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MSPA4023 - Clinical medical & public heath > Emergency Medicine (A-E) > Flashcards

Emergency Medicine (A-E) Flashcards

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USMLE® Step 1 flashcards
1
Q

what is the presentation of acute severe asthma?

A

acute breathlessness and wheeze

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2
Q

what investigation would you do if suspect of acute severe asthma

A

Peak expiratory flow rate
ABG
CXR
FBC
U&E

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3
Q

the different of severe and life-threatening acute asthma attack

A

severe attack:
- can’t complete sentences in 1 breath
- RR >_25/min
- PR >_110bpm
- PEF 33-50%

Life threatening attack
- Silent chest, cyanosis feeble respiratory effort
- arrhythmia / hypotension
- exhaustion, confusion /coma
- PEF <33%

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4
Q

Immediate treatment and management for acute asthma

A

Give O2 -> maintain 94-98%
salbutamol 5mg nebulized with O2
severe/ life-threatening -> ipratropium 0.5mg /6hrs to nebulizer
Hydrocortisone 100mg IV / prednisone 40-50mg PO

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5
Q

Which department to refer if the acute asthma doesn’t improve?

A

ICU

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6
Q

what is in the presentation of acute exacerbations of COPD?

A
  • Increase cough
  • breathlessness
  • wheeze
  • decreased exercise capacity
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7
Q

what investigation would you do on acute exacerbations of COPD?

A

ABG
CXR - exclude pneumothorax and infection
FBC
U&E
CRP
ECG
sputum culture
blood cultures if pyrexia

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8
Q

management of acute COPD

A
  1. Nebulized bronchodilators - salbutamol 5mg/4hrs and ipratropium 500mcg/6hrs
    ____________________________
  2. controlled oxygen therapy if SaO2 <88% or PaO2<7kPa
    starts at 24-28% aim sats 88-92%
  3. steroids
    IV hydrocortisone 200mg and oral prednisolone, 30mg OD (continue for 7-14days)
  4. antibiotics (if there’s infection)
    amoxicillin 500mg/8hrs PO
    alternatively clarithromycin / doxycycline
    **if no response to nebulizers and steroids –> IV aminophylline
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9
Q

Clinical features on pneumothorax?

A

-sudden onset of dyspnoea
-pleuritic chest pain
-sudden deterioration
-mechanically ventilated patient - suddenly develop hypoxia / increase in ventilation pressures
-reduced expansion
-hyper-resonance to percussion
-diminished breath sounds on the affected side

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10
Q

Clinical features on tension pneumothorax?

A

SOB
tachycardia
hypotension
distended neck veins
trachea deviated away from the side of pneumothorax
hyperresonance
reduced air sound on the affected side

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11
Q

how you would investigate pneumothorax?

A

CXR *(don’t use when suspicion of tension pneumothorax)
ABG
Bloods and U&E

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12
Q

Differences of primary and secondary pneumothorax

A

primary pneumothorax develops in the absence of an underlying disease process.

secondary pneumothorax develops as a result of underlying lung disease such as asthma or COPD.

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13
Q

management of pneumothorax

A

needle decompression

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14
Q

What’s the signs and symptoms of pneumonia

A

fever
rigors
malaise
anorexia
dyspnoea
cough
purulent sputum
haemoptysis
pleuritic chest pain

cyanosis
confusion
tachypnoea
tachycardia
hypotension
diminished expansion, dull percussion, tactile vocal fremitus, vocal resonance

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15
Q

investigation on pneumonia

A

CURB-65

CXR
ABG
FBC, U&E, LFT, CRP
BLOOD CULTURES
SPUTUM CULTURES
urine pneumococcal antigen
viral throat

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16
Q

how would you assess the severity of pneumonia?

