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Year 2- ICM > ICM > Flashcards

ICM Flashcards

1
Q

What is this?

A

Staghorn Calculus of the left kidney

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2
Q

What is this?

A

Calcified gallstone

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3
Q

What is the abnormality and what is visible in the colon?

A

Watch batteries are visible in the stomach and faeces is visible in the colon

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4
Q

What is this?

A

Ureteric calculus

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5
Q

What is wrong in this X-ray?

A

Missing left leg

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6
Q

What is the pathology here and what may have caused it?

A

Air is present in the biliary tree, possibly caused by a cholecystectomy

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7
Q

What are the folds called in the large bowel and are they complete or incomplete?

A

Haustra, and they are incomplete

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8
Q

What are the folds in the small bowel called and are they complete or incomplete?

A

Valvulae conneventes- they’re complete

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9
Q

What is the most common cause of large bowel obstruction?

A

Tumour

Other causes- Sigmoid volulus of the sigmoid colon.

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10
Q

What is the pathology visible here?

A

Dilation of the small bowel

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11
Q

What can cause small bowel obstruction?

A

Adhesions

Hernias

Peritoneal tumour

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12
Q

What is visible in this x-ray?

A

Air under the diaphragm

Could be caused by bowel perforation

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13
Q

What is the name of the sign in this film?

A

Rigler’s sign

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14
Q

What signs indicate small bowel dilatation?

A

Valvulae conneventes (go all the way across)

Multiple loops

Central

No faeces present

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15
Q

4 signs that help you to determine it is the small bowel you are looking at on a abdominal radiograph?

A
  1. Folds go all the way across- Valvulae Conniventes
  2. No faeces present
  3. Central location and cannot be traced all the way around
  4. There is bowel adjacent to bowel
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16
Q

What position is an abdominal radiograph taken in?

A

Supine

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17
Q

What diameter indicates small bowel dilatation?

A

> size indicates 3cm

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18
Q

What is the maximum normal diameter of the large bowel?

A

6cm

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19
Q

Is this large or small bowel?

A

Small bowel

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20
Q

What are the 3 main causes of small bowel dilatation?

A
  1. Obstruction from adhesions
  2. Hernias
  3. Peritoneal malignancy
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21
Q

What is the typical lesion seen in the large bowel when a tumour is present?

A

‘Apple core’ lesion

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22
Q

What is this and what causes it?

A

Sigmoid volvulous and it is caused by twisting of the bowel

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23
Q

What sign is present in these radiographs and what does it indicate?

A

Rigler’s sign

It indicates there is free air in the abdominal cavity

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24
Q

What is wrong in this radiograph?

A

Two fractures in the rt. pubic rami

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25
Q

Present this radiograph

A
  • Initially, no name, Hospital Number, Date film taken
  • There is a marker
  • No AP / PA marker – assume AP
  • No indication of whether supine or erect – assume supine at start
  • Bowel dilated –
  • Position – central and bowel next to bowel
  • Folds (valvulae conniventes) go all way across
  • ie. Small Bowel Dilation
  • Need erect Chest X-Ray to exclude perforation
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26
Q

What does each number refer to in this radiograph?

A
    1. Trachea
    1. Hilum – remember this comprises the bronchus, pulmonary blood vessels and the lymph nodes
    1. Lungs
    1. Hemidiaphragm
    1. Heart
    1. Aortic Arch
    1. Ribs
    1. Scapula or axilla
    1. Breast shadows
    1. Cardio-phrenic angle
    1. Costa-phrenic angle
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27
Q

What do you expect in a normal in a chest x-ray?

A

Position is PA and erect

Cardio-thoracic ratio should be less than 50%

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28
Q

What is wrong in this CXR?

A

It’s overexposed

Medical clips in the left lung

Patient has Situs inverta (NOT detrocardia as the stomach is also on the other side)

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29
Q

What is the pathology here?

