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Yr 5 - A&E > Corrections > Flashcards

Corrections Flashcards

1
Q

Glasgow-Blatchford vs Rockall score in an upper GI bleed?

A

Glasgow-Blatchford –> used at first assessment to determine severity (if they can be managed as outpatient)

Rockall –> used after endoscopy, provide % risk of rebleeding and mortality

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2
Q

What is the purpose of the Mantoux test?

A

Screening tool for TB

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3
Q

What medication can give a false -ve Mantoux test?

A

Steroids

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4
Q

What is the main side-effect of using topical decongestants for prolonged periods in allergic rhinitis?

A

Tachyphylaxis –> the rapid decrease in response to a drug following repeated administration, requiring increasingly larger doses to achieve the same therapeutic effect

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5
Q

When is a diagnosis of atelectasis made?

A

Clinical diagnosis made when SOB & lower than normal sats occur within 24h of surgery

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6
Q

What enzyme is deficient in suxamethonium apnoea?

A

Pseudocholinesterase deficiency

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7
Q

What ASA grade is a patient with end stage renal disease undergoing regular scheduled dialysis?

A

III

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8
Q

How should TPN be administered?

A

Via a central line as its strongly phlebitic

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9
Q

For correcting Na+ too quickly:

A

Low to high - pons will die (myelinolysis)
High to low - brain will blow (oedema)

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10
Q

What is a consequence of rapidly correcting hyponatraemia?

A

Central pontine myelinolysis

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11
Q

What is the muscle relaxant of choice for RSI?

A

Suxamethonium

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12
Q

Mechanism of lidocaine

A

Blockage of sodium channels

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13
Q

What can cause malignant hyperthermia?

A

1) suxamethonium

2) volatile anaesthetics e.g. isoflurane

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14
Q

Diabetes drugs on surgery day:

a) metformin

b) sulfonylureas

c) DPP-4 inhibitors

d) GLP-1 mimetics

A

a) OD & BD take as normal, TDS (omit lunchtime dose)

b) OD omit dose, BD (omit morning dose for morning operation, omit both doses for afternoon operation)

c) take as normal

d) take as normal

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15
Q

A posterior STEMI can present with ST depression.

What leads would this typically be seen in?

A

V1-V3

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16
Q

Features of Kawasaki disease?

A

1) high-grade fever which lasts for >5 days (characteristically resistant to antipyretics)

2) conjunctival injection

3) bright red cracked lips

4) strawberry tongue

5) red palms of the hands and the soles of the feet which later peel

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17
Q

What class of medication is nicorandil?

A

Potassium channel activator

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18
Q

Indication of Nicorandil?

A

Angina: has a vasodilatory effect on the coronary arteries.

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19
Q

Side effects of nicorandil?

A
  • headache
  • flushing
  • anal ulceration
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20
Q

What would global T wave inversion (i.e. not fitting a coronary artery territory) indicate?

A

Non-cardiac cause e.g. head injury

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21
Q

What are the effects of adenosine:
a) blocked by
b) enchanced by?

A

a) theophylline
b) dipyridamole (antiplatelet agent)

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22
Q

Mechanism of action of adenosine?

A

Causes transient heart block in the AV node:

Agonist of the A1 receptor in the AV node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarisation by increasing outward potassium flux.

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23
Q

How does a posterior MI typically present on an ECG?

A

1) Tall R waves in V1-V3
2) ST depression

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24
Q

What is the Killip Classification?

A

Quantifies severity of heart failure in NSTEMI and predicts 30-day mortality.

I - No clinical signs heart failure
II - Lung crackles, S3
III - Frank pulmonary oedema
IV - Cardiogenic shock

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25
Q

RBBB is most likely to be caused by occlusion of which artery?

A

LAD

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26
Q

What is andexanet alfa?

A

A recombinant form of factor Xa

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27
Q

Wht are the 2 groups of causes of aortic regurg?

A

1) disease of the aortic valve

2) distortion or dilation of the aortic root and ascending aorta

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28
Q

Pulse pressure in aortic regurg?

A

Wide

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29
Q

What 2 signs may be seen in aortic regurg?

A

1) Quincke’s sign (nailbed pulsation)

2) De Musset’s sign (head bobbing)

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30
Q

What manouevre can make an AR murmur louder and easier to hear?

