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Past Questions Flashcards

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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
Ear pain, fever, odorous discharge, affecting facial nerve, conductive hearing loss
Infected cholesteatoma
26
4 complications of Barotrauma in lungs
Pneumothorax Sinus and middle ear damage Pneumomediastinum/subcut emphysema Cerebral artery gas embolism
27
Symptoms of Type 2 decompression illness
Neurological - paresis, numbness and tingling, difficulty urinating, incontinence. Respiratory - SOB, cough, chest pain
28
Older person with atrial fibrillation - suddenly onset of pale leg
Patient foremen ovale arterial embolism?
29
Fracture associated with posterior fat pad in children?
Elbow? Supracondylar
30
Paediatric CAP, most likely organism
Strep pneumoniae
31
Dysuria without bacteruria or pyuria in 3rd trimester - correct Rx
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)
32
Chlamydia in pregnancy
Azithromycin 1g stat Test of cure at 4 weeks Rescreen in 3rd trimester
33
BIB family: Psychotic recently, not taking medications, episodes of anger and staring upwards when medication discussed
Deescalate Lorazepam 2mg OPD psych referral
34
Management of lab tests MSU coags Potassium/phosphate Stool culture BSL
MSU - refrigerate Coags, stools - send within 4 hours, no fridge Potassium/phosphate - do not leave overnight or in fridge BSL - asap
35
Referral criteria to regional burns centre
>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
36
Referral criteria for National Burns unit
>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
37
Young child with radius fracture - what type of cast
Below elbow soft cast
38
Pre-eclampsia symptoms
Hypertension, hyperreflexia and clonus, organ dysfunction (liver, renal), uteroplacental dysfunction HELLP Haemolysis Elevated liver enzymes Low platelets
39
Damaged structure with dorsal dislocation PIPJ
Volar plate
40
Damaged structure with volar dislocation of PIPJ
Central slip
41
Canadian C spine rule
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
42
Clinical management of scaphoid tenderness - no fracture on X-ray
Scaphoid cast 10-14 days, re-X-ray
43
Lateral cervical spine X-ray - soft tissue limits
C1-4 <7mm (<30% vertebral body) C5-7 <22mm (100% vertebral body) Landmark - glottis
44
Acute angle closure glaucoma presentation
Severe retroocular pain Reduced vision, halos around light Asymmetrical non reactive pupil Ciliary flush - red eye around iris Hazy cornea Nausea vomiting Headache Photophobia
45
2 common organisms for atypical community acquired pneumonia
Mycoplasma pneumoniae Legionella Chlamydia
46
4 broad classes of medication which cause urinary retention
Anticholinergics Antihistamines Antipsychotics Anti-Parkinsonian Muscle relaxants Sympathomimetics Beta adrenergics Antihypertensives Antidepressents
47
2 clinical signs of respiratory acidosis
Cyanosis Altered mental state
48
Fracture seen on lateral X-ray dorsum of proximal carpal row
Triquetral
49
Pregnant lady, low grade headache postpartum, worse on day 3
Pre-eclampsia
50
4 venemous creatures in NZ
Box jellyfish Black widow (Lactrodectus) Cone shell Sea urchins
51
Serotonin Syndrome - triad of symptoms
CNS - altered mental state, seizures Autonomic dysfunction - BP, HR, fever, dysrhythmia, flushing, sweating, mydriasis Neuromuscular dysfunction - clonus, rigidity, hyperreflexia
52
Charcot triad for ascending cholangitis
Fever Jaundice RUQ pain
53
Local anaesthetic dose for lignocaine
1% lignocaine - 3-5mg/kg 1% lignocaine + adrenaline - 6mg/kg
54
4 treatments for paraphimosis
Osmotic agent Ice Compression Manual reduction
55
Parasuicide (attempted suicide) risk factors
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
56
Treatment of campylobacter
None Erythromycin 400mg or 10mg/kg QID 5 days - High fever, bloody diarrhoea, prolonged >7 days, pregnant women, immunocompromised, food handlers, childcare worker, carer
57
Low back pain - period of bed rest?
