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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
Strawberry cervix | Dx
Trichmonas vaginalis
26
Trichmonas vaginalis | pH discharge
>4:5
27
Trichmonas vaginalis | Associated with
PID HIV Preterm delivery
28
Trichmonas vaginalis | Tx
Metronidazole
29
Missed COCP | Plan
<72h - take pill immediately and continue as normal >72h - emergency contraception, continue as normal, add in barrier until next cycle?
30
TRALI Define Sx
``` Transfusion related lung injury Hypoxia & bilateral p edema W/i 6h transfusion ```
31
TRALI | Tx
Stop trans O2 Resp support: NIV, int&vent
32
Pre eclampsia | RF
``` 1st pregnancy Multiple preg Obesity >35yo DM HTN Kidney ds ```
33
Pre eclampsia | Define
Pregnancy induced HTN And Proteinuria (>0.3g/24h)
34
Severe pre eclampsia | Define
``` BP>160/110 Severe proteinuria Oliguria Headache and clonus Plt<100 Epigastric pain Deranged LFT ```
35
Pre eclampsia | Complications
``` Eclampsia HELLP ARDS Cerebral haemorrhage Stroke P edema Renal failure DIC ```
36
Biochem teat to predict complications of pre eclampsia
Uric acid level
37
Pre eclampsia | Tx
Labetolol
38
Calcium gluconate | Used to Tx
Low K Low calcium CCB OD
39
APLS calcium gluconate | Dose
0.3ml/kg | 10% sol
40
APLS fluid bolus | Shock
20ml/kg
41
APLS Maintenance fluids (Daily vol)
1st 10kg : 100ml/kg 2nd 10kg: 50ml\kg Subsequent kg: 20ml/kg
42
Estimate % paediatric | Dehydration
Clickable signs dehydration w/o shock ~5% With shock~ 10%
43
Otitis media | Most common organism
Streptococcus pneumoniae
44
Paeds DKA | Tx
``` Fluid bolus to reverse shock (20ml\kg) Rehydrate over 48h Insulin after 1h fluids — 0.1unit/kg/h Check electrolytes ```
45
Emergency contraception | Types
Levonorgestrel Ulipristal acetate Copper IUD
46
Levonorgestrel aka
Levonelle
47
Dose of | Levonorgestrel
1.5mg
48
Levonorgestrel | Hour many hours after unprotected
Up to 72h
49
Ulipristal acetate | Up to how many hours after unprotected
Up to 120h
50
Copper IUD | Up to how many days after unprotected sex
5 days
51
Mitral stenosis | Most commonly due to
Rheumatic heart disease
52
Mitral stenosis | Signs
``` Malar flush AF Tapping apex beat (palpable 1st heart sound) Loud 1st HS Left parasternal heave Mid diastolic murmur (best at apex) ```
53
B blocker OD
Atropine 500mcg | Glucagon 2mg
54
ALS bradycardia algorithm Stable 1st and 2nd line Tx
``` 1st line Atropine 500mcg up to 3mg 2nd line Transcutaneous pacing Isoprenaline 5mcg/min Adrenaline 2-10mcg/min ```
55
Glucagon | Used to Tx which ODs
B blocker | CCB
56
NAC anaphylactic reaction | % patients
20%
57
NAC anaphylactic reaction | RF
Female Low paracetamol levels Brittle asthma
58
NAC anaphylactic reaction | Tx
Stop infusion Restart at slower rate (once controlled) 10mg piriton IV 5mg salbutamol
59
Koplick spot | Seen in which ds
Measles | Buccal mucosa
60
Incubation period | Measles
~10d
61
Measles | Ix
``` Salivary swab - measles IgM - RNA detection Serum sample - measles IgM ```
62
Measles | Complications
``` Febrile convulsions Pneumonia Meningitis/encephalitis Subacute sclerosing panencephalitis Otitis media Death ```
63
Paeds DKA | Fluid deficit Assumptions
~5% in mild-mod DKA | ~10% in severe DKA
64
Paeds <5yo | Signs of UTI
Frequency, abdo pain Irritable, lethargic Vomiting Poor feeding
65
Paeds | Sign of impacted FB in oesophagus
``` Pain Drooling Gagging Retching Vomiting ```
66
Intravascular volume Infant Older child
Infant = 80ml/kg | Older child - 70ml\kg
67
Philadelphia chromosome | Associated which ds
CML
68
Philadelphia chromosome | Translocation
T 9:22
69
CML | Complications
Splenic infarction Gout CVA priapism
70
CML | Stages
Chronic Accelerated Blast crisis
71
CML | Tx
Tyrosine kinase inhibitors | Eg imatinib
72
Febrile convulsions | Tx
Strip down Paracetamol 20mg/kg Ibuprofen 5mg/kg
73
Complex febrile convulsions | Define: features
Focal seizure Seizure >15min >1 convulsion per febrile illness Post ictal focal neuro deficit
74
Inhaled FB (Paed) Ix
``` CXR Inhalation And exhalation: exaggerates diff Effected lung is hyperlucent ```
75
Inhaled FB | Complications
``` Pneumonia Atelectasis Bronchospasm Pneumothorax Broncho oesphageal fistula Bronchiectasis ```
76
Hyperkalaemia Salbutamol Nebs Act w/i:... Drops K+ by...
