19/3

Question 1

What observation finding is associated with sleep apnea?

Answer 1

HTN

• unknown pathology

Question 2

Pt is only using topical aminosalicylates and is experiencing mild flare up of UC - next step?

Doesn’t respond to this - next step?

What makes a severe flare?

Answer 2

Add oral

Steroids

> 6 stools per day + features of systemic upset

Question 3

red flag symptoms for rhino/sinusitis

What kind of symptoms may it present with?

How is it managed?

Answer 3

• Unilateral symptoms
• Not improving in 3 months
• Epistaxis

Facial pain - worse on bending forward
Purulent nasal discharge
Mouth breathing

Intranasal steroids if >10 days - use for 2 weeks e.g. fluctiasone
~nasal irrigation
avoid allergens

Question 4

Colles vs Smiths vs monteggia vs galeazza vs nightstick vs Barton’s

How are they all managed?

Answer 4

ALWAYS check peripheral pulses and innervation
- can be managed conservatively or operatively depending
- Smith’s is v unstable and will need ORIF

Colles and Smith’s are radial fractures

Colles (Cooeehh - dinners ready - imagine someone waving)
= Wave = FOOSH
= dinner = dinner fork deformity = dorsal angulation

Smith’s (Katie smith ran with her wrists flexed)
= fall onto flexed writs
= opposite of Colles and volar angulation
= NEEDS ORIF

Barton’s
- intra-articular

Monteggia (think Monty breaking in and popping out of a house)
= BREAK IN = ulnar break
= POP OUT = radial dislocation

Galeazzi = opposite of Monteggia

Nightstick = simple ulnar fracture

Question 5

What antibiotic should be avoided with methotrexate. Why?

Answer 5

Trimethoprim
DON’T double up on your ‘meths’

causes bone suppression and severe/fatal pancytopenia

Question 6

How do you explain using nasal spray?

Answer 6

Ask pt if they can taste the spray at the back of their mouth - if they can using it incorrectly

Use opposite hand to nostril and spray away from nasal septum

DO NOT sniff at same time as spraying