Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y5 Emergency Medicine > 1 - Induction Week > Flashcards

1 - Induction Week Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What risks do you need to consider when requesting imaging?

A

IRMER 2000

  • Radiation Risks: Carcinogenosis, Genetic, Fetal developmental risks
  • IV Contrast Risk: Anaphylaxis, Compartment Syndrome, Contrast-induced nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can be some of the issues with Gadolinium and Iodine contrast?

A

Iodine

  • Allergy/Anaphylaxis
  • Contrast induced nephropathy if eGFR<30
  • Compartment syndrome if soft tissue extravasation of contrast (ice and elevate arm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some contraindications for an MRI?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which patients cannot have a CT colonogram as buscopan is required?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you make a referral for imaging?

A

SPOTIQR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you make a referral for interventional radiology?

A
  • Hb
  • G+S
  • Coagulation screen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you prepare a patient on the ward on the day of interventional radiology?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do we need to be careful when requesting a CTPA for young women??

A

Risk of breast cancer as young and over heart/breast tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What condition should not be referred to liaison psychiatry?

A

DELIRIUM

Can use MCA for DOLS, doesn’t need MHA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the main issue with malnourishment in hospital?

A

SARCOPENIA

They lose muscle over fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you monitor patients on parenteral nutrition?

A

Make sure plastic bag stays on to prevent lipids and vitamins degrading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you monitor patients on parenteral nutrition?

A

Make sure plastic bag stays on to prevent lipids and vitamins degrading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risks with PN?

A

THROMBOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should you do if a patient has pyrexia and is on PN?

A

Only restart if temperature drops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some signs of a hickman line infection?

A
  • Pyrexia on feeding
  • Rigors on feeding
  • Muscle pains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How much fluids do people require a day?

A

30ml/kg/day + losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the issues with normal saline for maintenance fluids?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should you do before prescribing fluids?

A

Check U+Es!!!!!

If potassium persistently low then check Mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When can you switch from IV to PO abx?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If a patient grows MRSA on a blood culture post-surgery, where could the source of infection be?

A
  • Wound site
  • Catheter
  • Line
  • Epidural site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do gram-negative bacteria lead to septic shock?

A

Endotoxins that lead to vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do gram-negative bacteria lead to septic shock?

A

Endotoxins that lead to vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What antibiotic do you need to add to Benzylpenicillin for necrotising fascitis?

A

Clindamycin

Consider early IVIG

23
Q

What is an inquest?

A
24
Q

When does a coroner have to perform an inquest?

A
  • Unexpected death
  • Custody inc MHA, DOLS, Custody
25
Q

What should you do if a patient dies in your care and is likely to go to inquest?

A

Write an account in your own words as soon as possible!!!!

26
Q

How do you write a statement to the coroner?

A

It is a factual summary, do not speculate or give hearsay (second or third hand)

If asked a question and it is not in your area of expertise you should say this

27
Q

What is a problem representation?

A
28
Q

What is Murtagh’s method for diagnostic reasoning?

A
  • Most likely diagnoses
  • 2 less likely diagnoses
  • 2 not to be missed diagnoses
29
Q

How do you receive a handover and what questions are important to ask when receiving this?

(IMPORTANT CARD TO PRACTICE)

A

ISBAR

  • What is the NEWS and what are they scoring on?
  • PMHx
  • Does the senior know about this?
  • Do they have an escalation plan or a DNACPR?
  • What have you done already?
  • What would you like me to do?
30
Q

What is included in a discharge letter?

A
  • Elective or Emergency?
  • Main Diagnosis
  • PMHx
  • Clinical Hx: include if new DNACPR in place
  • Ix
  • Follow up plans

Need extra letter for anticoagulation or emergency EoL plan

31
Q

How do you commence warfarin in hospital?

A

LMWH bridging therapy until 2 INRs within therapeutic range

32
Q

What should patients do if they miss a dose of warfarin for DVT treatment ?

A

Target INR: 2-3

Just miss it and take the next dose as normal as warfarin has a long half life

33
Q

If a patient has a VTE provoked by malignancy what treatment should they be given?

A

DOAC >LMWH

Usually Apixaban or Rivaroxaban. Avoid rivaroxaban in GI malignancy as associated with GI bleeds

Dabigatran and Edoxaban require bridging

34
Q

If a patient has a low eGFR and CKD but has septic shock how do you fluid resuscitate?

