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UKMLA Prep > A&E 🚨 > Flashcards

A&E 🚨 Flashcards

1
Q

What are the broad classifications of blood product transfusion complications?

A

Immunological, infective, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), other complications (e.g., hyperkalaemia, iron overload, clotting).

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2
Q

What is a non-haemolytic febrile reaction caused by?

A

Antibodies reacting with white cell fragments and cytokines that have leaked from blood cells during storage.

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3
Q

What are the features of a non-haemolytic febrile reaction?

A
  • Fever
  • Chills
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4
Q

How should a non-haemolytic febrile reaction be managed?

A

Slow or stop the transfusion, administer paracetamol, and monitor the patient.

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5
Q

What causes a minor allergic reaction during a blood transfusion?

A

Foreign plasma proteins.

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6
Q

What are the symptoms of a minor allergic reaction?

A

Pruritus, urticaria.

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7
Q

What is the management for a minor allergic reaction?

A

Temporarily stop the transfusion, administer antihistamine, and monitor.

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8
Q

What can cause anaphylaxis during blood transfusion?

A

IgA deficiency in patients with anti-IgA antibodies.

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9
Q

What are the symptoms of anaphylaxis during a blood transfusion?

A
  • Hypotension
  • Dyspnoea
  • Wheezing
  • Angioedema
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10
Q

How should anaphylaxis during a transfusion be managed?

A

Stop the transfusion, administer IM adrenaline, provide ABC support, oxygen, and fluids.

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11
Q

What is an acute haemolytic reaction caused by?

A

ABO-incompatible blood due to human error.

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12
Q

What are the symptoms of an acute haemolytic reaction?

A
  • Fever
  • Abdominal pain
  • Hypotension
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13
Q

What is the management for an acute haemolytic reaction?

A

Stop transfusion, confirm diagnosis, check patient identity, send blood for direct Coombs test, supportive care.

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14
Q

What causes transfusion-associated circulatory overload (TACO)?

A

Excessive rate of transfusion, pre-existing heart failure.

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15
Q

What are the symptoms of TACO?

A
  • Pulmonary oedema
  • Hypertension
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16
Q

How should TACO be managed?

A

Slow or stop transfusion, consider IV loop diuretic (e.g., furosemide) and oxygen.

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17
Q

What characterizes transfusion-related acute lung injury (TRALI)?

A

Non-cardiogenic pulmonary oedema due to increased vascular permeability.

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18
Q

What are the features of TRALI?

A
  • Hypoxia
  • Pulmonary infiltrates on chest x-ray
  • Fever
  • Hypotension
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19
Q

What is the management for TRALI?

A

Stop the transfusion and provide oxygen and supportive care.

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20
Q

What pathogens are RBCs primarily at risk for transmitting?

A
  • HIV
  • HBV
  • HCV
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21
Q

What is the clinical impact of viral infections from RBC transfusions?

A

Chronic disease states such as chronic hepatitis or AIDS.

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22
Q

What is the risk associated with platelet transfusions?

A

Bacterial contamination due to storage at room temperature.

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23
Q

What are common bacterial contaminants of platelet transfusions?

A
  • Staphylococcus epidermidis
  • Bacillus cereus
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24
Q

What is the risk of infectious complications from blood products based on?

A

Storage conditions, components involved, and duration of storage.

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25
Q

What is a chronic subdural haematoma?

A

A collection of blood within the subdural space present for weeks to months.

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26
Q

What are the typical symptoms of a subdural haematoma?

A
  • Headache
  • Confusion
  • Lethargy
  • Altered mental status
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27
Q

What imaging technique is first-line for diagnosing acute subdural haematoma?

A

CT imaging.

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28
Q

What characterizes an acute subdural haematoma?

A

Collection of fresh blood within the subdural space due to high-impact trauma.

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29
Q

What is the management for a chronic subdural haematoma without neurological deficits?

A

Conservative management.

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30
Q

What are the two main types of strokes?

A
  • Ischaemic
  • Haemorrhagic
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31
Q

What is a transient ischaemic attack (TIA)?

A

Sudden onset of focal neurologic symptoms lasting typically less than an hour.

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32
Q

What is the significance of a stroke being referred to as a ‘brain attack’?

A

It emphasizes the need for emergency assessment and treatment.

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33
Q

What is the clinical feature of lacunar strokes?

A

Isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia.

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34
Q

What is the peak incidence time for seizures during alcohol withdrawal?

A

36 hours.

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35
Q

What is the first-line treatment for alcohol withdrawal?

A

Long-acting benzodiazepines (e.g., chlordiazepoxide, diazepam).

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36
Q

What is the characteristic feature of acute subdural haematomas on CT imaging?

A

Crescentic collection, hyperdense compared to the brain.

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37
Q

What are the associated effects of anterior cerebral artery lesions?

A
  • Contralateral hemiparesis and sensory loss, lower extremity > upper
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38
Q

What are common symptoms of chronic subdural haematomas?

A
  • Confusion
  • Reduced consciousness
  • Neurological deficit
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39
Q

What is the essential problem in ischaemic strokes?

A

‘Blockage’ in the blood vessel stops blood flow

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40
Q

What is the essential problem in haemorrhagic strokes?

A

Blood vessel ‘bursts’ leading to reduction in blood flow

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41
Q

What percentage of strokes are ischaemic?

A

85%

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42
Q

What percentage of strokes are haemorrhagic?

A

15%

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43
Q

Name a subtype of ischaemic stroke.

A

Transient ischaemic attack (TIA)

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44
Q

What is a TIA?

A

Sudden onset of a focal neurologic symptom lasting typically less than an hour

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45
Q

What are the general risk factors for cardiovascular disease?

A
  • Age
  • Hypertension
  • Smoking
  • Hyperlipidaemia
  • Diabetes mellitus
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46
Q

What is a common risk factor for cardioembolism?

A

Atrial fibrillation

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47
Q

List some symptoms of stroke.

