Other

Question 1

Hypothermia ECG

Answer 1

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

Question 2

Complication of NIV e.g CPAP

Answer 2

Pneumothorax

Question 3

Which drugs to stop during AKI

Answer 3

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

Question 4

pH change in salicylate poisoning (early and late)

Answer 4

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

Question 5

Features of salicylate poisoning

Answer 5

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

Question 6

Salicylate poisoning mx

Answer 6

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

Question 7

ECG in PE

Answer 7

1. Sinus tachycardia
2. S1Q3T3

Question 8

Indications for RRT (dialysis)

Answer 8

AEIOU

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

Question 9

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

Answer 9

• Raised JVP
• Ankle oedema
• Hepatomegaly

Question 10

Hypothermia causing cardiac arrest

Answer 10

3 shocks
chest compression till temp > 30
then more shocks

Question 11

When abx in bronchitis

Answer 11

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

Question 12

1st line imaging for suspected perforated peptic ulcer

Answer 12

Erect chest x-ray (pneumoperitoneum)

Question 13

Staph toxic shock syndrome

Answer 13

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

Question 14

Staph toxic shock mx

Answer 14

1. Remove source of infection
2. IV abx
3. IV fluids

Question 15

CURB65

Answer 15

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

Question 16

CRB65 treatment

Answer 16

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

Question 17

AF + acute ischaemic stroke

Answer 17

14 days 300mg aspirin, then anticoagulation (DOAC)

Question 18

Neutropenic sepsis abx

Answer 18

IV tazocin
If central line - + IV vancomycin

Question 19

Hypovolaemic shock

Answer 19

BP, cardiac output ↓
Systemic vascular resistance, HR ↑

Question 20

Turner syndrome cardiac abnormality

Answer 20

• Bicuspid valve (crescendo-decrescendo)
• Coarctation of aorta

Question 21

Causes of Torsades de Pointes and Mx

Answer 21

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

Mx: IV magnesium sulphate

Question 22

Persistent ST elevation after MI and no chest pain

Answer 22

Left ventricular aneurysm

Question 23

Acute haemolytic reaction after blood transfusion sx

Answer 23

Hypotension
Fever
Abdominal pain

Question 24

Acute haemolytic reaction after blood transfusion mx

Answer 24

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

Question 25

*when in doubt ACS

Answer 25

Monitor troponin I trend

Question 26

False positive TnI

Answer 26

- Severe CHF - Large PE - Myocarditis - Aortic dissection - Aortic stenosis - Hypertrophic cardiomyopathy - Advanced renal failure

Question 27

ACS Ix

Answer 27

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

Question 28

ACS mx

Answer 28

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

Question 29

STEMI and PCI available within 2hrs

Answer 29

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

Question 30

STEMI and PCI not available within 2hrs :(

Answer 30

1. 300mg Aspirin 2. Alteplase (fibrinolysis) 3. Ticagrelor *if ST elevation persists after fibrinolysis, send for PCI!

Question 31

Antiplatelet changes when on anticoagulant

Answer 31

Praugrel -> clopidogrel

Question 32

STEMI presents >12hrs after onset of symptoms

Answer 32

PCI if ongoing myocardial infarction

Question 33

NSTEMI management

Answer 33

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

Question 34

Secondary management of ACS

Answer 34

- 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

Question 35

Causes of clubbing

Answer 35

- coeliac disease - inflammatory bowel disease - lung malignancy

Question 36

Causes of Dupuytren's contracture

Answer 36

- alcoholic liver disease - familial - DM