CPP Case Studies

Question 1

What is your fluid endpoint in a patient that you suspect has internal bleeding?

Answer 1

• Titrate to maintain radial pulse, approx. SBP 80 mmHg
• Normal mentation

Question 2

What does an EEA do when the patient reaches the hospital?

Answer 2

Detains them for 6 hours to allow a medical professional to further assess and treat them and can be extended up to 12 hours.

Question 3

What are some common drugs that may be administered during a hypoglycaemic emergency?

Answer 3

• Glucose Gel
• Glucose 10%
• Glucagon

Question 4

What is the appropriate management for a pulsatile cord present in the vaginal opening?

Answer 4

• Assist the mother into the exaggerated SIMS position
• Ask the mother to gently push the cord back into the vagina (this must be done carefully to avoid vasospasm) using a dry pad

Question 5

What are the expected vital signs of a 1 year old?

Answer 5

Weight: 10kg
HR: 90-150bpm
RR: 25-50rpm
SBP: 70-100mmHg

Question 6

What are the signs suggestive of placental separation during labour?

Answer 6

• Uterus rises in the abdomen and becomes firmer and globular
• Fresh show/trickle of blood
• Lengthening of the umbilical cord

Question 7

What are some intrapartum (during labour) risk factors for primary PPH?

Answer 7

• Expedited or prolonged second stage
• Prolonged third stage greater than 30 minutes
• Macrosomia (large baby)
• Polyhydraminos (excess amniotic fluid)
• Infection/Prolonged rupture of membranes

Question 8

What are some common causes of palpitations?

Answer 8

• Strong emotional distress
• depression
• Stimulants
• Exercise/physical exertion
• Fever
• Hormones changes
• Thyroid hormones – too much or too little

Question 9

Describe how beta blockers might impact a patient’s presentation?

Answer 9

Beta blockers bind to B1 and B2 receptors, inhibiting the catecholamines adrenaline and noradrenaline, reducing the inotropic and chronotropic effects on the heart

unable to have a tachycardic response

Question 10

What are some questions to ask parents of a seizing patient with a history of seizures?

Answer 10

• What has concerned mum the most in this seizure compared to other ones – length, different type of seizure?
• Has she been unwell recently?
• Do they have midazolam at home and have they given any prior to our arrival (take into drug protocol)
• Was the Pt her normal self prior to the seizure?
• How often does she have seizures?
• How long do they normally last?
• Is the buccal midazolam usually effective?

Question 11

Define Obtunded

Answer 11

lessened interest in the environment, has slowed responses to stimulation, and tends to sleep more than normal, with drowsiness in between sleep states

Question 12

What are some neonate complications associated with shoulder dystocia?

Answer 12

• Brachial plexus injuries
• humeral and clavicular fractures
• hypoxic brain injury
• stillbirth

Question 13

What are your actions with a newborn that doesn’t respond to stimulation?

Answer 13

• IPPV room air for 30 secs (20-30 breaths)
• Reassess: sats probe on right hand, HR should be >100

Question 14

Describe and justify your management for a pt with COPD, with low SPO2, fever and low BP

Answer 14

• 4L oxygen via nasal prongs to increase SPO2 to between 88-92% and increase partial pressure of oxygen to aid in oxygen binding to haemoglobin
• salbutamol
• IV access – to administer fluids and medications
• IV fluids – titrate to maintain radial pulse if lost - and increase blood pressure and possibly secondary effect of reducing fever and BGL
• antipyretic

Question 15

What is the cause of acute febrile illness headaches?

Answer 15

Pneumonia, URTI, viral infections or UTIs

Question 16

What are the risk factors associated with the development of pre-eclampsia?

Answer 16

• Diabetes
• Extremes of maternal age
• Family history
• Gestational hypertension
• History pre-eclampsia
• Multiple pregnancies
• Obesity
• Renal disease

Question 17

What is the definition of TIA and can it be differentiated from stroke?

Answer 17

stroke signs and symptoms caused by a temporary occlusion, that self resolve within 60 minutes to 24 hours.

It can’t be differentiated at the time of treatment by paramedics.

Question 18

What questions specific to females should you ask a female patient who has fainted/had a syncopal event?

Answer 18

• Sexual activity
• Contraceptive use
• Chance of pregnancy

Question 19

What tools can be used to identify Sepsis?

Answer 19

QAS sepsis criteria:

Temperature
AVPU
Respiration rate
Heart rate
Systolic BP

Question 20

Outline the NEXUS criteria.

Answer 20

• ALOC
• focal neurological deficit
• midline tenderness
• intoxication
• distracting injury

If patient is positive for at least one of the criteria, c spine precautions need to be implemented

Question 21

What is the cause of meningitis headaches?

Answer 21

Inflammation of the meninges

Question 22

What are the signs and symptoms for peritonitis and sepsis?

Answer 22

• Fever or low body temperature/rigors
• rash
• ALOC
• Lethargy/weak/fatigue
• Thirst
• Loss of appetite
• Tachypnoea
• Hypotension
• Tachycardia
• Abdominal pain or tenderness
• Bloating or a feeling of fullness in the abdomen
• Nausea/vomiting/diarrhea
• Decreased urine output
• Not able to pass stool or gas

Question 23

What are some risk factors for aortic aneurysm?

Answer 23

• Age
• Male gender
• Family history
• Hypertension
• Hx aortic dissection
• Preexisting cerebral aneurysm
• Several syndromes (marfan, turner)
• Trauma (particularly deceleration)

Question 24

+3 Sedation Assessment Tool (SAT) behaviour score description

Answer 24

combative, violent, out of control

Question 25

What are the common signs and symptoms of mild alcohol withdrawal?

Answer 25

• anxiety
• anorexia
• insomnia
• hypertension
• tachycardia
• nausea
• coarse tremor

Question 26

Define Delirious

Answer 26

disorientated; restless, hallucinating, sometimes delusional

Question 27

What are your post ROSC cares for a paediatric drowning pt?

Answer 27

Continue ventilations and oxygen, maintain SPO2 >94%, ETCO2 35-45mmHg, PEEP
Circulation – SBP >80 mmHg, consult for fluids if needed
Consider C spine mobilisation, warming patient, rapid transport
Post ROSC cares

Question 28

What are some considerations/queries on the way to a job for third trimester pregnant patient with a headache?

Answer 28

Gestation
Prenatal cares
Complications with this pregnancy
In labour

Question 29

What is Atacand Plus presribed for?

Answer 29

hypertension

Question 30

Outline the different types of hallucinations that can occur.

Answer 30

Visual – seeing things that aren’t there
Auditory – hearing things that aren’t there
Tactile – feeling things on skin that aren’t there
Olfactory – smelling things that aren’t there
Somatic – feeling of being touched when you aren’t
Gustatory – strange or unpleasant taste in mouth with nothing in it

Question 31

Describe the body’s normal glucose homeostasis mechanisms.

Answer 31

The balance and interaction of insulin and glucagon

Question 32

What does the mental status assessment affect component assess?

Answer 32

Emotion as observed (Objective)

Question 33

Westley Croup Score LOC Variables and Scores

Answer 33

Disorientated - 5

Normal, including sleep - 0

Question 34

Define Faeculent vomiting

Answer 34

vomiting faecal material

Question 35

What do you look for when you inspect the placenta?

Answer 35

Completeness, smoothness and integrity – missing parts or ragged membranes

Question 36

What does the mental status assessment perceptions component assess?

Answer 36

How they perceive their world

Question 37

Describe the methods to deliver effective chest compressions in the newborn?

Answer 37

• 2 fingers/or 2 thumbs
• Rotate 2 minutes

Question 38

What occurs in the second stage of labour?

Answer 38

full dilation of the cervix and birth of the baby

Question 39

What is Zocor presribed for?

Answer 39

hypercholesterolaemia

Question 40

What should you do if you notice ongoing bleeding post delivery and why?

Answer 40

Fundal massage until firm and central – increases uterine tone, expresses clots and reduces haemorrhage

Question 41

What is Zoloft presribed for?

Answer 41

anxiety

Question 42

What are the signs and symptoms of shock?

Answer 42

• Hypotension
• Tachycardia
• anuria
• unconsciousness

Question 43

What are the expected vital signs of a 9 year old?

Answer 43

Weight: 34kg
HR: 70-120bpm
RR: 15-25rpm
SBP: 90-115mmHg

Question 44

What are some high risk signs for sepsis in paediatrics?

Answer 44

• Capillary refill 3 seconds or longer
• Hypoglycaemia
• Moderate respiratory distress/tachypnoea
• Moderate tachycardia
• Pale or flushed/mottled/cold extremities
• Reduced urine output
• Unexplained pain or restlessness

Question 45

What is the definition of sepsis?

Answer 45

Life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 46

What class of drug is ventolin?

Answer 46

bronchodilator/short acting beta agonist

Question 47

What is the presentation of uterine rupture?

Answer 47

• abnormal labour or failure to progress
• severe localised abdominal pain
• non-reassuring foetal heart patterns
• uterine tenderness
• loss of intrauterine pressure or cessation of contractions
• vaginal bleeding
• maternal hypovolaemic shock

Question 48

Describe the steps of the Valsalva manoeuvre?

Answer 48

• Explain the procedure to the patient
• Position them supinely
• Take a baseline 12 lead ECG
• Have them forcefully blow into a 10ml syringe for 15 seconds
• Repeat 12 lead ECG

Question 49

Describe the pathophysiology of seizures and common types of seizures.

Answer 49

Abnormal electrical discharges (neuronal activity) within the brain causing random, uncontrolled neuronal depolarisation to one or more regions of the brain.

Question 50

What are the clinical features of acute febrile illness headaches?

Answer 50

Fever and symptoms of underlying cause eg URTI, tonsillitis

Question 51

Outline your initial management of an unrespnsive patient, with a snore, RR 4, slow radial pulse and cold, and why?

Answer 51

• Reposition to supine with neutral head alignment to open airway and remove snore
• IPPV 15L oxygen to supplement RR of 4 and add additional and supplementing breaths to increase resp rate to 18 p/min to improve oxygenation and reverse any hypoxia that may have already occurred
• Place blanket over patient to improve body temperature

Question 52

What are the clinical features of encephalitis headaches?

Answer 52

reduced conscious level
confusion
fever

Question 53

What is the pathophysiology of croup?

Answer 53

virus causes swelling of the larynx and trachea causing the airways to narrow and breathing to become more difficult

Question 54

What red flags may arise in history taking, suggesting non-accidental injury?

Answer 54

• Poor history or account of the injury occurring
• Hx of unwitnessed trauma
• Hx or family violence (may or may not know this)
• Mechanism non compatible with child’s age or development capabilities
• Hx does not match with patient findings
• Inconsistencies in hx
• Delay in seeking medical attention for an injury in a non ambulatory infant
• Patterns of bruising or shapes, old bruising

Question 55

Outline reverse wood’s screw manoeuvre

Answer 55

apply pressure to posterior of foetus posterior shoulder and rotate in opposite direction to Wood’s Screw manoeuvre

Question 56

What are the expected vital signs of a 10 year old?

Answer 56

Weight: 37kg
HR: 70-120bpm
RR: 15-25rpm
SBP: 90-115mmHg

Question 57

What is the pathophysiology of peritonsilar or retropharyngeal abscess?

Answer 57

infection from tonsilitis

Question 58

What are the effects of a life threatening serotonin toxicity?

Answer 58

• Seizures
• Hyperthermia
• Cardiovascular dysfunction
• QT prolongation
• Torsades de pointes
• Multiorgan failure
• Rigidity

Question 59

What are the general categories of acute behavioural disturbances?

Answer 59

• Substance toxicity
• Medical and organic disorders
• Acute mental health conditions
• Situational/behavioural

Question 60

What is the management for stroke?

Answer 60

• Position Pt with 45 degree head elevation
• Consider:
  Midazolam
  IV Access
  IV fluids
  Oxygen
  Analgesia
  Antiemetics
• Repeat stroke assessment to trend condition
• Rapid transport to appropriate facility

Question 61

What are some common causes of abdominal distension?

Answer 61

• Fat
• Fluid (ascites)
• Flatus
• Faeces
• Foetus
• Filthy big tumour

Question 62

What is the drug flixotide and what is it used for?

Answer 62

corticosteroid
asthma and allergies

Question 63

What characterises a mild airway obstruction?

Answer 63

• patients themselves will optimise position (e.g. siting forward)
• effective cough
• crying or verbal responses present
• able to take breath before coughing
• fully responsive

Question 64

What are some differential diagnoses of headaches in pregnancy?

Answer 64

Pre-eclampsia
Eclampsia
Central venous thrombosis
Primary headache
Secondary headache

Question 65

What is the treatment for an anaphylaxis patient and the mechanism of management?

Answer 65

appropriate dose adrenaline IM – sympathomimetic agent alpha and beta adrenergic receptor antagonist that makes the heart beat faster and harder due to alpha 1 causing peripheral vasoconstriction and beta 1 increasing ventricular irritability, contractile force, conductivity and AV node. Beta 2 stabilises mast cells to negate their deregulatory effect

Question 66

What is the treatment for epiglottitis?

Answer 66

Reassure
Consider oxygen – mask and rate dependent upon SPO2
Position of comfort
Rapid transport

Question 67

What is the pathophysiology of agitated delirium?

Answer 67

Hyperthermia causing rhabdomyolysis and acidosis due to antagonism of M1 and M2 muscarinic receptors

Question 68

What class of drug is lantus?

Answer 68

long acting insulin

Question 69

What organs are in the Left Iliac Region?

Answer 69

• parts of sigmoid colon
• descending colon
• small intestine

Question 70

What gynaecological history questions should you ask a female patient who has abdomen pain?

Answer 70

• Are her menses regular?
• Has she had any PV bleeding?
• Is there a possibility that she could be pregnant?
• Does she have any gynaecological Hx in general?
• Does she take contraceptives?

Question 71

What is the drug salbutamol taken for?

Answer 71

asthma
COPD

Question 72

What are the main principles to consider when speaking with someone who is suicidal?

