YEAR 4 NOTES Flashcards
(302 cards)
1
Q
ecoli
A
gram negative rod (haemolytic uraemic syndrome)
2
Q
staph
A
gram positive coccus
3
Q
strep
A
gram positive coccus
4
Q
neisseria
A
gram negative coccus
5
Q
moraxella
A
gram negative coccus
6
Q
Actinomycetes
A
gram positive rod
7
Q
bacillus cereus / anthrax
A
gram positive rod
8
Q
clostridium
A
gram positive rod
9
Q
diphtheria
A
gram positive rod
10
Q
Listeria
A
gram positive rod
11
Q
pseudomonas
A
gram negative rod
12
Q
h/influenzae
A
gram negative rod
13
Q
salmonella
A
gram negative rod
14
Q
shigella
A
gram negative rod
15
Q
campylobacter
A
gram negative rod
16
Q
Ca125
A
Ovarian cancer
17
Q
Ca 19-9
A
Pancreatic
18
Q
Ca15-3
A
Breast cancer
19
Q
PSA
A
prostate carcinoma
20
Q
Alpha fetoprotein
A
HCC / teratoma
21
Q
Carcinoembryonic antigen CEA
A
Colorectal
22
Q
S100
A
Melanoma / schwannoma
23
Q
Bombesin
A
SCLC / gastric cancer / neruoblastoma
24
Q
Raised h-bCG + raised AFP
A
Nonseminomas testicular cancer
25
Raised b-hCG and normal AFP
Seminoma testicular cancer
26
things that can raise a Ca 125
○ Cervical adenocarcinoma ○ Endometrial carcinoma ○ Fallopian tube cancer ○ Heart failure ○ Hypothyroidism ○ Liver cirrhosis with severe necrosis ○ Non-Hodgkin’s lymphoma ○Pleural effusion
27
Conns syndrome
Low K+ and Normal/ high Na+
28
Addisons
Hyperkalaemia metabolic acidosis
29
Cushing's disease
Hypokalaemic metabolic alkalosis
30
Ix findings in SIADH
U+E = hyponatraemiaUrinary sodium / osmolaltiy will be HIGHSerum osmolality = LOWBUT EUOVOLEMIC --> normal BP + skin turgor etc
31
How slow should you replace sodium in SIADH and why
10 mmol/l per 24 hoursto prevent central pontine myelinolysis
32
SIADH causes mnemonic
S - surgeryI - intracranial --> infection (meningitis) / CVAA - Alveolar --> malignancy / pus (atypical pneu or TB)D - Drugs --> thiazide diuretics, carbamazepine, vincristine, cyclophosphamide, antipsychotics, SSRIs, NSAIDSsH - Head injury
33
FLuid restriction in SIADH
500-1000ml
34
Oxycodone generally causes compared to morphine
less sedation / vomiting / pruitus than morphine BUT more constipation
35
oral codeine to oral morphine conversion
divide by 10
36
oral tramadol to oral morphine conversion
divide by 10
37
oral morphine to oral oxycodone conversion
divide by 1.5 (to 2 but bnf says 1.5)
38
transdermal fetanyl 12 mcg patch equals
approx 30mg oral morphine daily
39
transdermal buprenoprhine 10 mcg patch equals
approx 24mg oral morphine daily
40
when increasing dose of opiods - next dose should be increased by
30-50%
41
for metastatic bone pain strong opiods PLUS
bisphopshonates / radio / denosumab may be used
42
breakthrough dose of morphine is
1/6th the daily dose
43
all pts prescribe dopioid should be coprescribed a
laxative
44
opioids in CKD
use w caution:- oxycodone preferred in palliative pts with mild-mod pain- if renal impairment severe , alfentanil / buprenorphine / fentanyl preffered
45
when prescribed an opioid if they get nausea
advise it is often transient --> if persists offer an antiemetic
46
when prescribed an opioid if they get nausea
advise it is often transient --> if persists offer an antiemetic
47
CAP in alcoholics
klebsiella --> (klepSTELLA)
48
most common cause of CAP
strep pneumoniae
49
CAP assoc w erythema multiforme / haemolytic anaemia / ITP and diagnosed by serology
Mycoplasma pneumonia
50