A

Rt. Tension pneumothorax

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30
Q

How will a tension pneumothorax present?

A

Patient will be unwell

  • Tracheal deviation
  • Decreased chest expansion on right side
  • Hyperesonance on right side
  • No breath sounds on right side
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31
Q

What signs are worrying in this CXR?

A

Shadow in the Rt. lung

Unilateral pleural effusion (Lt. sided blunting of the costophrenic and cardiophrenic angles)

Increased Hilar markings

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32
Q

What is the pathology here?

A

Left pneumothorax

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33
Q

What will the rate be if there are 3 large squares beetween R waves?

How is this calculated?

A

100bpm

Number of large squares/ 300

34
Q
A
35
Q
A
36
Q

What is the sign visible in this abdominal x-ray and what causes it?

A

Thumbprinting

Occurs during mucosal oedema- Ulcerative colitis

37
Q

A 21-year-old woman is thrown from her horse at a local event. On the way to hospital she has become increasingly drowsy and the paramedics have inserted

an oropharyngeal airway and given high flow oxygen via a face-mask. Inspired oxygen 40% (FiO2 0.4)

**ABG shows: **
normal values
PaO2 18.8 kPa >10 kPa (75 mmHg) on air
pH 7.19 7.35 – 7.45
PaCO2 10.2 kPa 4.7 – 6.0 kPa
Bicarbonate 23.6 mmol l-1 22 – 26 mmol l-1

Is the patient Adidotic or alkalotic?

A

Acidotic

pH= 7.19

38
Q

What does this ECG show and what is the sign callled?

A

Atrial flutter

  • Saw-tooth sign
39
Q

What is happening in this ECG?

A

Atrial fibrillation

40
Q

What does this ECG show?

A

Ventricular fibrillation

41
Q

What does this ECG show?

A

Ventricular tachycardia

42
Q

What are the shockable rhythms in cardiac arrest?

A

Ventricular fibrillation

Pulseless ventricular tachycardia

43
Q

What inspiratory sounds are there , where do the arise and what do the indicate?

A

Snoring (Pharynx)- obstruction by soft tissues, soft palate, epiglottis of the larynx and tongue.

**Stridor (large diameter extrathoracic airways: larynx, trachea)- **indicates that the airway diameter is < 50% or < 4.5mm.

**Hoarseness (larynx)- **Oedema as above, tumours, trauma.

Gurgling (pharynx)- Liquid/semisolid: vomit, blood, secretions.

**Crowing (larynx)- **Spasm of the laryngeal muscles: stimulation when the airway reflexes are intact eg with instrumentation.

Drooling (pharynx and larynx)- Infection eg retropharyngeal abscess, acute epiglottis. Inability to swallow saliva.

44
Q

What expiratory sounds are there?

A

Stridor

Wheezing

45
Q

What signs show hypercapnoea?

A

Increased sympathetic activity: tachycardia, arrhythmias and hypertension.

46
Q

How do you open a patients airway without any equipment?

A

Head tilt, chin lift

47
Q

What are the contraindications to performing head tilt/chin lift?

A

Unstable cervical spine or trauma

Chin lift only or Jaw thrust

48
Q

What do you do when an adult is conscious, choking with an ineffective cough?

A

5 back blows

5 abdominal thrusts

49
Q

How long should it take to assess for ‘signs of life’ in a child before starting CPR?

A

A maximum of 10s

50
Q

How deep should chest compressions be?

A

A minimum of 1/3 the AP depth

51
Q

In paediatric BLS what ratio should chest compressions to rescue breaths be?

A

15:2

52
Q

A child is unresponsive, after shouting for help and opening the airway they are still not breathing properly.

What do you do next?

A

5 rescue breaths

53
Q
A
54
Q

What does this abdominal x-ray show?

A

Intersussesception

55
Q

What are the layers of the appendix, colon and rectum wall?

