Q to work on #4

Question 1

What disease are you thinking of?

Answer 1

Kawasaki Disease (Mucocutaneous Lymph nod syndrome)

Question 2

What is Kawasaki disease?

Answer 2

A self-limiting vasculitis of vessels, ~12days of fevers and symptoms.

Question 3

Symptoms/Signs of Kawasaki Disease

Answer 3

Initially: Respiratory or gastrointestinal symtpoms

Later:

• Bilateral non-exudative conjunctivitis
• erythema of lips and oral mucosa
• Cervical lymphadenopathy
• rash
• Extremity changes

Question 4

What specific markers will be elevated in Kawasaki

Answer 4

ESR, CRP, Ferritin and Thrombocytopenia will occur

Question 5

What treatment for Kawasaki do you administer

Answer 5

IV immunoglobulin and aspirin

Question 6

Cholesteatoma is?

Answer 6

A benign growth of stratified squamous epithelial cells occuring in the middle ear, sometimes after trauma

Question 7

Ototoxic drugs to be aware of

Answer 7

• Aminoglycsides: Gentamicin
• IV Loop diuretics: Frusomide
• Chemo agents: C**isplatin

Question 8

Complete the table for Rheumatoid Arthritis vs Osteoarthritis

Answer 8

Question 9

When does Hypovolemic shock occur.

What are the consequences of it

Answer 9

Following a large drop in circulatory volume, which like other forms of shock, leads to a reduction in tissue perfusion which causes decreased oxygen delivery..

this can lead to cellular hypoxia and metabolicwaste, evetually causing multisystem organ failure and death.

Question 10

George Moran, age 81, comes to the emergency department looking frail and weak. His vital signs are: blood pressure, 82/40 mm Hg; heart rate 130 beats/minute and regular; and oral temperature 37° c. He weighs 2.3kg less than his normal weight. On inspection, you detect poor skin turgor and dry mucous membranes; on palpation, you note his abdomen is tender but not distended.

He has had nausea, vomiting, and watery diarrhea for the last 2 days and that he fell earlier today when getting up from a chair.

When laboratory results come back, you note an elevated white blood cell count, high blood urea nitrogen level, and borderline-low creatinine level (0.8).

Explain the bodies response to Hypovolemia with a flow diagram

Answer 10

Question 11

5 places that a trauma patient can lose or sequester sufficient blood to cause haemorrhagic shock?

Answer 11

1. Pelvis
2. Abdomen
3. Chest: massive haemothorax
4. Long Bone fracture
5. “street” open wound

Question 12

What investigations could you do in ED to identify the source of someones haemorrhage if you believe them to e in haemorragic shock?

Answer 12

• FAST Exam: Focused Abdominal Sonography in Trauma
  
  • Bedside ultrasound technique that is quick and sensitive to free fluid
  • Looks in 3 parts abdo, 1 part cardiac view (to rule out cardiac tamponade)
• CXR: haemothorax
• Pelvis xray: fractures

Question 13

What are the three types of shock (and the 3 stages)

Answer 13

1. Hypovolemic
2. Cardiogenic
3. Distributive
4. Pre-shock
5. Shock
6. End-organ dysfunction

Question 14

Signs that would lead you to suspect sepsis would be…

((Both early and late ))

Answer 14

Early:

• Fever
• Tachycardia
• Tachypnoea
• Signs of peripherl vasodilitation
• Change in mental state/ confusion

Late:

• Hypotension
• decreased capillary refill
• Mental instability

Question 15

What is Lichen Sclerosis

Answer 15

A form of a vulvar skin disorder that causing painful burning sensation durin intercourse. The vulvular skin may appear white and crinkled

It currently has no cure

Question 16

Should Thyroid hormone replacements be altered for pregnancy and if so, why?

Answer 16

Yes, they should be increased to match early trimester levels.

If not hypothyroidism can lead to fetal loss or cognitive defects.

Question 17

What is the numbness, tingling and pain in Carpal Tunnel caused from, and why?

Answer 17

Compression of the Median Nerve due to inflammation of the tendons or surrounding tissues that run within the carpal tunnel.

Question 18

What are the borders of the carpal tunnel

Answer 18

Palmar: Flexor Retinaculum

Dorsal/Floor: Bony arch or “carpal arch”

Question 19

Why is the Palm of the hand not affected in Carpal tunnel Syndrome?

Answer 19

Because the sensory innervation to the palm is supplied by the palmar median nerve which runs outside of the carpal tunnel

Question 20

What are some risk factors of Carpal Tunnel Syndrome?

Answer 20

• Obesity
• Pregnancy
• Conditions: Rheumatoid Arthritis

Question 21

What diagnostic tests can be done to confirm Carpal tunnel?

Answer 21

• Phalen’s Manouver >1min
• Tinel’s Test
• Durkans Manouver 30sec