Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRCEM ‘23 > Medical > Flashcards

Medical Flashcards

1
Q

When should NIV be considered in COPD

A

Within 60 mins in all pt’s with eCOPD and a persistent resp acidosis (pH<7.35 and PaCO2>6.5) or RR>23 in whom medical rx is unsuccessful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Absolute contraindications for NIV

A

Severe facial deformity
Facial burns
Fixed upper airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PNX Chest drain insertion

A

If pnx >2cm at the hilum OR SOB!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Reticulated and erythematous rash over the legs in elderly patients who are otherwise well.

A

Erythema ab igne - secondary to chronic exposure to infrared radiation usually from heat sources

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What must be present to diagnose DKA?

A

D - BM >11 or known DM
K - Ketones >3 in blood or 2+ or more urine
A - HCO3<15 or pH<7.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Reversal agent for Dabigatran

A

It is a direct thrombin inhibitor and is reversed by Idarucizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the relative NIV contraindications (5)

A

PH <7.15
PH<7.25 and other adverse feature
GCS<8
Confusion/agitation
Cognitive impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the initial settings for NIV setup?

A

EPAP 3 (or higher if known OSA)
IPAP 15 (20 if pH<7.25)
Uptitrate over 10-30 mins.

Do not exceed 30/8 without expert review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the reversal agent for riavroxaban/apixaban?

A

They are both factor Xa inhibitors and are reversed by andexanet Alfa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you perform an LSBP?

A
  1. Take BP after lying for at least 5 mins
  2. Take BP within 1 min of standing
    3 take BP after three mins of standing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What’s is a positive postural drop? (3)

A
  1. A systolic drop of 20mmHg or more (with or without st)
  2. A drop in SBP below 90 (with or without st)
  3. A diastolic drop of 10 or more with st
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Features of life threatening asthma

A

SpO2 <92%
PEFR<33% of predicted/best
Cyanosis/confusion
Hypotension
Exhaustion/poor resp effort
Silent chest
Tachy arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the features of acute chest syndrome in sickle cell ds.? (4)

A

Abnormal resp signs/st
Chest pain
Fever
Hypoxia
- sats 95% and below
- escalating oxygen requirement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the complications seen with acute painful sickle cell episodes? (5)

A

Acute stroke
Aplastic crisis
Infections
Osteomyelitis
Splenic sequestration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain the findings on a HINTS exam that would suggest a central cause?

A
  1. HI normal in central (positive = peripheral)
  2. Nystagmus - vertical, rotational, or bidirectional horizontal in central. (Unidirectional horizontal in P)
  3. Vertical skew correction in Central
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a complication if inferior myocardial infarcts?

A

Complete HB
- the RCA supplies the AV node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Dix-Hallpike test and what does it tell you?

A

Turn head 45 degrees and lay the pt backwards with neck extension. Look for onset of nystagmus and st of vertigo.
If +ve - indicates BPPV
So perform epley manoeuvre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of methaemaglobinaemia?

A

Congenital
Medications: chloroquine, prilocaine (LA’s), metoclopramide, nitrites

Low sats with normal PaO2. Chocolate blood. Cyanosis and sn of reduced O2 delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why is levopromazine recommended in EoL care?

A

It is an anti-emetic with analgesic and sedative properties.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can trigger ocular gyros crises/extrapyramidal SE?

A

Metoclopramide, haloperidol, neuroleptics/anti-psychotics

Rx. With procyclidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the MOA for Heparin?

A

Anti-thrombins. They bind thrombin 3, preventing activation for clotting factor X to Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CURB65 score

A

Confusion - AMTS<8
Urea >7
RR>30
BP <90/60
Age >65

23
Q

What is the treatment for methanol poisoning?

A

Fomepizole (or ethanol infusion 2nd line)
- works to block alcohol dehydrogenase so methanol is excreted prior to being metabolised to formic acid which attacks the optic nerve

24
Q

How do you calculate osmolality?

A

2Na + Ur + BM
HHS if >320 (normal is 275-295)

25
Q

What does the PT measure?

A

Prothrombin time (INR 0.8-1.2)
12-13 seconds
It measures the extrinsic pathway - factor VII (as well as I, II, V, & X)
The extrinsic pathway is mainly made up of tissue factor and fVII which then trigger fX activation and the common pathway.

26
Q

What does the APTT measure?

A

The Intrinsic pathway
Normal = 35-45 seconds.
FVIII (& vWF), IX, XI, & XII
FVIII activates fX and the common pathway.

27
Q

What does the TT measure?

A

Thrombin time
Assesses fibrin formation from fibrinogen. (This is carried out by thrombin, which also activates fXIII, which stabilises the fibrin clot)

28
Q

What are the three types of vWD?

A

Type I - low vWF - can Rx with desmopressin to release stores of vWF
Type II - abnormal vWF (many subtypes)
Type III - complete absence of vWF (most severe) - Rx does not require levels. Replace vWF or fVIII

29
Q

What are the three features of Wernicke’s encephalopathy?

A

Confusion
Gait abnormality/ataxia
Eye movement disorder

Thiamine (B1) deficiency

30
Q

What elements make up a Comprehensive Geriatric Assessment?

A

Functional capacity
Falls risk
Cognition
Mood
Polypharmacy
Social support
Financial concerns
Goals of care
Advanced care preferences

31
Q

What is the BP control of choice in phaeochromocytoma?

A

IV Phentolamine

32
Q

Frostbite injuries should be considered for…?

A

Thrombolysis
Discuss with burns unit

33
Q

What treatment should be given in SAH?

A

Oral nimodipine - calcium channel blocker used to avoid vasospasm.

34
Q

What electrolyte abnormality exacerbates digoxin toxicity?

A

Hypokalaemia - digoxin normally binds to the ATPase pump on the same site as potassium. When potassium levels are low, digoxin can more easily bind to the ATPase pump, exerting the inhibitory effects.

35
Q

What are the ECG findings of WPW?
And what drugs should be avoided?

A

PR interval<120, Delta wave, QRS prolongation>110ms and pseudo-Q wave.
In these patients, you should avoid drugs that would further block the AV node (and exacerbate the use of the accessory pathway) such as adenosine, beta blockers or calcium channel blockers.

36
Q

What is the management for warfarin reversal in bleeding?

A

Prothrombin Complex Concentrate or PCC, should be your first choice in warfarin reversal. FFP can be used, but is only recommended if PCC is not available.
If this was considered a “minor bleed”, then IV vitamin K should be enough, and would only be given if INR was greater than 5. A minor bleed with an INR of 4.9 would only warrant a hold of their warfarin.

37
Q

What are the signs of acute severe asthma in adults?

A

PEFR 33-50%
RR 25+
HR 110+
Unable to complete sentences in a finale breath

38
Q

What are the adult asthma drug dosages?

A

Salbutamol IV 250mcg over 5-10 mins
Prednisolone 40mg or Hydrocortisone 100mg
MgSO4 2g IV over 20 mins
Aminophylline 5mcg/kg IV over 20 mins then 0.5-0.7mg/kg/hr infusion
(Omit loading dose if on oral theophylline)

39
Q

When should endoscopy be offered in upper GI bleeds?

A

Offer immediately to unstable patients with severe acute upper GI bleed immediately after resuscitation.

Offer within 24 hours of admission to all other patients with upper GI bleeding.

40
Q

PPI’s in non variceal upper GI bleeds

A

Do not offer pre-endoscopy. But do after endoscopy if there is stigmata of recent haemorrhage on endoscopy.

41
Q

What investigation findings are seen in DIC?

A

Reduced plts
Increased PT
Reduced fibrinogen
Raised D-dimer/FDP

42
Q

What are the common triggers of DIC?

A

Major trauma
Organ destruction
Sepsis
Severe obstetric disorders
Some malignancies
Severe toxic/immunological reactions

43
Q

What are the three most common cause of sudden cardiac death in young people?

A
  1. Arrhytmogenic right ventricular dysplasia
  2. Brigades
  3. HOCM
44
Q

In HF diuretics are first line. Nitrites are not routinely offered but when might you consider them?

A

Concomitant myocardial ischaemia
Severe HTN
Regurgitate aortic/mitral valve ds.

Monitor BP closely in level 2 setting.

45
Q

NIV is not routinely offered in HF with pulmonary oedema. When would you consider it?

A

Acute presentation

Adjunct to medical therapy if pt’s condition has failed to respond

Resp failure (despite Rx)

Reduced LOC or exhaustion (despite Rx)

46
Q

How do we determine the severity of hypercalcaemia?

A

<3.0 asymptomatic, does not require urgent correction
3-3.5 - May be well tolerated if slow rise but may be symptomatic requiring urgent Rx.
>3.5 requires urgent Rx due to risk of dysthymia and coma.

47
Q

What is the treatment for hypercalcaemia?

A

IV NaCl 0.9% 4-6 L over 24 hours.

Further Rx with Zolendronic acid 4mg over 15 mins IV may be required.
(Alt: Pamidronate, Ibandronic acid)

90% is due to primary hyper parathyroidism or malignancy

48
Q

What are the three grades of hyponatraemia?

A

Mild 130-135
Moderate 125-130
Profound <125

49
Q

Clinical assessment of hyponatraemia may not match biochemistry. What are the severe st?

A

Vomiting
Cardio respiratory arrest
Seizures
GCS 8 and below

Mod - nausea without vomiting, confusion, headache

50
Q

What is the emergency management of hyponatraemia?

A

150mls 3% hypertonic NaCl over 20mins with close monitoring

Check Na and repeat above until 5mmol/L rise in Na

After 2 of the above or 5mmol rise, stop hypertonic and move to 0.9% NaCl
Limit rise to 10mmol in first 24hrs.
Then 8mmol/24 hrs subsequently until Na 130+

51
Q

What are the common drug causes of hyponatraemia?

A

Phenothiazine
Carbamazepine
Valproic acid
SSRI’s
Morphine
Amitriptyline

52
Q

In DKA, once pt is started on fluids and fixed rate, what should be done if they are usually on long acting insulin?

A

Continue at usual dose and time.
E.g. glargine, detemir, degludec

53
Q

What characterises Ramsay Hunt syndrome?

A

Sensorineural deafness
Vertigo
Facial paralysis

Associated with herpes zoster infection. There are usually vesicles in/around the ear on the affected side.

FRCEM ‘23 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions