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1
Q

Hypothermia ECG

A

ST elevation
J waves (Osborn waves)
*rapid rewarming can lead to shock

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2
Q

Complication of NIV e.g CPAP

A

Pneumothorax

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3
Q

Which drugs to stop during AKI

A

DAMN drugs
- Diuretics
- ACEi and ARBs
- Aminoglycosides e.g. gentamicin
- Metformin
- NSAIDs (apart from low dose aspirin)

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4
Q

pH change in salicylate poisoning (early and late)

A
  • Early: stimulation of respiratory centre, respiratory alkalosis (blowing off CO2)
  • Late: metabolic acidosis
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5
Q

Features of salicylate poisoning

A
  • Tachypnoea (raised RR)
  • Tinnitus
  • Pyrexia
  • NV
  • Seizure and coma
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6
Q

Salicylate poisoning mx

A
  • Activated charcoal (< 1 hr)
  • IV sodium bicarbonate
  • Haemodialysis §
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7
Q

ECG in PE

A
  1. Sinus tachycardia
  2. S1Q3T3
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8
Q

Indications for RRT (dialysis)

A

AEIOU

  • Acidosis (refractory)
  • Electrolytes (hyperkalaemia)
  • Intoxicants (lithium and salicylates)
  • Oedema (fluid overload)
  • Uraemia (pericarditis and encephalopathy)
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9
Q

Signs of right-sided heart failure (e.g. cor pulmonale)

A
  • Raised JVP
  • Ankle oedema
  • Hepatomegaly
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10
Q

Hypothermia causing cardiac arrest

A

3 shocks
chest compression till temp > 30
then more shocks

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11
Q

When abx in bronchitis

A
  • Pre-existing comorbidities
  • CRP raised
  • Systemically unwell
    *Doxycycline first line
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12
Q

1st line imaging for suspected perforated peptic ulcer

A

Erect chest x-ray (pneumoperitoneum)

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13
Q

Staph toxic shock syndrome

A
  1. Pyrexia
  2. Erythematous and desquamating rash (palms and soles)
  3. Hypotension (rash)
  4. confusion, renal impairment, NV

Systemic reaction to staphylococcus exotoxin TSST-1 superantigen toxin
*tampons

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14
Q

Staph toxic shock mx

A
  1. Remove source of infection
  2. IV abx
  3. IV fluids
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15
Q

CURB65

A

Confusion (AMS ≤ 8)
Urea > 7 (secondary care)
RR > 30
BP < 90/60
Age ≥ 65

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16
Q

CRB65 treatment

A

0 - treat at home, give oral abx
1-2 consider hospital, give abx
3-4 urgent hospital admission

17
Q

AF + acute ischaemic stroke

A

14 days 300mg aspirin, then anticoagulation (DOAC)

18
Q

Neutropenic sepsis abx

A

IV tazocin
If central line - + IV vancomycin

19
Q

Hypovolaemic shock

A

BP, cardiac output ↓
Systemic vascular resistance, HR ↑

20
Q

Turner syndrome cardiac abnormality

A
  • Bicuspid valve (crescendo-decrescendo)
  • Coarctation of aorta
21
Q

Causes of Torsades de Pointes and Mx

A

Causes:
- Erythromycin, Hypothermia, hypokalaemia, hypocalcaemia
- Subarachnoid haemorrhage
- Myocarditis

Mx: IV magnesium sulphate

22
Q

Persistent ST elevation after MI and no chest pain

A

Left ventricular aneurysm

23
Q

Acute haemolytic reaction after blood transfusion sx

A

Hypotension
Fever
Abdominal pain

24
Q

Acute haemolytic reaction after blood transfusion mx

A
  • Stop
  • check pt and blood bag ID
  • Bloods for DCT and crossmatching
  • Fluid resuscitation
25
Q

*when in doubt ACS

A

Monitor troponin I trend

26
Q

False positive TnI

A
  • Severe CHF
  • Large PE
  • Myocarditis
  • Aortic dissection
  • Aortic stenosis
  • Hypertrophic cardiomyopathy
  • Advanced renal failure
27
Q

ACS Ix

A
  • Full A-E
  • 12 lead ECG
  • Troponin I (again in 1hr)
  • FBC, lipid profile, HbA1c, UE
28
Q

ACS mx

A

MONA

Morphine + anti-emetic
O2 (if <94%)
GTN sublingual
Aspirin 300mg

29
Q

STEMI and PCI available within 2hrs

A
  1. 300mg Aspirin
  2. Praugrel
  3. Radial access + unfractionated heparin (+ bailout glycoprotein iib/iiia)
    - Drug eluting stents used
30
Q

STEMI and PCI not available within 2hrs :(

A
  1. 300mg Aspirin
  2. Alteplase (fibrinolysis)
  3. Ticagrelor

*if ST elevation persists after fibrinolysis, send for PCI!

31
Q

Antiplatelet changes when on anticoagulant

A

Praugrel -> clopidogrel

32
Q

STEMI presents >12hrs after onset of symptoms

A

PCI if ongoing myocardial infarction

33
Q

NSTEMI management

A

300mg Aspirin + fondaparinux (if no immediate PCI)

High risk
- PCI (immediate or within 72hrs)
- Prasugrel or ticagrelor
- unfractionated heparin

Low risk
- Ticagrelor

*anticoagulants, swap prasugrel for ticagrelor/ ticagrelor for clopidogrel
**Give unfractionated heparin regardless of fondaparinux

34
Q

Secondary management of ACS

A
  • Dual antiplatelet (aspirin + prasugrel/ ticagrelor) for 12 months
  • ACEi (or ARB) continue indefinitely
  • Beta-blocker (or diltiazem/ verapamil if contraindicated
  • Statins

Conservative
- Cardiac rehabilitation
- Smoking cessation
- Diet
- Physical activity

35
Q

Causes of clubbing

A
  • coeliac disease
  • inflammatory bowel disease
  • lung malignancy
36
Q

Causes of Dupuytren’s contracture

A
  • alcoholic liver disease
  • familial
  • DM

Emergency medicine (5 decks)

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