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MRCP Part 1 > Acute Care > Flashcards

Acute Care Flashcards

1
Q

What scores are the GCS components out of?

A

Eyes 4

Verbal 5

Motor 6

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2
Q

What are the GCS values for Eyes

A

Eyes

  1. Spontaneously
  2. Speech
  3. Pain
  4. None
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3
Q

What is the GCS for verbal response

A

5 Orientation to time, person and place
4 Confused
3 Inappropriate words
2 Incomprehensible
1 None

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4
Q

What is the GCS for motor

A

6 Obeys command
5 Moves to localised pain
4 Withdraws from pain
3 Abnormal flexion
2 Abnormal extension
1 None

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5
Q

What posture is this and what is the

a) Signifiance
b) Potential progression

A

Decorticate: Abnormal flexion due to significant head trauma

Can progress to decererbate, indicating brain herniation (uncal)

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6
Q

Who gets a 1hour CT following a head injury?

A

GCS <13 on initial assessment

GCS <15 after 2 hours

Suspected skull or basilar skull fracture

Post-traumatic seizure

Focal neuro deficit

>1 episode of vomiting

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7
Q

Who gets an 8 hour CT following head injury

A

>65 years

Bleeding/clotting disorders

High velocity/height (>1m or 5 stairs)

>30 mins retrograde amnesia of events prior to injury

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8
Q

What criteria indicates immediate CT for children?

A

GCS < 14, <15 if under 1 year

LOC or amnesia >5 mins

>3 vomiting episodes

Sign of skull, basilar fracture

Dangerous mechanism (fall >3m, high velocity)

SUSPICION OF NAI

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9
Q

How do you manage a GCS of

<8

3-8

A

<8 means intubate

ICP monitoring (must do if CT abnormal)

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10
Q

How do toxidromes affect pupil responses

A

Dilate: Anticholinergics, sympathomimetic

Pinpoint: Cholinergics, opioids

No change: Sedative hypnotic

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11
Q

How do you distinguish between overdoses of

anticholinergics (atropine, antihistamine, tricyclics, olazapine, quetiapine)

sympathomimetic (Caffeine, cocaine, (meth)amphetamines, ritalin, LSD, theophylline, MDMA)

A

Anticholinergics: no RR change, bowel sounds or sweating

Sympathomimetics: Raised RR, bowel sounds present and sweating

Both have dilated pupils, raised HR and warm skin

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12
Q

How do you tell the difference between

cholinergics (mushrooms, pilocarpine, -cholines)

opioids (morphine, codeine, tramadol, heroin, fentanyl)

sedative-hypnotics (benzodiazepines, muscle relaxants, antiepileptics, anti-anxiety meds

A

Both cholinergics and opioids have pinpoint pupils

Cholinergics: Bowel sounds + sweaty; no changes to numbers (HR,RR, temp)

Opioids: No bowel sounds, dry skin. Reduced HR, RR and skin temp

Sedative-hypnotics: As per opioids but no pupil changes

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13
Q

Toxin Treatments

Paracetamol

A

N-acetylcysteine (+activated charcoal if <1hr)

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14
Q

Toxin treatments

Aspirin/salicylates

A

IV bircarbonate

+/- haemodialysis

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15
Q

Toxin treatments

Opioids/opiates

A

Naloxone

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16
Q

Toxin Treatments

Benzodiazepines

A

Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.

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17
Q

Toxin treatments

Tricyclic antidepressants

A

Prevent arrythmias: IV bicarbonate

Manage arrhythmias

lignocaine (NOT quinidine, flecainide)

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18
Q

Toxin treatments

Lithium

A

mild-moderate: fluid resuscitation

Severe: haemodialysis

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19
Q

Toxin treatments

Warfarin

A

Vitamin K, prothrombin complex

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20
Q

Toxin treatments

Heparin

A

Protamine sulphate

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21
Q

Toxin treatments

Beta-blockers

A

bradycardic then atropine

Glucagon if resistant

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22
Q

Ethylene glycol

A

fomepizole 1st line

Haemodialysis if refractory

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23
Q

Toxin treatments

Methanol poisoning

A

fomepizole or ethanol

haemodialysis

24
Q

Toxin treatments

Organophosphate insecticides

A

atropine

25
Q

Toxin treatments

Digoxin

A

Digoxin-specific antibody fragments

26
Q

Toxin treatments

Iron

A

Desferrioxamine

27
Q

Toxin treatments

Lead

A

Dimercaprol

calcium edetate

28
Q

Toxin treatments

Carbon monoxide

A

100% oxygen

hyperbaric oxygen

29
Q

Toxin treatments

Cyanide

A

Hydroxocobalamin

Also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

30
Q

When are the 5 doses of tetanus vaccine given?

A

2,3,4 months

3-5 years

13-18 years

31
Q

For tetanus, what is considered a clean wound?

A

<6 hours old

non-penetrating with negligible damage

32
Q

For tetanus, what is a prone wound?

A

Puncture typee injuries in contaminated envirnoment

Wounds containing foreign bodies

Compound fractures

Wound/burns with systemic sepsis

Animal bites + scratches

33
Q

What is a high-risk tetanus wound?

A

Soil, manure contaiminated wounds

Wounds with excessive devitalised tissue

Wounds requiring surgical intervention

34
Q

Shot or not?

Full dose with final < 10 years ago

Full course with final >10 years ago

Unknown/incomplete vaccination status

A

No shot or Ig needed

Reinforce if tetanus prone, +IgG if high risk

Reinforce regardless, + Ig if high risk

35
Q

What is a common complication of N-acetylcysteine and how do you manage this?

A

AnaphylacticOID reaction (non-IgE mediated)

Stop drug, give neb salbutamol and recommence at slower rate

36
Q

What from the following would predispose someone to hepatotoxcity following paracetamol overdose?

Alcohol intake

Epilepsy treatment

Smoking

Depression treatmetn

A

Epilepsy treatment

Carbamazepine is an enzyme inducer

37
Q

What class of drug leads to a mixed resp alkalosis and metabolic acidosis?

A

Aspirin/salicylate

resp alkalosis then later acidosis

38
Q

How would you diferrentiate between sertraline and amitriptyline?

A

Both produce dilated pupils

TCAs produce dry skin, sertraline does not

TCAs cause QTc prolongation, SSRIs bar citalopram do not

39
Q

What is the most important monitor for paracetamol overdose?

A

pH as <7.3 after 24 hours ingestion is bad

40
Q

What are the King’s College Hospital criteria for liver transplantation?

A

Arterial pH <7.3 after 24 hours

or all 3 of:

  • PT >100s
  • Creatinine >300umol/l

grade III/IV encephalopathy

41
Q

Where is dialysis useful in tricyclic overdoses?

A

Its not

42
Q

What is the impact of alcohol on paracetamol overdose toxicity?

A

Not much and may be protective

43
Q

What do ALTs and ASTs in the 10,000s indicative of?

A

Paracetamol overdose

44
Q

What causes hyponatraemia?

A

Depletion of sodium

Excess of water

45
Q

Outline the complication of hyponatraemia when

untreated

Overtreated

A

Untreated

Cerebral oedema –> uncal herniation (ipsilateral dilated pupil, contralateral paralysis)

Overtreated

Osmotic demyelination syndrome (paralysis, mouth problems, coma, locked in syndrome)

46
Q

How do the causes of hyponatraemia differ if the urinary sodium is…

>20mmol/L

<20mmol/L

A

>20mmol/L

Low BP (renal loss): Diuretics, Addison’s, renal failure

Normal BP: SIADH (osmolality >500mmol/kg), hyothyroidism

<20mmol/L

Low BP (extra-renal): diarrhoea, vomiting, burns, sweating

High BP (water excess): hyperaldosteronism, nephrotic syndrome, IV dextrose, psychogenic polydipsia

47
Q

How do you do you treat

Chronic, severely symptomatic hyponatraemia?

Acute, severly symptomatic hyponatraemia?

A

Chronic

hypovolaemic: isotonic saline

Eu/hypervolaemic: Fluid restrict to 500-1000ml/day

Acute

Close monitoring with hypertonic saline (3%) to correct faster

48
Q

What is the rate of sodium correction in hyponatraemia?

A

4-6mmol/L in 24hrs

49
Q

How do you manage a haemothorax post ABCDE

A

36F wide bore chest drain

Thoracotomy if >1.5L loss initially or ongoing loss of 200ml/hour for >2 hours

50
Q

How to treat anaphylaxis initially (with doses)

A

IM adrenaline to anterolateral middle third of thigh

<6m: 100-150ug

<6yrs: 150ug

<=12yrs: 300ug

>12yrs: 500ug

Repeat dose every 5 mins

51
Q

What is a common pitfall for adrenaline anaphylaxis dosing?

A

Anaphylaxis: 1:1000 IM

Cardiac arrest: 1:10,000 IV (100mcg in 1ml)

ANAPHYLAXIS USES 10X THE STRENGTH

52
Q

What is a normal anion gap in metabolic acidosis?

What conditions have a raised anion gap?

A

(Na+ + K+) - (HCO3- + Cl-) = 8-14

Raised anion gap (introduction of acid into the body)

Lactate (shock, hypoxia)

Ketoacidosis (diabetic, alcoholic)

Uric acid (renal failure)

Acid poisoning (salicylates, methanol)

53
Q

What things tend to cause metabolic alkalosis?

A

GI or renal upset

54
Q

What things cause a respiratory acidosis?

A

When you can’t blow off enough CO2

  • COPD
  • Decompensation
  • Sedatives
55
Q

Respiratory alkalosis tends to be caused by what?

A

Where you’re hyperventilating so not getting enough CO2

Anxiety

Pulmonary embolism

Salicylate poisoning

CNS disorders

Altitude

Pregnancy

MRCP Part 1 (32 decks)

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