Professional Documents
Culture Documents
Emergency Medicine
Emergency Medicine
AIntubation
BIV coamoxiclav
CIV penicillin
DMask ventilation
EOral erythromycin
FOropharyngeal airway
GOral penicillin V
HOxygen via facemask
IOxygen via headbox
Correct
Correct
Correct
PaCO2 mmHg 34 - 45
pH 7.36 - 7.44
H + molarity nmol/l 35 - 45
Bicarbonate mmol/l 24 – 30
Correct
Correct
Correct
Correct
There is an acidosis with a normal
bicarbonate, and hypercapnia, on high
flow O2. This is the picture of acute
respiratory failure often found in patients
with chronic obstructive airways disease
who have lost their hypoxic drive and
have been given high concentrations of
O2.
Theme:Trauma management
Correct
A 20-year-old female horse rider was
brought into A and E on a spinal board
having fallen of her horse. She was
complaining bitterly about being
restrained on the spinal board because
her back was hurting. On examination,
she had a pulse of 120/min, blood
pressure of 84/30 mmHg, normal chest
examination. Abdominal examination
showed a bruise and tenderness on her
left hypochondrium and lumbar regions.
She had a decreased sensation below her
knees and she couldn’t move her toes.
Theme:Oxygen therapy
A24% oxygen
B24% oxygen and antibiotics
C24% oxygen and intravenous
furosemide
D24% oxygen and nebulised
bronchodilators
E24% oxygen, antibiotics and nebulised
bronchodilators
F24% oxygen, diamorphine and
intravenous furosemide
G60% oxygen
H60% oxygen and antibiotics
I60% oxygen and intravenous
furosemide
J60% oxygen and nebulised
bronchodilators
K60% oxygen, antibiotics and nebulised
bronchodilators
L60% oxygen, diamorphine and
intravenous furosemide
Correct
This young woman has severe asthma
and needs nebulisers and high
concentration of oxygen.
Correct
Correct
Theme:Complications of fractures
AAvascular necrosis
BCompartment syndrome
CFat emboli
DGangrene
EHaemorrhagic Shock
FMal-union
GOsteoarthritis
HOsteomyelitis
IRhabdomyolysis
JTetraparesis
KVenous thromboembolism
Correct
Theme:Back pain
Correct
Correct
Correct
Correct
Again Myeloma is the most likely
diagnosis in this case. Metastatic prostate
carcinoma may present with lytic lesions
and pathological fractures, but would not
cause proteinuria, which in this case is
likely to indicate Bence-Jones protein.
Theme:Treatment of cardiological
patients
AAspirin
BDigoxin
CDC cardioversion
DIntravenous morphine
EIntravenous naloxone
FIntravenous verapamil
GInsertion of chest drain
HOxygen therapy only
IPulmonary embolectomy
JPericardial drainage
KWarfarin
Correct
Correct
Correct
Correct
Theme:Signs of life
ABarbiturate coma
BBrain stem death
CCardiac arrest with agonal rhythm
DClinical diagnosis of death
EPulseless Electrical Activity
FHypothermia
GHypoxic cerebral depression
HRigor mortis
ISudden cardiac arrest
JVentricular tachycardia
Correct
Correct
The patient with carcinomatosis, when all other options to this question are considered is most likely to
have a clinical diagnosis of death. Drowning is associated with hypothermia and the femoral pulses are
not palpable due to pulseless electrical activity. A patient found with no vital signs of life with stiff
limbs,i.e. rigor mortis, is likely to have been dead for some considerable time. When a relatively normal
rhythm is present on the monitor in a cardiac arrest situation, pulseless electrical activity must be
considered. The most likely cause of wide, regular complexes in a patient in cardiac arrest is ventricular
tachycardia. Other causes of wide complexes in this situation could be hyperkalaemia, Bundle Branch
Block (e.g. in presence of myocardial infarction) or ST elevation giving the appearance of widened QRS
complex
Theme:Substance abuse
AAspirin
BBarbiturates
CBenzodiazepines
DCannabis
ECocaine
FEcstasy
GHallucinogenic Mushrooms
HMethanol
IOpiates
JSolvent abuse
KTricyclic antidepressants
Correct
Correct
Correct
Correct
Correct
Theme:CAUSES OF
BREATHLESSNESS
AAcute blood loss
BAsthma
CAtypical pneumonia
DBronchiectasis
EBronchopneumonia
FCarcinoma of the bronchus
GCentrilobular emphysema
HExtrinsic allergic alveolitis
IMesothelioma
JChronic anaemia
KSarcoidosis
Correct
Correct
Correct
Correct
Correct
Theme:Acute poisoning
ABenzodiazepines
BDigoxin
Cecstasy
DOpioids
EOrganophosphorus compounds
FParaquat
Gparacetamol
HSalicylates.
IWarfarin
Correct
3,4- methylenedioxymethamphethamine
(MDMA), commonly known as
‘ecstasy’. Clinical features in most cases
of mild abuse are characterized by
agitation, tachycardia, hypertension,
widely dilated pupils, trismus and
sweating. In more severe cases,
hyperthermia, disseminated intravascular
coagulation, rhabdomyolysis and acute
renal failure predominate. Treatment in
severe cases involves the use of
intravenous fluids and, if necessary,
dantrolene, 1 mg/kg body weight
intravenously,should be administered and
repeated as necessary to reduce
hyperthermia.
Correct
Correct
Opiod toxicity may manifest as coma,
very low respiratory rate and pin-point
pupils. Other complications include
convulsions, hypotension, peripheral
circulatory failure, cardiac arrhythmias
and conduction defects, hypothermia,
pulmonary oedema, renal failure and
rhabdomyolysis. Resuscitation comprises
establishing a clear airway, giving
oxygen, placing the patient in a semi-
prone position to reduce the risk of
aspiration in the event of vomiting, and
immediate intravenous injection of an
adequate dose of naloxone. Assisted
ventilation may be required if naloxone
is not immediately available or if very
large doses are required.
Correct
Theme:CNS PROBLEMS
ABacterial meningitis
BCryptococcal meningitis
CGuillian-Barre syndrome
DHuman immunodeficiency virus (HIV)
infection
EListeriosis
FMultiple sclerosis
GEncephalitis
HSubarachnoid haemorrhage
ISecondary cancer
JViral meningitis
Correct
Correct
Correct
Correct
Correct
Bacterial meningitis usually has a rapid
onset on less than 48 hours.
Meningococcus, pnumococcus and
Haemophilus are the common causes of
pyogenic infection.
Theme:Abdominal pain
AAcute cystitis
BAddison's disease
CAppendicitis
DCancer of the colon
EChronic inflammatory bowel disease
FDiverticular disease
GEctopic pregnancy
HEndometriosis
IInguinal hernia
JLead poisoning
KPelvic inflammatory disease
LPrimary spasmodic dysmenorrhoea
MPseudo-obstruction
NRuptured follicular cyst
OToxic megacolon
PUrinary retention
QVesical calculus
RVolvulus
Correct
Correct
Correct
Theme:Investigation of Emergencies
Correct
Correct
Correct
Correct
Correct
ABoerhaave's syndrome
BCardiac tamponade
CDiaphramatic rupture
DDissecting thoracic aorta
EFlail chest
FMallory-Weiss syndrome
GRuptured thoracic aorta
HTension pneumothorax
ITraumatic haemothorax
Correct
Correct
Theme:Overdosages/ poisoning
ADigoxin
BIron
COrganophosphates
DParacetamol
EParaquat
FSalicylate
GSodium hypochlorite (bleach)
HTricyclics
Correct
Correct
Correct
Salicylate (present in aspirin
preparations) causes hyperventilation
which may result in a respiratory
alkalosis. Massive overdose may cause a
metabolic acidosis.
Correct
Correct
Theme:Upper gastrointestinal
haemorrhage
Apeptic ulcer
Bacute erosive gastritis
Coesophageal varices
DMallory-Weiss tear
EGastric leiomyoma
FAorto-enteric fistula
Goesophagitis
Hduodenal lymphoma
Correct
Correct
Correct
Correct
This patient has been previously fit and
well and taking no medication. Of the
options offered it seems most likely that
this is due to an acute peptic ulceration.
Patients with severe upper GI haemorrhage require resuscitation with respect to their airway, breathing,
and circulation. A history should be gained contemporaneously. The underlying cause should then be
treated. Bleeding ulcers are injected with adrenalin or underrun, varices may be injected or banded.
Question: 4 of 30 /
Overall score: 100%
A 22-year-old male is admitted wheezing
with a respiratory rate of 35/min, a pulse
of 120 beats per min, blood pressure
110/70 mmHg, Peak Expiratory Flow
rate < 50% predicted. The Emergency
Medical Services have administered
salbutamol 5mg (twice), Ipratroprium
0.5mg and face mask oxygen.
pH 7.42 (7.36-7.44)
PaCO2 5.0 kPa (4.7-6.0)
PaO2 22 kPa (11.3-12.6)
Base excess -2 mmol/L (+/-2)
SpO2 98
Question: 1 of 30 /
Overall score: 100%
A 22-year-old female is admitted very
distressed and short of breath.
Examination reveals a respiratory rate of
35/min, a pulse of 120 beats per min, a
blood pressure 110/70 mmHg, oxygen
saturations of 90% and a Peak Expiratory
Flow rate < 50% predicted. The
Emergency Medical Services have
administered salbutamol 5mg (twice) and
face mask oxygen.
Pulse 110/min
Blood pressure 160/90 mmHg
Urinalysis 3+ proteinuria
After Airway, Breathing and circulation, the immediate drug therapy should be:
Investigations
The Back to Sleep campaign seems to have reduced the incidence, although the rate had already started
to decline prior to it.