E MED Flashcards
(128 cards)
1
Q
Top ddx for abdominal free fluid in female with UPT negative
A
Ruptured ovarian cyst
2
Q
Mx of biliary cholangitis
A
Abx(roc and flagyl) + ERCP
3
Q
Most common triggers of pancreatitis
A
1.Biliary stones
2.Alcohol
4
Q
Most common causes of small bowel intestinal obstruction
A
- Hernia
- Adhesions(if prev abdo surgery)
5
Q
Most useful POCTs for abdo pain
A
UPT
Urine dipstick
ABG/istat
Capillary glucose
ECG
bedside Ultrasound
6
Q
Facets of Mx of Asthma exacerbation
A
O2
Salbutamol
Ipratropium
Corticosteroids
MgSO4 if severe
Intubation if severe
7
Q
Tension pneumothorax definition
A
Pneumothorax with hemodynamic instability(tachycardia,hypotension cyanosis,cardiac arrest)
8
Q
Aspiration site for pneumothorax
A
2nd intercostal space mid clavicular line
9
Q
Chest tube insertion site
A
Triangle of safety
Above 5th intercostal space/above level of nipples
Posterior to edge of pec major
Anterior to edge of lat dorsi
10
Q
Radiological sign for SAH
A
Star sign on NC CT Brain
11
Q
Mx of SAH
A
BP control to prevent hematoma expansion
Thus IV antihypertensive eg Labetalol,nifedipine
12
Q
Types of primary headaches
A
Tension headache
Cluster headache
Migraine +- aura
13
Q
Mx of migraine
A
1st line:paracetamol, nsaids and antiemetics
2nd line: migraine specifics 3g triptans, ergotamine
Migraine prophylaxis eg topiramate, beta blockers
14
Q
Causes of heart blocks
A
ACS(AV node supplied by RCA)
Drugs(AV nodal blocking agents eg BB,CCB,digoxin)
Electrolytes eg K+
Myocarditis
15
Q
MOA of calcium gluconate
A
Stabilises cardiac membrane by reducing gradient between resting membrane potential and threshold
16
Q
Toxins that are exacerbated by excessive oxygenation
A
Chlorine poisoning
Ammonium Chloride poisoning
17
Q
Toxins where intubation may not be necessary due to their respiratory alkalemic effect
A
Salicylate,toxic alcohols,metformin
18
Q
Types of toxidromes
A
Fast
Slow
Wet
Dry
19
Q
Antidote for opioids
A
Naloxone(Narcan)
20
Q
Triad of opioid toxidrome
A
Pinpoint pupils,respi depression, unconscious
21
Q
Triad of serotonin syndrome
A
Neuromuscular excitability
AMS
Autonomic dysfunction
22
Q
ECG changes of Na channel poisoning,K channel poisoning
A
Na channel: QRS prolongation
K channel: QTc prolongation
23
Q
Methods of decreasing GIT removal of poisoning
A
Gastric lavage
Single dose activated charcoal
Whole bowel irrigation
Physical removal from bowels
24
Q
Name antidotes for paracetamol, salicylate, opioids and TCAs
A
Paracetamol: N acetyl cysteine
Salicylate: Na bicarb
Opioids: Naloxone
TCA: Na bicarb
25
Main clinical concern in a patient with hemoptysis
Airway compromise(choking) rather than hemodynamic instability due to blood loss
26
expected HR in a severe asthma episode
>110
27
Markers of imminent respiratory arrest
AMS, Bradycardia and a silent chest
28
What is the cause of metabolic acidosis in asthma
Beta adrenergic stimulation leading to increased lactate pdn
29
Best drug for rapid sequence intubation(RSI) in asthma
Ketamine, which also helps reduce bronchospasm
30
Most common causes of ARDS
Trauma
Sepsis
31
DDx for low consciousness and respiratory depression
Opioid overdose
Brainstem stroke/bleed
32
Common causes of type 1 respiratory failure( Hypoxemia)
Acute pulmonary oedema(APO) or acute lung injury
33
Common causes of type 2 respiratory failure( Hypercapnea)
