everything else Flashcards

1
Q

A 23-year-old patient presents to the emergency department 30 minutes after sustaining severe burns in a house fire. Using a Lund and Browder chart, it is estimated that 42% of his body is affected. There are large areas affected by full-thickness burns. There is significant oedema. On examination his heart rate is 124/min and his blood pressure is 92/48 mmHg.

What is the most likely cause for his vital signs?

A

third space fluid loss

bruns most associated wth this due to

After severe burns, fluid may be extravasated into the area around cells the so-called ‘third space’. This results in oedema, tachycardia and hypotension.

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2
Q

what should you do immediately if someone is burnt

A

Immediate first aid
airway, breathing, circulation
burns caused by heat: remove the person from the source. Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes. Cover the burn using cling film, layered, rather than wrapped around a limb

electrical burns: switch off power supply, remove the person from the source

chemical burns: brush any powder off then irrigate with water. Attempts to neutralise the chemical are not recommended

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3
Q

what can you use to assess the extent of burns

A

Wallace’s rule of nines
lund and Browder chart
palmar surface equivalent to 1% of total body surface area

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4
Q

colours of assessing depth of burn

degrees of burns

A

red and painful is first degree and sup epidermal

2nd degree is pale and pink maybe blistered and white with reduced sensation - dermal layer

full thickness 3rd degree burns are white/brown/black in colour with no blisters or pain

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5
Q

most common cause of heel pain in adults

A

Plantar fasciitis is the most common cause of heel pain seen in adults. The pain is usually worse around the medial calcaneal tuberosity.

Management
rest the feet where possible
wear shoes with good arch support and cushioned heels
insoles and heel pads may be helpful

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6
Q

Which one of the following structures passes through the quadrangular space near the humeral head?

A

The axillary nerve and the posterior humeral circumflex artery pass through this space from anterior to posterior.

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7
Q

A 70-year-old woman who has a strong family history of fragility fractures secondary to osteoporosis presents as she is concerned about her own risk. What is the most appropriate way to assess her risk?

A

frax tool

estimates the 10-year risk of fragility fracture
valid for patients aged 40-90 years
based on international data so use not limited to UK patients
assesses the following factors: age, sex, weight, height, previous fracture, parental fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol intake
bone mineral density (BMD) is optional, but clearly improves the accuracy of the results. NICE recommend arranging a DEXA scan if FRAX (without BMD) shows an intermediate result

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8
Q

indirect hernia is where in comparison to epigastric vessels

A

Indirect inguinal hernias occur due to failure of the processus vaginalis to regress. The protrusion occurs through the deep inguinal ring and enters the inguinal canal. It may progress and enter the scrotum in males or labia in females.

The deep inguinal ring is lateral to the epigastric vessels, therefore an indirect inguinal hernia is also lateral to the epigastric vessels.

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