CAP assoc w lymphopenia and hyponatraemia, recently holdica (or AC units) and diagnosed by urinary antigen
Legionella pneumophila
51
how to work out anion gap
(Na + K) - (Cl + HCO3)
52
normal anion gap
10-18 mmol/L
53
Causes of normal anion gap mneumonic
HARDASS
54
HARDASS stands for
H- hyperalimentationA - AddisonsR- Renal tubular acidosisD - diarrhoeaA - AcetazolamideS - SpirinolactoneS- saline infusion
55
Mnemonic for raised anion gap metabolic acidosis
A CAT MUDPILES
56
A CAT MUDPILES
A- AspirinC - Cyanide, carbon monoxideA - Alcoholic ketoacidosisT - TolueneM - Methanol, metforminU - UraemiaD - Diabetic ketoacidosisP - Phenformin, pyroglutamic acid, paraldehyde, propylene glycol, paracetamolI - Iron, isoniazidL - Lactate (numerous causes)E - Ethanol, ethylene glycolS - Salicylates
57
alpha 1 agonist
decongestant e.g. phenylephrine / oxymetazoline
58
alpha 2 agonist
glaucoma Tx e.g. topical brimonidine
59
alpha antagonist
BPH - tamsulosinHTN - doxazosin
60
beta 1 agonists
inotropes e.g. dobutamine
61
beta 1 blockers
non selective + selective bblockers e..g atenolol / bisoprolol
62
beta 2 agonists
bronchodilators e.g. salbutamol
63
b 2 antagonists
nonselective bblockers e.g. propanolol / labetalol
64
dopamine agonists
parkinsons disease - ropiniroleprolactinoma
65
dopamine antagonists
antipsychotics - haloperidolantiemetics - metoclopramide / domperidone
66
GABA agonist
benzodiapines baclofen
67
GABA antagonists
flumazenil - reversal of benzos
68
histamine 1 antagonists
antihistamines e.g. loratidine
69
histamine 2 antagonists
antacids - ranitidine
70
muscarininc agonist
glaucoma e.g. pilocarpine
71
muscarinic antagonist
atropine - bradycardiabronchodilator - ipatroprium bromide / tiotropiumurge incontinence - oxybutinin
72
nicotonic agonist
nicotinevareniciline - used for smoking cessationdepolarising muscle relaxant = suxamethonium
73
nicotonic antagonist
nondepolarising muscle relaxants - atracurium
74
oxycotin agonist
inducing labour - syntocinon
75
oxycotin antagonist
tocolysis e.g. atosiban
76
serotinin agonist
triptans e.g. zolmitriptan
77
serotinin antagonists
antiemetics - ondasteron
78
MEN1 syndrome
the 3 Ps- parathyroid ( hyper due to parathyroid hyperplasia)- pituitary - pancreas --> insulinoma / gastrinoma
79
MEN1 genetics
MEN1 gene
80
most common presentation of MEN1
hypercalcaemia
81
MEN2a syndrome
Medullary thyroid cancer AND the 2Ps- parathyroid- phaechromocytoma
82
Men2b syndrome
Medullary thyrpoid cancer and 1 P- phaechromocytomas(+ marfanoid body habitus and neuromas)
83
MEN2a genetic component
RET oncogene
84
MEN2b genetic component
RET oncogene
85
genetics in Lynch syndrome
Mismatch repair gene defect - MHS1/2
86
FAP genetics
APC mutation
87
liver mets usually come from
colorectal cancer
88
SCLC is a
central lung cancer (not in apices)
89
type of lung cancer seen more often in nonsmokers
adenocarcinoma
90
pernicious anaemia predisposes to
gastric cancer
91
right sided murmur heard best on
inspiration
92
Left sided murmur heard best on
expiration
93
holo/pansystolic
mitral / tricuspid regurg (high pitched and blowing)VSD (harsh)
94
aortic stenosis
ejection systoliclouder on expiration
95
pulmonary stenosis
ejection systoliclouder on inspiration
96
late systolic
mitral valve prolapse
97
aortic regurg
early diastolic high-pitched and 'blowing' in character)
98
mitral stenosis
mid-late diastolicrumbling in character
99
.
learn it bitch xoxox
100
head bobbing is a sign of
aortic regurg
101
Mitral stenosis is typically caused by
rheumatic fever
102
acute relapse Mx
high dose steroids for 5 days to shorten course(don't affect degree of recovery just length of flare)
103
Indications for DMARDs
- relapsing remitting disease + 2 relapses in past 2 years + ablte to walk 100m unaided- secondary progressive disease + 2 relapses in past 2 yrs + able to walk 10 (aided/unaided)
104
Natalizumab
- monoclonal antibody --> antagonises integrin on surface of leukocytes- inhibit migration of leucocytes across endothelium into blood brain barrier- used first line (best evidence base) - given IV
105
Ocrelizumab
- humanised antibody CD20 monoclonal antibody- often used first line too- given IV
106
fingolimod
- S1P receptor modulator- prevents lymphocytes leaving lymph nodes- oral forms available
107
Mx of fatigue
- amantadine- other options = mindfulness / CBT
108
Spaciticity Mx
- baclofen and gabapentin first line- physio is important
109
Bladder dysfunction Mx
- in form of urgency / incontinence / overflow- get USS to assess bladder emptying- if signic residual volume = intermittent self catheterization- if no signif residual volume = anticholinergics
110
HLA-B27
ankylosing spondylititsreactive arthritis
111
HLA-DQ2/8
coeliac disease
112
HLA-A3
haemochromatosiss
113
HLA-DR2
narcolepsygoodpastures syndrome
114
HLA-DR3
dermatitis herperitiformissjorgens syndromeprimary billiary cirrhosis
115
HLA-DR4
T1DMRA
116
Anti-Jo1
Polymyositis and dermatomyositis
117
Anti centromere
limited systemic sclerosis - aka CREST
118
Anti-Scl-70
diffuse systemic sclerosis
119
Anti-Ro
Sjorgens
120
Anti-RNA polymerase III
nonspecific for systemic sclerosis- more a marker of renal involvement
121
antihistone
drug induced lupus
122
ANA
SLE
123
ANCA
various vasculitises
124
AMA
PBC
125
Ank spond MX
DMARDs found not to be useful --> form NSAIDs skip straight to biologics like etanercept / infliximab
126
etanercept and infliximab are Egs of
tnf alpha blockers
127
cANCA
granulomatosis w polyangiitis
128
granulomatosis w polyangiitis Fx
ent stuff (sinusitis etc) + resp + kidney
129
amoxicillin
rash if have glandular fever
130
Co-amoxiclav
cholestasis
131
flucloxacillin
cholestasis -->wks after use
132
Erythromycin
long QTGI upset
133
Ciprofloxacin
Lowers seizure thresholdTendonitis
134
Metronadizaole
Reaction following alcohol ingestion
135
Doxycycline
photosensitivity and N+V
136
Trimethoprim
Rashes, including photosensitivityPruritusSuppression of haematopoiesis
137
gentamicin
ototoxicitiy and nephrotoxcitiy
138
Hep A presents as
- flu like Sx- RUQ pain- tender hepatomegaly- deranged LFTs
139
Metoclopramide
Dopamine (D2) receptor antagonists should be used in palliative care for nausea and vomiting that is due to gastric dysmotility and stasis
140
Levomepromazine
broad-spectrum anti-emetic useful for mechanical obstruction, and for persistent nausea and vomiting uncontrolled by other anti-emetics
141
Ondanestron
serotonin antagonist anti-emetic which is used for nausea and vomiting related to chemotherapy and radiotherapy as well as for post-operative nausea and vomiting
142
for migraine nausea
metoclopramide --> gastric stasis
143
how to work out alcohol units
volume (ml) * ABV / 1,000
144
Clarithromycin contrindicated w
STATINS --> increased risk of rhabdomyolysis
145
CML causes
M -assive splenomegaly
146
CLL causes
L - lymphadenopathy
147
metformin titration
slowly! leave at least 1 wk between change of dose
148
if someone bad GI SE w metformin
try MR before swapping
149
osmotic laxatives MOA
increase amount of fluid in bowel --> therefore soften stool
150
Osmotic laxatives e.g.
