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Yr3 geriatrics > emergency medicine AMK > Flashcards

emergency medicine AMK Flashcards

1
Q

A 67-year-old man presents to the Emergency Department with 2 hours of left-sided
chest pain. He reports having had similar pains that come and go when he exercises. The
pain usually subsides when he rests. He appears sweaty, agitated and short of breath.
An ECG is performed and shows new T-wave inversion in V3-V6.
His troponin and d-dimer levels are as shown:
Troponin 223 ng/L (<5)
D-Dimer 932 ng/mL (< 400)
What is the most likely diagnosis?

A

NSTEMI

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2
Q

ACS is umbrella term fro STEMi Nstemi and unstable angina
symtpoms socrates

A

central crushing chest pain
sudden
crushing
jaw and arm
SOB and palpitions pale, clammy m sweating , N+V
not related to food positon
exertion

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3
Q

unstable angina presents with

A

normal troponin and other change on ECG and or no change

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4
Q

immediate management of ACS

MONA

A

ABCDE
MONA
IV morphine and anti-emetic
oxygen sats over 94
nitrate - GTN
aspirin 300mg

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5
Q

long term management ACS

A

aspriin, atorvastatin and ACEi
beta blocker
cardiac rehab
driving , diet and dyspepsia (PPI)

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6
Q

RCA

A

inferior leads II, III, aVF

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7
Q

LAD

A

anterior leads V1-4

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8
Q

left circumflex

A

lateral leads I and V5-6

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9
Q

tachycardia is unstable what to do

A

DC shock 3 times before amiodarone

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10
Q

if not life threatening tachy and narrow QRS management for both regular and irregular

A

regular - vagal manouevere such as valsalva - if not adenosine

irregular prosb AF 0 rate control with beeta blockers - if heart fialure digoxin

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11
Q

broad complex tachy irregulr vs regular

A

regular - amiodaroje 300mg IV over 10 -60 mins

iregular - IV mg

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12
Q

bradycardia life threating mangemetn

A

atropine

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13
Q

if atropine does not work

A

adrenaline or transvenous pacing

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14
Q

A 31-year-old male presents to the emergency department with sudden-onset ‘tearing’ pain in his chest.
On examination, his heart rate is 70 beats per minute, respiratory rate is 16 breaths/min, temperature is
36.7oC, oxygen saturations are 100% on room air, blood pressure is 165/82mmHg in the right arm and
138/70mmHg in the left arm. He has no past medical history but on examination, you note he has a tall
stature, pectus excavatum and joint hypermobility.
Chest x-ray is performed which shows a widened mediastinum.
What is the most appropriate investigation?

A

CT TAP

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15
Q

aortic dissection tear through what wall

A

tunica intima

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16
Q

type a is in the ascendign aorta type b is where

A

descendign aorta

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17
Q

type a is surgical what happens to type b

A

conservative management and labetaolol

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18
Q

PE worst on isnpriation and cough up blood can show as sinus tachy on ECG what is the gold standard

A

CTPA

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19
Q

ci to CTPA

A

allergic , pregnant, renal impairment

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20
Q

acute asthma what do you given like an attack
OSHITME

A

Oxygen
salbutamol
hydrocortisone
ipratropium bromide
theophylline
magnesium sulphate
escalation to ITU

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21
Q

mild moderate asthma is 50-77 PEFR
norm speach
RR under 25
pulse under 1220
wheeze
sats above 92

what is severe nad life threatening ( 2nd number)

A

33-50%
use of accesoory mucles t complete exhausted bradycaridas and cannpto speak

RR over 25
pulse over 110

cyanosis and agitation adn altered conscious level

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22
Q

anaphylaxis what do you give

A

adrenaline

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23
Q

adult or child over 12 what dose of adrenaline for anaphylaxis

A

500micrograms IM or 0.5ml

24
Q

child 6-12 years what dose of adrenaline

A

300micrograms IM or 0.3ml

25
Q

child 6m to 6 years what dose of adrenaline

A

150micrograms IM - 0.15ml

26
Q

child under 6 months what dose of adrenlaine do we give

A

100-150 micrograms IM or 0.1-0.15ml)

27
Q

what should you do in anaphylacitc shock

A

ABCDE
skin itchy and airwyas calling for help
remove trigger adn lie pateitn flat with or without legs elevated
sitting psotn may make breathign easie r
pregnant women needs to be lying on left side
give IM adrenaline
and montiors
repat if no repsonse after 5 min

28
Q

NAC treatmetn over what level

A

75mg

29
Q

if under 4 hours paracetamol ingestion what do you do

A

activated charcoal unde teh hour and take paracetamol conc at 4 hours post ingestions

30
Q

serotonin syndrome sx

A

increased reflexes , clonus, dilated pupils

31
Q

at what age is Screening for AAA

A

single abdo USS aged 65

32
Q

AAA are usually asymtpomatic and may be pulsatile and can obstruct GI structures
if rupture what triad do they present with

A

flank or back pain
hypotension
pulsatile abdo mass

other sx
radiating to back pain
tachycardia
profoudn anameia
sudden death

33
Q

under 3cm requires no furhter action
a small aneurysm 3-4.4 cm is required to be seen

A

every year

34
Q

medium aneurysm is 4.5-5.4 required to be seen

A

every 3 months

35
Q

5.5 is considered large what should happen

A

2WW to vascular surgery for probable intervention

36
Q

unruptured AA treatment

A

careful control of hypetension, lipid lowering meds adn smokign cessation
regular USS
and surgical repiar