Answer 72

• Safety for everyone
• Clear communication
• Tell the person you care and can help them at this time
• Gather pertinent information about their situation from family, friends, carers, bystanders or other credible sources or health services
• Taking time to listen to the person

Question 73

What are some common anti-depressants and their mechanism of action?

Answer 73

• Selective serotonin reuptake inhibitors (SSRIs) – Serotonin (5HT) reuptake inhibitors– fluoxetine, sertraline, citalopram
• Serotonin noradrenaline reuptake inhibitors (SNRIs) –5HT & noradrenaline reuptake inhibitors– venlafaxine, desvenlafaxine, duloxetine
• Tricyclic antidepressants (TCAs) - 5HT & noradrenaline reuptake inhibitors & receptor blockers - amitriptyline, imipramine, nortriptyline
• Monoamine oxidase inhibitors (MAOIs) - Inhibits breakdown of 5HT, noradrenaline, & dopamine, and catecholamines - phenelzine, tranylcypromine, moclobemide

Question 74

Outline the mechanism of serotonin toxicity.

Answer 74

Increased concentrations of serotonin in the CNS interacting with G-protein-coupled receptors, inhibit auto receptors, causing increased serotonin synthesis and decreased reuptake – makes serotonin and stops the body from re-uptaking excess serotonin

Question 75

What organs are in the Left Hypochondriac Region?

Answer 75

• spleen
• large/small intestines
• left kidney
• pancreas
• stomach
• tip of the liver

Question 76

Describe the pathophysiology of pulmonary embolism during pregnancy

Answer 76

hypercoagulable state and decreased blood flow from uterine veins can cause blood clots in the legs

Question 77

How does the baby present in a footling breech?

Answer 77

One or both feet presents first, with the buttocks at a higher position. The hips and knees are flexed so that the foetus is sitting cross-legged, with feet beside the buttocks.

Question 78

List some common psychostimulants

Answer 78

• Cocaine
• methamphetamine
• methylenedioxymethamphetamine (MDMA)

Question 79

What does a mental status assessment include?

Answer 79

• Appearance
• Behaviour
• Perceptions
• Speech
• Affect
• Mood
• Thought content
• Thought form
• Insight & Judgement

Question 80

How may a beta blocker overdose present?

Answer 80

• Pulmonary oedema
• Hypotension
• Bradycardia
• Heart block
• Cardiogenic shock
• Hypoglycaemia/hyperglycaemia
• Seizures, coma (propranolol)

Question 81

What is the treatment for bacterial tracheitis?

Answer 81

symptomatic

Question 82

What occurs in the third stage of labour?

Answer 82

delivery of the placenta

Question 83

What are the expected vital signs of a 5 year old?

Answer 83

Weight: 22kg
HR: 80-140bpm
RR: 20-30rpm
SBP: 80-110mmHg

Question 84

What type of drug is metoprolol?

Answer 84

beta blocker

Question 85

What are some red flags associated with headaches?

Answer 85

• Thunderclap headache (intense, exploding, and hyperacute onset)
• Headaches associated with fever, rash or ALOC
• Meningeal signs (stiff neck, photophobia, or vomiting)
• New onset headache in patients > 50 or < 10
• Persistent morning headache with nausea
• New onset of headache in Pt with cancer or HIV
• Progressive headache worsening over weeks
• Headaches associated with postural changes
• Aura (warning sensation) that lasts longer than an hour, is different from previous aura, or occurs for first time on using oral contraceptive

Question 86

Define wheezing and its mechanism

Answer 86

high-pitched whistling noise – sound of air moving in constricted airways

Question 87

What are some causes for an altered level of consciousness?

Answer 87

• Stroke
• Inadequate cerebral perfusion
• Hypoxia
• Increased carbon dioxide levels
• Metabolic disturbances
• Drugs or toxins
• Post ictal seizure
• Intracranial pathology
• Extracranial pathology
• AEIOUTIPS

Question 88

Outline the steps involved in the management of a breech delivery.

Answer 88

• Call for backup
• Prepare for neonatal resuscitation
• Hands off - Delivery should proceed spontaneously through gravity, maternal effort and uterine action
• Assist with delivery of legs if needed
• Perform manoeuvres if complications or failure to deliver
• Thumbs on bum
• manoeuvres if needed - Lovesets 1, Lovesets 2, Lovesets 3
• MSV maneouvre (to deliver the head)

Question 89

What considerations should you have when getting a history from older patients?

Answer 89

Forgetfulness/confusion
A lot of medications
Sudden decline in mobility, self care, chores etc

Question 90

What is the pathophysiology of placental abruption?

Answer 90

Rupture of the maternal vessels in the pregnancy modified endometrium causing the placental to separate partially or completely from the uterine wall.

Question 91

How does excess alcohol consumption contribute to the underlying mechanism of pancreatitis?

Answer 91

small pancreatic ducts blocked by viscous secretions and activation of lysosomal and digestive enzymes in acinar cells and association with GI bleed and ruptured varices

Question 92

What is the Tx for a PE Pt?

Answer 92

anticipate deterioration and CPR
* High flow oxygen – PEs can be resistant to oxygen therapy
* Pain relief – morphine – indications, contraindications, consult for more
* 12 lead
* No need for aspirin

Consider:
* differential diagnosis
* IV fluids – max 1L due to failing RV and risk of increasing preload
* adrenaline
* CCP backup
* transport
* pre-notify as appropriate

Question 93

What are the cholinergic signs and symptoms?

Answer 93

dumbbells

D - diarrhoea
U - urination
M – miosis
B – bronchorrhea
B – bradycardia
E – emesis
L – lacrimation
L - lethargy
S – salivation/sweating

Question 94

What is the drug effect of Span-K?

Answer 94

increases levels of K+ in the blood

Question 95

What suffix do a lot of TCAs end in?

Answer 95

ine

Question 96

What options do you have to get a patient off the floor?

Answer 96

Manual lift
Raizer
Camel
Hover mat

Question 97

What is the cause of encephalitis headaches?

Answer 97

Inflammation of active brain tissues from infection or autoimmune response

Question 98

What assessments or clinical tests can you carry out to assist with a diagnosis of meningitis?

Answer 98

• Head to toe to identify and rashes – non-blanching purpuric or petechial rash or bruising
• Difficulty touching chin to chest with mouth closed
• Difficulty touching forehead to knee
• Brusinski sign
• Kernig’s signs

Question 99

What does it mean when the baby’s head fails to restitute/what is this a sign of, and why does this occur?

Answer 99

Shoulder dystocia as the baby’s shoulders are too wide for the pelvic inlet and the anterior shoulder impacts on the symphysis pubis

Question 100

How is stimulant toxicity graded?

Answer 100

Mild, moderate, severe

Question 101

What are some considerations you would have enroute to a chest pain call?

Answer 101

• Previous heart Hx/medical Hx
• ACS protocols – early 12-lead with serial printouts, aspirin, GTN
• Nearest cath lab
• Knowing what hospitals have different capabilities
• Differentials

Question 102

What is the definition of secondary postpartum haemorrhage?

Answer 102

Abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks following birth, usually defined as more than one heavily soaked pad per hour

Question 103

What are the clinical features of raised ICP headaches?

Answer 103

Worse on waking/sneezing
Raised BP
Reduced pulse rate

Question 104

Define septic abortion

Answer 104

serious uterine infection before, during or shortly after a spontaneous or induced abortion

Question 105

How can you differentiate between croup and epiglottitis?

Answer 105

Croup - gradual onset with hx of runny nose or illness that gets worse at night

Epiglottitis - acute fast onset

Question 106

What is ALOC?

Answer 106

reduced alertness or inability to arouse

Question 107

What type of drug is rosuvastatin?

Answer 107

statin

Question 108

What is the pathophysiology of a focal seizure?

Answer 108

abnormal neuronal activity originates and is limited to one hemisphere of the cerebral cortex

Question 109

What type of drug is rivaroxaban?

Answer 109

anticoagulant

Question 110

Define induced abortion

Answer 110

intentional termination of a pregnancy by a procedure or medication

Question 111

Compare and contrast the Valsalva and the modified Valsalva manoeuvre

Answer 111

The Valsalva manoeuvre requires the patient to be sitting in the one semi-recumbent position, however the modified Valsalva manoeuvre requires to patient to be initially semi recumbent, then supine with legs elevated and then back into a semi recumbent position

Question 112

What are some risk factors for complications during pregnancy and possible consequences that can be associated?

Answer 112

• Alcohol or drug abuse – cause miscarriage, defects, early labour
• Eclampsia
• Extremes of maternal age – very young or older – increased risk of complications
• Foetal growth restriction
• Gestational or preexisting diabetes – macrosomic babies, foetal death, foetal malformations and growth restriction and increased need for interventiosn during labour
• Hypertensive disorders – chronic hypertenstion, preeclampseia, help
• Older women – increased risk of complications
• Preterm – baby at risk due underdeveloped
• Previous c sections/shoulder dystocia – increased risk of shoulder dystocia
• Prior preterm delivery, prior stillbirth – increased risk in subsequent pregnancies

Question 113

Describe your ABD sedation brief to the team and what equipment you will have available.

Answer 113

• Allocation of sedation supervisor, sedation assistant and other required personnel
• Advising QPS of requirements for positioning of patient – avoiding pressure on the head, neck and chest/back
• Restraint of the patient to occur as late as possible
• Equipment on hand is resuscitation kit and defibrillator

Question 114

What could be an additional differential in a pregnant patient presenting with chest pain and SOB?

Answer 114

Peripartum cardiomyopathy
Aortic dissection
Pulmonary embolism

Question 115

What type of drug is Frusemide?

Answer 115

loop diuretic

Question 116

Where do you clamp and cut the cord?

Answer 116

10cm, 15cm and 20cm
Cut between 15cm and 20cm

Question 117

What is the definition of primary postpartum haemorrhage?

Answer 117

Blood loss of greater than 500 mls from birth canal within the first 24 hours following birth

Question 118

What are some red flags for sepsis? Why may these factors be considered red flags?

Answer 118

• Re-presentation to a health care professional within 48 hours – treatment not working
• Age less than 3 months OR greater than 65 years – reduced immune system
• Recent trauma or surgery/invasive procedure/wound within last 6 weeks – possible cause of infection
• Indwelling medical devices (e.g. IDC) – possible cause of infection
  *Immunocompromised/unimmunised – reduced immune system
• Parental/family/health care professional concern for the patient – medical knowledge of health concern
• Aboriginal or Torres Strait Islander/Pacific Islander/Maori cultural backgrounds – reduced access to health care

Question 119

Outline the important elements of the “golden hour” and the benefits that it may have.

Answer 119

• general management
• skin to skin contact
• delay non urgent parts of assessment
• early initiation of breast feeding
• keep bub warm

It promotes bonding and milk supply as well as the release of oxytocin in mum and bub

Question 120

What is a thunderclap headache?

Answer 120

sudden onset of severe thunderclap type head pain

Question 121

Define spontaneous abortion

Answer 121

natural loss of pregnancy prior to 20 weeks gestation

Question 122

Provide some common calcium channel blocker drug names

Answer 122

• Verapamil
• Diltiazem
• Amlodipine
• Nifedipine
• Felodipine
• Lercanidipine

Question 123

What are some differential diagnoses for a Pt who is:
tripoding - significant SOB
increased WOB
pale, clammy
sudden onset of sharp right-sided chest pain whilst mobilising and is worsened on inspiration?

Answer 123

• Pulmonary embolism – especially if tachycardic
• Spontaneous pneumothorax (tall skinny fellow) – diminished chest sounds
• Myocardial infarction
• Congestive Heart Failure
• Pericardial tamponade
• Pericarditis
• Infection

Question 124

What is the management for a DKA patient and why?

Answer 124

• Oxygen – increase SPO2 >94% and reduce amount of CO2
• IV access - for drug administration
• IV fluids – to increase vascular volume to improve BP and maintain radial pulse and to dilute blood concentration of glucose
• Consult for salbutamol to shift K back to cells
• Rewarming - reversible cause of cardiac arrest
• Pads on - as can deteriorate
• CCP backup - to provide additional knowledge and assistance in treating

Question 125

What is the management for a patient in cardiac arrest refractory to 3 stacked shocks?

Answer 125

• Amiodarone – (unless contra for TCA) 300mg IV slow push over 1-2 minutes
• after 5th DCCS 150mg IV slow push over 1-2 minutes
• after 6th DCCS adrenaline – 1mg IV every 3-5 minutes

Question 126

What are the indications for an acute stroke referral?

Answer 126

Mandatory for all Pts with symptoms suggestive of stroke who meet the following:
* Onset of stroke symptoms less than 24 hours; AND
* The patient is able to be transported to an acute stroke centre (ASC) within 60 minutes (from stroke assessment)

Question 127

Define inevitable abortion

Answer 127

uterine contractions causing cervix dilation leading to a complete or incomplete abortion

Question 128

What other steps can be taken to assist with uterine contractions/haemorrhage control post delivery?

Answer 128

• Stimulate endrogenous oxytocin release by the commencement of breastfeeding
• Have mum urinate

Question 129

What are the clinical features of tension type headaches?

Answer 129

Band around the head
Stress
Low mood

Question 130

0 Sedation Assessment Tool (SAT) behaviour score description

Answer 130

Awake/calm and cooperative

Question 131

What are the clinical features of migraine headaches?

Answer 131

Aura
visual disturbance
unilateral headache
nausea/vomiting
trigger

Question 132

What is the pathophysiology of bacterial tracheitis?

Answer 132

bacteraemia and/or pathogenic invasion of the epithelial layer

Question 133

What is Ezetrol presribed for?

Answer 133

hypercholesterolaemia

Question 134

What does the mental status assessment judgement component assess?

Answer 134

ability to evaluate choices and make appropriate
choices

Question 135

What is your initial management for an unconscious hypoglycaemic patient and justify why?

Answer 135

• IV access to administer glucose 10% as glucose is the preferred fuel source over glucagon. This is with the aim of returning his BGL back to within normal limits.
• If can’t get IV access, go glucagon however if don’t have appropriate store of glycogen in liver, glucagon won’t work

Question 136

Describe the general pharmacology of steroids.

