Phase 4 2015

Question 1

Define compartment syndrome

Answer 1

Life and limb threatening event
Occurs when swelling of the tissues in an anatomic compartement occludes the vascular supply leading to hypoxia and eventually necrosis
Susequent rhabdomyolysis can cause renal failure

Question 2

Treatment of compartment syndrome

Answer 2

Urgent fasciotomy

Question 3

4 treatments for the management of a fracture

Answer 3

Resuscitation
Reduction
Restriction
Rehabilitation

Question 4

Features of a viral conjunctivits

Answer 4

Serous discharge 
Lack of itch 
Red eyes 
Gritty eyes 
Morning crusting 
Hx of an URTI

Question 5

Signs of viral conjunctivitis

Answer 5

Preauricular lymph nodes
Recurrence of conjunctivitis
Bilateral eyes involved
Pinpoint conjunctival haemorrhages

Question 6

Mode of inheritance of Polycystic kidney disease and name the chromosomes

Answer 6

Autosommal dominant
PKD1 Chrom 16
PKD2 Chrom 4

Question 7

Signs observed on examination in appendicitis

Answer 7

Rebound tenderness
Guarding
Rovsing’s sign: pain is > in the RIF than the LIF when the LIF is pressed
Psoas sign: pain on extending the hip if retrocaecal appenditis

Question 8

What is a cohort study

Answer 8

Population without the disease is followed over time

Measures incidence

Question 9

Define attributable risk

Answer 9

The rate of disease in the exposed that may be attributed to the exposure, i.e. incidence in exposed minus incidence in unexposed.

Question 10

Relative risk

Answer 10

Ratio of risk of disease in the exposed to the risk in the unexposed, i.e. incidence in exposed divided by incidence in unexposed.
Measures strength of association

Question 11

Define confounding

Answer 11

A situation in which the estimate between an exposure and an outcome is distorted because of the association of the exposure with another factor (confounder) that is also independently associated with the outcome.

Question 12

Name the blood test you would do for a dementia screen

Answer 12

FBC
B12/Folate 
ESR
U&E
LFT
Ca2+
TFTs
Serology for syphilis

Question 13

Drugs used in dementia

Answer 13

Anti-cholinesterase inhibitors : rivastigmine

NMDA receptor antagonist: memantine

Question 14

Signs of hypovolaemic shock

Answer 14

Cool/Clammy 
CRT>2 secs
Low BP
Reduced urine output 
Tachycardia
Reduced GCS

Question 15

Discuss the mechanism behind a mallory weiss tear

Answer 15

Excessive vomiting increases intraabdominal pressure
Tear in the mucosal layer of the oesophagus
Reaches the oesphageal venous or arterial plexus

Question 16

Most common causing organism of CAP

Answer 16

Strep pneumonia
Mycoplasma pneumonia
Haemophilus influenza
Moraxella

OTHERS
Chlamydia
Legionella
Staph aureus

Question 17

Outline the management of a renal laceration

Answer 17

Grade 1-4
Can be managed conservatively with strict bed rest until gross haematuria has resolved
Intervention is required if
- Persistent bleeding (ie, enough to necessitate repeated transfusions)
- Expanding perinephric hematoma
- Renal pedicle avulsion or other significant renovascular injuries

Question 18

What are 4 pathological mechanisms of ascites

Answer 18

Hypoalbuminia
Portal hypertension
Reduce oncotic pressure

Question 19

Why perform an asictic tap

Answer 19

New-onset ascites: To determine aetiology, To differentiate transudate versus exudate, To detect cancerous cells.
Suspected spontaneous or secondary bacterial peritonitis.

Question 20

Describe the formation of oesophageal varices

Answer 20

Progressive liver fibrosis + regeneration of the contractile elements in the liver vascular bed
Portal HTN
Splanchnic vasodilation
Increased cardiac output
Salt and water retention
Hyperdynamic circulation
Formation of collateral between lower oesophagus and carida of the stomach

Question 21

Reduce the risk of bleeding in oesophageal varies

Answer 21

Non selective beta blocker: Propanalol