Visual diagnosis

Question 1

Answer 1

Hangman’s fracture or C2 pars interarticularis fracture with subluxation

Question 2

Answer 2

Jefferson fracture

C1 fracture through anterior and posterior arches

Question 3

Answer 3

Clay Shovelers fracture

spinal process fracture

Question 4

Answer 4

Chance fracture

vertebral body fracture secondary to extension / flexion injury

Question 5

Answer 5

Osborne or J waves seen with hypothermia

Question 6

Answer 6

HOCM

Dagger like Q-waves, particularly in the lateral and inferior leads

Question 7

Answer 7

Diagnostic Criteria Type 1 (Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave) is the only ECG abnormality that is potentially diagnostic.

This ECG abnormality must be associated with one of the following clinical criteria to make the diagnosis:

Documented VF or VT

Fam hx sudden cardiac death at <45 years old .

Coved-type ECGs in family members.

Inducibility of VT with programmed electrical stimulation .

Syncope.

Nocturnal agonal respiration.

Question 8

Answer 8

ECG showing regular broad complex tachycardia with widened QRS and abnormal terminal R wave in aVR.

Findings associated with TCA overdose

Question 9

Answer 9

Irregularly irregular wide complex tachycardia

atrial fibrillation with LBBB based on QRS morpho: aberrant ventricular entry via WPW

**favour electricity over meds to cardiovert

Question 10

Answer 10

The epsilon wave is a small positive deflection (‘blip’) buried in the end of the QRS complex.

The ECG changes in ARVD include:

Epsilon wave (most specific finding, seen in 30% of patients)

T wave inversions in V1-3 (85% of patients)

Prolonged S-wave upstroke of 55ms in V1-3 (95% of patients)

Localised QRS widening of 110ms in V1-3

Paroxysmal episodes of ventricular tachycardia with a LBBB morphology

Question 11

Answer 11

2nd degree AV block

Mobitz type 1

usually due to reversible conduction block at the level of the AV node.

Malfunctioning AV node cells tend to progressively fatigue until they fail to conduct an impulse

Question 12

Answer 12

2 degree AV block

Mobitz type II

cells of the His-Purkinje system which tend to fail suddenly and unexpectedly (i.e. producing a Mobitz II block)

Question 13

Answer 13

Tillaux fracture

(no coronal component)

Question 14

Answer 14

It comprises of:

a vertical fracture through the epiphysis

a horizontal fracture through the physis

an oblique fracture through the metaphysis

Question 15

Identify the ligaments of the ankle

Answer 15

Question 16

Jimson weed

Answer 16

Atropine! Anticholinergic toxidrome

delirium, hallucination, hyperthermia, tachycardia, bizarre behavior, and severe mydriasis

supportive care, physostigmine and atropine as needed

Question 17

Water hemlock

Answer 17

signs of cicutoxin poisoning start 15–60 minutes after ingestion: vomiting, convulsions, widened pupils, salivation, excess sweating and the patient may go into a coma

*** convulsions and either an overactive or underactive heart

No antidote, treatment is supportive.

Question 18

Oleander

Answer 18

Digoxin intoxication

starts with intestinal symptoms, then lethargy, visual disturbances, disorientation, HYPERKALEMIA (profound Na-K-ATPase inhibition)

cardiac with prolonged AV from 1st-3rd degree heartblock, escape rhythms

Question 19

Fox glove

Answer 19

Digoxin intoxication

starts with intestinal symptoms, then lethargy, visual disturbances, disorientation, HYPERKALEMIA (profound Na-K-ATPase inhibition)

cardiac with prolonged AV from 1st-3rd degree heartblock, escape rhythms

Question 20

Amanita

Answer 20

Amanita phalloides

vomiting starts >6hrs post ingestion

hepatic failure >24hrs post ingestion

Rx fluid and electrolyte replacement, activated charcoal, dialysis