Answer 136

Inhibit the inflammatory action of the phospholipase A2 enzyme and used for multiple reasons for infections in a variety of setting for long term disease processes

Question 137

What is the pharmacology of a calcium channel blocker?

Answer 137

Restrict calcium ingress, slowing cardiac conduction and contractility and decreasing the oxygen demand of the heart

Verapamil and diltiazem also cause peripheral vasodilation, lowering arterial blood pressure and reducing ventricular afterload

Question 138

What is the pathophysiology of a cardiac arrest with an underlying asthmatic disease process?

Answer 138

Air trapping causing obstructive shock which increases intrathoracic pressure and compressing inferior vena cava, stopping blood flow to right side of heart. Right ventricle depends on preload forcing contraction.

Question 139

Define “coffee ground”

Answer 139

vomit that looks like it has coffee grounds in it due to coagulated blood

Question 140

What is the underlying pathophysiology that contributes to the development of pre-eclampsia?

Answer 140

Unclear, however is thought to be from an abnormal placentation, endothelial dysfunction, inflammation, immune system activation, oxidised stress, renal involvement due to impaired kidney function, hormone imbalance or other genetic factors

Affects some pregnant women typically after 20 weeks and characterised by hypertension and protein in urine

Question 141

Outline rubins II manoeuvre

Answer 141

insert gloved hand and apply posterior pressure to anterior shoulder of the foetus to rotate shoulders to oblique diameter

Question 142

What are the three main priorities after administering an initial adrenaline dose in anaphylaxis?

Answer 142

High flow oxygen
Further appropriate doses adrenaline – appropriate time frame
Throughough head to toe – to identify any external cause

Question 143

Under which act does an EEA operate?

Answer 143

Public Health Act 2005

Question 144

How does paracetamol produce analgesia?

Answer 144

works through cox inhibition and production of prostaglandins

Question 145

What risks are associated with cord prolapse?

Answer 145

• Foetal blood supply occluded, leading to hypoxia and death
• Vasospasm when manoeuvring the umbilical cord

Question 146

Define the pattern of pain for Pancreatic pain

Answer 146

• left hypochondriac or epigastric region pain, worsened within minutes after eating or drinking, especially high fat foods, can become constant and more severe and can last several days
• Worsened when lying on back and can radiate to the back or below left scapula

Question 147

What are the expected vital signs of a 11 year old?

Answer 147

Weight: 40kg
HR: 70-120bpm
RR: 15-25rpm
SBP: 90-115mmHg

Question 148

What is the drug class and use of panadol-osteo?

Answer 148

analgesic
osteoarthritis

Question 149

What are the clinical features of subarachnoid haemorrhage headaches?

Answer 149

‘Thunder-clap’ or very sudden onset headache
+/- stiff neck

Question 150

What is your management if the newborn’s pulse drops below 60?

Answer 150

• Place on flat surface
• CPR: 3:1 (Compressions:breath)
• Paeds pads on
• If shockable rhythm, shock at 4joules/kg – manual defib setting
• IV access
• 50 mics (0.5ml) adrenaline every 3-5 mins (using 1:10,000 (100mic/1ml) ampoule)

Question 151

What does GTN do?

Answer 151

reduces preload and afterload, allowing blood flow through cardiac arteries and veins and peripheral blood pooling to reduce workload of the heart

Question 152

Using the above graphic, estimate the blood loss in each picture

Answer 152

• 30ml
• 100ml
• 500ml
• 60ml
• 350 ml
• 250ml
• 1000ml
• 2000ml
• 1500 ml

Question 153

What is your management for an unresponsive patient presenting with:
Respiratory Status Assessment
* Rate – the intrinsic rate is 4
* Rhythm – regular
* Effort – decreased and shallow
* Sats – 85%
* Skin – pale
* Speech – none
* Sounds – normal
* Speech – none
* Sounds – normal

Cardiovascular Assessment
* HR – 50
* BP – 90/45
* BGL – 2.0
* Temp – 33.2°C

Neurological Assessment
* GCS – eyes do not open, no verbal response, nil motor response
* Pupils – size 2 and non-reactive
* Motor – nil

H-T
* Urinary incontinence

Answer 153

• Call for CCP backup and additional bravo crew – CCP can administer adrenaline
• Continue IPPV/NPA/OPA – to increase oxygen saturations
• Blanket on patient and open warming blanket and allow to warm up – takes 30 mins to warm up
• IV access to administer drugs
• IV glucose 10% - 15g (150 ml), repeated at 10g (100ml) every 5 minutes until BGL >4 mmol
• IV sodium chloride 0.9% - titrate to increase SBO >100 mmHg
• 12 lead ECG – to ascertain any ECG changes such as terminal R wave and QRS widening
• Place onto stretcher – once backup arrives to get off cold ground and to commence transport

Question 154

Outline the McRoberts manoeuvre

Answer 154

mum laying supine with knees to nipples - to increase anteroposterior diameter of the pelvic inlet

Question 155

-1 Sedation Assessment Tool (SAT) verbal score description

Answer 155

slurring or prominent slowing

Question 156

What are the ECG features of AF?

Answer 156

• Absent P waves
• Chaotic irregularly baseline/fibrillatory waves
• Irregularly irregular
• Wide QRS
• Fibrillation waves may mimic p waves

Question 157

What are the clinical features of meningitis headaches?

Answer 157

fever
photophobia
stiff neck
rash
limb pain
cold peripheries
mottled skin
bulging fontanelle (babies)

Question 158

What is your management for a patient with a mild airway obstruction where back blows and chest thrusts have failed?

Answer 158

Removing the obstruction via direct laryngoscopy and magill forceps

Question 159

Discuss the risks associated with the reversal agent.

Answer 159

Can cause APO due to catecholamne surge creating and adrenergic crisis causing volume to shift to pulmonary vasculature

Question 160

-3 Sedation Assessment Tool (SAT) behaviour score description

Answer 160

no response to stimulation

Question 161

What are the risks associated with the administration of droperidol in a patient presenting with sepsis?

Answer 161

Can cause profound hypotension – especially in urosepsis

Question 162

Outline the different methods of arrhythmia termination that may be used within the emergency department

Answer 162

• Cardioversion
• Adenosine – stopping heart from beating for a short period of time

Question 163

What are your first three priorities of management for a seizing patient?

Answer 163

1. Checking the airway for vomitus and suctioning if required or postural drainage
2. Oxygen administration – 15L/min via non- rebreather mask
3. IM midazolam

Question 164

How do benzodiazepines cause CNS depression?

Answer 164

strengthens the inhibitory neurotransmitter GABA within the CNS, which inhibits nerve transmission and reduces neuronal excitability

Question 165

What is the cause of subarachnoid haemorrhage headaches?

Answer 165

leak of blood of rupture from intracranial vessel

Question 166

What are the ventilation rates?

Answer 166

20 per minute = 1/3
18 per minute = 1/3
16 per minute = 1/4
14 per minute = 1/4
12 per minute = 1/5

Question 167

What are some risks associated with CNS depression?

Answer 167

• loss of airway reflexes
• aspiration
• positional asphyxia
• hypotension
• bradycardia
• hypothermia

Question 168

What is the appropriate management for a pregnant female in third trimester with a severe headache?

Answer 168

IV access for drug administration
CCP backup for IV magnesium sulphate
Paracetamol 1g – analgesia
Morphine 2.5mg – analgesia

Question 169

What are the expected vital signs of a 6 year old?

Answer 169

Weight: 25kg
HR: 70-120bpm
RR: 15-25rpm
SBP: 90-115mmHg

Question 170

Describe your immediate actions with a newborn that requires assistance.

Answer 170

• Initiate tactile stimulations
• Skin to skin contact
• Warm bub with skin to skin contact with mum and blanket over the top
• Suction mouth before nose
• Clamp and cut cord
• Consider: IPPV room air

Question 171

What features are present for a diagnosis of pre-eclampsia?

Answer 171

• systolic blood pressure (SBP) ≥ 140 mmHg and/or
• diastolic blood pressure (DBP) ≥ 90 mmHg plus one or more of:
  o neurological problems
  o proteinuria
  o renal insufficiency
  o liver disease
  o haematological disturbances
  o foetal growth restriction

Question 172

Define confused

Answer 172

disorientated; bewildered, and having difficulty following commands, not knowing date/month/year/location etc

Question 173

What are some complications associated with breech delivery?

Answer 173

Footling and kneeling breech – prolapsed cord

Question 174

What time is placed on the EEA?

Answer 174

Triage

Question 175

What does the mental status assessment mood component assess?

Answer 175

Emotion as described (Subjective)

Question 176

Outline the pathophysiology and management of febrile convulsions

Answer 176

Self-limiting muscle originating process - can’t regulate temperature and convulsing to create movement to decrease body temp through fanning type mechanism.

Active cooling of patient

Question 177

What is a primary headache?

Answer 177

A headache caused by the issue itself does not have an underlying cause

Question 178

What is the drug class and use of Crestor?

Answer 178

statin
hyperholesterolaemia

Question 179

What are some causes of APH after 20 weeks?

Answer 179

• Placental abruption
• Placenta praevia
• Uterine rupture
• Loss of pregnancy

Question 180

Describe your managment of a paediatric drowning pt with PEA?

Answer 180

• CPR: 15-2, good quality compressions, rotate officers
• suctioning/OPA/ETCO2
• Maintain normothermia

Question 181

Define Rhonchi and its mechanism

Answer 181

low pitched wheezing/snoring – sound of air moving through mucous in bronchial tubes

Question 182

What are some common opioid medications and their trade names?

Answer 182

• Heroin
• Morphine
• Fentanyl
• Oxycodone
• Codeine
• Buprenorphine
• Hydromorphone
• Methadone
• Tramadol
• Tapentadol

Question 183

Westley Croup Score Chest Wall Retractions Variables and Scores

Answer 183

Severe - 3

Moderate - 2

Mild - 1

None - 0

Question 184

What is the purpose of the shoulder dystocia interventions?

Answer 184

To increase the functional size of the bony pelvis and change the relationship between the size of the bony pelvis and the foetus and to reduce biacromial diameter of the foetus or to rotate foetus into oblique diameter

Question 185

Westley Croup Score Air Entry Variables and Scores

Answer 185

Markedly decreased - 2

Decreased - 1

Normal - 0

Question 186

What are the types of antidepressant drugs?

Answer 186

SSRIs
SNRIs
TCAs
MAOIs

Question 187

What are some risks associated with new onset AF?

Answer 187

• Thromboembolism in lung vasculature

Question 188

What is your definition of asthma?

Answer 188

Reversible obstructive lower respiratory disease characterised by chronic airway inflammation, bronchial hyperresponsiveness and intermittent airway narrowing, +/- excess mucous production and mucous plugging

Question 189

Describe common seizure presentations in paediatric patients.

Answer 189

• Vacant stares
• Lack of gross muscle tonicity
• Fixed gaze
• Facial muscle twitching

Question 190

What is the drug class and use of Ramipril?

Answer 190

ACE inhibitor
hypertension

Question 191

What are the four classes of cardiovascular drugs?

Answer 191

I - sodium blockers
II - beta blockers
III - potassium blockers
IV - calcium blockers

Question 192

What are the signs and symptoms for Uncontrolled gastrointestinal tract (GIT) haemorrhage?

Answer 192

• fatigue
• shortness of breath
• vomit that looks like coffee grounds or has bright red blood
• abdominal cramps
• black or tarry stool
• haematochezia - dark or bright red blood mixed with stool
• Shock

Question 193

What are you looking for in a H2T of a Pt who you suspect has a pulmonary embolism?

Answer 193

swelling to legs to identify presence of thrombus with pain on palpation – especially calf
redness or swelling around incision sites to identify presence of infection
sensations

Question 194

Can asthmatic pts tolerate 6-8 breaths per minute adult and 8-15 breaths per minute paeds?

Answer 194

yes

Question 195

What are the signs and symptoms of acute pancreatitis?

Answer 195

• Fever
• Tachypnoea
• Hypotension
• Tachycardia
• Epigastric pain radiating to the back
• Nausea and vomiting
• Jaundice
• Ecchymosis

Question 196

Outline some of the services that an elderly patient could be referred to for help at home

Answer 196

Home care
Community transport
Social worker
Services Australia website – nationwide number for state service
Dedicated dementia lines
Geri referral team

Question 197

What is the mechanism of dexamethasone?

Answer 197

anti-inflammatory that reduces inflammation

Question 198

Outline the pathophysiology of anaphylaxis

Answer 198

Exposure to allergens where IgE sensitisation occurs – additional exposures causes crosslinking of IgE causing mast cell deregulation and release of mediators that can cause symptoms or recruit inflammatory cells continuing a chain reaction resulting in a myriad of symptoms

Question 199

What are some antenatal risk factors for primary PPH?

Answer 199

• Previous history of post-partum haemorrhage
• Anaemia
• Age greater 35 years
• Multiparity
• Prior uterine surgery, including caesarean section
• Pre-eclampsia and HELLP syndrome − these interfere with liver enzymes which in turn interferes with clotting factors.
• Obesity
• Uterine anomalies, including fibroids
• Abnormal placentation
• Multiple pregnancy

Question 200

What immediate assessments indicate that the newborn requires assistance?

Answer 200

HR
breathing status
tone

Question 201

What is the treatment for FBAO?

Answer 201

encourage cough
back blows
chest thrusts
laryngoscope/magills forceps & rapid transport

Question 202

What are the common signs and symptoms of severe alcohol withdrawal?

Answer 202

• anxiety
• insomnia
• irritability
• seizures
• fever
• visual hallucinations
• hypertension
• tachycardia
• tremor

Question 203

What are the common sodium blocker drugs?

Answer 203

TCAs - ‘ine’ suffix
flecainide (CVS)
propafenone (CVS)
propranolol (CVS)
dextropropoxyphene (opioid)

Question 204

What are the signs and symptoms of ectopic pregnancy?

