Exam recall 2019 - RURAL GP, GENMED, PSYCH, GERRIES, PALL CARE. Flashcards
Which one is a negative symptom of schizophrenia?
- Apathy
- Blunted affect
Both apathy and blunted affect are negative symptoms of schizophrenia. However, if you need to choose just one, blunted affect (reduced emotional expression) is the more specific term for a negative symptom, while apathy can also be considered one but is sometimes seen in other conditions as well.
Highest risk factor for developing an eating disorder?
- Weight loss
- Perfectionism
Perfectionism is the highest risk factor for developing an eating disorder. Individuals with perfectionistic tendencies may have higher levels of self-criticism and pressure to meet unrealistic standards, which can contribute to the development of eating disorders. Weight loss can be a consequence of an eating disorder but is not necessarily a risk factor for developing one.
Management of acute mania?
- Clonazepam
- Olanzapine
For the management of acute mania, Olanzapine is generally preferred. It is an antipsychotic medication that can help stabilize mood and manage symptoms of mania.
Clonazepam, a benzodiazepine, may be used as an adjunctive treatment to help with agitation or sleep disturbances, but it is not the primary treatment for acute mania.
Man likes to walk 400m instead of taking a taxi thinks he sees people in the shadows but when he looks just realizes its shadows?
- Panic
- Illusion
- delusion
The situation described is best characterized as an illusion.
- Illusions involve misinterpretations of real external stimuli (e.g., misperceiving shadows as people but realizing they are just shadows upon closer inspection).
- Delusions are strongly held false beliefs that are resistant to reasoning or contrary evidence (e.g., believing that someone is plotting against you when there is no evidence to support it).
- Panic refers to a sudden feeling of intense fear or anxiety, often accompanied by physical symptoms, but it does not specifically pertain to the misinterpretation of sensory input.
A lady who hears rustling of trees but they sound like voices to her.
- Illusion?
- Delusion?
- Hallucination?
- Sensory disturbance?
= Illusion - an instance of a wrong or misinterpreted perception of a sensory experience.
Substance associated with highest degree of burden in people who already have a mental illness?
- Smoking
- Alcohol
- Opioids
- Benzos
Alcohol is associated with the highest degree of burden in people who already have a mental illness. Alcohol use can exacerbate existing mental health conditions, lead to more severe psychiatric symptoms, increase the risk of self-harm or suicide, and contribute to a range of physical health problems. It can also interact negatively with medications used to treat mental illness, complicating treatment and recovery.
Dynamic risk factor associated with suicide?
= Psychosis
- A dynamic risk factor associated with suicide is one that can change over time and may influence a person’s risk of suicide. An example of a dynamic risk factor is:
- Recent life stressors: Such as job loss, relationship breakdown, or significant changes in life circumstances.
- Dynamic risk factors can be modified or managed, and monitoring these factors is crucial in suicide risk assessment and intervention.
- Other dynamic factors include substance abuse, recent psychiatric hospitalization, and acute suicidal ideation.
- Static risk factors would be variables that the provider would be unable to change, while dynamic factors can be modified in some way. Into the static category go gender, race, age, personal history of suicide attempt, and family history of suicide.
Lady says she wants to kill her husband but is not depressed or psychotic and is adamant she is going to what do you do?
- Inform her that you have to tell the police and tell them
- Consult a colleague
- Nothing it is confidential
Inform her that you have to tell the police and tell them
Which drug most likely to cause neck spasm, oculogyric crisis (Acute dystonia symptoms)?
- Haloperidol
- Quetiapine
- Other atypicals
Haloperidol is most likely to cause neck spasm and oculogyric crisis, which are symptoms of acute dystonia.
- Haloperidol: It is a typical antipsychotic and is known to cause extrapyramidal side effects, including acute dystonia, which can present as neck spasms, oculogyric crisis, and other involuntary muscle contractions.
- Quetiapine: It is an atypical antipsychotic and is less likely to cause these types of acute dystonic reactions compared to typical antipsychotics like haloperidol.
- Other atypicals: Generally, atypical antipsychotics have a lower risk of causing acute dystonia compared to typical antipsychotics.
If acute dystonia occurs, treatment often involves anticholinergic medications like benztropine or diphenhydramine.
Drug to prevent relapse of alcohol abuse?
The drug commonly used to prevent relapse of alcohol abuse is Disulfiram (Antabuse).
Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, which leads to the accumulation of acetaldehyde when alcohol is consumed. This results in unpleasant reactions such as flushing, nausea, and palpitations, which serve as a deterrent to drinking.
Other options for relapse prevention include:
- Naltrexone: An opioid antagonist that reduces cravings for alcohol.
- Acamprosate: Helps to restore the balance of neurotransmitters in the brain and reduces cravings.
The choice of medication can depend on individual patient needs, side effect profiles, and the presence of any co-occurring conditions.
Intervention with the most evidence for treatment of ADHD?
- CBT
- Schooling
- Stimulants
Stimulants have the most evidence for the treatment of ADHD. Medications such as methylphenidate (Ritalin) and amphetamines (Adderall) are well-established in their efficacy for reducing the core symptoms of ADHD, including inattention, hyperactivity, and impulsivity.
While Cognitive Behavioral Therapy (CBT) and school-based interventions can be beneficial as part of a comprehensive treatment plan, especially for addressing behavioral strategies and academic challenges, stimulant medications remain the primary and most evidence-supported treatment for managing ADHD symptoms effectively.
Most common schizophrenia symptom?
- Lack of insight
- Delusions
- Apathy
The most common symptoms of schizophrenia are delusions and hallucinations. Among these, auditory hallucinations are often the most frequently experienced symptom. These can include hearing voices that others do not hear. Delusions, which are false beliefs not based on reality (such as believing one has special powers or is being persecuted), are also a central feature of the disorder.
Both symptoms are key in the diagnosis of schizophrenia and are central to understanding the impact of the disorder on an individual’s perception and cognition.
Adverse effect associated with MAOIs like phenelzine?
Phenelzine, a monoamine oxidase inhibitor (MAOI), can cause a hypertensive crisis, especially when consumed in conjunction with foods high in tyramine. Tyramine is an amino acid found in various aged, fermented, and processed foods. When MAOIs inhibit the breakdown of tyramine, it can lead to excessive levels in the body, resulting in a hypertensive crisis.
To manage and prevent hypertensive crises in patients on MAOIs like phenelzine, it is crucial to adhere to a tyramine-restricted diet and be aware of possible interactions with other medications. Symptoms of a hypertensive crisis include severe headache, chest pain, neck stiffness, and confusion, and it requires immediate medical attention.
Adverse effect of clozapine?
Clozapine, an atypical antipsychotic, is known to be associated with seizures. It has a dose-dependent risk of seizures, with the likelihood increasing at higher doses. The risk of seizures can be managed by gradually titrating the dose and monitoring the patient closely. If a seizure occurs, clozapine may need to be adjusted or discontinued, and alternative treatments for managing the patient’s condition should be considered. Other antiepileptic drugs might also be used to control the seizures if necessary.
What symptoms might a patient taking amitriptyline develop?
anticholinergic
Screening for a 32-year-old man in a stable relationship (long-term) with female partner?
- STI
- BP?
- fasting BSL?
= BP
Lady wants influenza vaccination at 16 weeks gestation is it safe?
- Wait till third trimester?
- Okay to have influenza now?
- Advise not to have?
Okay to have it now - It is generally safe and recommended for pregnant women to receive the influenza vaccination at any stage of pregnancy, including at 16 weeks gestation. Influenza vaccination during pregnancy helps protect both the mother and the baby from the flu and its complications.
Safety: The flu vaccine is safe during all stages of pregnancy and does not harm the fetus.
Effectiveness: Early vaccination provides the best protection throughout the flu season, including the third trimester.
Recommendations: Health authorities, such as the CDC and WHO, recommend that pregnant women get the flu vaccine as soon as it becomes available in the flu season.
