Pastest

Question 1

Acute limb ischaemia 6Ps

Answer 1

pain
pallor
paraesthesia
perishingly cold
paralysis
pulseless.

Question 2

when does irreversible tissue damage occur in acute limb ischaemia?

Answer 2

6h

Question 3

Causes of acute limb ischaemia?

Answer 3

embolus, acute thrombosis, intra arterial injection, embolism (air, fat, amniotic)

Question 4

pathophysiology of acute limb ischaemia?

Answer 4

Occlusion of arterial supply
acute thrombosis/or embolus
decreased perfusion leading to tissue ischaemia

Question 5

ALI due to embolism vs thrombosis

Answer 5

embolism - more acute onset, no hx of claudication, no onset AF,

thrombosis - slower onset due to development of collaterals, pulses absent in the other limb too, significant cardiovascular disease history

Question 6

How to calculate ABPI?

Answer 6

systolic BP at ankle / systolic BP at brachial artery

Question 7

ABPI in arterial disease

Answer 7

<0.9 peripheral artery disease
<0.5 critical limb ischaemia (emergency specialist referral)

Question 8

5 year prognosis in intermittent claudication

Answer 8

5-10% critical ichaemia
1-2% amputation

Question 9

appearance of arterial ulcers:

Answer 9

ankle/foot, over pressure areas
deep, punched out appearance, painful,
pain worse at night

Question 10

appearance of venous ulcer:

Answer 10

gaiter area (between knee and ankle),
around medial malleolus
shallow, irregular (slopping) edges, painful, granulating base

Question 11

Phlegmasia alba dolens

Answer 11

-painful while inflammation-
complication of extensive DVT

Question 12

acute pancreatitis classifications

Answer 12

mild (absence of complications or organ dysfunctions)
moderate (local or organ complications resolving in 48h)
severe (persistent organ dysfunction leading to complications or death, eg necrosis, abscess, pseudocst)

Question 13

causes of pancreatitis

Answer 13

50% obstruction of pancreatic duct by gallstones
other cases are alcohol related

Question 14

acute gallstone pancreatitis treatment

Answer 14

ERCP (decompression)

Question 15

causes of acute pancreatitis

Answer 15

GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidaemia, hypercalceamia
ERCP
Drugs (steroids, antiretrovirals, oral contraceptives

Question 16

Cullen’s sign

Answer 16

discolouration around umbilicus

Question 17

Grey Turner sign

Answer 17

discolouration around flanks

Question 18

APACHE II score

Answer 18

scores for high risk acute pancreatitis

Question 19

McBurney’s point

Answer 19

right illiac fossa pain 1/3 from ASIS to umbilicus

Question 20

Investigations in appendicitis

Answer 20

Urinalysis: leukocytes
Bloods: raised WCC and CRP

Question 21

mortality rate of acute appendicitis

Answer 21

0.8%

Question 22

appendicitis in pregnancy

Answer 22

6 in 10 perforate
1 in 10 die
3 in 10 have foetal loss

Question 23

what vessel supplies appendix

Answer 23

appendicular artery, branch of posterior caecal artery

Question 24

Rovsing’s sign

Answer 24

palpation in LIF gives pain in RIF

Question 25

position of appendix

Answer 25

62% - retrocaecal (psoas stretch sign, increased pain on passive extension of hip) 34% pelvic

Question 26

Alvarado score

Answer 26

score out of 10 marking likelihood diagnosis of appendicitis (<5 unlikely, >7 strongly predictive) RIF migratory pain 1, anorexia 1, N&V 1, RIF tenderness 2, rebound tenderness 1, fever 1, raised WCC 2, left shift/immature neutrophils 1

Question 27

Aaron's sign

Answer 27

pain referred to epigastrium when pressure applied to McBurney's point (appendicitis)

Question 28

Dunphy's sign

Answer 28

pain on coughing in appendicitis

Question 29

Murphy's sign

Answer 29

pain in RUQ when palpation on inspiration (inflamed gallbladder)

Question 30

Rigler's sign

Answer 30

air visible on both sides of Abdominal X ray

Question 31

Cardinal symptoms of meningitis

Answer 31

Headache Fever Photophobia Vomiting Neck stifness

Question 32

Bacterial meningitis Tx

Answer 32

IV ceftriaxone

Question 33

Most common cause of meningitis

Answer 33

Meningococcal infection more common than Pneumococcal

Question 34

Children >3mth + adults - most common cause of meningitis

Answer 34

Neisseria meningitidis (meningococcal infection) Strep pneumonia (pneumococcal) Hib haemophilus

Question 35

Neonates <1 mth cause if meningitis

Answer 35

Strep agalactiae Escherichia coli S pneumoniae Listeria monocytogenes (+ this also in the elderly)

Question 36

Mx of Meningococcal infection