Week 1 - Acute Emergencies & Pre-Hospital Care

Question 1

4 general features of acute abdominal pain

Red Flags
Colic Pain
Back Pain
Movement

Answer 1

1. ) Red Flags
   - PR bleeding, iron deficient anaemia
   - change in bowel habit, tenesmus
   - age >50, unexplained weight loss (>10%)
2. ) Colic Pain - transient, after meals, (due to gallstones)
   - biliary colic occurs after a fatty meal
   - lasting 3-4 mins suggests small bowel obstruction
   - lasting 10-15 mins suggests large bowel obstruction
   - ischaemia lasts much longer at around 4 hours
3. ) Back Pain
   - pyelonephritis, pancreatitis, AAA
   - prostate cancer (may have urinary symptoms)
4. ) Movement
   - lying still: peritonitis, paralytic ileus
   - rolling in agony: intestinal, biliary, or renal colic

Question 2

Acute Abdominal Pain Locations

Epigastrium (7), RUQ (5), LUQ (2)
Peri-Umbilical (2), R/L Flanks (3)
Hypogastrium (4), RLQ (6), LLQ (7)

Answer 2

1. ) Epigastrium
   - biliary colic, acute cholecystitis, pancreatitis
   - oesophagitis, gastroduodenal ulcers, gastric cancer
   - myocardial infarction
2. ) RUQ
   - biliary colic, acute cholecystitis, ascending cholangitis
   - hepatitis, liver abscess
3. ) LUQ
   - splenic abscess/rupture/infarct
   - acute mesenteric isachemia (splenic flexure)
4. ) Peri-Umbilical
   - appendicitis (early), AAA
5. ) R/L Flanks
   - pyelonephritis, renal colic
   - acute mesenteric isachemia (left sided)
6. ) Hypogastrium
   - UTI, urinary retention, testicular torsion, hernia
7. ) RLQ
   - acute appendicitis, IBD (Crohn’s), inguinal hernia
   - ectopic pregnancy, ovarian cyst, PID
8. ) LLQ
   - diverticulitis, volvulus, IBD (UC), inguinal hernia
   - ectopic pregnancy, ovarian cyst, PID

Question 3

5 associated symptoms w/ abdominal pain

Nausea/Vomiting 
Fever
Bowel Movements
Stools
Others x2

Answer 3

1. ) Nausea/Vomiting - any inflammatory condition
   - more pronounced in acute pancreatitis
   - bilous and early suggests upper GI problems
   - faeculent and late/delayed suggests distal GI
2. ) Fever - suggests infection
   - could also be widespread inflammation in the peritoneum (peritonitis)
3. ) Bowel Movements
   - diarrhoea: gastroenteritis, IBD
   - constipation: obstruction (large>small)
4. ) Stools
   - haematochezia (distal GI), melaena (upper GI)
   - pale stools (dysfunction in biliary system)
   - steatorrhoea (exocrine pancreatic insufficiency)
5. ) Others
   - bleeding: haematemesis or PR bleeding
   - urinary: dysuria, haematuria

Question 4

Chest Pain

Cardiac
Pleuritic
Differential Diagnoses

Answer 4

1. ) Cardiac Chest Pain
   - central, dull/crushing, poorly localised, radiating
   - sweating, nausea
2. ) Pleuritic Chest Pain
   - lateral, sharp, well localised, often w/ SOB
   - worse on inspiration, coughing, positional movement
   - pericarditis presents as pleuritic
3. ) Differential Diagnoses
   - costochondritis, pleurisy, rib fracture, shingles
   - GORDs, peptic ulcers, aortic dissection

Question 5

Shortness of Breath

History 
Associated Symptoms
SOB w/ Productive Cough
SOB w/ Dry Cough
Non-Respiratory Causes