A
  • Motor weakness
  • Speech problems (dysphasia)
  • Swallowing problems
  • Visual field defects (homonymous hemianopia)
  • Balance problems
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48
Q

What is the definition of stroke?

A

A clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function caused by a vascular problem

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49
Q

What characterizes cerebral hemisphere infarcts?

A
  • Contralateral hemiplegia
  • Contralateral sensory loss
  • Homonymous hemianopia
  • Dysphasia
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50
Q

What are lacunar infarcts?

A

Small infarcts around the basal ganglia, internal capsule, thalamus, and pons

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51
Q

What is the Oxford Stroke Classification used for?

A

To classify strokes based on the initial symptoms

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52
Q

What criteria should be assessed in the Oxford Stroke Classification?

A
  • Unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  • Homonymous hemianopia
  • Higher cognitive dysfunction e.g. dysphasia
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53
Q

What are the four types of strokes classified by the Oxford Stroke Classification?

A
  • Total anterior circulation infarcts (TACI)
  • Partial anterior circulation infarcts (PACI)
  • Lacunar infarcts (LACI)
  • Posterior circulation infarcts (POCI)
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54
Q

What is a common symptom more likely in haemorrhagic strokes?

A

Decrease in the level of consciousness

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55
Q

What does the FAST mnemonic stand for?

A
  • Face
  • Arms
  • Speech
  • Time
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56
Q

What is the first-line imaging technique for suspected stroke?

A

Non-contrast CT head scan

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57
Q

What is the recommended immediate treatment for ischaemic strokes?

A

Thrombolysis if certain criteria are met

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58
Q

What is the ABCD2 prognostic score used for?

A

To risk stratify patients who present with a suspected TIA

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59
Q

What is the recommended immediate antithrombotic therapy for TIAs?

A

Aspirin 300 mg immediately, unless contraindicated

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60
Q

What should be done if imaging confirms a haemorrhagic stroke?

A

Consider neurosurgical consultation for further management

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61
Q

What should be done with anticoagulants in the event of a haemorrhagic stroke?

A

Stop anticoagulants to minimize further bleeding

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62
Q

What is thrombolysis used for?

A

To treat acute ischaemic stroke

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63
Q

What are the absolute contraindications to thrombolysis?

A
  • Previous intracranial haemorrhage
  • Seizure at onset of stroke
  • Intracranial neoplasm
  • Suspected subarachnoid haemorrhage
  • Stroke or traumatic brain injury in preceding 3 months
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64
Q

What is mechanical thrombectomy?

A

A treatment option for patients with acute ischaemic stroke

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65
Q

What is the recommended secondary prevention for ischaemic stroke?

A

Clopidogrel is recommended ahead of combination use of aspirin plus modified-release dipyridamole

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66
Q

Fill in the blank: The FAST campaign uses the mnemonic _______.

A

[Face, Arms, Speech, Time]

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67
Q

True or False: Symptoms alone can differentiate between haemorrhagic and ischaemic strokes.

A

False

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68
Q

What does the ROSIER score assess?

A

It assesses the likelihood of stroke based on specific criteria

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69
Q

What is the significance of the hyperdense artery sign in acute ischaemic stroke?

A

It corresponds with the responsible arterial clot and tends to be visible immediately

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70
Q

What should be maintained within normal limits in acute stroke management?

A
  • Blood glucose
  • Hydration
  • Oxygen saturation
  • Temperature
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71
Q

What is the recommended time frame for administering thrombolysis in acute ischaemic stroke?

A

Within 4.5 hours of onset of stroke symptoms

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72
Q

What is the recommended action for patients with suspected TIA in the last 7 days?

A

Arrange urgent assessment (within 24 hours) by a specialist stroke physician

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73
Q

What imaging is necessary to confirm thrombolysis eligibility?

A

Imaging must definitively exclude haemorrhage

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74
Q

What are the three criteria assessed in the Bamford Classification for strokes?

A
  • Unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  • Homonymous hemianopia
  • Higher cognitive dysfunction (e.g. dysphasia)
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75
Q

What characterizes Total Anterior Circulation Infarcts (TACI)?

A

Involves middle and anterior cerebral arteries with all three criteria present.

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76
Q

What defines Partial Anterior Circulation Infarcts (PACI)?

A

Involves smaller arteries of anterior circulation with 2 of the 3 criteria present.

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77
Q

What are the characteristics of Lacunar Infarcts (LACI)?

A

Involves perforating arteries with presentations including:
* Unilateral weakness (and/or sensory deficit)
* Pure sensory stroke
* Ataxic hemiparesis

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78
Q

What symptoms are associated with Posterior Circulation Infarcts (POCI)? (3)

A

Presents with:
* Cerebellar or brainstem syndromes
* Loss of consciousness
* Isolated homonymous hemianopia

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79
Q

What is Lateral Medullary Syndrome also known as?

A

Wallenberg’s syndrome

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80
Q

What are the symptoms of Lateral Medullary Syndrome?

A
  • Ipsilateral ataxia
  • Nystagmus
  • Dysphagia
  • Facial numbness
  • Cranial nerve palsy (e.g. Horner’s)
  • Contralateral limb sensory loss
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81
Q

What is Staphylococcal toxic shock syndrome?

A

A severe systemic reaction to staphylococcal exotoxins, particularly TSST-1.

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82
Q

What are the CDC diagnostic criteria for Staphylococcal toxic shock syndrome?

A
  • Fever: temperature > 38.9ºC
  • Hypotension: systolic blood pressure < 90 mmHg
  • Diffuse erythematous rash
  • Desquamation of rash, especially of palms and soles
  • Involvement of three or more organ systems
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83
Q

What management is recommended for Staphylococcal toxic shock syndrome?

A
  • Removal of infection focus
  • IV fluids
  • IV antibiotics
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84
Q

Define osteoporosis.

A

A condition where bones gradually decrease in bone mineral density, increasing the likelihood of fragility fractures.

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85
Q

What is the male-to-female ratio for osteoporosis?

A

1:6

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86
Q

What are common sites for osteoporotic fractures?

A
  • Spine (vertebra)
  • Hip
  • Wrist
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87
Q

List risk factors for osteoporotic fractures.

A
  • Advancing age
  • Previous history of fragility fracture
  • Frequent or prolonged use of glucocorticoids
  • History of falls
  • Family history of hip fracture
  • Low BMI (< 18.5)
  • Tobacco smoking
  • High alcohol intake
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88
Q

What signs may indicate osteoporotic vertebral fractures?

A
  • Loss of height
  • Kyphosis
  • Localized tenderness on palpation
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89
Q

What is the first investigation ordered for suspected osteoporotic fractures?

A

X-ray of the spine

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90
Q

What tools can estimate the 10-year risk of a fracture?

A
  • FRAX tool
  • QFracture tool
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91
Q

What defines neutropenic sepsis?

A

Neutrophil count of < 0.5 * 10^9 with temperature > 38ºC or other signs of sepsis.

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92
Q

What is the most common cause of neutropenic sepsis?

A

Coagulase-negative, Gram-positive bacteria, particularly Staphylococcus epidermidis.

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93
Q

What is the initial management for neutropenic sepsis?

A

Start antibiotics immediately without waiting for WBC results.

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94
Q

What are the updated definitions of sepsis according to the Surviving Sepsis Guidelines?

A
  • Sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection
  • Septic shock: a more severe form of sepsis with greater risk of mortality
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95
Q

What is the qSOFA score used for?

A

To identify adult patients outside of ICU at heightened risk of mortality with suspected infection.

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96
Q

List the red flag criteria for sepsis.

A
  • Responds only to voice or pain/unresponsive
  • Acute confusional state
  • Systolic B.P <= 90 mmHg
  • Heart rate > 130 per minute
  • Respiratory rate >= 25 per minute
  • Needs oxygen to keep SpO2 >= 92%
  • Non-blanching rash, mottled/ashen/cyanotic
  • Not passed urine in last 18 h/UO < 0.5 ml/kg/hr
  • Lactate >= 2 mmol/l
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97
Q

What are the components of the ‘sepsis six’ management?

A
  • Administer oxygen
  • Take blood cultures
  • Give broad-spectrum antibiotics
  • Give intravenous fluid challenges
  • Measure serum lactate
  • Measure accurate hourly urine output
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98
Q

What is the mortality risk associated with a SOFA score of 2 or more?

A

Approximately 10% in a general hospital population with suspected infection.

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99
Q

What are common factors associated with an increased risk of suicide?

A
  • Male sex
  • History of deliberate self-harm
  • Alcohol or drug misuse
  • History of mental illness
  • Depression
  • Schizophrenia
  • History of chronic disease
  • Advancing age
  • Unemployment or social isolation
  • Being unmarried, divorced, or widowed
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100
Q

What factors reduce the risk of a patient committing suicide?

A
  • Family support
  • Having children at home
  • Religious belief
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101
Q

What is the presentation of a ruptured abdominal aortic aneurysm?

A
  • Severe, central abdominal pain radiating to the back
  • Pulsatile, expansile mass in the abdomen
  • Patients may be shocked or may have collapsed
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102
Q

What is the management for a suspected ruptured AAA?

A

Immediate vascular review with a view to emergency surgical repair.

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103
Q

What are the two main types of respiratory failure?

A
  • Type 1: ↓ pO2 with normal or ↓ pCO2
  • Type 2: ↑ pCO2 with normal or ↓ pO2
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104
Q

List causes of type 1 respiratory failure. (5)

A
  • Pneumonia
  • Pulmonary embolism
  • Asthma
  • Pulmonary oedema
  • Acute respiratory distress syndrome
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105
Q

List causes of type 2 respiratory failure.

A
  • Chronic obstructive pulmonary disease
  • Decompensation in other respiratory conditions
  • Neuromuscular disease
  • Obesity hypoventilation syndrome
  • Sedative drugs
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106
Q

What is the condition characterized by ↑ pCO2 with a normal or ↓ pO2?

A

Type 2 respiratory failure

Hypercapnia leads to ↓ pH and respiratory acidosis.

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107
Q

List the causes of type 1 respiratory failure. (5)

A
  • pneumonia
  • pulmonary embolism
  • asthma
  • pulmonary oedema
  • acute respiratory distress syndrome
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108
Q

What are common causes of type 2 respiratory failure?

A
  • chronic obstructive pulmonary disease
  • decompensation in other respiratory conditions
  • neuromuscular disease
  • obesity hypoventilation syndrome
  • sedative drugs
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109
Q

What guidelines did the British Thoracic Society publish in 2002?

A

Guidelines on the use of non-invasive ventilation in acute respiratory failure

Followed by the Royal College of Physicians guidelines in 2008.

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110
Q

What are key indications for non-invasive ventilation? (4)

A
  • COPD with respiratory acidosis (pH 7.25-7.35)
  • Type II respiratory failure secondary to chest wall deformity
  • Cardiogenic pulmonary oedema unresponsive to CPAP
  • Weaning from tracheal intubation
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111
Q

What are the recommended initial settings for bi-level pressure support in COPD?

A
  • EPAP: 4-5 cm H2O
  • IPAP: 10-15 cm H2O
  • Back up rate: 15 breaths/min
  • Inspiration:expiration ratio: 1:3
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112
Q

What is the purpose of head tilt and chin lift in airway management?

A

To open the airway

Jaw thrust is preferred if there is concern about cervical spine injury.

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113
Q

What is an extradural (epidural) haematoma?

A

A collection of blood between the skull and the dura, typically caused by trauma

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114
Q

What is the classical presentation of an extradural haematoma?

A

Loss of consciousness, brief regain, and then loss again after a low-impact head injury

This brief regain is termed the ‘lucid interval’.

