Mock 4 Flashcards
A 58-year old man underwent surgery for varicos veins of the leg. He is now complaining of numbness on the medial side of his foot. What is the SINGLE most likely nerve involved?
A. Common peroneal nerve B. Tibial nerve C. Sural nerve D. Saphenous nerve E. Medial plantar nerve
SAPHENOUS NERVE
- Remember that it is the largest cutaneous branch of the femoral nerve
- a strictly sensory nerve with no motor functions
Loss of sensations in medial foot. Structure involved?
Saphenous nerve
Loss of sensations in lateral foot
Sural nerve
- Tibial Nerve (through the MSC medial sural cutaneous n.) + Common peroneal nerve (through the lateral cutaneous nerve LCN) as conjoined by the Peroneal communicating nerve
- it courses posterior to lateral malleolus
A 50-year old man complains of a productive cough over the past 12 months and the development of greenish coloured sputum. 20-pack yr smoker. In the past 3 years, admitted in 4 occasions to the hospital with cough and purulent sputum. PE: (+) clubbing, (+) coarse crackles.
Lung function: impaired - evidence of an obstructive pattern
CXR- normal
HRCT - bronchial dilatation, thickening bronchial walls, lack of bronchial tapering
A. Sq CA of the lung B. Mesothelioma C. Bronchiectasis D. Bronchial Asthma E. COPD
Bronchiectasis
- typical presentation: chronic cough, excessive sputum production
Gold standard for the diagnosis oof bronchiectasis
Chest HRCT
Characteristic HRCT findings seen in bronchiectasis
bronchial dilatation - tram-track or signet ring sign
Lack of bronchial tapering
Bronchial wall thickening
Describe the murmur seen in Paten Ductus Arteriosus
Continuous machinery-like murmur
Left infraclavicular area or upper left sternal border
75-year old man presents with difficulty swallowing both solids and liqiuds, While he admits to having a mild and more bearable difficulty in swallowing for the past 3 years, his symptom has worsened over the past two weeks, and he has been unable to drink or eat since yesterday despite maintaining a good appetite. He was diagnosed with esophageal cancer a year ago, which had metastasized to the liver and lungs at the time. Additionally, he reports that he lost 2 kg of body weight since the time of diagnosis. Provided the stage of cancer and the age of the patient, surgery was not a feasible option. He understands the implications of his diagnosis and wishes to live in comfort for the remainder of his time. Which of the following is the most appropriate management of this patient?
Esophageal stent
A 20-year old was found unconscious on the floor at the park in the early morning after a night out with his friends in the pub. The paramedics are unable to arouse him. He smells of alcohol. He has a heart rate of 100bpm RR 18cpm, CBG of 1.2. No IV access. Single most appropriate mgt?
A. Glucagon 1mg IM B. Glucagon 2mg IM C. Oral glucose gel 4g buccal D. Insert IV line and give glucose 20% 75mL IV E. Novorapid 10u SC
D
Paramedics are trained to obtain IV access
Patient is hypoglycemic and unconscious, either IM glucagon or glucose /IV is an option. However, since patient might also be alcohol-intoxicated, glucagon is ineffective to ROH-related hypoglycemia.
IV glucose over 10 mins
75mL of 20% glucose
OR
150mL of 10% glucose
IV glucose over 15 mins
100mL of 20% glucose
OR
200mL of 10% glucose
How to give IV glucose
10% solution of 50mL repeatedly q1-2mins until patient is conscious or 250mL has been given
A 33-year old man has lower back pain shooting down his right leg that started two days ago after lifting heavy boxes. He has intact ankle and knee jerk reflexes. He has reduced sensory stimulus on the dorsum of the right foot. Which nerve root is likely affected?
A. L3 B. L4 C. L5 D. S1 E. Cauda equina
C. L5
Which lumbosacral nerve root causes knee jerk reflex changes?
L3-L4
Which lumbosacral nerve root causes ankle jerk reflex changes?
S1 and S2
