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AMC MCQ > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Benzodiazepine overdose management

A

IV fluids and monitoring
-AVOID Flumazenil

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2
Q

Situation where flumazenil can be given for benzodiazepine OD

A
  • Unintentional lone paediatric benzodiazepine ingestion with compromised airway and breathing
  • When benzodiazepine overdose results in compromised airway or breathing in
    settings where resources for intubation are not available
  • Iatrogenic over-treatment with benzodiazepine
  • An elderly patient with respiratory disease/ intubation should be avoided
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3
Q
A
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3
Q

Cocain overdose treatment

A

1st: Sub-lingual nitro-glycerine
2. Benzodiazepines

NOTE: BB and aspirin are contraindicated

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4
Q

Gram -ve organisms

A

H influenzae
P aeruginosa,
K pneumoniae,
Escherichia coli

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5
Q

Gram +ve organisms

A

S pneumoniae
Staphylococcus aureus

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6
Q

paracetamol overdose management

A
  • < 2 hours: activated charcoal
    2-8 hours: paracetmaol concentration + ALT and if serum concentration low, no treatment
    If concentration high: IV N-acetyl cysteine
  • > 8 hours: IV N-acetyl cysteine
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7
Q

Metabolic effects of aspirin overdose

A

– Early primary respiratory alkalosis.
– Late metabolic acidosis.
– Hypokalaemia.
– Hypoglycaemia-sometimes hyperglycaemia

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8
Q

hyperkalaemia treatment

A
  1. Calcium chloride
  2. sodium bicarbonate
  3. glucose/insulin
  4. haemodialysis
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9
Q

Tampon + diffuse rash + fever + confusion + hypotension + multiorgan damage

A

Toxic shock syndrome
- Staph aureus

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10
Q

Anaphylactic shock management

A

0.01ml/kg adrenaline IM
- IV hydrocortisone + antihistamine

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11
Q

type 2 DM + hyperglycaemia + dehydration with/o
ketoacidosis

A

hyperosmolar hyperglycaemia

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12
Q

hyperosmolar hyperglycaemia treatment

A

Sodium (corrected) = Sodium (measured)
+ glucose / 4 (all values in mmol/L)
- if Na > 150 = sodium chloride 0.45%

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13
Q

Diabetic ketoacidosis management

A
  1. IV saline 1 to 3 L of 0.9%
  2. insulin
  3. Dextrose 5%
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14
Q

gliclazide + reinal impairment fixed by glucose infusion

A

sulphonylurea-induced hypoglycaemia
- IV glucose (5% dextrose) infusion for several days

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15
Q

haemorrhage + lung Edema with/o
parenchymal disruption + several hours after the initial injury

A

Pulmonary contusion

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16
Q

Pulmonary contusion management

A

Supporative
- good oxygenation
- adequate pulmonary toilette

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17
Q

Diabetic ketoacidosis investigation

A
  1. Capillary blood sugar level
  2. Venous or arterial blood gases
  3. Blood or urinary ketone level
  4. Other investigations like chest X-ray, blood culture, urine culture, full blood count etc
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18
Q

Chest trauma + Dyspnoea + Hypotension + Hyper-resonance + mediastinal shift

A

Tension pneumothorax

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19
Q

Tension pneumothorax

A

needle thoracotomy
- chest tube after patient stable with needle

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20
Q

Difference between pneumothorax vs haemothorax

A

pneumothorax: high percussion resonance
haemothorax: dull percussion resonance

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21
Q

best indicator of an effective CPR

A
  1. Pupil size and reaction to light
  2. carotid and femoral pulse
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22
Q

Nausea and vomiting + Excessive sweating + severe headache + Coagulation defects (raised INR,
APTT, bleeding)

A

Snake envenomation

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23
Q

Snake envenomation management

A
  1. Apply pressure immobilisation/elastic bandage (PIB)
  2. Check sign for envenomation
    3: No envenomation: topical anaesthetics & swab bites
    check labs for envenomation: if no signs release PIB, repeat blood test post removal if PIV, then 6 and 12 hours
    4: If clinical envenomation present: 2 IVs + take bloods
  3. Resuscitate
  4. Prep for anaphylactic reaction
  5. Give antivenom (1 vial tiger, 1 of brown)
  6. Release PIB after antivenom
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24
Q

Medication that can cause angioedema

A

ACE1 30%
ARBs

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25
Q

Angioedema treatment

A
  1. Cease offending drug
  2. steroids, antihistamines and epinephrine
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26
Q

Digoxin immune Fab indication for digoxin toxicity

A
  • Ingested dose (more than 10 mg in adults, more than 4 mg in children).
  • Cardiac arrest.
  • Potassium concentration above 5.0 mmol/L.
  • Life-threatening ventricular arrhythmias.
  • Decompensation (hypotension) from bradyarrhythmia’s
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27
Q

severe dyspnoea + distress +
pallor + sweating + tachycardia + poor peripheral perfusion
X-ray: bilateral basal + mid zone whiteout

A

Acute Pulmonary oedema

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28
Q

Chronic digoxin toxicity

A

associated with intercurrent illness, (with impaired renal function)
symptoms of insidious onset over days to weeks
features: acute digoxin toxicity features with visual disturbances (e.g. reduced acuity, yellow halos (xanthopsia) and altered color perception (chromatopsia)

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29
Q

Cardiac arrest management

A
  • Acidemic: compressions
  • if hyperkaliaemic/ hypocalcaemic/ CCB OD: calcium gluconate injection
  • TCA OD: Sodium bicarbonate
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30
Q

cardiac arrest core body temperature risk

A

32

31
Q

altered mental status + sedation, tachycardia + signs of anticholinergic toxicity (mydriasis, urinary retention, dry mucous membranes)_

A

tricyclic antidepressants (TCA) toxicity

32
Q

bradycardia + hypotension + hypoglycaemia within 6 hours of ingestion

A

beta blocker (BB) overdose beta blocker overdose

33
Q

Severe croup management

A

nebulised adrenaline (1 mL of 1%
adrenaline solution mixed with 3ml of normal saline)
- observation and repeat dose if needed

34
Q

Burn injury management

A

– Wash the area with water at room temperature.
– Avoid using ice water as further tissue damage will result otherwise.
– Do not peel the adherent clothing or burning substance.
– Do not apply lotions or creams except hydrogel.

35
Q

Absent/buried P waves + narrow/tall QRS

A

SVT

36
Q

SVT management

A

Stable:
1st: Valsalva
2nd: Adenosine
Unstable: DC cardioversion

37
Q

Acute pulmonary oedema management

A

-Commence oxygen (10–15 L/min via Hudson type mask and reservoir bag).
-Get intravenous access.
-Patient supported in sitting up position.
-Glyceryl trinitrate (vasodilator)
-Continuous positive airway pressure CPAP.
-Intravenous frusemide
– Morphine-to reduce sympathetic nervous activity

38
Q

Acute alcohol withdrawal treatment

A

Diazepam

39
Q

venlafaxine alternative

A
  • Reboxetine
  • mirtazapine
40
Q

MVA + fractured ribs on both sides + paradoxical breathing

A

Flail chest

41
Q

MVA + fractured ribs of > 2 ribs on one side + paradoxical breathing

A

Flail chest

42
Q

Flail chest management

A

Intubation and ventilation

NOTE: Splinting/wrapping considered in the acute setting in the absence of analgesia.

43
Q

Shockable rhythms for defibrillator

A
  • Ventricular tachycardia
  • ventricular fibrillation
  • asystole
  • pulseless cardiac
    activity
44
Q

Defib protocol

A
  1. Defib (300j)
  2. CPR
  3. Defib again + 1mg adrenlaine
  4. CPR 2 mins
45
Q

Tall P wave + broad QRS + ST segment depression

A

Hyperkalaemia

46
Q

Severe hyperkalaemia management

A

Calcium chloride 10 ml
- reduce risk of ventricular fibrillation

47
Q

most common cause of death seen in pre-hospital STEMI

A

Ventricular fibrillation
-occur within the first 24h of the onset of symptoms, and of these, over half occur in the first hour

48
Q

Organophosphate poisoning

A

DUMBELS
–Diarrhoea
–Urination
–Miosis
–Bronchorrhea, bradycardia
–Emesis
–Lacrimation
–Salivation.

49
Q

high-quality CPR

A

1.The depth of the chest compression should be at least 5 cm.
2.The rate of chest compressions should be 100 per minute and should never be
faster than 120 per minute.
3.The point of compression should be middle of the lower half of the sternum.
4.If the second rescuer is available, they should change the person every 2 minutes or earlier for high-quality CPR.
5.Give 30 compressions followed by two ventilations

50
Q

hypoperfusion + hypotension, + multiorgan dysfunction + white urine

A

Septic shock

51
Q

Septic shock treatment

A
  • immediate hydration
  • broad-spectrum antibiotics,
  • possible intubation
  • pressors,
  • admission to the intensive care unit
52
Q

severe headache, + breathlessness + nausea + vomiting + weakness + lassitude + retinal haemorrhages and venous
tortuosity

A

acute mountain sickness (AMS)

53
Q

acute mountain sickness (AMS) management

A
  • Descent
  • hyperbaric chambers
  • acetazolamide
54
Q

testicular torsion management

A

Rotate the testes in a medial to lateral direction as if you were opening a book

55
Q

elderly + delirious + blurry vision + dry mouth + constipation

A

Anticholinergic syndrome

56
Q

Hot and red + Tachycardia + Dry skin
+ Urinary retention + Constipation + Dilation of pupils.

A

Anticholinergic toxidrome

57
Q

zygomatic bone fracture features

A

Inability to open the mouth
Periorbital and/or subconjunctival ecchymosis
Horizontal diplopia
Vertical diplopia
Enophthalmos

58
Q

hyperthermia + muscle rigidity + altered mental status + autonomic
instability + antipsychotic medication

A

Neuroleptic malignant syndrome

59
Q

basophilic stippling + anaemia + low haemoglobin

A

Lead poisoning

60
Q

Rovsing sign

A

Acute appendicitis

61
Q

rAUNAUD’S

A

symmetrical cyanosis of the extremities with persistent, uneven, mottled blue or red discoloration of the skin of the digits, wrists, and ankles, along with profuse sweating and coldness of the fingers and toes

62
Q

Blumberg sign

A

peritoneal inflammation
- sharp pain when the examiner presses his or her hand over McBurney point and then releases the hand pressure suddenly.

63
Q

increased PaO2 + decreased PaCO2 + increased HCO3

A

Metabolic alkalosis secondary to bulimia

64
Q

-Blurred vision.
-Dry mouth.
-Unreactive or sluggish reactive pupil.
-Constipation.
-Urinary retention.
-Motor paralysis.

A

Botulism

65
Q

Hypotension, raised JVP, muffled heart sounds

A

Beck triad: Cardiac tamponade

66
Q

hypotension with either bradycardia +
normal heart rate despite fluid resuscitation

A

Neurogenic shock
- give vasopressor

67
Q

previous hx of cardiac disease + bradycardia + hypotension

A

Cardiogenic shock
- Give dobutamine

68
Q

capillary refill, cool and
mottled peripheries, tachycardia, drowsiness and hypotension

A

circulatory shock

69
Q

Blood loss estimation

A
70
Q

rabies featires

A
  • incubation period varies from 5 days to many years
  • ## fatal encephalitis and brain stem dysfunction
71
Q

Rabies management

A

Thoroughly wash the wound- clean and debride if indicated.
-Transmission between humans has not been proven.
-Post-exposure prophylaxis

72
Q

Rabies Post-exposure prophylaxis regime

A

first dose of rabies vaccines + immunoglobulins as soon as possible after the exposure. The schedule of vaccinations should be 0, 3, 7 and 14th day
- If immunocompromised: a 5th dose at 28-day post exposure

73
Q

Parkland formula:

A

(4 x bodyweight x burns %) / 2 (first 8 hours)

74
Q

cleaning fluid intoxication

A
  • potent hepatic toxin
  • increased ammonia due to liver damage
  • triphasic EEG
75
Q

drooling + radycardia + miosis + increased urination, + diarrhea

A

organophosphate poisoning

AMC MCQ (56 decks)

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