My Profile Sign Out - 1 File Download

My Profile Sign Out

Home Exam Revision Scores Help My Profile Sign Out

Work Smart Work Hard Mock Tests Group Learning 1 Revision Advice Tags

Learning Journal

Work SmartQuestion 1 of 22

Which of the following does not have a role in the management of chronic cancer pain?

(Please select 1 option)

Carbamazepine

Clodronate

Dexamethasone

Nifedipine Incorrect answer selected

Pinaverium This is the correct answer

Pinaverium is used to reduce the pain duration in irritable bowel syndrome (IBS).

Carbamazepine is in use for the treatment of neuropathic pain of malignancy, diabetes and otherdisorders.

Clodronate inhibits osteoclastic bone resorption and is used to treat malignant bone pain and theassociated hypercalcaemia.

The corticosteroids are used to treat pain from central nervous system tumours. Reducing theinflammation and oedema relieves the pain caused by neural compression.

Nifedipine helps relieve painful oesophageal spasm and tenesmus associated with gastrointestinaltumours.

Painful bladder spasm may be relieved by oxybutynin.

http://my.onexamination.com/Dashboard/Default.aspx

http://www.facebook.com/OnExamination

http://twitter.com/onexamination

http://my.onexamination.com/Account/Default.aspx

javascript:__doPostBack('ctl00$LoginStatus1$ctl00','')


http://my.onexamination.com/Assessment/Default.aspx


http://my.onexamination.com/Review/ScoreAnalysis.aspx

http://my.onexamination.com/Support/KnowledgeBase.aspx



http://my.onexamination.com/GenericAssessment/Generate.aspx


http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?type=WorkHard

http://my.onexamination.com/GenericAssessment/MockTests.aspx

http://my.onexamination.com/GroupAssessment/Default.aspx



http://my.onexamination.com/Assessment/RevisionAdvice.aspx

http://my.onexamination.com/GenericAssessment/GenericAssessmentBookmarkedList.aspx

http://my.onexamination.com/GenericAssessment/GenericAssessmentLearningJournal.aspx

1 11%2 8%3 7%4 56%5 18%

Answer Statistics

Times answered: 8539

Test Analysis

Score: 0%

Total Answered: 1

Feedback

Question Navigator

CorrectIncorrectPartiallyCorrect

http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=13002941#answerStatPanel

http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=13002941#testAnalysisPanel

http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=13002941#FeedbackContent

http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=13002941#QuestionNavigatorContent

Revision Notes

Tags

© 2018 BMJ Publishing Group Ltd . All rights reserved.

京ICP备15042040号-3

Contact . Corporate . Terms and conditions & Privacy policy

http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=13002941#ReflectionsContent

http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=13002941#TagsContent

http://company.bmj.com/


http://onexamination.com/more/contact

http://onexamination.com/more/corporate

http://www.onexamination.com/more/legal

My Profile Sign Out



Learning Journal


An 18-year-old woman sustains severe head injuries in a road traffic accident.

The following day her investigations show:

Sodium 160 mmol/L (137-144)

Potassium 3.7 mmol/L (3.5-4.9)

Chloride 120 mmol/L (95-107)

Urea 3.0 mmol/L (2.5-7.5)

Creatinine 90 µmol/L (60- 110)

Which one of the following statements is correct?


Rapid rehydration with 5% dextrose is indicated

She has the syndrome of inappropriate antidiuretic hormone secretion (SIADH)

She should be treated with sodium restriction

She will have a hypercholraemic acidosis

Urine osmolality will be low Correct

There is a marked hypernatraemia with elevated chloride but normal potassium and urea in a patient























with severe head injuries.

The likely cause of this presentation is diabetes insipidus. Urine osmolality is therefore likely to below.

You cannot say that she has a hyperchloraemic acidosis as you do not have her bicarbonateconcentration but if you assume that the anion gap would be normal, that is 10-12, then this wouldsuggest that the bicarbonate is elevated, suggesting either a metabolic alkalosis or respiratoryacidosis with compensation.

Although restoration of normal volaemia and osmolality is required, giving 5% dextrose mayexacerbate any cerebral oedema and so correction should be gradual.

1 12%2 19%3 16%4 16%5 37%

Answer Statistics


Test Analysis


https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0028166/



Score: 50%

Total Answered: 2

Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


A 14-year-old boy bangs heads with an opponent during an unofficial football game. He is knockedout for 30 seconds and is amnesic for the event. He recovers quickly and continues playing.

