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Y3 GP > Acute > Flashcards

Acute Flashcards

1
Q

What is the AVPU method?

A

Alert, responds to Vocal stimuli, responds to Painful stimuli or Unresponsive to all stimuli. Alternatively, use the Glasgow Coma Scale score. A painful stimuli can be given by applying supra-orbital pressure (at the supraorbital notch).

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2
Q

What is a more likely cause of deterioration: Hypervolemia or hypovolemia?

A

Hypovolemia. In C- always give more fluids than you think necessary to begin with.

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3
Q

What is your review in an A-E assessent?

A

If you have done an intervention in the steps above then now may be a good time to review

Go rapidly back through the observations and ABCDE at a short interval after every intervention

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4
Q

In the A-E emergency approach, what do you assess in D?

A

Assess AVPU (and GCS if you have time)
Check fingerprick glucose
Do: Give glucose if under 4mmol/l (give 50ml of 50% glucose [or 100ml 20%] IV)
Look: for pupil size and reaction to light; unusual posturing
Feel: for tone in all four limbs and plantar reflexes

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5
Q

What is the immediate general treatment for ACS?

A

Immediate general treatment for ACS includes:
Aspirin 300 mg, orally, crushed or chewed, as soon as possible.
Nitroglycerine, as sublingual glyceryl trinitrate (tablet or spray).
Oxygen: only give oxygen if the patient’s SpO2 is less than 94% breathing air alone.
Morphine (or diamorphine) titrated intravenously to avoid sedation and respiratory depression.

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6
Q

How is the diagnosis of an acute abdomen in the community different to the hospital?

A

In the community diagnosis will rely more on history taking and examination skills.

The community may be limited to a pregnancy test, in the hospital it will include:

  • Group and save
  • Cross match
  • Urinalysis
  • ECG and cardiac enzyme changes
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7
Q

How is the management of an acute abdomen in the community different to the hospital?

A

In the hospital you can start:

  • IV fluids
  • Analgesia
  • CT/MRI abdomen
  • NG tube
  • Oxygen
  • Antiemetics/antibiotics
  • Surgical review
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8
Q

What are the mistakes in the assessment of an acute abdomen in the community?

A
  • Underestimation of the severity
  • Late referral to secondary care
  • Failure to consider extra-abdominal causes
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9
Q

For acute chest pain, what is the only investigation you can really carry out in primary care?

A

An ECG

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10
Q

What is the initial treatment for ACS in the community?

A
  • Aspirin
  • GTN
  • Oxygen
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11
Q

What are life threatening diagnoses of chest pain?

A

Acute coronary syndrome (acute myocardial infarction, unstable angina pectoris)
Pulmonary embolism
Aortic dissection
Spontaneous pneumothorax

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12
Q

What are some stratification scores for chest pain in the community?

A
  • TIMI
  • GRACE
  • HEART
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13
Q

What are some investigations in the hospital for acute chest pain?

A

Investigations may be required to exclude non-cardiac causes of chest pain - eg, CXR (pneumonia), abdominal ultrasound (gallstones), serum amylase (acute pancreatitis).
Initial blood investigations include cardiac enzymes, fasting lipids, fasting glucose and FBC (to exclude anaemia, and high white cell count may suggest pneumonia).
Resting ECG - a resting ECG is of limited value in the evaluation of coronary heart disease but can be highly specific for acute myocardial infarction.[5]
CXR - this may be useful in evaluating the presence of heart failure or an alternative diagnosis - eg, aortic aneurysm, pneumonia, rib fractures, rib secondaries or osteoporosis.
Exercise tolerance testing should not be used to diagnose or exclude stable angina for people without known coronary artery disease.[3] See the separate article on Stable Angina for further discussion on diagnosis of angina.
Depending on the presentation, further investigations may include echocardiogram, coronary angiography, V/Q scan or pulmonary angiography (pulmonary embolus), CT aortography (aortic dissection) or upper gastrointestinal endoscopy (gastro-oesophageal reflux disease, peptic ulcer).

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14
Q

What are some high risk symptoms/signs of a sick child?

A
  • Mottled/blue skin
  • No response to social clues
  • Appears ill to a healthcare professional
  • Does not wake or if roused does not stay awake
  • Weak, high pitched or continuous cry
  • Grunting
  • Tachypnoea RR >60
  • Reduced skin turgor
  • Neck stiffness
  • Status epilepticus
  • Focal seizures
  • Non-blanching rash
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15
Q

What are signs of respiratory distress in children?

A
  • Grunting
  • Flaring of the nostrils
  • Tracheal tug
  • Accessory muscle use
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16
Q

With acute shortness of breath, when should you arrange emergency admission?

A
  • Heart failure
  • Sepsis
  • Asthma attack
  • COPD attack
  • CURB 65 of 3 or more
  • Arrhythmia or ACS
  • Pulmonary embolism. For more information, see the CKS topic on Pulmonary embolism.
    Pneumothorax.
    Cardiac tamponade.
    Pulmonary oedema.
    Superior vena cava syndrome.
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17
Q

How can you investigate shortness of breath in a GP?

A
  • ECG
  • Pulse oximetry
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18
Q

How can you investigate acute shortness of breath in a hospital?

A
  • CT/MRI
  • ABG
  • Spirometry
  • Bronchoscopy
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19
Q

What is a TIA?

A

Is defined as stroke symptoms and signs that resolve within 24 hours

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20
Q

What assessment tool is used (mainly in the community) for suspicion of a stroke?

A

FAST

Suspect stroke if one or more of the following are present: new facial weakness (asymmetry such as the mouth or eye drooping), arm or leg weakness, or speech disturbance (such as slurring or difficulty in finding names for commonplace objects).

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21
Q

What may the GP do while waiting for emergency services for a suspected stroke?

A
  • Check vital signs
  • Neurological assessment- level of consciousness, pupil size and reactivity and basic motor and sensory functions
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22
Q

When do you administer alteplase in a stroke?

A

4.5 hours from onset and confirmed ischemic stroke.

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23
Q

When do you offer thrombectomy for patients with an acute ischemic stroke?

A

Timing: Thrombectomy is done ASAP, ideally within 6 hours of stroke onset, but can be up to 24 hours for some cases, like wake-up strokes.
Criteria: Patients with confirmed blockage in major brain arteries on CTA or MRA scans are eligible.
Pre-stroke Status: Patients need low disability before stroke (Rankin scale < 3) and severe stroke symptoms (NIHSS > 5).
Options: Thrombectomy alone or with thrombolysis (clot-busting medication) depending on timing and patient’s condition.
Imaging: Scans must show potential to save brain tissue based on blood flow and tissue damage.
Thrombectomy requires 24/7 specialist teams and resources

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24
Q

What are some differential diagnoses of stroke?

A
  • Head injury
  • Hypoglycaemia
  • Subdural hemorrhage
  • Intracranial tumor
  • Wernicke’s encephalopathy
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25
Q

How can you manage anaphylaxis in primary care?

A

Adrenaline
0.5mg 1:1000
Repeat every 5 minutes

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26
Q

What are the signs and symptoms of anaphylactic shock?

A
  • Itching, sweating, diarrhoea and vomiting, erythema, urticaria, oedema
  • Wheeze, laryngeal obstruction, cyanosis
  • Tachycardia and hypotension
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27
Q

What is the management of anaphylaxis in a hospital?

A
  1. Secure the airway and give 100% O2
  2. Remove the cause; raising the feet may help restore the circulation
  3. Give adrenaline
  4. Secure IV access
  5. Chlorphenamine 10mg IV and hydrocortisone 300mg IV
  6. IV saline 0.9%
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28
Q

What are the elements of a safe working culture?

A
  • Open
  • Just
  • Reporting
  • Learning
  • Informed
29
Q

What is a POPs chart?

A

Paediatric observation priority score, sats, breathing, AVPU, gut feeling and other

30
Q

With food and water, how much of their normal should a child be drinking for you to be worried?

A

50% of normal. Not as worried about how much they are eating.

31
Q

For POPS, what score should be considered for transfer to resus?

A

8

32
Q

Social history for kids

A
  • Going to school
  • Development
  • Problems before or after pregnancy
  • Motor, sensory skills?
  • Vaccination status
33
Q

What are some clinical examination findings for aortic dissection?

A

Blood pressure, weaker on the right, stronger on the left.
Aortic regurgitation
Ripping pain radiating to the back

34
Q

What is a hemicolectomy?

A

The term “hemi-“ refers to “half,” and a hemicolectomy involves the removal of either the right or left half of the colon.

35
Q

What are some causes of vitamin B12 deficiency?

A
  • Metformin use
  • Pernicious anaemia
  • Gastrointestinal surgery
  • Crohn’s/Coeliac
36
Q

How often do you have vitamin B12 injections?

A

Every 3 months

37
Q

What does FAST stand for in stroke?

A

Facial droop
Arm weakness
Speech difficulty
Time to call the emergency services

38
Q

What are the two types of hemorrhagic stroke?

A

Intra-cerebral and subarachnoid

39
Q

How long do you have to wait to drive after a stroke?

A

1 month with satisfactory results

40
Q

What two medications are you prescribed after an ischaemic stroke?

A

Statin and Clopidogrel

41
Q

What is the first line drug for obstructive uropathy?

A

Tamsulosin (alpha blocker)
This relaxes the muscles and helps with the flow

42
Q

What are some features of migraines?

A
  • Typically associated with nausea and sometimes vomiting
  • Often accompanied by photophobia and/or phonophobia.
  • Usually described as throbbing, pounding or pulsating in nature
  • Normally lasts about 4-72 hours
  • Sufferers from migraines usually find them disabling and are usually unable to continue with their usual activities.
43
Q

What is the management of acute episodes of migraines?

A

Sumatriptan is the first line and other triptans (Rizatriptan)
Diclofenac may also be used in acute attacks

44
Q

What is the medication used in prophylaxis of migraines?

A

Propanolol
Amitryiptyline
Topiramate

45
Q

When should you consider preventative treatment for migraines?

A

Migraine attacks are having a significant impact on quality of life and daily function, for example they occur frequently (more than once a week on average) or are prolonged and severe despite optimal acute treatment.

Acute treatments are either contraindicated or ineffective.

46
Q

What pain is typical of gastroenteritis?

A

Intermittent gripping

47
Q

Is Scarlet fever a notifiable disease?

A

Yes
Public health should be contacted

48
Q

What is the difference in definition between septicaemia and bacteriaemia?

A

The definition of septicaemia is the multiplication of the bacteria in the bloodstream, this is rare compared to bacteriaemia which is the presence of bacteria in the bloodstream.

49
Q

How would you describe a left facial nerve palsy?

A
  • Best assessed with dynamic movement of the patient’s facial muscles
  • Asymmetry of facial tone
  • Left conjunctivitis (secondary to incomplete eye closure)
  • Loss of the melolabial and frontal forehead creases to suggest underlying paresis.
50
Q

What is the acute treatment of tension type headaches?

A

Aspirin
NSAIDs
Paracetamol

51
Q

What is the first line in prophylaxis of tension type headaches?

A

Amitryptyline

52
Q

What should you do with a FeverPAIN score of 2-3?

A

Consider delayed antibiotic prescription

Phenoxymethylpenicillin

53
Q

What should you do with a FeverPAIN score of 4-5?

A

Consider immediate antibiotic prescription

54
Q

When does the rash appear in chickenpox?

A

The classic pustular rash develops following a few days of mild flu-like symptoms.

55
Q

What are some other symptoms of chickenpox?

A

Nausea, muscle aches, loss of appetite and headaches.

56
Q

What is the incubation period of chickenpox?

A

10-21 days

57
Q

How long is the patient infectious for with chickenpox?

A
  • The infection may spread about 2 days before the appearance of the rash
  • The patient is infectious for roughly 5-7 days after the appearance of the rash
  • There is a danger of infection spread until the last lesions have burst and crusted over
58
Q

When do patients require aciclovir with chickenpox?

A

Not commonly used in previously fit young patients.

Used for chickenpox in pregnancy, very young babies and patients with compromised immune systems.

59
Q

What do you give your patients with chickenpox?

A

Paracetamol
Adequate fluid intake

Avoid aspirin in patients younger than 16!! (Reye’s syndrome)

60
Q

What are complications of chickenpox?

A
  • Secondary infection of the blisters
  • Pneumonia
  • Myocarditis
  • Encephalitis
  • Transient arthritis
  • Cerebellar ataxia
61
Q

What blood tests do you request if your patient is septic?

A

He should have bloods (including an arterial blood gas to check oxygenation and lactate, cultures, full blood count, urea and electrolytes, a CRP, liver function tests and a bone profile)

62
Q

What is refractory anaphylaxis defined as?

A

Respiratory/cardiovascular problems that do not resolve despite two doses of IM adrenaline

63
Q

What is the significance of tryptase in anaphylactic reactions?

A

Tryptase is an enzyme released by mast cells in an allergic reaction

Tryptase levels typically peak 1 to 2 hours after the onset of symptoms and can remain elevated for several hours.

64
Q

What is the management after a patient presents with anaphylaxis?

A

All patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic

An adrenaline injector should be givens an interim measure before the specialist allergy assessment (unless the reaction was drug-induced)
patients should be prescribed 2 adrenaline auto-injectors
training should be provided on how to use it

65
Q

Why do you not get loss of sensation over the facial nerve distribution in bell’s palsy?

A

The facial nerve is motor function only

It does NOT have cutaneous distribution

66
Q

What symptoms would you get with Bell’s palsy and why?

A

Post-auricular pain
- The facial nerve traverses through the facial canal in the temporal bone, and inflammation or swelling can cause pain behind the ear. This pain often precedes the onset of paralysis and is due to the nerve’s proximity to the ear.

Altered taste
- The chorda tympani branch of the facial nerve carries taste sensations from the anterior two-thirds of the tongue. When Bell’s palsy affects this branch, patients may experience altered taste or loss of taste sensation.

Dry eyes
- The facial nerve controls the lacrimal glands, which are responsible for tear production. Damage or inflammation of the nerve can impair tear production, leading to dry eyes. Additionally, facial nerve paralysis can prevent the eyelid from closing fully, exacerbating dryness.

Hyperacusis
- The stapedius muscle in the middle ear, which dampens sound vibrations to protect the inner ear from loud noises, is innervated by the facial nerve. When the nerve is affected, the stapedius muscle may not function properly, causing increased sensitivity to sound (hyperacusis).

67
Q

What is the new definition of a transient ischemic attack?

A

Therefore, a new ‘tissue-based’ definition is now used: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

68
Q

What are the features of ramsay hunt syndrome?

A

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

69
Q

What is the management of ramsay hunt syndrome?

A

oral aciclovir and corticosteroids are usually given

Y3 GP (13 decks)

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