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Emergency Medicine > Emergency Medicine - COPIED > Flashcards

Emergency Medicine - COPIED Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

When would you use a collar and Cuff sling?

A
  • gravity assist
  • eg. impacted head of humerus (refer if impacted head)
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2
Q

When to use Equinus cast

A

Ruptured achilles tendon

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4
Q

Which bone is boxer’s fracture?

A

5th metacaral

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5
Q

managment for sprains

A

Ice 20 mins every two hours. elevate << swelling.

Increase in pain 48 hours after injury. Takes 6-8 weeks to heal.

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8
Q

Signs of scaphoid fracture?

A
  • tenderness at anatomical snuff box.
  • pain when pressing thumb proximally

IMP. Danger of avascular necrosis

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9
Q

Scaphoid fracture management

A

Cast if suspected (scaphoid backslab)

Refer to review clinic in 10-12 days

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10
Q

Types of wrist fracture

A

Smith’s - surgery

Colle’s (often due to FOOSH). Tx in A & E

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11
Q

What is a haematoma block?

A

Analgesic technique used to allow painless manipulation of fractures while avoiding the need for full anesthesia.

This procedure is normally only appropriate for fractures of the radius and ulna.

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12
Q

elbow fracture - what will you find on x-ray?

A

The sail sign.

Never a posterior fat pad unless there is a fracture.

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13
Q

Tender points for knee - ottawa

other factors

> 55 yrs

can’t weight bear

can’t flex 90 o

A
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14
Q

When?

A

Meniscus tear

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15
Q

sling for elbow fracture?

A

Broad arm sling,

and backslab up to the shoulder.

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16
Q

Clavicle management

A

Broad arm sling and let heal.

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17
Q

Hamstring injury management

A

crutches and refer to fracture clinic

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20
Q

Common cause of metatarsal fractures?

A

stress fractures; don’t need trauma history

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21
Q

Weber fractures

A
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22
Q
A

Battle’s sign, also mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma.

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23
Q

Otitis media bugs

A

haemophilus influenzae

streptococcus pneumoniae

moraxella catarrhalis

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24
Q
A

Jones fracture is a break between the base and middle part of the fifth metatarsal of the foot.

tx. cast, 6 weeks rest.

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25
Q
A

Stress fracture - metatarsals

Can occur from running or significant walking

can be hairline fracture with no displacement.

tx. review 7-10 days. analgesia and << activity. Possibly x-ray.

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26
Q

Management of Otitis media

A

analgesia. 80% improve spontaneously.

>48hrs require antibiotics

amoxiciliin/ clarithromycin

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27
Q
A

usually bilateral.

Refer to orthopaedics ; other injuries likely.

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28
Q

What is the cause of most URTI?

A

common cold virus

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29
Q

organism; bacterial tonsilitis

A

group A beta haemolytic streptococcus

‘Strep throat’

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30
Q
A

peri-orbital cellulitis

painful, unilateral red swollen eyelids

px often systemically unwell

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31
Q
A

Orbital cellulitis; an emergency and requires intravenous (IV) antibiotics.

In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye (proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision.

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32
Q

Why avoid amoxicilin with tonsillitis?

A

in case causative organism is Epstein-Barr virus (glandular fever); rash

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33
Q
A

Acute-angle closure glaucoma

acutely painful red eye.

Px usually > 60, other symptoms; headache, nausea, blurred vision and haloes around lights.

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34
Q
A

Giant cell arteritis

painless visual loss, px usually >60.

Scalp tenderness, jaw claudication, headache.

Blindness if not prompt treatment.

refer.

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37
Q
A

dentritic ulcer - not common

presents as red eye with FB sensation.

seen with fluoroscein , caused by herpes-simplex virus

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38
Q

sudden foot inversion can cause….

A

avulsion fracture of the base of the 5th metatarsal.

(tightening of peroneus brevis tendon)

tx. support bandage if can weight-bear

backslab is unable to weight-bear

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39
Q

hyphaema

A

Hyphaema

refer.

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40
Q
A

Dacryoadenitis

  • Swelling of the outer portion of the upper lid, with possible redness and tenderness
  • Pain in the area of swelling
  • Excess tearing or discharge
  • Swelling of lymph nodes in front of the ear

Common causes include mumps, Epstein-Barr virus, staphylococcus, and gonococcus.

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43
Q
A

It transmits the infraorbital artery and vein, and the infraorbital nerve, a branch of the maxillary nerve

Can be palpated during an examination.

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44
Q

Toes - x-ray or not?

A

If associated wound present, or injury is with the great toe.

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46
Q

Rhonchi

A

Continuous low pitched, rattling lung sounds that often resemble snoring.

Obstruction or secretions in larger airways.

Chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis.

Rhonchi usually clear after coughing.

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47
Q

Eye conditions not to miss

A
  • acute-angle closure glaucoma
  • peri-orbital cellulitis
  • giant cell arteritis
  • keratitis
  • uveitis
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48
Q

drainage of aqueous humour

A

Formed in the anterior portion of the ciliary process in the posterior chamber of the eye.

Drains into the scleral venous sinus (Schlemm’s canal)

Blockage = glaucoma

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51
Q

What can cause sudden loss of vision?

A

retinal detachment

central retinal artery occlusion

vitreous detachment/ haemorrhage

+ full neurological examination for cv event

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54
Q

Conjunctivitis characteristics

A
  • red, watery eye, often bilateral.
  • VA is usually normal.
  • bacterial or viral

Infectious, topical treatment,

NB> check for FB, abrasion before diagnosing conjunctivitis

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55
Q

allergic conjunctivitis

A

bilateral, often related to hay-fever.

Chemosis (oedema of the conjunctiva) is a classic sign.

tx. antihistamines

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57
Q
A

an injury to the spine in which the vertebral body is severely compressed.

  • severe trauma, such as a motor vehicle accident or a fall from a height.
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58
Q
A

Compression fracture.

collapse of a vertebra.

Trauma or a weakening of the vertebra (compare with burst fracture). This weakening is seen in patients with osteoporosis

Wedge deformities, with greater loss of height anteriorly than posteriorly

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59
Q
A

Vertical shearing

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60
Q
A

Anterior compression/ Open book

Look at SI joint and pubic symphysis

61
Q

management of corneal abrasion

A

remove FB with damp cotton bud/ bevel of needle (with slit lamp)

antibiotic ointment

review 2-3 if not improving.

62
Q
A

bilateral - basilar skull fracture

Bilateral hemorrhage occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses

65
Q
A
67
Q

Le Fort Fractures

A
68
Q

What passes through the optic canal?

A

optic nerve

ophthalmic artery

ophthalmic vein

69
Q

Which part of the orbit do the cranial nerves IV, III, VI pass?

A

Superior orbital fissure

71
Q

which extraoccular muscle attaches nasally?

A

Inferior Oblique

72
Q

What nerve supplies the lateral rectus muscle?

A

abducens (VI)

long nerve makes it prone to injury.

73
Q

foot bones 1

A
74
Q

Foot bones 2

A
75
Q

Foot bones 3

A
76
Q

Foot bones 4

A
77
Q

What is the anatomical signifiance of the central artery of the retina?

A

It runs WITHIN the optic nerve.

It’s an end artery, a branch of the ophthalmic artery.

79
Q

What’s a common symptom of a fractured orbit?

A

Diplopia

due to obstruction of rectus muscles, or suspensory ligament is not fixed.

81
Q

Two main types of conjunctiva based anatomically

A
  • palpebral conjunctiva lines the lids
  • bulbar conjunctiva is over the eyeball
82
Q

What’s the function of the choroid?

A

Dark pigmentation to prevent internal light reflection, supplies blood to the retina

83
Q

What can cause miosis?

NB> latency of pupillary responses increases with age

A

Light

opiates/ opioids

anti-hypertension medication

84
Q

What can cause mydriasis?

A

anticholinergic drugs

MDMA

cocaine

amphetamines

some hallucinogens

85
Q

What is the signifance of a lack of consensual pupillary response?

A
  • problem with motor connection
  • could be; oculomotor nerve or Edinger-Westphal nucleus
86
Q

What is Argyll Robertson (AR) pupil and what’s the most important cause (and very specific)?

A

bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light

Syphilis

+ diabetic neuropathy

87
Q

What drug can be used for emergency treatment of acute-angle closure glaucoma

A

pilocarpine

NB. causes miosis

92
Q

Cauda Equina - signs and symptoms

A
  • altered sensation perineal area, bowel/ urine/ sexual dysfunction
  • PR - loss of tone and sensation
94
Q

PPPP

stop bleeding

A

Pressure

Posture

Patient - time

Pray

95
Q

Signs/ symptoms of fractured zygomatic arch

A

swelling/ bruising - periorbital

pain, numbness, diplopia, reduced eye movements

altered pupillary reflexes, facial flattening/ symmetry

  • look at jaw from behind and put fingers on zygomatic arches. Compare for differences.
97
Q

White-Eyed Blowout

A

Greenstick fracture of the orbital floor or medial orbital wall resulting in ischemic entrapment of an extraocular muscle.

