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USMLE Step 2 - Top 5% > Multi-system > Flashcards

Multi-system Flashcards

1
Q

What spinal issue can be see in duchenne

A

Scoliosis

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2
Q

Dx and Tx for Duchenne

A

Dx with either biopsy of muscle or genetic test. Tx with steroids

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3
Q

What can eventually occur in the joints of a DMD patient

A

Joint contractures

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4
Q

Why does CK drop in the progression of duchenne

A

As the muscle is replaced by fibrofatty infiltration… the CK will drop a bit

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5
Q

List so,e complications of Prada Willi syndrome

A

All relates to obesity. Sleep apnoea, DM, choking, gastric rupture. So make sure to limit food for these little chubby kids. Also can give GH, to increase vertical growth

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6
Q

Protruding Metopic suture, seen where

A

Seen in cris du chat

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7
Q

Name some of the less obvious edwards signs

A

Low set ears, small jaw, limited hip abduction

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8
Q

Screening recommendations for gon chlam infx

A

Annual NAAT test, for sexually active under 25 (or has RFs)

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9
Q

What is congenital contractural arachnodactylyl

A

A fibrilin II defect, causing Mariah features, except no CV or ocular signs

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10
Q

AL Amyloidosis main manifestations

A

Nephrotic syndrome, Hmeg, periorbital purpurin, waxy skin, restrictive cardiomyopathy

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11
Q

Why is lymphoedema not pitting

A

Because the protein concentration is high

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12
Q

Two reasons we need estrogen therapy in turners syndrome

A

For sexual development, but also to decrease risk of osteoporosis

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13
Q

The gene test we have to do for CHARGE syndrome

A

CHD7

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14
Q

Contrast manifestions of CREST and diffuse SS

A

CREST:
• Scleroderma on head & distal UE
Prominent vascular manifestations
• Raynaud phenomenon
• Cutaneous telangiectasia
• Pulmonary arterial hypertension
• CREST syndrome

Diffuse SS:
• Scleroderma on trunk & UE
• Prominent internal organ involvement
• Scleroderma renal crisis
• Myocardial ischemia & fibrosis
• Interstitial lung disease

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15
Q

Joint fluid:

> 10,000 wbc

> 75% PMN

A

culture it… likely septic

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16
Q

WBC numbers in joint fluid to remember for step

A

<2000 is normal

2,000-10,000 is inflam

> 10,000 is septic

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17
Q

Join fluid with blood and fat droplet

A

Maybe fracture

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18
Q

Foot puncture wound and osteoM… cover which bac

A

Pseudomonas

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19
Q

Adults vs kids. Osteomyelitis. Which is more from seeding and which from contiguous spread

A

Adults from spread, kids more seedinh

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20
Q

If patient had allergic rash on penicillin, can we give ceph? What about anaphylaxis or angioedema

A

Yes, and No

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21
Q

Are OA patients at higher risk of osteoporosis after Sx

A

Yes

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22
Q

Viscosity of joint fluid in inflam

A

Lower!

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23
Q

Retina bulls eyes appearance

A

Chloroquine tox

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24
Q

Don’t forget carpal tunnel from RA

A
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25
Q

Other than AR… what other cardiac issue in ank spond

A

Heart block

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26
Q

Mixed connective tissue disease AB

A

U1 RNP Ab

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27
Q

Other than our tigger and target zones… what else do we see in myofascial pain and not fibromyalogia

A

Myofascial pain can be seen in muscle tissue only. Whereas fibro also in other CT

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28
Q

Anti RNA polymerase III in SS a risk for what?

A

Scle renal crisis

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29
Q

CS can be given for SS flare…. But what is the main risk

A

Increased risk for renal crisis

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30
Q

CREST mainstay Tx

A

Methotrexate usually

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31
Q

Is lupus arthritis deforming

A

No

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32
Q

Aortic complications of GCA

A

Aneurysm

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33
Q

Most common artery affected in AION in GCA

A

Posterior ciliary artery. From the ophthalmic. From the ICA

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34
Q

Commonest cause of mortality in Behcets

A

Thrombosis

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35
Q

Preventing recurrence in Behcets?

