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Fourth Yerar > ACC > Flashcards

ACC Flashcards

1
Q

First line initial management of DKA

A

Isotonic saline- IV 0.9% sodium chloride

THEN give fixed-rate insulin infusion

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2
Q

At what point during DKA management do you worry about hypoglycaemia

A

When the glucose is <14mmol/L then you give 10% dextrose infusion alongside continuing fluids and insulin therapy to prevent hypoglycaemia when the glucose levels. Have corrected

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3
Q

Which heart murmur is pan-systolic, high-pitched blowing murmur loudest on expiration

A

Mitral regurgitation

Leaky mitral valve causes backflow of blood back to the left atrium

Left heart sounds are louder on expiration

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4
Q

Explain the regurgitation murmurs and when you hear them

A

Regurgitation is leaking through the leaky valves of the heart

Tricuspid and mitral are the two in between the atria and ventricles and so you hear them during systole as thats when the leaking happens (pan systolic)

Aortic and pulmonary would be heard during diastole as thats when the blood leaks back into the ventricles

Left side is heard louder during expiration and right side is heard louder during inspiration

So e.g. a pan-systolic murmur louder on expiration= tricuspid regurgitation

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5
Q

What is the common vascular injury in a subdural haemorrhage

A

Ruptured bridgin veins

Connect the cortex to the dural sinuses

Characterized by fluctuating conscious level

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6
Q

What is the difference between breathing and ventilation

A

Breathing is the chemical and mechanical processes of inhaling and exhcjanging gases (ventilation and respiration)

Ventilation is the act of moving gases through the conducting sections of the airway due to pressure gradients

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7
Q

Causes of metabolic acidosis

A

DKA
Addison’s
Alcohol
Uraemia
Renal failure (build up of uric acid)
Lactate build up
High ectrolytes e.g. lhypercalcaemis
Lithium toxicity

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8
Q

Causes of respiratory alkalosis

A

Increased respiratory drive e.g. thyroid, pregnancy, sepsis, anxiety, pain, DKA, hyperthermia,

Induced by hpoxaemia e.g. pneumonia , PE , asthma, congenital heart disease

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9
Q

Causes of respiratory acidosis

A

Decreased respiratory drive e.g. Brain injury, sedative drugs,

neuro disorders e,g myasthenia gravies

Trauma to chest wall

Obstructive disease

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10
Q

What is a curb65 score and how to calculate and interpret

A

To assess severity of pneumonia

Confusion (are they confused)
Uraemia (high urea >7.1)
Respiratory Rate (>30)
Blood pressure (<90/60)
65- Age > 65

If score is 0-1 consider OP Tx, single Abx
2= short inpatient and dual Abx
3= IP Tx and IV therapy
4-5= HDU/ specialist care, dual Abx

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11
Q

How to interpret curb 65 score

A

If score is 0-1 consider OP Tx, single Abx
2= short inpatient and dual Abx
3= IP Tx and IV therapy
4-5= HDU/ specialist care, dual Abx

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12
Q

How do you work out positive predictive value and how is it different to sensitivity

A

Sensitivity is the proportion of people that have a condition that have a positive test (e.g. there are total 100 people with a PE and 95 of these had positive D-dimer, 5 had negative so sensitivity is 95%)

Positive predictive value is the number of positive tests that actually have the condition (e.g. there 95 positive D-dimers that have a PE but also 55 positive D-dimers that didn’t have a PE. So total 150 people with positive D-dimers. Total number of people who actually have a PE is 120 as there were 35 that had a PE with D-dimer negative. So the positive predictive value is 120/150= 80%

TLDR positive predictive value is total number of people with condition/ total number of positive tests whereas sensitivity is the proportion of people who have the condition that also had positive test

Negative predictive value is the opposite (number of negative tests/ total number of negative individuals)

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13
Q

What is first line Tx when PE is suspected

A

DOAC e.g. rivaroxaban

Even give when waiting for scan results

Don’t give if already on warfarin, pregnant/ BF or slots around metalworks

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14
Q

3 CI of DOAC Tx for PE`

A

Patient already on warfarin

Pregnant/ breast feeding (give LMWH)

Clot formed around metalwork e.g. around stents

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15
Q

How long do you treat a PE with anticoagulants for

A

If provoked minimum 3 months

If unprovoked consider beyond 3 months

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16
Q

What defines a provoked VTE

A

Within 3 months of:
- surgery
- major immobility
- pregnancy
- hormonal contraception

Unprovoked is none of the above

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17
Q

What do you investigate for in an unprovoked VTE even

A

Looking for cause of VTE (think malignancy)

bloods inc clotting factors for anticoagulation

Calcium and PSA

Consider breast/ postate/ testicular

Only investigate further e.g. CT if cancer suspicion

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18
Q

What else can D-dimer be raised in

A

It is a marker of clotting burden, not to diagnose PEs

Pregnancy
After major surgery
After trauma
After severe infection

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19
Q

How do you decide whether to skip to a CTPA or do a D-dimer first

A

Wells score 4 or more= straight to CTPA.

