TLOC, HI, OD

Question 1

Cardiac causes of syncope

Answer 1

MI

Arrhythmia

HOCM

Aortic stenosis

Question 2

Vascular causes of syncope

Answer 2

Ruptured AAA/haemmorhage

Aortic dissection

PE

SAH

Question 3

Drugs causing syncope

Answer 3

antihypertensitves (esp orthostatic)

Antiarrhythmics, anti-emetics, antipsychotics > long Q-T

Alcohol/rec drugs may present similarly but not strictly syncope

Question 4

Metabolic causes of TLOC

Answer 4

Hypoxia/hypoglycaemia (unlikely, will be more prolonged loss of consciousness)

Question 5

First-line hospital management of status epilepticus

Answer 5

4mg lorazepam IV over 2min, then wait 10min

Check blood glucose, consider dextrose (50ml of 50%) +/- pabrinex (250mg IV)

Consider eclampsia if possibility of pregnancy

Question 6

2nd line management of status

Answer 6

IV lorazepam 4mg over 2 min then wait 10min

2nd dose including what is given in ambulance

Question 7

3rd line management of status epilepticus

Answer 7

Phenytoin 15mg/kg continuous IV (at 50mg/min rate)

Loading dose over 30min but not if already on it

Wait 20 min

Consider non-epileptic seizure

Question 8

Early complications of head injury

Answer 8

Extradural/subdural haematoma

Seizures

FREQUENT NEURO OBS ESSENTIAL

Question 9

Late complications of head injury

Answer 9

Subdural haemmorhage

DI

SIADH

Parkinsonism

Dementia

Question 10

Early management of SAH

Answer 10

Nimodipine

Fluids to maintain BP

Ventilate to low normocapnia

Strict bed rest

Inform neurosurgery

Question 11

Complications of SAH

Answer 11

Rebleed

Vasospasm

SIADH

Seizures

Hydrocephalus

Question 12

Criteria for urgent CT head (<1h)

Answer 12

Fracture of skull suspected

Seizures

GCS <15 2h later or <13 on initial assessment

Vomiting >1 episode

Neurology: focal deficit

Question 13

Criteria for CT head <8h

Answer 13

Retrograde amnesia >30min

Dangerous mechanism

Coagulopathy

Age >65

Question 14

Management of head injury

Answer 14

A>E assessment

Nexus C-spine clearance

CT Head if indicated, also check clotting + bloods

Maintain BP + normoxia/normocapnia

Nurse at 30 degrees

Mannitol if signs of raised ICP

Question 15

Approach to overdose

Answer 15

A>E Assessment

Charcoal 50g if within 1hr and airway reflexes not compromised, plus NOT alcohols, metal salts, petroleum products

Bicarbonate to increase elmination of acidic drugs (e.g. salicylate, barbiturate)

Question 16

Toxic dose of paracetamol

Answer 16

>12g

>150mg/kg

Question 17

Paracetamol overdose timeline of syptoms

Answer 17

N+V, abdo pain (esp RUQ) within 12h

Deranged INR (most Sn marker) from 24h

1-4 days: development of jaundice, hypoglycaemia, encephalopathy

Question 18

Management of paracetamol OD

Answer 18

Activated charcoal within 1h

NAC within 8h if above treatment line on nomogram

Check LFTs + clotting before discharge

Question 19

Management of opiate overdose

Answer 19

Naloxone 400mcg every min until return of spontaneous ventilation

Question 20

Manageent of N-AC side effects

Answer 20

Rash: managed with chlorphenamine

Question 21

Management of TCA overdose

Answer 21

Supportive, plus fix acidosis (bicarbonate 8.4%)

Question 22

Features of TCA overdose

Answer 22

Ileus, urinary retention

Hypotension ,tachycardia

heart block, long Q-T, arrhythmia

Drowsy, coma, seizure

ataxic, hypertonic, hyperreflexive

Acidosis

Question 23

N-acetylcysteine first infusion timing/dose

Answer 23

150 mg/kg over 1 hour, dose to be administered in 200 mL Glucose Intravenous Infusion 5%

Question 23

Naloxone infusion dosing

Answer 23

60% of total bolus naloxone dose used in 1st hour used as hourly infusion rate

Question 24

Community management of status epilepticus

Answer 24

Buccal midazolam 10mg

Rectal diazepam 10mg

Question 25

N-acetylcysteine second infusion timing/dose

Answer 25

50 mg/kg over 4 hours in 500ml of 5% glucose