A

CURB-65
Confusion
Urea >7mmol/L
Respiratory rate>30/min
BP <90/60mmHg
Age >65
0-1 home treatment
>2 hospital therapy
>3 severe pneumonia and consider ICU referral

17
Q

Management of pneumonia

A

treat oxygen of hypoxia
dehydration then iv fluid support 500ml bolus
amoxicillin / Doxycycline / clarithromycin (if allergic to penicillin)

paracetamol/NSAIDS 1g/6hrsfor pleuritic chest pain

18
Q

signs and symptoms of Pulmonary embolism (PE)

A

acute dyspnea
pleuritic chest pain
hemoptysis
syncope
hypotension
tachycardia
gallop rhythm (added S3 / S4)
raised JVP
right ventricular heave
pleural rub
tachypnoea
cyanosis
AF
loud p2

19
Q

common cause of PE?

A

DVT

20
Q

What is a risk score for PE/DVT?

A

Well score

20
Q

what investigation if suspect of PE?

A

U&E
FBC
baseline clotting
ECG
CXR
ABG
D-dimer
CTPA

21
Q

management of pulmonary embolism

A

Oxygen if hypoxic - 10-15L/min
morphine 5-10mg IV with anti-emetic if pt in pain / very distressed
IV LMWH/ fondaparinux
if BP low give 500ml IV fluid bolus & call ICU
if hemodynamic instability –> thrombolysis
long-term anticoagulation - DOAC / warfarin

22
Q

recognition of sepsis

A

Altered mental state – ‘confused’, ‘drowsy’, ‘not themselves’

Fever – ‘warm to touch’, ‘shivery’, ‘burning up’

Hypotension – ‘dizzy’, ‘faint’, ‘lightheaded’
systolic bp <90mmHg mean arterial pressure <65mmHg

Tachypnoeic – ‘out of breath’, ‘breathless’
RR >25 bpm

Tachycardic – ‘heart is racing’, ‘heart is pounding’.
> 130 bpm

lactate > 2mmol/l
Not passed urine in 18hours
non-blanching petechial or purpuric rash

23
Q

What are the sepsis 6?

A

Give oxygen
Give IV fluids
Give IV antibiotics

Take bloods and latate & blood cultures
Monitor NEWS2 & urine output
Notify senior clinician

24
Q

Signs and symptoms of AAA

A

intermittent / continuous abdominal pain (radiates to the back, iliac fossae / groins)
hypotension
collapse / lightheadedness
expansible pulsatile abdominal mass
shock

25
Q

What are the 9 quadrants?

A
26
Q

What are the management for AAA

A

Surgical review (for if EVAR is needed)+ anesthetics + ITU ASAP
FAST scan - bedside USS
*CT abdo if stable
Crossmatch
Fluid resus
Analgesia

27
Q

What are the 6P’s of vascular assessment?

A

Pain
Pallor (pale appearance of the limb)
Paresthesia (abnormal sensation of the limb)
Paralysis
Pulselessness
Perishing with cold

28
Q

clinical features of acute limb ischaemia

A

sudden onset of the 6P’s
limb appears white
vascular examination in the other leg is usually normal
chronic rest pain (worst at night)
absent foot pulses

29
Q

investigation for limb ischemia

A

past history
vascular examination
ankle brachial pressure index (APBI)
CT angiography
bloods
serum lactate
group and save
ECG
thrombophilia screen

30
Q

management on limb ischemia

A

urgently refer to a vascular specialist
paracetamol and weak / strong opioids

31
Q

in the ABPI what ratio shows the present of disease of the limbs?

A

<0.5 - severe arterial disease
0.5-<0.8 presence of arterial disease / mixed a/v disease
0.8-1.3 normal result
1.3< - arterial calcification

32
Q

how long should acute limb ischemia be treated before becoming irreversible ?
And what need to be done?

A

within 4-6 hours
Oxygen
start on IV heparin
analgesia
imaging
require surgical intervention within 6hrs
if embolic:
- embolectomy
- bypass surgery
if thrombotic:
- angioplasty + thrombolysis
- bypass

33
Q

how can DVT be treated?

A

Start with LMWH then swapped to a DOAC

MSPA4023 - Clinical medical & public heath (13 decks)

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