EOPW 1 Cohort 2019 (Jan 2013)

Question 1

1) What kind of Cox- Inhibitor is Diclofenac (NSAID)?
2) What synergistic effect does diclofenac (NSAID) have with anticoagulants like warfarin?

Answer 1

1) Selective Cox-2 inhibitor
2) They have synergistic effect on bleeding and pose a high risk for bleeding tendencies

Question 2

1) What are the lab results of someone with rhabdomyolysis? (high/normal/low)
- HCT
- Cr
- Urea
- CK
-LDH
- Urine specific gravity
- Blood in urine?
- Protein in urine?
2) What can cause rhabdomyolysis? (9)

Answer 2

1) - Normal HCT
- High creatinine
- High urea
- High creatinine kinase
- High Lactate dehydrogenase
- Urine specific gravity normal
- Blood in urine present
- Protein in urine present

2) Crush injury
exertion or prolonged bed rest
Toxins- alcohol
Muscle ischemia
Drugs
Infections
Electrolyte abnormalities
Muscular genetic disorders
Neuroleptic Malignant Syndrome (NMS)

Question 3

1) Termite poison is an organophosphate
What symptoms (3) would one present with after ingestion?
2) Vital signs of someone with organophosphate poisoning?
BP (elevated/low/normal)
RR (elevated/low/normal)
HR (elevated/low/normal)
SpO2 (elevated/low/normal)

3) What is the antidote for organophosphate poisoning?

Answer 3

Ingestion would cause organophosphate poisoning.
1) - Sweating
- Nausea
- Vomiting

2)BP (elevated/low/normal)
RR (elevated/low/normal)
HR (elevated/low/normal)
SpO2 (elevated/low/normal)

3) Atropine

Question 4

1) What is HACE?
2) Pathophysiology of HACE? (3)
3) Best prophylaxis against HACE?
4) What is the type of medication answered in Q3

Answer 4

1) High altitude Cerebral Edema
2) - Hypoxia
- elicits neurohumoral and hemodynamic responses(brain)
- results in capillary leakage from microvascular beds –> edema
3) Acetazolamide
4) Acetazolamide is a carbonic anhydrase inhibitor that has significant diuretic effects

Question 5

1) Atrial fibrillation can cause thrombosis.
Patient presenting with:
Generalized abdominal pain
PS 10/10
Centrally located, no radiation

U/L:
AF
HPTN

What is the Dx.?
What is SMA arterial supply?

Answer 5

Dx.: Superior Mesenteric Artery thrombosis
- SMA supplies blood to the ascending colon and small intestine

Question 6

What is stable SVT’s immediate management and then the following? (2)

Answer 6

1) Vagal maneuvres:
- Carotid sinus massage 10 secs
- Blow through closed nose
- Put ice pack on the forehead
2) 6mg Adenosine & 20CC saline
If have asthma, change to Verapamil.
IF 1st dose fail–> 12 mg adenosine (2nd dose)
IF 2nd dose fail –> 12 mg adenosine (3rd dose)

Question 7

1) What is Charcot’s triad? –> Cholangitis (3)

Answer 7

1) - Fever
- Jaundice
- Abdominal pain (right hypochondriac)

Question 8

1) Normal ABG readings range?
pH:
PaO2:
PaCO2:
HCO3:

2) What type of respiratory failure is seen in COPD?

3) What is the target of the following for people with COPD?
SpO2:
PaO2:

4) What oxygen supplementation device is best for COPD with risk of hypercarbia?

5) Why cannot give full oxygen (100%) to patients with COPD? (5)

Answer 8

1) pH: 7.35-7.45
PaO2: >90 mmHg
PaCO2: 35-45 mmHg
HCO3: 18-24 mEq/L

2) Type II respiratory failure AKA hypercapnic respiratory failure

3) SpO2: 88-92%
PaO2: 60-70 mmHg

4) Venturi mask –> it can give a fixed FiO2

5)
- It will remove patient’s hypoxic respiratory drive
- causing hypoventilation which causes
- higher CO2 retention
- apnea
- Finally: respiratory failure

Question 9

1) Best analgesia to treat testicular torsion pain of patients in ED?

