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OSCE Round 2 > Random > Flashcards

Random Flashcards

1
Q

VT vs SVT with abberancy

A
  1. Epidemiological criteria: age > 35, IHD, structural heart disease. FHx sudden cardiac death.
  2. Clinically unstable —> DCR
  3. Features of VT —> treat as VT
    - Very broad, QRS > 160 msec
    - North west axis
    - AV dissociation
    - Capture / fusion beats
    Brugada Criteria
    - absence of RS complex in all precordial leads (concordance)
    - RS inverval of > 100 msec in precordial lead
    - AV dissociation
    - Morphological criteria for VT in V1-2 and V6
    — Dominant R in V1 (RBBB) - smooth monophasic R, taller initial R in RSR (taller L rabbit ear). V6 QS complex (no R)
    — Dominant S in V1 (LBBB) - R wave > 30-40 msec, notchign S wave (josephson’s sign), RS inverval >60 msec (brugada sign), QS wave in V6
    Vereki algorithm.
    - Dominant inital R wave in aVR
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2
Q

Indications for thrombolysis in ischaemic stroke

A

Age > 18 yrs
Consistent clinical syndrome with significant deficit, not rapidly resolving
< 4.5 hrs from onset
Exclusion of stroke mimics (migraine, hypoglycaemia, seizure)
Clinical and CT findings suggestive of ischaemic stroke

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3
Q

Contraindications for thrombolysis in ischaemic stroke

A

Clinical CI:

  • seizure at onset, hypoglycaemia
  • improving, or obtunded / severe (NIHSS > 25)
  • Septic embolism / dissection
  • BP > 180/110

Hx CI
CNS: No ICH, AVM, SOL.
CAP: no trauma, AMI or surgery in last month, or bleeding GI/GU
No blood thinners
No dementia, disseminated cancer or frailty/dependence

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4
Q

Describe central cord syndrome

A

Hyperextension injury
Motor effects upper limb > lower, distal effects > proximal
Variable sensory involvement

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5
Q

Describe anterior cord syndrome

A

Flexion injury to spine or vascular insufficiency - anterior spinal artery
Motor loss / weakness below level
Loss pain / temperature (preserved proprioception/vibration)

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6
Q

Hard signs of penetrating neck trauma

A 
Bubbling air 
Massive haemoptysis 
Stridor, hoarse voice or airway compromise 
Rapidly expanding haematoma 
Vascular bruit / thrill 
Cerebral ischaemia
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7
Q

.

A

.

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8
Q

DDx acute red eye, painless

A

Diffuse:

  • Lids: blepharitis, ectropion, eye lid lesion
  • conjunctivitis

Localised:

  • pterygium
  • corneal FB
  • occular trauma
  • subconjunctival haemorrhage
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9
Q

Differential diagnosis painful acute red eye

A

Orbit: cellulitis

Lids: chalazion, blepharitis, HZV

Diffuse conjunctival: conjunctivitis, dry eyes

Corneal

  • HSV, dendritic ulcer
  • bacterial ulcer (contacts?)
  • Marginal keratitis (bacterial)
  • foreign body / corneal abrasion

Acute angle closure glaucoma
Ciliary injection - vascular / connective tissue
Anterior chamber -
- uveitis / iritis
- hypopyon
- hyphaema - trauma, NAI, bleeding disorder

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10
Q

DDx sudden loss of vision

A

Transient: amaurosis fugax

Vaso-occlusive:

  • CRAO
  • CRVO

Optic nerve

  • optic neuritis
  • GCA

Retinal detachment

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11
Q

DDx diplopia

A

Mono-ocular:

  • distorsion of lens/cornea - corrects with pinhole
  • retina - not correcting with pinhole
  • functional

Binocular

  • cranial nerve palsy: III, IV, VI
  • impaired globe movement (muscle entrapment)
  • Gaze palsy (internuclear - ms), normal ROM independently
  • Peripheral vertigo
  • neuromuscular - myasthenia
  • occipital cortical - CVA, SOL
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12
Q

Describe management of massive transfusion

A
  1. What is massive transfusion? 1/2 blood volume 4 hrs (70 mls/kg = TBV adult).
  2. Stop bleeding. ED & definitive. Tourniquet, pressure. Arrange definitive care.
  3. Large bore IV access. X-match - crossmatched blood when available.
  4. Balanced transfusion, 1:1:1 PRBC, FFP to platelets. Then viscoelastography guided.
  5. Targets for transfusion
    - SBP of X
    - No haemoglobin target
    - Avoid acidosis pH > 7.2, avoid hypothermia temp > 36 (warm blood)
    - iCa > 1.1 (give calcium), APTT & INR < 1.5 x normal, plt > 50 (give platelets), Fibrinogen > 1 (give Cryo)
  6. Reverse coagulopathy if present. Specific reversal agent.
  7. Monitor for complications
    - of blood loss: worsening hypotension / clinical condition
    - of blood transfusion: fever, TACO
    - distraction from other priorities (to OT)
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13
Q

Addisons disease

  • causes
  • clinical findings
  • treatment
A 
Primary adrenal insufficiency
- autoimmune 
- infection (viral, TB, protozoa)
- adrenal haemorrhage 
- malignancy 
- sarcoid 
Secondary adrenal insufficiency
- drugs 
- pituitary failure 
- hypothalamus

Findings

  • Fluid resistant hypotension
  • hyponatraemia, hyperkalaemia
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14
Q

Clinical / investigation findings in conns and cushings syndrome

A

Hypertension
Alkalosis
Hypokalaemia
Hypernatraemia / oedema

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15
Q

Clinical and investigation findings in Addisons

A

Primary adrenal insufficiency

Hypotension 
Hyponatraemia 
Hyperkalaemia 
Acidosis 
Hypoglycaemia
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16
Q

Causes of addisons disease

A

Primary adrenal insufficiency

Autoimmune
Infection
haemorrhage (sepsis, anticoagulants)
Malignancy

17
Q

Causes of adrenal insufficiency

A

Primary = Addisons

  • autoimmune
  • infection
  • Haemorrhage
  • malignancy

Secondary

  • Drugs
  • pituitary failure
  • hypothalamic failure
18
Q

Findings in congenital adrenal hyperplasia

A 
Different forms. 
Salt loosing male form, presents 7-14 days with shock 
- hyponatraemia 
- hyperkalaemia 
- hypoglycaemia

Girls - ambiguous genitalia
Boys - non-salt loosing, present 2-4 years with early virilization (androgen excess)

19
Q

Definition of anaphylaxis

A
  1. Acute onset of skin/mucosal features (urticaria, angiooedema) and
    - CVS: hypotension, dizziness, OR
    - Resp: stridor, hoarse voice, bronchospasm
    - GIT, persistent/severe: abdominal pain, vomiting, diarrhoea.
    OR
  2. Acute onset of hypotension, bronchospasm or upper airway obstruction where anaphylaxis is considered possible.

OSCE Round 2 (6 decks)

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