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Practice Exams > 27/11/21 > Flashcards

27/11/21 Flashcards

1
Q

Dermatomes of Upper Limb - C5-T1. Basic Description of regions.

A

C5 - Upper Arm
C6 - Lateral Forearm + Thumb and Index Finger half
C7 - Palm and middle finger and half indec
C8 - 4th and 5th fingers, medial forearm
T1 - anterior arm and medial forearm

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2
Q

Cervical Spine Level if Biceps and Brachioradialis Reflexes are affected?

A

C5-C6

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3
Q

Cervical Spine level if triceps reflex is affected?

A

C7

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4
Q

Movements affected if C5 is affected?

A

Shoulder Abduction
External Rotation
Elbow Flexion
Forearm Supination

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5
Q

Movements affected if C6 is affected?

A

Shoulder Abduction
External Rotation
Elbow Flexion
Forearm Supination and Pronation

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6
Q

Movements affected if C7 is affected?

A

Elbow Extension
Forearm Pronation
Wrist Extension
Wrist Flexion

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7
Q

Movements affected if C8 is affected?

A

Wrist Extension
Finger Extension + Flexion + Adduction + Abduction
Distal Thumb Flexion

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8
Q

Movements affected if T1 is affected?

A

Finger Abduction + Adduction
Distal Thumb Flexion
Thumb Abduction

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9
Q

Clinical Manifestations of Cervical Radiculopathy (4 points)

A
  • Neck, Shoulder or Arm Pain
  • Upper extremity muscle weakness
  • Sensory symptoms
  • Diminished Deep Tendon Reflexes
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10
Q

Mechanisms of Cervical Radiculopathy (2)

A
  1. Cervical Spondylosis

2. Disc Herniation

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11
Q

Do you use chronological age or adjusted age when calculating timing of vaccination doses of pre-term infants?

A

if medically stable - use chronological age

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12
Q

Recommended schedule for Hep B vaccinations in premature infants? How is this different to the normal vaccination schedule?

A
  • Recommended Schedule
    • Hepatitis B vaccine at birth
    • 3 Doses of Hepatitis B Vaccination at 2,4 and 6 months
    • BOOSTER HEPATITIS B VACCINATION at 12 months
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13
Q

Pneumococcal Schedule for Preterm Infants? How is this different to the normal vaccination schedule?

A
  • All preterm infants <28 weeks gestation → 4 doses of 13vPCV and 2 doses of 23vPPV
    • 13vPCV → 2,4,6 and 12 months of age
    • 23vPPV → 1st Dose: 4 years of age, 2nd Dose 5 years after 1st later.

Dose at 6 months is extra

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14
Q

Age range for febrile seizures? Proportion of children that get Febrile Seizures? Associated with_____?

A
  • 6 months - 5 years
  • Benign - occur in 3% of healthy children
  • Associated with simple viral infections
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15
Q

Recurrence of Febrile Seizures? What does it depend on?

A
  • Recurrence Rate
    • Depends on the age of the child at first seizure → the younger the child at initial seizure, the greater the risk of further febrile seizures
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16
Q

Risk Factors to develop epilepsy from having febrile seizures (4 points)

A
  • FHx of Epilepsy
  • Neurodevelopmental Problem
  • Prolonged or Focal Febrile Seizures
  • Febrile Status Epilepticus
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17
Q

Characteristics of Simple Febrile Seizures (4 points)

A
  • FHx of Epilepsy
  • Neurodevelopmental Problem
  • Prolonged or Focal Febrile Seizures
  • Febrile Status Epilepticus
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18
Q

Characteristics of a complex Febrile Seizures (4 points)

A

Fever and ANY of the following:

  • focal features at onset or during the seizure
  • duration >10minutes
  • incomplete recovery within 1 hour
  • recurrence WITHIN the same illness
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19
Q

WTF is an afebrile febrile seizure?

A

Seizures in an acute infectious illness (particularly gastroenteritis) without documented fever
Features consistent with simple febrile seizures

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20
Q

Investigations for a febrile seizure?

A
  • If focus of infection identified → no investigations are indicated
  • NO ROLE for EEG in simple of complex febrile seizures
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21
Q

What NOT to do in a febrile seizure?

A
  • During a seizure → do NOT put child in the bath, do NOT restrain them, DO NOT put anything in their mouth
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22
Q

How long should you wait before calling an ambulance in the context of a febrile seizure?

A

Call ambulance if seizure lasts for more than 5 minutes

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23
Q

When to refer to a paediatrician in the context of a febrile seizure?

