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PACES Flashcards

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1
Q

Cardio PACES cases

A 
AS
AR
MS
MR
Valve replacement
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2
Q

Resp PACES cases

A

COPD
Pneumonectomy
Fibrosis
Pleural effusion/malignancy?

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3
Q

Gastro PACES cases

A

Stoma
Liver transplant
Kidney transplant
Abdo scar from resection or Ca/IBD

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4
Q

Neuro PACES case

A 
Stroke
Bells palsy
Myasthenia
Pakinson's
MS
MND
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5
Q

COPD examination findings
Peripheral inspection
Specific inspection
Chest

A

Inhalers, peak flow, meter, nebuliser
Pursed lip breathing, cushingoid
Tar staining, asterexis, central cyanosis, flushing
Barrel chest, ↓cricosternal dis, ↓ expansion, ↓ breath sounds, exp wheeze, prolonged exp phase

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6
Q

Bronchitis

Emphysema

A

Cough productive of sputum most days for >3mnths on .2 years

Histological destruction of alveolar destruction

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7
Q 
COPD Ix
Bedside
Spirometery
Blds
Imaging
A 
Bedside
PEFR, Sputum MC+S
Spirometery
Obstructive, ↑TLC+RV, FEV1 <80% FEV1:FVC<0.7, ↓transfer factor
Blds
FBC ↑HB ↑WCC, ABG, CRP, alpha1 antitryp 
Imaging
CXR hyperexpansion flat diaphragm, PTX
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8
Q

COPD classification

A

GOLD

mMRC dyspnoea score, airflow limitation, freq of exacerbation

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9
Q

Airflow limitation

A

Mild: FEV1>80%
Mod: FEV1 50-79%
Severe: 30-49%
Very severe: FEV1 <30%

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10
Q

mMRC dyspnoea score

A
  1. SOB vig exercise
  2. SOB mild exercise
  3. walks slowly or stops for breath
  4. Stops after short distance
  5. SOB on dressing
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11
Q

COPD Mx
General
Medical
Surgical

A

General
Smoking cessation, MDT, pulmonary rehab, co-morbidities
Medical
SABA, LABA/LAMA, LABA+ICS/LAMA, LTOT, exacerbation pack,.
Surgical
Lung reduction, bullectomy, recurrent PTX

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12
Q

COPD acute Mx

A 
Sit up, 24% O2 venturi mask, aim for SpO2 88-92%
SABA 50mg nebulised, Ipratropium 0.5mg
IV hydro, PO pred
Abx
NIV if no response, BIPAP pH <7.35
Invasive vent <7.2
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13
Q

Asthma Examination findings

A

Mostly normal, Inhalers, wheeze,

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14
Q

Asthma definition

A

Episodic reversible airway obstruction due to bronchial hyperactivity to a variety of stimuli

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15
Q

Asthma Ix

A 
Bedside - PEFR
Blds - IgE, ABG acute
CXR - Hyperexpansion
Spirometery - Obstructive
PEFR monitoring/diary
Atopy - skin prick testing, RAST
Fractional inhaled silver nitrate
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16
Q

Asthma Mx

A

General - TEAM technique inhaler, educate, avoid triggers, monitor peak flow

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17
Q

Acute asthma classification

A

Severe
PEFR<50%, can’t complete sentence, RR>25, HR>110
Life threatening
PEFR<33%, SpO2<92%, Cyanosis, hypotension, exhaustion, silent chest, Tachy arrhythmias

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18
Q

Acute asthma Mx

A

Sit up, 100% O2 non rebreathe mask SpO2 92-94%
Salb nebs 5mg, Ipratropium 0.5mg, Hydro IV/Pred PO
ITU, MgSO4, Neb salb every 15mins
Improvement = Pred PO 5 days, PEFR
No improvement =Neb Salb, Ipratropium, Aminophylline, Invasive ventilation
Monitor
PEFR, SpO2, ABG

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19
Q

Fibrosis examination findings

A

General
Clubbing, cushingoid
Evidence of cause
RA hands/nodules, SS microstomia sclerodactyly, SLE rash, Sarcoid

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20
Q

Fibrosis causes
APEN
STAIR

A

Upper
Aspergillosis, pneumoconiosis, ExAA, negative sero arthropathy, TB
Lower
Sarcoid, Toxins, Asbestosis, IPF, Rheum
Toxins
Bleomycin, amiodarone, nitorfurantoin, sulfalazine, Methotrexate

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21
Q

Fibrosis Ix

A

Bedside - PEFR, ECG
Bld - ABG T2RF, Sarcoid seACE Ca2+
Spirometery - restrictive
Imaging - CXR reticulonodular shadowing, ↓lung volume, HRCT honeycombing

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22
Q

Fibrosis Mx

A 
General
MDT, Stop smoking, Pulmonary rehab
Med
Rx specific causes = steroids for Sarcoid/EAA/connective tissue
Surgery = Lung Tx for IPF
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23
Q

Pleural effusion Classification

A 
Transudate vs Exudate
Exudate >35
Infx, Ca, inflammation, PE, trauma
Transudate <25
CCF, ↓albumin, renal failure

*Between = lights criteria

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24
Q

Pleural effusion Ix

A

Sputum - MC+S
Imaging
CXR homogenous opacification w/ fluid level
US for pleurocentesis

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25
Pleural effusion Mx
Rx cause | Drainage
26
Complications of Lung Ca
SVCO - plethoric face, dilated neck veins, stridor RLNP - hoarse voice Pancoast tumour - Horner's Dermatomyositis
27
Lobectomy vs Pneumonectomy Scar Ex findings
Lateral thoracotomy, healed chest drains Reduced expansion, dull percussion, Pneumonectomy = absent breath sounds throughout Lobectomy = reduced breath sounds focally
28
Indications for Lobectomy/Pneumonectomy
90% non-disseminated bronchial carcinoma Bronchiectasis Fibrosis COPD lung reduction
29
``` Pakrinson's examination findings Inspection Arms Eyes Extras ```
Inspection - asymmetrical resting tremor 5Hz worsened by ignorance, hypomimia Arms - Tone cogwheel rigidity Eyes - Nystagmus, saccades slow initiation and movement Extras - Glabellar tap, slow initiation, shuffling, Post Hypot
30
Parkinson's disease causes
``` Idiopathic Parkinson's plus Infarcts in substantia nigra Wilson's Drugs: metoclopramide+neuroleptics ```
31
Parkinson's triad
Akinesia Rigidity Tremor
32
``` Parkinson's Hx Autonomic ADLs Sleep Complications ```
Autonomic - postural hypotension, urinary ADLs - Handwriting, buttons Sleep - Turning in bed, insomnia Complications - Depression, drug SE
33
Parkinson's Ix
Blds - Caeruplasmin ↓Wilsons Imaging CT - exclude vascular cause DaTscan - Ioflupane, visualisation of substantia nigra
34
Parkinson's Mx
``` General - MDT, Assess disability, physio, depression screening Medical L-Dopa Carbidopa Da agonists - bromocriptine, cabergoline MAO-b inhibitors - Selegiline COMT inhibitors - Tolcapone Amantadine ``` Deep brain stimulation
35
Parkinsonism features | TRAPPS PD
``` Tremor Rigidity Akinesia Postural instability Postural hypotension Sleep disorders Psychosis Depression ```
36
L-DOPA SE | DOPAMINE
``` Dyskinesia On-off phenomena Psychosis ABP↓ Mouth dryness Insomnia N/V EDS excessive daytime sleeping ```
37
Other causes of Parkinsonism Parkinson plus syndrome PMLC
Progressive supranuclear palsy - MSA - cerebellar ataxia Lewy body dementia - visual hallucinations Corticobasilar degeneration - unilateral parkinsonism esp rigidity
38
Types of tremor
Resting Intention Postural Benign essential tremor
39
Cerebellar syndrome DANISH Manifesting syndrome caused by lesion of cerebellum
``` Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech Hypotonia ```
40
Cerebellar syndrome | DAISIES
``` Demyelination Alcohol Infarct - brainstem stroke SOL - Schwannoma Inherited - Wilson's, Freidrich's ataxia Epilepsy medication e.g. phenytoin System atrophy multiple ```