Answer 204

• abnormal vaginal bleeding
• hx of amenorrhoea (at least one missed period)
• nausea
• pelvic and/or abdominal pain
• presyncopal symptoms

Question 205

What are some techniques for de-escalation?

Answer 205

1. Respect personal space
2. Do not be provocative
3. Establish verbal contact
4. Be concise
5. Identify wants and feelings
6. Listen closely to what the patient is saying
7. Identify areas upon which to agree
8. Set clear limits
9. Offer choices and optimism
10. Evaluate the outcome of de-escalation and consider further options

Question 206

What are the signs and symptoms of testicular torsion?

Answer 206

• nausea and vomiting
• abdominal pain on the same side as the torsion
• sudden, severe pain in the scrotum
• swelling of the scrotum, redness, tenderness or hardening of the scrotum
• the testicle being in a strange position, such as higher than normal or on an unusual angle
• one testicle looks larger than the other
• tenderness if the area is touched
• discolouration of the scrotum
• difficulty walking

Question 207

What are the benefits of delayed cord clamping?

Answer 207

• Increases baby’s blood volume by around 80-100mls, possibly up to 300mls
• Improved iron scores at 3-6 months
• Supports transition from foetal to neonatal circulation
• Reduced risk of brain haemorrhage and ischaemic gut in premature babies
• Reduced risk of baby becoming anaemic
• Transferring blood rich in antibodies and stem cells – boosting immunity

Question 208

What organs are in the Epigastric Region?

Answer 208

• liver
• stomach
• pancreas
• duodenum
• spleen
• adrenal glands

Question 209

What is the pathophysiology of an acute asthma attack?

Answer 209

Response to allergen or environmental factors – exercise, weather, infective causes – releasing endogenous irritant and inflammatory mediators that cause reversible airway obstruction and narrowing from airway smooth muscle constriction

Question 210

What are the indications for pre-hospital administration of fibrinolysis?

Answer 210

• Pt located more than 60 minutes transport time (from first STEMI 12-Lead) to a pPCI capable hospital
• GCS = 15
• Classic ongoing ischaemic chest pain less than 6 hours in duration (excluding atypical ischaemic chest pain)
• 12-Lead consistent with STEMI

Question 211

What is the drug metropolol taken for?

Answer 211

angina
hypertension
heart failure
previous MI
tachyarrhythmias/AF

it controls heart rate

Question 212

Outline the management involved with the administration of fibrinolysis.

Answer 212

Complete informed consent for tenecteplase (weight based) and given in conjunction with 300mg clopidogrel and 30mg IV enoxaparin followed up at 15 mins with 1mg/kg enoxaparin subcut dose

Question 213

Define Somnolent

Answer 213

sleepy, responding to stimuli only with incoherent mumbles or disorganised movements

Question 214

How quickly should the shoulders be delivered under normal circumstances?

Answer 214

60-90 seconds

Question 215

What is Kernig’s Sign?

Answer 215

inability to straighten the leg when the hip is flexed to 90 degrees

Question 216

What is your first pharmacological agent of choice for croup and why?

Answer 216

Adrenaline NEB – 5mg, single dose only – as had stridor at rest

Question 217

Is a 12 lead ECG warranted in a ptient with abdominal pain?

Answer 217

Yes, as abdominal pain can be present rather than chest pain in ACS

Question 218

What are common stroke symptoms?

Answer 218

• Thunderclap headache
• ALOC
• Focal neurological deficits
• Dysphasia/asphasia
• Hemiplegia
• Nausea

Question 219

What is the presentation of placental abruption?

Answer 219

• Constant pain in the abdomino-pelvic region
• Fundal height may increase due to expanding intrauterine haemorrhage
• Tetanic uterine contractions
• Uterine hypertonicity – feels rigid on palpation
• Bleeding may range from absent to profuse, occurring in waves as the uterus contracts
• Signs of maternal shock

Question 220

What is Betaloc presribed for?

Answer 220

hypertension/angina

Question 221

What are the symptoms of brain hypoxia?

Answer 221

Loss of concentration
Poor decision making
Memory loss
Cyanosis/pallor
Coma
Seizures
Brain death

Question 222

Define Pleural friction rub and its mechanism

Answer 222

rough, scratchy sound – pleural membranes rubbing together

Question 223

What are some differential diagnoses of confusion in the elderly?

Answer 223

• Stroke/TIA
• Infection/UTI
• Sepsis
• Polypharmacy overdose

Question 224

Describe the pathophysiology of peripartum cardiomyopathy

Answer 224

hormones of late pregnancy causing endothelial dysfunction and cardiomyocyte death

Question 225

What are your first actions for a patient who is supine in bed, cyanotic, speaking in phrases with an audible respiratory sound and SPO2 of 50%?

Answer 225

• Reposition pt to semi-recumbent – to increase available space in the thorax
• Administer 15L oxygen via non rebreather mask – to return sats to a normal level and improve hypoxemia

Question 226

If a patient who has just delivered a baby haemorrhages and continues to deteriorate, outline your ongoing management and justify your reasoning.

Answer 226

IV TXA, 1g, slow push over 10 minutes, single dose only – to assist with blood clotting

Question 227

How long should each shoulder dystocia manoeuvre be done for?

Answer 227

30 seconds

Question 228

Define missed abortion

Answer 228

pregnancy stops developing but products of conception remain in the uterus and the cervical os is closed

Question 229

How does alcohol cause CNS depression?

Answer 229

strengthens the inhibitory neurotransmitter GABA within the CNS, which inhibits nerve transmission and reduces neuronal excitability. It also inhibits glutamate which affects memory, cognition and mood

Question 230

What is cervical shock and what are some differential diagnoses that could contribute to presentation?

Answer 230

Neurocardiogenic shock form dilation of the cervix
Hypovolaemic shock

Question 231

What are some common risk factors for developing hypoglycaemia in diabetics?

Answer 231

• Took insulin and forgot to eat
• Increased age
• Skipping meals
• Erratic eating patterns
• Heavy exercise
• Weight loss
• Beta blockers
• Using same injection site too frequently
• Antidepressants
• Alcohol
• Cognitive dysfunction
• Underlying kidney damage
• Underactive thyroid
• Gastroparesis
• Chronic diabetes
• Pregnancy

Question 232

What is your pharmacological management for a pregnant patient with suspected pre-eclampsia who begins to convulse?

Answer 232

5mg IM midazolam, repeated every 10 mins, max 20 mg; OR if have IV access;
5mg IV every 5 minutes, max 20 mg

No as it will not correct the underlying cause of peripheral vasoconstriction and increased tone

Question 233

Describe how patients should be restrained for sedation and the rationale behind this.

Answer 233

Laterally with hands in front to ensure that the patient’s face is visible at all times for monitoring and airway maintenance and restrained for as short a time as possible

Question 234

What are some risk factors for shoulder dystocia?

Answer 234

• Previous SD
• Macrosomia (large foetus > 4 kg)
• Maternal diabetes mellitus
• Maternal obesity (BMI > 30)
• Older maternal age
• Post term pregnancy
• Excessive weight gain in pregnancy

Question 235

How do you manage a croup patient with global expiratory wheeze and prolonged expiratory phase after administering adrenaline?

Answer 235

Salbutamol NEB 2.5mg, PRN
Dexamethasone 0.5ml, PO – anti-inflammatory steroid
Paracetamol 150mg (6ml), PO – antipyretic

Question 236

What is the pathophysiology of an ischaemic stroke?

Answer 236

intracranial or perforator artery occluded by a thromboembolism from within the brain or one which has travelled from the heart or distal limb which causes hypoxia in downstream brain tissue

Question 237

What is metoprolol administered for?

Answer 237

Hypertension
Angina
Suspected MI
Migraine prophylaxis

Question 238

What are some examples of activities of daily living, and how may they be measured in the elderly?

Answer 238

Walking – walking frame/stick
Cleaning – cleaning themselves or having cleaners come in
Self care – showering themselves or having carers come in

Question 239

Westley Croup Score Cyanosis Variables and Scores

Answer 239

At rest - 5

With agitation - 4

None - 0

Question 240

What are the expected vital signs of a 6 month old?

Answer 240

Weight: 7kg
HR: 100-160bpm
RR: 25-50rpm
SBP: 70-100mmHg

Question 241

What are the clinical features of cluster headaches?

Answer 241

Usually male
Often a smoker
Nightly pain in 1 eye for 2−3 months then pain free for at least a year

Question 242

What are some stroke mimics?

Answer 242

• Conversion disorder (results from psychological stress)
• Electrolyte derangement
• Encephalitis
• Hypoglycaemia
• Infection (particularly with fever in elderly) and sepsis
• Migrainous aura and/or hemiplegia (with/without pain)
• Space-occupying cerebral lesions
• Seizures and post-ictal periods

Question 243

Westley Croup Score Components

Answer 243

Level of consciousness - disorientated/normal

Cyanosis - at rest/with agitation/none

Stridor - at rest/with agitation/none

Air entry - markedly decreased/decreased/normal

Chest wall retractions - severe/moderate/mild/none

Question 244

What is the appropriate management for a pregnant female in third trimester with a severe headache who is refractory to initial analgesia with increasing hypertension?

Answer 244

Morphine 2.5mg IV – analgesia
Position of comfort and quiet environment - consult for GTN for hypertension

Question 245

What is the estimated weight of a newly born and expected vital signs?

Answer 245

• Weight: 3.5kg (CPG says 3-5)
• Heart rate: 100-160 bpm
• Respirations: 25-50 rpm
• Systolic blood pressure: 60-70 mmHg
• SPO2: low post delivery and increases over 10 minutes

Question 246

What are some yellow flags associated with headaches?

Answer 246

• Worsening headache following recent trauma to head
• Taking an anticoagulant or antiplatelet drug
• Hypertension during pregnancy
• Previous Hx of intracranial bleeding
• Onset during sexual activity
• Family history of cerebral vascular abnormalities

Question 247

What are the clinical features of head injury headaches?

Answer 247

bruising and/or history of injury
reduced conscious level
periods of lucidity and amnesia

Question 248

What are some mechanisms that cause orthostatic syncope?

Answer 248

• Volume depletion (haemorrhage, diarrhoea, vomiting)
• Medications (vasodilators or diuretics)
• Cardiovascular autonomic dysfunction

Question 249

What organs are in the Umbilical Region?

Answer 249

• duodenum
• the small intestine
• transverse colon

Question 250

Outline your plan of management for an overdose patient who presents as:

Neurological Assessment
* GCS – eyes do not open, groans, withdraws
* Pupils – size 4 and reactive
* Motor – nil

Respiratory Status Assessment
* Rate – 38
* Rhythm – regular
* Effort – shallow
* Sats – 92%
* Skin – pale
* Speech – none
* Sounds – normal

Cardiovascular Assessment
* HR – 60
* BP – hypotensive
* BGL – 1.2
* Temp – 36.3°C

Answer 250

• CCP backup for atropine and adrenaline for low HR
• 6L oxygen via face mask to increase SPO2 >94%
• IV access to administer drugs
• IV glucose 10% at 0.25g/kg (2.5ml/kg) repeated at 0.1g/kg (1ml/kg) until BGL >4 mmol = 2.5g (25ml) repeated at 1g (10ml)
• IV fluids to increase SBP to MAP 90 or SBO to 10p - 120
• 12 lead ECG

If can’t get IV access 0.5mg glucagon IM, single dose only

Question 251

Westley Croup Score Results

Answer 251

MILD CROUP: <2

MODERATE CROUP: 3 to 5

SEVERE CROUP: 6 to 11

SEVERE RESPIRATORY FAILURE: >12

Question 252

What are the expected vital signs of a 12 year old?

Answer 252

Weight: 43kg
HR: 70-120bpm
RR: 15-25rpm
SBP: 90-115mmHg

Question 253

What is the treatment for refractory anaphylaxis and why?

Answer 253

Persistent wheeze
* NEB Salbutamol – appropriate dose, PRN, no max dose – affects B2 receptors causing bronchodilation
* IV Hydrocortisone – appropriate dose, single dose only, slow push over 1 minute (dilute with 2 ml sodium chloride, then discard 0.24 ml) – stabilises mast cells
Persistent hypotension/shock
* Glucagon – increases accessory pathway of cyclic amp to increase myocardium calcium release, increasing hr and contractility via non adrenergic pathway
* Fluid for hypotension – end goal of return of radial pulse
Upper airway obstruction
* Neb adrenaline – if persistent stridor – providing localised vasoconstriction to target tissues in larynx and airways reducing capillary leakage and airway oedema

Question 254

Describe the consequences of hypoxia on the brain.

Answer 254

Hypoxia triggers a cascade of physiologic events on the brain including energy failure due to impaired cellular respiration leading to disfunction of ion pumps and accumulation of excitatory neurotransmitters resulting in cellular swelling leading to additional hypoxia and oxidative stress causing cell death

Question 255

How do you manage a focal seizure?

Answer 255

• Airway
• Breathing
• Circulation
• Positioning – 45 degrees to allow for cerebral drainage
• 5mg IM midazolam if required
• Backup
• Transport

Question 256

What is the definition of septic shock?

Answer 256

subset of sepsis with profound circulatory, cellular, and metabolic abnormalities that are associated with a greater risk of mortality

Question 257

What are the signs and symptoms of Ovarian torsion?

Answer 257

• Nausea and vomiting
• Cramping
• Severe sudden pain in lower abdomen

Question 258

List some common causes of acute gastrointestinal bleeding

Answer 258

• Crohn’s disease
• Diverticulitis
• Haemorrhoids
• Mass lesions
• Oesophageal varices
• Pancreatitis
• Peptic ulcers
• Portal hypertension gastropathy
• Ruptured abdominal aortic aneurism
• Severe gastritis
• Severe oesophagitis
• Ulcerative colitis
• Upper GIT haemorrhage

Question 259

What is the drug effect of rosuvastatin?

Answer 259

Causes liver to make less cholesterol and increases its uptake of cholesterol from the blood

Question 260

What are the patient’s possible outcomes when placed under an EEA?

Answer 260

They can be admitted or discharged following examination or referred for further assessment.