lactulose / movicol
151
Stimulant laxatives MOA
stimulate bowel to contract --> thus expel faeces
152
Stimulant laxatives e.g.
senna / picosulphate
153
Bulk forming laxatives MOA
help stool retain water and thereby soften stool
154
Bulk forming e.g.
Ispaghula husk
155
Rectal meds e.g.
glycerin supppository (stimulant)phosphate enema (stimulant)
156
Pts w chronic constipation will benefit from
stool softening laxative (movicol / lactulose) but may need glycerin suppositories initially n rectal stool
157
Pts w post op ileus / opiod induced constipation / soft stool will benefit from
stimulant laxatives e.g. senna or picosulphate
158
prophylactic laxatives should be given to
pts w opiod analgesia --> esp elderly (stimulant laxative)
159
Used to determine the need to anticoagulate a patient in atrial fibrillation
CHA2DS2-VASc
160
Prognostic score for risk stratifying patients who've had a suspected TIA
ABCD2
161
HF severity score
NYHA
162
Measure of disease activity in rheumatoid arthritis
DAS28
163
A scoring system used to assess the severity of liver cirrhosis
Child-Pugh classification
164
DVT Risk
Wells score
165
cognitive impairment assessment
MMSE
166
MH scoring
HAD / PHQ9 / GAD7
167
Alcohol screening tools
AUDIT / CAGE / FAST
168
Prognosis of pneumonia
CURB65
169
assess of suspected OSA
Epworth sleepiness scale
170
Prostate Sx scoring
IPSS
171
Prognositc indicator of prosate cancer
Gleason score
172
Risk of pressure sore assessment
Waterloo score
173
10 yr risk of osteoporotic related fracture
FRAX
174
Acute pancreatitis scoring
Ranson criteria
175
Malnutrition screening
MUST
176
Infective endocarditis
Modified dukes criteria
177
ovarian cancer risk
Risk of malignancy index-Ca125 number + menopausal (1=pre/3= post) + USS score depending on number of Fx(0 = none , 1=1 , 3= 2+ features)
178
ECOG status
deciedes how well pt is --> deciede between active and passive
179
Grade mitotic rate of cancer cells (how quick it is growing)
Ki-67 index
180
measures disability or dependence in activities of daily living in stroke patients
Barthel index
181
Cyanide Mx
Hydroxycobalamin + sodium nitrite/thiosulphate
182
Carbon monoxide Mx
100% O2
183
Iron overload
Desferrioxamine
184
Digoxin tox Mx
DIgoxin specific antibody fragments ( digibind)
185
Organophosphate (insecticide) poisoning
Atropine
186
Methanol poisoning
fomepizole / ethanol PLUS haemodialysis
187
Ethylene glycol Mx
Fomepizole / haemodialysis
188
BBlocker OD
bradycardia = atropineresistant cases = glucagon
189
Lithium toxicity
mild mod = volume resus w salinesevere = haemodialysis?sometimes sodium bicarb?
