Acute Medicine

Question 1

alcohol withdrawal aetiology

Answer 1

in an alcohol dependent person body cannot immediately adapt to reduced ethanol conc. therefore there is an excess excitatory effect from the upregulation of NMDA receptors and downregulation of inhibitory GABA (type A) receptors

Question 2

signs of chronic or decompensated liver disease

Answer 2

caput medusa
palmar erythema
hepatic encephalopathy
hepatomegaly
jaundice
ascites

Question 3

signs of Wernicke’s encephalopathy

Answer 3

confusion
ataxia
nystagmus

Question 4

alcohol withdrawal presentation

Answer 4

minor symptoms (SNS, 6hrs)
- anxiety/agitation
- palpitations
- GI upset
- sweating/tremor

alcoholic hallucinosis (mind, 12hrs)
- hallucinations

withdrawal seizures (body, 24hrs)
- generalised tonic-clonic seizures

withdrawal delirium (systematic, 48hrs)
- delirium tremens
- severe tremour
- fever
- high BP + HR

Question 5

alcohol withdrawal Ix

Answer 5

CAGE/AUDIT-C
CIWA-AR scale

ECG
VBG
glucose (hypo)
FBC
U+E
LFT
coagulation
CT head
CXR

Question 6

alcohol withdrawal Mx

Answer 6

urgent:
benzos
CT head - head injury, cognition, seizures
treat co-existing illness

supportive:
rehydrate - IV fluid
Pabrinex - vitB, for Wernicke’s
glucose if hypo
electrolyte imbalances

manage underlying alcohol dependence long-term

Question 7

anaphylaxis aetiology

Answer 7

triggers: foods, drugs, chemicals
RF: Hx of atophy
systemic mast degranulation > vessel dilation, increase vessel permeability, bronchospasm

Question 8

anaphylaxis Ix

Answer 8

medical emergency

A-E (with reassessment)
if uncertain elevated serum tryptase and plasma histamine

Question 9

anaphylaxis presentation

Answer 9

shortness of breath
stridor
wheezing

pale and clammy
hypotension

flushing
urticaria
angio-oedema

Question 10

anaphylaxis Mx

Answer 10

call for help, lie flat, IM adrenaline

monitoring, high flow O2, IV fluid, chlorphenamine, hydrocortisone

aftercare: observe, safety net, EpiPen, refer to allergy services

Question 11

aspirin OD aetiology

Answer 11

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

Question 12

aspirin OD presentation

Answer 12

early:
tinnitus, deafness, dizziness
hyperpnoea
hyperthermia, sweating
N+V, diarrhoea

late/severe:
low BP and heart block
pulmonary oedema
low GCS and seizures

Question 13

clinical examination findings for aspirin OD

Answer 13

warm peripheries and bounding pulse
tachypnoea and hyperventilation
cardiac arrythmia
acute pulmonary oedema

Question 14

aspirin OD ix

Answer 14

ECG- arrythmia
CBG, ABG

plasma salicylate concentration
plasma paracetamol conc
FBC, LFT, U&Es, coagulation

CT head

Question 15

aspirin OD mx

Answer 15

supportive
consider ICU
consider GI tract decontamination with charcoal

Question 16

paracetamol OD aetiology

Answer 16

OD > 150mg/kg

Question 17

paracetamol OD presentation

Answer 17

<24hrs
often asymptomatic
mild n+v and lethargy

24-72hrs
RUQ pain
vomiting
hepatomegaly

> 72hrs
acute liver failure (jaundice)

Question 18

paracetamol OD ix

Answer 18

ABG - lactic acidosis bad sign
urinalysis - haematuria or proteinuria indicate kidney failure

serum paracetamol concentration
LFT
prothrombin time/INR
blood glucose
U&E- raised creatinine
FBC - leucocytosis, anaemia, thrombocytopenia

Question 19

paracetamol OD Mx

Answer 19

supportive care according to symptoms

consider:
IV N-acetylcysteine
active charcoal if presenting within an hour of ingestion

Question 20

opiate OD presentation

Answer 20

early:
reduced consciousness
respiratory distress
miosis
bradycardia, hypotension

late/severe:
low GCS
coma

Question 21

opiate OD Ix

Answer 21

CBG, ABG

plasma paracetamol concentration
FBC
U+E
LFT

CT head

Question 22

opiate OD mx

Answer 22

with cardiac arrest:
-CPR and advanced life support
-consider IV naloxone (not helpful if pulseless)

no cardiac arrest:
- first ventilation then IV naloxone