41
``` Cerebellar syndrome Mx general and specific M E I S W ```
``` General - MDT, CV risk, ↓ETOH MS - methylprednisolone ETOH - Thiamine Infarct - consider thrombolysis Schwannoma - gamma knife, surgery Wilson's - penicillamine ```
42
``` UMN signs Inspection Gait Reflexes Tone Power ```
``` Inspection - Walking aid, fixed flexion deformity Gait - circumducting/scissoring Tone - ↑ Reflexes - ↑ Power - ↓ ```
43
Mixed UMN+LMN | MAST
MND Ataxia Freidrich's Subacute combined degeneration of the spinal cord Taboparesis
44
Paresis | Plegia
Weakness | Paralysis
45
Lower limb paraparesis
Bilateral MS, Cord compression, Cord trauma, Cerbral palsy Unilateral Stroke, MS, SOL, Cerbral palsy
46
Cord compression features
Radicular pain Weakness Sensory level Sphincter disturbance
47
Causes of cord compression | TIMD
Trauma Infx - abscess, TB Malignancy Disc prolapse - aboveL1/l2
48
Cord compression Ix Mx
Ix - MRI definitive Mx Neurosurgical emergency - decompressive/I+D Dexamethasone IV
49
Cauda equina syndrome features
Back pain, radicular pain down legs Weakness Sensation - saddle anaesthesia Sphincter disturbance - poor anal tone
50
Syringomyelia definition
Collection of CSF in syrinx classicly in the cervical cord leading to pressure on anterior tracts (spinothalamic)
51
Syringomyelia features
Cloak distribution causing Loss of pain and temperature Weakness
52
Acute stroke definition
Rapid onset focal neurological deficit of vascular origin last >24hrs
53
Stroke pathogenesis
Ischaemic 80% | Haemorrhagic 20%
54
Stroke classification
Bamford classification
55
Bamford classification
TACS Hemiparesis/hemisensory deficit, Homonymous hemianopia, higher cortical dysfunction PACS 2/3 TACS criteria usually eyes and speech POCS Cerebellar syndrome, brainstem syndrome, homo hemianopia LACS - infarct around basal ganglia, internal capsule, thalamus and pons
56
Stroke Mx/Ix
RESUS - NBM until SALT, patent airway, BM Monitor - neuro obs, BP, BM Blds - FBC infx, U+E ↓Na coma, glucose, Clotting Imaging - CT/MRI, MRI most sensitive, CT exclude haemorrhage
57
Stroke medical Mx
Thrombolysis if 18-80 and <4.5hrs of Sx Aspirin 300mg Surgery coil bleeding aneurysms, decompressive hemicraniectomy Follow up Stroke unit Secondary prevention Rehab
58
MS definition
Chronic inflammatory condition of the CNS characterised by multpile plaques of demyelination disseminated in time and space
59
MS classification
Relapsing remitting 80% Secondary progressive Primary progressive Progressive relapsing
60
MS presentation | TEAM
Tingling Eye - optic neuritis, opthalmoplegia Ataxia + other cerebellar signs Motor - usually spastic paraparesis
61
MS Ix
Gd enhance MRI - hyper-intense plaques LP oligoclonal bands Clinical diagnosis may use McDonalds criteria
62
MS Mx ``` Symptomatic Rx F D P S U E T ```
``` General - MDT Acute attack Methylpred, Prevetion DMARDS IFNbeta, prevention biologicals Natalizumab Symptomatic Rx Fatigue - modafinil Depression - SSRI Pain - amitryptiline Spasticity - physio, baclofen Urgency - oxybutynin ED - sildenafil Tremor - clonazepam ```
63
MND features
``` Fasciculation Tone - spastic Power - reduced Reflexes - absent or brisk, classically absent knee jerk w/ up-going plantars Sensation normal ``` *Doesn't affect eyes
64
MND Mx
``` General MDT, end of life decisions Specific Riluzole - prolongs life by 3mnths Symptomatic Drooling - amitryptiline Dysphagia - NG/PEG Resp failure - NIV Pain - analgesic ladder Spasticity - baclofen ```
65
MND classification
Amyotrophic laterla sclerosis 50% Progressive bulbar palsy 10% Progressive muscular atrophy 10% Primary lateral sclerosis 30%
66
