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SDEC Prep 3 Flashcards

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1
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), SDEC Inclusion

A

Severely elevated BP (e.g., ≥180/110–120) without acute end‑organ damage, asymptomatic or mild headache/anxiety

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2
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Red Flags → Admit/Escalate

A

Hypertensive emergency evidence: neuro deficit, chest pain/ACS, pulmonary oedema, aortic dissection symptoms, encephalopathy, AKI/oliguria, eclampsia, papilloedema, refractory BP

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3
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Key History

A

Duration of hypertension, adherence

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4
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Exam – Positive Findings

A

Very high BP on repeated measures (proper cuff/position), fundus exam (AV nicking vs papilledema)

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5
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), ECG / Imaging

A

ECG for LVH/ischemia, CXR if pulmonary oedema suspected

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6
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Biomarkers/Labs

A

U&E (renal function, K+), urinalysis (protein/haematuria), FBC, consider TFTs/catecholamines only if indicated.”

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7
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), First-Hour Actions

A

Confirm BP correctly, rest quietly 20–30 min and recheck

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8
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Initial Management

A

Gradual reduction over days—not hours. Start/uptitrate oral agents (e.g., amlodipine, ACEi/ARB, thiazide). Avoid rapid large drops (>25% MAP in 24–48 h). Counsel adherence/salt/alcohol

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9
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Discharge Criteria

A

Asymptomatic, BP improving/stable with plan

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10
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Safety-Net & Follow-Up

A

Return for chest pain, neuro symptoms, dyspnoea, visual changes, confusion, vomiting. GP/HTN clinic review in ≤1 week with home BP log

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11
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Clinical Pearls

A

25–30% of ‘severe BP’ normalises after 30 minutes’ rest. Treat the patient, not the number—avoid IV drugs in urgency

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12
Q

SDEC—Hypertensive Urgency (no acute end-organ damage), Decision Rules

A

Non-specific, disposition based on the absence of end‑organ damage and follow‑up reliability

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13
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis,SDEC Inclusion

A

Pleuritic or focal chest wall pain reproducible on palpation/movement, normal ECG/troponin or alternative cause excluded

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14
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Red Flags → Admit/Escalate

A

Features suggestive of ACS/PE/aortic dissection/pneumothorax, fever with toxicity

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15
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Key History,

A

Localised sharp pain worse with movement, deep breath, coughing, recent strain/infection/cough

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16
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Exam – Positive Findings

A

Point tenderness over costochondral joints or chest wall musculature, pain reproduced by movement/press

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17
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, ECG / Imaging

A

ECG normal, CXR if pneumonia/pneumothorax suspected

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18
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis,Biomarkers/Labs,

A

None routinely, troponin only if cardiac features.

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19
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, First-Hour Actions

A

Rule out life‑threatening causes (brief ACS/PE/dissent screen as appropriate), give NSAID/analgesia

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20
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Initial Management

A

NSAIDs or paracetamol, topical NSAIDs/heat

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21
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Discharge Criteria

A

Pain controlled, serious causes excluded

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22
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Safety-Net & Follow-Up

A

Return if pain becomes exertional/central/pressure‑like, dyspnoea, syncope, fever. GP review if persistent >2–4 weeks or recurrent.

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23
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Clinical Pearls

A

Reproducible chest wall tenderness reduces but does not eliminate the chance of ACS—ensure appropriate initial screen.

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24
Q

SDEC—Musculoskeletal Chest Wall Pain / Costochondritis, Decision Rules

A

None required. Clinical diagnosis after exclusion of serious pathology.

