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5th Year!! > A+E > Flashcards

A+E Flashcards

1
Q

GCS?

A

654 MoVE

Eye opening
4. Spontaneous
3. To speech
2. To pain
1. None

Verbal response
5. Orientated
4. Confused
3. Words
2. Sounds
1. None

Motor response
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None

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2
Q

Acute pulmonary oedema initial Mx

A

Sit up, IV loop diuretic

Can also give oxygen and or vasodilators if clinically approrpiate

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3
Q

Tension pthx Mx

A

Immediate needle decompression

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4
Q

How to decide whether to give acetylcysteine when u have g of paracetamol

A

Divide mg of paracetamol by their weight in KG

If above 150 then give

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5
Q

What is the adrenaline dose in anaphylaxis and cardiac arrest

A

Anaphylaxis= 0.5mg= 0.5ml 1:1000- give IM

CA= 1mg= 1ml 1:1000 IV- give IV

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6
Q

Which blood test to confirm anaphylaxis

A

Serum mast cell tryptase

Rises following an acute episode

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7
Q

How do you manage someone having a cardiac arrest (e.g. VT) when they’re already hooked up to a monitor

A

Up to three successive shocks

Looks like the type of CA doesn’t matter here

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8
Q

How to manage alcoholic ketoacidosis

A

IV 0.9% NaCl

IV thiamine also which prevents Wernicke’s encephalopathy

Ketones in urine as they are made as a byproduct of fat metabolism (due to starved body)

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9
Q

What GCS to intubate

A

Less than 8- intubate

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10
Q

How would a patient present in VF

A

VF causes immediate loss of consciousness and requires resuscitation

Life-threatening arrhythmia leading to cardiac arrest

In contrast in torsades des pointes they may be conscious with an irregular pulse and neurological Sx and palpitations

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11
Q

Commonest viral cause of encephalitis and meningitis

A

Encephalitis = HSV 1

Meningitis = Enterovirus e.g. Coxsackie B virus)

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12
Q

How to assess someone with major trauma

A

C-ABC

normal abcde but with C-spine/ catastrophic haemorrhage first

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13
Q

What type of cells to give in major haemorrhage

A

Red cells
fresh frozen plasma

Give these in a ratio of 1:1

And then give 1 unit of platelets for every 4 units of the other two

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14
Q

Trauma triad of death

A

Coagulopathy leads to increased lactic acid in blood leading to acidosis

Acidosis leads to decreased heart performance which leads to low body temperature

Low body temp leads to decreased coagulation which leads to coagulopathy

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15
Q

Definitive management for theophylline toxicity

A

Haemodialysis

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16
Q

How does oesophageal perforation present

A

Boerhaave syndrome

Perforation due to forceful vomiting

Triad of:
- vomiting
- severe retrosternal chest pain radiating to the back
- subcutaneous emphysema (suprasternal crepitus)

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17
Q

What are thiazolidinediones e.g. pioglitazone CI in heart failure

A

Can cause peripheral oedema

Also can cause weight gain, liver impairment and bladder cancer

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18
Q

Epididymo-orchitis management if unknown organism

A

Single dose IM ceftriaxone and 10-14 days of doxycycline

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19
Q

Which travel disease presents with two phases with remission in between

A

Yellow fever
‘It can present very quickly with non-specific symptoms and it has an incubation period of 2-14 days

20
Q

Which antibiotic to give in MRSA

A

Vancomycin
Teicoplanin
Linezolid

21
Q

What CSF results in subarachnoid haemorrhage

A

Do it hours (6?) after CT scan

Bilirubin in the CSF (xanthchromia)
And normal/ raised opening pressure

22
Q

Anterior middle and posterior cerebral artery stroke what presentation

A

Leg weakness pretty much only on the contralateral side

Middle cerebral artery causes more arm symptoms as well as contralateral homonymous hemianopia and aphasia

Posterior cerebral artery causes contralateral homonymous hemianopia with macular sparing (no limb involvement?)