A

Colchicine (sounds Turkish too)

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36
Q

Some other random causes of adhesive capsulitis

A

DM, hypothyroid, contractures, stroke, shoulder injury

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37
Q

Rotator cuff impingement Dx test

A

X-ray! Not MRI (if tear)

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38
Q

Compartment syndrome delta pressure cut off

A

30

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39
Q

Open fractures usually need what intervention (medically)

A

Abx and Tet prophylx

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40
Q

Within how many hours to prevent long term complications of compartment syndrome

A

6 hours to do fasciotmy. Main Px factor

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41
Q

Durkan test (carpal compression): positive in what?

A

Carpal tunnel

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42
Q

Carpal tunnel worse when

A

At night

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43
Q

Carpal tunnel risks

A

Preg, DM, hypothyroidism, acromegaly, RA, amyloidosis, overuse

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44
Q

Are ganglion cysts mobile

A

Not usually

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45
Q

Dupytrens contracture…. High recurrence after Tx?

A

Yes?

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46
Q

Alarm signs of hand bite and invx to do

A

Crepitus and skin discolouration. Do X-ray and usual labs

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47
Q

Osteochondritis dissecans Signs

A

Antalgic gait patient, usually adol boy, how does a lot of activity. Almost OA like signs. Often has history of ankle inversions

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48
Q

Patellofemoral pain syndrome overview of signs

A

Anterior knee pain. Overuse injury. Worse when walking up and downstairs. Worse when squatting. Squeeze test positive. Just rest and give nsaid, quad training

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49
Q

Morton neuroma signs

A

Click sensation when palpating area, numbness and pain and paraesthesia. Symptoms worse than squeezing metatarsal

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50
Q

Postmenopausal women is a risk factor for gout.

A
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51
Q

Salicylates. High-dose or low-dose can cause hyperuricaemia

A

Low-dose

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52
Q

Acute attacks for gout first line is NSAID. Name me a couple of circumstances where the contra indicated.

A

Heart failure, chronic kidney disease, peptic ulcer disease, anticoagulant patient

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53
Q

Colchicine is only useful in gout and Sudo gout after how long after disease Flair onset

A

24 hours

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54
Q

Xanthine oxidase inhibitor is an increase the risk of what in gout

A

Nephrolithiasis

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55
Q

Uricosuricsh drugs are contraindicated in what circumstances in gout

A

Toffee, nephrolithiasis, CKD

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56
Q

What’s the issue with giving a. XOI, In patients were taking Azathioprine or six mercaptopurine

A

Remember these therapeutics require xanthine oxidase as degradation

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57
Q

Hypothyroidism is linked to go out or pseudogout

A

Pseudogout

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58
Q

A couple of ways to distinguish between L2 to L4, and L5

A

First one will have lots of hip flexion, need extension, foot dorsi flexion. Patella reflex gone. Anterior thigh and medial aspect of lower leg is gone.

L5 you will lose big toe dorsi flexion and foot aversion. Lateral aspect of the leg and dorsum of the foot tend to go

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59
Q

 Is active ROM, but with limited impact on passive ROM, is characteristic of which specific problem. Could be more than one,

A

Bursitis

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60
Q

Post op fever timing.

any time:

One to 3 days:

4 to 5 days:

More than a week:

A

Drug reactions

Atelectasis or pneumonia

UTI

DVT/PE

Surgical site infection

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61
Q

If fever of unknown origin work up is negative, what is the prognosis for the patient

A

Usually very good

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62
Q

What is the malaria prophylaxis a GP should give

A

Before patient travels to endemic region give atovaquone proguanil, mefloquine. They should be given two weeks before travel and continued for four weeks after return

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63
Q

CI to give the following:

Primaquine
Mefloquine
Arovaquone
Chloroquine:

A

G6PD (test prior)
Seizure, psych, cardiac condition issue
Preg or breastfeed, or CKD
Psoriasis

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64
Q

Malaria fever patters

A
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65
Q

Chikungunya

A

Join pain (mozzy bite)

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66
Q

We all know Zeca can cause micro carefully. What can I do neurologically to the patient directly

A

Guillain barré

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67
Q

What is the diagnosis steps for Lymes disease initially

A

Do no serology. Since usually negative until weeks after. So just clinical

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68
Q

Diagnostic steps for disseminated or late limes

A

Must do ELIZA. Then if positive to Western blot

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69
Q

If someone has a tick bite, what are the criteria to give prophylactic doxycycline

A

The Tick is ixodes.
The tick was in for more than 36 hours. Prophylaxis can be started less than 72 hours of removal. They have no contra indications to doxy.

