New content quiz September 2015

Type I Hangmans fracture accounts for 65% of cases. It is a hair-line fracture but the C2-3 disc is normal and has > 90% fusion rate with non operative external immobilisation. Type II injuries account for 30% of cases, it is a displaced fracture of C2 with a disrupted C2-3 disc and is unstable. Type III injuries comprise only 5% of cases and involve a displaced fracture of C2, C2-3 bilateral interfacet dislocation and is severely unstable. (link)

PEP is recommended in source HIV status unknown-receptive or insertive anal intercourse but not recommended in the following situations.
Vaginal or oral intercourse: with source from a low prevalence country (e.g. Australia or NZ); in HIV positive source without detectable viral load; non blood contamination of mucous membrane or non intact skin exposure (unless source has detectable viral load).

Or in HIV unknown source: needlestick from a discarded needle; bite or clenched fist injury; percutaneous, mucosal or cutaneous exposure to urine or saliva (link)

Patient streaming involves selecting types of patients to be seen in different areas of the Department or by different types of practitioners (e.g. Nurse practitioners). Efficiency gains may be achieved by concentrating resources for processes commonly required for the stream in the appropriate area (e.g. suture material, casting material, nurse practitioner in ambulatory care zone). Effectiveness may be improved by concentrating expertise in an area where it is most required (e.g. resuscitation team), however streaming necessitates separate queues for each stream which may reduce efficiency if any stream is overwhelmed or under utilised and control of the streams vitally important. (link)

Metastases are present at the time of diagnosis in ovarian carcinoma in approximately 60% of cases. (link)

Peramivir is the only antiviral for influenza that is able to be given intravenously. (link)

Plain CT is approximately 40% sensitive and 90% specific for ischaemic stroke when performed within 6 hours of onset. (link)

The Australian national quality standards are: Governance for Safety and Quality in Health Service Organisations; Partnering with Consumers; Preventing and Controlling Healthcare Associated Infections; Medication Safety; Patient Identification and Procedure Matching; Clinical Handover; Blood and Blood Products; Preventing and Managing Pressure Injuries; Recognising and Responding to Clinical Deterioration in Acute Health Care; Preventing Falls and Harm from Falls. (link)

Professional ethical principles include: ensuring the interests of patients are not be compromised by market forces, societal pressures or administrative issues; patient autonomy – let the competent patient or substitute decide; beneficence – try to do good; non-maleficence – try to do no harm; distributive justice – try to share available resources as fairly as possible between patients. (link)

The process of obtaining, verifying and documenting an accurate list of a patient’s current medications on admission and comparing this list to the admission, transfer, and/or discharge medication orders to identify and resolve discrepancies. At the end of the episode of care the verified information is transferred to the next care provider. (link)

IPPV is indicated for: apnoea for 30 seconds; gasping breaths at any time; heart rate < 100/min. after 30 seconds of stimulation. An SpO2 of < 90 would be considered normal for at least 10 minutes following delivery. (link)

Tidal volumes required for IPPV are only 25-30mL in a term newborn, which is only about 1/8th of volume of the self inflating neonatal bag. (link)

The correct length of insertion of an emergency umbilical vein catheter is 5cm + the umbilical stump length. (link)

Neonatal jaundice is pathological when it appears within 24 hours or bilirubinaemia is conjugated or lasts > 2 weeks in a term infant.(link)

In borne errors of metabolism is the only cause of conjugated bilirubinaemia from the list. (link)

Patients with bacterial tracheitis usually have had an URTI for a few days, then develop high fever, neck pain and cough which is often dry. They are unwell looking, but surprisingly often prefer to lie flat. (link)

Early features of rabies include: paraesthesia around bite site; neuropathic pain from region of the bite; intense pruritus at the bite site progressing to involve the limb or side of the face; myoedema (sustained contraction of the muscle elicited by being struck by a tendon hammer that resolves within seconds). (link)

Indications for chest CT following trauma include: 3 or more visible rib fractures; any haemothorax visible on CXR or US; widened mediastinum; suspected major vascular injury; suspected diaphragmatic injury; and when CT of head/neck and abdomen are going to be performed. (link)

Current evidence supports transfusion at a 5:5:1 ratio (i.e 5 packed cells, 5 FFP and 1 adult dose platelets). (link)

Conjunctivitis and myalgia are considered diagnostic – jaundice only occurs in 5-10% of cases. (link)

Chilblains are a non-freezing injury causing red, oedematous lesions on the fingertips or toes. They are caused by an exaggerated inflammatory response to cold and most commonly affects young females. Symptoms are intense pain, itching, or burning and are treated by re-warming and lesions usually resolve by 1-2 weeks. (link)