If <4 do a D-dimer first. If also negative then PE excluded

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20
Q

What are the rules for fasting before surgery

A

2 hours clear fluid e.g. orange squash
4 hours breast milk
6 hours solid food- light meals preferable e.g. not pizza

Paediatrics can have fluids up to 1 hour before to make sure they’re optimised before surgery e.g. moody

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21
Q

3 essential medications to continue pre-op

A

Anti-epileptics
Parkinson meds (time critical)
Steroids (if taking 5mg a day)

Also important to continue if able:
- beta-blockers
- aspirin for IHD
- ppis for gord

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22
Q

Do you continue aspirin pre op

A

Yes

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23
Q

Do you continue clopidogrel pre op

A

No. Stop 7 days prior

Seek expert advice if they have had a CV event in the past year

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24
Q

Do you continue DOACs pre op

A

Stop them 24-72 prior to surgery

(Depends on specific drug and renal function tho so check guidelines)

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25
Q

Do you continue warfarin pre op

A

Stop 5 days prior

If risk of thrombosis e.g. previous VTE then bridge with LMWH until 12 hours prior

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26
Q

Do you continue LMWH pre op

A

Last dose 12 hours before surgery.

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27
Q

Do you continue insulin in T1DM pre-op

A

Yes continue giving it

Give 80% of normal dose on the day before

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28
Q

Do you continue diabetes drugs in T2DM pre-op

A

Omit agents with a potential for hypos
- sulphonylureas, SGLT-2 inhibitors (-flozins)

Not insulin tho keep insulin even tho it can cause hypos

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29
Q

What are the 3 aspects of general anaesthesia

A

Amnesia (unconsciousness)
Analgesia (pain relief)
Akinesis (immobilisation)

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30
Q

What is an induction agent and types

A

Basically hypnosis drug to cause loss of consciousness very quickly

Intravenous
- propofol/thiopentone/etomidate/ketamine

Inhalations agents
- isoflurane/sevoflurane/desfluraje/enflurane

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31
Q

Name 4 IV induction agents

A

Propofol
Thiopentone
Etomidate
Ketamine

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32
Q

Name 4 inhalation induction agents

A

Isoflurane
Sevoflurane
Desflurane
Enflurane

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33
Q

Advantages and disadvantages of propofol

A

IV Induction agent

Most commonly used

Marked drop in BP

Causes pain on injection and involuntary movements

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34
Q

Advantages and disadvantages of thiopentone

A

Iv Induction agent

Mainly used for Rapid Sequence Induction

CI in prophyrias

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35
Q

Advantages and disadvantages of etomidate

A

IV induction agent

Mainly used in cardiac patients induction for its haemodynamic stability

Causes adrenal-cortical supression

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36
Q

Advantages and disadvantages of ketamine

A

IV INDUCTION AGENT

?used in emergency settings

CAUSES DISCCOCIATIVE ANASTHESIA AND EMERGENCE DELERIUM

INCREASES HEART RATE AND BP

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37
Q

What is MAC in anaesthesia

A

Dose of an inhalational agent that is needed for 50% of people to not respond to a surgical stimuli

Wants to be around 1

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38
Q

Which inhalational agent is sweet smelling

A

Sevoflurane

Often used for induction in needlephobic patients

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39
Q

Advantages and disadvantages of desflurane

A

Inhalation agent in anaesthesia

Rapid onset nd offset so used in long surgeries or in obese patients

Maximum greenhouse effect

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40
Q

Which inhalation agent is used in organ donations

A

Isoflurane

Least effect on organ blood flow

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41
Q

What is the most common depolarising muscle relaxant used and what are the advantages and disadvantages

A

Suxamethonium (1-1,5 mg/kg)