1. Airflow obstruction
2. Decreased respiratory compliance
3. Decreased respi muscle power 2* NMJ issues
4. Central respi failure causing decreased respi drive
34
sign of chronic respiratory failure
1.pH is only decreased by 0.03/ 10mmHg compared to 0.08 in acute RF
2. Compensatory polycythemia
3.Cor pulmonale
35
FiO2 of assisted breathing
Room Air: 0.21
Nasal cannula: +0.04/L
Venturi:0.4-0.6
Non rebreather mask: 0.6-0.9
36
Berlin definition of respiratory failure
1. Acute onset <1/52
2. Bilateral opacities consistent w APO, on CXR or CT
3. P/F ratio <300, minimum 5cmH2O PEEP
4.Not fully explained by CHF or fluid overload
37
Invx for asthmatic pt
1. FBC tro infection
2. RP tro hypoK induced by salbutamol
3. CXR tro pneumothorax
4. ABG
38
ABG differences in mild vs severe asthma
pH: alkalemia vs acidemia
PaCO2: low vs high
PaO2: normal vs low
bicarb: normal vs low
39
Outpatient Mx of pneumonia
Macrolides eg Clarithromycin(clacid)
Fluoroquinolones eg levofloxacin
40
Ddx for ST elevations in AvR
Proximal LAD occlusion
LMCA occlusion
Triple vessel disease
41
Cardiopulmonary causes of raised troponins
AMI
Myocarditis
Pulmonary embolism
Heart Failure
Tachydysrhthmias
42
Non cardiopulmonary conditions causing raised troponins
Renal failure
Sepsis
Stroke
SAH
43
Role of CXR in chest pain evaluation
1. Check for Cx of AMI eg APO
2. Check ETT is placed correctly
3. Rule out other causes of chest pain eg aortic dissection, pneumothorax, pulmonary embolism
44
What does unexplained hypoxaemia with a clear CXR raise suspicion of?
Pulmonary embolism
45
Mx of STEMI
DAPT: SOLUBLE aspirin in water+ticagrelor/clopidogrel
O2 only if necessary
Judicious fluid challenge
Fentanyl if severe pain
Send to cath lab for PCI
46
Impt facets of answering a ED management question
1. Triage into which category
2. Place on continuous spO2 and ECG monitoring
3. Judicious fluid challenge
4. POCT, bloods and imaging studies
5.Who needs to be referred
47
Mx of Acute Pulmonary Edema
1st line: High dose IV GTN to reduce preload and afterload + NIV/intubation
Ace inhibitors
IV furosemide 30mins after GTN, make sure pt not hypovolemic
Beta blockers CI in APO
48
Triggers for decompensated heart failure
1.ACS
2.Arrhythmia eg AF
3 Non compliance to med/fluid restriction
4.Uncontrolled HTN
5.Progressive valvular disease eg MR
6.High output cardiac failure- thyrotoxicosis,anemia etc
7.Post partum CMP
49
Signs of pulmonary embolism on ECG
Right heart strain: Sinus tachycardia and T wave inversions
Classically but kess commonly S1Q3T3
50
Mx of massive pulmonary embolism
1. Thrombolysis with rTPA
2. Perc or open thrombectomy or embolectomy
51
Mx of submassive pulmonary elbolism and low risk PE
Submassive:Heparin/clexane
Low risk:NOACs eg rivaroxaban/apixaban
52
6 Life threatening causes of chest Pain
Unstable angina
STEMI/NSTEMI
Aortic dissection
Pulmonary embolism
Tension Pneumothorax
Esophageal rupture
53
Why do right sided leads in Inferior MI?
To rule out RV infarct, where giving GTN will cause hypotension
54
What should be ruled out in chest pain with neurological Sx?
Aortic dissection
55
Ddx for dengue
Zika,chikugunya,other viruses
56
Indications for platelet transfusion in dengue
Severe bleeding manifestations eg ICH,BGIT
57
Causes of wide complex tachycardia
1. VT
2. Drugs eg TCA poisoning
3. HyperK
4 aberrancy?
