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Year 5 Acute Care & Trauma > MedEd > Flashcards

MedEd Flashcards

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1
Q 
A 26 year old unconscious man is brought into A&E having been found lying alone on the street with needles next to him. The patient’s GCS = 11, RR = 10, BP = 97/65 mmHg and has pinpoint pupils. This patient likely has:
Alcohol toxicity
Aspirin overdose
Opiate overdose
Paracetamol overdose
Warfarin toxicity
A

Opiate overdose

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2
Q 
A 26 year old unconscious man is brought into A&E having been found lying alone on the street with needles next to him. The patient’s GCS = 11, RR = 10, BP = 97/65 mmHg and has pinpoint pupils. The most appropriate treatment is:
IV naltrexone
IV naloxone
Mechanical Ventilation
IV N-Acetyl-Cysteine
IV Sodium Bicarbonate
A

IV naloxone

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3
Q

A 25 year old man is rushed to A&E after presenting with vomiting, hyperventilation and ringing in his ears. ABG shows a respiratory alkalosis.
The most likely cause of his presentation is:
Alcohol toxicity
Aspirin Overdose
Opiate Overdose
Paracetamol Overdose
Warfarin toxicity

A

Aspirin Overdose

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4
Q

what are different types of opiates

A

heroin
morphine
codeine

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5
Q

what are risk factors for opiate overdose

A

IVDU

patients in chronic pain

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6
Q

what is the triad of features in opiate overdose

A 
CNS depression (coma)
Respiratory depression
Pinpoint pupils
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7
Q

what might patients with opiate overdose have (to do with bowel movements)

A

constipation

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8
Q

what is used for investigation and management of opiate overdose

A

IV naloxone

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9
Q

what are associations or risk factors for aspirin overdose

A

suicide attempts

accidents in children

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10
Q

what are features of aspirin overdose

A

hyperventilaiton
tinnitus
vomiting
sweating

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11
Q

what are investigations for aspirin overdose

A

salicyclate levels
ABG
-respiratory alkalosis (early due to hyperventilation)
-metabolic acidosis (late)

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12
Q

what are associations or risk factors with paracetamol overdose

A

chronic alcohol use (enzyme inducer)

intentional self harm

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13
Q

what are features of paracetamol overdose

A

asymptomatic - 1st 24hrs
then acute liver failure
-abdominal pain, vomiting, confusion (encephalopathy)

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14
Q

what investigations are completed in paracetamol overdose

A

paracetamol levels at 4hours post ingestion

ABG for acidosis

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15
Q

when are paracetamol levels at their highest in the plasma

A

4hours post ingestion

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16
Q

what is the management for paracetamol overdose

A

IV N-acetyl cysteine

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17
Q

what are features of digoxin overdose

A

xanthopsia (yellow-green halos)
arrhythmias
hypokalaemia
N+V

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18
Q

what are features of iron overdose

A

D+V
liver failure
drowsiness + coma

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19
Q

what can causes of hyponatraemia be split into

A

hypovolaemia
euvolaemia
hypervolaemia

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20
Q

what are hypovolaemic causes of hyponatraemia

A
  • D+V

- diuretics

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21
Q

what are euvolaemic causes of hyponatraemia

A
  • hypothyroidism
  • adrenal insufficiency
  • SIADH
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22
Q

what are hypervolaemic causes of hyponatraemia

A
  • HF
  • cirrhosis
  • nephrotic syndrome
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23
Q

how is hyponatraemia caused by diuretics investigated

A

measure low urine sodium

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24
Q

what is the first line investigation for hyponatraemia

A

short synacthen test

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25
what is the management for hypovolaemic hyponatraemia
volume replacement with 0.9% saline | stop diuretics
26
what is the management for euvolaemic hyponatramia
fluid restriction | treat cause
27
what is the management for hypervolaemic hyponatraemia
fluid restriction | treat cause
28
what cancer can cause SIADH
small cell lung cancer
29
what infection can cause small cell lung cancer
pneumonia
30
what is the presentation of SIADH
confusion, lethargy, N+V, muscle weakness
31
what is the first line management for SIADH
fluid restriction
32
what is the management for SIADH
``` 1 fluid restriction 2 demeclocycline (DMCT) -for ADH resistance 3 tolvaptan -V2 receptor antagonist ```
33
what is given in severe cases of SIADH (low GCS and seizures)
hypertonic 3% saline
34
what is a serious complication of SIADH
central pontine myelinolysis
35
what is central pontine myelinolysis
osmotic demyelination
36
how does central pontine myelinolysis occur
rapid correction of serum Na which leads to seizures and coma
37
what can causes of hypernatraemia be split into
hypovolaemia | euvolaemia
38
what are hypovolaemic causes of hypernatraemia
Losses - GI losses (D+V) - Skin losses (burns, sweating) - Renal losses (osmotic diuresis with hyperglycaemia)
39
what are euvolaemic causes of hypernatraemia
inability to access water (elderly) | DI (cranial or nephrogenic)
40
what investigations are competed for DI
``` 1 glucose (exclude DM) 2 high plasma (concentrated) and low urine osmolality (dilute) ```
41
how does DI respond to the water deprivation test
urine osmolality does not increase (become more concentrated)
42
what is the management for DI
fluid replacement - correct water deficit with 5% dextrose - correct fluid volume depletion (hypovolaemia) with 0,9% saline
43
what might persistant diarrhoea in the question indicate
dehydration
44
what are causes of hypokalaemia
``` GI - vomiting Renal -diuretics -primary hyperaldosteronism Redistribution into cells -Salbutamol -Alkalosis ```
45
what is primary hyperaldosteronism
conns syndrome
46
what are features of hypokalaemia
muscle weakness arrhythmias polyuria
47
why does alkalosis cause hypokalaemia
potassium moves into cells in an attempt to displace H+ cells out of cells to normalise pH
48
what happens to the aldosterone: renin ratio in conns
it is increased (higher levels of aldosterone in conns)
49
what happens to levels of Na and K in conns syndrome
low K and high Na
50
what happens to levels of Na and K in addisons disease
high K and low Na
51
what is the treatment for hypokalaemia
treat cause if K between 3-3.5 give oral potassium chloride if K below 3 give IV potassium chloride
52
what is addisons disease
low aldosterone
53
what are causes of hyperkalaemia
addisons disease (low aldosterone) drugs (ACEi, ARBs, spironolactone) renal impairment
54
when is K released from cells in huge amounts
rhabodomyolysis | acidosis
55
what is the management for hyperkalaemia
10ml 10% calcium gluconate (cardioprotective) 50ml 50% dextrose + 10units of insulin nebulised salbutamol treat cause
56
what are causes of hypocalcaemia
``` 1 renal failure 2 vit D deficiency -lack of sunlight -malabsorption (IBD) 3 low PTH ```
57
what syndrome causes low PTH
di-george syndrome
58
how does hypocalcaemia present
``` 1 neruomuscular excitability -trousseau's sign -chvostek's sign 2 convulsions 3 paraesthesia ```
59
what is seen on ECG with hypocalcaemia
arrhythmias + prolonged QT interval
60
what investigations should be completed for hypocalcaemia
1 bloods - Ca first - PTH - Vit D, ALP
61
what is the management for hypocalcaemia
calcium and Vit D replacement
62
what causes hypercalcaemia
1 PTH suppression - malignancy - sarcoidosis
63
what malignancies commonly suppress PTH and cause hypercalcaemia
multiple myeloma bone mets squamous cell lung cancer (PTHrP)
64
what does sarcoidosis do to PTH
suppresses it and causes hypercalcaemia
65
when is PTH not suppressed in hypercalcaemia
with primary or tertiary hyperparathyroidism
66
how does hypercalcaemia present
bones, stones, abdominal groans and psychiatric mones polyuria and polydipsia constipation, pain (renal stones) depression + confusion
67
what are the investigations for hypercalcaemia
1 bloods - Ca (first line) - PTH
68
what is the management for hypercalcaemia
IV saline rehydration
69
what is the management for hypercalcaemia caused by malignancy
IV saline rehydration and biphosphonates (pamidronate)

Year 5 Acute Care & Trauma (35 decks)

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