Acute and Emergency

Question 1

What is Anaphylaxis

Answer 1

Acute, life-threatening, type 1 hypersensitivity reaction due to IgE-mediated mast cell activation

Degranulation of Mast Cells → Massive Histamine Release → Systemic Vasodilation → Increased Capillary Leakage → Anaphylactic Shock

Question 2

What are clinical features of anaphylaxis

Answer 2

Respiratory Symptoms:

• Airway Swelling (Angio-Oedema)
• Stridor, Dyspnoea, Wheezing, Respiratory Arrest

Circulatory symptoms:

• Pale, Clammy skin, Hypotension, Tachycardia, Confusion

Skin Symptoms:
- Urticaria, Erythema, Pruritus

Question 3

What is the management for Anaphylaxis

Answer 3

• ABCDE + High flow oxygen (15L/min non-rebreathe mask)

1st Step → Remove the Trigger

• Give ASAP → Intramuscular Adrenaline, even if have IV access

After Adrenaline → IV chlorphenamine 10mg + IV hydrocortisone 200mg

Question 4

What is the most common site of rupture for extra dural haemorrhage

Answer 4

Pterion→ thinnest part of skull where the middle meningeal artery lies

Question 5

What is the main clinical feature of Extra Dural Haemorrhage

Answer 5

Inital loss of consciousness following head injury

temporary recovery of consciousness with return to normal neurological function (lucid interval)

neurological status declines again due to haematoma expansion

Question 6

What are other clinical features of Extra Dural Haemorrhage

Answer 6

• Contralateral focal neurological deficits
• Signs of raised ICP → headache, confusion (decreased GCS)
• Compression of Occulomotor Nerve (CN3) → Fixed, dilated pupils

Question 7

What is the main investigation for Extra Dural Haemorrhage

Answer 7

Non-Contrast CT Scan → biconvex lesion, hyperdense in appearance (brighter), limited by suture lines

Question 8

What is the management plan for Extra Dural Haemorrhage

Answer 8

• Definitive Treatment → Craniotomy and Haematoma Evacuation
• In patients who have no neurological deficit, cautious clinical and radiological observation is appropriate.
• ICP Management
• Anticoagulant Reversal → prevent haematoma expansion

Question 9

What is Respiratory Arrest

Answer 9

Complete cessation of breathing in patients with a pulse

Question 10

What are the extrapulmonary causes of Respiratory arrest

Answer 10

CNS depression (opioid intoxication), respiratory muscle weakness (myasthenia gravis, ALS), airway obstruction (aspiration), drowning, trauma

Question 11

What are the pulmonary causes of Respiratory arrest

Answer 11

airway obstruction (bronchospasm in asthma/COPD patients), impaired alveolar diffusion (pulmonary oedema, pneumonia)

Question 12

What are the clinical features of Respiratory arrest

Answer 12

-Cyanosis
- Tachycardia
- Diaphoresis
- CNS Impairment → altered mental status

Question 13

What are the investigations of Respiratory arrest

Answer 13

• ABG → reduced oxygen, increased carbon dioxide
• Pulse Oximetry

Question 14

What is the management of Respiratory arrest

Answer 14

• Intubation
• Mechanical Ventilation

Question 15

What is unstable angina

Answer 15

Myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis

Question 16

What is the management plan for unstable angina

Answer 16

• 1st Line → Aspirin 300mg (and continue indefinitely) **+ Fondaparinux (antithrombin - if no immediate PCI planned)
• Calculate GRACE (estimated 6 month mortality)
  • Low Risk (6 month mortality ≤3%) **→ ticagrelor + aspirin
  • Intermediate/High Risk (6 month mortality >3%) → angiography with followup PCI if indicated. Give ticagrelor.