Revision 2 Flashcards
(187 cards)
1
Q
What is the dose of adrenaline for ADULT ALS?
A
1mg
2
Q
What is the dose of adrenaline for KID ALS?
A
10mcg/kg
3
Q
What is the charge of defib for ADULT ALS?
A
200J
4
Q
What is the charge of defib on PAEDS ALS?
A
4J/kg
5
Q
What is the amiodarone dose for adults and kids ALS?
A
300mg adult, 5mg/kg for kids
6
Q
What are the 4 types of shock and give one example of each
A
Hypovolemic: major haemorrhage
Distributive: sepsis, anaphylaxis
Obstructive: PE
Cardiogenic: MI
7
Q
In what setting would you not give fluids for resus?
A
Someone in cardiogenic shock or aortic dissection or identified haemorrhage/AAA
8
Q
As an intern, what is important mgmt after seeing a shocked patient?
A
BOOK ICU BED
9
Q
What examination signs are specific for heart failure?
A
Displaced apex beat, 3rd heart sound, raised JVP and +hepatojugular reflux test
10
Q
Name 3 contraindications to thrombolysis
A
Coagulation disorder, recent surgery, recent head trauma, prior intracranial haemorrhage
11
Q
Name 5 causes of an APO
A
MI, arrythmia, non-compliance of fluid restriction, CKD, PE, ischaemia
12
Q
What is the Epipen dose for anaphylaxis in child and adult?
A
0.15mg in child (<20kg), 0.30mg (>20kg)
13
Q
What is the management post anaphylaxis reaction Rx?
A
Epipen education, anaphylaxis action plan and immunology ref in kids
14
Q
What is the emergency mgmt of a seizure? Apart from ABCDE. 6steps
A
1) Gain IV access and draw up midazolam
2) If still seizing, give midazolam and monitor response
3) Place in recovery position
4) Consider oxygen therapy if required
5) Start phenytoin infusion
6) Consider more benzos if still seizing/ICU.
15
Q
What are 4 main causes of liver cirrhosis?
A
Alcohol, NAFLD, Hep B and Hep C
16
Q
What is the diagnosis if only the unconjugated bilirubin is raised?
A
Gilberts or haemolysis
17
Q
What are the 3 stages of alcoholic liver disease?
A
Fatty liver–> hepatitis–> cirrhosis
18
Q
What 3 investigations (specific) measure the synthetic function of the liver?
A
INR, platelets and albumin
19
Q
Name one pre, intra and post-hepatic causes of jaundice
A
Pre: haemolysis and Gilbert’s. Unconjugated up.
Intra: autoimmune, vasculitis, drugs, toxins
Post: obstruction ie stones, cancer
20
Q
What is the treatment for low-mod HAP?
A
Augmentin DF
21
Q
What is the Rx for high severity HAP?
A
Pipericillin and tazobactam IV
22
Q
What are 4 factors that indicate severity in HAP?
A
Tachypnoea, heart rate >100, hypotension an acute onset confusion
23
Q
What is the Rx for aspiration pneumonia?
A
Same as CAP/HAP. Change to amoxicillin+ metronidazole if no improvement in 48 hours.
24
Q
What is the Abx treatment pathway for bronchiectasis?
A
Nonsevere: start with aoxicillin or doxy. Change to Amoxy DF if no improvement in 48 hours.
25
What does COPD-X stand for in terms of COPD mgmt?
C: confirm diagnosis and severity
O: optimise fn (medications, oxygen, education)
P: prevent deterioration: smoking, vaccination
D: develop action plan (personal and MDT input)
X: manage exacerbations
26
What % change is required on spirometry to display reversibility?
12% change
27
What are the 4 questions asked to understand asthma control?
1) Daytime symptoms (> or <2 days/week)
2) Need for SABA >2days/week
3) Limitations of activities
4) Night time symptoms/on waking
28
What defines poor control?
Three or more of:
1) >2 days of daytime symptoms/week
2) >2 days of SABA use/week
3) Limitations on activity
4) ++ nigh time symptoms/ on waking
29
What are 8 side effects of chemotherapy?
Nausea, vomm, diarrhoea, skin changes, hair loss, fatigue, constipation, neutropenia, peripheral neuropathy
30
What are 4 short-term s/e of steroids and how can you minimise them?
