Acute Medicine Presentations Flashcards by David Houghton

In a patient who is unresponsive, what must we always consider?

1 - heart attack
2 - stroke
3 - cardiac arrest
4 - PE

3 - cardiac arrest
- heart stops beating properly
- no beating heart stops blood to the brain and we collpase

How well did you know this?

Not at all

Perfectly

If we suspect a cardiac arrest, which of the following must we do immediately?

1 - Assess self risk and shout for help
2 - ABC
3 - Call 999 or 222 (in hospital( on mobile phone on speaker
4 - Start CPR
5 - enlist help from others and request defibrillator
6 - all of the above

6 - all of the above

How well did you know this?

Not at all

Perfectly

What is the effective chest compressions to rescue breaths (if applicable) rate?

1 - 20:5
2 - 30:2
3 - 30:5
4 - 40:10

2 - 30:2
- 30 compressions
- 2 rescue breaths

How well did you know this?

Not at all

Perfectly

Which 2 of the following are shockable rhythms using a defibrillator?

1 - Ventricular fibrillation (eg acute MI)
2 - Ventricular tachycardia (eg myocardial scar)
3 - asystole
4 - pulseless electrical activity

1 - Ventricular fibrillation (eg acute MI)
2 - Ventricular tachycardia (eg myocardial scar)

3 and 4 are unshockable

How well did you know this?

Not at all

Perfectly

Which of the following is NOT one of the 4 Hs responsible for a Reversible Causes of Cardiac Arrest?

1 - Hypoxia
2 - Hypertension
3 - Hypovolaemia
4 - Hypokalaemia (low K+) / (h)Acidosis
5 - Hypothermia

2 - Hypertension

How well did you know this?

Not at all

Perfectly

Which of the following is NOT one of the 4 Ts responsible for a Reversible Causes of Cardiac Arrest?

1 -Thrombus
2 - Tension pneumothorax
(Cardiac)
3 - Tamponade
4 - Toxins (eg sepsis, drugs)
5 - Temperature

5 - Temperature

How well did you know this?

Not at all

Perfectly

If you are performing CPR and a patient is unshockable (asystole or pulseless electrical activity) what should you then do?

1 - give a 2nd shock
2 - seek senior advice
3 - continue CPR
4 - swap defibrillator

3 - continue CPR

How well did you know this?

Not at all

Perfectly

What should be given to patients in a cardiac arrest every 3-5 minutes?

1 - beta blockers
2 - adrenaline
3 - amiodarone
4 - aspirin

2 - adrenaline

ideally via IV

How well did you know this?

Not at all

Perfectly

In a cardiac arrest, if a reversible cause can be identified, which of the following drugs can be administered following 3 separate shocks?

1 - beta blockers
2 - adrenaline
3 - amiodarone
4 - aspirin

3 - amiodarone

given via IV
blocks Na+, K+ and Ca2+ channels (reduces ability to depolarise)
blocks alpha and beta receptors
interferes with AV node conduction
essentially tries to reset the heart

How well did you know this?

Not at all

Perfectly

What is the adult dose used on a defibrillator?

1 - 100J
2 - 150J
3 - 250J
4 - 300J

2 - 150J
- can be increased to 200J

How well did you know this?

Not at all

Perfectly

The image here illustrate an rhythm from a patient on a defibrillator. What rhythm is in the bottom image?

1 - VF
2 - asystole
3 - VT
4 - Pulseless electrical activity

3 - VT

broad QRS

How well did you know this?

Not at all

Perfectly

The image here illustrate an rhythm from a patient on a defibrillator. What rhythm is in the bottom image?

1 - VF
2 - asystole
3 - VT
4 - Pulseless electrical activity

1 - VF

narrow QRS

How well did you know this?

Not at all

Perfectly

What is a respiratory arrest?

1 - patient heart stops beating
2 - lack of blood to midbrain
3 - cessation of breathing
4 - breathing is dysfunctional

3 - cessation of breathing
- this is a medical emergency

How well did you know this?

Not at all

Perfectly

Respiratory arrest is the cessation of breathing. Which of the following can cause respiratory arrest?

1 - asthma or COPD exacerbation
2 - acute on chronic respiratory failure
3 - obstruction (foreign body)
4 - respiratory depressants (opioids)
5 - neuromuscular failure (Guillain Barre, myasthenia gravis)
6 - secondary to cardiac arrest
7 - all of the above

7 - all of the above

How well did you know this?

Not at all

Perfectly

What is Dyspnoea?

1 - awareness of difficulty to breathe
2 - rapid breathing
3 - slow breathing
4 - irregular breathing

1 - awareness of difficulty to breathe

How well did you know this?

Not at all

Perfectly

What is Tachypnea?

1 - awareness of difficulty to breathe
2 - rapid breathing
3 - slow breathing
4 - irregular breathing

2 - rapid breathing
- >20 breaths per minute

How well did you know this?

Not at all

Perfectly

What is Hyperpnoea?