A

Handgrip manouevre

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31
Q

Main mechanism of amiodarone?

A

Blocks potassium channels –> inhibits repolarisation and prolongs the action potential.

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32
Q

Is amiodarone an inducer or inhibitor?

A

Inhibitor

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33
Q

Side effects of amiodarone?

A

1) Thyroid dysfunction: both hypo- and hyper-

2) Pneumonitis/pulmonary fibrosis

3) Liver fibrosis/hepatitis

4) Corneal deposits

5) Slate grey appearance

6) Photosensitivity

7) Peripheral neuropathy

8) Thrombophlebitis and injection site reactions

9) Lengthens QT

10) Bradycardia

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34
Q

What is Beck’s triad?

A

Findings associated with cardiac tamponade:

1) hypotension
2) raised JVP
3) diminished heart sounds

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35
Q

Which class of medication can lead to unawareness of hypoglycemic events?

A

Beta blockers

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36
Q

1st line Abx in native valve infective endocarditis?

A

IV amoxicillin

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37
Q

What 3 electrolyte imbalances can cause long QT?

A

1) hypokalaemia
2) hypomagnesaemia
3) hypocalcaemia

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38
Q

What is isosorbide mononitrate?

A

A long acting nitrate

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39
Q

Which drug is contraindicated in VT?

A

Verapamil –> can precipirate cardiac arrest

40
Q

What should be given to patients who are in VF/pulseless VT after 3 shocks have been administered?

A

IV amiodarone 300mg & IV adrenaline 1mg

41
Q

General stepwise management of angina?

A

1) Aspirin & statin –> all patients

2) GTN spray

3) Beta blocker and/or CCB

42
Q

Diastolic murmur + AF → ?

A

Mitral stenosis

43
Q

Why may a pulse ox be falsely high in carbon monoxide poisoning?

A

Due to similarities between oxyhaemoglobin and carboxyhaemoglobin.

44
Q

1st line investigation in carbon monoxide poisoning?

A

VBG or ABG

45
Q

Management of carbon monoxide poisoning?

A

1) 100% high-flow oxygen via a non-rebreather mask: target sats 100%

2) hyperbaric oxygen

46
Q

Is dialysis effective in TCA OD?

A

No (but it is in salicylate & lithum OD)

47
Q

Reversal agent of iron?

A

Desferrioxamine, a chelating agent

48
Q

Management of cyanide OD?

A

Hydroxocobalamin

49
Q

What test is offered to patients with chronic pancreatitis to screen for diabetes?

A

Annual HbA1c

50
Q

What is Budd-Chiari syndrome?

A

A condition characterised by obstruction to hepatic venous outflow.

Also knownas hepatic vein thrombosis.

51
Q

What is a key investigation in a suspected perforated peptic ulcer?

A

CXR

52
Q

What is acalculous cholecystitis?

A

Gallbladder inflammation without gallstones.

It’s less common, but usually more serious.

53
Q

What serology result is highly specific for primary biliary cholangitis?

A

AMA

54
Q

What condition causes classic ‘beaded’ strictures on ERCP?

A

UC

55
Q

What classification system is used to guide management of cellulitis?

A

Eron classification

56
Q

Describe the Eron classification

A

Class I - no systemic toxicity or comorbidity

Class II - systemic toxicity or comorbidity

Class III - significant systemic toxicity or significant comorbidity

Class IV - sepsis or life-threatening infection

57
Q

What Eron classification indicates admission for IV Abx?

A

Class III and IV

58
Q

What is typical 1st line Abx for mild/moderate cellulitis?

A

Oral flucloxacillin

59
Q

1st line Abx for mild/mod cellulitis in pregnancy?

A

Oral erythromycin

60
Q

1st line Abx for mild/mod cellulitis in penicillin allergy?

A

oral clarithromycin, erythromycin or doxycycline

61
Q

What is usually the 1st choice Abx for cellulitis near the eyes or nose?

A

Co-amoxiclav

62
Q

1st line Abx in severe cellulitis?

A

Oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone

63
Q

What are the 4 types of NF?

A

Type I: polymicrobial (most common)

Type II: monomicrobial (caused by Streptococcus pyogenes)

Type III: monomicrobial (caused by the Clostridium species most commonly)

Type IV: fungal NF, mainly Candida species

64
Q

What is gas gangrene?

A

A form of NF caused by clostridium specicies (C. perfringens), resulting in gas being produced by the bacteria within the tissue.

65
Q

What is the only definitive management of NF?

A

Surgical debridement

66
Q

What is Trousseau’s sign?

A

Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic –> indicates hypocalcaemia

67
Q

What lead is T wave inversion a normal variant?

A

Lead III

68
Q

Side effects of amiodarone therapy?

A

1) thyroid dysfunction: hypo- and hyperthyroidism

2) pulmonary fibrosis/pneumonitis

3) liver fibrosis/hepatitis

4) corneal deposits

5) ‘slate-grey’ appearance

6) bradycardia

7) QT lengthening

8) photosensitivity

69
Q

What are the 2 important drug interactions of amiodarone?

A

1) decreased metabolism of warfarin –> increased INR

2) increased digoxin levels

70
Q

Adverse effects of methotrexate?

A

1) myelosuppression
2) liver fibrosis
3) lung fibrosis
4) mucositis
5) pneumonitis

71
Q

What investigations need to be regularly monitored in patients on methotrexate?

A

FBC, U&Es, LFTs

72
Q

What drug is commonly used in the treatment of SLE?

A

Hydroxychloroquine

73
Q

What electolyte abnormality is hypokalaemia often associated with?

A

Hypomagnesaemia

74
Q

What can the correction of:

a) hyponatraemia
b) hypernatraemia

too quickly lead to?

A

a) osmotic demyelination syndrome
b) cerebral oedema

75
Q

Acute vs chronic hyponatraemia?

A

Acute: <48h

Chronic: >48h

76
Q

What type of hyponatraemia does Addisons cause?

A

Hypovolaemic hyponatraemia (high urinary sodium)

77
Q

Management of hypovolaemic hyponatraemia?

A

Isotonic saline (0.9% NaCl)

If serum sodium rises –> supports a diagnosis of hypovolemic hyponatraemia

If the serum sodium falls –> alternative diagnosis such as SIADH is likely

78
Q

if the serum sodium falls in the mx of hypovolaemic hyponatraemia (with 0.9% NaCl), what does this suggest?

A

Alternative diagnosis e.g. SIADH

79
Q

Management of acute, severe hyponatraemia (<120 mmol/L) or symptomatic hyponatraemia?

A

Hypertonic saline (3%) is typically used.

80
Q

Symptoms of osmotic demyelination syndrome?

A

dysarthria
dysphagia
paraparesis or quadriparesis
seizures
confusion
coma
can have ‘locked in syndrome’

81
Q

How is osmotic demyelination syndrome avoided?

A

Na+ levels are only raised by 4-6 mmol/L in a 24h period

82
Q

Management of severe hypocalcaemia?

A

IV 10% calcium gluconate over 10 mins

83
Q

How can UH and LMWH affect potassium?

A

Can cause hyperkalaemia (this is throught to be caused by inhibition of aldosterone secretion).

84
Q

What is Chvostek sign?

A

Tapping the facial nerve in front of the ear leads to contraction of the facial muscles on the same side of the face –> indicates hypocalcaemia.

85
Q

Mechanism of thiazide-like diuretics?

A

Block the Na/Cl cotransporter in the distal convoluted tubule.

This results in an increased excretion of sodium and chlorine (and therefore water) in the urine.

86
Q

What is the most common presentation of MEN 1?

A

Hypercalcaemia

87
Q

What is the most common presentation of MEN 1?

A

Hypercalcaemia

88
Q
A
89
Q

What is the max daily dose of metformin?

A

2g/day

90
Q

What is the most common complication of thyroid eye disease?

A

Exposure keratopathy

91
Q

What are 3 key complications of thyroid eye disease?

A

1) Exposure keratopathy (most common)

2) Optic neuropathy

3) Strabismus and diplopia

92
Q

Management of optic neuropathy caused by thyroid eye disease?

A

it requires urgent medical intervention to prevent permanent vision loss.

93
Q

What condition is thyroid eye disease seen in?

A

Grave’s disease

94
Q

Features of thyroid eye disease?

A
  • exophthalmos
  • conjunctival oedema
  • optic disc swelling
  • ophthalmoplegia
  • inability to close the eyelids may lead to sore, dry eyes - if severe and untreated patients can be at risk of exposure keratopathy
95
Q
A

Yr 5 - A&E (14 decks)

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