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Year 5 Acute Care & Trauma > MedEd > Flashcards

MedEd Flashcards

1
Q 
A 26 year old unconscious man is brought into A&E having been found lying alone on the street with needles next to him. The patient’s GCS = 11, RR = 10, BP = 97/65 mmHg and has pinpoint pupils. This patient likely has:
Alcohol toxicity
Aspirin overdose
Opiate overdose
Paracetamol overdose
Warfarin toxicity
A

Opiate overdose

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2
Q 
A 26 year old unconscious man is brought into A&E having been found lying alone on the street with needles next to him. The patient’s GCS = 11, RR = 10, BP = 97/65 mmHg and has pinpoint pupils. The most appropriate treatment is:
IV naltrexone
IV naloxone
Mechanical Ventilation
IV N-Acetyl-Cysteine
IV Sodium Bicarbonate
A

IV naloxone

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3
Q

A 25 year old man is rushed to A&E after presenting with vomiting, hyperventilation and ringing in his ears. ABG shows a respiratory alkalosis.
The most likely cause of his presentation is:
Alcohol toxicity
Aspirin Overdose
Opiate Overdose
Paracetamol Overdose
Warfarin toxicity

A

Aspirin Overdose

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4
Q

what are different types of opiates

A

heroin
morphine
codeine

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5
Q

what are risk factors for opiate overdose

A

IVDU

patients in chronic pain

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6
Q

what is the triad of features in opiate overdose

A 
CNS depression (coma)
Respiratory depression
Pinpoint pupils
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7
Q

what might patients with opiate overdose have (to do with bowel movements)

A

constipation

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8
Q

what is used for investigation and management of opiate overdose

A

IV naloxone

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9
Q

what are associations or risk factors for aspirin overdose

A

suicide attempts

accidents in children

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10
Q

what are features of aspirin overdose

A

hyperventilaiton
tinnitus
vomiting
sweating

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11
Q

what are investigations for aspirin overdose

A

salicyclate levels
ABG
-respiratory alkalosis (early due to hyperventilation)
-metabolic acidosis (late)

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12
Q

what are associations or risk factors with paracetamol overdose

A

chronic alcohol use (enzyme inducer)

intentional self harm

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13
Q

what are features of paracetamol overdose

A

asymptomatic - 1st 24hrs
then acute liver failure
-abdominal pain, vomiting, confusion (encephalopathy)

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14
Q

what investigations are completed in paracetamol overdose

A

paracetamol levels at 4hours post ingestion

ABG for acidosis

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15
Q

when are paracetamol levels at their highest in the plasma

A

4hours post ingestion

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16
Q

what is the management for paracetamol overdose

A

IV N-acetyl cysteine

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17
Q

what are features of digoxin overdose

A

xanthopsia (yellow-green halos)
arrhythmias
hypokalaemia
N+V

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18
Q

what are features of iron overdose

A

D+V
liver failure
drowsiness + coma

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19
Q

what can causes of hyponatraemia be split into

A

hypovolaemia
euvolaemia
hypervolaemia

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20
Q

what are hypovolaemic causes of hyponatraemia

A
  • D+V

- diuretics

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21
Q

what are euvolaemic causes of hyponatraemia

A
  • hypothyroidism
  • adrenal insufficiency
  • SIADH
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22
Q

what are hypervolaemic causes of hyponatraemia

A
  • HF
  • cirrhosis
  • nephrotic syndrome
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23
Q

how is hyponatraemia caused by diuretics investigated

A

measure low urine sodium

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24
Q

what is the first line investigation for hyponatraemia

A

short synacthen test

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25
Q

what is the management for hypovolaemic hyponatraemia

A

volume replacement with 0.9% saline

stop diuretics

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26
Q

what is the management for euvolaemic hyponatramia

A

fluid restriction

treat cause

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27
Q

what is the management for hypervolaemic hyponatraemia

A

fluid restriction

treat cause

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28
Q

what cancer can cause SIADH

A

small cell lung cancer

29
Q

what infection can cause small cell lung cancer

A

pneumonia

30
Q

what is the presentation of SIADH

A

confusion, lethargy, N+V, muscle weakness

31
Q

what is the first line management for SIADH

A

fluid restriction

32
Q

what is the management for SIADH

A 
1 fluid restriction
2 demeclocycline (DMCT)
-for ADH resistance
3 tolvaptan
-V2 receptor antagonist
33
Q

what is given in severe cases of SIADH (low GCS and seizures)

