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!VIVA/PACES/PSA > PACES viva Qs > Flashcards

PACES viva Qs Flashcards

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1
Q

Contents of inguinal canal

A

Ilioinguinal nerve
Genital branch of genitofemoral nerve
Round ligament or spermatic cord

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2
Q

Contents of femoral canal

A

Efferent lymphatic vessels

LNs

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3
Q

Borders of inguinal canal

A

Roof: internal oblique and tranversus abdominis
Floor: inguinal ligament
Anterior: aponeurosis of external oblique
Posteriorly: transversalis fascia

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4
Q

Borders of femoral canal

A

Medially: lacunar ligament
Laterally: femoral vein
Anteriorly: inguinal ligament
Posteriorly: Pectineus muscle

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5
Q

What is Gardner’s syndrome?

A 
Syndrome within spectrum of familial polyposis coli syndromes
Includes:
= Adenomatous polyposis of large bowel
= Multiple osteomata of skull
= Desmoid tumours
= Epidermoid cysts
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6
Q

Borders of anterior triangle of neck

A

Midline
Ant border of sternocleidomastoid
Mandible

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7
Q

Borders of posterior triangle of neck

A

Posterior border of sternocleidomastoid
Clavicle
Anterior border of trapezius

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8
Q

Causes of cervical lymphadenopathy?

A 
LIST
Lymphoma/leukaemia
Infection
Sarcoidosis
Tumours (primary or secondary)
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9
Q

What nerve may be damaged in posterior triangle?

A

Spinal accessory nerve

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10
Q

Causes of proximal myopathy

A

Endocrine: COT

  • Cushings
  • Osteomalacia
  • Thyrotoxicosis

Neuromuscular

  • Duchennes/Beckers
  • Myotonic dystrophy

MSK

  • PMR
  • Myositis
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11
Q

Causes of peripheral neuropathy

A

Sensory

  • Diabetes
  • B12 deficiency
  • Hypothyroidism
  • ETOH
  • Uraemia
  • Leprosy
  • Amyloidosis
  • Iatrogenic eg drug-induced (Isoniazid), amiodarone

Motor

  • GBS
  • Pb poisoning
  • Porphyria
  • Hereditary sensorimotor polyneuropathies eg charcot-marie-tooth
  • Diphtheria
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12
Q

What are the ECG changes in first degree heart block?

A

Prolongation of PR interval but no dropping of QRS

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13
Q

What are the ECG changes in Mobitz type I heart block?

A

Successive prolongation of PR interval until QRS dropped

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14
Q

What are the ECG changes in Mobitz type II heart block?

A

Fixed PR interval with some p waves not conducted to QRS complexes in certain ratio

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15
Q

What are the ECG changes in third degree heart block?

A

Complete dissociation between atrial and ventricular contraction

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16
Q

SRS pattern in V1 and RSR pattern in V6

A

LBBB

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17
Q

RSR pattern in V1 and SRS pattern in V6

A

RBBB

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18
Q

Most specific marker for pericarditis on ECG?

A

PR depression

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19
Q

ECG findings posterior MI?

A

Tall R waves V1-V3

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20
Q

What does vitamin B12 deficiency cause?

A

Subacute degeneration of spinal cord

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21
Q

Causes of SIADH?

A

Malignancy
- Small cell lung Ca
(pancreas/prostate also possible)

Neurological

  • Stroke
  • SAH
  • Subdural haemorrhage
  • Meningitis/encephalitis/abscess

Infection

  • TB
  • Pneumonia

Drugs:

  • Carbamazepine
  • Sulphonyureas
  • SSRIs
  • Tricyclics
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22
Q

Why does hyponatraemia need to be corrected slowly?

A

Risk of central pontine myelinolysis

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23
Q

What are the causes of a collapsing pulse?

A

Aortic regurgitation
Hyperkinetic states eg thyrotoxicosis, anaemia, fever, pregnancy, exercise
PDA

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24
Q

What are the causes of pulsus paradoxus?