Local rate of infection in the tics for Borrelia is more than 20%

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70
Q

If patient gets limes disease. You usually treat this early disease with doxycycline. How do you treat pregnant patient? How do we treat young patients? How do we treat more advanced disease, CNS involvement, cardiac involvement, arthritic involvement.

A

Amoxicillin for pregnant patients. Young patients can be given doxy. Advance cases you can give Foxy

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71
Q

Dengue virus

A

Phone pain, thrombocytopenia, shock, hi LFT. Just give fluids and blood products as needed

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72
Q

Banesiosis

A

Also by same tick as limes disease. Coinfection common. Causes intravascular homolysis and the Maltese cross in blood Smith. Give oral azithromycin

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73
Q

Rocky mountain spotted fever. How to manage

A

Clinical diagnosis at 1st to empiric treatment. Give doxycycline. If patient is pregnant in first two trimesters, tried to give chloramphenicol. Confirmed diagnosis with biopsy and immunofluorescence

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74
Q

Name some states that rocky mountain spotted fever can be seen

A

North Carolina, Virginia, Missouri, Arkansas

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75
Q

Name a few complications of infectious mononucleosis

A

Nasopharyngeal carcinoma, haemolytic anaemia, hepatic necrosis, bacterial superinfection, upper airway obstruction, spleen rupture, CNS infection

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76
Q

If a patient with infectious mononucleosis gets upper airway obstruction (swollen tonsils), or haemolytic anaemia what do we do

A

Give corticoster

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77
Q

If a patient has infectious mononucleosis presentation, Monospot is negative. What two steps do you have to do in your head

A

Test the EBV antibody. As the Monospot can be negative.

If the antibody test is negative then it maybe is CMV, toxo, HIV

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78
Q

What is the caveat with B cells and T cells in EBV infection

A

The bee cells cause the lymphocytosis, but the T cells are the atypical cells

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79
Q

Why is a concurrent STI a risk for HIV

A

Because there’s lots of macrophages in the area, and that means that more HIV can infect the macrophages

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80
Q

Recall my three structural genes in HIV

A

Env (GP120 and GP41) gag (P24 and P17) pol (Reverse transcriptase, integrates, protease

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81
Q

Recall the receptor on macrophages, and the receptor on T cells that allow HIV to enter

A

CCR five on macrophages, CXCR4 On T cells. CCR five mutations can cause immunity if homozygous, or slower course if heterozygous

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82
Q

HIV patient, cd4 less than 50. Fever, night sweats, focal lymphadenitis

A

MAC

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83
Q

List the opportunistic infections that can occur at a CD less than 500

A

Oral thrush, hairy leukoplakia, Kaposia, HPV and TB

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84
Q

List the opportunistic infections that can occur at a CD less than 200

A

Histoplasmosis, HIV Dementia, junkie cerebrum, pneumocystitis

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85
Q

List the opportunistic infections that can occur at a CD less than 100

A

Bartonella, candida oesophagitis, the CMV infections, Cryptococcus meningitis, Cryptosporidium, EBV, MAC, toxo

86
Q

HIV patient with non-enhancing areas of focal demyelination on MRI

A

Progressive multifocal Luca and kettle apathy

87
Q

If you are doing HAART for HIV, and after a few months the viral load as above 50, what do you do. Whereas if it’s below 20 what do you do

A

Above 50 you need to do regime change/check for resistance. If it’s below 20 this is good

88
Q

General HAART therapy

A

To reverse transcriptase inhibitors. Plus either and integrate inhibitor, non-nucleoside reverse transcriptase inhibitor, or protease and

89
Q

Tegravir

A

Integrase inhibitor

90
Q

List me all the nuclear side and non-nucleoside reverse transcriptase inhibitors

A

Abacavir, emteicitabine , lamivudine,, tenofovir, zidovudine, didanozine

Efavirenz, nevirapine

91
Q

-navir

A

Protease inhibitor

92
Q

Before starting abacavir,
What do you need to check

A

The HLA-B 570 one. Hypersensitivity risk

93
Q

If patient has a little bit of cryptococcus meningitis, why do we need to be slow giving HAART, and even treat the cryptococcus first

A

Cryptococcus is famous for causing immune reconstitution syndrome.

