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Flashcards in Emergency And Ward Medicine Deck (48):
1

Important differentials for acute lower abdo pain in any woman of childbearing potential?

GI stuff
Ectopic pregnancy
Ruptured ovarian cyst, ovarian torsion (ovarian accident)
(Miscarriage)

2

5 step approach to ABGs?

Patients clinical picture
Oxygenation
pH
Respiratory component - CO2 as marker of ventilation
Metabolic component - bicarbonate and base excess

3

What indicates respiratory involvement on an ABG? How?

CO2 - if it is in the 'expected direction' e.g. High in an acidosis then it is a respiratory acidosis, if in the 'opposite' direction it is a compensatory change for a metabolic disturbance

4

Describe the role of base excess in ABGs?

Essentially the CO2 equivalent for metabolic disturbance - if in the 'expected direction' of pH change then it is a metabolic disturbance (e.g. Negative = metabolic acidosis)

5

2 important causes of coma + sweating?

Sepsis
Hypoglycaemia

6

What does the serum anion gap represent?

The unmeasured anions - albumin, phosphate, sulphate, lactate, ketoacids

7

KLAPS of unmeasured anions?

Ketoacids
Lactate
Albumin
Phosphate
Sulphate

8

2 causes of a low anion gap?

Lithium toxicity
IgM/IgG multiple myeloma

9

5 causes of a raised anion gap?

Ketoacids - alcohol or DM
Lactate (sepsis)
Sulphate/phosphate - AKI
Uraemia

10

Which type of bilirubin is water soluble and therefore detectable directly and visible in urine?

Conjugated

11

What does bilirubinuria suggest?

Conjugated bilirubin (as this is the only type that is water soluble) - cholestasis

12

3 causes of isolated raised ALP?

Paget's disease
Normal pregnancy
Bony mets/blastic lesions e.g. Breast, prostate cancer

13

2 causes of a low ALP?

Hypothyroidism
Pernicious anaemia

14

Metabolic cause of a really really low ALP in the context of acute liver failure?

Willsons disease

15

2 causes of an isolated raised AST?

Rhabdomyolysis
Acute MI

16

What does a raised ALT and AST with a predominant AST suggest?

Alcoholic disease

17

5 major causes of a macrocytic anaemia?

Pernicious
Other B12/folate def
Alcohol
Hypothyroidism
Reticulocytosis

18

5 SIRS criteria?

HR > 90
RR > 20
Temp >38.3 or 12000 or

19

What blood abnormality may be present in non-diabetics in the context of SIRS?

Raised BM

20

What is severe sepsis?

SIRS + bacteraemia + end organ damage

21

Signs of severe sepsis?

Hypotension and reduced urine output
Bounding pulse, increased CRT
Mottling, clotting dysfunction/DIC

22

2 criteria for septic shock?

Persistent hypotension in spite of adequate fluid resus
Organ hypoperfusion as evidenced by lactate >4

23

Warm vs cold shock?

Warm shock is early; bounding pulse, peripheral vasodilation and warmth
Cold shock is late; relative hypoperfusion and peripheral shutdown

24

What type of shock is septic?

Distributive

25

What is the sepsis 6?

High flow O2 via non-rebreathe mask
IVT
IVAbx
Take blood cultures
Take lactate
Measure urine output

26

Endocrine complication of septic (typically meningeal) shock?

Waterhouse-Friedrichson syndrome - bilateral adrenal haemorrhage

27

Describe foot associated with autonomic neuropathy?

Dry (reduced sweating)
Bounding pulses due to peripheral vasodilation

28

What is Charcot arthropathy?

Sensori-autonomic neuropathy
Hypervascularisation making unstable and easily fractured

29

Describe an acute Charcot joint?

Hot, red, swollen in DM patient ddx septic, osteomyelitis, DVT, cellulitis, gout
Warm with bounding pulses, 'painful' in a neuropathic foot

30

Most important management of an acute Charcot joint?

Offload - air cast
To prevent arch collapse, subluxation of Ts and MTs, 'rocker bottom foot'

31

How long do you have to wait post-bronchodilator to assess asthma reversibility via PEFR?

20 mins

32

SPACESPIT for describing lumps?

Size and Shape
Position
Attachments and skin changes
Consistency
Edge
Surface
Pulsatile?
Inflammation?
Transillumination?

33

3 crystalloid fluids?

Normal saline
Dextrose/dexsaline
Hartmanns

34

2 colloid fluids?

Albumin
Blood products

35

Extrinsic RFs for pressure ulcers?

Heat
Friction and shearing
Uniaxial pressure
Moisture
Posture

36

Intrinsic RFs for pressure ulcers?

Immobility
Infection
Incontinence
Sensory loss
Old age
Poor nutrition
Chronic disease

37

What is a grade 1 pressure ulcer?

Intact skin with patch of non-blanching erythema, typically over bony prominence

38

What scoring systems are used to assess RFs for pressure ulcers?

Braden score
Waterlow

39

What is a grade II pressure ulcer?

Partial thickness skin loss, involving epidermis and or dermis
Or intact/open blister

40

What is a grade 3 pressure ulcer?

Full thickness skin loss, damage or necrosis of subcutaneous tissue down to but not through underlying tissue

41

What is a grade 4 pressure ulcer?

Skin loss through full thickness of skin, extensive destruction and necrosis to underlying bone, tissue muscle or joint capsule. +/- Slough and eschar

42

What is erythema nodosum?

Painful raised rash on lower limbs

43

Normal QRS interval length?

Less than 0.12s

44

Drop of BP by how much is postural hypotension?

At least 20/10

45

When should BP be measured when checking for postural hypotension?

Lay down for 5 mins then measure
Stand up for 1 min then measure
Measure after 3 mins of standing

46

How long is a urine sample valid to be tested for after it is produced?

4 hours

47

How big suggests small bowel dilatation? How do you know it's small bowel?

Over 3cm
Valvulae coniventes thoughout thickness

48

How big suggests large bowel dilatation? Caecum? How do you know it's large bowel?

6cm normally, 9cm for caecum
Has haustra transversely (makes little houses) not through full thickness and taenia coli longitudinally (big long worm)