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75 Cards in this Set
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Define hypovolemia |
A state of decreased blood volume; more specifically, decrease in volume of blood plasma.
Hypovolemia is characterized by sodium (salt) depletion and thus differs from dehydration, which is defined as excessive loss of body water |
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What are some of the common causes of hypovolemia? |
Loss of blood- external bleeding/ blood donation Loss of plasma- severe burns and lesions discharging fluid Loss of body sodium and consequent intravasular water eg diarrhea or vomiting Excessive sweating is NOT a cause of hypovolemia, because the body elimates lots more water than sodium |
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How can you recognise hypovolemia? |
it often doesn't present until 10-20% of whole-blood volume is lost Tachycardia, diminished blood pressure, poor peripheral perfusion, lengthened cap refil, they may feel dizzy, faint, nauseated or thirsty |
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What interventions are important for the hypoglycemic patient? |
O2- to increase the efficacy of the patients remaining blood supply IVT- but will dilute clotting factors so be careful |
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Describe stage 1 hypovolemia |
Up to 15% blood loss Blood pressure maintined HR/ RR- normal Mental status- normal Pale skin Cap refil- normal urine output- normal |
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Describe stage 2 hypovolemeia |
15-30% blood loss Increased diastolic BP Slight tachycardia >100bpm RR >20 Slight anxiety, restless Skin- pale, cool, clammy Cap refil- delayed Urine output- 20-20mL/hr |
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Describe stage 3 hypovolemia |
30-40% blood loss Systoloc BP <100 Tachycardia tachyneic RR >30 Altered mental state, confused Delayed cap refill Urine output 20ml/hr |
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Describe stage 4 hypovolemia |
Over 40% blood loss Systolic BP <70 Extreme tachycardia >140bpm with weak pulse Extreme tachypnea Decreased mental status, LOC, lethargy, coma Skin mottling Cap refil absent Urine output negilable |
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Define septic shock |
A serious medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism |
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Define shock |
Inadequate perfusion to maintain normal organ funtion Characterised by tachycardia and hypotension and features of decreased organ perfusion: E.G. Brain and Kidney |
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What is the sepsis 6 |
Give 02 Give IVT Give Abx Take blood cultures Take lactate Take urine output |
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Define anaphylaxis |
Anaphylaxis a severe, life-threatening, generalised or systemic hypersensitivity reaction which is likely when both of the following criteria are met: Sudden onset and rapid progression of symptoms.Life-threatening airway and/or breathing and/or circulation problems. |
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Describe the pathophysiology of anaphlaxic shock |
An anaphylactic reaction occurs when an allergen reacts with specific IgE antibodies on mast cells and basophils (type 1 hypersensitivity reaction), triggering the rapid release of stored histamine and the rapid synthesis of newly formed mediators. These cause capillary leakage, mucosal oedema and ultimately shock and asphyxia |
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What allergens commonly cause anphylatic reactions? |
Peanuts, pulses, tree nuts, fish and shellfish, eggs, milk, sesame, bee stings, wasp stings, antibiotics, opiods, NSAID's, IV contrast media, muscle relaxants, anesthetic drugs |
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How does anaphylaxis tend to present? |
Initially- generalised itching, uticaria, erthymea, rhinitis, conjunctivits and angio-oedema Then dypnoea, larygeal oedema, wheeze, tachycardia, nausea, vommiting, abdo pain, feeling faint, sense of impending doom, LOC Then swelling, stridor, breathing difficulty, wheeze, cyanosis, hypotension, tachycardia, reduced cap refil |
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What life threatening differentials are important to consider in suspected anaphylaxis? |
Life threatening asthma Septic shock |
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What non-life threatening differentials are important to consider in suspected anaphylaxis? |
Vaso-vagal Panic attack Breath holding attack Idiopathic non-allergic urticaria or angio-oedema |
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How should you manage anaphylaxis? |
ABCDE- remove any traces of allergen, high flow O2, lie patient flat with legs raised IM adrenaline Establish airway Rapid fluid challenge Chlorphenamine Hydrocortisone |
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What are the main types of shock? |
Cardiogenic shock Hypovolemic shock Anaphylatic shock Septic shock Neurogenic shock |
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How does eczema tend to present? |
Extremley itchy Poorly demarkated rash Acutly- ozzing papules and vesicles Subacutely- red and scaley Chronic- lichenfication -Skin thickening with exaggeration of skin markings |
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What are the common causes of atopic eczema?
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TH2 driven inflammation with IgE production specific allergens- house dust mites, animal dander, or dietry eg dairy |
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How does atopic asthma tend to present?
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face- especially around eye s and cheeks Flexures- knees, elbows May become secondarily infected |
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How do you treat secondary infections of eczema? |
Staph- Flucoxicillin HSV- Aciclovir |
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What are common causes of irritant contact dermatitis? |
Detergents, soaps, oils, solvents, venous stasis |
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What is allergic contact dermatitis and what commonly causes it? |
Type IV hypersensitivity reaction Nickel- jewelry, watches, coins Chromates- leather Lanolin- creams, cosmetics |
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What is adult seborrhoeic dermatitis? |
Red scaley rash Caused by overgrowth in skin yeasts Location: scalp (dandruff), eyebrows, cheeks, nasolabial folds |
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What are the principles of management of atopic eczema? |
Education- avoid triggers Soap substitutes Emollients Topical steroid therapies 2nd line treatments |
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What substitutes are useful in eczema? |
Aqueous cream Dermol cream Epaderm ointment |
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What emolients are useful in eczema? |
Epaderm Dermol Diprobase Oitatum (bath oil) |
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What topical steroids are available for eczema? |
1% hydrocortisone- face groin Emumovate- can use < 1 week on face Betnovate Dermovate- very strong- brief use on thick skin- palms, soles |
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What second line therapies are available for eczema beyond topical steroids? |
Topical tacrolimus Phototheraphy Ciclosporin or asathioprine |
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Describe the basic epidemiology if psorasis |
2% of Caucasians Peaks in 20's and 50's F=M 30% have FH |
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What is the pathophysiology of psorasis? |
Type IV hypersensitivity reaction Epidermal proliferation T cell driven inflammatory infiltration |
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What are common triggers in psoriasis? |
Stress, infections esp. Streps, skin trauma, drugs- anti-malarials, alcohol Smoking |
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Describe the plaques in psorasis? |
Symmetrical well-defined red plaques with silvery scale Extensor surfaces Flexures- no scales axillae, groin, submammary Scalp, behind ears, naval, sacrum |
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Describe psoratic nail changes? |
Pitting Oncholysis Subungal hyperkeratosis |
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Describe psoratic arthritis? |
Mon/ oligoarthritis- DIP's commonly involved Rheumatoid like Asymmetrical polyarthritis Psoratic spondylitis Arthritis mutilans |
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Describe guttate psorasis |
Drop like salmon-pink papules with fine scale Mainly on trunk Occurs in children with strep infections |
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Describe pustular psorasis |
Sterile pustules May be localized to palms and soles |
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Describe erythoderma and generalized pustular psorasis |
Generalised exfoliative dermatitis Severe systemic upset: fever, ↑WCC, dehydration May be triggered by rapid steroid withdrawal |
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What are the main principles of psoriasis management? |
Avoid triggers Sop substitutes Emollients Topical therapy UV phototherapy Non-biologics Biologics |
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Describe the topical treatment options in psorasis |
Vit D3 alalogue- eg calcipotriol Steroids eg betamethasone Dovobet = calipotrol + betmethasone Tar: mainly for inpatients Dithranol Retinoids |
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Describe phototheraphy is psorasis |
Causes local immunosupression Narrowband UVB Psoralen + UVA= PUVA Psoralen is a photosensitising agent and can be topical or oral PUVA is more effective but increases skin cancer risk |
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What non-biologics used in Psorasis |
methotrexate Ciclosporin Acetretin (oral retinoid/ vit A analogue) |
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What biologics are used in psosrasis? |
Infliximab Etanercept Adalimuab |
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What are the features of malignant melanoma? |
Asymmetry
Boarder: irregular Colour: non-uniform Diameter > 6mm Evolving / Elevation |
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What are the risk factors for skin cancer? |
Sunlight exposure, especially intense exposure in early years Fair skinned Increase in number of moles FH Older Immunosupression |
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What are the principles of management of malignant melanoma? |
Excision and secondary margin excision depending on bres depth +/- lymphadenectomy +/- adjuvant chemo |
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What are poor prognostic indicators for malignant melanoma? |
Male sex Icrease mitoses Satalite lesions- lymphatic spread Ulceration |
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What do SCC's look like? |
Ulcerated lesion with hard raised everted edges In sun exposed area |
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Describe the evolution of SCC's |
Solar/actinic keratosis → Bowen’s → SCC
Lymph node spread is rare |
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What is Bowen's disease? |
Red/brown scaly plaques SCC in situ |
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What is BCC? |
Commonest cancer Pearly nodule with rolled telangiectasic edge May ulcerate Typically on face in sun-exposed area Above line from tragus to angle od mouth |
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Bowens disease (SCC in situ) Superfical intra epidermal carcinomaFingers, lower legsMimics solitary patch of psoriasis or discoid eczemapresent for years, very slow growth |
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Nodular/ cystic BCC Pearly nodule Telangiectasia Crusting, scaling DD: SCC, intra- dermal naevus |
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Superficial BCC Erythematous scaly patch Common on trunk Thread like elevated edge DD- eczema, psoriasis Bowen’s disease |
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Superficial BCC |
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Morphoiec BCC |
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SCC |
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SCC |
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SCC |
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SCC |
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SCC |
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Malignant melanoma |
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Malignant melanoma |
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Malignant melanoma |
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Malignant melanoma |
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What is a fibroadenoma? |
Most are smooth or slightly lobulated
Usually 2-3 cm in diameter Usually present between 16 and 24 yrs of age Very mobile – breast mouse Approximately 10% of fibroadenomas are multiple Most can be observedExcision indicated if large, patient choice or uncertain diagnosis |
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What is a Phyllodes tumour? |
Occur in premenopausal women Wide spectrum of activity Vary from benign to locally aggressive Have cellular fibrous element Excise with margin of normal tissue Re-exciseor mastectomy for local recurrence |
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What us a breast cyst? |
7% of women will develop a clinically palpable cyst Usually occurs in perimenopausal women Singular or multiple May appear suddenly, sometimes painful Treatment is aspiration Nothing further required if lump resolves and aspirate is not blood stained |
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What is a lactational breast abscess? |
Usually due to Staph aureus
Attempt aspiration If no pus - antibiotics If pus present, repeated aspiration Continue breast feeding from opposite breast |
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What is a Non-lactational breast abscess? |
Occur in periareolar tissue Culture yield - Bacteroides, anaerobic strep, enterococci Usually manifestation of duct ectasia / periductal mastitis Occur 30- 60 years, usually smokers Repeated aspiration is thetreatment of choice |
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What are the non-modifiable risk factors for breast cancer? |
Female Age Geneticmutations / FH Personalhistory Race Densebreast tissue Certainbenign breast conditions EarlyMenarche, late menopause Previousirradiation |
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What are the modifiable risk factors for breast cancer? |
Nulliparity Older first full pregnancy Hormonal contraceptives HRT Alcohol Smoking Obesity |
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What factors decrease risk of developing breast cancer? |
Breast feeding Physical activity |
