Med Ed Revision > SDEC Prep 2 > Flashcards

SDEC Prep 2 Flashcards

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1
Q

SDEC—Acute Asthma (mild–moderate),SDEC Inclusion,Mild–moderate exacerbation

A

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2
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SDEC—Acute Asthma (mild–moderate),Red Flags → Admit/Escalate

A

“Life‑threatening/severe: silent chest, exhaustion/confusion, SpO₂ <92%, PEF <50% (severe) or <33% (life‑threatening), RR ≥25, HR ≥110, cyanosis, poor response after 1 h, evidence of pneumonia or pneumothorax, pregnancy, brittle asthma, previous ICU/intubation.”

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3
Q

SDEC—Acute Asthma (mild–moderate), Key History

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“Onset/trigger (viral, allergen, NSAIDs/β‑blocker), nocturnal symptoms, previous ICU/ventilation, steroid use/adherence, action plan, smoking, PEFR baseline/best.”

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4
Q

SDEC—Acute Asthma (mild–moderate),Exam – Positive Findings

A

“Wheeze, accessory muscle use, tachypnoea, tachycardia inability to speak full sentences (severity), pulsus paradoxus (severe), reduced air entry.”

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5
Q

SDEC—Acute Asthma (mild–moderate),ECG / Imaging,

A

ECG usually sinus tachycardia consider if chest pain/arrhythmia. CXR only if fever, focal chest signs, suspected pneumothorax, or poor response.”

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6
Q

SDEC—Acute Asthma (mild–moderate),Biomarkers/Labs

A

Not routinely needed consider VBG/ABG if severe or drowsy (look for CO₂ retention/acid–base).

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7
Q

SDEC—Acute Asthma (mild–moderate),First-Hour Actions

A

Nebulised salbutamol 5 mg ± ipratropium 0.5 mg (back-to-back if needed) prednisolone 40–50 mg PO (or IV hydrocortisone 100 mg if unable PO)

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8
Q

SDEC—Acute Asthma (mild–moderate),Initial Management

A

Continue bronchodilators (spacer MDI preferred once stable) consider magnesium sulfate 1.2–2 g IV if poor response

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9
Q

SDEC—Acute Asthma (mild–moderate), Discharge Criteria

A

Symptoms improved, PEF ≥75% best/predicted and stable ≥1 h

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10
Q

SDEC—Acute Asthma (mild–moderate),Safety-Net & Follow-Up

A

Return if increasing SOB, SpO₂ <94%, needing salbutamol >10 puffs/4 h, nocturnal waking, chest pain. GP/asthma nurse in 48 h consider referral if frequent exacerbations.”

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11
Q

SDEC—Acute Asthma (mild–moderate), Clinical Pearls

A

Spacer with 10 puffs salbutamol (1 puff every 30–60 s) ≈ nebuliser once stable, steroids early reduce relapse

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12
Q

SDEC—Acute Asthma (mild–moderate),Decision Rules

A

Use BTS/SIGN severity bands: Moderate (PEF 50–75%), Severe (any of RR ≥25, HR ≥110, PEF 33–50%)

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13
Q

SDEC—Acute Pericarditis,SDEC Inclusion

A

Stable vitals, typical pleuritic, positional chest pain better sitting forward

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14
Q

SDEC—Acute Pericarditis,Red Flags → Admit/Escalate

A

Suspected tamponade (hypotension, raised JVP, muffled heart sounds), large/moderate effusion on echo/CXR, high fever, immunosuppression, trauma, anticoagulation with effusion, myocarditis with LV dysfunction, diagnostic uncertainty/ACS.

