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Finals: Speciality Blocks > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Tinnitus is a characteristic feature of which type of overdose?

A

Aspirin

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2
Q

What would the ABG show in an aspirin overdose

A

Initially respiratory alkalosis (caused by activation of respiratory centres in the brain)

Later metabolic acidosis (causes by wasting of bicarbonate ions due to the ingested acid load)

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3
Q

Respiratory depression, reduced consciousness and bilaterally constricted (pinpoint) pupils are characteristic features of an overdose of what medication?

A

Opioid overdose

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4
Q

Respiratory depression, confusion and cerebellar symptoms such as nystagmus and ataxia are features of an overdose of what medication?

A

Benzodiazepine such as diazepam

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5
Q

What is the first step in the management of suspected choking?

A

Encourage the patient to cough

If the cough is effective, they are encouraged to continue coughing.

If ineffective, five back blows are delivered followed by five abdominal thrusts, and this is repeated

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6
Q

Cherry red skin and confusion is pathognomonic for which condition

A

Carbon Monoxide poisoning

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7
Q

How is Carbon Monoxide poisoning managed

A

100% oxygen via face mask

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8
Q

How is a clinical diagnosis of meningococcal infection made

A

Blood or CSF culture

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9
Q

How is heroin withdrawal managed

A

NICE specifically advises against prescribing opiates in withdrawal, favouring either lofexidine (an alpha 2 receptor agonist) or symptomatic management with medications such as benzodiazepines for agitation and anti-emetics/loperamide for GI symptoms.

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10
Q

What is the mainstay of treatment for ventricular fibrillation

A

Defibrillation and CPR

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11
Q

If ventricular fibrillation is not resolving with Defibrillation and CPR what can be given after the 3rd shock

A

Amiodarone 300mg IV and Adrenaline 1mg IV (1:10,000)
Amiodarone is given as a one-off dose. However Adrenaline may be repeated every other cycle following a shock (i.e. cycles 3, 5, 7 etc.)

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12
Q

What is the mainstay of treatment for pulseless electrical activity

A

Defibrillation and CPR

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13
Q

What is the first step in managing DKA

A

IV fluids as the acute issue in these patients is severe dehydration which needs to be treated with IV fluids.

The patient should only be started on a fixed rate insulin infusion at a rate of 0.1 units/kg/hr once the first bag of fluids is complete

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14
Q

What features indicate that a PE is massive

A

Hypotension (systolic < 90 mmHg or a drop in systolic blood pressure of ≥ 40 mmHg for ≥ 15 minutes)

Signs of shock

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15
Q

What side does the tracheal deviation in relation to the side of the pneumothorax

A

Tracheal deviation AWAY from the pneumothorax

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16
Q

How is a tension pneumothorax managed

A

Immediate needle decompression with a large-bore needle inserted into the 2nd intercostal space in the midclavicular line
This should be followed by chest drain insertion to reduce the risk of an immediate recurrence of the tension pneumothorax.

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17
Q

What scoring system is used to predicts mortality in upper GI bleeds

A

Rockall score
OR
Glasgow-Blatchford Score (only for pre-endoscopy)

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18
Q

In what scenario’s would you immediately give N-acetylcysteine in a paracetamol overdose

A

Ingested >15 hours ago
OR
Staggered overdose

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19
Q

In what scenario’s would you immediately give activated charcoal in a paracetamol overdose

A

If ingested within the last hour

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20
Q

In what scenario’s would you have to wait until 4 hours post-ingestion in a paracetamol overdose

A

If pt is presenting with ingestion < 4 hours ago

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21
Q

Paracetamol overdose can be life-threatening.

What can it cause?

A

Hepatocellular necrosis
Renal tubular necrosis
Hepatic encephalopathy
Death

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22
Q

What is the most appropriate emergency treatment for anaphylaxis

A

500 micrograms of 1:1000 adrenaline IM injected into middle third of anterolateral thigh

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23
Q

What is the first line management of severe hypoglycaemia eg. Seizures, Unconscious

A

150ml IV 10% dextrose STAT

Provides a rapid increase in plasma glucose levels

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24
Q

Pancreatic pseudocyst are a recognised complication of acute pancreatitis.

Those that are not symptomatic and non-communicating are managed conservatively.

How are those that are symptomatic and communicate managed?