Question 261

What is Span-K administered for?

Answer 261

hypokalaemia

Question 262

Do asthma and anaphylaxis present similarly in some cases?

Answer 262

yes as pathophysiology is similar

Question 263

What is Xarelto presribed for?

Answer 263

AF

Question 264

-1 Sedation Assessment Tool (SAT) behaviour score description

Answer 264

asleep

Question 265

What does the mental status assessment behaviour component assess?

Answer 265

attitude
manner
observed behaviours

Question 266

What is the drug effect of metoprolol?

Answer 266

Relaxes blood vessels and slows HR improving blood flow and decreasing BP

Question 267

What are the common MAOI drugs?

Answer 267

phenelzine
tranylcypromine
moclobemide

Question 268

What is the drug effect of rivaroxaban?

Answer 268

stops blood clotting

Question 269

Define Stridor and its mechanism

Answer 269

squeaking sound – sound of air moving around airway blockage

Question 270

What are the four main presentations for breech birth?

Answer 270

complete
footling
kneeling
frank

Question 271

What are some green flags associated with headaches?

Answer 271

• Symptoms associated with influenza
• Known headache with ‘usual; symptoms and triggers
• Normal vital signs, normal assessment using FAST technique and able to walk normally

Question 272

What are some of the physiological changes that occur with ageing and how do they impact the patient? Be systematic.

Answer 272

CNS and peripheral nervous system
* Decrease in baroreceptor responses
* Decreased in b adrenergic response in receptors
* Decreased transduction through general CNS

Pulmonary:
* Decreased vital capacity
* Decreased lung compliance/elasticity
* Increased residual volume

Cardiovascular:
* Decreased endothelial dependent vasodilation
* Increased peripheral resistance
* Decreased intrinsic heart rate and ability to increase heart rate to compensate for stressors
* Increased av conducting time and ectopics

Metabolism
* Decrease in overall ability to metabolise drugs

Question 273

Describe the airway management in a newborn doesn’t respond to stimulation and initial IPPV?

Answer 273

• PEEP on BVM with good seal (2 person)/ETCO2
• neutral positioning with towel etc
• keep warm
• If need to suction – make sure it is brief or can stimulate reflexes and cause bradycardia

Question 274

What is the pathophysiology of a pulmonary embolism?

Answer 274

recent insult/surgery (within 2-3 weeks) associated with period of stasis leads to formation of DVT in lower limbs that works its way through circulation and into microcirculation within pulmonary vasculature.

Question 275

What is the mangement of an overdose patient who deterioriates into cardiac arrest?

Answer 275

• Pads on
• 3 stacked shocks
• Check temp as may need to alter doses if hypothermic
• Amiodarone – 300mg slow push over 1-2 minutes
• After 5th DCCS – Amiodarone – 150 mg slow push over 1-2 minutes
• After 6th DCCS – Adrenaline – 1mg every 3-5 minutes, no max dose
• Good quality compressions – 1/3 depth chest, 100 per minute

Question 276

What is the treatment for tonsilitis/abscess/Quincy?

Answer 276

symptomatic

Question 277

What are some differentials of centralised upper abdominal pain?

Answer 277

• Aortic aneurysm
• Acid reflux/heart burn
• Cholecystitis
• Pancreatitis
• Renal colic

Question 278

What are some differences between adult and paediatric components of breathing?

Answer 278

• Obligatory nasal breathers
• Increased resp rates
• Smaller tidal volume
• Decreased functional residual capacity – reduced ability to tolerate occluded airway
• Diaphragmatic breathers
• Greater oxygen demand

Question 279

What are some considerations for mandatory transport for a hypoglycaemic pt?

Answer 279

• Injury sustained from hypoglycaemic episode requiring further investigation
• Intentional overdose of glucose lowering agent
• Newly diagnosed diabetes
• No previous diagnosis of diabetes
• Not returned to normal mental state within 20 mins of IV glucose or incomplete recovery to normal conscious state
• Pt taking long acting oral hypoglycaemic agent that causes hypoglycaemia
• Pregnancy
• Recovered but unable to be monitored by a responsible adult for 4 hours or unable to self care
• Risk of prolonged or recurrent hypoglycaemia
• Seizure
• Severy hypoglycaemia episode within previous 48 hours
• Suspected cause of hypoglycaemia due to illness that requires further investigation
• Unable tor unwilling to consume long acting carbohydrate
• Unwitnessed onset or prolonged episode

Question 280

What are some causes of psychosis?

Answer 280

• Primary psychotic disorder - Schizophrenia
• disillusion disorders
• brief psychotic disorders
• organic causes – infection, inflammatory processes
• elderly pts with UTI
• substances/medications/alcohol

Question 281

What is the age group for paediatric pad use?

Answer 281

under 6

Question 282

What organs are in the Right Hypochondriac Region?

Answer 282

• Liver
• gallbladder
• right kidney
• large/small intestine

Question 283

What is the cause of head injury headaches?

Answer 283

Bruising, swelling or injury to the brain tissue

Question 284

What does the acronym AEIOUTIPS stand for?

Answer 284

A - Acidosis/ Alcohol
E - Epilepsy
I - Infection
O - Overdose
U - Uremia
T - Trauma to head
I - Insulin: too little or or too much
P - Pyschogenic
S - Stroke

Question 285

In a patient that presents in cardiac arrest in the first instance, what may be some signs that suggest a FBAO?

Answer 285

• Difficulty ventilating
• Equal rise and fall of the chest
• +/- hx of eating or playing with small objects prior

Question 286

What are likely causes of headache and ACS-type presentations in psychostimulant overdose patients? Why?

Answer 286

Psychostimulants are sympathomimetic substances (fight or flight syndrome) that cause significant vasoconstriction particularly in the microcirculation of brain and heart

Question 287

What is the drug class and use of Esomeprazole?

Answer 287

proton pump inhibitor
acid reflux

Question 288

What are the causes of PPH?

Answer 288

• Tone - Poor uterine tone (70%)
• Tissue - Retained products (10%)
• Trauma - tears of the vulva, vagina or cervix, as well as uterine rupture (20%)
• Thrombin - Coagulopathy disorders (1%)

Question 289

What are the common TCA drugs?

Answer 289

amitryptyline
imipramine (endep)
nortryptyline

Question 290

Why can asthmatic Pts tolerate low resp rates in ROSC?

Answer 290

to prevent air trapping, and build up of intrinsic PEEP

Question 291

Outline the normal management of the healthy newly born.

Answer 291

• Clean mouth and nose
• Initiate tactile stimulation
• Within 30 seconds assess heart rate and breathing status
• Apgar at 1 and 5 minutes

Question 292

List some examples of time-critical abdominal emergencies

Answer 292

• Aortic dissection
• AAA
• Peritonitis and sepsis
• Uncontrolled gastro intestinal tract (GIT) haemorrhage
• Acute pancreatitis
• Ectopic pregnancy
• Acute bowel obstruction
• Testicular/ovarian torsion

Question 293

What is your management of a patient refractory to 10mg droperidol?

Answer 293

CCP backup and second dose of Droperidol – IM – 10mg

Question 294

What is rivaroxaban administered for?

Answer 294

AF
(atrial fibrillation)

Question 295

What characterises a severe airway obstruction?

Answer 295

• absent or ineffective cough
• unable to vocalise
• worsening stridor
• quiet or silent chest / unable to breath
• cyanosis
• decreasing level of consciousness

Question 296

What type of drug is span-k?

Answer 296

potassium chloride

Question 297

What medications or ingestible agents can be fatal in small amounts in paediatric overdose?

Answer 297

• Antiarrhythmics
• Essential oils
• Opioids
• Organophosphate
• Paraquat
• Stimulants – MDMA, methamphetamine
• Alcohols
• TCAs

Question 298

What are the components of FLACC

Answer 298

face
legs
activity
cry
consolability

Question 299

What is your management of a pancreatitis patient and justify why?

Answer 299

• IV access – to administer analgesia and fluids
• IV fluids – to maintain radial pulse and SBP of 80 mmHg
• IV fentanyl 25 – 50 mcg – to reduce pain
• IV ondansetron 4 – 8 mg – to stop vomiting
• Oxygen – 15L min via non-rebreather - if shocked and to return SPO2 >94%
• Active warming as patient is hypothermic and to prevent coagulopathy
• CCP backup

Question 300

What type of drug is nordip and what is it used for?

Answer 300

calcium channel blocker - hypertension

Question 301

Outline the effects and mechanism of tricyclic antidepressant overdose

Answer 301

Acts on multiple receptor sites inhibiting the reuptake of serotonin and norepinephrine, blocks sodium channels and inhibits muscarinic, histamine and adrenergic receptors, causing anticholinergic effects, neurotoity and cardiotoxicity/ECG changes

Question 302

What type of drug is inderal and what is it used for?

Answer 302

beta blocker - hypertension

Question 303

What is your provisional diagnosis for an unresponsive patient, with a snore, RR 4, slow radial pulse, size 2 pupils and cold, and why?

Answer 303

opioid overdose due to symptoms of:
small pupils
decreased resp rate
environmental factors

Question 304

What is the pathophysiology of epiglottitis?

Answer 304

Infection causing an inflammation of the lining of the cartilaginous tissue in the airway

Question 305

What is the appropriate management for a non-pulsatile cord present in the vaginal opening?

Answer 305

• Assist mother to assume the knee-chest position
• Carefully attempt to push the presenting part off the cord

Question 306

What are some risk factors for SPPH?

Answer 306

• Prolonged rupture of membranes
• Prolonged labour
• Emergency caesarean section
• Vaginal birth after caesarean (VBAC)
• Ragged membranes or incomplete placenta (unlikely after a caesarean section)
• Manual removal of the placenta

Question 307

What is the cause of tension type headaches?

Answer 307

extracranial muscles become tense

Question 308

What characteristics lead to a diagnosis of autism?

Answer 308

Persistent deficit in social communication and interaction across contexts from early childhood and manifests by:
* Abnormal speech, failure to engage in normal conversations
* Deficits from being able communicate
* Social communication and interaction in multiple situations
* Restricted interests and activities
* Repetitive patterns of behaviour

Question 309

What are the signs and symptoms of acute bowel obstruction?

Answer 309

• fever
• nausea/vomiting
• sudden onset abdo pain
• abdominal distension
• obstipation (no movement of gas or stool)
• dehydration
  
  • tachycardia
  • orthostatic hypotension
  • decreased urine output
  • dry mucous

Question 310

What are some differential diagnoses for a paediatric patient presenting with high-pitched grunting noise/barking seal like cough?

Answer 310

Croup
Epiglottitis
Bacterial tracheitis
Peritonsillar or retropharyngeal abscess
FBAO

Question 311

What is the pathophysiology of DKA?

Answer 311

• High BGL draws water out of cells due to increased blood osmolality causing cellular dehydration, and osmotic diuresis and polyuria leading to severe dehydration & hypovolaemia
• Ketones (organic acids) produced from using alternative fuel sources resulting in metabolic acidosis
• Dehydration leading to polydipsia
• Loss of potassium from the body

Question 312

What is your airway management for a pregnant patient with suspected pre-eclampsia who begins to convulse?

Answer 312

Suctioning the airway for 10-20 seconds
NPA if unable to open mouth due to trismus
Oxygen via non-rebreather mask – 15L minute

Question 313

What is the drug tiotropium bromide taken for?

Answer 313

asthma
COPD

Question 314

What are some of you considerations going to a PV bleed in a pregnant patient?

Answer 314

• Ectopic pregnancy
• Miscarriage
• Delicate emotional state in both mum and partner

Question 315

Describe the ideal positioning of the patient for direct laryngoscopy and why is it beneficial?

Answer 315

Sniffing position to align the oropharyngeal laryngeal axis to improve visualisation of the glottis

Question 316

What suffix do beta blockers end in?

Answer 316

lol

Question 317

What is catopril administered for?

Answer 317

Hypertension
Congestive heart failure

Question 318

What is the definition for hypertension during pregnancy?

Answer 318

Systolic blood pressure >140 mmHg
Diastolic blood pressure >90 mmHg

Severe
Systolic blood pressure >160 mmHg
Diastolic blood pressure >110 mmHg

Question 319

How does oxygen administration effect patient’s with COPD?

Answer 319

It can cause hypoventilation due to increased blood flow to poorly ventilated alveoli, increasing V/Q mismatch dead space

Question 320

How does fentanyl produce analgesia?

Answer 320

binds with opioid receptors altering pain perception

Question 321

What are some risk factors for pancreatitis?

Answer 321

• Alcoholic
• Gallstones
• Obesity
• Smoking
• Type 2 diabetes mellitis (T2DM)

Question 322

What is the definition of anaphylaxis?

Answer 322

Acute onset of illness with skin features of urticaria or erythema/flushing and/or angioedema WITH:
respiratory and/or cardiovascular and/or persistent severe gastrointestinal symptoms; OR
acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is possible, even without skin features

Question 323

What is the pharmacology of a beta blocker?

Answer 323

Antagonise beta adrenergic receptors, stopping the release of catecholamines, slowing the heart and reducing its contractility

Question 324

What are some other priorities of management for a STEMI pt?

Answer 324

• Reversible causes – thrombus
• Consult for management pathway and prepping for cath lab or fibrinolysis depending on where you are

Question 325

What should you do if a STEMI pt is accepted for PCI?

Answer 325

Complete the decision supported PCI checklist
transport to nearest hospital
call cardiologist at cath lab to accept pt for PCI and order for 5000 units of heparin and find out what drug they want administered (enoxaparin or clopidogrel)

Question 326

What conditions can mimic or mask alcohol intoxication?

Answer 326

• other intoxications
• electrolyte imbalance (hypo or hypernatremia, hypercalcemia) – abnormal ECG
• hypoglycaemia - BGL
• hypothermia - temperature
• head injury – clinical assessments/history taking
• stroke – clinical assessments
• seizure
• encephalitis or meningitis
• sepsis
• renal failure
• encephalopathy (hepatic, HIV, Wernicke)
• hypothyroidism

Question 327

What are the three categories of adrenal insufficiency?

Answer 327

• Primary adrenal insufficiency (PAI)
• Secondary adrenal insufficiency (SAI)
• Tertiary adrenal insufficiency (TAI)

Question 328

Outline the body’s processes for homeostatic acid-base balance?

Answer 328

• Bicarbonate buffer system counteracts pH changes within minutes
• Respiration rate changes to alter the blood’s carbon dioxide concentration within minutes to hours
• Kidneys change bicarbonate generation and reabsorption and cause the excretion of hydrogen ions via phosphate and amnionic buffers
• Phosphate buffer system proteins and haemoglobin

Question 329

What is hemiplegia?

Answer 329

one-sided muscle paralysis or weakness

Question 330

How do you test a rash to see if it is blanching?

Answer 330

pressing down on it with a clear glass etc – if it does not disappear under pressure it is non-blanching

Question 331

What are the neurotoxicity effects of a TCA overdose?

Answer 331

• Sedation/Coma
• Seizures

Question 332

Outline some features of common behavioural disorders.

Answer 332

• Conduct disorder - when you struggle with antisocial behaviours, following rules, and showing empathy towards those around you – usual onset around 16yrs – physical altercations, bullying or threatening peers, staling, destroying or breaking into private property
• Oppositional defiant disorder (ODD) – acting out in defiance - frequent questioning of authority, excessive arguing, refusing to comply, and intentionally engaging in behaviours that upset others.
• Attention deficit hyperactivity disorder (ADHD) – inability to sit still and concentrate – impulsivity, inability to pay attention, lack of time management skills, mood swings, low frustration threshold and trouble coping with stress
• Obsessive-compulsive disorder (OCD) - thoughts, actions, and impulses that are chronic, uncontrollable, and intrusive - constant washing and cleaning, repeating phrases or prayers, following strict routines, or repetitively counting and checking, the need to have things orderly or symmetrical, ideation about losing control or harming yourself or others, unwanted aggressive or sexual thoughts
• Behavioural addiction – can’t stop doing something due to brain associating pleasure and activating reward mechanism when engaging in the activity – gambling, sex, internet, shopping, video games, plastic surgery, binge eating and risky behaviours

Question 333

What are some causes of cardiac arrest in a Pt with underlying asthma/COPD disease?

Answer 333

• Tension pneumothorax
• Hypovolaemia
• Arrhythmias
• Myocardial depression from prolonged hypoxia

Question 334

Outline all fours position

Answer 334

mum on hands and knees to alleviate SD pressure to dislodge the shoulder

Question 335

-3 Sedation Assessment Tool (SAT) verbal score description

Answer 335

nil

Question 336

What elements of history taking may assist with defining the cause of syncope?

Answer 336

Medications
Past medical Hx
List of lasts
Events

Question 337

What questions may be asked in the assessment of a child?

Answer 337

Gestational age at birth
NICU stay after birth
Pregnancy complications
Is child hydrated – wet nappies, bottle feeding appropriately, solids
Sick siblings
Going to school
Sickness at school

Question 338

What is the drug effect of escitalopram?

Answer 338

increases serotonin levels

Question 339

What is your immediate management of a child found at the bottom of a pool with bystander CPR in progress?

Answer 339

• Bystander continue CPR
• Cut off clothes, dry pt and move to dry location
• Towel under shoulders
• Manage airway, suction, IPPV, adjuncts
• Pads on (Paed pads if under 6 years)
• Assess rhythm and shock if required
• IV access

Question 340

How may a calcium channel blocker overdose present?

Answer 340

• Seizures
• Coma
• Hypotension
• Bradycardia
• Heart block
• Cardiogenic shock
• Hyperglycaemia
• Metabolic acidosis

Question 341

Describe your managment of a paediatric drowning pt with VF?

Answer 341

• Shock @ appropriate joules
• CPR – good quality compressions (one handed), rotate officers
• IV access
• Adrenaline @ appropriate dose every 3-5 minutes
• reassess

Question 342

What is the pathophysiology of uterine rupture?

Answer 342

A spontaneous tearing of the uterus usually from trauma, genetic uterine wall weakness, prolonged labour augmentation or stretching of the uterine wall

Question 343

Outline wood’s screw manoeuvre

Answer 343

keeping first hand in place, insert second hand and apply pressure to anterior of foetus posterior shoulder – to rotate foetus to oblique diameter

Question 344

Define Steatorrhoea

Answer 344

stool containing excessive amounts of fat

Question 345

Define incomplete abortion

Answer 345

partial loss of products of conception in the first 20 weeks gestation

Question 346

Describe how and why fever occurs

Answer 346

Release of pyrogens from white blood cells or pathogen triggering the hypothalamus to raise body’s set point temp. Causes physiologic changes resulting in a change to body’s set point temperature, blood vessel constriction, metabolism increase, shivering/rigors to try to generate heat

Natural defence mechanism response to infection.

Question 347

What would be your considerations surrounding transporting to the closest appropriate hospital versus patient’s preferred destination?

Answer 347

• Happy as they have all of the patient’s medical history, but have to call ahead for approval first
• The facilities available in the closest hospital and the preferred destination and where will they get better care

Question 348

What are some mechanisms that cause reflex syncope?

Answer 348

Vasovagal response to emotional stress and/or pain, visualisation of blood, after urination defecation, coughing or straining

Question 349

What is your ongoing managment of a paediatric patient who is no longer seizing?

Answer 349

• Maintain neutral positioning for airway patency (snoring)
• Prepare additional midazolam
• Continue oxygen administration – titrating to >92-96%
• Consider IV access
• Consult for fluids as hypotensive
• Consider administration of paracetamol to reduce fever if patient able to swallow
• CCP to help during transport
• Pre-notification

Question 350

What is the treatment plan for an adult, with purulent leg ulcer, difficult to rouse with low sats, hypotensive and hypoglycaemic who has just finished a dose of steroids?

Answer 350

• Oxygen to increase SPO2 to above 94%
• IV access to administer fluids and medication
• IV glucose 10% - 15g (150 ml), repeated at 10g (100 ml), every 5 minutes until BGL is >4 mmol – to bring BGL to within normal limits
• IV fluids – titrate to maintain radial pulse – to increase blood pressure
• Consider hydrocortisone as treating possible adrenaline insufficiency

Question 351

What are the common SNRI drugs?

Answer 351

venlafaxine (efexol)
desvenlafaxine
duloxetine

Question 352

Why do you administer antiemetics to stroke patients?

Answer 352

to prevent vomiting and further increase in ICP
if haemorrhagic stroke as blood is toxic to the brain when not in blood vessels

Question 353

What is the mechanism of shoulder pain in patient’s presenting with abdominal pain?

Answer 353

The phrenic nerve runs from the diaphragm up through to the spine, and blood in the abdominal cavity irritates the diaphragm causing this pain to travel through to the shoulders.

Question 354

What are your considerations surrounding transport of a paediatric patient who is no longer seizing to hospital?

Answer 354

• Transport to nearest suitable hospital
• Have midazolam prepared, ready to go
• Have mum travel in ambulance if there is someone there to look after the other children
• Pre-notify

Question 355

What are some indicators of serious aetiology syncope?

Answer 355

• History of cardiac disease
• New or unexplained dyspnoea
• Syncope during physical exertion
• History or physical signs of cardiac failure
• History of anemia
• Family history of sudden cardiac death and/or history of an inherited cardiac condition
• > 50 years age
• Evidence of new ECG abnormalities

Question 356

What can you consult for in a PE cardiac arrest Pt?

Answer 356

autonomous fibrinolysis administration

Question 357

What class of drug is Seretide?

Answer 357

corticosteroid

Question 358

Define Crackles (Rales) and its mechanism

Answer 358

bubbling, rattling or clicking – sound of air moving through fluid in lungs

Question 359

What is your management for VT when witnessed?

Answer 359

• Check for response
• Check for pulse – if no pulse - 3 stacked shocks
• Good quality compressions – 100 per minute – 1/3 depth chest
• Pharmacological prioritisation

Question 360

What is the cause of cervicogenic headaches?

Answer 360

Issues with bones in neck eg arthritis, injury

Question 361

What are some risk factors for non-accidental injury/DV?

Answer 361

• Known family dysfunction
• Child has multiple medical conditions
• Poor parental care
• Numerous separations for the child in 1st year of life
• Hx of psychiatric issues/stresses
• Criminal activity in older children

Question 362

What are the expected vital signs of a 2 year old?

Answer 362

Weight: 13kg
HR: 80-140bpm
RR: 20-30rpm
SBP: 80-110mmHg

Question 363

What are some considerations enroute to an imminent delivery patient?

Answer 363

• Drugs – oxytocin & TXA
• PPE maternity kit
• 2 Pts – role delineation
• CCP backup

Question 364

What are some signs of imminent delivery?

Answer 364

• Loss of operculum mucous plug (bloody show) - (may have occurred days before)
• increasing frequency and severity of contractions
• with an urge to push, or open bowels
• membrane rupture (this may not occur and active membrane rupture will be required if the head has been delivered with the membrane intact)
• bulging perineum
• appearance of the presenting part at the vulva

Question 365

What are some common classifications of syncope?

Answer 365

Orthostatic
Reflex
Cardiac

Question 366

What happens if a patient absconds before assessment when detained under an EEA?

Answer 366

Authority to return completed by hospital and QPS or QAS requested to bring them back

Question 367

+2 Sedation Assessment Tool (SAT) verbal score description

Answer 367

loud outbursts

Question 368

What are some behavioural indications or warning signs of suicide?

Answer 368

• Talking about death or suicide
• Seeking methods for self harm
• Talking about feeling hopeless or having no reason to live
• Changes in drug and alcohol use
• Changes in sleeping patterns
• Reckless behaviour
• Feelings of isolation, desperation or feeling trapped - expressed in conversations.
• Social withdrawal or disengagement in usual activities
• Putting affairs in order

Question 369

Why do DKA patients present the way they do?

Answer 369

• Acidosis and low cpp = low map
• Profound hyperkalaemia – osmolarity shift of water and K+ out of cells and cells uptake H ions and to maintain electroneutrality

Question 370

How does paracetamol reduce fever? Do all patients with fever need to be treated?

Answer 370

inhibiting the hypothalamus prostaglandin production, reducing the body’s set temperature leading to heat dispersion and reduced body temperature

Question 371

Define whooping and its mechanism

Answer 371

high-pitched gasp – respiratory infection

Question 372

How can you assess pain in paediatric patients?

Answer 372

• FLACC – face legs activity crying consolability
• Wong baker faces

Question 373

What are the post ROSC cares/goals?

Answer 373

Maintaining airway
Maintaining ventilation status
Maintaining cardiovascular status
Titrate fluid for SBP of 100 or greater

Question 374

Q. Outline and justify management of a secondary postpartum haemorrhage.

Answer 374

• Fundal massage
• Patient to empty bladder
• Consider:
• Tone – fundal massage &Oxytocin
• Trauma – control external haemorrhage & Analgesia
• Tissue/temperature/Thrombin – fundal massage, inspect for membranes and pieces of placenta
• External aortic pressure
• Bimanual compression

Question 375

What is the drug class and use of metformin?

Answer 375

anti-hyperglycaemic
diabetes

Question 376

What makes children more vulnerable to FBAO?

Answer 376

• Smaller airway
• Can not generate the same force when coughing as an adult
• Commonly put objects in their mouth when they are discovering their environment

Question 377

What is the pharmacology of naloxone?

Answer 377

Reverses the effects of opioids by competing for the same opioid receptors

Question 378

How does the baby present in a complete breech?

Answer 378

hips and knees are flexed so that the foetus is sitting cross-legged, with feet beside the buttocks

Question 379

What is the pathophysiology of a STEMI?

Answer 379

Atherosclerotic plaque buildup narrows lumen or breaks off (instigating clotting factors), obstructing blood flow distal to the occlusion, decreasing perfusion leading to injury and necrosis

Question 380

Outline all fours running start

Answer 380

mum on hands and knees with one foot forward so it is near hand & apply gentle downward traction to foetus posterior shoulder or gentle upward traction to foetus anterior shoulder

Question 381

What is the pharmacology of psychostimulants?

Answer 381

enhance prefrontal cortex norepinephrine levels and the activation of adrenergic receptors by binding to norepinephrine transporters in the prefrontal cortex

Question 382

What are the elements of the paediatric assessment triangle?

Answer 382

Appearance – tone, interactiveness, consolability, look & gaze, speech and cry
Work of Breathing – nasal flaring, retractions, posturing, breath sounds, apnoea or gasping
Circulation to skin – pallor, mottling, cyanosis

Question 383

How does the baby present in a kneeling breech?

Answer 383

kneeling position, with one or both legs extended at the hips and flexed at the knees.

Question 384

What are differentials for syncope?

Answer 384

Cardiac syncope
Orthostatic syncope
Reflex syncope
Seizure

Question 385

Describe the pathophysiology of alcohol withdrawal

Answer 385

Ethanol inhibited GABA and glutamate receptors no longer being inhibited resulting in unopposed sympathetic and central nervous system stimulation

Question 386

+2 Sedation Assessment Tool (SAT) behaviour score description

Answer 386

very anxious and agitated

Question 387

What is the pathophysiology of primary adrenal insufficiency (PAI)?

Answer 387

Direct adrenal gland dysfunction typically caused by an autoimmune disease such as Addison’s disease.

Question 388

What is the cause of cluster headaches?

Answer 388

dysfunction of trigeminal nerve

Question 389

Describe the physiological mechanisms by which the body compensates for insufficient perfusion.

Answer 389

Baroreceptors send negative feedback loop to cardiovascular centre to increase peripheral vasoconstriction and venous return – decreased perfusion detected in kidneys which stimulates the release of renin to stimulate renin angiotensin aldosterone system – causing many effects by increasing sympathetic nervous activity which directly stimulates peripheral vasoconstriction, aldosterone release to work in kidneys to stimulate the retention of sodium and water – and antidiuretic hormone from post pituitary gland further increasing water retention

Question 390

How would you troubleshoot/what are your considerations in a difficult ventilation with an igel in a cardiac arrest due to underlying asthma/COPD Pt?

Answer 390

Bilateral decompression of chest to rule out haven’t transferred from asthmatic arrest due to bronchospasm to tension pneumothorax

Question 391

Provide some common beta blocker drug names.

Answer 391

mostly end in lol

• Propranolol
• Sotalol
• Atenolol
• Bisoprolol
• Carvedilol

Question 392

What is the drug effect of frusemide?

Answer 392

Makes person pee:
causes kidney to excrete higher levels of water and salt into urine

Question 393

What organs are in the Right Iliac Region?

Answer 393

• appendix
• cecum
• ascending colon
• small intestine

Question 394

List some normal gross motor milestones for children

Answer 394

6wks – good head control in vertical
3mths – no head lagging or pulling, lying on abdo with good head control
6mths – sits up with good support
12mths – taking first steps
13mths – walks unsupported
18mths – runs, climbs
2yrs – runs, walks down steps 2 feet at a time
3yrs – able to catch objects and hold a pencil to draw objects
4-5yrs – can climb, skip, hop and colour in neatly

Question 395

Compare cholinergic and anticholinergic agents

Answer 395

Cholinergic agents activate acetylcholine receptors, stimulating the parasympathetic nervous system

Anticholinergic agents block the action of acetylcholine, inhibiting the parasympathetic nervous system

Question 396

What are some common calcium channel blockers?

Answer 396

verapmil
diltiazem

Question 397

What is status epilepticus?

Answer 397

seizure activity > 5 minutes in duration or recurrent seizure activity where the patient does not recover to a GCS of 15 prior to another seizure

Question 398

Following your initial treatment, what is your ongoing management of a patient presenting with meningitis and justify why?

Answer 398

Airway – good oxygenation
Breathing
Circulation
* IV access – further doses morphine, possibly saline, ceftriaxone and ondansetron
* IV fluids – titrate to MAP 90
* Antiemetic – ondansetron 8mg IV, slow push over 2-3 minutes, to stop nausea and to also reduce ICP when vomiting
* Further doses of morphine to max 20mg to control pain, also has anti-anxiety properties which may help the Pt
* CCP backup
* Rapid transport
* Pre-notify hospital
* Consult for Ceftriaxone – 2g, slow push over 5 minutes as meets risk criteria for meningococcal bacteria

Question 399

What is Frusemide administered for?

Answer 399

Hypertension
Oedema – heart, kidney & liver failure

Question 400

What does the mental status assessment thought content component assess?

Answer 400

the content of their thoughts

Question 401

0 Sedation Assessment Tool (SAT) verbal score description

Answer 401

speaks normally

Question 402

What is Protonix presribed for?

Answer 402

acid reflux

Question 403

What are the anticholinergic effects of a TCA overdose?

Answer 403

• Hot as a hare: increased body temperature
• Mad as a hatter: delirium
• Blind as a bat: mydriasis (dilated pupils)
• Red as a beet: flushed face
• Dry as a bone: dry mouth, dry eyes, decreased sweat
• Fast as a fox: tachycardia
• Full as a flask: urinary retention

Question 404

What are some signs and symptoms of anaphylaxis?

Answer 404

Gradual or rapid onset of:
Cutaneous – urticaria (rash), angioedema (swelling), pruritus (itch), flushed skin
Respiratory – difficulty breathing, wheeze, upper airway swelling, rhinitis (runny nose)
Cardiovascular – hypotension, dizziness, bradycardia or tachycardia, collapse
Abdominal – nausea, vomiting, diarrhoea, abdominal pain

Question 405

What are the contraindications for an acute stroke referral?

Answer 405

• Advanced terminal cancer with a life expectancy of less than 6 months
• Seizure/s at onset of symptoms

Question 406

How do opioids cause CNS depression?

Answer 406

act on both opioid and non-opioid receptors in the nervous system, GIT, cardiovascular and immune systems blocking pain messages

Question 407

What are some additional causes of SPPH?

Answer 407

• Perineal trauma / Perineal repair infection
• Uterine Abnormalities - Fibroids
• Vascular anomalies - arteriovenous malformation or pseudoaneurysm
• Caesarean section wound dehiscence / infection
• Bleeding disorders or coagulopathies

Question 408

What is your management for a patient with a mild airway obstruction, unable to dislodge with their own efforts to cough?

Answer 408

5 back blows, checking to see if the obstruction has been dislodged between blows, and if unsuccessful, 5 chest thrusts, checking to see if the obstruction has been dislodged between blows

Question 409

Define complete abortion

Answer 409

full loss of products of conception in the first 20 weeks gestation

Question 410

Define Stuporous

Answer 410

profoundly reduced alertness and requiring continuous noxious stimuli for arousal

Question 411

Define Haematochezia

Answer 411

per rectum bleed of fresh blood

Question 412

What role does naloxone have in an overdose patient who deteriorates into cardiac arrest?

Answer 412

No role in cardiac arrest as it is secondary to opioid and Narcan/naloxone has no cardiac effects

Question 413

What factors may support the patient’s presentation of an acute behavioural disturbance (ABD) being associated with a medical aetiology?

Answer 413

• first presentation/episode of ABD in a person aged 45 years or older
• abnormal vital signs
• focal neurologic findings
• decreased awareness of surroundings
• difficulty paying attention
• absence of a clear trigger for ABD

Question 414

What is the pathophysiology of secondary adrenal insufficiency (SAI)?

Answer 414

Deficiency in adrenocorticotropin hormone (ACTH) secretion by the pituitary gland.

Question 415

What would you consider appropriate analgesia for a pregnant patient with abdo pain and PV bleed?

Answer 415

2.5mg IV morphine, or
3ml methoxyflurane

Question 416

Define Ascites

Answer 416

fluid build up in the spaces within the abdomen

Question 417

What are some risks associated with post-term delivery?

Answer 417

• Macrosomia
• Shoulder dystocia
• Placental breakdown
• Infection
• Stillbirth
• Maternal mortality

Question 418

What are some risk factors for Cholecystitis?

Answer 418

• Fat
• Female
• Fair (Caucasian)
• Fertile
• Over 40
• Pregnancy
• Hormone therapy
• Diabetes

Question 419

What does the mental status assessment thought form component assess?

Answer 419

the amount of thought and the rate of
production

Question 420

Define threatened abortion

Answer 420

vaginal bleeding in the first 20 weeks of gestation

Question 421

What does the mental status assessment appearance component assess?

Answer 421

the general appearance of your pt

Question 422

What does the mental status assessment insight component assess?

Answer 422

degree to which the client understands the importance of their illness or current state

Question 423

Define HELLP syndrome and how it is different to other conditions.

Answer 423

A marker for severe pre-eclampsia, where 2 of the 3 elements of Haemolysis, Elevated Liver enzymes and Low Platelets are required for a diagnosis

Question 424

What may be some common rhythms that may present as palpitations?

Answer 424

• Broad complex tachycardia
• Narrow complex tachycardia
• Sinus rhythm

Question 425

Outline different agents that primarily cause CNS depression.

Answer 425

• Alcohol
• Benzodiazepines
• Opioids

Question 426

What does the mental status assessment speech component assess?

Answer 426

volume at which they speak

Question 427

What constitutes a normal birth?

Answer 427

• spontaneous onset
• low-risk at the start of labour
• remaining low-risk throughout labour and birth
• the newborn is born:
  o spontaneously
  o in the vertex position
  o between 37 and 42 completed weeks gestation
• After birth mum and bub in good condition

Question 428

What is the pathophysiology of tertiary adrenal insufficiency (SAI)?

Answer 428

Hypothalamic dysfunction, resulting in a decrease in corticotropin releasing hormone (CRH), which stimulates the pituitary gland to produce ACTH. Sudden withdrawal from long-term exogenous steroid use is the most common cause of TAI

Question 429

What is the presentation of placenta praevia?

Answer 429

• no pain, other than that associated with contractions
• a soft, non-tender uterus
• several small warning bleeds
• bright red blood
• significant blood loss, which may lead to hypovolaemic shock

Question 430

What are the expected vital signs of a 4 year old?

Answer 430

Weight: 19kg
HR: 80-140bpm
RR: 20-30rpm
SBP: 80-110mmHg

Question 431

What are some potential differential diagnoses for chest pain?

Answer 431

• Acute myocardial infarction
• Angina stable/unstable
• Aortic dissection
• Cardiac tamponade
• Pulmonary oedema
• Pericarditis
• Spontaneous pneumothorax

Question 432

What are some high risk for sepsis in paediatrics?

Answer 432

• Severe tachycardia or bradycardia
• Severe respiratory distress/tachypnoea/apnea
• Needs oxygen to maintain SpO2 greater than 92%
• Hypothermia
• Non-blanching rash/mottled ashen/cyanotic
• Altered GCS/AVPU

Question 433

What are the expected vital signs of a 7 year old?

Answer 433

Weight: 28kg
HR: 70-120bpm
RR: 15-25rpm
SBP: 90-115mmHg

Question 434

Outline your management for a birth at 20 weeks gestation with the foetus having gasping respirations?

Answer 434

• Pull over and have second assist
• Backup with second crew to assist
• No resuscitation
• Wrap baby and present to mum
• Be very supportive and ensure psychological cares
• Manage mother as post delivery – oxytocin etc

Question 435

Define the pattern of pain for Bowel obstruction

Answer 435

sudden onset of abdo pain in the periumbilical region, cramping waves every 4-5 minutes if in small bowel, or every 20 minutes if in large bowel

Question 436

What are the signs and symptoms for AAA?

Answer 436

• ALOC
• shoulder tip pain
• myocardial infarction
• hypotension
• asymmetrical/absent distal pulses
• abdo pain
• palpable mass
• ecchymosis (bruising around flank)
• limb ischaemia
• shock (hypovolaemic)

Question 437

What are focal neurological deficits?

Answer 437

signs or symptoms in which causation can be localized to an anatomic site in the central nervous system, eg paralysis, weakness, loss of muscle control, increased muscle tone, loss of muscle tone, tremors, sensation changes

Question 438

Why is it important to guard the uterus when applying cord traction?

Answer 438

To prevent uterine inversion

Question 439

What enroute considerations do you have for a child found at the bottom of a swimming pool, with CPR in progress?

Answer 439

• CCP QFS back up
• Do calculations:
  o Pts weight (age x 3) + 7
  o Defib joules weight x 4 (round up to next highest setting)
  o Amiodarone – CCP administration after 3rd DCCS
  o Adrenaline dose 10mic/kg, every 3-5, no max, after 5th DCCS
• scene control
• Best facility to transport to

Question 440

Define Comatose

Answer 440

state of deep, unarousable, sustained unconsciousness

Question 441

What are some differences between adult and paediatric components of circulation?

Answer 441

• Increased hr
• Decreased ability to increase stroke volume
• Increased vagal tone
• Smaller blood volume – 9-10 ml/kg

Question 442

Westley Croup Score Stridor Variables and Scores

Answer 442

At rest - 2

With agitation - 1

None - 0

Question 443

What occurs in the first stage of labour?

Answer 443

gradual effacement and dilation of the cervix through regular contractions up to 10cm dilation

Question 444

What is the maximum joulage of paediatric pads?

Answer 444

100 joules

Question 445

What is the pathophysiology of placenta praevia?

Answer 445

The embryo implants in the lower part of the uterus causing the placenta to grow close to or over the cervical os

Question 446

Why is rapid transport for a stroke patient essential?

Answer 446

for urgent stroke testing

Question 447

What is Brusinksi Sign?

Answer 447

patient’s hips and knees flex when the neck is flexed

Question 448

When do you administer naloxone to an opioid overdose patient?

Answer 448

to be administered after immediate cares commenced and resp rate and oxygen sats have improved – fix hypoxia first

Give it prior to immediate cares if unable to manage airway - anatomically difficult etc

Question 449

What are some mechanisms that cause cardiac syncope?

Answer 449

• Structural cardiac abnormality (aortic stenosis, cardiomyopathy, aortic dissection)
• Cardiac arrhythmia (sinus node dysfunction, atrioventricular block, tachycardia)

Question 450

What are the risk factors for epiglottitis?

Answer 450

Adults and children who are not vaccinated – haemophilis influenza type B (HIB)

Question 451

What are some differences between adult and paediatric components of airway?

Answer 451

• Large head/occipult
• Small oral cavities and oral airway openings
• Large tongue
• Large tonsils
• Large floppy u-shaped epiglottis
• More proximal and anterior larynx
• Absence of tracheal ridge

Question 452

What are some causes of arrhythmias?

Answer 452

• Ischemic heart disease
• Hypertension
• Heart failure
• Heart disease
• Diabetes
• Electrolyte disturbances

Question 453

How do you instruct the mother to push when the head is crowning? Do you touch the baby?

Answer 453

Small pushes with contractions
Place 2 fingers against baby’s head to prevent explosive delivery of the head

Question 454

-2 Sedation Assessment Tool (SAT) behaviour score description

Answer 454

physical stimulation

Question 455

What type of drug is catopril?

Answer 455

ace inhibitor

Question 456

What is the cause of migraine headaches?

Answer 456

traction or inflammation of cranial blood vessels

Question 457

What other assessment needs to be completed with the NIHSS-8 score?

Answer 457

GCS

Question 458

Compare and contrast DKA and HHS

Answer 458

DKA:
* T1DM
* BGL >10 mmoL
* +/- Kussmaul respirations
* rapid onset
* Not enough insulin to convert sugar into energy, so liver uses fats for energy instead of sugar, creating ketones

HHS:
* T2DM
* BGL > 40 mmoL
* does not have kussmaul respirations
* develops over long period
* pancreas creates insulin, but peripheral tissues resistant causing an increase in bsl

Question 459

Outline the elements of the APGAR and when it is performed.

Answer 459

Appearance – skin colour
Pulse – count heart rate
Grimace – monitor response to stimulation
Activity – muscle tone
Respiration – count and assess resp rate

APGAR is performed at 1 and 5 minutes

Question 460

What is the management for abdominal pain and why?