2) Testicular torsion presentation?`(3)

3) What is the cremasteric reflex? (2)
AND it targets which nerve?

Answer 9

1) Morphine

2) Symptoms:-
- Acute Severe pain
- Swollen testicle
- Absent cremasteric reflex

3) - testis go up when
- ipsilateral medial thigh is stimulated downwards in a stroking manner
- targets genitofemoral nerve (L1-L2)

Question 10

1) Anaphylaxis typical presentation?

2) Immediate management if anaphylactic shock?

Answer 10

1)
- SOB
- generalized itchiness
- Periorbital and perioral swelling
- Urticarial rash
- Hypotension
- Hypoxia
- Elevated respiratory rate
- Lung compromise: Rhonchi

2) IM adrenaline

Question 11

1) What first line modality of oxygen supplementation is best for those with Covid?

2) If a patient has a comorbid (like hypoxic respiratory failure, etc.) What oxygen modality is best for Covid?

Answer 11

1) High Flow Nasal Cannula (HFNC)

2) Non-invasive ventilation

Question 12

1) Typical presentation of aortic dissection?

2) Immediate management with which drug to control BP of someone with Aortic Dissection?

Answer 12

1) - Tearing chest pain
- Radiating to the back

2) Labetolol

Question 13

Paracetamol poisoning treatment?

Answer 13

IV NAC (Intravenous N-acetylcysteine

Question 14

What investigation should be done prior to administration of antivenom in a patient with snake poisoning?

Answer 14

Coagulation profile
(Venom cause coagulopathy and this is how patient usually dies)

Question 15

12 month old with:
- vomiting
- inconsolable cry
- stool reddish mucus
- Palpable sausage mass on abdomen

Diagnosis?

Answer 15

Intussusception

Question 16

1) Epiglottitis in children presentation? (7)

2) Management of epiglottitis with impending complete airway obstruction?

Answer 16

1) Epiglottitis:
- Fever
- Reduced appetite
- Respiratory distress
- Anxiety
- Tripod/sniffing posture (trunk leaning forward, neck hyperextended, chin thrust forward)
- Drooling
- Stridor

2) Securing the airway: Endotracheal intubation

Question 17

Hypoglycemia management?

Answer 17

IV Dextrose

Question 18

Headache: unilateral, severe, thunderclap sound.

Diagnosis?

Answer 18

Subarachnoid Hemorrhage

Question 19

1) What does it mean when radial pulse disappears on inspiration?

2) What does it mean when there is alternating QRS complexes?

3) What is treatment of pericardial effusion and cardiac tamponade? (1)

Answer 19

1) Pulsus paradoxus caused by cardiac tamponade

2) Electrical alternans seen in pericardial effusion

3) Pericardiocentesis

Question 20

First line and second line Rx. (if first is not effective) of external hemorrhage?

Answer 20

First line: Direct manual pressure
Second line: Tourniquet

Question 21

What drug is given during intubation to obtund the sympathetic effect of the airway?

Answer 21

Fentanyl

Question 22

What is the advantage of enteral (through gut) route?

Answer 22

• Reduce gastric emptying
• Reduces bacterial translocation
• Prevent villous atrophy
• Increases gastric secretion
• Increase intestine peristalsis

Question 23

Prophylactic platelet transfusions are given in dengue fever with thrombocytopenia to prevent hemorrhagic complications.

1) At what platelet count to give prophylactic platelet transfusion? (low/Moderate/Severe)

2) What is range for Low risk/ Moderate risk/ High risk?

3) When to transfuse whole blood in dengue fever? (3)

Answer 23

1)
Low: No need to give platelet transfusion

Moderate: Transfuse platelet if there is hemorrhagic symptoms

High: Transfuse immediately

2)
Low: 40,000-100,00
Moderate: 20,000-40,000
High: <20,000

3)
When there is visual bleeding,
Dropping HCT
Dropping/Low Hb