Great Mix Flashcards
1
Q
Hickman Line
A
This is a an example of a long term central venous line which is inserted in a similar way to a central line (usually subclavian).
The remnant of the line is tunnelled subcutaneously, which decreases the incidence of line infection.
These are indicated for long-term parenteral nutrition, long-term intravenous antibiotic therapy and chemotherapy.
1
Q
What is Mannitol?
A
Mannitol is an osmotic diuretic which can be used to lower raised intracranial pressure or drive the urine output in a patient with obstructive jaundice to prevent hepato renal syndrome.
2
Q
IM Femoral Nail
A
This is an intramedullary femoral nail which is used to internally fix femoral shaft fractures.
Interlocking screws are used to fix the nail. They are usually removed after 12 / 18 months.
3
Q
Monopolar Diathermy Handle
A
Monopolar diathermy is used for coagulation and dissection of tissue during open or laparoscopic surgery.
4
Q
Swan Ganz catheter
A
This is a Swan Ganz catheter which is used to measure the pressures in the heart, the pulmonary artery wedge pressure and can also be used to measure the cardiac output.
These are used in the intensive care setting and are typically inserted into a central vein.
5
Q
Ryles NG Tool
A
This is a Ryles nasogastric tube which is primarily used for decompression (drip and suck) in bowel obstruction, but can also be used to insert drugs or contrast into the GI tract.
After explaining what you are about to do to the patient, you will require a NG tube which has been in the fridge as it is stiffer, some lubricant, a bladder syringe, a drainage bag and pH dipstick.
The correct position of the tube is checked by aspirating gastric contents and checking for acidity on pH dipstick, if this is unavailable then air can be inserted to the tube and the epigastrium auscultated for bubbling. Finally, an x-ray can be taken to identify the tube.
Once the tube is in the correct position a bag is attached and it is taped to the patients face.
6
Q
Surgical vs anatomical neck of the humerus?
A
The surgical neck is much more frequently fractured than the anatomical neck of the humerus. This type of fracture takes place when the humerus is forced in one direction while the joint capsule and the rotator cuff muscles remain intact.
It is a clinically important anatomical feature of the humerus as it is the most frequently fractured site of the proximal humerus, putting the axillary nerve and posterior circumflex humeral branch of the axillary artery at risk.
7
Q
General principles of fracture management?
A
Reduce (open or closed)
Hold (metal or no-metal)
Rehabilitate (move, physiotherapy, use)
8
Q
What hold options are there for fractures?
A
Closed = plaster, traction
Fixation
9
Q
Internal fixation?
A
Intramedullary - nails, pins
Extramudllary - plates, pins
10
Q
External fixation?
A
Monoplanar, multiplanar
11
Q
Causes of patellar effusion:
A
Damaged structure in the knee.
Synovoitis, OA, torn menisucus, torn ACL, chondral injury
12
Q
Movements to test median nerve?
A
thumbs up don’t let me push it down
13
Q
Movements to test radial nerve?
A
o Fingers straight don’t let me push them down
14
Q
Movements to test ulnar nerve?
A
spread fingers – don’t let push it in
o Looks like a U when they spread
15
Q
Heberden’s nodes?
A
Bony bumps on the DIPs are called Heberden’s nodes.
More OA?
16
Q
Bouchard’s nodes?
A
Bony bumps on the PIPs
Mora RA?
17
Q
Empty can test assesses what?
A
Supra-spinatus weakness
18
Q
Scarf test assess what?
A
Rotator cuff pathology
19
Q
Joints involved in RA?
A
Multiple joints affected: usually small joints of hands and feet such as the proximal interphalangeal (PIP) joint, metacarpophalangeal (MCP) joint, wrist, knee, ankle, metatarsophalangeal (MTP) joint, and cervical spine
20
Q
Hawkin’s kenedy test - robot arm push down assess what?
A
Subacromial impingement
21
Q
The most common etiology of a winged scapula?
A
damage or impaired innervation to the serratus anterior muscle.
22
Q
External rotation against resistance
A
This clinical test assesses the function of the infraspinatus muscle and teres minor.
23
Q
Arthroscopy
A
Can be used to visualise the meniscus within the joint and is the gold-standard investigation for diagnosing a meniscal tear. Arthroscopy can also be used to repair or remove damaged sections of the meniscus.
