__Y6 Emergency Med

Question 1

Ptosis, pupil down and out

Which nerve?

Answer 1

3rd Nerve Palsy

Question 2

4 most common causes of 3rd nerve palsy

Answer 2

Diabetes
HTN
Posteriod communicating artery aneurysm (painful)
Multiple Sclerosis

Question 3

2 types of 3rd nerve palsy

What pupil signs are present?

Answer 3

Surgical - pupil dilates early

Medical - pupil sparing

Question 4

Ptosis and miosis (constricted pupil)

Diagnosis?

Causes x6

Answer 4

Horner’s syndrome

Stroke, demyelination
Pancoast’s tumour
Dissection (painful)
Trauma, Inflammatory conditions

Question 5

Inability to abduct eye

Diagnosis?

x4 causes

Answer 5

6th nerve palsy

Diabetes, HTN
Raised ICP
Multiple sclerosis

Question 6

Signs of raised ICP

x4

Answer 6

Cushing’s triad: HTN, bradycardia, abnormal resp

Papilloedema
Focal neurology
Seizures

Question 7

Clinical features of Neurofibromatosis Type 1 (x3)

Answer 7

Neurofibromas, cafe au lait (>x6, >15mm), Lisch nodies (iris hamartoma)

Question 8

Clinical features of Neurofibromatosis Type 2

Answer 8

Bilateral 8th nerve palsy

Acoustic neuromas

Question 9

Complications of Neurofibromatosis Type 1

x5

Answer 9

HTN assoc with RAS
Thoracic kyphosis (resp comp)
10% Malignant change
Learning difficulties/behavioral problems  
Association with phaeochromocytomas

Question 10

What else would you like to examine with a Bell’s Palsy diagnosis/7th nerve palsy?

Answer 10

Ears - Ramsey Hunt sydrome and acute otitis media
The parotids
Tongue anterior 2/3 (change in taste)

Question 11

Crescenteric shaped mass on CT

Answer 11

Subdural haematoma

Question 12

Lens shaped mass on CT

Answer 12

Extradural haematoma

Question 13

Nail changes in psoriasis

Answer 13

(POSH)

Pitting
Onycholysis
Subungal Hyperkeratosis

Question 14

Psoriasis patient

Must also examine:

Answer 14

Scalp, nails, joints

Question 15

Skin conditions where Koebner’s phenomenon can occur (x3)

Answer 15

Psoriasis, lichen planus, vitiligo

Question 16

Main complications of MI

Answer 16

Heart failure
Arrhythmia
Murmurs

Question 17

Clinically assessing severity of AS

Answer 17

Soft S2, narrow pulse pressure

Question 18

Causes of raised JVP (x5)

Answer 18

CCF
Tricuspid regurg
Pericardial effusion/cardiac tamponade/restrictive pericarditis
Complete heart block
SVC obstruction (non-pulsatile)

Question 19

Complications of prosthetic valves

Answer 19

(FIBAT)

Failure, infection, bleeding, anaemia (MAHA), thromboembolic

Question 20

Signs of pulmonary HTN

Answer 20

Loud P2
Left parasternal heave
Graham Steel murmur (EDM due to pulm regurg)

Question 21

Three main signs of Parkinson’s

Answer 21

Bradykinesia, resting tremor, rigidity

Question 22

Parkinson plus syndromes

Answer 22

Multisystem atrophy
Progressive supranuclear palsy
Lewy body dementia

Question 23

Bowed legs, hearing aids

Answer 23

Paget’s disease

Question 24

In rheumatoid arthritis also need to examine:

Answer 24

Alanto-axial subluxation
Pulm effusion/nodules
Spleen (Felty syndrome)
Peripheral neuropathy

Question 25

Tunnel vision, loss of night vision

Answer 25

Retinitis pigmentosa

Question 26

Cardiogenic vs. septic vs hypovolaemic shock

Answer 26

All low BP

Cardiogenic - raised JVP
Septic - warm peripheries
Hypovolaemic - low JVP and cold peripheries

Question 27

Causes of erythema nordosum

Answer 27

Sarcoid, sulphonamides, salicylates, IBD (Crohn’s/colitis), TB/leprosy, streptococcal infection

Question 28

Cause of erythema multiforme

Answer 28

7-14 days post HSV (30%)
Mycoplasma
Unusual infections → strep, TB, Orf, Yersinia
Drug → sulphonamides, Sulphonylureas (e.g. cotrimoxazole)