Its dangerous out there
Ortho Bro
Eye, Eye, Eye Doctor
Mr Yuk
EK-Geezter
100
- This type bite can mimic appendicitis
Black widow spider bite
100
This refers to a midshaft ulnar fracture caused by a direct blow.
What is a nightstick fracture
100
What is dacrocystitis?
- Infection of the nasolacrimal system, possible purulent discharge
100
- A 29 year old man arrives in the Emergency Department after his estranged wife poisoned him with a cyanide-contaminated paracetamol tablet. Management of this patient's condition should include (besides marital counselling)
Large doses of cyanide prevent cells from using oxygen and eventually these cells die. T Amyl/sodium nitrate helps convert Hb to a form that binds cyanide, & thereby keeping circulating cyanide away from cytochrome oxidase. Methhemoglobinemia greater affinity for methemoglobin than cytochrome oxidase. Hydroxy cobalamin is a vitamin B12 precursor given IV that will scavenge cyanide until becomes oxidase.
100
- A 61-year-old lady is brought in by ambulance with palpitations and dizziness. GCS 15. HR 190, BP 75/50.
- What is wpw, wolff, parkinson white, atrial fibrillation, AF, pre-excitation
200
- What is the difference between heat exhaustion and heat stroke
What is altered sensorium and CNS dysfunction(so); may also see cardiovascular collapse.
200
A 29 year old man stumbled into a gutter, tripped awkwardly and fell injuring his left foot. He has diffuse swelling and tenderness of the mid foot and is unable to weight bear on that limb.
What is a “Lisfranc” injury. There are many types of Lisfranc injuries which can be caused by indirect force such as a rotational dorsiflexion mechanism, as in this case, or by direct force such as being run over by a car tyre.
200
- What is the diagnosis?
Sixth-Nerve Palsy
The abducens nerve innervates the lateral rectus muscle and is the most common single muscle palsy, causing loss of abduction and resultant horizontal diplopia, worse in ipsilateral gaze
200
The mixture of alcohol and chloryl hydrate is known with the colloquium:
- What is a Mickey Finn
- It is a drugged alcoholic drink given to someone without them knowing. It's named for a late 19th-century bartender and pickpocket who was notorious for drugging people's drinks. Giving someone a Mickey Finn is sometimes called “slipping a mickey
200
A 57-year-old man is referred in by his GP following two weeks of episodic left axillary pain. HR 73, BP 134/64, SpO2 97 RA.
He is pain free at triage when the following ECG is taken:
What is wellen, wellens, dynamic, t-wave
300
- This lab abnormality is nearly universal in heat stroke.
What are elevated LFTs? ; "liver melt"
300
A 24 year old man is brought into the ED with an injury suffered playing touch rugby. He tried to stop and turn suddenly just as another player collided with him. He felt immediate right knee pain and has only been able to hobble a few steps since. What abnormality can be seen on his AP X-ray? Explain the significance of this finding.
What is a so called “Segond” fracture"
he bone fragment seen is an avulsion fracture from the lateral ligament complex but the real significance is that there are usually also injuries to the anterior cruciate and medial meniscus. So it represents a major knee joint disruption with potential for significant instability.
300
Diagnosis?
What is acute angle-closure glaucoma (ACG)
is secondary to narrowing or closure of the anterior chamber angle, resulting in increased IOP, with subsequent damage to the optic nerve. Normally, aqueous humor drains out of the anterior chamber via Schlemm canal in the anterior chamber angle. In ACG, this flow is impeded, and the IOP rises from a normal range of 10 to 21 mm Hg to 50 mm Hg or higher. What
300
An 18 year old woman is rushed to the Emergency Department by her mother. Upon examination she is showing signs of delirium, comabativeness, hallucinations, rotary nystagmus, miosis, hyperreflexia & sensory anesthesia. She is also exhibiting muscle rigidity & occasional catatonic posturing. Intoxication by which agent can best explain these symptoms?
What is PCP?
It produces both stimulation and depression of the CNS. PCP is a non-competitive antagonist to the NMDA receptor, which causes analgesia, anesthesia, cognitive defects, and psychosis. PCP blocks the uptake of dopamine and norepinephrine, leading to sympathomimetic effects such as hypertension, tachycardia, bronchodilation, and agitation. PCP can also cause sedation, muscarinic, and nicotinic signs by binding to acetylcholine receptors and GABA receptors.
300
A 47-year-old woman presents with four hours of right shoulder pain and diaphoresis. HR 70 reg, BP 177/87, SpO2 95 RA. An ECG is taken at triage. The computer reads “inferior ischaemia” – do you agree?