A

500mls over 15 minutes, shock takes priority and their eGFR may be low due to the sepsis

35
Q

Which of the following drugs need to be stopped if there is an eGFR of less than 30?

  • Metformin
  • Citalopram
  • Ramipril
  • Gliclazide
A
  • Metformin: risk of acidosis
  • Gliclazide: hypo risk, put on sliding scale
  • Ramipril: nephrotoxic

Ciprofloxacin is hepatically excreted so can continue

36
Q

What are the three principles of treatment for anaphylaxis?

A

Adrenaline, Oxygen, Fluids

Can give non-sedating antihistamine once acute phase is over

37
Q

If the source of sepsis is known how does this change your sepsis 6?

A

Use narrow spectrum antibiotics e.g Flucloxacillin IV for cellulitis origin

38
Q

How are Gentamicin and Vancomycin prescribed?

A

Need to base next dose on levels before so daily levels are needed. Also need U+Es

Be careful as Red Man Syndrome (antihistamine release) and Ototoxic!!!

39
Q

Why do you need to be careful when stopping a prescription of oxybutynin in a patient with Parkinson’s?

A

It is an anticholinergic and the ratio of acetylcholine:dopamine affects balance in Parkinson’s

40
Q

What sedation is appropriate for a patient with PD?

A

Appropriate: Lorazepam (can increase agitation in 10%), Olanzapine, Quetiapine

Not appropriate: Haloperidol and Chlorpromazine as D2 antagonists

41
Q

If a Parkinson’s patient is NBM what can you switch their meds to?

A

Rotigotine patch but takes 24 hours to kick in so will be temporary drop in functioning

42
Q

How do you confirm a death?

A

Time of death is when it is confirmed by Doctor not when they take their last breath for example

43
Q

How do you certify a death?

A

Remember 1b caused 1a

44
Q

What can you NOT write in 1a on a death certificate?

A

1a should be the disease, illness or complication which led to death and not a mode of dying

45
Q

What are some reasons to refer a death to the coroner?

A
46
Q

What is essential to be included on a cremation form 4?

A

If there is a pacemaker as it can explode

47
Q

If a woman has a high output ileostomy how can we work out the fluid replacement including potassium needed?

(IMPORTANT CARD)

A

Fluids (using fluid balance chart)

  • Work out maintenance for 24 hours (25ml x kg)
  • Work out deficit for 24 hours (do loss/hr x 24)
  • Add together
  • Take away fluid intake

Potassium Replacement

  • 3.5 - actual potassium
  • Above x daily requirement x 0.4 gives deficit
  • Deficit plus daily requirement
48
Q

When prescribing in DKA what is very important to continue prescribing?

A

Normal long acting insulin in the background

DO NOT GIVE A MIXED INSULIN AS THEIR BACKGROUND

49
Q

How should you adjust someone’s insulin after a hypo?

A

20% decrease in dose

50
Q

How should you adjust someone’s insulin if there are having persistently high BMs?

A

10% increase

51
Q

What can cause normal BM in DKA?

A

SGLT2 Inhibitors

52
Q

How do you take someone off of a DKA protocol once their DKA has resolved?

A

Eating and drinking: Give them s/c insulin, let them eat, 30 minutes later take off

Not eating and drinking: Go to sliding scale

53
Q

What are the premises of prescribing in DKA?

A

Insulin: 0.1 units/kg/hr, if delay of more than half hour give stat of 10 units s/c

Fluids: Start with sodium chloride, Add potassium to next bags if necessary but no more than 10mmol/hr

Switch to 10% dextrose if BM<14

54
Q

How often should you check BM in sliding scale?

A
  • Hourly
  • Use 5% dextrose with K+ as fluids
  • Keep long acting insulin prescribed, if NBM then decrease to 80%
55
Q

Who should you not give glucagon to in a hypo and what should you give them instead?

A

Anyone with liver disease or emaciated e.g elderly with low muscle mass

Give them 50ml/hr 20% IV dextrose

56
Q

What is the difference in treatment between DKA and HHS?

A

Only give fluids in HHS

If significant ketonuria give 0.05 units/kg/hr of insulin

Y5 Emergency Medicine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions