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00 SpR > Advice/EPIC > Flashcards

Advice/EPIC Flashcards

1
Q

Mental health

A 
CDD (capacity, drugs, dependants)
Capacity: weigh
Risk: 
- green/amber/red
Nursing 1:1?
Frisked? Sharps/drugs 
Dependents
Cause for concern form
Drugs/alcohol
MSE: psychosis/manic
Section
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2
Q

Calls for help

A 
ED Consultant
Major haemorrhage; code red
Trauma
Adult cardiac arrest
MET/ Cardiac, Peri arrest
Obstetric emergency
Paediatric emergency
Neonatal emergency
Security (A+V)

Fast bleep
Intensive care
Anaesthetic

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3
Q

TIA

A 
CT head -> Aspirin 300mg
High risk factors:
ABCD2 >4
Crescendo TIA (>1/week)
On anticoagulant 
In AF?
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4
Q

TLoC

Reasons to admit

A

During exertion or supine
Family history <40
>65 w/o prodrome

Abnormal ECG
Heart murmur

Heart failure
New SOB (?PE)
Abdominal pain (?AAA)
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5
Q

?Seizure

Signs

A 
Eyes open
Snoring/grunting
Foaming/biting
Blue
Synchronous limb movement 
Partial seizure
Lateral tongue bite
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6
Q

Signs NEAD

Pseudo seizure

A 
Fluctuating course 
Closed eyes
Asynchronous movements
Pelvic thrust
Side to side head/body movement
Ictal crying
Absence postictal confusion
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7
Q

?aortic dissection

A

Pulse deficit
Bilat BP
Focal neurology

ECG
CXR

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8
Q

ECG ?HOCM

A

Dagger Q waves
(Deep and narrow)
- lateral and inferior

+- signs LVH

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9
Q

ECG ?LV hypertrophy

A

R wave lead I
+
S wave lead III
>25mm

Or R wave in aVF>20mm

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10
Q

Investigations to check

A

BED, obs, scan
- Blood and VBG
(Blood glucose)
- ECG +/- monitor
- Urine + bHCG

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11
Q

Sedation

Overnight Qs

A 
Department safe 
Time critical?
Comorbidities
Starved? 
Reflux?
Airway
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12
Q

Cardiac arrest Qs

Pre alert

A 
Time onset/ duration arrest
Bystander CPR
Initial rhythm 
Treatment
Cause of arrest?
AMP QT
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13
Q

Paeds GCS

V1-5

A

V5: coos babbles
V4: irritable cry, confused
V3: cry in response to pain, inappropriate words
V2: moans in response to pain, incomprehensible words/sounds
V1: no response

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14
Q

Paeds GCS

M to 1-6

A 
M6: purposeful movement
(Obey command)
M5: withdraw to touch
(Localise pain)
M4: withdraw to pain
M3: abnormal flexion
M2: abnormal extension
M1: no response
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15
Q

Acute liver injury

Dx and Mx

A 
ALT>500
PT>17
?paracetamol OD
IVF and lansoprazole
-> Medical referral

?Encepahlopathic
-> IV Abx +/- ICU

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16
Q

Encephalopathy

Grade

A

1: abnormal behaviour
2: disorientated, drowsy, flap
3: confused, incoherent, drowsy
4: comatose

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17
Q

Fracture description

A 
Open/closed
Neurovascular status 
Stable/unstable 
Displaced/angulated/shortened
Comminuted
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18
Q

Spinal shock
Vs
Neurogenic shock

A

Spinal concussion

- transient loss of function

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19
Q

Sign of tamponade/ effusion

on ECG

A

Electrical alternans
Low voltage criteria

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20
Q

Self discharging patient

A

Attempt to persuade
- concerns, risks, plan in ED
- safety net
Capacity? Mental health?

Self discharge papers
Document
Against medical advice

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21
Q

Does person have capacity?