Hep B vaccine for infants? What should Infants born to hepatitis B surface antigen (HBsAg)–positive mothers receive?
Hep B vaccine (dose 1 or 0) should ideally be given to all infants within 24 hours of birth, but at most within seven days of birth. Infants born to hepatitis B surface antigen (HBsAg)–positive mothers should be given hepatitis B immune globulin (HBIG) and a
dose of monovalent hepatitis B vaccine on the day of birth (preferably within 12 hours of birth and certainly within 48 hours).
Pregnant lady with child with vesicular rash she is Ig negative what to do?
- MMR vaccination
- Ig Varicella
- some other options???
= Ig Varicella
For a pregnant woman who is IgG negative for varicella (chickenpox) and has been exposed to a child with a vesicular rash (likely varicella), the appropriate management is:
- Administer Varicella-Zoster Immune Globulin (VZIG): This is recommended if the exposure occurred within 96 hours. VZIG can help reduce the severity of chickenpox in those who are susceptible and at risk.
- MMR Vaccine: This is not appropriate for pregnant women. The MMR vaccine is contraindicated during pregnancy due to the risk of live attenuated viruses affecting the fetus.
- Avoidance of Varicella Vaccine: The varicella vaccine is also a live attenuated vaccine and should not be given during pregnancy.
Therefore, the correct action would be to administer Varicella-Zoster Immune Globulin (VZIG) if exposure was within the recommended timeframe.
Most common cause of death on farms in children <4 years?
- Drowning
- Quad bikes
- Falls from heights
= Drowning
Man, with chemical injury to the eye on a farm what do you tell him?
- Get his wife to bring bicarbonate?
- Wash eye in water trough?
- Go to house immediately and wash for 15 mins?
- Go to ED?
Go to house immediately and wash for 15 mins
Picture of impetigo how do you manage?
- Topical steroids?
- Topical antifungal?
- Topical antibiotic?
For managing impetigo, which is a bacterial skin infection typically caused by Staphylococcus aureus or Streptococcus pyogenes, the best treatment option is:
- Topical antibiotics, such as mupirocin or retapamulin, are commonly used for localized impetigo. These antibiotics help eliminate the bacteria causing the infection and are applied directly to the affected skin.
- Topical steroids: These are used for inflammatory skin conditions but are not effective against bacterial infections like impetigo. In fact, they can worsen the infection by suppressing the local immune response.
- Topical antifungal: These are used for fungal infections, not bacterial infections like impetigo.
For extensive or severe cases of impetigo, or if there is no improvement with topical treatment, oral antibiotics might be necessary. It’s also important to practice good hygiene and keep the affected area clean and covered.
What is the diagnosis?
Scabies
Management of scabies?
Prevention of transmission and reinfection
1. Wash all clothing and bedding in hot water ≥ 50°C (≥ 122°F).
2. Treat all of the following individuals simultaneously with the patient: Household members within the last month, Sexual partners within the last two months
3. Advise household members to avoid direct, prolonged contact with the patient’s skin, bedding, and clothing until treatment completion.
4. In the event of a suspected outbreak:
- Notify the local health department.
- Increase surveillance to identify new cases.
Splenectomy- what vaccinations do they need? (5)
- Hib (Haemophilus influenzae type b) vaccine
- Influenza vaccine
- Meningococcal vaccines (MenACWY, MenB)
- Pneumococcal vaccines
- Respiratory syncytial virus (RSV) vaccine
Lady has non-healing lesion, area where she had a previous burn, not healing, requiring lots of dressings what is this?
- Angiosarcoma?
- Squamous cell carcinoma?
A non-healing lesion in an area of previous burn injury is most likely to be: Squamous cell carcinoma (SCC)
Chronic ulcers or non-healing lesions in areas of previous burns or scars can develop into squamous cell carcinoma due to the long-term irritation and damage to the skin. This is known as Marjolin’s ulcer.
Angiosarcoma is a rare and aggressive cancer of the blood vessels that can also occur in chronic wounds or areas of previous radiation or trauma, but it is less common than squamous cell carcinoma in this context.
Given the history of a previous burn and a non-healing lesion, SCC is the more likely diagnosis.
Guy with discharge what is the best empirical management?
- IM ceftriaxone
- IV azithromycin
- Some other ones
The most appropriate empirical treatment for common STI-related discharge, the combination of IM Ceftriaxone and Oral Azithromycin is generally recommended.
Erythema multiforme - What is it? What does it look like?
TIA- stenosis 25% whats the management?
= Low dose aspirin
- Surgical or Endovascular Interventions: For 25% stenosis, surgery (like carotid endarterectomy) or stenting is generally not recommended unless there are other complicating factors or higher degrees of stenosis. These interventions are typically considered for more severe stenosis (usually >70%).
Zoonoses EMQ - What is the diagnosis:
a) Guy with a cough/respiratory symptoms, something about a bird?
b) Guy with the cattle with flu like illness?
c) Marathon runner in water
d) Lady struck by “creature”, friend says she should “get some needles”?
e) Some rogue one about some guy with a lesion down to his dermis when travelling?
a) Guy with a cough/respiratory symptoms, something about a bird = Psittacosis (Ornithosis) – This is often associated with exposure to birds, especially parrots, and can present with respiratory symptoms like cough.
b) Guy with the cattle with flu like illness - Q Fever – This is caused by Coxiella burnetii and is associated with exposure to cattle, sheep, or goats.
c) Marathon runner in water = Leptospirosis – This disease is often contracted through contact with water contaminated by animal urine, particularly in areas with poor sanitation.
d) Lady struck by “creature”, friend says she should “get some needles” = Rabies – The “creature” could be a bat or another animal, and “get some needles” refers to rabies post-exposure prophylaxis (PEP) which involves a series of injections.
e) Some rogue one about some guy with a lesion down to his dermis when travelling = Cutaneous Leishmaniasis – This disease causes skin lesions that can extend into the dermis and is often seen in travelers to endemic regions.
Lady who was in a car accident, front seat of car, internal rotation and leg shortening and adduction, hip slightly forward what is it?
- Posterior dislocation
- Anterior dislocation
- NOF
- Femoral fracture
The description of the injury—internal rotation, leg shortening, adduction, and the hip being slightly forward—suggests a posterior dislocation of the hip.
- In a posterior hip dislocation, the affected leg often appears shortened, internally rotated, and adducted. The position of the hip being slightly forward can also be indicative of a posterior dislocation.
- Anterior dislocation typically presents with the leg in external rotation and abduction.
- NOF (Neck of Femur) fracture usually results in leg shortening and external rotation.
- Femoral fracture might cause shortening but does not typically present with the described positioning of the hip.
Girl with nephrotic syndrome what is most appropriate management?
Corticosteroids:
Initial Treatment: The first-line treatment for nephrotic syndrome, especially in children, is corticosteroids such as prednisone. This treatment helps reduce inflammation and proteinuria.
Weak shoulders, wasting of muscles, UMN signs below lesion, LMN at the lesion, pain on neck turn?
- Cervical spondylitis?
- Polymyositis?
- Syringomyelia??
The symptoms described—weak shoulders, muscle wasting, upper motor neuron (UMN) signs below the lesion, lower motor neuron (LMN) signs at the lesion, and pain on neck turn—are most consistent with syringomyelia.
Lady with stress incontinence and positive for UTI but no dysuria or frequency what do you do?
- Don’t treat
- treat UTI
= Do not treat - Asymptomatic bacteriuria
Stress incontinence not usually caused by UTI
Man, with big skull, big calves, lytic lesions on skull?
Paget’s
What nerve is responsible for external sphincter in urination for women?
External Sphincter - Pudendal
Internal Sphincter = Hypogastric Nerve: This nerve carries sympathetic fibers that are responsible for the contraction of the internal urethral sphincter. Sympathetic stimulation maintains the internal sphincter in a contracted state to prevent involuntary leakage of urine.
Pes cavus deformity? (hereditary neuromuscular disorder)
Charcot-Marie Tooth
Best discriminatory initial investigation for a patient presenting with ascending muscle paralysis post viral illness?
- LP
- Muscle conduction studies
- Some others
Suspected Guillian Barre - Do an LP
In summary, lumbar puncture is the most discriminatory initial investigation for confirming a diagnosis of GBS in the context of ascending muscle paralysis following a viral illness.
ABG showing alkalosis, which isn’t this representative of? Calculate A-a gradient
answer was hyperventilation
Most common presentation for DKA?
- Steroid use
- Foot infection
- Non-compliance with insulin
- Non-diagnosed Insulin dependent diabetes
Non-compliance with insulin
Guy with worsening back pain not responsive to opioids what is this?
- Impending spinal cord compression
- Opioid tolerance
Given the rapid worsening of pain and lack of response to opioids, impending spinal cord compression is a more pressing concern and should be evaluated urgently. Diagnostic imaging, such as MRI of the spine, would be necessary to assess for spinal cord compression and guide appropriate management.
Family wants to stop feeding patient in terminal phase is this appropriate?
Yes - usually they will not eat and drink much anyway???
What directs best treatment for palliative care patients?
- Close family and friends
- Nurses input
- Advanced health directive
- Legal will
The best treatment direction for palliative care patients is primarily guided by:
Advanced Health Directive: An advance health directive (or advance directive) outlines the patient’s preferences for medical treatment and care if they become unable to make decisions for themselves. It reflects the patient’s wishes about their care and should be the primary guide for treatment decisions in palliative care.
Patient with spinal mets has neuropathic pain already on pregabalin, opioid, paracetamol, what initial adjunct should be given?
- Dexamethasone
- Amitriptyline
- NSAID
Patient with increasing abdominal pain with ascites whats the best immediate treatment?
- Drainage
- Spironolactone
= Drainage
Best option for opioid driven nausea?
- Promethazine
- Haloperidol etc.
Metoclopramide would be best but wasn’t an option??
Sudden onset severe abdominal pain in a diabetic smoker, but then she had a soft mildly tender abdomen. What is the cause?
a) Acute vascular event
b) Peptic ulcer
a) Acute vascular event
Post proctectomy erectile dysfunction – most likely nerve?
a) Splanchnic nerve
b) Ilioinguinal nerve
c) Dorsal nerve of penis
a) Splanchnic nerve??
Patient found to be drinking fluids within 2 hours of surgery. Which is most likely to cause operation to be cancelled?
a) Coke
b) Lemonade
c) Water
d) Tea with milk
e) Orange juice
= Tea with milk
Patient has come into hospital say that she has swallowed 5 razor blades. This in confirmed on CXR, with the blades sitting in her stomach. How should they be dealt with?
a) Upper GI removal via upper GI scope
b) Laparotomy
c) Ipecac
Upper GI removal via upper GI scope
Lady had an open abdominal surgery. Since she’s been home she has been coughing heaps. CT of abdomen shown. What has happened?
a) Rectus sheath haematoma
b) Ovarian something
c) AAA
For a patient who has undergone open abdominal surgery and is now experiencing significant coughing, and with a CT of the abdomen showing findings, the most likely issue is:
- Rectus Sheath Hematoma.
Old lady falls and hits their forehead. Finds it difficult to lift herself back up and on examination is found to have 2+ power on wrist extension andsome other movements, also absent triceps reflex. Following day she develops hyperreflexic lower limbs and slightly reduced power. What type of injury is this?
a) Cervical nerve root
b) Brachial plxus
c) Central cord
d) Frontal lobe
Central Cord Syndrome: This condition is often associated with cervical spinal cord injury, particularly in older adults with pre-existing cervical spondylotic changes. It typically presents with:
Weakness predominantly in the upper limbs compared to the lower limbs (as seen with 2+ power on wrist extension and difficulty lifting herself up).
Hyperreflexia in the lower limbs, which indicates upper motor neuron involvement.
Reduced power and other symptoms in the lower limbs may develop as the condition progresses or if there is significant spinal cord involvement.
Best medication for initial management of metastatic brain lesions?
a) Dexamethasone
b) Mannitol
c) Hypertonic saline
Dexamethasone
Lady post appendicectomy. Has temperature of 39.5. Medial end of the wound is red with fluctuant mass underneath. How do you manage?
a) IV fluclox
b) IV gent
c) Wound aspirate
d) CT image
e) Wound drainage
In a patient post-appendicectomy with a fever of 39.5°C, redness at the medial end of the wound, and a fluctuant mass underneath, the most appropriate management step is:
Wound Drainage.
Female has a breast lump that was FNA’ed – this demonstrated green fluid. This lump is no longer palpable. How should she be managed?
a) Send fluid for cytology
b) Refer to surgeon
c) Excise the cyst capsule
d) Do nothing
For a female with a breast lump that was aspirated and yielded green fluid, and where the lump is no longer palpable, the appropriate management is:
Do Nothing
Most common cause of primary hyperparathyroidism?
a) Single adenoma
b) Multiple adenoma
c) Hyperplasia
a) Single adenoma
Lady with a 2cm thyroid nodule that was iodine cold. How do you manage?
a) FNA
b) Iodine Ablation
c) Thyroxine
d) Partial Thyroidectomy
For a 2 cm thyroid nodule that is “iodine cold” (meaning it does not take up iodine on a radioactive iodine scan, which suggests it is less likely to be hyperfunctioning and may be malignant), the most appropriate management is:
FNA (Fine Needle Aspiration).
Patient has had a closed NOF. The next day on the ward she is hypotensive and tachycardic and has a Petechial rash. What is the likely diagnosis?
a) PE
b) Fat embolism
c) Blood Loss
In a patient who has had a closed neck of femur (NOF) fracture and presents the next day with hypotension, tachycardia, and a petechial rash, the likely diagnosis is:
Fat Embolism.
Patient with DVT extending up popliteal vein. How should they be managed
a) SC heparin
b) IV heparin
c) Oral warfarin
d) Aspirin
b) IV heparin
Elderly woman has fallen over at home and is no longer weight bearing. What does her leg likely look like?
a) No change
b) Externally rotated, adducted, shortened
c) Externally rotated, abducted, shortened
d) Internally rotated, adducted, shortened
e) Internally rotated, abducted, shortened
Suspected NOF
- Externally Rotated, Abducted, Shortened
Patient is due for an op. What would help determining how much he could bleed?
a) Bleeding time
b) Clotting time
c) Number of platelets
d) Past bleed Hx
e) APT
To help determine how much a patient might bleed during an operation, the most relevant test would be:
Number of Platelets.
Patient has GCS 9 post MVA plus tracheal deviation to the right, with dullness to percussion on the left. X-ray is suggestive of a haemothorax. What’s the most appropriate initial management.
a) Intubate
b) Explorative lap
c) Fluids
d) Drain the haemothorax
For a patient with a Glasgow Coma Scale (GCS) score of 9 post motor vehicle accident (MVA), tracheal deviation to the right, dullness to percussion on the left, and an X-ray suggestive of a hemothorax, the most appropriate initial management is:
Drain the Hemothorax.
What would you expect as a result of compression of the sciatic nerve roots
a) Faecal incontinence
b) Loss of knee jerk reflex
c) Sensory loss over knee
d) Sensory loss over lateral calf
e) Weakness of leg adductors
Sensory Loss over Lateral Calf
Most common cause of post-op restlessness
a) Pain
b) Hypoxia
c) Urinary retention
Pain
Man who’s had a TURP and is now hyponatraemic. What is the cause?
a) Dilutional effect from fluids
Microcytic anemia, what cancer will cause this?
Caecal
Fasting protocols
a) No food overnight
b) 6 hours for solids, four hours for clear fluids
c) 6 hours solids, 2 hours clear fluids
The commonly accepted fasting protocols for elective surgery or procedures that require anesthesia are:
- 6 hours for solids, 2 hours for clear fluids.
Patient feeling very weak, trouble standing up or putting her arms up to the washing line. What investigation should be done?
a) CK
b) ESR
c) ANA
or a patient feeling very weak, having trouble standing up, and difficulty with activities such as putting her arms up to the washing line, the most appropriate initial investigation is:
CK (Creatine Kinase).
Patient with AS presents with back pain, not managed adequately by NSAIDs and exercise. What’s the best management?
a) Methotrexate
b) Anti-TNF
c) Sulfasalazine
For a patient with ankylosing spondylitis (AS) who presents with back pain that is not adequately managed by NSAIDs and exercise, the best management option is:
Anti-TNF (Tumor Necrosis Factor) agents.
What’s the best initial management in septic arthritis?
a) IV Abx
b) Washout
c) Hydration
d) Analgesia
The best initial management for septic arthritis is: IV Antibiotics
13-year-old buy presenting with knee pain, limp and normal knee exam
a) SUFE
b) Perthes
c) Osgood-Schlatter
= SUFE
Slipped capital femoral epiphysis
(Juvenile femoral head detachment, Juvenile epiphyseal detachment)
- Summary?
- Epidemiology?
- Aetiology? (4)
- Pathophysiology?
Epidemiology
- Prevalence: most common hip disorder in adolescents
- Peak incidence: 10–16 years (often occurs during a growth spurt)
- Sex: ♂ > ♀
Aetiology - The exact etiology is still unknown. However, there are some risk factors that increase the likelihood of SCFE:
1. Obesity
2. Family history
3. Endocrine or hormonal factors (e.g., hypothyroidism, pituitary tumors, down syndrome, renal osteodystrophy, craniopharyngioma)
4. Trauma (e.g., sports-related injury or fall)
Slipped capital femoral epiphysis
(SUFE)
- Summary?
- Clinical features?
Slipped capital femoral epiphysis
(SUFE)
- Diagnosis?
- Treatment? (3)
- Complications? (3)
Treatment
1. Avoid weight bearing before stabilization
2. Urgent surgical internal fixation with pinning of the femoral head
3. Prophylactic fixation of the contralateral hip
Complications
1. Avascular necrosis of the femoral head
2. Early hip osteoarthritis
3. Chondrolysis of the hip: rapid degeneration of articular cartilage
Old bloke has bilateral forefoot pain, particularly around the MTP. High serum urate and high creatinine. What’s the best management?
a) Celecoxib
b) Colchicine
c) Allopurinol
= b) Colchicine - but need to lower the dose in renal failure pts.
Woman has RA and is managed with methotrexate. She wants to have a child and stops Rx but symptoms worsen. What should she do?
a) Stop methotrexate
b) Switch to NSAIDs
c) Switch to sulfasalazine
The best management for a woman with rheumatoid arthritis (RA) who wants to conceive, stops methotrexate, and experiences a worsening of her symptoms is:
Switch to sulfasalazine.
Patient with knee pain, palpable popping on flexion, medial joint line tenderness + effusion.
a) Medial Meniscus
b) MCL injury
Medial Meniscus injury.
Rheum EMQ - RA, SLE, SJogrens, PMR, Ankylosing spondylitis, reactive arthritis, gout, pseudogout, psoriatic arthritis, dermatomyositis
1) Patient with pain in hands, knee and foot. Recalls having a rash on his belly 2 weeks ago with a fever?
2) Patient with pain in her DIPS and PIPS. Worse in her right hand. There is evidence of deformity at these joints. Father has psoriatic arthritis?
3) Patient had gastro 2 weeks ago, now presenting with asymmetrical oligoarthritis - reactive arthritis
4) Post surgical, wrist swelling, Positively birefringent – pseudogout
5) Answer was Dermatomyositis, don’t recall the stem
1) Patient with pain in hands, knee and foot. Recalls having a rash on his belly 2 weeks ago with a fever = viral arthritis
2) Patient with pain in her DIPS and PIPS. Worse in her right hand. There is evidence of deformity at these joints. Father has psoriatic arthritis = psoriatic arthritis
3) Patient had gastro 2 weeks ago, now presenting with asymmetrical oligoarthritis - reactive arthritis
4) Post surgical, wrist swelling, Positively birefringent – pseudogout
5) Answer was Dermatomyositis, don’t recall the stem
Patient presents to your ED up north with unilateral facial palsy (they included a pic) – and all potential causes are excluded. How should they be managed?
a) Immediate steroids
b) Eye patch
c) Anti-viral
d) Refer to ENT
a) Immediate steroids
Truck driver with BMI of 42 presents because of loud snoring and difficulty staying awake while driving. He has a crowded oropharynx & big tonsils. How should he be immediately managed?
a) CPAP
b) Tonsillectomy
c) Weight loss
d) Oral appliance
CPAP (Continuous Positive Airway Pressure).
Patient presents with discharging lump in the midline of his neck that moves up and down when he sticks his tongue out. What is the likely diagnosis?
a) Thyroglossal cyst
b) Branchial cyst
c) Cystic hygroma
a) Thyroglossal cyst
Patient presents with 6 months of hoarse voice – no weight loss, haemoptysis or other symptoms. Laryngoscopy shows this (picture shown) on vocal cord. What is the likely diagnosis?
a) Laryngeal SCC
b) Laryngeal papillomata
= Laryngeal SCC
Clinical features of Laryngeal Carcinoma
1. Hoarseness/change in voice
2. Foreign body sensation
3. Dyspnea
4. Dysphagia
5. Stridor (due to airway narrowing)
6. Aspiration while eating or drinking
7. Unexplained hoarseness for longer than 3 weeks should always be investigated by laryngoscopy!
Baby presents with fever of 39 and discharge in the ear canal. The post-auricular aspect of the ear is tender and red. What is the likely diagnosis?
a) Acute mastoiditis
b) Acute otitis media
Acute mastoiditis
Patient has had 7 days of facial pain, mucopurulent nasal discharge and has taken the last two days of work. How will you manage them?
a) Topical nasal saline
b) Antibiotics
c) Swab
For a patient with 7 days of facial pain, mucopurulent nasal discharge, and taking the last two days off work, the likely diagnosis is acute bacterial sinusitis. The appropriate management would be:
Antibiotics.
A patient has fractured their nose – how do you manage them
a) Refer them to be seen by ENT today
b) Refer them to be seen by ENT in 7-10 days
c) Refer them for rhinoplasty
Refer them to be seen by ENT in 7-10 days
Patient now presents with signs of meningitis and brain abscess. What was the primary cause?
a) Cholesteatoma
b) Membrane Rupture
Cholesteatoma
Kid with sore throat, SOB and sitting with neck extended, fully vaccinated (basically textbook description)?
Epiglottitis
Patient has been constantly using nasal decongestants and now finds they are not having any effect for her recent episode of congestion.
a) Acute sinusitis
b) Rhinitis medicamentosa
Rhinitis medicamentosa
Cause of cavernous sinus thrombosis
a) Epistaxis
b) Sinusitis
Sinusitis - pecifically, acute or chronic bacterial sinusitis can lead to cavernous sinus thrombosis. The infection can spread from the sinuses, particularly the ethmoid or sphenoid sinuses, into the cavernous sinus, leading to thrombosis. This condition can cause serious complications due to the proximity of the cavernous sinus to critical structures like the cranial nerves and the internal carotid artery.
Epistaxis: Although epistaxis (nosebleed) can be a symptom or consequence of nasal and sinus issues, it is not a direct cause of cavernous sinus thrombosis.
Most important factor for management of chronic tonsillitis in 47ish year old with one larger than the other
a) Number of episodes tonsilitis in a year
b) Chronic fatigue
c) Asymmetry of tonsils
d) Throat Swab
Asymmetry of tonsils.
Patient with long history of painful smelly leg ulcer. Dr thinks it sounds venous. What investigation should be done before applying compression bandage?
a) Biopsy of edge
b) Arteriogram
c) Duplex U/S
d) Arterial Pressure Duplex
Biopsy of edge = gold