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115
Q

What imaging appearance does an extradural haematoma have?

A

Biconvex (lentiform), hyperdense collection around the surface of the brain

Limited by the suture lines of the skull.

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116
Q

What is idiopathic intracranial hypertension?

A

A condition seen in young, overweight females, also known as pseudotumour cerebri

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117
Q

List the risk factors for idiopathic intracranial hypertension.

A
  • obesity
  • female sex
  • pregnancy
  • drugs (e.g. combined oral contraceptive pill, steroids)
  • tetracyclines
  • retinoids
  • lithium
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118
Q

What are the common features of idiopathic intracranial hypertension?

A
  • headache
  • blurred vision
  • papilloedema
  • enlarged blind spot
  • sixth nerve palsy
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119
Q

What is the management for idiopathic intracranial hypertension?

A
  • weight loss
  • carbonic anhydrase inhibitors (e.g. acetazolamide)
  • topiramate
  • repeated lumbar puncture (temporary)
  • surgery (optic nerve sheath decompression)
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120
Q

What does papilloedema describe?

A

Optic disc swelling caused by increased intracranial pressure

It is almost always bilateral.

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121
Q

List the features observed during fundoscopy of papilloedema.

A
  • venous engorgement
  • loss of venous pulsation
  • blurring of the optic disc margin
  • elevation of optic disc
  • loss of the optic cup
  • Paton’s lines
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122
Q

What are common causes of papilloedema? (5)

A
  • space-occupying lesion
  • malignant hypertension
  • idiopathic intracranial hypertension
  • hydrocephalus
  • hypercapnia
123
Q

What is the normal intracranial pressure (ICP) in adults?

A

7-15 mmHg in the supine position

124
Q

What is cerebral perfusion pressure (CPP)?

A

The net pressure gradient causing cerebral blood flow to the brain

CPP = mean arterial pressure - ICP.

125
Q

What are the features of increased intracranial pressure?

A
  • headache
  • vomiting
  • reduced levels of consciousness
  • papilloedema
  • Cushing’s triad
126
Q

What is a subarachnoid haemorrhage (SAH)?

A

An intracranial haemorrhage defined as the presence of blood within the subarachnoid space

127
Q

What is the most common cause of spontaneous SAH?

A

Intracranial aneurysm (saccular ‘berry’ aneurysms)

128
Q

What are classical presenting features of spontaneous SAH?

A
  • sudden-onset headache
  • severe headache
  • nausea and vomiting
  • meningism
  • coma
  • seizures
129
Q

What is the first-line investigation for SAH?

A

Non-contrast CT head

130
Q

What should be done if CT head is normal within 6 hours of symptom onset?

A

Consider an alternative diagnosis

New guidelines suggest not doing a lumbar puncture.

131
Q

What is the aim of investigation after confirming spontaneous SAH?

A

Identify a causative pathology that needs urgent treatment

132
Q

What are the common complications of aneurysmal SAH? (5)

A
  • re-bleeding
  • hydrocephalus
  • vasospasm
  • hyponatraemia
  • seizures
133
Q

What is a subdural haematoma?

A

A collection of blood deep to the dural layer of the meninges

134
Q

List the classifications of subdural haematomas based on age.

A
  • Acute
  • Subacute
  • Chronic
135
Q

What are the typical clinical features of a subdural haematoma?

A
  • altered mental status
  • focal neurological deficits
  • headache
  • seizures
136
Q

What is an acute subdural haematoma?

A

A collection of blood within the subdural space that presents variably, from incidental findings to severe coma.

137
Q

What imaging technique is used as the first-line investigation for acute subdural haematomas?

A

CT imaging.

138
Q

What does CT imaging show in cases of acute subdural haematomas?

A

A crescentic collection, hyperdense compared to the brain.

139
Q

What is the typical management for small or incidental acute subdural haematomas?

A

Observation and conservative management.

140
Q

What are the surgical options for large acute subdural haematomas?

A

Monitoring of intracranial pressure and decompressive craniectomy.

141
Q

What defines a chronic subdural haematoma?

A

A collection of blood within the subdural space present for weeks to months.

142
Q

What is the typical presentation of a chronic subdural haematoma?

A

Progressive confusion, reduced consciousness, or neurological deficit.

143
Q

What imaging findings are associated with chronic subdural haematomas?

A

Hypodense crescentic shapes that compress the brain.

144
Q

What is the management for small chronic subdural haematomas without neurological deficits?

A

Conservative management.

145
Q

What are the potential features of pulmonary embolism?

A
  • Chest pain
  • Dyspnoea
  • Haemoptysis
  • Tachycardia
  • Tachypnoea.
146
Q

What percentage of patients present with the textbook triad of pleuritic chest pain, dyspnoea, and haemoptysis in pulmonary embolism?

A

Around 10%.

147
Q

What is the PIOPED study?

A

A study that examined the frequency of symptoms and signs in patients diagnosed with pulmonary embolism.

148
Q

What is the significance of tachypnea in the context of pulmonary embolism?

A

It occurs in 96% of patients with pulmonary embolism.

149
Q

What is the pulmonary embolism rule-out criteria (PERC)?

A

Criteria used to rule out PE when the pre-test probability is low (< 15%).

150
Q

What should be done if the suspicion of pulmonary embolism is greater than low probability?

A

Move straight to the 2-level PE Wells score.

151
Q

What is the 2-level PE Wells score used for?

A

To assess the likelihood of pulmonary embolism based on clinical features.

152
Q

What is the management recommendation for patients with a likely PE (> 4 points)?

A

Arrange an immediate computed tomography pulmonary angiogram (CTPA).

153
Q

What is the recommended initial lung-imaging modality for non-massive PE?

154
Q

What is the sensitivity and specificity of V/Q scans?

A

Sensitivity of around 75% and specificity of 97%.

155
Q

What are the key changes in NICE guidelines regarding the management of VTE in 2020?

