PACES 2 Flashcards
(125 cards)
1
Q
key management points to remember
A
MDT
conservative
medical surgical
2
Q
key investigation points
A
bedside
bloods
imaging
special tests
3
Q
what to remember in resp stations?
A
ABG
4
Q
mx of AF
A
- acute (48hr) and unstable = cardioversion
- rhythm control (BB or CCB)
- anticoag using CHA2DS2VASc (apixaban)
5
Q
NSTEMI vs UA
A
NSTEMI = +ve trop
UA = -ve trop
(measure trop twice)
6
Q
STEMI management
A
A-E
oxygen if needed
morphine and metoclopramide
aspirin 300 and clopi 300
GTN
if <12 hours = PCI (give heparin)
if not thrombolysis
7
Q
NSTEMI management
A
A-E
oxygen if needed
morphine and metoclopramide
aspirin 300 and clopi 300
GTN
Fondaparinux
Calculate GRACE score
8
Q
ongoing therapy in IHD
A
ACEi
BB
Cardiac rehab
statin
DAPT (aspirin lifelong and clopi for 1 year)
9
Q
angina management
A
GTN + BB/CCB + statin
consider ACEi if DM/HTN and angina
10
Q
HF investigation to remember
A
BNP
11
Q
management of HF
A
ACEi
BB
Spironolactone
SGLT-2
add ons: hydralazine, entresto, CRT
weights, manage RFs
12
Q
Severe pulmonary oedema management
A
A-E
Sit up and give oxygen
Morphine
Furosemide
GTN
CPAP
13
Q
Management of AS
A
Optimise RFs (statins, anti-HTN, DM)
Regular F/U with echo
BB if angina
Valve replacement (severe symptoms, dec EF, undergoing CABG)
Unfit = valvuloplasty, TAVI
14
Q
Management of AR
A
Optimise RFs
Regular F/U
Dec afterload = ACEi / CCB
Replace (if HF or reduced EF)
15
Q
Management of MR
A
Optimise RFs
Monitor
Control AF and anticoagulants
Dec afterload (ACEi)
Diuretics if HF
Replace valve (symptoms, dec EF)
16
Q
Pneumonia management
A
CURB-65
Antibiotics
Oxygen
Fluids
Analgesia
Chest physio
X-ray
17
Q
Bronchiectasis investigations
A
CXR (tramlines)
Spirometry
HRCT chest (dilated airways)
18
Q
Management of bronchiectasis
A
Chest physio
Antibiotics for exacerbation
Bronchodilators
Treat underlying cause
Surgery if localised disease
19
Q
Management of CF
A
MDT
Chest: physio, antibiotics (acute and prophylaxis), mucolytics, bronchodilators, vaccinate
GI: Creon, ADEK supplements, insulin, ursodeoxychokic acid
20
Q
Lung cancer management
A
MDT
Assess risk of operative mortality
Smoking cessation
NSCLC: surgery, radio, chemo
SCLC: palliative mostly, radiotherapy
21
Q
Asthma investigations
A
FBC (eosinophillia)
Inc IgE
Aspergillosis serology
CXR
Spirometry
PEFR monitoring
22
Q
Management of asthma
A
TAME
Drugs:
1. SABA
2. SABA +ICS
3. LABA + ICS
4. + LTRA
specialist help
23
Q
Investigations for COPD
A
Bloods (inc FBC)
ABG
CXR
ECG
Spirometry
Echo (PHT)
Assess severity by FEV1
24
Q
Management of COPD
A
General: stop smoking, pulmonary rehab, vaccinate (influenza, pneumococcal)
Optimise treatment for co-morbidities
Meds:
Non-asthmatic features: LABA+LAMA, add ICS if lots of exacerbations
Asthmatic features: LABA+ICS, LABA+LAMA+ICS
LTOT
25
Pulmonary fibrosis investigations
CXR and HRCT: reticulonodular shadowing, honeycombing
26
Pulmonary fibrosis management
Supportive
Stop smoking, rehab, oxygen therapy, palliative
27
Treatment of hyderaldosteroism
Bilateral adrenal hyperplasia = spironolactone
Adrenal adenoma (Conn’s) = lap adrenelectomy
28
Dyspepsia what to check
ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset progressive symptoms
Melaena or haematemesis
Swallowing difficulties
29
Dyspepsia management
Stop smoking
Stop NSAIDs
Avoid hot drinks and spicy food
OTC (antacids)
Lose weight
30
Upper GI bleeding
1. Resus (fluids, oxygen, check coagulopathy)
2. Terlipressin if variceal, prophylactic antibiotics
3. Urgent endoscopy
4. After endoscopy = IV omeprazole, NBM, daily bloods
31
Scoring systems for UGI bleed
Glasgow blatchford
Rockall
32
Cirrhosis investigations
Bloods (FBC: dec WCC, dec platelet, inc LFTs, inc INR, dec albumin)
Find cause
33
Cirrhosis management
General: good nutrition, ETOH absence, colesytramine
Screening: HCC= US +AFP, Varices = endoscopy
Treat specific cause
Treat decompensation (acute, coag, encephalopathy, SBP)
Child Pugh Grading
34
Alcoholic Hepatitis
Check CAGE
Stop ETOH, withdrawal, Pabrinex, optimise nutrition
Check LFT/U&E/INR, manage complications
35
NAFLD investigations
BMI, glucose, fasting lipids, LFTs, biopsy
36
NAFLD management
Lose weight,
Control HTN, DM, lipids
37
PBC/PSC
Symptomatic: priorities (colestramine), diarrhoea (codeine)
Specific: ADEK vitamins, ursodexoycholic acid
38
IBD extra-articular
Skin: clubbing, erythema nodosum
Eyes: arthritis
Joints: arthritis
HPB: PSC, gallstones
39
Chron’s pathology
Skip lesions
Rose thorn ulcers
Cobblestoning
String sign of kantor
40
Chronic pancreatitis management
Drugs: analgesia, CREON, ADEK vits, DM
Diet: no ETOH, dec fat, inc carb
Surgery: pancreatectomy
41
Criteria for AKI
RIFLE criteria
42
chronic renal failure management
general: reverse reversible causes, stop nephrotoxic drugs
lifestyle: exercise, healthy weight, stop smoking, fluid/phosphate retention
CV risk: statins, treat DM
HTN: target <140/90 (give ACEi)
Anaemia: EPO
Bone disease: phosphate binders
43
renal transplant complications
post-op: bleeding, graft thrombosis, infection
hyderacute rejection: ABO incompatibility
acute rejection (<6mo)
chronic rejection (>6mo): interstitial fibrosis
SEs of immunosuppression
CVD (HTN, atherosclerosis)
44
PCKD management
General: inc water, dec Na
monitor U&Es, BP
genetic counselling, MRA for berry aneurysms
medical: treat HTN and infections aggressively
surgical: cyst removal, nephrectomy
45
stroke management
urgent CT
aspirin 300mg
consider thrombolysis <4.5 hrs
consider thrombectomy
46
primary prevention of strokes
- control RFs (HTN, inc lipids, DM, smokers)
- consider lifelong and anti-coag in AF
- carotid endarterectomy if symptoms 70% stenosis
- exercise
47
secondary prevention of strokes
- RF control = start statin after 48 hours
- aspirin/clopi 300mg for 2 weeks, then clopi for 75mg
- carotid endarterectomy if good recovery and ipsilateral stenosis >70%
48
stroke rehab
- MDT (OT, physio, SALT, dietacian, neurologist)
- eating (consider swallow)
- neurorehan
- DVT prophylaxis
- sores
49
TIA management
1. anti-plt therapy (300mg for 2 weeks, then 75mg/d)
2. cardiac RF control
3. specialist referral to TIA clinic (MRI)
50
subdural management
irrigation/evacuation via burr hole craniostomy
51
extradural management
neuroprotective ventilation
consider mannitol
craniectomy for clot evacuation
52
GCS verbal
1: none
2: sounds
3: words
4: confused
5: orientated
53
Parkinson's management
MDT
Assess disability
Physio
Depression screening
Medical: L-DOPA, MOA-B inhibitors, Da agonists
+ COMT (lessen end of dose)
+ Quietapine (disease-induced psychosis)
+ Citalopram (depression)
54
MS management
MDT
acute attack: methylpred
preventing relapse: IFN-beta, natalizumab
symptomatic management
55
poor prognostic features of MS
- older
- male
- motor signs at onset
- many relapses
- many MRI lesions
56
Charcot-Marie Tooth investigations
PMP22 gene mutation
nerve conduction speed
57
CMT management
supportive
physio, podiatry, orthoses
58
MND management
MDT
Riluzole
Supportive: drooling (amitriptyline), dysphagia (NG feed), resp failure (NIV), spasticity (baclofen)
59
OA management
cons: wt loss, alter activites, physio, walking aids
med: analgesia, joint injection
surg: replacement
60
RA management
cons: rheum, regular exercise, PT, OT
med: monitor with DAS28, DMARDs, steroids, NSAID
manage CV risk
61
conservative management of gout
lose weight
avoid prolonged fasting and ETOH excess
62
osteoporosis investigations
DEXA scan
FRAX score
63
management of osteoporosis
cons: stop smoking, dec ETOH, weight bearing, Ca/Vit D, falls prevention
med: bisphosphonates, supplements
64
Pre-op checks
OP CHECS
Operative fitness (cardio resp co-morbidities)
Pills
Consent
History (conditions, complications of anaesthesia)
Ease of intubation
Clexane (DVT prophylaxis)
Site
65
oesophageal Ca management
MDT
Surgical (25%): oesophagectomy (2 or 3 stage approach)
Palliative: stenting, analgesia, radiotherapy
66
perforated peptic ulcer management
1. Resus --> fluid
2. NBM
3. Analgesia
4. Abx: cef and met
5. NGT
consider laparotomy if defect needs repairing
67
biliary colic management
cons: hydrate, NBM, opioid analgesia
surg: lap chole (try for same admission)
68
ascending cholangitis management
Cef + Met
ERCP
69
pancreatitis management
cons: fluid resus, NBM, NGT, analgesia (opioid)
interventional: ERCP if dilated ducts secondary to gallstones
70
chronic pancreatitis management
- lifestyle: no ETOH, dec fat, increase carb
- drugs: analgesia, CREON, ADEK, DM Rx
71
appendicitis management
fluids, NBM
abx (cef and met)
analgesia
operation
72
acute severe UC management
resus: IV hydration, NBM
hydrocortisone
LMWH
monitoring
improvement = switch to oral therapy
73
what additional thing would you add to management in Chron's?
dietician review
74
mesenteric ischaemia management
fluids
Abx
LMWH
laparotomy
75
anal cancer management
- most chemoradiation
- surgery reserved for tumours that fail to respond to radiotherapy/ GI obstruction/ small anal margin tumours
76
definition of hernia
protrusion of a viscus through walls of its containing cavity into abdominal position
77
inguinal hernia management
non-surgical: control RFs of cough, constipation, lose weight, truss
surgical: tension free mesh
78
complications of hernia repair
early = haematoma, infection, intra-abdo injury
late = recurrence, chronic groin pain
79
general aspects of breast Ca management
MDT
1-2 = surgical
3-4 = chemo, palliation
80
surgical management of breast Ca
WLE + radiotherapy or mastectomy
sentinal node biopsy +/- axillary clearance
81
breast cancer surgical complications
haemotoma
frozen shoulder
long thoracic nerve palsy
lymphodema
82
systemic breast cancer management
radio
chemo
endocrine therapy
biological therapy
83
main sx and management of duct papilloma
bloody discharge
excise
84
management of phyllodes
WLE
85
claudication values of ABPI
0.6-0.8
86
fontaine classification
asymp
intermittent claudication
ischaemic rest pain
ulceration/gangrene
87
chronic limb ischaemia management
cons: inc exercise, stop smoking, wt loss, foot care
med: RFs (BP, lipids, DM), anti-plt, analgesia
surg: bypass, endarterectomy
88
acute limb ischaemia management
NBM
rehydration
analgesia
unfractionated heparin
complete occlusion: yes (embolectomy/bypass), no (angiogram and observe)
89
venous ulcer management
- refer to leg ulcer communtiy clinic
- optimise RFs (nutrition, smoking)
- analgesia
- 4 layer graded bandaging (if ABPI >0.8)
90
4 R's of fracture management
1. Resus (ATLS, neurovasc, X-rays)
2. Reduce (closed vs open reduction)
3. Restrict (non-rigid, plaster, ex-fix, internal fixation)
4. Rehab (OT, PT)
91
fracture complications
Imm: NV damage, visceral damage
Early: compartment syndrome, infection, fat embolism
Late: AVN, problems with union, complex regional pain syndrome
92
Hip fracture appearance
short, externally rotated
93
Garden classification of intracapsular fractures
1. incomplete, undisplaced
2. complete, undisplaced
3. complete, partially displaced
4. complete, completely displaced
94
management of 1 and 2
ORIF with cannulated screws
95
management of 3 and 4
young = ORIF with screws
55-75 = THR
>75 = hemi
96
OA management
MDT
cons: lifestyle, dec wt, inc exercise
physio for muscle strengthening and OT
med: analgesia, joint injection
surg: arthroscopic washout, replacement
97
L5 nerve root compression
foot drop
weak inversion
dec sensation on inner dorsum
98
S1 root compression
weak plantarflexion and eversion
loss of ankle jerk
dec sensation over sole of foot and back of calf
99
management of Dupuytren's
cons: physical exercises
fasciectomy
100
stoma exam findings
exam standing up
patient = well, no acute abdo
abdomen = scar from stoma formation operation
stoma = site, surrounding skin, opening, contents, pt coughs
palpate = abdo around stoma
101
definition of a stoma
artificial conduit between internal viscera and outside of skin
102
indications of end colostomy
AP resection
Hartmann's
103
indications of loop colostomy
- divert faecal load from newly formed distal anastomosis
- palliative in Ca patient with distal obstruction
- bowel decompression
104
indications of loop ileostomy
- anterior resection (bowel rest before reversed)
- following panprotocolectomy who have ileo-anal pouch formed
105
indications of end ileostomy
following panprotocolectomy when can't anastomose
106
complications of stoma
early: surg complication, ischaemia, high output, stomal retraction
late: parastomal hernias, prolapse, obstruction due to adhesion
107
indications for stoma
- exteriorisation
- diversion
- decompression
- feeding
- lavage
108
any acute station
A-E approach
109
acute abdo key investigation
amylase
110
important questions in endo history
- menstrual cycle
- headache and vision
- muscle weakness
- weight changes
- urinary symptoms
- sweaty/hypoglycaemia symptoms
- blood pressure
- libido
111
important screening questions
- headache
- changes to vision
- SOB
- nausea/vomiting
- chest pain
- palpitations
- abdo pain
- change in bowel habit
- change in urinary symptoms
- back pain
- leg swelling
- leg weakness
- any change in sensation
- FLAWS
( rashes)
112
what to give in any chronic lung condition
- vaccinations
- chest physio
113
c spine exam
- look
- feel (trapezius, C7 up to C2) - put hand on pt forehead
- move (left to right, up and down, side to side)
- special test (Spurling = extend neck, tilt to one side, push down)
- neuro (power, tone, sensation, reflexes)
114
breast screening
50-71 every 3 years
115
common breast mets
liver
lung
brain
bones
116
bowel screening
60-74 every 2 years
117
what to do in vascular ?
radial femoral delay
118
views of CT scan
axial
coronal
119
extra bits of hand exam
hands on table - Duputyrens
Finklestein test
120
appearance of blood and oedema in CT scan
- blood is high attenuation
- associated oedema is low attenuation
- check mass effect
121
location of descending aorta on scan?
more towards the back
122
look part of spinal exam
- gait
- inspect from behind and side
123
feel part of spinal exam
- spinous processes and sacroiliac joints
- paraspinal muscles
- also schober's test
124
move part of spinal exam
- lateral flexion (arm down leg)
- lumbar flexion and extension
- cervical spine movements
- thoracic rotation
125
special tests in spine
- Schober's test
- femoral nerve stretch test (pt prone, passively flex knee and extend hip)
- straight leg raise (pt supine, lift leg to full flexion then passively dorsiflex foot)
