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final year past papers > Difficult Topics > Flashcards

Difficult Topics Flashcards

1
Q

Compartment syndrome common in which types of fractures?

A

Supracondylar and tibial shaft fractures

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2
Q

2 types of extracapsular fracture

A

Intertrochanteric and subtrochanteric

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3
Q

Colles Fracture treatment

A

Reduction with cast

-use IV regional anaesthesia (Bier’s Block) when reducing dorsally displaced radius in ED

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4
Q

Shaft of humerus fractured = which nerve?

A

Radial nerve –> wrist drop

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5
Q

Supracondylar fracture = which nerve?

A

Ulnar nerve –> claw

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6
Q

What is Weber Classification?

A
  • A: below joint line –> below-knee POP
  • B: at joint line –> below-knee POP
  • C: above joint line –> closed reduction and POP
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7
Q

o Intense pain on first step after period of inactivity

o Heel pain worse after long period of standing

A

Plantar Fasciitis

= chronic degeneration of plantar fascia

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8
Q

Feels like pebble under foot

A

Morton’s Neuroma –> buy metatarsal pad over-the-counter

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9
Q

Topical NSAIDs used in which areas affected by OA?

A

Hands and knee only (oral paracetamol used as first-line everywhere else)

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10
Q

Twisted knee while leg flexed –> now cannot extend leg straight

A

Meniscus injury

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11
Q

Knee injury –> now tibia looks posterior than other side

A

PCL injury

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12
Q

Acute cord compression – where are the UMN signs and where are the LMN signs?

A
  • LMN signs at compression level

* UMN signs and sensory level below compression

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13
Q

droPED and TIPtoe

A

Peroneal Everts and Dorsiflexes, causing foot drop

Tibial Inverts and Plantarflexes, causing inability to tiptoe

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14
Q

Pain at radial wrist –> ulnar deviation worsens pain

A

De Quervain Syndrome (Tenosynovitis)

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15
Q

Elbow injury –> now can’t extend elbow

A

Olecranon fracture

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16
Q

Tender when palpate biceps groove

A

Biceps Tendinopathy

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17
Q

Lateral knee pain in runners

A

Iliotibial Band Syndrome

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18
Q

Uncontrolled increase in BP and HR when insert catheter

A

Autonomic Dysreflexia
Lesion above T6
Stimulus below lesion (e.g. insert catheter)
–> causes sympathetic response via spinal cord
–> ↑ BP and HR
–> brain asks parasympathetic to ↓ BP and HR
–> … but parasympathetic fibres can’t pass below level of lesion
–> uncontrolled ↑↑↑ BP and HR

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19
Q

Homonymous heminanopia, spares macula

A

Occipital cortex

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20
Q

Lateral hemisection of cord – what are features?

A

Same side: loss of proprioception/vibration and UMN weakness

Other side: loss of pain sensation (because this pathway decussates at nerve root = bit that leaves the cord)

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21
Q

Giant Cell Arteritis associated with which disease?

A

Polymyalgia Rheumatica

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22
Q

Triptans contraindicated in who?

A

Ischaemic Heart Disease

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23
Q

Antiplatelets after stroke

A

Aspirin 300mg for 2 weeks –> clopidogrel 75mg life

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24
Q

Subdural and extradural haemorrhages – which vessels affected?

A 
Subdural = bridging veins between cortex and sinuses
Extradural = middle meningeal artery
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25
Q

Meningitis prophylaxis for close contacts

A

Ciprofloxacin (one dose)

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26
Q

Cushing’s Triad in raised ICP

A

↑BP, ↓HR, irregular breathing

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27
Q

What is coning?

A
  • ↑ pressure in posterior fossa → displacement of cerebellar tonsils through foramen magnum
  • → compression of brainstem and cardioresp centres in medulla
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28
Q

Uncal (transtentorial) herniation causes…

A

Ipsilateral CN III palsy

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29
Q

Treatment used in motor neurone disease

A

Riluzole

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30
Q

Diagnostic criteria for cafe-au-lait spots in neurofibromatosis

A

More than 6, each >15mm

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31
Q

Definition of narrow and broad QRS

A

Narrow <120ms (3 small squares)

Broad >120ms (3 small squares)

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32
Q

How to remember ortostatic hypotension definition?

A

3-2-1 drop (after 3 mins standing, drop systolic 20/diastolic 10)

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33
Q

Factors favouring rate control in AF

A
  • Older than 65

- Ischaemic Heart Disease

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34
Q

INR inducers

A 
Smoking
Chronic alcohol
Anti-epileptics
Rifampicin 
St John's Wort
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35
Q

INR inhibitors

A

Antibiotics
SSRIs
Sodium valproates
ZOLES

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36
Q

MI definition

A

Troponin above 99th percentile, with 1 of:

  • Ischaemic symptoms
  • New ST changes
  • Pathological Q waves (wider and deeper than normal)
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37
Q

Beck’s triad in cardiac tamponade

A

↓BP, ↑JVP, muffled heart sounds

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38
Q

NSTEMI management

A

Fondaparinux 2.5mg SC –> GPIIb/IIIa antagonist and angiography within 96hrs if high-risk (positive trop)

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39
Q

Which type of CCB can you use with beta-blockers?

A

Dihydropyridine CCBs (amlodipine)

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40
Q

Malar flush, loud S1 with opening snap, mid-diastolic rumble

A

Mitral stenosis

41
Q

When would you get strep viridans infective endocarditis?

A

Dentist

42
Q

When would you get staph epidermidis infective endocarditis?

A

Prosthetic valve

43
Q

Differentiate between portal HTN and IVC obstruction

A

Press vein below umbilicus

  • Blood away from umbilicus = portal HTN
  • Blood towards umbilicus = IVC obstruction
44
Q

Investigation in IBS

A

Faecal calprotectin: differentiates from IBD

45
Q

Treatment of constipation in IBS

A

Ispaghula husk (bulk-forming laxative)

46
Q

Child-Pugh criteria for cirrhosis

A 
	Albumin
	Bilirubin
	Clotting
	Distension: ascites
	Encephalopathy
47
Q

SAAG > 11g/L means?

A

Portal HTN

48
Q

Alcohol unit calculation

A

(Volume x alcohol %)/100

49
Q

How much pure alcohol in 1 unit?

A

10ml

50
Q

Hep B core antibody vs surface antibody

A

Core antibody = previous infection

Surface antibody = immune

51
Q

Treatment of pruritis in PSC

A

Colestyramine (bile acid sequestrant)

52
Q

Carcinoid tumour secretes which hormone?

A

Serotonin (5HT)

53
Q

What concomitant disease do you need with carcinoid tumours to get Carcinoid Syndrome?

A

Liver mets (do not metabolise secretions from tumour)

54
Q

Investigation for carcinoid syndrome

A

Urine 5HIAA

55
Q

Trachea deviated away from lesion vs toward lesion

A 
Away = tension pneumothroax and effusion
Toward = lung collapse and pneumonectomy
56
Q

1L flow rate = how much oxygen?

A

25% (add 4% when add a L)

57
Q

Definition of bronchodilator reversibility in asthma

A

FEV1 increases by 20% or 200mL

58
Q

Definition of variable PEFR in asthma

A

Varies by 20% for 3 days a week for 2 weeks

59
Q

When would you step up from salbutamol PRN to ICS?

A

If use salbutamol >1/day or night-time symptoms

60
Q

Pink puffer vs blue bloater

A

Pink puffer = emphysema
- ↑ alveolar ventilation → breathless but not cyanosed
→ T1 respiratory failure

Blue bloater = bronchitis
- ↓ alveolar ventilation → cyanosed but not breathless
→ T2 respiratory failure and cor pulmonale

61
Q

Best oxygen delivery for COPD

A

Venturi mask (white) = 28% 4L O2

Use 15L non-rebreather if critically ill (“hypoxia kills”)

62
Q

Management of PE

A

Hypotensive: thrombolysis (alteplase)
Normotensive: LMWH

63
Q

Multiple fractures –> within 24hrs: hypoxia, neuro signs, petechial rash

A

Fat Embolism

64
Q

Management of tension pneumothorax

A

14G Venflon (orange) in 2nd ICS, mid-clavicular line

65
Q

Management of primary pneumothroax

A

Not SOB and <2cm: discharge

SOB and >2cm: aspirate

  • ->Aspiration successful if not SOB and <2cm
    • otherwise, do chest drain
66
Q

Management of secondary pneumothroax

A

Not SOB and <1cm: observe for 24hrs + high-flow O2
Not SOB and 1-2cm: aspirate, then admit for 24hrs

SOB and >2cm: chest drain

67
Q

Definition of transudate vs exudate pleural effusion

A

Transudate <25g/L effusion protein

Exudate >25g/L effusion protein

68
Q

Drug causes of ILD

A

BANS ME

Bleomycin
Amiodarone
Nitrofurantoin
Sulfasalazine
MEthotrexate
69
Q

Upper zone ILD

A

APENT

Aspergillus
Pneumoconiosis
EAA
Negative sero-arthropathy
TB
70
Q

Lower zone ILD

A

SDAIR

Sarcoidosis
Drugs (BANS ME)
Asbestos
IPF
Rheum (RA, SLE, scleroderma)
71
Q

Triangle of safety for chest drains

A 
Right = lateral edge of pec major
Left = lateral edge of lat dorsi
Top = base of axilla
Bottom = 5th ICS
72
Q

Mechanism of BiPAP

A

Higher inspiratory than expiratory –> ventilate during inspiratory, recruit collapsed alveoli during expiratory

73
Q

Mechanism behind raised anion gap

A
  • ve ions that normally shouldn’t be there
  • Lactate in shock
  • Salicylate in aspirin overdose
  • Ketones in DKA
74
Q

Mechanism behind normal anion gap

A

Losing HCO3- and have too much Cl-

  • Kidneys: diuretics, Addison’s, renal tubular acidosis
  • GI: diarrhoea
75
Q

Hyponatraemia causes

A

Hypovolaemia

  • Fluid loss
  • Diuretics

Euvolaemic

  • SIADH
  • Hypothyroid

Hypervolaemia

  • Heart failure
  • Renal failure
  • Cirrhosis
76
Q

Hypokalaemia causes

A

DIRE

Drugs (diuretics)
Intestinal loss
Renal tubular acidosis
Endocrine (Conn’s and Cushing’s)

77
Q

Hyperkalaemia causes

A

DREAD

Drugs (ACEi and spironolactone)
Renal failure
Endocrine (Addison's)
Artefact
DKA
78
Q

Potassium 2.5-3.5 treatment

A

Sando-K, 2 tablets TDS

79
Q

How many units in 1mL of insulin?

A

100 units! (give insulin via special syringe)

80
Q

When would you step up to gliclazide?

A

If HBA1c >58mmol = 7.5%

81
Q

DKA diagnosis

A
  • Acidosis: pH <7.3
  • Hyperglycaemia: ≥11.1mM
  • Ketonaemia: ≥3mM (++ on urine dipstick)
82
Q

Osmolality calculation

A

2(Na+K) + U + G

83
Q

Anion gap calculation

A

Na + K - Cl - Bicarb

84
Q

Biopsy shows nuclei that are enlarged, hyperchromatic and pleomorphic – what type of tumour?

A

Carcinoma

85
Q

Proctitis and tender inguinal lymphadenopathy

A

Lymphogranuloma venereum (chlamydia)

86
Q

TCA overdose treatment

A

Sodium bicarbonate

87
Q

Unprovoked DVT - apart from duplex, what investigation would you do?

A

CT CAP (check for undiagnosed tumour)

88
Q

Koebner Phenomenon occurs in which skin diseases?

A

Psoriasis and vitiligo

89
Q

Which type of airway protects against aspiration?

A

Endotracheal tube

90
Q

Screening test for haemachromatosis

A

Transferrin saturation

91
Q

First-line treatment for superficial thrombophlebitis

A

NSAIDs

92
Q

What do you do with metformin and gliclazide before surgery?

A

Omit gliclazide day before

Continue metformin

93
Q

Post-op complications

A

Day 1-2: wind – atelectasis, pneumonia
Day 3-5: water – UTI
Day 5-7: wound – infection at site
Day 5+: walking – DVT –> PE

94
Q

Why do you apply cricoid pressure when start general anaesthetic?

A

Prevents the passage of gastric contents into the airway

95
Q

Sore throat with palatal petechiae

A

EBV (glandular fever)

96
Q

Seizure with lip smacking, deja vu, funny smell – what area of brain affected?

A

Temporal

97
Q

Seizure with sensory disturbance (tingling, numbness) – what area of brain affected?

A

Parietal

98
Q

Seizure with motor disturbance (Jacksonian march, arrest) – what area of brain affected?

A

Frontal

final year past papers (3 decks)

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