A

Endoscopic or surgical intervention due to the risks of infection, haemorrhage or rupture of the cyst

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25
Q

Which interleukins are important in the mediating the underlying inflammatory response in bacterial infections

A

IL1, 4, 6, 10 and 13

Activates B and T lymphocytes and promotes inflammation

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26
Q

What is the four components of the Systemic inflammatory response syndrome (SIRS)

A

≥ 2 of:
- 38°C or < 36°C
- Heart rate > 90
- Respiratory rate > 20
- Raised WBC

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27
Q

Define sepsis

A

Systemic inflammatory response syndrome (SIRS) (i.e. at least two of the following: fever, high HR, high RR, raised WBC)
AND
Presumed or confirmed infection

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28
Q

Define septic shock

A

Severe sepsis with either:
Hypotension despite adequate fluid resuscitation
OR
Lactic acidosis

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29
Q

Name the 6 components of sepsis 6

A

1) Take bloods (FBC, U&E, LFT, CRP, lactate)
2) Take blood cultures
3) Administer oxygen if required
4) Administer IV antibiotics
5) Administer IV fluid resuscitation
6) Monitor urine output

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30
Q

What is IV adenosine used in ILS

A

In the treatment of supra-ventricular tachycardias (SVT)

second line after vagal manoeuvres

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31
Q

What is the first line pharmaceutical management of bradycardia associated with haemodynamic compromise

A

IV atropine

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32
Q

What is the second line pharmaceutical management of bradycardia associated with haemodynamic compromise if IV atropine has not helped or countraindicated

A

IV adrenaline

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33
Q

What is the first line pharmacotherapy given in suspected opioid overdose

A

Naloxone

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34
Q

Characteristic Hx of acute pericarditis is pleuritic chest pain and low-grade fever.

What ECG pattern would you have in acute pericarditis

A

PR depression and global saddle-shaped ST elevation

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35
Q

How is acute pericarditis managed

A

Analgesia (NSAIDs such as aspirin or ibuprofen) and bed rest
If underlying cause is known - treat it
Colchicine and steroids may also be used

36
Q

What are the two serious complications of pericarditis

A

1) Cardiac tamponade
2) Chronic constrictive pericarditis

37
Q

Spinal cord compression needs urgent neurosurgical review. What medication should be given whilst awaiting specialist advice

A

Loading dose of dexamethasone

38
Q

What is the most common cause of spontaneous intracerebral haemorrhage.

A

Hypertensive vasculopathy

Hypertension leads to the formation, and subsequent rupture, of Charcot-Bouchard aneurysms in the small penetrating blood vessels of the brain

39
Q

How are extra-dural haematoma that is less than 30cm in volume, less than 15mm thick and causing less than 5mm midline shift managed

A

Conservative management

40
Q

How are extra-dural haematoma that is greater than 30cm in volume managed

A

Surgical evacution e.g. burr holes regardless of their GCS

41
Q

Likely bleeding site?

Lucid interval after an initial loss of conciousness, which may then be followed by rapid deterioration

A

Extra-dural haematoma

42
Q

What type of haematoma is this?

A

Extradural haematoma

Extradural = Egg shaped

43
Q

Beck’s triad is a triad of signs of cardiac tamponade.

What are the 3 components of the triad?

A

Raised JVP
Hypotension
Muffled heart sounds

44
Q

Nothing

A

Nothing

45
Q

Preceding viral infection with pleuritic chest pain worsening on lying down and relieved on sitting forward is the classic presentations what condition

A

Acute pericarditis

46
Q

Likely Dx:

Child with fever with SoB and signs of respiratory distress e.g. stridor, increase WoB, use of accessory muscles
Unvaccinated

A

Acute epiglottitis.

This is a serious, but now rare due to the introduction of Haemophilus influenzae type B (HibB) vaccinate as the infection is most commonly caused by Haemophilus influenzae type B

47
Q

How should child with acute epiglottitis be managed

A

Endotracheal intubation by an anaesthetist

These patients should not be examined, treated or cannulated, but left alone. Any upset or distress may lead to total airway obstruction

48
Q

What is the gold standard investigation for diagnosis of suspected cauda equina syndrome or cord compression

A

Urgent whole spine MRI

49
Q

Which one of these is a life-threatening complication of sepsis?

Disseminated intravascular coagulation (DIC)

Immune thrombocytopenic purpura (ITP)

A

Disseminated intravascular coagulation (DIC)

Over-activation of the coagulation pathway leading to increased risk of thrombosis and subsequent risk of bleeding due to depletion of clotting factors and platelets

Characterised by raised PT, APTT and D-Dimer, and low platelet count and fibrinogen level

50
Q

How is Disseminated intravascular coagulation (DIC) managed

A

Supportive with blood products and treatment of the underlying cause

51
Q

What medication is used to manage the symptoms of thyrotoxic storm

A

IV propanolol

52
Q

What is the first line medication used to treat thyrotoxic storm

A

Propylthiouracil (PTU)

53
Q

What is the first line medication used to treat thyrotoxic storm in first trimester of pregnancy

A

Propylthiouracil (PTU)

54
Q

What is the first line medication used to treat thyrotoxic storm after the first trimester of pregnancy

A

Carbimazole

55
Q

What are the 4 factors that indicates haemodynamic compromise (and therefore the need for treatment) in bradycardia

A

Shock
Syncope
Myocardial ischaemia
Heart failure

56
Q

How is cardiac tamponade managed?

A

Pericardiocentesis where fluid is aspirated and subsequently drained from the pericardium

57
Q

In shockable cardiac arrest, after the third shock a 300mg of IV amiodarone is given.

When and at what dose will the next IV amiodarone be given?

A

Given after the 5th shock

The further dose is half the initial i.e. 150mg

58
Q

What is the management of amitriptyline overdose

A

Sodium bicarbonate

59
Q

What scoring scale is used to assess the severity of alcohol withdrawal

A

Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised

Takes into account the following features:
Tremor
Nausea and vomiting
Anxiety

60
Q

If a patient has been in asystole for more than how many minutes, in the absence of a reversible cause, it is reasonable grounds for stopping the CPR attempt

A

20 minutes

61
Q

What medication is used in aspirin overdose to maintain good kidney function and to alkalise the urine in order to increase salicylate excretion

A

IV sodium bicarbonate

62
Q

First line management of supraventricular tachycardia (SVT)

A

Vagal manoeuvres

63
Q

What type of haematoma is this?

A

Subdural haematoma

suB = Banana shaped

64
Q

What is the definitive treatment of acute compartment syndrome

A

Fasciotomy

65
Q

What is the gold standard diagnostic tool for encephalitis

A

Lumbar puncture with CSF analysis - microscopy, serology, cultures

66
Q

What is the empirical treatment for suspected encephalitis

A

IV acyclovir and IV ceftriaxone

67
Q

IV fluids with an insulin infusion is the initial treatment for DKA.

What kind of rate is the insulin?

A

IV fluids and a fixed rate insulin infusion

68
Q

Except bloods, which is the most important investigation in amitryptiline overdose

A

Electrocardiogram (ECG)

Classic progression from sinus tachycardia, to widened QRS and then ventricular arrhythmias

69
Q

What is the first line management of a spontaneous primary pneumothorax:
Pt has SoB
OR/AND
Pneumothorax is > 2cm

A

Needle aspiration with 16-18G cannula followed by a period of observation

70
Q

What is the first line management of a spontaneous primary pneumothorax:
No SoB
AND
Pneumothorax is < 2cm

A

Conservative management followed by outpatient review in 2-4 weeks

71
Q

What is the first line management of a secondary pneumothorax:
No SoB
AND
Pneumothorax is < 1cm

A

Admit for observation for 24 hours and administered oxygen as required

Secondary meaning they have an underlying lung disease

72
Q

What is the first line management of a secondary pneumothorax:
No SoB
AND
Pneumothorax between 1-2 cm

A

Needle aspiration using a 16G cannula

Secondary meaning they have an underlying lung disease

73
Q

What is the first line management of a secondary pneumothorax:
SoB
OR/AND
Pneumothorax > 2 cm

A

Insert a chest drain

Secondary meaning they have an underlying lung disease

74
Q

Overdose of what substance causes an initial respiratory alkalosis and later a metabolic acidosis

A

Aspirin

75
Q

How is Torsades de Pointes managed in an unstable patients with haemodynamic compromise

A

Synchronised DC cardioversion

Haemodynamic features include heart failure, ischaemia, syncope or hypotension

76
Q

How is Torsades de Pointes managed in an stable patient

A

IV Magnesium Sulphate 2g over 1 to 2 minutes

77
Q

What scoring system is used to assess the risk of patients who present with an upper GI bleed when the patient has yet to have an endoscopy

A

Glasgow-Blatchford score

Rockall score is most appropriate post-endoscope

77
Q

What scoring system is used are used to assess the risk of patients who present with an upper GI bleed when the patient has yet to have an endoscopy

A

Glasgow-Blatchford score

Rockall score is most appropriate post-endoscope

78
Q

What blood test is most specific for acute pancreatitis

A

Serum amylase

Serum lipase as a similar sensitivity and specificity to serum amylase but hardly used in hospital

79
Q

Name the triad of key features of Hyperosmolar Hyperglycaemic State

A

1) Hyperglycaemia
2) Hyperosmolality (serum osmolality >320 mmol/kg)
3) Volume depletion in the absence of ketoacidosis (pH >7.3, HCO3 >15 mmol/l)

80
Q

How long should direct oral anticoagulant be continued in an unprovoked pulmonary embolism

A

6 months

81
Q

How long should direct oral anticoagulant be continued in a provoked pulmonary embolism

A

3 months

82
Q

What are the three main sites for intraosseous access

A

Proximal tibia
Distal tibia
Proximal humerus

83
Q

IV atropine 500 micrograms is used to treat bradycardia with adverse features. Atropine should only be used up to what dose?

A

3mg i.e. 6 doses 500 micrograms

84
Q

What is the first line management of wound abscess

A

Wound exploration and washout

85
Q

Most common causative agent in glandular fever

A

Epstein-Barr virus (EBV)

Finals: Speciality Blocks (11 decks)

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