A
  • Complex Febrile Seizure
  • Seizures unable to be controlled
  • Child clinically unwell
  • Child does not return to normal mental state in 1 hour
  • Concern regarding nature of febrile illness
  • Frequent seizures
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24
Q

Characteristic symptoms associated with alcohol withdrawal? (4 points)

A
  • Anxiety
  • Tremor
  • Sweating
  • Nausea and Vomiting
  • Agitation
  • Headache
  • Perceptual Disturbances
  • Occasionally - seizures
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25
Q

Medications to manage alcohol withdrawal (2 points)

A
  • Prescribing short-course of diazepam to reduce withdrawal severity -> Diazepam 20mg PO every 2 hours until symptoms subside → cumulative total of 60mg is usually adequate. Do not use more than 100mg without seeking specialist advice.
  • Thiamine to reduce risk of Wernicke’s Encephalopathy -> Thiamine 300mg IM or IV daily for 3-5 days then thiamine 300mg orally daily for several weeks.
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26
Q

Eligibility Criteria for Outpatient Alcohol Withdrawal Management? 5 points

A
  • No previous severe withdrawal including no seizures or delirium tremens
  • No concurrent acute medical illness
  • No evidence of psychosis, suicidal thoughts or severe depression
  • No evidence of other drug use except cannabis
  • Supportive, stable and drug free, alcohol free home environment
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27
Q

Options for alcohol cessation? Be Specific with dosing

A
  1. Disulfiram 100mg PO, once daily for 1-2 weeks, increased as required and as tolerated to 300mg daily
  2. Acamprosate 666mg PO TDS (>66kg) OR 666mg PO mane, 333mg midi and nocte (<66kg)
  3. Naltrexone 50mg PO daily
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28
Q

Basic Principles of each alcohol cessation medication?

A

Disulfiram - makes patient physically unwell if drink alcohol
Naltrexone - reduces pleasure related to alcohol + reduce cravings
Acamprosate -> reduce withdrawal symptoms which trigger people to drink

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29
Q

Characteristics of an infected diabetic foot ulcer? (5 points)

A

At least 2 of the following:

  • Local Swelling or Induration
  • Erythema extending more than 0.5cm in any direction from the wound
  • Local Tenderness or Pain
  • Local Warmth
  • Purulent Discharge
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30
Q

Classification of Mild Infected Diabetic Foot Ulcer?

A

erythema <2cm from wound margin

involves just skin and subcut tissue

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31
Q

Classification of Moderate Infected Diabetic Foot Ulcer?

A

erythema >2cm from wound margin OR involving deeper structures -> muscle, joint, bone

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32
Q

Classification of Severe Infected Diabetic Foot

A

SIRS response

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33
Q

Management of an acute mild diabetic foot ulcer?

A
  • Dicloxacillin 500mg PO Q6H

- OR Flucloxacillin 500mg PO Q6H

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34
Q

Rank the dressings from least absorbent to most. Alginate, Foams, Hydroactive, Hydrocolloid, Hydrogels, Semi-Permable Films.

A
  1. Semi-Permable
  2. Hydrogels
  3. Hydrocolloid
  4. Foam
  5. Alginate
  6. Hydroactive
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35
Q

Wound dressing for chronic ulcers?

A

Hydrocolloid Dressings

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36
Q

Cause of Hyperparathyroidism (1 point)

A
  • Most commonly caused by single parathyroid adenoma
37
Q

Management options for hyperparathyroidism?

A

Definitive surgery → cures 95% of cases and low morbidity

Watch and Wait in patients who are >50yo and have:

  • Corrected Ca <2.90
  • Normal Renal Function
  • No Nephrolithiasis or Nephrocalcinosis
  • BMD T-Score >-2.5
  • No Symptoms
38
Q

Clinical Manifestation of Hypercalcaemia

A

BONES, STONES, GROANS AND PSYCHIC MOANS

  • Bone Pain
  • Polyuria
  • Nephrolithasis
  • Constipation
  • Fatigue
39
Q

2 Main Causes of Hypercalcaemia

A
  1. Parathyroid Disease

2. Malignancy

40
Q

Who should be tested for chlamydia?

A
  • Offered to <30years and sexually active
  • Partner change in last 12 months
  • STI in last 12 months
  • Sexual Partner with STI
  • Increased risk of complications of Chlamydia Infection → TOP or IUD insertion
  • Signs or Symptoms of Chlamydia
41
Q

For women, what are the options for chlamydia testing?