So it can actually worse in the infection given HAART without treating cryptococcus first

94
Q

We know about PCP and toxo prophylaxis in HIV. We also know about histoplasmosis prophylaxis if the patient is in an endemic area and the CD is less than 150. What about if a less than 50 CD

A

Is this from my son for MAC prophylaxis

95
Q

If emergency and haven’t ruled out cervicle injury. . Do we intubate

A

Yes, and immobilise the neck

96
Q

When is nasotracheal intubation preferred and when CI

A

Bronchial tree rupture. CI if basilar skull fracture

97
Q

Aside from our massive radiation 1:1:1. In other emergency transfusion; for every 4 RBC, do what?

A

1 FFP

98
Q

alternative to IV access? If many attempts

A

Interosseous line

99
Q

To note: blood at the meatus, hematuria, difficulty voiding, high riding prostate, scribal hematoma

A

Voiding yrethrogralhy

100
Q

Best imaging of neck, in emergency, if NEXUS. If find fracture, what do we do?

A

CT! If find fracture, do imaging of whole spine

101
Q

Why might patient with orbital fracture get bradycardia

A

Due to trapped interior rectus muscle… causing a oculocardiac reflex. Should do Sx release

102
Q

If sus of orbital globe laceration,.. what to do

A

Maybe flourescin test. Avoid eyelid retraction, vom, crying. And do not do tonometry

103
Q

Otorrhea in face of facial injury/laceration, should be tested for what

A

B transferrin. To see if CSF leakage. Consider a CT too

104
Q

Patient with Colliflower ear… how?

A

Auricular hematoma forms, and isn’t sufficiently drained

105
Q

Risks of having a septal hematoma

A

Pressure injury and because the area isn’t well vascularised…. It can perforate

106
Q

Tension Pneumothorax. Neck veins?

A

Often distended (pressures are usually high in thorax)

107
Q

True penetrating neck wound. Mx

A

Unstable = Sx

Stable = CTA, then consider Sx

108
Q

New diastolic murmur after chest trauma

A

Maybe AR and dissec

109
Q

If patient has neck wound, and significant hypovolemic shock. When you check the neck wound, you see it doesn’t penetrate the platysma…. What next

A

Check for other bleed. Doesn’t pass through plastysma = not true neck laceration

110
Q

Penetration to the abdomen reqcuires lap when?

A

Any peritonitis, unstable signs. If not, then explore yourself (if peritoneal sign, do lap also). Otherwise observe for 24 hours

111
Q

Gunshot wound to thorax… below 4th IC space

A

Always lap

112
Q

Remember can apply hard and soft signs of Clavicular fracture to most things

A

!!!

113
Q

Amputation stump painful neuroma can be treated with?

A

Anaesthetic injection

114
Q

DVT common in amputation stump

A

Yes yes yes

115
Q

If have urethral injury, and it’s so bad we need to do Sx at a later date, how to deal with urine

A

Urine diverted to suprapubic catheter

116
Q

Our two urethral injuries: anterior and posterior. Location? Association? Tx?

A

Anterior:
Distil to membranous urethra. Straddle, penile fracture etc. do catheter, supeapubic if needed. May need Sx

Posterior:
Membranous and prostatic. Seen with hip dislocation. Usually do normal catheter, but may need same as above

117
Q

Differences between extra and intra peritoneal bladder injury

A

Extra: rupture of neck or trigone. Pain only in the lower abdomen or pelvis. Causes major hematuria. Do Foley catheter

Intra: dome rupture . Abdomen pain all over with some guarding. Low urine output all together. Do Sx

118
Q

Carnett sign and forthergill sign, to differentiate rectus sheath hematoma, from abdominal originating issue

A

Point of max tenderness doesn’t change when supine or upright.
Mass doesn’t cross midline.

