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Medical School > Acute Medicine > Flashcards

Acute Medicine Flashcards

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USMLE® Step 1 flashcards
1
Q

Superficial epidermal burns

  1. Initial advice
  2. When to seek further treatment
  3. Important prophylaxis if deeper
  4. Important blood test if smoke inhalation
A
  1. Cool bath / shower, topical emollients, cold compress, simple analgesics
  2. Blister formation - may indicate further dermal injury
  3. Tetanus
  4. Carboxyhaemaglobin
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2
Q

Cardiac arrest

  1. Rhythm disturbances classed as cardiac arrest
  2. Bedside tests
  3. Shockable rhythms
  4. Adrenaline - method and frequency
  5. Ant-arrhythmic to consider
  6. Frequency to check rhythm
  7. ROSC management
  8. Reversible causes of CA - 4Hs and 4 Ts
A
  1. VF, pulseless VT, PEA, asystole
  2. ABG (pH, lactate, electrolytes), lactate, troponin, glucose
  3. Pulseless VT, VF
  4. IV every 3-5 minutes after 3 shocks, or 2mg diluted through ET tube
  5. Amiodarone
  6. Every 2 minutes
  7. ABCDE, SpO2 94-98%, 12 lead ECG, treat precipitating cause
  8. H (hypothermia, hypovolaemia, hypoxia, hypo/hyperkalaemia), T(thrombus, tamponade, tension, toxins)
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3
Q

Hypoglycaemic episode

  1. 1st line
  2. 2nd line
  3. Causes
A
  1. Oral glucose - if alert (tablets if can swallow)
  2. IV glucose 20% in saline (if IV access and drowsy), IM glucagon - no IV access
  3. Insulin, alcohol, liver disease, Addison’s
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4
Q

Meningitis

  1. Differential diagnoses (3)
  2. Kernig’s sign - what it is, + other cause
  3. 1st line investigations (bloods, other, imaging)
  4. Investigation to avoid if septicaemic
  5. Antibiotics < 3 months for meningitis
  6. Antibiotics > 3 months-50 years for meningitis
  7. Add what if recent travel / prolonged or multiple ABX exposure
  8. Antibiotics for meningococcal disease
  9. Listeria antibiotics
  10. Drug to avoid neurological sequelae
  11. Bacterial LP (white cell, glucose, protein)
  12. Viral LP (white cell, glucose, protein)
  13. TB LP (appearance, white cell, glucose, protein)
A
  1. Encephalitis, septicaemia, SAH
  2. Pain on passive knee extension when hip is flexed, SAH
  3. Culture, FBC, CRP, U+E, Ca2+, Mg2+, glucose, coagulation profile, CT head, LP
  4. LP
  5. IV cefotaxime + amoxicillin/ampicillin
  6. IV ceftriaxone
  7. IV vancomycin
  8. Ampicillin
  9. IV amoxicillin + gentamicin
  10. Dexamethasone
  11. Polymorph, glucose <1/2 plasma, protein level >1.5
  12. Mononuclear (lymphocytes), glucose >1/2 plasma, protein level <1
  13. Fibrin web, mononuclear (lymphocytes) glucose <1/2 plasma, protein level >1.5
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5
Q

Encephalitis

  1. When to suspect
  2. Investigations
  3. LP results
  4. Common organism
  5. Common area of brain affected + subsequent signs
  6. CT changes seen
  7. Management
A
  1. Abnormal behaviour, reduced consciousness, focal neurological signs PRECEEDED BY INFECTIOUS ILLNESS
  2. Urine dip, culture, CT, LP (send for PCR)
  3. Lymphocytosis, elevated protein
  4. HSV 1
  5. Temporal lobe, so e.g. aphasia
  6. Medial temporal and inferior frontal changes (e.g. petechial haemorrhages) (normal in 30%)
  7. IV aciclovir
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6
Q

Poisoning

  1. Bloods
  2. Monitoring

Paracetamol overdose

  1. 1st line if presenting <1 hours post-OD
  2. When should blood paracetamol level be taken
  3. Treatment if levels above the treatment line and stable and OD <12 hours ago
  4. Day after OD, bloods
  5. Treatment if unsure when OD happened/staggered dose
  6. NAC - side effects
A
  1. VBG, LFT, INR, U+E, glucose, FBC, paracetamol/salicyclate levels, toxicology screen
  2. Vitals, ECG, urine output
  3. Activated charcoal
  4. 4 hours post-ingestion
  5. N-acetylcysteine - IV with dextrose after level
  6. INR, U+E, LFTs
  7. Give n-acetylcysteine without waiting for levels
  8. Hypoglycaemia, bronchospasm, shock, vomiting
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7
Q

Maintenance fluids

  1. Calculation - fluid requirements
  2. Potassium requirements
  3. Glucose requirements
  4. Simple maintenance fluid prescribing
A
  1. 30ml/kg/24hrs, then work out how many ml per hour
  2. 1 mmol/kg/day of potassium
  3. 50-100 g/day of glucose
  4. 1 saline, 2 dextrose, each with 20mmol of potassium
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8
Q

