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Year 1 Medicine - ICM > ICM Questions > Flashcards

ICM Questions Flashcards

1
Q

What is “Stony Dull” sound on percussion indicative of?

A

Fluid in Pleural Cavity

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2
Q

What is “Dull” sound on percussion indicative of?

A

Pneumonia, atelectasis, (solid organ enlargement)

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3
Q

What is “Resonant” sound on percussion indicative of?

A

Normal

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4
Q

What is “Hyperresonant” sound on percussion indicative of?

A

Pneumothorax, COPD, bullae

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5
Q

When prescribing what does the term “MANE O.M.” mean?

A

in the morning

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6
Q

When prescribing what does the term “STAT” mean?

A

Immediately

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7
Q

A patient has a complete airway obstruction, what should you do?

A

CPAP and maximum % oxygen until Anaesthetist and Surgeon arrive
Cricothyrotomy - if pt deteriorates and help does not arrive

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8
Q

What does the Glasgow Coma Scale (GCS) rate?

A

Conscious level of patient (3-15)

Takes into account eye opening, motor and verbal response

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9
Q

What happens to cells in:

1) Hypotonic solution; 2) Hypertonic Solution

A

1) Hypotonic solution - Cell Swell

2) Hypertonic Solution - Cell Shrink

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10
Q

What controls the distribution of fluid between the ECF and ICF?

A

Na/K ATPase

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11
Q

What is so Abnormal about “Normal Saline”?

A

↑Cl - causes hyperchloraemic metabolic acidosis

Leading to hyperkalaemia

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12
Q

Name some Crystalloids

A

Hartmanns Solution

5% Dextrose

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13
Q

What are the problem associated with giving too much 5% Dextrose?

A

Glucose is metabolised by RBCs, the water that is left is HYPOTONIC and is distributed throughout the tissues
Water enters cells

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14
Q

Name a Colloid

A

Gelafusine - consists of electrolytes + larger weight molecule
Hypertonic - water will diffuse out of cells

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15
Q

What are the possible causes of Cardiac Arest?

A 
4Ts & 4Hs
Tension Pneumothorax
Caridiac Tamponade
Toxins
Thrombosis
Hypoxia
Hypovolaemia
Hyper/Hypokalaemia/Hypocalcaemia
Hypothermia
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16
Q

What should be checked on “A”?

A

Airway

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17
Q

What should be checked on “B”?

A 
RR
Respiratory Pattern
Trachea position
Palpation/Percussion/Ausculation
SpO/FlO2
Arterial blood gas
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18
Q

What should be checked on “C”?

A 
ECG 3 lead continuous monitoring
Pulse rate + rhythm + volume
BP
JVP
CRT
Auscultation
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19
Q

What should be checked on “D”?

A

GCS/AVPU
Pupils
Blood Glucose

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20
Q

What does NEWS stand for?

A

National Early Warning Score

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21
Q

What is Resuscitation Algorithm?

A

Signs of life? (15 secs)
Call Resuscitation Team
CPR 30:2
Apply Pads/Monitor

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22
Q

What do you look for on inspection for the Upper and Lower Neuro exam?

A 
Posture
Muscle Bulk
Scars
Fasciculation
Involuntary movements (tremors, tics, chorea, athetoid)
Ulceration
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23
Q

What are Choreiform movements?

A

Involuntary movements - rapid and jerky

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24
Q

What are Athetoid movements?

A

Involuntary movements - Sinous and writhing

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25
Q

What scale is used to assess Power as part of the neurological exam?

A

MRC
0 - No muscle contraction
1 - Flicker of movement
2 - Able to move but NOT against gravity
3 - Movement against gravity BUT NOT against Resistance
4 - Against Resistance - but NOT full strength
5 - Full Strength

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26
Q

What is Rhomberg’s Test used to differentiate between?

A

Ataxic gait due to proprioceptive disturbance (+ve) vs cerebellar disease (-ve)

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27
Q

What is Allen’s Test?