37
Q

ruputred AAA treatment

what blood pressure should you keep them below

A

ABCDEFG
raising BP will dilodge a clot and may precipiate further bleeding so keep BP below 100mghg
urgent surgery

38
Q

A 56-year-old man presents to the emergency department with severe abdominal pain. He has a past
medical history of atrial fibrillation and type 2 diabetes mellitus.
His observations on admission are: respiratory rate = 20/min, heart rate = 112/min, irregularly irregular,
blood pressure = 134/97 mmHg, oxygen sats = 97%
An arterial blood gas sample is performed and shows the following:

What is the most likely diagnosis?
A) DKA
B) Mesenteric ischaemia
C) Ruptured AAA
D) Metformin-induced lactic acidosis
E) Acute pancreatitis

pH 7.21
PaO2 10.3 kPa
PaCO2 3.4 kPa
HCO3 15.1 mmol/l
Lactate 7.1 mmol/l ( range: < 1

mmol/l)

A

mesenteric ischaemia

39
Q

what is msenteric ischaemia

A

Rapid block in blood flow through the SMA due to a thrombus or an embolus

40
Q

sx of mesenteric ischaemia

A

Acute, non-specific abdo pain
* Pain disproportionate to exam findings
* Go on to develop shock, peritonitis and sepsis

41
Q

sx of mesenteric ischaemia

A

Acute, non-specific abdo pain
* Pain disproportionate to exam findings
* Go on to develop shock, peritonitis and sepsis

42
Q

investiagations of choice and what would blood gas show in mescenteric ischaemia

A

Contrast CT, metabolic acidosis and raised lactate due to ischaemia

43
Q

Mx os mesenteric ischaemia

A

Surgery- remove necrotic bowel and remove or bypass thrombus

44
Q

A 24-year-old woman presents to her GP with lower abdominal pains that have been getting worse
over the past two days. The pain is in the suprapubic area and slightly to the right. She had some
vaginal bleeding this morning which she describes as being like a light period. The patient also
describes some shoulder pain which she thinks came on following a game of squash. Her last period
was eight weeks ago and was described as normal. In the past, she has been treated for Chlamydia
infection and admits to not practicing safer sex.
On examination, she is tender in the right iliac fossa. Blood pressure is 100/60mmHg and the pulse is
102/min.
What is the most likely diagnosis?
A) Appendicitis
B) Ovarian torsion
C) Miscarriage
D) PID
E) Ruptured ectopic pregnancy

A

ruptured ectopic

45
Q

peritonitis symtoms

A

Peritonitis:
* Guarding
* Rigidity
* Rebound tenderness
* Coughing test
* Percussion tenderness

46
Q

sx of ectopic

A

Suspect in any female with abdo pain
* Missed period
* Constant lower abdo pain in RIF/LIF
* Vaginal bleeding
* Lower abdo or pelvic tenderness
* Cervical motion tenderness
* Dizziness or syncope (blood loss)
* Shoulder tip pain (peritonitis)

47
Q

rf of ectopic

A

Risk Factors:
* Previous ectopic
* Previous PID
* Fallopian tube surgery
* IUD
* Older age
* Smoking

48
Q

mx of ectopic

A

Management:
* Must be terminated- not a viable pregnancy
* Expectant management (awaiting natural termination)
* Medical management (methotrexate)
* Surgical management (salpingectomy or salpingotomy)
Expectant Management:
* Follow up needs to be possible to ensure successful termination
* The ectopic needs to be unruptured
* Adnexal mass < 35mm
* No visible heartbeat
* No significant pain
* HCG level < 1500 IU / l
Medical Management:
* As above but
* HCG level must be < 5000 IU / l
* Confirmed absence of intrauterine pregnancy on ultrasound
Surgical Management:
Anyone not meeting above criteria, including:
* Pain
* Adnexal mass > 35mm
* Visible heartbeat
* HCG levels > 5000 IU / l

49
Q

someone who is struglling to breath in ABCDE what can you do to help

A

15L O2 via non rebreath mask - less for COPD

50
Q

what should you check under d

A

glucose
GCS
pupils reactivity and symmetry and pain assessment and CT brain

51
Q

when is a DOAC contrinidacted

A

renal impairment

52
Q

signs of sepsis

A

Signs of potential sources such as cellulitis, discharge from a wound, cough or dysuria Non-blanching rash can indicate meningococcal septicaemia
Reduced urine output
Mottled skin
Cyanosis
Arrhythmias such as new onset atrial fibrillation
There are a few key points worth being aware of:
High respiratory rate (tachypnoea) is often the first sign of sepsis
Elderly patients often present with confusion or drowsiness or simply “off legs”
Neutropenic or immunosuppressed patients may have normal observations and temperature despite being life threatening unwell

53
Q

sepsis 6

A

bufalo

54
Q

when does neutropenic sepsis occur

A

Sepsis in patients with a neutrophil count of <1 x 10^9/L
Usually the result of chemotherapy, TB drugs or immunosuppression (see notes for list)

55
Q

what do we treat neutropenic spesis with

A

piperacilin and tazocin

56
Q

what drugs cause neutropenic sepsis

A

Anti-cancer chemotherapy
Clozapine (schizophrenia)
Hydroxychloroquine (rheumatoid arthritis)
Methotrexate (rheumatoid arthritis)
Sulfasalazine (rheumatoid arthritis)
Carbimazole (hyperthyroidism)
Quinine (malaria)
Infliximab (monoclonal antibody use for immunosuppression) Rituximab (monoclonal antibody use for immunosuppression)

57
Q

what test can confirm if someone has had an anaphylactic shock

A

mast cell tryptase within 6 hours

Yr3 geriatrics (6 decks)

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