youve been plabbed

Question 1

intercondylar fracture mechanism of action

Answer 1

direct blow to elbow

Question 2

condylar fracture mechanism of action

Answer 2

direct blow to flexed elbow

Question 3

olecranon fracture mechanism of action

Answer 3

Elderly- pulling of tricepts/ brachiradialis

children- direct blow to elbow

Question 4

fracture from FOOSH

-swelling/pain over lateral elbow
-limited range of motion
-pain greatly increased with passive rotation of elbow
-pain on fingers extended against resistance
-examination of radial nerve reveals tenderness over radial tunnel

what fracture?

Answer 4

if child= radial neck

adult= radial head

radial nerve is damaged causing:
-pain on finger extension against resistance
-tenderness of radial tunnel

Question 5

laxatives to completely avoid palliative care

Answer 5

isaghula husk (bulk forming laxative)

-absorbs water, increasing stool bulk + so requires more water intake, not ideal for palliative

-opioids also prevent peristalisis of increased bulk so can lead to bowel obstruction

Question 6

laxative typically used in palliative care

Answer 6

1st= stimulant laxative (bisacodyl or senna)

2nd= osmotic laxative (lactulose or macrogel)

suppository= quicker acting than oral

Question 7

no reversal agents available for apixaban (andexanet alfa) :( + old man having an intra cranial bleed!

but luckily blood components all available XD

-what you giving

Answer 7

prothrombin complex concentrate

-can used for any DOAC that needs reversed especially if no reversal agents available

Question 8

what are the factor Xa inhibitor DOACs

Answer 8

-Rivaroxaban
-Apixaban
-Edoxaban

Question 9

Dabigatran moa

Answer 9

direct inhibor of antithrombin (Factor IIa)

Question 10

dabigatran reversal agent

Answer 10

idarucizumab

Question 11

presentation physiological jaundice neonate

Answer 11

-presents at 2/3 days old
-begins to disappear in 1st week of life
-usually completely gone by day 10

(due to increased erythrocyte breakdown and immature liver function)

Question 12

causes of early neonatal jaundice (<24 hours)

Answer 12

Haemolytic disease (MOST COMMON):
-rhesus incompatibility
-ABO incompatibility
-G6PD deficiency
-Spherocytosis

Congenital TORCH infections

Gilberts

other rare syndromes

Question 13

causes of prolonged jaundice newborn (last >14 days)

Answer 13

-Congenital hypothyroid
-Hypopituitarism
-Breast milk jaundice
-Biliary atresia (probs most concerning)
-Neonatal hepatitis

Question 14

normal baby stools- what they look like

Answer 14

yellow to mustard coloured + seedy appearance

Question 15

neonatal jaundice >14 days with creamy or paste like stools

Answer 15

breast milk jaundice

Question 16

18 year old nulliparous woman mild learning difficulties wants contraception, doesnt smoke, drink, is mobile, not overweight. Wants something more reliable than condoms. which is best out of options:

-COC
-Nexplanon
-IUS
-IUD
-POP

Answer 16

Nexplanon is best

COC + POP not so reliable + may forget to take

Nulliparous woman- harder to fit coils

Coils UKMEC 2 <20 years

Question 17

when do you treat anaemia in pregnancy

Answer 17

<110 1st trimester

<105 2nd trimester

<100 post partum

Question 18

Child was left alone with a nut, mum came back concerned that they breathing funny:

-expiratory wheeze

-inspiratory stridor

donde esta la foreign body for both presentations + what investigations

Answer 18

expiratory wheeze: typically bronchi
bronchoscopy= gold

inspiratory stridor: above the glottis
flexible nasal endoscopy

Question 19

you about to do PR + offer chaperone
-Patient refuses chaperone!

what u gonna do

Answer 19

accept refusal, document that they refused chaperone + continue with examination

Question 20

2 year old comes in with 5 day history of:
-palpable pupuric rash on bum and legs
-pain in joints
-abdo pain

the past hour he begins to poo blood +
-what the diagnosis!

Answer 20

Intusussception

-complication of henoch shonlein purpura (purpuric rash, abdo pain + arthralgia)

Question 21

polyhdramnios
-absent fetal stomach bubble detected on US

Why does she probs have poly

Answer 21

oesophageal atresia

Question 22

5 year old foul thick smelling discharge coming from one nostril for 2 months

-what is it + why

Answer 22

foreign body
-one nostril
-foul smelling
-thick

polyp would appear in older people + cause think + non smelly discharge

Question 23

Ganser syndrome

Answer 23

often referred to as prison psychosis (any people get in prison)

-person gives responses that are clearly wrong but in the correct category

e.g. ask who prime minestor of UK is and they say Donald Trump

Question 24

samster triad

Answer 24

Nasap polyps
Asthma
Aspirin sensitivity

Question 25

criteria tonsillectomy

Answer 25

>7 episodes in one year >5 episodes per year for 2 years >3 episodes per year for 3 years

Question 26

when to give antibiotics tonsillitis

Answer 26

CENTOR CRITERIA Fever >38 Tonsillar exudates Absence cough Tender anterior cervical lymphadenopathy 3 or 4 give phenocymethylpenicillin

Question 27

how much blood lost in class 1 haemorrhagic shock?

Answer 27

<15% (<750mls)

Question 28

Obs of someone with class I haemorrhagic shock

Answer 28

blood loss <15% or <750mls Obs are normal range HR 60-100 BP normal RR 12-20

Question 29

class 2 haemorrhagic shock blood loss

Answer 29

15-30 % or 750- 1500ml

Question 30

obs of someone with class 2 haemorrhagic shock

Answer 30

HR increased (101- 120) BP normal RR increased (21-30) (15-30 % or 750- 1500ml blood loss)

Question 31

blood loss class 3 haemorrhagic shock

Answer 31

>30 % or 1500- 2000ml

Question 32

obs class 3 haemorrhagic shock?

Answer 32

HR 121-140 (raised) BP drops RR 31-40 (highhh)

Question 33

class 4 haemorrhagic shock blood loss

Answer 33

>2000 ml (>40%)

Question 34

class 4 haemorrhagic shock obs

Answer 34

HR >140bpm BP lowww RR highhh >35

Question 35

management of pre eclampsia in primary care

Answer 35

refer to obs same day

Question 36

4 year old child begins wetting the bed didnt used to -what you gonna do

Answer 36

refer to paeds -refer secondary enuresis to paeds primary notcurnal enuresis- reassure that they will probs grow out of it by the age of 5

Question 37

BB antidote

Answer 37

glucagon atropine is often first line to stop the bradycardia but IS NOT AN ANTIDOTEEE

Question 38

palliative patient has catastrophic GI bleed vomiting 1100ml blood -management?

Answer 38

midazolam (for anxiety) Morphine (if pain) -dont do blood transfusions, endoscopy or anything as too agressive

Question 39

premature ovarian failure LH + FSH

Answer 39

Raised

Question 40

cocaine toxicity management

Answer 40

benzodiazepines (beta lockers are CI)