SDL Corrections Flashcards
A 79 year old man has been admitted following a fall. He has sustained a fractured neck of femur that requires surgical repair. He is known to have some co-morbidities and his prescription list is as follows:
A) Furosemide
B) GTN
C) Levetiracetam
D) Metformin
E) Paracetamol
Which medication would be classified as time critical?
C) Levetiracetam (as is an anti-epileptic).
A 23 year old man with asthma has severe shortness of breath. He is speaking partial sentences. He has significantly increased respiratory effort with a prolonged expiratory time and widespread wheeze. He is alert and his observations are: P 125 bpm (sinus), BP 85/55mmHg, RR 31 and SpO2 94% on high flow oxygen.
Which feature indicates this is a life-threatening exacerbation of his asthma?
A) BP 85/55mmHg
B) High-flow oxygen therapy
C) Pulse 125 bpm
D) Respiratory rate 31
E) SpO2 94%
BP 85/55 mmHg
An ambulance has been called to a 34 year man with a sudden onset of breathlessness and facial swelling whilst popcorn in the cinema. He has obvious facial swelling and is agitated. Observations show: P 130 bpm, BP 70/40 mmHg, RR 28, SpO2 88% in air.
Which is the most appropriate initial treatment for this man?
A) Adrenaline
B) Amiodarone
C) Intravenous fluids
D) Oxygen via a non-rebreathe mask
E) Salbutamol
A) Adrenaline
Remember –> give adrenaline ASAP in suspected anaphylaxis.
A 49 year old man was found on the ground outside the ED having a generalised seizure. He is well known and regularly presents with issues relating to illicit drug and alcohol use. He has now been taken into the resuscitation room and has a nasopharyngeal airway. He is receiving high-flow oxygen via a non-rebreathe mask. He has been fitting for 5 minutes.
Which is the most appropriate initial management plan to terminate the seizure?
A) Administer intravenous lorazepam
B) Bolus intravenous glucose
C) Contact an anaesthetist for rapid sequence induction and intubation
D) Give naloxone (opioid antidote)
E) Give rectal diazepam
A) Administer IV lorazepam
A 50 year old man has just had a cardiac arrest in the MAU. During the event, his airway was managed with positioning and an oropharyngeal airway (OPA). After 15 minutes of CPR, he regained a cardiac output. He has now had a pulse for 10 minutes but he is very agitated. He is on 15L of oxygen via a NRBM and his GCS is E1V2M4.
Which is the most appropriate device to manage his airway now?
A) Endotracheal tube
B) i-Gel® supraglottic airway
C) Laryngeal mask airway
D) Nasopharyngeal airway
E) Oropharyngeal airway
A) Endotracheal tube
Remember - GCS<8, intubate!
A 70 year old man with advanced COPD has just had a cardiac arrest in the MAU. He was admitted with severe pneumonia and acute kidney injury. He received 5 minutes of CPR and now has a cardiac output.
Which is the most appropriate oxygen delivery device to use in his initial post- resuscitation care?
A) Nasal cannula
B) No device required
C) Non-rebreathe mask with reservoir
D) Simple face mask
E) Venturi mask
C) NBR with reservoir
For all critically ill patients, high concentration oxygen should be administered immediately until the patient is stable (even in COPD).
Which is the most appropriate initial fluid prescription for a patient in DKA?
A) 250ml bolus of 0.9% sodium chloride over 10-15 minutes.
B) 500ml bolus of 0.9% sodium chloride over 10-15 minutes.
C) 500ml bolus of 0.9% sodium chloride over 30 minutes.
D) 1000ml infusion of 0.9% sodium chloride over 60 minutes.
E) 1000ml infusion of 0.9% sodium chloride over 120 minutes.
D) 1000ml infusion of 0.9% saline over 60 mins
What are the 4 main principles of maangement of DKA?
1) Fluid replacement
2) Insulin
3) Correction of electrolyte disturbance
4) Long acting insulin should be continued, short-acting insulin should be stopped
What type of fluid therapy is given in DKA?
isotonic saline is used initially, even if the patient is severely acidotic
Example fluid regime in DKA for patient with a systolic BP on admission 90mmHg and over?
Over 1st hour: 1000ml 0.9% saline
Over next 2 hours: 1000ml 0.9% saline with potassium chloride
Over next 2 hours: 1000ml 0.9% saline with potassium chloride
Over next 4 hours: 1000ml 0.9% saline with potassium chloride
Over next 4 hours: 1000ml 0.9% saline with potassium chloride
Over next 6 hours: 1000ml 0.9% saline with potassium chloride
Why may a slower fluid infusion may be indicated in young adults (aged 18-25 years) in DKA?
Due to greater risk of cerebral oedema
How is DKA resolution defined?
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
How soon should the ketonaemia and acidosis be resolved in DKA?
Within 24 hours - if not, patient requires senior review from an endocrinologist.
When can the patient be switched to SC insulin in DKA?
If DKA resolution criteria has been met AND the patient is eating and drinking.
What is rate of insulin infusion in DKA?
0.1 unit/kg/hour
Note - once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime
When is 10% dextrose infusion started in DKA?
Once blood glucose is < 14 mmol/l
A 32 year old woman is in active labour for the first time. She is in delivery suite and is requesting more pain relief. Her pain is uncontrolled despite inhaled Entonox® (nitrous oxide and oxygen mix) and two doses of pethidine (last dose 45 minutes ago). She has just been examined and her cervix is 5 cm dilated.
Which strategy to address her pain is most appropriate at this time?
A) Epidural analgesia
B) Offer a pudendal nerve block
C) Refer the patient for a PCA (patient controlled analgesia)
D) Suggest self-management techniques such as hypnobirthing
E) Supplement the current analgesia with a TENS machine
A) Epidural analgesia
A 58 year old man has been diagnosed with a femoral DVT following a long-haul flight and is being counselled about treatment. He is usually well and takes no medication currently. There are no concerns about the need for rapid reversal.
Which is the most appropriate treatment regime to suggest?
A) DOAC
B) Dual antiplatelets
C) Low molecular weight heparin
D) IVC filter
E) Warfarin
A) DOAC
A 77 year old man is hypotensive on HDU. He is usually well. He underwent an emergency laparotomy in theatre 4 hours ago for a bleeding duodenal ulcer and required a large blood transfusion. He has cold peripheries and his observations show temperature 36.5◦C, P 170-190 bpm, BP 85/50 mmHg, SpO2 95% on 3L oxygen. His catheter shows a urine output of 100mls per hour.
Which is the most likely cause of his hypotension?
A) Cardiac arrhythmia
B) Hypovolaemia
C) Pulmonary oedema due to fluid overload
D) Sepsis
E) Transfusion reaction
A) Cardiac arrhythmia
The patient is showing signs of cardiogenic shock.
A 40 year old man is to undergo general anaesthetic and is having an airway assessment. A visual examination of his pharyngeal structures has just been undertaken.
Which scoring system is it most appropriate to use to document the findings?
A) Cormack-Lehane Grading
B) LEMON
C) Mallampati classification
D) MOANS
E) The 3-3-2 evaluation
C) Mallampati classification
A 37 year old woman has presented with sudden-onset, severe, right iliac fossa pain, and a syncopal episode. She has had vague abdominal pain for several days and has had two episodes of diarrhoea today. She also describes feeling ‘dizzy’ whenever she tries to sit up on the trolley. She looks very pale and her lower abdomen is distended. Observations show: Temperature 36.6°C, P 135, BP 90/60mmHg, SpO2 97% in air.
Which underlying diagnosis is the likely cause of her symptoms?
A) Ectopic pregnancy
B) Appendicitis
C) Gastroenteritis
D) Supraventricular tachycardia
E) Urinary sepsis
A) Ectopic pregnancy
A 55 year old man has presented with a frontal headache and blurred vision. He describes headaches for the past two months but isn’t entirely sure when they started. He knows they are usually worse in the morning and when he strains to open his bowels or sneezes. He has felt nauseated but has not vomited. He is systemically well and has not experienced any weight loss. He is known to have hypertension controlled by amlodipine.
Which is the most likely cause of his symptoms?
A) Hypertensive encephalopathy
B) Idiopathic intracranial hypertension
C) Migraine
D) Space occupying lesion
E) Tension headache
D) Space occupying lesion
A 23 year old man has been found unconscious in a park. He appears unkempt and is cold to touch. His pulse is palpable with normal volume and rate. His respiratory rate is approximately 6 and his breathing pattern is shallow. His pupils are markedly constricted and he has an abrasion to his cheek.
Which is the most likely cause of his current state?
A) Alcohol excess
B) Benzodiazepine usage
C) Hypoglycaemia
D) Intracranial haemorrhage
E) Opioid poisoning
E) Opioid poisoning
A 68 year old woman is waiting to go to theatre and has been found to be disorientated and agitated. She is known to have insulin-dependent diabetes. She was started on an appropriate regime but a problem with the pump has meant that she has not received any glucose for some time . She is awake but is clammy to touch. Her capillary blood glucose is 2.8 mmol/L.
Which is the most appropriate treatment for her hypoglycaemia?
A) 10% glucose
B) 50% glucose
C) Glucagon
D) Glucogel
E) Glucose tablets
D) Glucogel
Management of moderate hypoglycaemia.
