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AMC MCQ - Key points > Emergency > Flashcards

Emergency Flashcards

1
Q

Describe acute parotitis.

A

Acute parotitis is characterized by painful swelling and pus from the duct of the parotid gland, often caused by bad oral hygiene and dehydration.

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2
Q

What is the most common site for salivary gland stones?

A

The most common site for salivary gland stones is the submandibular gland.

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3
Q

How can salivary gland stones be diagnosed if not visible on X-ray?

A

If salivary gland stones are not visible on X-ray, a sialogram can be performed for diagnosis.

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4
Q

Define pleomorphic adenoma in salivary gland tumors.

A

Pleomorphic adenoma is the most common benign salivary gland tumor.

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5
Q

What is the main treatment for glomus tumor in soft tissue disorders?

A

The main treatment for glomus tumor is surgical removal.

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6
Q

Describe the characteristics of hypertrophic scar compared to keloid.

A

Keloid scars extend beyond the original scar, while hypertrophic scars are limited to the scar itself.

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7
Q

What is the main route of infection in pulp space infection?

A

The main route of infection in pulp space infection is direct inoculation.

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8
Q

How is tenosynovitis treated in cases of mild symptoms?

A

Mild tenosynovitis is treated with NSAIDs, rest, and the use of a brace.

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9
Q

Define Dupuytren’s contracture.

A

Dupuytren’s contracture is a condition commonly seen in middle-aged men with a positive family history, often associated with alcoholism.

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10
Q

Describe the management of Volkmann’s ischemic contracture.

A

Immediate removal of the cast in early cases, immediate exploration if no response, and physiotherapy and surgery in late cases.

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11
Q

How can ingrowing toenail be treated?

A

Mild cases can be treated with a piece of gauze soaked with antiseptic and wearing proper size shoes. Severe cases may require wedge resection.

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12
Q

Define solitary thyroid nodule and its common site.

A

A solitary thyroid nodule is a single lump in the thyroid gland, most commonly found at the junction of the isthmus with the lateral lobe.

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13
Q

What are the types of thyroid cancers and their distinguishing features?

A
  1. Papillary carcinoma - most common, affects young females, with characteristic psammoma bodies. 2. Follicular carcinoma - differentiated from adenoma by infiltration of the capsule. 3. Anaplastic - most fatal, seen in elderly males, hard with rapid growth.
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14
Q

Describe the management of a simple ganglion.

A

A simple ganglion, a cystic swelling related to the tendon, is treated with puncture followed by surgery or excision.

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15
Q

How can a thyroid disorder like thyroglossal cyst be managed?

A

Thyroglossal cyst is managed by removal of the cyst along with the body of the hyoid bone and remnants of the thyroglossal duct.

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16
Q

What are the risk factors and types of thyroid cancers?

A

Risk factors include radiation exposure, genetic predisposition, Hashimoto’s disease, and endemic goiter. Types include papillary carcinoma, follicular carcinoma, and anaplastic carcinoma.

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17
Q

Describe the presentation and treatment of nail hematomas.

A

Small and painless nail hematomas require no treatment, while larger ones may need drilling or removal of the whole nail.

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18
Q

How does Volkmann’s ischemic contracture develop and what are its causes?

A

Volkmann’s ischemic contracture develops from ischemia leading to fibrosis and permanent shortening of muscles. It is commonly caused by a supracondylar fracture or fractures of the tibia and fibula.

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19
Q

What are the early signs and late complications of ischemia in Volkmann’s ischemic contracture?

A

Early signs include pain, pallor, parathesia, and pulselessness. Late complications may involve flexion deformity.

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20
Q

Describe the treatment for hoarseness of voice due to recurrent laryngeal nerve infiltration.

A

Main line of treatment is total thyroidectomy. Removal of lymph nodes is only done if affected.

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21
Q

What are the main complications of thyroidectomy?

A

Main complications include stridor, which can be caused by blood collecting under the fascia. Immediate removal of all stitches and opening the wound in the yard is crucial.

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22
Q

How is acute hyperthyroidism managed post-thyroidectomy?

A

Acute hyperthyroidism, known as thyroid crisis, should be addressed immediately after the operation. Symptoms may include hyperpyrexia, tachycardia, hypertension, dyspnea, and convulsions.

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23
Q

Define the treatment for hypoparathyroidism following thyroid surgery.

A

Hypoparathyroidism, caused by the removal of the 4 parathyroid glands, presents with perioral numbness and tetany. Emergency treatment involves slow intravenous administration of 10% calcium gluconate, followed by maintenance therapy with calcium and vitamin D.

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24
Q

Describe the management of progressive exophthalmos post-thyroidectomy.

A

Progressive exophthalmos can be managed by tarsorrhaphy to protect the eye, sleeping semi-sitting, and cortisone. In severe cases, orbital decompression may be necessary.

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25
Q

What is the recommended treatment for postoperative fever and agitation?

A

Postoperative fever and agitation can be caused by various factors like atelectasis, UTI, pneumonia, endometritis, PE, DVT, wound infection, abscess, or mastitis. Treatment involves addressing the underlying cause, such as physical exercise, oxygen therapy, or incentive spirometry.

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26
Q

How is urinary tract infection (UTI) diagnosed and managed?

A

UTI typically presents with urgency, frequency, and dysuria. The most common organism is E. coli. Diagnosis involves urine analysis followed by urine culture for confirmation.

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27
Q

How to collect urine samples in pediatrics?

A

Mid-stream collection if over 4 years, suprapubic aspiration if younger, catheterization if other methods fail.

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28
Q

When is a suprapubic aspiration best for urine collection in pediatrics?

A

Especially in children under 1 year old.

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29
Q

What are the indications for further investigation in children with UTI?

A

More than 10 WBCs or more than 100,000 colonies.

30
Q

What is the recommended further investigation for recurrent UTIs in children?

A

Micturating cystourethrography.

When indicated, renal ultrasonography can prevent recurrent UTIs by identifying structural abnormalities that require subsequent renal imaging and further intervention. In most instances, antibiotic prophylaxis and surgical intervention are not required to prevent UTIs. Rather, good hygiene, prevention of constipation, adequate fluid intake and complete bladder emptying can help to prevent most recurrences.

31
Q

Describe the clinical presentation of endometritis.

A

High-grade fever, foul-smelling lochia, uterine tenderness.

32
Q

What are the symptoms of pneumonia?

A

Fever, cough, dyspnea, secretion.

33
Q

What are the symptoms of pulmonary embolism?

A

Sinus tachycardia, chest pain, dyspnea, hemoptysis.

34
Q

When is a VQ scan indicated?

A

In cases of allergy, renal impairment, pregnancy, or mismatch with LMWH.

35
Q

What are the main clinical features of shock?

A

Tachycardia, hypotension.

36
Q

What are the types of shock and their unique characteristics?

A

Neurogenic (bradycardia), cardiogenic (increased CVP), septic (increased CO).

37
Q

What is the most common cause of cardiogenic shock?

A

Myocardial infarction.

38
Q

What is the most common cause of hypovolemic shock?

A

Hemorrhage.

39
Q

What is the main treatment for neurogenic shock?

A

IV pressors and fluids.

40
Q

What is the main treatment for septic shock?

A

Fluids and antibiotics.

41
Q

What is the main treatment for cardiogenic shock?

A

Inotropes.

42
Q

What type of saline is used in resuscitation?

A

Normal saline.

43
Q

What is the main treatment for hypovolemic shock?

A

Fluid resuscitation with normal saline.

44
Q

What is the solution of choice for fluid management in operations?

A

Hartman’s solution.

45
Q

When should Hartman’s solution be given before an operation?

