Acute Medicine Presentations Flashcards
In a patient who is unresponsive, what must we always consider?
1 - heart attack
2 - stroke
3 - cardiac arrest
4 - PE
3 - cardiac arrest
- heart stops beating properly
- no beating heart stops blood to the brain and we collpase
If we suspect a cardiac arrest, which of the following must we do immediately?
1 - Assess self risk and shout for help
2 - ABC
3 - Call 999 or 222 (in hospital( on mobile phone on speaker
4 - Start CPR
5 - enlist help from others and request defibrillator
6 - all of the above
6 - all of the above
What is the effective chest compressions to rescue breaths (if applicable) rate?
1 - 20:5
2 - 30:2
3 - 30:5
4 - 40:10
2 - 30:2
- 30 compressions
- 2 rescue breaths
Which 2 of the following are shockable rhythms using a defibrillator?
1 - Ventricular fibrillation (eg acute MI)
2 - Ventricular tachycardia (eg myocardial scar)
3 - asystole
4 - pulseless electrical activity
1 - Ventricular fibrillation (eg acute MI)
2 - Ventricular tachycardia (eg myocardial scar)
- 3 and 4 are unshockable
Which of the following is NOT one of the 4 Hs responsible for a Reversible Causes of Cardiac Arrest?
1 - Hypoxia
2 - Hypertension
3 - Hypovolaemia
4 - Hypokalaemia (low K+) / (h)Acidosis
5 - Hypothermia
2 - Hypertension
Which of the following is NOT one of the 4 Ts responsible for a Reversible Causes of Cardiac Arrest?
1 -Thrombus
2 - Tension pneumothorax
(Cardiac)
3 - Tamponade
4 - Toxins (eg sepsis, drugs)
5 - Temperature
5 - Temperature
If you are performing CPR and a patient is unshockable (asystole or pulseless electrical activity) what should you then do?
1 - give a 2nd shock
2 - seek senior advice
3 - continue CPR
4 - swap defibrillator
3 - continue CPR
What should be given to patients in a cardiac arrest every 3-5 minutes?
1 - beta blockers
2 - adrenaline
3 - amiodarone
4 - aspirin
2 - adrenaline
- ideally via IV
In a cardiac arrest, if a reversible cause can be identified, which of the following drugs can be administered following 3 separate shocks?
1 - beta blockers
2 - adrenaline
3 - amiodarone
4 - aspirin
3 - amiodarone
- given via IV
- blocks Na+, K+ and Ca2+ channels (reduces ability to depolarise)
- blocks alpha and beta receptors
- interferes with AV node conduction
- essentially tries to reset the heart
What is the adult dose used on a defibrillator?
1 - 100J
2 - 150J
3 - 250J
4 - 300J
2 - 150J
- can be increased to 200J
The image here illustrate an rhythm from a patient on a defibrillator. What rhythm is in the bottom image?
1 - VF
2 - asystole
3 - VT
4 - Pulseless electrical activity
3 - VT
- broad QRS
The image here illustrate an rhythm from a patient on a defibrillator. What rhythm is in the bottom image?
1 - VF
2 - asystole
3 - VT
4 - Pulseless electrical activity
1 - VF
- narrow QRS
What is a respiratory arrest?
1 - patient heart stops beating
2 - lack of blood to midbrain
3 - cessation of breathing
4 - breathing is dysfunctional
3 - cessation of breathing
- this is a medical emergency
Respiratory arrest is the cessation of breathing. Which of the following can cause respiratory arrest?
1 - asthma or COPD exacerbation
2 - acute on chronic respiratory failure
3 - obstruction (foreign body)
4 - respiratory depressants (opioids)
5 - neuromuscular failure (Guillain Barre, myasthenia gravis)
6 - secondary to cardiac arrest
7 - all of the above
7 - all of the above
What is Dyspnoea?
1 - awareness of difficulty to breathe
2 - rapid breathing
3 - slow breathing
4 - irregular breathing
1 - awareness of difficulty to breathe
What is Tachypnea?
1 - awareness of difficulty to breathe
2 - rapid breathing
3 - slow breathing
4 - irregular breathing
2 - rapid breathing
- >20 breaths per minute
What is Hyperpnoea?
1 - awareness of difficulty to breathe
2 - rapid breathing
3 - slow breathing
4 - increased volume of air inhaled (could be exercise or illness)
4 - increased volume of air inhaled (could be exercise or illness)
What is Orthopnoea?
1 - awareness of difficulty to breathe
2 - rapid breathing
3 - breathlessness when lying flat
4 - increased volume of air inhaled (could be exercise or illness)
3 - breathlessness when lying flat
What is Paroxysmal nocturnal dyspnoea?
1 - sudden onset of dyspnoea at night that wakes patient
2 - rapid breathing
3 - breathlessness when lying flat
4 - increased volume of air inhaled (could be exercise or illness)
1 - sudden onset of dyspnoea at night that wakes patient
What is Cheyne Stokes?
1 - sudden onset of dyspnoea at night that wakes patient
2 - abnormal breathing that gets deeper and faster
3 - breathlessness when lying flat
4 - increased volume of air inhaled (could be exercise or illness)
2 - abnormal breathing that gets deeper and faster
- caused by issue in brainstem respiratory centres
Which 2 of the following, would present with acute Pleuritic Chest Pain?
1 - Pneumothorax
2 - Pulmonary embolus
3 - Pneumonia
4 - Musculoskeletal pain
5 - Lung cancer
1 - Pneumothorax
2 - Pulmonary embolus
What is a pneumothorax?
1 - air in the mediastinum
2 - air in the pleural space
3 - air in the trachea
4 - air in the pericardial sac
2 - air in the pleural space
- medical emergency
- can causes a mediastinal shift resulting in a Cardiac Arrest
Which of the following is a risk factor for a primary pneumothorax?
1 - gender
2 - asthma
3 - smoking
4 - tall/thin
5 - collagen vascular diseases (Marfans)
6 - all of the above
6 - all of the above
- reoccurrence risk of 54% within 4 years
Is a primary or secondary pneumothorax more serious?
- secondary
- normally caused by underlying disease, such as COPD, Pulmonary fibrosis or Cystic fibrosis
What is a tension pneumothorax?
1 - air in pleural space is = to atmospheric air
2 - air in pleural space is < atmospheric air
3 - air in pleural space is > to atmospheric air
3 - air in pleural space is > to atmospheric air
- air cannot escape
- lungs and mediastinum are compressed
- reduces venous return and cardiac output
Which of the following is NOT a sign of a pneumothorax?
1 - dyspnoea/tachypnoea (↑ RR)
2 - tracheal deviation
3 - decreased air entry on the side of the pneumothorax
4 - hyper-resonance on percussion
2 - tracheal deviation
- present in a tension pneumothorax
Which of the following is NOT a sign of a tension pneumothorax?
1 - Silent chest /hyper-resonance
2 - Mediastinal shift away from side of pneumothorax (tracheal deviation, displaced apex beat)
3 - Collapse
4 - Dyspnoea/tachypnoea (↑ RR)
5 - Cardiac Arrest
4 - Dyspnoea/tachypnoea (↑ RR)
If a pneumothorax is suspected, which of the following imaging is most commonly performed?
1 - chest X-ray
2 - MRI
3 - high resolution chest CT
4 - ultrasound
1 - chest X-ray
In a patient with a pneumothorax, what would we expect to see on the arterial blood gas?
1 - >paO2
2 - <paO2
3 - >paCO2
4 - <PaCO2
2 - <paO2
Type 1 respiratory failure is hypoxia due to lack of O2 to lungs. What is the cut off using an ABG in kPa?
1 - <12 kPa
2 - <10 kPa
3 - <8 kPa
4 - <5 kPa
3 - <8 kPa
Type 2 respiratory failure is hypercapnia (high CO2) due to an inability of the lungs to remove the CO2. What is the cut off using an ABG in kPa?
1 - >5 kPa
2 - >6 kPa
3 - <10 kPa
4 - <5 kPa
2 - >6 kPa
- can also see a reduction in paO2
Patients can be discharged if they have a small pneumothorax if the following are true, EXCEPT which one?
1 - <50 y/o
2 - symptomatic
3 - not hypoxic
4 - all of the above
2 - symptomatic
- patients must be relatively asymptomatic
If a patient has a small pneumothorax with symptoms, are they typically discharged?
- no
- monitored with 10L of O2
If a patient has a pneumothorax >2cm what is typically done 1st?
1 - chest drain
2 - antibiotics
3 - simple aspiration
4 - all of the above in this order
3 - simple aspiration
- this can be done up to 2 times
If a patient has a large recurrent pneumothorax what is typically done?
1 - chest drain
2 - antibiotics
3 - simple aspiration
4 - wait and see
1 - chest drain
In a patient who has had a pneumothorax, which of the following should they be advised?
1 - no air flight
2 - no diving until asymptomatic 3 - smoking cessation
4 - all of the above
4 - all of the above
Which of the following is NOT an indication for a chest drain insertion?
1 - primary pneumothorax <2cm
2 - secondary pneumothorax
3 - bilateral pneumothorax
4 - traumatic pneumothorax
5 - Rib fracture / haemothorax
1 - primary pneumothorax <2cm
- generally for large pneumothorax or recurrent small pneumothorax not responding to treatment
Tension pneumothorax is a clinical diagnosis. If this is confirmed, what must be done immediately?
1 - chest X-ray
2 - high resolution chest CT
3 - chest aspiration
4 - fluids and analgesia
3 - chest aspiration
- following be intercostal tube drainage at 2nd intercostal space in the anterior axillary line
What is the definition of a pulmonary embolism?
1 - thrombosis blocking pulmonary vein
2 - thrombosis blocking pulmonary artery
3 - thrombosis blocking tricuspid valve
4 - thrombosis blocking left coronary artery
2 - thrombosis blocking pulmonary artery
- part of thromboembolic disease (TED)
- clot arises from the deep veins in the calf/calves (DVT)
Which of the following is NOT a clinical presentation of a PE?
1 - Acute breathlessness
2 - Shoulder pain
3 - Cough/haemoptysis
4 - Hypotension
5 - Collapse
6 - Cardiac arrest
2 - Shoulder pain
- typically pleuritic chest pain
Which of the following physical signs could indicate a PE?
1 - Tachycardia
2 - Tachypnoea
3 - Raised JVP
4 - RV heave (pulmonary hypertension)
5 - Accentuated P2 (pulmonary hypertension)
6 - Hypoxia (only in 60%)
7 - Pleural rub
8 - Deep vein thrombosis (DVT)
9 - all of the above
9 - all of the above
Which of the following is NOT part of Virchows triad?
1 - Stasis
2 - AF
3 - Hypercoagulability
4 - Endothelial damage
2 - AF
Which scoring tool can be used to assess the risk of a venous thromboembolism (VTE)?
1 - Modified Wells score
2 - GURB-65 score
3 - Modified Glasgow score
4 - CHADS2 score
1 - Modified Wells score
Which scoring system should be used to assess the risk of a pulmonary embolism?
1 - Modified Wells score
2 - Pulmonary Embolus Severity Index
3 - Modified Glasgow score
4 - CHADS2 score
2 - Pulmonary Embolus Severity Index
If we suspect a patient has a PE, all of the following should be done EXCEPT which one?
1 - CXR
2 - ECG
3 - ABGs
4 - D-dimer
5 - troponin
6 - CT pulmonary angiogram
7 - Echocardiogram
8 Doppler ultrasound of lower limbs
5 - troponin
- typically measured of MI is suspected
- Uses 11 clinical criteria
- Predicts 30 day outcome
In a patient with a suspected PE, all of the following should be performed EXCEPT which one?
1 - ABC
2 - Oxygen
3 - Analgesia
4 - Low molecular weight heparin (LMWH)
5 - anticoagulant once PE confirmed
6 - tissue plasminogen activator (r-tPA)
6 - tissue plasminogen activator (r-tPA)
- only performed if PE is serious and admitted to ITU
Anaphylaxis is a severe and potentially life-threatening reaction to a trigger, often an allergy (peanuts, seafood, bee and wasp stings, medication etc) that is typically a differential for breathlessness. Which cell is responsible for releasing a molecule that induces vasodilation and increase vascular permeability in anaphylaxis?
1 - macrophages
2 - mast cells
3 - B cells
4 - neutrophils
2 - mast cells
Anaphylaxis is a severe and potentially life-threatening reaction to a trigger, often an allergy (peanuts, seafood, bee and wasp stings, medication etc) that is typically a differential for breathlessness. Mast cells release a molecule that induces vasodilation and increase vascular permeability in anaphylaxis. What molecule is released by mast cells to cause this?
1 - histamine
2 - CRP
3 - adrenaline
4 - nitrates
1 - histamine
- causes acute breathlessness, upper airway oedema, bronchospasm and obstruction
Which of the following are clinical presentations of anaphylaxis?
1 - feeling faintness
2 - feeling of impending doom
3 - flushing
4 - itchy rash (urticaria or erythema)
5 - angioedema: facial swelling extending to upper airway
bronchoconstriction
Vomiting and diarrhoea
6 - hypovolaemia and cardiovascular collapse
7 - all of the above
7 - all of the above
In a patient who is anaphylactic we would do the usual ABC and put them on high flow oxygen. We then need to prescribe all of the following EXCEPT?
1 - Adrenaline (1:1000 1 mg/ml IM in adults)
2 - IV fluids: 0.5 L – 1.0 L of NaC l/ Hartmann’s (avoid colloids)
3 - aspirin
4 - Inhaled ß2 agonist (salbutamol)
3 - aspirin
- always refer to anaphylaxis guide
