Enhanced learning conditions

Question 1

how does aortic dissection present

Answer 1

severe ripping / tearing pain
intrascapular pain
syncope

Question 2

what is the management principles for aortic dissection

Answer 2

oxygen
ALS
haemodynamic support

Question 3

what investigations are diagnostic

Answer 3

CT
MRI
TOE

Question 4

how is aortic dissection managed

Answer 4

1. ascending aorta
urgent surgical repair
2. descending aorta 
beta blockade / medical management
life long surveillance with regular imaging

Question 5

what investigations are useful for management

Answer 5

ECG
CxR
cardiac enzymes
CTPA
U+E / LFT
lactate
FBC

Question 6

what is medical management for aortic dissection

Answer 6

beta blockade
opioid analgesia
vasodilators

Question 7

what are the symptoms of pericarditis

Answer 7

severe retrosternal chest pain

worse with inspiration + supine position

Question 8

examination findings in pericarditis

Answer 8

pericardial friction rub

low grade fever

Question 9

what are diagnostic signs for pericarditis

Answer 9

diffuse ST elevations

small pericardial effusions on echo

Question 10

what is the treatment for pericarditis

Answer 10

treat underlying systemtic disorder
NSAIDs + colchicine
pericardiocentesis

Question 11

what investigations for pericarditis

Answer 11

ECG
troponin
pericardial fluid culture

Question 12

symptoms of pneumothorax

Answer 12

dyspnoea

chest pain

Question 13

symptoms of tension pneumothorax

Answer 13

rapid laboured respirations
cyanosis
profuse diaphoresis
tachycardia

Question 14

what is first line treatment for pneumothorax

Answer 14

observation with supplemental oxygen therapy

Question 15

what is the next step in treatment for pneumothorax

Answer 15

percutaneous aspiration
chest drain
suction

Question 16

examination findings in pneumothorax

Answer 16

hyperexpand ipsilateral hemithorax
hyper-reasonant
absent / diminsihed breath sounds

Question 17

investigations for pneumothorax

Answer 17

CxR

Question 18

what is the management for tension pneumothorax

Answer 18

immediate needle decompression
- 14G IV cathether mid calvicular line 2/3rd intercostal space
oxygen therapy
tube thoracostomy

Question 19

what are 3 key symptoms + signs of opiate overdose

Answer 19

respiratory depression
miosis
apnoea

Question 20

what is initial treatment for opiate overdose

Answer 20

adequate ventilation
naxloxone
monitor for re-sedation and repear antidote dose

Question 21

investigations for opioid overdose

Answer 21

trial of naloxone - reverse of symptoms
ECG
opioid urine screen

Question 22

what are markers for suspected TCA overdose

Answer 22

hx of sucidide
sudden deterioration in mental status + vital signs
hypotension
tachycardia

Question 23

how is TCA overdose diagnosis made

Answer 23

clinical history

ECG changes - sinus tachy moving to wide complex tachycardia

Question 24

what are the symptoms of TCA overdose

Answer 24

tachycardia
hypotension
mydriasis
warm + flsuhed 
urinary retention
decreased bowel sounds

Question 25

what invesitgations for TCA overdose

Answer 25

ECG sodium bicarbonate trial- narrows QRS ABG-metabolic acidosis

Question 26

what is the management for TCA overdose

Answer 26

supporttive care GI decontamination sodium bicarbonate bolus

Question 27

signs + symptoms of TIA

Answer 27

focal neurological deficit sudden onset + brief symptoms resolve < 48hrs

Question 28

risk factors for TIA/stroke

Answer 28

AF / valvular disease / carotid stenosis / CHF / HTN

Question 29

what are the investigations for TIA

Answer 29

``` Blood glucose FBC prothrombin time / INR / PTT ECG brain MRI with diffussion CT head ```

Question 30

what is the management for TIA

Answer 30

antiplatelet therapy statin life style modifications carotid endarterectomy

Question 31

what the the class 4 symptoms of stroke

Answer 31

visual field deficit weakness aphasia impaired co-ordination

Question 32

what are the main investigations for stroke

Answer 32

``` CT head glucose electrolytes U+E cardiac enzymes ECG FBC ```

Question 33

what is treatment of stroke <4.5 hours of onset

Answer 33

``` altephase aspirin endovascular intervention supportive care swallowing asssessment VTE prophylaxis + ealry mobilisation ```

Question 34

what is the management of stroke > 4.5 hrs

Answer 34

aspirin 300mg supportive care swallowing asssessment VTE prophylaxis

Question 35

what are the features of moderate acute asthma

Answer 35

increasing symptoms PEF - 50-75% best no features of acute severe

Question 36

what are features of acute severe asthma

Answer 36

PEF 33-50% RR > 25 HR > 110 inability to complete sentences in one breath

Question 37

what are features of life-threatening asthma

Answer 37

``` PEF < 33 Sp02 < 92 Pa02 < 8kPa normal PaC02 silient chest cyanosis poor resp effort arrhythmia exhaustion hypotension ```

Question 38

what is the management of an acute asthma attack

Answer 38

``` Oxygen - keep sats 94-98 nebulised B2 agonist driven by oxygen add ipratropium bromide Steroids -continue pred 40 for atleast 5 days after nebulised magnesium sulphate refferal to ITU ```

Question 39

when should patients be referred to intensive care

Answer 39

require ventilatory support deteriorating PEF worsening hypoxia hypercapnia