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Year 6 - MBBS COPY > PACES: Wk A > Flashcards

PACES: Wk A Flashcards

1
Q

AS

A

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2
Q

MR

A

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3
Q

AR

A

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4
Q

MS

A

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5
Q

Ddx for Collapsing Pulse (3)

A

AR Normal psychological state eg pyrexic or pregnant High output state eg anaemia or thyrotoxicosis

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6
Q

How do you elicit Quincke’s sign?

A

Ask the pt to push their finger into the table and observe for the border b/w red and pale move to pulse

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7
Q

AF

A

Ix: Hx (ETOH/Caffeine), Obs (Pulse/HTN), Bloods (TFTs/BNP/D-dimer), ECG, Echo (IHD/RHD) Unstable Tx: DCCV +/- Amiodarone Stable Tx: Rate (BB/CCB +/- Digoxin), Rhythm (DCCV or Flecainide/Amiodarone), Anticoag (CHA2DS2-VASc vs HAS-BLED)

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8
Q

STEMI

A

Atypical px in elderly + women Anteroseptal - LAD: V1-4 Lateral - LCX: V5-6, I, aVL Inferior - RCA: II, III, aVF Tx: MONAT + PCI/Thrombolysis Comps: FAM ie Failure, Arrhythmias, Murmurs

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9
Q

Stridor Ddx

A

Quinsy Epiglottitis Foreign Body Anaphylaxis Malignancy

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10
Q

Wheeze Ddx

A

Asthma COPD Pulm Oedema Anaphylaxis Malignancy

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11
Q

What are the headlines for treating acute asthma/copd?

A

Oxygen, Bronchodilators, Steroids

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12
Q

Asthma Px

A

Salbutamol Inhaler Resonant and symmetrical percussion w equal air entry and no added sounds Findings consistent w controlled asthma Ddx: physiological normal chest + COPD Ascertain if any prev ITU admissions or night sx

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13
Q

COPD Px

A

Prolonged exp phase and pursed lip breathing Signs of hyperinflation specifically red cricosternal distance, loss of cardiac dullness and displaced liver edge No features of pulm htn or cushings Findings consistent w COPD

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14
Q

What are the signs of hyperinflation? (3)

A

Red cricosternal distance, loss of cardiac dullness, displaced liver edge

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15
Q

Fine Crepitations Ddx

A

Fibrosis + HF

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16
Q

Rheumatoid ILD vs Bronchiectasis

A

O/e: if there’s a sputum pot nearby + quality of crackles Ix: PFTs inc spirometry, lung volumes, gas transfer (restrictive vs obstructive) + HRCT (honeycombing and ground glass vs dilatation and mucus plugging)

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17
Q

ILD Px

A

Sup O2 at 2L/min via nasal cannula w RR of 20 Features of rheumatoid hands w/o clubbing, characteristic find end insp crackles, peripheral oedema Findings consistent w pulmonary fibrosis perhaps 2° to RA w pulm HTN leading to RHF requiring LTOT

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18
Q

Mx of ILD

A

Ix: Drug Hx, Complement, Autoantibodies, Precipitins, CXR, HRCT, PFTs, BAL, Echo Tx: MDT, Smoking Cessation, Pulm Rehabilitation Plus: ambulatory O2, LTOT, antifibrotics for IPF, immunosuppressives for CTD/sarcoid related, transplant workup

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19
Q

What are the causes of HF?

A

LHF: HTN, IHD, L Side Valves RHF: LHF, Cor Pulmonale, R Side Valves

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20
Q

Mx of HF

A

Acute: 1. Sit Up & Call Help 2. Diamorphine 1.25mg 3. Furosemide 40mg 4. GTN Spray x2 SL Chronic: 1. CAGES, Dec RFs, Vaccines 2. ACEi/ARB/Hydralazine + BB 3. Add MRA 4. Specialist

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21
Q

Coarse Crepitations Ddx

A

Bronchiectasis + Pneumonia NB: may change w cough and should ask to sample sputum

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22
Q

Mx of Bronchiectasis

A

Ix: Obstrc Spirometry, Sputum Cultures, HRCT, Immunoglobulins, Sweat Test, Aspergillus Markers Tx: MDT, Smoking Cessation, Pulm Rehabilitation Plus: physio, abx, correct underlying cause

23
Q

Bronchiectasis Px

A

Clubbed Bilateral coarse insp crackles which alter but do not fully clear w coughing Findings consistent w bronchiectasis Ddx: pneumonia + ILD

24
Q

Mx of Pneumonia

A

Calculate CURB-65: confusion, urea >7, RR >30, SBP <90, Age >65 If 0-1: home - PO amoxicillin 500mg/8h If >=2: hosp - PO amoxicillin 500mg/8h AND clarithromycin 500mg/12h If >=3: ICU - IV augmentin 1.2g/8h AND clarithromycin 500mg/12h F/U @ 6wks

25
Pneumonia O/E
Trachea - central Expansion - reduced Fremitus - increased Percussion - dull Auscultation - bronchial Added - crackles
26
Pneumothorax O/E
Trachea - deviated away Expansion - reduced Fremitus - decreased Percussion - resonant Auscultation - absent Added - occasional click
27
Pleural Effusion O/E
Trachea - deviated away Expansion - reduced Fremitus - decreased Percussion - stoney dull Auscultation - absent Added - occasional rub
28
Collapse/Lobectomy/Pneumonectomy O/E
Trachea - towards Expansion - reduced Fremitus - decreased Percussion - dull Auscultation - absent Added - none
29
What are the headlines for treating PE?
Oxygen, Anticoagulation, Analgesia
30
What are the signs of CLD? (4)
PDGS Palmar Erythema Dupuytren’s Contracture Gynaecomastia Spider Naevi
31
What are the signs of portal HTN? (4)
SAVE Splenomegaly Ascites Varices Enlarged Abdo Veins
32
What are the signs of decompensation? (4)
JBAE Jaundice Bruising Asterixis Encephalopathy
33
Where is the best place to look for jaundice?
Sclera + under the tongue
34
Hepatomegaly Causes
Hepatic: hepatitis, cirrhosis, budd-chiari, NAFLD, hereditary haemochromatosis Cardiac: cor pulmonale, right valvular disease, right heart failure Other: infection, malignancy, myeloproliferative
35
Splenomegaly Causes
Vascular: haemolysis, leukaemia, lymphoma, CML, MF, portal HTN Infective: malaria, leishmaniasis, hydatid disease, EBV, CMV, HIV, TB, IE, chlamydia psittaci Inflam: sarcoid, amyloid, pancreatitis, RA, SLE, sjogrens
36
What causes massive splenomegaly? (4)
MF CML Malaria Leishmaniasis
37
Ddx for RIF Pain
GI: appendicitis, mesenteric adenitis, terminal ileitis GY: ectopic, tubo-ovarian, endometriosis GU: stone, UTI, cystitis
38
Workup for Acute Abdomen
NBM Fluids Analgesia Antiemetics Antibiotics Bleeding Risk Allergies Airway Difficulty Refer to Surgeons Monitor Vitals
39
Proximal Myopathy Ddx
Polymyositis, Dermatomyositis, Cushing’s Disease Plus working through surg seize: MG/LEMS, HIV, hereditary, sarcoidosis, paraneoplastic, drugs eg statins
40
Peripheral Neuropathy Ddx
Diabetes, Alcohol, B12 Deficiency Plus working through surg seize: GBS/CIDP, HIV, hereditary, sarcoidosis, paraneoplastic, drugs eg metronidazole
41
What reflexes do you want to offer as part of the CN exam?
Jaw Corneal Gag
42
Mx of OA
Confirm dx w hx, exam, ix Take an MDT approach w PT, OT, podiatrist Consrv: manage RFs ie optimise weight, diet, low impact exercise, ensure other medical conditions are well controlled + applying warm/ice packs Med: analgesia up WHO pain ladder + intra-articular steroid injections Surg: referral to ortho for osteotomy, arthrodesis and more likely arthroplasty
43
Mx of Open Fracture
ATLS NV Status Photograph Soaked Gauze Abx + Tetanus Restrict Xrays Theatre Rehab
44
Mx of NOF#
Upon admission MMSE, seen by orthogeris, operate within 36hrs Intracapsular: 1,2,Screw + 3,4,Austin-Moore Extracapsular: inter DHS + sub nail Mobilise early w physio and minimise risk of future falls and osteoporosis
45
How do you px normal auscultation of the lungs?
There was equal air entry and symmetrical vesicular breathing in all zones bilaterally
46
What should you say if you don’t know the abx?
Consult local guidelines and microbiology for a suitable course of action
47
What are you looking for in the hands?
Gen: clubbing, tar staining, colour/temp Cardio: evidence of IE + CRT Resp: evidence of steroid use + RA GI: evidence of CLD + koilonychia/leukonychia
48
Why do you look at the armpits in the abdo exam?
Acanthosis Nigricans - benign, T2DM, stomach malignancy Hair Loss - shaven, IDA, malnutrition
49
How should you describe any ABG?
Met/Resp Acid/Alk AND T1RF/T2RF
50
PACES WkA Stations 2021: Cardio, Resp, Abdo, Neuro, MSK, Acute
Tues: AS, wheeze, RIF pain, peripheral neuropathy, NOF#, DKA Wed: AR, fine creps, LIF pain, proximal myopathy, knee OA, SBO Thurs: MR, coarse creps, RIF pain, proximal myopathy, hand RA, UTI
51
How should you categorise your ix?
Bedside Bloods Imaging
52
S3
TBC
53
S4
TBC
54

Year 6 - MBBS COPY (35 decks)

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