Common AMK pathologies :)

38-year-old male fell whilst horse riding earlier in the day. He was unconscious briefly after his fall but was able to continue horse riding. He now complains of disorientation and a severe headache. His GCS is 13. He feels nauseous. Examination reveals a bruise on his temple. His blood pressure is 160/105, HR 55bpm, RR 20, temperature 37.1. What vessel may have been ruptured?

A 42 year old male, of no fixed abode, presents with increased forgetfulness over the past month. He complains of a mild headache which does not improve with paracetamol. Initial blood tests show ALT 392 (0-55), AST 228 (0-60), ALP 160 (40-150), bilirubin 45 (3-21). He has a 20 pack year smoking history and his alcohol intake is 80u/week. What is the most likely diagnosis?

An elderly female presents to ED with subacute worsening of back pain which is 5/10 in severity. She has had longstanding lower back pain. She does not report any recent changes in urinary or bowel symptoms. Examination reveals local, central tenderness on lower palpation. There is normal lower limb sensation and power. Renal function and FBC are normal. Spinal XR is ordered. What is the next step in management?

An elderly male attends his GP complaining of left-sided hip pain. The pain has been worsening slowly over the past few weeks and has not responded to naproxen. On further questioning, he admits he has been feeling tired and has stopped gardening. Examination reveals full range of hip motion, non-tender to palpation and left hip feels slightly warm. Hb 120 (130-180) Plt 110 (150-400) WCC total 12.5 (4-11) CRP 27 (<10) Ca 2.3 (2.1-2.6) eGFR 59 (>90) Cr 190 (70-150) Urea 9.1 (2.5-6.7) What is the diagnosis?

Diagnosis of multiple myeloma has been made. What do you expect to see on urinary electrophoresis?

Ig[blank_start]A[blank_end] is present in breast milk. Ig[blank_start]G[blank_end] is transplacental and is a specific antibody Ig[blank_start]M[blank_end] is a general antibody Ig[blank_start]E[blank_end] is allergy related Ig[blank_start]D[blank_end] is a BCR

75 year old male was found unconscious at home and initial assessment has revealed a neck of femur fracture. He was previously able to walk 4 miles without stopping and performed all activities of daily living. What is the most appropriate definitive management plan?

75 year old male was found unconscious at home and initial assessment has revealed a neck of femur fracture. He was previously able to walk 4 miles without stopping and performed all activities of daily living. In ED, he suddenly becomes tachypnoeic, and complains of pleuritic chest pain. His O2 sats drop to 88% (10L O2), HR is 120 and BP is 90/50. What is the most likely diagnosis?

55 year old male presents to his GP with a lump on DIP on his left hand. The lump is hard, non-mobile and adherent to overlying and underlying tissue. The lump does not give him any issues. He does not want surgical intervention. He has a history of multiple episodes of acute finger joint pain. His regular medication is naproxen, ramipril and bendroflumathiazide. What is the most appropriate management plan?

You are a GP and are called out to see a known IVDU who complains of a painful right knee. She is walking with a limp. On examination, her right knee is erythematous, tender and warm on palpation and there is reduced knee flexion. She is tachypnoeic and sweating.  What is the next most appropriate step?

You are a FY1 and you aspirate the swollen knee of a 55 year old female patient. She presented with a red, hot, swollen knee. She is otherwise well. The fluid is turbid and straw coloured. What is the most likely diagnosis: 

On a normal healthy patient, bridging veins should be visible.

Calcification of the choroid plexus is common in elderly patients and can be seen in CTs as surrounding the ventricles

What's this pattern indicative of? Trauma--> Lucid phase--> Headache

Because the complications of epidural hemorrhages include [blank_start]herniation[blank_end], the management is a urgent [blank_start]non[blank_end]-[blank_start]contrast[blank_end] [blank_start]CT[blank_end] of the head and urgent [blank_start]neurosurgeon[blank_end] [blank_start]referral[blank_end].

Because subdural hemorrhages are [blank_start]venous[blank_end] and slower, even [blank_start]acute[blank_end] subdural hemorrhages take place over many [blank_start]days[blank_end]/weeks. They're usually due to [blank_start]minor[blank_end] trauma and are more common in children, elderly, and [blank_start]alcoholics[blank_end]. Symptoms include [blank_start]pseudo[blank_end]-[blank_start]dementia[blank_end] and [blank_start]confusion[blank_end].

Acute subdural hematoma requires urgent referral to the neurosurgeon.

What are the different types of subdural hemorrhages?

What is true regarding subarachnoid hemorrhages?

Which of these is not a Liver Function Test?

Raised ALP alone can be helpful in differential diagnosis.

If ALP and AST are more raised than ALP and Bilirubin, this is indicative of

Isolated raised bilirubin levels are indicative of [blank_start]Gilbert's[blank_end] [blank_start]Syndrome[blank_end].

Types of Hip Fractures:

The joint capsule is made up of a femur [blank_start]head[blank_end] and [blank_start]neck[blank_end].

Only intracapsular fractures can be either displaced or nondisplaced.

Which of these can you manage via internal fixation with a dynamic hip screw (DHS)?

The management for an intracapsular displaced fracture is hip arthroplasty within 24 hrs (total hip replacement or hemiarthroplasty)

Paget's disease is very much visible in an x-ray of a spinal vertebrae.

In Paget's disease, serum calcium and phosphate levels would be increased drastically.

Osteopenia may present with a history of excessive steroid usage or fraility fractures.

Osteoporosis will have normal calcium serum levels but a raised ALP

Alendronic acid is a treatment for osteoporosis.

some bone conditions and pathologies involve DEXA scans for diagnostic purposes.

What is true regarding multiple myeloma?

For Multiple Myeloma: Monoclonal band urine electrophoresis known as Bence [blank_start]Jones[blank_end] proteins aka monoclonal [blank_start]kappa[blank_end] [blank_start]light[blank_end] chains Also: [blank_start]low[blank_end] RBC, Calcium [blank_start]high[blank_end] ALP [blank_start]normal[blank_end], PTH [blank_start]normal[blank_end]

If IgM is found in urine electrophoresis, the condition is Waldenstrom’s macroglobinaemia.

What would you prescribe for a 40 year old with a painful red toe?

Hemarthrosis is due to factor 11 deficiency.

Septic arthritis is usually seen in one really red, hot, and tender joint (large.)

In any really red and hot joint, always aspirate to investigate.

What is true regarding septic arthritis?

[blank_start]Gout[blank_end] in common in middle aged males. There is a history of poor diet, such as too much [blank_start]meat[blank_end], alcohol, and too high of a [blank_start]BMI[blank_end]. There is high serum levels of [blank_start]urate[blank_end], which may be due to renal failure. Usually, there is [blank_start]monoarthropathy[blank_end] because the problem is in only one joint. It presents acutely, and the patient may suddenly wake in the middle of night from the pain.

Osteoarthritis/rheumatoid arthritis is better at night .

Aspirate: Septic arthritis: [blank_start]opaque[blank_end] (clarity) and [blank_start]red[blank_end] (color) Rheumatoid arthritis: [blank_start]straw[blank_end] colored Osteoarthritis: [blank_start]clear[blank_end] colored

Acute Gout: 1st treatment: [blank_start]NSAIDS[blank_end] such as [blank_start]naproxen[blank_end], diclofenac Contraindications to NSAIDS include: [blank_start]peptic[blank_end] [blank_start]ulcer[blank_end] disease, [blank_start]Asthma[blank_end], [blank_start]renal[blank_end] [blank_start]failure[blank_end] 2nd line medication is then: [blank_start]colchicine[blank_end]

[blank_start]Allopurinol[blank_end] (xanthene oxidase inhibitor) if there are [blank_start]two[blank_end] or more attacks per year It will increase uric acid initially so give [blank_start]NSAIDs[blank_end] short course.

What is true regarding pseudogout?

Reactive athritis can have diarrhea as well

Drugs to stop before surgery: Aspirin [blank_start]7[blank_end] [blank_start]days[blank_end] Clopidrogrel [blank_start]7[blank_end] [blank_start]days[blank_end] Metformin [blank_start]morning[blank_end] [blank_start]of[blank_end]

adrenaline in anaphylaxis is 1 in 1000

Adrenaline in advanced life support is less than the amount in an anaphylactic treatment.

Metformin can cause hyperglycemia.

Veraparil can be given as hypertension medication. (calcium channel blocker)

Calcium channel blockers (should be given at [blank_start]night[blank_end]) and can cause [blank_start]pulmonary[blank_end] [blank_start]edema[blank_end]. EX: [blank_start]Valpromide[blank_end]

Hyperkalemia can cause heart arrhythmias.

A potential side effect of ACE inhibitors: renal failure

Break through morphine dosage calculation for acute pain: ([blank_start]total[blank_end] [blank_start]morphine[blank_end] dose for the day) divided by ([blank_start]6[blank_end])

INFR deals with thrombopoietin

if INFR is [blank_start]8[blank_end]< (major bleeding) then give [blank_start]Vitamin[blank_end] [blank_start]K[blank_end] or [blank_start]fresh[blank_end] [blank_start]plasma[blank_end] if needed. if INFR is [blank_start]8[blank_end]> (minor to no bleeding) then just [blank_start]vitamin[blank_end] [blank_start]K[blank_end] if needed at all