Two hours later he complains of headache, begins vomiting, then loses consciousness. He had a fullterm normal delivery with no neonatal complications. His immunisations are up to date. There is noFH/SH of note.

On examination he responds only to deep pain. He is apyrexial with respiratory rate of 10/min(irregular), pulse of 40/min. He has a large bruise in the right temporal area.

Which is the most likely diagnosis?


Cerebral contusion

Contrecoup injury

Extradural haematoma Correct

Subdural haematoma

Tonsillar herniation

The history is of a closed head injury, followed by a lucid period followed by decreasing level ofconsciousness.

The time course suggests an extradural haematoma, where there is arterial bleeding whichaccumulates rapidly outside the dura causing raised intracranial pressure.























Subdural haematoma in infants may accompany massive axon injury in 'shaken baby syndrome', andpresents acutely. Retinal haemorrages are often present. (Chronic subdurals due to birth trauma canpresent much later due to the open fontanelle.)

Epidural haematoma, typically from a torn middle meningeal artery and associated with skull fracture,accumulates much more rapidly.

There may be apparent recovery from the initial concussion, but deterioration is usually within 15-30minutes.

© Colin Melville 2012

1 5%2 5%3 56%4 26%5 9%

Answer Statistics


Test Analysis




Score: 66.67%

Total Answered: 3

Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


A 56-year-old man is admitted with epigastric pain after drinking heavily.

He has a temperature of 36.9°C, a pulse of 95/min, a blood pressure of 85/60 mmHg, and arespiratory rate of 32/min.

Investigations reveal:

Haemoglobin 126 g/L (130-180)

Platelets 169 ×10 /L (150-400)

White cell count 3.9 ×10 /L (4-11)

Which of the following is the diagnosis?


Leaking aortic aneurysm

Multiple organ dysfunction syndrome (MODS) Incorrect answer selected

Severe sepsis

Septic shock

Systemic inflammatory response syndrome (SIRS) This is the correct answer

This patient has features of pancreatitis. He also has hypotension, and leucopenia. He therefore fulfils

9

9























the criteria for systemic inflammatory response syndrome. This is equivalent to sepsis, but occurs inthe absence of infection (e.g. in pancreatitis).

SIRS is defined as two or more of the following:

Temperature more than 38°C or less than 36°CHeart rate more than 90 beats/minRespiratory rate more than 20 breaths/min or PaCO2 less than 4.3 kPaWBC count 12,000/mm , less than 4000/mm , or more than 10% immature (bands) form.

A leaking aortic aneurysm is still a possibility, however a decreased white cell count would not beexpected.

We do not have enough information to diagnose multiple organ dysfunction. There is no evidence ofinfection to make a diagnosis of septic shock or severe sepsis. For information, sepsis is defined asthe association of systemic inflammatory responses with evidence of microbial origin. Severe sepsisalso has hypoperfusion or dysfunction of at least one organ system, and septic shock is this plushypotension refractory to fluid resuscitation.

3 3

1 18%2 6%3 23%4 9%5 44%

Answer Statistics


Test Analysis




Score: 50%

Total Answered: 4

Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


A 56-year-old man diagnosed with systemic inflammatory response syndrome (SIRS) secondary topancreatitis is admitted to the High Dependency Unit.

He has a pulse of 109 beats/min and a blood pressure of 89/74 mmHg despite receiving IV fluids andurine output of 25 ml/hour after catheterisation.

Which of the following is the most appropriate course of action for this patient?


A central line Correct

A CT abdomen

A surgical referral

An arterial line

Broad spectrum antibiotics

Early goal-directed therapy (EGDT) in cases of SIRS or septic shock is becoming increasinglyrecognised as potentially beneficial. If fluids are not achieving haemodynamic stability, and there isindication of hypoperfusion as indicated by oliguria or lactataemia, then vigorous resuscitation isindicated.

EGDT aims to increase organ perfusion through restoration of mean arterial pressure using inotropesif necessary, maintaining central venous pressure (CVP), maintaining oxygenation, and using SjVO(jugular venous oxygen saturation) as a guide to oxygen utilisation at the tissue level. SjVO higher

2

2























http://ccforum.com/content/9/4/307

than 70% is indicative of organ hypoperfusion, as oxygen is not being extracted.

Insertion of a central line above allows measurement of CVP, SjVO and the use of inotropes.2

1 57%2 8%3 6%4 7%5 23%

Answer Statistics


Test Analysis

Score: 60%

Total Answered: 5

Feedback





Question Navigator

Revision Notes

Tags


京ICP备15042040号-3










My Profile Sign Out



Learning Journal


A 64-year-old man is admitted with severe epigastric pain. He has had the pain for 36 hours. Anabdominal x ray shows a central, dilated small bowel loop.

His temperature is 37.0°C, pulse 130 bpm, blood pressure 80/50 mmHg, respiratory rate 29/min,SpO2 85% on air.

His full blood count reveals:



Platelets 108 ×10 /L (150-400)

MCV 105 fL (80-96)

Which of the following is the most appropriate initial treatment of this patient?


Administer high-flow oxygen This is the correct answer

Insert 2 × 14 gauge venflons and give 2 litres Hartmann's solution Incorrect answerselected

Intensive care

Intubation and ventilation

Invasive monitoring

9

9























This patient has systemic inflammatory response syndrome, possibly caused by acute pancreatitisgiven the finding of an isolated dilated loop of small bowel on abdominal radiograph. However, theinitial treatment is the same independent of the underlying cause.

All of the above answers are reasonable, however resuscitation of the sick patient still follows theABC algorithm:

AirwayBreathingCirculation.

Airway control and oxygen to maintain normal saturations is the first part of that algorithm.Subsequent fluid resuscitation and treatment of the underlying cause can then be initiated. The needfor invasive monitoring and intensive care is then assessed, depending on the response to initialtreatment.

1 32%2 50%3 13%4 3%5 2%

Answer Statistics


Test Analysis




Score: 50%

Total Answered: 6

Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


A 64-year-old man is admitted with 12 hours of central and epigastric pain.

An abdominal x ray shows a central, dilated small bowel loop. His temperature is 37.2°C, pulseregular at 130 beats per min, blood pressure 95/55 mmHg, respiratory rate 29/min, and SpO2 90% onair.

His admission full blood count is:



Platelets 96 ×10 /L (150-400)

MCV 105 fL (80-96)

Which of the following is the most likely diagnosis?


Gall stone ileus

Ischaemic bowel

Pancreatitis Correct

Perforated duodenal ulcer

Small bowel obstruction

9

9























Ischaemic bowel and perforated duodenal ulcer would be high in the differential list. However, thehistory and raised mean corpuscular volume (MCV) suggests chronic high alcohol use and theseverity of his observations would suggest a systemic inflammatory response which is more commonwith pancreatitis.

Acute pancreatitis has a mortality of 7-10%, often due to sepsis or multiorgan failure. There are anumber of scoring systems which can be used to guide prognosis, but they are unreliable within thefirst 48 hours o f the illness. Gallstones account for 50% of cases, with the majority of the rest beingassociated with alcohol.

Patients typically present with severe epigastric pain which radiates to the back, and vomiting. Asseen in this example, there is often a systemic inflammatory response (SIRS), Amylase is markedlyraised, often in excess of four times the normal value. Early complications include ARDS (adultrespiratory distress syndrome), acute kidney injury and disseminated intravascular coagulation (DIC).

Treatment is essentially supportive, and high levels of monitoring are usually required (often in theintensive care unit). Those patients who are found to have gallstones should be considered for urgentERCP when stable. All should have a cholecystectomy either during the same admission or withinfour weeks depending on their clinical progress.

1 6%2 14%3 41%4 14%5 25%

Answer Statistics


Test Analysis




Score: 57.14%

Total Answered: 7

Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


A 74-year-old man with ischaemic heart disease is in the surgical high dependency unit following aHartmann's procedure completed 12 hours previously.

He is in pain. He has drained 100/200/300 mls of blood into his drains in each of the last three hours.His blood pressure is 110/80 mmHg, his pulse 105/min. He has a respiratory rate 32/min, SpO2100% on oxygen by face mask.

Crossmatched blood is available.



Platelets 132 ×10 /L (150-400)

Which of the following actions would be undertake as your initial priority?


Give 1000 ml of colloid stat

Give 1000 ml of crystalloid stat

Morphine 5 mg intravenously Incorrect answer selected

Return to theatre

Transfuse 2 units of packed red blood cells stat This is the correct answer

9

9























He is still actively bleeding and haemodilution will not have been achieved so his Hb will be lowerthan the result given. It will take at least 30-60 minutes before he is back in theatre and anaesthetized(CEPOD lists/emergency sections/crash calls/no porter etc). With IHD he is at at high risk of aperioperative MI. He should have the blood first as crossmatched blood is available.

His observations could be caused by pain. However in the face of a falling haemoglobin, a risingpulse rate, and an increasing loss into his drains this patient needs to return to theatre.

His blood pressure is not critically low and although many would give crystalloid or colloid, it isreasonable in an elderly man with ischaemic heart disease to give blood if it is easily available.Overload with non-oxygen carrying fluid should be avoided (although the red cells are not functionalfor a while).

1 25%2 11%3 10%4 16%5 38%

Answer Statistics


Test Analysis




Score: 50%

Total Answered: 8

Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


You are asked to see a 75-year-old man post-oversew of a duodenal ulcer. He is confused.

His SpO2 is 97 on oxygen. Pulse 110 beats per min, blood pressure 100/50 mmHg, respiratory rate32/min and his urine output is 10 ml in the last hour.

Which of the following is the most appropriate treatment for this man?


100% oxygen via face mask

Central line and arterial line

Haloperidol 2.5 mg intravenously

Noradrenaline via central line

Normal saline 500 ml stat Correct

Postoperative confusion is common in the elderly. However this can be caused by a low perfusionstate.

His observations are indicative of underfilling/dehydration. (He could also have atelectais or havedeveloped a chest infection. Post-operative problems are often multifactorial.)

Of the options given a fluid bolus is appropriate. This is what you would expect your FY1 to do whilewaiting for the blood test results and before calling you.

Some would argue that 100% oxygen comes before fluids but with an SpO2 of 97 it is unlikely thathypoxia is contributing to his problems (nonetheless oxygen therapy would be recommended).























The other options would come further down the line if initial interventions were unsuccessful and hedeteriorated.

1 7%2 14%3 2%4 2%5 76%

Answer Statistics


Test Analysis

Score: 55.56%

Total Answered: 9

Feedback





Question Navigator

Revision Notes

Tags


京ICP备15042040号-3










My Profile Sign Out



Learning Journal


A 67-year-old man is three days post-operation for a sigmoid colectomy. He has insulin dependentdiabetes mellitus. He complains of dizziness, upper abdominal discomfort, and faintness.

His blood pressure is 110/75 mmHg, his pulse is 95 bpm, he has a respiratory rate 24/min, and hehas SpO2 99% on air. His blood glucose is 18 mmol/l.

His electrocardiogram shows ST depression of 2 mm in leads II, III and AVF.

Which of the following is the initial drug therapy for this patient?


Aspirin 300 mg Correct

Clexane 1 mg/kg subcutaneously

Clopidogrel 75 mg

Diamorphine 2.5 mg

Glycerol trinitrate 800 mcg sublingually

Initial treatment of an acute coronary syndrome is aspirin 300 mg. This should be safe in the post-surgical patient with no signs of bleeding at three days post operation. Clexane would have also beengiven pre- and post-operation.

The dose of clopidogrel is 300 mg in an acute coronary syndrome.

Diamorphine is used to treat anxiety and pain, neither of which is commented upon.























GTN would be reasonable to try, however the blood pressure is low.

Remember that in the diabetic, chest pain may not be a feature of acute coronary syndrome due toautonomic dysfunction, and in most post surgical patients myocardial infarct is silent.

1 59%2 15%3 3%4 6%5 17%

Answer Statistics


Test Analysis

Score: 60%

Total Answered: 10




Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


A 56-year-old man with severe brain damage is apnoeic, unsedated, and temperature 36.9°C.

He is intubated and ventilated. His biochemistry is normal.

The combination of which of the following specialists would be able to confirm brain stem death?


Consultant/specialist trainee with one years experience Incorrect answer selected

Consultant/specialist trainee with three years experience

Consultant/specialist trainee with four years experience

Consultant/specialist trainee with five years experience This is the correct answer

Consultant/specialist trainee with two years experience

The conventional criteria previously established for clinical death were based upon lack ofcardiorespiratory function.

The development of organ transplantation highlighted patients who had conditions incompatible withlife, but who continued to have some form of cardiorespiratory function with artificial support. This ledto a code of practice for the diagnosis of brain stem death.

This is based on the knowledge that when the brain stem is damaged to such a degree that itsfunctions are irreversibly destroyed, the heart will inevitably stop beating shortly afterwards. Whenthis occurs, therefore, the patient is dead even though respiration and circulation can be artificiallymaintained. Brain stem function is checked through set criteria, and the findings must be agreed by at























least two senior doctors. One should be a consultant, and the other must have at least five years postregistration who has experience in the testing of brain stem death.

Life support should be withdrawn at this point, but consideration should be taken as to whether theperson would be a suitable organ donor.

Reference:

Department of Health. A code of practice for the diagnosis of brain stem death, including guidelinesfor the identification and management of potential organ and tissue donors.

1 10%2 28%3 13%4 36%5 13%

Answer Statistics


Test Analysis


http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4035462.pdf

http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4035462.pdf



Score: 54.55%

Total Answered: 11

Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


An 18-year-old male is admitted with a history of diarrhoea and vomiting associated with weaknessand lethargy.

His motor power in the distal arms and legs is decreased and he describes difficulty swallowing. Hisforced vital capacity (FVC) is 1.5 litres.

Which of the following is the most appropriate immediate treatment for this condition?


Cyclophosphamide

Intravenous immunoglobulin therapy (IgG) 0.5 g/kg This is the correct answer

Intubation and ventilation Incorrect answer selected

Plasmapheresis

Prednisolone 60 mg

This scenario is suggestive of Guillain-Barré syndrome (GBS).

Dysphagia is a dangerous symptom suggestive of bulbar involvement. However a FVC of 1.5 litres isnot an indication for immediate ventilation (a FVC of less than 1 litre would be an indication).

First line therapy is intravenous IgG. Plasmapheresis can also be used but requires specialistequipment.

Steroids are of no benefit.























Cyclophosphamide, although an immune suppressant, is a red herring.

1 1%2 44%3 32%4 15%5 8%

Answer Statistics


Test Analysis

Score: 50%

Total Answered: 12

Feedback





Question Navigator

Revision Notes

Tags


京ICP备15042040号-3










My Profile Sign Out



Learning Journal


A 21-year-old male is admitted with acute onset headache and is drowsy.

He is opening his eyes spontaneously, is disoriented but is localising to painful stimuli.

Which of the following is the investigation of choice for this man?


Computed tomography (CT) Correct

Lumbar puncture (LP)

Magnetic resonance angiography (MRA)

Magnetic resonance imaging (MRI)

Positron emission tomography (PET)

Urgent CT will confirm diagnosis in 95% of patients with subarachnoid haemorrhage.

Lumbar puncture is not usually required unless the history is suggestive and the CT is normal.

Blood will be present in the cerebro-spinal fluid (if a bloody tap is suspected the number of red bloodcells should fall with each successive sample).

If the LP is performed six hours after onset of symptoms the supernatant fluid should be examined forxanthochromia after centrifugation.























http://patient.info/doctor/subarachnoid-haemorrhage-pro

1 77%2 12%3 5%4 5%5 1%

Answer Statistics


Test Analysis

Score: 53.85%

Total Answered: 13

Feedback

Question Navigator

Revision Notes







Tags


京ICP备15042040号-3








My Profile Sign Out



Learning Journal


A 21-year-old male is admitted with acute onset headache and is drowsy.

He is opening his eyes spontaneously, is disoriented and is localising painful stimuli. He has a normalcomputed tomography (CT) scan.

Which of the following is the most appropriate next investigation for this patient?


Cerebral angiography

Lumbar puncture Correct

Magnetic resonance angiography

Magnetic resonance imaging

No further investigations necessary

Lumbar puncture (LP) is not usually required unless the history is suggestive and the CT is normal asin this case.

Blood will be present in the CSF (if a bloody tap is suspected the number of red blood cells should fallwith each successive sample).

If the LP is performed six hours after onset of symptoms the supernatant fluid should be examined forxanthochromia after centrifugation.























1 3%2 81%3 6%4 6%5 4%

Answer Statistics


Test Analysis

Score: 57.14%

Total Answered: 14

Feedback

Question Navigator

Revision Notes







Tags


京ICP备15042040号-3








My Profile Sign Out



Learning Journal


A 78-year-old male who presents with increasing dysphagia is diagnosed with an inoperablecarcinoma of the distal oesophagus. Oesophageal spasm causes food to stick after swallowing whichcauses odynophagia.

Which drug would be most helpful in relieving his chronic pain?


Clodronate

Dexamethasone

Nifedipine Correct

Oxybutynin

Pinaverium

Nifedipine helps relieve painful oesophageal spasm and tenesmus associated with gastrointestinaltumours and could be used to relieve his odynophagia.