Acts w/i: 30mins | Drops K+ by ~1mmol
77
APLS algorithm | High K
>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
Discitis | Most common pathogen
S aureus Or Strep viridans in IVDU/ immuno comp
79
Discitis | Complications
Sepsis Epidural abscess Neuro deficit ~50%
80
Discitis | RF
``` Spinal surg Immuno deficiency DM Malignancy IVDU <8yo ```
81
Discitis | Ix
MRI whole spine (Often at multiple levels) 3x cultures
82
Discitis | Tx
IV fluclox +/- gent (IVDU) IV Vanc if hospital acquired
83
IV magnesium sulphate | Dose in adult asthma
2g over 30mins
84
Lithium OD | High and toxic lithium levels
>1 is high | >1.5 is toxic
85
Types of lithium OD
Acute - GI upset, tremor, ataxia, confusion, coma Acute on chronic Chronic - precipitated by new medication. Primarily neuro sx
86
Free NHS services | For oversees visitors
``` A&E Family planning Tx infectious ds Tx STI Tx torture, FGM, IDSVA Except when specifically travelled for Tx ```
87
GMC | Good medical practice domains
- Knowledge, skills, performance - safety and quality - communication, partnership and teamwork - maintaining trust
88
Infantile hypertrophic pyloric stenosis VBG finding
Hypochloraemic metabolic alkalosis
89
Tx | Infantile hypertrophic pyloric stenosis
Ramstedt pyloromyotomy
90
Testicular torsion | Ddx
``` Torsion testicular appendage Epididymitis Orchitis Epididymo-orchitis Appendicitis ```
91
Testicular torsion | Exam signs.
Tender High riding Loss cremasteric reflex Opposite testis in horizontal lie
92
Prehns sign
NEG = Testicular torsion Lift affected testicle Relieves pain epididymitis It by torsion
93
Testicular torsion | Irreversible ischaemia in how many hours
>6h
94
APLS Anaphylaxis adrenaline dose Per age
<6yo = 150mcg (0.15ml of 1:1000) 6-12yo = 300mcg >12 = 500mcg
95
APLS Anaphylaxis Chlorphenamine dose Per age
1-6yo =2.5-5mg IM 6-12yo = 5-10mg IM >12yo = 10-20mg IM
96
APLS Anaphylaxis Hydrocortisone Dose per age
<6m = 25mg 6m-6yo = 50mg 6-12yo - 100mg >12yo - 200mg
97
Mumps | Complications
``` Meningitis Encephalitis Orchitis Pancreatitis Sensorineural hearing loss ```
98
Paeds | Most common non arrest rhythm
SVT
99
Paeds SVT (stable) Tx
``` Vagal manoeuvres Adenosine - 100mcg/kg -> 200mcg/kg -> 300mcg/kg -> 400-500mcg/kg -> sync DC shock -> Amiodarone (5-10mg/kg over 30mins) ```
100
Paeds SVT (unstable) Tx
Sync DC shock 1J/kg -> 2J/kg for all subsequent shocks

ACCS EM (11 decks)

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