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ED -passmed points Flashcards

1
Q

describe the ABG of a patient who has taken an aspirin OD

A

START RESP ALKALOSIS due to hyperventilation then proceed to mixed metabolic ACIDOSIS and resp alkalosis

patient will have tinnitus

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2
Q

which drugs need stopped in an AKI or to prevent lithium toxicity

A

STOP the DAMN drugs in AKI/lithium toxicity

D- Diuretics (esp thiazide), A- ACEi/ARB,
M- metronidazole, metformin
N- NSAIDS -> not aspirin

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3
Q

in treated DKA, which electrolyte abnormality do we need to monitor for>

A

hypokalaemia
- insulin causes potassium to move intracellularly
- drops conc in blood
- monitor with bloods and ECG

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4
Q

difference between type1 and type 2 resp failure

A

Type 1 respiratory failure: Low pO2, no CO2 retention
Type 2 respiratory failure: Low pO2, high pCO2

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5
Q

a stroke in which artery causes C/L homonomymous hemaniopia with macular sparin

A

posterior cerebral A

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6
Q

when do we give NIV to patients with infective exac of COPD

A

when they still have resp acidosis despite the full ceiling of care

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7
Q

vomiting causes what changes to an ABG

A

metabolic alkalosis with normal anion gap

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8
Q

diarrhoea causes what changes to an ABG

A

metabolic acidosis with normal anion gap
- loss of bicarb

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9
Q

when to have repeat CXR for inpt pneumonia

A

6 weeks after

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10
Q

what are the different stages of COPD

A

1 - FEV1 >80%, Mild - symptoms should be present to diagnose COPD in these patients

2 - FEV1 50-79, modeate

3 - FEV1 30-49, severe

4 FEV1<30 very severe

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11
Q

dose of adrenaline for 6-11 years ol

A

300mcg every 5 mins IM if needed

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12
Q

what is normal QRS interval time

A

0.8-0.12

this means that a narrow complex tachy falls into this interval time

broad complex will be more than 120ms

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13
Q

what drugs react with SSRI to cause serotonin syndrome

A

st johns wort
tramadol

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14
Q

what fluid is given in dka

A

isotonic saline

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15
Q

fever, rash, desquamation of hands and feet, hypotension are characteristic of which syndrome

A

staph toxic shock syndrome

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16
Q

triad of acute interstitial nephritits

A

fever
arthralgia
rash

+ AKI, urinary white cell casts and raised eosinophils

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17
Q

causes of increased anion gap

A

MUDPILES – Methanol, Uraemia, DKA, Propylene glycol, Iron/isoniazid, Lactate, Ethylene glycol, Salicylates

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18
Q

important complication of a subarachnoid haem and how do we monitor this

A

SIADH

  • U+E -> monitor for hyponatriema
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19
Q

Bilateral, mid-to-lower zone patchy consolidation in an older patient -> what organism causes this type of pneumonia

A

legionella

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20
Q

describe appearance of chronic subdural haem on CT head

A

hypodense (dark), crescentic collection around the convexity of the brain

not bound by falx cerebri

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21
Q

what pulses to check on baby in BLS

A

brachial
femoral

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22
Q

dry cough, erythema multiforme (symmetrical target shaped rash with a central blister) with reticulo-nodular shadowing on CXR and red cell agglutination on blood smear suggests what bacterial cause of pneumonia

A

mycoplasma pneumoniae
- causes haemolytic anaemia

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23
Q

What is the most common cause of viral meningitis in young adults

A

Enteroviruses like coxsackievirus are the most common cause of viral meningitis

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24
Q

what type of NIV is used in refractive infective exacerbation of COPD

A

bipap

  • need help removing CO2 retention as pt in type 2 resp failure
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25
Q

how to work out urea:creatinine ratio

A

creatinine/1000 = same units

urea/creatinine

> 100 = pre-renal cause
<100 = intrinsic cause

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26
Q

complication of DKA treatment and why does it occur

A

cerebral oedema -> rapid fluid resus can cause the blood osmol to drop so fluids move into the brain tissue

glucose high to low = brain will blow

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27
Q

common cause of meningitis in immunocompromised patients

A

Cryptococcus neoformans is an encapsulated yeast and an obligate aerobe

this stains well with india ink

common in ppl with HIV

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28
Q

if a bradycardic patient is allergic to atropine, what can you give them?

A

infusion of adrenaline

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29
Q

patient with AKI is on metformin, what do you do

A

may have to stop metformin as there is an increased risk of toxicity as it is renally cleared but it does not worsen an AKI itself

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30
Q

which drugs may need to be stopped in an AKI due to increased risk of toxicity

A

*Metformin
* Lithium
* Digoxin

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31
Q

signs and symptoms of a pneumococcal pneumonia

A

30 y/o
productive cough, fever, chest pain
herpes labalis
consolidation in lower zones

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32
Q

persistent ST elevation following recent MI, no chest pain is a sign of which MI complication

A

Left ven aneurysm

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33
Q

PICA stroke symptoms

A

sudden onset vertigo and vomiting
dysphagia
ipsilateral facial pain and temperature loss
contralateral limb pain and temperature loss and ataxia

34
Q

ipsilateral oculomotor palsy CNIII and contralateral weakness of the upper and lower extremity - signs of whoch type of stroke?

A

branches of posterior cerebral A that supply midbrain
WEBER’s syndrome

35
Q

brown granular casts in urine -> which disease

A

ATN

35
Q

when do we use PERC test

A

when there is a low <15% chance pre-test prob of a PE

36
Q

NICE diagnosis criteria for an AKI

A

↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours

37
Q

criteria for surgical mx of an ectopic

A

> 35mm in size
BHCG of >5000
fetal heart beat

38
Q

Fever, abdominal pain, hypotension during a blood transfusion -> what type of reaction?

A

acute haemolytic reaction
- when given red cells vs febrile non-hame which is more common with platelets or WCC
- also no abdo pain in FNHR

39
Q

contraindication for carboprost

A

asthma - can exacerbate bronchoconstriction

40
Q

urea increase proportionally higher than creatinine increase is a sign of what cause of oliguria

A

dehydration

41
Q

normal CT in suspected stroke?

A

doesnt rule out ischaemic stroke, only rules out if haemorrhage

42
Q

liver transplant criteria for paracetamol OD

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

43
Q

when should you not use steroids in meningitis

A

Do not use corticosteroids in children younger than 3 months with suspected or confirmed bacterial meningitis

44
Q

most common type of pneumonia in alcoholics

A

klebsiella
- gelatinous sputum
- consolidation higher in lungs

45
Q

what is refractory anaphylaxis

A

defined as respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline

give IV adrenaline infusion

46
Q

CT signs of an acute ischaemic stroke

A

hyperdense artery
areas of low density in grey and white matter of the territory in question

47
Q

definitive tx for a persisitent leak in a pneumothorax or recurrent eps

A

video assisted thoracoscopic surgery procedure
- allows for pleurodesis by olbiterating the pleural space and allows for bullecotmy

48
Q

tx of legionella

A

clarithromycin / any macrolide

49
Q

which artery is likely to be blocked if patient has complete heart block post mi?

A

RCA -> supplies the AVN

50
Q

absolute contraindications to thrombolysis

A
  • Previous intracranial haemorrhage
  • Seizure at onset of stroke
  • Intracranial neoplasm
  • Suspected subarachnoid haemorrhage
  • Stroke or traumatic brain injury in preceding 3 months
  • Lumbar puncture in preceding 7 days
  • Gastrointestinal haemorrhage in preceding 3 weeks
  • Active bleeding
  • Oesophageal varices
  • Uncontrolled hypertension >200/120mmHg
51
Q

relative CI to thrombolysis

A

Pregnancy
- Concurrent anticoagulation (INR >1.7)
- Haemorrhagic diathesis
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in the preceding 2 weeks

52
Q

definitive tx of SAH

A

arterial coiling

53
Q

when are nitrates contraI in ACS

A

when pt has hypotension <90mmhg

54
Q

4 H and 4T

A

hypoxia
hyperkalaemia
hypothermia
hypovolemia

thrombus
tamponade
toxins
tension pneumothorax

55
Q

important step to do in an obstetric cardiac arrest

A

if >20 weeks, left lateral tilt to the table

56
Q

what is a jacksonian march and what area of the brain is it associated with in a seizure?

A

type of focal aware seizure where jerking starts distally in limb and moves proximally up the limb

associated with seizure in frontal lobe

57
Q

3 ways you can test to determine if a COPD patient is steroid sensitive

A

asthma prev
eosinophilia
dinural variation in symptoms

58
Q

when do you seek a surgical opinion when treating a pneumothorax

A

if after 3-5 days there is persistent air leak (e.g. bubbling chest drain) or failure of the lung to re-expand, a thoracic surgical opinion should be sought

59
Q

electrolyte imbalance in legionella pneumonia

A

hyponatriema

60
Q

which antiplatelet do you give if pt has high bleeding risk in NSTEMI

A

clopidogrel

normally give ticagrelor

61
Q

blood vessels disturbed in a subdural haemorrhage?

A

Subdural haemorrhage is caused by damage to bridging veins between cortex and venous sinuses

62
Q

how to manage a post-ischaemic stroke in pt with AF

A
  • exclude haemorrhagic cause
  • aspirin for 2 weeks
  • then lifelong anticoag -> either DOAC or warfarin
63
Q

how to manage a post-ischaemic TIA in pt with AF

A

exclude haemorrhagic cause
anticoag can start straight away

64
Q

urine osmol in ATN?

A

<350 low

65
Q

what investigation needs to be performed if someone has a TCA OD

A

ECG -> risk of widening of QRS causes increased risk of seizures and arrhythmias

66
Q

which patients can have fast track discharge after anaphylaxis

A

following needs to be met -> can leave 2 hours after discharge
- good response to a single dose of adrenaline
- complete resolution of symptoms
- has been given an adrenaline auto-injector and trained how to use it
- adequate supervision following discharge

67
Q

which patients need to have a minimum 6 hour resolution of symptoms before discharge after anaphylaxis

A

2 doses of IM adrenaline needed, or
previous biphasic reaction

68
Q

which patients need to have a minimum 12hour resolution of symptoms before discharge after anaphylaxis

A
  • severe reaction requiring > 2 doses of IM adrenaline
  • patient has severe asthma
    possibility of an ongoing reaction (e.g. slow-release medication)
  • patient presents late at night
    patient in areas where access to emergency access care may be difficult
  • observation for at 12 hours following symptom resolution
69
Q

best test for legionella pneumonia?

A

urinary antigen

70
Q

what is the window for thrombectomy in an acute ischaemic stroke

A

6 hours

71
Q

what abx cover to give if meningitis is suspected to be listeria?

A

IV amoxicillin -> suspect this in adults >50y/o

72
Q

indications for dialysis in an AKI pt

A

AEIOU:
A—acidosis;
E—electrolytes/hyperkalemia;
I— overdose of medications/drugs;
O—overload of fluid ;
U—uremia leading to encephalitis/pericarditis.

73
Q

when should beta blockers be stopped in acute heart failure

A

patient has heart rate < 50/min
second or third degree AV block
shock

74
Q

complication of rapid draining of pneumothorax

A

re-expansion pulmonary oedema

75
Q

which artery is affected in amaurosis fugax

A

retinal/ opthalmic artery

76
Q

first line anti-epileptic in atonic seizures for women

A

lamotrigine

77
Q

ECG change with TCA OD?

A

QRS widening

78
Q

what is the risk in use of large volumes of NACL for fluid resus

A

risk of hyperchloraemic metabolic acidosis
- normal anion gap

79
Q

what are the preferred type of stent in a PCI

A

drug-eluting -> coated in an antiproliferative agent

vs bare-metal stent

80
Q

what is a marker for poor prognosis in a paracetamol OD

A

prothrombin time elevated as it suggests liver failure

81
Q

when do you start a dextrose infusion in a DKA pt

A

once BG <14mmol/L
start 10% dextrose as an addition to the saline ay 125mls/hr

passmed ! (6 decks)

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