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!VIVA/PACES/PSA > PACES viva Qs > Flashcards

PACES viva Qs Flashcards

1
Q

Contents of inguinal canal

A

Ilioinguinal nerve
Genital branch of genitofemoral nerve
Round ligament or spermatic cord

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2
Q

Contents of femoral canal

A

Efferent lymphatic vessels

LNs

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3
Q

Borders of inguinal canal

A

Roof: internal oblique and tranversus abdominis
Floor: inguinal ligament
Anterior: aponeurosis of external oblique
Posteriorly: transversalis fascia

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4
Q

Borders of femoral canal

A

Medially: lacunar ligament
Laterally: femoral vein
Anteriorly: inguinal ligament
Posteriorly: Pectineus muscle

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5
Q

What is Gardner’s syndrome?

A 
Syndrome within spectrum of familial polyposis coli syndromes
Includes:
= Adenomatous polyposis of large bowel
= Multiple osteomata of skull
= Desmoid tumours
= Epidermoid cysts
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6
Q

Borders of anterior triangle of neck

A

Midline
Ant border of sternocleidomastoid
Mandible

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7
Q

Borders of posterior triangle of neck

A

Posterior border of sternocleidomastoid
Clavicle
Anterior border of trapezius

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8
Q

Causes of cervical lymphadenopathy?

A 
LIST
Lymphoma/leukaemia
Infection
Sarcoidosis
Tumours (primary or secondary)
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9
Q

What nerve may be damaged in posterior triangle?

A

Spinal accessory nerve

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10
Q

Causes of proximal myopathy

A

Endocrine: COT

  • Cushings
  • Osteomalacia
  • Thyrotoxicosis

Neuromuscular

  • Duchennes/Beckers
  • Myotonic dystrophy

MSK

  • PMR
  • Myositis
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11
Q

Causes of peripheral neuropathy

A

Sensory

  • Diabetes
  • B12 deficiency
  • Hypothyroidism
  • ETOH
  • Uraemia
  • Leprosy
  • Amyloidosis
  • Iatrogenic eg drug-induced (Isoniazid), amiodarone

Motor

  • GBS
  • Pb poisoning
  • Porphyria
  • Hereditary sensorimotor polyneuropathies eg charcot-marie-tooth
  • Diphtheria
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12
Q

What are the ECG changes in first degree heart block?

A

Prolongation of PR interval but no dropping of QRS

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13
Q

What are the ECG changes in Mobitz type I heart block?

A

Successive prolongation of PR interval until QRS dropped

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14
Q

What are the ECG changes in Mobitz type II heart block?

A

Fixed PR interval with some p waves not conducted to QRS complexes in certain ratio

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15
Q

What are the ECG changes in third degree heart block?

A

Complete dissociation between atrial and ventricular contraction

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16
Q

SRS pattern in V1 and RSR pattern in V6

A

LBBB

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17
Q

RSR pattern in V1 and SRS pattern in V6

A

RBBB

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18
Q

Most specific marker for pericarditis on ECG?

A

PR depression

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19
Q

ECG findings posterior MI?

A

Tall R waves V1-V3

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20
Q

What does vitamin B12 deficiency cause?

A

Subacute degeneration of spinal cord

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21
Q

Causes of SIADH?

A

Malignancy
- Small cell lung Ca
(pancreas/prostate also possible)

Neurological

  • Stroke
  • SAH
  • Subdural haemorrhage
  • Meningitis/encephalitis/abscess

Infection

  • TB
  • Pneumonia

Drugs:

  • Carbamazepine
  • Sulphonyureas
  • SSRIs
  • Tricyclics
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22
Q

Why does hyponatraemia need to be corrected slowly?

A

Risk of central pontine myelinolysis

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23
Q

What are the causes of a collapsing pulse?

A

Aortic regurgitation
Hyperkinetic states eg thyrotoxicosis, anaemia, fever, pregnancy, exercise
PDA

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24
Q

What are the causes of pulsus paradoxus?

A

Severe asthma

Cardiac tamponade

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25
Q

What are the causes of pulsus alternans?

