20 cards

Question 1

When would you give a tetanus vaccine booster for wound?

Answer 1

Last booster more than 5 years ago

Question 2

When would you give ppx ABx for tetanus?

Answer 2

Wounds that may contain foreign bodies or that can be significantlly contaminated

Question 3

Which ABx would you give for tetanus prophylaxis

Answer 3

Flucloxacillin 500mg PO QID

Question 4

When is it indicated to give tetanus immunoglobulin

Answer 4

If less than 3 doses of the vaccine have been given and the wound is anything other than a small and clean wound.

Question 5

tetanus vaccine reccomendatiosn

Answer 5

https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/tetanus

Tetanus-toxoid vaccine is recommended for:
routine vaccination in infants, children and adolescents
routine booster vaccination in adults, including travellers to countries where health services are difficult to access
post-exposure prophylaxis in people with a tetanus-prone wound
vaccination of people who have missed doses of tetanus-toxoid vaccine

B

Question 6

Horner’s sydnrome

Answer 6

Miosis , ptosis +/- anhidrosis

This condition results from lesions that interrupt the ipsilateral sympathetic nervous supply to the head, eye, and neck. Most cases of HS are idiopathic, but conditions such as brainstem stroke, carotid dissection, and neoplasm are occasionally identified as the cause of HS.

Question 7

Management of rectourethral fistula

Answer 7

Nasogastric decompression and cross table lateral XR to determine presence of air in perineum

Question 8

https://app.emedici.com/storage/media/c098d1a1-9b3f-4a9f-91fe-4fabc00a70fc.jpg

Answer 8

sigmoid volvulus
Coffee Bean Sign – The dilated sigmoid colon appears as a large, inverted U-shaped loop with a central double wall, resembling a coffee bean. This is due to twisting of the sigmoid colon around its mesentery, creating a closed-loop obstruction.

Absence of Haustration – The affected bowel segment appears smooth rather than showing the usual haustral markings, which can indicate a distended and twisted sigmoid.

Bowel Dilatation – The sigmoid colon is significantly distended, often larger than 10 cm in diameter, which increases the risk of perforation.

Left-Sided Large Bowel Obstruction – Sigmoid volvulus is one of the most common causes of large bowel obstruction, leading to proximal bowel dilation while the distal bowel may be decompressed.

Supine Position Label (“SUPINE”) – Since this is a supine X-ray, the characteristic loop can be visualized more clearly in this projection.

Question 9

https://app.emedici.com/storage/media/6afe2196-0765-4bd0-98d8-1b1e8e021376.jpg

Answer 9

sigmoid volvulus

Inverted U or Coffee Bean Sign

The sigmoid colon is grossly distended and takes on a characteristic bent inner tube or “coffee bean” appearance.

The apex of the dilation typically points toward the right upper quadrant.

Lack of Haustration

The affected loop of bowel appears smooth due to extreme distension and twisting, which reduces the visibility of normal haustra.

Displacement of Surrounding Structures

Other bowel loops are pushed aside, and the large, air-filled loop rises toward the upper abdomen due to the patient’s upright position.

Absence of Free Air

There is no visible pneumoperitoneum, which would suggest perforation.

Obstruction Pattern

Proximal bowel dilation with absent gas distally suggests a closed-loop obstruction, which is common in volvulus.

Question 10

Which sign is associated with sigmoid volvulus on AXR?

Answer 10

cOFEE BEAN SIGN

Question 11

Patient demographics for sigmoid volvulus

Answer 11

Elderly nursing home residents- related to chronic constipation

Question 12

Management of sigmoid volvulus without complications

Answer 12

Sigmoidoscopy and flatus tube

Question 13

Management of sigmoid volvulus - non viable and perforated colon

Answer 13

Laparotomy -> Hartmann

Question 14

Clin F of subdural hematoma

Answer 14

Head trauma - lucid interval and then gradual decline in GCS

Question 15

Types of subdural hematomas

Answer 15

Acute: Symptoms usually develop within 48 hours of injury, characterised by rapid neurological deterioration
Subacute: Symptoms manifest within days to weeks post-injury, with a more gradual progression.
Chronic: Common in the elderly, developing over weeks to months. Patients may not recall a specific head injury.

Question 16

https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/xrb031b.jpg

Answer 16

Subdural hematoma

Question 17

https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/xrb002b.jpg

Answer 17

Subdural hematoma

Question 18

https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/xrb983b.jpg

Answer 18

subdural hematoma

There is a large crescent-shaped area of high density over the right side of the brain, extending from the top (right medial convexity) to the bottom (right temporal lobe). This has caused a midline shift of brain structures, along with subfalcine herniation (where brain tissue is pushed under the falx cerebri).

Question 19

Which vessels are affected in subdural hematoma

Answer 19

Tearing of the bridging veins

Question 20

Which vessels are affected in extradural hematoma

Answer 20

Middle meningeal artery clot formation

Question 21

What is a tetanus prone wond

Answer 21

Compound #, bite wounds, deep/penetrating wounds, FB wounds, wounds complicated by pyogenic inf, wounds with extensive tissue damange, any superficial wound cotaminated with soil, dust, manure, reimplantation of avulsed tooth, depot injections in IVDU