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CST Interview > Clinical > Flashcards

Clinical Flashcards

(59 cards)

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1
Q

Incidence of compartment syndrome in tibial fracture?

A

Up to 45%

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2
Q

Is compartment syndrome excluded in open injury?

A

No - There could be compression on another compartment

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3
Q

Causes of compartment syndrome

A 
Fracture
Plaster compression
Burns
Crush injury
Bleeding
Haematoma
Postischaemic swelling
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4
Q

Compartments of lower limb

A

Anterior
Posterior
Deep posterior
Perineal (Lateral)

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5
Q

Signs and symptoms of compartment syndrome?

A

Main symptom I look out for is pain out of proportion to injury, despite adequate analgesia, and pain on passive stretch of a muscle.
Later signs may include pallor, paraesthesia and pulseless

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6
Q

Management of compartment syndrome

A

If in backslab —> Elevate, Cut the backslab on soft part to skin, or if full plaster then split, keeping it partially intact for support
Provide analgesia
Check distal pulse and sensation and skin
Keep NBM
If available could check compartment pressures
Inform my registrar what i have just done and check on patient again in 20 minutes
If settled, continue as is, if no better book for theatre, take bloods, inform anaesthetist and senior and mark consent for fasciotomy

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7
Q

Measuring compartment in CS

A
  • Sterile conditions
  • Probe inserted into each compartment
  • Within 5 cm of fracture site
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8
Q

Normal compartment pressure?

A

0-10 mmHg

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9
Q

Pressure indicative of CS?

A

within 30 of Diastolic BP or absolute pressure of >30

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10
Q

Signs of Critical Ischaemia

A 
Pain
Pallor
Pulseless
Paraesthesia
Perishingly cold
Paralysis
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11
Q

Low urine output post op (AKI)

Causes?

A

Pre renal

  • Hypovolemia/haemorrhage
  • Renovascular

Renal

  • Acute tubular necrosis
  • Glomerulonephritis
  • Necrosis

Post renal

  • Obstruction
  • Extrinsic compression
  • Iatrogenic
  • Trauma
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12
Q

Define acute tubular necrosis

A

Renal failure resulting from injury to the tubular epithelial cells

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13
Q

Two types of Acute Tubular necrosis

A

Ischaemic

Nephrotoxic
E.g. drugs, toxins or myoglobin

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14
Q

Medications that cause AKI

A 
NSAIDS
ACE-I
Diuretics
Antibiotics e.g. Gentamicin, trimethoprim
Paracetamol
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15
Q

Complications of AKI?

A

Hyperkalemia

Flash pulmonary oedema

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16
Q

Indications for dialysis?

A
  • Refractory or persistent Hyperkalemia
  • Metabolic acidosis
  • Refractory pulmonary oedema
  • Signs of uraemia encephalopathy
  • Signs of Uraemic pericarditis
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17
Q

Risk factors for UGI bleed?

A

Drugs - NSAIDS, anticoagulants
Oesophasgus - Vacrices, Mallory Weiss tear
Gastric - Ulcer, gastritis, drugs, malignancy
Duodenal - ulcer, drugs, malignancy, injury

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18
Q

Scoring system for UGI bleed?

A

Rockall Score
- Pre and Post endoscopy

Age
BP
HR
Co-morbidity

Post endoscopy —> Diagnosis and signs of recent haemorrhage

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19
Q

High risk score for UGI Bleed?

A

> 3

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20
Q

Types of Stoma

A

Colostomy

Ileostomy

End

Loop

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21
Q

Ileostomy

A

End of ileum to the abdomen.

Spouted.

Loop is double barrelled (diverts away from obstruction)

Greenish, loose product

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22
Q

Crohns vs. UC

A

Crohns

  • Rose thorn ulcers
  • Skip Lesions
  • Throughout alimentary tracts
  • Can involve all layers of bowel wall
  • Deep ulceration
  • Fistula formation
  • Cobblestone appearance
  • Worsened by smoking
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23
Q

Consequence of multiple bowel resections?

A

Short gut syndrome.

Malabsorption.

Malnutrition.

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24
Q

Complications of Crohn’s?

