4th year Acute care 1

Question 1

What are the 3 methods of treatment for overdose?

Answer 1

Prevent absorption
Enhance elimination
Anti-dotes

Question 2

What are the 3 commonest drugs in overdose?

Answer 2

Paracetamol
Anti-depressants
Opiates

Question 3

Where is paracetamol absorbed?

Answer 3

In the small bowel

Question 4

What treatment can be given for paracetamol overdose if within the first hour?

Answer 4

Activated charcoal

Question 5

When should you measure the first paracetamol level in suspected overdose?

Answer 5

At 4 hours

Question 6

What is the anti-dote for paracetamol overdose?

Answer 6

Acetylcysteine - replenished glutathione which detoxifies paracetamol

Question 7

When should you measure LFT’s in paracetamol overdose?

Answer 7

At 24 hours - all paracetamol should be gone from the system

Question 8

What ss the toxidrome for opiate overdose?

Answer 8

Pin point pupils
Respiratory depression
Decreased consciousness

Question 9

When should you treat an opiate overdose?

Answer 9

If RR <10, 02 <95%, or if drowsy/snoring

Question 10

What is the treatment for opiate overdose?

Answer 10

Naloxone

Question 11

What dose should you give as a bolus of naloxone?

Answer 11

400mcg

Question 12

What does of Naloxone should be given to post op patients with opiate overdose?

Answer 12

40mcg

Question 13

Name 3 symptoms/signs of tricyclic overdose?

Answer 13

Big pupils
Tachycardia
Hypotension
Dyskinesia
Dysarthria

Question 14

What complications can arise as a result of tricyclic overdose?

Answer 14

Arrhythmia and seizures

Long QRS,

Question 15

What is the treatment for tricyclic overdose?

Answer 15

Sodium bicarbonate

Question 16

What drugs should be given to treat seizures in tricyclic overdose?

Answer 16

Lorazepam - 4mg

If unsuccessful after 2 doses - give phenytoin IV

Question 17

What is the treatment for benzodiazepine overdose?

Answer 17

Flumazenil

Question 18

What is a risk of treating benzodiazepine overdose?

Answer 18

May lower seizure threshold and mean that seizures cannot be treated

Question 19

Flumazenil should not be given in benzodiazepine overdose if the patient has also taken which other type of drug?

Answer 19

Tricyclic - seizure risk

Question 20

What antibiotic should be given for a dog bite?

Answer 20

Co-amoxiclav

Question 21

What are the 5 types of shock?

Answer 21

Hypovolaemic
Cardiogenic
Neurogenic
Septic 
Anaphylactic

Question 22

What is the definition of shock?

Answer 22

Abnormality of the circulatory system resulting in inadequate organ perfusion

Question 23

Name 3 causes of hypovolaemic shock?

Answer 23

Loss of blood
Severe burn
GI obstruction, malabsorption

Question 24

Why does hypo perfusion worsen bleeding?

Answer 24

Hypoperfusion causes acidosis which causes clotting factors not to work

Question 25

What ratio of red cells to FFP should be given in hypovolaemic shock due to blood loss?

Answer 25

1:1

Question 26

Name 3 causes of a cardiogenic shock?

Answer 26

Pump failure - MI Sever arrhythmia Flow obstruction e.g. PE

Question 27

What treatment should you not give in cardiogenic shock?

Answer 27

Fluids - risk of pulmonary oedema

Question 28

What to inotropes do?

Answer 28

Tightens vessels to increase BP

Question 29

Name 1 cause of neurogenic shock?

Answer 29

High spinal cord transection

Question 30

Name the two types of vasogenic shock?

Answer 30

Anaphylaxis and septic

Question 31

Name 1 inotropic drug?

Answer 31

Dobutamine

Question 32

What type of shock is likely if the patient is cold and clammy?

Answer 32

Cardiogenic or hypovolaemic

Question 33

Wha type of shock is likely if the patient is warm with a bounding pulse?

Answer 33

Septic

Question 34

What might cause a difference in BP between the left and right sides?

Answer 34

Aortic dissection

Question 35

What are the 6 steps in securing an airway?

