Emergency medicine Flashcards

Question

Differentials for acute pancreatits?

Answer 1

ACS Perforated peptic ulcer Ruptured abdominal aortic aneurysm Bowel obstruction Cholecystitis

Answer 2

ABG, ECG, pregnancy test, capillary blood glucose FBC, CRP, LFT, amylase, lipase, LDH, bone profile Blood cultures Coagulation Lipid profile Autoimmune markers Abdominal USS, CXR, CT with contrast, MRCP

Answer 3

Catheterise and monitor urine input/ output Consider NG tube IV fluid resuscitation , crystalloids Analgesia Antiemetics Laparoscopic cholecystectomy, debridement of necrotic tissue

Answer 4

Pancreatic pseudocyst Pancreatic necrosis Peripancreatic fluid collections Haemorrhage Pancreatic fistulae Acute respiratory distress syndrome AKI DIC Multi organ failure Hyperglycaemia

Answer 5

Guideline based approach to treating patients who have had a cardiac arrest to improve chances of successful resuscitation and survival

Answer 6

Out of hospital In hospital

Answer 7

Hypoxia Hypovolaemia Hypokalaemia, Hyperkalaemia Hypothermia, Hypothermia Thromboembolism Tamponade Tension pneumothorax Toxins

Answer 8

Depends on whether rhythm is shockable or non shockable Shockable rhythm; pulseless ventricular tachycardia, ventricular tachycardia Non shockable rhythm; pulseless electrical activity, asystole

Answer 9

Organised cardiac electrical activity in the absence of of any palpable pulse Survival is unlikely unless reversible cause and identified and treated effectively

Answer 10

If doubt whether rhythm is shockable or non shockable

Answer 11

Attempt defibrillation if VT or VF is identified Immediately resume CPR after first shock at 30:2 Continue CPR for 2 minutes and pause to check for pulse If no pulse give a second shock Continue CPR for 2 minutes and pause to check for pulse Give a third shock Continue CPR for 2 minutes and give 1mg adrenaline or 300mg amiodarone Give repeat doses of adrenaline every 3-5 minutes After 5 shocks give further dose of 150mg of amiodarone

Answer 12

Start CPR at 30:2 Give 1mg IV adrenaline, repeat dose every 3-5 minutes

Answer 13

Angioedema Anaphylaxis Thermal injury Neck haematoma Wheeze Surgical emphysema Reduced conciousness

Answer 14

Suction; if visible vomit, blood, secretions, foreign body Turn patient onto side if actively vomiting Head tilt/ chin lift Place pillow under neck Aim for sniffing position Jaw thrust

Answer 15

Oropharyngeal airway; Guedel, Nasopharyngeal airway

Answer 16

Laryngeal mask airway, i- Gel that sits on top of larynx

Answer 17

Used for prolonged ventilation and acts as a protected airway

Answer 18

Tracheostomy Cricothyroidotomy

Answer 19

When a patient who is dependant on alcohol suddenly stops or drastically reduces alcohol consumption

Answer 20

Affects 24% of the UK population

Answer 21

Chronic exposure to alcohol causes tolerance to its effects, reduced GABA activity and increased glutamate activity

Answer 22

6-12 hours from last drink; Insomnia, tremor, anxiety, agitation, nausea, vomiting, sweating, palpitations 12-24 hours; visual hallucinations, auditory hallucinations, tactile disturbance (sensation of crawling bugs) 24-48 hours; alcohol withdrawal seizures 48-72 hours; delirium tremens Delirium, agitation, hallucinations, delusions, tachycardia, hypertension, hyperthermia, diaphoresis, coarse tremor

Answer 23

Benzodiazepine withdrawal Sepsis Hepatic encephalopathy Psychosis Hypoglycaemia

Answer 24

ECG Capillary blood glucose FBC, CRP, LFT, Bone profile, blood culture CXR, CT head

Answer 25

Use Clinical Institute Withdrawal Assessment of Alcohol scoring system to assess symptoms and guide prescription of benzodiazepines Chlordiazepoxide (long acting) is first line Oxazepam/ lorazepam are used in patients with liver disease Treat seizures with short acting benzodiazepines, IV lorazepam Pabrinex to prevent Wernicke's encephalopathy

Answer 26

Post operative complication which occurs as a result of a defect in the joint between two hollow viscera that allows contents to leak into the abdomen

Answer 27

Occur 3-5 days post operatively Frequency depends on location of surgery

Answer 28

Emergency surgery Prolonged operative time Peritoneal contamination during surgery Immunosuppressant medication IBD Smoking Alcohol excess Diabetes Obese/ malnourished patients

Answer 29

Progressive worsening of abdominal pain Prolonged ileus Tenderness on palpation of abdomen Peritonism Abdominal distention Fevers Tachycardia Hypotension Delirium Nausea and Vomiting

Answer 30

Post operative ileus Surgical site infection Intra-abdominal abscess

Answer 31

Blood gas; raised lactate Blood cultures FBC, CRP, clotting, group and save CT with contrast

Answer 32

Nil by mouth IV fluids Monitor input and output IV antibiotics TPN Surgery/ emergency laparotomy

Answer 33

Sepsis Ileus Abscess formation Increased postoperative mortality

Answer 34

Tear in the tunica intima of the aorta creates a false lumen through which blood can flow between inner and outer layers of the aortic walls

Answer 35

Hypertension Connective tissue disease Valvular heart disease Cocaine/ amphetamine use Male over 50 years

Answer 36

Type A; involves ascending aorta, arch of aorta Type B; involves descending aorta

Answer 37

Sudden onset tearing chest pain/ intrascapular pain that radiates to the back Bowel/ limb ischaemia Renal failure Syncope

Answer 38

Radio-femoral delay Radio-radial delay Blood pressure differential between arms

Answer 39

CT angiogram ECG Echo; pericardial effusion CXR; widened mediastinum Troponin and D-dimer may be elevated

Answer 40

Prompt diagnosis and treatment as rupture carries 80% mortality

Answer 41

Resuscitation Cardiac monitoring Strict blood pressure control Type A; requires surgical managements Type B; managed conservatively with BP control, endovascular/ open repair may be required

Answer 42

Death due to internal haemorrhage Rupture End organ damage Cardiac tamponade Stroke Limb ischaemia Mesenteric ischaemia

Answer 43

Discomfort or pain in the mid section of the abdomen

Answer 44

Injury to skin caused by heat, electricity, chemicals and radiation

Answer 45

Young children, under 5 years Elderly patients Reduced mobility/ sensory impairment Patients with reduced sense of danger (Dementia, learning difficulty)

Answer 46

Thermal burns; flames, hot objects Chemical burns; acids, alkalis, organic compounds Electrical burns; high/ low voltage

Answer 47

Superficial epidermal burns; affects only epidermis, skin is erythematous and painful but not blistered, rapid CRT Superficial dermal burns; affects epidermis and upper layer of dermis, erythematous, painful blistered skin with delayed CRT Deep dermal burns; affects all layers of the dermis but not underlying subcutaneous tissue, dry, blotchy, blistered painful skin that does not blanch under pressure Full thickness burns; extend to SC tissue and may involve muscle and bone, skin is white or black and may feel rubbery/ leathery/ waxy and is not painful Complex; >15% of BSA or affect critical area (face, perineum, hands, feet, genitals) and all chemical and electrical burns Non-complex; <15% BSA, partial thickness

Answer 48

Pain Erythema Swelling Blistering and peeling of skin Respiratory distress Hypotension Tachycardia

Answer 49

Cellulitis Stevens- Johnson Syndrome Toxic Epidermal Necrolysis Pyoderma gangrenosum

Answer 50

Divides areas of the body into multiples of 9 of the TBSA Head- 9% Whole arm-9% Front of torso-18% Back of torso-18% Whole leg-18%

Answer 51

Wallace tule of 9's Palmar method Lund and Browder method

Answer 52

EARLY Dehydration, hypovolaemic shock Rhabdomyolysis AKI Electrolyte imbalance Hypothermia Respiratory distress due to smoke inhalation Curling's ulcer Infection, sepsis Arrhythmia Loss of limbs if amputation necessary Death LATE Scarring Chronic pain Contractures Low mood Anxiety, PTSD

Answer 53

4% of trauma patients Higher risk in those with decreased consciousness C2 and C7 are most commonly fractured vertebrae

Answer 54

Road traffic accidents Falls Sports related injury Assaults Osteoporotic compression fractures

Answer 55

Age over 65 Dangerous mechanism of injury Paraesthesia in upper or lower limb

Answer 56

Accident is a minor rear end motor vehicle collision Comfortable in sitting position No midline cervical spine tenderness Delayed onset of neck pain Unable to rotate neck 45 degrees to left and right

Answer 57

Neck pain Mid line cervical tenderness Focal neurological deficit Limited range of motion in neck movements Haematoma/ oedema around cervical vertebrae Sensory/ motor deficits- paralysis may affect trunk, upper and lower limb Peripheral paraesthesia Incontinence

Answer 58

Assess high or low risk as per Canadian C-spine rule CT of neck If neurological abnormalities do MRI

Answer 59

Imobilise and place in neck collar IV morphine for pain control Neurosurgical and spinal surgical review

Answer 60

Foreign object becomes lodged in a patients airway causing acute airway obstruction that is life threatening

Answer 61

Dysphagia Poor dentition Eating when not upright Alcohol intoxication Extremes of age Risky foods

Answer 62

Gagging, choking, distress Unable to speak, breathe or cough Clutching or pointing at neck Stridor Wheezing Respiratory distress Cyanosis Attempts o cough a quiet or silent Loss of consciousness

Answer 63

Anaphylaxis Asthma exacerbation Syncope

Answer 64

Encourage coughing Give 5 back blows between shoulder blades with heel of hand and patient leaning forward 5 abdominal thrusts Sequence until dislodged

Answer 65

Slurred speech Lethargy Ataxia Reduced levels of consciousness (may compromise airway) Respiratory depression Large overdoses may cause hypotension, bradycardia and hypothermia

Answer 66

A to E assessment Consider risk of aspiration pneumonia Flumazenil

Answer 67

Flumazenil- useful in iatrogenic overdose

Answer 68

Risk of seizures, used in ITU/ HDU Avoid in epilepsy, chronic benzodiazepine use

Answer 69

Small overdoses may be asymptomatic Bradycardia Hypotension Drowsiness Confusion Seizures Coma Bronchospasm Cardiac arrest

Answer 70

Prolonged PR interval Bradycardia (most common) Heart block QRS widening (especially propranolol) which may progress to ventricular arrhythmias QT prolongation (especially sotalol) with risk of torsades de pointes

Answer 71

Resuscitation Correct glucose Activated charcoal if within 1 hour Symptomatic bradycardia; atropine Glucagon High dose insulin

Answer 72

Nausea and vomiting Hallucinations, agitation and psychosis Delirium Hyperreflexia Tremor Hyperthermia Diaphoresis Flushing Mydriasis Tachycardia Hypertension

Answer 73

Arrhythmias Rhabdomyolysis Seizures Cardiovascular collapse Hyponatraemia Serotonin syndrome Acute renal failure Disseminated intravascular coagulation Coma

Answer 74

Resuscitation Benzodiazepines Cooling if hyperthermic If hyponatraemic fluid restriction and hypertonic saline Labetolol Dantrolene

Answer 75

Remove clothing Protect airway Intubation and ventilation Gastric lavage Give IV atropine Pralidoxine

Answer 76

Nausea and vomiting Headache Tachycardia Hypertension Tachypnoea Loss of consciousness Seizures Respiratory depression

Answer 77

Decontamination Intubation and ventilation High flow oxygen Dicobalt edetate

Answer 78

Dicobalt edetate

Answer 79

Lactate over 10

Answer 80

Inflammation of injured muscle causes an increase in pressure within fascial compartment As pressure rises circulation is cut off leading to tissue damage and necrosis

Answer 81

Fractures; commonly tibial, forearm, wrist Crush injuries Constrictive dressings/ plaster casts Prolonged immobilisation Reperfusion of ischaemic limb

Answer 82

Severe pain out of proportion of initial injury Passive stretching of affected muscles exacerbates pain Paraesthesia Pallor Pulselessness Paralysis Coolness of the affected limb The area may feel tense on palpation

Answer 83

DVT Cellulitis Acute limb ischaemia

Answer 84

Measure intracompartmental pressures- typically around 40mmHg Creatinine kinase U+E, FBC, LFT, clotting, group and save ECG

