9/11/21 Flashcards
Mechanism of Injury of an AC joint injury.
Injury to the AC joint usually occurs from direct trauma to the superior or lateral aspect of the shoulder (acromion) while the arm is adducted, such as a direct blow or falling onto the shoulder.
Examination findings in an AC joint injury (2 point)
- Reveals tenderness directly over the AC joint and possible deformity
- Passive cross-body adduction of the arm to compress the AC joint can help to confirm the diagnosis
Managmenet options. General. What does the management depend on?
- Rest, Ice and Protection using a Sling
- Minor (Type 1 and 2) → non-operatively
- Type 3 → operative management does not appear to improve functional outcome comapred to conservative management. So NON-OPERATIVE management for 3 too.
- Major (Type 4-6) → referral to orthopaedic surgeon for operative management
common clinicl features of Primary Adrenal Insufficiency (5 points + 1 main)
- Chronic Malaise
- Lassitude
- Fatigue → worsened by exertion and improved with bed rest
- Weakness
- Anorexia
- Weight Loss
- Other Clinical Manifestations:
- GIT symptoms
- Hypotension
- Electrolyte Abnormalities
-
Hyperpigmentation
- MOST CHARACTERISTIC PHYSICAL FINDING
- Generalised hyperpigmentation but most noted in areas exposed to light and areas exposed to chronic friction of pressure
- Prominent in the palmar creases → escapes being worn away by friction
Investigations for Primary Adrenal Insuffiency (2 points)
-
Morning Serum Cortisol Concentration
- Low → strongly suggestive of adrenal insufficiency
- **Short ACTH Stimulation Tests aka Synacthen Test
- should be performed in all patients in which the diagnosis of adrenal insuffiency is being considered
- blood sample is collected → Synacthen injected into the vein → blood sample collected 30mins later
- Synacthen acts like ACTH by stimulating the adrenal gland to produce more cortisol
Treatment for Atypical Pneumonia?
- doxycycline 100mg orally, 12 hourly for 5-7 days
Clinical Features of Sarcoidosis (2 CXR findings + 3 resp findings + other)
- bilateral hilar adenopathy (see below)
- pulmonary reticular opacities
- skin, joint and/or eye lesions
Common presenting respiratory symptoms:
- Cough
- Dyspnoea
- Chest Pain
- Accompanied by: fatigue, malaise, fever and weight loss
- Systemic inflammation → muscle weakness and exercise intolerance
Diagnosis of Sarcoidosis (3 points + 1 bonus)
Diagnosis requires 3 elements:
- Compatible clinical and radiographic manifestations
- Exclusion of other diseases that may present similarly
- Histopathologic detection of noncaseating granulomas - via biopsy → Ultrasound Guided Endoscopy or Flexible Bronchoscopy with Encobronchial Biopsy
DO NOT biopsy erythema nodosum as it will be reported as panniculitis even is sarcoidosis exists.
Incubation period of varicella?
10-21 days
Clinical features of varicella. Natural Progression and Infectious period? Return to School
- Prodrome: Fever, Lethargy, Anorexia
- Rash erupts after 3-5 days → crops of small papules that quickly become vesicular then crust over after the vesicles have ruptured
- Recurrence of Infection → can spread over more than one dermatome, but usually milder than in adults.
- Lesions are fully crusted over by 10 years
- Infectious from 1-2 days before the onset of the rash until the lesions have been fully crusted over. Children should be excluded from school until fully recovered (all lesions crusted over) or at least one week after the eruptions first appears.
When do you need to give anti-viral therapy?
Children with pre-existing skin disease
non preg adults within 36 hours of onset of rash
preg adults within 72 hours of onset of rash
How soon after exposure is preferrable to give varicella vaccination? What is the purpose of the vaccination post-exposure?
- Reduces the likelihood of varicella infection after exposure → by vaccinating exposed people during outbreaks, prevents further cases and controls outbreaks
- People should receive the varicella vaccination within 5 days of exposure, PREFERRABLY WITHIN 3 DAYS
Who qualifies for Zoster Immunoglobulin? 5 points
- Pregnant women who are presumed to be susceptible to varicella infection
- Neonates whose mothers develop primary varicella infection within 7 days before delivery to 2 days after delivery → neonates must receive ZIG as early as possible
- Neonates exposed to varicella in the 1st month of life, if mother has no personal history of infection with varicella virus and is seronegative
- Premature infants (<28 weeks) who are exposed to varicella while still hospitalised → should receive ZIG despite mothers serology status
- Patients with primary or acquired diseases associated with cellular immune deficiency and people receiving immunosuppressive therapy. If contact is immunocompromised patients has recent evidence of detectable antibodies - do NOT need ZIG.
How soon after exposure should patients receive ZIG?
- People must receive ZIG within the first 96 hours and up to 10 days following exposure
What is the dose and drug to treat chickepox in children with history of skin disease?
aciclovir 20mg/kg up to 800mg 5 times daily for 7/7
What is the drug and dose to treat chickenpox in an adult?
valciclovir 1g TDS for 7/7
If high risk wells score in context of PE, next step?
CTPA or V/Q
Most common cause of lateral hip pain in adults?
Greater Trochanteric Pain Syndrome
Risk Factors of Greater Trochanteric Pain Syndrome
- Female
- Obesity
- Lower Back Pain
- Scoliosis
- Leg Length Discrepancy
- Hip and Knee Arthritis
- Painful Foot Disorders → Plantar Fasciitis
Examination of Greater Trochanteric Pain Syndrome
Tenderess on palpation of the greater trochanter
Management of Greater Trochanteric Pain Syndrome (4 points
- Self-limiting condition
- Exercise and Activity Modification - referral for physical therapy
- NSAIDS
- Glucocorticoid Injection - immediate pain relief
Who should be treated for shingles?
- Rash <72 hours
2. Immunocompromised individuals any time
Treatment for shingles?
- valaciclovir 1g TDS for 7/7 (children >2yo -> 20mg/kg up to 1g)
Characteristics Manifestations of Marfan’s Syndrome
Aortic Root dilation/dissection
Ectopia Lentis
other: excess linear growth of long bones and joint laxity, mitral valve prolapse, dural ectasia, pneumothorax, skin striae
Characteristics of Wernickes Encephalopathy (3 points)
opthalmoplegia/oculomotor dysfunction, gait ataxia and confusion/encephalopathy
Management of Wernicke’s Encephalopathy (1 point)
- Thiamine 500mg TDS IV for 5-7 days. DO NOT NEED TO WAIT TO CONFIRM DIAGNOSIS -> GIVE THIAMINE
Mechanism of Injury for Scapholunate Dissociation?
Mechanism: Fall back onto an outstretched, extended wrist that disrupts the supporting ligaments forcing the carpal bones to shift dorsally.
Clinical Features of Scapholunate Dysfunction (5 poins)
- Swelling and Pain over the dorsoradial aspect of the wrist (overlying the scaphoid and lunate)
- Grip Weakness
- Painful or Decreased Wrist ROM
- Tenderness over the scapholunate junction
- Scaphoid shift test → can detect ligamentous instability
Imaging findings and management of Scapholunate Dissociation?
- *Imaging**
- Interosseous distance >3mm between scaphoid and lunate on the plain radiograph suggests a ligamentous injury
- *Management**
- Refer to hand surgeon
Mechanism of Eustachian Tube Dysfunction
Eustachian Tube is blocked or does not open normally to allow air into the middle ear from the nose → air pressure across the tympanic membrane is unequal (outside drum pressure > inside drum pressure) → drum is pushed inward → tense and dysfunctional.
