Past Questions Flashcards
Male, recent onset flaking smelly skin rash, 98% body
Exfoliative dermatitis “the red man”
Derm emergency
Stop all unnecessary meds
3 cardinal signs of psoas abscess
Fever
Limp
Abdominal/flank pain
3 cardinal signs of ileofemoral vein thrombosis
Pain in buttocks/groin
Thigh swelling
Collateral superficial veins
4 Kanavel signs of flexor tenosynovitis
Fusiform swelling
Pain with passive extension
Flexed posture
Tenderness along flexor sheath
3 month old baby with recent onset non-itchy flexor and scalp rash
Infantile sebhorreic dermatitis
Severe twisting injury to ankle, normal foot and ankle X-rays
Important fracture to consider:
Maisonneuve
Snowboarders commonly fracture:
Lateral process talus - dorsiflexion and inversion
18 month old child with low-grade fever, colicky LIF pain, normal MSU - important condition to consider:
Intussusception, incarcerated hernia, volvulus, mesenteric adenitis, psoas, abscess
Olecranon bursitis - 4 signs to distinguish septic from effusion
Fever
Redness/cellulitis
Warmth
Pain
Trauma or skin lesion
Initial medication for preeclampsia
Antihypertensive - nifedipine, labetalol, hydralazine
Magnesium sulfate
Antibiotic for COPD exacerbation in patient with penicillin allergy
Doxycycline 100mg 5 days
Recently started risperidone with fever and muscle rigidity - which toxidrome?
Neuroleptic malignant syndrome
Which bone does the lunate remain in contact with in a perilunate dislocation?
Radius
Risk factors for otitis media
Daycare
Passive smoking
Overcrowded home
Seasons
Air pollutants
Age - 6-24months
Male
Anatomical abnormalities/Down syndrome
Breastfeeding < 6 months
Use of dummy after 6 months
Aortic aneurysm risk score
Male
Age >65
Smoking >100 in lifetime
Atherosclerosis
Cerebrovascular disease
Coronary artery disease
HTN
Hypercholesterolaemia
First degree relative with AAA
Other vascular aneurysm
Obesity
Slit lamp features in iritis
Cells
Flare
Hypopyon
Clouding of anterior chamber
Sudden onset flashes and floaters
Retinal detachment
Common skiing injury
UCL sprain/rupture
Treatment of acute adrenal insufficiency
Hydrocortisone 100mg IV
IV fluids
Complication of proximal pole scaphoid fracture
AVN
Non union
2 tests for peritonitis
Rebound tenderness
Percussion tenderness
Circulatory changes in neurogenic shock
Low HR <80
Low BP <90 syst
Fever and stridor in child
Croup
Tonsillitis
Epiglottitis
Bacterial tracheitis
Lymphoma
Child with fever, trismus, difficulty swallowing
Peritonsillar abscess
Dental infection - Ludwig’s angina
Ear pain, fever, odorous discharge, affecting facial nerve, conductive hearing loss
Infected cholesteatoma
4 complications of Barotrauma in lungs
Pneumothorax
Sinus and middle ear damage
Pneumomediastinum/subcut emphysema
Cerebral artery gas embolism
Symptoms of Type 2 decompression illness
Neurological - paresis, numbness and tingling, difficulty urinating, incontinence.
Respiratory - SOB, cough, chest pain
Older person with atrial fibrillation - suddenly onset of pale leg
Patient foremen ovale arterial embolism?
Fracture associated with posterior fat pad in children?
Elbow?
Supracondylar
Paediatric CAP, most likely organism
Strep pneumoniae
Dysuria without bacteruria or pyuria in 3rd trimester - correct Rx
Empiric treatment until cultures back
Cefalexin 500mg BD 7 days
Trimethoprim 300mg OD 7 days ( avoid in first trim)
Nitrofurantoin 50mg QID 7 days (avoid at 36+ weeks)
Chlamydia in pregnancy
Azithromycin 1g stat
Test of cure at 4 weeks
Rescreen in 3rd trimester
BIB family: Psychotic recently, not taking medications, episodes of anger and staring upwards when medication discussed
Deescalate
Lorazepam 2mg
OPD psych referral
Management of lab tests
MSU
coags
Potassium/phosphate
Stool culture
BSL
MSU - refrigerate
Coags, stools - send within 4 hours, no fridge
Potassium/phosphate - do not leave overnight or in fridge
BSL - asap
Referral criteria to regional burns centre
> 10% adult >5% child
Full thickness burn >5%
Burns to special areas - face hands perineum genitalia joints
Inhalation injury
Electrical burns
Chemical burns
Circumferential burns or chest/limbs
Very old or very young
Pre-existing medical conditions that complicate recovery
Abuse
Referral criteria for National Burns unit
> 30% TBSA
Full thickness burns to special areas - face hands perineum genitalia joints
Significant inhalation
Electrical burns with high voltage and underlying tissue damage
Significant chemical burns
Young child with radius fracture - what type of cast
Below elbow soft cast
Pre-eclampsia symptoms
Hypertension, hyperreflexia and clonus, organ dysfunction (liver, renal), uteroplacental dysfunction
HELLP
Haemolysis
Elevated liver enzymes
Low platelets
Damaged structure with dorsal dislocation PIPJ
Volar plate
Damaged structure with volar dislocation of PIPJ
Central slip
Canadian C spine rule
Age >65, paraesthesia of extremity, dangerous mechanism (fall >0.9m, 5 stairs, axial load, high speed MVA/roll over/ejection, bike collision, motorised rec vehicle)
No low risk factors - sitting or ambulatory, delayed neck pain, no midline tenderness. Simple rear end MVC
Cannot actively rotate 45 deg left and right
Clinical management of scaphoid tenderness - no fracture on X-ray
Scaphoid cast 10-14 days, re-X-ray
Lateral cervical spine X-ray - soft tissue limits
C1-4 <7mm (<30% vertebral body)
C5-7 <22mm (100% vertebral body)
Landmark - glottis
Acute angle closure glaucoma presentation
Severe retroocular pain
Reduced vision, halos around light
Asymmetrical non reactive pupil
Ciliary flush - red eye around iris
Hazy cornea
Nausea vomiting
Headache
Photophobia
2 common organisms for atypical community acquired pneumonia
Mycoplasma pneumoniae
Legionella
Chlamydia
4 broad classes of medication which cause urinary retention
Anticholinergics
Antihistamines
Antipsychotics
Anti-Parkinsonian
Muscle relaxants
Sympathomimetics
Beta adrenergics
Antihypertensives
Antidepressents
2 clinical signs of respiratory acidosis
Cyanosis
Altered mental state
Fracture seen on lateral X-ray dorsum of proximal carpal row
Triquetral
Pregnant lady, low grade headache postpartum, worse on day 3
Pre-eclampsia
4 venemous creatures in NZ
Box jellyfish
Black widow (Lactrodectus)
Cone shell
Sea urchins
Serotonin Syndrome - triad of symptoms
CNS - altered mental state, seizures
Autonomic dysfunction - BP, HR, fever, dysrhythmia, flushing, sweating, mydriasis
Neuromuscular dysfunction - clonus, rigidity, hyperreflexia
Charcot triad for ascending cholangitis
Fever
Jaundice
RUQ pain
Local anaesthetic dose for lignocaine
1% lignocaine - 3-5mg/kg
1% lignocaine + adrenaline - 6mg/kg
4 treatments for paraphimosis
Osmotic agent
Ice
Compression
Manual reduction
Parasuicide (attempted suicide) risk factors
Male
Age (15-24)
Mental health
Substance use
FHx/friend suicide
Prev attempt
Childhood trauma
Unskilled occupation
Lack of support
Single
Sexual minority
Chronic medical illness/pain
TBI
Treatment of campylobacter
None
Erythromycin 400mg or 10mg/kg QID 5 days
- High fever, bloody diarrhoea, prolonged >7 days, pregnant women, immunocompromised, food handlers, childcare worker, carer
Low back pain - period of bed rest?
<2 days
4 extra-articular features of Reiter’s syndrome
Uveitis/conjunctivitis
Urethritis/cystitis/cervicitis/balanitis
Haematuria/hydronephrosis
Enteritis
Aortitis/aortic insufficiency/heart block
What bone articulates between lunate and 3rd metacarpal?
Capitate
Treatment of erysipelas in penicillin allergy
B-haemolytic Strep
Erythromycin 400mg or 10mg/kg QID 10-14 days
Impetigo treatment
Clean, cut (nails), cover
Hydrogen peroxide/povidone iodine 2-3 times/day, 5 days
If extensive: Flucloxacillin 500mg or 12.5-25mg/kg QID 5 days
Burn - palm of hand excluding fingers. TBSA?
