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ACCS EM > Part B 03 > Flashcards

Part B 03 Flashcards

1
Q

Monteggia #

Description

A 
# distal ulnar
Dislocation radial head
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2
Q

Whooping cough

Organism

A

Bordatella pertussis

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3
Q

Whooping cough

Tx

A

Erythromycin
Or
Clarithromycin

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4
Q

FB in airway

Tx

A

Bronchoscopy

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5
Q

Asthma Tx Paeds

A

1) Bronchodilator
- 10 puff salbut in spacer
- Neb salbut 2.5-5mg
+ ipratropium 250mcg
Sara<92% add Mg sulphate (150mg neb)
2) Steroids
- 2-5y: 20mg
- >5y: 30-40mg
3) second line Tx
IV salbut (15mcg/kg over 10m)

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6
Q

Paeds asthma

Bronchodilator Tx

A

1) Bronchodilator
- 10 puff salbut in spacer
- Neb salbut 2.5-5mg
+ ipratropium 250mcg
Sats<92% add Mg sulphate (150mg neb)

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7
Q

Paeds asthma

Steroid Tx

A

2) Steroids
- 2-5y: 20mg
- >5y: 30-40mg

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8
Q

Paeds asthma

Second line Tx

A

IV salbut (15mcg/kg over 10m)

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9
Q

Amiodarone

APLS dose

A

5mg/kg

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10
Q

Alternative to amiodarone

APLS drug and dose

A

Lidocaine 1mg/kg (max100mg)

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11
Q

Croup

Organism

A

Parainfluenza virus

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12
Q

Croup

Tx

A

Oral Dex: 0.15mg/kg
Neb budesonide if too unwell: 2mg
Neb adrenaline

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13
Q

Croup

Scoring system called

A

Westley croup score

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14
Q

Westley croup score

A 
Stridor (0-2)
-None, agitated, rest
Retractions 
- nil, mild, mid, severe
Air entry
- normal, mild, severe
SaO2<92%
- nil, agitation (4), rest (5)
Consciousness
- normal, decreased (5)
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15
Q

AAA

Defined

A

> 3cm

>1.5 x normal

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16
Q

AAA

Elective surgery

A

> 5.5cm

Or >4.5 and increasing >0.5cm/6m

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17
Q

Inguinal hernia

Comp

A

Pain
Incarceration
Strangulation

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18
Q

Salicylate levels
Mild
Mod
Severe

A

Mild <450mg/L
Mod 450-750
Severe >700

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19
Q

Salicylate OD

Tx

A

Severe cases >750mg/L

IV fluids and 1.26% na bicarbonate

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20
Q

MetHb

Define

A

> 1%

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21
Q

MetHb
When to
Tx

A

> 25%

Or symptomatic

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22
Q

MetHb

Tx

A

IV fluids
IV methylene blue 1% (1mg\kg)
Refer to ITU

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23
Q

Salicylate OD

Sx

A

Tinnitus, hearing loss
Sweating, high RR
Flushing, high T (esp Paeds)

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24
Q

Thin profuse yellow green discharge PV

Dx

A

Trichomonas Vaginalis

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25
Q

Strawberry cervix

Dx

A

Trichmonas vaginalis

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26
Q

Trichmonas vaginalis

pH discharge

A

> 4:5

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27
Q

Trichmonas vaginalis

Associated with

A

PID
HIV
Preterm delivery

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28
Q

Trichmonas vaginalis

Tx

A

Metronidazole

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29
Q

Missed COCP

Plan

A

<72h
- take pill immediately and continue as normal
>72h
- emergency contraception, continue as normal, add in barrier until next cycle?

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30
Q

TRALI
Define
Sx

A 
Transfusion related lung injury 
Hypoxia 
&amp;
bilateral p edema 
W/i 6h transfusion
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31
Q

TRALI

Tx

A

Stop trans
O2
Resp support: NIV, int&vent

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32
Q

Pre eclampsia

RF

A 
1st pregnancy 
Multiple preg
Obesity
>35yo
DM
HTN
Kidney ds
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33
Q

Pre eclampsia

Define

A

Pregnancy induced HTN
And
Proteinuria (>0.3g/24h)

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34
Q

Severe pre eclampsia

Define

A 
BP>160/110
Severe proteinuria 
Oliguria
Headache and clonus
Plt<100
Epigastric pain
Deranged LFT
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35
Q

