Miscellaneous stuff I get wrong - part 2 Flashcards
Define mild traumatic brain injury
brief LOC <30 mins
headache
amnesia lasting <24 hours
GCS 13-15
CT normally NAD
Define moderate traumatic brain injury
LOC >30 mins <24 hours
amnesia <7 days
GCS 9-12
potential Sx: severe headache, repeated eps vom, convulsions, pupil dilatations, loss coordination
+/- CT scan changes
Define severe traumatic brain injury
LOC >24 hours
post traumatic amnesia >7 days
GCS 3-8
familial hypocalciuric hypercalcaemia
affects ca sensing receptors in parathyroid glands + kidneys
mildly elevated Ca
normal/mildly elevated PTH
Ca not excreted in urine
rarely symptomatic, does not usually req Tx
encapsulated thyroid carcinoma with brain mets?
follicular thyroid carcinoma
Mx arterial bleed from laceration
torniquet application above systolic BP
after venous draining
Mx venous bleed from laceration
pressure dressing of wound
immediate Mx for all patiets GCS 8 or <
intubate
pulse oximetry 95% or less in pre operative clinic –>
ABG
pre-operative neck cirucmference of >60cm –>
35% difficult intubation
pre-operative - bicarb >25 in obese people
likely 2’ to sleep apnoea/ obesity hypoventilation syndrome
–> hence sleep studies indicated
necrotising fascitis Mx regime:
surgical debride
ampicillin 2g IV 4’
clindamycin IV
ciprofloxacin
fracture with reduced blood flow - 1st step
reduce fracture to attempt revascularisation before surgical Mx
shoulder pain after FOOSH + lateral tenderness with normal ROM?
acromioclavicular joint sprain
Mx complex regional pain syndrome type 1
sympathetic nn block around paravertebral sympathetic ganglia
physio
Mx complex regional pain syndrome type 2
surgical mx e.g. if in wrist - carpal tunnel release as are 2’ to nerve injury
FOOSH + wrist/hand pain + median Nn symtpoms?
lunate dislocation
hamate fracture vs hook of hamate fracture Sx
both ps with ulnar nn symptoms
hook of hamate tends to be delayed Sx
gastrocnemius vs soleus vs sural flap
gastrocnemius - good for proximal 1/3 leg injury
soleus - good for middle 1/3 leg injury
sural - good for distal 1/3 leg injury
typical torniquet pressure for upper arm operation
250mmHg
typical torniquet pressure for thigh operation
300mgHg
APLS lifelong Tx
low dose aspirin
Gastoschisis
Isolated abnormality, bowel lies outside abdominal wall through defect located to right of umbilicus
Omphaleocele
Liver and gut remain covered with membranous sac connected to umbilical cord. It is associated with other developmental defects.
cut off for USS with Ix Perthe’s
3 months
Imagine for developmental dysplasia of the hip if missed on XR
MRI
Greenstick fracture vs Buckle fracture
Greenstick: unilateral cortical disruption + haematoma
Buckle: periosteal haematoma only
Ladd’s procedure
paediatric surgical procedure for intestinal malrotation
= laparotomy + division of adhesional bands
bowel returned to abdo in non-rotated fashion ie caecum on left, small bowel on right
usually + an appendicectomy to avoid confusion in future
midgut volvulus in paeds what happens
bowel undergoes a 720’ twist, the bowel viability depends upon a narrow mesentery containing the superior mesenteric artery
Ix midgut volvulus (+ positive results)
abdominal ultrasound scan - determine the relationship between the superior mesenteric artery and vein (normally SMA lies to the left of the SMV).
+ upper GI contrast series - establish that the DJ flexure is correctly sited to the left of the vertebral bodies.
SMA + DJ flexure should be LEFT to SMV + VB respectively
what is osteogenesis imperfecta + PS
congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine.
–> failure of maturation of collagen in all the connective tissues
PS:
translucent bones,
multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification)
trefoil pelvis
Bronchogenic cyst cause
anomalous development of the ventral foregut
Hirschprung’s first line Mx
enemas of either dilute gastrograffin or N-acetyl cysteine
(C/I if suspect perforation)
Hypospadias most common location
distal ventral side of penis
Kocher’s criteria septic arthritis
Kocher’s ‘WIFE’ is:
WCC >12
Inability to weight bear
Fever
ESR >40
= >90% chance of septic arthritis
Biliary atresia surgical Mx
Roux-en-Y portojejunostomy
which bacteria tends to colonic plastic devices e.g. breast implant
staph epidermidis
most common causative organism septic arthritsi
staph aureus
which bacterial gastroenteritis are birds associated with
Campylobacter jejuni
grey membrane in soft palate/oropharynx indicates which infection
diphtheria
which bacteria is associated with Ca colon?
strep bovis
What drain should be used to prevent seroma post breast surgery
use a Redivac type system that is made of polypropylene.