24
immediate management of a suspected ACL tear
RICE (Rest, Ice, Compression and Elevation)
25
ACL treatment:
Conservative treatment involves rehabilitation, which utilises strength training of the quadriceps to stabilise the knee
In the emergency setting, inpatient admission is rarely required; the patient can often partially weight bear and a cricket pad knee splint can be applied for comfort.
Surgical reconstruction of the ACL (Fig. 4) involves the use of a tendon or an artificial graft
This is not performed acutely but following a period of ‘prehabilitation’, whereby the patient will engage with a physiotherapist for a period of months prior to the surgery
26
6Ps
Pale, Pulseless, Paraesthesia, Paralysis, Pain, Perishingly cold
27
Vascular exam:
Ankle-brachial pressure index
<0.9 = intermittent claudication
<0.6 = rest pain
<0.3 = critical ischaemia
NB: ABPI may be falsely elevated in patients with calcified arteries.
Imaging
Duplex ultrasound (first line imaging)
MR or CT angiography (second line imaging, MR preferred but CT more widely available)
Catheter angiography (third line)
Bloods: lipid levels, fasting glucose, FBC (rule out anaemia), U&Es (to check renal function prior to contrast), coagulation screen
ECG: to look for AF as a cause of emboli
28
Homonymous hemianopia
Homonymous hemianopia refers to a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. Vascular causes such as cerebral infarction or cerebral haemorrhage are the most commonly identified causes. In children, this visual field defect is commonly the result of a tumour.
Right homonymous hemianopia is due to a lesion on the left side of the brain and vice versa.
29
Superior homonymous quadrantanopia
A visual field defect involving the two right or two left upper quadrants of the visual fields in both eyes. Classically due to a lesion involving the temporal lobe optic radiations. Causes may include stroke, tumour, or demyelination. Accompanying features may include aphasia, memory deficits complex seizures, and auditory and visual hallucinations (depending on the dominance of the lobe).
A left superior homonymous quadrantanopia is due to a lesion on the right side of the brain (e.g. right temporal lobe)
30
Inferior homonymous quadrantanopia
A visual field defect involving the two right or two left lower quadrants of the visual fields in both eyes. Classically due to a lesion involving the parietal lobe optic radiations. Causes may include stroke, tumour, or demyelination. Accompanying features may include finger agnosia (inability to identify specific fingers), acalculia (inability to perform simple cautions), and right-left disorientation, neglect and inattention (depending on the dominance of the lobe).
A left inferior homonymous quadrantanopia is due to a lesion on the right side of the brain (e.g. right parietal lobe)
31
Third nerve palsy causes?
Presumed microvascular (42 percent)
Trauma (12 percent)
Compression from neoplasm (11 percent)
Post-neurosurgery (10 percent)
Compression from aneurysm (6 percent)
32
Fourth nerve palsy causes?
Fourth nerve palsy may be caused by hypertension, diabetes, TIA (transient ischemic attack/mini stroke), stroke or as a result of head trauma. Other causes may require investigation such as a scan. Sometimes a cause may not be found despite extensive investigation.
33
Sixth nerve palsy causes?
The most common causes of sixth nerve palsy are high blood pressure, diabetes, TIA (transient ischemic attack/mini stroke) or stroke.
34
4th CN muscle
The fourth nerve supplies the superior oblique muscle, which moves an eye down and ‘also rotates the eye’. If the fourth nerve is not working (palsy), then the superior oblique muscle will become weak and not work properly.
35
6th CN muscle innervation?
The sixth nerve supplies the eye muscles which are attached on the outer aspect of the eye (lateral rectus). The left lateral rectus moves the eye to the left and the right moves it to the right. If the sixth nerve is not working (palsy) then the lateral rectus muscle will become weak and not work properly.
36
3rd CN muscle innervation?
Medial Rectus. The medial rectus is also a muscle of the eye's orbit. ...
Inferior Rectus. The inferior rectus is also a muscle of the orbit. ...
Superior Rectus. ...
Inferior Oblique.
37
What is a heave?
Right ventricular enlargement
38
Murmur + thrill = grade?
4
39
Principles of treating a fracture?
Reduce, restrict/hold, rehabilitate
40
Peripheral Neuropathy
Peripheral neuropathy refers to reduced sensory and motor function in the peripheral nerves, typically affecting the feet and hands (“stocking-glove” distribution). It is a characteristic feature of Charcot-Marie-Tooth.