A

Close off radial +ulnar arteries -> hand goes white
Let go of ulnar artery -> should go red
If not, ulnar artery is not sufficient

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28
Q

What can splinter haemorrhages be indicative of? (cardio exam)

A

Subacute infective endocarditis

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29
Q

What can Koilonychia be indicative of? (cardio exam)

A

Iron Deficiency

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30
Q

What can Leuconychia be indicative of? (cardio exam)

A

Hypoalbuminaemia

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31
Q

What can Osler’s Nodes be indicative of? (cardio exam)

A

Bacterial endocarditis

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32
Q

What can Janeway lesions be indicative of? (cardio exam)

A

Infective Endocarditis

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33
Q

What is Xanthelasma?

A

Yellow (cholesterol) deposits around the eye

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34
Q

What is collapsing pulse testing for?

A

Aortic Regurgitation

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35
Q

What valves are heard to close on S1 and S2?

A

S1 - mitral and tricuspid

S2 - aortic and pulmonary

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36
Q

What added sounds can be heard on heart auscultation?

A

S3 - physiological (<30yrs); or pathological (consider heart failure)
S4 - can be heard before S1, pathological

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37
Q

What can be heard in mitral and aortic stenosis?

A

A CLICK - on valve opening (normally silent)

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38
Q

Describe the Korotkoff sounds

A

Phase 1 - Sharp Tapping (systolic pressure)
Phase 2 - swishing sound
Phase 3 - Tapping
Phase 4 - Tapping sounds replaced by muffled sound
Phase 5 - Sounds cease altogether (diastolic pressure)

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39
Q

What can the different colours of sputum suggestive of?

A 
Grey - COPD
Yellow - Infection (e.g. pneumonia)
Green - Bronchiectasis/Abscess
Red - PE, Pulmonary carcinoma
Rusty/Gold - Pneumococcal pneumonia
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40
Q

What is Asterixis (Flapping Tremor) suggestive of (Resp Exam)?

A

Metabolic Encephalopathy

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41
Q

What organisms would you look for from a High Vaginal Swab?

A

Candida albicans/Gardnerella vaginalis

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42
Q

What organisms would you look for from an Endocervical swab?

A

Chlamydia trachomatis/Neiserria gonorhoeae

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43
Q

If oxygen supply is stopped, how long can the stored oxygen last?

A

3 minutes in a 70kg male

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44
Q

What is the most reliable method to detect whether intubation has been successful?

A

Carbon dioxide waveform and maximum partial pressure (Capnogram)

45
Q

How do you know that the cuff of an endotracheal tube has been optimally inflated?

A

Pressure too low = leak, hypoxaemia, hypercapnia + aspiration risk

46
Q

How long is the period of time that intubation should be done in?

A

20-30 seconds (Max 2 attempts)

47
Q

What do you do if you can’t intubate the trachea?

A

Ventilate using non rebreathing self inflating bag-valve-mask

48
Q

What are the contraindications for oral tracheal intubation?

A

Inability to open mouth
Inabilioty to move neck
Pathology in upper airway
Friable: fragmentation, haemorrhage, oedema

49
Q

What are the complications associated with tracheal intubation?

A

Laryngeal trauma
Oesophageal trauma ->✞
Bronchial intubation
Dental Trauma
Airway Reflexes: Laryngeal spasm, Coughing, Bronchospasm
↑Sympathetic activity: ↑BP, arrhythmias, MI, ↑Intracranial pressure

50
Q

In what patients should you avoid the use of a Laryngeal Mask Airway?

A

Pregnant
Obese
Alcoholic + Ate a lot

51
Q

How is a nasopharyngeal airway measured?

A

Tragus of ear to tip of nose

52
Q

How is an oropharyngeal airway measured?

A

Incisor teeth to angle of jaw

53
Q

What are the indications for intubation?

A

Surgery
If aspiration is a possibility
Airway may collapse (anaphylaxis, burns)

54
Q

What is guarding?