Clodronate inhibits osteoclastic bone resorption and is used to treat malignant bone pain and theassociated hypercalcaemia.

Pinaverium is used to reduce the pain duration associated with irritable bowel syndrome (IBS).

Corticosteroids are used to treat pain from central nervous system tumours and painful bladderspasm may be relieved by oxybutynin.























1 3%2 10%3 63%4 16%5 7%

Answer Statistics


Test Analysis

Score: 60%

Total Answered: 15

Feedback

Question Navigator






Revision Notes

Tags


京ICP备15042040号-3









My Profile Sign Out



Learning Journal


Exam Themes January 2007

Which of the following statements regarding the subclavian vein and its relations is correct?


Begins at the lateral border of the first rib This is the correct answer

Forms the axillary vein

Joins the superior vena cava Incorrect answer selected

The thoracic duct joins the right subclavian

The subclavian vein passes posterior to scalenus anterior

The subclavian vein is a continuation of the axillary vein, beginning at the lateral border of the first rib.

It passes anterior to scalenus anterior.

The subclavian and internal jugular vein unite to form the brachiocephalic vein, subsequently the leftand right brachiocephalic veins unite to form the superior vena cava.

The thoracic duct enters the left subclavian.

The brachiocephalic trunk is a branch of the aortic arch, which divides to form the right subclavianand right common carotid arteries.























1 20%2 12%3 22%4 34%5 11%

Answer Statistics


Test Analysis

Score: 56.25%

Total Answered: 16

Feedback

Question Navigator

Revision Notes







Tags


京ICP备15042040号-3








My Profile Sign Out



Learning Journal


Which of the following statements regarding the internal jugular vein and relations is true?


Lies lateral to the common carotid artery This is the correct answer

Originates at the carotid canal

Passes behind the clavicle to join the superior vena cava

Passes posterior to the subclavian artery

Receives a lymphatic trunk at its union with the external jugular vein Incorrect answerselected

The internal jugular vein originates at the jugular foramen.

It initially lies posterior to the carotid artery, as it descends in the carotid sheath it lies lateral first tothe internal then the common carotid artery within the carotid sheath.

It passes anterior to the subclavian artery to join the subclavian vein and then form thebrachiocephalic vein; the left and right brachiocephalic veins unite to form the superior vena cava.

The internal jugular vein receives a lymphatic trunk at its union with the subclavian vein.

The external jugular vein drains into the subclavian vein.























1 50%2 3%3 22%4 13%5 12%

Answer Statistics


Test Analysis

Score: 52.94%

Total Answered: 17

Feedback

Question Navigator

Revision Notes







Tags


京ICP备15042040号-3








My Profile Sign Out



Learning Journal


A 67-year-old man complains of dizziness and faintness. He has insulin dependent diabetes mellitusand he had a sigmoid colectomy three days previously.

His blood pressure is 80/50 mmHg, his pulse 110 beats per min, his respiratory rate 24/min, and hehas SpO2 99% on air. His plasma glucose concentration is 18 mmol/L (3.0-6.0 fasting)

Which of the following is the most appropriate investigation for this patient?


Arterial blood gas Incorrect answer selected

Chest x ray

Electrocardiogram This is the correct answer

Serum lactate

Urine ketones

This man may have a cardiac cause for his dizziness.

The highest prevalence of myocardial infarction is 72 hours post operation. Patients with diabetesmay not have chest pain due to autonomic dysfunction.

The differential diagnosis would include pulmonary embolus. It may also include diabeticketoacidosis, but this would be unlikely with his glucose at 18 mmol/l and would not directly explainhis hypotension. Also, he would be expected to have a slightly higher respiratory rate than 24/min.Sepsis is also a possibility, but you would expect there to be a temperature abnormality.























The most appropriate immediate investigation in this scenario would be ECG. This would help toconfirm or exclude a cardiac cause. Sinus tachycardia may make the differential diagnoses morelikely.

If the scenario involved a shorter postoperative time frame (up to 48 hours), exclusion ofhaemorrhage would take high priority.

1 32%2 3%3 23%4 15%5 27%

Answer Statistics


Test Analysis

Score: 50%

Total Answered: 18




Feedback

Question Navigator

Revision Notes

Tags


京ICP备15042040号-3











My Profile Sign Out



Learning Journal


A patient needs central venous access for total parenteral nutrition (TPN).

Which of the following is the cleanest site for placement?


Left femoral

Left internal jugular

Right femoral Incorrect answer selected

Right internal jugular

Right subclavian This is the correct answer

Right or left subclavian is regarded as the cleanest site for central venous access. It also the mosttolerated by patients.

However the incidence of subclinical pneumothorax even in the hands of experienced clinicians hasled to it falling out of favour.

Answer Statistics
























1 1%2 8%3 2%4 40%5 49%


Test Analysis

Score: 47.37%

Total Answered: 19

Feedback

Question Navigator

Revision Notes


Tags







京ICP备15042040号-3







My Profile Sign Out



Learning Journal


A 26-year-old female is admitted to ICU with severe asthma.

She is ventilated for one week and receives IV co-amoxiclav/clarithromycin, magnesium,prednisolone, sedatives and muscle relaxants.

She improves gradually but two days after stopping muscle relaxants she still is unable to be weanedfrom ventilatory support.

On examination, she is alert but has flaccid weakness of all limbs.

Which of the following is the likely diagnosis?


Critical illness polyneuropathy Incorrect answer selected

Guillain-Barré syndrome

Hypermagnesaemia

Prolonged neuromuscular blockade This is the correct answer

Steroid induced myopathy

The history suggests prolonged neuromuscular junction (NMJ) blockade which may be exacerbatedby both corticosteroids and magnesium.

This condition was originally described with suxamethonium due to hereditary reductions in plasmacholinesterase activity.























However, drugs and electrolyte abnormalities may exacerbate this.

1 28%2 16%3 13%4 34%5 8%

Answer Statistics


Test Analysis

Score: 45%

Total Answered: 20

Feedback





Question Navigator

Revision Notes

Tags


京ICP备15042040号-3










My Profile Sign Out



Learning Journal


A 58-year-old man with known alcoholism is admitted to the Emergency Department following a largeupper GI haemorrhage. As far as you are, aware he has no other significant past medical history andis non compliant with medications for his liver disease, including propranolol which was started afterhis last admission to the Gastroenterology ward. On admission to the Emergency Department, he isdrunk and aggressive

Which of the following is the likely initial reaction to blood loss in this patient?


Aldosterone release

Angiotensin 2 production

Hypotension

Increased aquaporin 2 expression Incorrect answer selected

Tachycardia This is the correct answer

The answer is Tachycardia. Increased output of noradrenaline, coupled with decreased vagal tonepost acute blood loss is responsible for the initial tachycardia seen. These changes also driveincreased myocardial contractility and vasoconstriction, preserving blood pressure at least in theinitial period after blood loss. Blood pressure generally only falls if the amount of blood loss exceedsthese compensatory mechanisms (increased cardiac output, tachycardia, and increased arterialtone).

Aldosterone release and angiotensin 2 production are incorrect. The renin system is activated by























blood loss, but the resultant angiotensin 2 production with subsequent aldosterone release is lessrapid. Aquaporin 2 expression is increased in response to more chronic hypovolaemia, improving theaction of ADH and promoting greater reabsorption of water in the kidney.

1 4%2 7%3 15%4 4%5 71%

Answer Statistics


Test Analysis

Score: 42.86%

Total Answered: 21

Feedback





Question Navigator

Revision Notes

Tags


京ICP备15042040号-3










My Profile Sign Out



Learning Journal


Core Questions

A 24-year-old man presents with rash, lip and eye swelling, and tachypnoea 15 minutes following ameal at his local Chinese restaurant. On auscultation of his chest there is widespread wheeze.

Which treatment should be given immediately?


IM adrenaline Correct

IM chlorphenamine

IV adrenaline

IV atropine

IV hydrocortisone

This presentation is classical for anaphylaxis, which should be treated immediately with IMadrenaline. Patients known to have a severe allergy might carry this in the form of an Epipen.

IV adrenaline should only be used in the setting of cardiac arrest, unless in a critical care setting withexpert supervision.

IV atropine is indicated in the management of unstable patients with bradycardia.

Hydrocortisone and chlorphenamine are indicated in the subsequent management of anaphylaxis, butadrenaline should be used first in patients with respiratory compromise.























1 80%2 3%3 6%4 0%5 11%

Answer Statistics


Test Analysis

Score: 45.45%

Total Answered: 22

Feedback

Question Navigator

Revision Notes







Tags


京ICP备15042040号-3








Documents

My Profile Sign Out - 1 File Download