23
Q

How many doses of IV Loraz can you give in status epilepticus

A

2 doses! Usually of 4mg

After that give a second-line e.g. levetiracetam or sodium valproate or phenytoin

24
Q

How does investigation change in epididymoorchitis change depending on age

A

Younger men more likely to be chlamydia so arrange urine sample for NAAT

In older men more likely to be enteric E.coli so arrang mid-stream sample for microscopy and culture

Obvs do NAAT test if likely in history

25
Q

Facial pain/sensory symptoms vs facial paralysis which stroke type

A

Posterior inferior cerebellar artery = facial PAIN / sensory Sx

AICA is facial paralysis and deafness

26
Q

Which valve is most commonly affected in infective endocarditis in IVDU

A

Tricuspid valve

27
Q

Most common complication after bacterial meningitis

A

Sensorineural hearing loss

In 34% of cases

28
Q

What electrolyte imbalance does LMWH cause

A

Hyperkalaemia

Due to inhibition of aldosterone

29
Q

First line management of acute pericarditis

A

NSAID and colchicine

30
Q

SVCO management

A

Endovascular stenting provides symptoms relief

Glucocorticoids evidence base is weak but often given

31
Q

Antifreeze (ethylene glycol) toxicity management

A

Fomepizole

Flumanezil for benzos

32
Q

Hypertrophic obstructive cardiomyopathy mx

A

Depends on severity

Amiodarone
Beta blockers

Cerdioverter defib implanted to protect those at risk of sudden death

Dual chamber pacemaker
Endocarditis prophylaxis?
Surgical myomectomy

33
Q

What is total amount of atropine you give in bradycardia

A

3mg

Give in 500mcg doses

34
Q

Global T wave inversion cause

A

Non cardiac cause

Think brain

35
Q

What is Cushing triad and what is it a sign of

A

Bradycardia, hypertensive and tachypnoeic (signs of cheyne-stokes breathing) also widened pulse pressure

Sign of high intracranial pressure think brain herniation

CSB is progressively deeper breathing then shallow breathing then temporary apnoea

36
Q

Which t2dm meds cause hypos

A

NOT metformin

SGLT-2i e.g. Flozins CAN

NOT pioglitazone

Gliclazide (sulphonylureas) CAN

NOT DPP-4i e.f. Gliptins

So only flozins and gliclazide can

37
Q

Which t2dm meds cause hypos

A

NOT metformin

SGLT-2i e.g. Flozins CAN

NOT pioglitazone

Gliclazide (sulphonylureas) CAN

NOT DPP-4i e.f. Gliptins

So only flozins and gliclazide can

38
Q

How do the different T2DM meds affect weight

A

Metformin = weight loss

SGLT-2i e.g. Flozins= weight loss

Pioglitazone = weight gain

Gliclazide (sulphonylureas) = weight gain

GLP-1 mimetics e.g. exenatide = weight loss

So metformin and SGLT-2i cause weight loss

39
Q

Unique side effect profile of SGLT-2i

A

Glycosuria
UTI
Genital infections
Lower limb amputations
Fournier gangrene

Weight loss

DKA

40
Q

Unique side effects profile of glitazones

A

Weight gain

Heart failure

Bone fractures

Bladder cancer

41
Q

Unique side effect profile of gliclazide

A

Weight gain

Hypoglycaemia

42
Q

Unique side effect profile of DPP-4i

A

E.g. gliptins

Headaches

Low risk of acute pancreatitis

43
Q

Unique side effect profile of GLP-1 mimetics

A

E.g. exenatide

Reduced appetite

Weight loss

GI symptoms s

44
Q

Unique side effect profile of GLP-1 mimetics

A

E.g. exenatide

Reduced appetite

Weight loss

GI symptoms s

45
Q

Unique side effect profile of metformin

A

GI symptoms

Lactic acidosis (AKI)

Weight loss

NOT hypos

46
Q

When to do an LP when suspecting SAH

A

only do if CT head has been done more than 6 hours after symptom onset

LP must be done at least 12 hours after sx onset

If this is negative think about other diagnoses

Don’t do one in positive CT

5th Year!! (10 decks)

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