1) Insominia: take in the morning
2) Indigestion: take with/after food
3) Psychosis
4) Impaired glycaemic control
31
How often is FOBT done for screening? And what age?
Every 2 years from 50-74.
32
What screening for CRC is needed for a symptomatic patient?
Colonoscopy
33
What is the classical symptoms for CRC on L versus R?
R bleeds
| L causes obstruction
34
Name 5 risk factors for breast ca
Age of menarche (early), smoking, family history, metabolic syndrome, nulliparity(imp to ask about breastfeeding too) and any hormone replacements
35
What is the most common type of breast ca?
Invasive ductal carcinoma (IDC)
36
Three important DDc for Breast ca
Fibroadenoma, mastitis, mets, fibroadenoma
37
What hormone therapy is used for Breast Ca (pre vs post-menopausal)
Pre: Tamoxifen (blocks oestrogen, causes menopause)
Post: Letrozole
38
What are 3 complications of Breast Ca w/lymph node removal?
Lymphoedema of arm, infection and poor wound healing
39
When is screening for Breast Ca started earlier than 50?
Start at 40 if first degree had breast ca <50, if first degree relative had bilateral ca or if >2 second degree relatives have breast ca
40
Apart from smoking, what are other risk factors for lung ca? (3)
Genetics, occupational exposure (asbestos), scar tissue in lungs
41
What is the most common ca associated with paraneoplastic syndromes?
Small cell lung ca
42
What cancer type does smoking cause? (be specific)
Smoking causes a SMALL cancer in the CENTRE of the chest that is BAD. Small cell lung ca.
43
What is the most common non-small cell lung ca?
Adenocarcinoma, common in females and non-smokers
44
What are three most common paraneoplastic syndromes seen in lung ca?
SIADH (check sodium!), hypercalcaemia, Cushing's
45
Which lung ca presents with Horner's syndrome?
Pancoast tumour
46
Name 4 symptoms of SVC syndrome
Facial plethora, oedema of peripheral limbs, early morning headaches, jugular vein distention
47
What 3 factors impact on the side effect profile of radiation for a specific patient?
Tissue receiving radiation, volume of tissue total dose and number of treatments
48
What are 3 oncological emergencies that can be treated with radiation?
Bleeding, cord compression and SVC obstruction
49
What are the electrolyte disturbances for Tumour Lysis Syndrome?
High PO4, uric acid and K+. Low Ca.
50
What are the 3 steps to treatment for tumour lysis syndrome?
IV hydration, treat electrolyte disturbances and monitor renal function
51
What is the prophylaxis for tumour lysis syndrome?
Allopurinol for susceptible patients ie lymphoma etc.
52
What investigations are part of a septic screen for febrile neutropenia. (5)
FBC, UEC, LFTS, CRP, blood cultures (x2), urine (UA and MC+S).
Then if applicable: sputum culture, faecal sample, NPA swab, central catheter site etc,
CXR.
53
What is the treatment for neutropenic sepsis?
Piperacillin and tazobactam. Not Vanc unless suspect MRSA
54
How does multiple myeloma present?
C: hypercalcaemia! Abdo groans, stones, bones and psychogenic overtones
R: renal function reduced (think oliguria, peripheral oedema)
A: anaemia
B: bone pain
55
What investigations needs to be done for Multiple myeloma?
Bedside: UA (renal fn), ECG (electrolyte)
Bloods: FBC, UEC, Ca, PO4, PTH, thyroid,QEPP
Bone marrow biopsy: diagnostic
56
What is the prognosis for multiple myeloma?
9 years
57
What is the symptomatic treatment of MM?
```
C: creatnine. fluids
R: fluids, correct electrolytes. Monitor.
A: iron infusion
B: analgesia, bisphosphonate
REF TO ONC
```
58
What leukemia is more common in kids vs adults?
AML in adults and ALL in kids.
59
What treatment is used to treat MM overall?
Stem cell transplant
60
What is the staging system for lymphoma?