Both point toward rectus sheath hematoma

119
Q

Rectus sheath hematoma Invx

A

CT. And do CT guided hematoma evacuation. Lugs tree the vessels needed. Transfuse as needed

120
Q

Why do rectus sheath hematoma more commonly occur below arcuate

A

There is no posterior sheath below arcuate. So there is huge shearing forces of the rectus abdominus. Causing a rupture

121
Q

General workup for pelvic fractures

A

Assess hemodynamic (around 40 % have bleed and need transfusion). Apply pressure to ASIS both sides to
Assess stability. X-ray or CT (if stable). Retrograde cysto in men, proctoscopy, pelvic exam in women.

Unstable patients should have binder over trachanters (this tamponades any bleed). Then do angio embol.

122
Q

Other than duodenal Hematoma… what else can be damaged with handlebar injuries

A

Pancreas

123
Q

After spleen injury from blunt abdo trauma. When give the Vx

A

2 weeks afte r

124
Q

After spleen injury from blunt abdo trauma. When give the Vx

A

2 weeks after

125
Q

Patient on anticoag and has cardiac catheterisation. Had back pain and flank bruise and hemodynamic instability. At risk for what

A

Retroperitoneal Hematoma

126
Q

Note: treat aortic disruption (after blunt chest trauma) invx the same as aortic dissec

A
127
Q

General Mx of pulmonary contusion

A

Intubate if needed or NIPPV. Be conservative with fluid (can worsen it)

128
Q

Chest injury. Segment of chest moves IN on INspiration

A

Flail chest

129
Q

If after blunt chest trauma, there is fractures of either sternum, clavicle, first rib…. Check what

A

See if aortic disruption. Associated, since such large forces are needed to break these bones

130
Q

Once done a CXR in suspected unilateral phrenic nerve injury. Do what test

A

Flourscopic sniff test. Watch patient inspire (sniff), and see paradoxical elevation of hemidiaphragm)

131
Q

Left sided diaphragm ruptured can be repaired with surgery… what about right

A

Non op at first (liver tampnades injury)

132
Q

Any blunt force can cause diaphragm rupture. But what areas of penetration trauma can cause it?

A

Any penetration between T4-T12

133
Q

Linear skull fracture Mx

A

Non op, unless comminuted/displaced

134
Q

Subdural Hematoma Mx

A

If major AMS, midline shift on CT, then craniotomy. Otherwise manager ICP and little fluid (edema risk)

135
Q

Most basilar scull fractures can be left unTx. But if there’s CSF leak for more than a week?

A

Consider Sx, due to high risk of mengitis

136
Q

If child had bad head trauma and CT negative..: what to do

A

MRI. Better to see DAI etc.

137
Q

After child TBI… why is there risk if secondary hypoxia injury

A

Decrease perfusion and increase demands

138
Q

Le Fort fracture

A

Midface fracture. Generally need fixation and good approximation of dental surfaces. Then do liquid diet

139
Q

Le fort 1-3

A

1: mobile maxilla with rocking maneuvre

3: compete instablity of midface (and often send in basilar skull fractures)

140
Q

If GCS above 14 and patient seems ok. If they had nasty fall or loss of consciousness prior… what to do?

A

Can discharge, and ask patient to return if Neuro symptoms develops

141
Q

Angular stomatitis cheiliosis corneal vasc

A

Vit B2 (riboflavin def)

142
Q

How can B6 def relate to B3 def.

A

B6 def can cause B3 def. So INH can also cause B3 def

143
Q

Dermatitis, enteritis, alopecia, adrenal insufficiency

A

b5 def

144
Q

Sideroblastic anemia and peripheral neuropathy after INH

A

B6 def. Give with INH

145
Q

Dementia and enteritis. Ears a lot of raw eggs. Or recent ABx

A

Biotin def (B7)

146
Q

Vit C def

A

Swollen gums, bruising, anemi, poor wound healing

147
Q

b12 like disorder. (Neuro symptoms and anemia). But it’s normocytic with signs of hemolysis