41
Causes of peripheral neuropathy
Charcot-Marie Tooth syndrome:
Other causes of peripheral neuropathy can be remembered with the ABCDE mnemonic:
A – Alcohol
B – B12 deficiency
C – Cancer (e.g., myeloma) and Chronic kidney disease
D – Diabetes and Drugs (e.g., isoniazid, amiodarone, leflunomide and cisplatin)
E – Every vasculitis
42
example of mononeuropathy?
Carpal tunnel syndrome
42
Cerebellar signs?
Dysdiadochokinesia/ dysmetria.
Ataxia.
Nystagmus.
Intention tremor.
Speech - slurred or scanning.
Hypotonia.
42
Anterior horn cell disease?
poliomyelitis, SMA, ALS,
43
Parkinson's diseae?
involuntary shaking of particular parts of the body (tremor)
slow movement
stiff and inflexible muscles
44
Causes of spinal cord pathology?
Spinal artery occlusion
Abscess
Viral infection
Syphillus
Trauma
B12, copper deficiency
Degenerative disc disease
Neoplastic - cancer
45
Muscle weakness in UMN?
Lower limb > flexors
Upper limb > extension
46
how to reinforce reflexes?
Pull hands apart – lower limb reflexes
Clench jaw – upper limb reflexes
47
Lower limb reflexes: which dermatomes?
Knee and ankle
Knee = L3/4
Ankle = L5/S1
48
Romberg test?
It is a sign of a disturbance of proprioception, either from neuropathy or posterior column disease. The patient does not know where their joint is in space and so uses their eyes. In the dark or with eyes closed they have problems.
49
Indications for midline sternotomy scar?
open valve surgery (most commonly aortic or mitral), coronary artery bypass grafting (CABG), cardiac transplant or operations performed for the correction of congenital cardiac defects
50
posterolateral thoracotomy
Mainly used for pulmonary resections (pneumonectomy or lobectomy), chest wall resection, or oesophageal surgery.
51
Anterolateral thoracotomy
variety of operations for cardiac, pulmonary, and oesophageal pathology.
52
Telengectasia, sclerodactyly, fine crackles and dull bases?
CREST syndrome
53
Crest/scleroderma ix?
Pulmonary function tests or breathing tests to measure how well the lungs are working.
CT chest scan may also be ordered to evaluate the extent of lung involvement.
Electrocardiogram (EKG or ECG) to see if there are changes in the heart muscle tissue due to scleroderma.
54
Causes of pulmonary fibrosis?
Idiopathic,
drugs such as amiodarone, nitrofunatoinm sulfasalazine, methotrexate, propanolol
Smoking
Fumes
Radiation therapy
silica dust
Bird and animal droppings
RA, viral lung infections, TB, pneumonia, SLE, pulmonary hypertension, sarcoidosis, fungal infection
Coal workers, ankylosing spondylitis
55
Indications for laproscopy?
Ectopic pregnancy
Fibroid surgery
Hysterectomy
Acute abdomen diagnostic
staging tumour/biopsy
Orchidopexy
Inguinal hernia repair
Cholecystecomy
Recurrent abdo pain
56
Types of stoma?
Colostomy, ileostomy and urostomy
Can be permanent or temporary
Temprorary = diverticulitis, obstruction, bowel leak, emergency bowel resection
Permanent = FAP, cancer, UC
57
Charcot Marie’s tooth sx?
Reduced fine touch sensation, high stepping gait, reduce power peripherally
58
Triple assessment breast cancer?
Triple assessment, as the name indicates, includes three modalities, physical examination, imaging (mammography and/or ultrasound), and biopsy (FNAC and core biopsy)
59
Causes of illiac fossa mass?
Diverticulitis, loaded colon, cancer, ovarian mass, fibroids, loaded colon, lymph node swelling, enlarged undescended testis, appendicular abscess (Right side)
60
achilles tendinopathy
61
unilateral knee swelling
Septic arthritis, reactive arthritis, meniscal tear, ACL injury, pseudogout
62
Midline laparotomy scar
(anterior resection, APER, open repair of AAA).
63
Causes of lung crackles?
Coarse crackles or crepitations are associated with bronchiectasis or resolving pneumonia, whereas fine crackles can be heard with either pulmonary oedema or interstitial fibrosis.
64
Ix for IE?
Blood cultures are essential before starting antibiotics. Three blood culture samples are recommended, usually separated by at least 6 hours and taken from different sites. The gap between repeated sets may have to be shorter if antibiotics are required more urgently (e.g., sepsis).
