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ED Flashcards

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1
Q

What comes under ACS?

A

Unstable angina
NSTEMI
STEMI

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2
Q

Definition of MI

A

2 out of 3
Hx of cardiac like chest pain
Changes in serial ECGs
Rise in serum cardiac markers

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3
Q

What is the ECG finding in pericarditis?

A

Global ST changes - saddle like

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4
Q

Name some causes of pericarditis

A 
MI
Viral/bacterial infection
TB
Carcinoma
Post-cardiac surgery 
Drugs
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5
Q

What makes pericarditis pain worse?

A

Deep inspiration
Position change
Exercise
Swallowing

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6
Q

What is the management of viral pericarditis?

A

NSAID
PPI cover
Infection is self limiting

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7
Q

What is Dressler’s syndrome?

A

Autoimmune pericarditis +/- effusion occurring 2-14 weeks after MI

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8
Q

What is sick sinus syndrome?

A

Ischaemia or degeneration of the SAN causing sinus pauses or sinus arrest. Junctional or other escape beats may occur.

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9
Q

What are the causes of AV block?

A

IHD
Drugs
Cardiac surgery

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10
Q

What is a first degree AV block?

A

PR interval >0.2 secs (5 small squares)

Conduction occurs every time but is delayed

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11
Q

What are the types of second degree block?

A

Mobitz 1 = PR interval increases in length until one fails to conduct
Mobitz 2 = PR interval remains constant but not everyone is conducted (regularly or irregularly)

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12
Q

What is third degree heart block?

A

Atrial activity is not conducted to ventricles

P waves and QRS complexes are not related

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13
Q

What is a bifascicular block?

A

Blockage of 2 out of 3 of:
LBB - anterior superior branch
LBB - posterior superior branch
RBB

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14
Q

What is trifascicular block?

A

Blockage of 2 out of 3 of:
LBB - anterior superior branch
LBB - posterior superior branch
RBB

And a prolonged PR interval

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15
Q

What are the management options for bradycardia?

A 
Atropine (IV 500 mcg)
Adrenaline 
Transcutaneous pacing 
Transvenous cardiac pacing 
Permanent pacemaker
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16
Q

What kinds of drugs cause a long QT?

A

Sotalol
Antipsychotics
Antihistamines
Antidepressants

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17
Q

What are the different types of narrow complex tachycardia?

A

Sinus tachy
SVT
AF
Atrial flutter

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18
Q

What are the types of broad complex tachycardia?

A

VT
VF
SVT with aberrant conduction

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19
Q

What are the management options for narrow complex tachycardia?

A

Valsalva manoeuvre
Carotid massage
Adenosine

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20
Q

What are the contraindications to adenosine?

A

2nd or 3rd degree HB
WPW
Asthma

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21
Q

What are the sepsis red flags?

A 
Systolic < 90
HR >130
Oxygen <91
RR >25 
Scoring VPU
Lactate >2
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22
Q

What is the sepsis 6?

A 
Blood culture
Urine output monitoring 
Fluids
Antibiotics
Lactate
Oxygen
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23
Q

What is the dose of adrenaline for anaphylaxis?

A

1 in 1,000 of 500 micrograms

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24
Q

What are the medications and doses needed for anaphylaxis?

A

Adrenaline 1 in 1000 500 micrograms
Chlorphenamine IV 10mg
Hydrocortisone IV 200mg

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25
What are the 4 Hs and Ts of reversible cardiac arrest causes?
Hypoxia, hypovolaemia, hyper/hypokalaemia and hypothermia | Tension pneumothorax, tamponade, toxins and thromboembolism
26
What is the criteria for DKA?
Glucose >11 Ketones >3 (blood) or 2+ urine pH < 7.3
27
What is the treatment for DKA?
Fixed rate insulin infusion 0.1 units/kg/hr Fluids Correct electrolytes Hourly BMs and ketones
28
What defines HHS?
Hyperglycaemia > 30 Hypovolaemia Without significant ketosis or acidosis Osmolality > 320
29
How do we calculate osmolality?
2Na + glucose + urea
30
What is the treatment for HHS?
FRII 0.05 units/kg/hr
31
What is the serotonin syndrome triad?
Mental state changes Autonomic hyperactivity Neuromuscular abnormalities
32
First line Mx for renal colic
PR diclofenac
33
Define the CURB criteria
``` Confusion Urea > 7 RR > 30 BP <90/60 Age 65 + ```
34
What are the Abx treatments for mild, moderate and severe CAP?
Mild - amoxicillin Moderate - amoxicillin + doxycycline Severe - co-amoxiclav + clarithromycin (or erythromycin)
35
Commonest organisms CAP
S pneumonia H influenzae Mycoplasma pneumonia
36
Commonest organisms HAP
S aureus Klebsiella Pseudomonas
37
Major criteria (Duke) for infective endocarditis
Positive culture for typical IE organism | Evidence of endocardium involvement (positive echo or new valve regurgitation)
38
Risk factors for IE
``` Valvular heart disease Valve replacement CHD Previous IE IVDU Hypertrophic cardiomyopathy Invasive vascular procedures ```
39
Common organisms in IE
S aureus (commonest) Strep viridans Group B strep
40
Describe the rule of nines
``` Percentage of body covered by a burn Head 9% Each arm 9% Each leg 18% Front of trunk 18% Back of trunk 18% ```
41
How do we work out the anion gap?
(Na + K) - (Cl + HCO3)
42
Causes of a raised anion gap
``` Lactic acidosis Tissue hypoperfusion Hepatic/renal failure Methanol poisoning Cocaine ```
43
Common causes of acute liver failure
Paracetamol overdose Alcohol Viral hepatitis Acute fatty liver of pregnancy
44
Mx of falciparum malaria
IV artesunate | 2nd line = IV quinine
45
Define AAA
Permanent and irreversible dilatation of a blood vessel by at least 50% of normal 3cm +
46
When to consider surgery for AAA?
> 5.5 cm
47
Mx of acute pulmonary oedema
``` IV nitrates Morphine CPAP Loop diuretics VTE prophylaxis ```
48
Triad seen in Wernicke’s encephalopathy
Confusion Ataxia Ophthalmoplegia
49
Causes of delirium
``` Trauma Hypoxia Infection NOF # Smoker Drugs Environment Lack of sleep Imbalanced electrolytes Retention Iatrogenic/increasing age Uncontrolled pain Medical conditions ```
50
What is included in the confusion assessment method?
acute onset, fluctuating Inattention Disorganised thinking Altered level of consciousness
51
Beck’s triad tamponade
Muffled heart sounds Low BP Raised JVP
52
CT head criteria after injury
``` GCS < 13 or <15 (2 hours later) Suspected open or depressed skull # Signs of basilar skull # Post trauma seizure Focal neuro deficit >1 episode of vomiting ```
53
Red flag sx of back pain
Trauma Unexplained weight loss Neuro deficit Age > 50 Fever Immunosuppression Spinal tenderness HX of cancer or infection
54
Peripheral neuropathy causes
``` Alcohol B12 def Chemotherapy Diabetes and drugs eg. Isoniazid Every vasculitis ```
55
What do we use the Parkland formula for?
Calculate fluid requirement needed over 24 hours for a burns patient
56
Describe the Garden classification for NOF #
``` 1 = non displaced, incomplete # 2 = non displaced, complete # 3 = partial displacement 4 = complete displacement ```
57
What are the mx options for NOF #?
Intracapsular - Hemiarthroplasty or THR | Extracapsular - Dynamic hip screw or intramedullary nail
58
ECG changes hyperkalaemia
Peaked T waves P wave widens and flattens PR prolonged Widened QRS
59
ECG changes hypokalaemia
``` P wave increases height and width PR prolonged T wave flattens (or inverts) ST depression U waves ```
60
MRC Dyspnoea score
1 : not troubled by SoB unless strenuous exercise 2 : SoB when hurrying on level or up slight hill 3 : walks slower than most on level, stop after 15 mins 4 : stops for breath after 100 yards 5 : too SoB to leave the house
61
Define chronic bronchitis
Productive cough for >3 months per year for >2 years
62
Define emphysema
Destruction of lung tissue with dilatation of distal air spaces Loss of elastic recoil, hyperinflation and gas trapping
63
What type of test is used to detect HIV?
ELISA | and Western blot
64
Causes of generalised bronchiectasis
CF Ciliary dyskinesia Pulmonary fibrosis Immune defects
65
Causes of localised bronchiectasis
Pneumonia Foreign body Tumour TB nodes
66
What do a CXR and CT scan show in bronchiectasis?
CXR - ring shadow or tram lines | CT - signet ring sign
67
How many sputum samples do we need if suspecting TB?
3
68
Dose of naloxone for opioid overdose
400 micrograms
69
Post MI drugs
``` Aspirin ACEi Atorvastatin Beta blocker Clopidogrel ```
70
Important seizure hx points to ask
``` Pro drome Post-ictal state Witnessed Incontience Tongue biting ```
71
Variceal bleed management