Answer 460

• 400 mg ibuprofen – to assist with pain
• 1g paracetamol to assist with pain
• 4-8 mg ondansetron - Antiemetic to stop nausea and vomiting if present
• IV access - to administer drugs
• 2.5 – 5mg IV morphine – to assist with pain

Question 461

Define Melaena

Answer 461

dark sticky stool that contains partly digested blood from internal bleeding or swallowing blood

Question 462

+1 Sedation Assessment Tool (SAT) behaviour score description

Answer 462

very anxious/restless

Question 463

What type of drug is diamicron and what is it used for?

Answer 463

antihyperglycaemic, - T2DM

Question 464

What are the benefits of active management of third stage of labour?

Answer 464

Speeds up the delivery of the placenta and reduces risk of post partum haemorrhage

Question 465

What are some maternal complications associated with shoulder dystocia?

Answer 465

• postpartum haemorrhage
• severe vaginal and perineal trauma
• uterine or bladder rupture
• psychological distress

Question 466

What is the drug class and use of Escitalopram?

Answer 466

SSRI
depression

Question 467

What is your management plan for a STEMI? ie what will you do?

Answer 467

• CCP backup
• Pads on as deteriorate quickly
• Check contraindications
• 300mg, single dose Aspirin for antiplatelet properties to stop platelets aggregating
• 400 mics, every 5 GTN for vasodilation, reduction of preload and afterload, allowing blood flow through cardiac arteries and veins and peripheral blood pooling to reduce workload of the heart
• IV access
• 25mcs Fentanyl – analgesia and more efficacy with PCI drugs
• Commence pPCI pathway

Question 468

What organs are in the Hypogastric Region?

Answer 468

• bladder
• parts of sigmoid colon
• small intestine
• and reproductive organs

Question 469

What are high risk features of sepsis in adults?

Answer 469

• Respiratory rate greater than 25 breaths/min
• Systolic BP less than 90 mmHg (or a drop of greater than 40 mmHg from normal)
• Heart rate is equal to or greater than 130 beats/min
• Needs oxygen to maintain SpO2 greater than 92%
• Non-blanching rash/mottled/ashen/cyanotic
• Deterioration in mental status (from normal)
• Recent chemotherapy
• Anuria in last 18 hours OR significantly reduced urine output

Question 470

What is the difference between active management of the third stage and physiological management of the third stage?

Answer 470

active management is the process of cord clamping, oxytocin and active cord traction

physiological management is all maternal effort

Question 471

What are the clinical features associated with stimulant overdose?

Answer 471

• Psychosis
• Anxiety agitation paranoia
• Dilated pupils
• Tachycardia
• Hypertension
• ACS
• Cardiac dysrhythmias
• Diaphoresis
• Tremor
• Metabolic – dehydration, rhabdomyolysis, hyperkalaemia
• Acute renal failure
• Death

Question 472

Define recurrent abortion

Answer 472

2 or more successive pregnancy losses

Question 473

Define Haematemesis

Answer 473

vomiting fresh blood

Question 474

What do each of the APGAR score ranges suggest?

Answer 474

• 0-3: indicates severe distress in the newborn requiring immediate resuscitation
• 4-6: indicates moderate distress that requires medical attention and extreme vigilance
• 7-10: indicates the newborn is coping well at that point in time

Question 475

Define the pattern of pain for Peptic ulcer disease

Answer 475

burning or gnawing pain in the epigastrium that slowly builds for 1-2 hours, then gradually decreases
Is aggravated by meals

Question 476

How does methoxyflurane produce analgesia?

Answer 476

by altering tissue excitability

Question 477

What type of drug is cartia and what is it used for?

Answer 477

aspirin - antiplatelet

Question 478

What organs are in the Left Lumbar Region?

Answer 478

• descending colon
• small intestine
• left kidney

Question 479

What are the elements of the NIHSS-8 assessment?

Answer 479

1. Level of consciousness
2. Level of consciousness questions – ask age, current month
3. Commands – open/close eyes, grip and release
4. Best gaze – horizontal eye movements tracking
5. Facial palsy – show teeth, close eyes, raise eyebrows
6. Motor Arm – hold arms outstretched
7. Dysarthia – slowly count to 5
8. Extinction/Neglect – motor sensory with eyes closed & show fingers in both visual fields

Question 480

What is Dysphasia/asphasia?

Answer 480

Full or partial loss of language

Question 481

What is the definition of psychosis and what are the defining features?

Answer 481

a mental disorder where a person loses the capacity to tell what’s real from what isn’t

• Delusions
• Hallucinations
• Disordered thinking
• Disordered behaviour
• General thought disorganisation

Question 482

What does the mental status assessment judgement component assess?

Answer 482

ability to evaluate and make appropriate choices

Question 483

Outline supra-pubic pressure

Answer 483

pressure superior to symphysis pubis or continuous rocking motion (back of foetus towards front) – to reduce diameter of foetal shouters and rotate anterior shoulder into oblique diameter - do with McRoberts

Question 484

What is the cause of raised ICP headaches?

Answer 484

Pressure on the brain due to increased amount of fluid and restricted room in skull

Question 485

What is the pathophysiology of a generalised seizure?

Answer 485

abnormal neuronal activity rapidly engages both hemispheres of the cerebral cortex (absence, atonic, tonic, myoclonic and tonic/clonic)

Question 486

What is the pathophysiology of a haemorrhagic stroke?

Answer 486

blood vessel within the brain ruptures and bleeds into surrounding tissue and possibly subarachnoid space, causing hypoxia in downstream brain tissue and increasing ICP

Question 487

What is the treatment for croup?

Answer 487

Depending on Wesley croup score, dexamethasone +/- adrenaline
Dexamethasone, PO, 0.5ml, may be repeated once if spat out
Adrenaline, NEB, 2.5mg, single dose only

Question 488

What is the pathophysiology of sepsis?

Answer 488

Infection penetrates the blood causing dysregulated inflammation response and body is overwhelmed by release of anti-inflammatory mediators increasing vascular permeability causing fluid shifts and cellular hypoxia. Fluid loss into interstitium causes increase in peripheral vascular resistance worsening tissue ischemia and increasing lactate. Within sepsis response microcirculatory dysfunction resulting in circulatory dysfunction and DIC

Question 489

What are some causes of APH before 20 weeks?

Answer 489

• Miscarriage
• Ectopic pregnancy
• Implantation bleeding

Question 490

What are the expected vital signs of a 3 year old?

Answer 490

Weight: 16kg
HR: 80-140bpm
RR: 20-30rpm
SBP: 80-110mmHg

Question 491

+3 Sedation Assessment Tool (SAT) verbal score description

Answer 491

continual loud outbursts

Question 492

What are the clinical features of cervicogenic headaches?

Answer 492

Unilateral or bilateral; band from
neck to forehead and scalp
tenderness

Question 493

How does the baby present in a frank breech?

Answer 493

buttocks presents first, with the legs flexed at the hip and extended at the knees, placing the feet near the ears.

Question 494

Define the pattern of pain for Renal colic

Answer 494

mild to intense pain beginning around the flank and moving anteriorly towards abdomen and inguinal region

Question 495

What should you consider when deciding on medication doses in the elderly?

Answer 495

Decreased kidney function and ability to metabolise drugs

Question 496

Name the 9 abdominal regions

Answer 496

right hypochondriac region
epigastric region
left hypochondriac region
right lumbar region
umbilical region
left lumbar region
right iliac region
hypogastric retion
left iliac region

Question 497

At what point would you consider physical management of the PPH? Outline the procedures for each method and reasoning why?

Answer 497

If blood loss over the 10 minutes of TXA administration does not improve
* External aortic compression – manual compression of the abdominal aorta against the vertebral column to restrict uterine blood flow
* Bimanual compression - invasive two-handed technique to manually compress the uterus wall - continued through to definitive care (theatre).

Question 498

What is the drug effect of catopril?

Answer 498

Decreases BP and improves contractility

Question 499

Outline some of the common gaps in health outcomes and risk factors for First Nations people.

Answer 499

• Low birthweights
• More likely to die before 5th birthday
• Hearing problems in children
• More likely to smoke
• More likely to have physiological distress due to chronic medical conditions
• Higher rates of mental health issues

Question 500

-2 Sedation Assessment Tool (SAT) verbal score description

Answer 500

few recognisable words

Question 501

What are the common SSRI drugs?

Answer 501

fluoxetine (prozac)
sertraline
citalopram

Question 502

Outline your treatment of a 2 year old presenting with shortening to right leg, swelling in thigh and bad nappy rash.

Answer 502

• Reassurance
• ABC’s in tact
• Check pedal pulse and mark location – future assessments
• Advise mother of what’s going to occur
• NAS fentanyl – 1.5mcg/kg
• Clean nappy if available or dressing to groin
• Traction
• Transport
• Notify triage of safety concerns

Question 503

Describe the pathophysiology of aortic dissection during pregnancy

Answer 503

pregnancy hormones creating a hyperdynamic state in vasculature

Question 504

What is the pathophysiology of epiglottitis?

Answer 504

Infection causing an inflammation of the lining of the cartilaginous tissue in the airway

Question 505

How do you treat pregnant patients when it comes to analgesia?

Answer 505

same as non pregnant for analgesia – except for imminent delivery stage (as opioids can lead to resp depression when baby is born)

Question 506

What are the manoeuvres designed to relieve shoulder dystocia?

Answer 506

Primary:
* All fours position
* McRoberts
* Supra-pubic pressure

Secondary:
* Rubins II
* Wood’s screw
* Reverse Woods screw
* All fours running start

Question 507

What is your initial management for a patient with a mild airway obstruction?

Answer 507

position and encourage patient’s own effort to cough

Question 508

What are some risk factors for suicide?

Answer 508

job loss/unemployment
legal/financial problems
stress
serious/mental illness
substance misuse
relationships
adverse childhood events
bullying
stigma associated with seeking help

Question 509

What are the effects of a mild serotonin toxicity?

Answer 509

Mild - Moderate
* Tremor
* Hyperreflexia
* Diaphoresis
* Clonus

Question 510

What are some protective factors for suicide risk?

Answer 510

• Future orientation
• Engagement in help seeking behaviours
• Coping and problem solving skills
• Connections to friend, family and community supports
• Availability of physical and mental health care
• Limiting the access to lethal means

Question 511

What are the cardiotoxicity/ECG changes of a TCA overdose?

Answer 511

• Hypotension
• Prolonged PR and QRS interval
• Prominent terminal R wave in aVR
• Ventricular tachycardia

Question 512

What are some important questions to ask to ascertain pertinent points of the maternal history for an imminent delivery pt?

Answer 512

• How many weeks gestation?
• Singleton or multiparity?
• Antenatal care up to date?
• When was last antenatal visit?
• Any complications with this pregnancy?
• Any foetal movements today?
• Any complications with previous pregnancy or delivery?
• What was the gestation period for last pregnancy?
• How long did the last delivery take?
• Any postpartum haemorrhage
• Gravidity and Parity
• Last known position of foetus

Question 513

What is your initial management of a pregnant patient with PV bleed and abdo pain?

Answer 513

Fresh pad – to monitor amount of bleeding
IV access – to administer drugs
IV morphine – 2.5mg, every 5 if required, max dose 20 mg – pain management
Reassure mum and partner
Rapid transport

Question 514

What does Aspirin do?

Answer 514

stop platelets aggregating

Question 515

What organs are in the Right Lumbar Region?

Answer 515

• ascending colon
• small intestine
• right kidney

Question 516

How can you differentiate between syncope and seizure?

Answer 516

• Seizures have a post-ictal period where the patient can be drowsy, confused, have a headache and nauseous
• Ask – muscular jerking, how long did it last for
• Incontinence occurred

Question 517

What are your priorities of management for a patient who has been sedated for ABD?

Answer 517

• maintain normothermia
• capnography
• Pads on – for monitoring
• IV access – to administer medications
• Transport

Question 518

How does morphine produce analgesia?

Answer 518

binds with opioid receptors altering pain perception

Question 519

Define the different types of delusions

Answer 519

• Grandiose delusions: the person believes they are very talented, rich or influential
• Paranoid delusions: the person believes others want to harm them or are persecuting them
• Somatic delusions: the person believes there is something wrong with a part of their body, or that part of them is missing
• Reference delusions: the person believes other people’s thoughts or actions are directed towards them, or that special messages are being sent to them via the TV or radio
• Bizarre delusions: the person believes in something that is physically impossible
• Delusional jealousy: the person believes their partner is being unfaithful, even when that’s impossible
• Misidentification syndrome: the person believes someone they know has been replaced by an imposter who looks identical to that person

Question 520

+1 Sedation Assessment Tool (SAT) verbal score description

Answer 520

normal/talkative

Question 521

Outline the maternal changes that occur during pregnancy.

Answer 521

• Respiration increases
• HR increase as is responsible to maintain cardiac output
• Normal ECG changes
• Blood volume increases 30-40%
• Vasodilation secondary to hormone release – increases cardiac output and decreased systemic vascular resistance
• Clotting factor changes – more likely to clot – hypercoagulable state
• Fluid retention
• Urinary stasis – increasing risk of UTI
• Reduction in sphincter tone

Question 522

Why are rashes non-blanching?

Answer 522

• DIC – thrombosis – tiny blood clots preventing blood from displacement when pressure applied
• Vessel damage or inflammation – vasculitis – inflamed and effecting ability to blanch under pressure

Question 523

Define the pattern of pain for Biliary pain

Answer 523

right upper quadrant
tender on palpation and may radiate to back and right shoulder. Intense pain lasting at least 30 minutes, reaching plateau within hour and will resolve with 6 hours.

Question 524

What are the expected vital signs of a 8 year old?

Answer 524

Weight: 31kg
HR: 70-120bpm
RR: 15-25rpm
SBP: 90-115mmHg

Question 525

What are the main signs of epiglottitis?

Answer 525

sitting forward
don’t want to swallow
drooling
upper airway sounds

Question 526

What class of drug is novorapid?

Answer 526

hyperglycaemic