Emergency Medicine Flashcards
classification system for ankle fractures?
Ottowa rules
classification system for scaphoid fractures?
Herbert classification:
Grade A: acute/ stable
Grade B: acute/ unstable
Grade C: Delayed union
Grade D: Established non-union
Herbert classification of scaphoid fractures?
Grade A: acute/ stable
- A1: Tubercle
- A2: non displaced waist crack
Grade B: acute/ unstable
- B1: Oblique/distal third
- B2: Displaced waist
- B3: Proximal pole
- B4: Fracture dislocation
- B5: Comminuted fracture
Grade C: Delayed union
Grade D: Established non-union
- D1: Fibrous
- D2: Sclerotic
Classification system for fractures involving the growth plate (epiphyseal fractures)?
Salter- Harris classification
Salter-Harris classification of epiphyseal fractures?
I: Straight across the growth plate
II: Above. through growth plate + above (metaphysis)
III: Below. through growth plate + below (epiphysis)
IV: Through (metaphysis + growth plate + epiphysis)
V: Crush injury involving growth plate
Classification of supracondylar fractures in children?
Gartland classification
Salicylate poisoning - effect on Respiratory rate?
Salicylates e.g. aspirin increase RR -> hyperventilation and respiratory alkalosis
ECG changes in hyperkalaemia?
tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
Does acidosis or alkalosis lead to hyperK?
Acidosis.
H+ and K+ ions compete with each other for exchange with sodium ions across cell membranes and in the distal tubule.
Causes of hyperuricaemia due to increased synthesis of uric acid?
increased cell turnover/ increased production of uric acid:
- Lesch-Nyhan disease
- myeloproliferative disorders
- diet rich in purines
- exercise
- psoriasis
- cytotoxics
Causes of hyperuricaemia due to decreased renal excretion of uric acid?
- drugs: low-dose aspirin, diuretics, pyrazinamide
- pre-eclampsia
- alcohol
- renal failure
- lead
- acidosis (eg, diabetic ketoacidosis, ethanol or salicylate intoxication, starvation ketosis) The organic acids that accumulate in these conditions compete with urate for tubular secretion.
Drugs that cause hyperuricaemia due to reduced excretion of uric acid?
CANT LEAP
C iclosporin
A lcohol
N icotinic acid
T hiazides
L oop diuretics
E thambutol
A spirin
P yrazinamide
Purpose of BHCG rise in first trimester of pregnancy?
to maintain the corpus luteum and thereby progesterone production
What proteins are the alpha-subunit of HCG identical to?
It is a protein dimer. Its alpha subunit is identical to LH, FSH, TSH
most dangerous location for ectopic pregnancy?
isthmus of Fallopian tube
Borders of the femoral triangle?
Superiorly: Inguinal ligament
Laterally: Sartorius
Medially: Adductor longus
Contents of the femoral triangle?
- Femoral vein (medial to lateral)
- Femoral artery-pulse palpated at the mid inguinal point
- Femoral nerve
- Deep and superficial inguinal lymph nodes
- Lateral cutaneous nerve
- Great saphenous vein
- Femoral branch of the genitofemoral nerve
Causes for high anion gap metabolic acidosis (>11 mEq/L)?
MUDPILES:
Methanol Uraemia DKA Paraldehyde Infection Lactic acidosis Ethylene glycol/ethanol Salicylates
Causes for normal anion gap metabolic acidosis (3-11 mEq/L)?
Diarrhoea
Type I, III, & IV renal tubular acidosis
Alcohol
Addison’s disease
Causes of low anion gap metabolic acidosis?
Haemorrhage
Nephrotic syndrome
Intestinal obstruction
Wallace’s rules of nine for assessing extent of burns in children >16?
head + neck = 9% each arm = 9% each anterior part of leg = 9% each posterior part of leg = 9% anterior chest = 9% posterior chest = 9% anterior abdomen = 9% posterior abdomen = 9%
palmar surface 1%
most accurate method for assessing extent of burn?
Lund and Browder chart
Which burns should be referred to secondary care?
- all deep dermal and full-thickness burns.
- superficial dermal burns of more than 2% TBSA in children
- superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
- any inhalation injury
- any electrical or chemical burn injury
- suspicion of non-accidental injury
indications for escharotomies in burns?
- Indicated in circumferential full thickness burns to the torso or limbs.
- Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso)/ relieve compartment syndrome and oedema (where a limb is involved)
What level does the spinal cord terminate?
L1/L2
What is Rovsing’s sign?
A positive sign is determined when palpation in the left lower quadrant of a patient’s abdomen causes pain in the right lower quadrant.
- suggestive of appendicitis
What is Murphy’s sign?
Inhalation causes the gallbladder to descend which catches on the fingers causing pain.
- suggests gallbladder inflammation
What is Cullen’s sign?
bruising around the umbilicus
- suggestive of pancreatitis/ ectopic pregnancy
What is Battle’s sign?
bruising behind the ear suggesting a basal skull fracture of the posterior cranial fossa.
Mx of primary pneumothorax <2cm?
if <2cm + not SOB: conservative mx
if SOB: consider aspiration
if >2cm or still SOB: chest drain
advise to stop smoking
Mx of secondary pneumothorax?
if SOB: Chest drain
if 1-2cm: aspiration
if <1 cm: give O2 and admit for 24h
avoid scuba diving
Mx of Complete hydatidiform mole?
urgent referral to specialist centre - evacuation of the uterus is performed
effective contraception is recommended to avoid pregnancy in the next 12 months
features of molar pregnancy?
- bleeding in first or early second trimester
- exaggerated symptoms of pregnancy e.g. hyperemesis
- uterus large for dates
- very high serum levels of HCG
- hypertension and hyperthyroidism may be seen
Mx of accidental injection of adrenaline?
local infiltration of phentolamine
Recommended dose of adrenaline in anaphylaxis in children?
adrenaline 150 mcg IM in children <6 years
300 mcg IM in children 6-12 years
500 mcg in children >12 y
Recommended dose of adrenaline in cardiac arrest in children?
10 mcg/ kg every 3 to 5 min (i.e. every other loop)
unhappy triad injury of the knee?
medial collateral ligament + medial meniscus + anterior cruciate ligament
(classically the medial meniscus but recent evidence shows that the lateral meniscus is more commonly injured)
occur due to a lateral impact resulting in Valgus stress.
Causes of meningitis in 0-3 mo olds?
Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes
Causes of meningitis in 3 mo - 6 years old?
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Causes of meningitis in 6 - 60 yr olds?
Neisseria meningitidis
Streptococcus pneumoniae
Rate of paediatric CPR?
100-120 bpm
Effect of burns on Haemoglobin?
Haemolysis due to damage of erythrocytes by heat and microangiopathy
Dose of im adrenaline in anaphylaxis in children?
10 microgram/kg
Dose of IV Hydrocortisone in anaphylaxis in children?
4mg/kg
most common causative organism of meningitis in non-vaccinated young child?
Haemophilus influenzae type B
Hypertrophic vs keloid scars?
Typically a keloid scar will pass beyond the boundaries of the original injury.
Hypertrophic scars remain confined to the boundaries of the original wound
Drugs which impair wound healing
NSAIDs
Steroids
Immunosupressive agents
Anti neoplastic drugs
Cough + SOB + Sore throat + exposure to distinctive rotten egg smell
Exposure to Hydrogen sulphide
- Hydrogen sulphide can be released from agricultural plants ie. industrial farms
Ingestion of mothballs + haemolytic anaemia
Napththalene poisoning
Ingestion of inorganic compound + hypotension, tachycardia and ECG changes
Selenium poisoning
Contaminated water supplies + nausea, diarrhoea and vomiting?
arsenic poisoning