<2 days
58
4 extra-articular features of Reiter's syndrome
Uveitis/conjunctivitis Urethritis/cystitis/cervicitis/balanitis Haematuria/hydronephrosis Enteritis Aortitis/aortic insufficiency/heart block
59
What bone articulates between lunate and 3rd metacarpal?
Capitate
60
Treatment of erysipelas in penicillin allergy
B-haemolytic Strep Erythromycin 400mg or 10mg/kg QID 10-14 days
61
Impetigo treatment
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
62
Burn - palm of hand excluding fingers. TBSA?
1%
63
Appropriate dressing to send burn to hospital
Plastic cling film - not circumferential
64
FDP injury - position of finger
More extended
65
Nasal fracture - important sign to look for
Septal haematoma
66
What deformity can arise in untreated septal haematoma
Saddle nose
67
Erythema marginatum appearance
Acute rheumatic fever Trunk, upper arms, legs Red macules/papules spreading circular --> clear centre, raised red border
68
Sacred part of body for Maori
Head (tapu)
69
Near drowning episode - 2 findings
Hypoxia Unconscious Arrest
70
GCS for child - Crying and inconsolable - Opens eyes to pain - Withdraws to painful stimuli
3+ 2 + 4= 9
71
Minimise bleeding in facial fractures
Nasal packing Oral packing
72
Management of acute MI
Aspirin 300mg po chewed IV lines, defibrillator ready Analgesia - morphine O2 if sats <92% GTN - unless inferior/RV infarct/low BP Refer cardiology acutely
73
Management of PE
O2 IV lines Refer to gen med Anticoagulants
74
2 common causes of knee effusion in injury
ACL rupture Meniscal tear
75
2 structures injured when knee flexed and twisted
ACL Meniscus
76
Causes of posterior dislocation of shoulder
Seizure Electrocution
77
2 risks for sudden death in asthma
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
78
Potential complications in otitis media
Mastoiditis Intracranial extension Facial nerve palsy
79
Minimum hepatotoxic dose of paracetamol
>10g/day adult, >200mg/kg/day child >6g or 150mg/kg per day, >48hr >4g or 100mg/kg per day, >48hr with liver toxicity
80
Ankle drawer test checks for which ligament?
Anterior talofibular ligament
81
Management of traveller's diarrhoea
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
82
Findings for retropharyngeal abscess
Upper airway obstruction Holding neck in flexion Pharyngeal swelling and erythema Dysphagia, torticollis, neck swelling, trismus
83
Sexual assault - things that can affect specimen collection
Showering Passing urine/bowels Changing clothes Smoking Eating/drinking
84
4 clinical features of unstable angina
Angina more frequent, lower threshold, longer duration Negative troponin No ECG changes
85
4 clinical features of heart failure
PND Orthopnoea Pedal oedema SOBOE
86
2 methods to splint flail chest
Direct pressure with hand Position pt to lay on flail Tape bag of fluid to flail
87
Low back pain - signs of infection
Fever Erythema/warmth Fatigue Anorexia
88
Cauda equina - symptoms other than back pain
Saddle anaesthesia Bowel/bladder incontinence Loss of power/sensation Sexual dysfunction
89
How to Weber test
Tuning fork activated, place in middle of forehead. Check if sound localises.
90
When do you see sail sign?
Elbow joint effusion Fracture of distal humerus, prox ulna, radial head
91
What condition must be excluded in young male with testicular pain?
