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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
Meningitis prophylaxis for close contacts
Ciprofloxacin (one dose)
26
Cushing's Triad in raised ICP
↑BP, ↓HR, irregular breathing
27
What is coning?
* ↑ pressure in posterior fossa → displacement of cerebellar tonsils through foramen magnum * → compression of brainstem and cardioresp centres in medulla
28
Uncal (transtentorial) herniation causes...
Ipsilateral CN III palsy
29
Treatment used in motor neurone disease
Riluzole
30
Diagnostic criteria for cafe-au-lait spots in neurofibromatosis
More than 6, each >15mm
31
Definition of narrow and broad QRS
Narrow <120ms (3 small squares) | Broad >120ms (3 small squares)
32
How to remember ortostatic hypotension definition?
3-2-1 drop (after 3 mins standing, drop systolic 20/diastolic 10)
33
Factors favouring rate control in AF
- Older than 65 | - Ischaemic Heart Disease
34
INR inducers
``` Smoking Chronic alcohol Anti-epileptics Rifampicin St John's Wort ```
35
INR inhibitors
Antibiotics SSRIs Sodium valproates ZOLES
36
MI definition
Troponin above 99th percentile, with 1 of: - Ischaemic symptoms - New ST changes - Pathological Q waves (wider and deeper than normal)
37
Beck's triad in cardiac tamponade
↓BP, ↑JVP, muffled heart sounds
38
NSTEMI management
Fondaparinux 2.5mg SC --> GPIIb/IIIa antagonist and angiography within 96hrs if high-risk (positive trop)
39
Which type of CCB can you use with beta-blockers?
Dihydropyridine CCBs (amlodipine)
40
Malar flush, loud S1 with opening snap, mid-diastolic rumble
Mitral stenosis
41
When would you get strep viridans infective endocarditis?
Dentist
42
When would you get staph epidermidis infective endocarditis?
Prosthetic valve
43
Differentiate between portal HTN and IVC obstruction
Press vein below umbilicus - Blood away from umbilicus = portal HTN - Blood towards umbilicus = IVC obstruction
44
Investigation in IBS
Faecal calprotectin: differentiates from IBD
45
Treatment of constipation in IBS
Ispaghula husk (bulk-forming laxative)
46
Child-Pugh criteria for cirrhosis
```  Albumin  Bilirubin  Clotting  Distension: ascites  Encephalopathy ```
47
SAAG > 11g/L means?
Portal HTN
48
Alcohol unit calculation
(Volume x alcohol %)/100
49
How much pure alcohol in 1 unit?
10ml
50
Hep B core antibody vs surface antibody
Core antibody = previous infection | Surface antibody = immune
51
Treatment of pruritis in PSC
Colestyramine (bile acid sequestrant)
52
Carcinoid tumour secretes which hormone?
Serotonin (5HT)
53
What concomitant disease do you need with carcinoid tumours to get Carcinoid Syndrome?
Liver mets (do not metabolise secretions from tumour)
54
Investigation for carcinoid syndrome
Urine 5HIAA
55
Trachea deviated away from lesion vs toward lesion
``` Away = tension pneumothroax and effusion Toward = lung collapse and pneumonectomy ```
56
1L flow rate = how much oxygen?
25% (add 4% when add a L)
57
Definition of bronchodilator reversibility in asthma
FEV1 increases by 20% or 200mL
58
Definition of variable PEFR in asthma
Varies by 20% for 3 days a week for 2 weeks
59
When would you step up from salbutamol PRN to ICS?