A
  • Female - endocervical swab (best test if examined)
    • If not examined - self-collected vaginal swab.
    • If endocervical swab or self-collected vaginal swab cannot be taken
42
Q

Management of Chlamydia

A
  • Doxycycline 100mg PO BD for 7 days
    • If uncomplicated genital or pharyngeal infection → 7/7 course
    • If ano-rectal infection → 7/7 if asymptomatic, 21/7 if symptomatic
  1. Contact tracing up to 6 months
  2. No Sexual Contact for 7 days after treatment is administered
  3. No sex with partners from the last 6 months until they have been tested and treated
  4. Notify State Health Department
  5. can complete Partner Directed Partner Therapy
  6. check in 1 week time - review compliance, review contact tracing
  7. TEST OF CURE IS NOT ROUTINELY RECOMMENDED → only if pregnant or if ano-rectal chlamydia - retest for cure in 4 weeks time
  8. Test for re-infection in 3 months time - to detect re-infection
43
Q

5 As of Smoking Cessation Approach

A 
Ask
Assess
Advise
Assist
Arrange Follow-Up
44
Q

Main questions when assessing nicotine dependance?

A
  1. How long from first waking up to first cigarette?
  2. How many cigarettes/day?
  3. Cravings/Withdrawal symptoms in previous quit attempts
45
Q

Pharmacotherapy for nicotine dependance?

A
  1. NRT
  2. Varenicline
  3. Bupropion Sustained Release (if top 2 are unsuitable)
46
Q

Which Pharmacotherpay for smoking cessation is safe in pregnancy?

A

NRT

47
Q

Contraindications for use of Bupropion Sustained Release? 3 points

A

Monoamine Oxidase Inhibitor concurrent
Pregnancy
Seizure history

48
Q

Atypical Presentation of Chest Pain

A
  • burning pain
  • pain that increases with respiration
  • “sharp” pain
  • upper abdominal pain
  • remember “silent infarctions” especially in those with diabetes or older patients
49
Q

Management Points for Chest Pain

A
  1. ECG
  2. Arrange Ambulance transfer for Hopsital
  3. Aspirin 300mg PO stat
  4. If haemodynamically stable and NO INFERIOR MI -> GTN spray 400-800mg sublingually, repeat every 5 mints if pain persists up to total of 3 doses
  5. If pain persists -> add opioid - Morphine 2.5-5mg IV → repeated at 5-10minute intervals
  6. O2 only if patient is hypoxaemic -> O2<94%
50
Q

Diagnosis of PCOS (basic steps)

A
  1. Irregular Menstrual Cycles AND Hyperandrogenism
  2. if no hyperandrogenism -> for biochemical testing
    3, if no irregular cycles OR hyperandrogenism -> for U/S - 10 follicles on both ovaries
51
Q

After menarche, how long does it take for a regularity of menstrual cycles to occur?

A

2 years

52
Q

For regulating menstrual cycles in the context of PCOS, what are the options?

A
  1. COCP
  2. levonorgesterol IUD
  3. Metformin
53
Q

Base investigations in HTN (7 points)

A
  1. Urine Dipstick for blood
  2. Proteinuria/Albuminuria - first void specimen
  3. ECG
  4. FBE
  5. UEC
  6. Fasting Glucose
  7. Fasting Lipids - Total Cholesterol, LDL, HDL, TGs
54
Q

What investigations are recommended in the context of CVD + HTN?

A

Echocardiography + Carotid Ultrasound

55
Q

What investigations are recommended in the context of CKD and HTN?

A

Renal Artery Doppler U/S

56
Q

When would you suspect renovascular disease as the cause of secondary hypertension?

A
  • Unexplained creatinine elevation and/or acute and persistent elevation in serum creatinine of at least 50% after administration of ACEi, ARB or Renin Inhibitor
  • Systolic or Diastolic Abdominal Bruit
57
Q

What is the diagnostic triad of a pheochromocytoma?

A

Headache
Palpitations
Sweating

58
Q

Diagnostic Investigation Options of Pheochromocytoma.

A

Metanephrine and Normetanephrine Excretion AND/OR plasma catecholamine, metanephrine and normetanephrine concentration OR 24-hr urinary catecholamine

59
Q

What pathogen is responsible for Q Fever? Main mode of transmission?

A
  • From Coxiella burnetti
    • Most commonly reported zoonotic disease
  • Main transmission route of C. burnetti is through inhalation of aerosols or dust contaminated by secretions from infected animals including birth products, faeces and urine.
    • Contact with livestock and other animals
60
Q

Clinical Features of Q-Fever (1 specific to Q fever, others are general)

A
  • Not all patients show clinical symptoms
  • Fever - Rigors - Chills
  • Headache
  • Extreme Fatigue
  • Drenching sweats
  • Weight Loss
  • Arthralgia - Myalgia
  • Abnormal LFTs**
61
Q

Investigations in the context of Q-Fever

A

AVOID Blood Culture → high risk of laboratory acquired infections

Nucelic Acid Testing → collect within 1 week of disease onset. Fastest turnaround time to achieve diagnosis. Also a negative nucleic acid testing does not exclude the possibility of Q Fever

Serology

LFTs → elevated AST and ALT but other LFTs are normal

62
Q

Management of Q Fever (ABx choice)

A

Doxycycline 100mg BD for 14/7

63
Q

Brucellosis Clinical Features (3)

A
  • Acute Non-Specific Symptoms
  • Inflammation of the Live or Spleen OR Gastrointestinal Signs may occur
  • Testicles and Epididymis may become inflamed
  • Symptoms last for 2-4 weeks and followed by spontaneous recovery
  • Some infected people develop an intermittent fever → “undulant fever”
64
Q

Leptospirosis Clinical Features (3)

A
  • Fever, Chills, Headache
  • SEVERE MYALGIA - particular of the calves, thighs and lumbar region
  • Conjunctival Suffusion
65
Q

Clinical Presentation of External Auditory Exostosis (3 points)

A
  • EAE is usually asymptomatic and is only diagnosed at the advanced stage
  • can present with prolonged blocked feeling in the ears following water activities because of water trapping in the EAC or chronic cerumen/wax impaction
  • can also present with recurrent otitis externa, otalgia, conductive hearing impairment due to stenosis of the EAC
66
Q

What is external auditory exostosis also known as?

A

Surfer’s Ear

67
Q

What is the management of External Auditory Exostosis?

A
  • Surgical removal is the definitive management
68
Q

Causes of Barotrauma?

A
  • Flying (most common)

- Diving, Decompression, Hyperbaric Oxygen Chambers + Blast Injuries

69
Q

Clinical Features of Barotrauma? (4 points)

A
  • Ear Pressure or Pain
  • Hearing Loss
  • Tinnitus
  • Bleeding into the Tympanic Membrane
  • Rarely → rupture of the round or oval window → vertigo and sensorineural hearing loss
70
Q

Management of Barotrauma? (2 points)

A

Most barotrauma injuries heal spontaneously
Analgesia PRN
Nil requirement for ABx
Nil evidence for decongestants, antihistamines, glucocorticoids

71
Q

Prevention options for Barotrauma? (2 points)

A
  • Oral Decongestants, Antihistamines, Nasal Decongestants prior to flying or diving can reduce obstruction around the Eustachian Tube and facilitate pressure equalisation
  • Swallowing or Valsalva manoevre → equalise pressures and prevent tissue damage
  • Chewing gum or sucking on hard candies
  • Special Earplugs for flying but not for diving
72
Q

Clinical Features on History of Temporomandibular Dysfunction (4 points)

A
  • Main presenting complaint is pain in the TMJ or mandible → refer to scalp or neck, exacerbated by yawning, mastications, talking for extended periods of time.
  • Difficulty opening the mouth or brief locking of the mandible on opening or closing.
  • Clicking, popping or crepitus within the TMJ itself
  • Pain worse with mandibular movements - particularly when eating
  • Otological Symptoms: aural fullness, otalgia, tinnitus, vertigo and subjective hearing impairment → more common in myofascial than intra-articular disorder
  • Headache and TMD are comorbid diseases → presence of one may increase the prevalence of the other
73
Q

Non-Pharmacological Management of Temporomandibular Dysfunction (4 points)

A
  • Patient Education + Reassurance +/- CBT (given psychiatric component of TMD)
  • Jaw Rest
  • Soft Diet
  • Warm Compresses over region of pain
  • Passive Stretching Exercises
  • Behaviour Modification → improving sleep hygeine, stress reduction, elimination of parafunctional habits such as teeth clenching and grinding
74
Q

Red Flags to trigger referral to specialist in the context of Tempromandibular Dysfunction (4 points)

A
  • Persistent and Worsening Pain
  • Trismus
  • Cranial Nerve Abnormalities
  • Neurologic Dysfunction
  • Concurrent Infection
  • Systemic Illness
  • Weight Loss
  • Asymmetrical Neck or Facial Swelling
  • Unilateral Hearing Loss
  • Vestibular Dysfunction
  • New Onset or Unilateral Tinnitus
75
Q

Common Causes of Short Stature in Adolescents? (2 points)

A

1, Familal Short Stature

2. Constitutional Delay of Growth and Puberty

76
Q

Explain what is Familial Short Stature and what management?

A
  • Short compared to their peers but are an appropriate heigh in the family as evidenced by mid-parental height.
  • Monitoring growth is all that is required
77
Q

Definition of Constitutional Delay of Growth and Puberty? Boys? Girls?

A
  • Girls: Lack of Breast Development (Tanner Stage 2) in girls ages >13
  • Boys: Testicular Volume <4.0ml by the age of 14
78
Q

Management of Constitutional Delay of Growth and Puberty? Boys? Girls?

A
  • Without intervention, most adolescents with CDGP will undergo spontaneous puberty
  • If the adolescent is experiencing emotion distress → can consider low dose testosterone can be used to induce puberty in boys >14yo.
  • No clear evidence for use of oestrogen in females with CDGP
79
Q

Criteria for Referral to Specialist Service (4 points

A
  • Height less than the first centile or significantly out of keeping with mid-parental height expectation
  • Growth Velocity <25th centile
  • Height crossing two centile lines on growth chart
  • Delayed puberty
80
Q

Investigations of Short Stature in Adolescents?

A
  • FBE
  • UEC
  • LFTs
  • CMP
  • ESR
  • Coeliac Serology
  • TFTs
  • IGF-1
  • Karyotype Testing in all girls whose height is less than the 1st centile or significantly out of keeping with their mid-parental height, or with pubertal delay, even if the classical Turner Syndrome stigmata are not present
81
Q

Risk Factors for C. difficile infection (4 points)

A
  • exposure to broad spectrum ABx such as cephalosporins, quinolones and lincosamides
  • hospitalisation
  • cancer chemotherapy
  • use of proton pump inhibitors
82
Q

Diagnosis of C. difficile infection (2 points)

A

Clinical Features suggestive of C. difficile infection → diarrhoea, ileus, toxic megacolon

AND EITHER

  • microbiological evidence of toxin-producing C. difficile in stools
  • colonscopic findings or histopathology results that demonstrate pseudomembranous colitis
83
Q

Management of C. difficile infection (4 points include pharm and nonpharm)

A
  • if asymptomatic → do not require treatment
  • Rehydration Therapy
  • Stop implicated ABx
  • Avoid PPI after diagnosis

For first episode of Mild - Moderate C. difficile disease

  1. Metronidazole 400mg (child 10mg/kg up to 400mg) orally or enterally, 8-hourly for 10 days
84
Q

Clinical Features of Mumps? (3 points)

A
  • Few days of fever, headache, myalgia, fatigue and anorexia
  • Followed by development of salivary gland swelling within 48 hours - Parotitis
    • unilateral or bilateral
    • Initial unilateral involvement is followed by contalateral involvement a few days later in 90% of cases
  • Usually self-limited and individuals recover completely within a few weeks
85
Q

Complications of Mumps (2 points)

A
  • Orchitis

- Neurologic Manifestations → meningitis, encephalitis and deafness

86
Q

Treatment for Scarlet Fever of Strep Throat. Be specific

A
  • Phenoxymethylpenicillin 500mg (15mg/kg up to 500mg) 12 hourly for 10/7
  • If compliance to 10 day regimen of phenoxymethylpenicillin is unlikely
    • Use: benzathine benzylpenicillin IM, single dose
      • long-acting and adequate concentrations of benzylpenicillin for up to 4 weeks
87
Q

Indications for ABx in Streptococcal Pharyngitis (4 points)

A
  • patient aged 2-25 from populations with high incidence of acute rheumatic fever → e.g ATSI, Maori and Pacific Islander people
    • patients with existing rheumatic heart disease
    • patients with scarlet fever
  • very severe symptoms of pharyngitis (need for hospitalisation, severe throat pain, dysphagia)
88
Q

Suppurative Complciations of Streptococcal Pharyngitis (3)

A
  • Tonisillopharyngeal cellulitis or abscess
  • Otitis Media (OM)
  • Rhinosinusitis
  • Necrotising Fasciitis
  • Streptococcal Bacteraemia
  • Meningitis or Brain Abscess
  • Jugular Vein Septic Thrombophlebitis
89
Q

Non-Suppurative Complications of Streptococcal Pharyngitis (3)

A
  • Acute Rheumatic Fever
  • Reactive Arthritis
  • Scarlet Fever
  • Streptococcal Toxic Shock Syndrome
  • Acute Glomerulonephritis
  • Paediatric Autoimmune Neuropsychiatric Disorder associated with Group A Streptococci (PANDAS)

Practice Exams (45 decks)

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