A

Severe asthma

Cardiac tamponade

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25
What are the causes of pulsus alternans?
Severe LVH
26
What CLASS of drug should be prescribed for a patient with diabetes and hypertension who is found to have microalbuminuria?
ACEi
27
What effect do ACEi have on urinary albumin excretion?
Decrease it
28
Most likely cause of otitis media?
Strep pneumoniae
29
What are some consequences of acromegaly?
``` endocrine - impaired glucose tolerance, DM cardio - LVH, HTN, cardiomyopathy msk - carpal tunnel syndrome gi - recurrent GI polyps other - obstructive sleep apnoea ```
30
Examination findings for otitis media
Bulging tympanic membrane Loss of light reflex possible perforation and pus
31
Muscles innervated by trochlear nerve?
Superior oblique for abduction and depression
32
Muscles supplied by CNVI?
Abducens supplies lateral rectus for abduction of eye
33
Muscles supplied by CNIII?
``` Medial rectus Superior rectus Inferior rectus Inferior oblique LPS ```
34
What are some causes of paralytic strabismus?
CN III/IV/VI palsy
35
What are some causes of ptosis?
Unilteral CNIII palsy/Horner's Mechanical eg trauma or xanthelasma Bilateral MG, congenital, Myotonic dystrophy, senile
36
What is true ptosis caused by?
LPS weakness
37
What does the screening programme for colorectal cancer involve?
Screening every 2 years for 60-74 year olds
38
What malignancy is H pylori associated with?
MALToma
39
What is a skin flap?
Consists of tissue or tissues transferred from one site of the body to another whilst maintaining a continuous blood supply through a vascular pedicle
40
What is a graft?
Transfer of skin from a donor site to a recipient site independent of a blood supply
41
What causes lid lag?
Overstimulation of levator palpebrae superioris
42
What are the features of Grave's disease o/e?
``` Diffuse goitre Thyroid acropachy Eye disease Proximal myopathy Pretibial myxoedema ```
43
What are the causes of diffusely enlarged thyroid gland?
Simple Colloid goitre Grave's Thyroiditis
44
Findings for otoscopy and tympanometry for glue ear?
ear drum dull + retracted, fluid level visible | flat tympannogram
45
What are the causes of vertigo?
Peripheral/vestibular - Meniere's - BPPV - Labyrinthitis Central - Vestibular Schwannoma - MS - Stroke - Head injury - Inner ear syphilis Drug - Vancomycin - Loop diuretics - Metronidazole - Co-trimoxazole
46
Definition of a hernia
a protrusion of a viscous out of a containing cavity
47
Hypocalcaemia on ECG
Prolongation of QTc segment
48
Alternating amplitude of QRS on ECG
Electrical alternans - associated with pericardial effusion
49
Hypercalcaemia on ECG finding and causes?
QTc shortening, if severe J waves - hyperparathyroidism or malignancy?
50
Hypokalaemia findings on ECG?
T wave inversion, QTc prolongation and visible U waves i
51
Hyperkalaemia findings on ECG?
tall, peaked T waves, QTc shortening and ST-segment depression
52
What criteria is used for pleural effusion and what are the cutoffs?
Lights criteria to determine whether transudate or exudate <30 = transudate >30 = exudate Use criteria if 25-30, includes ratio of serum to aspirate protein and LDH - ie higher protein and LDH content the more likely its exudative
53
What are some causes of a transudate pleural effusion?
``` Nephrotic syndrome CCF Liver failure ie cirrhosis Myoexedema Meig's syndrome eg benign ovarian tumour, ascites, right sided pleural effusion ```
54
What are some exudative causes of pleural effusion?
``` Infection eg pneumonia, fungal infection, lung empyema, TB Malignancy PE Pancreatitis Trauma ```
55
What is the classification used for heart failure?
New York Heart Association Classification 1. No limitation on activity 2. Comfortable at rest, dyspnoea on ordinary activity 3. Marked limitation of normal activity 4. Dyspnoea at rest
56
What are some causes of a normal anion gap acidosis?
Addisons GI losses eg due to diarrhoea or fistula Renal tubular acidosis
57
What are some causes of a raised anion gap acidosis?
Ketones: DKA, Ethanol Lactate: shock, sepsis, hypoxia Urate: renal failure
58
What scores are used to assess Upper GI bleeding?
Blatchford - pre-endoscopy | Rockhall - post-endoscopy -> to guide prognosis eg rebreeding, mortality
59
What mode/plane of imaging is needed for scaphoid fractures?
Ulnar deviation AP view
60
What is the pattern of injury in a Colles fracture?
Dorsal displacement of distal radius
61
What is the pattern of injury in a Smith's fracture?
Anterior/volar displacement of radius
62
Blood finding with Paget's disease of bone?