1 - awareness of difficulty to breathe
2 - rapid breathing
3 - slow breathing
4 - increased volume of air inhaled (could be exercise or illness)

4 - increased volume of air inhaled (could be exercise or illness)

How well did you know this?

Not at all

Perfectly

What is Orthopnoea?

1 - awareness of difficulty to breathe
2 - rapid breathing
3 - breathlessness when lying flat
4 - increased volume of air inhaled (could be exercise or illness)

3 - breathlessness when lying flat

How well did you know this?

Not at all

Perfectly

What is Paroxysmal nocturnal dyspnoea?

1 - sudden onset of dyspnoea at night that wakes patient
2 - rapid breathing
3 - breathlessness when lying flat
4 - increased volume of air inhaled (could be exercise or illness)

1 - sudden onset of dyspnoea at night that wakes patient

How well did you know this?

Not at all

Perfectly

What is Cheyne Stokes?

1 - sudden onset of dyspnoea at night that wakes patient
2 - abnormal breathing that gets deeper and faster
3 - breathlessness when lying flat
4 - increased volume of air inhaled (could be exercise or illness)

2 - abnormal breathing that gets deeper and faster

caused by issue in brainstem respiratory centres

How well did you know this?

Not at all

Perfectly

Which 2 of the following, would present with acute Pleuritic Chest Pain?

1 - Pneumothorax
2 - Pulmonary embolus
3 - Pneumonia
4 - Musculoskeletal pain
5 - Lung cancer

Study These Flashcards

1 - Pneumothorax
2 - Pulmonary embolus

What is a pneumothorax?

1 - air in the mediastinum
2 - air in the pleural space
3 - air in the trachea
4 - air in the pericardial sac

Study These Flashcards

2 - air in the pleural space

medical emergency
can causes a mediastinal shift resulting in a Cardiac Arrest

Which of the following is a risk factor for a primary pneumothorax?

1 - gender
2 - asthma
3 - smoking
4 - tall/thin
5 - collagen vascular diseases (Marfans)
6 - all of the above

Study These Flashcards

6 - all of the above

reoccurrence risk of 54% within 4 years

Is a primary or secondary pneumothorax more serious?

Study These Flashcards

secondary
normally caused by underlying disease, such as COPD, Pulmonary fibrosis or Cystic fibrosis

What is a tension pneumothorax? 1 - air in pleural space is = to atmospheric air 2 - air in pleural space is < atmospheric air 3 - air in pleural space is > to atmospheric air

3 - air in pleural space is > to atmospheric air - air cannot escape - lungs and mediastinum are compressed - reduces venous return and cardiac output

Which of the following is NOT a sign of a pneumothorax? 1 - dyspnoea/tachypnoea (↑ RR) 2 - tracheal deviation 3 - decreased air entry on the side of the pneumothorax 4 - hyper-resonance on percussion

2 - tracheal deviation - present in a tension pneumothorax

Which of the following is NOT a sign of a tension pneumothorax? 1 - Silent chest /hyper-resonance 2 - Mediastinal shift away from side of pneumothorax (tracheal deviation, displaced apex beat) 3 - Collapse 4 - Dyspnoea/tachypnoea (↑ RR) 5 - Cardiac Arrest

4 - Dyspnoea/tachypnoea (↑ RR)

If a pneumothorax is suspected, which of the following imaging is most commonly performed? 1 - chest X-ray 2 - MRI 3 - high resolution chest CT 4 - ultrasound

1 - chest X-ray

In a patient with a pneumothorax, what would we expect to see on the arterial blood gas? 1 - >paO2 2 - paCO2 4 -

2 -

Type 1 respiratory failure is hypoxia due to lack of O2 to lungs. What is the cut off using an ABG in kPa? 1 - <12 kPa 2 - <10 kPa 3 - <8 kPa 4 - <5 kPa

3 - <8 kPa

Type 2 respiratory failure is hypercapnia (high CO2) due to an inability of the lungs to remove the CO2. What is the cut off using an ABG in kPa? 1 - >5 kPa 2 - >6 kPa 3 - <10 kPa 4 - <5 kPa

2 - >6 kPa - can also see a reduction in paO2

Patients can be discharged if they have a small pneumothorax if the following are true, EXCEPT which one? 1 - <50 y/o 2 - symptomatic 3 - not hypoxic 4 - all of the above

2 - symptomatic - patients must be relatively asymptomatic

If a patient has a small pneumothorax with symptoms, are they typically discharged?

- no - monitored with 10L of O2

If a patient has a pneumothorax >2cm what is typically done 1st? 1 - chest drain 2 - antibiotics 3 - simple aspiration 4 - all of the above in this order

3 - simple aspiration - this can be done up to 2 times

If a patient has a large recurrent pneumothorax what is typically done? 1 - chest drain 2 - antibiotics 3 - simple aspiration 4 - wait and see

1 - chest drain

In a patient who has had a pneumothorax, which of the following should they be advised? 1 - no air flight 2 - no diving until asymptomatic 3 - smoking cessation 4 - all of the above

4 - all of the above

Which of the following is NOT an indication for a chest drain insertion? 1 - primary pneumothorax <2cm 2 - secondary pneumothorax 3 - bilateral pneumothorax 4 - traumatic pneumothorax 5 - Rib fracture / haemothorax

1 - primary pneumothorax <2cm - generally for large pneumothorax or recurrent small pneumothorax not responding to treatment

Tension pneumothorax is a clinical diagnosis. If this is confirmed, what must be done immediately? 1 - chest X-ray 2 - high resolution chest CT 3 - chest aspiration 4 - fluids and analgesia

3 - chest aspiration - following be intercostal tube drainage at 2nd intercostal space in the anterior axillary line

What is the definition of a pulmonary embolism? 1 - thrombosis blocking pulmonary vein 2 - thrombosis blocking pulmonary artery 3 - thrombosis blocking tricuspid valve 4 - thrombosis blocking left coronary artery

2 - thrombosis blocking pulmonary artery - part of thromboembolic disease (TED) - clot arises from the deep veins in the calf/calves (DVT)

Which of the following is NOT a clinical presentation of a PE? 1 - Acute breathlessness 2 - Shoulder pain 3 - Cough/haemoptysis 4 - Hypotension 5 - Collapse 6 - Cardiac arrest

2 - Shoulder pain - typically pleuritic chest pain

Which of the following physical signs could indicate a PE? 1 - Tachycardia 2 - Tachypnoea 3 - Raised JVP 4 - RV heave (pulmonary hypertension) 5 - Accentuated P2 (pulmonary hypertension) 6 - Hypoxia (only in 60%) 7 - Pleural rub 8 - Deep vein thrombosis (DVT) 9 - all of the above

9 - all of the above

Which of the following is NOT part of Virchows triad? 1 - Stasis 2 - AF 3 - Hypercoagulability 4 - Endothelial damage

2 - AF

Which scoring tool can be used to assess the risk of a venous thromboembolism (VTE)? 1 - Modified Wells score 2 - GURB-65 score 3 - Modified Glasgow score 4 - CHADS2 score

1 - Modified Wells score

Which scoring system should be used to assess the risk of a pulmonary embolism? 1 - Modified Wells score 2 - Pulmonary Embolus Severity Index 3 - Modified Glasgow score 4 - CHADS2 score

2 - Pulmonary Embolus Severity Index

If we suspect a patient has a PE, all of the following should be done EXCEPT which one? 1 - CXR 2 - ECG 3 - ABGs 4 - D-dimer 5 - troponin 6 - CT pulmonary angiogram 7 - Echocardiogram 8 Doppler ultrasound of lower limbs

5 - troponin - typically measured of MI is suspected - Uses 11 clinical criteria - Predicts 30 day outcome

In a patient with a suspected PE, all of the following should be performed EXCEPT which one? 1 - ABC 2 - Oxygen 3 - Analgesia 4 - Low molecular weight heparin (LMWH) 5 - anticoagulant once PE confirmed 6 - tissue plasminogen activator (r-tPA)

6 - tissue plasminogen activator (r-tPA) - only performed if PE is serious and admitted to ITU

Anaphylaxis is a severe and potentially life-threatening reaction to a trigger, often an allergy (peanuts, seafood, bee and wasp stings, medication etc) that is typically a differential for breathlessness. Which cell is responsible for releasing a molecule that induces vasodilation and increase vascular permeability in anaphylaxis? 1 - macrophages 2 - mast cells 3 - B cells 4 - neutrophils

2 - mast cells

Anaphylaxis is a severe and potentially life-threatening reaction to a trigger, often an allergy (peanuts, seafood, bee and wasp stings, medication etc) that is typically a differential for breathlessness. Mast cells release a molecule that induces vasodilation and increase vascular permeability in anaphylaxis. What molecule is released by mast cells to cause this? 1 - histamine 2 - CRP 3 - adrenaline 4 - nitrates

1 - histamine - causes acute breathlessness, upper airway oedema, bronchospasm and obstruction

Which of the following are clinical presentations of anaphylaxis? 1 - feeling faintness 2 - feeling of impending doom 3 - flushing 4 - itchy rash (urticaria or erythema) 5 - angioedema: facial swelling extending to upper airway bronchoconstriction Vomiting and diarrhoea 6 - hypovolaemia and cardiovascular collapse 7 - all of the above

7 - all of the above

In a patient who is anaphylactic we would do the usual ABC and put them on high flow oxygen. We then need to prescribe all of the following EXCEPT? 1 - Adrenaline (1:1000 1 mg/ml IM in adults) 2 - IV fluids: 0.5 L – 1.0 L of NaC l/ Hartmann’s (avoid colloids) 3 - aspirin 4 - Inhaled ß2 agonist (salbutamol)

3 - aspirin - always refer to anaphylaxis guide

Acute Medicine Presentations Flashcards

(50 cards)