Urgent and Emergency Care Flashcards
Flash cards of practice exam questions.
You’re assessing a 65 year old male with suspected community acquired pneumonia. Your colleagues suggests using a tool, the CRB65 tool, as a strategy to decide if he requires referral to a General Practitioner or the Emergency Department, which four elements is this comprised of?
Confusion, Respiratory rate (>30/min), Blood Pressure (<90mmHg), Age (>65)
A 32 year old male presents with ‘severe’ central chest pain, radiating to his left arm for 30 minutes. He appears pale and sweaty; the 12-lead electrocardiogram (ECG) obtained shows 2.5 mm of ST-segment elevation only in leads V2&V3. The likely ECG diagnosis is?
An anterior ST-elevation myocardial infarction
A 30 year old female has been ‘punched to the left temple’, has been briefly unconscious but refuses to attend an Emergency Department thinking she will be ‘all right’ at home. The patient complains of a headache, with nausea, dizziness but no vomiting and confusion. Which type of intracranial injury is most likely in this patient?
Sub-dural haemorrhage
The parents of a 15 year old male have called an ambulance because they have found their son in bed behaving strangely following heavy consumption of alcohol and a fall where he struck his head the previous evening. They describe him experiencing a headache, vomiting and nausea; these symptoms are typically associated with which diagnosis?
Sub-arachnoid haemorrhage
An 18 year old female complains of chest pain and difficulty in breathing following an argument with her partner. She is 25 weeks pregnant with her first child; appears obese and is very anxious with the symptoms failing to resolve despite effective coaching of her breathing. Her observations reveal a heart rate of 110 beats per minute, oxygen saturations of 94% and an ECG displaying a S1, Q3, T3 pattern. Which is the most likely diagnosis?
Pulmonary embolism
Following two days of an intermittent productive cough the mother of a tenth month old female calls 111. On arrival your history reveals a two day history of coryzal symptoms, with a cough productive of ‘green/yellow’ sputum, with an increased pulse and respiratory rate. Examination reveals left-sided crepitation’s and expiratory wheeze. Which is the most likely diagnosis?
Pneumonia
A 90 year old male has fallen to the floor following a 30 second transient loss of consciousness episode (T-LOC); her career suspects a stroke because she had left sided body-weakness, right-sided facial droop and slurred speech. She remains FAST positive and has a new onset irregular pulse. Which arrhythmia is the likely cause for these symptoms?
Atrial fibrillation
You are called to a 70 year old male with acute onset difficulty in breathing at rest one hour ago. He is postured in a tripod position, using accessory muscles to breathe, exhaling through pursed lips and his respiratory rate is tachypnoeic. He has a medical history of pancreatic cancer that has spread to his bones and smokes 20 cigarettes per day for over 30 years. What condition should you have the highest index of suspicion for?
Pulmonary Embolism
In a patient experiencing a life threatening asthma attack they are likely to present with what range of Peak Expiratory Flow reading?
Less than 33% of best or predicted
You’re assessing a 65 year old male with suspected community acquired pneumonia. Your colleagues suggests using a tool, the CRB65 tool, as a strategy to decide if he requires referral to a General Practitioner or the Emergency Department, which four elements is this comprised of?
Confusion, Respiratory rate (>30/min), Blood Pressure (<90mmHg), Age (>65)
You are called to 70 year old male with sudden onset of shortness of breath and central ‘crushing’ chest pain. On examination the patient looks diaphoretic with pale cold peripheries; his pulse and heart rate are both noted to be increased with a hypertensive blood pressure measurement and bi-lateral lung base coarse crepitations. Which condition should you have the highest index of suspicion for?
Acute Cardiogenic Pulmonary Oedema
You’ve been called to an 80 year old female who is complaining of ‘severe’ back pain radiating along her left flank. Two days ago she developed a ‘burning’ sensation when passing urine but thought it would pass; she has felt unwell, with a fever, vomiting and diarrhoea. Her observations are: respiratory rate 20 breaths min1; pulse rate 98 min1; blood pressure 120/70 mmHg; oxygen saturations 97% on air; temperature 38.5°C. The abdomen is found to be symmetrical, non-distended, non-tender without guarding or rigidity and bowel sounds are present.
Pyelonephritis
You’ve been called to an 80 year old female complaining of ‘svere’ abdominal pain. She has a history of bowel cancer and for the past 48 hours has not felt like eating or drinking due to nauseas and has vomited twice today. Her bowels were last opened three days ago and she has been unable to pass wind for 24 hours. Her observations are: respiratory rate 14 breaths min1; pulse rate 72 min1; blood pressure 150/90 mmHg; oxygen saturations 95% on air; temperature 36.7°C. The abdomen is found to be symmetrical, distended, and tender with left-lower quadrant guarding and rigidity, and hyperactive bowel sounds are present.
Bowel obstruction
- You’ve been called to a 12 year old female who is complaining of ‘severe’ abdominal pain. She has vomited once due to the pain, which is coming in waves. She’s noticed the pain started near her ‘belly button’ before migrating towards and into her right lower quadrant. Her observations are: respiratory rate 20 breaths min1; pulse rate 88 min1; blood pressure 120/70 mmHg; oxygen saturations 97% on air; temperature 37.1°C. The abdomen is found to be symmetrical, non-distended, tender with guarding and rigidity in the right lower quadrant and bowel sounds are present.
Appendicitis
- You’ve been called to a 20 year old female who is complaining of ‘severe’ abdominal pain and is in a collapsed state. She has vomited four times today with eight episodes of diarrhoea and complains of ‘cramping’ colicky generalised abdominal pains. Her parents have both also been unwell with similar symptoms after her birthday party. She uses an intrauterine contractive device and has not been sexually active for eight weeks. Her observations are: respiratory rate 20 breaths min1; pulse rate 105 min1; blood pressure 100/60 mmHg; oxygen saturations 98% on air; temperature 37.0°C. The abdomen is found to be symmetrical, non-distended, and generally tender with epigastric guarding only and hyperactive bowel sounds are present.
Ectopic pregnancy