1%
Appropriate dressing to send burn to hospital
Plastic cling film - not circumferential
FDP injury - position of finger
More extended
Nasal fracture - important sign to look for
Septal haematoma
What deformity can arise in untreated septal haematoma
Saddle nose
Erythema marginatum appearance
Acute rheumatic fever
Trunk, upper arms, legs
Red macules/papules spreading circular –> clear centre, raised red border
Sacred part of body for Maori
Head (tapu)
Near drowning episode - 2 findings
Hypoxia
Unconscious
Arrest
GCS for child
- Crying and inconsolable
- Opens eyes to pain
- Withdraws to painful stimuli
3+ 2 + 4= 9
Minimise bleeding in facial fractures
Nasal packing
Oral packing
Management of acute MI
Aspirin 300mg po chewed
IV lines, defibrillator ready
Analgesia - morphine
O2 if sats <92%
GTN - unless inferior/RV infarct/low BP
Refer cardiology acutely
Management of PE
O2
IV lines
Refer to gen med
Anticoagulants
2 common causes of knee effusion in injury
ACL rupture
Meniscal tear
2 structures injured when knee flexed and twisted
ACL
Meniscus
Causes of posterior dislocation of shoulder
Seizure
Electrocution
2 risks for sudden death in asthma
Signs of life threatening asthma
Signs of severe asthma that persists after treatment
Social isolation
Psychological problem, disability
Prev near fatal attack
Exacerbation despite dose of steroid prior
Presentation at night
Pregnancy
Potential complications in otitis media
Mastoiditis
Intracranial extension
Facial nerve palsy
Minimum hepatotoxic dose of paracetamol
> 10g/day adult, >200mg/kg/day child
6g or 150mg/kg per day, >48hr
4g or 100mg/kg per day, >48hr with liver toxicity
Ankle drawer test checks for which ligament?
Anterior talofibular ligament
Management of traveller’s diarrhoea
Antiemetic
Oral fluid + electrolyte replacement therapy
Consider loperamide
Low threshold for abx - ciprofloxacin 500mg BD 3 days, or 750-1000mg stat
Azithromycin 1g stat or 500mg OD for 3 days if from South/SE Asia
Prolonged sx (10-14 days) Stool culture, shiga toxin assay, parasites, microscopy
Findings for retropharyngeal abscess
Upper airway obstruction
Holding neck in flexion
Pharyngeal swelling and erythema
Dysphagia, torticollis, neck swelling, trismus
Sexual assault - things that can affect specimen collection
Showering
Passing urine/bowels
Changing clothes
Smoking
Eating/drinking
4 clinical features of unstable angina
Angina more frequent, lower threshold, longer duration
Negative troponin
No ECG changes
4 clinical features of heart failure
PND
Orthopnoea
Pedal oedema
SOBOE
2 methods to splint flail chest
Direct pressure with hand
Position pt to lay on flail
Tape bag of fluid to flail
Low back pain - signs of infection
Fever
Erythema/warmth
Fatigue
Anorexia
Cauda equina - symptoms other than back pain
Saddle anaesthesia
Bowel/bladder incontinence
Loss of power/sensation
Sexual dysfunction
How to Weber test
Tuning fork activated, place in middle of forehead. Check if sound localises.
When do you see sail sign?
Elbow joint effusion
Fracture of distal humerus, prox ulna, radial head
What condition must be excluded in young male with testicular pain?