A

Mucosa
•Muscularis mucosa
•Submucosa: fat, nerves, blood vessels
•Muscularis propria: two layers of smooth muscle
•Serosa: layer of mesothelial cells (peritoneum)

56
Q

What tissue is this?

What are the layers indicated in the picture?

A

A section of the colon

A- Mucosa
B- Lymphoid follicle
C- Submucosa
D- Muscularis propria
E- Serosa

57
Q

What is ecchymosis?

A

Bruising not caused by any trauma

Caused by low platelet count

58
Q

What lines the crypts of the mucosa in the colon?

A

goblet cells

columnar cells with brush borders.
Endocrine cells.
Stem cells at the base

59
Q
A
60
Q

What is this and what is the most common cause?

A

Impetigo

Staph aureus

61
Q

What is this and what is it associated with?

A

Eczema or atompic dermatits

Associated with asthma and hayfever

62
Q

What is this?

A

Basal cell carcinoma

Caused by sunlight exposure
Pearly white and has rolled edges

63
Q

What is this?

A

Melanocytic naevus

64
Q

What is this and what features distiguish it?

A

Malignant melanoma

Asymmetrical, irregular border and colour,
increasing size

65
Q

What is this and how does it characteristically present?

A

Squamous cell carcinoma

rapidly expanding, painless,
ulcerated nodule, rolled indurated margin.
Commonly ulcerate and bleed

66
Q

What’s this condition and what is it associated with?

A

Psoriatic plaques

Psoriatic arthritis

67
Q

What is this condition called, how are the lesions described and what can cause it?

A

Erythema multiforme- target lesions

barbiturates, aspirin, sulphonamides,
herpes simplex , TB, mycoplasma, typhoid,
pregnancy, vit c deficiency, collagen vascular
disease, IBD

68
Q

What causes this condition and what is the treatment?

A

Shingles is caused by herpes zoster

Aciclovir 800mg 5x/day for 7 days

69
Q

What’s the treatment for this condition?

A

Treatment for ringworm is topical antifungal therapy

Oral terbenfaine/itraconazole

70
Q

What is this?

A

Erythema nodosum

71
Q

What is this and what is it associated with?

A

Pretibial myxedema

Associated with Grave’s disease

72
Q

What conditions is this associated with?

A

Butterfly rash is associated with:

SLE, Pellagra, Dermatomyositis

73
Q

What can be used to try and restore sinus rhythm in an unstable patient with a tachycardia (>150bpm or >100bpm if serious chronic disease)?

A

Synchronised cardioversion

If this fails then 300mg Amiodarone over 20mins then re-attempt cardioversion

74
Q

What are the 4 steps in ALS that need to be taken to treat an adult tachycardia with a pulse before medications or shocks should be considered?

A

Assess using the ABCDE approach
Give oxygen if appropriate and obtain IV access
Monitor ECG, BP, SpO2 , record 12-lead ECG
Identify and treat reversible causes (e.g. electrolyte abnormalities)

75
Q

What does this ECG tracing show?

A

Torsades de pointes

76
Q

According to ALS guidelines, what factors determine whether you use cardioversion or medivcation to treat tachycardia?

A

If the patient is stable or there are no adverse features (Shock, syncope, MI or heart failure) then medical management should be used. Otherwise cardioversion is the treatment of choice.

77
Q

Accodring to ALS guidelines if a patient has bradycardia and adverse features (Shock, syncope, MI, heart failure) what should be given?

A

Atropine 500mcg IV

78
Q

What’s the difference between a direct and an indirect inguinal hernia?

A

A DIRECT hernia, pushes into the inguinal canal and enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)

An INDIRECT hernia, is the protrusion of the viscus through the deep inguinal ring.

79
Q
A
80
Q

What does this ECG show?

A

An inferior STEMI

  • ST elevation visible in aVF, II and III
81
Q

What does this ECG show?

A

Inferior STEMI

82
Q
A

Year 2- ICM (2 decks)

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