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Clinical Exam Flashcards > Criteria & Lists > Flashcards

Criteria & Lists Flashcards

1
Q

What are the components of the Glasgow scoring system for Pancreatitis?

A

Arterial oxygen less than 60mmHg. Age over 55. White cells over 15. Calcium less than 2. Urea greater than 16. LDH over 600. Albumin less than 32. Serum glucose over 10.

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2
Q

What is the Glasgow Scoring System for Pancreatitis?

A

The Glasgow system is a simple prognostic system that uses the data collected during the first 48 hours following an admission for pancreatitis. It is applicable to both biliary and alcoholic pancreatitis.

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3
Q

What are the 4 classic radiological features of osteoarthritis?

A
  1. Narrowed joint space
  2. Sclerosis
  3. Osteophytes
  4. Subchondral cysts
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4
Q

What are the risks of blood transfusion?

A

Minor allergic reaction 1/100
Major reaction 1/100,000
Hepatitis B 1/300,000
Hep C / HIV / HTLV 1/million

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5
Q

What are the risks of contracting HIV, Hep B, or Hep C from a single needlestick injury?

A

HIV : 0.3%
Hep B: 6-30%
Hep C: 1.8%

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6
Q

Key points in post-splenectomy counselling?

A
  1. Risk of sepsis from certain bacteria (encapsulated)
  2. Need vaccination within 2 weeks; repeated 3-5yrly
  3. Need yearly influenza vaccine
  4. Needs emergency antibiotics
  5. May need lifelong antibiotics
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7
Q

What is the definition of brain death?

A

Determination of brain death requires (irreversible):

  1. Unresponsive coma
  2. Absence of brain stem reflexes
  3. Absence of respiratory centre function
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8
Q

Describe the formal examination for diagnosis of brain death

A

Clinical testing is performed independently by two practitioners with specific experience and qualifications (ICU).

  • Absence of responsiveness (GCS 3)
  • Absence of brain stem reflexes (Pupils, Vestibulo-cochlear, Corneal reflex, Gag reflex, Cough reflex)
  • Presence of apnoea (check for spontaneous breathing after generating hypercapnoea with ventilator)
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9
Q

Give examples of reversible causes of coma:

A

Hypothermia
Sedatives, anaesthetic agents, muscle relaxants, narcotics
Electrolyte abnormalities, hypoglycaemia, acidosis, alkalosis

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10
Q

State the rates of pseudoaneurysm for elective and therapeutic procedures:

A

Elective: 0.05-2%

Therapeutic: 2-8%

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11
Q

What are the 4 characteristics of a pseudoaneurysm?

A
  1. Atypical location
  2. Sudden onset
  3. Transmitted pulsation
  4. History of local trauma
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12
Q

What is Type I error?

Give an example:

What is an indirect index of Type I error?

A

Rejecting the null hypothesis when it is true (i.e a false positive)

For example:
Where Drug A doesn’t have an effect but the study says it does.

The p-value is an indirect measure of Type I error; a p-value of 0.05 means there is a 5% chance of failing to reject the true null hypothesis.

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13
Q

What is type II error?

Give an example:

How do you minimise Type II error?

A

Type II error is the failure to reject a false null hypothesis (i.e a false negative)

For example:
Where drug A does have an effect but the study says it does not.

Adequate powering of a study minimises Type II error.

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14
Q

Describe the Ranson criteria for pancreatitis:

A

A score of one for each of the following:

Age over 55 (70 GSP)
WCC over 16 (18 GSP)
Glucose over 11 (12.2 GSP)
Serum AST over 250 
Serum LDH over 400
After 48h:
Calcium below 2
Ht drop of 10%
Pa02 of less than 60mmHg
BUN over 1.8 despite fluids
Base deficit over 4
Sequestration of fluids over 6L (4L GSP)
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15
Q

What are the risks of mortality associated with the Ranson score?

A

Score 0 to 2 : 2% mortality
Score 3 to 4 : 15% mortality
Score 5 to 6 : 40% mortality
Score 7 to 8 : 100% mortality

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16
Q

What are the specific symptoms to ask about in a hypertensive history?

A

Acute onset headache, blurred vision, nausea and vomiting for crisis.

Sweating, palpitations, and tremor for phaeochromocytoma.

Anorexia, weight loss, lethargy, and itching for renal disease.

17
Q

Name the 5 H’s and 5 T’s:

A

Hypothermia, Hypoglycaemia, Hypo/hyperkalaemia, Hypovolaemia, Hydrogen ions

Tamponade, Thrombus, Toxins, Tension pneumothorax, Trauma.

18
Q

Define bullying:

A

To bully is to threaten, oppress or tease, either physically or morally. It may include professionally undermining someone or consistently undervaluing effort and is an abuse of power.

19
Q

Define harassment:

A

Unwanted conduct affecting the dignity of men and women in the workplace.