Torsion
2 findings to suggest undisplaced supracondylar fracture
Sail sign
Posterior fat pad
Unwilling to flex + extend
Intact pronosupination
Most common STI in NZ
Chlamydia
Constipation - red flags
Abdominal mass
Weight loss
Blood mixed in stool
Rectal mass
iron deficiency anaemia
Contraindication to IUD insertion
STI/PID
Pregnancy
Molar pregnancy
Recent sepsis
Unexplained vaginal bleeding
Endometrial ca
Distortion of uterine cavity
Contraindication to COCP
Migraine with aura
DVT/PE
Breast ca
Liver disease
>35 smoker
HTN
Post partum <21 days, breast feeding
IHD, valvular disease
SLE, antiphospholipid antibodies
Clinical findings of pneumothorax
Hypoxia
Unilateral reduced breath sounds
Increased resonance to percussion
Tracheal deviation
Tachycardia
Tachypnoea + WOB
Early pregnancy, PV bleeding, shoulder tip pain - dx
Ectopic pregnancy
2 features of CAP needing admission
CURB-65
2+ of
Confusion
Urea >7
RR >30
BP <90/60
Age >65
Non verbal communication tools to build rapport
Eye contact
Smile
At same level
Arms not crossed
Not too relaxed
Management of Abnormal vaginal bleeding - not pregnant
Tranexamic acid
NSAIDs
Mirena
COCP
Medroxyprogesterone (Provera)
Post partum bleed - medications
IV oxytocin 10 units
Features of UTI requiring hospital admission
Systemically unwell
Older person not managing at home
Complicated pyelonephritis
Pyelonephritis in pregnancy
Failed abx
Immunocompromised
Urinary tract abnormality
Renal impairment
Laceration of medial upper eyelid - what structures to be concerned about
Lacrimal sac
Nasolacrimal canal
Superior lacrimal punctum and canal
Decerebrate posturing
Wrist flexion, elbow extension, shoulder pronation
Foot plantar flexion, knee extension
Sudden onset flashers and floaters in person with diabetes
Retinal detachment
Diabetic retinopathy
Unsafe INR requiring hospital admission
> 10
Active bleeding with any INR
4.5 threshold for Vit K
In rib fractures what 2 ribs are concerning for vascular injury
Ribs 1-2
In rib fractures what 3 ribs are concerning for intraabdominal injury
Ribs 10-12
4 symptoms/signs tension pneumothorax
Tachycardia
Hypoxia
Tracheal deviation
Reduced breath sounds
Hyperresonance
2 associated injuries with meniscal injury
MCL
ACL
Commonest bacteria for diarrhoea?
Bloody diarrhoea?
E. coli, Campylobacter jejuni
Enterohaemorrhagic E. coli, Shigella dysenteriae
4 causes of monoarthritis
Gout
Septic arthritis
Osteoarthritis
Trauma
Describe flat red skin lesion, not raised or depressed
Macule or patch
4 aspect of pre-hospital C spine management
Immobilisation
Neuro exam
Secondary survey
Spinal cares
4 causes of wheeze other than asthma
COPD
Pneumonia
Croup
Bronchiolitis
Anaphylaxis
Patient with eczema - can topical steroid be used in:
- Bacterial infection
- Herpes
Yes
No
4 ECG changes hyperkalaemia
Peaked T waves
Wide QRS
Long PR, Wide flattened P wave
Bradyarrhythmia
Conduction block
Test to perform prior to carotid sinus massage
Listen for carotid bruit
Cause of swollen lip not responding to adrenaline
Trauma
Angioedema
Infection
NSAID
Insect sting
Instructions for males to collect urine sample for chlamydia
At least 1 hr since prev urine
First pass urine
Major consequence of fracture to growth plate
Growth arrest
2 risk factors for bad outcome from upper GI bleed
Oesophageal varices
Hypotension
Flexion of fingers points to which structure?
Scaphoid
Mallet finger site of pain
Dorsum DIPJ
2 treatments for LA overdose
Stop administration
ABCs
Intralipid 1.5mL/kg over 1 min, can repeat x2
0.25mL/kg/min infusion
Carditis pain description
Pleuritic
Retrosternal
Improves leaning forward
Erythema infectiosum characteristics
Fifth’s disease
Parvovirus B19
Slapped cheeks appearance, lace-like rash on limbs and sometimes trunk
Most common elbow fracture in children
Supracondylar
What is sail sign?
Raised anterior fat pad of the elbow
What are you testing for with anterior drawer of knee?
