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4th Year ACC > very select ACC questions > Flashcards

very select ACC questions Flashcards

1
Q

Wernicke’s enceph triad?

A

Confusion

Ataxia

Nystagmus

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2
Q

Which alcohol withdrawal pts should be admitted for inpatient detox?

A

Delirium tremens

Seizures

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3
Q

What permanent Rx will complete HB probably need?

A

Pacemaker

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4
Q

Does ketonuria alone = DKA?

A

No

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5
Q

3 diagnostic criteria of DKA

A

Acidotic on VBG

Hyperglycaemic (>11BM or known diabetic)

Ketonaemia (>3) or uria (>2+)

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6
Q

What happens to normal long acting insulin in DKA?

A

Continue

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7
Q

when is DKA resolved?

A

Blood ketones <0.6

Venous pH >7.3

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8
Q

Can you use bicarb as a measure of progress in DKA?

A

Not after 6h as the NaCl can = hyperchloraemia which lowers bicarb

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9
Q

What do you do in head injury if GCS <8?

A

Anaesthetics to intubate

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10
Q

Retrograde vs anterograde amnesia?

A

prior event ….Retrograde….injury….anterograde…now

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11
Q

Unequal pupils in neuro exam suggests what?

A

raised ICP - neuro review

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12
Q

CSF leakage from nose or ear, battle sign, panda eyes or haemotympanium suggests what?

A

Basilar skull fracture

–> CT, tetanus toxoid, neurosurgeons

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13
Q

Indications for CT head <1hr

A
  1. Depressed/open/basal skull fracture
  2. Post injury seizure
  3. Vomiting >1
  4. Panda eyes
  5. Post auricular ecchymosis (Battle sign)
  6. CSF from ear/nose
  7. FND
  8. Haemotympanum
  9. GCS <13 (or <15 at 2h)
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14
Q

Indications for CT head <8hr?

A
  1. LOC or amnesia

AND

2a) >65yo
b) high impact injury
c) retrograde amnesia >30mins
d) coagulopathy

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15
Q

How do you know if CT C spine needed <1hr?

A

High risk factors present - CT

If no high risk- low risk factor present? - if no then not safe to assess neck movement- 3 view C spine Xray instead

If low risk factor is present- assess neck mov- if can’t rotate 45 L and R then X ray.

If all fine then can safely r/o C spine without imaging

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16
Q

what are the high risk factors for C spine

A
  1. > 65yo
  2. GCS <13
  3. Intubated
  4. X ray suspicious or abnormal
  5. Definitive answer needed e.g. for surgery
  6. FND peripherally
  7. Peripheral parasthesia
  8. Dangerous mechanism of injury (incl fall >1m/5 stairs)
  9. Other imaging being done for head/multi-region trauma
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17
Q

What are the low risk (ruling out) risk factors for C spine?

A
  1. Simple rear end motor collision
  2. Sitting comfortably in ED
  3. Ambulatory since injury
  4. No midline C-spine tenderness
  5. Delayed onset neck pain
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18
Q

When is permissive hypotension in trauma contraindicated?

A

Traumatic brain injury as risk hypoperfusion

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19
Q

Bloods to get if suspect bleeding in trauma

A

FBC

U+E

LFT

Coag

VBG

Crossmatch

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20
Q

GCS scores

A

Eyes open (4) : never/pain/speech/spontaneous

Verbalises (5) : never/incomprehensible/inappropriate/confused/orientated TPP

Motor (6): never/abnormal extension/abnormal flexion/flexes to withdraw from pain/localises pain/obeys commands

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21
Q

what does AMPLE stand for and when is it used?

A

Secondary survey for more info

Allergies

Medications

PMH

Last meal

Environment and events

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22
Q

What does secondary survey involve

A

AMPLE

Reassess A to E always

Full systems examination

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23
Q

Neuro signs + persistent moderate hypotension suggest what?

A

Neurogenic shock

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24
Q

How can you confirm neurogenic shock?

A

C-spine imaging

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25
Q

What imaging for thorax in trauma?

A

Screen - X ray

Blunt mechanism- CT

pneumo/haemothorax - USS (most life threatening)

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26
Q

Imaging for pelvis in trauma? What is a serious injury you can get?

A

X ray

Pelvic fractures can = significant haemorrhage –> hypotension

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27
Q

How would you get an indirect brain injury?

A

No impact but the contents of the skull set into vigorous motion

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28
Q

If they can tolerate an oropharyngeal airway, their GCS must be?

A

<8 - can’t protect so need ETT

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29
Q

How to prevent secondary brain injury

A

Good ABC

30
Q

What happens to BP in brain injury?

A

Cerebral autoregulation of blood flow lost so must maintain BP and control ICP

31
Q

Pupils that are both small indicates what?

A

Opiates or brain stem injury

32
Q

Pupils where one is fixed and dilated = what?

A

IIIrd nerve stretched on that side due to ipsilateral raised ICP

33
Q

Both pupils fixed and dilated =?

A

Poor outcome unless caused by drugs e.g. atropine/adrenaline or local eye injury

34
Q

How do you record GCS if motor response is asymmetrical?

A

Take best side

35
Q

On fundoscopy papilloedema indicates?

A

Non acute raised ICP

36
Q

On fundoscopy subhyaloid haemorrhage indicates?

A

SAH

37
Q

What does subhyaloid haemorrhage look like?

A

Fluid level in a circle on fundoscopy

38
Q

What ocular reflex would you expect to see in a comatose patient with an intact brain stem

A

Dolls head reflex- eyes still stare at ceiling when you move their head

39
Q

What ocular sign would you expect to see in a comatose patient with damaged brain stem

A

eyes move with head as if fixed

40
Q

What is the oculovestibular reflex? What results do you expect

A

Irrigate ear canal with ice cold water = nystagmus and vomiting in non-comatose patients

In a comatose patient with intact brain stem = tonic movement of eyes towards the ear

No response= no brain stem reflexes

41
Q

Cheyne stokes breathing suggests what

A

Ischaemic or metabolic hemispheric lesions

or heart failure

42
Q

Hyperventilation in the context of neuro injury suggests what

A

Hypothalamus/mid brain lesion

43
Q

Slow, irregular apneustic breathing suggests what

A

mid/lower pontine lesions

44
Q

Low/irregular RR and low HR with high BP in the context of neuro injury is what?

A

Cushing’s reflex

45
Q

Can TBI cause coagulopathy?

A

Yes

46
Q

When do you involve neurosurgeons in TBI?

A
  1. persisting GCS <8 after trauma
  2. unexplained confusion >4h
  3. Progressive focal neuro signs/GCS deteriorating
  4. seizure without full recovery
  5. Penetrating injury
  6. CSF leak
47
Q

(Mean arterial pressure)-(ICP)= ?

A

Cerebral perfusion pressure

48
Q

MAP must not fall below what in brain injury?

A

80mmHg

49
Q

How do you manipulate cerebral perfusion pressure?

A

Increase MAP (fluids, inotropes) or decrease ICP (avoid excess fluid, elevate head by 30 degrees, avoid constraints around neck, mannitol diuretic, oxygenate, ventilate, sedate)

50
Q

What does the cushing’s triad suggest?

A

Raised ICP

Terminal stage of acute head injury could = imminent herniation

51
Q

GCS 3-8 and abnormal CT scan = mandatory ?

A

ICP monitoring

52
Q

Cerebral perfusion pressure must be minimum what in adults?

A

70mmHg

53
Q

Bilaterally dilated but sluggish or fixed pupils =?

A

Poor cranial perfusion or IIIrd nerve palsy

54
Q

What can be given in cerebral oedema following head injury?

A

Mannitol

55
Q

Extradural haematoma is likely to be which blood vessel?

A

Middle meningeal artery

56
Q

old age, alcoholism and anticoagulation, with fluctuating confusion/consciousness in the history suggests what type of cranial bleed?

A

Subdural haematoma

57
Q

SAH often occurs due to what?

A

Ruptured aneurysm, but could also be TBI

58
Q

Most sensitive scan to diagnose diffuse axonal injury?

A

MRI

59
Q

HHS is which type of diabetes

A

2

60
Q

HHS triggered by what?

A

Infection/illness and dehydration

61
Q

Glucose is >? in HHS

A

30

62
Q

Ketones and pH in HHS?

A

Normal

63
Q

How does HHS present?

A

N+V

Weakness, cramps

Maybe polyuria and dipsia

Altered mental state

64
Q

Should you use oropharyngeal airway in seizure?

A

No use naso

65
Q

People having seizures are likely to bite which bit of tonue

A

Sides

66
Q

What is Todd’s Palsy?

A

Transient unilat weakness following seizure for a few hours (similar to TIA)

67
Q

Is it abnormal to have upgoing plantars and ankle clonus immediately after seizure?

A

No

68
Q

If you’re unsure of the diagnosis, what is raised 10-20m after seizure?

A

Prolactin

69
Q

Known epileptic presents with normal-for-them fit, wyd?

A

Discharge

70
Q

First fit presents, wyd?

A

Observe for 4h, if nil - discharge

Avoid activities like driving, machinery, ladders, swimming unsupervised until reviewed by specialist

Seen in OP clinic after ECG and CT

71
Q

Can you get vomiting and incontinence in syncope?

A

Yes

72
Q

How does hypoglycaemia present?

A

Any neuro presentation

4th Year ACC (9 decks)

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