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25
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, SDEC Inclusion
Haemodynamically stable, Hb typically ≥80–90 g/L (local thresholds)
26
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Red Flags → Admit/Escalate
Hb very low/symptomatic hypoxia/chest pain, haemodynamic instability
27
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Key History,
Fatigue, dyspnoea, pica, menstrual history
28
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Exam – Positive Findings
Pallor, tachycardia
29
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron,ECG / Imaging
ECG if symptomatic or cardiac disease, imaging per 2WW pathway (e.g., colonoscopy/OGD) not same‑day unless indicated."
30
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron,Biomarkers/Labs
FBC (microcytosis), ferritin low (<15–30 µg/L), iron/TIBC, coeliac screen (tTG IgA + total IgA)
31
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, First-Hour Actions
Confirm IDA, exclude active bleeding
32
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Initial Management
Oral ferrous (e.g., 100–200 mg elemental Fe/day, alternate‑day dosing improves tolerance) OR IV iron day‑case if intolerance/malabsorption/need rapid repletion."
33
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Discharge Criteria
Stable, plan in place (oral or IV iron booked)
34
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Safety-Net & Follow-Up
Return for melena, haematemesis, syncope, chest pain. GP: repeat FBC/ferritin in 2–4 weeks to confirm rise, continue iron 3 months after Hb normalises."
35
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Clinical Pearls
Ferritin is an acute-phase reactant—if borderline with raised CRP, use transferrin saturation/soluble transferrin receptor
36
SDEC—Iron-Deficiency Anaemia (IDA) Ambulatory Work-up / IV Iron, Decision Rules
2WW GI criteria (age ≥60 with IDA or <60 with additional red flags per local policy).
37
SDEC—Lower GI Bleed (minor, stable), SDEC Inclusion
Small-volume PR bleeding, haemodynamically stable
38
SDEC—Lower GI Bleed (minor, stable), Red Flags → Admit/Escalate
Haemodynamic instability, ongoing brisk bleeding
39
SDEC—Lower GI Bleed (minor, stable), Key History
Colour/amount (fresh vs maroon), mixed with stool vs on paper, pain/tenesmus, change in bowel habit/weight loss, anticoagulants/DOACs, prior diverticular disease
40
SDEC—Lower GI Bleed (minor, stable), Exam – Positive Findings
Vitals stable, abdominal tenderness absent/mild
41
SDEC—Lower GI Bleed (minor, stable), ECG / Imaging
ECG if anaemic/syncope. Imaging rarely needed acutely for minor bleeds.
42
SDEC—Lower GI Bleed (minor, stable), Biomarkers/Labs
FBC, U&E, coagulation profile, type & screen if risk
43
SDEC—Lower GI Bleed (minor, stable), First-Hour Actions
Risk assess, stop reversible anticoagulation/NSAIDs where safe
44
SDEC—Lower GI Bleed (minor, stable), Initial Management
Topical treatments (e.g., hydrocortisone suppository), stool softeners, fibre arrange outpatient colon investigation per age/risk."
45
SDEC—Lower GI Bleed (minor, stable), Discharge Criteria
Stable vitals, bleeding minimal or resolved
46
SDEC—Lower GI Bleed (minor, stable), Safety-Net & Follow-Up
Return if heavy ongoing bleeding, dizziness/syncope , black stools, anaemia symptoms. GP/2WW referral based on age/red flags
47
SDEC—Lower GI Bleed (minor, stable), Clinical Pearls
Bright red blood on paper with pain suggests fissure, mixed with stool or maroon warrants colon evaluation.
48
SDEC—Lower GI Bleed (minor, stable), Decision Rules
No widely used ambulatory score, use shock index/Hb trend clinically.
49
SDEC—Acute Low Back Pain / Sciatica (no red flags), SDEC Inclusion
Acute (<6 weeks) mechanical back pain ± radicular leg pain, able to mobilise
50
SDEC—Acute Low Back Pain / Sciatica (no red flags), Red Flags → Admit/Escalate
Cauda equina symptoms (saddle anaesthesia, urinary retention/incontinence, bilateral sciatica), progressive neuro deficit, fever/IVDU, cancer, weight loss, night pain, trauma, fracture risk, severe unremitting pain
51
SDEC—Acute Low Back Pain / Sciatica (no red flags), Key History
Onset, trauma/strain, radicular distribution (below knee), numbness/weakness, bladder/bowel, systemic symptoms, past malignancy/IVDU/steroids
52
SDEC—Acute Low Back Pain / Sciatica (no red flags), Exam
Positive Findings, Paraspinal tenderness/spasm, positive straight leg raise (sciatica)
53
SDEC—Acute Low Back Pain / Sciatica (no red flags), ECG / Imaging