A

Before intestinal operations.

46
Q

What is a contraindication to Hartman’s solution?

A

Metabolic alkalosis.

47
Q

What is the choice of fluid in intestinal obstruction with metabolic alkalosis?

A

Normal saline.

For managing intestinal obstruction with associated metabolic alkalosis, the choice of fluid is typically an isotonic fluid that helps correct electrolyte imbalances. The preferred fluid is 0.9% sodium chloride (normal saline). This is because patients with intestinal obstruction and metabolic alkalosis often suffer from hypochloremia (low chloride levels) and hypokalemia (low potassium levels) due to vomiting and loss of gastric fluids, which results in a significant loss of chloride and hydrogen ions.

Normal saline helps in replenishing these lost electrolytes, thereby correcting the hypochloremic state and the associated metabolic alkalosis oai_citation:1,Intestinal Obstruction: Evaluation and Management | AAFP oai_citation:2,Evaluation and Management of Intestinal Obstruction | AAFP.

48
Q

What are the daily fluid requirements post-operatively?

A

3 liters (2 liters dextrose 5% + 1 liter normal saline).

49
Q

What is the deficit therapy given in normal saline?

A

20mmol/liter potassium supplement.

50
Q

What is the minimum potassium requirement per day?

A

60mmol/day.

51
Q

What is the fluid management approach in hypovolemia due to vomiting?

A

Normal saline + 20mmol K, maintain urine output >0.5ml/kg/hour.

Initial Assessment:
1. Clinical Evaluation: Assess severity through vital signs, urine output, and physical examination.
2. Identify Underlying Cause: Determine the extent and cause of fluid loss.

Immediate Management:
1. Oral Rehydration: Preferred for mild to moderate dehydration using oral rehydration solutions (ORS).
2. Intravenous Fluids:
- For moderate to severe dehydration or if oral intake is not possible.
- Initial Bolus: 0.9% normal saline (20-30 mL/kg) over 1 hour.
- Maintenance Fluids: Continue based on clinical response and ongoing losses.

Specific Fluid Choice:
- Normal Saline + 20 mmol/L Potassium Chloride: Maintain urine output >0.5 mL/kg/hour.

Monitoring:
1. Continuous Assessment: Monitor vital signs, urine output, and electrolytes regularly.
2. Adjust Fluids: Modify fluid administration based on clinical response.

For more detailed guidelines, refer to the Royal Children’s Hospital Melbourne’s guidelines on intravenous fluids.

52
Q

What should be considered in fluid management for the elderly with dehydration?

A

Old age and dehydration pose specific challenges.

When managing dehydration in elderly patients, several key considerations are essential:

  1. Assessment of Hydration Status: It is crucial to evaluate the severity of dehydration accurately. Common signs include dry mucous membranes, decreased skin turgor, and orthostatic hypotension. Laboratory tests such as blood urea nitrogen (BUN), creatinine, and electrolytes can help in assessing dehydration levels.
  2. Identify the Cause: Understanding the underlying cause of dehydration is important. Common causes include reduced fluid intake, increased fluid loss (due to diarrhea, vomiting, or excessive sweating), and medications like diuretics.
  3. Fluid Replacement:
    • Oral Rehydration: For mild dehydration, encourage frequent intake of preferred fluids (e.g., water, tea, juice). Use oral rehydration solutions if there are electrolyte imbalances.
    • Subcutaneous Fluids: In cases where oral intake is insufficient, subcutaneous administration of isotonic fluids (e.g., 0.9% saline) may be appropriate. This method can be particularly useful in patients who cannot tolerate intravenous fluids.
    • Intravenous Fluids: Reserved for severe dehydration or when subcutaneous administration is not feasible. The rate and volume should be carefully monitored to avoid fluid overload, especially in patients with cardiac or renal conditions.
  4. Monitoring and Supportive Care:
    • Regular Monitoring: Check vital signs, weight, and urine output regularly. Monitor for signs of fluid overload, especially in patients with heart failure or renal impairment.
    • Electrolyte Management: Correct any electrolyte imbalances promptly to prevent complications.
    • Dietary and Nutritional Support: Ensure adequate nutritional intake to support overall health. Encourage the intake of nutrient-rich fluids and, if necessary, consult a dietitian.
  5. Preventive Measures:
    • Education and Awareness: Educate caregivers and healthcare staff about the importance of adequate fluid intake and recognizing early signs of dehydration.
    • Tailored Fluid Plans: Develop individualized fluid intake plans considering the patient’s preferences and swallowing abilities.

By implementing these strategies, healthcare providers can effectively manage and prevent dehydration in elderly patients, reducing the risk of associated complications such as acute kidney injury, delirium, and increased mortality oai_citation:1,RACGP - Managing undernutrition in the elderly – prevention is better than cure oai_citation:2,Dehydration and subcutaneous fluids | Queensland Health.

53
Q

Describe the management of post-operative oliguria.

A

Post-operative oliguria management includes checking for post-renal obstruction as the most common cause, followed by dehydration. The first step in treatment involves catheterization.

54
Q

What is the Rule of 9 in burn injuries?

A

The Rule of 9 in burn injuries is a method used to estimate the total body surface area affected by burns. It assigns percentages to different body parts to guide treatment and prognosis.

55
Q

Define the types of burns based on the depth of skin involvement.

A

First-degree burns involve only the epidermis, second-degree burns affect the epidermis and part of the dermis, and third-degree burns damage the entire skin.

56
Q

How is early asphyxia due to inhalation managed in burn patients?

A

Early asphyxia due to inhalation in burn patients is best managed by intubation. If soot is found, intubation is also recommended.

57
Q

Describe the immediate step in managing eschars in burn injuries.

A

The immediate step in managing eschars in burn injuries is escharotomy, not fasciotomy.

58
Q

What are the complications of central venous catheterization?

A

Complications of central venous catheterization include infection, with Staphylococcus being the most common organism. Symptoms may include pain and pus around the catheter.

59
Q

How is gas gangrene treated?

A

Gas gangrene, caused by Clostridium perfringens from infected wounds, is treated with debridement.

60
Q

Explain the management of necrotizing fasciitis.

A

Necrotizing fasciitis, often caused by Streptococcus pyogenes in patients with risk factors like diabetes mellitus, is treated with debridement and antibiotics post-surgery.

61
Q

Describe the indications for splenectomy.

A

Indications include Chronic ITP, Hereditary Spherocytosis, Hypersplenism, and complications from Lymphoma.

62
Q

What are the common infections that can occur post-splen?

A

Infections such as Pneumococcal, Meningococcal, and Hemophilus Influenza are common.

63
Q

How often should patients receive the Pneumococcus vaccine post-surgery?

A

Patients should receive the Pneumococcus vaccine after surgery and every 5 years.

64
Q

Define dehiscence of abdominal incision.

A

Dehiscence of abdominal incision refers to the separation of the layers of a surgical wound.

65
Q

What is the recommended treatment for evisceration complication post-surgery?

A

The treatment for evisceration complication is urgent surgery.

66
Q

How should a lacerated deep wound be initially managed?

A

The first step in managing a lacerated deep wound is debridement.

67
Q

Describe the main investigation for cancer tongue.

A

The main investigation for cancer tongue is a biopsy.

68
Q

What is the most common risk factor for cancer larynx?

A

Smoking is the most common risk factor for cancer larynx.

69
Q

What is the primary treatment for Zenker diverticulum?

A

The primary treatment for Zenker diverticulum is myotomy with excision of the diverticulum.

70
Q

What is the most important investigation in preoperative staging of gastric adenocarcinoma?

A

The most important investigation is a PET scan.

AMC MCQ - Key points (49 decks)

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