Additional

Question 1

Cannulation complication - infiltration`

Answer 1

Diffusion or accumulation of fluid into subcutaneous tissue

See swelling, slow infusion rate, discomfort and coolness of skin

Prevent bu selecting appropriate site and device, and proper stabilisation

Question 2

Cannulation extravasation

Answer 2

Infused substance damages tissue through irritation

Causes pain, burning stinging, haematoma, reduction in flow rate

Prevented by regular VIP scoring ti avoid occurence. and good site selection

Question 3

VIP score in cannulation

Answer 3

Visual infusion phlebitis score, 0-5 where 0 is healthy and 5 is extensive damage

Question 4

oesophagitis

Answer 4

Can have candidiasis.
Dysphagia, inflammation, heartburn, chest pain, acid brash, haematemesis, melaena.

Can occur in excessive reflux, prolonged gastric intubation, irritant ingestion, uraemia, bacterial, viral, fungal infections or post radiotherapy

Question 5

linitis plastica

Answer 5

Dffuse varient of signet ring cells infiltrating stomach wall, causing rigid, less mobile stomach that can’t expand as much.

Type of gastric cancer

Question 6

Comparison of CD and UC

Answer 6

Crohn’s can be any part of GI tract, transmural infiltration, skip lesions, strictures, fissuring ulcers, granulomas, fat wrapping, adhesions, perforations and raised cancer risk

UC is colon/rectum, mucosal infiltration, continuous pattern. bowel has thin wall and is dilated. No fissures, strictures are rare. No granulomas, no fat wrapping, no adhesions. Can get haemorrhage,e electrolyte loss, toxic megacolon, systemic effects. High cancer risk

Question 7

Plummer vinson syndrome

Answer 7

Iron deficiency and webbing of the oesophagus. Pre malignant condition that needs removal. Suspect in older woman with koilonychia and dysphagia

Question 8

Tpa bladder cancer

Answer 8

Confined to urothelial wall, but doesn’t need to have invaded the BM to be carcinoma in bladder. Can gte flat carcinoma in situ with high grade potential

Question 9

Lacunar infarct development

Answer 9

HTN causes thickening and inelasticity of small arteries and arterioles. Gives hyanilisation which can cause occlusion.
Commonly in basal ganglia, internal capsule, thalamus, hemispheric white matter

Can also make vessels more prone to rupture siwth haemorrhagic stroke.

Question 10

Xanthochromia

Answer 10

Yellow CSF found in SAH LP (can only do if CT scan inconclusive and no raised ICP concerns). Fresh blood is not indicator as can be traumatic tap.
Xanthochromia can be confirmed by measuring CSF bilirubin, but needs LFT for comparison

Question 11

Effects of subfalcine herniation

Answer 11

Local infarction (cingulate gyrus).

Question 12

Effects of transtentorial herniation

Answer 12

Can compress cerebral peduncle (hemiparesis), stretch occulomotor nerve (loss of pupil reaction), compress posterior cerebral arteries (infarct of visual cortex)

Question 13

Effect of cerebellar tonsilar herniation

Answer 13

Coning. Compress lower medulla dn causes resp arrest

Question 14

4-2-1 rule

4 heart related emergencies

Answer 14

ACS, aortic dissection, pericarditis/myocarditis, pericardial effusion/tamponade

Question 15

4-2-1 Lung pathologies

Answer 15

PE and pneumothorax

Question 16

4-2-1 oesophagus

Answer 16

Eosophageal perforation

Question 17

Intrascapular pain

Answer 17

MI pain, MSK pain, gallbladder pain, pancreatic pain

Question 18

Retrosternal pain

Answer 18

MI pain, percardial pain, oesophageal pain, aortic dissection, PE, mediastinal lesion

Question 19

Left lower/anterior chest pain

Answer 19

Intercostal neuralia, PE, myositis, pleurisy/pneumonia, splenic infarct, splenic flexure syndrome, subdiaphragmatic abscess, precordial catch syndrome, injury

Question 20

How long post MI for T wave to invert

Answer 20

Days

Question 21

Most common coronary occlusion sites

Answer 21

LAD, right coronary artery, circumflex,

Question 22

Non ischaemic causes of cardiac injury

Answer 22

myocarditis (can be toxic, immune or infectious, cardiomyopathy, radiation induced, iatrogenic via surgery, trauma, sepsis (cytokine mediated), CKD (toxic uraemia, mechanical stress)

