Everything Flashcards

Question

management of atrial septal defect

Answer 1

If small and asymptomatic, monitoring may be appropriate Closed through transvenous catheter closure or open heart surgery. Anticoagulants (aspirin, warfarin and NOACs- used to reduce stroke risk in ADULTS).

Answer 2

SOB Difficulty feeding Poor weight gain Lower respiratory tract infections Mid-systolic, crescendo decrescendo murmur, splitting S2 sound.

Answer 3

Paradoxical embolism (doesn’t go to lungs, goes through defect to brain) AF/ atrial flutter Pulmonary hypertension Eisenmenger syndrome- where pulmonary pressure > systemic pressure, resulting in a right to left shunt- cyanotic

Answer 4

A hole in the membrane that separates the atria. It is a congenital condition. The foramen ovale is present in fetal circulation and allows for unidirectional blood flow (which should shut and fuse at birth). Causes a left to right shunt (pressure). The pressure is higher on the left, which overloads the right with blood and if large can cause damage to the heart if left untreated.

Answer 5

Associated with foetal alcohol syndrome More common in down syndrome children

Answer 6

Distended/abnormally swollen blood vessels within the anal canal. They either present above the dentate line (internal) or below (external). The line is 2cm above the anal verge. 1st degree-4th degree piles internal Do not prolapse Prolapse on straining/reduce spontaneously Prolapse on straining /reduce manually Permanently prolapsed/ cannot be reduced. External- lie under perianal skin. Have sensory innervation so may be painful, may be visible

Answer 7

Constipation Prolonged straining Heavy lifting Increased abdo pressure, e.g. pregnancy ascites, pelvic mass Chronic cough Age Exercise

Answer 8

Prevent and manage constipation- increase fluids, fibre intake and laxatives Analgesia, topic anaesthetic, anusol, topical corticosteroid to reduce inflammation, Rubber band ligation, infrared coagulation, injection sclerotherapy Surgical- haemorrhoidectomy, stapled haemorrohoidectomy REFER & admit Extreme pain, external present within 72hr onset Internal haemorrhoids which have prolapsed and become swollen, thrombosed perianal sepsis Refer non urgent assessment if: 3rd or 4th degree which are too large for non operative measures Perianal haematoma if <24hrs Combined internal and external H’s with severe symptoms Thrombosed haemorrhoids when bleeding is problematic or chronic irritation/lead Large skin tags

Answer 9

mid/late diastolic at the left sternal edge, heard best during inspiraiton

Answer 10

Narrowing of the tricuspid valve (right atrium to right ventricle (deoxygenated blood flow)). It commonly occurs as a late complication of acute rheumatic aortic /mitral disease

Answer 11

Irrigate wound Consider tetanus immunization Abx prophylaxis- co-amoxiclav x5d (doxycycline + metronidazole for those with penicillin allergy) Cat, human <3 day old human bites, dog bites to face foot or genitals. Involve ortho or plastics if surgical debridement is required If human- blood tests for Hep B/C/ HIV

Answer 12

Decreased blood flow to the gastrointestinal tract. It can be acute or chronic mesenteric ischaemia or colonic ischaemia. Acute mesenteric ischaemia can be divided into embolic, thrombotic and venous. Colonic is most common and has the best prognosis.

Answer 13

Foregut (stomach, duodenum, biliary system, liver, pancreas, spleen) – coeliac artery Midgut- distal duodenum to frist ½ transverse colon- superior mesenteric artery Hindgut- second ½ of colon to recum- inferior mesenteric artery

Answer 14

AKA intestinal angina- is the result of narrowing of mesenteric blood vessles by atherosclerosis. Results in intermittent abdo pain when the blood supply cannot keep up with demand. central colicky abdo pain after eating (30 mins post, 1-2hr duration), weight loss (due to food avoidance), abdominal bruits. CT Angiography Reduce risk factors- smoking, diet Secondary prevention- statin, antiplatelet Revascularisation to improve blood flow- endovascular procedure (percutaneous mesenteric artery stenting) or open surgery

Answer 15

Typically cause by rapid blockage in blood flow through the superior mesenteric artery. This is caused usually by a throbus in the arty blocking blood flow. AF is a risk factor as the thrombus from the LA mobiliszes down the aorta to the superior mesenteric artery where it becomes stuck and cuts of the blood supply. Over time ischaemia to the bowel will result in nectosis of bowel tissue and perforation. non-specific abdo pain- can go into shock, peritonitis and sepsis Contrast CT, bloods- raised lactate & metabolic acidosis Remove or bypass thrombus- endovascular or open surgery

Answer 16

Truelove and witts severity score - #bowel movements per day - blood in stool - temperature - pulse >90 - anaemia - ESR

Answer 17

Ulcerative colitis

Answer 18

the colon and rectum. NEVER goes to anus or past caecum. Caused by environmental triggers in genetically susceptible people. Most common form of IBD (UC or Crohn’s). It is relapsing-remitting. A severe exacerbation may be life threatening- worry about toxic megacolon.

Answer 19

Diarrhoea- often bloody PR bleed Increased faecal frequency and urgency Tenesmus Abdominal Pain- left lower quadrant Weight loss Pallor, clubbing Abdominal distention, tenderness or mass Extra-intestinal manifestations Aphthous ulcers, erythema nodosum, VTE, metabolic bone disease, episcleritis

Answer 20

Truelove & witt severity Bloods- FBC, CRP/ESR, TFT, kidney & LFT, U&E, ferritin, vit d, b12, TTGT, TPMT Faecal calprotectin (<59 is normal) Stool saple MC&S Endoscopy- OGD and colonoscopy (pseudopolyp) w possibly biopsy. Abdo XR- mural thickening CT if toxic megacolon concern

Answer 21

Mild-mod – 1st line mesalazine, 2nd line corticosteroids Severe – IV hydrocortisone, 2nd line –surgery- colectomy Conservative- assess disease impact, annual bloods, assess osteoporosis risk, raise awareness for colorectal cancer surveillance Remission- mesalazine, thiopurine

Answer 22

Psychological impact Toxic megacolon Bowel obstruction Bowel perforation Intestinal stricture Fistula Anaemia Malnutrition Colorectal cancer- surveillance screening pouchitis

Answer 23

A form of IBD that can affect anywhere from the mouth to the anus in a discontinuous pattern (skip lesions). Inflammation is transmural, producing deep ulcers and fissures (cobblestone). It is not continuous, forming skip lesions. Relapsing-remitting.

Answer 24

Abdominal pain (colicky) Diarrhoea Fever RIF pain Weight loss Clubbing Apthous mouth ulcer Strictures Fistula Anaemia Erythema nodosum,anterior uveitis

Answer 25

Bloods (FBC (low HB., high platelet, high WCC) , U&E, LFT (low alb), high ESR, CRP Stool MC&S (exclude infective colitis) Faecal calprotectin AXR- Endoscopy (colonoscopy) and biopsy for definitive diagnosis – cobblestone appearance Stress, stop nsaids Induce remission Steroid for acute exacerbations – oral prednisolone 40mg x7 days (then reduce) Severe Flare- iv hydrocortisone 5-asa analogue- decrease the frequency of relapse in mild to moderate disease Immunosupressants- azathioprine, methotrexate Anti-TNFa agents – infliximab, adalimubab

Answer 26

Modify risk factors- stop smoking , exercise, weight loss, HTN control, statins. Immediate symptomatic relief GTN – glyceril trinitrate causes vasolidation and helps to relieve symptoms. GTN can be repeated after 5 minutes. Beta blocker- bisoprolol 5,g OD or CCB (amlodipine 5mg) Aspirin 75mg OD Atorvastain 80mg PCI with coronary angioplast is offered to patients with proximal or extensive disease on CT coronary angiography. This involves putting a catheter into patients brachial or femoral artery, feeding up to coronary artery under xray and injecting contrast. Treated with balloon dilation and stent. CABG with severe stenosis

Answer 27

A narrowing of the coronary arteries reduces blood flow to the myocardium. During exercise there is higher demand and therefore insufficient supply of blood to meet it. This causes angina. It is stable when relieved by rest of GTN.

Answer 28

The loss of control of urination. Can be stress or urge predominant Stress- weakens of the pelvic floor and sphincter muscles. Allows urine to leak at times of increased pressure on the bladder leakage When laughing, coughing or surprised Investigations Hx- caffeine, ETOH, med, BMI (ask frequency, nighttime urination and use of pads/clothes change Bimanual Examine- prolapse, vaginitis, masses, urethral diverticulum Bladder diary Urine dipstick Post-void residual bladder volume Management Avoid caffeine, diuretic, excessive fluid, kg loss 1st line – pelvic floor exercise (8 contractions TD for 3 months) 2nd- surgical- retropubic- mid urethral tape (TVT tension-free vaginal tape) 3rd- dulpxetine (if not surgical candidate)

Answer 29

The loss of control of urination. Can be stress or urge predominant Urge- is caused by overactivity of the detrusor muscle of the bladder. Sudden urge to pass urine Not reaching bathroom in time Conscious about having access to a toilet and may avoid places without access (QoL) Investigations Hx- caffeine, ETOH, med, BMI (ask frequency, nighttime urination and use of pads/clothes change Bimanual Examine- prolapse, vaginitis, masses, urethral diverticulum Bladder diary Urine dipstick Post-void residual bladder volume Management Bladder retraining 6w Bladder stabilizing drugs; 1- antimuscarinic (Oxybutynin, tolterodine, darifenacin)

Answer 30

high velocity then refer for slit lamp assessment- risk of penetration If low velocity/ no risky hx then attempt removal if confident Else refer use topical anaesthetic and the tip of a sterile needle at an oblique angle DONT USE COTTON BUD Topical prophylactic antibiotic (chloramphenicol) Oral analgesia

Answer 31

Inflammation of the pericardium. Can be idiopathic or secondary to viruses, bacteria, fungi, MI, drugs or other reasons. Central chest pain Worse on inspiration or lying flat SOB Possible pericardial rub: due to friction between the pericardial layers, typically loudest at the left lower sternal border, best heard with the patient leaning forward ECG- tachycardia, saddle ST bloods NSAID’s (with PPI)- paracetamol Antibiotics- if caused by bacterial infection. Pericardial window surgery if symptoms persist.

Answer 32

A rare disorder characterized by widespread inflammation, weakening and damage to small and medium-sized arteries. It can affect vessels in any organ or system including kidneys, heart, intestines, muscles. This can result in hypertension, aneurysms, thrombus or necrosis. Cause unknown but an attack can be triggered by drugs, vaccines or reaction to infection e.g. strep, stap, hep b.

Answer 33

A collection of pus within the breast lined with granulation tissue, most commonly developing from acute mastitis. Hx of recent mastitis or prior breast abscess Fever &/or general malaise A painful, swollen lump in the breast with redness and erythema Management Urgent referral to secondary care for confirmation of the diagnosis and management Drainage of the abscess (USS guided needle aspiration or surgical drainage) Culture of fluid from the abscess (which will guide the choice of antibiotic) Women can still breastfeed. If painful or infant refuses they can express milk by hand or pump until able to resume as normal.

Answer 34

Conservative exercise, weight loss if relevant, heat or cold packs, joint supports, physio or occupational therapists Medical Analgesia- paracetamol, topical NSAIDs/capsaicin (if ineffective codine or oral NSAID + PPI (omepreazole). Steroid injections Surgical Joint replacement/fusion if severe.

Everything Flashcards

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