A
  • Use of direct oral anticoagulants (DOACs) as first-line treatment
  • Outpatient treatment for low-risk PE patients.
156
Q

What is the cornerstone of VTE management?

A

Anticoagulant therapy.

157
Q

What should be the duration of anticoagulation for all patients with VTE?

A

At least 3 months.

158
Q

What is primary postpartum haemorrhage defined as?

A

Blood loss of > 500 ml after a vaginal delivery occurring within 24 hours.

159
Q

What are the causes of primary postpartum haemorrhage?

A
  • Tone (uterine atony)
  • Trauma (e.g., perineal tear)
  • Tissue (retained placenta)
  • Thrombin (clotting/bleeding disorder).
160
Q

What is the management approach for primary postpartum haemorrhage?

A

Involves the ABC approach, blood transfusion, and medications like IV oxytocin.

161
Q

What is the classification of pneumothoraces?

A
  • Spontaneous pneumothorax
  • Primary spontaneous pneumothorax (PSP).
162
Q

What is secondary postpartum hemorrhage?

A

Occurs between 24 hours - 12 weeks, typically due to retained placental tissue or endometritis.

163
Q

What is pneumothorax?

A

A condition characterized by the accumulation of air in the pleural space, resulting in the partial or complete collapse of the affected lung.

164
Q

What are the classifications of pneumothorax?

A
  • Spontaneous pneumothorax
  • Traumatic pneumothorax
  • Iatrogenic pneumothorax
165
Q

What is primary spontaneous pneumothorax (PSP)?

A

Occurs without underlying lung disease, often in tall, thin, young individuals, associated with the rupture of subpleural blebs or bullae.

166
Q

What is secondary spontaneous pneumothorax (SSP)?

A

Occurs in patients with pre-existing lung disease, such as COPD, asthma, cystic fibrosis, lung cancer, or Pneumocystis pneumonia.

167
Q

What is a tension pneumothorax?

A

A severe pneumothorax resulting in the displacement of mediastinal structures, potentially leading to severe respiratory distress and hemodynamic collapse.

168
Q

What are the clinical features of pneumothorax?

A
  • Dyspnoea
  • Chest pain (often pleuritic)
  • Hyper-resonant lung percussion
  • Reduced breath sounds
  • Reduced lung expansion
  • Tachypnoea
  • Tachycardia
169
Q

What are the symptoms of tension pneumothorax?

A
  • Respiratory distress
  • Tracheal deviation away from the side of the pneumothorax
  • Hypotension
170
Q

What are the minimal symptoms defined by the British Thoracic Society for pneumothorax?

A

No significant pain or breathlessness and no physiological compromise.

171
Q

What is the first step in managing a symptomatic pneumothorax?

A

Assess for high-risk characteristics.

172
Q

What are high-risk characteristics for pneumothorax?

A
  • Haemodynamic compromise
  • Significant hypoxia
  • Bilateral pneumothorax
  • Underlying lung disease
  • Age ≥ 50 with significant smoking history
  • Haemothorax
173
Q

What management options are available for pneumothorax?

A
  • Conservative care
  • Ambulatory device
  • Needle aspiration
  • Chest drain
174
Q

What is the role of a chest drain in pneumothorax management?

A

Inserted if needle aspiration is unsuccessful to allow continuous drainage of air.

175
Q

What is the recommended follow-up for patients managed conservatively for primary spontaneous pneumothorax?

A

Reviewed every 2-4 days as an outpatient.

176
Q

What is Legionnaire’s disease caused by?

A

The intracellular bacterium Legionella pneumophilia.

177
Q

What are common features of Legionnaire’s disease?

A
  • Flu-like symptoms
  • Dry cough
  • Relative bradycardia
  • Confusion
  • Lymphopaenia
  • Hyponatraemia
  • Deranged liver function tests
  • Pleural effusion
178
Q

What is the diagnostic test of choice for Legionnaire’s disease?

A

Urinary antigen.

179
Q

What distinguishes Mycoplasma pneumoniae from other pneumonias?

A

It often affects younger patients and lacks a peptidoglycan cell wall, leading to resistance to penicillins and cephalosporins.

180
Q

What are some complications of Mycoplasma pneumoniae? (7)

A
  • Cold agglutination
  • Erythema multiforme
  • Meningoencephalitis
  • Bullous myringitis
  • Pericarditis/myocarditis
  • Gastrointestinal issues
  • Renal problems
181
Q

What is the classical x-ray finding in pneumonia?

A

Consolidation.

182
Q

What are typical symptoms of pneumonia?

A
  • Cough
  • Sputum
  • Dyspnoea
  • Chest pain
  • Fever
183
Q

What is the CURB-65 scoring system used for?

A

Risk stratification in patients with community-acquired pneumonia.

184
Q

What does the ‘C’ in CURB-65 stand for?

A

Confusion (abbreviated mental test score <= 8/10).

185
Q

What is the recommended treatment for patients with a CURB-65 score of 0?

A

Home-based care.

186
Q

What antibiotic is generally used first-line for pneumonia?

A

Oral amoxicillin.

187
Q

What should be avoided for patients with pneumothorax regarding travel?

A

Flying for 2 weeks after successful drainage if there is no residual air.

188
Q

What is the risk of developing a pneumothorax in healthy smoking men?

A

Around 10%.

189
Q

What is the management for persistent or recurrent pneumothorax?

A

Consider video-assisted thoracoscopic surgery (VATS) for mechanical/chemical pleurodesis +/- bullectomy.

190
Q

What does the ‘C’ in the CRB65 criteria stand for?

A

Confusion (abbreviated mental test score <= 8/10)

191
Q

What does the ‘R’ in the CRB65 criteria indicate?

A

Respiration rate >= 30/min

192
Q

What does the ‘B’ in the CRB65 criteria refer to?

A

Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg

193
Q

What age group does the ‘65’ in CRB65 refer to?

A

Aged >= 65 years

194
Q

How is patient risk stratified based on CRB65 scores?

A

0: low risk (less than 1% mortality risk)
1 or 2: intermediate risk (1-10% mortality risk)
3 or 4: high risk (more than 10% mortality risk)

195
Q

What is the recommendation for patients with a CRB65 score of 0?

A

Home-based care should be considered

196
Q

What CRP level indicates that antibiotic therapy should not be routinely offered?

A

CRP < 20 mg/L

197
Q

What is the recommendation for patients with a CRP level between 20 - 100 mg/L?

A

Consider a delayed antibiotic prescription

198
Q

What should be offered to patients with CRP > 100 mg/L?

A

Offer antibiotic therapy

199
Q

What additional criterion does CURB65 include compared to CRB65?

A

Urea > 7 mmol/L

200
Q

What is the recommendation for patients with a CURB65 score of 0 or 1?

A

Consider home-based care (low risk, < 3% mortality risk)

201
Q

What is the recommendation for patients with a CURB65 score of 2 or more?

A

Consider hospital-based care (intermediate risk, 3-15% mortality risk)

202
Q

What is the recommendation for patients with a CURB65 score of 3 or more?

A

Consider intensive care assessment (high risk, > 15% mortality risk)

203
Q

What is the first-line treatment for low-severity community-acquired pneumonia?

A

Amoxicillin

204
Q

What alternative should be used if a patient is penicillin allergic?

A

Macrolide or tetracycline

205
Q

What is the recommended duration of antibiotic treatment for low-severity community-acquired pneumonia?

206
Q

What is the recommended treatment for moderate and high-severity community-acquired pneumonia?

A

Dual antibiotic therapy with amoxicillin and a macrolide

207
Q

What duration of antibiotic treatment is recommended for moderate and high-severity pneumonia?

208
Q

What should be monitored for admitted patients to determine response to treatment?

A

CRP levels

209
Q

What are the discharge criteria for patients with pneumonia?

A

Not routinely discharged if they have 2 or more of the following:
* Temperature > 37.5°C
* Respiratory rate >= 24 breaths per minute
* Heart rate > 100 beats per minute
* Systolic blood pressure <= 90 mmHg
* Oxygen saturation < 90% on room air
* Abnormal mental status
* Inability to eat without assistance

210
Q

What is the recommended follow-up for all cases of pneumonia after clinical resolution?

A

Repeat chest X-ray at 6 weeks

211
Q

What is the most common cause of community-acquired pneumonia?

A

Streptococcus pneumoniae

212
Q

What are characteristic features of pneumococcal pneumonia?

A

Rapid onset, high fever, pleuritic chest pain, herpes labialis

213
Q

What are common symptoms of pneumonia?

A
  • Cough with purulent sputum
  • Dyspnoea
  • Chest pain
  • Fever
  • Malaise
214
Q

What signs may indicate systemic infection in pneumonia patients?

A
  • High temperature
  • Tachycardia
  • Hypotension
  • Confusion
  • Tachypnoea
  • Low oxygen saturation
215
Q

What is the pathophysiology of pneumonia?

A

Inflammatory cascade begins after pathogen entry, leading to neutrophil migration and fluid accumulation in alveoli

216
Q

What are some common risk factors for pneumonia?

A
  • Aged under 5 or over 65 years
  • Smoking
  • Recent viral respiratory tract infection
  • Chronic respiratory diseases
  • Immunosuppression
  • Aspiration risk
  • IV drug use
  • Other non-respiratory comorbidities
217
Q

What is the initial treatment for paracetamol overdose if ingested less than 1 hour ago?

A

Activated charcoal

Activated charcoal is used to reduce absorption of the toxin.

218
Q

What is the main antidote for paracetamol overdose?

A

N-acetylcysteine (NAC)

NAC is used to replenish glutathione and prevent liver damage.

219
Q

What is the treatment for salicylate overdose?

A

Urinary alkalinization with IV bicarbonate

This increases the excretion of salicylates.

220
Q

What medication is used to reverse opioid overdose?

A

Naloxone

Naloxone is an opioid antagonist that quickly reverses the effects of opioids.

221
Q

What is the primary treatment for benzodiazepine overdose?

A

Flumazenil

Flumazenil can reverse benzodiazepine effects but is used cautiously due to seizure risk.

222
Q

True or False: The majority of overdoses are managed with supportive care only.

A

True

Supportive care is often sufficient, particularly in non-severe cases.

223
Q

What is the role of IV bicarbonate in tricyclic antidepressant overdose?

A

May reduce the risk of seizures and arrhythmias in severe toxicity

It helps to correct acidosis and stabilize cardiac function.

224
Q

Which class of antiarrhythmics should be avoided in tricyclic antidepressant overdose?

A

Class 1a and class Ic antiarrhythmics

These classes can prolong depolarization and worsen arrhythmias.

225
Q

What is the first-line management for tricyclic induced arrhythmias?

A

Correction of acidosis

Addressing acidosis is crucial before other interventions.

226
Q

In lithium toxicity, what may help in mild to moderate cases?

A

Volume resuscitation with normal saline

This aids in hydration and may improve kidney function.

227
Q

What is the management for severe lithium toxicity?

A

Haemodialysis

Haemodialysis helps to remove excess lithium from the body.

228
Q

What is the antidote for warfarin overdose?

A

Vitamin K and prothrombin complex

These agents help to restore clotting factors.

229
Q

What is the treatment for heparin overdose?

A

Protamine sulphate

Protamine sulphate neutralizes the effects of heparin.

230
Q

What is the treatment for bradycardia due to beta-blocker overdose?

A

Atropine

Atropine increases heart rate by blocking vagal effects.

231
Q

What are the first-line treatments for ethylene glycol poisoning?

A

Fomepizole or ethanol

Both agents inhibit alcohol dehydrogenase to prevent toxic metabolite formation.

