A&E

Question 1

man has head injury, unconscious then recovered and presented to a&e alert and orientated. Then he collapses with GCS 7/15. Dx?

Answer 1

Extradural haematoma

Question 2

34F took 50 paracetamol 7 hours ago over 30 mins. a blood ingested paracetamol conc is taken. estimated is 300mk/hr. results will take 90 mins. what do you do immediately?

Answer 2

start an IV acetlycysteine infusion

Question 3

when can activated charcoal be given?

Answer 3

within 1st 1hour of ingestion of paracetamol

Question 4

when is gastric lavage given in paracetamol OD? why?

Answer 4

hardly ever now, its obsolete as airway risk

Question 5

when should Tx be started within for paracetamol OD?

Answer 5

8 hours

Question 6

76 M COPD smoker with collapse, confusion, drowsy.
temp 35, hr 108, bp 9/54, rr 24/min, o2 sats 98% on air.
carboxyhaemoglobin 35% ( should be <1.5).
What is the best immediate O2 therapy?

Answer 6

15L/min by non rebreathe mask

Question 7

2 key symptoms of carbonmonoxide poisoning

Answer 7

headache, confusion, drowsy, collapse

Question 8

what is Tx for carbon monoxide poisoning

Answer 8

maximum oxygen treatment

Question 9

what happens to half life of carboxyhaemoglobin when o2 given

Answer 9

decreases

Question 10

70 year old man fell with back pain, progressive LL weakness, urinary/bowel incontinence. normal muscle tone but reduced power in both legs, absent reflexes, downgoing plantars. reduced perineal sensation. normal arms. Dx?

Answer 10

cauda equina

Question 11

29F with generalised abdo pain now localised to RIF. preg test negative. mass in RUQ. temp 37. Dx?

Answer 11

appendicular abcess

Question 12

60M presents after RTA. flexing to pain but no gag reflex. hr high, bp low. has high flow O2 and IV NaCl. what steps are you going to do immediately?

Answer 12

ABCDE

Question 13

60M presents after RTA. flexing to pain but no gag reflex. hr high, bp low. has high flow O2 and IV NaCl. next immediate Mx?

Answer 13

endotracheal intubation

Question 14

what is IV mannitol used for

Answer 14

cerebral oedema and raised ICP

Question 15

60M presents after RTA. flexing to pain but no gag reflex. hr high, bp low. has high flow O2 and IV NaCl. best Ix?

Answer 15

pan CT (full body)

Question 16

65F 1/12 D&V. Hx HTN and hypercholesterolaemia. hr 95, bp 110/60.
Na low, K high, HCO3 low, urea high, creatinine high.
best IV Tx?

Answer 16

0.9% NaCl

Question 17

what is the Tx for high K?

Answer 17

insulin and glucose

Question 18

57M collapsed at home with vodka, amitrptilyine and diazepam.
hr 127, bp 98/48, rr 23, sats 96% RA
ECG sinus tachy with broad complex QRS and 1st degree heart block.
IV Tx?

Answer 18

sodium bicarb

Question 19

57M collapsed at home with vodka, amitrptilyine and diazepam.
hr 127, bp 98/48, rr 23, sats 96% RA
ECG sinus tachy with broad complex QRS and 1st degree heart block.
what is the relevance of the broad complex QRS?

Answer 19

shows TCA overdose (amitriptyline)

Question 20

what is Tx for TCA overdose and why?

Answer 20

Na bicarb
- TCAs are acidic so Na bicarb neutralises this to protect myocardium

Question 21

what is the antidote to benzos?

Answer 21

flumazenil

Question 22

what is the issue with flumazenil?

Answer 22

it can precipitate a seizure

Question 23

67F chest pain, breathless, cold hands and feet.
weak, thready, fast pulse (160bpm)
bp 70/50 but known HTN.
ecg shows sinus tachy with broad complexes
Mx?

Answer 23

electrical cardioversion

Question 24

67F chest pain, breathless, cold hands and feet.
weak, thready, fast pulse (160bpm)
bp 70/50 but known HTN.
ecg shows sinus tachy with broad complexes
why are the broad complexes worrying?

Answer 24

could indicate V tach

Question 25

67F chest pain, breathless, cold hands and feet.
weak, thready, fast pulse (160bpm)
bp 70/50 but known HTN.
ecg shows sinus tachy with broad complexes
why does Mx need to be quick?

Answer 25

she is running very fast HR and could indicate v tach, so could potentially die from CVS compromise

Question 26

48M wheeze, dyspnoea, swelling of tongue/lips following bee sting. high flow O2 given.
what is the immediate Mx (inc route and dose)?

Answer 26

IM adrenaline 1:1000 0.5mL