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Y4 > Acute care > Flashcards

Acute care Flashcards

1
Q

What does a negative base excess indicate?

A

Excess acid

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2
Q

Respiratory acidosis

  • pH is high/low
  • CO2 is high/low
A

pH low

CO2 high

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3
Q

Metabolic acidosis

  • pH is high/low
  • bicarbonate is high/low
A

pH is low

bicarbonate is low

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4
Q

Anion gap = (Na +K) - (Cl + HCO3)

true or false

A

True

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5
Q

In COPD patients, raised PaCO2 with a NORMAL HCO3 suggests acute/chronic problem

A

Acute

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6
Q

What is wells score used for?

A

Determining likelihood of PE

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7
Q

If wells score is low, what does this mean and what do you do?

A

PE unlikely

D-dimers

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8
Q

Hyperventilation causes which ABG pattern

A

Respiratory alkalosis

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9
Q

panic attack causes which ABG pattern

A

Respiratory alkalosis

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10
Q

Severe asthma typically causes which ABG pattern

A

Respiratory acidosis

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11
Q

DKA typically causes which ABG pattern

A

Metabolic acidosis

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12
Q

Severe vomiting causes which ABG pattern

A

Metabolic alkalosis

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13
Q

Drug overdose (eg aspirin) typically causes which ABG pattern

A

Respiratory alkalosis

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14
Q

Paient with renal colic. What is first line treatment?

A

Diclofenac

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15
Q

What is the landmark for a cricothyroidotomy

A

Cricothyroid membrane

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16
Q

unwell patient in ED. ECG shows narrow QRS complex which is regular. How do you manage?

A

Vagal manouevres

Then administer adenosine 6mg -> 12mg

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17
Q

unwell patient in ED. ECG shows narrow QRS complex which is irregular. What is this likely to be and how do you manage in ED?

A

Likely AF

Rate control: B-blocker / diltiazem

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18
Q

unwell patient in ED. ECG shows broad QRS complex which is regular. What is this likely to be and how do you manage in ED?

A

VT

Amiodarone (300mg IV over 20-60 mins)

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19
Q

Patient in ED wit bradycardia. What is first line management?

A

Atropine 500mcg IV

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20
Q

Paeds CPR outline

A

5 rescue breaths

CPR 15:2

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21
Q

Name 2 unshockable rhythms

A

PEA

Asystole

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22
Q

Name 2 shockable rhythms

A

VF

Pulseless VT

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23
Q

When should you avoid head tilt chin lift manouvre

A

in trauma cases where there is concern about cervical spine injury

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24
Q

Gudel is example of

  • oropharyngeal airway
  • nasopharyngeal airway
A

Oropharyngeal airway

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25
Q

Size of nasopharyngeal airway equates to

A

diameter of patient’s little finger

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26
Q

When might nasopharyngeal airway be contraindicated?

A

If ?base of skull fracture

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27
Q

Periorbial bruising
Battles sign
CSF rhinorrhoea

What do these signs suggest

A

Base of skull fracture

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28
Q

Name 3 advanced airway techniques

A 
Endotracheal Intubation 
Laryngeal mask airway 
Surgical airway (needle cricothyrotomy)
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29
Q

What should be used in ?c spine trauma?

  • head tilt chin lift
  • jaw thrust
A

Jaw thrust

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30
Q

Airway management: when may suction be used?

A

If there is complete or partial visible LIQUID obstruction in the airway

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31
Q

Airway management: when may mcGills forceps be used?

A

If there is complete or partial visible SOLID obstruction in the airway

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32
Q

Name 2 types of airway adjuncts?

A

Nasopharyngeal airway

Oropharyngeal airway

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33
Q

How do you size a Gudel airway?

A

From the incisors to the angle of the mandible

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34
Q

What is the final option for airway management where you have been unable to clear obstruction, open airway and ventilate patient?

A

Surgical airway

- cricothyrotomy

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35
Q

Flail chest

A

Segment of rib cage breaks due to trauma

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36
Q

Where are chest drains inserted?

A

4th / 5th ICS mid axillary line in the safety triangle

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37
Q

Why might you use a Kendrick leg splint?

A

Femoral fracture

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38
Q

Minimum score of GCS

A

3

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39
Q

GCS 3 components

A 
Eye opening (4 max) 
Verbal response (5 max) 
Best motor response (6 points)
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40
Q

Eye opening - GCS

A

4 - eye opens spontaneously
3 - eye opens to voice
2 - eye opens in response to painful stimulus
1 - eye does not open

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41
Q

Verbal response - GCS

A 
5 - talking normally 
4 - confused conversation 
3 - inappropriate words 
2 - incomprehensible sounds 
1 - no speech
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42
Q

Best motor response - GCS

A 
6 - normal movements, obeys commands  
5 - moves towards painful stimulus 
4 - normal flexion 
3 - abnormal flexion 
2 - extension 
1 - no movement
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43
Q

Fasting before surgery

  • food
  • liquid
A

Fast for 6 hours before surgery (food)

Can drink water up to 2 hours before surgery

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44
Q

Anticoagulants need to be stopped before surgery. True or false?

A

True

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45
Q

How long before surgery do DOACs need to be stopped for?

A

24 hours before surgery

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46
Q

How long does COCP need to be stopped before surgery?

A

4 weeks

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47
Q

Surgery tends to increase/decrease blood sugar levels?

A

Increase

- due to the stress body is under

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48
Q

What are the 4 pillars of consent

A

Understand
Retain
Weigh up
Communicate decision

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49
Q

After an operation, what do patients complain of most?

A

Post op nausea and vomiting

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50
Q

When is clopidogrel stopped before operation ?

A

7 days

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51
Q

What are the 2 standard colours of adult cannulas?

A

Blue

Pink

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52
Q

3 pillars of general anaesthesia

A

Pain free
Not aware (patient is asleep)
Paralysis (not in all GA)

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53
Q

What % of air is oxygen?

A

21%

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54
Q

Where in the body is energy generated (which structure)?

A

Mitochondria

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55
Q

How much oxygen does a standard person USE per minute?

  • 250ml/min
  • 500ml/min
  • 750ml/min
  • 1000ml/min
A

250ml/min

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56
Q

What is the functional residual capacity?

A

Expiratory reserve volume + residual volume

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57
Q

In anaesthesia, why is pre-oxygenation used (ie hold oxygen mask to patient’s face for 3 mins)

A

This replaces the functional residual capacity with 100% oxygen (instead of 21% oxygen) so it essentially buys time by increasing oxygen in the lungs

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58
Q

Who should not receive a laryngeal mask airway (LMA) ?

A

Patient’s with reflux

- it doesn’t protect their airway

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59
Q

Patients with reflux should have which airway?

A

Endotracheal tube

- it has a cuff to protect the airway

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60
Q

For patient about to have surgery, which CARDIAC medications should be stopped on day of surgery? (and why?)

A

ACE inhibitor
Angiotensin receptor blocker
Thiazide diuretic

being anaesthetised causes hypotension but these drugs will cause prolonged hypotension

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61
Q

How long should aspirin be stopped before surgery?

A

7-10 days

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62
Q

How long should DOACs be stopped before surgery?

A

24-48 hours

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63
Q

Warfarin and surgery

A

Stop warfarin 5 days before surgery
Day 3 before surgery start LMWH injections for 2 days
After op restart LMWH injections + warfarin
When INR normal, stop LMWH injections

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64
Q

Patient 7 hr post op complains of pain despite having an epidural pre-operatively. What should be done first?

A

Check sensory block height

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65
Q 
Patient develops broad complex tachycardia
HR 160
BP 80mmHg systolic 
What should be done? 
- adenosine 
- amiodarone 
- synhronised DCCV 
- CPR
A

Got a pulse so CPR not required.

However, he is unstable so 3 x synchronised DCCV required first line

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66
Q 
Patient develops broad complex tachycardia
HR 120
BP 100mmHg systolic 
What should be done? 
- adenosine 
- amiodarone 
- synhronised DCCV 
- CPR
A

Amiodarone IV infusion

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67
Q

What ECG features do you need to diagnose STEMI

A

over 2mm in 2 contiguous chest leads OR
over 1mm in 2 contiguous limb leads OR
New LBBB

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68
Q

Identify a STEMI what is the management plan

A 
Morphine 
Oxygen (only if needed) 
Nitrates
Aspirin 
Ticagrelor

IV heparin (if going onto PCI)

PCI

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69
Q

In MONA + C what is used instead of clopidogrel now

A

Ticagrelor

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70
Q

Why does infection cause increased resp rate

A

Pain

Fever

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71
Q

If you need to fluid resuscitate a patient but there is a risk that the patient could get fluid overloaded, what do you do>

A

250ml (instead of 500ml) IV fluids (crystalloid)

frequent reassessment is crucial

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72
Q

All COPD patients have 88-92% oxygen range target. True or false ?

A

True

- even if not normally a CO2 retainer

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73
Q

How can you tell if someone is a CHRONIC CO2 retainer or an acute CO2 retainer?

A

If chronic, there will be metabolic compensation on the ABG

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74
Q

What is the treatment for acute exacerbation of COPD

A 
Oxygen 
Nebulisers: salbutamol 5mg
Nebulisers: Ipatropium bromide 
Amoxicillin 
Prednisolone 40-50mg
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75
Q

Non invasive ventilation is the same as BiPAP. True or false/

A

True

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76
Q

Explain how NIV works

A

Patient inhales themselves and BiPAP mask supplements with bursts of pressure and pushes air into the lungs

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77
Q

T wave inversion on an ECG suggests

A

Ischaemia

- NSTEMI

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78
Q

What is the management of NSTEMI

A 
Morphine 
Oxygen (if required) 
Nitrates
Aspirin 
Ticagrelor

+ FONDAPARINEUX

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79
Q

Key points to ask in history of head injury

A 
MECHANISM of injury 
loss of consciousness 
vomiting (one off vomit is ok) 
visual disturbance 
associated injuries 
seizures 
amnesia
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80
Q

Suspicious of base of skull fracture, what airway adjunct should you avoid?

A

Nasopharyngeal airway

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81
Q

Reduced GCS
Unequal pupils
What does this potentially suggest?

A

Raised intracranial pressure

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82
Q

Battles sign suggests

A

Base of skull fracture

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83
Q

Where should you test for pain (if needed) in GCS?

A

Trapezius squeeze

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84
Q

GCS 8 or less equates to what on AVPU

A

Response to Pain (P)

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85
Q

3rd nerve palsy: dilated/constricted pupil?

A

DILATED pupil

86
Q

Name 4 base of skull fracture signs

A

Battle’s sign (behind the ear)
CSF leak from nose
Racoon / panda eyes (bilateral bruising around the eyes)
Haemotympanum

87
Q

Hypertension
Bradycardia
Irregular breathing

A

CUSHINGS TRIAD

caused by reduced brain stem perfusion

88
Q

Raised ICP causes increased/decreased cerebral blood flow

A

Decreased

89
Q

Anyone with a GCS less than 13 and a head injury should have a CT scan within which time frame?

A

1 hour

90
Q

Indications for CT imaging within 1 hour (5)

A 
GCS less than 13 
Any sign of base of skull fracture 
Focal neurological deficit 
Post-traumatic seizure 
More than 1 episode of vomiting
91
Q

For adults who have sustained a head injury and have any of the following risk factors, perform a CT cervical spine scan within 1hour of the risk factor being identified. Name 2 risk factors

A

GCS less than 13

Patient that has been intubated

92
Q

Acute blood on a CT scan is what colour?

A

white

93
Q

Subdural haemorrhage crosses suture lines. True or false?

A

True

94
Q

Subdural haemorrhage often sudden/insidious?

A

Insidious

95
Q

Extradural haematoma - caused by which artery usually?

A

Middle meningeal artery

96
Q

Management of an extradural haematoma

A

Causes significant pressure

Neurosurgical theatre - burr hole

97
Q

Young people -> brief LOC -> lucid interval -> rapid deterioration

A

Extradural haematoma

98
Q

What is a spondylolisthesis?

A

When one of the vertebrae slips out of place onto the vertebrae below it

99
Q

Low backache, worse after activity, relieved by rest. What does this make you think of ?

A

spondylolisthesis

100
Q

Traumatic twisting injury to the knee when the leg is bent, and being unable to straighten knee (locked) suggests

A

medial meniscal injury

101
Q

Patient miscalculated stairs, put full weight on right leg with knee straight. Clinical haemarthrosis, tenderness maximally laterally, straight leg raise causes significant tenderness. What is most likely?

  • patellar fracture
  • tibial plateau fracture
  • quadraceps tendon rupture
  • ACL rupture
A

Tibial plateau fracture

102
Q

Which ligament is the most commonly injured in inversion injuries

  • anterior talofibular
  • posterior talofibular
  • calcaneofibular
  • tibionavicular
A

Anterior talofibular

103
Q

Septic artthritis suspected. What is best investigation?

A

Aspiration of synovial fluidd

104
Q

50 year old patient with a fracture following a fall. Has had previous total hysterectomy and bilateral salpingectomy. What is the appropriate management?

  • oestrodiol
  • alendronic acid
  • calcitriol
  • tibolone
A

Alendronic acid

105
Q

Young male with asthma. 4-6 attacks of migraine with aura per month. Needs prophylactic treatment. What treatment do you advise?

A

topiramate

would be propranolol but he is asthmatic

106
Q

pain that runs from the buttock through the back of the thigh and into the calf and outside of the foot (ie all down the leg). Numbness on lateral aspect of foot. What is likely nerve involved?

  • common peroneal nerve
  • L5 radiculopathy
  • S1 radiculopathy
  • cauda equina compression
A

S1 radiculopathy

107
Q

Someone with paracetamol overdose turns up to the ED within 1 hour. What do you do?

A

Give activated charcoal

108
Q

What is the antidote for paracetamol?

A

N-acetylcystine

Methionine

109
Q

What is the antidote for beta blockers?

A

Glucagon

110
Q

What is the antidote for opioids?

A

Naloxone

111
Q

Paracetamol is converted by which system to ____

A

Paracetamol is converted by the Cytochrome P450 system to NAPQI

112
Q

What are the common EARLY features of paracetamol poisoning?

A

Nausea and vomiting

113
Q

Delayed presentation of paracetamol poisoning (2-3 days later) features may include

A

features of hepatic necrosis

  • right subcostal pain
  • nausea and vomiting
  • jaundice
114
Q

When should blood paracetamol levels be checked?

A

4 hours

115
Q

How is N-acetylcystine given?

A

IV

given over 20 hours

116
Q

If blood paracetamol levels are checked at 4 hours and it is above the treatment line, what is used?

A

N-acetylcystine

117
Q

If the patient’s blood paracetamol level is elevated at 4 hours and they need treatment, what blood work is done after the treatment? and if the blood work is abnormal what is done?

A

INR
LFT
U+E

If these are abnormal - continue with N-acetylcystine

118
Q

What is rapid sequence induction?

A

A way of inducing anaesthesia in patients at risk of aspiration of gastric contents

119
Q

In CPR, after how many shocks do you start administering drugs ?

A

after 3rd shock

120
Q

What are the reversible causes of cardiac arrest?

A

4H’s and 4Ts

  • hypovolaemia
  • hypothermia
  • hypoxia
  • hypo/hyper kalaemia

Tension pneumothorax
Cardiac tamponade
Toxins
Thrombus

121
Q

After 3rd CPR shock which 2 drugs do you administer

A

Adrenaline 1mg
Amiodarone 300mg

Repeat adrenaline every 3-5 mins

122
Q

30 yo male, painful red eye for a week, worst at night. long sighted. What is likely diagnosis?

A

Acute angle closure glaucoma

123
Q

Eye trauma with suspected penetrating injury. What is the first line investigation?

A

CT orbits

124
Q

Patient develops acute muscle spasms after being treated with halloperidol yesterday. What is first line treatment?

  • baclofen
  • diazepam
  • procyclidine
A

Procyclidine

125
Q

Which colour of cannula is 22 gauge?

A

blue

126
Q

Name the colours of cannula from smallest to biggest

A

Blue - 22
Pink - 20
Green - 18
Grey - 16

127
Q

What colour of cannula is the ‘go to’ for non-emergency patients?

A

Pink

128
Q

Chronic pain is pain lasting longer than _____

A

Lasts longer than 3 months

129
Q

Which type of pain is being described here: burning, shooting, numbness, pins and needles, not well localised

A

Neuropathic pain

130
Q

What are the 4 steps involved in pain physiology

A

Periphery
Spinal cord
Brain
Modulation

131
Q

Pain signals travel in which 2 nerves to the spinal cord

A

A-delta nerve fibres

C nerves

132
Q

Which part of the spinal cord is involved in pain: dorsal horn or ventral horn

A

Dorsal horn

133
Q

In which part of the brain does pain perception occur?

  • cortex
  • limbic system
  • brainstem
A

Cortex

134
Q

WHO pain ladder (3 steps)

A
  1. Paracetamol +/- anti inflammatory (iboprufen, diclofenac)
  2. Codeine
  3. Morphine, oxycodone
135
Q

Drug (and non-drug) treatments for nociceptive pain (at periphery level)

A

R.I.C.E
Anti-inflammatory (ibuprofen, diclofenac)
Local anaesthetic

136
Q

Drug (and non-drug) treatments for nociceptive pain (at spinal cord level)

A

Acupuncture
Local anaesthetic
Opioid
Ketamine

137
Q

Drug (and non-drug) treatments for nociceptive pain (at brain level)

A

Paracetamol
Codeine
Morphine
Amitryptiline

138
Q

What is the biggest disadvantage of paracetamol

A

Liver damage in overdose

139
Q

Codeine is better for acute or chronic pain?

A

Acute

140
Q

Addiction is rare/common in acute pain?

A

Rare

141
Q

What is a good medication to use for post-operative pain?

A

Morphine

142
Q

Oral dose of morphine is 2-3 times IV / IM / SC dose. Why is this?

A

Due to tolerance

- increased doses needed over time

143
Q

Tramadol is a controlled drug. True or false?

A

False

144
Q

What are the disadvantages of using amitryptiline?

A

Anti-cholinergic side effects (dry mouth, constipation)

145
Q

What is a good medication for chronic cancer pain?

A

Morphine

146
Q

Patient with chronic pain presents with worsening pain. What do you do?

A

Continue normal opioids

add extra opioids to cover acute pain

147
Q

Which pain medications should be avoided in renal failure?

A

NSAIDs

148
Q

Paracetamol mechanism of action?

A

Inhibits prostaglandin synthesis in the CNS

149
Q

Management of opioid induced respiratory depression

A

Give oxygen
Adjust dose or stop delivery of opioid
Give naloxone if necessary

150
Q

Tramadol is a strong/weak opioid?

A

Weak

151
Q

Patient is on anticoagulants. This means epidural cannot be administered. True or false?

A

True

152
Q

Name an antihistamine used in nausea and vomiting?

A

Cyclizine

153
Q

Name a 5HT3 antagonist?

A

Odansetron

154
Q

Name 3 different classes of anti-emetics

A

Antihistamine
5HT3 antagonist
Anti-dopaminergic

155
Q

What is the first line treatment for a raised INR ?

A

Vitamin K

156
Q

It is very important to know that medication can be given (with a sip of water) to patients that are fasted for theatre. true or false?

A

True

157
Q

Emergency treatment of coagulopathy?

A

FFP

158
Q

INR ___ and below then it is ok to proceed with operation?

A

1.5 and below

159
Q

Standard PCA (patient controlled analgesia) prescription is what?

A

1mg morphine bolus, 5 min lockout

160
Q

Who goes to HDU, who goes to ICU ?

A

HDU - one failing organ

ICU - over one failing organ

161
Q

If you need invasive ventilation, where do you go?
Ward
HDU
ICU

A

ICU

162
Q

Define inotrope

A

A substance that affects the force of muscular contraction in the heart

163
Q

Define vasopressor

A

A hypOtensive agent (used to raise blood pressure)

164
Q

Inotropes must always be given by infusion through a central venous catheter. True or false?

A

true

165
Q

Name 2 examples of inotropes

A

Adrenaline

Dobutamine

166
Q

What 2 groups of antacids are commonly prescribed?

A

PPI (omeprazole)

H2RA (Ranitidine)

167
Q

Can antacids be given on the morning of surgery?

A

Yes

168
Q

Which drug is commonly used prior to induction of anaesthesia?

A

Midazolam

169
Q

Benzodiazepines bind to which receptor?

A

GABA receptor

170
Q

Name 3 IV anaesthetic agents

A

Propofol
Ketamine
Sodium thiopentate

171
Q

Name 3 volatile anaesthetic agents

A

Sevoflurane
Desflurane
Isoflurane

172
Q

Why are neuromuscular blocking drugs administered in anaesthesia?

A

To relax / paralyse muscles

Facilitate intubation

173
Q

Name 1 depolarising neuromuscular blocking agent?

A

Suxamethonium

174
Q

What has quicker onset of action

  • depolarising neuromuscular blocking agent
  • non-depolarising neuromuscular blocking agent
A

depolarising neuromuscular blocking agent

175
Q

Name 4 opioids

A

morphine
fentanyl
Alfentanil
Remifentanil

176
Q

name 2 topical anaesthetics used in paediatrics

A

EMLA

Ametop

177
Q

Different intravenous fluids cause different effects on body fluid compartments.
If you infuse: 1 litre 0.9% Saline or Hartmann’s (crystalloid).

You get an increase in

  • ICF
  • ECF
  • both
A

ECF (interstitial fluid + plasma)

178
Q 
Different intravenous fluids cause different effects on body fluid compartments.
If you infuse: 1 litre 5% Glucose.
you get an increase in 
- ICF
- ECF
- both
A

Both

179
Q

Frail 82 year old lady who broke her ankle and was found lying on the floor a day later. She is drowsy with dry mucous membranes. Urea and creatinine are raised. What fluid should you give?

  • crystalloids
  • 5% glucose
A

5% glucose

This lady has been lying on the floor and is dehydrated. She needs water which can be provided by 5% glucose.

180
Q

16 year old female involved in a road traffic accident. She has an open femoral fracture which is bleeding profusely. She is pale, tachycardic but normotensive. Which fluid should you give?

  • crystalloids
  • 5% glucose
A

This lady is hypovolaemic because of blood loss and again needs a fluid that will restore her circulating volume. Crystalloid is a good initial choice in this situation. Colloid, although not offered as a choice in this tutorial, would also be an acceptable choice for treating haemorrhagic shock. Ultimately, of course, this patient may require blood.

181
Q

If bradycardia is accompanied by life-threatening adverse signs, what is the treatment

a. Electrical Synchronised DC Shock
b. Amiodarone 300mg IV Infusion
c. Adrenaline 2-10 mcg min IV Infusion
d. Atropine 500mcg IV until max of 3 mg
e. Adrenaline 0.5mg 1M repeated until a response

A

d. Atropine 500mcg IV until max of 3 mg

182
Q

SVT not responding to vagal manouvres. What do you do?

a. Adrenaline 2-10 mcg min IV Infusion
b. Electrical Synchronised DC Shock
c. Amiodarone 900 mg IV Infusion over 24 hr
d. Adenosine 6 mg bolus rapid IV injection
e. Adenosine 12 mg bolus rapid IV injection

A

D

6mg -> 6mg -> 12mg

183
Q

Prior to completion of N-acetyl cystine infusion, which bloods should you check?

A

“post parvolex bloods” - LFT, INR, U+E

184
Q

If ‘post parvolex bloods’ are normal, what do you do?

A

Discharge patient and psycho input if required

185
Q

If ‘post parvolex bloods’ are abnormal, what do you do?

A

Continue acetylcysteine at the dose and infusion rate used in the 3rd treatment bag

186
Q

How long is the current N-acetyl cystine infusion?

A

21 hours

187
Q

Signs of ANTICHOLINERGIC toxicity

A

Dilated pupils
Dry mucous membranes
Confusion

188
Q

What is the antidote for anticholinergic toxicity

A

sodium bicarbonate

189
Q

What is the antidote for propranolol

A

Glucagon

190
Q 
72 year old female.  Known insulin dependent diabetic.  Found unconscious at home.  GCS 3,  P 80, RR 15,  BP 154/83. Pale, sweaty and clammy.  Paramedics BM 14.1,  Repeat BM 1.7. What is best immediate management? 
A
Give IV dextrose 5% 500mls 
B
Give IV Naloxone 
C
Give IV dextrose 10% 200mls 
D
Give IV flumazenil 200 micrograms 
E
Commence bag and mask ventilation
F
Perform RSI and CT head
A

C - IV dextrose 10% 200mls

191
Q

78 year old female. Thin and frail but mentally alert. Simple fall onto R hip which is painful on any movement. Distressed by pain. How do you manage pain?

A

IV morphine + fascia iliaca block

192
Q

Treatment of complete heart block

A

Atropine 0.5mg bolus up to 3mg

193
Q

In which 2 situations do you need to be cautious about giving adenosine?

A

Asthmatics - bronchospasm

if patient is on CCB (prolongs half life)

194
Q

18 year old male. Has just eaten a takeaway kebab. Sudden onset lip and facial swelling. Feels his throat is tight and has difficulty breathing.
P120 reg BP 85/40 sats 98%

What is your immediate treatment? (include dose)

A

IM adrenaline 500mcg

0.5mls of 1:1000

195
Q

23 year old male. Crushed between heavy machinery at work. Painful pelvis. P120 reg, BP 76/50, sats 100%. Pelvic X-ray shows open book pelvic fracture. What do you do in the ED department

A 
ABCDE 
Pelvic binder 
O negative blood 
Tranexamic acid 
Morphine
196
Q

How do you manage a depressed skull fracture?

A

Requires referral to neurosurgery for elevation of the bone fragments and wound care

197
Q

Which drug is used in the cute management of thyroid storm?

A

IV propranolol

198
Q 
Patient with hashimotos thyroiditisi comes for check up after being started on thyroxne 75mcg OD. What is the single most important blood test to assess  response to treatment?
Free T4
Total T4 
Free T3 
TSH
ESR
A

TSH

199
Q 
The correct dose and route of adrenaline for administration during cardiac arrest is
1mg IM
0.1mg IV
0.5mg IV
1mg IV
0.5mg IM
A

1mg IV

200
Q

Salbutamol causes tachycardia or bradycardia?

A

Tachycardia

- because it works on B2 receptors in the heart. Don’t need to treat it

201
Q

1g oral paracetamol 6 hourly as required
OR regular oral paracetamol 1g (4 times daily)

Which is best

A

regular oral paracetamol 1g (4 times daily)

202
Q

Type 1 diabetic going for day case short minor surgery. What should be done

A

Aim for ‘first on the list’
Omit all diabetes meds and insulin (APART FROM LONG ACTING INSULIN) on the morning of surgery
Restart all meds with first meal post op (apart from metformin)

203
Q

Salbutamol causes tachycardia or bradycardia?

A

Tachycardia

204
Q

Should you give fluids in acute asthma attack?

A

Yes if patient is dry

205
Q

What is the minimum acceptable urine output?

A

> 0.5ml/Kg/hour

206
Q

Sepsis leads to inappropriate vasodilation and hypotension. True or false?

A

Truee

207
Q

Cardiac output sum

A

HR x SV

208
Q

BP = ? x ?

A

BP = CO x SVR

209
Q

What is the minimum acceptable urine output?

A

> 0.5ml/Kg/hour

210
Q

Which of the following retains fluid

  • oncotic pressure
  • hydrostatic pressure
A

Oncotic pressure

211
Q

Which of the following forces fluid out of vessel

  • oncotic pressure
  • hydrostatic pressure
A

Hydrostatic pressure

Y4 (23 decks)

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