Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FACEM > Medicine > Flashcards

Medicine Flashcards

1
Q

Indications and relative indications for NIV

A

Indications:
Respiratory failure APO, COPD

Relative:
Asthma
ARDD
Pneumonia
Children
Pre-oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Physiological benefits of BiPAP in COPD

A

Reduces WOB
increases end inspiratory volume
EPAP prevents atelectasis
Improved CO2 elimination
Closed circuit (consistent FiO2)
Allows spontaneous ventilation
Alerts available

In COPD, reduces death, LOS & intubations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Advantages and disadvantages of NIV in asthma

A

Adv:
Extrinsic PEEP reduces WOB
IPAP improves TV
Reduce intubations (allow drugs to work)

Disadv:
Delay intubation (further deterioration)
Increased WOB if inappropriate settings
Barotrauma (pneumothorax)
Difficult to clear secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What constitutes massive PE

A

Sustained SBP <90
Requiring inotropes
Pulseless
Unstable sustained bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Thrombolysis in PE

A

Alteplase 1.5mg/kg (10mg over 2 minutes then rest over 2 hours)

50mg bolus if arrested

UFH 80u/kg load IV then IV 18u/kg/hr adjusted to aPTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ECG changes in PE suggestive of RV strain

A

RAD
RBBB
S1Q3T3
Non-specific ST changes
Dominant R wave in early precordial leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ECHO changes in PE

A

RV dilation (bigger than LV in apical view)
Dilated non-collapsing IVC
RV wall hypokinesis
McConnell sign (apex spared)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CXR changes in PE

A

Cardiomegaly
Elevated hemi diaphragm
Wedge infarct
Westermark sign (oligaemia)
Hamptons Hump (domed pleural opacity)
Fliesher sign (prominent PA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnosing exudate on pleural tap

A

Pleural protein:serum >0.5
Pleural LDH:serum >0.6
Pleural LDH >2/3 normal limit
Total protein >30g
pH <7.35

If pH <7.2 implies empyema and needs complete drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pleural exudate vs transudate causes

A

Exudate:
Cancer
Empyema
Para-pneumonic
RA/SLE
Haemothorax / Chylo

Transudate:
Failures
Meig syndrome
Sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RF for re-expansion pulmonary oedema

A

Young <30
Collapse >1 week
>3L pleural fluid
Suction use
Rapid drainage (1.5L/hr)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

2 pneumonia scoring systems

A

CORB (more specific)
Confusion
O2 <90%
RR >30
BP <90

SMART-COP (more sensitive)
SBP <90
Multilobar
Alb <35
RR 30 (25 if over 50yrs)
Tachycardia 125bpm
Confusion
O2 <90% (93% if over 50yrs)
pH <7.35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Distinguish mild, moderate and severe non-proliferative DM retinopathy

A

Mild: some micro-aneurysms

Mod:
<20 micro-aneurysms
Hard exudates
Cotton wool spots
Venous beading

Severe:
Micro-aneurysms in all 4 quadrants
Venous beading in 2 quadrants
AVM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why pregnancy increased RF for DKA

A

Vomiting and nausea
Baseline metabolic alkalosis
Lower fasting BSL (relative reduced insulin)
Higher glucagon levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Skin changes with DM

A

Necrobiosis lipoidica (yellow with red border)
Acrochordans (skin tags)
Carotenoderma (yellow deposits hands)
Scleroderma Adultorum (thick skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnostic criteria for HHS

A

BSL >30 with ketones <3
Dehydration
Osmolality >320

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management HHS

A

NSaline 1L/hr and adjust
Aiming fall BSL <5 per hour
Replace 50% losses in 12 hours (200ml/kg)
If Na rising greater than 2.5 per 5.5 BSL, increase fluids
0.45% saline if BSL or osmolality not falling
VTE prophylaxis
Insulin 0.05units per kg only if raised ketones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T1DM diagnostic bloods

A

Insulin antibody
GAD antibody
Islet cell antibody
Fasting C-peptide
TFT
Coeliac screen
ZnT8 antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk factors for cerebral oedema in DKA

A

<5 years
Long standing poor control
First presentation
Received sodium bicarbonate

Tx:
Head up
Reduce fluids by 1/3
Empirical mannitol 1g/kg (0.5g/kg kids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What classifies severe DKA

