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Who has two thumbs, a pint of coffee and is sitting at home revising for the AIM SCE all day?
Who is going to spam your timeline with factoids?
The same guy.
That guy is me.
Who is going to spam your timeline with factoids?
The same guy.
That guy is me.
Pre-menopausal woman presenting with iron deficiency anaemia, if their TTG is negative and they have no family history of GI malignancy, congrats, you've reached the end of the algorithm and no further investigations are required.
Iron supplements are the answer.
Iron supplements are the answer.
There is no evidence for the requirement of aciclovir in viral *_meningitis_*. Treatments for viral meningitis are supportive only.
Treatment for viral *_encephalitis_* includes aciclovir.
Treatment for viral *_encephalitis_* includes aciclovir.
If HSV2 is discovered on a lumbar puncture, the patient should be referred to a GUM/ID clinic for full sexual health screening.
Everyone should be receiving Dexamethasone with their Cef for their bacterial meningitis.
Over 60s should also receive Amoxicillin for their bacterial meningitis.
For pen allergic you're looking at IV Chloramphenicol and then Co-Trim if over 60.
Over 60s should also receive Amoxicillin for their bacterial meningitis.
For pen allergic you're looking at IV Chloramphenicol and then Co-Trim if over 60.
STarT Back Tool Scoring System can be used to determine the risk of a poor outcome for individuals presenting with new onset back pain.
NT-proBNP level at time of diagnosis are a marker of severity.
> 2,000 ng/litre (236 pmol/litre) need urgent assessment at TTE within 2 weeks.
> 2,000 ng/litre (236 pmol/litre) need urgent assessment at TTE within 2 weeks.
Bus, coach or lorry drivers must tell the DVLA about a diagnosis of heart failure and must stop driving for at least one month while the DVLA investigate the severity of symptoms.
In asthma, step wise management is:
SABA -> ICS -> LABA -> Increase the ICS or adding leukotriene receptor antagonist
SABA -> ICS -> LABA -> Increase the ICS or adding leukotriene receptor antagonist
SABA, LABA, ICS and theophyllines can all be used as normal during pregnancy.
If LRTA is required to achieve adequate control of asthma then they should be continued.
Manage acute asthma attacks in pregnant patients the same as for non-pregnant patients.
If LRTA is required to achieve adequate control of asthma then they should be continued.
Manage acute asthma attacks in pregnant patients the same as for non-pregnant patients.
Prostoglandins [like Carboprost and Misoprostol] should be used with extreme caution due to the risk of inducing bronchoconstriction.
Any tweet I could write about COPD would pale in comparison to this fantastic one page summary -> https://www.nice.org.uk/guidance/ng115/resources/visual-summary-treatment-algorithm-pdf-6604261741
LTOT provides survival benefit and improves pulmonary haemodynamics [reduced PAP] when worn for >15 hours a day.
LTOT indications:
Stable COPD, ILD, CF, advanced heart failure or pulmonary hypertension and resting PaO2 <7.3 *or* PaO2 <8 with peripheral oedema, polycythemia or pulmonary hypertension.
Smoking is not an absolute contraindication.
Stable COPD, ILD, CF, advanced heart failure or pulmonary hypertension and resting PaO2 <7.3 *or* PaO2 <8 with peripheral oedema, polycythemia or pulmonary hypertension.
Smoking is not an absolute contraindication.
You don't *have* to aspirate every unilateral pleural effusion - if there is sufficient evidence within the clinical picture to suggest a transudate you are justified in treating the cause.
Tests on pleural fluid:
Standard -> LDH, protein, MC&S, cytology
Extras when indicated -> pH [is it an empyema?], Glucose [is it a rheumatoid effusion?], AFBs [is it TB?], Triglycerides and cholesterol [determines if your milky effusion is a chylothorax]
Standard -> LDH, protein, MC&S, cytology
Extras when indicated -> pH [is it an empyema?], Glucose [is it a rheumatoid effusion?], AFBs [is it TB?], Triglycerides and cholesterol [determines if your milky effusion is a chylothorax]
Light's criteria, pleural fluid is an exudate if one or more of the following are present:
- aspirate fluid protein divided by serum protein is >0.5
- aspirate fluid LDH divided by serum LDF is >0.6
- aspirate fluid LDH is greater than â…” of the upper limit of serum normal
- aspirate fluid protein divided by serum protein is >0.5
- aspirate fluid LDH divided by serum LDF is >0.6
- aspirate fluid LDH is greater than â…” of the upper limit of serum normal
If a pleural effusion is not an exudate, it is a transudate.
Transudates are most commonly associated with failure...
Heart failure, liver failure, renal failure, nutritional failure [hypoalbuminaeima] and thyroid failure [hypothyroidism]
Transudates are most commonly associated with failure...
Heart failure, liver failure, renal failure, nutritional failure [hypoalbuminaeima] and thyroid failure [hypothyroidism]
Common causes of pleural exudates include:
- Malignancy
- Parapneumonic effusion
- TB
- PE
- Rheumatoid and other autoimmune
- Malignancy
- Parapneumonic effusion
- TB
- PE
- Rheumatoid and other autoimmune
Management of spontaneous pneumothorax is dependent on presence or absence of pre-existing lung disease, size of the pneumothorax and symptom associated with it.
Anyone with bilateral pneumothoracices [or is it pneumothoraxes?] or who is haemodynamically unstable gets a chest drain.
For someone with a primary pneumothorax [no pre-existing lung disease] who has a pneumothorax smaller than 2cm [when measured at the level of the hilum] who is not breathless could be ambulated.
>2cm and/or breathless and they need an aspiration.
>2cm and/or breathless and they need an aspiration.
Successful aspiration and you can consider ambulating.
Failure of aspiration means they need a chest drain. Failure is defined as aspiration not improving symptoms and/or not reducing the size of the pneumothorax and/or more than 2.5 litres being aspirated.
Failure of aspiration means they need a chest drain. Failure is defined as aspiration not improving symptoms and/or not reducing the size of the pneumothorax and/or more than 2.5 litres being aspirated.
