ACRRM Familiarisation Qs Flashcards
L3 radiculopathy
- hip adduction weakness - knee extension weakness
L4 radiculopathy
- ankle dorsiflexion weakness - decreased patella tendon reflex
L5 radiculopathy
- extensor hallicus longus weakness - ankle dorsiflexion weakness - ankle inversion weakness - hip abduction weakness
S1 radiculopathy
- ankle plantar flexion weakness (single leg toe stand) - reduced achilles tendon reflex
Arterial supply of nose
- arterial supply from internal and external carotid arteries
- keisselbach’s plexus: facial artery + greater palatine and sphenopalatine arteries
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Classification of epistaxis
Anterior: 90%, Keisselbach’s plexus, from Little’s area
Posterior: 10%, more commonly arterial
Clues for posterior epistaxis
- bilateral bleeding from both nostrils
- blood dripping down posterior pharynx
- nil anterior bleeding site visualised
Nasal packing
- used if cautery has not worked or unable to visualise bleeding region
- rhinorapid can be left for up to 3-4 days, insert entire pack
What are the 4 main types of dementia?
- Alzheimer’s: insidious, gradual cognitive decline, affects ability to store new memories
- Vascular: slowing of mental processing, scattered chanesg across multiple cognitive functions
- Frontotemporal: executive and language changes early in disease, present with behavioural, language and personality changes
- Lewy body: fluctuating confusion, visual hallucinations, Parkinsonism, rapid eme movement sleep behaviour disorder
Possible spinal cord compression in palliative care
- always consider cauda equina
- dexmethasone 16mg PO OR IV
- MRI
- refer for radiotherapy
- affects 5-10% of cancer patients
Acute severe pain in palliative care
- morphine (2.5-5mg IV Q5min) or fentanyl (25-50mcg IV Q5min)
- calulation of require break through pain relief = 1/12 –> 1/16 of total cumulative daily opioid
Sialoadenitis
- due to hyposecretion of duct obstruction
- major salivary glandds: parotid, submandibular, sublingual
- often in patienst 50-60s
- patients with sjogrens
- patients with xerostomia
- common cause: staph aureus
- treatment: dicloxacilling 250mg QID
- other : hydratyion sialagogues, warm compress, gland massage
Spontaneous pneumothorax
- risk factors: smoking, height, age > 60
- the longer the delay to presentation the greater the risk of re-expansion pulmonary oedema
- small = <2cm, large = > 2cm between lung margin and chest wall
- if SOB +/- = aspirate with 16/18G cannula
- if <2cm and not symptoms = consider DC and review in OPD in 2-4 weeks
- if >2cm in secondary pneumo (underlying disease) = chest drain (8-14 french) and admit
Travel and diving after spontaneous pneumothorax
- nil diving unless undergone bilateral pleurectomt with noraml lung function and CT post op
- air travel should be avoided until full resolution (1 week after resolution)
Severity assessment of croup
MILD; no stridor at rest, mild chest wall retraction, normal RR
MOD: stridor at rest, chest wall retraction, use of accessory muscles, increased RR and tachycardia
Rx: 1mg/kg prednisolone or 0.15mg/kg dexmethasone
Observe 30 min post steroid
SEVERE: persisting stridor at rest, markely increased or decreased RR, marked tachycardia, increasing fatigued
Rx: 5mgh adrenaline neb, repeat after 30 min, 2mg/kg prednisolone or 0.6mg/kg dexmethasone IM/IV
Risk factors for severe croup: kids < 6 months, pre-existing narrowing of upper airways, hx of severe croup, unplanned representation within 24 hours
DDx of croup
- infective: bacterial tracheitis, epiglottitis, tonsilitis/pharyngitis, retropharyngeal abscess
- foreign body inhalation
- chronic stridor: laryngomalacia
Hypercalcaemia of maligna
- most common cancers: breast, renal, lung and multiple myeloma
- GIT sx: constipation, anorexia, nausea
- Renal: polyuria = nephrogenic diabetes insipidus
- Cardiac: short QT interval
- MSK: muscle weakness
Hypercalcaemia
Stones
Bones
Abdominal moans
Psychic groans
CNS: lethargy, weakness, confusion, coma
Renal: polyuria, noctural, dehydration, renal stones
GIT: constipation, nausea, anorexia, pancreatitis