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15
Q

SDEC—Acute Pericarditis, Key History,

A

Sharp pleuritic chest pain, worse supine, improved leaning forward, recent viral illness

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16
Q

SDEC—Acute Pericarditis,Exam – Positive Findings

A

Pericardial friction rub, tachycardia

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17
Q

SDEC—Acute Pericarditis,ECG / Imaging

A

ECG: widespread concave ST elevation with PR depression, reciprocal PR elevation in aVR

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18
Q

SDEC—Acute Pericarditis, Biomarkers/Labs

A

hs‑Troponin may be mildly ↑ (myopericarditis), CRP/ESR ↑

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19
Q

SDEC—Acute Pericarditis,First-Hour Actions

A

Rule out STEMI/PE, ECG, troponin, CXR

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20
Q

SDEC—Acute Pericarditis, Initial Management

A

NSAID (e.g., ibuprofen 400–600 mg TDS) + colchicine 500 mcg OD–BD (dose adjust for weight/renal) for 3 months, PPI if GI risk

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21
Q

SDEC—Acute Pericarditis,Discharge Criteria

A

Pain controlled, no red flags

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22
Q

SDEC—Acute Pericarditis, Safety-Net & Follow-Up

A

Return if dyspnoea, syncope, hypotension, worsening pain/fever. GP/cardiology review in 1–2 weeks, CRP to guide taper

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23
Q

SDEC—Acute Pericarditis,Clinical Pearls

A

Colchicine halves recurrence, avoid NSAIDs post‑MI pericarditis (use aspirin). Check for myopericarditis if significant troponin rise.