A
  • Is there impairment/ disturbance of brain or mind?
  • Does that impairment make them unable to make a specific decision

Test
- understanding, weigh, retain, communicate

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22
Q

Personality disorder
Depression
And capacity

A

BPD: fluctuating capacity
Emotional dysregulation

Depression:
Pathological lack of care about ones own interests

Manifestation of the disorder

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23
Q

How long to observe anaphylaxis after treatment? (2021 RCUK guideline)

A

2h if:
- 1 dose adrenaline
- has autoninjector
6h if:
- 2 doses adrenaline
- previous biphasic
12h if
- >2 adrenaline
- continuing allergen release
- unsafe

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24
Q

65 year old with abdo pain

Ix

A 
?AAA : USS
ECG
Bloods, VBG, amylase 
CXR
CT abdo 
Surgical review
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25
Q

?orbital cellulitis

Signs

A

Proptosis
Opthalmoplegia

Pain on eye movement
RAPD
Orbital pain
Conjunctival chemosis
Purulent nasal discharge
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26
Q

Escalation problems in ED

A
  • Demand exceeding capacity
  • Exit block
  • Support process breakdown
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27
Q

Handover

ABCDE

A 
Areas and acuity
- resus, corridor
Beds 
- medics, surg, ortho
Colleagues
- sickness
Deaths, disasters, deserters
Equipment, events 
- blood gas
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28
Q

Night huddle

A 
Introductions
Number in Dept, wait TBS
Area (resus)
Acuity (Unwell patients)
Specialty take lists
- theatre planned?
Beds - flow
Colleagues - fully staffed?
Disasters;
Resus/Trauma call overnight
- roles
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29
Q

Eye pH

A

7.2

Equal bilat

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30
Q

Asymptomatic Electrical injuries

Ix and plan

A

ECG
Urine dip; myoglobin
U+E, CK

Home if normal

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31
Q

Diameter of abdominal aorta

A

2-3cm

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32
Q

Syncopal episode

Consider unusual causes;

A

PE
AAA
dissection

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33
Q

High risk groups

A 
Paeds
Pregnant
Elderly abdo/back pain
Atraumatic CP
Elderly trauma 
Syncope
Immunosuppressed
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34
Q

Things to consider as EPIC

A

Patients
Incoming
Department
Staff

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35
Q

General aspects procedure

A 
Consent
Equipment
Position
Aseptic; field/gloves/apron
Clean
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36
Q

USS Doppler colours

A

Red
= blood moving toward probe
Red artery

Blue
= moving away from probe
Blue vein

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37
Q

Rhabdomyolsis defined by

A

Raise in CK 5x baseline

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38
Q

Contraindication

Propofol

A

Soy or egg allergy

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39
Q

Nasty rash

Check

A

Mucosal membranes
?Steven Johnson’s syndrome
?TEN
Eczema ?herpeticum

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40
Q

Gentamicin dosing

A

3-5mg/kg
Based on ideal body weight
3mg if over 65
Max 80mg OD if on dialysis

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41
Q

Rotator cuff injuries

Tests

A 
Empty can - supraspinatus 
Ext rotation - infraspinatus
Lift off test (small of back)
- subscapularis
No test teres minor
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42
Q

Teenager social Qs

A 
HEADSSS
Home
Education
Activities
Drugs
Sex
Safety
Suicide
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43
Q

Pericarditis findings

A 
Pleuritic CP
Worse on lying flat
Better on sitting forward
Friction rub
ECG change
Troponin
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44
Q

Inferior ST elevation and back pain

Consider

A

Dissection

Flap covering R coronary Ostia

45
Q

Drugs causing dystonia

A 
Dopamine antagonists 
Antipsychotics 
Metoclopramide
Antiepileptics 
Amphetamines 
Antihistamines
46
Q

Volar plate injury

A

Hyperextension fingers
Avulsion at PIPJ
Tx buddy strap + F/U

47
Q

Mallet finger

A

Axial load or flx on finger
Unable to extend finger
Avulsion DIPJ
Tx mallet splint + F/U

48
Q

Bennett fracture

A 
Forced abduction thumb 
Fracture at base of 1st MTC
Tx 
Reduce and thumb spica POP
Refer to on call Ortho
49
Q

Maisonneuve fracture

A

Tailor shift
+/- # medial malleolus

+ proximal fibular #

50
Q

Taylor shift but no fracture

A

Maisonneuve fracture
Proximal fib fracture
Talofibular disruption
Deltoid ligament disruption
+- medial malleoulus #

51
Q

Hyperemesis gravidum

A

Prolonged N+V
Dehydration
Electrolyte disturbance
>5% pre-pregnancy weight loss

Consider admission if continued weight loss and ketonuria despite oral anti emetics

52
Q

PID

Sx

A 
Lower abdominal pain 
(Usually bilat)
\+\- deep dyspareunia 
\+\- abnormal PV discharge 
\+/- abnormal bleeding
53
Q