Ann Arbor
61
Name 3 unique features of Hodgkins lymphoma vs NHL
1) Reed Sternberg cells presents
2) Treatment with BEACOPP (NHL with RCHOP)
3) Bimodal distribution
4) HL present with an itch as well as B symptoms
62
How long does it take for a transfusion reaction to develop? What symptoms trigger a stop to transfusion?
In 30mins, dyspnoea and fever.
63
Name 3 massive transfusion complications
TRALI, dilutional coagulopathy, metabolic acidosis, hypothermia, air embolism
64
Name 4 classical symptoms of hypercalcaemia
Bones, groans, stones and psychogenic overtones
65
Name 2 causes of PTH mediated hypercalcaemia
Thyroid adenoma, pituitary tumour
66
Name a cause of non-PTH mediated hypercalcaemia
hypercalcaemia of malignancy (PTH related protein secreted)
67
What medications cause hypercalcaemia?
Calcium tabs, diuretics, lithium, excess Vit D
68
What is the 3 step Rx for hypercalcaemia?
1) IVH
2) IV bisphosphonate
3) Correct electrolyte abnormalities
69
What is the duration of anticoagulation Rx for a provoked/distal DVT?
6 weeks-3 months
70
What is the duration of anticoagulation for Rx of a proximal DVT/unprovoked?
3-6 months
71
What are 5 components of post-resus care?
1) Re-evaluate ABCDE
2) 12 lead ECG
3) Treat precipitating cause
4) Aim for Sp)2 94-98%, normocapnia and normoglycaemia
5) Targeted temperate management
72
Name 3 non-cancer causes of hypercalcaemia
PTH adenoma, CKD, diuretic use
73
What are 2 non-cancer causes of a febrile neutropenia?
Clozapine induced agranulocytosis, transplant patient
74
What does serum calcium need to be corrected for?
ALBUMIN!
75
Diagnosis: painful, red swollen foot in a diabetic?
Charcot's neuroarthropathy
76
Which diabetic drug class is best for CVD and heart failure?
SGLT2 inhibitors
77
Which diabetic medication has a high risk of DKA?
SGLT2 inhibitors
78
Which diabetic med class is best for eGFR<45?
DPP4 inhibitors
79
What is the typical place for a neuropathic ulcer?
Under first metatarsal, callus is present. (secondary to clawing of toes and fat pads being degraded)
80
What is the typical location for an ischaemic ulcer?
Tips of heels
81
What are the 4 principles of mananagement for a diabetic foot ulcer?
1) Pressure offloading when neccessary
2) Optimise vascular status (ABI, toe pressures)
4) Ensure glycaemic control
4) Investigate and/or treat infection if present
82
When do you start dextrose in a DKA patient?
When the BSL drops <15
83
When can sc insulin be commenced in a DKA?
When they can eat orally or if urine ketones drop to normal
84
What are 6 features of a febrile seizure?
1) <15mins
2) 6mo-6years
3) Febrile episode, prodromal viral illness
4) One seizure/illness
5) GTC, no focal component
6) Normal post-ictal phase
85
What is one symptoms that differentiates meningitis from encephalitis?
Confusion- in encephalitis
86
Name 3 organisms that cause meningitis
Strep penumoniae, Hib and Neisseria Meningitides
87
What are the antibiotic guidelines for meningitis (meds and time)?
Suspected bacterial meningitis (ie all until proven otherwise) need ceftriaxone+ dexamethasone within first 60 mins. (Add BenPen if >50, immunocomp, pregnant etc)
88
What are 3 differences between SVT and sinus tachy?
Sinus has p waves, slow rate of change and sloe response to Rx. SVT has sudden onset tachy and responds almost instataneously to Rx.
89
Name 3 causes of peripheral neuropathy
Diabetes, alcohol and VitB12 deficiency
90
3 causes of respiratory failure (over-arching)
Mechanical, oxygenation or ventilation abnormalities
91
Name 3 differences between delirium and dementia
Delirium is:
1) Acute onset
2) Abnormal vital signs
3) Disorientated
4) Fluctuating conscious state
92
What does PInCH me stand for re delirum?
```
P: pain
In: infection
C: constipation
H: hydration
M: medications
E: environment
```
93
What are 3 factors warranting admission to hospital for pericarditis?
