A&E Flashcards
(86 cards)
1
Q
Tests + Mx of persistent haematuria
A
- Dipstick, 3 sampes 2-3 weeks apart
- Renal function, ACR or PCR ratio and BP
- Microscopy
- Urgent referral if >/45 with UEVH with no UTI/persistent after uti Tx. oR 60+ AND UE non visible H and dysuria or WCC
2
Q
The triad of nephrotic syndrome and patho
A
- Nephrotic syndrome = proteinura, hypoalbuminaemia, oedema
- Caused by primary (minimal change disease etc), or secondayr causes (DM)
- Patho = damage to basememnet membrane and increased permeability to proteins
- Ix = Dip, MSU (exclude infection), FBC, Coag, U&Es and quantify protein.
3
Q
When not to diagnose a UTI with Dipstick and when to send off MSU
A
- DOnt use dipstick for = women>65, men and catheterised patients
- Send a culture if = women 65+, men, pregnant, recurrent UTI (2 ep in 6m or 3 in 12m), haematuria
4
Q
Definition of neuropathic pain and first line Tx
A
- NP pain = damage/disruption to the NS
- mitriptyline, duloxetine, gabapentin, pregablin.
5
Q
Pllaiative prescribing - pain
A
- If no co-morbidities = 20-30mg MR with 5mg breakthrough
- 1/6 is breakthrough generally
- Prescribe laxative like senna + macrogol/docusate with it
- If ckd = OXYCODONE AND IF MORE SEVERE THEN FENTANYL ETC.
6
Q
Acute interstitial Nephritis
A
- Drug induced AKI
- penicillin, NSAIDs, rifampicin, allopurinol, furosemide, infections, systemic disease
- Interstitial oedema and infiltrate
- fever, rash, eosinophilia, HTN etc
- White cell casts
- Canget tubulointersitital nephritis with uveitis in yougn women
7
Q
Three main causes of AKI
A
- Pre-renal = lack of blodo flow (hypovolaemia, renal artery stenosis)
- Intrinsic = intrinsic damage - glomerulonephritis, tumour lysis syndrome etc
- POst-renal = obstructive - ie kidney stone, BPH, external compression of ureter
8
Q
Drugs that commonly cause / can increase irs of AKI
A
- NSAIDs
- Aminoglycosides
- ACEi
- ARB
- Diurrtic
9
Q
Diagnosis of AKI
A
- Rise in creatinine of 26 umol/L or more in 48 hours OR
- > / 50% rise in creatinine over 7 days OR
- Fall in urine output less than 0.5ml/kg/hour for more than 6 hours in adults (8hr in children)
- > /25% dall in eGFR in children/young adults in 7 days
10
Q
Anaphylaxis symptoms and doses of adrenaline
A
- Sudden + rapid = airway +/- breathing +/- ciruclation problems (stridor, angioedema, hoarse voice, wheee, SOB, hypotension, tachy)
- Under 6months = 100-150 micrograms (0.1-0.15ml 1 in 1000)
- 6 months to 6 years = 150 micrograms (0.15ml 1 in 1000)
- 6-12 years = 300 micorgrams (0.3ml 1:1000(
- Adult and child over 12 = 500 micrograms (0.5ml 1:1000)
Can repeat every 5 mins, anterolateral aspect thigh. If use 2 and still anapphylaxis then refractory and expert help for ocnsideration iV adrenaline infusion.
11
Q
How to manage patients after stabilisation of anaphylaxis
A
- Non-sedating oral antihsitamines
- Serum tryptase can remain elevated up to 12hours after anaphylaxis for confirmation
- If new diagnosis then specialist allergy clinic and given epipen in mean time (2) and trained.
12
Q
Placental abruption vs placenta praevia (Antepartum haemorrhages)
A
- Placental abruption = shock out of keeping with visible loss, constant pain, tender/tense uterus, normal lie/presentation, absent/distressed fetal heart, coag problems etc
- Placenta praevia = shock in proportion to visible loss, no pain, uterus not tender, lie and presentation may be abn, fetal heart usually nromal
13
Q
Types of miscarriage
A
- Threatened = painless vaginal bleeding <24weeks, cervical os closed
- Missed 9delayed) = dead fetus <20 weeks with no signs expulsion. May have some bleeding. Os is closed.
- Inevitable = hevay bleeding, os opened
- Incomplete = not all products expelled, pain, vaginal bleeding, os opened
14
Q
Mx animal / human bites
A
- Animal = clean, close, co-amox
- Human bites = co-amox, consider HIV/Hep C
15
Q
Lyme disease symptoms and management
A
- bulls eye rash, systemic feautres (headache, lethargy, fever, arthralgia) and later on CV problems and neuro
- Dx = clinical and ELISA antibodies first line
- Asymptomatic = remove
- Suspected/confirmed lymes = doxycycline if early. Ceftriaxone if disseminated.
16
Q
Mx heat, electrical and chemical burns
A
- A,B,C
- Heat = remove from source, 10-30mins water (not iced). Cover and layer cling film around
- Electrical = switch off power, remove from source
- CHemical = brush of powder then irrigate with water
17
Q
Shockable vs non shockable rhythms
A
- SHockable = VF or pulseless VT
- Non shockable = asystole, PEA
18
Q
adrenaline/amidoarone rules with ALS
A
- Adrenaline = 1mg ASAP if non shockable and repeat every 3-5mins. If shockable then start adrelaine 1mg after 3rd shock.
- Amidoarone = 300mg in VF/Pulseless VT after 3 shocks,. Further 150mg after 5 shocks.
- If suspected PE then thrombolytic drugs but continue CPR 60-90mins.
19
Q
Reversibel causes Cardiac arrest
A
- Hs = Hypoxia, hypovolaemia, hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, (othe rmetbaolic), Hypoerthermia
- Ts = Thrombosis, tension PTX, tamponade, toxins
20
Q
Paeds Bls
A
- 5 Rescue breaths -c heck brachial or femoral pulse
- 15:2
- COmpressions in lower half of sternum. In infants use two thumb encircling technique
21
Q
ACS features
A
- Chest pain - LHS, may radiate to left arm or neck. If elderly/diabetc/female can be more atypical
- SOB
- N&V
- Sweating
- Palpitations
22
Q
Features aortic dissection
A
- Chest/back pain - sharp, severe, tearing, maximal at onset
- Pulse deficity between arms (>20)
- Aortic regur, HTN, anginal, paraplegia, limb ischaemia etc
23
Q
Key/common causes chest paina nd features
A
24
Q
Immedate mx of suspected acs
A
- Morphine if severe pain
- Oxygen if <94
- Nitrates - GTN
- Aspirin 300mg
- ECG - but dont delay transfer.
emegrency amdission if in under 12 hours. if 12-72hrs ago the same day assessment and if >72houts then do ECG/trop before deciding.
If its stable angina then CT coronary angiography
25
ECG territories of STEMI changes.
26
Myocarditis presentation, Mx
* Young patient, acute hx, chets pain, sob,a rrhythmias.
* Bloods (inflamm markers, cardiac enzymes, bNP all elevated).
* ECG - tachy, arrhythmias - st/t wave changes include st elevation and t wave inversion
* Tx of undelrying cause ie, Abx if bacterials.
27
Acyanotic vs cyanotic heart disease
* Acyanotic = VSD, ASD, PDA, Coarctationa orta, aortic valve stenosis
* Cyanotic = tet of fallor, transposiiton greta arteries, tricuspid atresia.
* In cyanotic - PG E1 (eg, alprostadil) to maintain PDA
28
Extradural haematoma - key Hx, how it is on CT
* Middle meningeal artery (pterion hit)
* Lucid interval after head injury
* Biconvex (lentiform) hyperdense collection, limited by suture lines of skull
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GCS
30
31
Features and tx of hypoglycaemia
* Sweat, hake, hunger, anxiety and if severe - visual, confusion, coma, weakness
* 102-g oral glucose or snack
* If hospital and unconscious then iV glucose 20% 100ml and if no cannula or community = IM glucagon
32
Features / Ix SAH
* Sudden onset headache, severe, occipital, peaks 1-5mins, N/V, meningism, seizures
* CT non contrast
* If a CT is done over 6 hours after symptom onset and normal then do LP (xanthochromia etc). Dont do LP if CT wihtin 6 hrs.
* Neurosrgery
* CX = re bleeding, hydrocephalus, vasospasm, hyponatraemia, seizures
33
SUbdural: Types, Presentation, CT
* Colleciton blood deep to dural laye
* **Acute** = symptoms within 48hours injury and rapid neuro deterioration. CT is cresenteric not limtied by sutures.
