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M4 Stuff > E MED > Flashcards

E MED Flashcards

1
Q

Top ddx for abdominal free fluid in female with UPT negative

A

Ruptured ovarian cyst

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2
Q

Mx of biliary cholangitis

A

Abx(roc and flagyl) + ERCP

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3
Q

Most common triggers of pancreatitis

A

1.Biliary stones
2.Alcohol

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4
Q

Most common causes of small bowel intestinal obstruction

A
  1. Hernia
  2. Adhesions(if prev abdo surgery)
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5
Q

Most useful POCTs for abdo pain

A

UPT
Urine dipstick
ABG/istat
Capillary glucose
ECG
bedside Ultrasound

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6
Q

Facets of Mx of Asthma exacerbation

A

O2
Salbutamol
Ipratropium
Corticosteroids
MgSO4 if severe
Intubation if severe

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7
Q

Tension pneumothorax definition

A

Pneumothorax with hemodynamic instability(tachycardia,hypotension cyanosis,cardiac arrest)

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8
Q

Aspiration site for pneumothorax

A

2nd intercostal space mid clavicular line

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9
Q

Chest tube insertion site

A

Triangle of safety

Above 5th intercostal space/above level of nipples

Posterior to edge of pec major
Anterior to edge of lat dorsi

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10
Q

Radiological sign for SAH

A

Star sign on NC CT Brain

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11
Q

Mx of SAH

A

BP control to prevent hematoma expansion

Thus IV antihypertensive eg Labetalol,nifedipine

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12
Q

Types of primary headaches

A

Tension headache
Cluster headache
Migraine +- aura

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13
Q

Mx of migraine

A

1st line:paracetamol, nsaids and antiemetics

2nd line: migraine specifics 3g triptans, ergotamine

Migraine prophylaxis eg topiramate, beta blockers

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14
Q

Causes of heart blocks

A

ACS(AV node supplied by RCA)
Drugs(AV nodal blocking agents eg BB,CCB,digoxin)
Electrolytes eg K+
Myocarditis

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15
Q

MOA of calcium gluconate

A

Stabilises cardiac membrane by reducing gradient between resting membrane potential and threshold

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16
Q

Toxins that are exacerbated by excessive oxygenation

A

Chlorine poisoning
Ammonium Chloride poisoning

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17
Q

Toxins where intubation may not be necessary due to their respiratory alkalemic effect

A

Salicylate,toxic alcohols,metformin

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18
Q

Types of toxidromes

A

Fast
Slow
Wet
Dry

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19
Q

Antidote for opioids

A

Naloxone(Narcan)

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20
Q

Triad of opioid toxidrome

A

Pinpoint pupils,respi depression, unconscious

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21
Q

Triad of serotonin syndrome

A

Neuromuscular excitability
AMS
Autonomic dysfunction

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22
Q

ECG changes of Na channel poisoning,K channel poisoning

A

Na channel: QRS prolongation
K channel: QTc prolongation

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23
Q

Methods of decreasing GIT removal of poisoning

A

Gastric lavage
Single dose activated charcoal
Whole bowel irrigation
Physical removal from bowels

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24
Q

Name antidotes for paracetamol, salicylate, opioids and TCAs

A

Paracetamol: N acetyl cysteine
Salicylate: Na bicarb
Opioids: Naloxone
TCA: Na bicarb

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25
Q

Main clinical concern in a patient with hemoptysis

A

Airway compromise(choking) rather than hemodynamic instability due to blood loss

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26
Q

expected HR in a severe asthma episode

A

> 110

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27
Q

Markers of imminent respiratory arrest

A

AMS, Bradycardia and a silent chest

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28
Q

What is the cause of metabolic acidosis in asthma

A

Beta adrenergic stimulation leading to increased lactate pdn

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29
Q

Best drug for rapid sequence intubation(RSI) in asthma

A

Ketamine, which also helps reduce bronchospasm

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30
Q

Most common causes of ARDS

A

Trauma
Sepsis

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31
Q

DDx for low consciousness and respiratory depression

A

Opioid overdose
Brainstem stroke/bleed

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32
Q

Common causes of type 1 respiratory failure( Hypoxemia)

A

Acute pulmonary oedema(APO) or acute lung injury

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33
Q

Common causes of type 2 respiratory failure( Hypercapnea)

A
  1. Airflow obstruction
  2. Decreased respiratory compliance
  3. Decreased respi muscle power 2* NMJ issues
  4. Central respi failure causing decreased respi drive
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34
Q

sign of chronic respiratory failure

A

1.pH is only decreased by 0.03/ 10mmHg compared to 0.08 in acute RF
2. Compensatory polycythemia
3.Cor pulmonale

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35
Q

FiO2 of assisted breathing

A

Room Air: 0.21
Nasal cannula: +0.04/L
Venturi:0.4-0.6
Non rebreather mask: 0.6-0.9

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36
Q

Berlin definition of respiratory failure

A
  1. Acute onset <1/52
  2. Bilateral opacities consistent w APO, on CXR or CT
  3. P/F ratio <300, minimum 5cmH2O PEEP
    4.Not fully explained by CHF or fluid overload
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37
Q

Invx for asthmatic pt

A
  1. FBC tro infection
  2. RP tro hypoK induced by salbutamol
  3. CXR tro pneumothorax
  4. ABG
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38
Q

ABG differences in mild vs severe asthma

A

pH: alkalemia vs acidemia
PaCO2: low vs high
PaO2: normal vs low
bicarb: normal vs low

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39
Q

Outpatient Mx of pneumonia

A

Macrolides eg Clarithromycin(clacid)
Fluoroquinolones eg levofloxacin

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40
Q

Ddx for ST elevations in AvR

A

Proximal LAD occlusion
LMCA occlusion
Triple vessel disease

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41
Q

Cardiopulmonary causes of raised troponins

A

AMI
Myocarditis
Pulmonary embolism
Heart Failure
Tachydysrhthmias

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42
Q

Non cardiopulmonary conditions causing raised troponins

A

Renal failure
Sepsis
Stroke
SAH

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43
Q

Role of CXR in chest pain evaluation

A
  1. Check for Cx of AMI eg APO
  2. Check ETT is placed correctly
  3. Rule out other causes of chest pain eg aortic dissection, pneumothorax, pulmonary embolism
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44
Q

What does unexplained hypoxaemia with a clear CXR raise suspicion of?

A

Pulmonary embolism

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45
Q

Mx of STEMI

A

DAPT: SOLUBLE aspirin in water+ticagrelor/clopidogrel

O2 only if necessary

Judicious fluid challenge

Fentanyl if severe pain

Send to cath lab for PCI

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46
Q

Impt facets of answering a ED management question

A
  1. Triage into which category
  2. Place on continuous spO2 and ECG monitoring
  3. Judicious fluid challenge
  4. POCT, bloods and imaging studies
    5.Who needs to be referred
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47
Q

Mx of Acute Pulmonary Edema

A

1st line: High dose IV GTN to reduce preload and afterload + NIV/intubation

Ace inhibitors
IV furosemide 30mins after GTN, make sure pt not hypovolemic
Beta blockers CI in APO

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48
Q

Triggers for decompensated heart failure

A

1.ACS
2.Arrhythmia eg AF
3 Non compliance to med/fluid restriction
4.Uncontrolled HTN
5.Progressive valvular disease eg MR
6.High output cardiac failure- thyrotoxicosis,anemia etc
7.Post partum CMP

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49
Q

Signs of pulmonary embolism on ECG

A

Right heart strain: Sinus tachycardia and T wave inversions

Classically but kess commonly S1Q3T3

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50
Q

Mx of massive pulmonary embolism

A
  1. Thrombolysis with rTPA
  2. Perc or open thrombectomy or embolectomy
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51
Q

Mx of submassive pulmonary elbolism and low risk PE

A

Submassive:Heparin/clexane

Low risk:NOACs eg rivaroxaban/apixaban

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52
Q

6 Life threatening causes of chest Pain

A

Unstable angina
STEMI/NSTEMI
Aortic dissection
Pulmonary embolism
Tension Pneumothorax
Esophageal rupture

53
Q

Why do right sided leads in Inferior MI?

A

To rule out RV infarct, where giving GTN will cause hypotension

54
Q

What should be ruled out in chest pain with neurological Sx?

A

Aortic dissection

55
Q

Ddx for dengue

A

Zika,chikugunya,other viruses

56
Q

Indications for platelet transfusion in dengue

A

Severe bleeding manifestations eg ICH,BGIT

57
Q

Causes of wide complex tachycardia

A
  1. VT
  2. Drugs eg TCA poisoning
  3. HyperK
    4 aberrancy?
58
Q

Cushings triad

A

Widened pulse pressure
Bradycardia
Irregular respiration

A reflex to increased ICP

59
Q

Definition of open book pelvic fx

A

Fratured at 2 points eg SIJ and pubic symphysis

60
Q

Format of handover from paramedics in trauma

A

MIST

Mechanism
Injury
Signs
Treatment given

61
Q

What is massive transfusion protocol

A

Equal ratio of blood:platelets:plasma

O+ blood

62
Q

Stroke mimics

A

Hypoglycemia
Seizures
Todd’s paralysis
Brain bleed
Space occupying lesion
CNS infections
Toxic causes

63
Q

Headache red flags

A

Thunderclap headache:SAH
Progressively worsening sx: Tumor
Neurological symptoms: Stroke
Meningism:Meningitis
Trauma

64
Q

Red flags for headache

A

Thunderclap headache:SAH

65
Q

Signs and sx of testicular torsion

A

Testicular pain
Abdominal pain
Retracted testis
Vomiting

Loss of cremasteric reflex

66
Q

Invx for suspected testicular torsion

A

Surgical exploration
US testis for whirlpool sign(if it does not delay surgery)

67
Q

Mx of testicular torsion

A

Orchidopexy
Orchidectomy

68
Q

Sepsis 7

A

Take 2
-Blood cultures
-Lactate and BG

Give 2
-high gflow O2
-IV abx
+-IV fluids and hydrocortisone

Monitor
-UO
-NEWS2

69
Q

Mimics of inferior MI

A

Aortic dissection involving right coronary artery

70
Q

How to rule out aortic dissection

A

Differential arm BPs
RR and RF delay
Widened mediastinum >8mm on AP

71
Q

Mx of hyperK

A

Insulin bolus
Calcium gluconate to stabilise cardiac membrane
Resonium
Nebulised Salbutamol
Dextrose to maintain normogly

72
Q

Contraindications to IDC

A

High riding prostate
Bleeding around meatus
Bruising around perineum

73
Q

Treatment of SVT

A

Vagal maneuvers: Carotid massage, blow thru tube
Pharm: Adenosine
Synchronised cardioversion

74
Q

Treatment of VT

A

Stable: Amiodarone
Unstable
Epi+amiodarone+defibrillation

75
Q

Treatment of VF

A

Epi+amiodarone+defibrillation

76
Q

Ddx of SVT

A

Sinus tachycardia
A fib
A flutter

77
Q

Weakest wall of orbital cavity

A

Medial wall with medial blowout fx
NOT orbital floor

78
Q

Mechanism of injury in extra dural hemorrhage

A

Middle meningeal artery rupture or injury to dural veins

79
Q

Common signs in intracranial hemorrhage

A

Effacement of ventricles
Midline shift

80
Q

Treatments for respiratory acidosis

A

Treat underlying cause

NIV or Intubation: increased RR and tidal volume

81
Q

Main considerations in placing chest tube

A

Triangle of safety(behind pec major, in front of lat dorsi,4th intercostal space or above)

Right above the rib to avoid damaging the neurovascular structures below the rib

82
Q

6 Hs and 5 Ts of reversible causes of cardiac arrest

A

Hypovolemia
Hypoxia
Hypothermia
Hypo/Hyperkalemia
Hypoglycemia
Hydrogen(acidosis)

Toxins(DO)

83
Q

ECG signs of pulmonary embolism

A
  1. Sinus tachycardia
  2. Signs of right heart strain(RAD, RBBB, right sided ischemia)
  3. S1Q3T3
84
Q

ddx of narrow complex tachycardia1

A

sinus tachy
A fib
A flutter
SVT

85
Q

ddx of ST elevation in AvR

A
  1. TVD(Triple Vessel Disease)
    2.Proximal LAD occlusion
  2. Critical but not total LMCA occlusion
86
Q

Torsades de pointes mx

A

Magnesium sulphate
Sync cardioversion

87
Q

What is water bottle shaped heart on CXR a sign of?

A

Pericardial effusion

88
Q

Signs of lidocaine toxicity

A

Circumoral numbness
Tongue paresthesia
Tinnitus
BOV
Restlessness,agitation
Seizures

89
Q

Types of anaesthetia used for manipulation and reduction

A

Hematoma block
Biers block

90
Q

Cause of abdominal pain and N/V that is often missed

A

Diabetic Ketoacidosis

91
Q

Anion

A
92
Q

What is a flail chest and its complications

A

3+ ribs that are fractured in 2 or more places

Interferes with breathing

93
Q

Words to describe intracranial hemorrhages

A

SDH:Lentiform
EDH:Biconvex
SAH:Star sign

94
Q

Treatment of VT

A

Pulseless: Same as VF
Unstable: synchronised cardioversion
Stable: IV amiodarone or lidocaine

95
Q

Causes of shock

A

Cardiogenic
Obstructive
Distributive
Hypovolemic

96
Q

3 main causes of obstructive shock

A

Tension pneumothorax
Pulmonary embolism
Cardiac tamponade

97
Q

3 main causes of distributive shock

A

Anaphylaxis
Sepsis
Neurogenic shock

98
Q

Intracranial causes of AMS

A

1) CVA: Stroke/hemorrhage
2) Seizure
3) Infection eg meningoencephalitis
4) Trauma
5) Space occupying lesions Encephalopathy
Encephalopathy

99
Q

Extracranial causes of AMS

A

1) POCT: hypogly, hypoxia, hypercapnea, hypotension
2) Sepsis
3) Endocrine: Thyroid storm of hypothyroid
4) Electrolytes
5) Substances
6) Heat stroke
7) Psychiatric causes

100
Q

Function of atropine

A

Bradycardia, to increase HR

101
Q

6 Ps of compartment syndrome

A

Pain
Pulselessness
Paresthesia
Paralysis
Poikilothermia
Pallor

102
Q

Scoring system for massive transfusion protocol

A

ABC Score( Assessment of Blood consumption)

103
Q

Elements of Massive Transfusion Protocol

A

1:1:1 ratio of pRBC,FFP and Platelets/Cryoprecipitate

104
Q

Eye opening scoring of GCS

A

4: Spontaneous
3: Sound
2: Pain
1: Nil

105
Q

Verbal scoring of GCS

A

5: Coherent
4: Confused
3: Inappropriate
2: Incomprehensible
1: Nil

106
Q

Movement scoring of GCS

A

6: Spontaneous
5: Localises pain
4: Moves away from pain
3: Abnormal Arm flexion
2: Abnormal arm extension
1: Nil

107
Q

Type of hematoma that causes lucid interval

A

Epidural hematoma

108
Q

Max size of urolith that will pass spontaneously

A

about 5mm

109
Q

what is special about plasma lyte

A

Highest osmolarity, fluid with lowest risk of raising ICP

110
Q

biggest cervical vertebrae onXR c spine

A

C2

111
Q

Patients for which flumazenil is CI

A

Long term BZD use, it may causes seizure

112
Q

Scoring system for Sepsis

A

qSOFA or SOFA

113
Q

Antidote for Paracetamol overdose

A

N Acetylcysteine or Single Dose activated charcoal(if within 1hr)

114
Q

Common Cx of giving NAC antidote

A

Anaphylactoid reaction( NOT anaphylaxis)

115
Q

7 Ps of RSI

A
  1. Prepare equipment
  2. Pre oxygenate without bagging
  3. Pretreatment
    4.Paralysis and induction
  4. Positioning
  5. Placement with proof
  6. Postintubation(Ventilate)
116
Q

continuous vs bilevel PAP indications

A

continuous: Fluid overload/ Pulmonary edema
bilevel: Hypercapnea eg type 2 respiratory failure

117
Q

Normal pre vertebral space in C spine XR

A

C2: 2mm
C7:22mm

???

118
Q

4 2 1 rule of fluid resus(Holliday Segar Method)

A

4ml/kg/hr for first 10kg
2ml/kg/hr for next 10kg
1ml/kg/hr for every kg beyond 20kg

119
Q

POCTs useful for suspected AAA

A

Urine dipstick for hematuria
Ultrasound

120
Q

best nsaid for ureteric colic

A

NSAIDs, reduces urteric SM tone so stone can be passed amd reduces ureteric spasm

121
Q

types of non invasive ventilation

A

cPAP and biPAP

122
Q

Cortical signs of stroke

A

Visual field defects
aphasia
Hemineglect
???

123
Q

NEXUS C Spine Imaging rule

A

NSAID

Neuro deficits
Spinal tenderness
AMS/Consciousness affected
Intoxication present
Distracting injury

124
Q

Electrolyte disturbance caused by salbutamol

A

hypoK

125
Q

Mx of HyperK

A

Calcium gluconate
Insulin( If glucose is normal)
Dextrose drip
Salbutamol

Hemodialysis may be indicated if CKD is underlying cause

126
Q

Why is atropine given together with neostigmine for NMBA reversal

A

To avoid cholinergic crisis

127
Q

Electrolyte derangement most likely to cause neurological changes

A

Sodium

128
Q

Best test for Hemothorax

A

Bedside Ultrasound

M4 Stuff (11 decks)

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