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
-
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
Mechanism of malignant hypercalcaemia
- Tumour secretyion of parathyroid releasing hormone
> 80% of hypercalcaemia of malignancy: common in SCC, renal, bladder, breast or ovarian carcinomas
- osteolyutic metastasis
- tumour production of calcitriol
Breast cancer and hypercalcaemia
- breast cancer bone mets express parathyroid related hormone causing osteolysis
- in patients with breast cancer + extensive skeletal metastasis tamoxifen can lead to hypercalcaemia
- aromatase inhibitors may also cause hypercalcaemia flares
Does ibuprofen increase risk of posttonsillectomy haemorrhage?
- possible increased tendancy to PTH with ibuprofen
-
Common post tonsillectomy presentations
- fever: not uncommon 24-48 hours post, nil indication for Abx if nil signs of infection
- pain: ? whether NSAIDs increaser risk of PTH
- halitosis: occurs in 70% of patients and lasts !5 days, doesn’t alone constitute infection
- uvula oedema: can use steroids if severe
- haemorrhage
Post tonsillectomy haemorrhage
- primary: within 24 hours
- secondary: 1-14 days post operatively (common day 6-10)
Morton’s neuroma
- often develops betweem 3rd/4th toes
- more common in females
- diagnosis: US or MRI
Purulent neonatal conjunctivitis
Viral: HSV
Bacterial: chlamydia, gonorrhoea
Management of gonococcal neonatal conjunctivitis
Consider gonococcal conjunctivitis if severe purulent discharge with conjunctival and lid oedema. Perform an urgent gram stain and contact ophthalmology
May need septic work up and systemic Ceftriaxone 50 mg/kg/dose (2g) iv 12H
Management of chlamydial neonatal conjunctivitis
Eye toilet
Oral erythromycin
Mellioidosis
- burkholderria pseudomallei (GNB)
- clinical spectrum from pneumonia to cutaenous infections and disseminated disease with fulminant septicaemia
- incidence after rain and in immunsuppressed patients
- risk factors: diabetes, ETOHJ, CKD and lung disease
- pulmonary infection is most common presentation (51%)
- often assocaited with splenic, liver, adrenal, renal and prostate abscess
- diagnosed by blood culture
- treated by meropenem 25mg/kg TDS
Characteristics of aortic stenosis
- crescendo-decrescendo
- low to medium pitch
- ahrms, rasping, grunting, rough
- best heard over priary and secondary aortic area
- trasnmitted widely over precordium and radiated to carotids
- increases with passive leg raise, suddent squatting
Rheumatic mitral valve regurgitation
- high pitched, blowing
- best heard at cardiac apex with radiation to axilla
- pansystolic
Mitral valve prolapse
- medium pitched, late systolic murmur, mid systolic click
- best heard over apex and generally doesn’t radiate
Mitral stenosis
- low pitch, rumbling characteri
- best heard at pex in left lateral position
- commences after opening snap of mitral valve
- duration correlates with severity
Live vaccinations (8)
- Routine: rotavirus, MMR, varicella, zoster
- Travel: JE, YF, typhoid, BCG
Must be given on same day or 4 weeks apart
Sensitivity definition
SNOUT - rules out
“Measures how often a test correctly generates a positive result for people who have the condition that is being tested for”
Sensitivity = true positive rate
If sensitive a test will flag almost everyone who has the disease and not generate many false results
Specificity
SPIN: Specific test when Positive rules IN the disease
Refers to tests accurate at identifying those who do not have condition
Identifies true negatives
Femoral canal
NAV
Nerve (medial)
Artery
Vein (lateral
Femoral nerve block
Lateral approach
Tranducer @ inguinal crease
Femoral nerve lateral to femoral artery
Pyogenic granuloma
- benign proliferation of capillary blood vessels
- lobular haemangioma
Diagnosis of diabetes: asymptomatic
Unlike in symptomatic patients if asymptomatic require 2 seperare blood tests to confirm diabetes
- either 2 x HBA1c > 6.5%
or
- FBG >7 and random BGL > 11.1 on seperate day
or
orOGTT : diabetes is diagnosed as FBG ≥7.0 mmol/L or two-hour post-challenge blood glucose ≥11.1 mmol/L
Diagnosis of diabetes: symptomatic
one of the following is confirmatory of a diagnosis of diabetes:
a patient presenting with hyperglycaemic crisis
a single elevated FBG ≥7.0 mmol/L
single HbA1c ≥6.5%
a random blood glucose ≥11.1 mmol/L.
PBS listing: statins
- coronary heart disease which has become symptomatic
- cerebrovascular disease which has become symptomatic
- peripheral vascular disease which has become symptomatic
- diabetes mellitus with microalbuminuria
- diabetes mellitus in Aboriginal or Torres Strait Islander patients
diabetes mellitus in patients aged 60 years or more - family history of coronary heart disease which has become symptomatic before the age of 55 years in two or more first degree relatives
- family history of coronary heart disease which has become symptomatic before the age of 45 years in one or more first degree relatives
Secondary dyslipidaemia
- diabetes
- cholestatic liver disease
- nephrotic syndrome/CKD
- hypothyroidism
- obesity
- smoking
- ETOH
- medications: beta blockers, estrogens, thiazides
OCD
- ICD 10 defintion:
Recurrent obsessional thoughts or compulsive acts
Obsessional thoughts are ideas/imagies/impulses that are repetitive and usually distressing. Patient recognises them as their own thoughts, patient often tries to resist them
Compulsive acts are repetitive, stereotypical and patient does not find them pleasurable.
5 dimensions: obessions about causes or failing to prevent harm (checking compulsion), symmetry obsession, contamination obsession, peungnant obsessions (related to sex, violence, religion), hoarding obsessions
Calcium channel blockers and constipation
- verapamil has more prodound effect on gut smooth muscle than other CCB
- hence causes reduced gut motility and constipation
- consider swapping to another CCB (diltiazem or a dihydropyridine)
