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UCPEX > Past Questions > Flashcards

Past Questions Flashcards

1
Q

Male, recent onset flaking smelly skin rash, 98% body

A

Exfoliative dermatitis “the red man”
Derm emergency
Stop all unnecessary meds

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2
Q

3 cardinal signs of psoas abscess

A

Fever
Limp
Abdominal/flank pain

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3
Q

3 cardinal signs of ileofemoral vein thrombosis

A

Pain in buttocks/groin
Thigh swelling
Collateral superficial veins

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4
Q

4 Kanavel signs of flexor tenosynovitis

A

Fusiform swelling
Pain with passive extension
Flexed posture
Tenderness along flexor sheath

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5
Q

3 month old baby with recent onset non-itchy flexor and scalp rash

A

Infantile sebhorreic dermatitis

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6
Q

Severe twisting injury to ankle, normal foot and ankle X-rays
Important fracture to consider:

A

Maisonneuve

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7
Q

Snowboarders commonly fracture:

A

Lateral process talus - dorsiflexion and inversion

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8
Q

18 month old child with low-grade fever, colicky LIF pain, normal MSU - important condition to consider:

A

Intussusception, incarcerated hernia, volvulus, mesenteric adenitis, psoas, abscess

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9
Q

Olecranon bursitis - 4 signs to distinguish septic from effusion

A

Fever
Redness/cellulitis
Warmth
Pain
Trauma or skin lesion

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10
Q

Initial medication for preeclampsia

A

Antihypertensive - nifedipine, labetalol, hydralazine
Magnesium sulfate

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11
Q

Antibiotic for COPD exacerbation in patient with penicillin allergy

A

Doxycycline 100mg 5 days

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12
Q

Recently started risperidone with fever and muscle rigidity - which toxidrome?

A

Neuroleptic malignant syndrome

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13
Q

Which bone does the lunate remain in contact with in a perilunate dislocation?

A

Radius

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14
Q

Risk factors for otitis media

A

Daycare
Passive smoking
Overcrowded home
Seasons
Air pollutants
Age - 6-24months
Male
Anatomical abnormalities/Down syndrome
Breastfeeding < 6 months
Use of dummy after 6 months

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15
Q

Aortic aneurysm risk score

A

Male
Age >65
Smoking >100 in lifetime

Atherosclerosis
Cerebrovascular disease
Coronary artery disease
HTN
Hypercholesterolaemia
First degree relative with AAA
Other vascular aneurysm
Obesity

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16
Q

Slit lamp features in iritis

A

Cells
Flare
Hypopyon
Clouding of anterior chamber

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17
Q

Sudden onset flashes and floaters

A

Retinal detachment

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18
Q

Common skiing injury

A

UCL sprain/rupture

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19
Q

Treatment of acute adrenal insufficiency

A

Hydrocortisone 100mg IV
IV fluids

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20
Q

Complication of proximal pole scaphoid fracture

A

AVN
Non union

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21
Q

2 tests for peritonitis

A

Rebound tenderness
Percussion tenderness

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22
Q

Circulatory changes in neurogenic shock

A

Low HR <80
Low BP <90 syst

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23
Q

Fever and stridor in child

A

Croup
Tonsillitis
Epiglottitis
Bacterial tracheitis
Lymphoma

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24
Q

Child with fever, trismus, difficulty swallowing

A

Peritonsillar abscess
Dental infection - Ludwig’s angina

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25
Q

Ear pain, fever, odorous discharge, affecting facial nerve, conductive hearing loss

A

Infected cholesteatoma

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26
Q

4 complications of Barotrauma in lungs

A

Pneumothorax
Sinus and middle ear damage
Pneumomediastinum/subcut emphysema
Cerebral artery gas embolism

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27
Q

Symptoms of Type 2 decompression illness

A

Neurological - paresis, numbness and tingling, difficulty urinating, incontinence.
Respiratory - SOB, cough, chest pain

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28
Q

Older person with atrial fibrillation - suddenly onset of pale leg

A

Patient foremen ovale arterial embolism?

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29
Q

Fracture associated with posterior fat pad in children?

A

Elbow?
Supracondylar

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30
Q

Paediatric CAP, most likely organism

A

Strep pneumoniae

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31
Q

Dysuria without bacteruria or pyuria in 3rd trimester - correct Rx

A

Empiric treatment until cultures back
Cefalexin 500mg BD 7 days
Trimethoprim 300mg OD 7 days ( avoid in first trim)
Nitrofurantoin 50mg QID 7 days (avoid at 36+ weeks)

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32
Q

Chlamydia in pregnancy

A

Azithromycin 1g stat
Test of cure at 4 weeks
Rescreen in 3rd trimester

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33
Q

BIB family: Psychotic recently, not taking medications, episodes of anger and staring upwards when medication discussed

A

Deescalate
Lorazepam 2mg
OPD psych referral

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34
Q

Management of lab tests
MSU
coags
Potassium/phosphate
Stool culture
BSL

A

MSU - refrigerate
Coags, stools - send within 4 hours, no fridge
Potassium/phosphate - do not leave overnight or in fridge
BSL - asap

