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AMC MCQ - Key points > Emergency 3 > Flashcards

Emergency 3 Flashcards

1
Q

Describe the first step in managing a trauma patient.

A

Secure the airway.

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2
Q

What should be done if a trauma patient with a Glasgow Coma Scale (GCS) of less than 8 is encountered?

A

Intubation.

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3
Q

When should intubation be considered for a trauma patient with head and neck trauma developing hoarseness of voice?

A

Immediately.

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4
Q

What action is recommended for a patient with burns on the face in terms of airway management?

A

Intubation.

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5
Q

In a trauma patient with soot in the airway, what is the next step in management?

A

Intubation.

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6
Q

If intubation fails in various trauma scenarios, what is the subsequent step?

A

Cricothyroidotomy.

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7
Q

Where is a tracheostomy typically performed for trauma patients?

A

In the operating room.

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8
Q

What should be suspected in a patient with severe head and neck injury?

A

Cervical neck injury.

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9
Q

How should the airway be maintained in a patient with suspected cervical neck injury?

A

Endotracheal tube (ETT).

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10
Q

What is the first indicator of hypovolemia?

A

Change in pulse.

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11
Q

What is the initial step in managing hypovolemia in a trauma patient?

A

Establishing an IV line and administering normal saline.

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12
Q

What is the second step in managing hypovolemia after establishing an IV line and giving normal saline?

A

Transfusing packed red blood cells after cross-matching.

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13
Q

What is the correct sequence for managing hypovolemia in a trauma patient: IV line, saline, cross-matching, packed red blood cells?

A

IV line, saline, cross-matching, packed red blood cells.

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14
Q

What does a change in blood pressure in a trauma patient indicate regarding volume loss?

A

At least 20-25% of intravascular volume.

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15
Q

What is the likely diagnosis in a trauma patient with hypotension, congested neck veins, and distant heart sounds?

A

Cardiac tamponade.

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16
Q

What is the typical X-ray finding in a patient with cardiac tamponade?

A

Enlarged cardiac shadow.

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17
Q

What is the immediate treatment for cardiac tamponade?

A

Emergent pericardiocentesis.

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18
Q

What is the diagnosis in a trauma patient presenting with dyspnea, absent breath sounds, hyperresonance in one lung, and tracheal deviation to the opposite side?

A

Tension pneumothorax.

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19
Q

What is the first-line management for tension pneumothorax?

A

Needle thoracotomy.

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20
Q

What are two incorrect answers for the first-line treatment of tension pneumothorax?

A

Oxygen and tube thoracotomy.

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21
Q

In a patient with chest trauma and a wide mediastinum on chest X-ray, what is the likely diagnosis?

A

Aortic rupture.

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22
Q

How should aortic rupture be managed in a patient with chest trauma?

A

Emergent surgery.

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23
Q

What is the initial step in managing a patient with rib fractures, severe pain, and difficulty breathing?

A

Administer IV morphine.

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24
Q

What is the likely diagnosis in a patient with chest trauma, paradoxical movement of a segment of the thoracic wall, and multiple contiguous fractured ribs on X-ray?

A

Flail chest.

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25
Q

Describe the treatment of flail chest.

A

Pain control, strapping of chest, mechanical ventilation.

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26
Q

What is the diagnosis for a head trauma patient with ecchymosis around the eye, behind the ear, and clear fluid dripping from the ear and nose?

A

Basal skull fracture.

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27
Q

How is a basal skull fracture typically treated?

A

Conservative approach (no antibiotics, no packing, advice not to sniff).

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28
Q

Define epidural hematoma.

A

A collection of blood between the skull and the dura mater.

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29
Q

What is the most important investigation for epidural hematoma?

A

CT scan (biconvex shaped hematoma).

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30
Q

What is the emergency treatment for epidural hematoma?

A

Emergent craniotomy.

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31
Q

What is the most important nerve to be affected in epidural hematoma?

A

Oculomotor nerve.

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32
Q

Describe the diagnosis for a head trauma patient, especially in older or alcoholic individuals, presenting with chronic headache, personality changes, and gradual memory loss.

A

Subdural hematoma.

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33
Q

How is a subdural hematoma typically managed?

A

Conservative treatment.

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34
Q

What is the imaging modality of choice for subdural hematoma?

A

CT scan (lens shaped hematoma).

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35
Q

What is diffuse axonal injury characterized by?

A

Diffuse small bleeding at the junction between gray and white matter on CT scan.

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36
Q

What is the first step in managing any patient with increased intracranial pressure?

A

CT scan.

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37
Q

What is the initial step in a patient with signs of meningitis, vomiting, and papilledema before performing a lumbar tap?

A

CT scan.

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38
Q

What is the first step in managing a patient with penetrating abdominal trauma?

A

Control the site of bleeding.

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39
Q

What is the second step after controlling bleeding in a patient with penetrating abdominal trauma?

A

Establish an IV line, administer normal saline, then packed RBCs if needed.

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40
Q

What is the final step in managing a patient with penetrating abdominal trauma involving a foreign object?

A

Exploratory laparotomy (removal of object only in the operating room).

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41
Q

In a scenario where a patient has a knife in the chest and presents with low oxygen saturation and hemothorax, what is the first intervention?

A

Intubation.

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42
Q

If a patient with a knife in the chest has low oxygen saturation and hypotension, what is the initial step?

A

Intubation.

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43
Q

What is the first intervention for a patient with a knife in the chest, low oxygen saturation, and pneumothorax?

A

Needle thoracotomy.

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44
Q

In a patient with a knife in the chest and normal oxygen saturation but hemothorax, what is the first step?

A

Chest tube insertion.

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45
Q

If a patient with a knife in the chest has normal oxygen saturation but hypotension, what is the initial action?

A

Establish an IV line, administer normal saline.

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46
Q

What is the recommended approach if a peripheral line fails in an infant or child with hypotension?

A

Intraosseous cannulation in the proximal tibia.

47
Q

Describe the first step in managing a blunt abdominal trauma patient with hemorrhagic instability.

A

Perform a FAST exam.

48
Q

Describe the first step in managing a blunt abdominal trauma patient with hemorrhagic stability.

A

Perform a CT scan without contrast.

49
Q

What is the next step if a FAST or CT scan shows internal bleeding in a blunt abdominal trauma patient?

A

Perform a laparotomy.

50
Q

What is the likely injury in a blunt abdominal trauma patient experiencing left upper quadrant pain radiating to the shoulder?

A

Splenic injury.

51
Q

What is the typical management approach for a blunt abdominal trauma patient with stable hemorrhage and a liver injury?

A

Conservative treatment.

52
Q

What is the recommended treatment for a blunt abdominal trauma patient with stable hemorrhage and a kidney injury?

A

Conservative treatment.

53
Q

What is the potential risk associated with blunt abdominal trauma at the epigastrium?

A

Risk of stomach injury.

54
Q

Why does pain from spleen, liver, and gallbladder pathology often radiate to the shoulder in blunt abdominal trauma patients?

A

Due to irritation of the diaphragm (phrenic nerve and supraclavicular nerve have the same cervical nerve origin; C3, C4).

55
Q

What is the initial step in managing an acute abdomen with suspected perforated abdominal viscera?

A

Perform an abdominal X-ray to check for air under the diaphragm.

56
Q

What does the presence of air under the diaphragm on an X-ray indicate, and what is the recommended action?

A

It indicates an emergent laparotomy.

57
Q

What is the preferred diagnostic investigation for esophageal rupture?

A

Gastrographin contrast esophagography.

58
Q

Describe the typical presentation of a patient with intestinal obstruction.

A

Colicky abdominal pain, persistent vomiting, absolute constipation (no stool, no flatus).

59
Q

What are common findings on abdominal examination in a patient with intestinal obstruction?

A

Distension, diffuse tenderness, hyperactive bowel sounds.

60
Q

What is the initial investigation for suspected intestinal obstruction?

A

Abdominal X-ray showing multiple air-fluid levels.

61
Q

What is the first step in managing a patient with intestinal obstruction?

A

Insertion of a nasogastric tube, IV fluid administration, and antibiotics (conservative treatment).

62
Q

What is the next course of action if there is no improvement after conservative treatment for intestinal obstruction?

A

Surgical intervention.

63
Q

What is the most common cause of intestinal obstruction overall?

A

Hernia.

64
Q

What is a likely cause of intestinal obstruction in a patient with a history of recent abdominal surgery?long time

A

Post-operative adhesions.

65
Q

What is a probable cause of intestinal obstruction in an elderly patient with sudden onset abdominal pain?

A

Volvulus.

66
Q

What is a potential cause of intestinal obstruction in an elderly patient with anemia and weight loss?

A

Colon cancer.

67
Q

What condition should be suspected in an elderly nursing home resident with chronic constipation, recurrent lower left quadrant abdominal pain, and intermittent soiling, with a full rectum on digital rectal examination?

A

Fecal impaction.

68
Q

What is the recommended treatment for fecal impaction?

A

Enema.

69
Q

Describe the presentation of a patient with sigmoid volvulus.

A

Sudden onset abdominal pain in old age, empty rectum in DRE.

70
Q

What is the diagnostic finding on abdominal x-ray in a patient with volvulus?

A

Omega loop.

71
Q

How is sigmoid volvulus initially managed?

A

Endoscopic decompression.

72
Q

What is the next step if endoscopic decompression fails or perforation occurs in sigmoid volvulus?

A

Surgery.

73
Q

Describe the first step in the management of cecal volvulus.

A

Surgery.

74
Q

What is the classic presentation of intussusception in a child?

A

Attacks of abdominal pain during which child draws his leg toward abdomen + red currant jelly stool.

75
Q

What is the imaging modality of choice for diagnosing intussusception?

A

Abdominal US.

76
Q

How is intussusception managed, both diagnostically and therapeutically?

A

Hydrostatic reduction (barium or air enema).

77
Q

Describe the clinical features of paralytic ileus.

A

Absent bowel sounds (silent abdomen), no abdominal pain after abdominal surgery, marked dilated intestinal loops in x-ray.

78
Q

What are important causes of paralytic ileus?

A

Hypokalemia, spine fracture.

79
Q

What is the treatment approach for paralytic ileus?

A

Conservative.

80
Q

What is the likely diagnosis when a patient on antiparkinsonian medications develops signs of intestinal obstruction?

A

Pseudoobstruction.

81
Q

Describe the presentation of an elderly patient with a history of chronic constipation who develops fever, LLQ abdominal pain, tachycardia.

A

Likely diverticulitis.

82
Q

What is the imaging modality of choice for diagnosing diverticulitis?

A

CT scan.

83
Q

Describe the clinical presentation of acute appendicitis.

A

Low-grade fever, anorexia, tachycardia, pain at right iliac fossa.

84
Q

What is the most specific sign of acute appendicitis?

A

Localized pain at right iliac fossa.

85
Q

What is the imaging modality of choice in diagnosing appendicitis?

A

CT scan.

86
Q

What is the treatment of choice for appendicitis?

A

Laparoscopic appendectomy.

87
Q

In a pregnant patient with RUQ abdominal pain, normal LFTs, and positive viral serology, what is the likely diagnosis?

A

Appendicitis.

88
Q

How is appendicitis managed in pregnancy?

A

Laparoscopic appendectomy.

89
Q

What is the most common complication after appendix rupture?

A

Pelvic abscess.

90
Q

Describe the presentation of a patient 10 days after appendicitis with a painful defecation and a fluctuant tender mass in DRE.

A

Likely pelvic abscess.

91
Q

What sign would be positive in a patient 10 days after appendicitis with a psoas abscess?

A

Psoas sign.

92
Q

Describe the presentation of a young patient with chronic abdominal pain and bloody diarrhea.

A

Incomplete, more information needed for a specific diagnosis.

93
Q

Describe the first step in the management of toxic megacolon.

A

Decompression, IV fluid, and IV antibiotics.

94
Q

What is the next step if initial management fails in toxic megacolon?

A

Surgery.

95
Q

Define ischemic colitis in a patient with chronic atrial fibrillation presenting with acute severe abdominal pain and bloody diarrhea.

A

Ischemic colitis.

96
Q

Describe biliary colic in a female patient who is fatty, forty/fifty, and fertile with recurrent right upper quadrant abdominal pain radiating to the shoulder.

A

Biliary colic (due to gallbladder stone).

97
Q

What is the recommended treatment for an asymptomatic gallbladder stone incidentally found on ultrasound?

A

No treatment.

98
Q

Define the most common type of gallbladder stone.

A

Cholesterol stone.

99
Q

How does the type of gallbladder stone differ in patients with hemolysis?

A

Pigment stone.

100
Q

What is the imaging modality of choice for gallbladder stones?

A

Ultrasound.

101
Q

What is the next step if an asymptomatic gallbladder stone is found incidentally on ultrasound but the common bile duct is markedly dilated?

A

ERCP.

102
Q

Describe the management of acute cholecystitis in a patient with chronic gallbladder stones presenting with severe right upper quadrant pain, fever, and leukocytosis.

A

IV fluid, antibiotics, followed by cholecystectomy within 72 hours.

103
Q

What is the most important investigation for acute cholecystitis?

A

Ultrasound.

104
Q

Describe the most specific sign of cholecystitis seen on ultrasound.

A

Pericholecystic fluid and gallbladder wall thickness (not gallbladder stone).

105
Q

What is the treatment for acute cholecystitis?

A

IV fluid, antibiotics, followed by cholecystectomy within 72 hours.

106
Q

Describe the presentation of acute cholangitis in a patient with chronic gallbladder stones presenting with severe right upper quadrant pain, fever, chills, and jaundice.

A

Acute cholangitis.

107
Q

What is the best initial investigation for acute cholangitis?

A

Ultrasound (to show dilated common bile duct).

108
Q

Describe the treatment approach for acute cholangitis.

A

IV fluid, antibiotics first, followed by ERCP decompression and then cholecystectomy.

109
Q

What is the first step in the treatment of acute cholangitis?

A

IV fluid.

110
Q

Describe the management of cholecystitis in a patient with a history of myocardial infarction.

A

Conservative treatment initially, then percutaneous cholecystectomy if conservative management fails.

111
Q

When is the best time to perform cholecystectomy in pregnancy?

A

2nd trimester (due to increased risk of cholestasis in pregnancy).

112
Q

What is the first step in the management of priapism?

A

Repeated saline flushing.

113
Q

Describe the management of a fractured penis.

A

Immediate surgery.

AMC MCQ - Key points (49 decks)

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