Acute Medicine Flashcards
A 60 year old man who has been in hospital for 4/52. He complains of a new sore leg. What would you like to ask?
Unilateral or bilateral?
Any trauma or break of skin?
Any associated fever?
Is it tender?
What will a DVT look like?
Unilateral
Leg swelling
Dilated superficial veins
oedema
Tenderness
Colour changes
What further examination would you like to perform if you suspect DVT?
Measure 10cm below the tibial tuberosity if you suspect DVT on each leg.
3cm+ difference is significant
What tests will you order for suspected DVT?
Doppler US of leg
D-dimers
Possible CTPA if PE suspected
What is the treatment for DVT? When should it be started?
Apixiban (straight away if suspected… don’t wait for Dgx)
Catheter-directed thrombolysis if not working
What preventions can be put in place to prevent DVT?
1) TED/Anti-Embolism Stockings
2) SCD (Sequential Compression Device)
3) DOACs
A man presents with SOB and pleuritic chest pain. What are the differential diagnosis?
PE
Pneumonia
TB
Rib Fracture
SLE
How do you decide whether a patient has a low, medium or high probability of PE?
Well’s Score > 4
Incl.
Symptoms of DVT
Tachycardia
Haemoptysis
Cancer
Immobile/Surgery
What test is used to confirm PE? Is there any contraindications to this?
CTPA
Renal Disease
Contrast Allergy?
If PE is confirmed what could be the possible underlying causes?
Underlying Malignancy
Thrombophillia
SLE
Oestrogen Therapy
Pregnancy
How do you treat a confirmed PE?
Apixiban (LMWH while awaiting results)
What is massive PE? How do we treat this?
Hypotensive or signs of R sided heart strain on echo
Thrombolysis w/ IV Alteplase
A woman presents to the Emergency Department with lip and tongue swelling following a bee sting. She is feeling breathless.
What initial assessments should be made?
A - Secure airway
B - Provide O2 if needed, wheeze/stridor? Salbutamol will help
C - IV Fluids, tachcardaic?
D - Lie patient flat to improve cerebral perfusion
E - Look for urticaria and angio-oedema
What treatment should be given in anaphylaxis?
IM Adrenaline (repeat every 5 mins)
Antihistamines (PO cetirizine)
IV Hydrocortisone
High Flow o2
IV Fluids
What are the common causes of anaphylaxis?
Drug Allergy
Food Allergy
Insect bites/stings
What is the pathophysiology of anaphylaxis?
Type 1 hypersensitivity reaction
IgE stimulates mast cells to release histamine + other pro-inflammatory mediators.
Causing vasodilation and bronchial constriction
(mast cell degranulation)
What are the potential consequences of anaphylaxis?
Cardiogenic Shock
Death
What advice should be given to a patient on discharge after anaphylaxis?
Need Allergy Action Plan
Given an epipen and shown how to use it
Avoid trigger
When would you suspect sepsis in a patient?
HR > 100
RR > 25
Sats < 95%
Temp > 38 (below 35 in elderly)
Confused
SBP < 100
What is the immediate management for sepsis?
Give fluids
Give IV abx (ceftriaxone)
Give O2
Take lactate
Take blood cultures
Take urine output
What further investigations should be carried out after the sepsis 6 has been given?
FBC
U+Es
LFTs
CRP
BM
Blood gases
CXR
Urine Dip/MCS
Lumbar puncture (meningitis)
If you are told the blood culture is growing gram -ve rods. What is the possible organism and source of infection? How would you treat this?
E coli (gastroenteritis)
Piperacillin or Tazobactam
What do we look for with head injury/suspected neurology presentation?
1) Meningism features
2) Raised ICP signs
3) Localising near signs?
4) Is patient fitting?
5) Neuromuscular weakness?
What’s the most common drug to cause headache?
GTN spray (vasodilator)
What is the main concern when a pregnant women or patient on the COCP comes to you with a headache? How can we confirm diagnosis?
Cerebral Venous Thrombosis
CT Venogram
How do we treat raised ICP?
1) Mannitol IV
2) IV Dexamethasone
3) Urgent CT Brain
4) Neuro/anaesthetics input
How do we treat a sub-arachnoid haemorrhage?
Nimodipine (Ca channel blocker)
Saline
Analgesics
How do we decide what management is needed for a stroke?
CT Brain to see if there is a bleed
NO BLEED:
Aspirin or thrombolysis w/ alteplase in the young
What drug do we give in an alcohol withdrawal seizure?
IV Pabrinex