Contraindication to

Beta blocker

A

Asthma
sBP<90
Severe HF
Phaeochromocytoma

54
Q

Obstetric cholestasis

A 
~1%
Prolonged pruritis
(Esp night including palms/soles)
Absence of rash
Abnormal LFT/bile acid

Comp:
Prematurity, intrauterine death

55
Q

Lidocaine

10ml of 1% =mg

A

100mg

Max 3mg/kg

56
Q

Causes of high anion gap acidosis

A 
LTKR
Lactate 
Toxins
Ketones
Renal

CATMUDPILES

57
Q

Calculate anion gap

A

Na+K - HCO3+ Cl
Raised >30
Borderline 20-29

58
Q

Causes normal anion gap acidosis

A 
ABCD
Addisons
Bicarbonate loss (GI/renal)
Chloride excess 
Diuretics
59
Q

Horners syndrome and pain

A

Partial ptosis
Miosis
Anhydrosis

Pain in neck; cervical artery dissection
Pain in chest/arm; pancoasts tumour

60
Q

Tripod fracture

Facial

A

Inferior orbital rim
Lateral orbital rim
Zygomatic arch

61
Q

Adequate c spine XR

A

Junction C7/T1

62
Q

Central slip injury

Test

A

Elsons test
Flx 90 deg then ext
Should extend with floppy distal phalanx

63
Q

Skiers thumb

A

Ruptured ulnar collateral ligament

Often associated avulsion fracture base of proximal phalanx of thumb

64
Q

Volume of anaesthetic in digital nerve block

A

2-3ml per side/injection

65
Q

ST elevation in aVR

A

> 1mm
with recipricol changes in lateral leads
Left coronary occlusion

66
Q

tachy and new low voltage ECG

A

Pericardial effusion until proven otherwise

67
Q

Causes of Low voltage ECG

A

Conduction:
Effusion; Pericardial/ pleural
Fat
Air (COPD, PNX)

Low power
- cardiomyopathy

68
Q

Locked knee Dx and Ddx

A 
Unable to extend knee same as good side 
Ddx
Meniscal tear 
ACL injury
Loose body
69
Q

Test ulnar collateral ligament of thumb
(Skiers thumb)

A

Fix MTC
Radial deviation of MCPJ
In extended and flexed position
Should be less than 15deg movement

70
Q

Angles of Louis

A

5cm below sternal notch
Gives you 2nd intercostal space

71
Q

Complications shoulder dislocation

A

Axillary nerve
Hill Sachs (top hill)
Bankart lesion (bank bottom)

72
Q

Sub talar dislocation XR findings

A

Talus not aligned with navicular

73
Q

AF management options

A

Unstable
Stable
- rhythm control (within 48h onset)
- rate control

74
Q

LV vs RV strain ECG T waves

A

LV strain = TWI laterally
RV strain = TWI v1-3 and S1Q3T3

75
Q

Post reduction TMJ dislocation

A

Soft diet 48h
Avoid wide mouth opening 2weeks
Support moth with hand during yawning
Consider Barton bandage if unable to comply or understand

76
Q

HIV PEP

A

Within 72h
4 weeks of drugs
Test at 3months

77
Q

Kawasaki diagnosis

A

CRASH and burn
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet
Fever (>39) over 5 days

78
Q

Zygomaticomaxillary injury advice

A

Avoid nose blowing
Do not occlude nose when sneezing

79
Q

Malar region numbness due to

A

Inferior orbital nerve injury

80
Q

Wernickes
Vs
Korsakoffs

A

Thiamine deficiency (acute vs chronic)
Wernickes
- triad; ataxia, confusion, opthalmoplegia
- reversible
Vs
Korsakoffs
- memory loss and confabulation
- irreversible

81
Q

Clinical frailty score

A

1: very fit
2: no active disease Sx
3: managing well
4: vulnerable; Sx limit activities
5; mildly frail; help with some ADLs
6; moderately frail; help with dADLs and pADLs
7; severely frail; completely dependent for pADLs
8; very severely frail; completely dependent
9; terminally ill

82
Q

Sudden onset sensorineural hearing loss Tx

A

Prednisolone 40mg OD, 1 week
PPI if indicated

83
Q

Bell’s palsy Tx

A

Presnisolone 60mg OD 10 days
+|- Aciclovir 200mg OD
Eye taping

84
Q

Manchester mandibular fracture rule ruled out if;