If use salbutamol >1/day or night-time symptoms
60
Pink puffer vs blue bloater
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
Best oxygen delivery for COPD
Venturi mask (white) = 28% 4L O2 Use 15L non-rebreather if critically ill ("hypoxia kills")
62
Management of PE
Hypotensive: thrombolysis (alteplase) Normotensive: LMWH
63
Multiple fractures --> within 24hrs: hypoxia, neuro signs, petechial rash
Fat Embolism
64
Management of tension pneumothorax
14G Venflon (orange) in 2nd ICS, mid-clavicular line
65
Management of primary pneumothroax
Not SOB and <2cm: discharge SOB and >2cm: aspirate - ->Aspiration successful if not SOB and <2cm - - otherwise, do chest drain
66
Management of secondary pneumothroax
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
Definition of transudate vs exudate pleural effusion
Transudate <25g/L effusion protein | Exudate >25g/L effusion protein
68
Drug causes of ILD
BANS ME ``` Bleomycin Amiodarone Nitrofurantoin Sulfasalazine MEthotrexate ```
69
Upper zone ILD
APENT ``` Aspergillus Pneumoconiosis EAA Negative sero-arthropathy TB ```
70
Lower zone ILD
SDAIR ``` Sarcoidosis Drugs (BANS ME) Asbestos IPF Rheum (RA, SLE, scleroderma) ```
71
Triangle of safety for chest drains
``` Right = lateral edge of pec major Left = lateral edge of lat dorsi Top = base of axilla Bottom = 5th ICS ```
72
Mechanism of BiPAP
Higher inspiratory than expiratory --> ventilate during inspiratory, recruit collapsed alveoli during expiratory
73
Mechanism behind raised anion gap
- ve ions that normally shouldn’t be there - Lactate in shock - Salicylate in aspirin overdose - Ketones in DKA
74
Mechanism behind normal anion gap
Losing HCO3- and have too much Cl- - Kidneys: diuretics, Addison’s, renal tubular acidosis - GI: diarrhoea
75
Hyponatraemia causes
Hypovolaemia - Fluid loss - Diuretics Euvolaemic - SIADH - Hypothyroid Hypervolaemia - Heart failure - Renal failure - Cirrhosis
76
Hypokalaemia causes
DIRE Drugs (diuretics) Intestinal loss Renal tubular acidosis Endocrine (Conn's and Cushing's)
77
Hyperkalaemia causes
DREAD ``` Drugs (ACEi and spironolactone) Renal failure Endocrine (Addison's) Artefact DKA ```
78
Potassium 2.5-3.5 treatment
Sando-K, 2 tablets TDS
79
How many units in 1mL of insulin?
100 units! (give insulin via special syringe)
80
When would you step up to gliclazide?
If HBA1c >58mmol = 7.5%
81
DKA diagnosis
* Acidosis: pH <7.3 * Hyperglycaemia: ≥11.1mM * Ketonaemia: ≥3mM (++ on urine dipstick)
82
Osmolality calculation
2(Na+K) + U + G
83
Anion gap calculation
Na + K - Cl - Bicarb
84
Biopsy shows nuclei that are enlarged, hyperchromatic and pleomorphic -- what type of tumour?
Carcinoma
85
Proctitis and tender inguinal lymphadenopathy
Lymphogranuloma venereum (chlamydia)
86
TCA overdose treatment
Sodium bicarbonate
87
Unprovoked DVT - apart from duplex, what investigation would you do?
CT CAP (check for undiagnosed tumour)
88
Koebner Phenomenon occurs in which skin diseases?
Psoriasis and vitiligo
89
Which type of airway protects against aspiration?
Endotracheal tube
90
Screening test for haemachromatosis
Transferrin saturation
91
First-line treatment for superficial thrombophlebitis
NSAIDs
92
What do you do with metformin and gliclazide before surgery?
Omit gliclazide day before | Continue metformin
93
Post-op complications
Day 1-2: wind – atelectasis, pneumonia Day 3-5: water – UTI Day 5-7: wound – infection at site Day 5+: walking – DVT --> PE
94
Why do you apply cricoid pressure when start general anaesthetic?
Prevents the passage of gastric contents into the airway
95
Sore throat with palatal petechiae
EBV (glandular fever)
96
Seizure with lip smacking, deja vu, funny smell -- what area of brain affected?
Temporal
97
Seizure with sensory disturbance (tingling, numbness) -- what area of brain affected?
Parietal
98
Seizure with motor disturbance (Jacksonian march, arrest) -- what area of brain affected?
Frontal

Final Year Past Papers (3 decks)

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