for temp • Look all over for rash or injuries • Repeat A-E until help arrives
56
Ix of meningitis
``` Ix: • FBC • U&E • LFT • LP - DO NOT PERFORM IF NEURO SIGNS OR CONSCIOUSNESS REDUCED. CT HEAD FIRST • Blood culture • CXR • CT head ```
57
Patho of encephalitis
Patho: • Infection of brain parenchyma • Most likely cause HSV
58
S&S and ix and tx
``` S&S: • Headaches • Fever • Meningism • Confusion • Delirium • Neuro deficits ``` ``` Ix: • FBC • U&E • Clotting • MRI head • LP • CT head ``` tx - aciclovir
59
S&S of extradural haematoma. how it happens
signs of raised ICP Lucid interval Results from acceleration-deceleration trauma or blow to side of head
60
S&S of subdural and RFs
RFs - old age, alcoholism, anticoagulation S&S - confusion, headache, nausea occurs after head injury but slower onset than extradural. can take days to weeks
61
What should you co-prescribe with LT steroids
Co-prescribe with LT steroids: • Bisphosphonates • PPI • Aspirin
62
Daily requirements for fluids
Daily requirements: • K and Na - 1mmol/kg/day • 50-100g glucose/day • 25-30ml water/kg/day
63
Contraindications in asthma?
BAN in asthma Beta blockers Adenosine NSAIDs
64
Ix of HIV
Ix: • HIV antibodies can take 3 months to develop • HIV tests may miss early stages of infection
65
Tx of HIV AIDS
Tx: • Antiretroviral drugs - HAART therapy • Prophylactic abx against opportunistic infections • Inactivated vaccines, live vaccines if not AIDS
66
S&S of genital herpes
H&E: • Lesions appear commonly on lips, conjunctiva, cornea, and genitals • Multiple painful ulcers on red background +/- inguinal lymph nodes <1wk after sex • Lesions crust then heal
67
Tx of genital herpes
``` Tx: • Refer to GUM for contact tracing • Treat with aciclovir if in first 5 days • Analgesia, ice packs for pain • Condoms etc ```
68
Causes of DIC
Sepsis, surgery, majkor trauma, cancer, pregnancy
69
Tx of DIC
• Treat cause • IV Platelets • FFP Low fibrinogen - Cryoprecipitate
70
Ix of DIC
``` Ix: • High INR • Low platelets • Low fibrinogen • High D-Dimer ```
71
Meconium risks
Smoking, oligohydramnios, placental insufficiency
72
Tx of Neuroleptic malignant syndrome
``` Treatment: • Removal of antipsychotic • IV fluids • Dantrolene • Cool patient ```
73
Severe hypothyroidism can result in..?
Myxedema coma
74
Pathophysiology of HF
Patho: • Heart overstretches and is unable to increase the force of its contraction in times of stress, as in starling's curve - reduced exercise tolerance • Decrease in BP as heart unable to sustain pressure - body compensates with increased TPR, increased heart workload • Decreased blood flow to kidneys, increase in renin, increase in salt and fluid retention
75
C section cx
``` Complications: • Post partum hemorrhage • Bladder injury • Lung aspiration • Pulmonary embolus • Infection ```
76
Cx of AEDs in pregnancy
• Atrial septal defect • NTDs eg spina bifida Autism
77
Tx of ILD
Oxygen therapy, physiotherapy, Vaccines, ppx abx
78
Extra GI manifestations of Crohsn
``` Extra GI manifestations: • Erythema nodosum • Uveitis + Episcleritis • HLA B27 spondyloarthropathies - Ank spon, reactive arthritis, psoriatic arthritis • Clubbing • Osteoporosis • Pyoderma gangrenosum ```
79
Organisms in UTIs
e coli, enterococcus bacillus, pseudomonas aeruginosa

Z IPE (15 decks)

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