No imaging in first 6 weeks unless red flags/severe deficit. MRI if progressive neuro deficit or CES features
54
SDEC—Acute Low Back Pain / Sciatica (no red flags), Biomarkers/Labs
Not required unless infection/malignancy suspected.
55
SDEC—Acute Low Back Pain / Sciatica (no red flags), First-Hour Actions
Analgesia ladder, brief education (stay active, avoid bed rest)
56
SDEC—Acute Low Back Pain / Sciatica (no red flags), Initial Management
NSAIDs + PPI, paracetamol
57
SDEC—Acute Low Back Pain / Sciatica (no red flags), Discharge Criteria
Pain reduced, mobilisation possible
58
SDEC—Acute Low Back Pain / Sciatica (no red flags), Safety-Net & Follow-Up
Return for new bladder/bowel symptoms, saddle anaesthesia, progressive weakness, fever, weight loss. GP review 2–4 weeks
59
SDEC—Acute Low Back Pain / Sciatica (no red flags), Clinical Pearls
Imaging rarely changes management in acute mechanical pain, red flag screen is the key job.
60
SDEC—Acute Low Back Pain / Sciatica (no red flags), Decision Rules
No formal score, use CES red flag checklists.
61
SDEC—Urticaria / Angioedema (non-airway), SDEC Inclusion
Isolated urticaria/limited angioedema without airway compromise or anaphylaxis, stable vitals
62
SDEC—Urticaria / Angioedema (non-airway), Red Flags → Admit/Escalate
Anaphylaxis (airway/breathing/circulation involvement), tongue/laryngeal swelling, wheeze/stridor, hypotension, severe ACE‑inhibitor angioedema, biphasic reaction, failure to respond to IM adrenaline where indicated
63
SDEC—Urticaria / Angioedema (non-airway), Key History
Onset, trigger (foods, meds, bites, infection), prior episodes, ACE‑inhibitor use, systemic symptoms (wheeze, GI, dizziness)
64
SDEC—Urticaria / Angioedema (non-airway), Exam – Positive Findings
Transient pruritic wheals, non‑pitting swelling
65
SDEC—Urticaria / Angioedema (non-airway), ECG / Imaging
Not required unless cardiopulmonary compromise.
66
SDEC—Urticaria / Angioedema (non-airway), Biomarkers/Labs
Generally, none acutely, consider C4/complement if recurrent angioedema without urticaria (hereditary/acquired).
67
SDEC—Urticaria / Angioedema (non-airway), First-Hour Actions
If anaphylaxis → ABC + IM adrenaline. Otherwise non‑sedating H1 antihistamine (cetirizine/loratadine). Consider short PO pred if severe.
68
SDEC—Urticaria / Angioedema (non-airway), Initial Management
Continue daily non‑sedating antihistamine for several days, avoid triggers
69
SDEC—Urticaria / Angioedema (non-airway), Discharge Criteria
Symptoms improving, no airway involvement
70
SDEC—Urticaria / Angioedema (non-airway), Safety-Net & Follow-Up
Return for breathing difficulty, lip/tongue swelling, dizziness/syncope, abdominal pain/vomiting. GP/allergy referral if recurrent or severe.
71
SDEC—Urticaria / Angioedema (non-airway), Clinical Pearls
ACE-I angioedema is bradykinin‑mediated—antihistamines/steroids often ineffective, airway protection is priority.
72
SDEC—Urticaria / Angioedema (non-airway), Decision Rules
Anaphylaxis diagnostic criteria (NIAID/FAAN) guide adrenaline use.
73
SDEC—Herpes Zoster (Shingles), SDEC Inclusion
Typical dermatomal vesicular rash, immunocompetent
74
SDEC—Herpes Zoster (Shingles), Red Flags → Admit/Escalate
Ophthalmic zoster (V1), disseminated rash, immunosuppression, severe pain not controllable, neurological complications (meningoencephalitis), pregnant with severe disease
75
SDEC—Herpes Zoster (Shingles), Key History
Unilateral dermatomal pain/tingling then vesicles, vaccination status
76
SDEC—Herpes Zoster (Shingles), Exam – Positive Findings
Clusters of vesicles on erythematous base in a dermatomal distribution, does not cross midline
77
SDEC—Herpes Zoster (Shingles), ECG / Imaging
Not required unless complications.
78
SDEC—Herpes Zoster (Shingles), Biomarkers/Labs
None routinely, swab PCR if atypical or immunocompromised.
79
SDEC—Herpes Zoster (Shingles), First-Hour Actions
Analgesia, start antivirals within 72 h (or later if new lesions ongoing/severe)
80
SDEC—Herpes Zoster (Shingles), Initial Management
Aciclovir/valaciclovir standard dosing (renal adjust), analgesics ± neuropathic agents
81
SDEC—Herpes Zoster (Shingles), Discharge Criteria
Pain controlled, antiviral started (if indicated)
82
SDEC—Herpes Zoster (Shingles), Safety-Net & Follow-Up
Return if spreading rash, fever, vision change, severe pain, GP for pain review and post‑herpetic neuralgia management."
83
SDEC—Herpes Zoster (Shingles), Clinical Pearls