Torsion
92
2 findings to suggest undisplaced supracondylar fracture
Sail sign Posterior fat pad Unwilling to flex + extend Intact pronosupination
93
Most common STI in NZ
Chlamydia
94
Constipation - red flags
Abdominal mass Weight loss Blood mixed in stool Rectal mass iron deficiency anaemia
95
Contraindication to IUD insertion
STI/PID Pregnancy Molar pregnancy Recent sepsis Unexplained vaginal bleeding Endometrial ca Distortion of uterine cavity
96
Contraindication to COCP
Migraine with aura DVT/PE Breast ca Liver disease >35 smoker HTN Post partum <21 days, breast feeding IHD, valvular disease SLE, antiphospholipid antibodies
97
Clinical findings of pneumothorax
Hypoxia Unilateral reduced breath sounds Increased resonance to percussion Tracheal deviation Tachycardia Tachypnoea + WOB
98
Early pregnancy, PV bleeding, shoulder tip pain - dx
Ectopic pregnancy
99
2 features of CAP needing admission
CURB-65 2+ of Confusion Urea >7 RR >30 BP <90/60 Age >65
100
Non verbal communication tools to build rapport
Eye contact Smile At same level Arms not crossed Not too relaxed
101
Management of Abnormal vaginal bleeding - not pregnant
Tranexamic acid NSAIDs Mirena COCP Medroxyprogesterone (Provera)
102
Post partum bleed - medications
IV oxytocin 10 units
103
Features of UTI requiring hospital admission
Systemically unwell Older person not managing at home Complicated pyelonephritis Pyelonephritis in pregnancy Failed abx Immunocompromised Urinary tract abnormality Renal impairment
104
Laceration of medial upper eyelid - what structures to be concerned about
Lacrimal sac Nasolacrimal canal Superior lacrimal punctum and canal
105
Decerebrate posturing
Wrist flexion, elbow extension, shoulder pronation Foot plantar flexion, knee extension
106
Sudden onset flashers and floaters in person with diabetes
Retinal detachment Diabetic retinopathy
107
Unsafe INR requiring hospital admission
>10 Active bleeding with any INR >4.5 threshold for Vit K
108
In rib fractures what 2 ribs are concerning for vascular injury
Ribs 1-2
109
In rib fractures what 3 ribs are concerning for intraabdominal injury
Ribs 10-12
110
4 symptoms/signs tension pneumothorax
Tachycardia Hypoxia Tracheal deviation Reduced breath sounds Hyperresonance
111
2 associated injuries with meniscal injury
MCL ACL
112
Commonest bacteria for diarrhoea? Bloody diarrhoea?
E. coli, Campylobacter jejuni Enterohaemorrhagic E. coli, Shigella dysenteriae
113
4 causes of monoarthritis
Gout Septic arthritis Osteoarthritis Trauma
114
Describe flat red skin lesion, not raised or depressed
Macule or patch
115
4 aspect of pre-hospital C spine management
Immobilisation Neuro exam Secondary survey Spinal cares
116
4 causes of wheeze other than asthma
COPD Pneumonia Croup Bronchiolitis Anaphylaxis
117
Patient with eczema - can topical steroid be used in: - Bacterial infection - Herpes
Yes No
118
4 ECG changes hyperkalaemia
Peaked T waves Wide QRS Long PR, Wide flattened P wave Bradyarrhythmia Conduction block
119
Test to perform prior to carotid sinus massage
Listen for carotid bruit
120
Cause of swollen lip not responding to adrenaline
Trauma Angioedema Infection NSAID Insect sting
121
Instructions for males to collect urine sample for chlamydia
At least 1 hr since prev urine First pass urine
122
Major consequence of fracture to growth plate
Growth arrest
123
2 risk factors for bad outcome from upper GI bleed
Oesophageal varices Hypotension
124
Flexion of fingers points to which structure?
Scaphoid
125
Mallet finger site of pain
Dorsum DIPJ
126
2 treatments for LA overdose
Stop administration ABCs Intralipid 1.5mL/kg over 1 min, can repeat x2 0.25mL/kg/min infusion
127
Carditis pain description
Pleuritic Retrosternal Improves leaning forward
128
Erythema infectiosum characteristics
Fifth's disease Parvovirus B19 Slapped cheeks appearance, lace-like rash on limbs and sometimes trunk
129
Most common elbow fracture in children
Supracondylar
130
What is sail sign?
Raised anterior fat pad of the elbow
131
What are you testing for with anterior drawer of knee?
ACL
132
Patient with atrial fibrillation and abdominal pain - important dx to consider
Mesenteric ischaemia
133
How to use the Rumack-Matthew nomogram
Check serum paracetamol concentration 4 hours post overdose. If above the line treat with NAC
134
Causes of respiratory distress in trauma
Pneumothorax Haemothorax Rib fracture Upper airway injury/obstruction Aortic dissection Cardiac tamponade
135
Symptoms of epiglottitis
Fever Sniffing position Stridor Drooling Dysphagia Dysphonia Dyspnea Distress
136
Ottawa ankle rules
Lateral malleolus posterior edge/tip Medial malleolus posterior edge/tip Base of 5th metatarsal Navicular Can't take 4 steps
137
What drug can cause adrenal insufficiency
Chronic steroids
138
Non-environmental causes of hypothermia
Hypothyroidism Hypopituitarism Anorexia nervosa CVA Alcoholism
139
3 indications for oxygen in cardiac chest pain
Sats <93%, cardiogenic shock, respiratory distress, other risks of hyperaemia
140
Acceptable angulation for metacarpal neck fractures
index and middle - 10-15 deg Ring 30-40 deg Little - 50-60 deg
141
Acceptable angulation for metacarpal shaft fractures
index and middle <10 deg Ring and little <20 deg Shortening <5mm Base of thumb <30 deg
142
Causes of pancreatitis
Idiopathic Gallstones ETOH Trauma Steroids Mumps, malignancy Autoimmune Scorpion stings Hypercalcaemia, hyperlipidaemia ERCP Drugs
143
Stages of pericarditis
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
Bohler's angle
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
Critical angle of Gissane
Line 1 - anterior downwards slope of calc Line 2 - superior upwards slope Normal 130-145 deg Abnormal - increase
146
Man has a scaly rash starting on trunk, spreads to rest of the body
Pityriasis rosea
147
Patient with photophobia, nausea, vomiting, blurry vision
Acute angle closure glaucoma
148
Heat stroke vs heat exhaustion
Change in mental state/seizures Core body temp >40 deg
149
Most common arrhythmia in children prior to arrest
Sinus bradycardia?
150
Laceration above lip on vermillion border - which nerve for regional bock?
Infraorbital nerve
151
Most common complication of acute otitis media
TM perforation
152
30 year old man, 5 day history of rash on back. Started with 2cm patch on front of chest.
Pityriasis rosea Herald patch
153
Sign on tympanic membrane for acute otitis media
Erythema Bulging Loss of light reflex Loss of mobility Dull/opaque
154
Features of bacterial sinusitis
Persistent for >10 days Initially improved then worsened again Purulent discharge Fever >39 Unilateral facial pain with percussion tenderness
155
20 year old with bilateral flank pain - common causes
Muscular strain Pyelonephritis PID Renal colic, hydronephrosis? Menorrhagia/endometriosis?
156
20 year old started on haloperidol, jaw movements and protrusion of tongue
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
Checking adequacy of PA chest X-ray
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
Continuous diaphragm on chest X-ray
pneumomediastinum pneumonpericardium pneumoperitonium
159
What loss of silhouette on CXR do you get in: Lingula pneumonia RLL pneumonia
L heart border R hemidiaphragm
160
What bone is fractured if line of the radius does not align with capitellum?
Radial head/neck Monteggia fracture
161
4 criteria for discharge after electrocution
Minor or no burn/trauma Normal ECG No seizure/LOC/arrest Low voltage <1000V
162
Ddx for child with fever and seizure other than febrile seizure
Meningitis/meningococcal Encephalitis Cerebral abscess Primary seizure Hypoglycaemia Trauma/intracranial bleed Electrolyte disturbance SOL/malignancy Poisoning
163
Medication for seizure >5-10mins
Status epilepticus Midazolam buccal/intranasal 0.5mg/kg Q10mins, max 10mg Diazepam IV/PO 0.25mg/kg, PR 0.7mg/kg, max 10mg
164
According to WHO: RR upper limit for 1. <2 month 2. 2 month - 12 months 3. 12 months - 5 years
1. <60 bpm 2. <50 bpm 3. <40 bpm
165
Resuscitation in near drowning - complications
Hypoxia Cerebral anoxia Airway obstruction Gastric distension/regurgitation C-spine injury
166
Criteria for HTN in pregnancy
Systolic >140 Diastolic >90 Measured x2 at least 4 hours apart
167
Symptoms of preeclampsia
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
Vitamin deficiency causing encephalopathy in hyperemesis gravidarum
Thiamine
169
Complication of UCL complete tear resulting in non-union
Stener lesion - UCL caught over adductor aponeurosis
170
Mallet finger referral criteria
<30% bony avulsion of joint Volar subluxation of distal phalanx
171
Punch in the eye - injuries not to miss
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
Orbital cellulitis - criteria for referral
Fever, systemically unwell Painful ocular ROM Proptosis Ophthalmoplegia/diplopia Reduced vision (optic nerve involvement)
173
Child eats egg, lip swelling, difficulty breathing - management
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
Maculopapular painful rash, unilateral forehead. What eye condition do you suspect?
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
Indications for referral for renal colic
Pregnant Infected, temp >38 Peritonitis >7mm ureteric stone Pain uncontrolled Known renal disease Bilateral obstructive stone Solitary kidney
176
Treatment of renal colic
NSAIDs - diclofenac Morphine Alpha blocker - Doxazosin
177
70 year old, painless loss of vision in 1 eye for 1 min, lightheaded. Dx?
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
Features of Colles fracture
Dinnerfork deformity Transverse distal radius fracture Dorsal angulation +/- displacement Can involve ulna styloid fracture
179
Possible tendon rupture with Colles fracture
Extensor pollicis longus
180
Non direct causes of Lisfranc injury
Axial load in hyperplantarflexion Fixed hindfoot, rotational force through forefoot
181
Grade 3 ACJ injury - which ligaments are ruptured?
Acromioclavicular Coracoclavicular - trapezoid, conoid
182
Additional xray views to assess ACJ injury
Bilateral zanca weight bearing views Axial view
183
TFCC ligament - which bones does it primarily articulate with?
Ulna + triquetrum with radius + lunate
184
4 signs of meniscal injury
Positive McMurrays, Apley's compression, Thessaly's test and joint line tenderness Delayed swelling, bruising, clicking, locking, crepitus
185
3 year old with fever 38.5, limp, minor trauma 2 days ago, no leg pain - diagnoses not to miss
Psoas abscess Appendicitis Osteomyelitis, septic arthritis
186
Two components for initiating Mental Health Act
Mood or delusional disorder Causing risk to self/others, or care of self/others
187
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?
Social anxiety
188
Risk factors for delirium
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
Alcohol limit for men and women
Men: 15 standards/week, max 3/day Women: 10 standards/week, max 2/day At least 2 ETOH free days/week
190
Symptoms of lithium toxicity
Altered mental state Nausea, vomiting, diarrhoea Tremor Ataxia Weakness Severe: hypotension, dysrhythmia, seizure, coma, death
191
Viruses that cause bronchiolitis
RSV Adenovirus Rhinovirus
192
Examination signs for scaphoid fracture
Tenderness in ASB Tenderness at scaphoid tubercle Pain on axial load of thumb
193
Most common preventable cause of death post-trauma
Haemorrhage
194
What 3 bones are in line on lateral wrist xray to check normal alignment
Radius, lunate, capitate
195
196
Types of scaphoid fractures at risk of AVN
Proximal pole Waist
197
9 year old boy drowsy, DKA - then develops headache, vomiting, confusion - what diagnosis not to miss?
Cerebral oedema
198
Seniors at risk tool
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
Dorsiflexion and internal rotation of ankle - what is commonly fractured?
Lateral process talus
200
4 differentials for cellulitis
Lipodermatosclerosis Dermatitis Psoriasis Superficial thrombophlebitis Urticaria Lymphoedema Fungal infection
201
3 zones of Jackson's burn wound model
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
Knee apprehension test - what is most likely injured
Patella dislocation Patellofemoral instability from rupture of MPFL
203
FOOSH, wrist pain, numbness and weakness index finger and thumb, what to look for on xray?
Displaced Colles or Smiths fracture, lunate/perilunate dislocation
204
Signs in quinsy
Stridor Hot potato voice Dysphagia, odynophagia Bad breathe Fever Trismus Drooling
205
Child with twisting injury and limping - traumatic and non traumatic dx
Toddler's fracture Contusion Femur fracture - think NAI Irritable hip Septic arthritis Osteomyelitis Tumour
206
Grade 3 supracondylar fracture - possible neurovascular injury?