232
Q

What is the role of haemodialysis in ethylene glycol poisoning?

A

Used in refractory cases

It helps to remove ethylene glycol and its metabolites.

233
Q

What is the primary management for methanol poisoning?

A

Fomepizole or ethanol

Similar to ethylene glycol, these agents inhibit the formation of toxic metabolites.

234
Q

What is the treatment for organophosphate insecticide poisoning?

A

Atropine

Atropine counteracts the effects of excessive acetylcholine.

235
Q

What is used for digoxin overdose?

A

Digoxin-specific antibody fragments

These fragments bind to digoxin and neutralize its effects.

236
Q

What is the chelating agent used for iron overdose?

A

Desferrioxamine

Desferrioxamine helps to remove excess iron from the body.

237
Q

What is the treatment for lead poisoning?

A

Dimercaprol and calcium edetate

Both agents chelate lead to facilitate its excretion.

238
Q

What is the management for carbon monoxide poisoning?

A

100% oxygen and hyperbaric oxygen

These treatments help to displace carbon monoxide from hemoglobin.

239
Q

What is the antidote for cyanide poisoning?

A

Hydroxocobalamin

Hydroxocobalamin binds to cyanide and forms a non-toxic complex.

241
Q

What are the central nervous system features of synthetic cannabinoid toxicity?

A

Agitation, tremor, anxiety, confusion, somnolence, syncope, hallucinations, changes in perception, acute psychosis, nystagmus, convulsions, coma

These symptoms can vary in severity and may require different management approaches.

242
Q

What cardiac symptoms are associated with synthetic cannabinoid toxicity?

A

Tachycardia, hypertension, chest pain, palpitations, ECG changes

These symptoms indicate potential cardiovascular complications from synthetic cannabinoid use.

243
Q

What renal complication is associated with synthetic cannabinoid toxicity?

A

Acute kidney injury

This can occur due to various factors, including dehydration and metabolic changes.

244
Q

List the muscular features of synthetic cannabinoid toxicity.

A

Hypertonia, myoclonus, muscle jerking, myalgia

These muscular symptoms can lead to significant discomfort and may complicate management.

245
Q

What are some other features of synthetic cannabinoid toxicity?

A

Cold extremities, dry mouth, dyspnoea, mydriasis, vomiting, hypokalaemia

Other symptoms may vary depending on the individual and the specific synthetic cannabinoid used.

246
Q

What is cocaine derived from?

A

The coca plant

Cocaine is an alkaloid that has significant recreational use.

247
Q

What mechanism of action does cocaine have?

A

Cocaine blocks the uptake of dopamine, noradrenaline, and serotonin

This action leads to its stimulant effects and potential for toxicity.

248
Q

List the cardiovascular adverse effects of cocaine.

A

Coronary artery spasm, myocardial ischaemia/infarction, tachycardia, bradycardia, hypertension, QRS widening, QT prolongation, aortic dissection

These effects can lead to serious complications and require prompt management.

249
Q

What are some neurological adverse effects of cocaine?

A

Seizures, mydriasis, hypertonia, hyperreflexia

Neurological effects can significantly impact patient management.

250
Q

What is the first-line management for cocaine toxicity?

A

Benzodiazepines

Benzodiazepines help manage agitation, seizures, and other complications.

251
Q

What is the role of glyceryl trinitrate in cocaine toxicity management?

A

Used for chest pain in combination with benzodiazepines

This combination can help alleviate myocardial ischemia.

252
Q

What are the clinical features of MDMA (Ecstasy) use?

A

Agitation, anxiety, confusion, ataxia, tachycardia, hypertension, hyponatraemia, hyperthermia, rhabdomyolysis

These symptoms can be life-threatening and require immediate attention.

253
Q

What is the management for hyperthermia due to MDMA?

A

Supportive care and dantrolene if simple measures fail

Dantrolene is particularly effective in cases of severe hyperthermia.

254
Q

What are the psychoactive symptoms of LSD toxicity?

A

Variable subjective experiences, impaired judgement, amplification of current mood, agitation, drug-induced psychosis

These symptoms can lead to significant distress and require careful management.

255
Q

What are the somatic symptoms of LSD toxicity?

A

Nausea, headache, palpitations, dry mouth, drowsiness, tremors

These symptoms can complicate the clinical picture of LSD intoxication.

256
Q

What is the typical clinical presentation following massive overdoses of LSD?

A

Respiratory arrest, coma, hyperthermia, autonomic dysfunction, bleeding disorders

These complications can be life-threatening and require intensive management.

257
Q

What is the mechanism of action of nitrous oxide?

A

Blocks NMDA receptors, impairing pain perception and inducing euphoria

This dissociative anaesthetic effect is why nitrous oxide is used in both medical and recreational settings.

258
Q

What are long-term effects of nitrous oxide misuse?

A

Vitamin B12 deficiency, neurological impairments, psychological issues, physical harm

Chronic misuse can lead to significant health complications.

259
Q

What are novel psychoactive substances (NPS)?

A

Chemically related to established recreational drugs, often referred to as ‘legal highs’

Their sale and distribution have been illegal in the UK since 2016.

260
Q

What are the features of opioid misuse?

A

Rhinorrhoea, needle track marks, pinpoint pupils, drowsiness, watering eyes, yawning

These signs can help identify individuals who may be misusing opioids.

261
Q

What complications can arise from opioid misuse?

A

Viral infections, bacterial infections, venous thromboembolism, overdose, psychological problems, social problems

These complications can significantly affect the health and well-being of individuals who misuse opioids.

262
Q

What is the emergency management for opioid overdose?

A

IV or IM naloxone

Naloxone has a rapid onset and is critical for reversing opioid overdose.

263
Q

What are the first-line treatments for opioid detoxification recommended by NICE?

A

Methadone or buprenorphine

These medications help alleviate withdrawal symptoms and cravings.

264
Q

What is the difference between methadone and buprenorphine?

