Elective 1 Flashcards
0
Q
Biliary colic
A
RUQ Radiates to scapula After food Gradually builds over hours Early hours morning
1
Q
Pancreatitis
A
Pain through to back
NV
Gall stones, alcohol
2
Q
Jaundice
A
Pale stools, dark urine
Pain
Offensive stool, difficulty flushing
Trigger, RF
3
Q
IHD
A
Central heavy CP radiates L
Exertion, rest, nitrates
Hx MI, angina, cardiac RF
NV, sweaty, clammy
4
Q
Arrhythmia
A
Type of rhythm
Dizzy, fall LOC
CP, orthopnea
Infx; fever, cold, LRTI, UTI, skin
5
Q
ACS
V
Angina
A
ACS; pain >20mins
V
Angina; walking distance/ rest time, nitrate spray
6
Q
HF
A
SOB at rest, sentences
Orthopnea
Edema
Cause???
7
Q
Endocarditis
A
New murmur
Fever
+- petechiae
8
Q
Dissection
A
Tearing -> interscapula/ back
Weakness/ numbness arms
Diff arm BP
CXR widened mediastinum
9
Q
Pericarditis
A
Pleuritic pain Worse lying, better leaning forward Recent viral illness Pericardial rub Saddle shape ST
10
Q
Acute asthma attack
A
SOB; sentences Wheeze, cough Triggers Normal meds Previous admissions
11
Q
Acute exacerbation COPD
A
SOB; sentences Wheeze, cough, sputum, fever Normal meds; inhaler, steroids, O2 Still smoke? Previous admissions - ventilation
12
Q
Pleural effusion
A
Gradual onset SOB
+- pleuritic CP
Dull percussion note
13
Q
Pneumothorax
A
Sudden onset SOB Pleuritic CP RF; smoking, COPD, chronic chest condition, tall thin male Hyper resonant Deviated trachea?
14
Q
ARDS
A
SOB
Concurrent severe illness
15
Q
Anaphylaxis
A
Trigger; food, drugs
Itching, rash
Swelling
SOB
16
Q
Pneumonia
A
SOB Cough, sputum Fever Confusion, muddled Hx Chest condition, smoking
17
Q
Peptic ulcer
A
Epigastric/ chest pain Heartburn, bloating, burping Antacids Melaena RF; Previous ulcers, NSAIDs, alcohol
18
Q
Gastric ulcer
V
Duodenal ulcer
A
G: Worse with food
V
D: Better with food, night pain
19
Q
Esophageal cancer
A
Swallowing; pain, sticking Haematemesis Hoarseness, Cough Lymphadenopathy, hepatomegaly RF; GORD, smoking
20
Q
Stomach Ca
A
Dyspepsia
Epigastric pain
Virchows node
RF ulcers, gastritis, blood group a
21
Q
Perforation
A
Sudden onset
Worse on movement/ coughing
RF ulcers, Ca, IBD, NSAIDs, alcohol
No bowel sounds
22
Q
GORD
A
Burning CP +\- reflux \+\~ Waterbrash; excess saliva Worse bending forwards Nocturnal cough Antacids better
23
Q
Diverticular ds
A
Pain/ cramps Better on BO Irregular BO Flatus, bloating PR bleed
24
Renal colic
Exclude AAA
Acute loin to groin
N&V
Haematuria, dysuria, frequency
25
Jaundice ddx
Pre; Gilbert, haemolysis, malaria
Hepatic; paracetamol, viral, alcohol, medications, vascular
Obstructive; luminal, mural, extra
26
Causes of chronic pancreatitis
```
Alcohol
Gall stones
Hyperparathyroidism
CF
Familial
```
27
Migraine
```
4-72h
Unilateral
Pulsating
Avoid activity
N or V
Photophobia, photophobia
Aura 25% pt, lasts 5-60mins
```
28
```
Meningitis
V
Encephalitis
V
Cerebral abscess
```
M: headache, fever, stiff, photophobia
- common to all
E; focal signs and cognitive deficits - headache is not usually not the primary feature
A: subacute onset
29
Courvoisiers law
In the presence of jaundice
A palpable gall bladder
Is unlikely due to gall stones
Rule out Ca
30
IBS
```
Central/ lower pain
Relieved by BO
Changeable BO
Bloating
Minimal mucus
```
31
Causes of imbalance/ ataxia
Cerebellar disorder; DANISHP
Spinal ds; dorsal column
Peripheral neuropathy
32
Post LP headache
| When? Tx
Usually within 24h, but up to 7d
Tx
Lie pt flat
Analgesia, increase fluid intake
33
Tx seizures
```
Start clock
High flow O2
Recovery position
Venous access, take bloods
Check BM
>5 mins
- call senior
- Lorazepam (IV)/ diazepam (PR)
```
34
Tx
| Hypoglycaemia
```
Hypostop
Low GCS
- 50ml, 50% glucose
- 100ml, 20% glucose
Aim BM over 5
```
35
Ix and Tx
| DKA/ HONK
BM, ABG, urine dip
1L normal saline stat
Insulin
Insulin plus glucose
36
Painful arc aka
Supraspinatus tendinitis
| Impingement syndrome
37
Facet joint pain
Acute or chronic
Worse in morning and on standing
Worse in extension of back
May be tender over facets
38
Extra dose of morphine for breakthrough pain
1/6 daily morphine dose
39
Worrying fevers in children
>38C under 3m; red flag
>39C: 3-6m, yellow flag
Fever >5d; yellow flag
40
Legionella features
```
Flu like Sx
Dry cough
Hyponatraemia
Deranged LFT
Pleural effusions; 30%
```
41
L dopa drug names
Madopar
| Sinemet
42
Causes of purpuric rash
Vascular;
- meningococcus, HSP, scurvy, vWds
Thrombocytopenia
- idiopathic, infx, drug, DIC
43
K+ additives to fluid rules
- No more than 40mmol per L
| - 10mmol per hour max
44
Sx thyrotoxicosis
```
Goitre
Palpitations, tremor
Heat intolerance, sweating
Weight loss, diarrhoea
SOB, tired, increase appetite
```
45
Before azathioprine tx
| Check
Thiopurine methyl transferase (tpmt) deficiency
Results in azathioprine toxicity
46
Chondromalacia patella
Softening of cartilage
Common teenage girls
Anterior knee pain: up/ down stairs
Tx physio
47
Max lidocaine infiltration dose
200mg
| 500mg with adrenaline
48
Guidelines for paracetamol OD tx
N acetyl cysteine
Tx: Staggered overdose, or if any doubt over time of OD
Or
Plasma conc above tx line at 4-15hrs
49
Lidocaine conc
```
1% = 10mg/ml
2% = 20mg/ml
```
w/o adrenaline max 200mg
50
Doses of adrenaline
0.5mg IM ; anaphylaxis
| 1mg : cardiac arrest
51
Length warfarin tx
| DVT
Unprovoked: 6m
Provoked: 3m
52
Causes of confusion/ behavioural changes
```
CVA
MI
Infx: LRTI/ UTI/ CNS infx
metabolic conditions
drug overdoses or poisonings.
```
53
Blatchford score criteria
Urea
Hb
sBP
Other markers; pulse, malaena, syncope, HF, LF
54
Drugs to be taken at night
Simvastatin
| Amitriptyline
55
Daily fluid, Na, K requirements
1.5 ml/kg/hr : 2-3L / day
Na: 1-2mmol/ kg
K: 1mmol/ kg
56
Typical maintenance fluids
| NBM pt
3x8h bags
2 sweet 1 salty, all with 20mmol K
5% dextrose
Normal saline
5% dex
57
Medications contra indicated in HF
Verapamil : neg inotrope
NSAIDs/ steroids : fluid retention
Pioglitazone: fluid retention
58
Beclometasone inhaler names
Clenil
Qvar
Easyhaler
59
When to gradually withdraw steroids
>40mg for >1w
>3w of tx
Recently received repeated courses
60
Deep ST depression. V1-V3 and talk at waves
Posterior STEMI
61
Posterior STEMI
| ECG changes
Deep ST depression V1-V3
| and tall T waves
62
Contraindications
| Exercise tolerance test
```
MI less than 7d ago
Unstable angina
Uncontrolled HTN/ hypotension
Aortic stenosis
LBBB
```
63
Status epilepticus tx
```
Oxygen
BM - correct blood sugar
After 5 mins: IV lorazepam 4mg
- or PR diazepam, buccal midazolam
Repeat after 10mins if no response/ recur
```