Antivirals within 72 h reduce acute pain and may reduce PHN, treat beyond 72 h if new lesions or severe pain.
84
SDEC—Herpes Zoster (Shingles), Decision Rules
None, clinical diagnosis.
85
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), SDEC Inclusion
Haemodynamically stable, no thyroid storm
86
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Red Flags → Admit/Escalate
Thyroid storm features (fever, delirium, heart failure, arrhythmia, hypotension), severe AF/HF, pregnant with severe symptoms, inability to cope
87
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Key History
Weight loss, heat intolerance, tremor, anxiety, palpitations, diarrhoea, eye symptoms (grittiness, diplopia)
88
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Exam – Positive Findings
Tremor, warm, moist skin, tachycardia/AF, goitre/bruit (Graves), ophthalmopathy, proximal myopathy
89
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), ECG / Imaging
ECG: sinus tachycardia or AF. Consider thyroid uptake scan outpatient if aetiology unclear (not acute).
90
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Biomarkers/Labs
Low TSH, high free T4/T3
91
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), First-Hour Actions
Assess severity, start β‑blocker (e.g., propranolol) for symptom control unless contraindicated
92
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Initial Management
Begin carbimazole (unless thyroiditis suspected—then NSAIDs ± steroids). Educate on agranulocytosis symptoms (sore throat/fever → urgent FBC). Consider steroids if severe eye disease (specialist)
93
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Discharge Criteria
Symptoms controlled, meds started
94
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Safety-Net & Follow-Up
Return if fever/sore throat (possible agranulocytosis), chest pain, dyspnoea. Endocrine review 2–4 weeks, TFTs to titrate therapy
95
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Clinical Pearls
Subacute (de Quervain’s) thyroiditis is painful with high ESR—treat with NSAIDs/steroids, not carbimazole
96
SDEC—Thyrotoxicosis (new diagnosis or mild–moderate decompensation), Decision Rules
Burch–Wartofsky Point Scale (BWPS) for thyroid storm severity (≥45 highly suggestive).
97
SDEC—Hyponatraemia (mild–moderate, ambulatory), SDEC Inclusion
Na⁺ typically 120–129 mmol/L, asymptomatic or mild symptoms, no, no seizures, no profound confusion
98
SDEC—Hyponatraemia (mild–moderate, ambulatory), Red Flags → Admit/Escalate
Na⁺ <120, seizures, severe confusion/vomiting, hypovolaemic shock, acute drop, severe hyperglycaemia, inability to monitor closely, suspected adrenal crisis/SAH/SIADH from CNS pathology.
99
SDEC—Hyponatraemia (mild–moderate, ambulatory), Key History
Chronicity (days–weeks vs acute), fluid intake, diuretics/SSRIs/carbamazepine, hypothyroid/adrenal symptoms, vomiting/diarrhoea, polydipsia
100
SDEC—Hyponatraemia (mild–moderate, ambulatory), Exam
Positive Findings, Volume status: dry mucosa/orthostasis (hypovolaemia) vs euvolaemia (SIADH) vs oedema (HF/cirrhosis).
101
SDEC—Hyponatraemia (mild–moderate, ambulatory), ECG / Imaging
ECG not diagnostic, consider CXR for pneumonia/malignancy causing SIADH
102
SDEC—Hyponatraemia (mild–moderate, ambulatory), Biomarkers/Labs
U&E, serum osmolality, urine sodium & osmolality, glucose, cortisol (AM) if concern, TFTs. Correct Na⁺ for hyperglycaemia if present
103
SDEC—Hyponatraemia (mild–moderate, ambulatory), First-Hour Actions:
Confirm hypotonic hyponatraemia, assess volume
104
SDEC—Hyponatraemia (mild–moderate, ambulatory), Initial Management
Aim slow correction (≤8–10 mmol/L in 24 h). Fluid restriction 800–1000 mL/day for SIADH. Treat cause (pneumonia, pain, nausea). Salt tablets/loop diuretic in selected cases per local guidance."
105
SDEC—Hyponatraemia (mild–moderate, ambulatory), Discharge Criteria
Asymptomatic, safe plan for correction, able to follow fluid advice, prompt U&E recheck in 24–48 h, reliable support
106
SDEC—Hyponatraemia (mild–moderate, ambulatory), Safety-Net & Follow-Up
Return for confusion, vomiting, seizures. GP/SDEC repeat U&E in 24–48 h, endocrine/renal referral if persistent SIADH.
107
SDEC—Hyponatraemia (mild–moderate, ambulatory), Clinical Pearls
Over‑rapid correction risks osmotic demyelination—document target rise and monitoring plan
108
SDEC—Hyponatraemia (mild–moderate, ambulatory), Decision Rules
No score, algorithmic approach: tonicity → volume → urine Na/osm → cause.
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