Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

- FINALS: Presentations > Lecture Notes > Flashcards

Lecture Notes Flashcards

1
Q

3 step Mx to high BMs in T2DM

A
  1. Review drug chart + oral hypoglycaemics
  2. Check ketones if BM >12 (more than 2x in 24hrs)
  3. Ask diabetes specialist nurse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mx of T2DM on steroids

A

Causes hyperglycaemia

May have high BM pattern

Double dose oral hypoglycaemics

OR

add 2nd agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Target BM in hospital

A

6-10 (4-12 acceptable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Insulin dependent T2DM

A

Usually 2x daily regime Increased insulin by 10%

Monitor BMs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

T1DM -Mx if hypos overnight?

A

Reduce basal insulin (night dose) - Decrease by 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Short Acting Insulin

  • Examples
  • Mode of Action
  • Use?
A

Act-rapid, Humilin-S

Onset: 30mins

Peak: 2-4 hours

Lasts: 8 hours

Use: IV in variable rate insulin
Mx of DKA, high K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rapid Acting Insulin

  • Examples
  • Mode of Action
  • Use?
A

Novarapid/humalog

Onset: 15 mins Peak: 40 mins

Lasts: 4 hours

Use: bolus insulin in T1DM (before meals/correction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mixed Insulin

  • Examples
  • Mode of Action
  • Use
A

Rapid + Intermediate Number = percentage of rapid acting insulin e.g. Novomix 30

Used in BD dosing (e.g. T2DM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Long Acting Insulin

  • Examples
  • Mode of Action
  • Use?
A

Lantus, glargine, degludec

Onset: 2 hours Offset: 24-42 hours (brand dependent)

Often no real peak
Usually OD basal dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Emergency Op in T1DM Mx

BM Target?

A

NBM
Continue basal insulin
Stop rapid acting
Start VR infusion using table

BM target = 6-10mmol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Indications for VR infusion

A

T1 DM - If missing 1 meal due to fasting - No background insulin

T2DM

  • If missing 1 meal and BM >12
  • Poor control with HbA1c >49
  • Emergency surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a VR infusion?

A

50 units act rapid in 49.5 ml normal saline

Run alongside Dex/sal infusion

Continue basal insulin in T1DM (at 80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T1DM Pre-Op

A

Admit night before

First on list

Stop short acting insulin

Start on VR infusion
80% basal insulin (DO NOT STOP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T2DM Pre-Op

A

Omit oral hypoglycaemics (day before)

VR infusion if BM >12

If insulin dependent: - Stop insulin, give VR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

VR infusion? Post Op

A

Stop VR 30 mins after giving short acting insulin

Increase basal dose to 100% when E+D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mnemonic for Venturi’s

A

Barry White Yearns for Right-wing Government

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Colour, % and L of venturi’s

A 
Blue = 24% = 2L 
White = 28% = 4L 
Yellow = 35% = 8L 
Red = 40% = 10L 
Green = 60% = 15L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Right Hemicolectomy

A

Ascending colon removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anterior Resection

A

Sigmoid colon removed

Proximal Rectum removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Abdominal-Perineal resection

A

Sigmoid colon
Rectum and anal canal removed

Anus is closed, colostomy created

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hartmann’s

A

Emergency - Sigmoid and rectum removed

Colostomy made
Can be reversed at a later date

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sub-total colectomy

A

Asc, trans, desc and sigmoid colon removed

Anastamosis with rectal stump to create storage pouch

Good as avoids stoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Intra Op Complications

A

Bleeding
Damage to tissue
Anaesthetic risk
Allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Post Op Complications 1-3 days

A

Bleeding
Atelectasis
MI/Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Post Op Complications 3-7 days
Infection - Wound, chest, urine Anastamotic Leak VTE
26
Post Op Complications >1 month
Hernia Chronic Pain Recurrence
27
Requesting Scans? | - Criteria
What question are we asking? How will that change management?
28
MRI Scans | - Co-morbidities to bear in mind?
MRI - pacemaker, metal fragments (eye) Orthopaedic plates/replacements ETC ok as not magnetic material
29
CT/AXR | - Co-morbidities to bear in mind?
Do PT in woman of childbearing age
30
CT with Contrast | - Co-morbidities to bear in mind?
Check eGFR Review Meds e.g. metformin May need to run IV fluids.
31
PRN Meds for Acute Abdo patient
Paracetamol Weak opiate - codeine Strong Opiate - Oramorph Anti-emetic - cyclazine
32
Acute Abdo Bloods
FBC, UEs, LFTs, Clotting, G+S, VBG CRP, Amylase PT ABG or cultures if indicated.
33
Gallbladder disease and Charcot's Triad
Biliary Colic = RUQ pain Cholecystitis = RUQ and fever (low grade) Cholangitis = RUQ, high fever and jaundice
34
Amylase in acute Abdo
Double normal = diagnostic of pancreatitis Raised <2x = PUD, AAA, gastritis
35
Glasgow Scoring | PANCREAS
``` PaO2 <8 Age >55 Neutrophils >15 Ca <2 Renal: urea >16 Enzymes: LDH>600, AST >2000 Albumin <32 Sugar >10 ``` Score 3+ in first 48 hours = significant pancreatitis
36
Examination in Surgery - Heart - Lungs - Testicular
Heart - Murmur = need ECHO - AF= think bowel infarct Lungs - Decreased air entry: effusion or infection Testicular - In all men with lower abdo pain: must rule out torsion!
37
Acute Indications for Dialysis
A = Acidosis pH <7.2 E = Electrolyte e.g. refractory high K+ I = intoxication = lithium, anti-freeze, barbituates O = overload, fluid not responding to meds U = Uraemia = pericarditis/encephalopathy OR lethargy, decreased appetite, metallic taste
38
Acute Mx of Hyperkalaemia
30ml of 10% calcium gluconate 10U actrapid in 50ml 50% glucose Salbutamol 5mg neb
39
Follow Up Mx of high K+
Treat cause Give fluids Review Nephrotoxics
40
Pre-Renal AKI
Decreased intake | Fluid loss
41
Renal AKI
IV Contrast Toxins Vasculitis Do Urine Dip for BLOOD and PROTEIN
42
Post-Renal AKI
Usually urological cause - obstruction, UTI Urine Dip Bladder scan Refer urology
43
Fluid Status Assessment
BP, HR, CRT, JVP Urine output Mucous membranes and skin turgor FLUID BALANCE CHART
44
STOP AKI
treat SEPSIS avoid TOXINS OPTIMISE BP PREVENT harm
45
Haematemesis Hx
When they last ate or drank (for endoscopy) BG sx: Weight loss/dysphagia/change of bowel habit = cancer Dyspepia = gastritis, GORD Abdo pain
46
SHOCK: what impairs physiological response?
Age Drugs e.g. beta blockers CV co-morbidity leads to organ failure as cannot increase HR or BP
47
Drug Hx in Haematemesis
NSAIDS? ulcer Antiplatelets: clopidogrel, aspirin, ticagrelor, dipyridamole Anticoagulants: warfarin, DOAC
48
Post GI Bleed Complications
MI Stroke Renal Failure Intestinal/liver ischaemia
49
Glasgow Blatchford
Do they need endoscopy? Used in A+E to discharge patients Score 0-1 = OGD endoscopy
50
Rockall Score
Post endoscopy, with diagnosis Co-morbidities = very high scoring e,g, organ failure, malignancy
51
Hb and Blood transfusion in GI bleed
Hb >100 = do not transfuse Hb <70 = aim for 70-90 Hb, unless anginal sx (can give more)
52
Pharmacotherapy for ulcer vs variceal bleed
Ulcer: - IV PPI post endoscopy Varicieal - Terlipressin, can be given in A+E - Gastro would give to any pt with stigmata of liver disease O/E, as likely to be hepatic cause for bleed
53
Chronic Liver Disease Definitions Comp vs De-Comp
