GP emergencies

Question 1

Which conditions should you refer someone with red eye for a same day assessment by an opthamologist (4)

Answer 1

• acute glaucome
• corneal ulcer/ foreign body/ contact lens related
• anterior uveitis
• scleritis
• trauma
• chemical injuries
• neonatal conjunctivitis

Question 2

How should chemical related eye injuries be managed in primary care?

Answer 2

irrigate with 0.9% saline and arrange urgent transfer to opthamology

Question 3

What are concerning signs of a red eye?

Answer 3

• reduced visual acuity
• deep pain within the eye
• unilateral red eye
• photophobia
• ciliary injection
• unequal or misshapen pupils

Question 4

Give 5 causes of an acute abdomen (severe abdominal symptoms with life threateining cause)

Answer 4

• acute cholecystitis
• acute appendicitis
• meckles diverticulitis
• acute pancreatitis
• ectopic pregnancy
• diverticulitis
• peptic ulcer disease
• Pelvic inflammatory disease
• intestinal obstruction
• acute intestinal ischaemia/ infarction
• renal colic
• acute urinary retention
• Abdominal aortic aneurysm
• testicular torsion

Question 5

Describe the preshopital management of someone with an acute abdomen

Answer 5

• call ambulance
• keep nil by mouth
• apply oxygen as appropriate
• IV fluids if shock and equiptment available
• send for blood group and save/ crosmatch and other bloods as appropriate
• morphine
• Iv cephalosporin if sepsis suspected and equipment available
• urine dip and pregnancy test

Question 6

How do gall stones present?

Answer 6

• Most present as billary colic (when stone moves into cystic duct):
• epigastric or RUQ pain, starts suddenly and after fatty meals, may radiate to inter scapular region
• doesnt fluctuate but persists from 15 mins to 24 hrs subsiding spontaneously or with analgesia
• N+V
• cholecystitis is where you also get inflammation: fever, pertionism, raised WCC etc
• if stone in CBD, may also get jaundice (cholangitis)
• if in amulla of vata, get acute pancreatitis also

Question 7

What are risk factors for bile stones

Answer 7

5 Fs:
Fat 
Female
Fertile
Forty
Family history 

Also pregnancy, oral contraceptives, haemolytic anaemia, malabsoption

Question 8

how does diverticulitis present

Answer 8

• usually L or RLQ pain, intermittent or constant
• change in bowel habits
• fever, tachycardia are common
• hypotension uncommon
• N+V
• PR bleeding
• with a complication such as perforation, abscess, fistula or obstruction

Question 9

How does intestinal obstruction present

Answer 9

• Diffuse, central abdopain with comes and goes every 15 s- 3 mins- severe pain suggests ischaemia or perforation
• N+V
• dysphagia
• constipation (when this occurs indicates level of obstruction)
• abdo distension
• loss of bowel sounds

Question 10

how does mesenteric ischaemia present

Answer 10

• age >50
• PMH of risk factors eg AF, MI, valvular endocarditis, atherosclorosis
• Severe colicky or constant and poorly localised pain
• early stages there is no tenderness or peritonitis
• peritonitis symptoms appear in later stages