High fever, large pericardial effusion, cardiac tamponade, failure to respond after 7/7 of taking NSAIDs
94
What is the Rx of pericarditis?
Colchicine for 7 days with aspirin
95
What are the 2 classical signs of pericarditis on ECG?
Widespread ST elevation and PR depression
96
What are the 6Ps of an ischaemic limb?
Pain, pallor, perishingly cold, pulseless, paresthesia and paralysis
97
What is the time from complete occlusion of blood supply--> irreversible tissue damage?
6 hours
98
What is the investigation of choice for ?acute limb ischaemia?
CT angiogram
99
Name 4 risk factors for peripheral vascular disease
Smoking, diabetes, alcohol, CVD, fam history, obesity
100
Name 4 examination findings for PVD on a limb
Shiny skin, loss of hair, atrophied muscles, cool to touch, Buerger test +
101
What ABI value indicates significant arterial disease?
<0.9 (0.4-0.9= claudication and <0.4= critical limb ischaemia)
102
What are two common bacteria causing uncomplicated UTIs?
E Coli or Staph Saprophyticus
103
What are 3 bugs causing complicated UTIs?
E.Coli, Proteus and Klebsiella species
104
What are risk factors for UTIs?
female, post-menopausal, urogenital abnormalities, sexually active, immunocompromised
105
What are 3 non-pharm measures to treat UTI/prevent them?
Perineal hygiene/wiping technique, ++fluid intake and peeing after sex
106
What is the first line of Abx for UTI?
trimethoprim or cephalexin or augmentin. (most people now resistant to trimethoprim)
107
What is the triad of AAA rupture?
Pulsatile mass in the abdomen, severe pain in the back and circulatory compromise (shocked patient)
108
Name 4 risk factors for AAA
Age, smoking, HTN, connective tissue disorders (Marfan's), male, CVD
109
What is the one investigation specific for detecting AAA rupture?
eFAST scan- detects free fluid in the abdomen.
| CT contrast can be done if diagnosis not clear
110
What are 5 ED management steps for a AAA rupture?
1) Insert 2xlarge IV bore cannulas
2) Maintain BP at 90systolic (allow end organ perfusion)
3) Crossmatch blood: activation of massive transfusion protocol
4) Analgesia: morphine/fentanyl
5) Transfer for surgery: stent or graft insertion
111
Name one complication of a AAA rupture repair that can lead to GI bleeding
Aortoenteric fistula
112
What is fulminant hepatitis?
Rare, but acute onset of hepatic failure with encephalopathy over days-weeks
113
What are 4 findings on LFTs and blood count for acute hepatitis?
ALTup, elevated bilirubin, elevated WBC, prolonged INR
114
Which hepatitis is D co-infected with?
Hep B
115
Name 5 signs on Hx and examination of inhaled foreign body
Hx: witnessed episode, choking, sudden onset SOB
Exam: Hyperexpanded lung (on side of obstruction), reduced breath sounds, asymmetrical chest expansion, wheeze/crackles. Stridor may be present depending on level of obs
116
What is the aetiology for SBO?
Adhesions, Bowel protrusion (hernia) and Cancer
117
What investigations would be done for a SBO? list all.
Bedside: ECG (electrolyte disturbance), BSL,temp/
Bloods: FBC, UEC, VBG with lactate, lipase
Imaging: AXR or CT abdo
118
What 3 things does vommiting lead to?
Hypokalemia, hypovolemia and metabolic acidosis
119
What are the mucosal folds called in small bowel vs large bowel?
Small: valvulae conniventes
Large: plicae semilunaris
120
What is the largest part of the large bowel?
Caecum, 9cm
121
What shows a coffee bean appearance on AXR?
Sigmoid volvulus , most common
122
Name 3 causes of a large bowel obstruction
Neoplasm, volvulus, diverticulitis, adhesions, faecal impaction, foriegn body
123
Name 3 broad categories for causes of AKI and one example of each
Pre-renal: HTN, renal vein thrombosis
Renal: ATN, nephrotoxic agents, vasculitis
Post-renal: obstruction
124
Assuming appropriate renal fn, during hypovolemia should FEN be high or low?
Low, kidney will retain sodium to retain water
125
What bloods are important for assessing AKI (7)?
VBG, FBC, UEC, LFTs, urine microscopy and analysis (osmolality), FEN and spot PCR
126
As an intern, what are 4 imp management steps for AKI (apart from ABCDE)
1) Ensure stabilisation
2) REVIEW DRUG CHART: remove nephrotoxic agents
3) Order further bloods re underlying cause
4) Treat electrolyte abnormalities
127
What is the Rx for severe croup?
Nebulised adrenaline and IM/IV dex
128
What bloods are important in ureteric colic?
FBC, UEC, Ca, PO4 and uric acid. Also CRP (incase infected, obstructed kidney)
129
What size stone will pass spontaneously?
4mm for sure, 4-7mm maybe
130
Which kidney stone can be seen on XR?
Calcium oxalate (most common). The rest of radiolucent.
131
What is the criteria used for determining if suspected infection will lead to prolonged ICU?
qSOFA.
Hypotension <100mmHg
Altered mental state
RR >15
132
What is SEPSIS 6
1) Oxygen
2) Blood cultures
3) IV fluids
4) IV Abx
5) Serial lactate
6) Measure urine output
133
What is the non-pharm mgmt for cellulitis?
Elevate legs, compresison bandage and bed rest
134
What is pharm mgmt for purulent vs non-purulent cellulitis?
Fluclox if purulent (staph aureus)
| Penicillin V if non-purulent (Strep pyogenes)
135
How do primary haemostasis disorders present?
Bleeding from mucous membranes (epistaxis), petechaie, menorrhagia. (think platelet disorders)
136
What is the treatment for VWB disease?
Desmopressin- stimulates release of vWF from cells
137
How do secondary haemostasis disorders present?
Deep tissue bleeding.
138
Name 3 ECG features of hyPERkalaemia
Flattening--> absent P waves, T wave tenting and widened QRS
139
What are 5 causes of hyperkalaemia?
CKD, tumour lysis syndrome, cell death (rhabdomyalosis), acidosis (DKA), drugs (beta blockers)
140
What are 5 common causes of hypokalaemia?
Excess insulin, renal losses (diuretics), non-renal losses (diarrhoea+vomm), decreased K intake and intracellular shift
141
What is the first step in determining the cause of hyponatraemia?
Determine osmolality
142
What are 2 causes of hypervolemic hyponatraemia?
CKD, CCF
143
What are 2 causes of euvolemic hyponatreaemia?
SIADH, hypothyroidism
144
What are 2 causes of hypovolemic hyponatraemia?
diuretics, fluid loss (through vomm), primary adrenal insufficiency
145
When do you cease SGLT2i, metformin and sulfonylureas for surgery?
SGLT2- 48 hours before (causes euglycaemic ketoacidosis)
Metformin: 24hours before (risk of lactic acidosis)
Sulfonylurea: cease when fasting
146
What 4 questions are important for a diabetic patient relating to medications consideration?
1) Current BSL
2) Risk of keotacidosis when fasting
3) Is patient on meds that have a risk of hypoglycaemia?
4) How stressful is BSL on the procedure?
147
3 reasons for hyperglycaemia in hospital?
1) Stress response: cortisol--> gluconeogenesis
2) Mischarting of medications
3) Non-diabetic diet
148
What is the treatment for Endopthlamitis?
Opthal ref and admission. IVAbs, intra-vitreal antibiotcs, topical steroids and eventually surgery
149
What is the Rx for episcleritis?
topical lubricants, topical steroids and oral NSAID
150
What is the Rx for scleritis?
Need to know the cause, can be immune or infected
151
What is the time window for a thrombelectomy?
6-8 hours.
152
What investigation is used to confirm peripheral neuropathy
Nerve conduction studies
153
4 top causes of CKD? (in order)
Diabetes, chronic glomerulonephritis, HTN and polycystic kidney disease
154
What diagnosis is important to rule out for painful knee?
Septic arthritis. Done through tap and analysis.
155
How do you treat alcohol withdrawal?
Thiamine, benzo for seizure prophylaxis
156
When should charcoal not be administered for decomtamination?
In a patient with GCS<8, can aspirate--> ++ risk of severe infection
157
What does excess anticholinergic look like?
Red as a beet, dry as a bone, blind as a bat (pupil dilation) and mad as a hatter
158
Do you put pressure bandage on spider bites or snake bites?
Snake.
159
What are 4 conditions that dictate requirement for a foot xray?
Pain in the midfoot, bony tenderness at navicular, pain at base of 5th metatarsal and inability to weight bear in ED/after incident.
160
What is the dosing for metoclopramide and why type of drug is it?
10mg qid PRN
| Prokinetic- great for opioid induced n+v
161
What is the dosing for stemetil (procloperazine) and what type of drug is it?
5mg tds PRN
| Dopamine antagonist and anti-histamine
162
What is the dosing for Haloperidol and what type of drug is it?
0.5-3mg nocte/bd.
| Dopaminergic-- very powerful. Good for chemical derangement affecting the CTZ ie cholestasis
163
What is the drug dosing of Ondansetron and what type of drug is it?
4-8mg bd PRN
| 5HT3 blocker- serotonin
164
What is the drug dosing for Phenergen (promethazine) and what type of drug if it?
25mg QID PRN. Max 100mg.
| Antihistamine
165
What is the dosing for cyclizine and what type of drug is ti?
25mg-50mg tds
| Antihistamine and antimuscarinic
166
What fraction of the total opioid dose is the breakthrough dose?
1/6
167
What should the dose be reduced by if given IV?
1/3 (bypass liver metabolism)
168
When should the regular dose of opiate medication be changed?
If ++ PRN use. Note >3xPRN use without relief= medical emergency.
169
What are the prognostic indicators of decline- for last 6-12 months of life?
1) >3unplanned hospital admission for the same illness in the past 12 months
2) Baseline functional status ( reduction in ADLs, more time in bed etc)
3) Comorbidities
4) Surprise question: would you be surprised if patient died in next year?
170
What is the Hawkins ABC of dying?
Reflects change in patients towards end of life.
A: Airway- not maintaining their own. ++ secretions.
B: breathing, laboured. Cheyne Stokes. Abdominal/intercostal breathing, tracheal tug, grunting/gasping
C: colour change (pallor/cyanosis), cool peripheries, pulse
D: depressed mental state (time of wakefulness shortens), delirium
E: eating and drinking can be reduced. Patient allowed to eat what they want.
171
3 principles of symptom management for end of life care?
1) Patient reassurance and education (to family)
2) Non-pharm
3) Pharm
172
Name 5 differentials for vertigo/dizziness
1) BPPV
2) Vestibular neuritis
3) Meniere's disease
4) Vestibular migraine
5) Stroke/TIA
173
List the causes of vertigo/dizziness in order from shortest to longest time course
Stroke/TIA
174
What is the time course for TIA/stroke?
Sudden onset
175
What is the time course for BPPV?
Seconds-minutes
176
What is the time course for vestibular neuritis?
Days-weeks
177
What is the time course for vestibular migraine?
hours-days
178
What is the time course for Meniere's disease?
Mins-hours
179
What does STOPBANG stand for?
```
Questionnaire for OSA.
S: snoring
T: tired?
O: observed apnoea
P: pressure
B: BMI>35
A: age >50
N: neck circumference
G: gender male
```
180
Name 4 complications of a fracture
Vascular injury, nerve injury, haemorrhage, fat embolism,compartment syndrome, avascular necrosis
181
Name 3 side effects of statins
Myalgias (settles after few weeks), risk in ALT/AST (settles on lowering dose/cessation) and nausea
182
What type of crystals (shape and staining) are seen in gour vs pseudogout?
Gout: needle shaped, negatively stained bifringent cystals
Pseudogout: rhomboid shaped, positively stained bifringent cystals
183
Name 4 risk factors/precipitants of gout
Alco, seafood, high cell turnover (myeloproliferative disorder, chemo), renal failure, diuretics
184
Name 3 markers/tests that are prognostic for CKD
Protein (spot ACR/PCR), eGFR (measured through creatinine) and BP
185
Name 3 histological findings for coeliac disease on biopsy
villous atrophy, crypt hyperplasia and loss of brush border
186
Which NOAC has a reversal agent?
Dabigatran
187
Why is warfarin better in patients with compliance issues?
Long half life means can miss few pills but still have effect