This is limb electrode misplacement leading to limb lead reversal. A northwest axis in an ECG with normal precordial leads simply does not make sense.
P wave axis is abnormal – upright in aVR, negative in II – this is seen with ectopic atrial rhythms
an upright P-QRS-T complex in aVR with otherwise normal QRS conduction should raise suspicion for limb lead reversal.
400
- Above what altitude does acute mountain sickness develop
Altitude sickness typically occurs only above 2,500 metres (8,000 ft), though some are affected at lower altitudes. Risk factors include a prior episode of altitude sickness, a high degree of activity, and a rapid increase in elevation.,
400
Comminuted intraarticular fracture of base of 1st metacarpal also known as a
What is Rolando fracture?
A Bennett fracture is an intra-articular, simple, oblique fracture at the base of the first metacarpal . A Rolando fracture is an intra-articular, comminuted fracture at the base of the first metacarpal
400
Patient complains of headache and blurry vision?
What is papilledema
Papilledema involves swelling of the optic nerve head, usually in association with elevated intracranial pressure. The optic disks are hyperemic with blurred disk margins; the venules are dilated and tortuous. The optic cup may be obscured by the swollen disk.
400
- What syndrome is associated with Jimson weed.
What are :Anticholiergic poisoning
400
You receive a pre-hospital notification regarding a 74-year-old man presenting with one hour of central chest pain.
His vital signs on arrival: HR 58, BP 133/75, SpO2 99% RA. He has no past medical history or cardiovascular risk factors. Diagnosis and what is colloquial name for this pattern?
Normal sinus rhythm
ST elevation in lead I, aVL and V1-2
ST depression and T-wave inversion in lead III
Hyperacute T-waves and pathological Q waves in V1-2
Trace ST elevation in V5-6
This ECG pattern, also known as the South Africa Flag Sign, is typically seen in “high lateral” Occlusion Myocardial Infarction, usually due to complete occlusion of the first diagonal branch of the LAD
500
A patient is brought down from the mental health unit after sustaining a bite wound.
What is a commonly identified bacterium?
Eikenella (more common in hospitalized and institutionalized patients
500
A 27 year old female was BIBA following a horse riding accident. She arrives in the ED in spinal precautions. She had transient hypotension en route that resolved with a 500 mL bolus of normal saline. The paramedics report tenderness on palpation of her iliac crests. Her vital signs are T 36.2C, P 90/min, R 22/min, BP 115/ 70 mmHg, SpO2 98%OA and GCS 15.
Just as you suspected there is a pelvic fracture. What type of fracture and what is the eponym?
What is a Malgaigne fracture is an unstable fracture of the pelvis. The Malgaigne fracture usually results from a vertical shear force causing two. This is an ipsilateral pelvic ring fractures.
Fractures are ipsilateral and vertically orientated (one anterior and one posterior to the acetabulum)
The most common disruption involves the superior/inferior pubic rami AND sacroiliac joint/sacral wing rather than the sacroiliac joint with a lateral fragment containing the acetabulum.
500
Patient c/o headache and whooshing noise in ears. What does this fundoscopic view suggest
What is a subhyaloid hemorrhage in subarachnoid hemorrhage
They may occur as a result of blunt trauma but are perhaps best known as a marker for SAH. In SAH, the hemorrhages appear as a “puff” of blood emanating from the central disk
500
A 12 year old boy is brought to your office by his grandmother. While spending the weekend at their strawberry farm, he became ill and developed symptoms including nausea, vomiting, GI cramps, diarrhea, tear formation & confusion. Upon examination you notice that the muscles in his arms & legs are exhibiting random "twitches", his pupils are constricted, and he has labored breathing. The first drug of choice to treat this patient's condition would be:
What is atropine?
A majority of his symptoms are muscarinic in origin, because he has most likely been exposed to a cholinesterase inhibitor (anticholinesterase), which are commonly used as insecticides in the farming industry. His symptoms reflect the SLUDE syndrome, and pinpoint pupils. The random twitches are muscle "fasiculations" - a nicotinic effect. Atropine has a wide therapeutic window. If the type of
anticholinesterase consumed or absorbed thru the skin was an organophosphate type, then administration of pralidoxime would also be advisable. On the other hand, if it was a carbamate type anticholinesterase, pralidoxime or 2-PAM would do no good
500
46 year old female with 5 hour history of shortness of breath and SSCP. No prior cardiac history. Nonsmoker; no use recreartional drugs. What is diagnosis?
Posterior myocardial infarction.
ST-segment depression in leads V1-V3
Upright T waves in V1-V3
Tall R waves with an R-wave/S-wave ratio greater than 1 in lead V1-V3, most often seen in V2-V3, developing over the course of hours