Acute medicine and critical care

Question 1

Gas gangrene causitive organism

Answer 1

Clostridium perfringens

Question 2

Indication for ECMO post drowning

Answer 2

Persistent hypothermia if cold water, reasonable chance for neurological recovery or lack of response to conventional/high frequency ventilation

Question 3

Management of thyrotoxic storm

Answer 3

Fluids, beta blockers and carbimazole

Question 4

Investigation for rhabdomyolysis

Answer 4

Creatine kinase. Often caused bny long lie and can cause kidney failure

Question 5

Most important treatment for broad complex tachycardia if unstable

Answer 5

Sedate and synchronised DC cardioversion (200, 300 and 360J)

Question 6

Initial management step in hyperkalaemia (plus next steps)

Answer 6

10ml 10% calcium gluconate slow IV injection. Then 5mg salbutomol, 10 units actrapid and 50% dextrose.

Question 7

ECG signs of hyperkalaemia

Answer 7

Peaked T waves, PR-segment lengthening, P-waves widening/flattening and then disappearing, broad QRS

Question 8

Management of refractory hyperkalaemia

Answer 8

Senior input: possible dialysis or bicarbonate

Question 9

Drugs in anaphylaxis

Answer 9

0.5mg of 1 in 1000 adrenaline (0.5ml) IM. 200mg hydrocortisone IV and 10mg chlorphenamine IM

Question 10

SIRS criteria

Answer 10

2 of: fever >38.0°C or hypothermia <36.0°C, tachycardia >90 beats/minute, tachypnea >20 breaths/minute, leucocytosis >12109/l or leucopoenia <4109/l

Question 11

Paediatric anaphylaxis adrenaline doses

Answer 11

0-6 years - 150mcg
6-12 years - 300mcg
over 12 - adult dose (500mcg)

Question 12

Differentiating subdural and extradural haemorrhage on CT

Answer 12

Extra dural is limited by the suture lines, subdural is not

Question 13

Which class of BP tablets can cause angio-oedema?

Answer 13

ACE inhibitors - via kininase ii inhibition leading to Bradykinin build up. 5x more common in african americans

Question 14

Criteria for CT in head injury

Answer 14

GCS less than 13 antime or 13 or 14 2h post injury
Focal neurological deficit
Suspect open/depressed fracture or sign basal skull fracture
Post traumatic seizure
Vomiting more than once
LOC + (>65yo, coagulopathy, dangerous mechanism or anterograde amnesia over 30 mins)

Question 15

Signs of base of skull fracture

Answer 15

Haemotympanum, panda eyes, CSF leak through nose/ears or Battle’s sign (bruising over mastoid process)

Question 16

Reversal agent for benzos

Answer 16

Flumazenil

Question 17

What is atropine?

Answer 17

Muscarinic antagonist used in bradycardia that is causing haemodynamic compromise

Question 18

What is acute respiratory distress syndrome?

Answer 18

Lung damage and release of inflammatory mediators causing increased capiliary permeability and non-cardiogenic pulmonary oedema, often accompanied by multi-organ failure.

Question 19

What is the Parkland formula?

Answer 19

Calculating necessary fluids for patient with burns
4ml x %SA x weight in kg
Give 50% in first 8 hours since injury (would be over 7 if started an hour after injury for example)

Question 20

Indictations for thrombolysis in PE

Answer 20

SBP <90 for >15 mins of fluid resus
>40 drop in baseline SBP for>15 mins fluid resus
Imminent or actual cardiac arrest
Presence of right heart thrombus
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