Question 23

Bridging coronary artery

Answer 23

Predisposes to MI in absence of coronary artery disease. Damages subendocardial region

Question 24

Caseating cardiac deposits

Answer 24

Seen in TB

Question 25

Non caseating cardiac deposits

Answer 25

Cardiac sarcoidosis. Granulomas. MAcrophage deposits

Question 26

ARDS

Answer 26

Interstitial lung disorder

Question 27

Direct lung injury ARDS causes

Answer 27

Pneumonia, gastric content aspiration. Can also be near drowning, fat embolism, inhalation injury,

Question 28

Indirect ARDS lung injury

Answer 28

sepsis, severe trauma with shock. Can be acute pancreatitis, drug overdose, uraemia

Question 29

Lung cancer complication: hoarseness

Answer 29

Recurrent laryngeal nerve palsy

Question 30

Lung cancer complication: Ptosis, miosis , anhidrosis

Answer 30

Horner's syndrome, pancoast tumour

Question 31

Lung cancer complication : diarrhoea, flushing, cyanosis, tachycardia, hypotension, wheeze

Answer 31

Carcinoid syndrome, excess 5HT

Question 32

Lung cancer complication : weight gain, skin hyperpigmentation, hypertension

Answer 32

Cushing's syndrome though ACTH production

Question 33

Lung cancer muscle weakness autoantibodies against neuronal calcium channels

Answer 33

Lambert Eaton myasthenic syndrome (LEMS)

Question 34

Distinguish between LEMS and MG

Answer 34

MG has antibody against AchR, associated with thymic tumours, worsens with movement, Has normal deep tendon reflex,. No autonomic dysfunction. REsponse reduces on repeated stimulation In LEMS, antibody is against calcium channel, associated with SC lung cancer, improves on exercise, decreased deep tendon reflex, has autonomic dysfunction and also stimulation improves response

Question 35

Compartment syndrome causes

Answer 35

More commonly due to tibia fracture but also reperfusion injury after tx for acute lower limb ischaemia

Question 36

Identifying compartment syndrome

Answer 36

Extreme pain, worse on active/passive movement, not alleviated by opioids, pulses present

Question 37

Indicator of acute mesenteric ischaemia

Answer 37

Severe abdo pain (in absence of clinical findings), metabolic acidosis, bloody diarrhoea. Should have CT angiogram

Question 38

Types of mesenteric ischaemia

Answer 38

Acute mesenteric ischaemia, chronic mesenteric ischaemia and colonic ischaemia

Question 39

Acute mesenteric ischaemia types

Answer 39

Embolic mesenteric ischaemia, thrombotic mesenteric ischaemia and venous mesenteric ischaemia

Question 40

Most common ischaemic bowel disease

Answer 40

colonic mesenteric ischaemia (and has best prognosis)

Question 41

Acute mesenteric ischaemia presentation

Answer 41

Sudden onset severe abdo pain, shock (rapid hypvolaemia) and lack ofabdominal clinical signs Pain often central or RIF. OOP to clinical signs If occured over hours then ? arterial, if over days then venous

Question 42

RF for acute mesenteric ischaemia

Answer 42

AF, hypercoagulable state, vasculitis, cocaine use.

Question 43

Acute mesenteric ischaemia biochem

Answer 43

leukocytosis, metabolic acidaemia, elevated serum amylase

Question 44

Acute mesenteric ischaemia imaging

Answer 44

Thumbprinting on AXR, mesenteric occlusion on angiography. Pneumoperitoneum if perorated. Use contrast CT for msesnteric venous thrombosis

Question 45

Chronic mesenteric ischaemia presentation

Answer 45

Poorly localised pain, insidious. Repeated episodes occuring over months. Worse after meals.

Question 46

Chronic mesenteric ischaemia RF

Answer 46

Age, smoking, atherosclerosis, peripheral vascular disease, sitophobia

Question 47

Diagnosis if chronic mesenteric ischaemia

Answer 47

Angiography.

Question 48

Colonic ischaemia

Answer 48

Often presents as lower left sided pain and bloody diarrhoea. OFten pyrexial, tachycardia and leukocytosis.