Emergencies

Question 1

amitriptyline overdose

Answer 1

Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.

Features of severe poisoning include:
arrhythmias
seizures
metabolic acidosis
coma

mx.
IV sodium bicarb
(dialysis does not work)

Question 2

QRS limits associated with seizures vs ventricular arrhythmias

Answer 2

Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS > 160ms is associated with ventricular arrhythmias

Question 3

Management of accidental injection of adrenaline

Answer 3

accidental injection can resulting in digital ischaemia (fingers turn blue and cold)

give phentolamine (a short acting alpha blocker)

Question 4

organophosphate poisoning signs

Answer 4

Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation

or
DUMBELLS
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweating

Question 5

MOA organophosphorus

Answer 5

which causes inhibition of the enzyme acetylcholinesterase

excessive ACH

Question 6

Management organophosphate poisoning

Answer 6

atropine

Question 7

first-line treatment for cyanide poisoning

Answer 7

hydroxocobalamin

Question 8

treatment option for beta-blocker overdose

Answer 8

atropine
if resistant, Glucagon

Question 9

what worsens prognosis in paracetamol overdose

Answer 9

• mixed overdose with CYP inducers
• chronic alcohol intake
• anorexia/ low body mass/ malnourished

Question 10

what is the most common complication following meningitis?

Answer 10

Sensorineural hearing loss

Question 11

what kidney complication are patients with meningococcal meningitis are at risk of?

Answer 11

Waterhouse-Friderichsen syndrome (adrenal insufficiency secondary to adrenal haemorrhage).

Question 12

aspirin overdose management

Answer 12

Treatment
general (ABC, charcoal if within 1hour)
urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
haemodialysis

Indications for haemodialysis in salicylate overdose
serum concentration > 700mg/L
metabolic acidosis resistant to treatment
acute renal failure
pulmonary oedema
seizures
coma

Question 13

life-threatening C. difficile infection treatment

Answer 13

ORAL vancomycin and IV metronidazole

Question 14

severe cases of serotonin syndrome management

Answer 14

more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

Question 15

Clostridium tetani vs Clostridium botulinum

Answer 15

Clostridium tetani
- blocks GABA (inhibitory) release
- results in spasm, lockjaw, respiratory paralysis

Clostridium botulinum
- Blocks acetylcholine (ACh) release leading to flaccid paralysis

Question 16

what makes Plasmodium knowlesi infections particularly dangerous?

Answer 16

shortest erythrocytic replication cycle, leading to high parasite counts in short periods of time

Question 17

Cyanide may be used in insecticides, photograph development and the production of certain metals.

Answer 17

Cyanide inhibits the enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain.

Presentation
‘classical’ features: brick-red skin, smell of bitter almonds
acute: hypoxia, hypotension, headache, confusion
chronic: ataxia, peripheral neuropathy, dermatitis

Management
supportive measures: 100% oxygen
definitive: hydroxocobalamin (intravenously), also combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)

Question 18

cocaine + abdo pain/ melaena

Answer 18

ischaemic colitis