Emergency Medicine

Question 1

When do you request for a CT scan within 1 hour when a patient has head injury?

Answer 1

GCS < 13 on initial assessment at the ED
GCS < 15 2 hours after injury on initial assessment in the ED
More than 2 episodes of vomiting
Post-traumatic seizure
Focal neurologic deficits
Suspected open or depressed skull fracture
Any sign of basial skull fracture (battle, racoon, CSF rhinorrhea, hemotypanum)

Question 2

When do you request for a CT scan within 8 hours when a patient has head injury?

Answer 2

>65 y/o
Any history of bleeding or clotting disorders
On anticoagulation treatment
Dangerous mechanism of injury
>30 mins of retrograde amnesia

Question 3

When do you request for a CT scan within 1 hour when a child has head injury?

Answer 3

GCS < 14 on initial assessment in the ED (GCS<15 if less than 1 year old)
GCS < 15 2 hours after injury
Post-traumtic seizure without epilepsy
Focal neurologic deficit
Suspected open or depresed skull fracture
Any sign of basal skull fracture

Question 4

A child gets involved in a road traffic accident. A CT scan is indicated within 1 hour if TWO of the following is present:

Answer 4

Amnesia lasting more than 5 minutes
High-speed RTA
3 or more episodes of discreet vomiting
Loss of consciousness for more than 5 mins
Abnormal drowsiness
Fall from a height > 3 meters

Question 5

Expected pupillary response in a patient with space-occupying lesion (abscess, tumor, hematoma)

Answer 5

UNILATERALLY DILATED PUPIL

Question 6

Expected pupillary response in a patient with stimulants or TCA overdose

Answer 6

BILATERAL MYDRIASIS

Question 7

Expected pupillary response in a patient with opiate OD

Answer 7

BILATERAL MIOSIS

Question 8

Expected pupillary response in a patient with BRAINSTEM STROKE

Answer 8

BILATERAL MIOSIS

Question 9

Manifestations of patient with Paracetamol OD

Answer 9

RUQ pain
Vomiting
Jaundice
Liver failure

Question 10

Management for Paracetamol OD in less than 1 hour

Answer 10

Activated Charcoal

Question 11

Presentation of a patient with Aspirin overdose

Answer 11

Hyperventilation
Tinnitus
Vertigo
Vomiting
Respiratory Alkaloses -> Metabolic Acidosis

Question 12

When do you advise for dialysis in a patient who presents with ingestion of an unknown medication with the following features: tinnitus, vertigo, vomiting, hyperventilation and ABG of RAlk then MetAc?

Answer 12

If Salicylate level > 700

This is a probable aspirin overdose

Question 13

Antidote for opioid OD

Answer 13

IV Naloxone

Question 14

What is the most appropriate initial management if there is doubt over the time of ingestion of paracetamol irrespective of plasma concentration?

Answer 14

Start NAc immediately

Question 15

When should you arrange for an imediate liver transplant with a paracetamol overdose?

Answer 15

pH < 7.3 (24 hrs after ingestion)

Or all of the following criteria:

	- Prothrombin time > 100 seconds
	- Creatinine > 300 umol/L
	- Grade III or IV encephalopathy

Question 16

Which commonly prescribed OTC drug initially causes respiratory alkalosis then later a metabolic acidosis?

Answer 16

ASA

Question 17

WET SLUD of Organophosphate poisoning

Answer 17

Salivation
Lacrimation
Urination
Diarrhea

Question 18

Treatment for Organophosphate Poisoning

Answer 18

Atropine

Pralidoxime

Question 19

Treatment for TCA (Amitriptyline) OD

Answer 19

Sodium bicarbonate

0.9% NS (for hypotension)

Question 20

Features of a patient with TCA OD

Answer 20

Widened QRS + broad-complex tachycardia

Question 21

What is the difference between naloxone and naltrexone in terms of opioid treatment?

Answer 21

nalOXone - OX stands for treatment for overdose

nalTREXone - REX stands for relapse prevention

Question 22

Naloxone
Naltrexone
Methadone

Functions in terms of opioid

Answer 22

Naloxone - OD
Naltrexone - relapse prevention
Methadone - detox (metadox)

Question 23

IM glucagon is given as management for hygpoglycemia except for the following population:

Answer 23

Chronic Alcoholism or Alcohol intoxication
Liver Failure
Hypoglycemia sec to Sulfonylureas

Question 24

What laboratory findings would you expect in a chronic alcoholic who is vomiting profusely?

Answer 24

Hypoglycemia

Hypokalemia

Question 25

In a suspected variceal bleed, what is the INITIAL management?

Answer 25

Resuscitate with IV Fluids

Question 26

In a suspected variceal bleed, what medications should be started?

Answer 26

Terlipressin

Prophylactic antibiotics

Vitamin K if prolonged INR

Question 27

Definitive management for a confirmed variceal bleed

Answer 27

Band ligation

Question 28

What can be offered to a patient with confirmed variceal bleed and the definitive management still did not achieve symptom control?

Answer 28

TIPS - transjugular intrahepatic portosystemic shunt

Question 29

WHat is the most important presentation of a patient with BDZ OD?

Answer 29

Respiratory depression (ABG can show resp acidosis)

Question 30

Treatment for BDZ OD

Answer 30

Flumazenil

Question 31

What is an important presentation of a patient with cocaine OD?

Answer 31

Perforated nasal septum
Also, MI
Also, high BP, HR, RR

Question 32

Treatment for cocaine OD

Answer 32

BDZ

Question 33

SEPSIS SIX

Answer 33

Blood culture
FBC. U&E. Clotting, Lactate
I&O monitoring

HIgh-flow oxygen
IV fluids
IV antibiotics

Question 34

Most important step in the management of severe GI bleeding

Answer 34

Fluid resuscitation