A

Severe LVH

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26
Q

What CLASS of drug should be prescribed for a patient with diabetes and hypertension who is found to have microalbuminuria?

A

ACEi

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27
Q

What effect do ACEi have on urinary albumin excretion?

A

Decrease it

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28
Q

Most likely cause of otitis media?

A

Strep pneumoniae

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29
Q

What are some consequences of acromegaly?

A 
endocrine - impaired glucose tolerance, DM
cardio - LVH, HTN, cardiomyopathy
msk - carpal tunnel syndrome 
gi - recurrent GI polyps 
other - obstructive sleep apnoea
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30
Q

Examination findings for otitis media

A

Bulging tympanic membrane
Loss of light reflex
possible perforation and pus

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31
Q

Muscles innervated by trochlear nerve?

A

Superior oblique for abduction and depression

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32
Q

Muscles supplied by CNVI?

A

Abducens supplies lateral rectus for abduction of eye

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33
Q

Muscles supplied by CNIII?

A 
Medial rectus
Superior rectus 
Inferior rectus 
Inferior oblique 
LPS
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34
Q

What are some causes of paralytic strabismus?

A

CN III/IV/VI palsy

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35
Q

What are some causes of ptosis?

A

Unilteral
CNIII palsy/Horner’s
Mechanical eg trauma or xanthelasma

Bilateral
MG, congenital, Myotonic dystrophy, senile

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36
Q

What is true ptosis caused by?

A

LPS weakness

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37
Q

What does the screening programme for colorectal cancer involve?

A

Screening every 2 years for 60-74 year olds

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38
Q

What malignancy is H pylori associated with?

A

MALToma

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39
Q

What is a skin flap?

A

Consists of tissue or tissues transferred from one site of the body to another whilst maintaining a continuous blood supply through a vascular pedicle

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40
Q

What is a graft?

A

Transfer of skin from a donor site to a recipient site independent of a blood supply

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41
Q

What causes lid lag?

A

Overstimulation of levator palpebrae superioris

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42
Q

What are the features of Grave’s disease o/e?

A 
Diffuse goitre
Thyroid acropachy
Eye disease
Proximal myopathy
Pretibial myxoedema
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43
Q

What are the causes of diffusely enlarged thyroid gland?

A

Simple Colloid goitre
Grave’s
Thyroiditis

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44
Q

Findings for otoscopy and tympanometry for glue ear?

A

ear drum dull + retracted, fluid level visible

flat tympannogram

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45
Q

What are the causes of vertigo?

A

Peripheral/vestibular

  • Meniere’s
  • BPPV
  • Labyrinthitis

Central

  • Vestibular Schwannoma
  • MS
  • Stroke
  • Head injury
  • Inner ear syphilis

Drug

  • Vancomycin
  • Loop diuretics
  • Metronidazole
  • Co-trimoxazole
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46
Q

Definition of a hernia

A

a protrusion of a viscous out of a containing cavity

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47
Q

Hypocalcaemia on ECG

A

Prolongation of QTc segment

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48
Q

Alternating amplitude of QRS on ECG

A

Electrical alternans - associated with pericardial effusion

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49
Q

Hypercalcaemia on ECG finding and causes?

A

QTc shortening, if severe J waves -

hyperparathyroidism or malignancy?

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50
Q

Hypokalaemia findings on ECG?

A

T wave inversion, QTc prolongation and visible U waves i

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51
Q

Hyperkalaemia findings on ECG?

A

tall, peaked T waves, QTc shortening and ST-segment depression

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52
Q

What criteria is used for pleural effusion and what are the cutoffs?

A

Lights criteria to determine whether transudate or exudate
<30 = transudate
>30 = exudate

Use criteria if 25-30, includes ratio of serum to aspirate protein and LDH - ie higher protein and LDH content the more likely its exudative

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53
Q

What are some causes of a transudate pleural effusion?

A 
Nephrotic syndrome
CCF
Liver failure ie cirrhosis
Myoexedema 
Meig's syndrome eg benign ovarian tumour, ascites, right sided pleural effusion
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54
Q

What are some exudative causes of pleural effusion?