ACL
Patient with atrial fibrillation and abdominal pain - important dx to consider
Mesenteric ischaemia
How to use the Rumack-Matthew nomogram
Check serum paracetamol concentration 4 hours post overdose. If above the line treat with NAC
Causes of respiratory distress in trauma
Pneumothorax
Haemothorax
Rib fracture
Upper airway injury/obstruction
Aortic dissection
Cardiac tamponade
Symptoms of epiglottitis
Fever
Sniffing position
Stridor
Drooling
Dysphagia
Dysphonia
Dyspnea
Distress
Ottawa ankle rules
Lateral malleolus posterior edge/tip
Medial malleolus posterior edge/tip
Base of 5th metatarsal
Navicular
Can’t take 4 steps
What drug can cause adrenal insufficiency
Chronic steroids
Non-environmental causes of hypothermia
Hypothyroidism
Hypopituitarism
Anorexia nervosa
CVA
Alcoholism
3 indications for oxygen in cardiac chest pain
Sats <93%, cardiogenic shock, respiratory distress, other risks of hyperaemia
Acceptable angulation for metacarpal neck fractures
index and middle - 10-15 deg
Ring 30-40 deg
Little - 50-60 deg
Acceptable angulation for metacarpal shaft fractures
index and middle <10 deg
Ring and little <20 deg
Shortening <5mm
Base of thumb <30 deg
Causes of pancreatitis
Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps, malignancy
Autoimmune
Scorpion stings
Hypercalcaemia, hyperlipidaemia
ERCP
Drugs
Stages of pericarditis
2 weeks - widespread STE, PR depression
1-3 weeks - ST normalising, T wave flattening
3+ weeks - T wave inversion
several weeks - T wave normalise
Bohler’s angle
Line 1 - highest point of tuberosity - high point posterior facet
Line 2 - highest point anterior process - highest point posterior facet
Normal 20-40 deg
Abnormal - decrease
Critical angle of Gissane
Line 1 - anterior downwards slope of calc
Line 2 - superior upwards slope
Normal 130-145 deg
Abnormal - increase
Man has a scaly rash starting on trunk, spreads to rest of the body
Pityriasis rosea
Patient with photophobia, nausea, vomiting, blurry vision
Acute angle closure glaucoma
Heat stroke vs heat exhaustion
Change in mental state/seizures
Core body temp >40 deg
Most common arrhythmia in children prior to arrest
Sinus bradycardia?
Laceration above lip on vermillion border - which nerve for regional bock?
Infraorbital nerve
Most common complication of acute otitis media
TM perforation
30 year old man, 5 day history of rash on back. Started with 2cm patch on front of chest.
Pityriasis rosea
Herald patch
Sign on tympanic membrane for acute otitis media
Erythema
Bulging
Loss of light reflex
Loss of mobility
Dull/opaque
Features of bacterial sinusitis
Persistent for >10 days
Initially improved then worsened again
Purulent discharge
Fever >39
Unilateral facial pain with percussion tenderness
20 year old with bilateral flank pain - common causes
Muscular strain
Pyelonephritis
PID
Renal colic, hydronephrosis?
Menorrhagia/endometriosis?
20 year old started on haloperidol, jaw movements and protrusion of tongue
Acute dystonia
Discontinue haloperidol
Benzatropine 2mg IV or procyclidine
Baclofen 60-120mg/day for oromandibular dystonia
Mexilitine for cervical dystonia
Benzos if anticholinergics not enough
Checking adequacy of PA chest X-ray
Rotation - spinous process and head of clavicles
Adequate inspiration - 6 ribs ant, 8-9 ribs post
Penetration - lower T spine just visible
Angulation - clavicle heads over ribs 3-4
Continuous diaphragm on chest X-ray
pneumomediastinum
pneumonpericardium
pneumoperitonium
What loss of silhouette on CXR do you get in:
Lingula pneumonia
RLL pneumonia
L heart border
R hemidiaphragm
What bone is fractured if line of the radius does not align with capitellum?