Study These Flashcards
A
  • Abscesses
  • Fistula
  • Small bowel obstruction
  • Toxic Megacolon
  • Short bowel
  • Malignancy
  • Primary Sclerosing Cholangitis
  • Gall stones
25
Management of DKA
Fixed rate insulin infusion 0.1 units/kg/hr IV Fluids 4-6 litres/24 hours First 2 in 3 hours
26
Resolution Criteria for DKA
pH >7.35 HCO3 >18 Serum Ketones <0.3
27
Define HONK
Hyperosmolar Non-Ketotic Coma Hypersomolar hyperglycemia Hormone excess with relative insulin deficit
28
Tests for HONK
Glucose >40 Electroluytes suggest dehydration Serum osmolality >350 Normal ketones and ph
29
Treat HONK
IV Fluids to correct dehydration 3-5 units/hr insulin
30
Manage Hypoglycemia in conscious patient
Fast acting oral carbohydrate e.g. gel (20-30 grams)
31
Manage hypoglycaemia in unconscious patient
IM Glucagon 1 mg IV Dextrose (20%, 100 ml)
32
Consequences of poorly controlled T2DM
- PVD - Heart disease - Neuropathy - Retinopathy - Nephropathy
33
AKI Classification
``` R- Risk I- Injury F- Failure L- Loss of function E- End stage ```
34
AKIN Criteria AKI
Stage 1 - 1.5x Cr Stage 2 - 2x Cr Stage 3 - 3x Cr
35
Virchow's Triad
- Haemostasis - Endothelial Damage - Hypercoagualability
36
Embolus vs. Thrombus
Embolus: More acute Painful Risk factors e.g. AF, Surgery, Endocarditis, Prosthetic heart valves
37
Left iliac fossa pain Septic 61 year old DDX?
Abdominal: AAA, Diverticulitis, Ischaemic bowel, Volvulus, Perforation Gynae: ovarian torsion Urinary: Renal calculus, Urine infection, Pyelonephritis
38
SIRS
SIRS: Two or more of: - Raised or low WCC - Temp 38, < 36 - HR >100 - Tachynpneoa - Altered Mental State - BM >6.6
39
Sepsis
SIRS with a known source of infection Severe when there is end organ dysfunction
40
Septic Shock
Sepsis with refractory hypotension
41
Sepsis Six
1) Take Cultures 2) Take Bloods inc. Lactate 3) Take urine culture 4) Give abx 5) Give O2 6) Give fluids
42
Lethal Triad in ATLS
- Metabolic Acidosis - Coagulopathy - Hypothermia
43
Signs of Urological Injury in trauma?
- Blood at meatus - Difficulty passing catheter - Suprapubic bruising - Extravasation of urine
44
Metabolic Acidosis
Kidneys unable t excrete hydrogen ions or increased lactate | Body Compensates by increasing respiratory drive to blow off CO2
45
Intra-operative findings of Nec Fasc
- Necrotic tissue - Fascial oedema - Vessel Thrombosis - Dishwater-colour fluid - Pus
46
Charcot Triad
RUQ Pain Jaundice Fever/Rigors
47
Charcot Triad indicates?
Ascending cholangitis
48
Glasgow score for pancreatitis
``` PO2 <8 Age >55 Neuts >15 Ca <2 (Renal) Urea >16 Enzymes (LDH >600/AST >2000) Albumin <32 Sugar >10 ```
49
Causes of acute pancreatitis?
- Gall Stones - Ethanol - Trauma - Steroids - Mumps - Autoimmune - Scorpion venom - Hypothermia, hyperlipidemia, hypercalcemia - ERCP - Drugs (e.g. NSAIDS)
50
Fat embolism
Fat molecule that enters the circulation, to a distant location. Often associated with trauma, fractures and limb surgery.
51
Pneumothorax compromises Cardiovascular function
Obstructs venous return to the heart
52
Investigating tension pneumothorax
ABG, Examination | NOT CHEST X RAY
53
Risk factors for DVT
- Previous DVT - Family history - Lower limb surgery - Prolonged period of immobility - Lower limb fracture requiring plaster cast and NWB - Malignancy - Medication e.g. Oral contraceptive pill
54
Three factors for VTE
1) Hypercoagulability 2) Endothelial damage 3) Haemostasis
55
Risks for secondary pneumothorax
- Trauma - Ruptured bullae due to emphysema - Cystic fibrosis - infection - Malignancy - Iatrogenic - Asthma
56
Ruptured bullae
- Pressure changes - Trauma - Intubation - Iatrogenic - Infection
57
CT Head indications in trauma
- Focal Neurology - Evidence of base of skull fracture - Seizure - Vomiting (>1 episode) - GCS <13 on admission - GCS <15 after 2 hours
58
GLASGOW Score severity
>6 Severe, high mortality
59
Signs of base of skull fracture
- CSF Rhinorrhea - Otorhoea - Bilateral echymosis - Battle sign (Bruising around mastoid process) - Depressed skull fracture

CST Interview (3 decks)

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