20
Q

How would you advise a colleague to deal with bullying or harassment?

A

Tell the perpetrator to STOP.
Document their actions with examples.
Discuss concerns with your supervisor or an equivalent boss, the college, or the employers. Make these formal.
Seek the support of RACSTA

21
Q

What are the recommended margins for excision biopsy of BCC and SCC?

A

BCC: 3mm for small, 5-15mm for large, pleomorphic BCC

SCC: 4mm in low risk patients, 6mm in high risk patients.

22
Q

What is the recommended excision biopsy margin for possible melanoma?

A

A 2mm margin for biopsy is adequate.

From MoH Melanoma Guidelines

23
Q

What are the recommended radical excision margins melanoma according to T stage?

A 
MiS = 5mm
T1 = 1cm
T2 = 1-2cm
T3 = 1-2cm
T4 = 2cm
24
Q

What are the principles of post needle stick injury occupational safety?

A
  1. Local wound care
  2. Take blood for HIV, Hep B, and Hep C at baseline, 6 weeks, 3 months, and 6 months.
  3. Assess need for Hep B and tetanus prophylaxis, and initiate
  4. Counsel patient and family about these measures.
25
Q

List the causes of bilateral parotid enlargement:

A

Mumps
Sarcoidosis
Alcohol related parotiditis
Malnutrition

26
Q

List the causes of unilateral parotid swelling:

A

Mumps
Pleomorphic adenoma (80% of benign tumours)
Tumour infiltration
Salivary calculus

27
Q

List the generic operative risks of surgery:

A 
Pain
Bleeding
Infection
Venous thromboembolism
Death
Further procedures
Scar
Damage to surrounding structures
28
Q

What are the elements of critical analysis of IOC?

A
  1. Flow into duodenum
  2. No filling defects in CBD
  3. Presence of spiral valves in CD
  4. Proximal hepatic duct identified
  5. Filling of left hepatic duct, right anterior and right posterior sectoral ducts.
29
Q

Outline the disabilities and subsequent care required in spinal injury? (e.g. T12)

A 
Paraplegia/paralysis
Numbness and pressure care
Abnormal dryness of skin
Bowel and bladder dysfunction
Sexual dysfunction and implications for family planning
Contractures and need for physiotherapy.
30
Q

What are the differentials for a lump at the angle of the jaw?

A

Metastatic SCC from the AED
Pleomorphic adenoma or adenolymphoma
Malignant salivary; mucoepidermoid or adenocystic
Mumps, TB, lymphoma, Sjogren’s

31
Q

What are Waddell’s signs?

A

A group of physical signs that can be elicited within a one minute examination that may indicate a non-organic cause for a patient’s back pain. If three or more signs are present there is a clinically significant chance that the pain has a non-organic component or aetiology.

  1. Tenderness test: Non-anatomic tenderness
  2. Distraction test: Sitting SLR
  3. Simulation test: Axial loading causing pain
  4. Regional disturbance with pain not in keeping with accepted neuroanatomy
  5. Over-reaction
32
Q

What is the lifetime risk of overwhelming sepsis from encapsulated organisms in post-splenectomy patients?

A

5%

Patients may want to consider wearing a medic-alert bracelet.

33
Q

At the start of any procedure station…

A

Check correct patient, check indication, obtain consent, and ensure protective gown, gloves, and eye wear are on.

34
Q

Risk factors for DVT:

A

Age and Obesity.

Stasis: Immobility, paralysis, recent surgery, heart failure, varicose veins.

Coagulopathy: Oestrogen exposure, cancer, Protein C/S deficiency, Factor V Leiden, Cancer

Endothelial damage: Sepsis, trauma, vasculitides, age, IV catheter.

35
Q

Contraindications to thromboprophylaxis:

A 
Active bleeding
Previous haemorrhagic CVA
Previous GI bleed
Advanced liver disease
Previous reaction to Heparin
Very high falls risk 
Palliative care
36
Q

Which other exams are relevant to examination for hypertension?

A

Optic fundoscopy

Cardio respiratory examination.

37
Q

Settings for a nerve stimulating needle in femoral nerve blockade?

A

Positive electrode on patient. Negative electrode on needle.

Frequency of 2Hz, current output of 1-2mA.

Watch for rectus femoris twitch.

38
Q

List the causes of carpal tunnel syndrome:

A 
Pregnancy
Rheumatoid arthritis
Arthritis (degenerative) 
Growth hormone excess
Metabolic abnormalities (DM, TSH)
Alcoholism
Trauma
Idiopathic 
Connective tissue disorders.
39
Q

What is commonly forgotten in assessment of an iliac fossa stab injury?

A

Assessment of an injury to the lumbar plexus.

Check femoral, obturator, and sciatic nerves.

Clinical Exam Flashcards (1 decks)

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