Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AKT Prep > Acute Presentations > Flashcards

Acute Presentations Flashcards

1
Q

What defines a moderate asthma exacerbation?

A

PEFR more than 50–75% best
Normal speech
No features severe or life threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What defines a severe asthma exacerbation?

A

Any of: PEFR 33–50% best or predicted
RR > 25 (if over 12 yrs)
Pulse > 110 (if over 12 yrs)
Unable to complete sentences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What defines a life threatening asthma exacerbation?

A

Any of: PEFR less than 33%
Sats <92%
Exhaustion/ poor effort/ silent chest
Cyanosis
Altered consciousness/ confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the dose/ duration of oral steroid given to an acute asthma exacerbation for:
a) A 26 year old
b) An 8 year old
c) A 3 year old

A

A) 40-50mg for 5 days (all over 12’s)
B) 30-40mg for 3 days (6-12yrs)
C) 20mg for 3 days (2-5yrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A patient has a moderate asthma exacerbation with no adverse features. What options do you have for steroids?

A

1) Oral steroid
2) Consider advising quadrupling inhaled corticosteroid (ICS) at the onset of an asthma attack and for up to 14 days
(Better option for less severe and those who may not be adherent to their ICS if you feel they will comply)
- Needs to be ICS alone (not combo) and not helpful in those who are compliant with their ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

30y patient presents with an asthma exacerbation, PEFR is 60% normal, RR is 30 and sats are 95%.
A) What category exacerbation is this?
B) Immediate management?
C) Does this patient need hosptial?

A

A) Severe (RR>30)
B) Nebulisers
C) All patients who have any features of severe asthma post nebuliser would need to go to hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 18 year old female asthmatic presents to you. Her peak flow is 85% of her best last year. According to latest guidance how would you define her severity?

A

Normal variation
(Moderate is 50-75%, as above this normal varient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name 3 presenting symptoms and 3 signs of otitis externa?

A

Syx: Ear pain, tragus or pinna pain, discharge, itch of canal, (hearing loss, less common)

Signs: Tender tragus/ pinna, ear canal red/ oedematous/ debris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 3 features that would make you suspicious of malignant otitis externa?

A

Unremitting, disproportionate ear pain
Profound conductive hearing loss
Systemically unwell/ fever
Vertigo
Facial nerve palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What management advice should be given to a patient with acute otitis externa (3)

A

Clean/ dry swab, no cotton buds, don’t swim 10days
7-14 days of acetic acid 2% ear drops (with steroid+neomycin = otomise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the expected duration of acute otitis externa and how is treatment failure managed?

A

Should improve within 2-3 days of tx, should resolve in 2 weeks

Consider swab, swapping spray to drops or vice versa, oral ABx, aural toilet (dry swabbing or ear irrigation if can visualize TM and no immunocompromise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

You suspect a patient has had a TIA, what is the most appropriate management step if the TIA symptoms were:
A) 3 days ago
B) 8 days ago

A

A) Aspirin 300mg and assessment/ investigation in 24 hours (all who have TIA <7 days)

B) Refer for assessment/ ix within 7 days (for all who’s TIA symptoms were over 7 days ago)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is first line treatment for a child with suspected balanitis?

A

Advise cleaning regularly, don’t use soap, don’t try to retract foreskin if not back

Topical clotimazole (+/- hydrocortisone) 2-3x daily for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is first line treatment for an adult with suspected balanitis?

A

Advise cleaning regularly, don’t use soap, don’t try to retract foreskin if not back

Topical clotimazole (+/- hydrocortisone) 2-3x daily for 14 days

Can also use oral fluconazole 150 mg as a single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A 20year old adult patient is struggling with recurrent thrush and phimosis, he is not able to retract back his foreskin at all. Along with oral fluconazole, what is the most appropriate mx option?

A

Hydrocortisone 1% cream (for the phimosis, 2-4 weeks)
+ topical clotrimazole/ miconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the most common symptoms of acute sinusitis?

A

Facial discomfort/ fullness (can be unilateral, worse bending forward)
Nasal obstruction
Decreased smell

+Headache/ fatigue/ cough/ fullness in ears/ halitosis/ dental pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long does acute sinusitis usually last? When should prescriptions be considered?