58
Cushings triad
Widened pulse pressure
Bradycardia
Irregular respiration
A reflex to increased ICP
59
Definition of open book pelvic fx
Fratured at 2 points eg SIJ and pubic symphysis
60
Format of handover from paramedics in trauma
MIST
Mechanism
Injury
Signs
Treatment given
61
What is massive transfusion protocol
Equal ratio of blood:platelets:plasma
O+ blood
62
Stroke mimics
Hypoglycemia
Seizures
Todd's paralysis
Brain bleed
Space occupying lesion
CNS infections
Toxic causes
63
Headache red flags
Thunderclap headache:SAH
Progressively worsening sx: Tumor
Neurological symptoms: Stroke
Meningism:Meningitis
Trauma
64
Red flags for headache
Thunderclap headache:SAH
65
Signs and sx of testicular torsion
Testicular pain
Abdominal pain
Retracted testis
Vomiting
Loss of cremasteric reflex
66
Invx for suspected testicular torsion
Surgical exploration
US testis for whirlpool sign(if it does not delay surgery)
67
Mx of testicular torsion
Orchidopexy
Orchidectomy
68
Sepsis 7
Take 2
-Blood cultures
-Lactate and BG
Give 2
-high gflow O2
-IV abx
+-IV fluids and hydrocortisone
Monitor
-UO
-NEWS2
69
Mimics of inferior MI
Aortic dissection involving right coronary artery
70
How to rule out aortic dissection
Differential arm BPs
RR and RF delay
Widened mediastinum >8mm on AP
71
Mx of hyperK
Insulin bolus
Calcium gluconate to stabilise cardiac membrane
Resonium
Nebulised Salbutamol
Dextrose to maintain normogly
72
Contraindications to IDC
High riding prostate
Bleeding around meatus
Bruising around perineum
73
Treatment of SVT
Vagal maneuvers: Carotid massage, blow thru tube
Pharm: Adenosine
Synchronised cardioversion
74
Treatment of VT
Stable: Amiodarone
Unstable
Epi+amiodarone+defibrillation
75
Treatment of VF
Epi+amiodarone+defibrillation
76
Ddx of SVT
Sinus tachycardia
A fib
A flutter
77
Weakest wall of orbital cavity
Medial wall with medial blowout fx
NOT orbital floor
78
Mechanism of injury in extra dural hemorrhage
Middle meningeal artery rupture or injury to dural veins
79
Common signs in intracranial hemorrhage
Effacement of ventricles
Midline shift
80
Treatments for respiratory acidosis
Treat underlying cause
NIV or Intubation: increased RR and tidal volume
81
Main considerations in placing chest tube
Triangle of safety(behind pec major, in front of lat dorsi,4th intercostal space or above)
Right above the rib to avoid damaging the neurovascular structures below the rib
82
6 Hs and 5 Ts of reversible causes of cardiac arrest
Hypovolemia
Hypoxia
Hypothermia
Hypo/Hyperkalemia
Hypoglycemia
Hydrogen(acidosis)
Toxins(DO)
83
ECG signs of pulmonary embolism
1. Sinus tachycardia
2. Signs of right heart strain(RAD, RBBB, right sided ischemia)
3. S1Q3T3
84
ddx of narrow complex tachycardia1
sinus tachy
A fib
A flutter
SVT
85
ddx of ST elevation in AvR
1. TVD(Triple Vessel Disease)
2.Proximal LAD occlusion
3. Critical but not total LMCA occlusion
86
Torsades de pointes mx
Magnesium sulphate
Sync cardioversion
87
What is water bottle shaped heart on CXR a sign of?
Pericardial effusion
88
Signs of lidocaine toxicity
Circumoral numbness
Tongue paresthesia
Tinnitus
BOV
Restlessness,agitation
Seizures
89
Types of anaesthetia used for manipulation and reduction
Hematoma block
Biers block
90
Cause of abdominal pain and N/V that is often missed
Diabetic Ketoacidosis
91
Anion
92
What is a flail chest and its complications
3+ ribs that are fractured in 2 or more places
Interferes with breathing
93
Words to describe intracranial hemorrhages
SDH:Lentiform
EDH:Biconvex
SAH:Star sign
94
Treatment of VT
Pulseless: Same as VF
Unstable: synchronised cardioversion
Stable: IV amiodarone or lidocaine
95
Causes of shock
Cardiogenic
Obstructive
Distributive
Hypovolemic
96
3 main causes of obstructive shock
Tension pneumothorax
Pulmonary embolism
Cardiac tamponade
97
3 main causes of distributive shock
Anaphylaxis
Sepsis
Neurogenic shock
98
Intracranial causes of AMS
1) CVA: Stroke/hemorrhage
2) Seizure
3) Infection eg meningoencephalitis
4) Trauma
5) Space occupying lesions Encephalopathy
Encephalopathy
99
Extracranial causes of AMS
1) POCT: hypogly, hypoxia, hypercapnea, hypotension
2) Sepsis
3) Endocrine: Thyroid storm of hypothyroid
4) Electrolytes
5) Substances
6) Heat stroke
7) Psychiatric causes
100
Function of atropine
Bradycardia, to increase HR
101
6 Ps of compartment syndrome
Pain
Pulselessness
Paresthesia
Paralysis
Poikilothermia
Pallor
102
Scoring system for massive transfusion protocol
ABC Score( Assessment of Blood consumption)
103
Elements of Massive Transfusion Protocol
1:1:1 ratio of pRBC,FFP and Platelets/Cryoprecipitate
104
Eye opening scoring of GCS
4: Spontaneous
3: Sound
2: Pain
1: Nil
105
Verbal scoring of GCS
5: Coherent
4: Confused
3: Inappropriate
2: Incomprehensible
1: Nil
106
Movement scoring of GCS
6: Spontaneous
5: Localises pain
4: Moves away from pain
3: Abnormal Arm flexion
2: Abnormal arm extension
1: Nil
107
Type of hematoma that causes lucid interval
Epidural hematoma
108
Max size of urolith that will pass spontaneously
about 5mm
109
what is special about plasma lyte
Highest osmolarity, fluid with lowest risk of raising ICP
110
biggest cervical vertebrae onXR c spine
C2
111
Patients for which flumazenil is CI
Long term BZD use, it may causes seizure
112
Scoring system for Sepsis
qSOFA or SOFA
113
Antidote for Paracetamol overdose
N Acetylcysteine or Single Dose activated charcoal(if within 1hr)
114
Common Cx of giving NAC antidote
Anaphylactoid reaction( NOT anaphylaxis)
115
7 Ps of RSI
1. Prepare equipment
2. Pre oxygenate without bagging
3. Pretreatment
4.Paralysis and induction
5. Positioning
6. Placement with proof
7. Postintubation(Ventilate)
116
continuous vs bilevel PAP indications
continuous: Fluid overload/ Pulmonary edema
bilevel: Hypercapnea eg type 2 respiratory failure
117
Normal pre vertebral space in C spine XR
C2: 2mm
C7:22mm
???
118
4 2 1 rule of fluid resus(Holliday Segar Method)
4ml/kg/hr for first 10kg
2ml/kg/hr for next 10kg
1ml/kg/hr for every kg beyond 20kg
119
POCTs useful for suspected AAA
Urine dipstick for hematuria
Ultrasound
120
best nsaid for ureteric colic
NSAIDs, reduces urteric SM tone so stone can be passed amd reduces ureteric spasm
121
types of non invasive ventilation
cPAP and biPAP
122
Cortical signs of stroke
Visual field defects
aphasia
Hemineglect
???
123
NEXUS C Spine Imaging rule
NSAID
Neuro deficits
Spinal tenderness
AMS/Consciousness affected
Intoxication present
Distracting injury
124
Electrolyte disturbance caused by salbutamol
hypoK
125
Mx of HyperK
Calcium gluconate
Insulin( If glucose is normal)
Dextrose drip
Salbutamol
Hemodialysis may be indicated if CKD is underlying cause
126
Why is atropine given together with neostigmine for NMBA reversal
To avoid cholinergic crisis
127
Electrolyte derangement most likely to cause neurological changes
Sodium
128
Best test for Hemothorax
Bedside Ultrasound