Solitary rise in ALP
63
What are some common causes of carpal tunnel syndrome?
``` Idiopathic Pregnancy Rheumatoid arthritis Oedema Lunate fracture ``` Associated with: Hypothyroidism Diabetes Heart failure/COCP
64
Examination findings in CTS
Weakness of abductor pollicis brevis | Wasting of thenar eminence
65
Muscles supplied by median nerve
LOAF - Lateral two lumbricals - Opponens pollicis - Abductor pollicis brevis - Flexor pollicis brevis
66
Non-traumatic causes of AVN of femoral head?
Diabetes HIV Lupus Chronic renal failure
67
Late systolic murmur?
Mitral valve prolapse | Coarctation of aorta
68
What score can be used to assess mortality in ACS pts?
GRACE score - 6mth mortality in pts with ACS
69
? Diagnosis if ECG shows a shortened PR interval and wide QRS complexes associated with a slurred upstroke seen in lead II.
WPW
70
What are some causes of hypoglycaemia?
``` Exogenous drugs eg sulphonylureas or insulin Pituitary insufficiency Liver failure Addison's Insulinoma Non-pancreatic neoplasms ```
71
Causes of clubbing?
Cardiac causes cyanotic congenital heart disease (Fallot's, TGA) bacterial endocarditis atrial myxoma ``` Respiratory causes lung cancer pyogenic conditions: cystic fibrosis, bronchiectasis, abscess, empyema tuberculosis asbestosis, mesothelioma fibrosing alveolitis ```
72
What is an abnormally large drop in blood pressure on inspiration called and what does it signify?
Pulsus paraxodus - characteristic of cardiac tamponade
73
What is a raised JVP with inspiration called and in what condition is it found?
Kussmaul's sign | - constrictive pericarditis
74
Drugs that can induce intracranial hypertension?
``` COCP Tetracyclines Steroids Vitamin A Lithium ```
75
Widespread saddle-shaped ST elevation with PR segment depression indicates...
Pericarditis
76
Q waves in lead II, III, aVF indicates ...
Previous inferior MI
77
Downsloping ST depression ('reverse tick' sign) indicates...
Digoxin toxicity
78
Deep T wave inversion or biphasic T waves in V2-V3 indicates...
LAD stenosis
79
ECG findings left ventricular hypertrophy non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen deep Q waves
HOCM
80
What are some of the indications for ORIF in fracture management?
``` failed cons management intra-articular # multiple # same bone bilateral same # open # ```
81
Methods of non-operative fixation ortho?
Non-rigid eg slings POP Bracing Continuous traction eg collar and cuff
82
What are some general fracture complications?
Anaesthetic Intra-op Early / late post-op
83
Complications of fracture ortho specific?
Intra-op: visceral damage or NV injury Early: infection, compartment syndrome, fat embolism, VTE Late: malunion, AVN, joint loosening, fracture at site, complex regional pain syndromes
84
From what fractures is compartment syndrome most likely?
Tibial shaft | Supracondylar
85
Complications of compartment syndrome?
Rhabdomyalysis | Volkmann's contractures
86
What are the 5 causes of non-union of a fracture?
- ischaemia - infection - inter fragmentary strain increased - intercurrent disease - interposition of tissue between fragments
87
3 sites prone to AVN?
Femoral head Scaphoid Talus
88
How can you differentiate a fat embolism from a PE?
Neuro s/s - confusion - agitation - retinal haemorrhages - fat globules
89
ECG: inverted P wave in lead I, right axis deviation, and loss of R wave progression
dextrocardia | ?kartagener's syndrome
90
Features of IBD related to disease activity?
Arthritis: pauciarticular, asymmetric Erythema nodosum Episcleritis Osteoporosis
91
What are some absolute and contraindications to thrombolysis?
Absolute - Haemorrhage/active bleeding - GI bleeding within last 3wks - Prev intracranial haemorrhage - Pregnancy - Intracranial neoplasm - Intracranial infarct in last 3mths - Varices - Uncontrolled HTN Relative - Concurrent anticoag - Major trauma or surgery in last 2wks - Active diabetic haemorrhage retinopathy - Suspected intracardiac thrombus
92
How can you differentiate a bulbar palsy from a pseudo bulbar palsy?
Bulbar = LMN signs CN9-12 Pseudobulbar = UMN signs CN5/7, 9-12 eg jaw jerk bulbar = absent, pseud-bulbar = brisk
93
CT report describes a hypodense collection around the convexity of the brain that is not limited to suture lines - what is it?
Chronic subdural haematoma Note hypooodense rather than hyper as chronic not acute
94
What limits extra-dural haematomas?
Suture lines
95
left homonymous hemianopia - where is the lesion?
right optic tract
96
homonymous quadrantanopia inferior - where is the lesion?
optic radiation - parietal lobe
