Bromley Emergency

Question.

A 56-year-old male, diabetic, is presenting with recurrent brief headache for 3 weeks, affecting one side of the head and almost always around mouth, increasing with eating and loud laughing and resolves in minutes. On examination his temperature is 37.1C, random capillary glucose is 7.5 mmol/l, and his blood pressure is 110/70 mmHg. No neck stiffness, skin rash, or facial oedema. What is the most appropriate treatment?

• • • 1. Psychotherapy
      2. Prednisolone
      3. Carbamazepine
      4. Sumatriptan
      5. Losartan

  Answer

  Answer.

  3. 

   

  Explanation.

  Trigeminal neuralgia usually presents with paroxysms of intense, stabbing pain, in the trigeminal nerve distribution, typically affecting the mandibular or maxillary divisions on one side. It can be triggered with Washing the affected area, shaving, eating, and laughing. It’s more common in males above 50 years old. Diagnosis depends on looking for a secondary cause Compressing the trigeminal root by anomalous or aneurysmal intracranial vessels or a tumour, zoster, or skull base malformation. MRI Is necessary to exclude secondary causes. Carbamazepine is the first line treatment. Surgery may be needed in refractory cases.
   

Question.

A 65-year-old gentleman with no previous surgical history, underwent total hip replacement. He complains of abdominal distension, constipation and vomiting but no significant pain 2 days after surgery. Examination reveals absent bowel sounds and xray abdomen shows multiple gas, fluid levels in small and large bowel. Most appropriate initital management in this case could be

1. 1. Urgent exploratory laparotomy
   2. NG tube, electrolyte and fluid balance
   3. Broad spectrum Antibiotics
   4. Rectal tube and decompression

Question.

A 67 year old retired taxi driver with a history of a previous myocardial infarction presents to the emergency department with severe abdominal pain. He complained of bloody diarrhea earlier in the day. On examination he is found to have severe generalized abdominal tenderness. His bloods shows a WCC of 20 × 109 cells/l and a lactate of 5 mmol/L. A triple phase CT shows bowel ischemia from the splenic flexure to the proximal part of the rectum. Which vessel is likely to be compromised?

1. 1. Superior mesenteric artery
   2. Inferior mesenteric artery
   3. Left colic artery
   4. Coeliac axis
   5. Middle colic artery

Question.

A 85 year old man is due for elective right hip arthroplasty.

What nerve is at risk of injury at the back of the hip during this procedure?

1. 1. Femoral Nerve
   2. Lateral cutaneous femoral nerve
   3. Sciatic nerve
   4. Pudendal Nerve
   5. Peroneal nerve