Answer 5

1. ) History
   - onset, duration, progression, severity, triggers
2. ) Associated Symptoms
   - fever, chest pain, cough
   - palpitations, dizziness, fainting
   - weight loss, night sweats, malaise
3. ) SOB w/ Productive Cough
   - clear sputum: COPD, TB
   - Y/G sputum: pneumonia, bronchitis,bronchiectasis,TB
   - haemoptysis: cancer, PE, TB
4. ) SOB w/ Dry Cough
   - asthma/COPD, interstitial lung diseases
   - pleural effusion, pneumothorax, TB
5. ) Non-Respiratory Causes
   - heart failure, arrhythmia, anaemia,
   - anxiety, anaphylaxis, obesity, DKA

Question 6

Assessing and managing an acutely unwell (febrile) child

NICE Traffic Light
Life Threatening Features
Red/High Risk Features
Amber/Moderate Risk Features
Green/Low Risk Features

Answer 6

1. ) NICE Traffic Light - identifies risk of serious illness
   - life-threatening: arrange ambulance to A/E
   - red: high risk, urgent f2f consultations required
   - amber: intermediate risk, arrange f2f consultation
   - green: low risk, can be managed at home
2. ) Life Threatening Features
   - ABC compromise (airway, breathing, circulation)
   - features of sepsis or CNS infection e.g. meningitis
   - features of pneumonia or severe dehydration
3. ) Red/High Risk Features
   - < 3/12 old, bulging fontanelle, pale/blue skin
   - ↓↓↓activity, not waking if roused, weak high pitch cry
   - grunting, RR>60, chest indrawing
4. ) Amber/Moderate Risk Features
   - 3-6 months, fever > 5 days, rigors, swelling
   - pallor, nasal flaring, poor feeding, oliguria
   - ↓activity: no smile, wakes w/ prolonged stimulation
   - RR > 40, O2 <95%, HR >140, CRT >3s, crackles
5. ) Green/Low Risk Features
   - normal colour and skin, moist mucous membrane
   - normal activity: normal cry, stays awake, smiles
   - no amber or red signs

Question 7

Unitlateral Weakness

Stroke
Bell’s Palsy
Others

Answer 7

1. ) Stroke/TIA - FAST (face arms speech test), Call 999
   - produces face or limb weakness or sensory loss
   - other symptoms: blurred/lost vision, incontinence
   - LOC, confusion, dizziness, sudden headache
   - Stroke >24hrs, TIA <24 hrs
2. ) Bell’s Palsy - rapid onset facial muscle weakness
   - numbness, eyebrow drooping, drooling,
   - difficulty blinking, dry eyes, eye pain, excessive tears
   - difficulty chewing/talking, dry mouth, change in taste
   - hyperacusis, ear/postauricular pain
3. ) Others - causes of peripheral neuropathy
   - MSK: trauma, sciatica, SC compression
   - neurovascular: diabetes, vasculitis, MS, GBS
   - metabolic: hypothyroidism, low B12
   - infections: shingles, botulism

Question 8

Anaphylaxis

Answer 8

go read your notes innit

Question 9

Deep Venous Thrombosis (DVT)

Clinical Features
Risk Factors
Wells Criteria
Management

Answer 9

1. ) Clinical Features
   - unilateral localised pain when weight bearing
   - calf swelling or swelling of entire leg
   - tender, oedema, redness, warmth, vein distension
2. ) Risk Factors
   - previous history, >60, male, smoking, overweight,
   - HF, inflammatory disorders, varicose veins
   - recent major surgery, hospitilisation, trauma
   - cancer, chemotherapy, dehydration
   - significant immobility, prolonged travel
   - hormone treatment, pregnancy, post-partum period
3. ) Wells Criteria - assessment for suspected DVT
   - score: 2+ suggests DVT likely so refer to DVT clinic
   - whole leg swelling, swelling (>3cm), pitting oedema,
   - collateral superficial veins, localised tenderness along distribution of deep venous system
   - active cancer, previous DVT, recently bedridden or major surgery, recent immobilisation of lower limbs
   - alternative diagnosis as likely (score -2)
4. ) Management - often just refer to DVT clinic
   - DVT likely: ultrasound within 4 hrs, if not, D-dimer and interim therapeutic anticoagulation
   - DVT unlikely: if D-dimer positive, ultrasound within 4 hours, if not, interim therapeutic anticoagulation