Answer 85

Surgical management; fasciotomies Analgesia Monitor neurovascular status Monitor other limbs

Answer 86

Rhabdomyolysis Limb amputation Volkmann contracture

Answer 87

Cold air and exercise Pollution and cigarette smoke Allergens Chemical irritants Medications; NSAIDs, beta blockers

Answer 88

Type 1 hypersensitivity reaction

Answer 89

Wheeze Difficulty breathing Struggling to eat, speak or sleep due to breathlessness Cough Chest tightness Dizziness

Answer 90

Tachypnoea Increased work of breathing Hyperinflated chest Expiratory polyphonic wheeze throughout the lung fields Decreased air entry Cyanosis Tachycardia Altered mental state, e.g. drowsiness or confusion Exhaustion Hypotension

Answer 91

Pulmonary embolism Vocal cord dysfunction Acute exacerbation of COPD GORD Anaphylaxis

Answer 92

PEFR ABG ECG FBC, CRPU+E, LFT Blood cultures CXR

Answer 93

Respiratory failure Pneumothorax Status asthmaticus Death

Answer 94

ABCDE Maintain O2 sats 94-98% Nebulised salbutamol 5mg Ipratropium bromide 500mcg 4-6 hours Prednisolone 40-50mg and continue for atleast 5 days IV magnesium sulphate; 1.2-2g over 20 minutes Aminophylline

Answer 95

Chest pain - typically central and crushing in nature. May radiate to left arm/neck/jaw Shortness of breath Nausea +/- vomiting Sweating and clamminess Syncope Atypical presentations are more likely in some groups (e.g. the elderly or patients with diabetes who may not experience chest pain) Pain may be epigastric rather than in the chest, or there may be no pain Acute confusion or hyperglycaemic crises are examples of atypical ACS presentations

Answer 96

Myocarditis Pericarditis PE Costochondritis Aortic dissection

Answer 97

ECG Troponin, repeat after 4-6 hours U+E, HbA1c, lipid, FBC, CRP, coagulation CXR Echo

Answer 98

Loading dose of aspirin 300mg Second antiplatelet agent; prasugrel, clopidogrel Sublingual GTN Morphine PCI; primary if presented within 12 hours and can be offered in 2 hours

Answer 99

Loading dose of aspirin Antithrombin; fondaparinux Risk stratification; GRACE score Low risk patients managed medically; aspirin + ticagrelor Intermediate/ high risk managed with PCI and DAPT

Answer 100

Ventricular arrhythmia Acute mitral regurgitation Acute heart failure Heart block Cardiogenic shock Cardiac tamponade Ventricular septal defect Dressler's syndrome

Answer 101

Acute worsening of patients baseline symptoms beyond expected day to day variation

Answer 102

Viral; rhinovirus, influenza, parainfluenza, coronavirus, adenovirus, RSV Bacterial; haemophilus influenza, streptococcus pneumonia, moraxella catarrhalis, staphylococcus aureus, pseudomonas aeurginosa Nitrogen dioxide, particulates, sulphurdioxide Pneumothorax, PE, intra-abdominal pathology, heart failure, metabolic disturbance

Answer 103

Worsening shortness of breath Reduced exercise tolerance/not coping at home Worsening cough (especially if increased sputum production/change in colour) Worsening wheeze and chest tightness Infective symptoms (e.g. sore throat, coryza, fevers) Lethargy Confusion Ankle swelling

Answer 104

Tachypnoea and respiratory distress Tripod positioning (where patient leans slightly forward with arms propped up in front - reduces work of breathing and allows greater use of accessory muscles) Pursed lip breathing Reduced oxygen saturations from baseline Tachycardia Cyanosis Asterixis On auscultation: wheeze, reduced air entry, prolonged expiratory phase, crackles

Answer 105

ABG Sputum culture ECG FBC, CRP, U+E Blood culture CXR

Answer 106

Pneumonia Pneumothorax Pulmonary embolism Acute exacerbation of asthma Exacerbation of bronchiectasis Acute heart failure Exacerbation of interstitial lung disease Lung cancer Tuberculosis

Answer 107

Oxygen saturations between 88-92% Salbutamol 2.5-5mg Ipratropium 0.5mg QDS Steroids; prednisolone 30mg for 5 days, if unable to swallow IV hydrocortisone IV aminophylline Consider antibiotics if infectious

Answer 108

Blockage of the angle formed by the cornea and the iris which prevents the humour from draining resulting in progressive increase in intra-ocular pressure

Answer 109

Anatomical variations Older age Female sex East Asian ethnicity Medications e.g. oxybutynin, amitriptyline, tropicamide Hypermetropia (farsightedness) Family history of AACG Pupillary dilation e.g. being in a dark room

Answer 110

Rapid onset of severe eye pain Blurred vision which may progress to visual loss Nausea and vomiting Headache Coloured haloes around lights

Answer 111

Conjunctival injection in the affected eye Haziness of the cornea Mid-dilated or fixed pupil that is not reactive Globe feels hard and is tender on palpation

Answer 112

Open angle glaucoma Acute anterior uveitis Anterior scleritis

Answer 113

Slit lamp examination Ophthalmoscopy Gonioscopy; allows assessment of the angle between the iris and cornea Tonometry; >30mmHg

Answer 114

Goldmann applanation tonometry

Answer 115

Conservative management; Lie patient flat with their face up without pillows to relieve pressure on the angle Referral to ophthalmology Monitor symptoms and ensure analgesia and antiemetics Medical management; Dorzolaminde (carbonic anhydrase inhibitor) and timolol (beta blocker) Apraclonidine; alpha-2 agonist Polocapine; cholinergic agonist Acetazolamide Surgical management; Peripheral iridotomy Treat both eyes

Answer 116

Rapid onset of life threatening airway, breathing or circulatory dysfunction as a result of an immunological reaction when patient is exposed to allergen

Answer 117

20-30 deaths per year, about half are iatrogenic due to penicillin

Answer 118

Insect stings Nuts Other foods such as eggs or milk Latex Antibiotics (e.g. penicillins) Intravenous contrast agents Other medications (such as NSAIDs)

Answer 119

Airway; difficulty swallowing, breathing, stridor, hoarse voice, swelling of tongue and lips Breathing; difficulty breathing, wheeze, cough, respiratory distress, respiratory arrest Circulation; dizziness, pallor, clamminess, tachycardia, hypotension, arrhythmias, anaphylaxis, cardiac arrest Disability; sense of impending doom, confusion, agitation, loss of consciousness Exposure; erythematous patches, urtrcaria, angioedema GI manifestation; abdominal pain, incontinence, vomiting

Answer 120

Life threatening asthma exacerbation Other causes of angioedema; ACE inhibitors, histamine, bradykinin mediation Panic attack Vasovagal episode

Answer 121

ECG, ABG, mast cell tryptase

Answer 122

Remove triggers Lie patient flat and elevate legs IM adrenaline into anterolateral aspect of thigh Secure airway High flow oxygen Inhaled salbutamol/ ipratropium IV fluid bolus Repeat IM adrenaline after 5 minutes if no response Once stabilised; Oral non sedating antihistamine Observe for biphasic reaction

Answer 123

2 adrenaline auto injectors Advice on trigger avoidance Refer for follow up in specialist allergy service

Answer 124

When symptoms of anaphylaxis reoccur without further exposure to trigger

Answer 125

Cardiac causes; Ischaemic heart disease Hypertension Valvular heart disease (including rheumatic heart disease, typically affecting the mitral valve) Heart failure Cardiomyopathies Myocarditis and pericarditis Recent cardiothoracic surgery Non-cardiac causes; Electrolyte disturbances (e.g. hypokalaemia, hypomagnesaemia) Acute infections e.g. pneumonia, sepsis Pulmonary embolism Hyperthyroidism Alcohol excess Smoking Medications (e.g. lithium)

Answer 126

Paroxysmal; episodes last < 7 days and are intermittent Persistent; episodes last > 7days Permanent; lasts > days, no further attempts to get sinus rhythm are attempted

Answer 127

Palpitations Chest pain or tightness Shortness of breath Reduced exercise tolerance Light-headedness Syncope Fatigue A complication of AF e.g. a stroke or transient ischaemic attack

Answer 128

Irregularly irregular pulse Radial- apical deficit Variable intensity of first heart sound on auscultation Haemodynamic instability; tachycardia, hypotension, loss of conciousness, acute pulmonary oedema

Answer 129

Sinus tachycardia Atrial flutter Supraventricular tachycardia Multifocal atrial tachycardia

Answer 130

ECG; absence of p waves irregularly irregular QRS Bloods; FBC, CRP, U+E, bone profile, TFT, HbA1c, LFT, Lipids, clotting screen, blood cultures CXR Echocardiogram CTPA

Answer 131

AF with adverse signs; A to E approach DC cardioversion If 3 attempts are unsuccessful give 300kg IV amiodarone followed by another shock and 900mg amiodarone infusion over 24 hours Stable patients Synchronised DC cardioversion with sedation or general anaesthetic Pharmacological cardioversion with flecainide Rate control Ongoing management; Anticoagulation; DOAC

Answer 132

Embolic event Hear failure Myocardial ischaemia Tachycardia induced cardiomyopathy Increased risk of vascular dementia

Answer 133

The elderly Young children Pregnant women People with anaemia People with cardiovascular disease

Answer 134

Headache Dizziness Lethargy Flushing Myalgia and weakness Confusion Nausea and vomiting Cherry red skin (rare) Tachycardia and hypotension Seizures

Answer 135

Migraine Viral infections Diabetic ketoacidosis

Answer 136

Pulse oximetry Blood gas ECG Capillary blood glucose Bloods; FBC, U+E, CK, Troponin, lactate

Answer 137

A to E assessment 100% oxygen IV fluids

Answer 138

Emotional lability and personality change Difficulty concentrating Insomnia Lethargy Movement disorders such as chorea and Parkinsonism Memory impairment and dementia Psychosis Neuropathy

Answer 139

Compression of heart by fluid accumulation in the pericardial sac which impairs cardiac filling during diastole compromising cardiac output leading to cardiac arrest

Answer 140

Trauma; especially penetrating injuries Iatrogenic causes; cardiothoracic surgery Pericarditis which can be secondary to malignancy, myocardial infarction, HIB, TB, connective tissue disease, radiation, CKD Aortic dissection Medication; minoxidil, hydralazine Cardiac perforation Pneumopericardium

Answer 141

Fatigue Dyspnoea Cold and clammy peripheries Confusion

Answer 142

Beck's triad (raised jugular venous pressure, hypotension and muffled heart sounds) Pulsus paradoxus (a decrease in systolic blood pressure by more than 10 mmHg during inspiration) Tachycardia Tachypnoea Altered mental state Hepatomegaly Pericardial friction rub Cyanosis JVP shows an absent Y descent (due to reduced diastolic filling of the ventricles)

Answer 143

Raised JVP Hypotension Muffled heart sounds

Answer 144

Acute heart failure Constrictive pericarditis Pulmonary embolism Tension pneumothorax

Answer 145

ECG; electrical alternans where height of QRS complexes alternate due to movement of heart in pericardial space FBC, CRP, U+E, coagulation, HIV testing, group and save, troponin Imaging; echocardiogram, CXR, CT Pericardiocentesis fluid for cytology

Answer 146

Supportive therapy; oxygen, IV fluids, inotropes Pericardiocentesis Open surgical drainage Percutaneous balloon pericardiotomy, pericardiectomy Treat underlying cause

Answer 147

Hyperglycaemia; >11mmol/L Ketosis; >3 mmol/L Acidosis; pH <7.3

Answer 148

Insulin deficiency leads to hyperglycaemia which are converted to ketones which leads to ketosis

Answer 149

Infections Dehydration and fasting Missing doses of insulin Medications e.g. steroid treatment or diuretics Surgery Stroke or myocardial infarction Alcohol excess or illicit drug use Pancreatitis

Answer 150

Blood ketones > 6mmol/L Bicarbonate < 5mmol/L Blood pH < 7 Anion gap above 16 Hypokalaemia on admission GCS less than 12 Oxygen saturations < 92% in air Systolic BP < 90mmHg Brady or tachycardia (heart rate < 60 or > 100bpm)

Answer 151

Nausea and vomiting Abdominal pain Polyuria Polydipsia Weakness

Answer 152

Dry mucous membranes Hypotension Tachycardia Altered mental state (drowsiness, confusion, coma) Kussmaul's breathing (deep, sighing breathing to compensate for metabolic acidosis by blowing off carbon dioxide) Fruit-like smelling breath (due to ketosis)

Answer 153

Capillary blood glucose Blood or urinary ketones Urine dip and MSU ECG Venous blood gas U+E, FBC, CRP Blood cultures HbA1c

Answer 154

A to E assessment Ensure IV access Consider urinary catheterisation and monitor fluid balance IV fluids Potassium replacement Insulin 0.1 units/ kg/ hour

Answer 155

Chemical in antifreeze or radiator coolant

Answer 156

Early; Apparent intoxication (similar to that of alcohol) Nausea and vomiting Haematemesis Seizures Ataxia Ophthalmoplegia Papilloedema Raised anion gap metabolic acidosis Pulmonary oedema Late; Acute tubular necrosis Flank pain Oligouria Hypocalcaemia Hyperkalaemia Hypomagnesaemia

Answer 157

Alcohol intoxication Poisoning with other substances Acute renal failure

Answer 158

Urine sample ECG Blood gas; metabolic acidosis with raised anion gap U+E, LFT Bone profile, hypocalcaemia Magnesium, hypomagnesaemia CT head

Answer 159

A to E assessment Monitor urine output Gastric lavage, NG aspiration Fomepizole Ethanol Haemofiltration Treat any electrolyte imbalance

Answer 160

Competitive inhibitor of alcohol dehydrogenase

Answer 161

Complication of T2DM commonly seen in older patients with known diabetes

Answer 162

Blood glucose ≥ 30 mmol/L Serum osmolality ≥ 320 mOsm/kg Significant hypovolaemia Blood ketones ≤ 3 mmol/L pH ≥ 7.3 and bicarbonate ≥15.0 mmol/L

Answer 163

Infection Recent trauma or surgery Acute events like stroke or MI Medications; steroids

Answer 164

Polyuria Polydipsia Nausea Lethargy Weakness Confusion Drowsiness Loss of consciousness

Answer 165

Tachycardia Hypotension Altered mental state Sunken eyes Dry mucous membranes

Answer 166

Capillary glucose; over 30 VBG Capillary blood ketones ECG Urine dip Serum osmolality, glucose, U+E, FBC, CRP, LFT Bone profile Blood cultures CXR

Answer 167

Fluid resuscitation; 1L of 0.9% saline over 1 hour Potassium replacement Monitor glucose, ketones, U+Es hourly and calculate serum osmolality every hour VTE prophylaxis Refer to diabetes specialist

Answer 168

Hypovolemic shock Cerebral oedema Thromboembolic events Acute kidney injury Cardiac arrhythmias Respiratory failure Long-term neurological sequelae

Answer 169

Inflammation of the pericardium

Answer 170

Idiopathic Viral; echovirus, enterovirus, cocksackievirus, adenovirus Bacterial; pneumococcus, staphylococcus, mycoplasma TB Dresslers syndrome Autoimmune; rheumatoid arthritis, SLE, scleroderma Uraemic pericarditis Malignancy Drugs; isoniazide, hydralazine Trauma

Answer 171

Acute onset pleuritic chest pain; relieved by leaning forward, retrosternal may radiate down left arm/ shoulder Pericardial friction rub Fever Cough Arthralgia

Answer 172

ECG; acute phase PR depression, global saddle shaped ST elevation FBC, CRP, Troponin, U+E, Echo CXR

Answer 173

NSAIDs Low dose colchicine Steroids in uraemic pericarditis, connective tissue disorders Aspirin is used in pericarditis post MI

Answer 174

Large pericardial effusion or tamponade Myopericarditis (elevated troponin) Immunosuppression High fevers (>38 degrees) Trauma On oral anticoagulants Subacute cause Not responding to initial treatment (after 1-2 weeks)

Answer 175

Collection of air in the pleural cavity which may cause collapse of underlying lung parenchyma

Answer 176

Spontaneous Traumatic Tension

Answer 177

Sudden onset shortness of breath Pleuritic chest pain Dry cough Tachypnoea and increased work of breathing

Answer 178

Unilateral reduced expansion Unilateral hyper-resonance to percussion Reduced or absent breath sounds Reduced vocal resonance or tactile vocal fremitus Tracheal deviation to the contralateral side Tachycardia Hypotension Distended neck veins

Answer 179

CXR ABG CT chest Needle aspiration

Answer 180

Insertion of large bore cannula into second intercostal space, mid clavicular line Thoracostomy Chest drain

Answer 181

OPD in 2-4 weeks Smoking cessation No flying until 7 days post pneumothorax resolution No underwater diving

Answer 182

Sudden onset shortness of breath Pleuritic chest pain Haemoptysis

Answer 183

Sudden onset Shortness of breath Pleuritic chest pain Haemoptysis Cough Syncope RV ischaemia -> retrosternal chest pain

Answer 184

Tachypnoea Crackles o auscultation Tachycardia Hypoxia Low grade pyrexia

Answer 185

Less than 4; PE unlikely, perform D dimer More than 4; PE likely, CTPA or V/Q scan

Answer 186

ECG; sinus tachycardia ABG D-dimer FBC CRP U+E LFT Coagulation Troponin CXR CTPA V/Q scan TTE

Answer 187

Fleischner sign; enlarged pulmonary artery Hampton's sign; peripheral wedge shaped opacity Westermark sign; regional oligaemia

Answer 188

Anticoagulation Embolectomy Catheter directed thrombolysis

Answer 189

Withdrawal/ interruption or change in anti-epileptic medication Non compliance with medication Seizure threshold lowering medications Intercurrent illness Metabolic abnormalities Infection Brain injury; trauma, stroke, subarachnoid haemorrhage Withdrawal from benzodiazepines, alcohol

Answer 190

Abrupt generalised muscle stiffening (tonic phase) followed by rhythmic jerking of the muscles (clonic phase) Loss of consciousness Tongue biting - typically lateral tongue Urinary or faecal incontinence Clenched jaw Erratic eye movements Drooling Cyanosis

Answer 191

Reduced levels of consciousness Catatonia Behavioural changes/psychosis Subtle motor signs e.g. myoclonus, eye deviation or twitching Autonomic dysfunction Speech disturbance e.g. aphasia or perseveration

Answer 192

Last longer Eyes closed Emotional vocalisation; crying, screaming Limbs moving in phase with each other Head and trunk moving side to side React to external stimuli Incontinence and tongue biting

Answer 193

Encephalitis Hypoglycaemia Psychogenic pseudocoma Alcohol/ benzodiazepine withdrawal Transient global amnesia Stroke

Answer 194

Capillary glucose Blood gas; electrolytes, lactate Urine toxicology Pregnancy test ECG FBC, CRP, U+E, bone profile, magnesium LFT, clotting, serum anticonvulsant levels, blood cultures CT head, chest x ray Lumbar puncture

Answer 195

Ensure patient safety Airway adjunct High flow oxygen via non-rebreather Check glucose and give pabrinex is concern around alcohol excess At 5 minutes give 4mg of IV lorazepam (rectal diazepam or buccal midazolam) At 10 minutes repeat benzodiazepine At 15 minutes IV infusion of levetiracetam, phenytoin, sodium valproate If 30 minutes GA and intubate

Answer 196

Tachycardia originating above the level of bundle of his with narrow complex QRS

Answer 197

Unstable; DC cardioversion if signs of shock, syncope, heart failure, myocardial ischaemia Stable Vagal manoeuvre; carotid sinus massage, valsalva manoeuvre IV 6mg adenosine, 12mg then 18mg if unsuccessful Continuous ECG If adenosine fails, beta blocker or CCB with DC cardioversion

Answer 198

Difficulty breathing Chest tightness Flushing

Answer 199

Polymorphic ventricular tachycardia characterised by twisting and gradually changing amplitude QRS complexes around isoelectric line on ECG as a result of QT prolongation

Answer 200

Congenital long QT syndrome Stress, fear, exercise Toxins; heavy metals, insecticides Ischaemia Medications; erythromycin, ketoconazole, TCA, methadone, antipsychotics Electrolyte abnormalities; hypokalaemia, hypocalcaemia, hypomagnesaemia Subarachnoid haemorrhage

Answer 201

Upto 50% are asymptomatic Palpitations Lightheadedness Syncope Chest pain Nausea Cold sweats Dyspnoea Sudden cardiac death

Answer 202

ECG VBG Troponin Echo Genetic testing

Answer 203

IV fluids Correct any electrolyte imbalance IV magnesium 2g DC cardioversion Defibrillation

Answer 204

Haemorrhage in the GI tract anywhere between oesophagus and duodenum at the ligament of treitz

Answer 205

Peptic ulcer disease

Answer 206

Oesophageal causes; Oesophageal varices Oesophagitis Mallory- Weiss tear Oesophageal cancer Stomach causes; Peptic ulcer Gastric varices Gastritis Gastric cancer Vascular malformation Duodenal causes; Peptic ulceration Aortoenteric fistula

Answer 207

Glasgow blatchford score Rockall score

Answer 208

Haematemesis Coffee ground vomit Melena Lightheadedness Syncope Abdominal pain Fatigue Shortness of breath Decreased exercise tolerance Palpitations

Answer 209

Tachycardia Hypotension Prolonged capillary refill time Altered mental state Abdominal tenderness Melaena or haematochezia (fresh red blood) on rectal examination Stigmata of chronic liver disease; spider naevi, gynaecomastia, palmar erythema, caput medusae

Answer 210

VBG ECG FBC U+E LFT Coagulation Group and save Cross match OGD CXR

Answer 211

Aspirin All other anticoagulation is discontinued

Answer 212

Major haemorrhage protocol Airway support Ensure adequate IV access, bloods and blood gas Fluid bolus and blood transfusion if Hb under 70 (target 70-100) Correct coagulopathy/ anticoagulation Band ligation Sclerotherapy PPI

Answer 213

Rebleeding Aspiration of haematemesis Complications of endoscopy; perforation Death

Answer 214

Broad complex tachycardia with HR over 100bpm, and QRS width over 120ms

Answer 215

Severe decompensated hypothyroidism characterised by profound hypothermia, decreased mental status, systemic manifestations of severe hypothyroidism

Answer 216

Very rare More common in elderly women

Answer 217

Severe untreated hypothyroidism Infection Myocardial infarction Stroke Trauma Heart failure Drugs Exposure to cold temperatures

Answer 218

Profound lethargy or coma Hypothermia (typically below 35°C) Bradycardia and hypotension Hypoventilation leading to respiratory failure Hypoglycaemia Hyponatraemia Generalized myxoedema

Answer 219

Sepsis Stroke Drug overdose

Answer 220

TSH, free T4 FBC U+E Blood glucose ABG

Answer 221

ITU/HDU care IV T3/T4 50-100mg IV hydrocortisone Mechanical ventilation and oxygen - if hypoventilation IV fluid - to correct hypovolaemia Correction of hypothermia Correction of hypoglycaemia Treatment of any heart failure

Answer 222

Increase in serum creatinine by 26.5 mmol/l within 48 hrs Increase in serum creatinine > 1.5 times baseline in last 7 days Urine output under 0.5ml/kg/hr for 6 hours

Answer 223

Patients with CKD Elderly patients Previous AKI Malignancy Medical conditions increasing risk of urinary obstruction (e.g. benign prostatic hyperplasia) Cognitive impairment and disability (may be reliant on others for fluid intake) Recent use of medications such as NSAIDs or ACE inhibitors Recent administration of iodine-containing contrast media

Answer 224

Pre-renal; Hypovolaemia; dehydration, haemorrhage, GI losses, burns Renal artery stenosis Medications; NSAIDs, ACE-i, ARB, diuretics Hypotension Renal; Glomerulonephritis Nephritic syndrome Acute tubular necrosis; ischaemia, toxins, rhabdomyolysis Renal vein thrombosis Vasculitis Post renal; Ureteric stones Blocked catheter Urethral/ ureteric strictures Ureteric carcinomas Abdominal/ pelvic tumours BPH

Answer 225

Stage 1 if any of; Creatinine rise over 26 micromol/L in 48 hours Creatinine rise to 1.5-1.99 times baseline within 7 days Urine output < 0.5ml/kg/hr over 6 hours Stage 2 if any of; Creatinine rise to 2-2.99 times baseline within 7 days Urine output < 0.5ml/kg/hr over 12 hours Stage 3 if any of; Creatinine rise to 3x baseline or higher within 7 days Creatinine rise to 354 micromol/L or more with either Acute rise of 26 micromol/L or more within 48 hours or 50% or more rise within 7 days Urine output < than 0.3 mL/kg/hour for 24 hours Anuria for 12 hours

Answer 226

Symptomless Fatigue Confusion Anorexia Pruritus Nausea and vomiting

Answer 227

Hypertension Bladder distention Hypotension and dehydration Signs of fluid overload; raised JVP, pulmonary/ peripheral oedema Fevers, sepsis, rashes, vasculitis Pericardial rub

Answer 228

Urinalysis ECG Blood gas U+E, FBC, U+E, Clotting, bone profile Creatinine kinase CRP Bladder scan USSKUB Renal biopsy Consider acute renal screen; ANA Double-stranded DNA Anti-nuclear cytoplasmic antibodies Anti-GBM antibodies Erythrocyte sedimentation rate Serum immunoglobulins Serum electrophoresis Serum free light chains Complement levels (C3 and C4) HIV screening Hepatitis B and C serology

Answer 229

IV fluids Assess fluid balance Catheter Screen for complications; hyperkalaemia, acidosis, pulmonary oedema Suspend nephrotoxic drugs; NSAIDs, aminoglycosides, ACE-i, ARB Consider renal replacement therapy if; Acidosis; <7.2 Electrolyte imbalance Intoxication Oedema Uraemia

Answer 230

Infection Surgery Injury Dehydration Sudden withdrawal of exogenous steroids Sudden loss of endogenous steroids; bilateral adrenal haemorrhage, pituitary apoplexy

Answer 231

Autoimmune Surgical removal of adrenal glands Trauma Infectious disease; TB Haemorrhage Infiltration; malignancy, sarcoidosis, amyloidosis Medications Congenital adrenal hyperplasia

Answer 232

Pituitary tumours (e.g. adenomas) Pituitary surgery Post-traumatic hypopituitarism Hypophysitis (autoimmune inflammation) Sheehan's syndrome (avascular necrosis of the pituitary secondary to massive postpartum haemorrhage) Radiotherapy Congenital causes Pituitary apoplexy

Answer 233

Exogenous steroid administration (most common) Hypothalamic tumours Traumatic brain injury

Answer 234

Fatigue Malaise Abdominal pain Nausea and vomiting Myalgia and muscle weakness Headaches

Answer 235

Dehydration Hypotension Hypovolaemic shock Low-grade fever Confusion or coma Seizures Signs of chronic hypoadrenalism e.g. hyperpigmentation due to increased ACTH in Addison's disease

Answer 236

Capillary glucose ECG VBG, ABG U+E, FBC, CRP, LFT, Cortisol, Bone profile, ACTH, TFT Short synacthen test Autoantibodies CT/ MRI Pituitary MRI

Answer 237

A to E IV/ IM hydrocortisone 100mg Regular fludrocortisone 50mg IV QDS IV glucose to correct hypoglycaemia

Answer 238

Cardiogenic; CAS, heart failure, mitral regurgitation, acute arrhythmia, myocarditis, post partum cardiomyopathy, NSAIDs, hypertensive crisis Non-cardiogenic; ARDS, renal artery stenosis, AKI, fluid overload, high altitude, neurogenic pulmonary oedema

Answer 239

Severe dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea (PND) Anxiety Diaphoresis Cough - may be dry or productive of pink frothy sputum Nausea

Answer 240

Respiratory distress Tachypnoea Tachycardia Raised jugular venous pressure (JVP) Inspiratory crepitations on auscultation Gallop rhythm (3rd heart sound) Peripheral oedema and hepatomegaly if secondary to right heart failure Hypotension and oliguria if in cardiogenic shock

Answer 241

Acute exacerbation of COPD Pneumonia Pulmonary embolism

Answer 242

ECG ABG FBC, CRP, U+E, LFT, BNP CXR, Echo

Answer 243

Nausea and vomiting Tinnitus Epigastric pain Confusion Dizziness

Answer 244

Hyperventilation Tachycardia and a bounding pulse Diaphoresis Fevers Pulmonary oedema Seizures Coma

Answer 245

VBG, capillary glucose ECG Urinary pH Salicylate levels U+E Paracetamol levels

Answer 246

If less than 1 hour ago give activated charcoal Fluids Correct hypokalaemia Manage hyperthermia Haemodialysis

Answer 247

Accidental or intentional overdose Deterioration in renal function Dehydration Medication interactions (e.g. macrolides, antifungals, verapamil) Electrolyte derangement (hypomagnesaemia, hypercalcaemia, hypokalaemia) Elderly patients are at greater risk of digoxin toxicity

Answer 248

Dizziness Nausea and vomiting Diarrhoea Anorexia Palpitations Syncope Blurred vision Yellow-green discolouration of vision Visual haloes Confusion

Answer 249

Supraventricular tachycardias Atrioventricular block Frequent premature ventricular contractions Sinus bradycardia Slow atrial fibrillation Ventricular tachycardia

Answer 250

ECG VBG Capillary blood glucose Digoxin level U+E, magnesium, bone profile, CRP, FBC

Answer 251

A to E Charcoal if within 1 hour of ingestion Correct electrolyte abnormality DigiBind or DigiFab Magnesium sulphate until antidote is available

Answer 252

Blood glucose below 3.5 mmol/L

Answer 253

A low blood glucose level Symptoms or signs of hypoglycaemia Resolution of symptoms/signs once blood glucose normalises

Answer 254

Alcohol Insulin Oral hypoglycaemic medications such as sulphonylureas Decreased oral intake Excessive exercise Insulinomas Adrenal insufficiency Reactive hypoglycaemia (e.g. after upper gastrointestinal surgery) Self-induced hypoglycaemia

Answer 255

Hunger Anxiety/irritability Tremor Sweating Headache Double vision Slurred speech Confusion Decreased level of consciousness

Answer 256

If conscious and able to swallow; 15-20g of fast acting carbohydrate 40% glucose gel Once over 4mmol/L give long acting carbohydrate If unconscious and unable to swallow; A-E 100mls of 20% glucose or 200mls of 10% IV If no IV access 1mg of IM glucagon

Answer 257

Episodic hypertension Anxiety Weight loss Fatigue Palpitations Excessive sweating Headaches Flushing Fever Difficulty breathing (dyspnea) Abdominal pain

Answer 258

Hypertension Postural hypotension Tremor Hypertensive retinopathy

Answer 259

Anxiety disorder Hyperthyroidism Essential hypertension

Answer 260

Plasma metanephrines Adrenal imagine; CT, MRI if needed PET scan

Answer 261

Alpha blockade; phenoxybenzamine Beta blockade Surgical removal

Answer 262

Trauma Malignancy Infection Epidural haematoma Intervertebral disk prolapse

Answer 263

Back pain, which is typically: Severe Progressive Aggravated by straining e.g. coughing Difficulty walking Weakness below the level compressed (typically bilateral and symmetrical) Numbness below the level compressed Urinary or faecal incontinence Urinary retention Constipation

Answer 264

Hypertonia Hyperreflexia (although reflexes may be absent at the level compressed) Clonus Upgoing plantars Sensory loss (a "sensory level")

Answer 265

Transverse myelitis Cauda equina syndrome Peripheral neuropathy Spinal metastases Sciatica

Answer 266

MRI whole spine Whole body CT Bladder scan; retention Tumour markers Biopsy

Answer 267

Management depends on the underlying cause as well as the patient's background Patients with traumatic spinal cord injuries should be transferred to a major trauma centre General principles include: Immobilise the patient and nurse with spinal precautions (e.g. log-rolling) Regular repositioning to prevent pressure ulceration in immobile patients Analgesia for pain VTE prophylaxis Catheterise if in urinary retention Counselling and rehabilitation is key, with multidisciplinary input (e.g. physiotherapy) 16mg dexamethasone and PPI cover

Answer 268

More common in women and those with Grave's disease

Answer 269

Acute illness Surgery Trauma Radioactive iodine therapy

Answer 270

Tachycardia Fever Altered mental status Sweating Tremor Nausea and vomiting

Answer 271

Sepsis Acute coronary syndrome Phaeochromocytoma

Answer 272

TFT Cardiac monitoring Sepsis 6

Answer 273

Symptom control; IV propanolol or digoxin if propanolol is contraindicated Reduce thyroid activity; Propylthiouracil Carbimazole Lugol's iodine- 4 hours after Propylthiouracil IV hydrocortisone If pregnancy Propylthiouracil in first trimester, carbamizole in later pregnancy

Answer 274

Trauma Oxygen via nasal cannulae Recent ENT or maxillofacial surgery Tumours Inflammation, nasal polyp Illicit drug use, alcohol Medications; nasal steroids Bleeding disorders Inhaled irritants, temperature, humidity

Answer 275

Direct compression Sit patient forward, breathe through mouth and pinch cartilaginous part of nose for 10-15 mins Topic antiseptic; naseptin, mupirocin Cautery Lidocaine with phenylephrine Nasal packing Embolisation Tranexamic acid

Answer 276

Anaemia Recurrent epistaxis Hypovolaemia Aspiration of blood and airway compromise Nasal cautery may cause septal perforation Nasal packing may lead to sinusitis, septal haematoma or pressure necrosis

Answer 277

Upper GI tract; Oesophageal/ gastric malignancy Peptic ulcer disease Boerhaave syndrome Ingestion of sharp or caustic materials Iatrogenic Lower GI tract; Diverticulitis Colorectal cancer Bowel obstruction Colitis (e.g. inflammatory bowel disease) Appendicitis Infection (e.g. toxic megacolon secondary to C. difficile infection) Iatrogenic (e.g. abdominal surgery or colonoscopy) Mesenteric ischaemia Invasion of the bowel by other tumours

Answer 278

Abdominal pain, which is sudden in onset and severe Nausea and vomiting Malaise Lethargy

Answer 279

Peritonism e.g. guarding, rebound tenderness, rigidity on palpation of the abdomen Hypotension Tachycardia Tachypnoea Fevers

Answer 280

Non specific abdominal pain Spontaneous bacterial peritonitis Appendicitis Pancreatitis

Answer 281

Blood gas Pregnancy test FBC, CRP, LFT, U+E, Group and save, blood cultures CT with contrast CXR Abdominal Xray

Answer 282

Conservative; Make the patient nil by mouth Urgent surgical review May require critical care input e.g. in cases of organ failure secondary to sepsis Consider nasogastric tube insertion e.g. in severe vomiting Medical; Start IV broad spectrum antibiotics IV fluid resuscitation as required Give analgesia and antiemetics - may need to be parenteral Certain cases of perforation may be managed with medical treatment only, for example a localised diverticular perforation in a well patient Surgical; Most cases of perforation will require surgical management with a laparotomy This usually involves a thorough washout, identifying the cause of perforation and repairing the defect For example, cases of bowel perforation would usually be managed with a bowel resection and formation of a temporary stoma to protect the site of repair

Answer 283

Core body temperature over 38 degrees

Answer 284

Heatstroke Sepsis Endocrine; hyperthyroidism, phaeochromocytoma, adrenal crisis Drugs Malignant hyperthermia Neuroleptic malignant syndrome Serotonin syndrome Anticholinergic toxicity Status epilepticus Encephalitis Intracranial haemorrhage Stroke

Answer 285

Extremes of age (young children and the elderly) Obesity Physical exertion Impaired sweating Cognitive impairment Dehydration

Answer 286

Thirst Fatigue Weakness and lethargy Dizziness Headache Nausea and vomiting Sweating (skin may be dry in severe hyperthermia or due to certain causes e.g. anticholinergic toxicity) Muscle cramps Confusion and agitation

Answer 287

High body temperature Tachycardia Hypotension Tachypnoea Oliguria Impaired consciousness Slurred speech Seizures

Answer 288

A to E Fluid resuscitation with cooled fluids Catheterise Remove excess clothing Place ice packs and spray cool water Fan skin Cold water immersion Bladder/ Gastric lavage

Answer 289

Rhabdomyolysis Lactic acidosis Disseminated intravascular coagulation Acute kidney injury Arrhythmias Liver failure Non-cardiogenic pulmonary oedema Hyperkalaemia Hypocalcaemia Death

Answer 290

Core body temperature below 35 degrees

Answer 291

Shivering Hunger Dizziness Chills Slurred speech Paradoxical undressing

Answer 292

Tachycardia Tachypnoea Cool peripheries Hypotension Ataxia Reduced level of consciousness Fixed and dilated pupils

Answer 293

A to E Passive rewarming; remove wet/ cold clothing, blanket Active rewarming; bair hugger, warm IV fluids Cardiac monitoring, rectal temperature Extracorporeal rewarming

Emergency medicine Flashcards

(321 cards)