Answer 35

``` Head tilt chin lift Jaw thrust Oropharyngeal airway Nasopharyngeal airway Laryngeal mask airway ET tube ```

Question 36

How should you measure an oropharyngeal airway?

Answer 36

Measure from incisors to angle of mandible

Question 37

What should you do with a reservoir mask before giving to patient?

Answer 37

Occlude valve to fill bag with O2

Question 38

What should you give as resus fluid?

Answer 38

500ml 0/9% saline

Question 39

What should you give for hypoglycaemia?

Answer 39

100ml of 10% glucose 5% not fast enough 50% too thick

Question 40

Which 2 cardio drugs should be withheld before surgery?

Answer 40

ACE inhibitors and anticoagulants

Question 41

What should INR be before surgery in patients who have had warfarin discontinued?

Answer 41

<1.5

Question 42

How long should clopidogrel be stopped for before surgery?

Answer 42

7 days

Question 43

Describe the Glasgow coma scale?

Answer 43

``` Eye opening 4 - spontaneous opening 3 - to speech 2 - to pain 1 - no response Best verbal response 5 - orientated to time and place 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - no response Best motor response 6 - obeys commands 5 - localises to pain 4 - flexes to pain 3 - abnormal flexion to pain 2 - extension 1 - no response ```

Question 44

What is an adults daily sodium and potassium requirement?

Answer 44

1-2mmol/kg/day

Question 45

How should morphine be given in acute pain?

Answer 45

Diluted in 0/9% saline and give in 1-2mg increments until comfortable

Question 46

What is the standard PCA dose?

Answer 46

1mg morphine - 5 minute lock out

Question 47

Conversion rate for oral morphine to IV?

Answer 47

Divide by 2

Question 48

Conversion rate for oral morphine to oxycodone?

Answer 48

Divide by 2

Question 49

In elderly patients what should you prescribe with an opiate?

Answer 49

A laxative

Question 50

What is the main general anaesthetic agent?

Answer 50

Propofol

Question 51

What gas is used for general anaesthetic?

Answer 51

Isoflurane

Question 52

Beta blocker and SABA Beta 1 or 2?

Answer 52

Beta blocker - B1 | Salbutamol B2

Question 53

What drug is commonly used for neuromuscular blockade in general anaesthetic?

Answer 53

Suxamethonium

Question 54

Step wise treatment of anaphylaxis?

Answer 54

100% O2 Adrenaline IM 0.5mg - repeat every 5 mins if needed Chlorphenamine IV Hydrocortisone IV

Question 55

Features of severe acute asthma?

Answer 55

Unable to complete sentences, RR>25, Pulse >110, PEFR <50% predicted

Question 56

Features of life threatening asthma?

Answer 56

PEFR <35% predicted, silent chest, cyanosis, bradycardia, hypotension, PaO2 <8, SaO2 <92%, pH<7.35

Question 57

Stepwise treatment of acute COPD exacerbation?

Answer 57

24-28% O2 Salbutamol and ipratopium neb IV hydrocortisone Abx if evidence of infection

Question 58

Initial treatment of DKA?

Answer 58

IV insulin 4-8 units

Question 59

When should you give dextrose in DKA?

Answer 59

When blood glucose is <10mmol/l

Question 60

When is urgent treatment required in hyperkalaemia?

Answer 60

When K>7

Question 61

Management of hyperkalaemia?

Answer 61

10mg Calcium gluconate IV | Insulin 10u

Question 62

What does a high PaCO2 indicate?

Answer 62

Respiratory acidosis

Question 63

What does a low PaCO2 indicate?

Answer 63

Respiratory alkalosis

Question 64

What does a low bicarbonate indicate?

Answer 64

Metabolic acidosis

Question 65

What does a high bicarbonate indicate?

Answer 65

Metabolic alkalosis

Question 66

What does a -ve BE indicate?

Answer 66

Metabolic acidosis

Question 67

What does a +ve BE indicate?

Answer 67

Metabolic alkalosis

Question 68

How does the body compensate for a metabolic alkalosis?

Answer 68

Raising CO2 - hypoventilating

Question 69

How does the body compensate for a metabolic acidosis?

Answer 69

Lowering CO2 - hyperventilating

Question 70

How does the body compensate for a respiratory acidosis?

Answer 70

Retaining bicarb

Question 71

How does the body compensate for a respiratory alkalosis?

Answer 71

Lower bicarb