Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Acute Medicine > Flashcards

Acute Medicine Flashcards

1
Q

What is triage?

A

Principle used when casualties > HCWs using rapid A-C assessment

Ensuring the right patient, the right place at the right time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Using the Adult Triage Sieve, a patient who is walking is?

A. P1

B. P2

C. P3

D. P4

E. Dead

A

P3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Using the Adult Triage Sieve, a patient who is breathing with a respiratory rate of 7 is?

A. P1

B. P2

C. P3

D. P4

E. Dead

A

P1

RR <10 or >30 = P1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Using the Adult Triage Sieve, a patient who is breathing at a rate of 34 breaths per minute is?

A. P1

B. P2

C. P3

D. P4

E. Dead

A

P1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Using the Adult Triage Sieve, a patient who has a CRT of <2 and a respiratory rate of 10-29 (normal) is?

A. P1

B. P2

C. P3

D. P4

E. Dead

A

P2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Using the Adult Triage Sieve, a patient who has a CRT of 3 seconds is?

A. P1

B. P2

C. P3

D. P4

E. Dead

A

P1

CRT > 2s = P1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Using the Manchester Triage System, how long should a red patient have to wait?

A. See immediately

B. 10 minutes

C. 1 hour

D. 2 hours

E. 4 hours

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Using the Manchester Triage System, how long should a green patient have to wait?

A. See immediately

B. 10 minutes

C. 1 hour

D. 2 hours

E. 4 hours

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Using the Manchester Triage System, how long should an amber patient have to wait?

A. See immediately

B. 10 minutes

C. 1 hour

D. 2 hours

E. 4 hours

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Using the Manchester Triage System, how long should a yellow patient have to wait?

A. See immediately

B. 10 minutes

C. 1 hour

D. 2 hours

E. 4 hours

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Using the Manchester Triage System, how long should a blue patient have to wait?

A. See immediately

B. 10 minutes

C. 1 hour

D. 2 hours

E. 4 hours

A

E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

State 5 admission factors in acute medicine.

A

Age
Social history
Comorbidities
Access to hospital

Resources available
Condition requiring admission
FU care
Time of presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Outline the key features of an SBAR.

A

Situation
Background
Assessment
Recommendation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the key features of an ATMIST

A

Age
Time

MOI
Injuries
Signs
Treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does the primary surgery involve?

A

A systematic method of managing life-threatening conditions. The principles are conducted in order of urgency. Any intervention or change in status requires reassessment starting from A.

Danger – environment, people, surroundings 
Response – of patient 
Airway
Breathing
Circulation
Disability
Exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the airway ladder.

A

The airway ladder is a series of steps used to regain airway patency.

  • Positioning (c-spine) – MILS
  • Chin-tilt (2 fingers) or Jaw thrust (2 fingers at mandible angle)
  • OPA (mandible to teeth)/NPA (height)
  • SGA (hold like pen and insert)
  • ETT
  • Cricothyroidotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the recovery position.

A

Position to protect the airway for an unconscious casualty who is breathing spontaneously

  • Straighten both legs
  • Place arm nearest you, at right angles to casualty, with elbow bent and palm facing upwards
  • Bring furthest away arm across the casualty’s chest and hold the back of that hand against his cheek, on the side of his face nearest you
  • With your other hand grasp his far leg just above the knee and pull it up, keeping the foot on the ground
  • Keeping his hand pressed against his cheek, pull the bent leg and roll the casualty towards you and onto his side (Use the pelvis as a fulcrum)
  • Adjust the upper leg so that both hip and knee are bent at right angles
  • Tilt head back to keep the airway open
  • Adjust the hand under the cheek, if necessary, to keep head tilted
  • Check breathing regularly (reassessing ABC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What aspects make up circulation in an A-E assessment?

A

HR - Rate, rhythm, volume

CRT

IV/IO access

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the usual PaO2 pressures?

A

10-12kPa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the normal PaCO2 pressure?

A

4.5-6kPa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the usual pH of blood?

A

7.35-7.45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the usual concentration of bicarbonate?

A

22-24mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Outline how you would interpret a CXR.

A

Mnemonic: DR ABCDE

Details: Patient/Setting/AP vs PA/ Rotation/Inspiration/Picture/ Exposure

Airway: Trachea -> Carina -> Bronchi -> Hilar; Mediastinal width (=8cm)

Breathing: Lung fields in an S-shape and pleura

Circulation: Aortic knuckle; Heart; Borders

Diaphragm: costophrenic angles; gastric bubble; free air?

Everything else: Bones; soft tissues; other iatrogenic aspects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

State 5 types of injuries you may encounter.

A 
RTA
Pedestrian 
Falls 
Burns 
Lacerations 
Sporting 
Blast injuries 
Gunshot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How may you assess for a C-spine injury?

A

Mnemonic: NSAID (from NEXUS criteria)

Neuro deficit 
Spinal midline tenderness
Alertness
Intoxication
Distracting injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How may you stabilise a C-spine injury?

A

1) MILS
2) Cervical collar
3) Triple immobilisation (hard collar + head block + tape)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Give 5 signs of an obstructed airway.

A 
Accessory muscle recruitment
Distress
Pallor/Cyanosis 
Paradoxical chest movements 
Reduced consciousness

Absent breath sounds
Stridor
Snoring/Gurgling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What might an indication for suction?

A

Audible secretion
Noisy crackles of secretions
Ineffective cough and physical deterioration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the name of the forceps which use twin-bladed forceps at an oblique angle to prevent obstruction of view?

A

Magill Forceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When may you not give an OPA or NPA?

A

Mandible fracture
Oral trauma
Trismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do you size an OPA?

A

front teeth to angle of mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does insertion of an OPA differ in children vs adults?

A
  • In adults, insert pointing up and rotate 180 degrees.

- In children, insert directly pointing downwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do you insert an NPA?

A
  • Insert with bevel pointing towards septum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the indications for definitive airway management?

A 
Apnoea 
Airway protection from aspiration 
Unconsciousness (GCS <8) 
Faciomaxillary fractures 
Risk of obstruction 
Impending airway compromise e.g. burns or anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How do you assess a patient’s breathing in the acute setting?

A

Mnemonic: RIPA

RR (12-20)

Inspection: Cx deformity; accessory muscle recruitment; skin colour; injuries; previous surgeries; tracheal position)

Palpation: Tracheal position; Cx expansion; Surgical emphysema

Percussion: Resonant vs Hyper resonant vs Hyporesonant

Auscultation: Air entry; breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the potential interventions in Breathing in an acute situation?

A 
Mouth to mouth 
Pocket mask 
Bag valve mask 
±
SGA or ETT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the physiology behind exercising caution when oxygenating CO2 retainers with COPD?

A

V-Q mismatch: COPD patients develop V-Q mismatching by hypoxic vasoconstriction to underperfused regions to optimise GE. Excess oxygen overcomes high leads to blood flow to poorly ventilated alveoli with increased physiological dead space

Haldane effect: Oxygen can induce RHS shift of CO2 dissociation curve thus greater CO2 retention known as the Haldane effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How is a needle thoracostomy conducted?

A

14-16G IV cannula placed in 2nd ICS at MCL over third rib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How is a chest drain inserted?

A

Identify triangle of safety (MAL + pec border + nipple line)

Inject 10-20mL of 1% Lidocaine above rib (in triangle of safety)

Blunt dissect down to level of pleura and puncture pleura with scissors or forceps

Advance drain slowly, stopping if you hit serious resistance

Attach other end of drain to underwater seal

Request CXR to check drain placed correctly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the major sites of bleeding in the body?

A

Mnemonic: 4 and the floor

Thorax

Abdomen

Pelvis

Long bones

Externally (the floor/surrounding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the ways to manage a catastrophic haemorrhage in the acute setting?

A

Direct pressure and elevation

Windlass technique

Tourniquet

Activate major haemorrhage protocol

  • Call 2222
  • Respond: Control bleed; Venous access; Warm fluids; Blood tests
  • Blood tests: FBC; Crossmatch; Coag screen; Biochemistry; ABG
  • Request Group O- blood; Group specific blood; Platelets; FFP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How much does 1 unit of blood raise Hb by?

A

1 unit of blood raises Hb by 10g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Give 3 contraindications to an intraosseous injection?

A 
Inability to locate landmark 
Fractures in targeted bone 
PMHx surgery in targeted bone 
Infection at target site 
Previous failed IO access within 24 hours in targeted bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How should fluid be administered in the acute scenario?

A

Give fluid via cannulas in 250mL boluses should radial pulse be impalpable. Continue to fluid resus until radial pulse returns (≈ > 80mmHg). Choice of fluid should be isotonic saline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Give the causes of cardiac arrest (collapse)?