A

Vit E def

148
Q

Impaired taste, poor wound healing, alopecia, hypogonadism,, acrodermatitis enterioathica, anosmia

A

Zinc def

149
Q

Main risk of acyclovir

A

Cyrstalluria. Give with fluids

150
Q

Amantadine SE

A

Ataxia, livedo retic, antiCh

151
Q

Amphotericin SE

A

Fever or rigours. Nephrotox. BM surp

152
Q

Azoles P450

A

Inhib

153
Q

Carabamazepine P450

A

Inducer. Can induce own degrad, so increase doses for these people in the first few weeks

154
Q

Clonidine side effects

A

Dry mouth, severe rebound headache/HTN

155
Q

Cataracts from CS

A

Yes

156
Q

Hemolysis from G6PD Def. I’m INH

A

Yes

157
Q

Metformin Vit def?

A

B12, withold until it improves

158
Q

Metronidazole SE

A

Disulfiram, vestibular dysf, metallic taste,

159
Q

Penicillinamine main SE

A

DILE

160
Q

Phenytoin main SES

A

Nystagmus diplopia ataxia gingival hyperplasia histriism

161
Q

Prazosin on first dose, issues

A

Low BP

162
Q

Quinidine SE

A

CInchonism, TCP, QT prolongation

163
Q

Trazadone SE

A

Priapism (Trazabone), QT prolong, serotonin syndrome

164
Q

Can tetracyclines cause Fanconi…

A

Yes

165
Q

Zidovudine SE

A

TCP, megalobalstic anemia.

166
Q

Vincristine can cause neuropathy and paralytic ileus. Vinnlastine causes BM surp

A

🙌🙌🙌

167
Q

Vancomycin SE

A

Nephrotox, ototox, thrombophleb, red man (recall picture)

168
Q

Gynaecomastia drugs

A

Spirino, digitalis, cimetidine, alcohol, ketoconazorl,

169
Q

DILE drugs

A

Procainamide, hydralazine, INH, pencilliamine,, quinidine, chlorpromazine, methylodopa,

170
Q

Cyp inducers

A

Barbi, St. John’s, phenytoin, rifampin, griseofulvin, carabamazepine,

171
Q

CYP inhibitor

A

Quinidine, cimetidine, azole, INH, grapefruit, erythromycin, sulfonamide

172
Q

Meds increasing risk for digoxin tox

A

Quinidine, cimetidine, Amiodarone, CCB

173
Q

G6PDH def drugs

A

Sulfas, INH, ASA, ibuprofen, nitro, primquine, pyrimethamine, chloramphenicol, dapsone

174
Q

Charcoal good for acetaminophen at what point!

A

<4hours

175
Q

Acid alkali ingestion Mx

A

Endoscopy. ABC and remove clothing. Not charcoal, vom, or neutralising agent. If I’m eyes, irrigate a lot

176
Q

Anticholinestwease tox Tx (our gardening stuff)

A

Atropine and pralidoxime

177
Q

Antimuscarinic tox Tx

A

Physostigmine

178
Q

Garlic breath in which toxicity

A

Arsenic

179
Q

Child with hematemesis and met acidosis (hemorhafic gastritis). See eadioopaque tablets of X-ray)

A

Iron tox!!! Five deferxamine

180
Q

Digitalis tox… give the Fab first or correct electrolytes

A

Fab first

181
Q

We use flumazenil for acute benzos tox… but what do we give in chronic

A

NOT FLUMANEZIL. Causes withdrawal, even in acutely Intox too

182
Q

Cyanide tox.. Tx or test blood levels first

A

Tx… slow blood results common

183
Q

Drugs heavily depend on CYP

A

benzos, barbi, metoprolol, CCB, warfarin, quinidine, phenytoin, carbamazepine, theophylline,

184
Q

Overview of Invx for CO tox

A

Our proper ABG analysis (O2 normal I’m pulse ox). ECG done in most, and preg test in women

