QuQuick recall 3 Flashcards
Pathways!
Warfarin:
Heparin:
LMWH:
Warfarin: Extrinsic pathway –> prothrombin time
Heparin: Intrinsic pathway –> APTT
LMWH: enoXaparin - anti-factor Xa levels
Septic arthritis requires prolonged antibiotic therapy of at least
4-6 weeks
Standard heparin vs LMWH
Adverse effects of heparin:
–> bleeding
–> thrombocytopenia
–> osteoporosis (increased risk of fractures|0
–> hyperkalaemia
Heparin over dose: reversed by protamine sulphate
IgG,A,M,D,E
IgG: G for gestational - only Ig that can cross the placenta
IgA: A being the first letter, is the first Ig to be given to baby thru breastfeeding
IgM: M is a simp for the body (M’lady i’ll be the Main protector from pathogens)
IgD: D is like unsolicited dick pics, nobody knows what they’re good for
IgE: E is for Eosinophiles, which are also associated with the allergic response
IgM - pentamer
IgA - monomer / dimer
Rest monomer
The diagnostic criteria for HHS include
- hypovolaemia
- hyperglycaemia (BM > 30mmol)
- serum osmolality (320 mosmol/kg)
Clinical features
- fatigue
- lethargy
- altered consciousness
- hypotension
- tachycardia
monitor SERUM OSMOLALITY
Carcinoid syndrome: investigation and management
Investigation
–> Urinary 5-HIAA
–> plasma chromogranin A y
Management
–> somatostatin analogues e.g. octreotide
–> diarrhoea: CRYPTOHEPATIDINE
Features
- flushing
- diarrhoea
- bronchospasm
- hypotension
- right heart valvular stenosis
- rare: pellagra
Hyperkalaemia management
mild: 5.5-5.9mmol/l
moderate: 6-6.4 mmol/l
severe: > 6.5mmol/l
- stabilisation of cardiac membrane: IV calcium gluconate
- Short term shift i K+ from ECF to intracellular fluid compartment
–> combined insulin / dextrose infusion
–> nebulused salbutamol - Potassium removal from body
–> calcium resonium (enema»_space; oral)
–> loop diuretics
–> dialysis (w/ AKI
ECG: QRS widening and peaked T waves
TIA: assessment and referral
- ABCDE prognostic score
- Immediate antithrombotic therapy
–> aspirin 300mg
–> UNLESS: bleeding disorder, already on low dose aspirin or contraindicated - Specialist review
–> in last 7 days: arrange urgent assessment w/i 24 hrs
–> post 7 days: asap w/i 7 days
INVESTIGATION:
1. MRI (diffusion-weighted and blood-sensitive sequences)
2. Carotid imaging: urgent carotid dopller
Further management
1. Secondary prevention: clopidogel 1st line
–> OR aspirin + dipyridamole
2. Statin
3. carotid stenosis > 70% –> CAROTID A. ENDARECTOMY (on side contralateral to symptoms)
Episodic, intense, unilateral eye pain, lacrimation, restless →
cluster headache
–> high flow oxygen + subcutaneous sumatriptan
Prophylaxis
- verampil
Paroxysmal hemicrania responds well to indomethacin
mnemonic for raised anion gap based on symptoms
In acidosis –> kussmaul breathing
K - ketones
u - uraemia
s - sepsis
s - salicylate
m - methanol
a - aldehyde
l - lactic acidosis
OR
MUDPILES for high anion gap
Methanol
Uraemia
DKA
Paracetamol/Paraldehyde
Iron
Lactate
Ethanol
Salicylates/Sepsis
Normal ion gap metabolic acidosis:
normal anion gap (6 - 16 mmol/L)
HARD ASS
Hyperalimentation
Addison’s
RTA
Diarrhoea
Acetazolamide
Spironolactone
Saline
Triad of sudden onset abdominal pain, ascites, and tender hepatomegaly: seen in
BUDD CHIARI SYNDROME (hepatic vein thrombosis)
- raised SAAG >11 indicates portal HTN caused the ascites
IX - USS w/ doppler flow studies
Variceal haemorrhage: management
ABCDE
1. correct clotting: FFP, vit K
Before endoscopy
2. Vasoactive: terlipressin (or octreotide?)
3. prophylactic IV Abx (quinolones?)
4. Endoscopic varcieal band ligation
UNCONTROLLED HAEMORRHAGE
–> SENGSTAKEN-BLAKEMORE TUBE
TIPS if all else failed!
Prophylaxis of variceal haemorrhage
- Propranolol
- Endoscopic variceal band ligation (at 2 weekly intervals until eradication) + PPI
- TIPS if unsuccessful
DVLA: neurological disorders
Epilepsy
–> unprovoked: 6 months off IF no abnormalities on EEG (increased to 12 months)
–> established: driving licence if seizure free 12 months, no seizure for 5 years
–> withdrawal of AED: 6 months after last dose
Syncope
–> faint: no restriction!
–> single, explained, treated –> 4 WEEKS OFF
–> single, unexplained –> 6 MONTHS off
–> 2 or more –> 12 months off
Stroke / TIA
–> 1 month off, no need to inform DVLA if no neurological deficiit
–> multiple TIAs: 3 months off driving and inform DVLA
Craniotomy
–> 1 year off driving
Pituitary tumour
–> 6 months
Statin doses for primary and secondary prevention
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller →
DENGUE fever
–> maculopapular after 3-4 days after onset of illness
–> thrombocytopenia
Recent sore throat, rash, arthritis, murmur →
rheumatic fever
- following streptococcus pyogenes infection
Hyperosmolar hyperglycaemia state: Pathophysiology
hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion
Managment:
1. IV fluid replacement (0.5-1L/hr) , monitor K+
2. Insulin (not until BG stops falling while giving IV Fluids)
3. VTE prophylaxis
The anion gap is calculated by:
(sodium + potassium) - (bicarbonate + chloride). A normal anion gap is 10-18 mmol/L.
Paget’s disease of the nipple:
Diagnosis made via punch biopsy, mammography and USS of breast
Needs breast clinic referral urgent!
THESE are typically spared in motor neurone disease
Eye movements
CT shows:
**Aortic dissection **
- intraluminal tear formed a ‘flap’ in the ascending aorta
- Stanford TYPE A DISSECTION
HTN common in AD aar cathecholamine surge
Hoffman’s sign
Involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail down.
Degenerative cervical myelopathy.
