IBSc: Question 3 By Alan McLeod. Getting the best marks Read the whole question – a latter section...
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Transcript of IBSc: Question 3 By Alan McLeod. Getting the best marks Read the whole question – a latter section...
iBSc: Question 3
By Alan McLeod
Getting the best marks
Read the whole question – a latter section may give you a
clue about an earlier one.
To see how many points you need look at the marks
allocated – for example a 3 point question is generally looking for 3 salient points
If giving a list answer put the best answers first – examiners will not usually mark answers too
far down a list
Always write something – it may get you part of a mark and is anonymised so
no one will think you are stupid!
If you genuinely have no clue then re-write the question to see if this sparks
some ideas.
If not then move on and come back at the end. And remember – always
write something.
Good luck!
Question 3
Mr El-Hawrini, a 29 year old lawyer has been involved in a
motorcycle accident during which he lost
consciousness
• Q3.1• Describe the most
vital checks you would make when he arrives into A+E (5)
Question 3
A Diagnosis of extradural
haemorrhage is made.
Q3.2• What blood vessel is
responsible for this bleed. (1)
Q3.3• List three symptoms from
a typical history that might lead to this diagnosis (3)
Q3.4 Label the arrowed structures (8)
Skull
Potential space
Subarachnoid space Skull
Question 3
In addition to his head injury, Mr El-
Hawrini has sustained the
fracture pictured
Q3.5
What is this fracture (2)
Question 3
Bones are capable of self-healing under
the right circumstances.
Q3.6• Describe the typical
pattern of long-bone healing (4)
Q3.7• Describe four factors that
might interfere with this healing (4)
Question 3
Sadly, Mr El-Hawrini dies. You are given
the job of delivering the news
to his wife – you use the SPIKES
protocol.
• Q3.8• Describe the SPIKES
protocol (6)
Factors influencing Healing
Local• Tissue damage• Tissue loss• Infection• Foreign body
Systemic• Patient age• Nutritional status• Smoking / alcohol• Steroids• Systemic illnesses such as
diabetes, renal, lung, cardiac.
The Answers
View these on ‘note view’ rather than on full screen – additional
notes are provided for some slides
Emergency ManagementD Danger? Check that the scene is safe
R Run Check for response
H Happily Call for HELP!
A Away andCheck and secure airway and C-spine
B Buy Check breathing, Resp rate
C Chocolate! Pulse, Heart rate
Emergency Management
D ‘Disability’Neuro exam: minimum is pupil size / response + GCS or AVPU
E ‘Exposure’1: Expose to seek injuries
2: Keep warm + take temperature
DEFG Don’t Ever Forget Glucose!!!
Extradural Subdural SubarachnoidBetween skull and
periosteal duraBetween periosteal and
meningeal duraInto subarachnoid
space
Middle meningeal a. Cerebral vein Cerebral artery
Major trauma Trivial trauma in elderly Berry aneurysm
Loss of consciousness for a short time
Lucid period lasting hours – days (as
pressure builds up within the skull)
Drowsiness, coma, death if no intervention
Diagnosed by CT or MRI.
Days – months pass (as pressure builds up slowly
within the skull)
Headache, drowsiness and confusionPossible hemiparesis / sensory
loss
Coma, death if no intervention (or may resolve on their own)
Diagnosed by CT or MRI.
Sudden onset intense headache with stiff neck (as aneurysm bursts).
Possible papilloedema and retinal haemorrhage
Usually vomiting, possible loss of
consciousness for hours days
Diagnosed by CT or MRI.
Head Trauma
SkullPeriosteal Dura mataMeningeal Dura mataPotential spaceArachnoid mataSubarachnoid spacePia mata
Middle Meningeal A.Cerebral Artery
Cerebral Vein
Extradural Haemorrhage
SkullPeriosteal Dura mataMeningeal Dura mataPotential spaceArachnoid mataSubarachnoid spacePia mata
Middle Meningeal A.Cerebral Artery
Cerebral Vein
Subdural Haemorrhage
SkullPeriosteal Dura mataMeningeal Dura mataPotential spaceArachnoid mataSubarachnoid spacePia mata
Middle Meningeal A.Cerebral Artery
Cerebral Vein
Subarachnoid Haemorrhage
SkullPeriosteal Dura mataMeningeal Dura mataPotential spaceArachnoid mataSubarachnoid spacePia mata
Middle Meningeal A.Cerebral Artery
Cerebral Vein
Monteggia and Galleazzi
Medics Monteggia (a)
Under Ulnar shaft
Pressure Proximal Radio-ulnar Joint
Get Galleazzi (b)
Really Radial Shaft
Drunk Distal RUJ
Fracture-dislocations
Bone Healing
Mins – 3 days
• Haematoma and Necrotic tissue
2 days – 2 weeks
• Phagocytosis
• Provisional callus
3 weeks on
• Firm callus
• Mineralisation
Weeks - months
• Remodeling
SPIKES – Bad News…
S SETTING UP: Having info ready; involving family as appropriate; location and privacy; time constraints, sit down; connect.
P Perception: What does the patient already know of believe?
I Invitation: find out what sort of invitation the patient is extending – do they want to know everything or do they wish to be told less
K Knowledge: as Invited in simple language
E Emotion and Empathy: Assessing the patients emotions and dealing with them empathically
S Summary and Strategy: Going back though it all again, identifying points that need futher expalnation and formulating a plan.
The End
The slides here should allow you to mark your own work – remember 1 mark per
answer up to the maximum for the question. Multiply by 3 to get percentage points. I assume a 60% pass mark. Sorry but I am unable to give further advice on
answers due to time constraints.