A

All negative
Malocclusion
Trismus
Pain with mouth closed
Broken teeth
Step deformity

85
Q

Signs Ludwig’s angina

A

Trismus (reduced mouth opening)
Woody submandibular region
Tender submandibular region
Inability to protrude tongue
Tongue displaced superior and anterior

86
Q

Upper airway signs of concern

A

Stridor
Trismus (limited opening)
Drooling
Change in voice
Tripoding
Resp distress
Limited neck movement

87
Q

Biphasic T wave

A

Do not exist
Terminal portion determines if
Positive or negative

88
Q

TWI normal variants

A

Isolated inversion (not in contigous leads)
aVR, V1
V2, III, aVL
Juvenile Twaves = TWI V1-3

89
Q

RF for cerebral venous thrombosis

A

Third trimester
Recent oral contraceptive (oestrogen)
Coagulopathy
Recent sinusitis

90
Q

Pregnancy drugs to avoid

A

Trimethoprim
tetracyclines
NSAIDS
Operates at birth
Sodium valproate
Ondanesetron under 12weeks

91
Q

Headache in pregnancy consider

A

Cerebral vein thrombosis
Pre eclampsia

92
Q

Consider neutropaenic sepsis and Dx

A

Chemotherapy last 6 weeks
Haematological malignancy
Stem cell transplant
Myelodysplastic syndrome
Dx
Neutrophil less than 0.5 and sepsis

93
Q

Achilles tendon rupture signs

A

Palpate tender, step deformity
Active movement reduced
Simmons test
Feet hang over edge, squeeze calf, no movement shows tendon rupture

94
Q

Normal anion gap

A

8-16 when not including K
10-20 when including K

95
Q

Phaechromocytoma Tx

A

Alpha blockade
- phenoxybenzamine or phentolamine
Then b blockade
- propranolol

96
Q

Lemierre syndrome

A

Thrombophlebitis of internal jugular vein
Secondary to oropharyngeal infection
Usually young people
Can lead to cerebral vein thrombosis and metastatic infection

97
Q

Hereditary angioedema treatment

A

C1 esterase inhibitor
(Icatibant acetate)
FFP

98
Q

SVCO Tx

A

? Intubation
IV steroids
IV furosemide
Endovascular stenting
Radiotherapy, chemotherapy
?surgical resection

99
Q

Retinal artery occlusion. Tx

A

Ocular massage 10 sec on 5 off
Increase blood oxygen content 15L
Dilate retinal arteries; GTN
Reduce intra ocular pressure:
- acetazolamide and mannitol
Irreversible damage after 4h

100
Q

Orthostatic hypotension Dx

A

30mmHg drop sBP if hypertensive
20mmHg drop sBP if normotensive
10mmHg drop dBP

101
Q

Facial structures at risk of injury in facial lacerations

A

Parotid gland and duct
Lacrimal gland and duct
Facial nerve

102
Q

DVLA medical reasons to stop driving (class1)

A

Ask if have class 2 licence
Arrhythmia: stop until diagnosis and controlled for 4 weeks
Seizure; 6m seizure free
LOC; undiagnosed LOC: 4w or 6m depending on low high risk and if treatment started
TIA; 1m
Menieres; until Sx controlled
Psychosis and mania; 3m
Schizophrenia; 3m if stable
Sleep apnea: until symptoms controlled

103
Q

Test for rhinorrhea

A

Beta 2 transferrin

104
Q

Carbon monoxide questions

A

COMA
Co-occupants similar Sx?
Outdoors better?
Maintenance; boilers and cooking appliances?
Alarm; CO functioning?

105
Q

Indicators for liver transplant in paracetamol OD

A

pH <7.30 after 2 days
INR>6.5
Creatinine >300
Hepatic encephalopathy (grade 3/4)
Increasing INR on day 3 or 4

106
Q

Consent from child

A

Gillick competent child or over 16
Parental consent
Court order

107
Q

ECG in collapse - check

A

W - Wolff Parkinson White
O - Obstructed AV pathway
B - Bifascicular block
B - Brugada
L - LV Hypertrophy (consider AS, HOCM)
E - Epsilon wave
R - Repolarisation abnormality

108
Q

Pseudo hyponatraemia

A

Normal or high serum osmolality
Due to high BG, high lipid or para protein

00 SpR (23 decks)

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