Emergency Medicine

Question 1

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, extrapyramidal symptoms?

Answer 1

Antipsychotic (neuroleptic malignant syndrome)

Question 2

Side effects of corticosteroids

Answer 2

Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies

Question 3

Treatment of DTs

Answer 3

Benzodiazepines

Question 4

Treatment for acetaminophen overdose

Answer 4

N-acetylcysteine

Question 5

Treatment for opioid overdose

Answer 5

Naloxone

Question 6

Treatment for benzodiazepine overdose

Answer 6

Flumazenil (monitor for withdrawal and seizures)

Question 7

Treatment for neuroleptic malignant syndrome & malignant hyperthermia

Answer 7

Nitroprusside

Question 8

Treatment for atrial fibrillation

Answer 8

Rate control, rhythm conversion & anti coagulation

Question 9

Treatment for SVT

Answer 9

Stable –> carotid massage (rate control), other vagal stimulation

Unsuccessful –> consider adenosine

Question 10

Causes of drug induced SLE

Answer 10

INH, penicillamine,hydralazine, procainamide, chlorpromazine, methyl dopa, quinidine

Question 11

Macrocytic,megaloblastic anaemia with neurological symptoms

Answer 11

B12 deficiency

Question 12

Microcytic, megaloblastic anaemia without neurological symptoms

Answer 12

Folate deficiency

Question 13

A burn patient presents with cherry red, flushed skin & coma. SaO2 normal, but carboxyHb is elevated. Treatment?

Answer 13

CO poisoning –> 100% O2, or hyperbaric O2 if severe poisoning or pregnant

Question 14

Blood in the urethral meatus or high riding prostate

Answer 14

Bladder rupture or urethral injury

Question 15

Test to rule out urethral injury

Answer 15

Retrograde cystourethrogram

Question 16

Radiographic evidence of aortic disruption or dissection

Answer 16

Widened mediastinum (>8cm), 
Loss of aortic knob
Pleural cap
Tracheal deviation to the right
Depression of left main bronchus

Question 17

Radiographic indications for surgery in acute abdomen

Answer 17

Free air under diaphragm 
Extravasation of contrast 
Severe bowel distension
Space occupying lesion (on CT)
Mesenteric occlusion (angiography)

Question 18

Most common organism in burns related infections

Answer 18

Pseudomonas

Question 19

Method of calculating fluid repletion in burn patients

Answer 19

Parkland formula:

24hr fluids = 4 x kg x %BSA

Question 20

Acceptable urine output in trauma patient

Answer 20

50cc/hr

Question 21

Acceptable urine output in a stable patient

Answer 21

30cc/hr

Question 22

Signs of neurogenic shock

Answer 22

Hypotension & bradycardia

Question 23

Cushings triad (signs of raised ICP)

Answer 23

HTN, bradycardia & abnormal respirations

Question 24

Low cardiac output
Low PCWP
High peripheral vascular resistance

Answer 24

Hypovolaemic shock

Question 25

Low cardiac output High PCWP High PVR

Answer 25

Cardiogenic (or obstructive) shock

Question 26

High cardiac output Low PCWP Low PVR

Answer 26

Distributive (e.g. septic or anaphylactic) shock

Question 27

Treatment of septic shock

Answer 27

Fluid & antibiotics

Question 28

Treatment of cardiogenic shock

Answer 28

Identify cause --> inotropes (e.g. Dopamine)

Question 29

Treatment of hypovolaemic shock

Answer 29

Identify cause --> fluid and blood repletion

Question 30

Treatment of anaphylactic shock

Answer 30

Epinephrine 1:1000 & diphenhydramine

Question 31

Supportive treatment for ARDS

Answer 31

Low tidal volume ventilation

Question 32

Signs of air embolism

Answer 32

A patient with chest trauma who was previously stable suddenly dies

Question 33

Signs of cardiac tamponade

Answer 33

Beck triad: - distended neck veins - hypotension - diminishes heart sounds Pulsus paradoxus

Question 34

Absent breath sounds, dullness to percussion, shock, flat neck veins

Answer 34

Massive haemothorax

Question 35

Absent breath sounds, tracheal deviation, shock, distended neck veins

Answer 35

Tension pneumothorax

Question 36

Treatment for blunt or penetrating abdominal trauma in haemodynamically unstable patients

Answer 36

Immediate exploratory laparotomy

Question 37

Raised ICP in alcoholics or the elderly following heat trauma. Can be acute or chronic Crescent shape on CT

Answer 37

Subdural haematoma

Question 38

Head trauma with immediate LOC followed by lucid interval and then rapid deterioration Convex shape on CT

Answer 38

Extradural (epidural) haematoma

Question 39

Patient with singed nasal hairs, facial burns, hoarseness, wheezing, soot in posterior oropharynx or carbonaceous sputum. Suspect?

Answer 39

Thermal or inhalational injury to the airway

Question 40

When to intubate?

Answer 40

GCS < 8 = intubate!

Question 41

Immediately evaluate trauma patients for? (6)

Answer 41

``` Open pneumothorax Tension pneumothorax Flail chest Massive haemothorax Cardiac tamponade Airway obstruction ```

Question 42

ABCDE assessment airways

Answer 42

- ability to speak - look for airway obstruction - give O2 Intubate if compromised airway (jaw thrust or cricothyroidotomy)

Question 43

ABCDE breathing assessment

Answer 43

- auscultation breath sounds - if suspect tension pneumo —> needle decompression - CXR (rule out trauma) - if suspect pneumo or haemo —> chest drain

Question 44

ABCDE circulation assessment

Answer 44

- assess pulses - control active bleeding ; splint long-bone deformity/fractures - secure IV access - fluids & bloods if unstable

Question 45

ABCDE disability assessment

Answer 45

- GCS | - gross motor/sensory function in extremities

Question 46

ABCDE assessment exposure

Answer 46

- disrobe & inspect for more injuries | - cover patient to prevent hypothermia

Question 47

19 yo man gunshot wound to chest bp 60/30, no BS on left, raised JVP, tracheal deviation to right. Management?

Answer 47

- IV 14G cannula to 2nd ICS MCL | - chest drain

Question 48

Syndrome associated with weak aortic wall

Answer 48

Marfans Syphillis Ehlers Danlos

Question 49

25yo man stabbed in neck, calm and vital signs stable. O/E cut extends through platysma muscle. Management?

Answer 49

Admit for surgical exploration of wound All penetrating trauma that violates the platysma muscle mandates admission and surgical consultation for surgery or further diagnostic evaluation