Acute Care

Question 1

What are the three components of GCS?

Answer 1

Eye opening
Verbal response
Best motor response

Question 2

Describe eye opening

Answer 2

Opens spontaneously
Opens to command
Opens to pain
No response

Question 3

Describe verbal response

Answer 3

Orientated & talking
Confused
Inappropriate words
Incomprehensible sounds
No response

Question 4

Describe motor response

Answer 4

Obeys
Localises to pain
Flexion and withdrawal to pain
Abnormal flexion to pain
Extension to pain
No response

Question 5

What are the two keys types of head injury?

Answer 5

Primary
Secondary

Question 6

What can cause secondary brain injury?

Answer 6

Inflammation
Cerebral hypoperfusion
Increased ICP

Question 7

How do you calculate cerebral perfusion pressure?

Answer 7

MAP - ICP

Question 8

What is Cushing’s reflex?

Answer 8

Hypertension
Bradycardia
Irregular breathing

Question 9

How do skull base fractures present?

Answer 9

Subconjunctival haemorrhage
Bleeding from ear
CSF lead from nose/ear
Panda eye
Battle sign

Question 10

What are the 4H’s?

Answer 10

Hypoxia
Hypovolaemia
Hypothermia
Hypo/hyperkalaemia

Question 11

What are the 4 T’s?

Answer 11

Toxins
Thrombosis
Tamponade
Tension pneumothorax

Question 12

What drugs can be given in cardiac arrest?

Answer 12

Adrenaline every 3-5 minutes
Amiodarone after 3 shocks

Question 13

Name the four types of shock

Answer 13

Cardiogenic
Obstructive
Hypovolaemic
Distributive

Question 14

What are the causes of cardiogenic shock?

Answer 14

MI
Arrhythmia
Cardiomyopathy
Overdose (BB/CCB)

Question 15

What are the causes of obstructive shock?

Answer 15

PE
Tension pneumothorax
Cardiac tamponade

Question 16

Describe the pathophysiology of obstructive shock

Answer 16

Reduced cardiac filling will reduce preload and thus contractility and output
Impaired emptying restricts contractility

Question 17

What causes hypovolaemic shock?

Answer 17

Haemorrhage
Dehydration

Question 18

Describe the pathophysiology of hypovolaemic shock

Answer 18

Decreased circulating volume reduces stroke volume

Question 19

What causes distributive shock?

Answer 19

Sepsis
Anaphylaxis
Neurogenic

Question 20

Describe the pathophysiology of distributive shock

Answer 20

Peripheral vasodilation reduced blood pressure and increased cardiac output

Question 21

Describe the difference between acute overdose and toxic dose of paracetamol

Answer 21

Acute - >4g in last hour
Toxic - >150mg/kg

Question 22

How soon after consumption can serum paracetamol levels be checked?

Answer 22

4 hours

Question 23

How is a paracetamol overdose treated?

Answer 23

Acetylcysteine

Question 24

If <8 hours since paracetamol overdose what can be given?

Answer 24

Activated charcoal

Question 25

How does an opioid overdose present?

Answer 25

Pin point pupils Respiratory depression Drowsiness/coma

Question 26

What is the antidotes for opioids?

Answer 26

Naloxone

Question 27

How does a benzo overdose present?

Answer 27

Ataxia Dysarthria Drowsiness/coma

Question 28

What is the antidote for benzo?

Answer 28

Flumazenil

Question 29

How does an aspirin overdose present?

Answer 29

Tinnitus Vomiting Dehydration Hyperventilation

Question 30

How do you treat an aspirin overdose?

Answer 30

Supportive - fluids and bicarbonate infusion

Question 31

How does a beta blocker overdose present?

Answer 31

Bradycardia and QT prolongation

Question 32

What is given in a beta blocker overdose?

Answer 32

Glucagon

Question 33

How does a salbutamol overdose present?

Answer 33

Agitation Tremor Tachycardia, palpitations Hypokalaemia

Question 34

What can be given in a salbutamol overdose?

Answer 34

Potassium infusion

Question 35

How does an ethylene glycol overdose present?

Answer 35

Ataxia, dysarthria, nausea, vomiting, convulsions, coma Diagnosed - osmol gap on serum osmolality

Question 36

What are the antidotes to ethylene glycol?

Answer 36

Alcohol Fomepozil

Question 37

What is the main treatment for carbon monoxide poisoing?

Answer 37

Oxygen

Question 38

How soon before surgery should warfarin be stopped?

Answer 38

5 days

Question 39

In high risk patients what is used when they come off warfarin?

Answer 39

Heparin

Question 40

What is classed as high risk in terms of cessation of warfarin?

Answer 40

AF, VTE, Metal heart valve, multiple valve replacements

Question 41

In INF is 1.6 or above what must be given

Answer 41

Vitamin K

Question 42

What are the three key principles of anaesthesia?

Answer 42

Sedation - induction agent e.g propofol, maintenance e.g fluranes Muscle relaxant - rocuronium, vecuronium, suxamethonium Pain relief - opioids

Question 43

How are muscle relaxants reversed?

Answer 43

Neostigmine - ACh inhibitor

Question 44

What are the key complications of a GA?

Answer 44

Bradycardia Hypotension Laryngospasm Malignant hyperthermia Mendelson Syndrome

Question 45

How is bradycardia mangaged?

Answer 45

IV atropine

Question 46

How is hypotension managed?

Answer 46

Vasopressors - metarminol/ephedrine

Question 47

How is laryngospasm managed?

Answer 47

Severe - suxamethonium

Question 48

How is malignant hyperthermia managed?

Answer 48

IV dantrolene and active cooling

Question 49

What is Mendelson Syndrome?

Answer 49

Inflammation of the lungs when under GA due to aspiration of stomach acid

Question 50

How is Mendelson Syndrome prevented?

Answer 50

Pre-op antacid

Question 51

What is TIVA?

Answer 51

Total Intravenous Anaesthetic

Question 52

What is the alternative to TIVA?

Answer 52

Use of fluranes

Question 53

What are the two types of muscle relaxant?

Answer 53

Depolarising - suxamethonium Non-depolarising - atracurium/rocurium