GBS MS MND MG | UMN or LMN
UMN - MND, MS | LMN - MG, GBS
67
Peripheral polyneuropathy causes
Sensory DM, ETOH, B12 def, CRF+Ca, Vasculitis, Drugs isoniazid Motor HMSN/CMT, paraneoplastic, lead poisoning, Acute - GBS+botulism
68
Diabetic neuropathy features
Inspection - finger prick marks, vascular disease Motor - bilateral ankle jerk reflex absent Sensory - distal sensory loss in stocking distribution
69
Diabetic neuropathy Ix
Urine - glucose | Bld - Glucose, HbA1c, U+E
70
Diabetic neuropathy Rx
General MDT, glycaemic control, Med Amitryptiline for pain, Fludrocortisone for post hypotension
71
Charcot-Marie-Tooth syndrome definition
Hereditary motor and sensory neuropathy cauing peroneal muscular atrophy
72
C-M-T syndrome features
High stepping gait Weak foot and toe dorsiflexion Absent ankle jerks Variable loss of sensation in stocking distribution
73
C-M-T syndrome Ix Mx
NCS - ↓conduction velocity or amplitude Genetic testing Mx - MDT, foot care, orthoses
74
Myasthenia gravis def
Autoimmune condition affecting the AChr causing muscle fatigueability
75
Myasthenia gravis features
Eyes - bilateral ptosis Face - myasthenic snarl Voice - nasal, deteriorates on sustained talking Limbs - fatigueability To complete assess lung function
76
Myasthenia gravis Ix
Blds - anit AChr, anti MuSK Tensilon test - fatigue-ability improveswith edrophonium TFT's EMG - ↓w/ train of impulses
77
Myasthenia gravis Mx
Acute - plasmaphersis, IVIG Chronic Pyridostigmine, Steroids, Thymemectomy
78
Lambert-Eaton syndrome
Abs vs VGCC | Weakness improves on repetitive movement
79
GBS features
Symmetrical ascending neauropathy. affects legs>arms | After Campylobacter infx
80
GBS Ix
Evidence of infection stool MC+S Anti-ganglioside abs NCS - demyelination
81
GBS Mx | AAAA
``` Supportive Airway ventilation Analgesia Autonomic - inotropes catheter Antithrombotics Immunosuppresion IVIG Plasma exchange ```
82
Facial nerve palsy causes
Bell's (idiopathic) 75% Supranuclear - SOL, ascular, MS Pontine - SOL, vascular, MS
83
Facial nerve palsy features
``` Facial muscle paralysis - drooping Hyperacusis Eye dryness UMN forehead sparing LMN forehead affecting ```
84
Bell's Mx
General - Eye drops, tape lids shut | Med - pred, acyclovir if VZV1 suspected
85
Horner's syndrome examination findings | PEAS
Face - Ptosis, enopthalmus, anyhydrosis, small pupil
86
Horner's syndrome definition
Lesion to sympathetic trunk of the face
87
Oculomotor nerve palsy features
Complete ptosis Eye - down and out Dilated pupil Opthalmoplegia
88
Medical vs surgical 3rd nerve palsy
Medical - pupil sparing Surgical - pupil dilated Due to compression of parasympathetic fibres that run on the periphery of the oculomotor nerve
89
3rd nerve palsy causes
Medical - mononeuritis (DM)), MS, Infarction, migraine | Surgical - ↑ICP, cavernous sinus thrombosis,
90
Visual pathway
``` Retina Optic nerve Optic chiasm Optic tract Lateral geniculate nucleus of thalamus Optic radiation Visual cortex ```
91
Hernia types
``` Inguinal Femoral Incisional Umbilical Peri-umbilical ```
92
Hernia definition
Protusion of a viscus or part of a viscus through an abnormal defect in the wall of the cavity that contains it into an abnormal position
93
Inguinal canal anatomy
Floor - inguinal ligament Roof - arching fibers of transversalis and int. oblique Posterior - Transversalis and conjoint tendon medial 3rd Anterior - ext. oblique and int. oblique for medial 3rd
94
Contents of spermatic cord
``` 3 layers of fascia 3 arteries 3 veins 2 nerves 3 other ```
95
Contents of iguinal canal
M - spermatic cord + ilioinguinal nerve | F - round ligament + ilioinguinal nerve + gen branch of genitofemoral nerve
96
