Yr 5 Acute Care End of block assessment Flashcards
A 41 year old lady with no signicant past medical history is brought in to the ED by her husband. She describes a sudden onset occipitalheadache, like being hit with a hammer. She has vomited twice prior to her arrival in ED. She has a further vomit and drops her GCS to 6 (E2,V1, M3). The most appropriate immediate management is: Select one:
- Nurse 30 degrees head down to reduce intracranial pressure
- Urgent lumbar puncture to exclude subarachnoid haemorrhage
- Secure a defnitive airway
- Transfer the patient immediately to CT scan
- Deliver a bolus of 20% mannitol
Secure a defintiive airway
E2 - open to pain
V1 - no response
M3 - abnormal flexion - decorticate
A 35 year old man presents to the ED having fallen whilst leaving the pub. Witnesses state he had been drinking heavily and was grosslyintoxicated. There is evidence of an occipital laceration. He opens his eyes to pain, localises to pain, and on questioning appearsdisorientated to place and time. His GCS is?
Select one:
- 9
- 11
- 12
- 10
- 13
11
- E2 - eyes open to pain
- V4 - confused
- M5 - localises to pain
A 2 year old male has awoken during the night with a harsh cough and stridor. He has had a snuy nose for 24h prior to presentation. Hissats are 99% in air, RR 30, Pulse 120. He has stridor only when upset and crying. His chest is clear. He is alert and interacting normally. The best medication to treat him with is:
Select one:
- a. IM Adrenaline
- b. Oral Amoxicillin
- c. Oral Dexamethasone
- d. Salbutamol Nebuliser
- e. Adrenaline Nebuliser
c - oral dexamethasone (sounds like the child has croup)
Administer a dose of oral dexamethasone (0.15 mg/kg). If the child is too unwell to receive medication, inhaled budesonide (2 mg nebulised as a single dose) or intramuscular dexamethasone (0.6 mg/kg as a single dose) are possible alternatives.
A 25 year old female presents to the ED having cut her foot on glass the previous evening. Examination reveals a puncture wound to her leftfoot, and a subsequent Xray shows NO foreign body. She has had all her vaccinations as a child. Her friend told her that she may require atetanus booster. Do you?
Select one:
- Reassure her that no tetanus prophylaxis is required.
- Give a tetanus single booster and an anti-tetanus immunoglobulin as a combined injection
- Give an anti tetanus single booster only
- Give an anti tetanus immunoglobulin only
- Give a tetanus single booster and an anti-tetanus immunoglobulin at separate injection sites
- Reassure her that no tetanus prophylaxis is required.
- (search up on bnf for explanation)
A 3 year girl falls of her parent’s bed and injures her elbow. Her elbow is deformed and she is distressed with pain. The most appropriateanalgesic would be: Select one:
- a. Ibuprofen
- b. Paracetamol
- c. Intranasal Diamorphine
- d. Entenox
- e. Codeine Phosphate
Intranasal diamorphine
Ensuring appropriate analgesia and treatment for the patient
20 year old female attends the ED following a deliberate ingestion of 48 paracetamol 500mg tablets 3 hours ago. She weighs 80 kg. Do you?
Select one:
- Check LFTs and Clotting
- Check paracetamol levels at 8 hrs from ingestion to inform ongoing treatment
- Check paracetamol levels at 4 hrs from ingestion to inform ongoing treatment
- Refer for mental health assessment
- Immediately commence N-acetylcysteine treatment
- Check paracetamol levels at 4 hrs from ingestion to inform ongoing treatment
A 73 year old male is brought into the ED following a sudden collapse. He is complaining of severe back pain and abdominal pain. He has ahistory of high blood pressure and diabetes.
His obs are: BP 70/40, HR 110 reg, Sats 99%, BM 7, T 36.7.