Brachial artery Median nerve (AIN) Radial nerve (secondary)
207
Ddx for testicular mass not to miss
Testicular cancer Testicular torsion Appendage torsion Testicular rupture Epidydimitis Strangulated inguinal hernia
208
Blurry vision over days and pain on eye movements
Optic neuritis Causes: MS, infection (syphilis, Lyme, viral), sarcoidosis
209
Pancreatitis - lab test Ddx?
Lipase Aortic dissection, renal colic, biliary colic, cholecystitis, duodenal perforation, hepatitis, ischaemic bowel
210
Child with abdominal pain, blood and mucus in stool
Intussusception Pain relief, IVF, NBM, paeds surg referral
211
Woman with hx tubal ligation. Now LLQ pain, no PV bleed, tachycardia
Ectopic pregnancy PID Renal colic Bowel obstruction UTI/pyelonephritis Diverticulitis Bloods, bHCG Urine dip +/- pelvic USS
212
What chemical in the environment can give patient sialorrhoea?
Organophosphates Mushrooms
213
Woman with PV bleeding, intrauterine foetal heart beat seen. What is the type of miscarriage?
Threatened miscarriage
214
Happy child, 1 week of spreading lumpy rash, not itchy
Molluscum contagiosum
215
Most likely injured organ in blunt abdominal trauma
Spleen
216
PECARN score
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
Hunter serotonin toxicity criteria
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
4 diseases to test for in female STI screen
Chlamydia, gonorrhoea, HIV, syphilis
219
Causes of delayed skin healing
Diabetes Smoking Steroids Infection Sutures too tight Elderly Poor nutrition Obesity ETOH Immunocompromised
220
Primary treatment of dysmenorrhoea
NSAIDs OCP
221
Symptoms of myxoedema
Hypothyroid emergency - bradycardia - thinning hair - hypothermia - non-pitting oedema - altered LOC and coma - hypotension - enlarged thyroid - hypoglycaemia
222
Glucagon is antidote for...
Beta blocker overdose
223
CAGE questionnaire for ETOH excess
C - attempts to cut down A - annoyed by other people complaining G - guilty about drinking E - Need for eye-opener in the morning
224
Most effective emergency contraceptive
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
Management of acute prostatitis
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
Lisfranc ligament attaches to which bones?
medial cuneiform + base of 2nd metatarsal
227
3rd trimester PV bleed - what differentiates placental abruption vs previa?
Abdo pain Shock Foetal distress
228
Female with abdominal pain - dx not to miss
Ectopic pregnancy Appendicitis Ovarian torsion Ovarian cyst rupture
229
Alcohol hazard assessment tool
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
HDC code of rights
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
When to start steroids in preschool wheeze/asthma
Moderate-severe asthma Hx prev severe attacks Hospital stay >6 hrs
232
Red lateral neck mass in well person - dx and management?
Branchial cyst - inflamed Refer for removal
233
Which endocrine emergency - patient with tremor, anxiety, agitation, pedal + pulmonary oedema, hyperthermia
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
Acute sensorineural hearing loss
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
Atypical pneumonia vs lobar pneumonia - Signs - Treatment
- Insidious onset up to 4 weeks - GI symptoms - Scant sputum initially - arthritis/arthralgia, erythema mulitforme and nodosum, pericarditis, pancreatitis - Macrolides, tetracyclines
236
ECG changes in TCA overdose
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
Post viral symptom time frame: Cough Nasal discharge
Cough - 2-4 weeks Nasal discharge 2 weeks
237
DVT - how to measure calf circumference
10cm below tibial tuberosity, >3cm difference
238
Low speed injury, anterior neck pain, swelling and slurred speech
Cervical artery dissection with CVA Ipsilateral Horner's syndrome - ptosis, miosis, anhydrosis
239
Causes of otitis externa
Infection - bacterial, fungal Dermatological - atopic dermatitis, allergic/irritant contact dermatitis, psoriasis
240
2 fractures that can cause compartment syndrome
Forearm Tibial
241
Lifestyle modifications for EBV
No contact sports No ETOH
242
Management of gonorrhoea - 4 points
Test for chlamydia, HIV, syphilis Treat with IM ceftriaxone + azithromycin Contact tracing - 3 months Report to MOH

UCPEX (13 decks)

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