Radial head/neck
Monteggia fracture
4 criteria for discharge after electrocution
Minor or no burn/trauma
Normal ECG
No seizure/LOC/arrest
Low voltage <1000V
Ddx for child with fever and seizure other than febrile seizure
Meningitis/meningococcal
Encephalitis
Cerebral abscess
Primary seizure
Hypoglycaemia
Trauma/intracranial bleed
Electrolyte disturbance
SOL/malignancy
Poisoning
Medication for seizure >5-10mins
Status epilepticus
Midazolam buccal/intranasal 0.5mg/kg Q10mins, max 10mg
Diazepam IV/PO 0.25mg/kg, PR 0.7mg/kg, max 10mg
According to WHO: RR upper limit for
1. <2 month
2. 2 month - 12 months
3. 12 months - 5 years
- <60 bpm
- <50 bpm
- <40 bpm
Resuscitation in near drowning - complications
Hypoxia
Cerebral anoxia
Airway obstruction
Gastric distension/regurgitation
C-spine injury
Criteria for HTN in pregnancy
Systolic >140
Diastolic >90
Measured x2 at least 4 hours apart
Symptoms of preeclampsia
Severe headache
Visual disturbance - blurring, scotoma, blindness
Nausea/vomiting
Epigastric/RUQ pain
Sudden swelling of face, hands, feet
Chest pain/SOB
Reduced urine output
Reduced foetal movement
Vitamin deficiency causing encephalopathy in hyperemesis gravidarum
Thiamine
Complication of UCL complete tear resulting in non-union
Stener lesion - UCL caught over adductor aponeurosis
Mallet finger referral criteria
<30% bony avulsion of joint
Volar subluxation of distal phalanx
Punch in the eye - injuries not to miss
Globe rupture
Retrobulbar haemorrhage - proptosis, chemosis, reduced visual acuity, ophthalmoplegia
White eye blow-out fracture - no subconjunctival haematoma, painful restricted eye movement, nausea + vomiting, diplopia
Orbitozygomatic fracture
Isolated orbital fracture - medial and inferior walls most common
Traumatic optic neuropathy
Orbital cellulitis - criteria for referral
Fever, systemically unwell
Painful ocular ROM
Proptosis
Ophthalmoplegia/diplopia
Reduced vision (optic nerve involvement)
Child eats egg, lip swelling, difficulty breathing - management
O2
Adrenaline 0.01mg/kg IM (adult 0.5mg) 1:1000
IV fluids - 20mL/kg
Consider antihistamine
Consider IV steroid
Nebulised adrenaline for stridor, salbutamol for wheeze
Observe at least 4-6 hours (biphasic/rebound anaphylaxis)
Admit if requiring 2+ doses of adrenaline
Maculopapular painful rash, unilateral forehead. What eye condition do you suspect?
Herpes zoster ophthalmicus - V1 trigeminal nerve
Hutchinson’s sign - skin lesion at tip/side/root of nose
Valaciclovir 1g ads for 7-14 days
Aciclovir 800mg 5 times/day 7 days
Indications for referral for renal colic
Pregnant
Infected, temp >38
Peritonitis
>7mm ureteric stone
Pain uncontrolled
Known renal disease
Bilateral obstructive stone
Solitary kidney
Treatment of renal colic
NSAIDs - diclofenac
Morphine
Alpha blocker - Doxazosin
70 year old, painless loss of vision in 1 eye for 1 min, lightheaded. Dx?
Amaurosis fugax - transient loss of blood flow to optic nerve/retina
Treat as TIA, carotid artery disease
- Refer to hospital
- Bilateral carotid dopplers
- MRA/CTA of head and neck
- Echo
Features of Colles fracture
Dinnerfork deformity
Transverse distal radius fracture
Dorsal angulation +/- displacement
Can involve ulna styloid fracture
Possible tendon rupture with Colles fracture
Extensor pollicis longus
Non direct causes of Lisfranc injury
Axial load in hyperplantarflexion
Fixed hindfoot, rotational force through forefoot
Grade 3 ACJ injury - which ligaments are ruptured?
Acromioclavicular
Coracoclavicular - trapezoid, conoid
Additional xray views to assess ACJ injury
Bilateral zanca weight bearing views
Axial view
TFCC ligament - which bones does it primarily articulate with?
Ulna + triquetrum with radius + lunate
4 signs of meniscal injury
Positive McMurrays, Apley’s compression, Thessaly’s test and joint line tenderness
Delayed swelling, bruising, clicking, locking, crepitus
3 year old with fever 38.5, limp, minor trauma 2 days ago, no leg pain - diagnoses not to miss
Psoas abscess
Appendicitis
Osteomyelitis, septic arthritis
Two components for initiating Mental Health Act
Mood or delusional disorder
Causing risk to self/others, or care of self/others
23 year old woman, anxious with going to school and giving presentations. Works at home to study. Lives with parents. Has friends but don’t want to hang out as worried about what they will think of her. What psychiatric illness do you think she has?
Social anxiety
Risk factors for delirium
Elderly or young children
Away from familiar environment
Substance use
Poor sleep
Infection
Visual/hearing impairment
Hypoxia
Urinary/faecal retention
Meds: opioids, benzos, dihydropyridines, CCB, antihistamines
Alcohol limit for men and women
Men: 15 standards/week, max 3/day
Women: 10 standards/week, max 2/day
At least 2 ETOH free days/week
Symptoms of lithium toxicity
Altered mental state
Nausea, vomiting, diarrhoea
Tremor
Ataxia
Weakness
Severe: hypotension, dysrhythmia, seizure, coma, death
Viruses that cause bronchiolitis
RSV
Adenovirus
Rhinovirus
Examination signs for scaphoid fracture
Tenderness in ASB
Tenderness at scaphoid tubercle
Pain on axial load of thumb
Most common preventable cause of death post-trauma
Haemorrhage
What 3 bones are in line on lateral wrist xray to check normal alignment
Radius, lunate, capitate
Types of scaphoid fractures at risk of AVN
Proximal pole
Waist
9 year old boy drowsy, DKA - then develops headache, vomiting, confusion - what diagnosis not to miss?