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24
Q

SDEC—Acute Pericarditis, Decision Rules

A

ESC diagnostic criteria: need ≥2 of 4—typical chest pain, pericardial rub

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25
SDEC—Spontaneous Pneumothorax (small, uncomplicated), SDEC Inclusion
Minimal symptoms, stable
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SDEC—Spontaneous Pneumothorax (small, uncomplicated),Red Flags → Admit/Escalate
Tension physiology, significant breathlessness, large pneumothorax (>2 cm rim at hilum on CXR in BTS definitions), bilateral, SSP with hypoxia, pregnancy, haemodynamic instability, recurrence with failure of ambulatory device.
27
SDEC—Spontaneous Pneumothorax (small, uncomplicated), Key History
Sudden pleuritic chest pain and dyspnoea, smoking
28
SDEC—Spontaneous Pneumothorax (small, uncomplicated), Exam – Positive Findings
Reduced breath sounds, hyperresonance, tachycardia, tracheal deviation only in tension
29
SDEC—Spontaneous Pneumothorax (small, uncomplicated), ECG / Imaging
CXR PA preferred: visible pleural line with absent peripheral lung markings, measure interpleural distance. US can detect lung point. CT if uncertain.
30
SDEC—Spontaneous Pneumothorax (small, uncomplicated), Biomarkers/Labs
Not routinely needed, ABG if hypoxia/underlying disease.
31
SDEC—Spontaneous Pneumothorax (small, uncomplicated), First-Hour Actions
Confirm on CXR/US, assess size and symptoms
32
SDEC—Spontaneous Pneumothorax (small, uncomplicated), Initial Management
Primary spontaneous: Observation if small/asymptomatic, needle aspiration first‑line if symptomatic. Ambulatory device if needed. Secondary: often admit—consider aspiration or drain if >1 cm at hilum or symptomatic (follow BTS).
33
SDEC—Spontaneous Pneumothorax (small, uncomplicated), Discharge Criteria
Stable, improving symptoms, satisfactory re‑expansion or safe ambulatory plan
34
SDEC—Spontaneous Pneumothorax (small, uncomplicated), Safety-Net & Follow-Up
Return if worsening breathlessness or chest pain. Smoking cessation. Avoid air travel until radiographic resolution
35
SDEC—Spontaneous Pneumothorax (small, uncomplicated), Clinical Pearls
Small PSP often resolves. Check for apical blebs history
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SDEC—Spontaneous Pneumothorax (small, uncomplicated), Decision Rules
BTS size threshold (CXR rim at hilum ~2 cm ≈ 50% volume). Use local ambulatory pathways for aspiration vs drain.
37
SDEC—Headache Syndromes (Migraine/Cluster/Tension), SDEC Inclusion
Typical primary headache features, neuro exam normal
38
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Red Flags → Admit/Escalate
SNOOP10 features: systemic symptoms/cancer/HIV, neurological deficit
39
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Key History
Migraine: unilateral throbbing, photophobia/phonophobia, N/V, aura. Cluster: severe unilateral orbital/temporal pain 15–180 min with autonomic features (tearing, ptosis). Tension: bilateral band-like mild–moderate, no N/V.
40
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Exam – Positive Findings
Normal neuro, meningism absent
41
SDEC—Headache Syndromes (Migraine/Cluster/Tension), ECG / Imaging
No routine imaging for typical primary headache. CT head ± LP for thunderclap (consider Ottawa SAH rule) or focal deficits/meningism.
42
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Biomarkers/Labs
Not routine, consider CRP if infection suspected
43
SDEC—Headache Syndromes (Migraine/Cluster/Tension), First-Hour Actions
Treat first: Migraine—NSAID + anti‑emetic (prochlorperazine or metoclopramide) ± triptan. Fluids if dehydrated. Cluster—high‑flow O₂ and SC/IN sumatriptan. Reassess response
44
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Initial Management
Provide acute regimen and prophylaxis advice (e.g., propranolol/topiramate for frequent migraine, verapamil for cluster under a specialist). Trigger diary
45
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Discharge Criteria
Headache resolved or significantly improved, red flags excluded
46
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Safety-Net & Follow-Up
Return for sudden worst headache, neuro deficits, fever/neck stiffness, head injury, or new pattern. GP for prophylaxis discussion, cluster patients need urgent neuro/headache clinic.
47
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Clinical Pearls
Treat early and adequately, prochlorperazine often aborts migraine
48
SDEC—Headache Syndromes (Migraine/Cluster/Tension), Decision Rules
Ottawa SAH Rule (for thunderclap): age ≥40, neck pain/stiffness, witnessed LOC, exertional onset, thunderclap, limited neck flexion—any positive → imaging ± LP.
49
SDEC—BPPV / Vestibular Neuritis, SDEC Inclusion
Isolated vertigo with peripheral features, haemodynamically stable
50
SDEC—BPPV / Vestibular Neuritis,Red Flags → Admit/Escalate
Central signs: new focal neuro deficit, severe ataxia preventing standing, new headache/neck pain (dissection), high vascular risk with continuous vertigo/nystagmus, hearing loss with neuro signs, refractory vomiting/dehydration.
51
SDEC—BPPV / Vestibular Neuritis, Key History
BPPV: brief (<1 min) positional vertigo triggered by turning/looking up. Vestibular neuritis: acute sustained vertigo hours–days after viral prodrome, worse with head movement no hearing loss.
52
SDEC—BPPV / Vestibular Neuritis, Exam – Positive Findings
BPPV: positive Dix–Hallpike with torsional up‑beating nystagmus (posterior canal). Neuritis: unidirectional horizontal nystagmus, positive head‑impulse, gait imbalance but can stand.
53
SDEC—BPPV / Vestibular Neuritis,ECG / Imaging
No routine imaging in classic peripheral presentations. Consider MRI brain if central features or failed HINTS
54
SDEC—BPPV / Vestibular Neuritis, Biomarkers/Labs
Not typically required, glucose if symptomatic
55
SDEC—BPPV / Vestibular Neuritis, First-Hour Actions
BPPV: Epley manoeuvre. Neuritis: antiemetic (prochlorperazine short course), vestibular suppressants short term, hydration, begin vestibular rehab exercises."
56
SDEC—BPPV / Vestibular Neuritis, Initial Management
Teach home Epley/Brandt–Daroff for BPPV. For neuritis, limit vestibular suppressants to 48–72 h to avoid delaying compensation.
57
SDEC—BPPV / Vestibular Neuritis, Discharge Criteria
Symptoms improved, safe mobilisation
58
SDEC—BPPV / Vestibular Neuritis, Safety-Net & Follow-Up
Return if new neuro deficits, inability to stand, severe headache/neck pain, persistent vomiting. GP/ENT/physio if persistent BPPV or prolonged neuritis
59
SDEC—BPPV / Vestibular Neuritis, Clinical Pearls,
HINTS exam: peripheral pattern = abnormal head‑impulse, unidirectional nystagmus, negative skew. Any central sign → urgent imaging.
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SDEC—BPPV / Vestibular Neuritis, Decision Rules
No formal score, HINTS bedside triad for continuous vertigo
61
SDEC—Acute Gout Flare,SDEC Inclusion
Typical monoarthritis (1st MTP/knee/ankle), afebrile or low‑grade fever, septic arthritis unlikely, pain manageable with oral meds, able to self‑care.
62
SDEC—Acute Gout Flare,Red Flags → Admit/Escalate
Typical monoarthritis (1st MTP/knee/ankle), afebrile or low‑grade fever, septic arthritis unlikely, pain manageable with oral meds, able to self‑care.
63
SDEC—Acute Gout Flare, Key History
Rapid onset severe joint pain peaking <24 h, prior gout
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SDEC—Acute Gout Flare, Exam – Positive Findings
Red, hot, exquisitely tender joint, tophus
65
SDEC—Acute Gout Flare, ECG / Imaging
Not required. US may show double‑contour sign. X‑ray: punched‑out erosions in chronic disease.
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SDEC—Acute Gout Flare, Biomarkers/Labs
Serum urate may be normal during flare, FBC/CRP may be raised
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SDEC—Acute Gout Flare, First-Hour Actions
Analgesia, rule out septic arthritis in high‑risk
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SDEC—Acute Gout Flare, Initial Management
NSAID (e.g., naproxen) + PPI, or colchicine 500 mcg 2–3×/day (renal adjust)
69
SDEC—Acute Gout Flare, Discharge Criteria
Pain improving within 24–48 h, oral meds tolerated
70
SDEC—Acute Gout Flare, Safety-Net & Follow-Up
Return if fever, spreading erythema, uncontrolled pain, GP for urate target <300 μmol/L, ULT plan, lifestyle advice."
71
SDEC—Acute Gout Flare, Clinical Pearls
Serum urate can be normal in flare, aspiration is gold standard if in doubt. Review diuretics/alcohol.
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SDEC—Acute Gout Flare, Decision Rules
2015 ACR/EULAR gout classification in SDEC rely on clinical pattern ± aspiration.
73
SDEC—Bell’s Palsy (Peripheral Facial Palsy), SDEC Inclusion
Acute unilateral LMN facial weakness, no stroke signs, onset <72 h, stable, able to protect eye.
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), Red Flags → Admit/Escalate
Stroke/TIA features (forehead sparing, limb weakness, aphasia), vesicular rash/ear pain (Ramsay Hunt), severe eye exposure keratopathy, bilateral palsy, recurrent palsy, Lyme risk, immunosuppressed.
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), Key History
Acute facial droop including forehead, altered taste
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), Exam – Positive Findings
LMN pattern: cannot wrinkle forehead/close eye, check cornea/tear reflex
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), ECG / Imaging
Imaging not routine if classic. Consider MRI/ENT referral if atypical, recurrent, or no improvement by 3 months
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), Biomarkers/Labs
Not routine, glucose/HbA1c
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), First-Hour Actions
Differentiate central vs peripheral, urgent eye protection (artificial tears, tape at night)
80
SDEC—Bell’s Palsy (Peripheral Facial Palsy), Initial Management
Prednisolone 50–60 mg daily ×7 days then stop, eye lubrication q2h + ointment nocte
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), Discharge Criteria
Eye protected, steroid script given
82
SDEC—Bell’s Palsy (Peripheral Facial Palsy), Safety-Net & Follow-Up
Return for corneal pain/redness, new neuro deficits, vesicular rash. GP/ENT 1–2 weeks, ophthalmology if exposure keratopathy.
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), Clinical Pearls
Steroids within 72 h improve outcomes, antivirals add little unless zoster. Forehead involvement = LMN palsy.
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SDEC—Bell’s Palsy (Peripheral Facial Palsy), Decision Rules
House–Brackmann grading for documentation, otherwise clinical.
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