secondary care learning points

Question 1

list differential diagnoses of sudden onset headache

Answer 1

Migraine
Stroke
Meningitis
temporal arteritis

alcohol dependance? recreational drugs (cocaine)?

Question 2

what would make you suspicious of SAH?

Answer 2

reach full intensity by 10mins. and lasts up to 2hours

Question 3

what is the priority in first presentation of thunderclap headache?

Answer 3

exclusion of ruptured intracranial berry aneurysm causing an acute SAH

Question 4

how do you calculate units of alcohol?

Answer 4

alcohol vol X % / 1000

Question 5

what are we looking for when doing an LP after suspected SAH?

(NB you would do a CT head 1st then LP 12hours later)

Answer 5

bilirubin breakdown product in CSF after 12 hours. will exclude traumatic tap.

Question 6

name causes of finger clubbing

Answer 6

CV:

• infective endocarditis
• cyanotic CHD

Resp:

• lung Ca
• bronchiectasis
• lung abscess
• idiopathic pulmonary fibrosis

Question 7

list the features of checking someones pulse

Answer 7

1. rate
2. rhythm
3. character
4. volume
5. state of vessel wall

Question 8

what is the diagnosis of someone with an irregularly irregular pulse (irregular in force, rate and volume)

Answer 8

AF

Question 9

define JVP

Answer 9

double impulse visible not more than 3cm above the sternal angle with the pt at 45 degrees

Question 10

what would cause a displaced or thrusting apex beat?

Answer 10

1. thrusting - hypertrophied (AS or HTN)
2. displaced - dilated heart (ischaemic heart disease)
   both - AR
3. tapping - rheumatic fever –> MR

Question 11

discuss heart murmurs..

Answer 11

..

Question 12

what renal disease is associated with aneurysms/SAH

Answer 12

autosomal dominant PKD

Question 13

what signs suggest third nerve palsy?

Answer 13

1. fixed dilated pupil (unreactive to light)
2. ptosis
3. paresis of eye adduction and of upward and downward gaze

Question 14

list causes of hyponatreamia

Answer 14

• PPI
• euvolaemic causes (siADH, polydipsia, IV fluids)
• hypovolemic causes (vomiting, diarrhoea, thiazide, burns)
• hypervolaemic causes (HF, cirrhosis, CKD)

Question 15

what are the causes of siADH?

Answer 15

lung Ca (small cell)
drugs (PPI, carbemazipine, SSRI, amitriptyline)
idiopathic (usually in elderly)
CNS injury (meningitis, SAH)
hypothyroidism 
addisons

Question 16

what are the symptoms and Rx of hyponatraemia?

Answer 16

asymptomatic -> nausea/ confusion/ headache/ agitation -> vomiting/ coma/ seizure

if rapid drop: brain swelling/ cerebral oedema or non-cardiogenic pulmonary oedema

Mx:

• fluid restriction
• acute or severe symptoms treat with hypertonic solution
• sodium replacement

Question 17

is serum K+ is raised in the presence of hyponatreamia what should be suspected?

Answer 17

adrenal insufficency/ Addisons

• low serum cortisol/ short Synacthen test
• hypotensive

Question 18

what are causes of low HS?

Answer 18

COPD

effusion - pericardial or lung

Question 19

what is the max dose of lignocaine (LA) 1% (10ml per ml) you can give?

Answer 19

3mg/kg = 20ml in average person

Question 20

what is the max dose of lignocaine + adrenaline yo can give?

Answer 20

5mg/kg = 35ml in average person

Question 21

what suture would you use for face?

Answer 21

5/0 -6/0 ethilon (nylon)

3/0-4/0 ethilon for most stuff
2/0 for BIG wounds

Question 22

how long do you keep sutures in?

Answer 22

head and neck - 5 days
upper limbs and torso - 7days
pelvis and lower limbs - 10days

Question 23

what nerve palsy is indicated by dorsoradial movement of the hand?

Answer 23

posterior interosseous nerve palsy

• neuropathic compression of the PIN where it passes through the radial tunnel. may result in paresis or paralysis of the digital and thumb extensor muscles, resulting in an inability to extend the thumb and fingers at the MCP joint