Cerebral oedema
Seniors at risk tool
- Prior to illness/injury, need someone to help on regular basis?
- Since illness/injury, need increased help?
- Hospitalised for 1 or more nights in last 6 months?
- Trouble with vision?
- Problems with memory?
- More than 3 different meds/day?
High risk = 2 or more
Dorsiflexion and internal rotation of ankle - what is commonly fractured?
Lateral process talus
4 differentials for cellulitis
Lipodermatosclerosis
Dermatitis
Psoriasis
Superficial thrombophlebitis
Urticaria
Lymphoedema
Fungal infection
3 zones of Jackson’s burn wound model
Zone of coagulation - maximal damage, irreversible tissue loss due to coagulation of constituent proteins
Zone of stasis - decreased tissue perfusion, salvageable by minimising hypotension, infection, oedema
Zone of hyperaemia - increased tissue perfusion, most likely healing unless sepsis or prolonged hypoperfusion
Knee apprehension test - what is most likely injured
Patella dislocation
Patellofemoral instability from rupture of MPFL
FOOSH, wrist pain, numbness and weakness index finger and thumb, what to look for on xray?
Displaced Colles or Smiths fracture, lunate/perilunate dislocation
Signs in quinsy
Stridor
Hot potato voice
Dysphagia, odynophagia
Bad breathe
Fever
Trismus
Drooling
Child with twisting injury and limping - traumatic and non traumatic dx
Toddler’s fracture
Contusion
Femur fracture - think NAI
Irritable hip
Septic arthritis
Osteomyelitis
Tumour
Grade 3 supracondylar fracture - possible neurovascular injury?
Brachial artery
Median nerve (AIN)
Radial nerve (secondary)
Ddx for testicular mass not to miss
Testicular cancer
Testicular torsion
Appendage torsion
Testicular rupture
Epidydimitis
Strangulated inguinal hernia
Blurry vision over days and pain on eye movements
Optic neuritis
Causes: MS, infection (syphilis, Lyme, viral), sarcoidosis
Pancreatitis - lab test
Ddx?
Lipase
Aortic dissection, renal colic, biliary colic, cholecystitis, duodenal perforation, hepatitis, ischaemic bowel
Child with abdominal pain, blood and mucus in stool
Intussusception
Pain relief, IVF, NBM, paeds surg referral
Woman with hx tubal ligation. Now LLQ pain, no PV bleed, tachycardia
Ectopic pregnancy
PID
Renal colic
Bowel obstruction
UTI/pyelonephritis
Diverticulitis
Bloods, bHCG
Urine dip
+/- pelvic USS
What chemical in the environment can give patient sialorrhoea?
Organophosphates
Mushrooms
Woman with PV bleeding, intrauterine foetal heart beat seen. What is the type of miscarriage?
Threatened miscarriage
Happy child, 1 week of spreading lumpy rash, not itchy
Molluscum contagiosum
Most likely injured organ in blunt abdominal trauma
Spleen
PECARN score
Paediatric head injury:
<2
- GCS 14, palpable skull fracture, signs of altered mental state (agitation, somnolence, repetitive questioning, slow response to verbal comms)
- Occipital/parietal/temporal scalp haematoma, LOC >5s, abnormal behaviour, severe mechanism (ejection, death of passenger, pedestrian/biker without helmet struck by car, fall from >1m, head strike by high impact object)
> 2
- GCS <14, signs of basal skull fracture, altered mental state
- LOC, vomiting, severe headache, severe mechanism
Hunter serotonin toxicity criteria
Serotonergic medication in last 5 weeks
- Spontaneous clonus
- Inducible clonus + agitation or diaphoresis
- Ocular clonus + agitation or diaphoresis
- Tremor + hyperreflexia
- Rigidity/hypotonic + hyperthermia + ocular or inducible clonus
4 diseases to test for in female STI screen
Chlamydia, gonorrhoea, HIV, syphilis
Causes of delayed skin healing
Diabetes
Smoking
Steroids
Infection
Sutures too tight
Elderly
Poor nutrition
Obesity
ETOH
Immunocompromised
Primary treatment of dysmenorrhoea
NSAIDs
OCP
Symptoms of myxoedema
Hypothyroid emergency
- bradycardia
- thinning hair
- hypothermia
- non-pitting oedema
- altered LOC and coma
- hypotension
- enlarged thyroid
- hypoglycaemia
Glucagon is antidote for…
Beta blocker overdose
CAGE questionnaire for ETOH excess
C - attempts to cut down
A - annoyed by other people complaining
G - guilty about drinking
E - Need for eye-opener in the morning
Most effective emergency contraceptive
Levonorgestrel 1.5mg within 12hr (up to 72h) post coitus
For weight >70kg, BMI >26 - double to 3mg
BMI >30 copper IUD or CI to oestrogen
Within 5 days of ovulation, up to 120hrs post coitus
Management of acute prostatitis
Commonly gram -ve
Mild uncomplicated - trimethoprim 300mg OD 14 days
Mild complicated (hospitalisation, recent overseas travels) - cefalexin 500mg BD/augmentin 625mg tds for 14 days, cipro 500mg bd 14 days
Severe cefalexin 500-1g tds/augmentin 625mg tds 2-4 weeks
Lisfranc ligament attaches to which bones?
medial cuneiform + base of 2nd metatarsal
3rd trimester PV bleed - what differentiates placental abruption vs previa?
Abdo pain
Shock
Foetal distress
Female with abdominal pain - dx not to miss
Ectopic pregnancy
Appendicitis
Ovarian torsion
Ovarian cyst rupture
Alcohol hazard assessment tool
Audit-C, score 0-4 each, 5+ do full audit questionnaire
How often drink containing ETOH
How many drinks on a typical day
How often 6 or more
HDC code of rights
- Respect
- Freedom from discrimination
- Dignity and independence
- Services of appropriate standard
- Effective communication
- Fully informed
- Informed consent
- Support
- Teaching and research
- Complain
When to start steroids in preschool wheeze/asthma
Moderate-severe asthma
Hx prev severe attacks
Hospital stay >6 hrs
Red lateral neck mass in well person - dx and management?
Branchial cyst - inflamed
Refer for removal
Which endocrine emergency - patient with tremor, anxiety, agitation, pedal + pulmonary oedema, hyperthermia
Thyroid storm
Refer to hospital
ABCs
IVF + dextrose if hypoglycaemic
ECG + bloods
Infection screen
B-blockers for tachycardia - under guidance
Cooling
Benzos for agitation
Consider differentials - DKA, toxicity, sepsis
Do not use aspirin - releases more thyroid hormone
Acute sensorineural hearing loss
ENT emergency
Possible causes - idiopathic, vascular, malignancy, infective, traumatic, immune deficiency, aspirin
Refer for urgent audiogram
High dose steroid
50% patients recover within 2 weeks
Atypical pneumonia vs lobar pneumonia
- Signs
- Treatment
- Insidious onset up to 4 weeks
- GI symptoms
- Scant sputum initially
- arthritis/arthralgia, erythema mulitforme and nodosum, pericarditis, pancreatitis
- Macrolides, tetracyclines
ECG changes in TCA overdose
Sinus tachycardia
PR prolongation
Right axis deviation
<3mm R wave in avR
Long QT
Long QRS
RBBB
VF/VT/asystole
2nd/3rd degree HB
Post viral symptom time frame:
Cough
Nasal discharge
Cough - 2-4 weeks
Nasal discharge 2 weeks
DVT - how to measure calf circumference
10cm below tibial tuberosity, >3cm difference
Low speed injury, anterior neck pain, swelling and slurred speech
Cervical artery dissection with CVA
Ipsilateral Horner’s syndrome - ptosis, miosis, anhydrosis
Causes of otitis externa
Infection - bacterial, fungal
Dermatological - atopic dermatitis, allergic/irritant contact dermatitis, psoriasis
2 fractures that can cause compartment syndrome
Forearm
Tibial
Lifestyle modifications for EBV
No contact sports
No ETOH
Management of gonorrhoea - 4 points
Test for chlamydia, HIV, syphilis
Treat with IM ceftriaxone + azithromycin
Contact tracing - 3 months
Report to MOH