A

GCS <12
Ketones >6
Unstable
Bicarb <5
Hypokalaemic to start
pH <7
RAGMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Insulin in DKA & target

A

0.1u/kg/hr actrapid
(Increase in ketones not clearing 0.5 per hour)

Lantus 0.25units/kg daily (or regular)

Half insulin regime if under 5yrs, hospital transfer or starting BSL <15

When BSL <14, 10% dextrose 8hrly

22
Q

Thyroid storm treatment

A

Cooling, paracetamol
Empirical antibiotics
Propanolol 40-80mg PO QID
(IV version esmolol or metoprolol)
Propylthiouracil 200mg QID PO/NG/PR
(Can give carbimazole 20mg TDS)
Hydrocortisone 100mg TDS
Lugol’s iodine 0.5mls TDS (1hour after drugs)
Early ICU & Endocrine involvement

23
Q

Myoedema crisis symptoms

A

Menorrhoea
Drowsy
Reduced RR
Fluid overload (pericardial effusion, ascites, pleural effusion, hyponatraemia, hypoglycaemia)

24
Q

Myxoedema crisis management

A

Delirium work up
Consider IV antibiotics
Hydrocortisone IV
Replace electrolytes (BSL)
Levothyroxine 500mcg PO then 100mcg OD
IV liothyronine 20mcg BD

25
Q

NINDS stroke study 1995

A

Alteplase versus placebo
300 patients each arm
No blinding (less severe in tPA group)
No difference in mortality (3%)
13% improved disability
6% ICH vs 0.6% in placebo (1/2 died)
Led to FDA approval of Alteplase
In study given <3hrs from onset

26
Q

ECASS III 2008 Stroke Study

A

Alteplase vs placebo 3-4.5hrs
Placebo group worse stroke
Modified Rankin score 0-1 as endpoint
2-6 all grouped together
Showed improvement with Alteplase
Again high bleeding
No mortality difference
If endpoint was 0-2 & 3-6: no difference

27
Q

IST3 Stroke Study 2012

A

Alteplase up to 6hr vs placebo
Poorly done study
No blinding and no significant results
No change in disability or mortality

28
Q

When to consider decompressive craniectomy in ischaemia stroke

A

Young
Reduced GCS
Raised ICP
Centre with no stroke/Thrombolysis facilities
Within 48hrs stroke onset
Malignant MCA infarct (>50%)

29
Q

Reversing Thrombolysis
And other anticoagulants and anti platelets used in STEMI

A

Alteplase reversal:
FFP 2 units Q6h for 24 hours
Cryoprecipitate 10 units
Tranexamic acid 1g
Consider aminocaproic acid

Anti-platelets:
1 bag of platelets (4 pools/bag)
DDAVP 0.3microg/kg

Heparin:
1mg protamine for 100u UFH in last 4hrs
1mg protamine for 1mg enoxaparin in last 8hrs
Half dose if >1hr since last UFH
1/4 dose if >2hr since last UFH
Given slowly 5mg/min max (usually 50mg)

If ICH, above plus usual ICH management:
Raised head 30 degrees
BP control SBP <160; MAP <110
Neurosurgery / palliative services

30
Q

Acute transfusion reaction immediate management

A

Stop transfusion
Give fluid bolus via another IVC
Don’t flush line used for transfusion
Check blood and patient details
Contact pathology and send blood, line, new group and hold to them

31
Q

Informing patient after wrong transfusion / scan

A

Apologise
Open disclosure
Opportunity for patients to relate concerns, experience, adverse effects
Discussion of potential consequences
Explain further steps going to be taken to investigate and prevent in future

32
Q

Use of USS in hypotension
(5 different)

A

Lung: pneumothorax
TTE: pericardial effusion, LV fxn
FAST: haemoperitoneum
AAA
Proximal LL Veins for DVT

33
Q

Roper-Hall classification for chemical injury to eye (3 examination findings for severity)

A

Visual acuity
Degree of kimball ischaemia
Degree of corneal opacity

34
Q

Petechiae/Purpura rash divided into:
Sick: palpable and non-palpable
Well: palpable and non-palpable

A

Febrile/Sick
Palpable - meningococcal, IE, RMSF, HSP
Non-palpable: TTP, DIC, HUS

Well:
Palpable: autoimmune vasculitis
Non-palpable: ITP

35
Q

Vesicles/Bullae
Sick: diffuse vs local
Well: diffuse vs local

A

Sick:
Diffuse: varicella, disseminated gonococcal
Local: Nec Fasc, HF&M

Well:
Diffuse: pemphigoid disease
Local: Zoster, contact dermatitis, dyshidrotic eczema (bubbles on hands)

