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mrcpch > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

classification system for ankle fractures?

A

Ottowa rules

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2
Q

classification system for scaphoid fractures?

A

Herbert classification:

Grade A: acute/ stable
Grade B: acute/ unstable
Grade C: Delayed union
Grade D: Established non-union

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3
Q

Herbert classification of scaphoid fractures?

A

Grade A: acute/ stable

  • A1: Tubercle
  • A2: non displaced waist crack

Grade B: acute/ unstable

  • B1: Oblique/distal third
  • B2: Displaced waist
  • B3: Proximal pole
  • B4: Fracture dislocation
  • B5: Comminuted fracture

Grade C: Delayed union

Grade D: Established non-union

  • D1: Fibrous
  • D2: Sclerotic
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4
Q

Classification system for fractures involving the growth plate (epiphyseal fractures)?

A

Salter- Harris classification

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5
Q

Salter-Harris classification of epiphyseal fractures?

A

I: Straight across the growth plate
II: Above. through growth plate + above (metaphysis)
III: Below. through growth plate + below (epiphysis)
IV: Through (metaphysis + growth plate + epiphysis)
V: Crush injury involving growth plate

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6
Q

Classification of supracondylar fractures in children?

A

Gartland classification

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7
Q

Salicylate poisoning - effect on Respiratory rate?

A

Salicylates e.g. aspirin increase RR -> hyperventilation and respiratory alkalosis

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8
Q

ECG changes in hyperkalaemia?

A

tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole

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9
Q

Does acidosis or alkalosis lead to hyperK?

A

Acidosis.

H+ and K+ ions compete with each other for exchange with sodium ions across cell membranes and in the distal tubule.

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10
Q

Causes of hyperuricaemia due to increased synthesis of uric acid?

A

increased cell turnover/ increased production of uric acid:

  • Lesch-Nyhan disease
  • myeloproliferative disorders
  • diet rich in purines
  • exercise
  • psoriasis
  • cytotoxics
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11
Q

Causes of hyperuricaemia due to decreased renal excretion of uric acid?

A
  • drugs: low-dose aspirin, diuretics, pyrazinamide
  • pre-eclampsia
  • alcohol
  • renal failure
  • lead
  • acidosis (eg, diabetic ketoacidosis, ethanol or salicylate intoxication, starvation ketosis) The organic acids that accumulate in these conditions compete with urate for tubular secretion.
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12
Q

Drugs that cause hyperuricaemia due to reduced excretion of uric acid?

A

CANT LEAP

C iclosporin
A lcohol
N icotinic acid
T hiazides

L oop diuretics
E thambutol
A spirin
P yrazinamide

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13
Q

Purpose of BHCG rise in first trimester of pregnancy?

A

to maintain the corpus luteum and thereby progesterone production

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14
Q

What proteins are the alpha-subunit of HCG identical to?

A

It is a protein dimer. Its alpha subunit is identical to LH, FSH, TSH

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15
Q

most dangerous location for ectopic pregnancy?

A

isthmus of Fallopian tube

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16
Q

Borders of the femoral triangle?

A

Superiorly: Inguinal ligament
Laterally: Sartorius
Medially: Adductor longus

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17
Q

Contents of the femoral triangle?

A
  • Femoral vein (medial to lateral)
  • Femoral artery-pulse palpated at the mid inguinal point
  • Femoral nerve
  • Deep and superficial inguinal lymph nodes
  • Lateral cutaneous nerve
  • Great saphenous vein
  • Femoral branch of the genitofemoral nerve
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18
Q

Causes for high anion gap metabolic acidosis (>11 mEq/L)?

A

MUDPILES:

Methanol
Uraemia
DKA
Paraldehyde
Infection
Lactic acidosis
Ethylene glycol/ethanol
Salicylates
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19
Q

Causes for normal anion gap metabolic acidosis (3-11 mEq/L)?

A

Diarrhoea
Type I, III, & IV renal tubular acidosis
Alcohol
Addison’s disease

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20
Q

Causes of low anion gap metabolic acidosis?

A

Haemorrhage
Nephrotic syndrome
Intestinal obstruction

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21
Q

Wallace’s rules of nine for assessing extent of burns in children >16?

A 
head + neck = 9%
each arm = 9%
each anterior part of leg = 9%
each posterior part of leg = 9%
anterior chest = 9%
posterior chest = 9%
anterior abdomen = 9%
posterior abdomen = 9%

palmar surface 1%

22
Q

most accurate method for assessing extent of burn?

A

Lund and Browder chart

23
Q

Which burns should be referred to secondary care?

A
  • all deep dermal and full-thickness burns.
  • superficial dermal burns of more than 2% TBSA in children
  • superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
  • any inhalation injury
  • any electrical or chemical burn injury
  • suspicion of non-accidental injury
24
Q

indications for escharotomies in burns?

A
  • Indicated in circumferential full thickness burns to the torso or limbs.
  • Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso)/ relieve compartment syndrome and oedema (where a limb is involved)
25
Q

What level does the spinal cord terminate?

A

L1/L2

26
Q

What is Rovsing’s sign?

A

A positive sign is determined when palpation in the left lower quadrant of a patient’s abdomen causes pain in the right lower quadrant.

  • suggestive of appendicitis
27
Q

What is Murphy’s sign?

A

Inhalation causes the gallbladder to descend which catches on the fingers causing pain.

  • suggests gallbladder inflammation
28
Q

What is Cullen’s sign?

A

bruising around the umbilicus

  • suggestive of pancreatitis/ ectopic pregnancy
29
Q

What is Battle’s sign?

A

bruising behind the ear suggesting a basal skull fracture of the posterior cranial fossa.

30
Q

Mx of primary pneumothorax <2cm?

A

if <2cm + not SOB: conservative mx
if SOB: consider aspiration
if >2cm or still SOB: chest drain

advise to stop smoking

31
Q

Mx of secondary pneumothorax?

A

if SOB: Chest drain

if 1-2cm: aspiration

if <1 cm: give O2 and admit for 24h

avoid scuba diving

32
Q

Mx of Complete hydatidiform mole?

A

urgent referral to specialist centre - evacuation of the uterus is performed

effective contraception is recommended to avoid pregnancy in the next 12 months

33
Q

features of molar pregnancy?

A
  • bleeding in first or early second trimester
  • exaggerated symptoms of pregnancy e.g. hyperemesis
  • uterus large for dates
  • very high serum levels of HCG
  • hypertension and hyperthyroidism may be seen
34
Q

Mx of accidental injection of adrenaline?

A

local infiltration of phentolamine

35
Q

Recommended dose of adrenaline in anaphylaxis in children?

A

adrenaline 150 mcg IM in children <6 years
300 mcg IM in children 6-12 years
500 mcg in children >12 y

36
Q

Recommended dose of adrenaline in cardiac arrest in children?

A

10 mcg/ kg every 3 to 5 min (i.e. every other loop)

37
Q

unhappy triad injury of the knee?

A

medial collateral ligament + medial meniscus + anterior cruciate ligament

(classically the medial meniscus but recent evidence shows that the lateral meniscus is more commonly injured)

occur due to a lateral impact resulting in Valgus stress.

38
Q

Causes of meningitis in 0-3 mo olds?

A

Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes

39
Q

Causes of meningitis in 3 mo - 6 years old?

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

40
Q

Causes of meningitis in 6 - 60 yr olds?

A

Neisseria meningitidis

Streptococcus pneumoniae

41
Q

Rate of paediatric CPR?

A

100-120 bpm

42
Q

Effect of burns on Haemoglobin?

A

Haemolysis due to damage of erythrocytes by heat and microangiopathy

43
Q

Dose of im adrenaline in anaphylaxis in children?

A

10 microgram/kg

44
Q

Dose of IV Hydrocortisone in anaphylaxis in children?

A

4mg/kg

45
Q

most common causative organism of meningitis in non-vaccinated young child?

A

Haemophilus influenzae type B

46
Q

Hypertrophic vs keloid scars?

A

Typically a keloid scar will pass beyond the boundaries of the original injury.
Hypertrophic scars remain confined to the boundaries of the original wound

47
Q

Drugs which impair wound healing

A

NSAIDs
Steroids
Immunosupressive agents
Anti neoplastic drugs

48
Q

Cough + SOB + Sore throat + exposure to distinctive rotten egg smell

A

Exposure to Hydrogen sulphide

  • Hydrogen sulphide can be released from agricultural plants ie. industrial farms
49
Q

Ingestion of mothballs + haemolytic anaemia

A

Napththalene poisoning

50
Q

Ingestion of inorganic compound + hypotension, tachycardia and ECG changes

A

Selenium poisoning

51
Q

Contaminated water supplies + nausea, diarrhoea and vomiting?

A

arsenic poisoning

mrcpch (27 decks)

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