``` Resus mx Terlipressin IV co-amoxiclav Balloon tamponade TIPS ```
72
4As Test for delirium
Alertness AMT 4 (age, DoB, place, year) Attention (list the months backwards) Acute change/fluctuating
73
X-ray features RA
Loss of joint space Erosions Soft tissue swelling Soft bones - periarticular osteopenia
74
X-ray features OA
Loss of joint space Osteophytes Subchondral cysts Subchondral sclerosis
75
Early transfusion complications
ABO incompatibility Anaphylaxis Urticaria Febrile non-haemolytic transfusion reaction Transfusion associated acute lung injury Transfusion associated circulatory overload
76
Delayed transfusion complications
Delayed haemolytic reaction Transfusion associated graft vs host disease Transfusion transmitted infection Iron overload
77
Location and radiation of mitral murmur
5th ICS MCL | Gets louder if pt rolls to side listening to mitral area
78
Location of tricuspid murmur
4/5th ICS lower left eternal edge
79
Location of pulmonary murmur
2nd ICS left sternal edge
80
Location and radiation of aortic murmur
2nd ICS right sternal edge Stenosis - radiates to carotids Regurg - gets louder when pt leans forward (over aortic area)
81
Which MHA section can be used in ED?
Section 4 | Up to 72 hours
82
What are the different types of intracapsular and extracapsular NOF #?
``` Intra = subcapital and basocervical Extra = intertrochanteric and subtrochanteric ```
83
Open fracture mx
``` Immediate IV abx - recommended changes dependent on type/mechanism of injury Urgent irrigation and debride ent Tetanus prophylaxis Stabilisation Dressing ```
84
Cause of long QT
``` Hypo K, Ca, Mg Na blocking drugs Hypothyroidism Hypothermia IHD Raised ICP Congenital ```
85
Drug causes of pancreatitis
Thiazides Valproate Azathioprine
86
What level of amylase is diagnostic of pancreatitis?
3x upper limit normal
87
Glasgow score criteria for pancreatitis
``` PaO2 < 8 Age >55 Neutrophilia Calcium <2 Renal function Ur>16 Enzymes LDH>600, AST >200 Albumin <32 Sugar >10 ```
88
Commonest cause SBO
Adhesions | Hernia
89
Commonest causes LBO
Malignancy Diverticular disease Volvulus
90
Examination of pt with obstructed bowel shows
Distended abdo Tympanic percussion Tinkling bowel sounds
91
Complications of bowel obstruction
Ischaemia Perforation Dehydration
92
Commonest causes for bowel perforation
Peptic ulcer | Diverticulum in sigmoid
93
Mx of bowel perforation
``` Broad spec Abx NBM NG tube IV fluids Analgesia List for surgery ```
94
Moderate asthma attack features
Normal speech | PEFR 50-75%
95
Severe asthma attack features
``` PEFR 33-50% RR >25 HR >110 Inability to complete sentences Sats > 92% ```
96
Features of life threatening asthma attack
``` PEFR < 33% Sats < 92% Altered consciousness/confusion Exhumation Arrhythmia Hypotension Cyanosis Poor resp effort Silent chest ```
97
Feature that makes near fatal asthma
PaCO2 raised or ‘normal’
98
Mx of asthma attack
``` Oxygen Salbutamol Hydrocortisone Ipratropium Theophylline Magnesium Escalate ```
99
Pathology behind subdural haemorrhage
Tearing of bridging veins from cortex to draining venous sinuses
100
Electrolyte changes in Addisonian crisis
``` HypoNa HyperK Raised creatinine Hypoglycaemia HyperCa ```
101
Features of acute chest syndrome in sickle cell
``` Chest pain Hypoxia Pulmonary inflates Cough Increased RR Wheeze ```
102
Features of acute splenic sequestration in sickle cell
``` Sudden trapping of large number of RBCs in spleen Anaemia Splenomegaly Hypovolaemia Thrombocytopenia Shock ```
103
Commonest organism of septic arthritis in sickle cell patients
Salmonella
104
Aplastic crisis in sickle cell is associated with what infection?
Parvovirus B19
105
Who can set up a NIV?
CT1 or above
106
Mnemonic to aid memory of life threatening asthma features
33 92 CHEST
107
How many days of abx do we give for CAP?
5 days
108
Adverse features of arrhythmia
Shock Syncope MI HF
109
Treatment for torsades
IV magnesium sulphate
110
What joules do we use for shocking in arrests?
200 300 360
111
What number fall of ketones and glucose do we look for in treating DKA?
Ketones 0.5 per hour | Glucose 3 per hour
112
DKA insulin preparation
0.1 units/kg/hour | 50 U act rapid in 50ml NaCl
113
Insulin preparation in hyperkalaemia
10 units of actrapid in 20% dextrose
114
Keppra is the brand name for ...
Levetiracetam
115
Anti cholinergic toxidrome
``` Dry Red - flush Mad - confusion Hot Can’t shit, can’t spit, can’t see, can’t pee ```
116
Mx of anticholinergics overdose
Sodium bicarbonate
117
Cholinergic toxidrome
``` Salivate Lacrimate Urinate Diarrhoea Eg. OP poisoning ```
118
In DKA what rate of fall of ketones do we want?
0.5 mmol per hour
119
In DKA what rate of fall of glucose do we want?
3 mmol per hour
120
How do we prepare the insulin for treatment of hyperkalaemia?
10 unit of actrapid in 20% dextrose
121
What are the SEs of theophylline?
Hypokalaemia | Arrhythmia
122
What type of NIV is better for COPD exac?
BiPAP
123
How does pseudomonas gram stain?
Gram negative bacillus
124
What antibodies are seen in autoimmune hepatitis?
Anti smooth muscle antibodies

Finals Revision (6 decks)

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