  • Typically children
  • Minimal external signs of trauma mask the severity of the orbital injury.

Commonly due to sports injuries.

99
Q

Signs/ symptoms fractured mandible

A

pain/ restricted movement

missing teeth, numbness, teeth not meeting properly

Sublingual haematoma; often indicative of fractures.

100
Q

General advice for facial fractures

A

no nose blowing

no sneezing

knocked out teeth; keep in saline or milk. 1-4 hour window to reimplant.

Bites; Augmentin antibiotic

101
Q

What is the most common cause of hypotension?

+ what drugs commonly cause hypotension

A

hypovolaemia

>>> diuretics

alpha/ beta blockers

102
Q

Common causes of hypotension (6)

A
  • sepsis
  • acidosis
  • medications
  • nitrates (GTN)
  • CCBs
  • many anaesthetic agents
103
Q

orthostatic hypotension values

A

20 mmHg drop of systolic pressure

20 beats per minute increase in HR

(remember two min delay between position changes)

108
Q

What is a Salter-Harris Fracture?

A

A fracture that involves the epiphyseal plate.

109
Q

What are the EM physiological side effects of NO insulin causing hypoglycaemia? (3)

A

>>> sugar in blood, none in cells.

Breakdown of fats and proteins; ketones and acidosis

leads to dehydration, Potassium loss and acidosis.

Dehydration because water follows excretion of sugar (osmotic diuresis)

110
Q

what could be triggers for hypoglycaemia attacks?

A

infections; UTI, pneumonia

physiological stressors including cold, status epilepticus.

111
Q

What is a big danger of px with long-standing diabetes and neuropathy?

A

MI or abdominal conditions such as infection or pancreatitis may be painless. Maybe osteomyelitis in the feet..

112
Q

Tests for diabetes

A

Blood glucose

urine or blood test for ketones

pH (venous fine)

113
Q

Symptoms of hypoglycaemia

A

confusion, sweating, fatigue and feeling dizzy.

maybe pale, weak, blurred vision, tachycardia, unconsciousness

114
Q

EM tx of hypoglycaemia

A

50ml of glucose 50% if IV access available.

otherwise 1 mg glucagon

(as PAs 10% glucose IV okay)

non-emergency; dextrose, then more complex carbohydrates.

115
Q

What is Kussmaul breathing?

A

Deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.

116
Q

What is diagnosis of DKA based on?

Diabetic ketoacidosis is a serious complication of Type I DM.

A

Diagnosis based on

diabetes (blood glucose >11 mmol/L)

ketones (urine or blood)

acidosis (pH <7.30 venous blood)

117
Q

Diagnositic symptoms of DKA?

A

polydipsia

weight loss

dehydration

+ Kussmaul breathing

118
Q

Tx for DKA

(Sickness and vomiting, abdominal pain, muscular weakness)

A

500ml then another 500ml then another 500ml (saline). MUST ensure patient is rehydrated before giving insulin. 0.1units per kilo per hour.

As sugar moves into cells (insulin taking effect) potassium follows therefore px becomes hypokalaemic. Normal potassium 3.5 to 5.

Watch urine output to check hydration.

Red flag; peds until 22-23 yr old. Can die from cerebral oedema; therefore don’t give insulin until properly hydrated.

119
Q

Why rehydrate gradually with DKA?

A

to avoid rapid intracellular osmotic/ sodium shifts that may cause fatal CNS oedema.

Remember: with DKA and polydipsia, rapid fluid shift from intracellular compartments.

120
Q

What factors cause cause a hypoglycaemic attack?

A

Too high a dose of medication (insulin or hypo causing tablets)

Delayed meals

Exercise

Alcohol

121
Q

What could blood clotting abnormalities and platelet consumption indicate with a septic px?

A

development of disseminated intravascular coagulation (DIC); clotting factors and platelets are consumed by clot formation in the peripheral circulation.

122
Q

Fluid challenge and central venous cannula/ measurement of CVP; what’s that about?