The most likely diagnosis is: Select one:
- a. Gall stones
- b. Renal colic
- c. Diverticulitis
- d. Acute MI
- e. Ruptured Abdominal Aortic Aneurysm
e - ruptured abominal aortic aneurysm
Patient is in pulsesless monomorphic ventricular tachycardia - so it is a shockable rhythm hence 3 shocks given
Give amiodarone 300mg and adrenaline 1mg after third shock
- (can give a further 150mg amiodarone after 5 shocks)
- (give 1mg adrenaline every 3-5 minutes after 3rd shock in shockable rhythm)
A 36 year old lady presents complaining of left elbow pain after falling o a ladder. On examination she is neurovascularly intact but younotice she has a reduced range of movement and is tender over her radial head. You perform an X-ray but cannot see an obvious fracture.Which radiological sign can indicate the presence of an undisplaced radial head fracture?
Select one:
- Elevated anterior fat pad
- Non-elevated anterior fat pad
- Displaced radio-capitellar line
- Absence of posterior fat pad
- Displaced anterior humeral line
Elevation anterior fat pad
Elevation of the anterior fat pad usually heralds the presence of an intra-articular fracture. In adults, this is usually a radial head fracture whereas in children, the commonest cause of a raised elbow fat pad is a supracondylar fracture.
What is the incidence of human error in healthcare according to the World Health Organisation (WHO) worldwide?
Select one:
- a. 1 in 3000
- b. 1 in 30000
- c. 1 in 10000
- d. 1 in 300
- e. 1 in 1000
1 in 300
You are asked to see a 48 year old gentleman who has just been admitted after falling from a ladder this morning. A chest x-ray revealednumerous fractured ribs on his right side. The patient has oxygen saturations of 92% on air. His RR 16 breaths/min, HR 90 bpm and BP106/67. On auscultation his chest is clear. What is the most likely reason for his low oxygen saturations?
Select one:
- Pleural effusion
- Underlying tension pneumothorax
- Pulmonary oedema
- Hypoventilation due to pain
- Pulmonary contusions secondary to the trauma
- Hypoventilation due to pain
What is the composition of the uid sodium chloride?
Select one:
- Na 131 mmol/l, Cl- 111 mmol/l, osmolairty 278 mOsm/l
- Na 135 mmol/l, Cl- 95 mmol/l, osmolarity 275 mOsm/l
- Na 154 mmol/l, Cl- 154 mmol/l, osmolairty 308 mOsm/l
- Na 77 mmol/l, Cl- 77mmol/l, osmolarity 154 mOsm/l
- Na 140 mmol/l, Cl- 98 mmol/l, K 5 mmol/l, HCO3 – 27 (acetate), osmolairty 295 mOsm/l
Na 154 mmol/l, Cl- 154 mmol/l, osmolairty 308 mOsm/l
The normal daily maintenance requirements of uids in a adult is:-
Select one:
10-15 ml/kg/day
40-50ml/kg/day
25-35 ml/kg/day
2 litres/day
5 litres/day
Questions says the answer is 25-35 ml/kg/day
(NICE says 25-30ml/kg/day in a patient with normal cardiac function)
The normal maintenance requirement of sodium a day is:-
Select one:
- 200mmol/day
- 2 – 3 mmol/kg/day
- 0.2 – 0.5 mmol/kg/day
- 0.9 – 1.2 mmol/kg/day
- 4 mmol/kg/day
Normal daily fluid and electrolyte requirements:
- 25–30 ml/kg/d water
- 1 mmol/kg/day sodium, potassium*, chloride
- 50–100 g/day glucose (e.g. glucose 5% contains 5 g/100ml)
2:1 hear block (unsure if this is Mobitz type 1 or Mobitz type 2 heart block)
Hyperglycaemic hyperosmolar state
Diagnoses
- Osmalality >320mosmol/kg (high serum glucose concentration)
- • Osmolality = 2x[Na+K] + Urea + glucose
- Normal osmolality 285-295msmol/kg
- In HHS osmolality is thought to be greater than 320mosmol/kg (usually around 400)
- Glucose levels >30mmol/;
- No switch to ketone metabolism as there is insulin present so no ketonaemia and therefore pH>7.3