A

hypertonic 3% saline

34
Q

what is a serious complication of SIADH

A

central pontine myelinolysis

35
Q

what is central pontine myelinolysis

A

osmotic demyelination

36
Q

how does central pontine myelinolysis occur

A

rapid correction of serum Na which leads to seizures and coma

37
Q

what can causes of hypernatraemia be split into

A

hypovolaemia

euvolaemia

38
Q

what are hypovolaemic causes of hypernatraemia

A

Losses

  • GI losses (D+V)
  • Skin losses (burns, sweating)
  • Renal losses (osmotic diuresis with hyperglycaemia)
39
Q

what are euvolaemic causes of hypernatraemia

A

inability to access water (elderly)

DI (cranial or nephrogenic)

40
Q

what investigations are competed for DI

A 
1 glucose (exclude DM)
2 high plasma (concentrated) and low urine osmolality (dilute)
41
Q

how does DI respond to the water deprivation test

A

urine osmolality does not increase (become more concentrated)

42
Q

what is the management for DI

A

fluid replacement

  • correct water deficit with 5% dextrose
  • correct fluid volume depletion (hypovolaemia) with 0,9% saline
43
Q

what might persistant diarrhoea in the question indicate

A

dehydration

44
Q

what are causes of hypokalaemia

A 
GI - vomiting
Renal
-diuretics
-primary hyperaldosteronism
Redistribution into cells
-Salbutamol
-Alkalosis
45
Q

what is primary hyperaldosteronism

A

conns syndrome

46
Q

what are features of hypokalaemia

A

muscle weakness
arrhythmias
polyuria

47
Q

why does alkalosis cause hypokalaemia

A

potassium moves into cells in an attempt to displace H+ cells out of cells to normalise pH

48
Q

what happens to the aldosterone: renin ratio in conns

A

it is increased (higher levels of aldosterone in conns)

49
Q

what happens to levels of Na and K in conns syndrome

A

low K and high Na

50
Q

what happens to levels of Na and K in addisons disease

A

high K and low Na

51
Q

what is the treatment for hypokalaemia

A

treat cause
if K between 3-3.5 give oral potassium chloride
if K below 3 give IV potassium chloride

52
Q

what is addisons disease

A

low aldosterone

53
Q

what are causes of hyperkalaemia

A

addisons disease (low aldosterone)
drugs (ACEi, ARBs, spironolactone)
renal impairment

54
Q

when is K released from cells in huge amounts

A

rhabodomyolysis

acidosis

55
Q

what is the management for hyperkalaemia

A

10ml 10% calcium gluconate (cardioprotective)
50ml 50% dextrose + 10units of insulin
nebulised salbutamol
treat cause

56
Q

what are causes of hypocalcaemia

A 
1 renal failure
2 vit D deficiency
-lack of sunlight
-malabsorption (IBD)
3 low PTH
57
Q

what syndrome causes low PTH

A

di-george syndrome

58
Q

how does hypocalcaemia present

A 
1 neruomuscular excitability
-trousseau's sign
-chvostek's sign
2 convulsions
3 paraesthesia
59
Q

what is seen on ECG with hypocalcaemia

A

arrhythmias + prolonged QT interval

60
Q

what investigations should be completed for hypocalcaemia

A

1 bloods

  • Ca first
  • PTH
  • Vit D, ALP
61
Q

what is the management for hypocalcaemia

A

calcium and Vit D replacement

62
Q

what causes hypercalcaemia

A

1 PTH suppression

  • malignancy
  • sarcoidosis
63
Q

what malignancies commonly suppress PTH and cause hypercalcaemia

A

multiple myeloma
bone mets
squamous cell lung cancer (PTHrP)

64
Q

what does sarcoidosis do to PTH

A

suppresses it and causes hypercalcaemia

65
Q

when is PTH not suppressed in hypercalcaemia

A

with primary or tertiary hyperparathyroidism

66
Q

how does hypercalcaemia present

A

bones, stones, abdominal groans and psychiatric mones

polyuria and polydipsia
constipation, pain (renal stones)
depression + confusion

67
Q

what are the investigations for hypercalcaemia

A

1 bloods

  • Ca (first line)
  • PTH
68
Q

what is the management for hypercalcaemia

A

IV saline rehydration

69
Q

what is the management for hypercalcaemia caused by malignancy

A

IV saline rehydration and biphosphonates (pamidronate)

Year 5 Acute Care & Trauma (35 decks)

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