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4th Year ACC > very select ACC questions > Flashcards

very select ACC questions Flashcards

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1
Q

Wernicke’s enceph triad?

A

Confusion

Ataxia

Nystagmus

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2
Q

Which alcohol withdrawal pts should be admitted for inpatient detox?

A

Delirium tremens

Seizures

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3
Q

What permanent Rx will complete HB probably need?

A

Pacemaker

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4
Q

Does ketonuria alone = DKA?

A

No

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5
Q

3 diagnostic criteria of DKA

A

Acidotic on VBG

Hyperglycaemic (>11BM or known diabetic)

Ketonaemia (>3) or uria (>2+)

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6
Q

What happens to normal long acting insulin in DKA?

A

Continue

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7
Q

when is DKA resolved?

A

Blood ketones <0.6

Venous pH >7.3

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8
Q

Can you use bicarb as a measure of progress in DKA?

A

Not after 6h as the NaCl can = hyperchloraemia which lowers bicarb

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9
Q

What do you do in head injury if GCS <8?

A

Anaesthetics to intubate

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10
Q

Retrograde vs anterograde amnesia?

A

prior event ….Retrograde….injury….anterograde…now

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11
Q

Unequal pupils in neuro exam suggests what?

A

raised ICP - neuro review

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12
Q

CSF leakage from nose or ear, battle sign, panda eyes or haemotympanium suggests what?

A

Basilar skull fracture

–> CT, tetanus toxoid, neurosurgeons

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13
Q

Indications for CT head <1hr

A
  1. Depressed/open/basal skull fracture
  2. Post injury seizure
  3. Vomiting >1
  4. Panda eyes
  5. Post auricular ecchymosis (Battle sign)
  6. CSF from ear/nose
  7. FND
  8. Haemotympanum
  9. GCS <13 (or <15 at 2h)
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14
Q

Indications for CT head <8hr?

A
  1. LOC or amnesia

AND

2a) >65yo
b) high impact injury
c) retrograde amnesia >30mins
d) coagulopathy

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15
Q

How do you know if CT C spine needed <1hr?

A

High risk factors present - CT

If no high risk- low risk factor present? - if no then not safe to assess neck movement- 3 view C spine Xray instead

If low risk factor is present- assess neck mov- if can’t rotate 45 L and R then X ray.

If all fine then can safely r/o C spine without imaging

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16
Q

what are the high risk factors for C spine

A
  1. > 65yo
  2. GCS <13
  3. Intubated
  4. X ray suspicious or abnormal
  5. Definitive answer needed e.g. for surgery
  6. FND peripherally
  7. Peripheral parasthesia
  8. Dangerous mechanism of injury (incl fall >1m/5 stairs)
  9. Other imaging being done for head/multi-region trauma
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17
Q

What are the low risk (ruling out) risk factors for C spine?

A
  1. Simple rear end motor collision
  2. Sitting comfortably in ED
  3. Ambulatory since injury
  4. No midline C-spine tenderness
  5. Delayed onset neck pain
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18
Q

When is permissive hypotension in trauma contraindicated?

A

Traumatic brain injury as risk hypoperfusion

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19
Q

Bloods to get if suspect bleeding in trauma

A

FBC

U+E

LFT

Coag

VBG

Crossmatch

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20
Q

GCS scores

A

Eyes open (4) : never/pain/speech/spontaneous

Verbalises (5) : never/incomprehensible/inappropriate/confused/orientated TPP

Motor (6): never/abnormal extension/abnormal flexion/flexes to withdraw from pain/localises pain/obeys commands

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21
Q

what does AMPLE stand for and when is it used?

A

Secondary survey for more info

Allergies

Medications

PMH

Last meal

Environment and events

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22
Q

What does secondary survey involve

A

AMPLE

Reassess A to E always

Full systems examination

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23
Q

Neuro signs + persistent moderate hypotension suggest what?

A

Neurogenic shock

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24
Q

How can you confirm neurogenic shock?

