Acute Care General

Question 1

A gurgling noise suggests what is happening in the airway

Answer 1

Obstruction by either secretions or blood

Question 2

Hoarseness suggests what is happening in the airway

Answer 2

It might be indicative of oedema of the larynx and cords and suggests impending airway obstruction particularly in the burns patient

Question 3

What are paradoxical breathing movements and what do they suggest

Answer 3

This is when the the patient attempts to breath in past the obstruction - their chest wall is drawn in and the abdomen expands.
Suggests complete airway obstruction

Question 4

How would you remove a foreign object from the airway

Answer 4

MacGills forceps

NEVER use your fingers

Question 5

Paradoxical chest wall movements in a specific area are suggestive of what

Answer 5

A flail segment of rib fractures (multiple consecutive ribs each broken in more than one place)
Very painful but also compromises breathing

Question 6

Which areas can hide significant blood loss in a shocked patient

Answer 6

Chest
Abdomen
Pelvis
Long bones - e.g femur

Question 7

Which type of fluid is used to resuscitate a shocked patient

Answer 7

Crystalloid IV fluid such as 0.9% Sodium Chloride or Hartmann’s solution
Start with boluses of 250-500ml and reassess

Question 8

When are blood products used for resus

Answer 8

If blood loss is the suspected cause of the shocked patient

Question 9

How is tranexamic acid used in major haemorrhage

Answer 9

It prevents clot breakdown and helps stop bleeding

Question 10

How are splints used in major haemorrhage

Answer 10

Brings ends of bones together - tamponades bleeding

Also reduces pain

Question 11

What is permissive hypotension

Answer 11

When a patient is sufficiently resuscitated that the vital organs are perfused and maintained but not allowing the blood pressure to become so high that clots are disrupted and bleeding restarts.
Keep BP relatively but safely low

Question 12

An AVPU score of P or less is roughly equivalent to a GCS of what

Answer 12

Less than 8

This is important as this score suggests they may not be able to protect their own airway

Question 13

List the eye response scores for GCS

Answer 13

4 Points for Spontaneous eye opening
3 points for opening their eyes to sound or speech
2 points to firm pressure
1 point for no response

Question 14

List the verbal response scores for GCS

Answer 14

5 points for orientated speech
4 points for confused conversation
3 points for Inappropriate Words
2 for incomprehensible sounds
1 for no verbal response

Question 15

List the motor response scores for GCS

Answer 15

6 points for Obeying commands
5 points for Localizing a pressure stimulus
4 points for Normal Flexion to pressure stimulus
3 points for Abnormal flexion to pressure stimulus
2 points for extension to pressure stimulus
1 point if they are flaccid and do not respond to any stimulus

Question 16

At what GCS would you typically intubate

Answer 16

8 or less

Question 17

How do you treat hypoglycaemia in ABCDE

Answer 17

A bolus of 10% Dextrose

Question 18

What are the contraindications to peripheral venous cannulation

Answer 18

AV Fistula – are precious and may be damaged
Thrombosed veins
Sites of previous surgery - e.g. mastectomy and lymph node clearance causing poor lymph drainage
Sites of localised infection, inflammation, haematoma (i.e. cellulitis, burns etc.)
Patient refusal

Question 19

List some complications of cannulation

Answer 19

Infection and Phlebitis
Missing the vein and damaging surrounding structures
Haematoma formation
Arterial puncture 
Excessive bleeding
Extravasation of IV fluids

Question 20

How often do PVCs need replaced

Answer 20

PVCs needs to be reviewed regularly and consider replacement at 72 hours

Question 21

Which patients would get a CT chest from the ED

Answer 21

Suspected PE (CTPA)
Aortic dissection
Oesophageal rupture
Major trauma

Question 22

What are the classic signs of PE on ECG

Answer 22

S1Q3T3
S waves in lead 1
Q waves in lead 3
Inverted T waves in lead 3

Question 23

How would pericarditis present in ECG

Answer 23

Saddle shaped ST segment

Question 24

What is the main scoring systems for a PE

Answer 24

Wells Score
PERC - rule out score
PESI - determines management

Question 25

List common causes of metabolic acidosis in the ED

Answer 25

DKA
Lactic acidosis
Alcohol
Salicylate toxicity

Question 26

List common causes of metabolic alkalosis in the ED

Answer 26

severe vomiting

loss of potassium

Question 27

List common causes of respiratory acidosis in the ED

Answer 27

Severe Asthma
Pneumonia
Hypoventilation

Question 28

List common causes of respiratory alkalosis in the ED

Answer 28

Hyperventilation
Panic attack
Salicylate poisoning

Question 29

All women presenting with abdominal pain must have which test

Answer 29

PREGNANCY

Do a urine BHcG

Question 30

Raised ICS makes you vomit - true or false

Answer 30

True

It can do

Question 31

What is involved in a specific head injury examination

Answer 31

GCS
Pupils
Ears 
External signs of head injury
Neurological examination
Cervical spine

Question 32

A fixed dilated pupil is a sign of what

Answer 32

3rd nerve palsy

Typically due to raised ICP

Question 33

What is Cushing’s triad and what is it a sign of

Answer 33

Hypertension
Bradycardia
Irregular breathing (reduced brain stem perfusion)

Late sign of raised ICP

Question 34

What are the NICE criteria for a CT head within one hour of presenting with head injury

Answer 34

GCS less than 13 on initial assessment in A&E
GCS less than 15 at 2hours after the injury in A&E
Suspected open or depressed skull fracture.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Post-traumatic seizure.
Focal neurological deficit.
More than 1 episode of vomiting.

Question 35

In trauma what comes before ABCDE in the primary survey

Answer 35

C-spine protection

Major haemorrhage

Question 36

What bedside test can be done to diagnose PE

Answer 36

ECHO

Shows right heart strain

Question 37

How would you treat PE in a collapsed patient

Answer 37

Thrombolyse with Alteplase 10mg stat then 90mg over 120mins

Question 38

How do you treat a extradural bleed

Answer 38

Immediate Burr hole / neurosurgical intervention

Question 39

How do you treat a depressed skull fracture

Answer 39

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

Question 40

What is the initial management for an asthma attack

Answer 40

Oxygen - high flow 15L, if nebs added give through nasal cannula to boost
Salbutamol neb - 5mg via 5L O2
Ipratropium neb - 0.5mg, alternated or with sal
Steroids - hydrocortisone

May put up a saline bag if getting dry

Question 41

What investigations would you do if someone was having an asthma attack

Answer 41

A-E
ABG
Bloods