Bowel obstruction

Question 1

What ways does a volvulus run on an x-ray

Answer 1

Sigmoid: bottom left to top right
Caecal: bottom right to top left

Question 2

Where are yellow cards sent to

Answer 2

The medicine and healthcare regulatory agency (MHRA)

Question 3

Treatment for anaphylaxis

Answer 3

100% O2, intubate if obstruction is imminent, 500 micrograms adrenaline IM (repeat every 5 mins), 10 mg chlorphenamine IV and 200 mg hydrocortisone IV, 0.9% NaCl STAT (may need up to 2L) and if there is wheeze treat for asthma

Measure serum tryptase 1-6 hrs after suspected anaphylaxis

Question 4

How do you insert an oropharyngeal airway

Answer 4

Insert curved side uppermost, twisting it through 180° once inserted halfway

Question 5

When would a nasopharyngeal airway be used instead of an oropharyngeal one

Answer 5

If the mouth is difficult to open eg. seizures or in lighter patients as it’s better tolerated

Contraindicated: possible base of skull fracture

Question 6

How do you wean patients off respiratory support in ICU

Answer 6

Tracheostomy

Question 7

What does the apache II score measure

Answer 7

Objectively how sick a patient is, taking into account both acute and chronic issues

Question 8

What should you suggest if a COPD patient with fully compensated type 2 respiratory failure is given venturi O2 but then they have increase CO2 and acidosis?

Answer 8

BiPAP

Question 9

Monitoring of different NEWS scores

Answer 9

> 7= continuous, <15 mins
1-4= hourly monitoring and inform a registered nurse

Question 10

High risk drugs in terms of prescribing errors

Answer 10

Opiates
Anticoagulants
Insulin
Antibiotics
Infusion fluids

Question 11

What is your individual duty of candour if an adverse event occurs

Answer 11

• Act immediately to put it right, and to prevent further harm.
• Notify the patient as soon as possible, providing a factual explanation.
• Give a verbal apology.
• Explain the short and long term affects.
• Offer support to put matters right (where possible).
• Explain what steps will be taken to prevent such an incident happening again.
• Record details of the discussion in the patient’s record.
• Report the incident through their hospitals process.

Question 12

When is a written apology to a patient needed when as adverse event occurs

Answer 12

It is a notifiable safety incident

Question 13

Notifiable safety incidents

Answer 13

An unintended or unexpected incident that occurred in respect to a patient’s care that, in the reasonable opinion of a healthcare professional, could result in or appears to have resulted in: the patient’s death, severe harm, moderate harm or prolonged psychological harm (>28 days).

A near miss cant be a notifiable safety incident

Question 14

Severe harm

Answer 14

A permanent lessening of bodily, sensory, motor, physiologic or intellectual functions, including removal of the wrong limb or organ or brain damage.

Question 15

Moderate and significant harm

Answer 15

Moderate harm: significant harm and moderate increase in treatment

Significant harm: the temporary lessening of bodily, sensory, motor, physiological or intellectual function

Question 16

What is a low harm incident

Answer 16

Any incident that required extra observation or minor treatment and caused potential harm to the patient

Question 17

Near miss incident

Answer 17

Any incident that has the potential to cause harm but was prevented and therefore no harm occurred to the patient

Question 18

What is the disclosure process for a notifiable safety incident

Answer 18

Incident detection and initial response, team discussion, notification and open disclosure, and follow up and process completion

The patient shoiuld be notified as soon as possible

Question 19

What does a patient need to be doing to be discharged from a major bowel surgery

Answer 19

Look well, be up and about, blood test be back to their baseline, be eating and drinking well and have some evidence of bowel functioning (eg. flatus as a minimum)

Question 20

Suspected meningitis treatment

Answer 20

Suspected meningococcal disease- empirical treatment based on superstition:
- Admit the person to hospital as an emergency by telephoning 999
- Parenteral benzylpenicillin at the earliest opportunity, provided that treatment does not delay urgent transfer to hospital

Question 21

Meningitis treatment in hospital

Answer 21

• For Meningococcal meningitis- Benzylpenicillin, Cefotaxime
• For Invasive Pneumococcal disease- Cefotaxime
• For Haemophilus meningitis- Cefotaxime

Question 22

Criteria for a lacuanar stroke

Answer 22

One of the following:
- pure sensory stroke
- pure motor stroke
- sensori-motor stroke
- ataxic hemiparesis

Question 23

Criteria for a posterior circulation stroke (POCS)

Answer 23

One of the following:
- CN palsy and a contralateral motor/sensory deficit
- bilateral motor/sensory deficit
- conjugate eye movement disorder
- cerebellar dysfunction
- isolated homonymous hemianopia or cortical blindness

Question 24

First line investigation for asthma exacerbation

Answer 24

Arterial blood gas

Question 25

First line diagnostic test for heart failure

Answer 25

Echocardiogram

Question 26

First line therapy for acute severe asthma

Answer 26

Inhaled bronchodilators- salbutamol nebulisers

Question 27

Initial management for intermittent claudication

Answer 27

Supervised exercise and cardiovascular risk management

Question 28

Elderly patient presenting with large amounts of blood PR

Answer 28

Diverticulosus

Question 29

Initial management for PE

Answer 29

Acute phase- low molecular weight heparin
Long term- warfarin (vitamin K antagonist) and Rivaroxaban (factor Xa inhibitor)

Question 30

What is used to grade the severity of airflow obstruction in COPD

Answer 30

Forced expiratory volume

Question 31

Positive predictive value

Answer 31

The probability that a patient with a positive test result will have the disease

Question 32

UTI differentils

Answer 32

Prostatitis- painful with severe urinary problems
Bladder calculis- pain or difficult micturition
Benign prostatic hypertrophy- urinary symptoms and occasional microscopic haematuria
Bladder cancer- painless haematuria
UTI- painful with positive leukocytes and nitrites

Question 33

How to diagnose coeliac disease

Answer 33

• Positive tissue transglutaminase
• Refer to gatroenterologist for an intestinal biopsy

Question 34

Different causes of anaemia

Answer 34

• Anaemia of chronic disease: normocytic and normochromic
• Gatro intestinal bleeding: microcytic and hypochromic with raised platelets
• Methotrexate toxicity: causes bone marrow suppression so is normocytic and platelets are low
• Vitamin B12 deficiency: macrocytic anaemia

Question 35

Arterial blood gas for meningitis

Answer 35

Metabolic acidosis

Question 36

When do you see an extensor plantar response

Answer 36

UMN lesion

Question 37

Treatment for rheumatoid arthritis

Answer 37

DMARD- methotrexate, sulfasaline and leflunomide

Methotrexate- teratogenic

Question 38

Red flags in back pain

Answer 38

Age >50, thoracic pain, unexplained weight loss, neurological symptoms, atypical pattern (night pain or sudden onset), fever, IV drug use, steroid use, history of cancer (mnemonic = A TUNA FISH).

Question 39

Using warfarin

Answer 39

Use LMWH as a cover as warfarin takes time to work
Warfarin can be used when there is a metallic heart valve

Question 40

What anticoagulant do you give in A fib

Answer 40

A DOAC

Question 41

WRISKE- NG insertion

Answer 41

Is it central?
Does it bisect the carina in the middle?
Is the tip visible below the diaphragm?
Is the tip visible at least 10cm below the gastro-oesophageal junction (where the stomach starts)?