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35
Q

Referral criteria to regional burns centre

A

> 10% adult >5% child
Full thickness burn >5%
Burns to special areas - face hands perineum genitalia joints
Inhalation injury
Electrical burns
Chemical burns
Circumferential burns or chest/limbs
Very old or very young
Pre-existing medical conditions that complicate recovery
Abuse

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36
Q

Referral criteria for National Burns unit

A

> 30% TBSA
Full thickness burns to special areas - face hands perineum genitalia joints
Significant inhalation
Electrical burns with high voltage and underlying tissue damage
Significant chemical burns

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37
Q

Young child with radius fracture - what type of cast

A

Below elbow soft cast

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38
Q

Pre-eclampsia symptoms

A

Hypertension, hyperreflexia and clonus, organ dysfunction (liver, renal), uteroplacental dysfunction

HELLP
Haemolysis
Elevated liver enzymes
Low platelets

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39
Q

Damaged structure with dorsal dislocation PIPJ

A

Volar plate

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40
Q

Damaged structure with volar dislocation of PIPJ

A

Central slip

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41
Q

Canadian C spine rule

A

Age >65, paraesthesia of extremity, dangerous mechanism (fall >0.9m, 5 stairs, axial load, high speed MVA/roll over/ejection, bike collision, motorised rec vehicle)

No low risk factors - sitting or ambulatory, delayed neck pain, no midline tenderness. Simple rear end MVC

Cannot actively rotate 45 deg left and right

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42
Q

Clinical management of scaphoid tenderness - no fracture on X-ray

A

Scaphoid cast 10-14 days, re-X-ray

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43
Q

Lateral cervical spine X-ray - soft tissue limits

A

C1-4 <7mm (<30% vertebral body)
C5-7 <22mm (100% vertebral body)
Landmark - glottis

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44
Q

Acute angle closure glaucoma presentation

A

Severe retroocular pain
Reduced vision, halos around light
Asymmetrical non reactive pupil
Ciliary flush - red eye around iris
Hazy cornea
Nausea vomiting
Headache
Photophobia

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45
Q

2 common organisms for atypical community acquired pneumonia

A

Mycoplasma pneumoniae
Legionella
Chlamydia

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46
Q

4 broad classes of medication which cause urinary retention

A

Anticholinergics
Antihistamines
Antipsychotics
Anti-Parkinsonian
Muscle relaxants
Sympathomimetics
Beta adrenergics
Antihypertensives
Antidepressents

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47
Q

2 clinical signs of respiratory acidosis

A

Cyanosis
Altered mental state

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48
Q

Fracture seen on lateral X-ray dorsum of proximal carpal row

A

Triquetral

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49
Q

Pregnant lady, low grade headache postpartum, worse on day 3

A

Pre-eclampsia

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50
Q

4 venemous creatures in NZ

A

Box jellyfish
Black widow (Lactrodectus)
Cone shell
Sea urchins

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51
Q

Serotonin Syndrome - triad of symptoms

A

CNS - altered mental state, seizures
Autonomic dysfunction - BP, HR, fever, dysrhythmia, flushing, sweating, mydriasis
Neuromuscular dysfunction - clonus, rigidity, hyperreflexia

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52
Q

Charcot triad for ascending cholangitis

A

Fever
Jaundice
RUQ pain

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53
Q

Local anaesthetic dose for lignocaine

A

1% lignocaine - 3-5mg/kg
1% lignocaine + adrenaline - 6mg/kg

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54
Q

4 treatments for paraphimosis

A

Osmotic agent
Ice
Compression
Manual reduction

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55
Q

Parasuicide (attempted suicide) risk factors

A

Male
Age (15-24)
Mental health
Substance use
FHx/friend suicide
Prev attempt
Childhood trauma
Unskilled occupation
Lack of support
Single
Sexual minority
Chronic medical illness/pain
TBI

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56
Q

Treatment of campylobacter

A

None
Erythromycin 400mg or 10mg/kg QID 5 days
- High fever, bloody diarrhoea, prolonged >7 days, pregnant women, immunocompromised, food handlers, childcare worker, carer

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57
Q

Low back pain - period of bed rest?

A

<2 days

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58
Q

4 extra-articular features of Reiter’s syndrome

A

Uveitis/conjunctivitis
Urethritis/cystitis/cervicitis/balanitis
Haematuria/hydronephrosis
Enteritis
Aortitis/aortic insufficiency/heart block

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59
Q

What bone articulates between lunate and 3rd metacarpal?

A

Capitate

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60
Q

Treatment of erysipelas in penicillin allergy

A

B-haemolytic Strep
Erythromycin 400mg or 10mg/kg QID 10-14 days

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61
Q

Impetigo treatment

A

Clean, cut (nails), cover
Hydrogen peroxide/povidone iodine 2-3 times/day, 5 days
If extensive: Flucloxacillin 500mg or 12.5-25mg/kg QID 5 days

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62
Q

Burn - palm of hand excluding fingers. TBSA?

A

1%

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63
Q

Appropriate dressing to send burn to hospital

A

Plastic cling film - not circumferential

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64
Q

FDP injury - position of finger

A

More extended

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65
Q

Nasal fracture - important sign to look for

A

Septal haematoma

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66
Q

What deformity can arise in untreated septal haematoma

A

Saddle nose

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67
Q

Erythema marginatum appearance

A

Acute rheumatic fever
Trunk, upper arms, legs
Red macules/papules spreading circular –> clear centre, raised red border

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68
Q

Sacred part of body for Maori

A

Head (tapu)

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69
Q

Near drowning episode - 2 findings

A

Hypoxia
Unconscious
Arrest

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70
Q

GCS for child
- Crying and inconsolable
- Opens eyes to pain
- Withdraws to painful stimuli

A

3+ 2 + 4= 9

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71
Q

Minimise bleeding in facial fractures

A

Nasal packing
Oral packing

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72
Q

Management of acute MI

A

Aspirin 300mg po chewed
IV lines, defibrillator ready
Analgesia - morphine
O2 if sats <92%
GTN - unless inferior/RV infarct/low BP
Refer cardiology acutely

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73
Q

Management of PE

A

O2
IV lines
Refer to gen med
Anticoagulants

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74
Q

2 common causes of knee effusion in injury

A

ACL rupture
Meniscal tear

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75
Q

2 structures injured when knee flexed and twisted

A

ACL
Meniscus

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76
Q

Causes of posterior dislocation of shoulder

A

Seizure
Electrocution

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77
Q

2 risks for sudden death in asthma

A

Signs of life threatening asthma
Signs of severe asthma that persists after treatment
Social isolation
Psychological problem, disability
Prev near fatal attack
Exacerbation despite dose of steroid prior
Presentation at night
Pregnancy

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78
Q

Potential complications in otitis media

A

Mastoiditis
Intracranial extension
Facial nerve palsy

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79
Q

Minimum hepatotoxic dose of paracetamol

A

> 10g/day adult, >200mg/kg/day child
6g or 150mg/kg per day, >48hr
4g or 100mg/kg per day, >48hr with liver toxicity

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80
Q

Ankle drawer test checks for which ligament?

A

Anterior talofibular ligament

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81
Q

Management of traveller’s diarrhoea

A

Antiemetic
Oral fluid + electrolyte replacement therapy
Consider loperamide
Low threshold for abx - ciprofloxacin 500mg BD 3 days, or 750-1000mg stat
Azithromycin 1g stat or 500mg OD for 3 days if from South/SE Asia
Prolonged sx (10-14 days) Stool culture, shiga toxin assay, parasites, microscopy

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82
Q

Findings for retropharyngeal abscess

A

Upper airway obstruction
Holding neck in flexion
Pharyngeal swelling and erythema
Dysphagia, torticollis, neck swelling, trismus

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83
Q

Sexual assault - things that can affect specimen collection

A

Showering
Passing urine/bowels
Changing clothes
Smoking
Eating/drinking

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84
Q

4 clinical features of unstable angina

A

Angina more frequent, lower threshold, longer duration
Negative troponin
No ECG changes

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85
Q

4 clinical features of heart failure

A

PND
Orthopnoea
Pedal oedema
SOBOE

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86
Q

2 methods to splint flail chest

A

Direct pressure with hand
Position pt to lay on flail
Tape bag of fluid to flail

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87
Q

Low back pain - signs of infection

A

Fever
Erythema/warmth
Fatigue
Anorexia

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88
Q

Cauda equina - symptoms other than back pain

A

Saddle anaesthesia
Bowel/bladder incontinence
Loss of power/sensation
Sexual dysfunction

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89
Q

How to Weber test

A

Tuning fork activated, place in middle of forehead. Check if sound localises.

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90
Q

When do you see sail sign?

A

Elbow joint effusion
Fracture of distal humerus, prox ulna, radial head

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91
Q

What condition must be excluded in young male with testicular pain?

A

Torsion

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92
Q

2 findings to suggest undisplaced supracondylar fracture

A

Sail sign
Posterior fat pad
Unwilling to flex + extend
Intact pronosupination

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93
Q

Most common STI in NZ

A

Chlamydia

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94
Q

Constipation - red flags

A

Abdominal mass
Weight loss
Blood mixed in stool
Rectal mass
iron deficiency anaemia

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95
Q

Contraindication to IUD insertion

A

STI/PID
Pregnancy
Molar pregnancy
Recent sepsis
Unexplained vaginal bleeding
Endometrial ca
Distortion of uterine cavity

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96
Q

Contraindication to COCP

A

Migraine with aura
DVT/PE
Breast ca
Liver disease
>35 smoker
HTN
Post partum <21 days, breast feeding
IHD, valvular disease
SLE, antiphospholipid antibodies

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97
Q

Clinical findings of pneumothorax

A

Hypoxia
Unilateral reduced breath sounds
Increased resonance to percussion
Tracheal deviation
Tachycardia
Tachypnoea + WOB

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98
Q

Early pregnancy, PV bleeding, shoulder tip pain - dx

A

Ectopic pregnancy

99
Q

2 features of CAP needing admission

A

CURB-65

2+ of
Confusion
Urea >7
RR >30
BP <90/60
Age >65

100
Q

Non verbal communication tools to build rapport

A

Eye contact
Smile
At same level
Arms not crossed
Not too relaxed

101
Q

Management of Abnormal vaginal bleeding - not pregnant

A

Tranexamic acid
NSAIDs
Mirena
COCP
Medroxyprogesterone (Provera)

102
Q

Post partum bleed - medications

A

IV oxytocin 10 units

103
Q

Features of UTI requiring hospital admission

A

Systemically unwell
Older person not managing at home
Complicated pyelonephritis
Pyelonephritis in pregnancy
Failed abx
Immunocompromised
Urinary tract abnormality
Renal impairment

104
Q

Laceration of medial upper eyelid - what structures to be concerned about

A

Lacrimal sac
Nasolacrimal canal
Superior lacrimal punctum and canal

105
Q

Decerebrate posturing

A

Wrist flexion, elbow extension, shoulder pronation
Foot plantar flexion, knee extension

106
Q

Sudden onset flashers and floaters in person with diabetes

A

Retinal detachment
Diabetic retinopathy

107
Q

Unsafe INR requiring hospital admission

A

> 10
Active bleeding with any INR
4.5 threshold for Vit K

108
Q

In rib fractures what 2 ribs are concerning for vascular injury

A

Ribs 1-2

109
Q

In rib fractures what 3 ribs are concerning for intraabdominal injury

A

Ribs 10-12

110
Q

4 symptoms/signs tension pneumothorax

A

Tachycardia
Hypoxia
Tracheal deviation
Reduced breath sounds
Hyperresonance

111
Q

2 associated injuries with meniscal injury

A

MCL
ACL

112
Q

Commonest bacteria for diarrhoea?
Bloody diarrhoea?

A

E. coli, Campylobacter jejuni
Enterohaemorrhagic E. coli, Shigella dysenteriae

113
Q

4 causes of monoarthritis

A

Gout
Septic arthritis
Osteoarthritis
Trauma

114
Q

Describe flat red skin lesion, not raised or depressed

A

Macule or patch

115
Q

4 aspect of pre-hospital C spine management

A

Immobilisation
Neuro exam
Secondary survey
Spinal cares

116
Q

4 causes of wheeze other than asthma

A

COPD
Pneumonia
Croup
Bronchiolitis
Anaphylaxis

117
Q

Patient with eczema - can topical steroid be used in:
- Bacterial infection
- Herpes

A

Yes
No

118
Q

4 ECG changes hyperkalaemia

A

Peaked T waves
Wide QRS
Long PR, Wide flattened P wave
Bradyarrhythmia
Conduction block

119
Q

Test to perform prior to carotid sinus massage

A

Listen for carotid bruit

120
Q

Cause of swollen lip not responding to adrenaline

A

Trauma
Angioedema
Infection
NSAID
Insect sting

121
Q

Instructions for males to collect urine sample for chlamydia

A

At least 1 hr since prev urine
First pass urine

122
Q

Major consequence of fracture to growth plate

A

Growth arrest

123
Q

2 risk factors for bad outcome from upper GI bleed

A

Oesophageal varices
Hypotension

124
Q

Flexion of fingers points to which structure?

A

Scaphoid

125
Q

Mallet finger site of pain

A

Dorsum DIPJ

126
Q

2 treatments for LA overdose

A

Stop administration
ABCs
Intralipid 1.5mL/kg over 1 min, can repeat x2
0.25mL/kg/min infusion

127
Q

Carditis pain description

A

Pleuritic
Retrosternal
Improves leaning forward

128
Q

Erythema infectiosum characteristics

A

Fifth’s disease
Parvovirus B19
Slapped cheeks appearance, lace-like rash on limbs and sometimes trunk

129
Q

Most common elbow fracture in children

A

Supracondylar

130
Q

What is sail sign?

A

Raised anterior fat pad of the elbow

131
Q

What are you testing for with anterior drawer of knee?

A

ACL

132
Q

Patient with atrial fibrillation and abdominal pain - important dx to consider

A

Mesenteric ischaemia

133
Q

How to use the Rumack-Matthew nomogram

A

Check serum paracetamol concentration 4 hours post overdose. If above the line treat with NAC

134
Q

Causes of respiratory distress in trauma

A

Pneumothorax
Haemothorax
Rib fracture
Upper airway injury/obstruction
Aortic dissection
Cardiac tamponade

135
Q

Symptoms of epiglottitis

A

Fever
Sniffing position
Stridor
Drooling
Dysphagia
Dysphonia
Dyspnea
Distress

136
Q

Ottawa ankle rules

A

Lateral malleolus posterior edge/tip
Medial malleolus posterior edge/tip
Base of 5th metatarsal
Navicular
Can’t take 4 steps

137
Q

What drug can cause adrenal insufficiency

A

Chronic steroids

138
Q

Non-environmental causes of hypothermia

A

Hypothyroidism
Hypopituitarism
Anorexia nervosa
CVA
Alcoholism

139
Q

3 indications for oxygen in cardiac chest pain

A

Sats <93%, cardiogenic shock, respiratory distress, other risks of hyperaemia

140
Q

Acceptable angulation for metacarpal neck fractures

A

index and middle - 10-15 deg
Ring 30-40 deg
Little - 50-60 deg

141
Q

Acceptable angulation for metacarpal shaft fractures

A

index and middle <10 deg
Ring and little <20 deg
Shortening <5mm
Base of thumb <30 deg

142
Q

Causes of pancreatitis

A

Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps, malignancy
Autoimmune
Scorpion stings
Hypercalcaemia, hyperlipidaemia
ERCP
Drugs

143
Q

Stages of pericarditis

A

2 weeks - widespread STE, PR depression
1-3 weeks - ST normalising, T wave flattening
3+ weeks - T wave inversion
several weeks - T wave normalise

144
Q

Bohler’s angle

A

Line 1 - highest point of tuberosity - high point posterior facet
Line 2 - highest point anterior process - highest point posterior facet
Normal 20-40 deg
Abnormal - decrease

145
Q

Critical angle of Gissane

A

Line 1 - anterior downwards slope of calc
Line 2 - superior upwards slope
Normal 130-145 deg
Abnormal - increase

146
Q

Man has a scaly rash starting on trunk, spreads to rest of the body

A

Pityriasis rosea

147
Q

Patient with photophobia, nausea, vomiting, blurry vision

A

Acute angle closure glaucoma

148
Q

Heat stroke vs heat exhaustion

A

Change in mental state/seizures
Core body temp >40 deg

149
Q

Most common arrhythmia in children prior to arrest

A

Sinus bradycardia?

150
Q

Laceration above lip on vermillion border - which nerve for regional bock?

A

Infraorbital nerve

151
Q

Most common complication of acute otitis media

A

TM perforation

152
Q

30 year old man, 5 day history of rash on back. Started with 2cm patch on front of chest.

A

Pityriasis rosea
Herald patch

153
Q

Sign on tympanic membrane for acute otitis media

A

Erythema
Bulging
Loss of light reflex
Loss of mobility
Dull/opaque

154
Q

Features of bacterial sinusitis

A

Persistent for >10 days
Initially improved then worsened again
Purulent discharge
Fever >39
Unilateral facial pain with percussion tenderness

155
Q

20 year old with bilateral flank pain - common causes

A

Muscular strain
Pyelonephritis
PID
Renal colic, hydronephrosis?
Menorrhagia/endometriosis?

156
Q

20 year old started on haloperidol, jaw movements and protrusion of tongue

A

Acute dystonia
Discontinue haloperidol
Benzatropine 2mg IV or procyclidine
Baclofen 60-120mg/day for oromandibular dystonia
Mexilitine for cervical dystonia
Benzos if anticholinergics not enough

157
Q

Checking adequacy of PA chest X-ray

A

Rotation - spinous process and head of clavicles
Adequate inspiration - 6 ribs ant, 8-9 ribs post
Penetration - lower T spine just visible
Angulation - clavicle heads over ribs 3-4

158
Q

Continuous diaphragm on chest X-ray

A

pneumomediastinum
pneumonpericardium
pneumoperitonium

159
Q

What loss of silhouette on CXR do you get in:
Lingula pneumonia
RLL pneumonia

A

L heart border
R hemidiaphragm

160
Q

What bone is fractured if line of the radius does not align with capitellum?

A

Radial head/neck
Monteggia fracture

161
Q

4 criteria for discharge after electrocution

A

Minor or no burn/trauma
Normal ECG
No seizure/LOC/arrest
Low voltage <1000V

162
Q

Ddx for child with fever and seizure other than febrile seizure

A

Meningitis/meningococcal
Encephalitis
Cerebral abscess
Primary seizure
Hypoglycaemia
Trauma/intracranial bleed
Electrolyte disturbance
SOL/malignancy
Poisoning

163
Q

Medication for seizure >5-10mins

A

Status epilepticus
Midazolam buccal/intranasal 0.5mg/kg Q10mins, max 10mg

Diazepam IV/PO 0.25mg/kg, PR 0.7mg/kg, max 10mg

164
Q

According to WHO: RR upper limit for
1. <2 month
2. 2 month - 12 months
3. 12 months - 5 years

A
  1. <60 bpm
  2. <50 bpm
  3. <40 bpm
165
Q

Resuscitation in near drowning - complications

A

Hypoxia
Cerebral anoxia
Airway obstruction
Gastric distension/regurgitation
C-spine injury

166
Q

Criteria for HTN in pregnancy

A

Systolic >140
Diastolic >90
Measured x2 at least 4 hours apart

167
Q

Symptoms of preeclampsia

A

Severe headache
Visual disturbance - blurring, scotoma, blindness
Nausea/vomiting
Epigastric/RUQ pain
Sudden swelling of face, hands, feet
Chest pain/SOB
Reduced urine output
Reduced foetal movement

168
Q

Vitamin deficiency causing encephalopathy in hyperemesis gravidarum

A

Thiamine

169
Q

Complication of UCL complete tear resulting in non-union

A

Stener lesion - UCL caught over adductor aponeurosis

170
Q

Mallet finger referral criteria

A

<30% bony avulsion of joint
Volar subluxation of distal phalanx

171
Q

Punch in the eye - injuries not to miss

A

Globe rupture
Retrobulbar haemorrhage - proptosis, chemosis, reduced visual acuity, ophthalmoplegia
White eye blow-out fracture - no subconjunctival haematoma, painful restricted eye movement, nausea + vomiting, diplopia
Orbitozygomatic fracture
Isolated orbital fracture - medial and inferior walls most common
Traumatic optic neuropathy

172
Q

Orbital cellulitis - criteria for referral

A

Fever, systemically unwell
Painful ocular ROM
Proptosis
Ophthalmoplegia/diplopia
Reduced vision (optic nerve involvement)

173
Q

Child eats egg, lip swelling, difficulty breathing - management

A

O2
Adrenaline 0.01mg/kg IM (adult 0.5mg) 1:1000
IV fluids - 20mL/kg
Consider antihistamine
Consider IV steroid
Nebulised adrenaline for stridor, salbutamol for wheeze
Observe at least 4-6 hours (biphasic/rebound anaphylaxis)
Admit if requiring 2+ doses of adrenaline

174
Q

Maculopapular painful rash, unilateral forehead. What eye condition do you suspect?

A

Herpes zoster ophthalmicus - V1 trigeminal nerve
Hutchinson’s sign - skin lesion at tip/side/root of nose
Valaciclovir 1g ads for 7-14 days
Aciclovir 800mg 5 times/day 7 days

175
Q

Indications for referral for renal colic

A

Pregnant
Infected, temp >38
Peritonitis
>7mm ureteric stone
Pain uncontrolled
Known renal disease
Bilateral obstructive stone
Solitary kidney

176
Q

Treatment of renal colic

A

NSAIDs - diclofenac
Morphine
Alpha blocker - Doxazosin

177
Q

70 year old, painless loss of vision in 1 eye for 1 min, lightheaded. Dx?

A

Amaurosis fugax - transient loss of blood flow to optic nerve/retina
Treat as TIA, carotid artery disease
- Refer to hospital
- Bilateral carotid dopplers
- MRA/CTA of head and neck
- Echo

178
Q

Features of Colles fracture

A

Dinnerfork deformity
Transverse distal radius fracture
Dorsal angulation +/- displacement
Can involve ulna styloid fracture

179
Q

Possible tendon rupture with Colles fracture

A

Extensor pollicis longus

180
Q

Non direct causes of Lisfranc injury

A

Axial load in hyperplantarflexion
Fixed hindfoot, rotational force through forefoot

181
Q

Grade 3 ACJ injury - which ligaments are ruptured?

A

Acromioclavicular
Coracoclavicular - trapezoid, conoid

182
Q

Additional xray views to assess ACJ injury

A

Bilateral zanca weight bearing views
Axial view

183
Q

TFCC ligament - which bones does it primarily articulate with?

A

Ulna + triquetrum with radius + lunate

184
Q

4 signs of meniscal injury

A

Positive McMurrays, Apley’s compression, Thessaly’s test and joint line tenderness
Delayed swelling, bruising, clicking, locking, crepitus

185
Q

3 year old with fever 38.5, limp, minor trauma 2 days ago, no leg pain - diagnoses not to miss

A

Psoas abscess
Appendicitis
Osteomyelitis, septic arthritis

186
Q

Two components for initiating Mental Health Act

A

Mood or delusional disorder
Causing risk to self/others, or care of self/others

187
Q

23 year old woman, anxious with going to school and giving presentations. Works at home to study. Lives with parents. Has friends but don’t want to hang out as worried about what they will think of her. What psychiatric illness do you think she has?

A

Social anxiety

188
Q

Risk factors for delirium

A

Elderly or young children
Away from familiar environment
Substance use
Poor sleep
Infection
Visual/hearing impairment
Hypoxia
Urinary/faecal retention
Meds: opioids, benzos, dihydropyridines, CCB, antihistamines

189
Q

Alcohol limit for men and women

A

Men: 15 standards/week, max 3/day
Women: 10 standards/week, max 2/day
At least 2 ETOH free days/week

190
Q

Symptoms of lithium toxicity

A

Altered mental state
Nausea, vomiting, diarrhoea
Tremor
Ataxia
Weakness

Severe: hypotension, dysrhythmia, seizure, coma, death

191
Q

Viruses that cause bronchiolitis

A

RSV
Adenovirus
Rhinovirus

192
Q

Examination signs for scaphoid fracture

A

Tenderness in ASB
Tenderness at scaphoid tubercle
Pain on axial load of thumb

193
Q

Most common preventable cause of death post-trauma

A

Haemorrhage

194
Q

What 3 bones are in line on lateral wrist xray to check normal alignment

A

Radius, lunate, capitate

195
Q
A
196
Q

Types of scaphoid fractures at risk of AVN

A

Proximal pole
Waist

197
Q

9 year old boy drowsy, DKA - then develops headache, vomiting, confusion - what diagnosis not to miss?

A

Cerebral oedema

198
Q

Seniors at risk tool

A
  1. Prior to illness/injury, need someone to help on regular basis?
  2. Since illness/injury, need increased help?
  3. Hospitalised for 1 or more nights in last 6 months?
  4. Trouble with vision?
  5. Problems with memory?
  6. More than 3 different meds/day?

High risk = 2 or more

199
Q

Dorsiflexion and internal rotation of ankle - what is commonly fractured?

A

Lateral process talus

200
Q

4 differentials for cellulitis

A

Lipodermatosclerosis
Dermatitis
Psoriasis
Superficial thrombophlebitis
Urticaria
Lymphoedema
Fungal infection

201
Q

3 zones of Jackson’s burn wound model

A

Zone of coagulation - maximal damage, irreversible tissue loss due to coagulation of constituent proteins
Zone of stasis - decreased tissue perfusion, salvageable by minimising hypotension, infection, oedema
Zone of hyperaemia - increased tissue perfusion, most likely healing unless sepsis or prolonged hypoperfusion

202
Q

Knee apprehension test - what is most likely injured

A

Patella dislocation
Patellofemoral instability from rupture of MPFL

203
Q

FOOSH, wrist pain, numbness and weakness index finger and thumb, what to look for on xray?

A

Displaced Colles or Smiths fracture, lunate/perilunate dislocation

204
Q

Signs in quinsy

A

Stridor
Hot potato voice
Dysphagia, odynophagia
Bad breathe
Fever
Trismus
Drooling

205
Q

Child with twisting injury and limping - traumatic and non traumatic dx

A

Toddler’s fracture
Contusion
Femur fracture - think NAI

Irritable hip
Septic arthritis
Osteomyelitis
Tumour

206
Q

Grade 3 supracondylar fracture - possible neurovascular injury?

A

Brachial artery
Median nerve (AIN)
Radial nerve (secondary)

207
Q

Ddx for testicular mass not to miss

A

Testicular cancer
Testicular torsion
Appendage torsion
Testicular rupture
Epidydimitis
Strangulated inguinal hernia

208
Q

Blurry vision over days and pain on eye movements

A

Optic neuritis
Causes: MS, infection (syphilis, Lyme, viral), sarcoidosis

209
Q

Pancreatitis - lab test
Ddx?

A

Lipase
Aortic dissection, renal colic, biliary colic, cholecystitis, duodenal perforation, hepatitis, ischaemic bowel

210
Q

Child with abdominal pain, blood and mucus in stool

A

Intussusception
Pain relief, IVF, NBM, paeds surg referral

211
Q

Woman with hx tubal ligation. Now LLQ pain, no PV bleed, tachycardia

A

Ectopic pregnancy
PID
Renal colic
Bowel obstruction
UTI/pyelonephritis
Diverticulitis

Bloods, bHCG
Urine dip
+/- pelvic USS

212
Q

What chemical in the environment can give patient sialorrhoea?

A

Organophosphates
Mushrooms

213
Q

Woman with PV bleeding, intrauterine foetal heart beat seen. What is the type of miscarriage?

A

Threatened miscarriage

214
Q

Happy child, 1 week of spreading lumpy rash, not itchy

A

Molluscum contagiosum

215
Q

Most likely injured organ in blunt abdominal trauma

A

Spleen

216
Q

PECARN score

A

Paediatric head injury:
<2
- GCS 14, palpable skull fracture, signs of altered mental state (agitation, somnolence, repetitive questioning, slow response to verbal comms)
- Occipital/parietal/temporal scalp haematoma, LOC >5s, abnormal behaviour, severe mechanism (ejection, death of passenger, pedestrian/biker without helmet struck by car, fall from >1m, head strike by high impact object)

> 2
- GCS <14, signs of basal skull fracture, altered mental state
- LOC, vomiting, severe headache, severe mechanism

217
Q

Hunter serotonin toxicity criteria

A

Serotonergic medication in last 5 weeks
- Spontaneous clonus
- Inducible clonus + agitation or diaphoresis
- Ocular clonus + agitation or diaphoresis
- Tremor + hyperreflexia
- Rigidity/hypotonic + hyperthermia + ocular or inducible clonus