A

If CVP doesn’t rise or rises transiently and then falls, then px is ‘underfilled’.

123
Q

What could cefuroxime and clarithromycin possibly treat?

A

CAP

+ may need vasopressor drugs to produce peripheral vasoconstriction if px adequately filled (CVP monitoring). Renal output would be poor.

124
Q

symptoms of septic shock

A
  • warm peripherae, bounding pulse with low diastolic pressure, low JVP
  • pyrexia (or hypothermia)
  • history and signs of underlying infection
125
Q

Symptoms of hypovolaemic shock (this includes burns)

A
  • symptoms of fluid loss, eg. melaena, haematemesis
  • cold peripherae; weak, thready pulse, low JVP
  • skin pallor, dry mucous membranes
126
Q

symptoms of cardiogenic shock

A
  • chest pain, palpitations, history of IHD, AF
  • Cold sweaty peripherae; weak pulse, JVP raised, tachycardia
  • pulmonary oedema
127
Q

What’s the difference between hemiparesis and hemiplegia?

A

Hemiparesis ; unilateral weakness

Hemiplegia; complete loss of power on one side

128
Q

What is Todd’s paralysis?

A

A focal appendage transient weakness after a seizure.

It usually subsides completely within 48 hours.

Todd’s paresis may also affect speech, eye position (gaze), or vision.

NB> important to differentiate from ischaemic stroke because seizure is an exclusion criteria for thrombolysis.

129
Q

What % of px presenting to hospital with strokes, fulfill criteria for thrombolytic tx, and what is the drug?

A

2%

Actilyse; recombinant tissue plasminogen activator alteplase

130
Q

What is the risk of thrombolytic tx of ischaemic stroke?

And the incidence?

A

significant risk of primary intracerebral haemorrhage

1 in 30

131
Q

In the case of ischaemic stroke, what is the window for treatment?

A

3 hours from onset of symptoms.

(this includes getting a CT scan!)

132
Q

Thrombolysis; remember that…

A

lots of exclusion criteria!!!

Including:

  • seizures
  • px on warfarin
  • previous stroke within three month
  • BP >110 diastolic, > 185 systolic
  • hypoglycaemic/ hyperglycaemic
133
Q

Risk factors for CVD?

A

hypertension

hyperlipidaemia

diabetes mellitus

obesity

family history

smoking

134
Q

What are Charcot-Bouchard aneurysms?

A

Aneurysms in the small penetrating blood vessels of the brain.

They are associated with hypertension.

The common artery involved is the lenticulostriate branch of the middle cerebral artery.

135
Q

What are the following acronyms?

TACI

LACI

A

TACI: Total Anterior Circulation Infarction

LACI: Lacunar Infarction

136
Q

How effective is prophylaxic treatment of AF with warfarin in preventing strokes?

A

yearly risk of cerebral embolism reduced from 3% to 1%.

137
Q

Aspirin, stroke, no CT scan results. What’s the story?

A

No evidence that starting aspirin before CT findings are known adversely affects prognosis.

138
Q

When is a CT scan URGENT following a stroke?

A
  • if 3 hour window to start thrombolytics
  • evidence of head injury
  • severe headache at the time of onset of weakness
  • GCS score deteriorating
  • prior anticoagulation treatment
139
Q

Are px with carotid artery stenosis at risk of embolic stroke?

+ exclusions?

A

Yes, especially if stenosis 70-99% (very high risk). Also: is px well enough to receive tx?

Carotid stenosis diagnosis; doppler

Exclusions?

haemorrhagic strokes - TACI or POCI

140
Q

Stroke tx whilst awaiting CT scan results

A

Px NBM

Nasogastric tube, IV fluids

Oxygen mask, monitor cardiac rhythm (digoxin if needed)

Possibly catheter to monitor output

Aspirin 75mg

Statins (low dose) even if lipid levels normal

TED (thromboembolic disease) stockings

141
Q

Why don’t you treat HT immediately following a stroke?

A
  1. cerebral autoregulation of blood flow is disturbed and therefore risk of hypoperfusion.
  2. Watershed infarction; there can be an extension of the stroke due to reduced blood supply around area of infarction.

NB. continue with regular BP meds if taken previously.

142
Q

High BP two weeks after stroke. Which meds?

A

ACE inhibitors (perindopril - take at bedtime because can become dizzy)

thiazide diuretics

Emergency Medicine (1 decks)

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