* **Subacute** = symptoms manifest within days-weeks ost-injury with more gradual progression.
* **Chronic** = common in elderly and alocholics, developing over weeks to months. May not recall specific head injury. CT is cresenteric, not restricted by sutures, compress brain (mass effect). In contrast to acute ones, these are hypodense (dark) vs acute which is bright. COuld be conservative mx.
Ams, fluctations in consciousness, focal neuro deficits, headache one side and worsening, seizures
Papilloedema, pupil changes, gait abnormalities, hemiparesis
Mmeory loss, perosnality changes
N&V, drowsy, raised intracranial pressure signs
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35
Fluid therapy requirements in adults
* 25-30 ml/kg/day of water and
* 1mmol/kg/day potassium/sodium/chloride
* 50-100g/day glucose
36
FLuid therapy children
*
37
Hyperosmolar hyperglycaemia state - features, mx
* Comes on over days
* Dehydration, polyuria, polydipsia, lethargy, N&V, altered level consciousness, focal neuro deficits, hyperviscosity
* Hypovolaemia, hyperglycaemi (>30), raised osmolarity, no significant ketonaemia, no significant acidosis
* Mx = fluidtypiclaly 500ml/1l per hour, monitor K, dont give insulin unless blood glucose stops falling, VTE prophylacis.
38
Categories asthma
39
Bronchitis features and mx
* Chets infection self limiting under 3 weeks usually
* Oedematous large airways and production sputum
* Cough, sore throat, rhinorrhoea, wheeze.
* VS pneumonia: may be absent in acute bronchitis but at least on e in pneumonia of sputum/wheeze/breathless. No focal chest signs but usually in pneumonia,.
* Consider Abx if systemically unwell, co-morbid, CRP higher (doxy)
40
Bronchiectasis - what is it, features and signs
* Permanent dialtion of airways secondary to chronic infection or inflammation.
* Persistent productive cough, lots sputum, sob, haemoptysis
* Coarse crackles, wheeze, clubbing
41
Features, Ix, COPD
* COugh (porductive often), sob, wheee, in severe RHF and periph oedema)
* Post-bronchodilator spirometry to FEV1/FVC les than 70%, CXR shows hyperinflation/bullae/flat hemidiaphragm FBC to exclude polycythaemia, BMI
42
Lung cancer featuresincluding paraneoplastic ie small cell/squamous cell/adenocarcinoma.
* Perisstent cough, haemoptysis, dyspnoea, chest pain,w eight loiss/anorexia, hoarseness (pancoast), svc syndrome
* Supraclavicular lymphadenopathy/persistent cervical LNs, clubbing
* Small cell = ADH, ACTH, Lambert eaton syndrome
* Squamous = PTH causing hypercalacameia, clubbing, HPOA, hyperthyroidism
* Adenocarcinom = gynaecomastic, HPOA
43
SYmptoms, assessment pneumonia
* COugh with purulent psutum, dyspnea, chets pain, fever, malaise , signs sytemic infection, tachy, low o2 sats
* CRB65 = Confusion, RR>30, BP (less than 90 +/- 60 DBP) and over 65 is all one point.
* 0 is low risk, 1.2 is intermediate, 3/4 is high risk
* CXR is consolidation +/- effusion
* FBC, U&E, CRP, blood culturesm, sputum
44
PTX Mx
45
PE features
* Chets pain, dyspnea, haemoptysis, tachy, chest clea rusually
46
Main causes hypercalcaemia and symptoms
* Primary hyperparathyroidism
* Malignancy - squamous cell lung, bone mets, myeloma
* Sarcoidosis, vit D intox, acromegaky, thiazides, dehydration, addisons Disease
**Symptoms** = Bones, stones, groans, psychic moans, corneal calcification, shortened Qt interval on ECG, hypertension
47
Causes hyperkalaemia
* AKI
* Drugs - potassium sparing diuretics, acei, ARBs, spironolactone, ciclosporin, heparin
* Metabp;ic acidosis, addisons disease, rhabdomyolysis, massive blood transfusion
48
Management Hyperkalaemia
* IV calcium gluconate - stabilise cardiac membrane
* - insulin/dextrose infusion, en salbutamol. - short term shift potassium ecf to icf
* Remove potassium from body - calcium resonium, loop diuretics, dialysis
* If severe >/6.5 or ecg treatment then IV calcium gluconate, insulin/dextrose infusion
49
Causes hypernatraemia and risks of correcting too quick
* Causes - dehydration, osmotic diuresis, diabetes insipidus, excess IV saline
* risk cerebral oedema if too quick
50
symptoms hypocalcaemia and management
* **Causes** = vitamin D def, CKD, hypoPTH, rhabdo, mg def, acute pancreatitis
* **Severe** - tetany, spasms, seixure,s prolonged QT needs IV calcium gluconate 10ml of 10% solution
* **Symptoms** = tetany (muscle twitching, crmaping, spasm), perioral paraesthesia, prologned QT
* **Trousseaus sign** - carpal sapsm if brachial artery occluded with BP and wrist flexion and fingers drawn together
* **Chvostek's sign** = tappiung over parotid causes facial muscles to twitch.
51
Hypokalaemia causes acidosis vs alkalosis
* Hypokalaemia with alkalosis = vomiting, thiazide and loop diuretics, cushings, conns syndrome
* Hypokalaemia with acidosis = diarrhea, renal tubular aciosis, acetazolamide, partially treated DKA
* Mg deficiency
52
Causes low magnesium
* Drug - diuretics, PPIs
* Parenteral nutrition, diarrhea, alcohol, hypokalaeia, hypercalcaemia, metabolic disorsers
* Features = paraesthesia, tetany, seizures, arrhythmias... (similar to low calcium)
* Under 0.4 or severe with seizures etc then IV mg
* If above 0.4 then oral
53
Mx epistaxis
* Sit town, torso forward, mouth open
* Pinch soft part nose at least 20mins
* If successful - consider naseptin to reduce crusting (not in peanut allegry)
* If bleeding doesnt stop then cautery if visible source and packing if cant be visualised as likely posterior
54
DDx GI bleed and features
Clinical features: haematemsis, melena, raised urea
* Oesophageal varicles - large vol blood
* Oesophagitis
* Cancer - often other ass symptoms
* Mallory weiss tear - after repeated vout vomiting
* Gastric ulcer - IDA presentation usuaully
* Gastric cancer - other featues
* AV malformations, erosive gastritis
* Duodenal ulcer- gastroduodenal artery, eating helps
* Aorto-enteric fistulas
Mx - glasgow batchford score (urea,S BP, Hb) , rockall score after endoscopy. Endoscopy within 24hours.
55
Variceal haemorrhage A-E management
* Terlipressin - vasoactive agent.
* Prophylactic IV Abx
* After these - endoscopy
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Extradural vs subdural vs SAH
57
Cluster headaches - features, mx
* Pain 1/2 day, each episode 15mins-2hours, restless, clusters are 4-12weeks, redness/lacrimation/nasal stuffiness associated
* Acute = 100% oxygen, subcut triptans
* Prophylaxis = verapamil
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Headache types
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Red flags headache
* compromised immunity, caused, for example, by HIV or immunosuppressive drugs
* age under 20 years and a history of malignancy
* a history of malignancy known to metastasis to the brain
* vomiting without other obvious cause
* worsening headache with fever
* sudden-onset headache reaching maximum intensity within 5 minutes - 'thunderclap'
* new-onset neurological deficit
* new-onset cognitive dysfunction
* change in personality
* impaired level of consciousness
* recent (typically within the past 3 months) head trauma
* headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked), sneeze or exercise
* orthostatic headache (headache that changes with posture)
* symptoms suggestive of giant cell arteritis or acute narrow-angle glaucoma
* a substantial change in the characteristics of their headache
60
Pre-Eclampsia
* New onset hypertension, proteinuria, oedema after 20 weeks.
* If risk factors then aspirin 75-150mg daily from 12 weeks til birth
* PO labetolol or nifedipine if asthmatic
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CO poisoning
* Headache, N&V, vertigo, confusion, subjective weakness
* Ix = pulse oximetyr might be falsy high so cabroxyHb level on bloog gas and ECG
* 100% high flow 02 via non rebreather mask . Specialists might do hyperbaric oxygen
63
Intussusception - symp, mx
* 6-18months
* Abdo pain, crying, draw knees up, vomiting, nlod stained (red currant) stool, sausage shaped mass in RUQ
* US - target mass
* Mx - air insufflation under radiological control.
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Rectal bleeding DDx
65
Epididymal cyst vs hydrocele vs varicoele
* E cyst = seperate from body of testicle and posterior.
* Hydrocele = soft, non tender swelling hemi-scrotum and cant get above mass. Transilluminates.
* Varicoecele = bag of worms, subfertility.
66
Testicualr torsion
* 10-30
* Pian severe and sudden
* Loss of cremasteric reflex and elevation of testis does not ease pain
67
Sepsis definition
* Lifw threatening organ dysfunction caused by dysregulated host response to infection
* SYmptoms like Increased RR (>22), altered mentation, SBP <100
O2, blood cultures, Abx, IV fluid, lactata, urine output
68
EPiglotttis key features
* Rapid osnet, hgih temp, stridor, drooling, tripod position
69
Thoracici trauma DDx
* Tension PTX
* Flail chest - abn chets motion
* Ptx
* haemothorax
* Cardiac tamponate - elevated venosu pressur,e reduced arterial pressure, reduced heart sounds
* Pulmonary contions
* Blunt cardiac injury
* AOrta disruption
70
Features Acute angle closure glaucoma, Ix, Mx
* Symptoms = severe pain, decreased visual acuiy, hard, red eye, haloes aroudn lights, semi-dilated non reacting pupil
* TOnometry for elevated IOP, Gonioscopy
* Urgent refferal, eye drops (pilocarpine) and posisble iV acetazolamide. Deifnitive is laser peripheral iridotomy
71
Bradycardia - periarrest - when to Tx and how
* Shock (hypotension, pallor, sweating, cold extremities), syncope, mI, heart failure
* Atropine 500mcg IV
* If unstisfactory then can give up to 3mg of atropine, or transcutaneous pce or adrenaline infusion etc.
72
Pulmonary oedema:
* interstitial oedema
* bat's wing appearance
* upper lobe diversion (increased blood flow to the superior parts of the lung)
* Kerley B lines
* pleural effusion
* cardiomegaly may be seen if there is cardiogenic cause
73
Chronci HF Mx
74
Acute exaceration COPD
* Increase freq bronchodilator, prednisolone 30mg 5dats, ?Abx if purulent sputum (amox/clarith/doxy)
* If severe - 88-92% if risk hypercapnia - before blood gas use 28% venturi at 4l/min. If pCO2 nomal then 94-98 fine. Neb bronchodilator, steroids etc. ?NIV (bipap)
75
COPD chronic mx
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Drug Tx for epileptic seizures
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Abx meningitis
* <3m - IV amox + IV cefotaxime
* >3m = IV cefotaxime
* Dexamethasone if urulent CSR with high WCC etc but not in <3m
* flUIDS
* crebral monitoring
* PH notification
78
Neoplastic pinal cord compression features
* Bakc pain - may be worse on lying or coughing
* Lower limb weakness
* Sensory loss and numbness
* Neuro signs
* WHole MRI spine in 24hours
* Need high dose oral dexamethasone
79
Idiopathic intracranial HTN features
* Headache, blurred vision, papilloedmea, enlarged blind spot, sixth nerve palsy
* Mx = weight loss, acetazolamide...
80
Raised intracranial pressure features and mx
* Headache, vomiting, reduced LOC, papilloedema, cushings triad (widening pulse pressure, bradycardia, irreg breathing)
* Head elevation 30 degress, IV mannitol, contorlled hyperventilation to reduce CO2 conc, removal CSF throught different technqiues
81
Neutorpenic sepsis mx
* Ppiperacillin and tazobactam
82
Example symptoms of strokes
* Sensory/motor loss
* isual agnosia
* Cranial nerve palsys and weakness
* Temp loss, facial pain, ataxia etc and weakness
* Facial paralysis and deafness
* Amaurosis fugac
* locked in syndrome
Oxford stroke classification:
- Unilat hemiparesis +/- hemisenspry loss face/arm/leg
- Homonymous hemianopia
- Higher cognitice dysfunction (dysphasia)
83
Mx stroke
* Once hameorrhagic exclduded then apsirin 300mg
* Thrombolysis in 4.5hours of onset after imaging excluded haemorrhagic
* Thrombectomy is new - within 6hours onset.
* Secondayr prveention - clopidogrel,
84
Alcohol withdrawal signs to look out for
* symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
* peak incidence of seizures at 36 hours
* peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
85
Mx alcohol withdrawal
* Long acting benzo (chlordiazepxodie)
* CIWA protocl
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