218
Q

4 diseases to test for in female STI screen

A

Chlamydia, gonorrhoea, HIV, syphilis

219
Q

Causes of delayed skin healing

A

Diabetes
Smoking
Steroids
Infection
Sutures too tight
Elderly
Poor nutrition
Obesity
ETOH
Immunocompromised

220
Q

Primary treatment of dysmenorrhoea

A

NSAIDs
OCP

221
Q

Symptoms of myxoedema

A

Hypothyroid emergency
- bradycardia
- thinning hair
- hypothermia
- non-pitting oedema
- altered LOC and coma
- hypotension
- enlarged thyroid
- hypoglycaemia

222
Q

Glucagon is antidote for…

A

Beta blocker overdose

223
Q

CAGE questionnaire for ETOH excess

A

C - attempts to cut down
A - annoyed by other people complaining
G - guilty about drinking
E - Need for eye-opener in the morning

224
Q

Most effective emergency contraceptive

A

Levonorgestrel 1.5mg within 12hr (up to 72h) post coitus
For weight >70kg, BMI >26 - double to 3mg
BMI >30 copper IUD or CI to oestrogen
Within 5 days of ovulation, up to 120hrs post coitus

225
Q

Management of acute prostatitis

A

Commonly gram -ve
Mild uncomplicated - trimethoprim 300mg OD 14 days
Mild complicated (hospitalisation, recent overseas travels) - cefalexin 500mg BD/augmentin 625mg tds for 14 days, cipro 500mg bd 14 days
Severe cefalexin 500-1g tds/augmentin 625mg tds 2-4 weeks

226
Q

Lisfranc ligament attaches to which bones?

A

medial cuneiform + base of 2nd metatarsal

227
Q

3rd trimester PV bleed - what differentiates placental abruption vs previa?

A

Abdo pain

Shock
Foetal distress

228
Q

Female with abdominal pain - dx not to miss

A

Ectopic pregnancy
Appendicitis
Ovarian torsion
Ovarian cyst rupture

229
Q

Alcohol hazard assessment tool

A

Audit-C, score 0-4 each, 5+ do full audit questionnaire

How often drink containing ETOH
How many drinks on a typical day
How often 6 or more

230
Q

HDC code of rights

A
  1. Respect
  2. Freedom from discrimination
  3. Dignity and independence
  4. Services of appropriate standard
  5. Effective communication
  6. Fully informed
  7. Informed consent
  8. Support
  9. Teaching and research
  10. Complain
231
Q

When to start steroids in preschool wheeze/asthma

A

Moderate-severe asthma
Hx prev severe attacks
Hospital stay >6 hrs

232
Q

Red lateral neck mass in well person - dx and management?

A

Branchial cyst - inflamed
Refer for removal

233
Q

Which endocrine emergency - patient with tremor, anxiety, agitation, pedal + pulmonary oedema, hyperthermia

A

Thyroid storm
Refer to hospital
ABCs
IVF + dextrose if hypoglycaemic
ECG + bloods
Infection screen
B-blockers for tachycardia - under guidance
Cooling
Benzos for agitation
Consider differentials - DKA, toxicity, sepsis

Do not use aspirin - releases more thyroid hormone

234
Q

Acute sensorineural hearing loss

A

ENT emergency
Possible causes - idiopathic, vascular, malignancy, infective, traumatic, immune deficiency, aspirin
Refer for urgent audiogram
High dose steroid
50% patients recover within 2 weeks

235
Q

Atypical pneumonia vs lobar pneumonia
- Signs
- Treatment

A
  • Insidious onset up to 4 weeks
  • GI symptoms
  • Scant sputum initially
  • arthritis/arthralgia, erythema mulitforme and nodosum, pericarditis, pancreatitis
  • Macrolides, tetracyclines
236
Q

ECG changes in TCA overdose

A

Sinus tachycardia
PR prolongation
Right axis deviation
<3mm R wave in avR
Long QT
Long QRS
RBBB
VF/VT/asystole
2nd/3rd degree HB

237
Q

Post viral symptom time frame:
Cough
Nasal discharge

A

Cough - 2-4 weeks
Nasal discharge 2 weeks

237
Q

DVT - how to measure calf circumference

A

10cm below tibial tuberosity, >3cm difference

238
Q

Low speed injury, anterior neck pain, swelling and slurred speech

A

Cervical artery dissection with CVA
Ipsilateral Horner’s syndrome - ptosis, miosis, anhydrosis

239
Q

Causes of otitis externa

A

Infection - bacterial, fungal
Dermatological - atopic dermatitis, allergic/irritant contact dermatitis, psoriasis

240
Q

2 fractures that can cause compartment syndrome

A

Forearm
Tibial

241
Q

Lifestyle modifications for EBV

A

No contact sports
No ETOH

242
Q

Management of gonorrhoea - 4 points

A

Test for chlamydia, HIV, syphilis
Treat with IM ceftriaxone + azithromycin
Contact tracing - 3 months
Report to MOH

UCPEX (13 decks)

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