A

C-spine imaging

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25
What imaging for thorax in trauma?
Screen - X ray Blunt mechanism- CT pneumo/haemothorax - USS (most life threatening)
26
Imaging for pelvis in trauma? What is a serious injury you can get?
X ray Pelvic fractures can = significant haemorrhage --> hypotension
27
How would you get an indirect brain injury?
No impact but the contents of the skull set into vigorous motion
28
If they can tolerate an oropharyngeal airway, their GCS must be?
<8 - can't protect so need ETT
29
How to prevent secondary brain injury
Good ABC
30
What happens to BP in brain injury?
Cerebral autoregulation of blood flow lost so must maintain BP and control ICP
31
Pupils that are both small indicates what?
Opiates or brain stem injury
32
Pupils where one is fixed and dilated = what?
IIIrd nerve stretched on that side due to ipsilateral raised ICP
33
Both pupils fixed and dilated =?
Poor outcome unless caused by drugs e.g. atropine/adrenaline or local eye injury
34
How do you record GCS if motor response is asymmetrical?
Take best side
35
On fundoscopy papilloedema indicates?
Non acute raised ICP
36
On fundoscopy subhyaloid haemorrhage indicates?
SAH
37
What does subhyaloid haemorrhage look like?
Fluid level in a circle on fundoscopy
38
What ocular reflex would you expect to see in a comatose patient with an intact brain stem
Dolls head reflex- eyes still stare at ceiling when you move their head
39
What ocular sign would you expect to see in a comatose patient with damaged brain stem
eyes move with head as if fixed
40
What is the oculovestibular reflex? What results do you expect
Irrigate ear canal with ice cold water = nystagmus and vomiting in non-comatose patients In a comatose patient with intact brain stem = tonic movement of eyes towards the ear No response= no brain stem reflexes
41
Cheyne stokes breathing suggests what
Ischaemic or metabolic hemispheric lesions | or heart failure
42
Hyperventilation in the context of neuro injury suggests what
Hypothalamus/mid brain lesion
43
Slow, irregular apneustic breathing suggests what
mid/lower pontine lesions
44
Low/irregular RR and low HR with high BP in the context of neuro injury is what?
Cushing's reflex
45
Can TBI cause coagulopathy?
Yes
46
When do you involve neurosurgeons in TBI?
1. persisting GCS <8 after trauma 2. unexplained confusion >4h 3. Progressive focal neuro signs/GCS deteriorating 4. seizure without full recovery 5. Penetrating injury 6. CSF leak
47
(Mean arterial pressure)-(ICP)= ?
Cerebral perfusion pressure
48
MAP must not fall below what in brain injury?
80mmHg
49
How do you manipulate cerebral perfusion pressure?
Increase MAP (fluids, inotropes) or decrease ICP (avoid excess fluid, elevate head by 30 degrees, avoid constraints around neck, mannitol diuretic, oxygenate, ventilate, sedate)
50
What does the cushing's triad suggest?
Raised ICP Terminal stage of acute head injury could = imminent herniation
51
GCS 3-8 and abnormal CT scan = mandatory ?
ICP monitoring
52
Cerebral perfusion pressure must be minimum what in adults?
70mmHg
53
Bilaterally dilated but sluggish or fixed pupils =?
Poor cranial perfusion or IIIrd nerve palsy
54
What can be given in cerebral oedema following head injury?
Mannitol
55
Extradural haematoma is likely to be which blood vessel?
Middle meningeal artery
56
old age, alcoholism and anticoagulation, with fluctuating confusion/consciousness in the history suggests what type of cranial bleed?
Subdural haematoma
57
SAH often occurs due to what?
Ruptured aneurysm, but could also be TBI
58
Most sensitive scan to diagnose diffuse axonal injury?
MRI
59
HHS is which type of diabetes
2
60
HHS triggered by what?
Infection/illness and dehydration
61
Glucose is >? in HHS
30
62
Ketones and pH in HHS?
Normal
63
How does HHS present?
N+V Weakness, cramps Maybe polyuria and dipsia Altered mental state
64
Should you use oropharyngeal airway in seizure?
No use naso
65
People having seizures are likely to bite which bit of tonue
Sides
66
What is Todd's Palsy?
Transient unilat weakness following seizure for a few hours (similar to TIA)
67
Is it abnormal to have upgoing plantars and ankle clonus immediately after seizure?
No
68
If you're unsure of the diagnosis, what is raised 10-20m after seizure?
Prolactin
69
Known epileptic presents with normal-for-them fit, wyd?
Discharge
70
First fit presents, wyd?
Observe for 4h, if nil - discharge Avoid activities like driving, machinery, ladders, swimming unsupervised until reviewed by specialist Seen in OP clinic after ECG and CT
71
Can you get vomiting and incontinence in syncope?
Yes
72
How does hypoglycaemia present?
Any neuro presentation

4th Year ACC (9 decks)

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