EMERGENCIES

Question 1

Headaches.

First and worse headache

Thunder clap headache

Answer 1

SUBARACHNOID HAEMORRHAGE

Question 2

Headaches.

Unilateral headache and eye pain

Answer 2

cluster headache

glaucoma

Question 3

Unilateral headache and ipsilateral (same sided) symptoms

Answer 3

migraine

tumour

vascular

Question 4

Headaches.

Cough initiates headache

Answer 4

Raised ICP

Venous thrombosis

Benign intracranial hypertension

Question 5

Headache worse in the mornings.

Worse on bending forwards

Answer 5

Raised ICP.

Venous thrombosis.

Benign intracranial hypertension

Question 6

Persisting headache +/- scalp tenderness in over 50s

Answer 6

Giant cell arteritis

Question 7

Headache with neck stiffness or fever

Answer 7

Meningitis

Question 8

Two very important additional things to ask in a headache history

Answer 8

Any recent travel (malaria)

Pregnancy possibility (pre-eclampsia)

Question 9

Stony dullness to percussion may indicate

Answer 9

Pleural effusion

Question 10

Key investigations to remember in a patient with acute breathlessness

Answer 10

Baseline observations –> sats, HR, Temp, peak flow

ABGs if sats are below 94% –> concerns over acidosis, drugs or sepsis

ECG (signs of PE, Left ventricular hypertrophy, MI)

CXR –> rule out any other pathology

Baseline bloods –> glucose, FBC, u&e’s and consider drug screen

Question 11

Life threatening differential diagnoses for acute chest pain

Answer 11

Acute MI

Angina / acute coronary syndrome

Aortic dissection

Tension pneumothorax

Pulmonary embolism

Oesophageal rupture

Question 12

What do you give in benzo overdose

Answer 12

Flumazenil

Question 13

Dose of adrenaline given in anaphylaxis management

Answer 13

0.5mg (0.5mls of 1:1000)

Question 14

Mimics of anaphylaxis involve

Answer 14

Carcinoid syndrome

Pheochromocytoma

Hereditary angioedema

Systemic mastocytosis

Question 15

Management of STEMI

Answer 15

300mg loading dose ASPIRIN ASAP

Angiography with primary PCI
- if within 12 hours of symptoms & PC can be done within 120 minutes

Fibrinolysis
- if within 12 hours of symptoms and PCI not possible in 120 minutes
- give antithrombin at same time
- ECG 60-90 mins post fibrinolysis

Question 16

NSTEMI / unstable angina: early management

Answer 16

300mg LOADING dose of ASPIRIN asap unless contraindicated

Initial antithrombin therapy –> fondaparinux unless high bleeding risk or immediate angiography

GRACE SCORE –> 6 month mortality
<3% LOW RISK
- conservative management
- offer ticagrelor with aspirin unless high bleeding risk

> 3% HIGH risk
- offer immediate angiography with follow on PCI if indicated within 72 hours.

Question 17

Cardiac rehabilitation and secondary prevention

Answer 17

1. Physical activity
2. Lifestyle advice: driving, flying and sex
   —-> ETOH < 14 units weekly
   —-> 20-30 mins physical activity daily to breathlessness
   —-> smoking cessation
   —-> weight management
   —-> Mediterranean diet (bread, fruit, veg, fish)
3. Stress management
4. Health education

DRUG TREATMENT
1. ACEi
2. Dual antiplatelet (aspirin + another) for 12 months
3. Beta blocker (if BB contraindicated then diltiazem or verapamil)
4. STATIN