A

Usually around 2.5 weeks, up to 4 weeks

If ongoing longer than 10 days:
-Consider high dose nasal corticosteroid for 14 days,
or if symptoms over 10 days can consider ABx (PenV) although ABx unlikely to help.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A patient presents as chronic sinusitus, what are the medical management options?

A

Nasal steroid (8-12weeks minimum, ensure proper use)
Consider antihistamines if allergic component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Patient presents with otitis externa, what are first two lines management?

A

Moderate: Acetic acid 2%- 1 spray TDS for 7/7
Moderate: Neomycin with dextamethasone + acetic acid (Otomise) 1 spray TDS 7/7

If systemically unwell, signs infection outside the ear then oral fluclox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 2ww criteria to refer to upper GI for suspected cancer?

A

Dysphagia (any age)
Age over 55 + weight loss and new:
- Upper abdominal pain
- Reflux
- Dyspepsia

(Stomach and oesophageal cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A 42 year old man presents with jaundice. Which NICE 2ww criteria is relevant to his presenation?

A

Pancreatic cancer 2ww:
Anyone over 40 presenting with jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A patient presents with CTS, what are your management options?

A

Lifestyle (avoid repetative movements regular breaks, workplace assessments)

6 week trial of conservative treatments (lifestyle + painkillers i.e. naproxen)
- Single corticosteroid injection can be considered

Then refer to specialist service

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the usual presentation of scarlet fever?

A

Initial non specific features (fever, sore throat, headache, N+V, lethargy)

Blanching rash usually develops on trunk first before speading, around 1-2 days after initial symptoms (red, pinpoint and sandpapery)

May also see stawberry tongue (initially white), flushed face, petechia on hard and soft palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the usual presentation of slapped cheek syndrome?

A

Parvovirus B19 - Biphasic illness with classic facial rash

Prodromal (fever, headache, coryza) around 1-2 week before rash
Macular erythematous facial rash, maculopapular rash may develop 1-4 days later on trunk

Usually lasts for around 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you advise parents around managing slapped cheek syndrome?

A

Mild, self limiting illness
(initially rash on cheeks with viral syx, may be followed by rash on body)
No longer infectious once rash develops, don’t need to stay off nursery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In the context of spreading viral or bacterial illness, what is the definition NICE use for significant contact?

A

Face to face contact
Same room for 15 mins or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A patient presents with new tinnitus - what screening questions should be asked to see if the patient needs urgent same day assessment/ referral? (5)

A

Sudden onset with:
- Any neurology (facial weakness etc.) or stroke suspicion
- New uncontrolled vertigo (think stroke)
- Sudden pulsatile tinnitus (to ENT)
- Tinnitus secondary to head trauma (to ENT)
- Sudden onset (<3days) tinnitus with hearing loss which has developed in last 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A patient presents with new tinnitus - what screening questions should be asked to see if the patient needs referral within 2 weeks? (2)

A
  • Tinnitus with sudden hearing loss (<3months) that occurred over 30 days ago
  • Distress affecting mental wellbeing or stops them performing daily tasks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

A 37 year old man presents with a 3 month history of feeling he can’t hear colleagues talking as well? What are key features of your assessment? (5)

A

1) Timing (sudden onset 72hrs or rapid progressing in 90 days refer)
2) Associated syx (tinnitus, vertigo, otorrhoea, otalgia, neuro syx)
3) PMH + FHx (otosclerosis)
4) Rinne and Webers
5) Otoscopy + examine CN’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do you classify thoracic outlet syndrome?

A

1) Neurogenic (most) vs. vascular (further split into artial/ venous - rare)

2) If neurogenic true (objective signs) vs. disputed (no objective)

Disputed neurogenic is by a long way most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A 52 year old man presents with symptoms of paraesthesia over the whole L arm, worse when arms close to his body. The is no objective neurology and you suspect thoracic outlet syndrome, how should this be managed?

A

If no objective neurology and no loss of function in the first instance conservative management is with physiotherapy
- It is important to consider whether CXR is indicated to rule out other pathology (i.e. pancoast tumour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does plantar fasciitis usually present?

A

Usually gradual onset
Intense pain during first few steps/ after inactivity - reduces with moderate activity - worse if strenuous activity or end of the day

Age 40-60 most common

33
Q

What are the key examination findings in plantar fasciitis? (3)

A

Tenderness on palpation of plantar heel area

Limited ankle dorsiflexion when knee extended

Pain recreated with extension of big toe (Positive Windlass test)

34
Q

How do you advise a patient on management of plantar fasciitis?

