Past exam questions

Question 1

Describe the paediatric GCS.

Answer 1

Question 2

How do you assess a patient with a potential fracture?
Pain, swelling and limited range of motion.

Answer 2

• Inspect: for open fracture while limiting movement, observe any displacement.
• Neurovascular examination:
  
  • Pulses
  • Perfusion: cap refill
  • Neuro function: assess sensory and motor (may need to give analgesia for this)
• Assess for compartment syndrone
• Check for associated injuries
• X-ray

Question 3

What is the importance of a transient lucid period/ lucid interval after a head trauma?

Answer 3

A lucid interval is a temporary improvement in a patient’s condition after a traumatic brain injury, after which the condition deteriorates. A lucid interval is especially indicative of an epidural hematoma. An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval

Question 4

Describe the clinical relevant pathophysiology of HSV.

Answer 4

• HSV-1 generally associated with orofacial ulcers
• HSV-2 generally associated with genital ulcers
• Family: Herpesviridae
• Subfamily: Alphaherpesvirinae
• ds-DNA virus
• Properties of the virus:
  
  • Neurovirulence: Invades and replicates in the nervous system
  • Latency: HSV-1 in trigeminal (mostly), HSV-2 sacral nerve root (S2-S5)
  • Reactivity
• Needs to vector to be transmitted
• Transmitted by close personal contact: infects mucosa

Question 5

What are the causes of AF?

Answer 5

• Cardiac:
  
  • Ischaemic heart disease
  • HTN
  • Vavlvular heart disease (mitral stenosis/ regurgitation)
  • Pericardial disease
  • Cardiomyopathies: dilated, hypertrophic
• Pulmonary:
  
  • PE
• Infections:
  
  • Acute infections
• Metabolic:
  
  • Electrolyte disturbance: hypokalaemia, hypomagnesaemia.
  • Thyrotoxicosis
  • Phaeochromocytoma
• Drugs:
  
  • Alcohol
  • Caffeine
    *

Question 6

What are the proposed mechanisms of AF?

Answer 6

• Focal activation: in which AF originates from an area of focal activity. This activity may be triggered, due to increased automaticity, or from micro re-entry. Often located in the pulmonary veins.
• Multiple wavelet mechanism: in which multiple small wandering wavelets are formed. The fibrillation is maintained by re-etry circuits formed by some of the wavelets. This process is potentiated in the presence of a dilated LA- the alrger surface area facilitates continuous waveform propagation

Question 7

What are the ECG changes AF? that are seen in

Answer 7

• Irregularly irregular rhythm
• No P waves
• Rate = 120-160/min
• QRS complex usually <120 ms

Question 8

What are the symptoms of AF?

Answer 8

• Palpitations
• Breathlessness
• Fatigue
• Syncope

Question 9

What is the treatment of AF?

Answer 9

• Medical:
  
  • Rate control: Digoxin, beta-blockers, and rate-limiting calcium antagonists (verapamil, diltiazem)
  • Reduce risk of thromboembolism: warfarin, bridge with LMWH.
  • Treatment of underlying disease i.e. cardiac disease.
• Surgical:
  
  • Cardioversion

Question 10

What is the CHADVASC score?

Answer 10

• CHADVASC score is a way of assessing a patients risk of stroke within the next year and assess their need for anticoagulation when they have AF.
  
  • CHF = 1
  • HTN = 1
  • Age: 65-74 = 1, >75 = 2
  • Diabetes = 1
  • Sex: female = 1
  • Vascular disease (MI, PVD) = 1
• Risk of stroke:
  
  • Score 0 = 5%
  • Score 5-8 = 70%
• Need for anti-thrombotic therapy:
  
  • Score 0 = no therapy
  • Score 1 = either anticoagulate or anti-platelet
  • Score >2= anticoagulate