A

Mnemonic: 4Hs and 4Ts

Hypoxaemia
Hypovolemia
Hyperkalaemia
Hypothermia

Tension pneumothorax
Tamponade
Toxin
Thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Outline the chain of survival.

A

Early recognition and call for help

Early CPR

Early defibrillation

Post resuscitation care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Outline the adult life support algorithm.

A

Recognise patient is unresponsive and not breathing normally

Look for dangers

Call for help

CPR at 30:2 (attach defibrillator)

Assess rhythm

Either:
1) Shockable rhythm thus 1 shock and continue CPR for 2 minutes then reassess

2) Non-shockable rhythm thus CPR for 2 minutes
3) Return of spontaneous circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How can consciousness be assessed in the acute setting?

A

1) AVPU

2) GCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Outline how GCS is scored.

A

GCS scored out of 15 (E4, V5, M6)

Eyes: 
1 = not open 
2 = open to pain 
3 = open to speech 
4 = open 
Verbal:
1 = none 
2 = incomprehensible 
3 = inappropriate - random speech patterns with no conversational speech 
4 = confused and disorientated 
5 = orientated 
Motor: 
1 = none 
2 = extends to pain 
3 = abnormal flexion to pain 
4 = flexion to pain 
5 = localising to pain or touch 
6 = obeys commands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How can you grade motor power in a neuro exam. Differentiate between the scores.

A 
0 = no contraction 
1 = flicker 
2 = movement but not against gravity 
3 = movement against gravity 
4 = movement against resistance 
5 = normal strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How can you score reflexes?

A

Can be scored from 0-5

0 = absent 
1 = trace response 
2 = normal 
3 = brisk 
4 = non-sustained clonus 
5 = clonus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How do you take a brief history in an acute situation?

A

Mnemonic: SAMPLE history

Signs and symptoms 
Allergies 
Medications
PMHx 
Last Eaten
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How do you manage a tension pneumothorax?

A

Needs thoracostomy

then Chest drain for definitive management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How do you manage an open pneumothorax?

A

One-way valve adhesive dressing
+
Chest drain

55
Q

How do you manage a massive haemothroax/

A

Chest drain

56
Q

How do you manage a flail chest?

A

Analgesia
+
Splintage

57
Q

How do you manage a cardiac tamponade?

A

Pericardiocentesis

58
Q

What is the Beck Triad?

A

Muffled heart sounds + Raised JVP + Hypotension

59
Q

What are the features of moderate acute asthma?

A

Increasing symptoms
PEF >50-75% best or predicted
No features of acute severe asthma

60
Q

What are the clinical features of acute severe asthma?

A

PEF 33-50%
RR >25/min
HR >110/min
Inability to complete sentences in one breath

61
Q

What are the clinical features of life threatening asthma?

A 
Cannot speak
Cyanosis 
PEF <33%
Altered consciousness level 
Silent chest 
Poor respiratory effort 
Hypotension 
SpO2 <92%
PaO2 <8kPa 
Normal PaCO2 (4.5-6kPa)
62
Q

How do you treat an acute exacerbation of asthma?

A

Mnemonic: O SHIT MAn

Oxygen
\+
Salbutamol 5mg 
\+
Ipratropium 5mcg 
±
IV Hydrocortisone
/
Theophylline 
/ 
Magnesium sulphate 
/ 
Anaesthetist Needed
63
Q

What are the components of Virchow’s triad?

A

Endothelial damage

Hypercoagulability

Venous stasis

64
Q

How do you treat a PE?

A

Stable = DOAC

Unstable = Intravenous thrombolysis

65
Q

How should you manage a PE in a patient with a eGFR of 10?

A

PE treatment but patient has severe renal impairment thus

LMWH as <15 - follow local guidance

66
Q

How long should a patient continue anticoagulation for following a PE?

A

3 months

Active cancer = 6 months

Unknown cause = 12 months +

67
Q

How do you manage acute pulmonary oedema?

A

Mnemonic: LMNOP

-	Loop diuretic: Furosemide 40mg 
\+
-	Morphine
\+
-	Nitrate: Nitroprusside
\+
-	Oxygen: High-flow O2 non-rebreathable mask targeting 94% < 
\+
-	Position: Upright
68
Q

What are the features of the CURB65 score?

A

Confusion

Urea >7

RR > 30

BP <90mmHg

65 years old

69
Q

What type of shock is caused by haemorrhage?

A. Hypovolaemic

B. Cardiogenic

C. Obstructive

D. Distributive

A

A

70
Q

What type of shock is caused by severe mitral regurgitation?

A. Hypovolaemic

B. Cardiogenic

C. Obstructive

D. Distributive

A

B

71
Q

What type of shock is caused by an SVCO?

A. Hypovolaemic

B. Cardiogenic

C. Obstructive

D. Distributive

A

C

72
Q

What type of shock is caused by sepsis?

A. Hypovolaemic

B. Cardiogenic

C. Obstructive

D. Distributive

A

D

73
Q

A patient has lost 10% of blood volume. What class of haemorrhagic shock have they experienced?

A

Class I

74
Q

A patient has lost 15% of blood volume with tachycardia and tachypnoea. What class of haemorrhagic shock is this?

A

Class II

75
Q

A patient presents with 32% EBL, tachycardia, tachypnoea and hypovolaemia.

What class of haemorrhagic shock is this?

A

Class III

76
Q

A patient presents with 45% EBL, tachycardia, hypovolaemia, tachypnea and anuria. What class of haemorrhagic shock is this?

A

Class IV haemorrhagic shock

77
Q

How is Hypoglycaemia managed in the acute setting?

A
  • Tx cause
    +
  • Glucose 10-20g

If unconscious: Glucose 75mL of 20% IV over 10 minutes

78
Q

How is a DKA managed?

A

Follow the DKA protocol

Insulin: 0.1U/kg/hour
+
IV Fluids: 1L 30 mins; 1L 1 hour; 1L 2 hours; 1L 4 hours

± Hypotension
IV Colloids

± Hypokalaemia
IV Fluids: Add KCl (10mmol/L if 3-5mmol/L or 20 if <3.5mmol/L)

± Glucose <14mmol/L
IV Glucose 10%

79
Q

What is the main difference between management of HHS and DKA regarding insulin?

A

In DKA use 0.1U/kg/hr cf in HHS use 0.05U/kg/hr

80
Q

Describe the process of syncope.

A

Transient, self-limited loss of consciousness with an inability to maintain postural tone followed by a spontaneous recovery.

81
Q

Give 5 causes of syncope.

A 
Neural:
Vasovagal faint 
Carotid Sinus Hypersensitivity 
Situational faint 
Trigeminal neuralgia 
Glossopharyngeal neuralgia

Orthostatic:
Orthostatic hypotension
Hypovolaemia

Cardiac: 
Arrhythmia 
Valvular disease 
Cardiomyopathy 
Aortic dissection
Pericardial disease 
Cardiac tamponade 
PE 
Subclavian steal syndrome
82
Q

What is important to ask regarding a falls history?

A

When did it happen?
Has this happened before?
How many times in last year?

What were you doing at the time?
Did you get any symptoms before?
Do you remember hitting the ground?
Did you hit any parts of your body? 
Did you get up by yourself? 
How long were you on the ground for?
How did you feel after?
83
Q

Describe what a TIA is?

A

Interruption of blood supply to focal part of brain causing a loss of neurological function with symptoms lasting < 24 hours without infarction

84
Q

What can be used to assess risk of a stroke after a TIA?

A

ABCD2 score

Age >60
Blood pressure >140/90mmHg
Clinical features: Unilateral weakness; speech disturbance without weakness
Duration of TIA: >60; 10-59; <10 minutes
Diabetes Mellitus

Score of 4-5 = 4.1%

Score of 6-7 = 8.1%

85
Q

How do you manage a TIA?

A

Secondary stroke prevention…

• Supportive: Lifestyle advice; RF modification; control of RFs
+
• Antiplatelets: Aspirin: Clopidogrel: 300mg (loading) then 75mg OD (if intolerant of aspirin)
+
• Statins: Simvastatin 40mg OD (Cl > 3.5mmol/L or LDL > 2.5mmol/L)

+ Tx any causes or risk factors

86
Q

What is a stroke?

A

Interruption of blood supply to focal part of brain (haemorrhage or infarction) causing a loss of neurological function with symptoms lasting > 24 hours or leading to death with no apparent cause other than vascular origin

87
Q

What is the most common type of stroke?

A

Ischaemic stroke

88
Q

What classification system can be used for strokes?

A

Bamford/Oxford Classification of Stroke

TACS = 3/3

  • Unilateral weakness/sensory deficit
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphagia, visuospatial disorder)

PACS = 2/3

POCS = 1 of the following 
- Cranial nerve palsy and contralateral motor/sensor deficit 
Bilateral motor/sensory deficit 
Conjugate eye movement 
Cerebellar dysfunction 
Isolated homonymous hemianopia

LACS = 1 of the following

  • Pure sensory stroke
  • Pure motor stroke
  • Sensori-motor stroke
  • Ataxic hemiparesis
89
Q

How long do you have from when a stroke patient presents to conduct thrombolysis?

A

< 4.5 hours to give Alteplase + Aspirin

90
Q

How long do you have once occlusion of circulation is identified in a stroke?

A

24 hours

91
Q

Give 5 causes of metabolic acidosis with an high anion gap.

A

Mnemonic: MUD PILES

Methanol
Uraemia
DKA

Paraldehyde 
Iron/Isoniazid
Lactic acidosis 
Ethylene glycol 
Salicylates
92
Q

How can you classify head injuries?

A
  • Mild head injury: 13-15
  • Moderate head injury: 9-12
  • Severe head injury: 3-8
93
Q

What is the criteria for a CT-head in a trauma situation?

A 
GCS < 15 at 2 hours after injury 
GCS <13 
Suspected skull fracture
Signs of basal skull fracture 
Post-traumatic seizure 
Focal neurological deficit 
2+ episodes of vomiting
94
Q

How are burns classified?

A
  • 1st Degree (epidermis only) -> dry and painful
  • 2nd Degree (epidermis and upper dermis) -> wet and painful
  • 3rd Degree (epidermis and dermis and appendages) -> dry and insensate
  • 4th Degree (subcutaneous tissue, tendon or bone)
95
Q

Give 3 types of burns.

A
  • Thermal
  • Electrical
  • Chemical
  • Non-accidental (the above but abuse or neglect)
96
Q

How can you calculate the amount of fluids to give in a patient with burns?

A

Use the Parkland formula

4ml/kg x VSA = volume in 24 hours

97
Q

Give 3 causes of J waves (Osborn waves)?

A 
Hypothermia 
Hypercalcemia 
Brain injury 
SAH
Sedation (and cardiopulmonary arrest)
Vasospastic angina 
Ventricular fibrillation
98
Q

How do you manage hypothermia?

A
  • Supportive: shelter, warm drinks, ABCDE, fluids, remove wet clothing, stop nephrotoxic drugs (medicine reconciliation)
     ‘passive rewarming’

± Moderate Hypothermia (28-32ºC)
- Transfer to hospital + CPR (5:5) + measure [K+] ? <8mmol/L

± Severe Hypothermia (<28ºC)
- Definitive airway management: SGA/Intubation
+
- Transfer to hospital ± Cardiopulmonary bypass

99
Q

What makes up the sepsis 6?

A

Mnemonic: BUFALO

Give 3 and take 3

Bloods
Urine output 
Fluids 
ABG 
Lactic acid 
Oxygen
100
Q

What are the signs of NAI?

A
  • Vague account
  • Incongruent stories
  • Story incompatible to injury
  • Delay in seeking help
  • Parent does not reflect level of caring: Too little or Too much
  • Child’s affect: Sad/Withdrawn/Fearful/Trusting in strangers
101
Q

What are the signs of neglect?

A
  • Inadequately fed
  • Poor dress
  • Poor hygiene
  • Deprived of satisfactory contact with parents/guardian
  • Deprived of social contact with friends and children
  • Failure to meet milestones
102
Q

What are the clinical features of schizophrenia?

A 
Tangentiality/ Thought processing 
Hallucinations (auditory/visual)
Reduced reality (Delusions)/Repetition of words (Verbigeration)
Emotional control: Incongruous effect?
Arousal 
Disorganised/ Catatonic Behaviour
Loss of volition/social settings/ Pleasure
Emotional flatness (Affective Blunting) 
Speech reduced (Alogia)
Slowness in thought (cognitive deficit)/Somatisation (physical Sx – expressed in body)
103
Q

How do you manage Schizophrenia?

A

• Anti-psychotic medication: Aripiprazole
+
• Psychological Interventions: Family/CBT/Social-skills training

104
Q

What is the difference between Bipolar I and Bipolar II Disorder?

A
  • Bipolar I Disorder (At least 1 manic/mixed episode)

- Bipolar II Disorder (At least 1 hypomanic + 1 major depressive disorder)

105
Q

What are the signs of opiate intoxication?

A
  • Sedation
  • Nausea
  • Vomiting
  • Mood change: Euphoria/Intense pleasure
  • Analgesia
  • Pupillary constriction
  • Respiratory depression
  • Bradycardia (Decreased SNS outflow)
  • Hypotension (Decreased SNS outflow)
  • Hypothermia
  • Cough reflex suppression
  • Analgesia
106
Q

What is the reversal agent of Morphine overdose?

A

Naloxone

107
Q

What are the clinical features of amphetamine overdose?

A
  • Euphoria
  • Hyperarousal: Energy + Alertness
  • Self-confidence
  • Reduced inhibitions + Impulsive behaviour
  • Reduced appetite (Appetite suppression)
  • Pupillary dilation
  • Blurred vision
  • Dry mouth
  • Tachycardia
  • Arrhythmia
  • Hypertension
  • Hyperthermia
  • Hyperhidrosis
  • Tremor
  • Dehydration -> Xerostomia
  • Agitation
108
Q

What can be used to treat a patient with an amphetamine overdose in an acute setting?

A

Benzodiazepines

109
Q

What are the clinical features of cocaine overdose?

A
  • Euphoria
  • Hyperarousal: Energy + Alertness
  • Self-confidence
  • Reduced inhibitions + Impulsive behaviour
  • Reduced appetite (Appetite suppression)
  • Pupillary dilation
  • Blurred vision
  • Tachycardia
  • Arrhythmia
  • Hypertension
  • Hyperthermia
  • Hyperhidrosis
  • Tremor
  • Dehydration
  • Agitation
110
Q

How can you manage a patient with cocaine overdose in an acute setting?

A

• Benzodiazepines: Lorazepam/Diazepam
+
• CBT

111
Q

What are the clinical features of a patient with MDMA intoxication?

A
  • Euphoria
  • Nausea
  • Vomiting
  • Hallucinations: Visual + Auditory
  • Insomnia
  • Impulsivity
  • Anorexia
  • Weight loss
  • Psychological Sx: Anxiety/Paranoia/Psychosis  Suicidal feelings
  • Low mood (come down)
  • Dilated pupils
  • Blurred vision
  • Dry mouth
  • Teeth grinding
  • Jaw tightening (bruxism)
  • Tachycardia
  • Hypertension
  • Tachypnoea
  • Hyperthermia
  • Hyperhidrosis
  • Dehydration
  • Tremor
  • Psychomotor activity increased
  • Agitation
112
Q

What are the clinical features of a patient with LSD intoxication?

A
  • Hallucinations: Visual + Auditory
  • Illusions
  • Micropsia/Macropsia
  • Synaesthesia
At higher doses, sympathomimetic effects 
•	Dilated pupils
•	Tachycardia
•	Hypertension
•	Hyperreflexia
•	Hyperthermia
113
Q

What are the clinical features of ketamine intoxication?

A
  • Hallucinations/Near-death
  • Out-of-body experience: Derealisation/Depersonalisation
  • Psychosis
  • Emergence phenomena
  • Cognitive impairment
  • Synaesthesia
  • Hypersalivation
  • Tachycardia
  • Hypertension
114
Q

What are the clinical features of magic mushrooms?

A
  • Hallucinations: Visual + Auditory
  • Illusions
  • Micropsia/Macropsia
  • Synaesthesia
  • Panic
  • Amnesia
  • Psychosis
  • Mydriasis
  • Acute stuporous state
115
Q

What is the reversal agent for benzodiazepine overdose?

A

Flumazenil

116
Q

What are the clinical features of Benzodiazepine toxidrome?

A
  • Impaired mental status: Attention; Memory; Inappropriate behaviour
  • Drowsiness
  • Slurred speech
  • Ataxia
  • Respiratory depression
  • Coma
  • Decreased deep tendon reflexes
  • Nystagmus
117
Q

What are the clinical features of cannabis intoxication?

A
  • Euphoria
  • Increased appetite
  • Sedation
  • Perceptual awareness
  • Hallucinations -> Psychosis
  • Tachycardia
  • Hypertension
  • Bronchodilation
118
Q

What questions can be used in suspected Eds?

A

Mnemonic: SCOFF Qs

Sick 
Control 
One stone 
Fat 
Food
119
Q

What does the Hip 6 bundle comprise of?

A

Analgesia

Monitoring (EWS)

Delirium screen

FBC

Iv fluids

Pressure area management

120
Q

What is the landmark for a fascia iliaca block?

A

Locate inguinal ligament

2cm inferior

2cm lateral from Femoral Artery (approx. 2/3 laterally)

Pierce two fascial compartments (fascia lata then iliaca fascia)

121
Q

What is an orbital blow out fracture?

A

Fracture in an orbital wall however orbital rim remains intact

122
Q

List 3 types of seizures.

A

Generalised

Focal

Absence

Febrile

Infantile spasms (West Syndrome)

Lennox Gastuat Syndrome (LGS)

123
Q

What are the differences between West Syndrome and Lenox-Gustaut Syndrome?

A

West Syndrome occurs in 4-8 months years old, commonly in males with salaam attacks (flexion of head, trunk and arms with extension of arms). These last 1-2 seconds and occur up to 50 times.

EEG shows hypsarrhythmia and CT shows diffuse or localised brain disease in 70%

Lenox-Gustaut Syndrome features numerous seizure types with tonic and atonic seizures. Often a background of behavioural problems, hyperactivity, agitation, aggression and autism.

EEG shows background slowing and slow spike-wave bursts. In sleep, generalised paroxysmal fast activity is seen.

124
Q

How quickly should a stroke thrombolysis be given?

A

4.5 hours from stroke symptoms

125
Q

What may contraindicate a patient to stroke thrombolysis?

A

ICH

SAH

Stroke/TBI past 3/12

Seizure at time of stroke

GI haemorrhage in past 3/52

Pregnancy

Oesophageal varices

Uncontrolled hypertension (>200/120mmHg)

126
Q

How quickly should thrombectomy be offered following a stroke?

A

Offer thrombectomy following IV thrombolysis within 6 hours of symptom onset

127
Q

What are the clinical features of an orbital blowout fracture?

A

Enophthalmos

Hypoglobus

Diplopia

Orbital emphysema

Malar region numbness (infraorbital nerve palsy)

128
Q

What is an Orthopantomogram (OPG)?

When may you use it?

A

Panoramic XR of upper and lower jaws

Look for:
Fractures
Dislocated jaw
Infection
Dentition
129
Q

How do you calculate the expected PaO2 in relation to FiO2?

A

FiO2 - 10kPa = PaO2

Thus if a patient is on 40% Oxygen, PaO2 is expected to be 30kPa

130
Q

Oxygen via a nasal cannula delivers how what FiO2 at which rate?

A

Rule of 4…

1L/min = 24%

2L/min = 28%

3L/min = 32%

4L/min = 36%

131
Q

Discuss the oxygen delivery devices and their usefulness in delivering oxygen.

A

Numerous oxygen delivery devices may be utilised: nasal cannulae, simple face masks, non-rebreathers and Venturi face masks.

Nasal cannulae deliver Oxygen between 1-4L/min with FiO2 ranging from 24-36%

Simple face mask gives a FiO2 at 40-60% at a flow-rate of 15L/min.

Reservoir mask (non-rebreather) gives flow rate of 10-15L/min at FiO2 of 60-90%.

Venturi mask gives a FiO2 at 24, 28, 35, 40 and 60%. Useful in patients at risk of carbon dioxide retention

132
Q

Outline the differences between type 1 and type 2 respiratory failure?

A

Type 1 Respiratory Failure = hypoxaemia (PaO2 <8kPa) with normocapnia

T1RF due to V/Q mismatch as volume of air in and out of lungs incongruent with perfusion. Rise in PaCO2 results in increased alveolar ventilation which blows of CO2 but not allowing adequate oxygenation

  • Pulmonary oedema
  • PE

Type 2 Respiratory Failure = hypoxaemia (<8kPa) AND hypercapnia (>6kPa)

T2RF = alveolar hypoventilation preventing patient from adequately oxygenating and eliminating CO2 from blood

  • COPD
  • Pneumonia
  • Rib fractures
  • Obesity
  • Guillain-Barré
  • Motor neurone disease
  • Opiates
  • BZD
133
Q

How do you calculate an anion gap?

A

Na+ - (Cl- and HCO3-)

134
Q

Give 3 causes of a high anion gap metabolic acidosis.

A

Mnemonic: MUD PILES

Methanol
Uraemia
DKA

Paraldehyde
Iron/Isoniazid
Lactic acidosis 
Ethylene glycol 
Salicylates

Medicine (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions