EM

Question 1

Autoimmune

Answer 1

Brought about by the body’s own natural defences but directed against one of its own tissues

Question 2

Insulin resistance

Answer 2

Failure of insulin, at relatively normal concentrations, to exert its normal effect

Question 3

Type 1 diabetes untreated

Answer 3

Catabolic state
Oxidation of fatty acids to produce ketones
Muscle breakdown

PH <7.3
BM > 11
Ketones 2+ urine
HC03- <15

Question 4

DKA treatment

Answer 4

Fluids
FRII
Glucose once BM <14
K+ 
VTE

Question 5

What is McBurney’s point? And what is the significance of pain here…?

Answer 5

McBurney’s point = 2/3 of the way between ASIS to umbilicus

Rebound tenderness here&raquo_space;> appendicitis

Question 6

Triad of appendicitis

Answer 6

Fever & vomiting
Anorexia
Migratory pain

Question 7

What is Rovsing’s sign?

Answer 7

Palpitation of LLQ results in inc pain in RLQ

Question 8

Triad of cholecystitis

Answer 8

Fever
Jaundice
RUQ pain

Question 9

Peptic ulcer disease risk factors / signs

Answer 9

Nausea relieved by eating
Smoker
Inc age
NSAIDs use
Iron def anaemia
Haematemesis/malaena

> > endoscopy & H.Pylori testing

Question 10

Triad of diverticulitis

Answer 10

LLQ pain
Fever
Bowel change

Question 11

CXR finding of aortic dissection

Answer 11

Loss of aortic knuckle contour
Widened mediastinum
Globular heart

Question 12

Paralytic ileus

Answer 12

No bowel sounds
Temporary impairment of peristalsis
Diffuse lay dilated loops of bowel

Causes:

• pancreatitis
• recent abdo surgery
• certain meds (Parkinson’s, opioids)
• abdominal infections

Question 13

Bowel obstruction

Answer 13

High pitched, tinkling bowel sounds

Causes:

• adhesions
• incarcerated hernias
• tumours
• volvulus

Question 14

Pancreatitis

Answer 14

Lipase (amylase can take 24-48 hours to rise)

Insulin production may go down&raquo_space;> high BM

Grey Turners & Cullens sign

Surgical admission

Question 15

Urobilinogen present on urine dip

Answer 15

Pre or intra hepatic causes

Question 16

Pre hepatic jaundice

Answer 16

Haemolytic

Rate of RBC breakdown overwhelms liver’s ability to conjugate

^^ unconjugated bilirubin

• sickle cell
• transfusion reaction
• malaria

Question 17

Intra hepatic jaundice

Answer 17

Hepatocellular damage

^^ ALT/AST
-^^ urinary bilinogen

• alcohol
• virus
• cancer

Question 18

Post hepatic jaundice

Answer 18

Obstructive

^^ ALP

• gallstones
• pancreatitis

Question 19

Chest pain differentials

Answer 19

PE
MI
CAP
Pneumothorax
Dissection
rAAA
Thoracic spine
Malignancy
Shingles

Question 20

TLOC

Answer 20

A loss of consciousness of rapid onset, short duration with complete spontaneous recovery

Question 21

Uncomplicated faint

Answer 21

Prodrome (sweating or feeling hot before TLOC, pallor)

Provoked (pain or medical procedure)

Posture (prolonged standing)

Question 22

5 categories of TLOC

Answer 22

1) Neurological
2) Cardiac
3) Orthostatic
4) Vasovagal
5) Unknown

Question 23

Example of situational vasovagal TLoC

Answer 23

Cough syncope

Micturition syncope

Question 24

Shingles

Answer 24

Pain & rash do not cross midline of body
Commonly affects face, chest, back +/- abdo
Reactivated varicella zoster virus

Rash contains live virus

Complications:

• postherpetic neuralgia
• ophthalmic shingles
• meningitis
• Ramsay Hunt Syndrome

Tx:
Analgesia
Pregabalin
TCA
Aciclovir

Question 25

Ophthalmoscope examination

Answer 25

Start at 9 o clock position and move medially for right eye (3 o clock for left eye)

Question 26

Low bicarbonate on ABG

Answer 26

More free H+ ions&raquo_space;> acidosis

Question 27

Suture of choice for uncomplicated laceration in an adult

Answer 27

Mono-filament, absorbable eg Ethilon

Question 28

What diameter suture for a face

Answer 28

6/7

Higher the number, narrower the suture thread

Question 29

3 things to think about when picking suture type

Answer 29

Anatomical location
Tensile strength needed
Ability to return for follow up