A 
Infection eg pneumonia, fungal infection, lung empyema, TB
Malignancy
PE
Pancreatitis
Trauma
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55
Q

What is the classification used for heart failure?

A

New York Heart Association Classification

  1. No limitation on activity
  2. Comfortable at rest, dyspnoea on ordinary activity
  3. Marked limitation of normal activity
  4. Dyspnoea at rest
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56
Q

What are some causes of a normal anion gap acidosis?

A

Addisons
GI losses eg due to diarrhoea or fistula
Renal tubular acidosis

57
Q

What are some causes of a raised anion gap acidosis?

A

Ketones: DKA, Ethanol
Lactate: shock, sepsis, hypoxia
Urate: renal failure

58
Q

What scores are used to assess Upper GI bleeding?

A

Blatchford - pre-endoscopy

Rockhall - post-endoscopy -> to guide prognosis eg rebreeding, mortality

59
Q

What mode/plane of imaging is needed for scaphoid fractures?

A

Ulnar deviation AP view

60
Q

What is the pattern of injury in a Colles fracture?

A

Dorsal displacement of distal radius

61
Q

What is the pattern of injury in a Smith’s fracture?

A

Anterior/volar displacement of radius

62
Q

Blood finding with Paget’s disease of bone?

A

Solitary rise in ALP

63
Q

What are some common causes of carpal tunnel syndrome?

A 
Idiopathic
Pregnancy
Rheumatoid arthritis
Oedema
Lunate fracture

Associated with:
Hypothyroidism
Diabetes
Heart failure/COCP

64
Q

Examination findings in CTS

A

Weakness of abductor pollicis brevis

Wasting of thenar eminence

65
Q

Muscles supplied by median nerve

A

LOAF

  • Lateral two lumbricals
  • Opponens pollicis
  • Abductor pollicis brevis
  • Flexor pollicis brevis
66
Q

Non-traumatic causes of AVN of femoral head?

A

Diabetes
HIV
Lupus
Chronic renal failure

67
Q

Late systolic murmur?

A

Mitral valve prolapse

Coarctation of aorta

68
Q

What score can be used to assess mortality in ACS pts?

A

GRACE score - 6mth mortality in pts with ACS

69
Q

? Diagnosis if ECG shows a shortened PR interval and wide QRS complexes associated with a slurred upstroke seen in lead II.

70
Q

What are some causes of hypoglycaemia?

A 
Exogenous drugs eg sulphonylureas or insulin
Pituitary insufficiency
Liver failure
Addison's
Insulinoma
Non-pancreatic neoplasms
71
Q

Causes of clubbing?

A

Cardiac causes
cyanotic congenital heart disease (Fallot’s, TGA)
bacterial endocarditis
atrial myxoma

Respiratory causes
lung cancer
pyogenic conditions: cystic fibrosis, bronchiectasis, abscess, empyema
tuberculosis
asbestosis, mesothelioma
fibrosing alveolitis
72
Q

What is an abnormally large drop in blood pressure on inspiration called and what does it signify?

A

Pulsus paraxodus

  • characteristic of cardiac tamponade
73
Q

What is a raised JVP with inspiration called and in what condition is it found?

A

Kussmaul’s sign

- constrictive pericarditis

74
Q

Drugs that can induce intracranial hypertension?

A 
COCP
Tetracyclines
Steroids
Vitamin A
Lithium
75
Q

Widespread saddle-shaped ST elevation with PR segment depression indicates…

A

Pericarditis

76
Q

Q waves in lead II, III, aVF indicates …

A

Previous inferior MI

77
Q

Downsloping ST depression (‘reverse tick’ sign) indicates…

A

Digoxin toxicity

78
Q

Deep T wave inversion or biphasic T waves in V2-V3 indicates…

A

LAD stenosis

79
Q

ECG findings

left ventricular hypertrophy
non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen
deep Q waves

80
Q

What are some of the indications for ORIF in fracture management?

A 
failed cons management
intra-articular #
multiple # same bone
bilateral same #
open #
81
Q

Methods of non-operative fixation ortho?