Compensated - peripheral stigmata of liver disease, functioning well, normal synthetic function Decompensated - Ascites, encephalopathy, jaundice, varices
54
Acute Liver Failure Definition
Jaundice, encephalopathy +/- ascites NO peripheral stigmata of liver disease
55
Causes of Acute Liver Failure
Drugs: Paracetamol OD Pregnancy (HELLP) Budd-chiari (hepatic vein thrombus) Virus
56
Ix in Acute Liver Failure
Pro-thrombin time - PT MOST IMPORTANT IN LIVER FAILURE If >30 secs, contact gastro >50 secs = liver unit AST may be in 1000s, irrelevant
57
Causes of Chronic Liver Failure
Alcohol Fatty liver disease Viral hepatitis (IVDU, abroad = Hep C) Rare
58
Fluids in Liver failure
Avoid normal saline as will follow osmotic gradient and go straight to abdomen, increase ascites Only give in resus scenario Give 5% dex
59
Why do liver patients decompensate?
Infection - UTI, chest, SBP Medications - opiates, diuretics AKI - Hepato-renal syndrome Disease progression - Increased alcohol intake, do not cease drinking GI bleed
60
Child Pugh Score
Albumin PT Bilirubin Ascites Encephalopathy Grade A, B, C (most serious)
61
Viral causes Acute LF
Serology for Hep B and C
62
USS and Dopplers in Acute LF
Rule out hepatic vein thrombus (budd chiari)
63
Immune Causes Acute LF
IgA - Alcohol IgG - Autoimmune hepatitis - ASMA IgM (M disease) - Primary biliary cirrhosis - Anti- mitochondrial antibody
64
Genetic Causes Acute LF
Wilson's disease Haemochromotosis Alpha a1 antitrypsin
65
Causes of Metabolic Acidosis
1. Lactic = tissue hypoxia 2. Keto = DKA 3. Renal = high urea and creatinine
66
BTS Oxygen Guidelines | - Critically ill?
15L NRB Mask, 60% 02
67
BTS O2 | - Seriously ill
Mod O2 if hypoxic 2-6L via Nasal canula/face mask
68
BTS O2 - COPD/scholiosis/obesity hypoventilation - Risk of loss of resp drive if oxygen toxicity
CONTROLLED O2 THERAPY Venturi mask and titrate
69
Judgement of PaO2
Below 8 = RESP FAILURE Work out if low % of oxgen inspired -10 Therefore: if patient on 15L NRB mask (60%) - PaO2 should be at least 50
70
PE: ECG
Sinus tachy, fast af RBBB (right heart strain) S1Q3T3
71
PE: ABG
Low PaO2 Low CO2 - due to increased work of breathing
72
PE: CXR
May be normal | May have small pleural effusion
73
Causes of COPD in a young person?
Heroin smoking | Alpha A1 anti tripsin
74
Secondary pneumothorax
Known resp. disease >50 with smoking hx
75
What is the Management? COPD patient on 15L NRB Mask ``` ph 7.29 PaCO2 7.1 PaO2 8.9 HCO3 28 Base Excess +1 ```
Oxygen toxicity TRY ON CONTROLLED O2 Therapy e.g. venturi mask
76
What is the management? COPD patient on 28% venturi mask ``` ph 7.29 PaCO2 7.1 PaO2 8.9 HCO3 28 Base Excess +1 ```
Need NIV! Indication for NIV = resp acidosis NOT hypoxia
77
NIV Principles
Biphasic pressure Inspiratory (IPAP) and expiratory (EPAP) Difference between IPAP and EPAP = increase tidal volume and decreased CO2
78
Indications for NIV
Resp Acidosis On controlled O2 therapy Recieved medical rx
79
Contraindications for NIV
Pneumothorax | - Will cause tension
80
CPAP
Continuous Positive airway pressure Used to splint open upper airway in Obstructive sleep apnoea
81
Life-Threatening Asthma
33 92 CHEST <33 Peak flow <92 O2 sats ``` Cyanosis Hypotension Exhaustion Silent Chest Tachycardia ```
82
Near Fatal Asthma
33 92 CHEST +++ HIGH CO2 LEVELS Need ICU involvement and potentially ventilation
83
Criteria for Asthma discharge
Off Nebs Peak flow >75% best Check - Inhaler technique - PEFR meter and diary - Self management plan
84
RED FLAGS Headache
Thunderclap - SAH Positional = raised ICP Malaise = meningitis Weight loss = Cancer
85
SNOOP 4Ps
Systemic features Neuro: arm weakness Onset? sudden - bleed Older: >50 years Pattern - Getting worse - Precipitated by valsalver - Papilloedema
86
Migraine Criteria
>5 episodes with 2 of: - unilateral - pulsating - worsened by moving - N+V - photophobia
87
Seizures? What medications cause?
Meds that cause long QT - Anti-histamines - Anti-psychotics - Anti-depressants - Anti-microbials - Anti-emetics - Anti-arrhythmics Not taking normal Anti-Epileptics
88
Epilepsy: Psychiatric
Ask re mental health problems Psychogenic seizures more common
89
Epilepsy: Lifestyle
DRIVING, alcohol, relationships, occupation
90
Epilepsy: Pregnancy
DO NOT PRESCRIBE SODIUM VALPROATE if Female <50 years
91
Epilepsy: Ix
DO AN ECG (look for long QT) MRI for mesotemporal sclerosis EEG only if primary generalised seizures (usually children)
92
Tests for Bradykinesia
Touch each finger to thumb in turn Finger tapping together (slower and smaller) Foot tapping on floor
93
SE Levo-dopa
Reduced efficacy Freezing Disinhibition - gambling etc.
94
Differences between Myesthenia Gravis and Guillain Barre
GB = Sensory loss, myesthenia does not GB = progressive, Myesthenia = worse with fatigue ``` GB = demyelination after viral illness Myesthenia = autoimmune to Ach Receptor ```
95
Causes of Pancreatitis I GET SMASHHHED
I - Idiopathic G - Gallstones E - Ethanol (alcohol) T - Trauma ``` S - Steroids M - Mumps A - Autoimmune S - Scorpion/Spider bite H - High PTH H - High Lipids H - High Calcium E - ERCP D - Drugs ```
96
Ewing's Sarcoma
Rare, 5-15 years lytic bone lesion with periosteal rxn 'onion skinning'
97
Chrondrosarcoma
Middle aged bone destruction and calcification rx with excision and chemo
98
Osteosarcoma
Young people | Comomn
99
Direct inguinal Hernia
Through abdo wall, not ing. canal Medial to inguinal ligament Alway acquired RF: smoking, obesity, heavy lifting Rarely strangulates
100
Indirect Inguinal Hernia
Through canal inyo scotum Young active men and prem babies Hernia above and medial to pubic tubercle Descent into scrotum on standing or coughinh
101
Hydrocele
Fluid in tunica vaginalis Tense, painless, fluctuant Transilluminates In adult, USS to rule out pathology
102
Varicocele
Left sided Bag of worms, heavy and dragging Harmless, supportive underwear
103
Hashimoto Goitre
Enlarged, firm, non-tender
104
MEN T1
Pituitary pancreas parathyroid
105
MEN T2 + T3
Pheochromocytoma parathyroid thyroid ca Type 3 = with marfans as well
106
Cystic Hygroma
benign lymph proliferation in post. triangle Transillumates brightly
107
Ant. Cord Syndrome
Loss of pain temp and motor Lower and upper limbs (worse in lower) Bad prognosis
108
Central Cord Syndrome
Weakness of upper limbs, not lower Good prognosis Older people with cervical spondylosis
109
Jones Fracture
5th metatarsal
110
Lis-Franc Fracture
2-4th metatarsal with dislocation
111
March Fracture
Stress/hairline fracture Callus on Xray
112
Snellen Test?
Visual Acuity
113
Pupillary light reflex | RAPD
Damaged optic nerve e.g. optic neuritis
114
Ischihara Plates
Colour vision
115
Amsler Grid
Straight lines = curved Sign of macular degeneration
116
Schirmer's Test
Tear production <5mm = abnormal e.g. dry eyes in sjrogens
117
Fluroscein Dye
Corneal ulcer, Dendritic shows green
118
H Test
CN III, IV and VI
119
Tonometry
Raised intra-ocular pressure (IOP) in glaucoma
120
Daily Na2+ requirements
1-2mmol/kg
121
Daily K+ requirements
0.5-1mmol/kg
122
Daily Fluid requirements
25-30ml/kg
123
Daily Fluid requirements - CCF - Small
20-25ml/kg

- FINALS: Presentations (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions