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CC2 - exam preparation > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Treatment for STEMI?

A

At The Museum My Parent Falls in 120 minutes

Aspirin
Ticagrelor
Morphine
Metaclopromide
PCI
Fibrinolysis if over 120 mins

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2
Q

NSTEMI treatment

A

At Night A Girl Fancies The New Boy

Analgesia
Nitrates
Aspirin
GRACE score
Fondaparinux
Ticagrelor
Nitrates
Beta blockers

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3
Q

Broad complex tachycardia

A

Always Eat At The Diner
Assess
electrolytes
amiodarone
three shocks 120j-150j, 160j-180j
dc

torsades

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4
Q

Supraventricular tachycardia

A

stable
Regular vagal manouvres
Adenosine 6,12, 12
Irregular treat as AF

unstable
DC three shocks
amiadarone

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5
Q

Bradycardia

A

Atropine
Transcutaneous pacing - heart block
Adrenaline
Isoprenaline

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6
Q

Pneumothorax

A

Primary spontaneous - discharge OR aspirate
Secondarary sponatenous <2cm - watch for 24 hours and 02 OR aspirate
Tension -decompression 2 ICS wide bore

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7
Q

Thyroid storm

A

Beta blockers or diltazem
carbizole after lugol’s
hydrocortisone, dexa

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8
Q

How to treat beta blocker toxicity?

A

Glucagon

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9
Q

How to treat benzo overdose?

A

Flumazenil

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10
Q

What potassium can be given if between 3.5-5.5

A

40, if lower ask for help

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11
Q

Hypothermia is associated with ?

A

J waves

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12
Q

How is severe COPD treated?

A

If 7.26 use NIV

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13
Q

How are haemorroids treated?

A

Fibre diet

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14
Q

Whata the transfusion reactions and how are they remedied?

A
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15
Q

What is the most common transfusion reaction?

A

Febrile reaction

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16
Q

What types of transfusion reaction do you slow?

A

TACO you slow and give diuretics

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17
Q

How do you treat a haemolytic reaction?

A

STOP and give fluids

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18
Q

What are some differentials for anaphylaxis?

A
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19
Q

What is the Jarisch herxheimer reaction?

A

Jarisch Herxheimer reaction (JHR) is a transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment. The reaction occurs within 24 hours of antibiotic treatment of spirochete infections, including syphilis, leptospirosis, Lyme disease, and relapsing fever.

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20
Q

What investigations are done for bowel obstruction?

Which would not be done?

A

CT scan

barium enema would require formal bowel preparation and this is contra indicated where large bowel obstruction is suspected. A flexible sigmoidoscopy is unlikely to be helpful and the air insufflated at the time of endoscopy may make the colonic distension worse. A cystogram would provide only very limited information.

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21
Q

What AAA should always be checked urgently

A

enlarging

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22
Q

Encephalitis with temporal lobe changes

A

Herpes simplex encephalitis (HSE) is the commonest cause of sporadic encephalitis and most commonly affects those <20 and >50. In contrast to other forms of encephalitis (e.g. CMV, cryptococcal), it often affects immunocompetent individuals (as well as the immunocompromised). HSE often has a prodrome of fever, headache and malaise followed by acute encephalopathy: focal neurological deficits, seizures, confusion and behavioural changes and potentially meningeal signs. Classically, HSE causes temporal lobe changes (hypodensities on CT, or hyperintensities on MRI) and bilateral temporal lobe changes are pathognomonic of HSE. (Note: although not required in this question, do be aware of the clinical features of temporal lobe changes e.g. aphasia, hemiparesis, memory loss etc since some questions may require you to infer temporal lobe involvement without imaging results).

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23
Q

Incubation periods of common GI infections?

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus*

12-48 hrs: Salmonella, Escherichia coli

48-72 hrs: Shigella, Campylobacter

> 7 days: Giardiasis, Amoebiasis

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24
Q

What rash is shown here?

A

Rose spot rash in typhoid

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25
Q

Acute asthma

A

33-50% of expected

No full sentences

RR = >25

HR =>110

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26
Q

What is TLCO?

A

Transfer factor

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27
Q

What conditions reduce TLCO?

A

pulmonary fibrosis

pneumonia

pulmonary emboli

pulmonary oedema

emphysema

anaemia

low cardiac output

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28
Q

For what procedures would you do group and save?

A

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

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29
Q

For what procedures would you do 2 cross match?

A

Salpingectomy for ruptured ectopic pregnancy, total hip replacement

30
Q

For what procedures would you do 4 cross match?

A

Total gastrectomy, oophorectomy, oesophagectomy

Elective AAA repair, cystectomy, hepatectomy

31
Q

How should you initially treat an oesophageal cancer?

A

Stent

32
Q

What fluids are used for DKA?

A

1l IV 1h

33
Q

What type of heart block is normal in atheletes?

A

First degree heart block

34
Q

How is COPD managed?

A

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

35
Q

What is a complication after bowel surgery?

A

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.

36
Q

What is a complication post-surgery?

A
37
Q

What should be done post fibrinolysis?

A

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

38
Q

What are rules for epilepsy?

A

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

39
Q
A
40
Q

Alcohol intoxication

A

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

41
Q

Legislation for pituitary tumour

A

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

42
Q

What is the CURB-65?

A

Confusion = 1

Urea > 7 = 1

Respiratory rate > 30 breaths per minute= 1

Systolic blood pressure < 90 mmHg / Diastolic < 60 mmHg = 1

Age > 65 = 1

43
Q

A 37-year-old attends surgery due to a one day history of severe central abdominal pain radiating through to the back. He has vomited several times and is guarding on examination. Parotitis and spider naevi are also noted. What could be the cause?

A

Acute pancreatitis because parotitis and spider nevi are associated with alcoholism

44
Q

What is a FAST scan?

A

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.

45
Q

New onset syncope after return from India?

A

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.

46
Q

What are sick day rules for diabetics?

A

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

47
Q

What is the signs of life threatening asthma?

A

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

48
Q

What are some strange signs of life threatening asthma?

A

Normal CO2

and 92% saturation

49
Q

Best investigation for acute pancreatitis?

A

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

50
Q

What causes a loud S2 sound?

A

Pulmonary hypertension

51
Q

Chest drain placement for pneumothorax

A

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

52
Q

DVLA, multiple seizures and driving

A

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.

53
Q
A
54
Q

How is LEMS different to MG?

A

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

55
Q

How is salicylate overdose managed?

A

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

56
Q

How is paracetemol overdose treated

A

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

57
Q

What are complications of Measles?

A

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).

58
Q

What are features of measles?

A

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

59
Q

What are the features of mumps?

A

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

60
Q

What are the features of rubella? Why vaccinate for rubella if mild?

A

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

61
Q

What are the features of whooping cough?

A

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

62
Q

What are the features of h. influenzae?

A

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

63
Q

What precaution is given with menigiococcal vaccine?

A

Paracetemol

64
Q

Hep B in children?

A

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%).

65
Q

What is rotavirus?

A

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

66
Q

What are menigioccal B and c?

A

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

67
Q

What is Lights criteria?

A
68
Q

What is cushing triad

A

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

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

69
Q

How is malignant hyperthermia treated?

A

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

70
Q
A

CC2 - exam preparation (76 decks)

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