Acute Care

Question 1

One essential investigation for chest pain

Answer 1

ECG

Question 2

Indications for a CT chest (4)

Answer 2

Large PE
Aortic Dissection
Oesophageal Rupture
Major Trauma

Question 3

Scoring System in PE

Answer 3

Well’s Scoring System

Question 4

Three characteristics of acute pain

Answer 4

Sudden onset
Known cause
Usually responds well to analgesics

Question 5

Oxygen taken in per minute (70kg man)

Answer 5

250ml/min

Question 6

Triad of anaesthesia

Answer 6

Hypnosis
Paralysis
Analgesia

Question 7

What is the functional residual capacity (average)?

Answer 7

2L - contains 400ml oxygen

Question 8

Aspirin
Problem with surgery
Protocol before surgery

Answer 8

Blocks platelets irreversibly

Need to stop 7 days before surgery (half life of a platelet)

Question 9

Warfarin

Protocol before surgery

Answer 9

AF - stop 5 days before surgery
Multiple DVTs or metal heart valve - consider bridging therapy: stop 5 days before and on day 3 onward give 24 hourly LMWH

Question 10

Head Injury Grading

Answer 10

Graded according to GCS
13-15 mild
9-12 moderate
3-8 severe

Question 11

AVPU ‘P’ response equates to…

Answer 11

GCS of 8

Need to consider intubation

Question 12

Cushing’s Triad

Answer 12

= bradycardia, hypotension and irregular breathing

Question 13

A CT head should be performed within 1 hour after risk factor being identified (7)

Answer 13

GCS <13 on initial assessment 
GCS <15 more than 2 hours after injury 
Suspected skull fracture 
Any sign of base of skull fracture 
Post traumatic seizure 
Focal neurological deficit 
>1 episode of vomiting

Question 14

A CT head should be performed within 8 hours of head injury if (4)

Answer 14

> 65 years old
Any history of bleeding or clotting disorders
Dangerous mechanism of injury
30 minutes retrograde amnesia

Question 15

Suspected STEMI needing PCI anti-coagulant measures

Answer 15

5000 units heparin IV

Ticagrelor

Question 16

Investigation of suspected appendicitis
Kids
Adults

Answer 16

Kids - USS

Adults - CT

Question 17

NSAIDs good in what kind of pain

Answer 17

Renal colic

Musculoskeletal

Question 18

Paracetamol antidote

Delivery

Answer 18

N-acetylcysteine
Given as three infusions across 20 hours: 1st infusion is a bolus over 1 hour
Co-prescribe an anti-emetic

Question 19

Tricyclic antidepressants antidote

Answer 19

Sodium bicarbonate

Question 20

Beta blockers antidote

Answer 20

Glucagon

Question 21

Opioids antidote

Answer 21

Naloxone

Question 22

When should assessment for effects of paracetamol overdose be done?

Answer 22

> 75mg/kg

Effects are unlikely to be seen unless >150mg/kg

Question 23

Presentation of paracetamol overdose

Answer 23

Acute - nausea, vomiting

Late - abdominal pain, jaundice, encephalopathy

Question 24

Contra-indication for nasopharyngeal airway

Answer 24

Base of skull fracture

Question 25

Oropharyngeal airway =

Answer 25

Guedel airway

Question 26

What level do you apply a pelvic binder at?

Answer 26

Greater trochanters

Question 27

Eye Opening GCS

Answer 27

``` Out of 4 4 - spontaneous eye opening 3 - open eyes to sound 2 - open eyes to firm pressure 1 - doesn't open eyes ```

Question 28

Verbal Response GCS

Answer 28

``` Out of 5 5 - spontaneous, orientated speech 4 - confused conversation 3 - inappropriate speech 2 - incomprehensible sounds 1 - no response ```

Question 29

Motor Response GCS

Answer 29

``` Out of 6 6 - obeying commands 5 - localising to firm pressure 4 - normal flexion to pressure 3 - abnormal flexion to pressure 2 - abnormal extension to pressure 1 - no movement ```

Question 30

Findings in anti-cholinergic toxidrome

Answer 30

``` Increased heart rate Increased temperature Dilated pupils Decreased bowel sounds Decreased sweating ```

Question 31

Anti-cholinergic antidote

Answer 31

Physostigmine

Question 32

Examples of cholinergics (3)

Answer 32

Organic compounds Pilocarpine Mushrooms

Question 33

Cholinergic antidote

Answer 33

Atropine Pralidoxime Benzodiazepines

Question 34

Findings in sympathomimetic toxidromes | e.g. caffiene, cocaine, metamphetamines, LSD

Answer 34

Increased heart rate Increased temperature Increased respiratory rate Dilated pupils

Question 35

Sympathomimetics management

Answer 35

Benzodiazepines

Question 36

Benzodiazepines management

Answer 36

Flumenazil

Question 37

Biochemical abnormalities in aspirin poisoning

Answer 37

Initial respiratory alkalosis - due to hyperventilation | Metabolic acidosis

Question 38

Blood on CT scan

Answer 38

Old - black | New - white

Question 39

Fragility pelvic fractures - Seen in - Main ones (2)

Answer 39

Women Superior and inferior pubic ramus Intracapsular fracture

Question 40

Increased rib spacing on CXR

Answer 40

Hyperinflation e.g. COPD

Question 41

Shockable rhythms

Answer 41

Ventricular Fibrillation | Ventricular Tachycardia

Question 42

Management of anaphylaxis

Answer 42

IM adrenaline 0.5ml of 1:1000 IV fluid challenge (saline or Hartmann's) IV/IM 10mg chlorphenamine IV/IM 200mg hydrocortisone

Question 43

Treatment of symptomatic bradycardia - 1st line - 2nd line

Answer 43

1: 500 micrograms atropine IV 2: transcutaneous pacing

Question 44

Management of tachycardia - 1st line - 2nd line

Answer 44

1: initially attempt vagal manoeuvres 2: adenosine 6mg IV bolus

Question 45

BZD used for sedation and amnesia

Answer 45

Midazolam

Question 46

Is lidocaine a short acting or long acting anaesthetic?

Answer 46

Short acting

Question 47

Examples of numbing creams (2)

Answer 47

EMLA | Ametop

Question 48

Purpose of premedication (2)

Answer 48

1. Prevention of parasympathetic effects of anaesthesia | 2. Reduction of anxiety or pain

Question 49

Examples of benzodiazepines used

Answer 49

Temazapam | Midazolam

Question 50

Examples of other hypnotics

Answer 50

Zopiclone Zolpidem Zaleplon

Question 51

Anti-emetic often used with anaesthesia

Answer 51

Droperidol

Question 52

Analgesic often used with anaesthesia

Answer 52

Fentanyl

Question 53

Common induction agent with anaesthesia

Answer 53

Propofol