Emergencies

Question 1

Dyspnoea. Sinus tachy. R axis deviation. Post op. Dx?

Answer 1

PE

Question 2

What is Tx for suspected PE?

Answer 2

Heparin

Then warfarin

Question 3

How is unfractionated vs LMW heparin administered?

Answer 3

UF = IV 
LMWH = subcut

Question 4

Confirmed massive PE. Stable BP and HR. Tx?

Answer 4

Alteplase

Question 5

What type of peptic ulcers do NSAIDs most commonly cause?

Answer 5

Gastric

Question 6

Distressed woman with extreme SoB, audible wheeze. Clear frothy sputum produced on coughing. Gallop rhythm. Dx?

Answer 6

Pulmonary oedema

Question 7

What does gallop rhythm signify?

Answer 7

Heart failure

Question 8

Fever, headache, neck stiffness. Dx?

Answer 8

BACTERIAL meningits

Question 9

Headache, fever, progressive drowsiness, confusion +/- hallucinations. Dx?

Answer 9

Encephalitis

Question 10

What is Mx of status epilepticus in community?

Answer 10

Rectal diazepam

Question 11

What is Mx of status epilepticus in hopsital?

Answer 11

IV lorazepam

Question 12

Acute abdo pain. Redcued skin turgor. Fruity breath. Dx?

Answer 12

Diabetic ketoacidosis

Question 13

Severe confusion in elderly woman. Oedematous, esp around neck. Tremor. Rusty coloured sputum. Hyponatraemia w normal BP. Dx?

Answer 13

Myxoedema coma

Question 14

What are Sx of myxoedema coma?

Answer 14

Hypothermia
Hyponatreamia 
Weight gain 
Confusion 
Heart failure

Question 15

What does rust coloured sputum indicate?

Answer 15

Pneumonia

Question 16

Pale w cold extremities. Low BP and high HR. Afebrile. Missed 1 week of Crohn’s meds. Dx?

Answer 16

Acute Addisonian Crisis

Question 17

What is the relevance of Crohns medication to Addisons?

Answer 17

Crohns medication = steroids
Steroids suppress the hypothalamic-pituitary-adrenal axis
Sudden increase in ACTH = increase in cortisol / aldosterone

Question 18

Pt with suspected PE. 1st line Ix/Mx?

Answer 18

D-dimer

Question 19

What is Mx of PE?

Answer 19

LMWH then warfarin

Question 20

What is a phaeo?

Answer 20

Tumour of SNS (90% in adrenals)

Question 21

Chest pain that becomes progressively worse until pain at rest. Dx?

Answer 21

Crescendo / unstable angina

Question 22

Chest pain worse in cold / after exercise / stress. Dx?

Answer 22

Classical / exertional angina

Question 23

Chest pain worse when doing from standing to lying down. Dx?

Answer 23

Decubitus angina

Question 24

Chest pain randomly without stressor. Dx?

Answer 24

Variant / prinzmetal angina

Question 25

Headache worse in morning. Weakness on one side of body. Recent otitis media. Dx?

Answer 25

Cerebral abscess

Question 26

Diagnostic Ix for aortic dissection?

Answer 26

CT scan with contrast

Question 27

Side effect of spironolactone?

Answer 27

Gynaecomastia

HYPERKALAEMIA !!

Question 28

Absent P waves, wide QRS, peaked T waves on ECG. Dx?

Answer 28

Hyperkalaemia

Question 29

What is the dose of adrenaline to give in anaphylaxis?

Answer 29

0.5mg (1:1000 dilution)

Question 30

What is 1st line Mx of uncontrolled HTN crisis?

Answer 30

oral ACEi or CCB

Question 31

Tx of DVT?

Answer 31

LMWH

Question 32

Seizure, bulging eye, ipsiliateral gaze palsy. Dx?

Answer 32

Cavernous sinus thrombosis

Question 33

What preceeds a cavernous sinus thrombosis and why?

Answer 33

Facial infection

Blood enters sinus through facial veins

Question 34

Suspected OD. Seizure, febrile, tachycardia, dilated pupils. Wide QRS on ECG. Dx?

Answer 34

TCA OD

Question 35

Name a TCA

Answer 35

Amitryptiline

Question 36

Man with multiple leg fracture. Then gets SoB and agitated with widespread petechial rash. Dx?

Answer 36

Fat embolism

Question 37

Outline the stages of ECG changes in MI

Answer 37

1. Hyperacute T waves
2. ST elevation
3. T wave inversion
4. Q waves