MU4 Ward Round Pearls

Question 1

What do you think of with an isolated hyperbilirubinaemia?

Answer 1

Gilbert’s syndrome

Question 2

What is the medical term for sunken chest? What are its complications?

Answer 2

Pectus excavatum

Often asymptomatic but may cause displacement of the heart to the left and restricted ventilatory capacity

Question 2

What are two causes of pleural effusions due to abdominal causes?

Answer 2

Sympathetic effusion due to exudate (eg from subdiaphragmatic abscess or pancreatitis)

Hole in the diaphragm

Question 3

What are is the acronium for CXR interpretation?

Answer 3

A - Airways

B - Bones

C - Cardiac

D - Diaphragm

E - Effusion

F - Fields

Question 3

What are the 10 consequences of alcoholism?

Answer 3

Cirrhosis

Wernicke’s encephalopathy

Korsakoff psychosis

Cerebellar ataxia

Subdural/extra dural bleeds due to falls

Cardiac myopathy

Acute/chronic pancreatitis

Proximal myopathy

Peripheral neuropathy

Psychosocial

Question 5

What must be considered when perscribing atenolol in the elderly?

Answer 5

It is renally secreted therefore the dose must be reduced as renal function declines with age

Question 6

What is the MELD score used for?

Answer 6

Mortality for post-operative risk in patients with cirrhosis

Question 7

What infections are worried about with a patient without a spleen?

Answer 7

Pneumonoccus

Neisseria meningitidis

Haemophilus influenza`

Question 7

What should you think of when you see dilated chest wall vessels?

Answer 7

SVC compression

Question 7

What are the 4 causes of seizures in alcoholics?

Answer 7

1. Electrolyte disturbances
2. Subdural/Extradural bleed due to alcohol induced fall
3. Hypoglycaemia due to depletion of glycogen stores
4. Alcohol withdrawal

Question 8

What percentage of elderly females will have bacteria in the urine?

Answer 8

>70%

Question 9

What is empysematous pyelonephritis?

Answer 9

A severe infection of renal parenchyma where there is gas accumulation in the tissues. It is commonly seen in diabetics. Can be fatal if not treated.

Question 11

How do you calculate the MAP?

Answer 11

1/3(Systolic - Diastolic) + Diastolic

Question 13

What should you have in the back of your mind with Italian patients?

Answer 13

Thalassemia

Question 15

What does a haemolytic screen consist of?

Answer 15

Full red blood cell count

Peripheral Blood smear

Serum Lactate dehydrogenase

Serum Haptoglobins

Indirect bilirubin

Question 16

How can you tell if bacteria in the urine of elderly women is signficant?

Answer 16

WBC >300

Other symptoms

Question 17

How long would you expect fever to persist in a patient with acute pyelonephritis that is apropriately treated?

Answer 17

72 hours

Question 18

What are some common sources of infection for septic arthritis?

Answer 18

Haematogenous spread secondary to:

Skin infections

UTIs

IVDU

Question 19

Which antibiotics put people at particularly high risk for C. difficile infection?

Answer 19

Clindamycin

Quinolones

3rd and 4th generation cephalosporins

Augmentin duofort

Question 20

What is platypnea and why does it occur?

Answer 20

SOB that is relieved upon lying

Weakened abdominal muscles cause lowering of the diaphragm which is improved with pressure from the abdominal organs below