Emergencies Flashcards

Question

Acute asthma

Answer 1

33-50% of expected No full sentences RR = \>25 HR =\>110

Answer 2

Transfer factor

Answer 3

pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output

Answer 4

Hysterectomy (simple), appendicectomy, thyroidectomy, elective lower segment caesarean section, laparoscopic cholecystectomy

Answer 5

Salpingectomy for ruptured ectopic pregnancy, total hip replacement

Answer 6

Total gastrectomy, oophorectomy, oesophagectomy Elective AAA repair, cystectomy, hepatectomy

Answer 7

First degree heart block

Answer 8

No asthmatic features/features suggesting steroid responsiveness add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA) if already taking a SAMA, discontinue and switch to a SABA Asthmatic features/features suggesting steroid responsiveness LABA + inhaled corticosteroid (ICS) if patients remain breathless or have exacerbations offer triple therapy i.e. LAMA + LABA + ICS if already taking a SAMA, discontinue and switch to a SABA NICE recommend the use of combined inhalers where possible

Answer 9

Post-operative ileus is a common complication in colorectal surgery due to intra-operative bowel handling. Management is conservative with nasogastric tube insertion for stomach decompression for symptom control and placing the patient nil by mouth to allow bowel rest. The recommencement of fluids/light diet should be in stages and guided by the clinical state of the patient.

Answer 10

If fibrinolysis is given for an ACS, an ECG should be repeated after 60-90 minutes

Answer 11

Patients cannot drive for 6 months following a first unprovoked or isolated seizure if brain imaging and EEG normal If syncope and first 1 month

Answer 12

CIWA score Onset of symptoms is usually 24-72hours after alcohol cessation of reduced intake, symptoms include: Severe tremor, delusions, tachycardia, pyrexia, visual and auditory hallucinations, confusion and disorientation, clouding of consciousness If agitation is severe, please refer to A long-acting benzodiazepine, such as chlordiazepoxide hydrochloride or diazepam, is recommended to attenuate alcohol withdrawal symptoms; local clinical protocols should be followed. Pabrinxes and thiamine

Answer 13

It is recommended that all patients with a pituitary incidentaloma, including those without symptoms, undergo clinical and laboratory evaluations for hormone hypersecretion and hypopituitarism. Surgery is only needed if: A visual field deficit due to the lesion. Other visual abnormalities, such as ophthalmoplegia or neurological compromise due to compression by the lesion. Lesion abutting or compressing the optic nerves or chiasm on MRI. Pituitary apoplexy with visual disturbance. Hypersecreting tumours other than prolactinomas

Answer 14

Confusion = 1 Urea \> 7 = 1 Respiratory rate \> 30 breaths per minute= 1 Systolic blood pressure \< 90 mmHg / Diastolic \< 60 mmHg = 1 Age \> 65 = 1

Answer 15

Acute pancreatitis because parotitis and spider nevi are associated with alcoholism

Answer 16

FAST scans (focused assessment with sonography for trauma), are used in trauma to quickly assess the extent of free fluid in the chest, peritoneal or pericardial cavities. This non-invasive test can be used within emergency care in the primary or secondary survey to quickly investigate the extent of free fluid or pneumothorax.

Answer 17

This patient has likely been infected with hookworm, explaining the anaemia, eosinophilia and the rash he described. Hookworms (nematodes) are acquired from skin contact with contaminated soil, commonly from walking barefoot in an affected area and are endemic in much of Asia, Africa and South America. The worm migrates from the skin into the intestine and from there causes chronic blood loss, hence causing anaemia. Diagnosis can be made from stool culture with identification of the ova in the patient's faeces.

Answer 18

Diabetes sick day rules: when unwell, If a patient is on insulin, they must not stop it due to the risk of diabetic ketoacidosis. They should continue their normal insulin regime but ensure that they are checking their blood sugars frequently

Answer 19

PEFR \< 33% best or predicted Oxygen sats \< 92% 'Normal' pC02 (4.6-6.0 kPa) Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma

Answer 20

Normal CO2 and 92% saturation

Answer 21

Serum lipase has a longer half-life than amylase when investigating suspected acute pancreatitis and may be useful for late presentations \> 24 hours

Answer 22

Pulmonary hypertension

Answer 23

It is advised that chest drains are placed in the 'safe triangle'. The triangle is located in the mid axillary line of the 5th intercostal space. It is bordered by: Anterior edge latissimus dorsi, the lateral border of pectoralis major, a line superior to the horizontal level of the nipple, and the apex below the axilla. Chest drain swinging: Rises in inspiration, falls in expiration

Answer 24

The person with epilepsy may qualify for a driving licence if they have been free from any seizure for 1 year. This needs to include being free of minor seizures and epilepsy signs such as limb jerking, auras and absences. Episodes not involving a loss of consciousness are included.

Answer 25

Lambert Eaton syndrome involves weakness in the muscles of the proximal arms and legs, and one of the ways it can be differentiated from myasthenia gravis is that the legs are normally worse affected

Answer 26

Both pulmonary oedema and metabolic acidosis are indications for haemodialysis in salicylate overdose.

Answer 27

activated charcoal if ingested \< 1 hour ago N-acetylcysteine (NAC) liver transplantation

Answer 28

Complications : transient immunosuppression otitis media (7 - 9%) pneumonia (1 - 6%) acute postinfectious encephalitis (~1 per 1000) subacute sclerosing panencephalitis (SSPE) (1 per 100 000) death (1 - 3 per 1000) SSPE Fatal degenerative central nervous system disease caused by persistent infection with a mutated measles virus. Onset is several years after measles (average seven years).

Answer 29

Viral illness, paramyxovirus - ssRNA Highly contagious and airborne, infectivity is close to 100% in susceptible individuals. A key diagnostic feature is the presence of prodromal illness for 2 -4 days before the rash fever conjunctivitis rhinorrhea sore throat dry cough Koplik’s spots on the oral mucosa → coalescing erythematous macules and papules begins behind ears / in hairline → spreads to rest of body

Answer 30

RNA virus, aerosol spread causes painful parotid swelling (lifting the earlobe) Usually a prodrome of malaise, fever, headache, myalgia and arthralgia for 3 - 5 days before swelling observable Complications include : Meningitis Swelling of testicles in 25 - 50% of males. If orchitis is bilateral (~30%) this may lead to oligospermia, subfertility and decreased testosterone production (but only rarely sterility). Encephalitis - rare but serious, 0.02 - 0.3% Pancreatitis

Answer 31

Viral infection, RNA virus. Droplet spread, highly contagious Rubella causes a mild childhood illness - the rationale for vaccination is to prevent congenital rubella syndrome, which has high incidence of serious birth defects if susceptible pregnant women are exposed in the first trimester. Features of rubella : Red pink rash Lymphadenopathy Fever Coryza Arthralgia Congenital rubella syndrome Cataracts Deafness Congenital heart defects Brain damage Fetal loss

Answer 32

Bacterial –Bordetella pertussis Highly contagious, droplet spread Initial coryzal symptoms with a cough, which is initally mild. becoming more severe after ~ 2 weeks The cough s characterised by episodes of numerous rapid coughs, followed by a crowing or high-pitched whoop. These episodes frequently end with the expulsion of a thick, clear mucous, often followed by vomiting Cough may last up to 2 months Most dangerous in infants as it is associated with apnoea (stopping breathing) which can be fatal To protect neonates, pregnant women should be vaccinated at 28-38 weeks

Answer 33

Bacteria, coccobacillus Can cause respiratory infections, ocular infection, sepsis and meningitis. In countries without vaccination programs, it is the commonest cause of meningitis in children \<5 years, with a mortality of ~ 10% Can also cause epiglottis short history of high fever, tachypnoea, inspiratory stridor and excessive drooling intubation or emergency tracheotomy may be required to prevent airway obstruction and death peak incidence 5–10 years

Answer 34

Paracetemol

Answer 35

Acute infection may present with fatigue myalgia pyrexia loss of appetite nausea diarrhoea abdominal pain jaundice dark urine and pale faeces but may be asymptomatic Development of chronic infection varies with age. Up to 90% of infants who are infected with the virus develop chronic infections but \<5% of adults. Chronic HBV complications include liver cirrhosis (25%) and cancer (5%).

Answer 36

dsRNA virus, most common cause of significant diarrhoeal illness in children worldwide Mostly faeco-oral spread Rarely fatal in developed world but higher mortality in developing countries Live attenuated vaccine (oral) developed in 2006 Symptoms : Fever Vomiting Diarrhoea Extensive nausea and vomiting in some children result in difficulties in providing oral fluids -\> dehydration

Answer 37

Bacterial disease, Neisseria meningitidis - gram negative diplococcus Commonly asymptomatically carried in the nasopharynx, occasionally causes invasive disease with 8–15% mortality. Two peaks of incidence, young children and adolescents, overall 0.6 per 100 000. Serogroups B and C are most common types isolated in Europe Can cause meningitis headache neck stiffness photophobia fever and septicaemia shock fever non-blanching rash (extravasation due to DIC) multiple organ failure Septicaemia has a 40% mortality If suspected give immediate antibiotics IV or benzylpenicillin intramuscularly if no IV access

Answer 38

As the brain and ventricles are enclosed by a rigid skull, they have a limited ability to accommodate additional volume. Additional volume (e.g. haematoma, tumour, excessive CSF) will therefore lead to a rise in intracranial pressure (ICP). Pathophysiology ## Footnote the normal ICP is 7-15 mmHg in adults in the supine position cerebral perfusion pressure (CPP) is the net pressure gradient causing cerebral blood flow to the brain CPP = mean arterial pressure - ICP

Answer 39

Malignant hyperthermia is a recognised serious side effect of suxamethonium among those who are susceptible and requires IV dantrolene therapy