190
TCA OD Mx
IV bicarb = reduce risk of seizure / arrhythmias
191
Benzo OD Mx
Flumenazil (risk of seizure w this so often managed supportively only)
192
Opiod OD Mx
Naloxone
193
Salicyate OD Mx
Urinary alkilization w IV bicarbhaemodialysis
194
paracetamol OD presenting 8-24 hrs later taken more than _____ to treat w NAC, before plasma levels
150mg/kg
195
Dabigatran MOA
direct thrombin(factor IIa) inhibitor
196
Dabigatran excretion + antidote
maj renal + idarucizumab
197
RIvaroxaban MOA
Direct factor Xa inhibitor
198
RIvaroxaban excretion + antidote
Maj liver + andexanet alpha (but it ain't gr8)
199
Apixaban MOA
Direct factor Xa inhibitor
200
Apixaban excretion + antidote
Maj faecal + andexanet alpha (not gr8 tho)
201
aplastic crisis has
low reticulocytes
202
Sequestration crisis has
high reticulocytes
203
FAB classification is for
AML --> shows what Fx seen on blood film
204
JAK2 mutation
polycythaemia rubra vera
205
Philadelphia chromosome
t(9:22)
206
ALL gentics
philadelphia chromosome
207
Auer rods suggest
APML
208
APML genetics
t(14:17)
209
Down syndrome is assoc w
ALL
210
smear / smudge cells indicative of
CLL
211
RIchters transformatio
CLL to a high grade lymphoma
212
ALL blood film shows
blast cells
213
CML genetics
philadelphia chromosome t(9:22)
214
AML blood film
blast cells and Auer rods
215
Lymph node biopsy hodgkin lymphoma
Reed-sternburg cells
216
Reed sternburg cells are
abnormally large B cells that have multiple nuclei that have nucleoli
217
CML Tx
Imatinib = tyrosine kinase inhibitor
218
Type 1 hypersensitivity
IgE mediated - mast cells
219
Type 2 hypersensitivity
IgG and IgM antibodies
220
Type 2 hypersensitivity e.g.
blood transfusion reaction / haemolytic disease of newborn / goodpastures syndrome
221
Type 3 hypersensitivity e.g.
RA / farmers lung
222
Type 3 hypersensitivity
Antibody-antigen complexes
223
Type IV hypersensitivity
T cell mediated
224
Type IV hypersensitivity
Nickel and gold / mantoux test / GVHD
225
incubation period of malaria
1-4 wks
226
IV Tx of mod-severe malaria
artensuate + quinine
227
How to get a diagnosis of malaria
- malaria blood film (sent in EDTA bottle)3 samples over 3 days to catch in 48hr life cycle of the parasite
228
whats the worst malaria
palmodium falciprum
229
Malaria prophylaxis options
progunail and atovaquonemefloquinedoxycycline
230
Proguanil and atovaquone as malaria prophylaxis
AKA MALARONE- Taken daily 2 days before, during and 1 week after being in endemic area- Most expensive (around £1 per tablet)- Best side effect profile
231
Mefloquine as malaria prophylaxis
- Taken once weekly 2 weeks before, during and 4 weeks after being in endemic area- Can cause bad dreams and rarely psychotic disorders or seizures
232
Doxycycline as malaria prophylaxis
- Taken daily 2 days before, during and 4 weeks after being in endemic area- Broad-spectrum antibiotic therefore it causes side effects like diarrhoea and thrush- Makes patients sensitive to the sun causing a rash and sunburn
233
MRSA carrier Tx
nose: mupirocin 2% in white soft paraffin, tds for 5 daysskin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
234
how to MRSA screening
charcoal swabsnasal swab and skin lesions or woundsthe swab should be wiped around the inside rim of a patient's nose for 5 secondsthe microbiology form must be labelled 'MRSA screen'
235
who should be screened for MRSA
all elective and emergency admissions
236
Ix for syphilis
(serological tests!!!)NON TREPONMONAL TESTS- not specific for syphilis, therefore may result in false positives- based upon the reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen- assesses the quantity of antibodies being produced- becomes negative after treatment- examples include: rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)TREPONMONAL SPEIFIC TESTS- more complex and expensive but specific for syphilis- qualitative only and are reported as 'reactive' or 'non-reactive'- examples include: TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)
237
confusion screen blood tests
Full blood countCRPU&EsBone profileB12 & FolateThyroid function testsGlucoseLFTsCoagulation/INR
238
confusion screen imaging
ct head
239
metformin SE
diarrhoea and abdo pain
240
metformin class
biguanide
241
metformin MOA
increase insulin sensitivity and decrease liver glucose production
242
pioglitazone class
thiazidiolines
243
pioglitazone SE
weight gain , fluid retention, BLADDER CANCER
244
pioglitazone MOA
increase insulin sensitivity and decrease liver glucose
245
gliclazide class
sulphonurea
246
gliclazide MOA
increase insulin release
247
Gliclazide SE
weight gain, HYPOS
248
sitagliptin class
DPP4 inhibitor
249
Sitagliptin MOA
increases incretins (which inhibit glucagon storage)
250
Sitagliptin SE
GI upset weight neutral
251
empagliflozin MOA
makes you wee out glucose
252
empagliflozin class
SGLT2 inhib
253
Empagliflozin SE
UTI / thrush, wloss
254
Exanatide MOA
incretin mimetic
255
Exanatide class
GLP1 mimetic
256
Exanatide SE
Wloss! but INJECTABLE
257
causes of liver cirrhosis
-alcoholic liver disease-nonalcoholic liver disease-hep b -hep c
258
monitoring of cirrhosis for HCC
6 monthly USS and AFP levels
259
first line for assessing NAFLD
ELF --> enhanced liver fibrosismeasures 3 markers to grade severity of cirrhosis
260
USS appearance in fibrosis
- Nodularity of the surface of the liver- “corkscrew” appearance to the arteries with increased flow as they compensate for reduced portal flow- Enlarged portal vein with reduced flow- Ascites- Splenomegaly
261
Screening for high risk of fibrosis
Fibro scan = transient elastography- measures elasticity using sound waves- retesting every 2 yrs in those w high risk
262
Those considered high risk for liver fibrosis
- Hepatitis C- Heavy alcohol drinkers (men drinking > 50 units or women drinking > 35 units per week)- Diagnosed alcoholic liver disease- Non alcoholic fatty liver disease and evidence of fibrosis on the ELF blood test- Chronic hepatitis B (although they suggest yearly for hep B)
263
endoscopy use in liver cirrhosis
assess any varices w portal HTNshould be done every 3 yrs
264
Whats in the child pugh score
BilirubinAlbumin INRAscitesencephalopathy
265
WHat is the MELD score
to be done every 6 months in pts w compensated cirrhosisto assess requirement for dialysisuses bilirubin, creatinine, INR and sodiumGives a 3 mnth mortality --> guides transplant refferal
266
Mx of ascites
Low sodium dietspirinolactoneParacentesis (ascitic tap or ascitic drain)Prophylactic antibiotics against SBP (ciprofloxacin or norfloxacin) in patients with less than 15g/litre of protein in the ascitic fluidConsider TIPS procedure in refractory ascitesConsider transplantation in refractory ascites
267
Mx of hepatic encephalopathy
- Laxatives (i.e. lactulose) promote the excretion of ammonia, aim is 2-3 soft motions daily, may require enemas initially- Abx reduce number of intestinal bacteria producing ammonia, Rifaximin is useful as it is poorly absorbed so stays in the GI tractNutritional support -->may need nasogastric feeding
268
WHat is the MELD score
to be done every 6 months in pts w compensated cirrhosisto assess requirement for dialysisuses bilirubin, creatinine, INR and sodiumGives a 3 mnth mortality --> guides transplant refferal
269
Sx of hypercalcaemia
- Renal stones- Painful bones- Abdominal groans refers to symptoms of constipation, nausea and vomiting- Psychiatric moans refers to symptoms of fatigue, depression and psychosis
270
Primary hyperthyroidism is caused by
uncontrolled parathyroid hormone produced directly by a tumour of the parathyroid glands
271
Mx of primary hyperparathyroid
surgical removal of tumour
272
Secondary hyperparaythoid is caused by