Rapid onset and offset so used in rapid sequence induction

Adverse effects include muscle pains, fascicukations, hyperkalaemia, hypothermia and a rise in body pressure leg. ICP

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42
Q

What is used to reverse muscle relaxants in surgery

A

Neostigmine and gylcopyrrolate

Neostigmine is a Acetylcholinesteras inhibitor which means that there is more Ach in the synapse that can bind to the muscle receptors

and glyco counteracts muscaricin effecrs of neo e.g. bradycardia as Ach powers the parasympathetic NS and so it would cause brady etc

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43
Q

What is the most common analgesic used at the time of induction

A

Fentanyl as short acting

?most commonly alfentanil

After that longer acting is used e,g. Morphine

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44
Q

What are the 2 most common IV nsaids

A

Ketorolac and parecoxib

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45
Q

What are the 3 layers that surround the spinal cord from inside to out

A

Pia mater

Arachnoid mater

Dura mater

Spinal block goes into sub-arachnoid space

Epidural goes outside the dura

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46
Q

What are you worried about in someone presenting with SOB after surgery

A

High spinal/ epidural
Causing respiratory muscle weakness
Where the anaesthetic spreads above T4

Also presents with arm weakness or reduced GCS

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47
Q

Which two antiemetics are safe in Parkinson’s

A

Cyclizine and ondansetron

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48
Q

How does local anaesthetic toxicity present

A

Perioral tingling and metallic taste
Tinnitus
Confusion and drowsiness
Dizziness
Arrhythmias

Emergency- ABCDE approach and call 2222

Treat with intalipid

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49
Q

How to treat local anaesthesia toxicity

A

Intralipid

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50
Q

Paracetamol overdose symptoms

A

24-48 hours after:
RUQ abdo pain (liver)
Vomiting

72+ hours after:
More serious: (indicates liver failure)
Jaundice
Coagulopathy
Confusion due to hepatic encephalopathy

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51
Q

Name 6 P450 inducers and their relevance in an acute setting

A

Carbemazepine (mood stabilizer, anticonvulsant)
Rifampicin (Abx)
Alcohol
Phenytoin (seizure prevention)

Griseofulvin (antifungal)
Phenobarbitone (seizure prevention)
Sulphonylureas (T2DM e.g. gliclazide)

They induce P450 which increases the amount of NAPQI which is hepatoxic which is relevant in paracetamol overdose

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52
Q

Describe the mechanism of paracetamol overdose

A

Normally 95% of paracetamol is metabolised through a mechanism that is non toxic and 5% is metabolised through a mechanism that is helped by CYP450 enzymes. This process produces NAPQI which is toxic unless its neutralised by glutathione

When there is too much paracetamol, the glutathione runs out and the good mechanism gets overloaded resulting in more NAPQI being produces which is toxic to the liver

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53
Q

When is the paracetamol level maximum and when do you test

A

It is highest at 4 hrs after dose taken

Take measurement 4 hours after the last dose was taken- be aware that if they took it staggered then the values could be funky so don’t trust

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54
Q

What is the medical management of paracetamol overdose

A

N-acetylcysteine

It’s a precursor to glutathione which helps to neutralise the toxicity of NAPQI

Treat them if they are symptomatic or if they have any worrying investigations e.g. para high, deranged LFTs, coag screen or U+Es

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55
Q

What stuff are you looking for in an Echo that you have requested suspecting ACS`

A

Regional wall motion abnormality to see if there is any infarction of the myocytes

Ejection fraction and valves

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56
Q

When do you not do a CTPA in high well’s score

A

If pregnant/ young woman (or with contrast allergy)

Do a VQ instead which images the difference between which parts of the heart are getting perfused and ventilated

Due to breast cancer risk

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57
Q

How to grade AKI using creatinine

A

Grade 1= rise of 150-200% or 26.4
Grade 2= rise of 200-300%
Grade 3= rise of >300%

when i say rise i mean 200% of baseline i.e. double

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58
Q

How to grade AKI using urine output

A

Grade 1= <0.5 mls/kg/hour for >6 hours
Grade 2= <0.5 mls/kg/hour for >12 hours
Grade 3= <0.3 mls/kg/hour for >24 hours/ no urine for 12 hours

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59
Q

What fluids do you give to someone in hyperkalaemia

A

30mls 10% calcium gluconate, 50mls 50% dextrose and 10 units actrapid (fast-acting insulin)

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60
Q

Where is the best place for interosseous access if IV isn’t working

A

Proximal tibia

Distal femur or distal tibia in paeds.

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61
Q

What does forehead sparing indicate in facial nerve palsy

A

LMN does not spare the forehead muscles (e.g. Ramsay-Hunt, Bell’s palsy, acoustic neuroma, HIV etc

UMN does spare the foreheard muscles (STROKE)

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62
Q

Causes of post-op pyrexia with timings

A

5W’s of Post-op Pyrexia:
-Wind (1day): atelectasis
-Water(3days): UTI
-Wound(5days): surgical site infection/abscess
-Walking(7days): DVT/PE
-Wonder-drugs(Anytime): adverse drug reaction

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63
Q

What do you do when you see someone and suspect domestic abuse/stalking/honour based violence

A

Complete a DASH risk assessment (big questionnaire)

If >14/24 scored refer to MARAC (multi-agency risk assessment conference)

Which is a big MDT meeting including police who discuss the case

64
Q

What is the gold standard Tx of septic arthritis

A

Surgical irrigation and debridement following Abx

65
Q

How does gastric volvulus present

A

Retching without vomiting

Severe epigastric pain

Inability to place an NG tube

Called Borchardt’s triad and treat with urgent surgery

66
Q

What do you give in cardiac arrest as a result of local anaesthetic

A

Intralipid is recommended for use in cardiac arrest associated with local anaesthetic toxicity.

67
Q

Which type of haemorrhage and blood vessel is likely affected in a patient with fairly low-level trauma who has a lucid interval before loss of consciousness. Hyperdense biconvex collection around the surface of the brain

A

Middle meningeal artery

Extradural haemorrhage

68
Q

Which type of haemorrhage and affected blood vessel in severe onset occipital headache with signs of meningism

A

Subarachnoid haemorrhage

Circle of Willis affected

69
Q

how do you treat malignant hyperthermia caused by suxamethonium or inhalation induction agents

A

Dantrolene

Dantrolene interrupts the muscle rigidity and hypermetabolism by interfering with the movement of calcium ions in skeletal muscle.

MH presents with hyperthermia, muscle rigidity, tachycardia, hyperkalaemia and increased CO2 production

70
Q

which anti-emetic do you not give operatively if the patient is at risk of prolonged QT interval

A

ondansetron

71
Q

which anti-emetic do you not give in patients with heart failure and elderly patients

A

cyclizine

72
Q

which reversal agent is given specifically in non-depolarising muscle relaxants e.g. rocuronium

A

Sugammadex

73
Q
A
74
Q

what are the two manouvres in a cardiac exam

A
  1. Mitral area patient leaning to left for diastolic mitral stenosis
  2. Tricuspid area with diaphragm with patient sat forward in expiration for aortic regurg
75
Q

how do you do manouvres for mitral stenosis

A

listen to mitral area patient leaning to left with the bell

diastolic murmur

76
Q

how do you manouvre for aortic regurg

A

tricuspid area with patient sat forward in expiration (diaphragm)

77
Q

face section of a cardiac exam

A

peripheral cyanosis (lips) and central (tongue).

Xanthelasma or corneal arcus (high cholesterol), corneal arcus, high arched palate (Marfans -> heart failure)

Looking at dental hygiene risk of endocarditis.

Looking at eyes for conjunctival pallor.

78
Q

what is radio-radial delay a sign of

A

coarctation of the aorta

79
Q

what in a cardiac exam is indicative of aortic regurg

A

collapsing pulse

listen to tricuspid area with the diaphragm of the scope with patient sat forward in expiration

80
Q

how do you work out routine maintenance IV fluids

A

Give maintenance IV fluids
Normal daily fluid and electrolyte requirements:
 25–30 ml/kg/d water
 1 mmol/kg/day sodium, potassium*, chloride
 50–100 g/day glucose (e.g. glucose 5% contains
5 g/100ml).

81
Q

things that slow gastric emptying

A

trauma
diabetes
gastroparesis e.g. neuropathy
opioid use

take care with fasting

82
Q

what is normal O2 on ABG if they’re on 15L O2 via a non-rebreathe mask

A

85KPa is the partial pressure of 15L O2 via non-rebreathe

take away 10 for normal O2 levels

so expected would be 75KPa

83
Q

tracheal deviation in simple and tension pneumothorax

A

in a simple pneumothorax the trachea is pulled towards the affected side

in a tension the trachea is deviated away from the affected side. there will also be hypotension

84
Q

FEV1:FVC ratio cut off for COPD

A

0.7

85
Q

opioid overdose drug management with route and dose

A

naloxone 400micrograms IV

86
Q

what is used to treat benzo overdose

A

flumazenil

be careful as it can induce seizures

87
Q

what is used to treat beta blocker overdose

A

glucagon

also used to treat hypos

88
Q

how do you manage severe hypoglycaemia (1 thing)

A

10g glucose given as a 20% solution IV

89
Q

bull’s eye bite diagnosis and causative organism

A

Lyme Disease

(bulls eye rash called erythema migrans )

caused by borrelia burgdorferi

90
Q

what do you need to do specifically when doing group and save/ cross match

A

group and save saves their blood group

cross match matches their blood with someone elses

so you need to ask for an amount of blood to be sent back

1 unit is 10 Hb

91
Q

which blood bottle is FBC

A

purple

92
Q

which blood bottle is UandEs

A

yellow

LFT’s and CRP are also yellow

93
Q

which blood bottle is group and save/ cross match

A

pink

94
Q

which blood bottle is clotting

A

blue

make sure this is full so do it first

95
Q

PEA in cardiac arrest what do you do alongside CPR

A

think about reversible causes of PEA

4H’s and 4T’s;
Hypovolaemia
Hypoxia
Hyper/hypokalaemia
Hypo(/hyper)thermia

Thrombosis
Tamponade
Tension PT
Toxins (drugs e.g. para, opioids, think broad)

96
Q

4H’s and 4T’s of reversible causes of pulseless electrical activity

A

Hypovolaemia
Hypoxia
Hypo/hyperkalaemia
Hypo(/hyper)thermia

Thrombosis
Tension PT
Toxins (drugs e.g. para, opioids etc)
Tamponade

97
Q

which blood culture bottle first

A

aerobic first which i think is blue

98
Q

what are the two types of partial seizure

A

partial or complex seizure is where patients remain awake but have a problem with e.g. hearing, speech

simple partial seizure where patients remain aware

complex partial seizures are where the patient does lose awareness

99
Q

difference between tonic-clonic and myoclonic seizures

A

tonic-clonic is tensing and jerking movement phases with loss of consciousness

myoclonic is sudden brief muscle contractions and they remain awake

100
Q

how do you treat all the different seizure types (excluding women of childbearing age)

A
  • sodium valproate for most
  • lamotrigine/ levetiracetam for partial
  • ethosuximide for absence

for women of child bearing age dont give sodium valproate and think either lamotrigine or levetiracetam

101
Q

tx of tonic clonic seizure and in women able to have kids

A

sodium valproate normally

lamotrigine/ levetiracetam for WATHK

102
Q

Tx of partial seizure and in women able to have kids

A

lamotrigine or levetiracetam for both

103
Q

Tx of myoclonic seizures and in women able to have kids

A

sodium valproate

levetiracetam in WATHK

104
Q

Tx of tonic or atonic seizure and in women able to have kids

A

sodium valproate

lamotroigine in WATHK

105
Q

Tx of an absence seizure and in women able to have kids

A

Ethosuximide for all

106
Q

notable side effects of sodium valproate

A

Teratogenic (harmful in pregnancy)

Liver damage and hepatitis

Hair loss

Tremor

Reduce fertility

also in pregnancy can cause NTD and developmental delay so dont give it at all to women able to have kids

107
Q

define status epilepticus

A

seizure last >5mins

OR

multiple seizures not regaining consciousness

108
Q

Mx of status epilepticus

A

ABCDE approach

benzo (buccal mid, rectal diaz, or IV loraz) repeated after 5-10 mins if still going

then IV levetiracetam, phenytoin or sodium valproate

then ?GA?

109
Q

what are the different benzos you can give in status epilepticus

A

Buccal midazolam (10mg) is first line in community

Rectal diazepam (10mg)

IV lorazepam (4mg) is first line if IV access already established

110
Q

what do you do if you dont get aspirate from an NG tube

A
  • Check the mouth for coiling
  • lean patient to their left
  • perform mouth care
  • flush NGT with AIR
  • let them drink if safe swallow
  • advance/ withdraw NGT a bit
  • wait 15-30 mins
111
Q

Safe dose of lignocaine (lidocaine) with and without adrenaline

A

Lignocaine without adrenaline= 3mg/kg

Lignocaine with adrenaline= 7mg/kg

112
Q

Safe dose of bupivicaine with and without adrenaline

A

Bupivicaine= 2mg/kg

Adrenaline doesn’t matter

113
Q

What is the typical presentation of MND

A

Late middle age e.g. 60 male
Potentially with affected relative
Insidious and progressive weakness of muscles throughout the body often first in upper limb

Can affect upper or lower motor neurons so can present either with increased or decreased tone

114
Q

Medical management of MND

A

Riluzole can slow the progression of the disease and extend survival by several months in ALS.

Nothing really work though

Non-invasive ventilation is used when resp muscles weaken

115
Q

What is the most common type of MND

A

Amyotrophic lateral sclerosis (ALS)

Causes range of symptoms to do with muscle weakness:
- tripping
- slurred speech
- twitching

Often starts in the upper limb (or lower limb)

116
Q

What investigation might you do if you suspect MND to rule out a neuropathy

A

Nerve conduction studies

Will show normal motor conduction

117
Q

Typical prognosis of MND

A

Poor

50% of patients die in 3 years

118
Q

How does ALS typically present in MND in the different limbs

A

typically LMN signs in arms and UMN signs in legs

119
Q

What is the mechanism of myasthenia gravis

A

Immune response causes blockage of the Ach receptors a neuro-muscular junctions

Therefore difficult to initiate e.g. movement. Most commonly presents with fatigue ability

Progressive onset

120
Q

What abnormal blood tests are normal in pregnancy

A

Decreased urea
Decreased creatinine

121
Q

What is the most common complication and also most deadly complication of measles

A

OM is most common

Pneumonia is most deadly

122
Q

Wernickes encephalopathy presentation

A

Wernicke’s encephalopathy is characterised by a tetrad of ataxia, ophthalmoplegia, nystagmus and confusion.

123
Q

What are the Venturi mask colors and their FiO2

A

Blue 2-4L/min= 24%
White 4-6 L/min= 28%
Yellow 8-10 L/min= 35%
Red 10-12 L/min= 40%
Green 12-15 L/min= 60%

124
Q

What is the flow rate through a nasal cannula

A

1-6 L/min

Comfortable up until 4l/min

FiO2 of 24-around 50%

125
Q

What size NPA for males and females

A

7 for males
6 for females

126
Q

Common causes of high base excess

A

Elevated lactate
Elevated urea
Elevated ketones

127
Q

What would make you admit someone with pre-eclampsia inc bloods

A

BP >160

High creatinine, high ALT, low platelets

Clinical signs that cause concern e.g. impending eclampsia

Suspected foetal compromise

128
Q

What bloods in pre-eclampsia

A

FBC-> low platelets= admit
LFTs -> high ALT= admit
UandEs-> high creatinine= admit

129
Q

How to treat regular narrow complex ventricular tachycardia

A

= pure SVT

Do vagal maneuvers first e.g. hold breath, blowing, massaging carotids)

THEN give adenosine

130
Q

How to treat regular narrow complex ventricular tachycardia

A

= pure SVT

Do vagal maneuvers first e.g. hold breath, blowing, massaging carotids)

THEN give adenosine

131
Q

How to differentiate between sinus tachycardia and SVT on an ECG

A

Sinus tachycardia would have a HR below 140bpm

SVT is usually above 140

They may often look similar on ECG

132
Q

What are the 4 life-threatening features of tachycardia which would make you manage with Synchronised DC shock

A

Shock
Syncope
Myocardial Ischaemia
Several heart failure

Up to 3 attempts
Done with sedation/ anesthesia is conscious

133
Q

What do you do if synchronised DC cardioversion is unsuccessful (up to three attempts) in tachycardia

A

give amiodarone 300mg IV over 10 mins

Then repeat the shock

134
Q

What do you do if synchronised DC cardioversion is unsuccessful (up to three attempts) in tachycardia

A

give amiodarone 300mg IV over 10 mins

Then repeat the shock

135
Q

How do you treat irregular broad complex tachycardia

A

This is likely to be polymorphic VT (e.g. torsades de pointes)

Treat with magnesium sulphate IV 2g over 10 mins

This would definitely require senior input

136
Q

How do you treat broad complex regular tachycardia

A

Amiodarone 300mg IV over 10-60 mins

137
Q

How do you treat narrow complex regular tachycardia

A

Vagal maneuvers e.g. feet over heads, blow into a syringe

If ineffective give adenosine 6mg rapid IV bolus

If unsuccessful give 12mg

If unsuccessful give 18mg

138
Q

How to treat narrow complex irregular tachycardia

A

Treat as atrial fibrillation

Control rate with a beta blocker

Consider digoxin

Anticoagulate if its been going on for over 48 hours

139
Q

What are the 4 common sites for central venom catheter insertion

A

Internal jugular vein (most commonly used)

Subclavian vein

Femoral vein

Axillary vein

140
Q

Stop COCP before surgery?

A

Yes

Stop 4 weeks pre-op

141
Q

How to treat a small non-tension unilateral pneumothorax, bilateral pneumothorax, tension pneumothorax

A

Small non-tension unilateral= aspiration aka thoracocentesis

Bilateral= chest drain

Tension= immediate needle decompression

142
Q

ABCDE management of anaphylaxis inc doses

A

adrenaline 1:1000 0.5ml IM

500ml 0.9% NaCl IV (if hypotensive)

Note that steroids (hydrocortisone) and anti-histamines (chlrphenamine) are given just not in the resus ABCDE algorithm

143
Q

How does upper MN and LMN signs differ on inspection , tone, power and reflexes

A

Upper= muscle bulk preserved, hypertonia, slightly reduced power, brisk reflexes

Lower= reduced muscle bulk with fasciculations, hypotonia, dramatically reduced power, reduced reflexes

144
Q

How to manage cerebral palsy

A

‘MDT approach’:
- physio to strengthen muscles
- OT to adjust houses etc
- SALT for speech and swallowing
- dieticians
- orthopedic surgeons for tendon lengthening
- Paediatric doctors
Etc etc etc

145
Q

Causes of cerebral palsy

A

Often unknown

Antenatal with chorioamnionitis/ trauma
Perinatal with asphyxia, pre-term birth
Postnatal with meningitis/ trauma

146
Q

Different types of squint

A

Esotropia= inward positioned squint
Exotropia= outward positioned squint
Hypertropia= upward positioned eye
Hypotropia= downward positioned eye

Note that strabismus is misalignment of the eyes and amblyopia is when one eye becomes passive (lazy eye)

147
Q

How to manage squints

A

Ophthalmology referral for sure

Occlusive patch over the good eye to force the weak eye to develop

Atropine drops in the good eye to make vision in good eye blurry

148
Q

4 risk factors for squint/ strabismus

A

Family history of strabismus

Low birth weight

Premature birth

Maternal smoking

149
Q

What is the difference between exo/endo phoria and tropia

A

Exotropia is when your eye is misaligned outwards without covering either eye

Exophoria is when your eye is misaligned outwards only when covering that eye, it returns to normal as you move the cover away

150
Q

which leads are raised in which type of STEMI and which artery affected

A

V1-V4= anterior STEMI= LAD

V5,V6, 1 and AVL= lateral STEMI= Left circumflex/ diagonal part of the LAD

2,3 and AVF= Inferior STEMI= Right Coronary/ LCx

151
Q

Where to inject adrenaline

A

IM adrenaline should be injected in the anterolateral aspect of the
middle third of the thigh

152
Q

Different types of dialysis and advantages and disadvantages of each

A

Continuous haemodialysis-> large volumes of fluid removed and large volumes of physiologically balanced solution given. Can do arteriovenous using BP from artery (low) or venovenous using a pump (high BP). AV is better as it is simple but gives unreliable flow

intermittent haemodialysis-> blood is taken out and ran against a semi-permeable membrane with physiological electrolyte levels to try and normalize. Intermittent cos u come in for sessions i think. Likely to cause hypotension during the session and difficult to control blood pressure

153
Q

Adverse effects of epidural and spinal

A
  • hypotension
  • headache (epidural -> dural tap)
  • infection, bleeding, nerve damage (rare)
  • motor weakness e.g. retention
154
Q

What is the definition of a massive bleed

A

Objective= 20% blood loss in 1 hour, or 50% blood loss in 3 hours

Subjective= clinical concern

155
Q

First thing to do when Major haemmorhage

A

Call 2222 state major hemorrhage and location and this will alert blood bank and also send a porter there. Blood bank will then need clinical details

Then ABCDE. Take bloods, give fluids warm to prevent hypothermia

Use cap refill to assess perfusion

Consider TXA

156
Q

What to do pre-op for someone on insulin

A

Reduce by 20%

Fourth Yerar (5 decks)

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