A

Reassure most make full recovery within 1 year - but takes time

Conservative: Rest food, supportive shoes, avoid barefoot, trial insoles, regular stretching

Analgesia: Paracetamol, ibuprofen and ice packs

Can consider referral for podiatrist or steroid injection if persistent

35
Q

How do you distinguish between idiopathic leg cramps and restless legs syndrome?

A

ILC - Sudden intense calf or foot pain at night and when resting
- Second to mins, unilateral, responds well to stretching

RLS - Itching, crawling or burning sensation with/ without pain nut NO tightening
- Bilateral, urge to move the legs which relieves symptoms

36
Q

How does measles classically present?

A

Fever, cough and coryza prodromal symptoms followed by a maculopapular rash

37
Q

How should measles be managed?(3)

A

1) Notify public health

2) Isolate for 4 days after development of rash

3) Paracetamol, ibuprofen, rest and fluids
Self limiting - usually resolves over a week

38
Q

How does mumps classically present?

A

Parotitis (bilaterally swollen parotids)
- Fever, muscle aches, generally unwell

Around 90% cases in adults. For men around half will have epididymo-orchitis

39
Q

How should mumps be managed?(3)

A

1) Notify public health

2) Isolate for 5 days after development of parotid swelling

3) Self limiting, resolves in 1-2 weeks without tx.

40
Q

How should suspected mumps epididymo-orchitis be managed?

A

Best rest, scortal swelling, application cold/ heat packs, paracetamol/ ibuprofen

Advise most cases resolve within 2 weeks, unlikely fertility issues but if concerned can do semen analysis after 3 months

41
Q

How does rubella classically present?

A

Rash - starts on face, spreads to body, pinky/red maculopapular

Lymphadenopathy, arthralgia and general viral symptoms

42
Q

How should suspected rubella be managed?

A

1) Notify public health
- Isolate for 5 days

2) If suspected in pregnancy, have very low threshold and refer if <20wks

3) Generally self limiting within a week, usual viral advice

43
Q

How should suspected rubella be managed?

A

1) Notify public health
- Isolate for 5 days

2) If suspected in pregnancy, have very low threshold and refer if <20wks

3) Generally self limiting within a week, usual viral advice

44
Q

Name 3 symptoms of acute angle closure glaucoma?

A

Acute and severe pain
Blurred vision
Halos around light (rainbow coloured circle around light)
Malaise (headache, nausea, vomiting

45
Q

Name 3 objective signs in acute angle closure glaucoma

A

Red eye
Hazy cornea
Fixed (or minimally reactive) pupil

46
Q

What three criteria would suggest a diagnosis of AKI?

A

Creatinine rise 26 micromol/L or greater within 48 hours
Creatinine rise > 1.5x baseline within 7 days
Urine output < 0.5mls/kg/ hr for >6hrs

47
Q

What does an erythema migrans rash appear as and what could it indicate?

A

Target like lesion (often over 5cm)
- Usually flat
- Expands over days to weeks
Indicative of Lyme disease

48
Q

How is Lyme disease managed?

A

If erythema migrans rash - start Tx
If no rash - do immunoblot/ ELISA test to assess

Tx: Doxycycline 100 mg twice daily (or 200 mg once daily) for 21 days.
(Amoxicllin or Azithromycin if CI)

49
Q

A 7 week old baby is brought in with bilateral watery discharge from both eyes for the last 3 weeks. Otherwise well, normal hx/ examination findings. What is most likely diagnosis?

A

Nasolacrimal duct obstruction
(Delay in development of nasolacrimal ducts, tears don’t drain - common in first few weeks of life, refer if persisting past 12 months)

50
Q

What are the most common presentations of MS? Who should diagnose and initate management for new presentations/ relapses?

A

Commonly presents: Optic neuritis (pain on eye movements, visual loss), transverse myelitis (weakness/ sensory changes), cerebellar-related symptoms, and brainstem syndromes

Diagnosis only made by neurologist, refer urgently. If relapses are suspected seek neurology advice before giving courses steroids

51
Q

How does lumbar spinal stenosis usually present?