CKD or vit D deficiencyparathyroid glands reacts to the low serum calcium by excreting more parathyroid hormone --> Over time the hyperplasia cos need to produce more PTH to keep calcium right
273
Labs in secondary hyperparathyroid
-Ca = low/normal-PTH = high
274
what causes tertiary parathyroid
secondary for long time --> permanent hyperplasiawhen initial cause of secondary fixed PTH remains highmeans hypercalcaemia
275
The rule of Es is
Excessive PTH results in excessive phosphate excretion
276
upper zone fibrosis
CHARTSC - Coal worker's pneumoconiosisH - Histiocytosis/ hypersensitivity pneumonitisA - Ankylosing spondylitisR - RadiationT - TuberculosisS - Silicosis/sarcoidosis
277
recommended weekly intake
14 units
278
spread drinking over
3 days if going up to 14 units
279
14 units is equal to
6 normal strength beersor 10 small glasses of low percentage wine
280
steps of cxr
Airway: trachea, carina, bronchi and hilar structuresBreathing: lungs and pleuraCardiac: heart size and bordersDiaphragm: including assessment of costophrenic anglesEverything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas
281
RIPE stands for
rotation --> spinous process in line w vertebral bodies AND clavicle equidistant from spinous processInspiration --> 5-6 anterior ribs, lung apices, both costophrenic angles and the lateral rib edges should be visible.Projection --> AP or PA (if shoulderblades in chest = AP)Exposure --> vertebrae visible behind heart
282
Sail sign
L Lower lobe collapse
283
things to say in A of CXR
trachea --> central?carina + bronchi --> (does NG tube disect carina)hilar region --> any adenopathy / symmetrical / enlargement?
284
things to say in B of CXR
lung fieldspleura
285
things to say in C of CXR
size - cardiothoracici ratio of less than 0.5borders - reduction in definition suggests consolidation
286
things to say in D of CXR
free gascostophrenic angles
287
things to say in E of CXR
aortic knucle / aortopulmonary window bonessoft tissuestubes / valves / pacemakers
288
Abdo xray approach
Exposure + projectionB - bowel and other organsb - bonesc - calcification
289
B(ow) for AXR
small bowel --> valvulae conniventes obstruction = coiled spring appearancelarge bowel = haustradilated?sigmoid = coffee beancaecal = looks like foetus3/6/9 rule - small / large / caecumriglers sign = double walled = pneumopertioneum
290
Fx of IBD on AXR
Thumbprinting: mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumbprints projecting into the lumen (wall of whiter bit looks poked in)Lead-pipe (featureless) colon: loss of normal haustral markings secondary to chronic colitisToxic megacolon: colonic dilatation without obstruction associated with colitis.
291
B(on) Fx of AXR
RibsLumbar vertebraeSacrumCoccyxPelvisProximal femursSclerotic / lytic lesions!!!Fractures
292
C Fx on AXR
Calcified gallstones in the right upper quadrantRenal stones/staghorn calculiPancreatic calcificationVascular calcificationCostochondral calcificationContrast (e.g. following a barium meal)Surgical clipsJewellery
293
for ?NOF fracture imaging
XRAY AP pelvisXRAP R/L lateral hip
294
confusion imaging clinical details
"to rule out reversible cause"
295
Mx of pulmonary fibrosis
O2/rehab/morphinepirfinedone --> antifibrotic and antiinflammNintedanib -->monocolonal antibody targeting TKI nausea + photosensitivity
296
OA Mx
up the pain ladderoral paracetamol + topical ibuprofenopioids arent effective against chronic pain + cause tolerancejoint replacement can be sought after
297
angina baseline Mx
GTN aspirin statin
298
Angina first line
either BBlocker or CCB (pt choice)
299
if monotherapy don't work add both together but
NEVER BBLOCKER W VERAPAMIL
300
third line
long acting nitrate / nicorandil / ivabradine BUT ONLY whilst waiting for CABG or PCI
301
calcineurin inhibitors
ciclosporin or tacrolimus
302
antimetabolite immunospuresion
mycophenolate mofetil / azaithioprine