97
homonymous quadrantanopia superior - where is the lesion?
optic radiation - temporal lobe
98
incongruous visual field defects - likely place of lesion?
optic tract
99
congruous visual field defects - likely place of lesion?
optic radiation or occipital cortex
100
Congenital conditions associated with epilepsy
Mitochondrial disease Tuberous sclerosis Cerebral palsy
101
What is a eye sign of Vestibular Schwannoma?
Loss of corneal reflex
102
What are your differentials for sudden onset headache?
SAH | Pituitary apoplexy
103
What marker in the blood do central seizures raise which can distinguish them from absence?
Prolactin
104
In addition to focal seizures, what can carbamazepine be used to treat?
Bipolar disorder | Trigeminal neuralgia
105
Contents of the lateral wall of the cavernous sinus?
Oculomotor nerve Trochlear nerve Ophthalmic branch of trigeminal nerve Maxillary nerve of trigeminal nerve
106
Contents of cavernous sinus?
Internal carotid artery | Abducens nerve
107
Sudden onset headache, visual field defects + BP changes or sth similar? What immediate management needs to be given?
Pituitary apoplexy | Replace steroids immediately
108
In what seizures is carbamazepine CI in?
Myoclonic | Absence
109
CT head - multiple ring enhancing lesions
Toxoplasmosis
110
CT head - single enhancing lesion
TB
111
Findings of RA on X-ray?
LESS - Loss of joint space - Erosions - Soft tissue swelling - Osteopenia later - subluxation
112
Adverse signs in cardiac arrest?
Hypotension Myocardial ischaemia Syncope Heart failure
113
Definitive treatment for acute glaucoma
Laser peripheral iridiotomy
114
Normal QT segment
less than 430 ms in males | less than 450 ms in females
115
Normal PR interval
120-200ms
116
Causes of cavitation on CXR?
``` abscess, infective eg staph aureus pneumonia, klebsiella, pseudomonas TB vasculitis eg Wegner's granulomatosis SCC PE Rheumatoid Aspergillosis ```
117
Causes of proximal myopathy
Inherited: Duchenne's muscular dystrophy, Becker's, myotonic dystrophy Endocrine: Cushings syndrome, thyrotoxicosis, hyperparathyroidism, diabetic amyotrophy Inflammatory: polymyositis, rheumatoid Metabolic: osteomalacia Malignancy: Lambert-Eaton syndrome, paraneoplastic Drugs: ETOH, steroids
118
Lateral epicondylitis - what movement is most painful?
Wrist extension on resistance with elbow extended or supination of forearm
119
Thyroid scan - globally reduced uptake of iodine-131 - cause?
Qe Quervain's
120
Most specific ECG marker for pericarditis?
PR depression
121
Most common tumour causing bony mets
1) Prostate 2) Breast 3) Lung
122
Most common sites of bony mets
1) Spine 2) Pelvis 3) Ribs 4) Skull 5) Long bones
123
Causes of a third nerve palsy
``` Medical: Diabetes Vasculitis -> GCA, SLE MS Raised ICP -> herniation through tentorial notch ``` Surgical - pupil dilated: Posterior communicating artery aneurysm Cavernous sinus thrombosis
124
Features of COPD on CXR
Flattened hemidiaphragms Hyperinflation Hyperlucent lung fields
125
What are the complications of acromegaly?
Cardiomyopathy HTN Diabetes Colorectal cancer
126
Considerations for transvenous pacing?
complete heart block with broad complex QRS recent asystole Mobitz type II AV block ventricular pause > 3 seconds
127
Pyrazinamide SEs
gout | hepatitis
128
What is myasthenia gravis?
An autoimmune disorder characterised by insufficient functioning of nicotinic ACH receptors leading to fatiguability
129
In what cancers is Lambert eaton syndrome seen?
SCLC Breast Ovarian
130
How does Pulmonary fibrosis present on a CT?
Honeycombing
131
Where do lung mets commonly come from?
``` Breast Prostate Renal Colorectal Bladder ```
132
Where do lung mets commonly come from?
Renal | could also be choriocarcinoma or prostate
133
Causes of cavitating lesions
``` Cancer e.g. SCC Autoimmune e.g. RA nodules, Wegener’s Vascular e.g. PE Infection e.g. upper zone TB, pulmonary abscess (Staph aureus, Klebsiella, Pseudomonas), fungi (Aspergilloma, histoplasmosis, coccidiomycosis) Trauma Youth e.g. bronchogenic cyst ```
134
Causes of hilar lymphadenopathy
TB Sarcoid Lymphoma
135
Causes of widened mediastinum
``` Thoracic aortic aneurysm Thyroid/retrosternal goitre Thymoma Teratoma Lymphoma ```
136
Causes of globular heart
Pericardial effusion Cardiac tamponade Tetralogy of Fallot (boot shaped)
137
Causes of Beck's triad
Hypotension JVP Muffled heart sounds
138
How do you tell an NG tube is well placed?
1) pH testing via aspiration <4 | 2) CXR: should bisect carina at T4

!VIVA/PACES/PSA (5 decks)

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