I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here
Most of this is really easy but the ones i struggle with are the drugs in glaucoma and the various associations with iritis
What is Iritis/Uveitis?
- The uvea consists of iris, ciliary body and choroid.
- features
- red
- sore
- pain on movement occasionally and tender globe
- pain with light (as the ciliary body has to constrict). Can be reproduced even with shining light in unaffected eye
- blurred vision and floaters (probably because of the cells in the ant chamber)
- pupil can become irregular with adhesions
- look for a hypopyon (a hyphaema of white cells)
- associations
- lots of HLA B27 associations (like i know what that means…)
- ank spond
- ulcerative colitis, crohns
- sarcoid
- Bechets
- Reactive arthrits (used to be Reiter’s)
- kawawsaki
- MS
- lupus
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What is glaucoma and its management?
(Nice RCEM Learning Piece)
- shallow anterior chamber at risk (in the long sighted older folk, these are the ones not to give pupillary dilation to)
- bunch of drugs (not just drops can precipitate it)
- sympathetics eg salbutamol
- anticholinergics eg hyoscine or ipratropium
- SSRIs
- Antihistamines (with anticholinergic effect) eg chlorpheniramine
- block in the canal of schlemm
- increased intra ocular pressure in the ant chamber
- features
- pain
- headache
- vomiting
- red eye
- mid size fixed pupil
- “halos”
- reduced VA
- hazy cornea
- management
- constrict the pupil -pilocarpine 4% ever 15mins
- prophylact the other side
- acetazolamide 500mg IV (diuretic)
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Name some bugs that cause conjunctivitis
- Adenovirus
- strep pneumo
- haemophilus
- gonorrhoea
- chlamydia
- mumps
- measels
- herpes
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Hi Andy
Your work is great and easy to read. Probably a slight slip but under management it should read ‘constrict’ the pupil (muscarinic parasympathomimetic :-)).
Thanks for all your hard work – it’s amazing!
Anbin
ooops!! thanks for pointing that out. now fixed