Emergencies

Question 1

What is the initial dose of adrenaline for anaphylactic shock?

Answer 1

500mcg of 1:1000 IM (repeat every 5 minutes)

Question 2

3 investigations in sepsis

Answer 2

Blood cultures, Urine output hourly, Lactate

Question 3

What is the recommended initial dose of oxygen for pulmonary edema?

Answer 3

15 L via non-rebreathe mask

Question 4

What is the cutoff diameter in primary and secondary pneumothorax to determine whether or not to aspirate

Answer 4

2 cm and 1 cm

Question 5

What antibiotics are recommended for meningitis before urgent transfer to the hospital?

Answer 5

Benzylpenicillin or cefotaxime (give IM)

Question 6

What is the secondary prevention for TIA with an ABCD2 score ≥4?

Answer 6

Clopidogrel 75mg for life

Question 7

What is the treatment for unconscious hypoglycemia?

Answer 7

20% glucose 50mL IV or glucagon 1mg IM/SC

Question 8

What is the fluid of choice for initial resuscitation in DKA?

Answer 8

0.9% sodium chloride 500mL boluses

Question 9

What is the antidote for paracetamol poisoning?

Answer 9

Acetylcysteine / activated charcoal (if within 1 hour)

Question 10

What is the specific antagonist for benzodiazepine poisoning?

Answer 10

Flumazenil

Question 11

What medication is administered after three shocks in non-shockable cardiac arrest rhythms?

Answer 11

Amiodarone 300mg IV

Question 12

What does MONAC stand for in the context of ACS treatment?

Answer 12

Morphine, Oxygen, Nitrates, Aspirin, Clopidogrel

Question 13

What is the recommended treatment for stable broad complex tachycardia with an irregular rhythm?

Answer 13

Magnesium sulfate 2g IV

Question 14

What is the recommended duration for secondary prevention of ischemic stroke with clopidogrel?

Answer 14

Lifelong

Question 15

What symptoms may overlap between meningitis and subarachnoid hemorrhage?

Answer 15

Headache and neck stiffness

Question 16

What type of hemorrhage presents with a lucid interval between loss of consciousness and rapid decline?

Answer 16

Extradural

Question 16

What is the primary treatment for oesophageal varices-related upper GI bleed?

Answer 16

Terlipressin IV + endoscopic therapy (EVL) + antibiotic

Question 17

What is the recommended treatment for conscious hypoglycemia?

Answer 17

Glucose 10-20g orally then a sustained carbohydrate

Question 18

What symptoms may indicate aspirin poisoning?

Answer 18

Hyperventilation, tinnitus, vasodilatation

Question 19

What is the role of GTN (glyceryl trinitrate) in the management of pulmonary oedema?

Answer 19

Vasodilator for blood pressure control

Question 20

What is the recommended secondary prevention for ACS with the acronym ‘BADS’?

Answer 20

BB (bisoprolol), ACEi (ramipril), Dual antiplatelets (aspirin and clopidogrel), Statin (atorvastatin)

Question 21

What are the reversible causes of cardiac arrest included in ‘The H’s’?

Answer 21

Hypoxia, hypovolemia, hypo-/hyper-kalemia, hypothermia

Question 22

Complication of correction of chronic hypernatraemia too fast

Answer 22

cerebral oedema

Question 23

Sepsis 6 (3 in, 3 out)

Answer 23

In: oxygen, fluid challenge, broad-spectrum antibiotics

Out: Measure serum lactate, blood cultures, urine output

Question 24

What is acute hypercalcaemia management

Answer 24

IV fluids + loop diuretics

Question 25

Which transfusion blood product has the highest risk of bacterial contamination?

Answer 25

Platelet transfusion

Question 26

Common triggers for anaphylaxis

Answer 26

Seafood, nuts, beans, chocolate, eggs, grains

Question 27

Signs / symptoms of anaphylactic shock

Answer 27

Hypotension, tachycardia, widespread urticaria, swollen tongue, lips, eyes, laryngeal oedema, swollen epiglottis

Question 28

Why does blood pressure drop in anaphylactic shock?

Answer 28

Vasodilatation, increased vascular permeability, fluid loss from vascular space

Question 29

Which immunoglobulin and inflammatory cells are involved in anaphylaxis ?

Answer 29

IgE and mast cells

Question 30

What enzyme / test can be used to detect anaphylaxis?

Answer 30

Tryptase

Question 31

Dose of IM adrenaline in anaphylaxis of different age groups

Answer 31

- Up to 6 years old = 150 mcg - 6-12 years old = 300 mcg - Above 12 = 500 mcg (0.5 ml 1 in 1000)

Question 32

Define refractory anaphylaxis and its management

Answer 32

2 doses of adrenaline (5 mins apart) fail to cease the reaction - seek specialist help to administer IV adrenaline

Question 33

Post-anaphylaxis management

Answer 33

Non-sedating antihistamine, refer to allergy specialist, adrenaline auto-injector, tryptase (if query diagnosis)

Question 34

When can we discharge patients following anaphylaxis?

Answer 34

- 2 hours in most patients - up to 6 hours if they required 2 doses of adrenaline / have a history of biphasic reaction - 12 hours if they had refractory anaphylaxis / severely unwell

Question 35

ECG changes in hyperkalaemia

Answer 35

Absent P waves, tall tented T waves, widened QRS complexes, PR prolongation

Question 36

Which drug is administered in severe hyperkalaemia and why?

Answer 36

Calcium gluconate IV - stabilises the cardiac membrane

Question 37

Which 2 drugs are administered after calcium gluconate in severe hyperkalaemia and why?

Answer 37

Insulin and dextrose - to ensure potassium ions enter cells

Question 38

How can we differentiate between second degree and third degree burns?

Answer 38

Third degree is a full thickness burn with no pain and no blisters

Question 39

Common organic causes of reduced GCS

Answer 39

Head injury, SAH, intracerebral haemorrhage, ischaemic stroke, brain abscess, meningitis, poisoning, trauma

Question 40

Non-brain causes of reduced GCS

Answer 40

Hepatic encephalopathy, hyperuraemic encephalopathy, sepsis

Question 41

Pre-operative assessment

Answer 41

- Medical and drug history - FBC, U&Es, clotting, group and save, LFTs - CXR and ECG - Pregnancy test - Sickle cell test - Urinalysis - VTE risk

Question 42

Signs of opioid overdose on examination

Answer 42

Respiratory depression Pinpoint pupils Shallow breathing Decreased GCS / GCS <15

Question 43

Which type of hypersensitivity is anaphylaxis?

Answer 43

Type 1

Question 44

What position should you place someone in with anaphylactic shock

Answer 44

Flat with legs raised To maximise venous return to the heart