Collapse

Question 1

Classification of AAA

Answer 1

Dilatation >3cm (normal 2cm) - any aneurysm is >50% original size of vessel

due to loss of elasticity and muscle cell degeneration

Question 2

USS monitoring schedule for AAA?

Answer 2

3 - 4cm - annual

4. 5 - 5.4 - 3 monthly
5. 5cm+ - consider surgery

Question 3

Triad of features of DKA?

Answer 3

Hyperglycaemia  =  >11mmol/L
Acidosis  =  pH <7.3    OR    Bicarb <15mmol/L
Ketonaemia  =  3+mmol/L  or  2+ on standard urine dip

Question 4

Presentation of DKA

Answer 4

polyuria, polydipsia, weakness, weight loss
pear drop acetone smell
Dry - membranes, turgor - hypovolaemic shock
Cerebral oedema in children

AKI due to hypovolaemia

Question 5

Management of DKA

Answer 5

Rehydration with 0.9% sodium chloride

Insulin therapy - fixed rate IV infusion - 0.1 units/kg/hour
- see DKA charts for exact amounts

Maintain K+ between 4-5.5mmol/L

Switch fluids to dextrose once BM <12mmol/L to prevent hypos

Question 6

What is Hyperglycaemic hyperosmolar state (HHS)?

+ clinical characteristics

Answer 6

Hyperglycaemia, in absence of ketogenesis –> leading to hyperosmolar state and severe volume depletion

Profound hyperglycaemia - >33mmol/L
Hyperosmolarity - >320mmol/Kg
Volume depletion with no acidosis - pH >7.3, Bicarb >15

Question 7

Management of HHS

Answer 7

IV fluid therapy - 0.9% sodium chloride

If glucose not sufficiently lowered with just fluids, use low dose insulin infusion (0.05 units/kg/hr)

Question 8

Investigations in seizures

Answer 8

Exclude other non-epileptic causes:
Infection
Electrolyte imbalance
Toxicology screen
Head injury/SoL - Head CT
Hypoglycaemia

EEG only useful if actively seizing

Question 9

Management ladder in seizures

Answer 9

1) make the area safe, protect the head, START TIMER
2) Buccal Midazolam
3) 5mins - Rectal diazepam, 2nd dose after 5 mins, call ambulance
4) Phenytoin/phenobarbital
5) Paraldehyde
6) RSI - GA with thiopentone

Question 10

What is the FAST Test

Answer 10

Face - facial movements
Arms - brief test of power/sensation in the arms
Speech - repeat a sentence - look for slurring, wrong words

Timing - call ambulance/get to hospital if suspected stroke

Question 11

Management of confirmed non-haemorrhagic stroke

Answer 11

Aspirin 300mg, for 2 weeks - then switch onto long term antithrombotic + PPI cover
+ Clopidogrel 75mg/OD
2nd line Dipyridamole

Thrombolysis - Alteplase - most effective if <90 mins
+ Post lysis CT scan to confirm no bleeding

Question 12

Timing of investigations at presentation to ED

Answer 12

CT/MRI within 25 minutes
Administration of Alteplase within 60 minutes

If symptoms more prolonged - CT/MRI within 24hrs

Question 13

Long term therapy after a stroke?

Answer 13

Confirmed no AF - Clopidogrel 75mg, OD. 2nd line dipyridamole 200mg BD
+ Lipid modification - high dose statin Atorvastatin 20-80mg

With AF - Aspiring 300mg for 2 weeks, then switch to Warfarin, (and then to DOAC) - target INR 2.5 (2-3)

Question 14

Investigations in syncope?

Answer 14

12 lead ECG
Bloods baseline - Hb, glucose, electrolytes
Cardiac enzymes, D-dimer
BP lying and standing
Cardio/neuro exam

Question 15

Aims of therapy in DKA?

Answer 15

Drop glucose by >3/hr, until <14 - then switch to dextrose
Drop Ketones 0.5/hr until <0.6
Rise Bicarb >3/hr until >15

Switch to S/C insulin with E+D, pH >7.3 and Ketones <0.6