A

Reflex contraction due to inflammation of the parietal peritoneum

55
Q

Where can IM injections be given?

A

Deltoid muscle
Dorsogluteal muscle
Vastus Lateralis muscle

56
Q

What are the features of an IM injection into the Deltoid Muscle?

A

1mL
Easy Access
Fast Absorption

57
Q

What are the features of an IM injection into the Dorsogluteal Muscle?

A

5mL
Slow Absorption Rate
(Double Cross method)

58
Q

What are the features of an IM injection into the Vastus Lateralis Muscle?

A

4mL

Fast Absorption

59
Q

At what angle should venopuncture be performed?

A

10-15

Why? -Reduces risk of trauma to underlying structures

60
Q

What size of cannula requires anaesthesia?

A

> 20G use lignocaine (topical/subcut)

61
Q

What complications are associated with Cannulation?

A

Vasovagal syncope (sinus brady & sometimes asystole)
Venous haemorrhage
Arterial Cannulation - immediate severe pain + paraesthesia
Infection (Staph epidermidis, Staph aureus, enterococcus)
Embolism
Nerve Injury
“Tissueing” -extravasation, fluid goes into tissues instead of blood

62
Q

What viruses are transmitted during a needlestick injury?

A

Hep B
Hep C
HIV

63
Q

What are the contraindications for cannulation?

A

Mastectomy, fistulas, fractures -> use opposite limb

64
Q

What is the angle of entry during cannulation?

A

20-40

65
Q

What is the speed and calibration on an ECG?

A

25mm/sec
i.e. large square= 0.2s; small square 0.04s
1cm = 1mV

66
Q

Where do the V leads (ECG) look?

A 
V1+V2 = Right Ventricle
V3+V4 = Septum
V5+V6 = Left Ventricle
67
Q

How do you position the ECG leads?

A 
V1 = 4th intercostal space (R)
V2 = 4th intercostal space (L)
V4 = 5th intercostal space mid clavicular line
V3 = between V2 and V4
V5 = anterior axillary line
V6 = mid-axillary line
68
Q

What does a P wave signify? (ECG)

A

Atrial depolarisation

69
Q

What does a Q wave signify? (ECG)

A

Septal depolarisation

70
Q

What do RS waves show? (ECG)

A

Ventricular depolarisation to apical epicardium and then widespread to surface

71
Q

What are the features of a 3 Lead ECG?

A

Can tell rhythm changes

Part of Minimal Mandatory Monitoring (O2, BP, ECG)

72
Q

When attaching the leads for a 12 Lead ECG, where do the Red, Yellow, Green and Black leads go?

A 
Red = RA (right arm)
Yellow = LA
Green = LL
Black = RL
73
Q

How can you tell dextrocardia from an ECG?

A

P wave inverted in lead I
Poor R wave progression
To confirm: position chest leads on Right Side

74
Q

What are the Fraser Guidelines?

A

Followed when prescribing contraception for women under 16 yrs - is the child mature enough to make decision?

75
Q

What are combined hormonal contraceptives?

A

Contain oestrogen and progesterone

76
Q

What are adv. and disadv, of combined hormonal contraceptives?

A 
Reliable & Reversible
Reduced dysmenorrhoea & Menorrhagia
↑Breast + endometrial cancer
↓Ovarian & Cervical cancer
↑CVA, DVT, migranes
77
Q

What are women at the increased risk of when taking oral contraceptives?

A

DVT during travel

78
Q

When are progestogen only contraceptives indicated?

A

When oestrogens are contraindicated (h/o DVT)
Suitable for older women
People with migraine
DM

79
Q

What are the options for Emergency contraception?

A

Levonorgestrel (effective within 72hrs)
Ulipristal (effective within 120hrs)
Should be taken asap
Efficacy decreases with time

80
Q

What level does the knee reflex test?

A

L4 (femoral nerve)

81
Q

What level does the ankle reflex test?