Pre eclampsia

Complications

A 
Eclampsia 
HELLP
ARDS
Cerebral haemorrhage
Stroke
P edema
Renal failure
DIC
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36
Q

Biochem teat to predict complications of pre eclampsia

A

Uric acid level

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37
Q

Pre eclampsia

Tx

A

Labetolol

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38
Q

Calcium gluconate

Used to Tx

A

Low K
Low calcium
CCB OD

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39
Q

APLS calcium gluconate

Dose

A

0.3ml/kg

10% sol

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40
Q

APLS fluid bolus

Shock

A

20ml/kg

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41
Q

APLS
Maintenance fluids
(Daily vol)

A

1st 10kg : 100ml/kg
2nd 10kg: 50ml\kg
Subsequent kg: 20ml/kg

42
Q

Estimate % paediatric

Dehydration

A

Clickable signs dehydration w/o shock ~5%

With shock~ 10%

43
Q

Otitis media

Most common organism

A

Streptococcus pneumoniae

44
Q

Paeds DKA

Tx

A 
Fluid bolus to reverse shock (20ml\kg)
Rehydrate over 48h
Insulin after 1h fluids
— 0.1unit/kg/h
Check electrolytes
45
Q

Emergency contraception

Types

A

Levonorgestrel
Ulipristal acetate
Copper IUD

46
Q

Levonorgestrel aka

A

Levonelle

47
Q

Dose of

Levonorgestrel

A

1.5mg

48
Q

Levonorgestrel

Hour many hours after unprotected

A

Up to 72h

49
Q

Ulipristal acetate

Up to how many hours after unprotected

A

Up to 120h

50
Q

Copper IUD

Up to how many days after unprotected sex

A

5 days

51
Q

Mitral stenosis

Most commonly due to

A

Rheumatic heart disease

52
Q

Mitral stenosis

Signs

A 
Malar flush
AF
Tapping apex beat (palpable 1st heart sound)
Loud 1st HS
Left parasternal heave
Mid diastolic murmur (best at apex)
53
Q

B blocker OD

A

Atropine 500mcg

Glucagon 2mg

54
Q

ALS bradycardia algorithm
Stable
1st and 2nd line Tx

A 
1st line
Atropine 500mcg up to 3mg
2nd line 
Transcutaneous pacing
Isoprenaline 5mcg/min
Adrenaline 2-10mcg/min
55
Q

Glucagon

Used to Tx which ODs

A

B blocker

CCB

56
Q

NAC anaphylactic reaction

% patients

A

20%

57
Q

NAC anaphylactic reaction

RF

A

Female
Low paracetamol levels
Brittle asthma

58
Q

NAC anaphylactic reaction

Tx

A

Stop infusion
Restart at slower rate (once controlled)
10mg piriton IV
5mg salbutamol

59
Q

Koplick spot

Seen in which ds

A

Measles

Buccal mucosa

60
Q

Incubation period

Measles

A

~10d

61
Q

Measles

Ix

A 
Salivary swab 
- measles IgM
- RNA detection 
Serum sample 
- measles IgM
62
Q

Measles

Complications

A 
Febrile convulsions 
Pneumonia
Meningitis/encephalitis
Subacute sclerosing panencephalitis 
Otitis media 
Death
63
Q

Paeds DKA

Fluid deficit Assumptions

A

~5% in mild-mod DKA

~10% in severe DKA

64
Q

Paeds <5yo

Signs of UTI

A

Frequency, abdo pain
Irritable, lethargic
Vomiting
Poor feeding

65
Q

Paeds

Sign of impacted FB in oesophagus

A 
Pain
Drooling
Gagging
Retching
Vomiting
66
Q

Intravascular volume
Infant
Older child

A

Infant = 80ml/kg

Older child - 70ml\kg

67
Q

Philadelphia chromosome

Associated which ds

A

CML

68
Q

Philadelphia chromosome

Translocation

A

T 9:22

69
Q

CML

Complications

A

Splenic infarction
Gout
CVA
priapism

70
Q

CML

Stages

A

Chronic
Accelerated
Blast crisis

71
Q

CML

Tx

A

Tyrosine kinase inhibitors

Eg imatinib

72
Q

Febrile convulsions

Tx

A

Strip down
Paracetamol 20mg/kg
Ibuprofen 5mg/kg

73
Q

Complex febrile convulsions

Define: features

A

Focal seizure
Seizure >15min
>1 convulsion per febrile illness
Post ictal focal neuro deficit

74
Q

Inhaled FB
(Paed)
Ix

A 
CXR
Inhalation 
And 
exhalation: exaggerates diff 
Effected lung is hyperlucent
75
Q

Inhaled FB

Complications

A 
Pneumonia
Atelectasis 
Bronchospasm
Pneumothorax 
Broncho oesphageal fistula 
Bronchiectasis
76
Q

Hyperkalaemia
Salbutamol Nebs
Act w/i:…
Drops K+ by…

A

Acts w/i: 30mins

Drops K+ by ~1mmol

77
Q

APLS algorithm

High K

A

> 6.5
With arrhythmia
-> 10% Ca gluconate (0.1mmol/kg)

W/O arrhythmia 
-> Neb salb (2.5-10mg)
If improved give calcium resonium
If not improved and acidotic 
- sodium bicarb
If not improved (normal ph)
- insulin and dextrose 
If no improvement -> dialysis
78
Q

Discitis

Most common pathogen

A

S aureus
Or
Strep viridans in IVDU/ immuno comp

79
Q

Discitis

Complications

A

Sepsis
Epidural abscess
Neuro deficit ~50%

80
Q

Discitis

RF

A 
Spinal surg
Immuno deficiency
DM
Malignancy 
IVDU
<8yo
81
Q

Discitis

Ix

A

MRI whole spine
(Often at multiple levels)
3x cultures

82
Q

Discitis

Tx

A

IV fluclox
+/- gent (IVDU)
IV Vanc if hospital acquired

83
Q

IV magnesium sulphate

Dose in adult asthma

A

2g over 30mins

84
Q

Lithium OD

High and toxic lithium levels

A

> 1 is high

>1.5 is toxic

85
Q

Types of lithium OD

A

Acute - GI upset, tremor, ataxia, confusion, coma
Acute on chronic
Chronic - precipitated by new medication. Primarily neuro sx

86
Q

Free NHS services

For oversees visitors

A 
A&amp;E 
Family planning
Tx infectious ds
Tx STI
Tx torture, FGM, IDSVA
Except when specifically travelled for Tx
87
Q

GMC

Good medical practice domains

A
  • Knowledge, skills, performance
  • safety and quality
  • communication, partnership and teamwork
  • maintaining trust
88
Q

Infantile hypertrophic pyloric stenosis

VBG finding

A

Hypochloraemic metabolic alkalosis

89
Q

Tx

Infantile hypertrophic pyloric stenosis

A

Ramstedt pyloromyotomy

90
Q

Testicular torsion

Ddx

A 
Torsion testicular appendage
Epididymitis 
Orchitis
Epididymo-orchitis
Appendicitis
91
Q

Testicular torsion

Exam signs.

A

Tender
High riding
Loss cremasteric reflex
Opposite testis in horizontal lie

92
Q

Prehns sign

A

NEG = Testicular torsion
Lift affected testicle
Relieves pain epididymitis
It by torsion

93
Q

Testicular torsion

Irreversible ischaemia in how many hours

A

> 6h

94
Q

APLS
Anaphylaxis adrenaline dose
Per age

A

<6yo = 150mcg
(0.15ml of 1:1000)
6-12yo = 300mcg
>12 = 500mcg

95
Q

APLS
Anaphylaxis
Chlorphenamine dose
Per age

A

1-6yo =2.5-5mg IM
6-12yo = 5-10mg IM
>12yo = 10-20mg IM

96
Q

APLS
Anaphylaxis
Hydrocortisone
Dose per age

A

<6m = 25mg
6m-6yo = 50mg
6-12yo - 100mg
>12yo - 200mg

97
Q

Mumps

Complications

A 
Meningitis
Encephalitis
Orchitis
Pancreatitis
Sensorineural hearing loss
98
Q

Paeds

Most common non arrest rhythm

A

SVT

99
Q

Paeds
SVT (stable)
Tx

A 
Vagal manoeuvres 
Adenosine 
- 100mcg/kg
-> 200mcg/kg
-> 300mcg/kg
-> 400-500mcg/kg
-> sync DC shock
-> Amiodarone (5-10mg/kg over 30mins)
100
Q

Paeds
SVT (unstable)
Tx

A

Sync DC shock
1J/kg
-> 2J/kg for all subsequent shocks

ACCS EM (11 decks)

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