Echocardiography is the usual imaging investigation. Transoesophageal echocardiography (TOE) is more sensitive and specific than transthoracic echocardiography. Vegetations (an abnormal mass or collection) may be seen on the valves.
Urne dipstick,
65
Long term complications of Cushing’s
Diabetes mellitus & osteoporosis
66
long term follow up measures for Cushing’s disease
Transphenoidal resection??
67
renal transplant - where to feel?
one in RIF which would be consistent with renal transplant
68
Similtaneous pancreatic and kidney transplant?
I presented it as a renal transplant and indicated that it might even be a simultaneous pancreatic kidney transplant as the scar was midline and not Rutherford Morris scar. Examiner seemed content with that.
69
Key in meningitis?
I guess asking for contacts was also key.
70
Which bacterial meningitis causes non-blanching rash?
Neisseria meningitidis (meningococcus)
71
LMN with pure motor deficit and sensory intact
making MND most likely.
Differentials offered: MND, GBS/ Chronic Inflammatory Demyelinating Polyradiculoneuropathy (caveat was this tended to affect motor more than sensory) Charcot-Marie.
myotonic dystrophy
72
hypokalaemia questions
muscle weakness, fatigue etc.
Only symptom was tiredness and pt sleeping multiple times throughout the day.
73
Complicatons of stomas?
prolapse, retraction, obstruction, around the stoma - dermatitis, parastomal herniation (cut me off before i could say systemic)
74
massive pleural effusion on cxr?
Homogenous opacification of the entire left lung field, associated with tracheal deviation to the right’
75
Classifying pleural effusion
transudative and exudative. Transudative is protein <25g/l and exudative <35g/L. Effusions with a protein between 25-35 can be determined by lights criteria.
76
A&E approach to NOF?
manage according an ATLS approach. I would want to do a full examination for neurovascular compromise or compartment syndrome, as well as concurrent injuries
77
Limb in NOF?
externally rotated & shortened
78
NOF mx as an F1?
ABC, Analgesia & Antiemetics, NBM for surgery, refer to Ortho
79
When to use 3-way catheter?
This is used in urology for bladder washout, such as in cystoscopy, TURP or in significant haematuria with risk of clot retention’
80
Ix AS?
full history & examination, bedside (ECG for LVH, Obs to look for narrow pulse pressure), bloods (FBC, CRP & BC to rule out IE acutely, lipids & Hba1c, U&Es as baseline)
81
CREST + fluid overload
This would be in keeping with CREST leading to pulmonary HTN & right heart failure. I did not note any evidence of pulmonary fibrosis but I ideally would have liked to listen for longer to confirm this’.
82
hypomimia
Blank face associated with PD
83
Why would you examine the eyes in PD?
progressive supranuclear palsy or a nystagmus in multiple system atrophy.
84
Managing PD
MDT approach with involvement of primary care for continuity and support, secondary care including neurologist & specialist nurse, as well as OT & physio. Conservative measures include occupational therapy involvement for assistance with ADLS, CV RF modification. Additionally regular follow up to screen for cognitive impairment & depression which can be debilitating. Medical therapy is in the mainstay dopaminergic drugs such as L-dopa given with a dopa decarboxylase inhibitor. Other drugs include dopamine agonists, drugs which enhance dopa effects such as COMT inhibitors, and drugs such as apomorphine which can be used for on-off side effects. Additionally, in select patients in a specialist unit deep brain stimulation can be used.
85
Small vs large bowel obstruction x-ray
Small bowel has characteristic circular folds (plicae circulares or valvulae conniventes) which appear radiographically as thin lines that span the entire diameter of the small bowel ( Fig. 1 ). In contrast, large bowel has haustral folds that do not span the entire diameter of the bowel
86
Complications of AV fistulas?
Thrombosis, bleeding, haematoma formation
Aneurysm, infection
87
Peritoneal vs AV fisula dialysis?
88
When to use non-absorbable sutures?
* Percutaneous wound closure
* Bowel anastomosis (Prolene)
* Vascular anastomosis (Prolene)
permanent support + slower healing tissued
tendon, fascia, anastomosis
89
Eponymous name nasal speculum?
Thudiculum's speculum.
90
Monofilament sutures pros and cons?
Less trauma and tissue reaction
Lower risk of infection
91
Braided sutures pros and cons?
Easier to handle + retain knots
Increased risk of infection
92
When to use absorbable sutures?
For deep or rapid healing tissues e.g. bowel/biliary/urinary anastomoses
93
JJ/ureteric stent
Relieves ureteric obstruction from stones/tumours
Complications: infection, blockage, displacement/migration
94
3-way catheter uses?
VIsible haematuria w clots + post bladder/prostate surgery, TURP, irrigation
95
Central venous catheter ports?
Brown port (distal) = taking, white (longer, medial) = giving TPN, blue = proximal, giving meds
96
Central venous catheter indications?
Central administration of medication - parenteral nutrition, infusion of irritant drugs e.g. chemo, vasopressors, inotropes
Monitoring - central venous pressure
Access for extracorporeal circuit - RRT
97
Hickman vs tesio?
Hickman = 2 ports and 1 tube
Tesio = 2 ports and 2 tubes
98
PICC line uses?
Inserted into basilic or cephalic veins with tip sitting in SVC, CXR used to check placement
Medium term use (weeks to months), tends to have a longer catheter vs central lines
IV admin of medication - abx, chemo
Poor peripheral access
99
Port-a-cath
Long term chemo or Abx.
100
Swan ganz catheter?
Used in ICU/ in cardiogenic or septic shock
Inserted into a central vein
Flow directed pulmonary artery catheter
Measure pulmonary capillary wedge pressure
Measure CO
101
Stiff neck cervical collar?
This is a stiff neck collar which is used to stabilise the cervical spine in a trauma patient when used in conjunction with 2 sand bags and tape (Triple Immobilisation).
Hole at the front for tracheal access.
They are sized by measuring the number of fingers from the clavicle to the angle of the mandible, and this is then compared to the measuring peg on the stiff neck collar.
102
Complications of chest drain?
Early
Pain
Haemorrhage due to NV bundle damage
Organ perforation
Incorrect location e.g. abdomen
Pneumothorax
Subcut emphysema
Late
Failure → bronchopleural fistula
LT n damage → winging of the scapula
Wound infection
Blockage
Obstruction, kinking, dislodging
Re-expansion pulm oedema
103
Surgical chest drains/thoracostomy
Sizing is measured in French (Ch) – smaller calibre drains used for pneumothorax, larger calibres needed for haemothorax, effusion and empyema.
Indications include: Pneumothorax, Malignant Pleural Effusion, Empyema, Traumatic pneumothorax or haemothorax, peri-operative.
104
thoracostomy vs seldinger technique
Larger diameter thoracostomy tubes require a blunt dissection technique procedure for placement (figure 1), whereas smaller diameter tubes and catheters can be placed using a percutaneous technique (ie, Seldinger technique over a wire) (figure 2) and cause less pain both during and after placement.
105
Complications of surgical drains?
Ascending infection
Foreign body reaction e.g. fibrosis, granulation
Migration
Obstruction/kinking
Fistulation
Tubes inserted into surgical field to allow decompression of fluid or air
Multiple uses in UGI, ortho, cardiothoracic, plastics, breast, H&N surgery
106
RediVac (Vacuum Drain)
Vacuum seal (Redi-Vac) – are high-negative pressure drains that draw fluids into the bottle. They are often used to reduce the incidence of seroma complications post surgery. They are commonly used post-breast surgery.
107
Drainage bag?
This is a drainage bag which can be connected to either a nasogastric tube or a drain coming out of the abdomen. Drainage relies on gravity, so this is an example of a closed passive drainage system.
108
ICD indications?
Sustained VT/VF
LVEF <35%
Brugada syndrome
Long QT syndrome
Surgical repair of congenital heart disease
HOCM
109
T tube
Biliary tree pathology - drainage
Ensures patency of distal Cystic Bile Duct
Can be removed after 6-10 days
110
Proctoscope indications?
Haemorrhoids
111
Laproscopic trocar
Indication: used to create entry ports in lap procedures
Several described techniques - Veress needle, Hasson technique. Once first port placed + pneumoperitoneum established the other ports are inserted under direct vision
CO2 is gas of choice - inert, highly soluble in blood and tissues, rapidly cleared by expiration
Complications
Initial entry carries highest risk of visceral perforation
112
Pacemaker indications?
AF with sinus ode synfunction
Third degree heart block
Symptomatic sinus bradycardia
Long QT syndrome
Cardiomyopathy
Sick sinus syndrome
Mobitz type II
AV block post MI
113
Unicompartmental knee arthroplasty
surgical technique used for the treatment of osteoarthritis in one compartment of the knee, most commonly in the medial compartment
114
Compartments of the knee?
Medial, patellofemoral, lateral
115
Where to tap in tinel's test
Middle of the wrist
116
Causes of carpal tunnel syndrome?
Diabetes.
Rheumatoid arthritis.
A cyst or tumor in your wrist.
Changes in certain hormones, which may cause swelling from extra fluid in your body. Examples include an underactive thyroid gland (hypothyroidism), pregnancy and menopause.
Problems with the way your wrist is formed.
Doing the same wrist and hand movements over and over, such as:
Assembly line work.
Carpentry or using tools that vibrate.
Knitting, gardening, or sports, such as golf.
117
Romberg test
a test that measures a persons sense of balance. Specifically, the test assesses the function of the dorsal column of the spinal cord (the dorsal column is responsible for proprioception).
Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception. If a patient is ataxic and Romberg's test is not positive, it suggests that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction instead.
118
Post-vascular exam ix?
blood pressure measurement, cardiovascular examination, ABPI)
119
Important parts of vascular exam?
Assess and compare the temperature of the lower limbs
Assess the capillary refill time of the lower limbs
120
Dysdiadochokinesia&dysmetria meaning?
Dysdiadochokinesia slowed or clumsy alternating supination/pronation of upper extremities, turning a doorknob, changing lightbulb movements, foot-tapping, and abdomen tapping. Dysmetria-inaccurate finger-to-nose and heel-to-shin testing
121
Cerebellar signs?
Dysdiadokinesia / dysmetria.
Ataxia.
Nystagmus.
Intention tremor.
Speech - slurred or scanning.
Hypotonia.
122
Gait (Acute Cerebellar Ataxia)
Acute cerebellar ataxia is a wide based and staggering gait.
123
Hereditary motor and sensory neuropathy
CMT
124
pes cavus
High foot arches
125
Peripheral neuropathy causes
A – Alcohol
B – B12 deficiency
C – Cancer (e.g., myeloma) and Chronic kidney disease
D – Diabetes and Drugs (e.g., isoniazid, amiodarone, leflunomide and cisplatin)
E – Every vasculitis
126
Motor polyneuropathies
chronic demyelinating inflammatory polyneuropathy, Guillain-Barré syndrome and Charcot-Marie-Tooth disease
127
Sensory polyneuropathies (glove and stocking)
diabetes mellitus, alcohol excess, chronic kidney disease and paraneoplastic syndromes
128
Polyneuropathy causes?
Idiopathic: no known cause (commonly a small fibre painful neuropathy)
Diabetes mellitus
Systemic illness: critical illness polyneuropathy, hypothyroidism, chronic kidney disease, chronic liver disease, amyloidosis
Autoimmune: Guillain-Barré syndrome
Inflammatory: chronic inflammatory demyelinating polyneuropathy (CIDP)
Toxic: Alcohol, chemotherapy, heavy metals
Neoplastic: myeloma, paraneoplastic syndrome
Hereditary: Charcot-Marie-Tooth
Nutritional: Vitamin B12, folate, pyridoxine, vitamin E deficiencies
Vasculitis
Medications: nitrofurantoin, isoniazid
129
CIPD?
acquired immune-mediated cause of polyneuropathy. As the name suggests, there is demyelination of peripheral nerves leading to the classic presentation of symmetrical sensorimotor polyneuropathy of which motor symptoms predominate in both proximal and distal muscle groups.
130
Polyneuropathy ix?
electromyography and nerve conduction studies).
Look for cause with blood test, genetic testing
131
Types of peripheral neuropathy
Radiculopathies
Polyneuropathies
Mononeuropathies
132
Causes of sensory ataxia?
Peripheral neuropathy (e.g. diabetes mellitus)
133
Causes of hemiplegic gait
Stroke
MS
SOL
(UMN)
134
Causes of Horner's syndrome?
Congenital, pancoast tumour, basal skull tumour, stroke, aortic dissection, neuroblastoma, herpes zoster, internal carotid artery dissection, cluster headache
135
NSTEMI changes?
ST depression, t wave inversion
136
When is T wave inversion normal?
T wave inversion is a normal variant in leads III, aVR and V1.
137
Psoriatic arthritis in the hands?
Nail pitting, joint swelling, dactylitis, plaques, uveitis
138
Smith's fracture?
A Smith's fracture is a volar displacement fracture where the fragment of the radius that has broken off projects towards the palm side of the hand, while a Colles fracture results in dorsal displacement, causing the bone fragment to bend towards the back of the hand.
139
Colles vs smith's mechanism of injury?
Colles fractures arise from falling on an outstretched hand. In contrast, Smith fractures are caused by falling on a flexed hand.
140
Differential Diagnosis for myopathy is a neurological cause rather than muscular:
MND, GBS, neuropathy, MG
141
Causes of opthalmoplegia?
Thyroid disease, MS, SOL, infection, migraines, stroke, congenital
142
Lymphoedema causes?
Surgery for cancer, radiotherapy, obesity, infection, primary, vascular disease, accidents
143
Extra-articular manifestations of RA?
nodules, anaemia, scleritis/episcleritis, dry mouth, pericarditis, ILD, malignancy, IBD??glomerulonephritis, felty's syndrome
144
Dull percussion causes?
Pleural effusion, consolidation, Pulmonary oedema
145
stoma complications?
Retraction, herniation, prolapse, stenosis, obstruction, skin irritation
146
Mercedes benz scar?
Liver transplant
147
Drugs post renal transplant?
Basiliximab is a monoclonal antibody targeting the interleukin-2 receptor on T-cells. Two doses are given after surgery to prevent acute rejection.
Patients require life-long immunosuppression to reduce the risk of transplant rejection. There are various options and combinations of:
Tacrolimus
Mycophenolate
Ciclosporin
Azathioprine
Prednisolone
148
Paramedian scar reasons?
Spleen, kidney, adrenal operations
149
Upper motor neuron lesions weakness?
Disproportionately affects upper limb extensors and lower limb flexors
150
when to do Invasive coronary angiography in NSTEMI?
Unstable patients
151
NSTEMI tx?
The management of patients with NSTEMI or UA can be remembered using the mnemonic BATMAN
B - Beta-blockers (unless contraindicated)
A - Aspirin (300 mg loading, then 75 mg once daily)
T - Ticagrelor (180 mg loading, then 90 mg twice daily), alternatively clopidogrel if high bleeding risk
M - Morphine (titrate for analgesia)
A - Antithrombotic agent (Fondaparinux 2.5 mg subcutaneous unless contraindicated)
N - Nitrates (sublingual nitrates to relief pain - consider infusion if ongoing pain)
152
Rigler's sign on AXR?
Rigler's sign is visible, and so obstruction has been complicated by perforation.
153
Paramedian incision?
Access to duodenum, stomach, spllen or kidnes
154
Feet puses?
the dorsalis pedis artery (DPA) and the posterior tibial artery (PTA)
155
Acute abdomen?
AAA, perforation, mesenteric ischaemia
156
Colic pain differentials?
biliary colic, ureteric colic, and bowel obstruction.
157
Bowel obstruction main causes?
Adhesions (small bowel)
Hernias (small bowel)
Malignancy (large bowel)
158
“drip and suck”:
Nil by mouth (don’t put food or fluids in if there is a blockage)
IV fluids to hydrate the patient and correct electrolyte imbalances
NG tube with free drainage to allow stomach contents to freely drain and reduce the risk of vomiting and aspiration
159
Fistula assesment?
Look for signs of recent use (e.g. dressings or needle entry)
Palpate for thrills (should be continuous) and a pulse (should be soft and easily compressible)
Elevate the upper limb and assess for its collapse
160
Auscultate for renal bruits where?
1cm superior and lateral to the umbilicus
161
Peritoneal Dialysis vs haemodialysis?
Peritoneal can be done from home. Fewer dietary and fluid restrictions. Has to be done daily. Requires constant tubing. Risk of peritonitis. Malnutrition
Haemodialysis requires 3-5x a week hospital visits
162
Post-abdomen exam ix?
External genitalia, hernia orifices (surgery ), obs, urinalysis
163
Complications of nasopharyngeal airways
Nasal trauma & bleeding
NOT for use in base of skull fractures
164
Complications of monopolar diathermy?
Burns (metal)/ fires (alcohol wash)/PPM dysfunction/environmental safety
165
Chronic inflammatory demyelinating polyneuropathy (CIDP)?
neurological disorder that involves progressive weakness and reduced senses in the arms and legs. It is caused by damage to the fat-based protective covering on peripheral nerves called the myelin sheath. Symptoms of CIDP are: Tingling or no feeling in fingers and toes.
166