36
Q

Complications of GCA

A

CVA
Aortic aneurysm
Limb ischaemia
Cognitive impairment
Scalp necrosis
Ischaemic Optic Neuropathy

37
Q

Erythema Nodosum causes and investigations

A

IBD, TB, Sarcoidosis, Pregnancy, OCP, Lymphoma, Salmonella, Strep infections

Ix:
ASOT, Quantiferon, stool M,C&S, blood film, BHCG, CXR (sarcoid/TB)

38
Q

5 drug rashes

A

Fixed drug reaction
Urticaria
Acute generalised exanthematous pustulosis
DRESS (eosinophilia, liver, LN, mouth, renal)
EM/TEN/SJS

39
Q

Drugs worst for drug skin reactions

A

Anticonvulsants (phenytoin)
Antibiotics
Allopurinol
NSAIDS

40
Q

Difference in EM/SJS/TEN and causes

A

EM major (mucosa)
SJS (2 mucosa and <10%)
TEN (2 mucosa and >30%)

Causes:
Mycoplasma
HSV
Lymphoma
Drugs (anticonvulsants, allopurinol, antibiotics, NSAIDS)

41
Q

Scorten Criteria

A

SCUBA 10

Sugar >14
Cancer
Urea >10
Bicarb <20
Age >40

10% BSA at Day 1
HR >120

42
Q

Dental Fracture Classification

A

Ellis
1: Enamel (white, not sensitive)
2: + dentin (yellow & sensitive)
3: + pulp (red dot, blood, pain)
4: devitalized (no sensation)
5: Tooth fell out

Pulp involved: GIC to area

43
Q

Rash and painful joint

A

Gonococcal
Viral (HIV)
Leukaemia
Psoriasis
Sarcoid
SLE
Vasculitis
Serum sickness (antivenom)

44
Q

Gout vs Pseudogout

A

Gout:
Needle, negative birefringent
Monosodium urate
Raised uric acid
Acute (hours)
Tophi and soft tissue involvement
Assoc with thiazides and aspirin

Pseudogout:
Rhomboid, positive birefringent
CPP (calcium pyrophosphate)
Normal uric acid
Subacute (days)
Usually knee and wrist (no tophi/ST)
Assoc with loop diuretics & bisphosphonates

45
Q

GCA

A

50:
Over 50 years
ESR >50
50% have PMR

PMR symptoms (weight loss, neck and shoulder pain), limb ischaemia, valvular disease on top of usual shit

Methylpred if eyes (15mg/kg) max 1g
Aspirin 100mg daily

46
Q

Takayuso

A

F:
< 40
Fainting with Flu
Female (Asian)

Similar symptoms to dissection

47
Q

HSP
Dx
Severe factors (admit)
Complications
Investigations
Tx

A

Rash and 1 of:
Arthralgia (migratory poly)
Nephritis
Abdominal pain

Usually recent viral, GAS or gastro

Severe: can’t walk, HTN, Neuro/Pulm, abdominal (intussusception/perf/testicle), urine PCR abnormal

Note can also get oedema

Complications:
HTN
Renal failure (nephrotic syndrome)
Intussusception / Perforation
Orchitis

Ix: BP, urine blood and protein, U&E, LFT (albumin), cultures if unclear, abdominal imaging, ASOT

Tx: NSAIDS in mild, steroids severe
(Helps pain but not complications)

Follow-up GP:
Weekly for 1 month
Fortnightly 1-3 months
Then at 6 and 12 months

48
Q

Triad of Behçet’s disease

A

Ocular lesions
Genital lesions
Aphthous mouth ulcers

49
Q

Complications of RA

A

Felty syndrome (splenomegaly)
Accelerated atherosclerosis
Iritis/Scleritis
Pericardial & Pleural effusions
Immunosuppression from meds

50
Q

Reye’s syndrome and stages

A

Aspirin in viral illness
Liver and brain

1: palmar erythema, GI, confusion
2: drowsy, hyperventilate
3: coma, cerebral oedema
4: fixed dilated pupils
5: seizures, MOF, high ammonia

Think of alcoholic for stages

FACEM (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions