AKT MiniQuiz Review

Distal Biceps Avulsion

  • Injuries to the biceps tendon at the radial tuberosity insertion, typically from eccentric contraction of the biceps brachii.
  • Diagnosis:
    • Clinically via hook test for complete tears.
    • MRI to distinguish between complete and partial tears.
  • Treatment:
    • Nonoperative:
    • Supportive care and physiotherapy for older, low-demand patients.
    • May result in:
      • 50%50\% loss of sustained supination strength.
      • 40%40\% loss of supination strength.
      • 30%30\% loss of flexion strength.
      • 15%15\% loss of grip strength.
    • Operative:
    • Surgical repair for young, healthy patients or partial tears unresponsive to nonoperative management.
    • Subacute/chronic ruptures may be treated with direct repair, possibly requiring elbow hyperflexion.
    • Surgical intervention should occur within a few weeks of injury.

Biceps Tendinopathy and Rupture

  • Proximal Biceps Tendon:
    • Diagnostic imaging (ultrasound, MRI) has limited role in initial workup.
    • Treatment: Rest, NSAIDs, physical therapy.
    • Referral: Not typically an emergency; consider for persistent pain or cosmetic concerns. Athletes/active individuals may need orthopedic consult.
  • Distal Biceps Tendon:
    • Diagnostic imaging: MRI is often necessary.
    • Referral: Surgical consultation recommended due to functional limitations.

Vertigo - Clinical Features of Common Causes

  • BPPV:
    • Triggered by head movements.
    • Peripheral nystagmus.
    • Diagnose with Dix-Hallpike manoeuvre.
  • Meniere's Disease:
    • Spontaneous episodes with aural fullness, tinnitus, hearing loss.
    • Peripheral nystagmus.
    • Audiometry shows low-frequency sensorineural hearing loss.
  • Vestibular Neuritis:
    • Acute onset, may follow viral infection.
    • Peripheral nystagmus, abnormal head thrust test.
  • Vestibular Migraine:
    • Accompanied by migrainous symptoms.
    • Central or peripheral nystagmus.
  • Cerebellar Infarction:
    • Sudden onset, vascular risk factors, headache.
    • Central nystagmus, postural ataxia.
  • Vertebrobasilar Insufficiency:
    • Sudden onset, vascular risk factors, cervical trauma.
    • Central nystagmus, brainstem signs.

Vertigo Treatment

  • Acute Unilateral Loss of Vestibular Function (e.g., Vestibular Neuritis):
    • Self-limiting, improves in days due to central compensation.
    • Motion-induced dizziness may persist.
  • Symptomatic Treatment (short-term):
    • Prochlorperazine or promethazine for nausea.
    • Diazepam or ondansetron if prochlorperazine or promethazine ineffective.

Vestibular Neuritis

  • Cause: Inflammation of the vestibular nerve, often post-viral.
  • Symptoms: Acute vertigo without hearing loss.
  • Management:
    • Bed rest and antiemetics for first 24-72 hours.
    • Corticosteroids (e.g., Prednisolone 1 mg/kg daily for 5 days, then taper) may hasten recovery.

Retroperitoneal Hemorrhage

  • Clinical Presentation:
    • Pain in abdomen, flank, or back.
    • Possibly a palpable mass.
    • Often nonspecific; may lack cutaneous bruising.
  • Etiology:
    • Trauma, blood dyscrasia, ruptured aneurysm, interventional procedures, bleeding from renal/adrenal pathology.

Lithium Toxicity

  • Clinical Presentation:
    • Acute: Nausea, vomiting, diarrhea (neurologic findings develop late).
    • Chronic: Neurologic symptoms (sluggishness, ataxia, confusion), neuromuscular excitability, seizures.
    • Irreversible neurotoxicity (SILENT) can occur.
  • Risk Factors for Chronic Accumulation:
    • Renal impairment, age >50, previous toxicity, drug interactions, nephrogenic diabetes insipidus, fluid restriction.
  • Key Investigations:
    • Serum lithium, creatinine, urea, sodium, thyroid function, ECG.
  • Management
    • Monitor serum lithium concentration.
    • Maintain concentration between 0.60.6 mmol/L and 0.80.8 mmol/L

Gastroenteritis in Children

  • Assessment:
    • Red flag features indicate consideration of alternative diagnoses.
  • Vomiting:
    • Bilious vomiting requires urgent surgical referral.
    • Consider other causes besides gastroenteritis.
  • Investigations:
    • BSL, ketones if indicated.

Diabetic Ketoacidosis (DKA)

  • Signs and Symptoms:
    • High blood glucose, ketones present.
    • Abdominal pain, vomiting, dehydration.
    • Rapid shallow breathing, acetone breath.
    • Confusion, potentially leading to coma.

Intimate Partner Abuse (IPA)

  • Clinical Indicators:
    • Physical: Injuries, chronic pain, fatigue.
    • Psychological: Anxiety, depression, fear, hypervigilance, suicidal ideation.
    • Children exposed may present with somatic problems, anxiety or aggressive behavior.

Managing Potential IPA

  • Key Recommendations:
    • Ask about possible experiences of IPAV
    • Express concern about safety, while respecting her autonomy.
    • Use direct questions to assess safety.

Nail Psoriasis