= a closed suction drain
what % of iron in the body is found in haemoglobin
70%
use of culposuspension
stress incontinence
Ependymoma - where in the brain and who gets it
33% of paeds tumours <3
arises from 4th ventricle and can grow through the foramina of Luschka and Magendie
what’s Berrys sign
Absence of carotid pulse due to malignant thyromegaly.
noradrenaline effect
alpha agonist
vasopressor action
minimal effect on CO
adrenaline effect
alpha + beta agonist
incr CO + PVR
dopamine effect
beta 1 agonist
incr contractility + rate
dobutamine effect
beta 1 +2 agonist
incr CO
decr SVR
milrinone effect
PDE inhibitor
incr cAMP levels –> improves mm contractility
short half life
where do the tinea coli converge
base of the appendix
which nn is the main responsible for the tonsillar fossa?
glossopharyngeal nn
transenamic acid - mechanism of action
plasmin inhibitor
important urinary base buffer?
phosphate
Ix of choice pre-operatively for localising a pituitary adenoma
Sestamibi scan
adhesive capsulitis vs rotator cuff tear - ROM
AC - both active and passive reduced
RTT - active reduced only - near normal passive ROM
Ix of choice to rule out urethral injury
retrograde urethrogam
patient on steroids pre-op - how to change regime
increase for 3 days to mimic HPA axis
acetabular fracture - which nn is affected
peroneal branch of sciatic nn
Hirschprungs vs small bowel atresia
Hirschprungs - failure to pass meconium in 48 hours
small bowel atresia - bilous vom, abdo distention, failure to pass further stools after meconium, distended loops w/ fluid level
stroke location - contralateral lower limb weakness and loss of sensation
ACA
where is the largest amount of pectinae musculae found in the heart?
RA
relation of sympathetic trunk to lung pleura
posterior to the parietal pleura
8 branches of the ECA - which are anterior, posterior medial + terminal branches
anterior - sup thyroid, facial + lingual
medial - pharyngeal aa
posterior - post auricular, occipital
terminal - maxillary, superficial temporal
relation to chorda tympani to the pars ear
runs medially to the pars flaccida
what are the 4 collateral venous return systems if the SVC is obstructed
Azygos venous system
Internal mammary venous pathway
Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
IVC tributaries (+ mnenomic)
I Like To Rise So High
Iliacs
Lumbar
Testicular
Renal
Suprarenal
Hepatic vein
which membrane does the cephalic vv pierce to terminate into the axillary vv (+ what is it a continuation of)
corocoid membrane
continuation of clavicopectoral fascia)
DRE - what would you feel anteriorly
Seminal Vesicle-
DRE - what would you feel posteriorly
Sacrospinous Ligament
DRE - what would you feel posterolaterally
Puborectalis
causes of raised TLCO (carbon monoxide transfer factor) (4)
asthma,
haemorrhage,
left-to-right shunts,
polycythaemia
what hormone stimulates prolactin release
TRH
Thyrotropin releasing hormone
which clotting factors are temperature sensitive
V
VIII
medical Tx carcinoid syndrome
octreotide (because it is the synthetic alternative to somatostatin)
ductal vs lobular carcinoma of the breast - which is more likely to mets to the contralateral breast?
lobular
Hurthle cell tumours prominent features
prominent oxyphil cells
scanty thyroid colloid
aka a subtype of follicular thyroid carcinoma
which type of biliary disease is HIV associated with
primary sclerosing cholangitis
Hyperhydrosis spinal level mnemonic
T2 & T3 Make the hands sweat-free
ECA, facial nn retromandibular vv over parotid - which is most sup + which is deepest
facial nn = most sup
retromandibular = middle
ECA = most deep
mm inn by ANSA CERVICALIS mnemonic
GHost THought SOmeone STupid SHot Izzy
GenioHyoid
ThyroidHyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid
structures crosses anterior and posteriorly - carotid sheath
anteriorly - hypoglossal nn + ansa cervicalis
posteriorly - cervical sympathetic chain
in what week do the pharyngeal arches develop
week 4 of embryonic growth
= series of mesodermal outpouchings of the pharynx which fuse in the ventral line
pharyngeal arch 1 - muscles
mm mastication
ant belly digastric
mylohyoid
tensor tympani
tensor veli palatini
pharyngeal arch 1 - skeletal structures
maxilla
meckels
incus/malleus
pharyngeal arch 1 - arteries
maxillary
ECA
pharyngeal arch 1 - nerves
mandibular nerve (CN V)
pharyngeal arch 2 - muscles
buccinator
platysma
mm facial expression
stylohoid
post belly digastric
pharyngeal arch 2 - skeletal structures
stapes
styloid process
lesser horn + upper body of hyoid
pharyngeal arch 2 - aa
stapedial aa
sup thyroid aa
pharyngeal arch 2 - nn
facial CN VII
pharyngeal arch 3 - muscles
stylopharyngeus
pharyngeal arch 3 - skeletal structures
greater horn + lower part hyoid
pharyngeal arch 3 - endocrine
thymus
inf parathyroid
pharyngeal arch 3 - aa
ICA
CCA
pharyngeal arch 3 - nn
CN IX
pharyngeal arch 4 - muscles
cricothyroid
intrinsic mm soft palate
pharyngeal arch 4 - skeletal structures
thyroid
epiglottic
pharyngeal arch 4 - endocrine
sup parathyroid
pharyngeal arch 4 - aa
R SCA
Aortic arch (L)
pharyngeal arch 4 - nn
CNX + sup laryngeal nn
pharyngeal arch 6 - muscles
all intrinsic mm of the larynx except cricothyroid
pharyngeal arch 6 - skeletal structures
cricoid
arytenoid
corniculate
pharyngeal arch 6 -aa
R pulm aa
L pulm aa
DA
pharyngeal arch 6 - nn
CNX. + rec laryngeal nn
