MISC

Question 1

Most common cause of conjunctival haemorrhage?

Answer 1

Diabetes and age

• self limited condition if not associated with systemic lllness
• associated conditions: HTN, diabetes, bleeding disorder, high cholesterol, coronary heart disease, medications, valsalva
• usually takes 1-2 weeks to resolve

Question 2

What is an orf?

Answer 2

• zoonotic viral skin infections
• contracted from sheeps and goats
• generally solitary lesion
• most common on hands
• clinical diagnosis in people handling goats and sheep

Question 3

ECG features of hyperkalaemia

Answer 3

• peaked T waves
• flat p waveas, PR prolongation, widened QRS
• bradycardia
• sine wave if severe

Question 4

Management of hyperkalaemia

Answer 4

• ABCD
• calcium 10ml of 10% gluconate
• insulin/dextrose: 10U in 50ml of 50% dextrose
• salbutamol neb/IV
• bicarb infusion: 1mmol/kg IV

If able calcium resonium 15-30g

Question 5

Q fever

Answer 5

• the most common zoonotic disease
• fever, rigors, chills, headache, fatigue, weight loss
• abnormal LFTs
• coxiella burnetti
• serology or PCR
• main source: cattle, sheep, goats

Question 6

Clinical signs and symptoms of Q fever

Answer 6

• fever
• headache
• myalgia
• cough
• influenza like illness
• weight loss
• pneumonia
• nausea
• jaundice (rare)
• meningeal signs (rare)
• rash (rare)

Question 7

Chronic Q fever

Answer 7

• chronic fatigue
• alcohol intolerance common

Question 8

Complications of Q fever

Answer 8

• Endocarditis
• Pnuemonia
• hepatitis
• meningitis

Question 9

Common blood finding of Q fever

Answer 9

• LFT derangement
• lymphopenia
• thrombocytopenia
• CRP elevated

Question 10

Abx for Q fever

Answer 10

100mg doxycycline BD for 14 days

Question 11

Vaccination for Q fever

Answer 11

• contraindicated if previous Q fever due to risk of reactivity

Question 12

What are the notifiable zoonotic disease in Australia?

Answer 12

• brucellosis (pigs)
• leptospirosis (infected urine/water)
• Q fever (cattle, goats, sheep)

Question 13

Brucellosis

Answer 13

• fever, headache, weakness, sweats, chills, myalgia
• inflammation or liver or pleen
• may cause inflammation of testes and epipdymis
• symptoms last 2-4 weeks followed by spontaneous recovery

Question 14

Leptospirosis

Answer 14

• fever, chills, headache, myalgias, conjunctival suffusion
• Weil’s disease: jaundice, renal failure, haemorrhage, myocarditis
• Meningitis
• pulmonary haemorrhage and ARDS

Question 15

Common presentation of acute and chronic Q fever

Answer 15

• chronic: endocarditis or hepatitis
• acute: pneumonia, hepatitis, osteomyelitis and meningitis or encephalitis.

Question 16

Management of brucellosis

Answer 16

• 6 weeks doxycycline + IV gentamicine for 7 days

or

• doxycycline and PO rifampicin (not subsidised on PBS)

Question 17

What is effort thrombosis?

Answer 17

• Axillosubclavian vein thrombosis
• form of venous thoracic outlet syndrome
• caused by venous injury due to mechanical compression
• chronic repetative venous compression at costoclavicular junction causes inflammatory response hence leading t o thrombosis of subclavian vein
• diagnosis: young, right handed with occupational or athletic history of overhead activity
• acute pain, heavy arm

Question 18

Main problems in snake bites (4)

Answer 18

1. Paralysis: ptosis, diplopia, opthalmoplegia, weakness, resp problems
2. coagulopathy: bleeding from bite site, gums and at IVC
3. myolysis: muscle pain and weakness, myoglobinuria, AKI, hyperk
4. renal damage: coaguloapathy, AKI,

Question 19

General and local snake bite symptoms

Answer 19

• headache, nausea, vomiting, abdominal pain, collapse, seziures
• local symptoms: local pain, swelling, bruising

Question 20

Snake bite first aid

Answer 20

• ABCD
• broad compression bandage to the bite site, extended bandage to cover whole of bitten limb including fingers and toes
• splint the limb

Question 21

Hospital management of snake bite

Answer 21

• ABCD
• IVC + IVF
• admit or transfer for clinical observation and serial labs
• maintain PBI until at a centre with lab
• antivenom indicated if any evidence of envenomation

Question 22

Clinical evidence of evenomation

Answer 22

• any paralysis (ptosis, opthalmoplegia, resp distress)
• excessive bleeding
• period of LOC, fitting, collapse, arrest
• oliguria, anuria, myoglobinuria

Question 23

Lab tests of envenomation

Answer 23

• INR, apTT, fibrinogen, d-dimer
• FBC, UEC, CK

If initial tests are normal (pre PBI removal), repeat testing 1 hr post-removal of PBI and then at about 6 & 12 hours post-bite, or more urgently if the patient develops clinical evidence suggestive of envenoming

Question 24

Antivenom therapy

Answer 24

• give IV
• have adrenaline ready and drawn up in case of anaphylaxis
• most cases give 1 vial of polyvalent

Question 25

Brown snake

Answer 25

• coagulopathy, renal failure and paralysis
• dominant feature is coagulopathy

Question 26

Red belly black snack

Answer 26

• haemorrhagic and myolytic

Question 27

Death adder

Answer 27

Neurotoxic/paralysis

Question 28

Taipan

Answer 28

Haemorrhagic and neurotoxic

Question 29

Tiger snake

Answer 29

-haemorrhagic and neurotoxic

Question 30

Red back spider bites

Answer 30

• common but unlikely lethal
• bite felt, severe localised pain and sometime localised sweating
• pain spreads proximally and causes lymphandopathy
• generalised pain with sweating, hypertension and malaise

Question 31

Funnel web spider bites

Answer 31

• potentially rapidly lethal, medical emergency
• painful with fang marks present
• systemic envenomatyion: perioral tingling, tongue fasciculation, increased salivation, lacrymation, piloerection, sweating, nausea, vomiting, headache, dyspnoea, pulmonary oedema

Question 32

Sting rays

Answer 32

• hot water immersion for pain
• ADT
• analgesia + regiona nerve block
• prophylaxtic Abx

Question 33

Blue ringed octopus

Answer 33

Most bites are minor, but potentially lethal. Bite may be painless. In significant cases, rapid development of systemic envenoming which may include: Perioral tingling. Progressive generalised weakness/paralysis. Respiratory paralysis. Hypotension. Maintain airway, respiration (intubate, ventilate), give IV fluids ± pressors to control hypotension. No antivenom is available.