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Revision Qs > Emergency And Ward Medicine > Flashcards

Emergency And Ward Medicine Flashcards

1
Q

Important differentials for acute lower abdo pain in any woman of childbearing potential?

A

GI stuff
Ectopic pregnancy
Ruptured ovarian cyst, ovarian torsion (ovarian accident)
(Miscarriage)

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2
Q

5 step approach to ABGs?

A

Patients clinical picture
Oxygenation
pH
Respiratory component - CO2 as marker of ventilation
Metabolic component - bicarbonate and base excess

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3
Q

What indicates respiratory involvement on an ABG? How?

A

CO2 - if it is in the ‘expected direction’ e.g. High in an acidosis then it is a respiratory acidosis, if in the ‘opposite’ direction it is a compensatory change for a metabolic disturbance

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4
Q

Describe the role of base excess in ABGs?

A

Essentially the CO2 equivalent for metabolic disturbance - if in the ‘expected direction’ of pH change then it is a metabolic disturbance (e.g. Negative = metabolic acidosis)

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5
Q

2 important causes of coma + sweating?

A

Sepsis

Hypoglycaemia

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6
Q

What does the serum anion gap represent?

A

The unmeasured anions - albumin, phosphate, sulphate, lactate, ketoacids

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7
Q

KLAPS of unmeasured anions?

A 
Ketoacids
Lactate
Albumin
Phosphate
Sulphate
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8
Q

2 causes of a low anion gap?

A

Lithium toxicity

IgM/IgG multiple myeloma

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9
Q

5 causes of a raised anion gap?

A

Ketoacids - alcohol or DM
Lactate (sepsis)
Sulphate/phosphate - AKI
Uraemia

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10
Q

Which type of bilirubin is water soluble and therefore detectable directly and visible in urine?

A

Conjugated

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11
Q

What does bilirubinuria suggest?

A

Conjugated bilirubin (as this is the only type that is water soluble) - cholestasis

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12
Q

3 causes of isolated raised ALP?

A

Paget’s disease
Normal pregnancy
Bony mets/blastic lesions e.g. Breast, prostate cancer

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13
Q

2 causes of a low ALP?

A

Hypothyroidism

Pernicious anaemia

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14
Q

Metabolic cause of a really really low ALP in the context of acute liver failure?

A

Willsons disease

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15
Q

2 causes of an isolated raised AST?

A

Rhabdomyolysis

Acute MI

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16
Q

What does a raised ALT and AST with a predominant AST suggest?

A

Alcoholic disease

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17
Q

5 major causes of a macrocytic anaemia?

A 
Pernicious
Other B12/folate def
Alcohol
Hypothyroidism
Reticulocytosis
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18
Q

5 SIRS criteria?

A

HR > 90
RR > 20
Temp >38.3 or 12000 or

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19
Q

What blood abnormality may be present in non-diabetics in the context of SIRS?

A

Raised BM

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20
Q

What is severe sepsis?

A

SIRS + bacteraemia + end organ damage

21
Q

Signs of severe sepsis?

A

Hypotension and reduced urine output
Bounding pulse, increased CRT
Mottling, clotting dysfunction/DIC

22
Q

2 criteria for septic shock?

A

Persistent hypotension in spite of adequate fluid resus

Organ hypoperfusion as evidenced by lactate >4

23
Q

Warm vs cold shock?

A

Warm shock is early; bounding pulse, peripheral vasodilation and warmth
Cold shock is late; relative hypoperfusion and peripheral shutdown

24
Q

What type of shock is septic?

A

Distributive

25
Q

What is the sepsis 6?

A 
High flow O2 via non-rebreathe mask
IVT
IVAbx
Take blood cultures
Take lactate
Measure urine output
26
Q

Endocrine complication of septic (typically meningeal) shock?

A

Waterhouse-Friedrichson syndrome - bilateral adrenal haemorrhage

27
Q

Describe foot associated with autonomic neuropathy?

A

Dry (reduced sweating)

Bounding pulses due to peripheral vasodilation

28
Q

What is Charcot arthropathy?

A

Sensori-autonomic neuropathy

Hypervascularisation making unstable and easily fractured

29
Q

Describe an acute Charcot joint?

A

Hot, red, swollen in DM patient ddx septic, osteomyelitis, DVT, cellulitis, gout
Warm with bounding pulses, ‘painful’ in a neuropathic foot

30
Q

Most important management of an acute Charcot joint?

A

Offload - air cast

To prevent arch collapse, subluxation of Ts and MTs, ‘rocker bottom foot’

31
Q

How long do you have to wait post-bronchodilator to assess asthma reversibility via PEFR?

A

20 mins

32
Q

SPACESPIT for describing lumps?

A 
Size and Shape
Position
Attachments and skin changes
Consistency
Edge
Surface
Pulsatile?
Inflammation?
Transillumination?
33
Q

3 crystalloid fluids?

A

Normal saline
Dextrose/dexsaline
Hartmanns

34
Q

2 colloid fluids?

A

Albumin

Blood products

35
Q

Extrinsic RFs for pressure ulcers?

A 
Heat
Friction and shearing
Uniaxial pressure
Moisture
Posture
36
Q

Intrinsic RFs for pressure ulcers?

A 
Immobility
Infection
Incontinence
Sensory loss
Old age
Poor nutrition
Chronic disease
37
Q

What is a grade 1 pressure ulcer?

A

Intact skin with patch of non-blanching erythema, typically over bony prominence

38
Q

What scoring systems are used to assess RFs for pressure ulcers?

A

Braden score

Waterlow

39
Q

What is a grade II pressure ulcer?

A

Partial thickness skin loss, involving epidermis and or dermis
Or intact/open blister

40
Q

What is a grade 3 pressure ulcer?

A

Full thickness skin loss, damage or necrosis of subcutaneous tissue down to but not through underlying tissue

41
Q

What is a grade 4 pressure ulcer?

A

Skin loss through full thickness of skin, extensive destruction and necrosis to underlying bone, tissue muscle or joint capsule. +/- Slough and eschar

42
Q

What is erythema nodosum?

A

Painful raised rash on lower limbs

43
Q

Normal QRS interval length?

A

Less than 0.12s

44
Q

Drop of BP by how much is postural hypotension?

A

At least 20/10

45
Q

When should BP be measured when checking for postural hypotension?

A

Lay down for 5 mins then measure
Stand up for 1 min then measure
Measure after 3 mins of standing

46
Q

How long is a urine sample valid to be tested for after it is produced?

A

4 hours

47
Q

How big suggests small bowel dilatation? How do you know it’s small bowel?

A

Over 3cm

Valvulae coniventes thoughout thickness

48
Q

How big suggests large bowel dilatation? Caecum? How do you know it’s large bowel?

A

6cm normally, 9cm for caecum

Has haustra transversely (makes little houses) not through full thickness and taenia coli longitudinally (big long worm)

Revision Qs (28 decks)

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