NSTEMI

  1. Risk stratification tool
A
  1. GRACE
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9
Q

Anaphylaxis

  1. 12+ adrenaline dose
  2. 12+ other medications
  3. 6-12 management
  4. 0.6-6 management
A
  1. 1:1000 0.5ml (500 micrograms) IM
  2. 10mg chlorphenamine, 200mg hydrocortisone, 5mg nebulised salbutamol
  3. 0.3ml A, 5mg C, 100mg H, 5mg S
  4. 0.15 A, 2.5mg C, 50mg H, 2.5mg S
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10
Q

Head injury

  1. CT scan (within 1 hour) criteria
  2. Basal skull fracture signs

Extradural haematoma

  1. Location
  2. Cause
  3. Presentation

Subdural haematoma

  1. Location
  2. Presentation
  3. Risk factors (3)
  4. Raised ICP - medical management (2)
A
  1. GCS <3 initially, GCS <15 after 2 hours, suspected open or depressed skull fracture, any sign of basal skull fracture, post-traumatic seizure, 2+ vomiting, focal neurological deficit
  2. Haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign
  3. Arterial bleed between dura and skull
  4. Temporal bone fracture causing rupture of the middle meningeal artery
  5. Quicker onset than subdural, raised ICP features, potentially lucid interval
  6. Venous bleed of outermost meninges layer
  7. Little while after a fall, become drowsy, slow onset of symptoms
  8. Old age, alcoholism, anticoagulation
  9. Mannitol, furosemide
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11
Q

GI bleed

  1. Initial management
  2. Initial bloods
  3. Fluid management
  4. Upper GI immediate investigation
  5. If variceal bleed identified, give
A
  1. Protect airway, NBM, 2 large bore cannula, catheterise, observations every 15 mins
  2. Coagulation, G+S and cross match
  3. Normal saline fast until blood arrives, consider FFP for low platelets, correct coagulopathy
  4. OGD
  5. Broad spectrum antibiotics, terlipressin
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12
Q

Status epilepticus

  1. Bloods
  2. Bedside tests
  3. Others to consider
  4. Initial management
  5. Further management if no response
  6. Definitive management
  7. If first presentation seizure, what is likely
A
  1. FBC, U+E, LFT, glucose, lactate, VBG, CRP, Ca2+
  2. Urine dip/culture, observations, ECG
  3. Toxicology screen, CT, EEG
  4. ABCDE, lorazepam (2-4mg slow IV bolus, can give another dose in 10 minutes) or diazepam (rectal)
  5. Phenytoin (IV infusion), thiamine (if ? alcohol), 50ml of 20% glucose (if hypo), treat acidosis/hypotension
  6. General anaesthetic
  7. Structural brain abnormality >50%
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13
Q

Shock

  1. Definition
  2. Mean arterial pressure - calculation
  3. Cardiac output - calculation
  4. Inadequate CO - causes (2 broad)
  5. SVR loss - cause (4)
A
  1. Circulatory failure resulting in inadequate organ perfusion
  2. Cardiac output (CO) x Systemic vascular resistance (SVR)
  3. Heart rate x Stroke volume
  4. Hypovolaemia (bleeding / fluid loss), pump failure - (arrhythmia, ACS, valve failure)
  5. Sepsis, anaphylaxis, neurogenic, endocrine (e.g. Addison’s)
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14
Q

Drugs

Ecstasy

  1. Presentation
  2. Temperature management if supportive fails

Cocaine

  1. Mechanism
  2. Cardiovascular effects
  3. ECG changes
  4. Neurological effects
  5. Systemic effects
  6. If abdominal pain, consider
  7. 1st line if toxic levels
A
  1. Agitation, anxiety, confusion and ataxia, tachycardia, HTN, low Na+, hyperthermia, rhabdomyolysis
  2. Dantrolene
  3. Blocks uptake of dopamine, noradrenaline and serotonin
  4. MI, abnormal HR, HTN, aortic dissection
  5. Ischaemic changes, wide QRS, prolonged QT
  6. Seizures, mydriasis, hypertonia, hyperreflexia
  7. Hyperthermia, metabolic acidosis, rhabdomyolysis
  8. Ischaemic colitis
  9. Benzodiazipines
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15
Q

Opioid overdose

  1. Presentation
  2. 1st line management
  3. Complications
A
  1. Pinpoint pupils, drowsiness, rhinorrhoea, watering eyes, yawning, track marks, respiratory depression
  2. Naloxone 400 micrograms IV
  3. Viral infection, infective endocarditis, VTE
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16
Q

Pupil changes

  1. Unilateral dilation of one pupil and sluggish light response / fixed
  2. Bilateral dilated + sluggish or fixed
  3. Bilaterally constricted
  4. Unilaterally constricted
A
  1. 3rd nerve palsy due to tentorial herniation
  2. Poor CNS perfusion, bilateral 3rd nerve palsy
  3. Opiates, pontine lesions, metabolic encephalopathy
  4. Sympathetic pathway disruption
17
Q

DKA - acute management (‘PANICS’)

A

Potassium - measure hourly
Acidosis - check venous pH and ketone levels
Normal saline - bolus if BP <90 or 1L in 1st hr
Insulin infusion - 0.1 units/kg/hr
Catheter and culture - urine and bloods
Stomach aspiration if drowsy

Medical School (28 decks)

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