ACC

Question 1

What are the Ottowa rules for an ankle X ray?

Answer 1

Pain in malleolar zone +
Tenderness at posterior edge/ tip of lateral or medial malleolus
Inability to weight bear immediately + for 4 steps

Question 2

What are the Ottowa rules for an foot X ray?

Answer 2

Pain in midfoot zone +
Tenderness at base of 5th metatarsal
Bone tenderness at navicular
Inability to weight bear immediately + for 4 steps

Question 3

Where do the leads go for an ECG?

Answer 3

V1 = 4th IC space right sternal border (nipple level)
V2 = 4th IC space left sternal border (nipple level)
V3 = between V2 + V4
V4 = 5th IC space mid clavicular line (under left nipple)
V5 = anterior axillary line
V6 = mix axillary line
RUL (red) = right wrist
LUL (yellow) = left wrist
LLL (green) = left ankle
RLL (black) = right ankle

Question 4

Pharmacological management of asthma

Answer 4

Salbutamol 5mg nebs with O2
Ipratropium 500mcg nevs (4-6 hrly)
Hydrocortisone 200mg IV or prednisolone 40mg oral
Magnesium sulphate 2g IV over 20 mins

Question 5

Pharmacological management of pulmonary oedema

Answer 5

Diamorphine 2.5mg IV
Furosemide 40mg IV
GTN 2 sprays
Consider CPAP or salbutamol if wheezy

Question 6

Management of DVT based on Wells score

Answer 6

<2 = d dimer 
>3 = USS + D dimer if negative

Question 7

Pharmacological management of DKA

Answer 7

0.1 units insulin/ kg/ hr

Add K+ if needed

Question 8

Pharmacological management of hypoglycaemia

Answer 8

Lucozade orally
50ml 20% dextrose IV
IM glucagon 1mg if no IV access

Question 9

Pharmacological management of alcohol withdrawal

Answer 9

Chlordiazepoxide
IV lorazepam if having seizures
DT = oral lorazepam
Pabrinex

Question 10

Recognition of AKI

Answer 10

Rise in creatinine >26 in 48hrs OR
Rise in creatinine 1.5 x baseline within 1 week OR
Urine output <0.5ml/kg/hr for 6 hours

Question 11

How to assess volume status?

Answer 11

CRT
Pulse 
BP 
JVP 
Skin turgor 
Pulmonary oedema
Peripheral oedema 
Urine output

Question 12

Pharmacological management of anaphylaxis

Answer 12

Adrenaline 500mcg IM every 5 mins
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Fluid bolus 500ml Hartmanns

Question 13

Management of seizure

Answer 13

1-2mg Lorazepam up to 4mg IV
Repeat after 5 mins
IV phenytoin 20mg/kg

Question 14

Pharmacological management of GI bleed

Answer 14

Blood transfusion, consider platelets + FFP
Terlipressin if varices
Ciprofloxacin if alcohol induced
Thiamine + B12 if alcohol induced

Question 15

Pharmacological management of hyperkalaemia

Answer 15

10% calcium gluconate 30ml over 2 mins
50mls 50% glucose over 5 mins with soluble insulin 10 units IV over 10 mins
Salbutamol 5mg nebs
Calcium resonium 15g orally