Operative distinction between direct and indirect hernia
Indirect - arise through deep inguinal ring, lat to inf. epigastric vessels Direct - arise through Hesselbach's triangle Med - rectus abdominis Lat - inf. epigastric artery Inf - inguinal ligament
97
Direct vs indirect on examination
Reduce hernia, fingers over deep ring at mid point of inguinal ligament, ask to cough.
98
Complications of hernia
Irreducible - strangulated Pain and ischaemia - incarcerated Bowel Obstruction
99
Inguinal vs femoral hernia
Inguinal - superior and medial to pubic tubercle | Femoral - inferior and lateral to pubic tubercle
100
Femoral facts and Mx
More common in females (inguinal still more common) High risk of strangulation 50% strangulate therefore urgent surgical management
101
Femoral hernia surgery
Elective - Lockwood low approach | Emergency - McEvedy high approach
102
Inguinal hernia surgery
Open vs Lap Open - LA or GA, Mesh repair Lap - bilateral or recurrent, totally extra peritoneal (TEP) or Trans-abdominal pre-peritoneal (TAPP)
103
Incisional hernia risk factors
Pre-operative ↑age, co-morbidities (DM), drugs (steroids), Obesity, Ca Operative Surgical technique/skill, suture bites, suture type, drains Post-operative ↑IAP, chronic cough, Infx, haematoma
104
Incisional hernai Mx
Conservative manage RF's - cough, Wt loss Corset Surgical - mesh repair
105
Pathogenesis of paraumbilical hernia
Acquired defect in linea alba Typically contain omentum Narrow neck - strangulation risk Obese patients
106
Umbilical hernia pathogenesis
``` Defects in the umbilical scar Typically congenital Afro-caribbean RF Usually asymptomatic and resolve by 2-3yrs Surgical repair if no resolution by 3yrs ```
107
Scrotal lump differentiation
Can you get above it? No = inguinoscrotal hernia Tender? epididymo orchitis Testis palpable separtely? No = tumour, yes = epididimal cyst Transiluminates? Hydrocele/spermatocele
108
Hydrocele
``` Collection of fluid in tunica vaginalis Mx Conservative - watch and wait Surgical Drainage - symptom relief but reaccumulates Plication of tunica vaginalis ```
109
Varicocele Def + Mx
Def - Dilated veins of the pampiniform plexus Mx Non-surgical - scrotal support, transfemoral radiological embolisation of testicular vein Surgical -
110
Testicular tumour Presentation Ix Mx
Presentation - 15-45yrs, painless lump or dull ache, heamatospermia Ix - Tumour markers (AFP, bHCG), CXR mets, US scrotum Mx - Ochidectomy
111
Stoma definition
The union between conduits or between a conduit and the outside
112
Examination of a stoma steps
Inspection Site Bag contents - formed/liquid stool/urine Appearance - spouted, lumens, mucosal health Scars Palpate - for parastomal hernia To complete remove bag to closely inspect and digitate conents, digitate lumens Examine perineum
113
``` Indications for a stoma E D D F L ```
Exteriorisation - perferation or contamination Diversion - protection of distal anastomosis Decompression - bypass of distal obstructing lesion Feeding - gastrostomy/jejunostomy Lavage- appendicostomy
114
Stoma distinction
Ileostomy - RIF, Spouted, liquid contents | Colostomy - LIF flush, formed stool contents
115
Surgeries resulting in ileostomy
End ileostomy Permanent - Panproctocolectomy (no anus), UC Temporoary - Total colectomy, FAP Loop ileostomy Temporary - To defunction distal bowel, anterior resection
116
Surgeries resulting in colostomy
End colostomy Permanent - AP resection (no anus), Colon Ca Temporary - Hartmann's, Diverticulitis Loop colostomy - Ca RUQ - defunctioning transverse colostomy to cover distal anastamosis (rare) LIF - Apex of sigmoid exteriorised w/o a resection for inoperable Ca rectum which is likely to obstruct
117
Complications of a stoma HHIPS PODSS
``` Early Haemorrhage High output - causing ↓, loperamide can thicken output Ischaemia Parastomal abscess Stoma retraction Late Parastomal hernia Obstruction Dermatitis Stomal prolapse Stenosis Fistulae Psychosexual dysfunction ```
118
Urostomy facts
Fashioned following total cystectomy | Ileal conduit
119
Surgical scars examination findings presentation
Give correct technical name where possible Otherewise describe anatomical locatin and orientation Well healed or not Examine for incisional hernias - lift head and cough Don't guess surgery unless asked Look for stoma and drain scars (bowel) or vascular access scars (AAA/graft)
120
Layers dissected in midline laparotomy scar
``` Skin Camper's fascia Scarpa's fascia Linea alba Transversalis fascia Pre-peritoneal fat Peritoneum ```
121
``` Abdo scars ML PM K R P L L RM L ```
``` Midline laparatomy Paramedian Kocher Rooftop Pfannenstiel Lanz Loin Rutherfor-Morrison Laparascopic port scars ```
122
List of colonic resections 7
Rt Hemicoloectomy (can be extended) Lft Hemicolectomy Anterior resction - anastamosis +/- loop ileostomy Hartmann's - No anastamosis, rectal stump, end colostomy Abdominoperineal resection Subtotal colectomy - Rectosigmoid stump Panproctocolectomy
123
IBD indications for surgery UC Crohns
UC Acute - Megacolon, Perforation, Haemorrhage (severe) Chronic - Medical Mx failure, Malignancy, Maturation failure Crohn's Acute - Obstruction, Perforation, Haemorrhage Chroinc - Fistulae, Abscesses, Medical Mx failure
124
Extra intestinal manifestations of IBD
Skin - erythema nodosum Joints - Arthritis Eyes - Iritis HBP - Gallstones, PSC, cholangiocarcinoma
125
Ix for IBD
``` Blds FBC - ↓Hb, ↑WCC U+E's - ↓K LFTs - derranged Clotting - ↑INR ↑ESR, ↑CRP - used to monitor activity Stool - culture Imaging AXR Contrast studies MRI ```
126
Causes of erythema nodosum | SIDIP
``` Systemic - sarcoid Infection - TB, strep Drugs - Sulphonamides, OCP Idiopathic Pregnancy ```
127
Gynaecomastia causes
``` Drugs - marijuana Physiological - Puberty Low androgen - klinefelters, hyperprolactinaemia High oestrogen - lung Ca ↑ aromatisation - CLD ``` Look for external genitalia, CLD, visual fields, hypogonadism
128
Examining a fistula
Look - scars, inflammation, swollen hand, signs of ESRF Palpate - Thrill Auscultate - high pitched bruit
129
Differentials for a midline sternotomy scar w/ relative positive finding
``` Mechanical valve - click Valvotomy - murmur CABG - vein harvest Congenital defect repair -old scar young patient Heart transplant - immunosuppressed Trauma/tamponade - No signs ```
130
Causes of MR
Functional - LV dilatation (HTN or idiopathic) Annular calcification Rheumatic heart disease Mitral valve prolapse
131
Rx of MR
General - MDT, Optimise cardiac risk factors, regular monitoring Specific - Rx AF, anticoagulate, ↓afterload (BB or ACEi) SurgicalValve replacement or repair
132
Echo signs of severe AS
Pressure gradient >40mmHg Valve area <1cm^2 Jet velocity >4m/s
133
Heart valve replacement options
Metallic - lasts longer ~20yrs, need for anticoagulation, use in younger pts+those already on Warfarin Bioprosthetic - shorter duration ~10yrs, no need for anticoagulation, use in older pts and women of child baring age
134
Cha2ds2vascs
``` Used to assess indication for anticoagulation treatment in patients with AF CCF HTN Age >65/>75 DM Stroke/TIA - 2 Vascular disease Sex female ```
135
HASLBLED
Risk of major bleeding
136
COPD definition
An airway disorder that is not fully reversible that is characterized by airway and parenchymal damage secondary to chronic inflammation
137
Blue bloaters vs pink puffers
Blue bloaters - predominantly bronchitis Copious sputum production, cough, cyanotic, volume overload Pink puffers - Predominantly emphysema Sever constant dyspnoea, pink, cachectic, ↓breath sounds
138
ABCDE - A
Look - snoring nose, swollen throat, distress, drowsy
139
ABCDE - B
Look - chest expansion, cyanotic, accesory muscles Feel - chest expansion, breath on cheek Listen - chest sounds, wheeze Measure - Temperature, O2 sats, RR, ABG Manage - O2 high flow non rebreathe mask titrated to sats, 2Lnasal cannulae, venturi, +/- nebulised salb/ipratropium bromide
140
ABCDE - C
Look - raised JVP, clammy, sweaty, pain Feel - pulse radially and centrally Listen - HS normal/↓ Measure - HR, 2X large bore cannulae w/ Blds (FBC/WCC/Clotting/X-match/LFT/troponin/BNP etc), BP, cap refill, ECG, Manage - MONA, fluids, analgesia, blood products
141
ABCDE - D
GCS BM Pupils Neuro exam (secondary survey)
142
ABCDE - E
``` Expose patients fully Look for Rash Melaena Trauma Open fracture ```
143
Asthma management
SABA +ICS +LTRA
144
Indications for LTOT
PaO2 <7.3 stable | PaO2 <8.0 stable w/ peripheral oedema, pulmonary HTN, polycythaemia
145
Complications of COPD | HAPRIP
``` Heart failure via cor pulmonale Atrial fibrillation PTX Respiratory failure Infection Polycythaemia ```
146
Causes of bronchiectasis
Congenital - Cystic fibrosis, alpha 1 antitrypsin, Kartageners, connective tissue Acquired - Infection, mechanical obstruciton by foreign body,
147
Bronchiectasis imaging signs
CXR - tramlines | HRCT - signet ring sign
148
How would you manage this patient
This disease is a 'brief definition' requiring the input of a multidisciplinary team and regular follow up. The aims of management would be to prevent disease progression and complications and improve quality of life. Specific Management of this disease include using.
149
Three types of Abdo station
Liver - jaundice, ascites, bruising peripheral oedema Renal - fistula, tessio lines, scars, peripheral oedema Stoma/scars - scars malnourished
150
Examination of a patient with chronic liver disease | Inspection general
Inspection General - Jaundice, ascites, cachexia, tattoos Hands - Clubbing, leukonychia, palmar eryhtema, dupytren's contractures Face - Xanthelasma, Keiser-Fleicher rings Trunk - Spider naevi, gynaecomastia Ankles - Oedema
151
Examination of a patient with chronic liver disease | Abdomen
Inspection - distension, dilated veins, drain scars | Palpation - hepatomegaly, splenomegaly, shifting dullness
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``` Signs of decompensated liver disease J E H C F ```
``` Jaundice Encephalopathy - asterixis, confusion (NH4 build up) Hypoalbuminaemia - oedema and ascites Coagulopathy - bruising Foetor hepaticus ```
153
Causes of CLD
``` ETOH Viral NAFLD Rarer Genetic - HH AI - AH Drugs - methotrexate ```
154
Investigating chronic liver disease
``` Urine - dip, MC+S Blood - LFT, FBC, WCC, INR, Glucose Ascitic tap - SAAG US+PV duplex - liver size, texture Liver screen ```
155
Liver screen Ix
``` ETOH - MCV, GGT, AST:ALT >2 Viral - Hep serology NASFLD - Lipids AutoAbs - SMA, AMA, pANCA Genetic - Caeruplasmin, ferritin, alpha1-antitrypsin ```
156
Complications of CLD | HECHAV
``` Hypoglycaemia Encephalopathy - lactulose Coagulopathy Hepatorenal syndrome Ascitea Varices ```
157
Child-Pugh
``` Scoring system of liver cirrhosis Albumin Bilirubin Clotting Distension Encephalopathy ```
158
Causes of ascites
CLD/cirrhosis CCF Nephrotic Buddi-Chiari
159
SAAG result
``` >1.1g/dL = Portal HTN <1.1g/dL = Neoplasia, inflammation ```
160
Portal hypertension causes
80% cirrhosis Pre hepatic - Portal vein thrombosis Hepatic - cirrhosis Post hepatic - cardiac (RHF), Budd-Chiari
161
Medical jaundice causes
Pre hepatic - anaemia, HS, CTD Hepatic - ETOH Post-hepatic - stones, malignancy (dark urine/pale stools)
162
Urine dip results of jaundicepatient
Pre hepatic - ↑urobilinogen Hepatic - cBR, ↑urobilinogen Post hepatic - ↑↑cBR
163
Mercedes Benz scar differential
Liver transplant Segmental resection Whipples' procedure - pancreaticoduodenectomy
164
Evidence of immunosupression
Cushingoid Skin tumours Gingival hypertrophy - ciclosporin
165
Splenomegaly causes
Haematological - pallor, bruising, purpura Portal HTN IE Felty's - Splenomegaly, rheumatoid, neutropenia
166
Psoriasis examination
Well demarcated salmon pink plaques w/ silvery scale Found on extensor surfaces, ears, scalp Nails - subungal hyperkeratosis, oncholysis, pitting
167
Psoriasis Mx
Conservative - MDT, avoid triggers | Med - Emollients, steroids, vit d analogues, tar, phototherapy
168
Skin changes in chronic venous insufficiency | HASLEGS
``` Haemosideran Atrophie blanche Swelling Lipodermatosclerosis Eczema Gaiter ulcers Star, venous ```
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CEAP classification of varicose veins
Clinical signs Etiology Anatomy Pathophysiology
170
Mx for chronic limb ischaemia non surgical
Walk through pain Optimise risk factor profile - stop smoking Antiplatelet and statins Foot care
171
Mx for chronic limb ischaemia surgical
Endarterectomy Bypass grafting Amputation
172
Types of bypass graft
``` Anatomical Fem-popilteal Fem-distal Aortobifemoral Extra anatomical Axillo-fem Axillo-bifem Fem-fem crossover ```
173
Indications for amputation
Dead Dangerous - sepsis Damaged - trauma, burns, frostbite Damned nuisance - pain neuro damage
174
Causes of chronic renal failure
``` DM HTN Glomerulonephritis Polycystc kidney disease Drugs ```
175
Complications of CRF
``` Acidosis Blood - anaemia Calcium - bones Damn uraemia Electrolytes Fluids ```
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Management of CRF
Hypertension - target of 140/90 or 130/80 in DM Odeama -frusemide Anaemia - EPO
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Ix for CRF
Urine dip - haematuria, proteinurea, glycosuria, BJP Blood - FBC ↓Hb, U+E ↓eGFR, boneprofile Ca/PTH Renal screen - DM, ESR, Immune causes Imaging - CXR oedema, renal US, bone Xrays, CT KUB Renal biopsy
178
Inducing remission in Crohn's and UC Maintaining remission in Crohn's and UC
Crohn's - steroids first line UC - Oral aminosalicylates (5ASA/mesalazine) or rectal Crohn's - Azathioprine/mercaptopurine or methotrexate UC - Aminosalycilate or azathioprine
179
Stages of diabetic retinopathy
Background retinopathy - microaneurysms (dots), blot haemorrhages, hard exudates Pre-proliferative - backrgound plus cotton wool spots Proliferative - neovascularisation Maculopathy
180
Types of systemic sclerosis
Diffuse 30% | Limited 70% including CREST
181
CREST syndrome
``` Calcinosis Raynaud's Oesophageal dymotility Sclerodactyly Telangectasia ```
182
Ix for systemic sclerosis
``` Blds - FBC ↓Hb Antibodies - ANA, centromere (limited), Scl70/topoisomerase (diffuse) Imaging CXR - fibrosis Hand XR - calcinosis HRCT - fibrosis Ba swallow - dysmotility ```
183
Mx for CREST
Hand warmers PPI for reflux Blood pressure control
184
Causes of gout negatively bifringement needle-shaped crystals
``` Drugs Drinking Diet - purine rich Decreased excretion - CRF Death of cells - leukaemia ```
185
Mx of Gout acute
Remove cause and ↑hydration NSAIDS intra-articular steroid injection Colchicine
186
Mx of gout chronic
Modify precipitants Allopurinol Mx CV risk

Final Year Flashcards (5 decks)

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