Emergency Medicine🆘

Question 1

mx of ethylene glycol poisoning (anti-freeze)

Answer 1

gastric lavage or NG aspiration if<1 hour
fomepizole

Question 2

presentation of carbon monoxide poisoning

Answer 2

confusion
tension-type headache
cherry-red skin
tachycardia
100% ox sats on pulse oximetry

Question 3

ix carbon monoxide poisoning

Answer 3

VBG/ABG
chest x ray
ECG
bloods including CK

Question 4

mx carbon monoxide poisoning

Answer 4

100% oxygen via face mask
hyperbaric oxygen

Question 5

in what paracetamol OD patients can NAC be administered immediately

Answer 5

pts on long-term enzyme inducers
regular alcohol excess
pre-existing liver disease
glutathione-deplete states; eating disorders, malnutrition and HIV

Question 6

mx of status epilepticus (seizure activity lasting longer than 5 mins)

Answer 6

A-E
oxygen
IV access
bloods for glucose
airway management
IV Lorazepam 4mg x2
then futher anti-convulsants can be used:
leviteractem
phenytoin
valporate

Question 7

Sepsis six

Answer 7

Take bloods
Take blood cultures
Administer oxygen if required
Administer IV abx
Administer IV fluid resuscitation
Monitor urine output

Question 8

How do you treat septic shock which is unresponsive to fluid resuscitation

Answer 8

Noradrenaline infusion is first line

Question 9

Empirical treatment for suspected encephalitis

Answer 9

IV acyclovir and IV ceftriaxone

Question 10

Presentation of acute pulmonary oedema

Answer 10

Extreme dyspnoea
Restlessness
Anxiety
Some pts may produce frothy sputum
May also be signs of fluid overload

Question 11

Management of acute pulmonary oedema

Answer 11

ABCDE approach
Sit patient up
Administer oxygen
Ensure IV access
IV furosemide

Question 12

Patients with a pulmonary embolism tend to present as

Answer 12

With pleuritic chest pain
Normal sounding chest
Risk factors such as recent surgery or long haul travel

Question 13

Initial management of hypoglycaemia below 4 mmol/l if the patient does not have a reliable swallow and in hospital

Answer 13

IV 10% glucose solution

Question 14

Definition of hypoglycaemia

Answer 14

Blood glucose <3 mmol/L

Question 15

Clinical features of hypoglycaemia

Answer 15

Shaking
Sweating
Palpitations
Hunger
Headache
Double vision and difficulty concentrating
Slurred speech
Confusion
Coma

Question 16

Management of mild hypoglycaemia still conscious

Answer 16

ABCDE
Eat/drink fast acting carbs
Avoid chocolate
Eat slower acting after

Question 17

Management of severe hypoglycaemia e.g seizures or unconscious

Answer 17

ABCDE
200ml 10% dextrose IV
1mg/kg glucagon IM if no IV access
Treat seizure if prolonged or repeated

Question 18

Interventional management of a PE

Answer 18

Embelectomy may be considered in patients when thrombolysis is contraindicated

Inferior vena cava filter may be considered in patients with recurrent DVTs on warfarin or patients in which anticoagulation is contraindicated

Question 19

Risk factors for haemorrhagic stroke

Answer 19

Age
Male sex
Family history
Haemophilia
Anticoagulation therapy
Illicit sympathomimetic drugs e,g amphetamine + cocaine

Question 20

Management of paracetamol overdose

Answer 20

If ingestion less than 1 hour + dose >150mg/kg - ACTIVATED CHARCOAL
if staggered overdose or ingestion >15 hours - N-ACETYLCYSTEINE
If ingestion <4 hours - wait until 4 hours to take a level and then treat with N-ACETYLCYSTEINE
if 4-15 hours ago - take IMMEDIATE level and treat

Question 21

What increases the risk of toxicity following a paracetamol overdose

Answer 21

Long term enzyme inducers
Regular alcohol excess
Pre-existing liver disease
Glutathione-deplete states; eating disorders, malnutrition and HIV

Question 22

Clinical features of cocaine overdose

Answer 22

Mainly neurological and cardiovascular
Anxiety
Agitation
Aggression
Paranoid psychosis
Hyperthermia
Seizures

Question 23

non-specific sx of lethargy, nausea, vomiting, diarrhoea and hypotension

biochemical findings : hyponatraemia, hyperkalemia, hypoglycaemia and hypercalcemia

Answer 23

addisonian crisis

Question 24

mx of addisonian crisis

Answer 24

Fluid resuscitation is hypotensive.
IV hydrocortisone 100mg (Stat and then continue regularly)
IV glucose if hypoglycaemic
Swap back to their oral steroids after 3 days
Consider fludrocortisone if there is adrenal disease

Question 25

a young woman with a headache and visual disturbances

on ophthalmoscopy: papilledema

Answer 25

idiopathic intracranial hypertension

Question 26

treating digoxin toxicity

Answer 26

Immediate digoxin level
IV fluids
Correct electrolyte abnormalities
Continuous cardiac monitoring
Give digibind if:
Level >15ng/ml after 6 hours of last dose
Level >10ng/ml within 6 hours of last dose
Symptomatic