Acute Medicine

Question 1

Acute Medicine primary actions?

Answer 1

ABCDE

Disability e.g. AVPU

Question 2

Airway management?

Answer 2

Assess: patency, secretions and vomit or obstruction
Manage: airway manouvres, suction or aiway adjuncts

Question 3

Breathing management?

Answer 3

Assess: RR or O2, palpations, percussion, auscultations, later CXR
Manage: Oxygen

Question 4

Circulation management?

Answer 4

HR and BP, cap refill perfusion, cyanosis, aucultation

Manage: fluids, bloods or ABG

Question 5

Disability management?

Answer 5

Assess: AVPU or GCS, or glucose, PEARL

Question 6

Exposure management?

Answer 6

Assess: whole body inspection

SBAR for handover

Question 7

What is alcohol withdrawal?

Answer 7

physical and psychological symptoms associated with sudden decrease in alcohol consumption

Question 8

What causes alcohol withdrawal symptoms?

Answer 8

Alcohol is a CNS depressant so increased CNS stimulation through upregulated glutamate causes it

Question 9

How does alcohol withdrawal present?

Answer 9

Day 1: anxiety, palpitations, GI upset, sweating and tremor
12hours = visual tactile (little people and insects on skin) hallucinations and normal mental stus

Day 2: 36hrs = short, generalised tonic-clonic seizures

Day 3 48 to 72hrs can be delirium tremens (fatal) -> delirium, severe tremor, fever and high BP and HR

Question 10

Alcohol withdrawal DDx of delirium tremens (confusion)

Answer 10

Acute liver failure so Ammonia, albumin, bilirubin, blood factors

Ammonia -> encephalopathy
Albumin -> Ascites + peripheral oedema
Bilirubin -> jaundice
Blood factors -> bruising

Question 11

What is wernickes encephalopathy?

Answer 11

CAN = Confusion, ataxia, nystagmus due to vitamin B1 deficiency

Question 12

Hx + Exam for alcohol withdrawal?

Answer 12

Hx + exam: screen for alcohol use disorder e.g. CAGE
Severity of withdrawal = CIWA-Ar scale
)/E signs of alcohol abuse (chronic liver disease) e.g. spider naevi, gynaecomastia

Question 13

Bedisde Obvs for alcohol withdrawal?

Answer 13

Obvs -> tachycardia, temperatuer urine distick and U&Es

Question 14

Bloods for alcohol withdrawal?

Answer 14

FBC, U&Es, LFTs, INR and glucose

Question 15

Management of alcohol withdrawal?

Answer 15

1) Benzodiazepine se.g. chlordiazepoxide, diazepam)
2) Pabrinex (b vitamines to prevent wernickes)
3) glucose if hypoglycaemic
4) manage alcohol dependece

Question 16

What is anaphylaxis?

Answer 16

Life-threatening, systemic, hypersensitivity reaction characterised by airway +/- breathing +/- circulation problems. Usually associated with skin/mucosal changes

Question 17

What are common triggers for anaphylaxis?

Answer 17

0-4YO

1) food e.g. nuts
2) Drugs/chemics e.g. penicillin, NSAIDs, latex, contrast
3) Toxins e.g. beewasp, venom

Question 18

Rf for anaphylaxis?

Answer 18

Hx of atopy e.g. hayfever or asthma

Question 19

What pathophysiological cause of anaphylaxis symptoms?

Answer 19

Mast cell and basophil degranulation = increased cap permeability, bronchospasm and reduced vascular tone

Question 20

Anaphylaxis presentation?

Answer 20

Airway = angioedema of throat, swelling and stridor
Breathing = SOB, increased RR decreased O2
Circulation = SHOCK -> low bp, high hr, decreased consciousness

Skin mucousal = urticaria and angioedema, flushing

SENSE OF IMPENDING DOOM

Question 21

Management for anaphylaxis?

Answer 21

1) HELP
2) Remove trigger
3) Lie flat and raise legs
4) IM adrenaline 0.5mg 1:1000
5) airway, breathing, circulation
6) IV chlorphenamine + IV hydrocortisone

Further investigation = serum tryptase and plasma histamine

Question 22

What follow up for anaphlaxis?

Answer 22

Refer to allergy or immunology e.g. RAST specifiv IgE testing
Provide epipen and education re anaphylaxis
Medic alert bracelet

Question 23

RFs for overdose?

Answer 23

<10 usually accidental

>10 usually deliberate and associated with alcohol abuse

Question 24

What to use in management?

Answer 24

TOXBASE
NPIS helpline
Consider activated charcoal if <4hours
Consider gastric lavage

Question 25

How much for aspiring OD?

Answer 25

Usually 300mg tablets so OD >150mg/kg, sever if >500mg/kg

Question 26

Early aspirin OD presentation?

Answer 26

Tinnitus, deafnes, dizziness, hyperpnoea, N+V, diarrhoea + hyperthermia, sweating
Per-spiring-g

Question 27

Late Aspiring OD presentation?

Answer 27

Low bp + Heart block, pulmonary oedema and low GCS + seizire

Question 28

Lab findings for Aspirin OD?

Answer 28

Early respiratory alkalosis

Late high anion gap metabolic acidosis

Question 29

Aspirin OD management?

Answer 29

urine alkalinisation with IV sodium bicard
Dialysis
Supportive

Question 30

Paracetamol OD Amount?

Answer 30

Usually 500mg so OD 150mg/KG, 12g can be fatal

Question 31

Pathophysiology of paracetamol OD?

Answer 31

Normally metabolised by CYP450 in liver to NAPQi, conjucated to glutathione and excreted. Therefore, run out of glutathionine and toxic NAPQi accumulates and hepatocyte necrosis

Question 32

Paracetamol OD presentation?

Answer 32

Often asymptomatic
<24hrs : mild N+V, lethargy
24-72 hrs: RUQ, vomiting and hepatomgealy
>72hrs : acute liver failure

Question 33

Management of paracetamol OD?

Answer 33

IV N-acetyl cysteine if below treatment line

Liver transplant if above on paracetamol normogram

Question 34

Presentation of Opiate OD?

Answer 34

CNS depressants = resp depression, bradycardia, hypotension, pinpoint pupils,.
Late severe = low GCS and coma

Question 35

Management of Opiate OD?

Answer 35

IV Naloxone