drabc-blog-blog

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Back Pain principles. Adapted from Apleys Concise guide to Orthopaedics

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Basic classifications of Neck Of Femor (NOF) fractures

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Dosage of Fluoxetine for Depression

Starting dose 20mg of Fluoxetine Can titrate up to a maximal dose of 60mg Note that the major side effects include: - no improvement for first few 2 weeks - first few days of feeling a bit odd - nausea and vomiting - insomnia - may experience worsening of depression or suicidality

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Side effects of Anti-tuberculous drugs Source - Get Ahead! 300 SBAs for Medicine

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Source - Get Ahead! 300 SBAs for Medicine

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Management of Vesicourereric Reflux

1. Medical - Abx for acute episodes, long term abx for prophylaxis 2. General management - double micturition, hygiene 3. Surgical - avoid if possible!

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Reflux nephropathy (paediatrics)

Investigate any child for Vesicourereric Reflux (VUR) and subsequent Reflux Nephropathy if: First UTI in a boy Second UTI in a girl Along with biochemistry, we can image with - IVP ("gold standard") - Renal US - CT - DMSA (excellent for visualizing hard to see renal scarring) - other imagine modalities We are looking for signs such as small kidneys, scarring, calyceal changes, etc Note that hypertension in children is a LATE SIGN of Reflux nephropathy Source - Prof Agar's "Nephrology Made Easy" (comprehensive yet easy to read and understand guide to nephrology)

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Greenstick Fracture In brief - an incomplete fracture through the radius of a child, owing to their more flexible bones. Source - Radiopedia (amazing resource)

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Oesophageal Atresia and VATER association

Oesophageal atresia may accompany the VATER association: Vertebral anomalies Anal imperforation Tracheo-Esophageal fistula Radial anomaly (limb deformity) Renal anomaly

Note that tracheo-esophageal fistulae can present later with recurrent pneumonias/pneumonitis (particularly H-type fistulae)

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MMSE and Dementia

Expect a 2 point drop in MMSE score each year in the patient with dementia.

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GALS framework

GALS= gait, arms, legs and spine 3 quick screening questions to rule out musculoskeletal complaints: - any stiffness or pain in your muscles, joints or back? - can you dress yourself completely without difficulty? (Upper limb screen) - can you walk up and down stairs without difficulty?

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Top tips. To Add - "if you've got grey hair, you've probably got a rotator cuff tear"

Paediatric Hip Disease - Tips!!

0-2 years - think Developmental Dysplasia of Hip (DDH)

2-4 years - think transient synovitis

4-10 years - think Perthes’ Disease

10-14 years - think Slipped Upper Femoral Epiphysis (SUFE)

0-100 years - ALWAYS THINK INFECTION!!

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Good Ano's practice

Mallampati Assessment

used in the anaesthetists patient assessment to help predict difficulties during intubation

patient sat upright, open mouth and maximally protrude tongue

view of pharynx is noted and given a score from I to IV

grades III and IV suggest difficult intubation - combined with a thyromental distance of <7cm predicts 80% of difficult intubations

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Those pesky 4 H's and 4 T's as the reversible causes in an arrest situation:

Reversible Causes

Hypoxia

Hypovolaemia

Hypo- / hyperkalaemia / metabolic

Hypothermia

Thrombosis - coronary or pulmonary

Tamponade - cardiac

Toxins

Tension pneumothorax

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Hot tips for Clexane dosages

Therapeutic dose: 1.5mg/kg once daily DVT prophylaxis: 20-40mg s/c once daily

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ECG Changes of Acute MI (Myocardial Infarct)

Progression Giant tall T waves --> ST elevation --> Q waves --> ST back to normal and T wave inversion Source - Case Files Series - Internal Medicine

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Revision of First Generation (Typical) Antipsychotics

Examples - Haloperidol, Chlorpromazine Mechanism - Dopamine antagonism Indication - great for positive symptoms of Schizophrenia (mediated by Dopamine). Largely superceded by the atypical antipsychotics. Major Side Effects: Motor - acute dystonia, tardiness dyskinesia Anti-cholinergic - dry mouth Cardiovascular - Orthostatic hypotension, prolonged QT Endocrine - DAergic effects can cause galactorrhoea, gynaecomastia and sexual dysfunction Weight gain Also beware of Neuroleptic Malignant Syndrome - motor symptoms (rigidity) + autonomic disturbances (agitation, sweats, fever)