A

S1 (sciatic nerve)

82
Q

What can the external anal sphincter tone tell you?

A 
↑Tone = UMN pathology
↓Tone = LMN pathology
83
Q

What is Gower’s sign? ( assessing gait, neuro exam)

A

Patient climbs up himself to stand (cannot stand-up without using hands)

84
Q

What symptoms would you get with central and posterolateral disc protrusion?

A

Central - Leg pain (bilateral), Reflex loss, Paraesthesia, sphincter paralysis
Posterolateral - affects one nerve root, therefore symptoms reflect this, no autonomic symptoms

85
Q

What are the actions of sympathetic and parasympathetic stimulations on the eye?

A

Parasympathetic system - circular muscles contract (constrict)
Sympathetic system - radial muscles contract (dilate)

86
Q

What structures will retinal artery obstruction affect?

A

Anterior retina
Posterior ciliary arteries supply posterior retina, fovea/macula, optic nerve head and photoreceptors (therefore won’t be affected)

87
Q

What is classed as “legally blind”?

A

6/60

88
Q

What signs should be looked for when taking a history regarding the Neck?

A

5 Ds and 3 Ns
Dizziness, Drop attacks, Diplopia, Dysarthria, Dysphagia
Ataxia
Nausea, Numbness, Nystagmus

89
Q

What myotomes are tested in the neck assessment?

A 
C1 - Cx Sp Flx
C2 - Cx Sp Ext
C3 - Cx Sp Side Flex
C4 - Shoulder elevation
C5 - GH Abd
C6 - Elbow Flex
C7 - Elbow Extension
C8 - Thumb Extension
T1 - Finger Abduction
90
Q

What is the function of the Dartos Muscle in the male genitalia?

A

Wrinkling of scrotum when cold

91
Q

What is the function of the Cremaster Muscle in the male genitalia?

A

Draws testicles in in cold/during exercise

92
Q

What is the venous drainage of the testicle

A

Pampiniform plexus -> Lt Renal Vein (L) & IVC (R)

93
Q

What do Seminiferous tubules do?

A

Make sperm & testosterone

94
Q

What is the difference between direct and indirect inguinal hernia?

A

Indirect: commonly descends into scrotum
Direct: Rarely descends into scrotum

95
Q

What are the 5Ps to ask for in a sexual history?

A 
Partners
Prevention of pregnancy
Protection from STIs
Practices
Past STIs
96
Q

What is Paediatric Basic Life Support Algorithm outline? (up 12 yrs of age)

A

1)Unresponsive?
2)Not breathing Normally?
3)5 Rescue breaths
4) 15 chest compressions
Continue 15:2

97
Q

What is an average RR for a 1 yr old?

A

30-40

98
Q

What is an average RR for a 1-2 yr old?

A

26-34

99
Q

What is an average RR for a 5-12 yr old?

A

20-24

100
Q

What is an average RR for 12 yrs and over?

A

12-20

101
Q

What is the average HR for a newborn?

A

140

102
Q

What is the average HR for a 3mnts-2yrs?

A

130

103
Q

What is the average HR for a 2-10yr old?

A

80

104
Q

What do you do with a child who is conscious and choking? (ineffective cough)`

A

5 back blows

5 thursts

105
Q

What do you do with a child who is conscious and choking? (effective cough)`

A

Encourage cough

106
Q

What are the signs of shock?

A

1) Pallor
2) Tachycardia
3) Decreased capillary return
4) Air hunger
5) Oliguria

107
Q

What is Kussmaul breathing indicative of?

A 
Labored breathing (hyperventilation)
Indicative of metabolic acidosis
108
Q

What are the roles of Cinnamon, Vanadium and Chromium in the treatment of diabetes?

A

↑ sensitivity to insulin

109
Q

What should happen to any UNEXPECTED blood glucose result ranging 20mmols/l?

A

Reading should be verified by sending off a grey topped bottle to analysis (venous blood sample)

Year 1 Medicine - ICM (1 decks)

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