Acute Medicine and Emergencies

Question 1

How is anaphylaxis managed?

Answer 1

• ABC assessment
• IM adrenaline: adults and children >12 years 500 micrograms
• Establish airway and give oxygen
• If no response after 5 minutes: repeat IM adrenaline and IV fluid challenge

Question 2

How can an acute exacerbation of asthma in children be managed?

Answer 2

• Oxygen if sats <94%
• SABA
• Oral prednisolone
• Nebulised ipratropium bromide +/- magnesium sulphate
• Aminophylline
• Possible transfer to HDU/ICU

Question 3

What dose of IM adrenaline would you give a child 6-12 years old for anaphylaxis?

Answer 3

300 micrograms

Question 4

What dose of IM adrenaline would you give a child 6 months to 6 years?

Answer 4

150 micrograms

Question 5

What dose of IM adrenaline would you give a child <6 months?

Answer 5

100-150 micrograms

Question 6

How can DKA be managed in children?

Answer 6

• 10ml/kg 0.9% NaCl bolus
• Give maintenance fluids (without glucose until BM is <14mmol)
• IV insulin 0.05-1 units/kg/hr

Question 7

Which drugs can be used in cardiac arrest?

Answer 7

• IV Adrenaline 1mg of 1 in 10,000 (100 micrograms/ml)

- IV amiodarone 300mg for VF or pulseless VT

Question 8

Which antibiotics would you give a patient with sepsis?

Answer 8

• Amoxicillin
• Metronidazole
• Gentamicin

Question 9

Which drug is used to treat an opiate overdose?

Answer 9

Naloxone (initially 400 micrograms, then 800 micrograms for another two doses)

Question 10

Which drug is used to treat paracetamol overdose and how is it used?

Answer 10

N-acetylcysteine
1st hour: 150mg/kg
Next four hours: 50mg/kg
Next sixteen hours: 100mg/kg

Question 11

How does aspirin (salicylate) overdose present?

Answer 11

• Nausea and vomiting
• Tinnitus
• Lethargy or dizziness
• Dehydration
• Sweating, bounding pulse, increased respiratory rate
• Acid-base disturbance
• Changes in blood sugar

Question 12

How can aspirin overdose be managed?

Answer 12

• Activated charcoal
• Aggressive rehydration
• Sodium bicarbonate
• Haemodialysis
• Mechanical ventilation

Question 13

How can TCA overdose be managed?

Answer 13

• Activated charcoal or gastric lavage

- Sodium bicarbonate

Question 14

How can acute alcohol withdrawal be treated?

Answer 14

• Benzodiazepines
• Carbamazepine
• Clomethiazole
• Chlordiazepoxide
• Thiamine

Question 15

Which deficiency causes congenital adrenal hyperplasia ?

Answer 15

21-hydroxylase deficiency

Question 16

How does Addison’s disease present?

Answer 16

• Weakness, fatigue, anorexia and weight loss
• Skin pigmentation or vitlligo
• Hypotension
• Vomiting or diarrhoea
• Salt craving
• Postural symptoms
• Hypotension
• Unexplained hypoglycaemia
• Depression
• Weight loss

Question 17

Which investigations can be used to diagnose adrenal insufficiency?

Answer 17

• Routine bloods
• Random cortisol
• Synacthen test

Question 18

How is adrenal insufficiency managed?

Answer 18

• Hydrocortisone (split into two doses)

- Fludrocortisone

Question 19

What would the blood results show in someone with SIADH

Answer 19

• Low sodium

- Low plasma osmolality

Question 20

What would the urine results show in someone with SIADH?

Answer 20

• Raised urine osmolality

- Raised urine sodium

Question 21

How can SIADH be managed?

Answer 21

• Fluid restriction
• Tolvaptan
• Demeclocycline

Question 22

How can hyperkalaemia be managed

Answer 22

Calcium gluconate

-Insulin or salbutamol

Question 23

How can hypercalcaemia be managed?

Answer 23

• IV 0.9% saline
• IV bisphosphonates
• Other therapies (calcitonin, calcimimetics etc.)

Question 24

How can hypocalcaemia be managed?

Answer 24

Calcium gluconate

Question 25

How can hypomagnesaemia be managed?

Answer 25

Magnesium sulphate IV or oral magnesium glycerophosphate

Question 26

How can hypermagnesaemia be managed?

Answer 26

Calcium gluconate