185
Q

100% O2 for CO poisoning, but when to give hyperbaric or intubate

A

If preg, CNS or cardiac issues or severe CO (<25%) do hyperbaric

If signs of airway burn or smoke inhalation, early intubate

186
Q

Causes of metHb

A

Dapsone, nitrate, local aneathsha

187
Q

Met Hb Tx

A

Methylene blue

188
Q

Inhaled burning carpet or textile and has elevated lactate

A

CN poisoning

189
Q

Discuss a bit about anticholinergic toxidrome

A

Usually from somebody taking antimuscarinics. Causes a sympathetic nervous system response (blind as a bat et cetera). Give physostigmine

190
Q

Discuss a bit about organophosphate poisoning

A

These are anticholinesterases. so they cause a pro parasympathetic response. Give atropine and pralidoxime

191
Q

General overview of activated charcoal for toxic things

A

Only really it’s less than 2 to 4 hours after ingestion. Exceptions is lithium, iron, lead, alcohol, alkalines, acids. These do not require Chaco

192
Q

Main management for chemical burn

A

Copious irrigation for 30 minutes before transferring to hospital

193
Q

Remember electrical burns caused the deep muscle injury and rhabdomyolysis. What’s the general management for electrical burns for this reason

A

Prophylactic fasciotomies to prevent compartment syndrome. Check kidney function, ECG et cetera

194
Q

Bikes with sharp teeth and deep punctures do they need to be sutured

A

No

195
Q

Rabies prophylaxis. Consider if immunised or never immunised

A

If immunise just get vaccine. If never immunised the vaccine and Ig

196
Q

Patient has clean minor wound. Usually you don’t give prophylaxis unless when

A

If the patient had less than three lifetime vaccines. All the last vaccine was more than 10 years ago

197
Q

And if patient has a non-clean or major wound. When do we give just the vaccine

A

If the last Vaccine was more than five years ago

198
Q

And if patient has a non-clean or major wound. When do we give the vaccine And Ig

A

If they’ve had less than three lifetime vaccines

199
Q

Black widow bite signs. Treatment

A

Causes muscle spasm. Even mimicking abdomen guarding.

Given antivenom

200
Q

Brown recluse spider bite signs and treatment

A

Causes necrosis (black Usher) and DIC potentially. Do cold compress, dapsone, debride meant

201
Q

Quick overview of shell fish bite, infection

A

Of vibrio valve in a kiss. Causes severe necrotising fasciitis and Paula solutions. Worse in patients with a liver disease. Give Ivy Doxey and foxy. And debridment

202
Q

Foremost cat and dog in human bites. What’s the main antibiotic to give

A

Amoxicillin clavulanic acid

203
Q

General rules about snakebites

A

Give antivenom. Keep the limb below the heart

204
Q

What methods to take in hypothermia:

32 to 35

28 to 32

Less than 28

A

Passive external rewarming. Like remove wet clothing give blanket

Active external warming. Light warm blanket, warm bath

Active internal rewarming. Like warmed IV fluids, warm lavash, warm ECMO

205
Q

Osborn ECG wave

A

Seen in hypothermia

206
Q

Generally, a patient is not dead until they’re warm and dead. What does this mean

A

Essentially means you can only diagnose death if the body is above 32°C. Don’t stop resus until we rewarm

207
Q

What’s the presentation difference between tunnelled and non-tunnelled catheter CLABSI

A

None tunnel usually don’t have any obvious local signs of infection. Where is tunnelled you will see usually signs of discharge in pain at the site of the catheter

208
Q

Obviously to diagnose ACLABSI, you need blood cultures. And of course of the lambs. But what’s the difference between non-tunnelled and tunnelled diagnosis

A

Non-tunnelled you do exactly what little micro George said. Isolation of organism from central line and peripheral blood sample, with a greater concentration at the central line. I.e. a shorter time to culture in the Central line in the peripheral vein.

Tunnel catheter you do a similar saying but you can take the bus Alexi date from the subcutaneous track Lane

209
Q

Blunt cardiac injury general treatment

A

Largely supportive, but a lot of the time you can give an inotrope

210
Q

Traumatic haemothorax management

A

Tube thoracostomy. And then if output more than 1.5 L or more than 300 mL over three consecutive hours. You do thoracotomy. Surgery if you think there’s aortic, diaphragm, oesophagus, tracheobronchial injury causing it. If there is an actual penetrating trauma then you may go straight to thoracotomy

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