A

Non-rigid eg slings
POP
Bracing
Continuous traction eg collar and cuff

82
Q

What are some general fracture complications?

A

Anaesthetic
Intra-op
Early / late post-op

83
Q

Complications of fracture ortho specific?

A

Intra-op: visceral damage or NV injury

Early: infection, compartment syndrome, fat embolism, VTE

Late: malunion, AVN, joint loosening, fracture at site, complex regional pain syndromes

84
Q

From what fractures is compartment syndrome most likely?

A

Tibial shaft

Supracondylar

85
Q

Complications of compartment syndrome?

A

Rhabdomyalysis

Volkmann’s contractures

86
Q

What are the 5 causes of non-union of a fracture?

A
  • ischaemia
  • infection
  • inter fragmentary strain increased
  • intercurrent disease
  • interposition of tissue between fragments
87
Q

3 sites prone to AVN?

A

Femoral head
Scaphoid
Talus

88
Q

How can you differentiate a fat embolism from a PE?

A

Neuro s/s

  • confusion
  • agitation
  • retinal haemorrhages
  • fat globules
89
Q

ECG: inverted P wave in lead I, right axis deviation, and loss of R wave progression

A

dextrocardia

?kartagener’s syndrome

90
Q

Features of IBD related to disease activity?

A

Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis

91
Q

What are some absolute and contraindications to thrombolysis?

A

Absolute

  • Haemorrhage/active bleeding
  • GI bleeding within last 3wks
  • Prev intracranial haemorrhage
  • Pregnancy
  • Intracranial neoplasm
  • Intracranial infarct in last 3mths
  • Varices
  • Uncontrolled HTN

Relative

  • Concurrent anticoag
  • Major trauma or surgery in last 2wks
  • Active diabetic haemorrhage retinopathy
  • Suspected intracardiac thrombus
92
Q

How can you differentiate a bulbar palsy from a pseudo bulbar palsy?

A

Bulbar = LMN signs CN9-12

Pseudobulbar = UMN signs CN5/7, 9-12

eg jaw jerk bulbar = absent, pseud-bulbar = brisk

93
Q

CT report describes a hypodense collection around the convexity of the brain that is not limited to suture lines - what is it?

A

Chronic subdural haematoma

Note hypooodense rather than hyper as chronic not acute

94
Q

What limits extra-dural haematomas?

A

Suture lines

95
Q

left homonymous hemianopia - where is the lesion?

A

right optic tract

96
Q

homonymous quadrantanopia inferior - where is the lesion?

A

optic radiation - parietal lobe

97
Q

homonymous quadrantanopia superior - where is the lesion?

A

optic radiation - temporal lobe

98
Q

incongruous visual field defects - likely place of lesion?

A

optic tract

99
Q

congruous visual field defects - likely place of lesion?

A

optic radiation or occipital cortex

100
Q

Congenital conditions associated with epilepsy

A

Mitochondrial disease
Tuberous sclerosis
Cerebral palsy

101
Q

What is a eye sign of Vestibular Schwannoma?

A

Loss of corneal reflex

102
Q

What are your differentials for sudden onset headache?

A

SAH

Pituitary apoplexy

103
Q

What marker in the blood do central seizures raise which can distinguish them from absence?

104
Q

In addition to focal seizures, what can carbamazepine be used to treat?

A

Bipolar disorder

Trigeminal neuralgia

105
Q

Contents of the lateral wall of the cavernous sinus?

A

Oculomotor nerve
Trochlear nerve
Ophthalmic branch of trigeminal nerve
Maxillary nerve of trigeminal nerve

106
Q

Contents of cavernous sinus?

A

Internal carotid artery

Abducens nerve

107
Q

Sudden onset headache, visual field defects + BP changes or sth similar? What immediate management needs to be given?

A

Pituitary apoplexy

Replace steroids immediately

108
Q

In what seizures is carbamazepine CI in?

A

Myoclonic

Absence

109
Q

CT head - multiple ring enhancing lesions

A

Toxoplasmosis

110
Q

CT head - single enhancing lesion

111
Q

Findings of RA on X-ray?

A

LESS

  • Loss of joint space
  • Erosions
  • Soft tissue swelling
  • Osteopenia

later - subluxation

112
Q

Adverse signs in cardiac arrest?

A

Hypotension
Myocardial ischaemia
Syncope
Heart failure

113
Q

Definitive treatment for acute glaucoma

A

Laser peripheral iridiotomy

114
Q

Normal QT segment

A

less than 430 ms in males

less than 450 ms in females

115
Q

Normal PR interval

116
Q

Causes of cavitation on CXR?

A 
abscess, infective eg staph aureus pneumonia, klebsiella, pseudomonas
TB
vasculitis eg Wegner's granulomatosis 
SCC
PE
Rheumatoid
Aspergillosis
117
Q

Causes of proximal myopathy

A

Inherited: Duchenne’s muscular dystrophy, Becker’s, myotonic dystrophy

Endocrine: Cushings syndrome, thyrotoxicosis, hyperparathyroidism, diabetic amyotrophy

Inflammatory: polymyositis, rheumatoid

Metabolic: osteomalacia

Malignancy: Lambert-Eaton syndrome, paraneoplastic

Drugs: ETOH, steroids

118
Q

Lateral epicondylitis - what movement is most painful?

A

Wrist extension on resistance with elbow extended or supination of forearm

119
Q

Thyroid scan - globally reduced uptake of iodine-131 - cause?

A

Qe Quervain’s

120
Q

Most specific ECG marker for pericarditis?

A

PR depression

121
Q

Most common tumour causing bony mets

A

1) Prostate
2) Breast
3) Lung

122
Q

Most common sites of bony mets

A

1) Spine
2) Pelvis
3) Ribs
4) Skull
5) Long bones

123
Q

Causes of a third nerve palsy

A 
Medical:
Diabetes
Vasculitis -> GCA, SLE
MS
Raised ICP -> herniation through tentorial notch

Surgical - pupil dilated:
Posterior communicating artery aneurysm
Cavernous sinus thrombosis

124
Q

Features of COPD on CXR

A

Flattened hemidiaphragms
Hyperinflation
Hyperlucent lung fields

125
Q

What are the complications of acromegaly?

A

Cardiomyopathy
HTN
Diabetes
Colorectal cancer

126
Q

Considerations for transvenous pacing?

A

complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds

127
Q

Pyrazinamide SEs

A

gout

hepatitis

128
Q

What is myasthenia gravis?

A

An autoimmune disorder characterised by insufficient functioning of nicotinic ACH receptors leading to fatiguability

129
Q

In what cancers is Lambert eaton syndrome seen?

A

SCLC
Breast
Ovarian

130
Q

How does Pulmonary fibrosis present on a CT?

A

Honeycombing

131
Q

Where do lung mets commonly come from?

A 
Breast
Prostate
Renal
Colorectal 
Bladder
132
Q

Where do lung mets commonly come from?

A

Renal

could also be choriocarcinoma or prostate

133
Q

Causes of cavitating lesions

A 
Cancer e.g. SCC
Autoimmune e.g. RA nodules, Wegener’s
Vascular e.g. PE
Infection e.g. upper zone TB, pulmonary abscess (Staph aureus, Klebsiella, Pseudomonas), fungi (Aspergilloma, histoplasmosis, coccidiomycosis)
Trauma
Youth e.g. bronchogenic cyst
134
Q

Causes of hilar lymphadenopathy

A

TB
Sarcoid
Lymphoma

135
Q

Causes of widened mediastinum

A 
Thoracic aortic aneurysm 
Thyroid/retrosternal goitre
Thymoma
Teratoma
Lymphoma
136
Q

Causes of globular heart

A

Pericardial effusion
Cardiac tamponade
Tetralogy of Fallot (boot shaped)

137
Q

Causes of Beck’s triad

A

Hypotension
JVP
Muffled heart sounds

138
Q

How do you tell an NG tube is well placed?

A

1) pH testing via aspiration <4

2) CXR: should bisect carina at T4

!VIVA/PACES/PSA (5 decks)

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