Acute Med

Question 1

4 signs of acute liver failure

Answer 1

Ammonia  encephalopathy
Albumin  ascites and peripheral oedema
Bilirubin  jaundice
Blood factors  bruising

Question 2

Triad of Wernicke’s encephalopathy

Answer 2

Confusion
Ataxia
Nystagmus

Question 3

What are the CAGE questions?

Answer 3

Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Question 4

Mx of alcohol withdrawal (4)

Answer 4

Benzodiazepines (chlordiazepoxide, diazepam)
Pabrinex (B vitamins) to prevent Wernicke’s
Glucose (if hypoglycaemic)

4. Manage alcohol dependence:
   Drug and Alcohol Liaison Specialist (DALS)
   Community services (e.g alcoholics anonymous)
   Therapy etc.

Question 5

Presentation of alcohol withdrawal (6, 12, 36 and 48hrs)

Answer 5

Agitation 6hrs
Hallucinations 12hrs
Seizures 36hrs
Delirium Tremens 48hrs

Question 6

Ix for alcohol withdrawal (5)

Answer 6

CIWA-Ar to assess severity

FBC/U&E/LFT, INR, Glucose

Question 7

Which Ig and cell is involved in immunologic human anaphylaxis

Answer 7

IgE

Mast-cell/basophil degranulation

Question 8

Three parts of anaphylaxis

Answer 8

Increased capillary permeability
Bronchospasm
Reduced vascular tone

Question 9

Mx of anaphylaxis

Answer 9

IM adrenaline 0.5mg 1:1000
ABC
IV chlorphenamine and IV hydrocortisone

Question 10

Ix in suspected poisoning

Answer 10

ABCDE
ECG
FBC, U&E, LFT, INR, glucose
Paracetamol and salicylate levels
ABG

Question 11

What should be considered to reduce absorption of drug if under 4hours

Answer 11

Activated charcoal

Question 12

S/s of aspirin OD early (4)

Answer 12

Tinnitus, deafness, dizziness (aspiringing)
Hyperpnoea (rasp-irin)
N&V/diarrhoea (most poisonings)
Hyperthermia and speaking (Per-spirin-g)

Question 13

S/s of aspirin OD late/severe (3)

Answer 13

Low BP and heart block
Pulmonary oedema
Low GCS + seizures

Question 14

Blood gas findings of aspirin OD early and late

Answer 14

Early respiratory alkalosis

Late: high anion gap metabolic acidosis

Question 15

Mx of aspirin OD

Answer 15

Urine alkalinisation with IV sodium bicarbonate

Dialysis

Question 16

Pathophysiology of paracetamol OD

Answer 16

Physiology: XS paracetamol metabolised by CYP450 in liver to NAPQI, which is conjugated with glutathione and excreted

Pathophysiology: glutathione depleted, toxic NAPQI accumulates, hepatocyte necrosis

Question 17

Presentation of paracetamol OD (under 24 hrs, 24-72hrs, after 72)

Answer 17

<24 hrs: mild N&V, lethargy
24-72 hrs: RUQ pain, vomiting, hepatomegaly
>72hrs: acute liver failure

Question 18

How many grams/kg for a paracetamol OD

Answer 18

OD> 150mg/kg, 12g can be fatal

Question 19

How many grams/kg of aspirin for OD and how many for serious OD

Answer 19

OD >150mg/kg, severe if >500mg/kg

Question 20

Mx of paracetamol OD

Answer 20

IV N-acetyl cysteine if below treatment line

Liver transplant

Question 21

Opiate OD presentation (5)

Answer 21

CNS depression (PNS effects):
Respiratory depression
Bradycardia, Hypotension
Pinpoint pupils
Late/severe: low GCS/coma

Question 22

Mx of opiate OD

Answer 22

IV naloxone

Question 23

What commonly causes catheter blockage

Answer 23

Can be due to biofilm formation (infection with Proteus mirabilis commonly)

Question 24

Indication for a 3 way catheter

Answer 24

recurrent clots/haematuria

Question 25

Indications of a suprapubic catheter (2)

Answer 25

Long-term use, urethral damage (trauma, surgery, stricture)

Question 26

Three types of catheter

Answer 26

Foley
3 way
Suprapubic

Question 27

Whats the indication for packed red cells

Answer 27

if Hb <70g/l or >30% loss of blood volume

Question 28

Whats the indication for platelets

Answer 28

If platelets <20*109/L

Question 29

Whats the indication for FFP

Answer 29

To correct clotting defects e.g DIC

Question 30

Early complications of blood transfusion (5)

Answer 30

Anaphylaxis
Acute haemolytic reaction
Bacterial infection
Febrile non-haemolytic reaction
Transfusion associated circulatory overload (TACO) or transfusion associated lung injury (TRALI)

Question 31

Late complications of blood transfusion (4)

Answer 31

Delayed haemolytic reaction
Infection
Transfusion associated graft vs host disease
Iron overload

Question 32

How much does 1 unit of packed red cells increase Hb by

Answer 32

1 unit increases Hb by 10-15g/l

Question 33

Complications of epidural (4)

Answer 33

Dural puncture
Vessel puncture
Hypoventilation
Epidural haematoma or abscess