A

Methadone is a full agonist; buprenorphine is a partial agonist and kappa-opioid antagonist

This difference impacts their effects and management of opioid dependence.

265
Q

What is adhesive capsulitis commonly known as?

A

Frozen shoulder

266
Q

In which population is adhesive capsulitis most common?

A

Middle-aged females

267
Q

What is the aetiology of frozen shoulder?

A

Not fully understood

268
Q

What percentage of diabetics may experience an episode of frozen shoulder?

269
Q

What shoulder movement is affected more in adhesive capsulitis?

A

External rotation

270
Q

How are both active and passive movement affected in frozen shoulder?

A

Both are affected

271
Q

What are the three typical phases of frozen shoulder?

A

Painful freezing phase, adhesive phase, recovery phase

272
Q

What percentage of patients may have bilateral frozen shoulder?

273
Q

How long does an episode of frozen shoulder typically last?

A

Between 6 months and 2 years

274
Q

What is the usual method of diagnosing adhesive capsulitis?

A

Clinical diagnosis

275
Q

What may be required for atypical or persistent symptoms of frozen shoulder?

276
Q

What is the effectiveness of a single intervention in improving long-term outcomes for frozen shoulder?

A

No single intervention has been shown to improve outcome in the long-term

277
Q

Name some treatment options for adhesive capsulitis.

A
  • NSAIDs
  • Physiotherapy
  • Oral corticosteroids
  • Intra-articular corticosteroids
278
Q

What condition is characterized by notching of the inferior border of the ribs in adults and older children?

A

Coarctation of the aorta

This occurs due to the development of dilated intercostal collateral vessels to maintain blood flow to the descending aorta.

279
Q

What causes the inferior margin of the ribs to erode in coarctation of the aorta?

A

Pressure from dilated intercostal collateral vessels

These vessels develop to compensate for the aortic obstruction.

280
Q

Which conditions do NOT cause rib notching?

A
  • Acromegaly
  • Liver cirrhosis
  • Renal artery stenosis

Rare cases of rib notching have been reported in Marfan’s syndrome, affecting the upper margin of the ribs.

281
Q

What is coarctation of the aorta?

A

A congenital narrowing of the descending aorta

It is more common in males and has a notable association with Turner’s syndrome.

282
Q

Name two associations with coarctation of the aorta.

A
  • Turner’s syndrome
  • Bicuspid aortic valve

Other associations include berry aneurysms and neurofibromatosis.

283
Q

What are the infant features of coarctation of the aorta?

A

Heart failure

This is a common presentation in infants with coarctation.

284
Q

What adult feature is commonly associated with coarctation of the aorta?

A

Hypertension

Refractory hypertension can also occur due to the condition.

285
Q

What is a typical physical exam finding in adults with coarctation of the aorta?

A

Radio-femoral delay

This finding indicates a difference in blood pressure between the arms and legs.

286
Q

What type of murmur is associated with coarctation of the aorta?

A

Mid systolic murmur, maximal over the back

An apical click from the aortic valve may also be heard.

287
Q

Fill in the blank: Coarctation of the aorta is associated with _______.

A

Turner’s syndrome

This condition has a notable association with coarctation.

288
Q

True or False: Notching of the inferior border of the ribs is seen in young children with coarctation of the aorta.

A

False

Notching is not seen in young children; it occurs in adults and older children.

289
Q

What tests are needed prior to starting anti-TB medications?

A

Urea and Electrolytes, LFTs, vision testing, FBC

These tests are crucial to monitor for hepatotoxicity and other potential side effects.

290
Q

Why must LFTs be taken before starting anti-TB medications?

A

All drugs in the regimen are hepatotoxic

This ensures that liver function is monitored before treatment initiation.

291
Q

What is the medication regimen for treating active tuberculosis?

A

Rifampicin, Isoniazid, Pyrazinamide, Ethambutol

This combination is known as the RIPE regimen.

292
Q

What is the duration of the initial phase of TB treatment?

A

First 2 months

This phase includes all four drugs in the regimen.

293
Q

What is the duration of the continuation phase of TB treatment?

A

Next 4 months

This phase continues with Rifampicin and Isoniazid.

294
Q

How long is treatment for latent tuberculosis?

A

3 months of isoniazid and rifampicin OR 6 months of isoniazid

Pyridoxine is recommended with isoniazid.

295
Q

What is the treatment duration for meningeal tuberculosis?

A

At least 12 months with the addition of steroids

Meningeal TB requires prolonged treatment due to its severity.

296
Q

What is directly observed therapy and when is it indicated?

A

A three times a week dosing regimen for certain groups

Indicated for homeless people, those likely to have poor concordance, and all prisoners.

297
Q

What is immune reconstitution disease?

A

Occurs typically 3-6 weeks after starting treatment, often presents with enlarging lymph nodes

It is a complication of TB treatment.

298
Q

What are the adverse effects of rifampicin?

A
  • Potent liver enzyme inducer
  • Hepatitis
  • Orange secretions
  • Flu-like symptoms

These side effects can significantly impact patients’ health.

299
Q

What is the main adverse effect of isoniazid?

A

Peripheral neuropathy

It can be prevented with pyridoxine (Vitamin B6).

300
Q

What are the adverse effects of pyrazinamide?

A
  • Hyperuricaemia causing gout
  • Arthralgia
  • Myalgia
  • Hepatitis

Monitoring for these effects is essential during treatment.

301
Q

What is a significant adverse effect of ethambutol?

A

Optic neuritis

Visual acuity should be checked before and during treatment.

302
Q

True or False: Rifampicin can cause urine and tears to turn orange-red.

A

True

This is a harmless side effect but does not affect urine tests.

303
Q

Fill in the blank: The initial phase of TB treatment includes the drugs _______.

A

Rifampicin, Isoniazid, Pyrazinamide, Ethambutol

Known collectively as RIPE.

UKMLA Prep (48 decks)

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