A

Gradual onset of unilateral or bilateral leg pain (with or without back pain), numbness, and weakness developing after the patient walks a predictable distance (downhill also harder than uphill)

Neurological claudication - exacerbated by standing, walking, or lumbar extension. It is relieved by forward flexion, sitting, or lying flat

52
Q

How is lumbar spinal stenosis managed?

A

Refer to spinal surgery (unless urgent red flag symptoms needing urgent)

Conservative: NSAIDS, physio, epidural spinal injection
SurgicalN

53
Q

Name 5 NICE red flag features to consider in a patient presenting with sciatica/ back pain? Which are same day and which are urgent?

A

Same day:
- Bowel/bladder dysfunction (most commonly urinary retention).
- Saddle anaesthesia
- Bilateral radiculopathy.
- Progressive neurological weakness.
(Objective neurology same day)

Urgent (2weeks)
- Bilateral sciatica
- Incapacitating pain.
- Unrelenting night pain.
- Use of steroids or intravenous drugs.

54
Q

A 23-year-old lady presents with a staggered paracetamol overdose. What should be done regarding NAC therapy?

A

MHRA recommends that acetylcysteine is commenced without delay in all patients who have taken a staggered overdose.

As detailed in TOXBASE, this can be discontinued if blood results, from a sample taken at least four hours after last ingestion, show a paracetamol concentration of less than 10 mg/l, normal alanine aminotransferase (ALT) levels, an international normalised ratio (INR) at or below 1.3 and no symptoms of liver damage.

55
Q

What is the definition of a staggered paracetamol overdose?

A

In a staggered overdose, paracetamol is ingested over a period of more than one hour for non-therapeutic purposes.

Doses of less than 75 mg/kg in any 24-hour period are very unlikely to be toxic.

56
Q

A 27-year-old man had acute gastroenteritis six weeks ago while on holiday in Morocco. Over the last three weeks he has had low back pain that wakes him in the early morning but improves with movement. He is otherwise well and his bowel function has returned to normal.
MLD and management?

A

Likely reactive arthritis

Treat with NSAID like naproxen

57
Q

You suspect a child has meningitis, you are arranging an ambulance. What dose of emergency benzylpenicillin do you give whilst waiting if:
a) 9 months
b) 4 years
c) 12 years

A

IM:
Children younger than 1 year of age: 300 mg
Children 1–9 years of age: 600 mg
Children 10–17 years: 1.2 g

58
Q

What features would make you consider a diagnosis of MND?

A

Progressive weakness/ wasting of limb muscles (70%) or cranial nerves (25%) - i.e. tongue fasiculation, swallow or speech syx

(Without sensory symptoms)

MND can affect both upper and lower nerves so can have examination findings of both

59
Q

A 22-year-old woman has developed sudden-onset, profuse sweating with diffuse muscle and deep bone pain. She has a past medical history of regular cannabis misuse but is otherwise well.

Observing her, she is tremulous, yawning constantly and agitated. Her pupils are dilated. Her pulse is 102/min, temperature 36.8°C, her chest is clear and abdominal examination is normal. There is no smell of alcohol on her breath.

Dipstick of her urine is negative for blood, protein, glucose, nitrites or leucocytes.

What is the SINGLE MOST likely diagnosis?

A

Opioid withdrawal

Although these are all features of a heightened adrenergic reaction – deep bone pain and yawning are typical of opioid withdrawal. Other symptoms of withdrawal can include dilated pupils, diarrhea, goose bumps, sweating, agitation and tremor.

60
Q

Name at least 5 high risk features if you are suspecting sepsis?

A

Mottled skin
No urine output for 18 hours
BP <90 systolic
RR > 25
HR >130
Altered mental state

61
Q

Name 3 characteristic features of epiglottitis?

A

Age 2-6 usually
Short history, high fever
Drooling
More comfortable sitting forward
Dysphagia

Possible croup like cough

62
Q

You are in GP and suspect a patient has DVT. The hospital plan to scan them tomorrow. What should you do regarding anticoagulation treatment?

A

DOAC
- If scan can’t happen within 4 hours of suspected diagnosis then start DOAC if DVT is likely

63
Q

A 67-year-old gentleman on warfarin sustains a head injury following a fall. He denies any loss of consciousness, vomiting or seizures. On examination, he is alert and orientated with normal vital signs and no neurological deficit.

How should he be managed?

A

Refer for CT head within 8 hours

(NICE guidance for all patients on any anticoagulation other than aspirin monotherapy who have head injury should be considered for CT scan within 8 hours of the injury)

64
Q

On a home visit, a 68-year-old diabetic patient on metformin and gliclazide is drowsy but rousable, sweaty and tachycardic. His blood sugar measurement is 2.5 mmol/L.

What is the MOST appropriate management option?

A

1mg IM glucagon

65
Q

You are on a home visit. How do you manage an acutely hypoglycemic patient if they are:
a) Conscious
b) Unconscious

A

a) 10-20grams oral glucose (two teaspons sugar or glucogel)

b) 1mg IM glucagon

66
Q

With regards to wells score for PE - what are:
a) 2 criteria which score 3 points
b) 3 criteria which score 1.5 points
c) 2 criteria which score 1 point

A

a) Most likely diagnosis + clinical signs and symptoms DVT

b) HR >100, Immobilization >3 days/ surgery, Previous DVT/ PE

c) Active cancer, haemoptysis

67
Q

What is DVLA guidance around stopping driving (Group 1) for significant head injuries?

A

The DVLA states that driving should cease for a period of 6–12 months following a significant head injury.

68
Q

When does neutropenia tend to occur for patients on chemotherapy? What are some of the early features of neutropenic sepsis (name 3)?

A

Usually 7-10 days post chemotherapy

Malaise, agitation, behavior change
May have infectious syx (dysuria, diarrhea, cough), fever/ chills,

69
Q

How does seretonin syndrome usually present?

A

Usually shortly (6hours) after starting serotonin drug, increasing dose or starting second agent (SNRI/ TCA/ SSRI etc).

Autonomic hyperactivity (sweating, HTN, tachycardia, hyperthermia, diarrhoea etc)
Neuromuscular abnormality (akathisia, tremour etc)
Mental status changes (confusion, pressured speech)

70
Q

Risk of sepsis is raised for how many weeks post operatively?

A

6 weeks

71
Q

What is the dose of adrenaline used for anaphylaxis in adults and children?

A

IM adrenaline (1:1000–0.5 ml - 500 mcg)

6-12’s - 300mcg
6m-6y- 150mcg
<6m - 100 mcg

Repeated at five-minute intervals

72
Q

What are the wells score cut offs for considering d-dimer vs. CTPA?

A

Wells 4 or less = D-dimer
Wells 5 or more = CTPA

73
Q

What are the 3 at risk groups with varizella infection - how should they be managed if significant exposure and suceptible?

A

Neonates/ infants <1yr
Immunosuppresed
Pregnant (any gestation)

If suceptible start oral aciclovir for all of them at day 7 following exposure

74
Q

What is the most common cause of fatal anaphylaxis in children?

A

Cows milk

(nuts most common thing to be anaphylactic to generally)

75
Q

What position should you put a patient in if having an anaphylactic reaction?

A

Before adrenaline lie flat or sit against a wall

  • If circulatory compromise elevate legs
  • If resp issues semi recumbant sitting position
76
Q

What is the role of antihistamines in anaphylaxis?

A

Can be use for angioedema for skin symptoms AFTER the patient is stable
(use non sedating)

Not part of emergency management

77
Q

How should a patient be followed up after being discharged from hospital for a first episode of anaphlaxis?

A

REACT
R- Refer to allergy clinic
E- Educate triggers, syx etc
A- Adrenaline autoinjector (before allergy clinic appointment, px for 2 injectors)
C- Code in notes
T- Tell friends and family

78
Q

In anaphylaxis - what is the only other treatment aside from adrenaline indicated acutely (if skills and resource available)

A

Fluid challenge 500-1000mls
(Children 10mls/ kg)

In addition to adrenaline IM
Lying patient down +/- leg elevation

No role for steroids, antihistamines only given AFTER stablised to reduce angiooedema/ itch

79
Q

A patient presents with angioedema - what are the possible differentials?

A

WIth urticaria:
- Anapylaxis - onset shortly after exposure to allergen (max 2 hours)
- Idopathic angioedema (recurrent episodes with no obvious trigger- more common in autoimmune)

Without urticaria:
- Non allergy drug reaction (i.e. ACEI)
- Hereditary (if hx of parent affected) - after puberty (swelling limbs/ tunk/ face/ genitals)
- Aquired (in thise with lymphoma or SLE and NO FHx).

AKT Prep (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions